AN EPITOME 
OF 
BRA ITHWAITE’S RETROSPECT. AN EPITOME 
OF 
BRAITHWAITE’S RETROSPECT 
OF 
PRACTICAL MEDICINE AND SURGERY: 
CONTAINING ' 
A CONDENSED SUMMARY OF THE MOST IMPORTANT CASES; THEIR TREATMENT, AND AM 
THE REMEDIES AND OTHER USEFUL MATTERS EMBRACED IN THE FORTY VOLUMES—THE 
WHOLE BEING ALPHABETICALLY CLASSIFIED, AND SUPPLIED WITH AN ADDENDA. 
COMPRISING A TABLE OF FRENCH WEIGHTS AND MEASURES, REDUCED TO ENGLISH 
STANDARD A LIST OF INUOMPATIBLES EXPLANATION OF THE PRINCIPAL 
ABBREVIATIONS OCCURRING IN PHARMACEUTICAL FORMULA A VOCA- 
BULARY OF LATIN WORDS MOST FREQUENTLY USED IN PRESCRIP- 
TIONS, AND A COPIOUS INDEX. 
|n (I too tklumcs. 
BY WALTER S. WELLS, M.D. 
V O Li. I. 
NEW YORK: 
PUBLISHED FOR TnE AUTHOR, BY 
CHARLES T. EVANS, 115 NASSAU STREET. 
1860. Entered according to Act of Congress, in the year I860, by 
WALTER S. WELLS, M.D., 
In tne Office of the Clerk of the District Court of the United States, in and for the Southern District ot 
New York. 
W. H. Tinson, Printer and Stereotyper, 43 & 45 Centre St. TESTIMONIALS. 
New York, April 17th, 1S59. 
Walter S. Wells, M.D., has submitted to my inspection his Epitome and Index of 
Braithwaite’s Retrospect, and I am very, very much pleased with the result of his labors. 
He has conferred a great favor upon the profession. Braithwaite’s Retrospect has become 
voluminous, and of itself makes quite a library. Dr. Wells’ book, not only furnishes us 
with a summary of the whole, but enables us to refer, without loss of time, to any special 
subject contained in the forty volumes. 
Willard Parker, M.D., 
Professor Surgery, College Physicians and Surgeons. 
New York, April 7th, 1859. 
To Walter S. Wells, M.D. 
Few periodical Journals devoted to Medical Science and its collateral branches have 
been so eminently distinguished by rich materials and important information, for a series 
of years, as Braithwaite’s Retrospect of Practical Medicine and Surgery. It may well be 
deemed quite a library of the great modern improvements in the noble art of healing. 
Your attempt to concentrate the essence of this extensive work into a manageable volume 
will prove a bold achievement, and judging from the ample specimen which I have had 
before me, I cannot hesitate to say that your undertaking will be an acceptable service to 
all readers, and widely diffuse the most wholesome knowledge for the benefit of practi- 
tioners in general, and the cultivators of profitable and saving wisdom. Your labor 
deserves the patronage of the Profession. John W. Francis, M.D., LL.D. 
New York Medical College, April 2Sd, 1859. 
Walter S. Wells, M.D. 
Dear Sir: It affords me great pleasure to offer my cordial commendation of your 
laborious undertaking, to present to the profession an Epitome of Braithwaite’s Retrospect 
of Practical Medicine and Surgery. 
You may feel assured that your Condensation and Tabulation of this voluminous work 
will be appreciated. 
Yours, etc., 
R. Ogden Doremcs, M.D., 
Professor Chemistry, N. Y. Med. Coll. 
Professor Chemistry, N. Y. Coll. Pharmacy. 
To Walter S. Wells, M.D. 
New York, April 8th, 1859. 
Dear Sir: I think you have rendered an essential service to the Profession by your 
Epitome of the extensive Retrospect of Braithwaite. The alphabetical arrangement of the 
subjects make it more easily available to practitioners of the city and country who have 
but little leisure for reading. I welcome it as a valuable present to the Physician and 
Surgeon. Yours truly, 
Professor Surgery, University Medical College. 
Valentine Mott, M.D., 
From Surgeon B. F. Bache, United States Navy, and Director of the Naval Laboratory. 
“ I have read with great interest the volume of your Epitome of Braithwaite’s Retro- 
spect. 
“ The value of the Retrospect to the Profession has long been settled, and you have, by 
condensing it into a portable form, and arranging its subjects alphabetically so as to facili- 
tate finding all the information it contains on any point, largely augmented its worth.” PREFACE. 
The design of the author, in presenting to the Profession an Epitome 
of “ Braitliwaite’s Retrospect of Practical Medicine and Surgery,” is 
to enable the practitioner to refer at once to the modern treatment of 
all varieties of disease—to refresh his memory in cases of emergency— 
and to speedily acquaint himself with such specific applications as 
would otherwise involve considerable research to acquire from the 
original volumes. 
A casual examination will suffice to assure the practitioner that he 
has been deemed competent to the formation of a correct diagnosis in 
any case for which he may turn to these pages in quest of remedial 
agents. 
It would be superfluous here to urge the importance of a thorough 
conversance with the semeiology of diseases in general; but upon this 
“sine qua non ” has the author devoted considerable time in the 
preparation of this summary, avoiding repetition, and selecting such 
versions as to him seemed most concisely descriptive. 
Reference to the part and page of the original volume of which the 
article is an abstract is appended, for the convenience of those who 
may wish to refer in detail. 
This Part will be followed, monthly, by the remaining Five Parts, 
which will embody all the 'practically useful portions of the volumes 
of the Retrospect now extant. 
Hoping this compilation may supply a necessity long experienced 
by the active practitioner, it is respectfully submitted. 
New York, January, 1860. SUBJECTS 
EMBRACED IN THE EPITOME. 
ABDOMEN. 
ABDOMINAL AFFECTIONS. 
ABORTION. 
ABSCESS. 
ACIDS AND ALKALIES. 
ACONITE. 
AIR. 
ALBUMEN. 
ALBUMINURIA. 
ALOES. 
ALUM. 
AMEN ORRHCE A. 
AMMONIA. 
AMPUTATION. 
ANAEMIA. 
ANAESTHESIA. 
ANAESTHETICS. 
ANEURISM. 
ANCHYLOSIS. 
ANTIMONY. 
ANTISEPTIC. 
ANUS. 
APERIENTS. 
APHONIA. 
APHTHA. 
APOPLEXY. 
ARSENIC. 
ARTERIES. 
ASPHYXIA. 
ASTHMA. 
BALDNESS. 
BATHS. 
BEBEERINE. 
BED-SORES. 
BENZOIC ACID. 
BLADDER. 
BLENORRHAGIA. 
BLOODLETTING. 
BOILS. 
BONES. 
BRAIN. 
BREAD. 
BREAST. 
BROMINE. 
BRONCHITIS. 
BUNION. 
BURNS AND SCALDS. 
BURSAL AFFECTIONS. 
CACHEXIA. 
CAESARIAN SECTION. 
CALCULI. 
CAMPHOR. 
CANCEROUS AFFECTIONS. 
CARBUNCLE. 
XI XII 
SUBJECTS EMBRACED IN THE EPITOME. 
CARIES. 
CARTILAGE. 
CASTRATION. 
CATARRH. 
CATALEPSY. 
CATHETERISM. 
CATHETERS. 
CAUSTICS. 
CHAPS AND FISSURES. 
CHARCOAL. 
CHILBLAINS. 
CHLOROFORM 
CHLOROSIS. 
CHOLERA. 
CHOLERA INFANTUM. 
CHOKING. 
CHORDEE. 
CHOREA. 
CICATRICES. 
CINCHONA. 
CLUB FOOT. 
CLYSTERS. 
COLCHICUM. 
COLD. 
COLIC. 
COLLAPSE. 
COLLODION. 
COMA. 
CONDYLOMATA. 
CONGESTION. 
CONIUM. 
CONSTIPATION. 
CONVULSIVE AFFECTIONS. 
COPAIBA. 
CORNS. 
CORYZA. 
COUGH. 
COUP DE SOLEIL. 
COUNTER-IRRITANTS. 
CRAMP. 
CREASOTE. 
CROUP. 
CUPPING. 
CYNANCIIE. 
CYSTS. 
DEAFNESS. 
DEFORMITIES. 
DELIRIUM. 
DELIRIUM TREMENS. 
DENTITION. 
DIABETES. 
DIAPHRAGM. 
DIARRIKEA. 
DIGITALIS. 
DIPETIIERITIS. 
DISINFECTANTS. 
DISLOCATIONS. 
DIURETICS. 
DROPSY. 
DROWNING. 
DYSENTERY. 
DYSMENORRIKEA. 
DYSPEPSIA. 
EAR. 
ECRASEUR. 
ELECTRICITY. 
EMMENAGOGUES* 
EMPHYSEMA. 
EMPYEMA. 
ENURESIS. 
ENTERITIS. 
EPILEPSY. 
EPISTAXIS. 
ERGOT. 
ERYSTPELAS. 
ETHER. 
EYE. 
FEET. 
FEVERS. 
FINGER. 
FIRE. SUBJECTS EMBRACED IN THE EPITOME. 
XIII 
FIRING. 
FISTULZE. 
FLATULENCE. 
FOOD. 
FRACTURES. 
FROZEN PERSONS. 
GALACTAGOGUES. 
GALLIC ACID. 
GANGLIONS. 
GANGRENE. 
GASTRALGIA. 
GASTRODYNIA. 
GLANDERS. 
GLANDULAR AFFECTIONS. 
GLEET. 
GLYCERINE. 
GONORRHOEA. 
GOUT. 
GRAVEL. 
GUARANA. 
GUMS. 
GUM RESINS. 
GUTTA PERCHA. 
HAIR. 
HAND- 
HANGING. 
HARE-LIP. 
HAY ASTHMA. 
HEADACHE. 
HEART AFFECTIONS. 
HEMATEMESIS. 
HEMATURIA. 
HEMATOCELE. 
HEMICRANIA. 
HEMIPLEGIA. 
HEMORRHAGIC DIATHESIS. 
HEMOPTYSIS. 
HEMORRHAGE. 
HEMORRHOIDS. 
HEPATIC AFFECTIONS. 
HERNIA. 
HICCOUGH. 
HOARSENESS. 
HOOPING COUGH. 
HYDATIDS. 
HYDROCELE. 
HYDROCEPHALUS. 
HYDROPHOBIA. 
HYPOCHONDRIASIS, 
HYSTERIA. 
INDIAN HEMP. 
INFANTS. 
INFLAMMATION. 
INFLUENZA. 
INSANITY. 
INTESTINAL AFFECTIONS. 
INTESTINAL OBSTRUCTIONS. 
INTESTINES. 
INTOXICATION. 
IODIC PREPARATIONS. 
IPECACUAN. 
IRON. 
IRRIGATION. 
ISSUES. 
JAUNDICE. 
JOINTS. 
KIDNEY AFFECTIONS. 
LABIUM. 
LABOR. 
LACTATION 
LARYNGEAL AFFECTIONS. 
LARYNX. 
LEAD. 
LEECHES. 
LEECH BITES. 
LEUCORRHOfiA. 
LIGATURES. 
LIGAMENTS. XIV 
SUBJECTS EMBRACED IN THE EPITOME. 
LINIMENT. 
LINT. 
LIP. 
LITHECTASY. 
LITHOLIBY. 
LITHOTOMY. 
LITIIOTRITY. 
LOBELIA INFLATA. 
LOCKJAW. 
LOINS. 
LUMBAGO. 
MALARIA. 
MANGANESE. 
MANIA. 
MARASMUS. 
MATICO. 
MEASLES. 
MEDICINES. 
MELANCHOLIA. 
MELANOSIS. 
MEL(ENA. 
MENINGITIS. 
MENORRHAGIA. 
MENSTRUATION. 
MERCURY. 
MILK. 
MOLES. 
MORBUS COXARIUS. 
MORTIFICATION. 
MOUTH. 
MOXA. 
MUSCLES. 
NiEYI. 
NECRiEMIA. 
NECROSIS. 
NEEDLES. 
NERVOUS DISORDERS. 
NEURALGIA. 
NIPPLE. 
NITRIC ACID. 
NOSE. 
NYMPHOMANIA. 
(EDEMA. 
(ESOPHAGUS. 
OIL. 
OMENTUM. 
ONYCHIA. 
OOPHORITIS. 
OPERATIONS. 
OPIUM. 
ORCHITIS. 
OVARIAN AFFECTIONS. 
OX GALL. 
PALATE. 
PANCREAS. 
PARACENTESIS. 
PARAPHYMOSIS. 
PARALYSIS. 
PARAPLEGIA. 
PARASITES. 
PARONYCHIA. 
PEDICULI. 
PENIS. 
PERICARDITIS. 
PERINEUM. 
PERIOSTEAL AFFECTIONS. 
PERITONITIS. 
PERSPIRATION. 
PESSARIES. 
PHLEBITIS. 
PHLEGMASIA DOLENS. 
PHTHISIS PULMONALIS. 
PIIYMOSIS. 
PILLS. 
PLACENTA. 
PLASTERS. 
PLEURISY. 
PNEUMONIA. 
POISONING. 
POLYPI. SUBJECTS EMBRACE!", IN THE EPITOME. 
XV 
PREGNANCY. 
PROLAPSIONS. 
PROSTATIC AFFECTIONS. 
PUERPERAL AFFECTIONS. 
PULSE. 
PURGATIVES. 
PYROSIS. 
QUININE. 
RECTUM. 
RESPIRATION. 
RHEUMATISM. 
RICKETS. 
SALIVATION. 
SARSAPARILLA. 
SCALP. 
SCARLATINA. 
SCIATICA. 
SCORBUTIC AFFECTIONS. 
SCROFULA. 
SEA SICKNESS. 
SENSATION. 
SILVER. 
SINUSES 
SKIN. 
SKIN DISEASES. 
SLEEPLESSNESS. 
SMALL POX. 
SNAKE BITES. 
SOAPS. 
SORES. 
SPASMODIC AFFECTIONS. 
SPERMATOCELE. 
SPERMATORRHOEA. 
SPINA BIFIDA. 
SPINE. 
SPLEEN. 
SPONGE TENTS. 
SPRAINS. 
SQUILL. 
STAMMERING. 
STERILITY. 
STOMACH. 
STRANGURY. 
STRICTURES. 
STYPTIC. 
SUPPOSITORIES. 
SUTURES. 
SYNOVITIS. 
SYPHILIS. 
TABES MESENTERICA. 
TANNIN. 
TEETH. 
TENDONS. 
TESTES. 
TETANUS. 
THROAT. 
THYROIDEAL AFFECTIONS. 
TIBIA. 
TOBACCO. 
TOE NAIL. 
TONGUE. 
TONSILS. 
TOOTHACHE. 
TOURNIQUET. 
TRACHEA. 
TRACHEOTOMY. 
TRANSFUSION. 
TUBERCLES. 
TUMORS. 
TURPENTINE. 
ULCERS. 
UMBILICAL CORD. 
UMBILICUS. 
UTERUS. 
UTERINE HEMORRHAGE. 
URETHRA. 
URINE. XVI 
SUBJECTS EMBRACED IN THE EPITOME. 
VACCINATION. 
YAGINA. 
YAGITUS UTERINUS. 
YARICOCELE. 
VARICOSE VEINS. 
VEINS. 
VENTILATION. 
VERMIFUGES. 
VOMITING. 
YULYA. 
WARTS. 
WATER. 
WHEY. 
WHITLOW. 
WORMS. 
WOUNDS. 
ADDENDA. 
FRENCH WEIGHTS, ETC. 
INCOMPATIBLES. 
LATIN VOCABULARY. 
TABLE OF THE MUSCLES. AN EPITOME 
OS' 
BRAITH WAITE’S RETROSPECT. 
ABDOMEN. 
Chloroform for 'painful affections of — Vide Art. “ Chloroform ” 
(post, —). 
Case of Wound of—This accident occurred to a boy between nine and 
ten years old, while bathing, by his falling upon a broken wash-hand basin. 
A wound thereby was inflicted, three inches in length, commencing a little 
below’ the umbilicus, nearly to the pubes, through which the greater part 
of the small intestines, transverse arch of the colon, and the omentum, 
immediately protruded. Mr. Blacklock states : 
When I first saw him he had been lying upon the bank of the river up- 
ward of an hour, and the protruded parts, which were chiefly hanging 
over his left thigh, had evidently been in contact with the ground, for a 
considerable quantity of sand, withered grass, and other extraneous mat- 
ters, adhered to them; and, from long exposure to the atmosphere, and 
fruitless attempts on his own part to force them back into the abdomen, 
they had become of a deep red color. Twenty minutes more had elapsed 
before a supply of warm wmter and a sponge could be procured, and the 
washing of the intestines and mesentery, which was chiefly done by allow- 
ing the water to flow over them from the sponge, also occupied a consider- 
able time before they could be replaced. The reduction was by no means 
so simple and easy a process as some might suppose; for it frequently hap- 
pened that patches of sand, etc., which had not previously been observed, 
were brought into view, as convolution after convolution of intestines wms 
about to be replaced, and of course had to be wrashed off before the oper- 
ation could be proceeded with. I may therefore safely say, that it was 
fully an hour and a half from the time that the intestines were immersed in 
the cold river until they were fairly returned into the abdominal cavity. The 
whole, however, being replaced, and the omentum spread out, so as to come 
as much as possible between the intestines and the external wound, the lips of 
the latter were immediately approximated, and secured in contact by three 
interrupted sutures, which were afterward supported by strips of adhesive 
plaster. The unfortunate boy wras now conveyed to his father’s house, 
about a mile from the place where the accident occurred; and three hours 
after, when reaction had fairly commenced (for, in the first instance, or at 18 
ABDOMINAL AFFECTIONS. 
least, from the time of my arrival, he was pale and almost pulseless, although 
little or no hemorrhage had taken place), twelve leeches were applied, and a 
grain and a half of calomel, combined with one-twelfth of a grain of opium, 
directed to be given every two hours. In about two weeks this patient 
was perfectly cured. Strict antiphlogistic measures, together with the 
foreffoince remedies, pro re nata, comprising the treatment. 
Part xxvi., p. 194. 
Pendulous—Mechanical Support in Cases of.—Very often from flatu- 
lence and intestinal torpidity. Its true pathological nature we once 
heard pointedly indicated by a Borough obstetrician in three words—“ fat, 
faeces, flatus.” 
The abdominal bandage tightly applied will soon dispel all suspicions, 
either of pregnancy or of ovarian disease, which might previously have 
been entertained. The use of tonics and mild purgatives (e. g. aloes) at 
the same time is of course advisable. Dr. West often employs frictions 
with the tincture of aloes over the abdomen, with the object of restoring 
tone to the muscles of the abdominal wall and the intestines. We believe, 
however, that he considers mechanical support as the most important part 
of the plan. Part xxxii., p. 241 
ABDOMINAL AFFECTIONS. 
Hints 07i the Diagnosis a7id Treatment of.—In the treatment of acute 
inflammation of the bowels by purgatives, there is a danger of the irrita- 
tion being propagated from the mucous to the serous surfaces; conse- 
quently, their use as derivatives cannot be taken advantage of, as in affec- 
tions of the head and chest. 
Of the use of opium in peritoneal enteritis, Dr. Griffin entertains the 
highest opinion, and relates several cases in which very large and frequent 
doses were given with the happiest results. In one case, first t«ro grains 
and then one-grain doses were given every two hours, until thirty-two 
grains had been taken, two or three-grain doses having been resorted to 
on the occurrence of a relapse. In the case of a girl ten years of age, 
whose condition had been previously much aggravated by the use of pur- 
gatives, and who appeared to be sinking, twenty drops of laudanum were 
given, and in half an hour a grain of opium. Sound sleep ensued, and the 
patient, who had seemed almost moribund, was saved, the opiate being 
continued for some time at longer intervals. To a boy, set. five, in whom 
peritonitis occurred during the last stage of typhus fever, probably from 
perforation, grain doses were given with a successful result. Dr. Griffin 
does not propose opium as a substitute for general or local bleeding where 
these can be borne, but as a most useful remedy where this is not the 
case; or where the disease continues in spite of their institution. The 
state of the bladder should be carefully watched, as retention of urine is 
not of unlikely occurrence during the use of full opiates. 
Dr. Griffin does not entirely condemn the use of purgatives, even in the 
early stages of enteritis, but the greatest advantage is to be derived from 
them when the force of the disease is broken, and we wish to empty the 
bowels of their contents. This he effects by mild purgatives, combined ABDOMINAL AFFECTIONS. 
19 
with henbane, but he would feel disposed to defer doing this till a later 
period, if there was no injurious distension present. He concludes, and 
general experience confirms the conclusion, that in the early stages of 
enteritis, purgatives do not act until the inflammation has been subdued 
by depletion, or the disease has otherwise subsided ; while, as soon as this 
has been accomplished, the bowels act spontaneously, or by the use of 
mild purgatives: that if purgatives are exhibited early, and act freely, 
death may nevertheless ensue, unless the disease is arrested by other 
remedies: that purgatives may, per se, occasion inflammation or cause its 
recurrence; and that inflammation of tlie bowels may be subdued without 
any evacuation at all, and the bowels may continue confined for three or 
four days without any injurious distension. 
In determining the diagnosis of abdominal inflammation, where both 
pain and tenderness on pressure exist, we should always endeavor to ascer- 
tain—1. Whether there be any pain or tenderness on pressure in the cor- 
responding portion of the spinal column; because, if there be, although it 
may not absolutely decide whether inflammation be present or not, it is 
quite sufficient to account for both the pain and tenderness, without assum- 
ing the existence of any inflammation. 2. Whether, if there be no spinal 
tenderness or pain, the soreness of the abdomen be superficial or deep- 
seated, which may be ascertained with tolerable certainty in all cases, by 
an examination directed to that end. And whether, if both superficial and 
deep-seated, as it usually is in peritoneal inflammation, gentle, steady press- 
ure with the flat of the hand can be easier borne than with the points of 
the fingers. In pain and soreness from affection of the spinal nerves it 
commonly can be so borne, while in peritonitis every kind of pressure, and 
even the weight of the bed-clothes, is very distressing. And yet, one of 
the best means of distinguishing hysterical tenderness will often be found 
to be the observation of how the slightest degree of pressure gives rise to 
the expression of intense suffering, although the countenance does not 
always corroborate this. The tenderness in these cases is quite cutaneous. 
3. Whether the boundaries of the pain or soreness extend beyond what 
the suspected inflammation could produce. Thus, if inflammation of the 
liver be suspected, and we find the soreness extending to the ileum or 
groin, or to the opposite side of the abdomen, it is obvious the soreness 
cannot be attributable to mere disease of that organ. Again, if the whole 
abdomen be tender to the touch in a case otherwise closely resembling 
peritonitis, and we find the tenderness is not confined to the abdomen, but 
extends over the hips and lower extremities, it is obvious we can attach 
no importance to the abdominal soreness as a sign of inflammation. 
Of the antiphlogistic powers of opium, Dr. Griffin expresses his high 
opinion ; and states that for many years he has almost entirely relied upon 
it for the subdual of enteritis and peritonitis. He bleeds first, however, 
in subjects who will bear depletion, employing calomel also when the dis- 
ease is very intense and resists opium powerfully—suspending this as soon 
as the symptoms give way, and giving the opium alone, whereby trouble- 
some salivation is usually prevented. In rheumatic inflammation it is as 
useful. In acute inflammation of the mucous membranes opium was 
formerly supposed to be contra-indicated ; but the cases published by Dr. 
Stokes and others, of cure of inflammation of the mucous membrane of the 
bowels with exhausting diarrhoea, show the propriety of the practice. Dr. 
Griffin attributes the evil effects which have followed the use of opium in 20 
ABORTION. 
these inflammatory affections to its having been given in too small doses, 
which, in cases of mucous phlegmasioe, suppress the diarrhoea without 
subduing the inflammation to which this had even acted as a relief. But 
in these, as well as in serous inflammations, bleeding must be premised 
where the strength will admit of it, applying at the same time warm poul- 
tices to the abdomen. In other cases, in which bleeding is out of the 
question, and opium seems powerless, as in bad dysentery, a combination 
of ipecacuan and opium acts sometimes surprisingly. Dr. Griffin alludes 
to two cases in which he gave three grains of opium with from three to 
five of ipecacuan every two hours with the best effect. 
Although opium is contra-indicated in inflammatory affections of the 
cerebro-spinal system, from its tendency to produce congestion, yet when 
combined with sufficient doses of tartar-emetic, it allays nervous irritation, 
quietens the action of the capillaries, and procures sleep. Its effects are 
wonderful in many cases of puerperal mania, delirium tremens, and the 
advanced stages of fever. It is to Dr. Graves we are indebted for point- 
ing out the value of this combination. 
Dr. Graves directs four gr. of emet. tart, and two drachms of laudanum 
to be mixed with lialf-a-pint of camphor mixture, two table-spoonfuls of 
which are to be given for the first dose, and one evei'y half hour after- 
ward, until the delirium abates, or some signs of drowsiness appear. 
Dr. Griffin believes that the restorative power of opium in exhaustion 
from haemorrhage, depends principally upon its property of producing 
congestion of the brain, and thus restoring tension to the cerebral vessels. 
Part xiii., p. 94. 
ABORTION .—(Vide “Labor”) 
Abortion—Ulceration of the Cervix Uteri—A cause of.—Dr. Bonnet 
observes that though ulcerative inflammation of the cervix, occurring in 
pregnant females, may generally be entirely subdued by judicious treat- 
ment without disturbance of the course of pregnancy, some cases occur 
where abortion cannot be prevented. This may be produced, in the early 
months, by disease of the ovum occasioned by the uterine inflammation ; 
and, in a more advanced stage, by contraction of the uterus excited by 
reflex action. He relates such a case, met with in the sixth month of 
pregnancy. The patient had miscarried four times previously. The first 
was at three months, the others at about six months ; they were preceded 
by slight pains and flooding, and the case now referred to had a yellow dis* 
charge ever since the second miscarriage. Dr. B. says : 
On examining with the hand, I found the abdomen developed, the uterus 
rising above the umbilicus, as in the beginning of the seventh month of 
pregnancy. The vagina was moistened by an abundant secretion. The 
cervix, in its usual position, more voluminous and softer than it is 
normally at this period of pregnancy, constituted a quaggy mass ; its 
surface, of a fungus softness, presented, more especially round the os, which 
was very open, numerous small indurations, about the size of small peas. 
On withdrawing my finger, it was covered with thick whitish pus. This 
pulpy, fungous state of the cervix, along with the partial indurations, the 
purulent discharge, the general symptoms, and the previous history of the ABORTION. 
21 
case—all indicating the existence of extensive ulcerative inflammation of 
the cervix, I mentioned the necessity of an instrumental examination. The 
vulva was congested and swollen; the vagina red, tender, and bathed 
with pus. On getting the cervix between the extended blades of the 
bivalve speculum, I found that it presented a large, soft, florid, fungous 
mass, covered with pus, and bleeding easily on being touched. The entire 
cervix was covered with these fungous granulations, and presented a very 
different appearance to what ulceration of that organ offers in the unim- 
pregnated state. It was a fungous ulcerated surface softened and broken 
up. From the regularity of its surface, however, the absence of uneven, 
deep-seated induration, and the frankly punilent nature of the secretion 
from its surface, it was evidently an inflammatory ulceration that I had 
to deal with. I therefore touched the entire ulcerated surface with the 
nitrate of silver, and ordered astringent vaginal injections with the sul- 
phate of zinc night and morning ; mild aperients, and a tonic antacid mix- 
ture (compound infusion of gentian, and carbonate of magnesia) ; light 
diet; complete rest. 
The application of the nitrate of silver was followed by a slight oozing 
of blood for three days, but by no increase in the local pains. The latter 
are still severe in the lower segment of the developed abdomen, and in the 
loins. The yellow discharge is very abundant. She has the same bearing- 
down pains which preceded her other miscarriages. 
The pains continued, and she bore a seven months’ child. In a few 
weeks the treatment was resumed, the ulcerated surface being cauterized 
once a week, with nitrate of silver, or the acid nitrate of mercury. In the 
beginning of June the catamenia appeared, attended with much pain. At 
the end of two months, the ulceration was healed, and all the symptoms 
ameliorated. Dr. Bennet makes the following remarks: 
When this disease exists in the pregnant state, its symptoms are the 
same as in the non-pregnant condition, but obscured, and more or less 
modified by the pregnancy. It is a frequent cause of disordered health 
during pregnancy, or of “ laborious pregnancy.” It is also one of the 
most frequent causes of abortion, both in the early and in the later months 
of pregnancy. It may occasion abortion ; either directly, by reflex action, 
or indirectly, by giving rise to disease of the ovum or placenta, or to 
uterine haemorrhage. 
The instrumental examination of females laboring under inflammatory 
ulceration of the cervix during pregnancy is unattended with any risk, 
either to the mother, or to the fcetus; and it is absolutely necessary, in 
order not only fully to recognize the disease, but also to treat it. The 
treatment of these forms of uterine inflammation must be governed by 
nearly the same rules in the pregnant as in the non-pregnant state. A 
properly conducted treatment is nearly always successful in preserving 
the life of the child, and the integrity of the pregnancy, as well as in curing 
the inflammatory and ulcerative disease. It is also the only means we 
possess of warding off the imminent danger of abortion to which the pa- 
tient is exposed. This form of uterine inflammation being, generally 
speaking, the cause of those repeated and successive miscarriages which 
prevent females giving birth to a living child ; it is only by curing it that 
we can hope to make them bear the product of conception to its full period. 
The serious inflammatory and hemorrhagic symptoms which sometimes 
follow abortions are generally occasioned by unrecognized inflammatory 22 
ABORTION. 
ulcerations of tlie uterine neck. On investigation it often becomes evident 
that this disease existed previous to the abortion, and occasioned it. The 
same remark may apply to some cases in which the above-mentioned 
symptoms precede and follow labor at the full time, as ulcerative inflam- 
mation of the cervix in the pregnant state is by no means necessarily fol- 
lowed by abortion. Although inflammatory ulceration of the cervix seems 
generally to be a cause of sterility, yet, as will appear from the above 
essay, there are frequent exceptions to the rule. In some females, the 
tendency to become impregnated is so great, that no amount of uterine dis- 
ease appears to prevent conception taking place. Part xv.p. 292. 
Puncturing tlie Membranes to produce Abortion.—To produce abortion 
during the early months of pregnancy, use a gum male catheter sufficiently 
firm to preserve its straight form against moderate resistance, and having 
a perforation at its extreme point large enough to admit the passage of a 
common wire stilet. The patient being placed on her left side, guide the 
instrument by the finger into the os uteri and through the cervix; pass it 
on until it meets the membranes, then introduce the stilet, and press it 
through the opening at the apex of the catheter so as to perforate the 
membranes; then push the catheter itself forward, and evacuate the liquor 
amnii. Part xvi., p. 244. 
New mode of bringing on Premature Delivery.—To excite premature 
labor, inject about an ounce and a half or two ounces of tar water slowly 
and gently through a canula introduced about two inches between the 
membranes and the anterior wall of the uterus. Repeat the operation 
in six hours, if labor does not seem to be approaching. 
Part xvi., p. 245. 
Prevention of Habitual Miscarriage.—Dr. Griffin, physician to the 
county of Limerick Infirmary, recommends to the notice of the profession 
the use of tonics and antispasmodics when there is a habitual tendency to 
abortion or miscarriage. In three cases, which he treated successfully, he 
employed the following remedies—two grains and a half of oxide of zinc, 
with two grains of extract of hops, three times a-day; and, after each pill, 
two tablespoonfuls of a mixture of valerian, aromatic spirits of ammonia, 
and infusion of snake-root. lie recommends also a box of pills to be kept 
by the patient, containing a grain of opium in each, to be taken when pain 
comes on, and to repeat the dose every hour till relief is obtained. 
Part xvi., p. 276. 
Note on Abortion.—If, after a careful examination, we find the cervix 
preserves its normal length, figure and thickness, we must try to prevent 
the abortion ; but if the cervix is found shortened or distended, and the 
organ is assuming the ovi-form shape, we must assist, by all safe means, the 
expulsive action. In making this examination, do not introduce the finger 
into the os. Part xvii., p. 215. 
Abortion: Flooding in cases of threatened.—When there is severe 
flooding during threatened abortion, evacuate the liquor amnii, pass a coni- 
cal plug into the os uteri, fill up the vagina behind it, and give one or 
more doses of ergot. Part xvii., p. 234. 
Abortion: Prevention of.—We must endeavor to ascertain the cause 
of the abortion, and attempt its removal. If the cause be ovarian irrita- ABORTION. 
23 
tion, we should give warm hip baths, not exceeding blood heat, and 
enemata of the same temperature; apply a plaster of opium to the sacrum, 
and enjoin the avoidance of coitus; these precautions must be especially 
attended to at the catamenial or periodic dates of pregnancy, for ascer- 
taining which a little table recently published, termed a periodoscope, will 
be found useful. Vaginal irritation being not an uncommon cause of 
abortion, the most rigid continence must be observed during the whole 
of pregnancy, by women who have previously aborted; and if we use the 
plug in threatened abortion, we must take care that it is not too large, and 
that it is introduced into the upper and roomy part of. the passage. 
Uterine irritation, dependent on ulceration of the os and cervix, or re- 
troversion, must be treated by the means calculated to relieve those 
diseases. Mammary, dental, vesical and rectal irritation, if existing, must 
also be removed by appropriate treatment. Morbid conditions of the 
placenta often cause abortion by preventing the due oxygenation of the 
foetal blood. We must treat these cases by great attention to the depura- 
tion of the blood of the mother, by means of carefully regulated diet, the 
respiration of pure air, attention to the secretions, etc. The exhibition of 
chlorate of potash has been found useful by Professor Simpson, by arterial- 
izing the maternal blood. To eradicate the abortive diathesis, prolonged 
continence is especially necessary. Besides this, any source of irritation 
and any disease of the utero-vaginal passage must be relieved ; and such 
tonics as iron, the cold douche, and cold bathing must be employed. In 
very obstinate cases, it is recommended to try the effect of a long-continued 
galvanic current through the spine and sexual organs, or to prescribe 
small and continued doses of ergotine or strychnine. 
Part xviii., p. 251. 
Mode of inducing Abortion.—A safe and efficient mode of inducing 
premature labor, is by the warm douche applied to the uterus twice a 
day, by means of a canula properly introduced into the vagina. The 
water should have a temperature of 108° F., and should be projected with 
a force equal to a fall of eight feet. 'Part xix., p. 235. 
Abortion.—In cases of inevitable abortion, where the uterine con- 
tractions are feeble and inefficient, and there is considerable hemorrhage, 
let the patient swallow pounded ice freely, with a view to promote the 
action of the uterus. Part, xix., p. 233. 
Abortion; Threatened.—An an early period of the attack, wrhen the 
hemorrhage is slight, and the pains few and weak, give tincture of Indian 
hemp (Donovan’s tincture of the resin), in doses of five drops thrice a day. 
Part xix., p. 329. 
Induction of Abortion by puncturing the Ovum.—The plan for open- 
ing the ovum by puncturing the membranes, is by employing an instru- 
ment which consists of a cylindrical silver canula, slightly curved at its 
further end, with a single opening, and two wire loops projecting from 
the sides of the other extremity, through which two fingers may be passed 
to hold and fix it. A movable stilette, tipped with a sharp point like a 
trocar, and so cut that the point does not touch the sides of the cylinder 
when the stilette is run through it, can be made at option to pass beyond 
the end of the canula. The way to use it is this : Place the patient, if 
you like, on the left side, run up the index finger of the left hand to the 24 
ABORTION'. 
os uteri, and if possible within it; then guide the instrument with the point 
of the stiletto concealed in the canula, on the finger, within the uterus, and 
carry it forward until you feel that there is some resistance; then press 
the point of the stilette against the membranes and press the canula a 
little further on. Then withdraw the stilette and let the liquor amnii flow 
through the canula. 
The time which elapses between the puncture of the ovum and the 
supervention of labor varies very much in different cases. Five or nearly 
six days is a long interval. Part xx., p. 200. 
Abortion produced by Metastasis in Cynanche Parotidoea.—[Mr. Sal- 
ter’s patient was a lady about twenty-five years of age, who was attacked 
with cynanche parotidoea when advanced just beyond the third month of 
her third pregnancy. (She had gone to the full time in her previous 
pregnancies.) The usual treatment was adopted. After a day or two 
of vaginal discharge, uterine pains and hemorrhage came on suddenly in 
the night, and a foetus was discharged. The hemorrhage continuing, 
Mr. Salter gave ergot of rye, and adopted other proper treatment, and in 
fifteen hours after the birth of the foetus, he was enabled to remove the 
placenta. Mr. S. says:] 
We have abundant experience to show, through the influence of the 
disease, the relation subsisting between the parotid glands, whilst affected 
with this specific inflammation, and the testicles in the male; and also 
between the same organs and the breasts in the female ; and from the 
known sympathetic association of the mammary glands with the ovaria 
and uterus, it may readily be supposed that in cynanche parotidoea, an 
irritation may be communicated to the uterine system leading to results 
incompatible with the continuance of the process of utero-gestation. 
And, on the other hand it is possible, in this chain of causation, in cases 
where the female breasts are affected in cynanche parotidoea, that the 
influence on them may be secondary to some primary disturbance of the 
ovaries, though this may not be disclosed by any palpable symptoms 
referred to the latter organs themselves. The analogy between the testes 
and the ovaries, and the sympathy of the breasts with the ovaries, are in 
favor of this hypothesis. Part xx., p. 201. 
Uses of Opium in.—[Speaking first of the uses of opium in threatened 
abortion, Dr. Lever says:] 
In the management of cases of threatened abortion, it is my rule, if pos- 
sible, to get a thorough knowledge of the immediate or exciting cause of 
the hemorrhage or pain, or both ; secondly, before using opium, to. ascer- 
tain the state of the os uteri, and especially whether the anterior part of 
the neck has lost its plumpness and firmness, and has become soft and 
baggy. If with the discharge we have a patent state of the os uteri, and 
if the neck be soft and loose, the exhibition of opium will do harm, by 
retarding the emptying of the uterus, which must sooner or later take 
place. But while I do not advocate the use of this drug under the cir- 
cumstances related, I can speak loudly in its praise after the abortion has 
occurred, especially if such have been attended with a large loss of blood; 
it will allay excitement, tranquillize the circulation, and procure sleep. 
These remarks, however, do not altogether apply to those cases which 
menace from accident, or from mental causes, or those which may be said 
to be due to habit. In these, with the application of cold, perfect ABORTION. 
25 
quietude, and unstimulating diet, I have known the exhibition of opium 
by mouth—or, what I prefer, a cold starch injection, with opium thrown 
into the bowel, and repeated every night or more often, according to exist- 
ing circumstances—followed by the best results. Part xxi., p. 305. 
Prophylactic Treatment of Habitual Disposition to Abortion.—When 
there is no local or general plethora, but the disposition to abort depends 
upon weakness of the uterine system, give savine, an infusion being made 
of from two to four drachms to six ounces of boiling water; give a table- 
spoonful morning and afternoon, in the intervals between the menstrual 
periods; rest of the uterine and general system, and regulation of the 
diet, being also enjoined. If, in addition to the uterine weakness, there 
is augmented irritability and contractility, give ergot of rye in con- 
junction with the savine. 
In cases of habitual abortion, occurring in women of weak and irritable 
fibre, and without vascular congestion, the administration of assafoetida 
as soon as pregnancy occurred, has been very beneficial. 
Part xxi., p. 308. 
Auxiliary Treatment of.—In a case of abortion at the sixth week, the 
administration of chloroform has been successful, in causing dilatation of 
the os uteri. 
In abortion during the early months, the ovum can always be got 
away by giving a stimulating enema, such as turpentine. 
jPart xxi., p. 363. 
Premature Labor—Induction of by Galvanism.—In a case where it 
was necessary to induce premature labor, for half an hour, on the 23d of 
Jan., the poles of the galvanic battery were applied on either side of the 
uterus. The womb became contracted. On the 24th and 26th the appli- 
cation was continued one hour, and on the evening of the 27th slight 
pains came on. On the morning of the 28th they had increased, and at 
9 a.at., the child was born. Galvanism is more valuable than ergot in 
these cases, because if any unforeseen obstacle occur to the birth of the 
child, rupture of the uterus might be induced. Besides, if the case were 
prolonged, there is some danger, from the number of closes required, of 
producing ergotism in the mother. Part xxix., p. 263. 
Premature labor Artificially Induced by Ergot of Pye.—In a large 
number of cases the following prescription proved successful in inducing 
premature labor. R. Secale cornut. pulv. 3iij.; aquae ferventis gvj.; 
infuncle per semihoram in vasa leviter clauso, et cola. ft. Infusi supra 
prescripti § vss.; acid, sulph. dil. 3ss.; syrupi 3ij.; tinct. card. co. 3ij.; 
Misce, sumat partem quartam 4tis horis. The doses required varied from 
three to thirty. Part xxix.,p. 274. 
Syphilis—a Cause of Abortion and premature labor.—Dr. Johns 
maintains that there is but one method of preventing aboi'tions and pre- 
mature labors in females tainted with syphilis, and that is the use of mer- 
cury for both parents—to the female when not pregnant—the patients 
being kept under its influence for six weeks or two months. Dr. Johns 
draws the following deductions : 
1. That secondary syphilis is not curable in the pregnant female. 26 
ABORTION. 
2 That mercury is the only certain means of preventing the abortions 
and premature labors depending on syphilis. 
3. That both parents must be submitted to this treatment. 
4. That as the disease in such cases exists in the secondary form, the 
system must be kept under the influence of the metal for at least six weeks, 
and. in some cases even longer. 
5. That syphilis is communicable to the female through the semen of the 
male, without the presence of any ulcer or purulent discharge. 
6. That secondary ulcers on the female genitals do not infect the male 
by whom she was contaminated, so long as he is poisoned by the infection 
which gave it to her. 
7. That as syphilis is communicable from a child to its nurse, and vice 
versa, great care ought to be taken that an infected child be not given to 
a sound nurse, nor a pocky nurse be hired for a sound child. 
8. That syphilis in infants is only curable by mercury, which is best given 
directly to the child, as also to its nurse. 
9. That there is no disease of the uterus, save the Hunterian chancre, 
which is pathognomonic of syphilis. 
10. That the order of abortions and premature labors is a very good test 
of their cause. 
11. That ulceration may exist to a great amount on the os and cervix 
uteri, and not be discoverable by the toucher. 
12. That the patulous state of the os uteri, induced by inflammation, may 
be present during pregnancy. 
13. That children dying in the uterus from syphilis, like those dying 
from other causes, are thrown olf within a fortnight or so after the cessa- 
tion of vitality. 
14. There is a class of abortions and premature confinements prevcntible 
by iodide of potassium and similar medicines. Part xxx, p. 200. 
Treatment of Abortion.—When nervous excitement prevails, with inter- 
mitting uterine pain, a full opiate is of great service. Hr. Fleetwood 
Churchill has given the cannabis Indica with good effect. As astringents, 
the acetate of lead or gallic acid with opium are the best. The patient 
must be kept cool, and in the horizontal position, for standing greatly adds 
to the probabilities of abortion. Keep the bowels open with conf. senna, 
or potass, bitart.; castor oil irritates the uterus and ought not to be given. 
When abortion has threatened at a catamenial period, great care ought to 
be taken as the next monthly period comes round, to avoid every cause of 
irritation, and keep perfectly quiet. 
In severe cases, where all the more powerful astringents have been tried 
in vain, the vagina must be plugged firmly with lint or sponge ; if this do 
not arrest the hemorrhage, the membrane should be ruptured to excite 
expulsive action of the uterus. If the bag of the early ovum can be felt 
with the finger in the cervix uteri, it can generally be separated by care- 
ful manipulation. Dr. Simpson recommends the introduction of a sponge 
pessary, to dilate the os and cervix, but if you do use the sponge, you must 
not allow it to remain long enough to become foetid. Galvanism has been 
suggested by Dr. Robert Barnes. A drastic cathartic will often complete 
the expulsion of an ovum in a very satisfactory manner. 
Part xxxiii., p. 255. 
Abortion, with Flooding—New Plug.—The common vulcanized india* ABSCESS. 
27 
rubber air ball, about the size of a large orange, makes an admirable and 
easily-adapted plug. If fastened to one end of a metallic tube, furnished 
with a stop-cock at the other end, when the air is pressed out and the tap 
turned, it may be very readily introduced into the upper part of the vagina ; 
air may then be admitted by turning the tap, or, if necessary, cold water 
maybe injected into it. Part 235. 
ABSCESS. 
Abscesses about the Anus and Perineum.—Abscesses about the anus or 
in the perineum are frequently met with in phthisical patients, and it is 
often dangerous under such circumstances to operate, as the thoracic 
symptoms are very apt to increase, when the local disease is meddled with. 
Part iii., p. 116. 
Abscess in the Pumbar and Sacral Pegions.—Caries of the crest of the 
os ilii is a not unfrequent cause of symptomatic abscess in the lumbar and 
sacral regions. Part iii., p. 116. 
Abscess in the Calf of the Peg.—In certain individuals, after lithotomy 
or other great operations, an abscess is apt to be formed in the calf of the 
leg. Pa/rt 116. 
Mammary Abscess.—Complete compression of the breast, by means of 
strips of plaster, broad and sufficiently long to go several times round the 
body recommended. To compression thus employed the authors attribute 
many advantages. In the first place, it immediately relieves the pain ; it 
combats and diminishes the inflammatory engorgement, at whatever period 
■ t is applied. When employed after opening the abscess, it decidedly favors 
ihe evacuation. And although when employed too long, at a period when 
be process of suppuration is active, it might have the disadvantage of 
making the pus extend over a larger surface, yet this may be avoided by 
removing the bandages at a time when it is probable that matter has fairly 
formed. If this be dune, and the abscess opened, the bandages may be 
again applied, after two or three days’ poulticing, with good effect. 
Part iv., p. 104. 
Chronic Abscesses—Sub-Cutaneous Method of Opening.—This opera- 
tion is in order to prevent the admission of air into the cavities of psoas 
and other abscesses of the like kind. M. Guerin uses a flat trocar, long, but 
of small diameter, and inclosed tightly in acanula. The canula is furnished 
with a cock near its larger end, which, when opened, permits the trocar to 
pass, but when shut, exactly closes the canula. The outer end of the canula 
fits on the nozzle of an ordinary syringe, and all those parts are so adapted 
that no air may pass where they lit one to the other. A fold of skin being 
made at some little distance from the abscess, the trocar and canula are 
introduced at its base, and carried under the integuments till the point of 
the former has entered the sac; then the trocar is slowly withdrawn, and 
at the instant that its point passes the cock, that is turned, and the pus 
prevented from flowing out. The syringe is now adapted, the cock turned 
back, and the pus sucked out at once, or with one or more emptyings and 
refillings of the syringe, if its quantity be very large. When this is finished, 28 
ABSCESS, 
the cannla is slowly withdrawn, care being taken to keep the walls of the 
track through which it passes close together. A pad and bandage are then 
put on the sac, and the track leading to it, and the orifice of the latter is 
closed with sticking-plaster. Part v., p. 141. 
Chronic. Abscess and Disease of the Heart and Joints.—In this case 
there was a chronic abscess of considerable size, the hand’s breadth above 
the right knee, the joint was much swollen, and there was a large indolent 
ulcer on the leg on the same side : her pulse was quick, and she was 
considerably emaciated. The following mixture was ordered: 
P Decoct. Guaiaci gviij. Potass. Iodid. gr. xxiv.; Tine. Cardam. co. §ss.; 
Tinct. Hyosciam. 5i. M. 
Dose.—One ounce, three times a day. An ointment consisting of equal 
parts of mercurial and iodine ointments was applied over the abscess. 
The ulcer on the leg was dressed with lint, moistened with black wash, 
and covered with oiled silk. The patient recovered. Part vi.,p. 64. 
Drinary Abscess—Complications of.—Sometimes the abscess in the 
perineum is accompanied by typhoid symptoms. If it is opened, the 
matter that issues is putrid and urinous ; if the opening is deferred, the 
patient may die. 
Sir B. Brodie remarks that it is often more complicated. It is not 
always confined to the perineum; sometimes it makes its way forward 
through the upper part of the scrotum, and presents itself on the lower 
part of the penis, between the scrotum and the glans. At other times it 
burrows in the opposite direction, forming a large collection of matter in 
the nates, or it may burst in the groin, or in the scrotum. In one case, in 
which I had the opportunity of examining the body after death, I found a 
large abscess in front of the pubes, extending half way toward the navel; 
another among the adductor muscles of the left thigh : and a third among 
the muscles at the upper part of the right thigh, as far outward as the 
foramen ovale of the ischium; the periosteum having been destroyed, and 
the bone itself rendered carious to a considerable extent; and all these 
abscesses could be traced into an abscess in the perineum, communicating 
with the urethra behind a stricture by a small orifice. In another case 
there was a fistula in perinceo, communicating with a large abscess of the 
pelvis on one side of the bladder. ( Vide, Art. “ Stricture of Urethra.”) 
Part vi., p. 93. 
Milk Abscess.—In cases of inflammation of the mammae, threatening 
milk abscess, the application of cataplasms, formed by adding to any quan- 
tity of the acetous tincture of the unripe fruit of the persimmon, when 
hot, the requisite proportions of any kind of farinaceous material, recom- 
mended. Part vii., p. 30. 
Mode of forcing out Collections of Pus from Pony Cavities by Atmos- 
pheric Pressure.—In a case of collection of pus in the antrum of High- 
more, for the evacuation of which a tooth had previously been extracted 
which communicated with the cavity, but through which the matter would 
not descend, owing to well known physical principles, a blow-pipe was 
procured, having the necessary degree of curvature at its smaller end, and 
a bladder attached to the other end, which was inflated by the patient. 
The nozzle of the blow-pipe was then introduced into the orifice in the 
bottom of the maxillary cavity, when, on compressing the bladder, the air ABSCESS. 
29 
ascended to the top of the antrum, and forced the matter downward into 
the mouth. By this means about one ounce and a half of foetid matter 
was discharged ; two ounces were collected, but probably at least half an 
ounce was saliva. The same operation was repeated morning and evening, 
and a small quantity of matter obtained for some time after. 
JPart ix., p. 191. 
Mammary Abscess—Treatment of by the Breast-pump and Syringe.— 
This very annoying affection most commonly occurs during lactation, and 
is then more unmanageable than when the breast is in its natural state. 
It is preceded by inflammation which is either acute or chronic, and as Sir 
Astley Cooper has succinctly expressed it—“ is adhesive in the first stage, 
suppurative in the second, and ulcerative in the third.” 
Notwithstanding the most prompt and judicious treatment of the first 
stage, suppuration will occasionally take place. As the inflammation by 
which these abscesses are preceded is either acute or chronic, so is the 
abscess itself. When chronic, they are apt to give rise to deep-seated 
sinuses, filled with a soft fungus. Previous to the time of Mr. Hey, the 
practice often was to extirpate the breast for this affection: he, however, 
suggested, as preferable, dividing the sinuses throughout. Sir A. Cooper, 
instead, recommended that they should be syringed with a solution of two 
or three drops of strong sulphuric acid to an ounce of rose-water, and that 
the same should be applied as a lotion to the breast. It is very evident 
that, however treated, this is a very formidable affection, and it is of great 
importance to prevent the formation of the sinuses. For this purpose, Sir 
Astley Cooper recommends early and free opening of these abscesses, 
particularly if there be much fever and symptoms of hectic, unless the 
abscess be deeply seated, in which case the aperture closes, and ulceration 
will still continue. In obedience to the precepts of Sir Astley Cooper, as 
soon as the indistinct fluctuation, or rather the boggy feeling, by which 
the formation of matter in these abscesses can be detected, is distinctly 
ascertained, let a small bistoury or abscess lancet (the common lancet will 
sometimes not penetrate deep enough) be carried down until the matter 
begins to escape. After all that can be squeezed out by the pressure is 
removed, let the breast-pump be applied over the orifice, and the rest of 
the matter be drawn out. The sinus is then to be injected with some 
astringent solution, by means of a small syringe. The syringe employed 
is the small glass one for the urethra, sold by most apothecaries. The 
lotion Dr. Wood has used is the one recommended by Mr. Iley, though it 
may be doubtful if it possesses any peculiar advantages. 
ft. Aqua? purse, gxv.; spt. rosmarin., gj.; spt. lavandul. comp. 5j.; zinei 
sulphat. gr. xxx. M. fiat lotio. 
The sulphuric acid lotion of Sir A. Cooper will probably answer as well. 
A pledget of lint dipped in the lotion is then to be applied outside, and 
covered with oiled silk; over this a compress may be placed, and firm 
pressure maintained on it by means of adhesive plaster. In some cases 
the walls of the abscess will unite at once, and all that remains to be done 
is to trust to time for the removal of the surrounding induration, or to 
attempt to discuss it by frictions with camphor liniment, mercurial or 
iodine ointment, or the application of the emplast. ammoniaci cum hy- 
drargyro. 
Where the surfaces do not thus unite, the falling in of the breast, pro- 30 
ABSCESS. 
duced by the exhaustion of the glass, will be found to have disappeared ; 
the cavity in such cases has only to be injected two or three times a-day, 
which will serve at once to keep the opening free for the discharge of 
matter, and will also tend to arrest the further extension of the ulcerative 
process. The treatment of acute and more superficial abscess may be con- 
ducted on the same general principles. The early evacuation of the mat- 
ter saves the patient muchisuffering, and also enables the nursing on that 
breast to be resumed at a much earlier period. The cicatrix is also much 
smaller than in cases where the matter is allowed to discharge spontane- 
ously; indeed, if the incision be made in the direction of the natural folds 
of the breast, that is, radiating toward the nipple, the cicatrix will in a 
short time be imperceptible. Part xi., p. 169. 
Abscess of the Tibia.—After alluding to organization of bone, and its 
liability, the same as other tissues, to diseased action, and remarking upon 
the peculiarity of the symptoms in consequence of the presence of phos- 
phate of lime, Sir B. Brodie asks, what symptoms lead us to suspect the 
existence of abscess in the tibia, and what can be done for its relief? He 
replies thus : 
When the tibia is enlarged from a deposit of bone externally—when 
there is excessive pain, such as may be supposed to depend on extreme 
tension, the pain being aggravated at intervals, and these symptoms con- 
tinue and become aggravated, not yielding to medicines or other treat- 
ment that may be had recourse to—then you may reasonably suspect the 
existence of abscess in the centre of the bone. You are not to suppose 
that there is no abscess because the pain is not constant; on th'e contrary, 
it very often comes on only at intervals, and in one of the cases which I 
have related, there was, as I then mentioned, an actual intermission of 
seven or eight months. 
After the disease has existed a certain number of years, indeed, the pain 
never entirely subsides, but still it varies, and there are periods of abate- 
ment and of exacerbation. The combination of circumstances which I 
have described will fully justify you in making an opening into the bone 
with a trephine. But how will it be if you are mistaken? This will not 
often occur, but if it should, really the taking out a circle of bone can be 
of no consequence; no injury follows the operation ; it is unattended with 
danger. The operation is a very simple one. You expose the surface of 
the bone, and make a circular opening with a trephine at that part where 
there seems to be some tenderness and some pain on pressure. One prin- 
cipal thing to be attended to is that you have a proper trephine. One of 
very small diameter is quite sufficient. The operation may be more easily 
performed with a trephine having no shoulder; which will at once pene- 
trate to the abscess, however deep it may be, and render the chisel unne- 
cessary. The after-treatment is as simple as possible. There may be some 
pain for a day or two, and especially, as in the case I last mentioned, if 
the patient be a hysterical female, there may be hysterical pain after- 
ward ; but all that is required is to maintain the general health, and lay 
on some simple dressing; the bone soon granulates, the space is .filled up 
by a sort of fibrous substance, and the wound cicatrizes. 
Part xiii., p. 180. 
Abscess in the Perineum.—The following is an abbreviated lecture on 
this subject, by Sir B. Brodie : ABSCESS. 
31 
Abscesses may occur in the perineum attended with disease of the 
urinary organs, in the cellular membrane, or in any other part. Abscesses 
in the perineum are generally connected with the prostate gland, and 
occasionally with the bladder. The most common circumstances under 
which these abscesses form are when the patient labors under gonorrhoea. 
Thus, a patient has a profuse gonorrhoeal discharge, which at first di- 
minishes little by little, till it disappears entirely ; this may happen in 
consequence of his using strong injections, but it often occurs in that stage 
when surgeons do not recommend injections, as in the inflammatory stage. 
The discharge suddenly ceases, then the patient complains of pain in the 
urethra, and experiences difficulty in making water, and particularly when 
in the commencement, from the pressure at the neck of the bladder, and 
the water comes away in a diminished stream. There is also pain felt in 
the back, groin, pubes, and sense of weight in the perineum. The stream 
is very small, and sometimes there is complete retention. The patient at 
last feels fullness in the perineum, which increases very much, and which 
depends on the presence of matter which forms deep in the perineum. If 
this is left to itself it breaks, perhaps, in the perineum or in the neck of 
the bladder, or sometimes, instead of coming down to the perineum, it 
makes its way back to the rectum and bursts in front of the anus. Now, 
you will observe that in this case all the painful symptoms indicate inflam- 
mation of the neck of the bladder ; I believe there is a translation of the 
inflammation from the urethra to the prostate gland or cellular mem- 
brane covering it. It may be that this inflammation is not only in the 
prostate itself, but in the cellular membrane covering it, in the same 
manner as you sometimes find suppuration about lymphatic glands. There 
is only one circumstance that would lead us to suspect that abscesses of the 
perineum have their origin in another way than what I have stated ; it is 
that when the abscess bursts, upon the patient making water, a small 
quantity of urine comes away from the perineal opening. 
When you are called to a patient under these circumstances of abscess 
after stoppage of the gonorrhoeal discharge, and there is inflammation of 
the neck of the bladder, it is very important that you should stop the 
progress of this inflammation of the bladder, to prevent its going on to 
suppuration. The patient should lose blood by the application of leeches 
to the perineum, or by cupping ; but employ none who is not a dexterous 
cupper, for it is not every cupper who can do it in this part successfully, 
though in London there are plenty who can do it very well. The patient 
may lose from §v. to §xiv. of blood, according to the intensity of the 
symptoms and the strength of his constitution. Give calomel and opium, 
so as to place the patient under the influence of mercury, as in the treat- 
ment of inflammation In general—as, for instance, of the iris ; two or 
three grains of calomel and half a grain of opium, or more ; endeavor to 
get the gums affected as soon as possible, until there is time for the cup- 
ping to have effect. You may relieve the patient by means of an opiate 
clyster ; I sometimes inject 5j- of tinct. of opium and fiij. of starch. The 
opium tends to allay the inflammation as well as the pain. A person 
sometimes cannot empty the bladder, and a straining is kept up from the 
morbid sensibility of the bladder, and this straining aggravates the in- 
flammation. Now, by administering opium you allay the pain which causes 
him to strain, and the consequence of the straining ceases. 
Another thing is necessary in some instances. The patient’s urine must 32 
ABSCESS, 
be drawn off with a catheter. Use, then, a small elastic catheter, and even 
when there is not absolute retention of urine, as when the patient is con- 
stantly straining to make water, because he cannot entirely empty the 
bladder, but at every time leaves some behind. This residuary quantity 
of urine keeps up a constant irritation, which the use of the small gum 
catheter will prevent; it may be used for this purpose two or three times 
in the day. 
But this catheter you must employ with alight hand, and as gently as pos- 
sible, as the inflamed parts are very much in danger of injury where the 
greatest care is not taken. Supposing the disease is in an advanced stage, 
and you have hardness and fullness of the perineum, and you examine the 
perineum, and can feel no matter there, but there is in one spot a more fluctu- 
ating feeling than elsewhere, and in some cases a rigor, or perhaps more than 
one. But the mere circumstance of hardness and increase in size of the parts 
is sufficient to show that there is a deep-seated abscess ; and the matter is 
situated behind the triangular ligament, which prevents its coming to the 
surface, and hinders you from feeling the fluctuation of matter. If you 
wait till the fluctuation becomes distinct, you may wait till the abscess has 
produced serious injury, by dissecting its wray among the neighboring 
textures. When you have hardness in the perineum in such a case, you 
must introduce the lancet in that part in which the hardness is most dis- 
tinct ; but the lancet will be required to enter very deep, even up to the 
shoulder, if the lancet is a common one, before you can reach the seat of 
the matter ; this is especially the case when your patient is fat, so that the 
lancet will barely reach it. However, you may introduce the lancet with 
the greatest confidence, there being nothing to injure ; if you introduce it 
to an insufficient depth, you do no good; and if you introduce it to a 
proper depth, the matter comes away, and your end is gained. When no 
matter has been felt externally, I have sometimes let out §ij. or giij. of pus, 
by this use of the lancet, from under the deep fascia?. 
In some cases you find that the abscess becomes fistulous ; a little urine 
drips out through the opening in the perineum, only a few drops perhaps 
at first; the flowing of these few drops will prevent the abscess from heal- 
ing, and make it a fistulous abscess; but the urethra contracts in the 
membranous part, and all you have to do is to introduce a bougie or sound 
every now and then into the bladder; the contraction is not a permanent 
one, and there is no difficulty in doing this; you may introduce a full- 
sized sound almost in the first instance ; should this, however, distress your 
patient, you may use a small one at first, and increase the size by degrees 
—using it once in two or three days. By this means the urine will be 
brought out at its proper canal, instead of the unfiatural opening, which 
soon heals. 
Abscesses of the perineum are often old strictures of the urethra. The 
patient’s stricture prevents his making water in a full stream, and the 
urine is pressed against the back part of the urethra ; this constantly oc- 
curring, at last the part ulcerates. At first the hole is not much bigger 
than a pin, through which a little drop of urine will escape into the cellu- 
lar membrane, whilst the great part will go along the natural passage, and 
half a drop is sufficient to cause inflammation of this membrane. 
You are called to a patient with an old stricture of the urethra, and you 
find symptoms of matter forming in the perineum, hardness and swelling; 
but, besides these symptoms, there is very great constitutional disturb ABSCE88. 
33 
ance. You find a small, quick pulse, dry black tongue, hot skin, sordes 
of the teeth, and the patient looks like one dying of putrid fever. These 
symptoms are caused by the generation of carbureted hydrogen and sul- 
phureted hydrogen from the putrid matter resulting from the mixture 
of urine with pus ; and patients have frequently died of the poisonous 
gases thus absorbed into the system. 
This is a very distressing case, but you may generally relieve it. In 
cases of stricture of the urethra, the treatment of abscess is different in 
one respect from those in which the abscess arises from gonorrhoea: in 
these last you may prevent the formation of matter, but in the other case 
you cannot prevent it, indeed you should not, and by applying leeches 
and exhibiting mercury you only do harm; you may retard this forma- 
tion of matter and thus prolong the case, but you cannot prevent it. 
Rather let the patient foment the parts, let him use the warm bath, and 
do all you can to promote suppuration; let him set over a bidet, and 
sponge the parts three or four times a day. Then, as soon as the abscess 
is well advanced, let out the matter with a lancet, especially if there are 
symptoms of presence of putrid matter, without a moment’s delay : this 
has been done over and over again. Patients have been brought into this 
hospital at death’s door, with hardness in the perineum, from presence 
of an old abscess, and all the symptoms of dying from putrid fever; I have 
run in a scalpel and found matter—I never failed ; the moment the matter 
has been let out, all these symptoms have subsided. 
These cases of abscess in the perineum, with typhoid symptoms or re- 
tention of urine, or both combined, require immediate attention ; their 
urgency will not allow you to go home and think about the case, or to con- 
sult with another upon it; while you are so doing the patient might die ; it 
is, therefore, of the greatest importance that you should bear in mind what 
I have just said, in order that you may have a fund of knowledge available 
at any moment. The treatment of these abscesses, then, in the first in- 
stance, is as simple as possible, namely, abscesses in the perineum, con- 
nected with old strictures, require to be opened, and, if not urgent, you 
may let it come near the skin before you make an opening, but if it is 
urgent, however deep, you must make it directly. But I told you there 
was a communication between the urethra and abscess: sometimes the 
opening is small, and only a drop of urine can get into the abscess ; and 
sometimes the opening is large, and the patient will make as much or 
more water through the orifice in the perineum, as through the natural 
passage. It was at one time thought that these fistula! should be laid open 
like fistula in ano. 
You cannot here perform that operation for obvious anatomical reasons. 
It was formerly supposed that all fistulas required to be laid open, but, 
except those in the rectum, there is no fistula requiring to be laid open 
unless there is a lodgment of matter. The first thing required for the 
healing is, that matter should come out as fast as it is generated, whether 
in one part of the body or another. Part xv., p. 229. 
Best means of Opening certain Abscesses.—Dr. Hargrave criticises the 
ordinary practice of opening abscesses in the groin by an incision parallel 
to Poupart’s ligament. He states that in this case the lips of the wound 
are never at rest, being continually displaced by the movements of the 
abdomen and by the motions of the thigh, which movements cannot be 34 
ABSCESS. 
entirely prevented by the best adjusted bandages. These unpleasant 
results can, he observes, be always obviated by opening the abscess by an 
incision at right angles to Poupart’s ligament. By this practice, the 
abscess is fully evacuated, the lips of the wound assume an oval figure, they 
remain in repose, not being affected by the abdominal movements, and 
when the incision heals, the mark is scarcely apparent. 
There are certain deep-seated abscesses, occasionally met with in locali- 
ties rendered dangerous by the proximity of large vessels, such as the calf 
of the leg, the sole of the foot, and the neck. Dr. Hargrave asks when 
the abscess is in the calf of the leg, at a considerable distance from the 
surface, between the thick superficial, and deep layer of muscles, and in the 
vicinity of the popliteal space, are we to cut boldly down to the matter, as 
is advised by some surgeons ? Dr. Hargrave thinks not, but recommends 
instead, that a careful examination be made along the external and internal 
part of the leg ; and if the abscess points externally, to make the incision 
parallel and posterior to the fibula, which will allow of the separation of 
the muscles, and puncture of the abscess without risk. 
In opening abscess in the sole of the foot, in which the matter has a ten- 
dency to pass through the metatarsal sj)aces, and to point on the dorsum 
of the foot, he advises that the pus be evacuated, not by a direct puncture 
through the sole of the foot, but by incision along the outer edges of the 
foot, near the fifth metatarsal bone, when, by dividing the subjacent 
tissues, the very centre of the sole of the foot may be reached without 
danger of wounding any important part. Part xvi., p. 321. 
Treatment of the Abscesses which precede Fistula in Ano.—Mr. Vincent 
says : I have many opportunities of treating those previous abscesses from 
which fistulas in ano are formed. In that mass of adipose substance filling 
up the ischio-coccygeal space, the patient’s notice is perhaps drawn to a 
deep tumor, just differing in substance enough to be clearly distinguishable 
from the surrounding structure, of a doughy consistence, little sensible, 
and not at all rising to the level of the surface. This is, I apprehend, the 
first abscess in its earliest state, which, if allowed to go on, will end in the 
genuine fistula in ano. I have had such cases in the hospital, and have no 
doubt that this is the fact, as I have compared these sort of swellings 
with other presentations in a more advanced stage in the formation of 
fistula?. The practice to be adopted is unhesitatingly pointed out: this 
lumpy mass is to be transfixed ; and this I have done the very first 
moment the case has been presented to me. I plunge a knife down to the 
very centre of the mass, and then I have found a small quantity of pus 
come out; and upon passing my finger down (and the opening should 
always be large enough to admit this part), I have found in the centre of 
the mass a small cavity of the peculiar pulpy feel that is familiar to surgeons 
as the interior of an abscess. This prompt measure stops all further pro- 
gress of the abscess, which otherwise would lead its way either to the 
rectum or to the surface, and terminate in fistula. The course of these 
abscesses, when opened, is to close, and finally heal; but the surgeon must 
not expect that they will heal with the readiness of ordinary active 
abscesses. Part xvii., p. 173. 
Treatment of Mammary Abscess.—The following is a case of no very 
unusual occurrence: A mother loses her infant, and broken-hearted at 
the event, she neglects to pay that attention to herself which her case ABSCESS. 
35 
requires. No attempts being made to relieve the distended breast of its 
secretion, the gland becomes hard and painful, and at length abscesses 
form in different situations. If the treatment is confined to the evacuation 
of matter by puncture, and to the application of fomentations and poultices, 
but little good is done. The former abscesses continue to discharge; 
fresh ones are constantly forming, and the woman at length sinks in a 
state of hectic. Means should be used to stop the secretion of milk, which 
has been going on all this time, and perpetuating the mischief. We have 
no better means of effecting this than by the administration of a hydra- 
gogue purgative. I am usually in the habit of prescribing the sulphate of 
magnesia in the compound infusion of roses, to which, when there is much 
hectic and debility, I add some quinine, and dilute sulphuric acid. The 
effect of this treatment is sometimes almost magical. I have known a 
woman, who for months had been suffering from a succession of mammary 
abscesses, begin to get well from the moment that the salt produced its 
liquid evacuations from the bowels; the secretion of milk ceased, and the 
purulent discharge diminished, a more adhesive inflammation being 
established in the place of these two actions. Part xvii., p. 293. 
Abscess in the Perineum.—Mr. B. Cooper gives the following case:— 
I was sent for to see a patient who was suffering from retention of urine, 
of which the symptoms were so urgent that I immediately attempted to 
pass a catheter; not succeeding, however, in relieving the patient, I pro- 
ceeded to examine the perineum, where I discovered a tumor of con- 
siderable size ; in this I made an incision, and a quantity of pus and urine 
was immediately evacuated. As the patient stated that he had been the 
subject of stricture for many years, I considered it better to open at once 
the membranous part of the urethra; I therefore passed a female catheter 
into the bladder, and, drawing off the urine, relieved the patient from the 
symptoms arising from the retention; I next passed a male catheter along 
the natural passage of the urethra, as a preliminary to the division of the 
stricture ; to my great surprise, the instrument passed readily on, and 
when the female catheter was withdrawn, at once entered the bladder: 
this circumstance showed that if I had attempted to pass the male catheter 
before I divided the membranous portion of the urethra, I should have 
found the more formidable part of the operation to be altogether unneces- 
sary. The experience I derived from this case has since often prevented 
me from cutting into the membranous part of the urethra, after opening 
an abscess in perineo, without first attempting to pass the male catheter 
along the natural course of the urethra; such a precaution is, indeed, ren- 
dered doubly necessary by the fact that abscesses in the perineum may 
result from external injury, without any other implication of the urethra 
or the canal than that arising from the mere pressure of accumulated 
matter, the evacuation of which immediately relieves the symptoms. 
Part xix., p. 181. 
Substitute for Tents in dressing Abscesses.—In place of introducing 
tents, which are not only painful, but give rise to other inconveniences, 
M. Nonat passes a crayon of nitrate of silver into the opening, to the 
depth of from i to 1 centimetre, withdrawing it immediately. The pain 
caused by this is trifling and evanescent, and the eschar produced prevents 
the union of the walls of the trunk of the abscess. It is in abscess of the 
breast that this procedure has been found especially useful; the deepest 36 
ABSCESS. 
abscesses being thus brought to heal in seven or eight days. The cauteri. 
zation has to be repeated every two or three days. Part xx.,p. 180. 
Pelvic Abscess.—The abscess must be opened where it points. If in 
the vagina, an incision may be made there ; but if in the hypogastric 
region, adhesion of the two surfaces of the peritoneum must be obtained 
before opening the abscess. In ox*der to effect this adhesion, apply a por- 
tion of potassa fusa cum calce, made into a paste with alcohol, to that 
part of the abdominal parietes where it is wished to make the opening. 
When, by the action of the caustic, after one or more applications, the 
seat of the fluctuation is nearly reached, an adhesion is shown to have 
taken place by the imjxossibility of moving the abdominal parietes over 
the tumor; then make an incision in the centre of the sore. Or, instead 
of using the caustic, make an incision through only a portion of the 
thickness of the abdominal parietes, and then apply linseed poultices; the 
pus will frequently find an exit through the sore. After the abscess is 
opened, use injections of tepid water, to remove foetid secretions, and to 
prevent the admission of air, by keeping the cavity full of liquid. 
Part xx., p. 230. 
Abscesses.—In opening abscesses, if the attenuated skin is of a circular 
form, so that when divided by the knife in any direction, it must leave 
broad thin flaps, apply caustic round the edge where the healthy and thin 
skin meet; and the whole of the latter being, as it were, included in a 
ring of eschar, will perish. This plan answers well in large buboes, 
especially in scrofulous subjects. If the abscess has opened spontaneously, 
and there is much unhealthy skin, and also unhealthy granular and cellular 
tissue below it, use the caustic at once, as all this has to be got rid of 
before a cure can be accomplished. Part xxii., p. 343. 
Pelvic Abscess.—Among the most important of the cases in which puru- 
lent collections form within the abdomen are those known as pelvic abscesses, 
in which inflammation of the cellular tissue of one or other part of the 
pelvis ends in suppuration. In all probability the disease is generally 
located in the cellular tissue only, and may originate in any part of the 
pelvis. 
The prognosis of pelvic abscess following parturition is probably for the 
most part favorable. The patients often sink into hectic under the profuse 
discharge which follows, but as there is no persistent cause of irritation (as 
in psoas abscess, or those depending on foreign bodies), they generally 
rally as the abscess diminishes in size. The treatment should of course 
consist of the most liberal diet, combined with such tonics as may appear 
necessary. The abscess should be opened as soon as a tendency to point 
in any direction is perceived. The most favorable class are those, perhaps, 
in which the opening is into the vagina, as a free and depending channel 
of exit is then procured, while no risk from the contraction of the cicatrix 
afterward is encountered, as might be the case were the rectum the part 
selected. Partxxx., p. 158. 
Deep-Seated Abscesses.—The injection of deep-seated abscesses with 
tincture of iodine is coming into more favor in hospital practice. In two 
cases during the present month, in the analogous sacs of ovarian cysts, one 
by Dr. West, at St. Bartholomew’s, and another at University College 
Hospital, iodine was used. In a third case of immense abscess of the loins ACIDS AND ALKALIES—ACONITE. 
37 
not lumbar abscess), Mr. Paget found the iodine injection very valuable. 
The rapidity with which the iodine is absorbed and spread over the sys- 
tem, and then eliminated by the kidneys, seems to prevent excessive local 
stimulation. In hydrocele, iodine is almost always used, also, as the danger 
of too much local inflammation by the old port wine injection is thus 
avoided. Part xxxii., p. 196. 
Abscesses in the Perineum.— Vide Art. “Perineum.” 
ACIDS AND ALKALIES. 
Proportions for the saturation of.—In the application of this table it 
should be observed, that the articles adduced are those of the London 
Pharmacopoeia of 1836, in their pure state. 
Supposing the articles kept by chemists and druggists to be in a perfect 
state of purity, this table will be found intrinsically correct, and available 
for all ordinary purposes in compounding prescriptions wherein “ quantum 
sufficit ad saturationem ” is ordered. 
ONE SCRUPLE. 
LEMON JUICE. 
CITRIC ACID. 
TARTARIC ACID. 
Drachms. 
Grains. 
Grains. 
Potass® Bicarbonas 
3 to 4 
13-68 
14-85 
“ Carbonas 
CO 
1 
£ 
16*^6 
n-95 
Ammoni® Sesquicarbonas 
5—6 
23-74 
25-44 
Sod® Carbonas.... 
2—3 
9-72 
10-41 
“ Sesquicarbonas 
3£ — 4* 
16-86 
18*07 
Part y., p. 82. 
ACONITE. 
Action and External Use of.—Dr. Eacles laments that the distinction 
between sedatives and narcotics is not more clearly defined, and remarks 
that, from the terms sedative, anodyne, soporific, and narcotic, being indis- 
criminately used by authors, the object of their treatment, or the treatment 
itself, is frequently rendered obscure, if not doubtful. He then says: 
“ To prevent any misunderstanding of the action of this substance, so 
far as our knowledge goes, I am anxious to have it classified among the 
cerebro-spinants, or, ‘those agents,’ to use the words of Pereira, ‘whose 
primary and specific effect is a disorder of one or more of the functions of 
the cerebro-spinal system. To this class, therefore, are referred all those 
substances which occasion sleep, insensibility, erroneous perceptions, judg- 
ments, and volitions, or delirium, stupor, or coma, paralysis, convul- 
sions,” etc. 
The cerebro-spinants are subdivided according to the nerves, motor or sen- 
tient, which they more particularly affect, or the systems upon which they 
more decidedly display their action. Thus Pereira places aconitum amongst 
those cerebro-spinants which cause paralysis of the nerves of sensation. 38 
ACONITE. 
[With a view to test the correctness of this classification, Dr. E. made 
some experiments with aconitine upon animals, the results of which were 
“ sufficient to show that aconitine acts as a paralyzer of the nerves of 
sensation, and does not cause stupor or convulsions; when the latter occur 
they take place a short time previous to death, and appear to be caused 
by a want of the circulation of the brain.” The first case in which 
Dr. E. tried this remedy externally, was a “ Mrs. H., of nervous tem- 
perament, married 6 years, had several miscarriages, caused by a morbid 
irritability of the sacral nerves.” The form used was the tincture of the 
root as an embrocation with tincture belladonna—5ij. of each in §iv. of 
rose water.] 
To have a couple of teaspoonfuls rubbed upon the sacrum, inguinal 
regions, and inside the thighs. In the course of a few minutes there was 
a complete suspension of pain. For five months she had every fourth 
week these attacks, and frequently in the interval sudden and severe excite- 
ment. It was such attacks as these which caused her former miscarriages, 
and after the sixth week of gestation, they always excited uterine pains 
with more or less of a “bearing down” sensation. 
I found that the belladonna, Avhen used alone, whether in the form of 
embrocation or a plaster, to the sacrum, gave no relief. At the expiration 
of the fifth month these pains returned no more ; she arrived to her full 
time and became the mother of a strong and healthy child. 
The second was a case of neuralgic attacks in the gums, jaws, and 
cheeks. As the patient was disposed to dyspepsia, these were supposed 
to be merely secondary, and the ordinary treatment was tried without 
effect. The tinct. aconite lotion, 5j. to §j., was then ordered as a gargle; 
and also to be applied externally to the cheeks ; after a few applications, 
this treatment succeeded perfectly, the pains not having returned for eight 
months. 
Dr. Eades has received accounts of cases where it has been tried, and 
one is mentioned which was communicated to him by a medical friend, of 
apparently pure neuralgic pain over the left eyebrow, “ which occasionally 
extended over the same side of the forehead and temple, and also down as 
far as the zygomatic arch.” 
[After a little aperient medicine had been given, bark was tried, toge- 
ther with leeches over the orbit, with hardly any good effect; the tinct. 
aconite was then tried per se, and the pain very soon yielded.] 
Of the preparations of aconite, the tincture of the root and the alcoholic 
extract are the most to be depended upon. The preparations, as ordina- 
rily met with, are not to be relied upon. In general one may form a 
pretty correct opinion as to the probable strength of the preparation, by 
the tingling sensation it produces upon the lips, and the degree and dura- 
tion of numbness which follows. Those preparations which do not pro- 
duce both these effects I have found to be almost inert. 
Mr. E. concludes by saying: 
From my own observations, I would thus sum up the most remarkable 
symptoms, as exhibited by animals; weakness, staggering, gradually in- 
creasing insensibility of the surface, slowly increasing weakness of the 
voluntary muscles, ending perhaps in paralysis, great languor of the pulse, 
more or less blindness, and convulsive twitchings before death. 
Part xi., p. 19. 
Physiological and Medicinal Properties of Aconite.—The practical ACONITE. 
39 
inferences which Dr. Fleming deduces from a consideration of the actions 
of aconite on the circulation, are as follows : 1. That it is a powerful 
antiphlogistic. 2. That it is calculated to be of great value in all cases 
where there is an inordinate activity of the circulation. 3. That it is 
contra-indicated, when there is obvious mechanical impediment to the 
passage of the blood, particularly through the heart or lungs. It is 
requisite, therefore, in every case, to ascertain that no such obstruction 
exists before commencing its use. 4. That it is contra-indicated when- 
ever there is irritability of the circulation, with great diminution ot 
power, such as occurs after severe venous hemorrhage. 
The diseases in which aconite is said by Dr. Fleming to be useful 
are neuralgia in various forms, hemicrania, angina pectoris, cephalalgia, 
general pains of fever, certain diseases of the heart, acute rheumatism, 
lumbago, erysipelas, cancer, pruritus, and hysterical spasmodic asthma. 
Those in which its use is most satisfactorily established, are neuralgia 
and rheumatism. It is decidedly objectionable in several of the above- 
named affections, particularly in the general pains of the typhus and 
other fevers, where the vis vitce is at a low ebb. 
Neuralgia of the Thoracic and Intercostal Nerves—Spinal Irritation. 
—I have found the topical application of the tincture extremely successful 
in the treatment of the neuralgic pains, so frequently complained of by 
females, as occurring about the seventh, eighth, and ninth ribs of the left 
side, as well as of spinal irritation, both when coexisting with, and inde- 
pendent of, these pains. 
Neuralgia of the Extremities.—In a case of crural neuralgia of the 
right side, where the pain was chiefly seated in a circumscribed spot on 
the inside of the patella, the external application of the tincture was, 
in eight days, followed by a complete cure. The disease, which occurred 
in a female of thirty years of age, was of three years’ standing, and 
the part had been frequently leeched and blistered without effect—the 
potential cautery having been the only application which had afforded 
any relief. 
Dr. Cormack has communicated to me a case of severe neuralgia of the 
right hand, which was at first treated successfully by the internal use of 
the tincture. The pain afterward returned in two of the fingers, to a 
slight extent; but the patient could not be prevailed upon to resume 
the remedy, in consequence of its having formerly produced some dim- 
ness of vision. Two cases of neuralgia of the fingers, in which the 
aconite wras had recourse to with success, are noticed in the table of 
neuralgic cases. 
As far as my own experience goes, I believe it will be found most useful 
in those cases of sciatica, which appear to owe their origin to a congested 
or inflammatory condition of the nerve. 
Aconite was recommended in acute rheumatism by Dr. Storek, and 
various other physicians have since followed the practice. 
The improvement following the administration of aconite is often very 
speedy, some alleviation of the pains being occasionally experienced in the 
course of an hour after the first dose has been taken, while there are few 
cases in which decided relief, with abatement of the redness, tension, and 
tenderness, is not obtained in a few hours. A longer period seems to be 
required to disperse the inflammation in the smaller joints than in the 
larger ones. Aconite not only effects a cure in a shorter period than any 40 
ACONITE. 
other mode of treatment, but appears to possess the great negative 
advantage of not increasing the liability to extension of the disease to'the 
membranes of the heart. Indeed, it seems rather to protect the patient 
from that dangerous complication. It may be thought that as aconite 
weakens the heart, it is probable that it will predispose that organ to 
suffer in the same way as blood-letting ; but this distinction must be borne 
in mind, that aconite acts as a pure sedative to the vascular and nervous 
systems, whereas blood-letting—although it produces a similar action 
when practised to a moderate extent—when performed largely and re- 
peatedly, has a peculiar effect in increasing the irritability of the heart. 
In a strong and healthy subject, with high inflammatory fever, a free 
blood-letting, practised at the outset, will not only be of service in afford- 
ing a more rapid relief to the patient’s sufferings, but will place his system 
in a more favorable condition for the action of aconite, which, if properly 
administered, will prevent reaction, and remove the necessity of abstract- 
ing more blood. 
Chronic Rheumatism.—Aconite may be used both internally and ex- 
ternally in this disease. The internal administration seems to be prefer- 
able, in what has been termed the active chronic rheumatism: that variety 
which is, perhaps, properly speaking, only a very mild form of the acute 
rheumatism, being attended with some heat and swelling of the part 
affected, and slight constitutional disturbance. On the other hand, I 
would recommend the external application of the tincture in what is 
termed the passive chronic rheumatism, “ characterized rather by 
coldness and stiffness of the painful joints, with entire absence of con- 
stitutional fever.” In every case, however, should the mode of treatment 
adopted fail to afford relief, the other should be had recourse to; while 
it is frequently of service to combine the internal and external use of the 
remedy. 
Administration of Aconite.—The alcoholic tincture of the root, pre- 
pared according to the following formula, is the best preparation of the 
drug for internal administration. It may be given simply with water, or 
it may be prescribed along with antimony, opium, or other remedies. 
Tixctuea Aconiti.—Take of root of A. napellus, carefully dried, and 
finely powdered, sixteen ounces, troy; rectified spirits, sixteen fluid 
ounces ; macerate for four days ; then pack into percolator; add rectified 
spirits until twenty-four ounces of tincture are obtained. 
It is beautifully transparent, of the color of sherry wine, and the taste 
is slightly bitter. As an anodyne, anti-neuralgic and calmative, five min- 
ims ought to be given at first, three times daily, to be increased daily to 
the extent of one minim each dose. 
The best method of administering the remedy in diseases of the heart, 
is to give it in smaller doses than those recommended for its use as an 
anodyne, but more frequently repeated, as three or four minims five times 
daily. Sickness may be avoided or checked by an effervescing draught, 
administered with, or immediately after, the dose. 
External Use.—The aconitina may be applied externally, either in the 
form of solution in alcohol, in the proportion of one or more grains to the 
drachm, -or of ointment made in the following manner : 
Aconitines, gr. xvi.; spir. rectif., m. xvi., tere optime. Deinde adde 
axungias, 5j., ut fiat unguentum. 
If, as occasionally happens, this ointment, after two or three applica- AIK. 
41 
tions, fail to produce its ordinary effects, the proportion of aconitina must 
be increased to three, four, or even eight, grains to the drachm. It is much 
to be regretted that the difficulty of preparing the akaloid, and its con- 
sequent high price, should prevent its more general use. A preparation 
of inferior quality, or, as is frequently the case, totally inert, is very com- 
monly substituted for it in the shops—a circumstance which fully accounts 
for the low estimation in which it is held by many who profess to have 
tried it. The tincture, however, will be found an excellent substitute. 
One or more drachms of it are to be rubbed over the affected part three 
times daily, the friction being continued at each time for a quarter of an 
hour, or, indeed, until the topical effects of the drug are fully developed. 
It is hardly necessary to add, that, when there is any abrasion of the skin, 
the external application of either of these preparations may be attended 
with danger. Dart xii., p. 37. 
Dr. Fleming's Tincture of.—Recommended in cases of tetanus. It 
acts mainly on the spinal cord, inducing muscular paralysis, and affecting 
the brain but little, if at all. Part xxxix., p. 70. 
AIR . 
Air—Exclusion of, in the Treatment of certain Diseases.—A favorite 
application in France, in cases of internal inflammation, is a large poultice. 
This is very useful, for example, in pleuritis and peritonitis. On this 
mode of treatment Dr. Marshall Hall makes the following remarks: 
It is probably by the exclusion of the atmospheric air that other reme- 
dies for inflammatory diseases act; the various plasters, the nitrate of sil- 
ver, even blisters, have this effect. I do not, however, mean to insinuate 
that they have no other. Cataplasms may further act by their warmth 
and moisture. The nitrate of silver possesses some extraordinary power 
over the actions which constitute or coincide with inflammation. But, 
certainly, mere adhesive plasters have an efficacy in cases of chronic chest 
affection, in lumbago, sciatica, and other forms of rheumatism, in neuralgia, 
and even of scirrhus, which cannot be easily explained. 
One of my patients, a martyr to extensive sciatica, was desired to enve- 
lop the limb in adhesive plaster. He was a joiner, and an ingenious man. 
He prepared the common stocking material with glue, dissolved in the 
proportion of one ounce to two pints of water, and had it spread over, 
when dry, with galbanum plaster, and if this exuded it was dusted with 
flour. By the steady application of this plaster his severe rheumatism 
was cured. 
I was once informed by a celebrated physician that he had prescribed 
adhesive plaster to be applied over a scirrhous tumor of the mamma. It 
remained adherent for years, and the disease remained stationary. The 
plaster then separated and from that period the disease pursued its devas- 
tating progress. 
Certain modes of the treatment of burns consist in excluding the influ- 
ence of the atmospheric air. 
Some affections of the face are remedied by applying a layer of gela- 42 
ALBUMEN, 
tine. Isinglass is dissolved in water, and the solution is applied with a 
camel’s-hair pencil and allowed to dry. Part x., p. 94. 
ALBUMEN. 
Detection of Albumen in Urine.—In cases of albuminous urine, it is 
necessary to bear in mind the recent investigations of Dr. Rees. The 
coagulation of urine by boiling, has hitherto been considered a sufficient 
proof of the presence of albumen ; but this is not the case ; urine may con- 
tain not only the albumen but also an alkali, and in this case boiling will not 
coagulate it. Albumen, therefore, may be present and not detected, accord- 
ing to the hitherto received mode of detection ; it is necessary, according 
to Dr. Rees, to add nitric acid, in which case, a copious precipitate will be 
produced, if an alkali be present. Dr. Rees asserts, that the knowledge 
of the acid or alkaline condition of urine cannot assist us in determining 
whether or not it contains albumen, by applying heat alone, if a positive 
result be obtained, “ for the coagulum may be caused by the earthy phos- 
phates, whether the urine be alkaline or acid; but the case is different 
when the result is negative, since acid urine never prevents the precipita- 
tion of albumen by heat, though alkaline urine may, and therefore a speci- 
men, if shown to be acid, and not coagulable by heat, may safely be 
declared free from albumen.” But nitric acid may also mislead the prac- 
titioner, unless perfectly conversant with the changes produced by other 
substances; thus, when the lithates exist in the urine in excess, a mineral 
acid will cause a deposit of litliic acid; but this is generally of a brownish 
red color, and very different to that of albumen produced by nitric acid. 
Part iii., p. 53. 
Circumstances influencing the Coagulation of Albumen.—Mr. Badley 
remarks as follows: A short time since some urine was left me for exami- 
nation, containing pus. It was filtered, and heat applied to the clear fluid, 
which was acid, to ascertain the quantity of albumen it contained; but it 
was boiled without effect. The non-occurrence of coagulation being 
unusual under such conditions, I added some nitric acid, which immediately 
caused a precipitate that became flocculent by heat. It is stated by Dr. 
Rees (whose researches in this department have deservedly given much 
authority to his name), that “ acid urine never prevents the precipitation 
of albumen by heat,” and that “ a specimen shown to be acid, and not 
coagulable by heat, may safely be declared free from albumen.” Here, 
however, was acid urine containing a considerable quantity of what I could 
not but consider albumen, yet unaffected by a boiling temperature, and 
therefore quite at variance with the above statement. On inquiry, the 
only thing I ascertained was, that some nitric acid had been previously 
poured into it. These two reagents, heat and nitric acid, are generally 
considered not only indispensable in examining urine for albumen, but 
when used together,- certain in their indications. The acid is thought by 
some to aid the effect of heat; its tendency is, to a certain extent, how- 
ever, to oppose it. The one is undoubtedly essential to correct the fallacies 
of the other ; but care should be taken that what is intended to correct is 
not itself a cause of error. Dr. Watson states that nitric acid “will ALBUMEN-. 
43 
detect albumen when the tested urine is alkalinethis is well known, 
“ and by restoring its acidity, will make the albumen discoverable by the 
test of heat.” This, however, is a condition which will as effectually pre- 
vent the coagulation by heat as the previous alkalinity; a drop beyond 
what would neutralize the alkali being sufficient for such a result. When 
the urine, therefore, is alkaline, the acid should always be employed as the 
precipitant, and never with the intention of “ restoring acidity.” 
Part xii., p. 115. 
Singular property of Albumen.—The following is valuable, as pointing 
out one of the sources of fallacy which may occur in testing for albumin- 
ous urine. 
Professor Wunderlich remarked that any albuminous fluid loses the pro- 
perty of coagulating by heat, when the free alkali contained in it is neu- 
tralized by a few drops of nitric or muriatic acid. Even if a slight tui’- 
bidness should result from the addition of the acid, this disappears on heat- 
ing the liquid. Remarks.—We have observed a similar effect on the 
addition of acetic acid to an albuminous liquid : but it appeared to depend 
on the quantity of albumen present. It was long ago shown by Magendie, 
that when acetic acid was added to serum, the mixture might be heated 
without coagulation taking place. It merely became opaline; and on cool- 
ing, if not too dilute, it became solid; on again heating it, liquid. 
Part xii., p. 115. 
JSfew Test for Albumen.—The highly acid liquid obtained by dissolving 
mercury in its own weight of nitric acid, constitutes an extremely delicate 
reagent for albumen and albuminous compounds. This mercurial solution 
communicates to albuminous substances an intensely red color, by means 
of which a very miimte proportion of albumen in water may be detected. 
To give an idea of the delicacy of this reagent, and to show its applica- 
bility to the study of vegetable organization, it may be stated that starch 
and gum acquire by its action a very distinct rose tint. Urine almost 
always becomes colored of a rose tint after the nitro-mercurial solution 
has been mixed with it, and the mixture has been warmed. The albumen 
of the blood, that of serous effusions, of plants and fibrin, casein, gluten, 
legumin, silk, wool, feathers, horn, epidermis, gelatin, chondrin and pro- 
tein, are equally affected. 
Protein rendered soluble by the prolonged action of an alkaline ley, 
or by sulphuric acid, is also colored red, but no preciptate is thrown 
down. 
This mercurial solution is most readily prepared by dissolving mercury 
in its weight of nitric acid (1.4) in the cold. When reaction has ceased, 
a gentle heat may be applied to facilitate the solution of metal. When 
the solution is complete, the liquid is to be diluted with two parts of 
distilled water by measure. After some hours the liquid is to be de- 
canted from any mixed crystals of nitrite and nitrate of mercui'y, that 
may subside. 
One or two drops of the test liquid are sufficient for the detection of 
albumen. Albumen has been detected in the liquid of cholera, when nitric 
acid and heat have failed to demonstrate its presence. 
This reagent acts on albuminous substances at low temperatures, but 
not so completely as at a temperature of from 140° to 150° Pah. 
Part xx., p. 96. 44 
ALBUMINURIA. 
ALBUMINURI A.—(Vide “ Kidney Affections.”) 
Large purgative doses of cream of tartar, given two or three times a 
week, in cases of this almost invariably fatal disease, were found to afford 
more relief to the uneasy sensations of the patient than any other remedy. 
Suggested to combine some diuretic, especially the infusion of diosma 
combined with sweet spirits nitre and tincture of squill. The tincture 
dantharidis was not found serviceable. 
There seems to be a certain analogy between various organic diseases 
of certain viscera, as tubercle in the lungs, cirrhosis of the liver, granular 
degeneration of the kidney, and opacity and thickening of the valves and 
membrane of the heart, all of which are regarded as the result of a 
deposit of lymph of an imperfectly organizable character, such lymph 
showing a strong tendency to induration and contraction subsequently to 
its deposition. Hence we may suspect that when one of these diseases 
is present, we will find analogous affections in the other organs which are 
disposed to receive these depositions. 
And in the cases detailed, granular disease of the kidney was found to 
be connected with tubercle of the lungs, and with a cirrhose state of the 
liver; also with diseased valves of the heart, and with tubercular deposit on 
the peritoneum. When the proper texture of the kidneys is thus sup- 
planted by a deposit of lymph of an imperfect character, we can easily see 
how their functions may be changed. If these organs possess the property 
which Dr. Prout assigns to them, of exerting a disorganizing influence on 
the materials to be discharged from them, this morbid deposit will so alter 
their powers that the fluid part of the blood will be poured out as through 
a mere filter, retaining more or less of its albuminous character. 
Part ix., p. 9. 
Treatment of Albuminuria.—The treatment of a case of ordinary al- 
buminuria will depend in some measure on its complications—especially with 
cardiac disease. If it be an acute case, in which there is reason to suspect 
an inflammatory and congested state of the kidneys, the first step will 
often be to diminish the quantity of unhealthy blood by bleeding ; this 
should be accompanied or followed by hydragogue purgatives. Some 
practitioners prefer giving large doses of bitartrate of potass, as half an 
ounce or an ounce every morning; others prefer elaterium when the 
stomach will bear it. Some prefer acting entirely on the alimentary 
canal, for the purpose of relieving the renal congestion and diminishing 
the quantity of liquid in the system, while others combine the use of 
diuretics of a more or less powerful nature. This latter mode, however, 
can only be admissible when the acute stage of inflammation has subsided, 
and when their use can have no irritating on the parts. The com- 
bination of the infusion of digitalis, as pointed out in Dr. Munk’s paper, 
may probably be useful in all stages of the disordei*, and especially as cai*- 
diac disease is so frequent a complication. Part x., p. 74. 
Compression of the Phenol Vessels as a cause of Albuminuria.—Mi*. 
George Robinson, from experiments which he instituted to ascertain the 
cause of the appeai*ance of albumen in the urine, has found that “ ob- 
struction to the return of blood thi*ough the renal vein,” give rise to the 
escape into the urinaiy passages, not only of liquid albumen and blood, ALBUMINURIA. 
45 
hut also of coagulating lymph or fibrin. Similar results were obtained 
when an increased quantity of blood was directed to one or both kidneys, 
no obstruction being offered to its return. In the first class of experiments, 
seven in number, a ligature was tightly applied to the renal vein ; in one 
case the urine, at the end of six minutes, was found highly albuminous, 
with traces of fibrin, whilst in another, after an hour’s compression, it was 
merely bloody. In four out of the seven, however, albumen was present. 
From these experiments Mr. R. infers that the degree of obstruction is 
only one of the conditions necessary for the exudation of the more viscid 
parts of the blood, and that various kinds of effusion may result from the 
same amount of obstruction. He explains these different degrees of exu- 
dation to be dependent upon the amount of arterial impulse at the moment 
of tying the ligature, and says he observed throughout that in these ani- 
mals which recovered most speedily from the operation, the effects of 
compression were manifested in the most intense degree. In the second 
class of experiments, increased determination of blood to one or both 
kidneys was effected in some cases by the removal of one of the kidneys, 
in others by tying the aorta below the spot rvhere the renal arteries arise, 
and this was found much the most effectual way. In four experiments 
the urine contained more or less albumen. 
Mr. Robinson considers that his experiments prove— 
1. That simple compression of the blood in its smaller vessels, will, in a 
direct ratio to the degree of intensity of that compression, cause the exu- 
dation of an albuminous fluid, of coagulating lymph, or the extravasation 
of blood. Its immediate effects, therefore, precisely resemble those of in- 
flammation ; and as it is well ascertained that both the essential causes of 
undue compression (viz., an obstruction or impediment to the flow of 
blood through the vessels of the inflamed part, and excessive action of the 
heart) coexist in that disease, it seems but reasonable to infer that the 
primary effects of inflammation, being identical with those of undue com- 
pression of the blood, are the mere consequences of that physical cause. 
2. That there is no relation between the composition of the effused 
matters and the extent of the dilatation of the coats of the vessels, as 
measured by the quantity of blood they contain. 
These experiments of Mr. Robinson seem, therefore, to offer an easy ex- 
planation of the existence of albuminous urine in pregnant women ; and in 
future it would be well for medical men when they meet with cases of 
mdema of the face, eyelids, etc., or disordered states of the kidneys, to 
examine minutely for albumen, and where this is present to be on their 
guard for fear of puerperal convulsions. These will probably be found to 
be more severe when the urine has been albuminous during pregnancy, 
than when it only becomes so during labor. In this latter case the con- 
vulsions will generally be milder, and the urine will be albuminous for a 
shorter time than in the former case. In the sthenic form we must have 
recourse to active depletion, tartarized antimony and purgatives ; taking 
care to interfere as little as possible with the os uteri. Part xi., p. 68. 
Albuminuria treated by Vapor-Baths and Extract of Bhatany.—The 
patient had been the subject of anasarca for fifteen years, with an exception 
of a short interval, when the symptoms had been relieved by warm 
baths, aromatic fumigations and iodide of potassium. In the beginning of 
last December he presented the following symptoms; 46 
ALBUMINURIA, 
The legs and scrotum were considerably infiltrated, and ascites was 
present: a general sensation of lassitude, and pain in one, sometimes 
both sides of the abdomen, were complained of; the bowels were con- 
fined, the appetite preserved, and frequent paroxysms of cough were ob- 
served ; the urine was pale, slightly acid, abundant, and contained a large 
quantity of albumen—coagulable by heat and nitric acid. Every day 3ss. 
of extract of rhatany was exhibited in a mixture ; vapor baths were or- 
dered, and low diet. Under the influence of this treatment a gradual 
amelioration occurred, and on the 10th of January the urine contained no 
more albumen. On the 12 th, the patient left the hospital, if not completely 
cured of his renal 'disease, at least cured of the symptoms which he had 
labored under, and which are generally looked upon as characteristic of 
granular disease of the kidney. Part xv.,y>. 135. 
Albuminuria— Chronic.—Give elaterium as a purgative; it will relieve 
the dyspnoea and assist the action of the diaphoretics. Insert a seton or 
an issue, but do not let the discharge be too profuse. When all inflam- 
matory symptoms have subsided, give iron ; either the mist, ferri comp , 
or the ammonia citrate, taken in soda or Seltzer water. 
[O r give pulv. potass, bitart. §ss.; pulv. jalapae <ss., in a tumbler of 
water every morning, or every other morning, counteracting the prostrat- 
ing effects by some gentle stimulant, as a little weak whisky and water, 
or diluted chloric ether.] Part xvi.,y>. 1G0. 
Indications of Treatment—Are, 1st, to remove the exciting and pre- 
disposing causes where they exist, such as intemperance, and residence in 
an unwholesome atmosphere; 2d, to oxygenize the blood by active exer- 
cise in the country and in the open air; 3d, to avoid fatty and all other 
non-nitrogenous articles of food ; 4th, to administer alkalies in free doses, 
which, by their action on the animal fats, will probably render their elimi- 
nation more easy of accomplishment; and, 5th, to administer purgatives, 
so as to keep up a tolerably free action of the bowels. Part xviii., p. 137. 
Use of Purgatives and Tonics.—Speaking of the employment of hydra- 
gogue purgatives in the treatment of this disease, Dr. Ileaton observes : 
I find none more convenient than croton oil, which produces copious 
evacuations, and with less sickness and discomfort than are caused by ela- 
terium. Some of the neutral salines, as sulphate of potash, are likewise 
useful for this purpose; these should be given in rather a concentrated 
solution, which then determines an endosmosis of the watery part of the 
blood into the intestine from the blood-vessels, which, thus deprived of 
their natural tension, become actively absorbent of the dropsical effusion 
which they had before allowed to escape. But if the saline be given much 
diluted, or, what is in effect the same, if followed by much diluent drink, 
it then enters the blood and acts upon the kidneys. Cream of tartar is 
likewise useful as a hydragogue purgative of mild operation, when given 
in full doses, and what enters the blood acts favorably upon the kidneys. 
[When there are no febrile symptoms, and it is required to give tonics 
to improve the general health, Dr. Heaton says:] 
In this disease, no medicines are equal to the preparations of iron, and 
of these I know none so suitable as the tincture of the muriate, which 
combines diuretic with its chalybeate properties. In many cases I have 
found most marked benefit from the use of this remedy, both to the gene- ALBUMINURIA. 
47 
ral health of the patients, and in producing a more healthy condition of 
the urine, which is the best proof of actual improvement. The elfect of 
this disease upon the blood is very marked and characteristic; besides the 
accumulation in the blood, of urea which should be excreted by the kid- 
neys, and the diminished jwoportion of albumen in the serum, there is a 
very great reduction in the amount of red globules which it contains. 
This is evident in the pale leucophlegmatic appearance of those who have 
been long the subject of albuminuria ; and we know that no medicine has 
an effect equal to chalybeate preparations, in restoring the red globules to 
blood in which they are deficient. Part xix., p. 110. 
Use of Gallic Acid in Albuminuria.—Give gallic acid in doses of eight 
or ten grains every six hours, in some convenient vehicle; not neglecting 
the use of other remedies to relieve occasional symptoms. 
Part xxi., p. 173. 
Albuminuria.—The presence of pus in the urine may obscure the diag- 
nosis in this disease. The pus corpuscles float in a fluid containing albu- 
men ; it thus becomes mixed with the urine and renders it albuminous. A 
good test for pus is the addition of liq. potassse, by which it is converted 
into a mucous fluid, and when poured from a vessel exhibits its glairy 
character. We must endeavor to obtain the urine free from pus, and if 
the urine then ceases to be albuminous, it is evident it has no connection 
with Bright’s disease, and vice versd. If, then, albumen exists in the urine 
independently of pus and blood, and if we have excluded puerperal fever, 
gestation and cholera, as possible causes, we may conclude the patient to 
be subject to one of the forms of Bright’s disease. Now, as owing to the 
drain of albumen, there is an excess of water in the blood, we must endea- 
vor to render the specific gravity as nearly proper as possible. To pro- 
mote this, experience has decided upon the use of hydragogue cathartics, 
vapor baths and iron. Iron should not be given in the active stages of the 
disease. As regards the use of iron in anemia generally, we are advised 
to persevere with its use, notwithstanding the frequent complaints of the 
patient that it does not agree with him. Abstract, then, the exeess of 
water from the blood by saline purges, and persevere in introducing iron 
into the system. Part xxiv., p. 136. 
Albuminuria.—Albumen is to be detected by nitric acid and heat. 
Albumen may be present in cholera, puerperal fever, pyelitis, gestation, 
or inflammation of urinary mucous membranes, but especially in 
1st. Acute Pesquamative Nephritis.—Here is inflammation or conges- 
tion characterized by fibrinous casts with blood discs, nuclei, and epithelial 
cells, united by fibrinous matter. 
2d. Chronic Pesquamative Nephritis.—A chronic form of last. By 
long-continued shedding of epithelium with the urine, in a more or less 
disintegrated state. 
3d. Waxy Pegeneration of Kidney.—By the discharge of waxy casts 
in urine, varying in size. All the cases of this kind, which Dr. Johnson 
has seen, have recovered. 
4th. Non-desquamative Pisease.—The elimination of some poison, as 
scarlet fever. There is congestion or inflammation and escape of serum, 
but no exfoliation of epithelium. 
5th. Patty Pegeneration.—Large quantities of oil globules, mixed with 48 
ALBUMINURIA. 
epithelial cells and tube casts. Oil cells are known by their rounded, 
uniform shape, and by their broad, black margins, produced by their 
strong refractive power. Part xxvii., p. 92. 
Albuminuria.—In that form which occurs after scarlet fever, it will 
generally disappear by the rigid adherence to a milk diet; if this should 
not suffice, urea given in doses of one-third of a grain, occasions an abund- 
ant secretion of urine and rapid disappearance of the dropsy. 
Part xxxiv., p. 118. 
Albuminuria.—The happiest effects frequently follow the treatment of 
cases of albuminuria, eai’ly in the disease, by iron. It acts not solely by 
imparting red’corpuscles to the blood, but by counteracting the commenc- 
ing deterioration of the liquor sanguinis, which constitutes the very es- 
sence of the disease. It should be given for a long period, extending over 
many months, and combined with nutritious diet, and occasional use of 
jalap purges. A vapor bath may be given once or twice a week, and 
flannel worn next the skin. A case is recorded in which, under the use of 
iron, anasarca entirely disappeared ; the urine became perfectly clear, and 
nine years after contained no albumen, though previously loaded with 
albumen. Part xxxviii., p. 112. 
Albuminuria—Scarlatinal.—As the renal disorder which succeeds to 
scarlet fever is identical with the acute form of morbus Brightii, it fol- 
lows that the principles on which these cases should be treated must be 
the same. They are summed up by Dr. Basham as follows: lessen the 
watery or dropsical state of the blood, and diminish the local blood stasis 
in the kidneys. The first is obtained by acting briskly on the intestinal 
track of mucous surface, by which a large amount of fluid is rapidly elimi- 
nated from the system. The second object is secured by calling into 
activity the functions of the skin by diaphoretics, warm clothing, and 
warm, or hot-air baths. The functions of the skin are vicarious of those 
of the kidney, and whatever augments the first, lessens the activity of the 
latter. The congestion of the kidneys is further alleviated by dry cupping, 
and occasionally by abstracting blood, by cupping, from the loins; but the 
cases are exceptional which will require the abstraction of blood. If these 
objects can be successfully attained—indicated by the disappearance of the 
dropsy and the absence of blood from the urine—no time should be lost 
in placing the organism in a condition to regain those qualities and powers, 
the loss of which are most plainly manifested by the impoverished state of 
the blood. Amongst medicinal remedies, the ferruginous are the most 
essential; and amongst these, the tincture of sesquichloride of iron is the 
most valuable and efficacious. But chalybeates are useless without a well- 
ordered diet. Nutrition must, therefore, be promoted, and it may be 
aided by a limited allowance of wine. Our best-directed efforts are, how- 
ever, often frustrated by the intensity of the disease and rapidity of its 
progress. Part xxxix., p. 20. 
Albuminuria in Cases of Piphtherite.—Dr. Wade urges the necessity 
of making (morning and evening) an examination of the urine in cases of 
diphtherite, whatever their degree of severity. If albuminuria be present, 
the prognosis should be carefully guarded, though not necessarily of the 
most unfavorable character. Vide, Art. “ Diphtheritis.” 
Part xxxix., p. 32. ALOES ALUM. 
49 
ALOES. 
Extract of Aloes—Horn to preserve Pills of.—Extract of aloes readily 
absorbs moisture from the atmosphere, which renders it difficult to pre- 
serve in the form of pills. This inconvenience may be perfectly avoided, 
according to M. Rottscher, by adding a fourth part of carbonate of mag- 
nesia. Part xi,,p. 102. 
ALUM. 
Observations on the Use of Alum.—[Sir James Murray thinks that the 
undoubtedly useful effects of alum as a remedy have been generally in a 
greater measure neutralized by the state in which it has been employed, 
i. e., in solution in water, or in astringent infusions or decoctions which it 
precipitates. He says:] 
To obviate these mal-administrations, I have long been in the habit of 
prescribing alum in substance, but in such state as to prevent its too 
sudden action on the tender tissue. I always order this medicine to be 
reduced to an impalpable powder, and to be mixed in molasses, as an elec- 
tuary. In this way, the remedy comes by slow gradations to constringe 
the relaxed fibres, and does not display all its action at once, like the or- 
dinary solutions; nor does it irritate the tunics or excite the bowels like 
alum in powder. 
When given in the state of electuary, in doses of about ten or twelve 
grains, three or four times daily, it seldom if ever failed to cure that 
obstinate disease, which I elsewhere described as catarrh of the stomach. 
I will only give a short abstract of one case out of many others. 
The patient was a lady. Formerly she vomited daily a great quantity 
of glairy viscid mucus. I have seen basins of it so viscid as to resemble 
the spawn of frogs. The lady suffered many years, whilst no remedy 
succeeded. The ropy mucus brought up was so albuminous, that reflect- 
ing upon the action of acidulous alum on albumen itself, I determined to 
give alum a fair trial. She had the electuary well made up. 
In this case, it was necessary to prevent constipation, and therefore 
an equal quantity of impalpable supertartrate of potass was combined 
with the alum, and also a little ginger, to obviate flatulence. This 
combination was most successful in this and many other cases, both of 
catarrh of the stomach and also of the bladder, and other mucous cavi- 
ties. Whether it may aid in preventing relaxation of the bowels, ante- 
cedent to cholera, it is probable there may be opportunities enough to 
determine. 
There is another method of using alum as a gargle, which far surpasses 
the usual applications. All gargles are hitherto taken into the mouth, and 
reverberated against the palate, but I found that alum, blended into an 
impalpable paste with honey or molasses, and then diluted with distilled 
water, forms an invaluable gargle, not only as a constringing lotion, 
diminishing the diameter of enlarged vessels, but also constricting turgid 
and relaxed glands and tunics. 50 
AMENOREIKEA. 
I noticed that by drawing the gargle here recommended into the 
throat, not through the mouth, but through one or both nostrils, the 
progress of cure was remarkable. There are untoward secretions of 
mucus, and sometimes an injected, relaxed, and turgid state of the coat 
and vessels of the back nasal passages; these troublesome conditions 
extend down the fauces and cause sore throats, with inflamed appearances 
over the glands and entire surfaces. These cannot be removed by gargles 
applied through the mouth, but if appropriate applications of alum, honey, 
and rose water, be drawn into the palate through the nose, the source of 
the irritation is healed, and the continuous surfaces soon partake of the 
same salutary influence. Pa/rt xix., p. 314. 
AMENORRHCE A. 
Treatment by Electricity.—Having removed the accumulations, often 
present in the bowels, and employed other means for the improvement of 
the general health of the patient, as exercise and tonics, a few electric 
shocks will usually restore menstruation. 
The mode of applying the electric shocks is the following: Let the 
patient be placed on a chair or stool; press the brass knob of a director 
against the sacrum; and if the stays be loosened, so that only the linen 
intervenes between the latter and the knob, no further exposure is neces- 
sary. A second director, furnished with a chain connected with the out- 
side of an electric jar, is passed by the female attendant under the 
patient’s dress, and the knob pressed against the pubes. The jar is then 
charged, and its ball touched by a third director, connected with the one 
held against the sacrum by means of a chain. The shock thus passes 
through the patient’s pelvis, and should be repeated ten or a dozen times. 
The jar employed should hold about a quart, and be about half charged. 
Part iii., jp. 26. 
Tincture of Muriate of Iron—Suggested in certain cases of amenor- 
rhoea, attended with leucorrhoea. Vide Art. “ Haematuria.” 
Part iii. p. 31. 
Chloride of Silver—Is recommended in doses sufficiently large to pro- 
duce the alterative and tonic action of silver. From 12 to 30 grains 
daily may be given in the form of pills. The catamenia, suspended for 
years, have, without any adjuvant treatment, returned after its free exhi- 
bition for two or three weeks. Part iv., p. 19. 
Leeches to the Knee.—The application of leeches to the internal surface 
of the knee-joints, suggested to promote the menstrual discharge. 
Part v., p. 61. 
Emmenagogue Remedies—May be employed when the health is so 
improved, in cases where atnenorrhoea arises from chlorosis, that there 
is less pallor, with regularity of the bowels and more, and better blood. 
The preparations of iron are indicated in combination with such other 
remedies, as each particular case demands. Vide “ Chlorosis.” 
Part vi., p. 79. 
Amenorrhcea, combined with Epilepsy.— Vide Art. “ Emmenagogues.” 
Part vi. p. 80. AMEXOERIKEA. 
51 
Electro-Magnetism in Suppressed Menstruation.—Dr Collins gives the 
following case: A female, set. 35, unmarried, rather delicate constitution; 
her menses were stopped by taking cold, some seven months before I first 
saw her. I tried all the usual remedies described in such cases, but I did 
not succeed in bringing about the desired effect. I had been using the 
electro-magnetic machine in some other cases with the happiest effects; 
and I therefore was induced to use it in this case, in which it succeeded 
most perfectly. I applied the buttons connected with the machine over 
the region of the womb, holding one on the lumbar region of the spine, 
and the other in front over the pubic region; using the negative and posi- 
tive wires alternately to the spine and abdomen. I continued the remedy 
five days, from five to ten minutes each day, when her menses were fully 
reestablished. Part xi., p. 230. 
Iodide of Potassium in Suppressio Mensium.—The employment of 
iodide of potassium as an emmenagogue, after the failure of our ordinary 
and well-known remedies, was first recommended by Mr. Pinching, of 
Dublin. Dr. Aldridge having had frequent opportunities of confirming 
its value in such cases, points out the conditions under which we may 
expect benefit from its use. These are where the absence of the catame- 
nial discharge is dependent on uterine irritation, whether from exposure 
to cold, mental emotion, or other causes, and accompanied by pain in the 
loins, aching of the head, palpitations, etc. The treatment most service- 
able in these cases is confirmatory of the inflammatory nature of the dis- 
ease, bloodletting being a necessary preliminary to the use of actual 
emmenagogues. In continuation, Dr. A. says : 
Now, these are the cases in which iodide of potassium will be found 
serviceable. Just as tartar emetic acts in pneumonia, and as calomel 
in iritis, does liydriodate of potash subdue the low and nearly latent 
metritis upon which this form of amenorrhoea depends. Like the medi- 
cines alluded to, the contra-stimulant efficacy of the liydriodate will be 
increased by previous depletion. These means of themselves are frequently 
sufficient to restore the menstrual secretion, when the suppression has 
been recent, in a young, robust girl. If they do not at once succeed in 
restoring the secretion, the employment of drastic purgatives, blisters to 
the sacrum, or, what I prefer to either, an electrical current from the 
lumbar spine to the pubis, will be, in general, much more successful, in 
consequence of the previous treatment. The dose in which I have been 
in the habit of exhibiting the liydriodate, has been that of ten grains three 
times a day; and I have never continued it for more than four or five 
days. I may add the caution, never to treat amenorrhoea unless the gene- 
ral symptoms of suppression be present. In cases of chlorosis, it is the 
diseased state of the blood you have to remedy; in morbus cordis and 
phthisis, your treatment must always be subordinate to the principal dis- 
ease ; and in amenorrhoea from uterine irritation, the remote symptoms of 
the head and chest are always sufficiently marked. If there be not chlo- 
rosis, phthisis, heart disease, or vicarious hemorrhage, and if the menses 
be suppressed without oppression of breathing, vertigo, and drowsiness, 
the chances are that the patient is pregnant. These chances will of course 
be increased if there be morning sickness, etc.; but the existence of the 
ordinary symptoms of incipient pregnancy are very generally known, and 
will be sometimes concealed. Cupping, electricity, and aloetic purgatives 52 
AMENOKRHCEA, 
in commencing pregnancy, are means not calculated to increase a physi- 
cian’s reputation. Part xii., p. 295. 
Tincture of Water-Pepper in Amenorrlicea.—Dr. Eberle states that he 
has found no remedy so effectual in the cure of amenorrhoea as the tincture 
of water-pepper. Dr. T. L. Ogier says, that he knows no medicine that 
has a more decided action on the uterus in producing the menstrual dis- 
charge. The preparation used by Dr. O. was a strong tincture made from 
the stem, leaves, and flowers; but he thinks that the active principle of 
the plant resides chiefly in the leaves. The dose was a teaspoonful of the 
tincture three times a day in a little sweetened water. Part xiv., p. 316. 
Amenorrhoea.—On the day of the menstrual period give three pills 
thrice a day, each containing two-thirds of a gr. of aloes, ergot of rye, and 
rue; apply four or five leeches to the vulva, and afterward a vapor 
bath. Repeat these for four days at every menstrual period, increasing 
the number of pills. If the menstrual period is not known, begin upon 
any convenient day, and repeat the treatment in a month. 
Give extract of chenopodium olidum, gr. v.-x. night and morning for 
a fortnight before the period. Part xv., p. 323. 
Electricity in Amenorrhoea.—In electricity, says Dr. G. Bird, we 
possess the only really direct emmenagogue which the experience of our 
profession has furnished us with. I do not think I have ever known it fail 
to excite menstruation where the uterus was capable of performing this 
function. Disappointment will, however, most certainly result if we have 
recourse to electricity merely because a girl does not menstruate; and we 
must never lose sight of the fact that, after all, the large majority of 
cases of amenorrhoea depend upon an anaemic condition; and the patient 
does not menstruate, simply because she has no blood to spare. Nothing 
can be more ridiculous than applying electricity or any other local stimu- 
lant to the uterus when chlorosis exists ; the first great indication will be 
to restore general health, give iron to make up for the previous deficiency 
of that element in the blood, and then, and not before, use electricity. 
Transmit a dozen shocks through the uterus, from a jar holding about a 
pint, one conductor being placed over the lumbo-sacral region, and the 
other on the pubes ; or use the alternating current from the electro-mag- 
netic machine, as the electricity seems here to act simply as a local stimu- 
lant quite independently of exciting any uterine contraction. 
Part xvi., p. 286. 
Suppressio Mensium—Stramonium as an Emmenagogue.—Give a 
purgative, and then administer tincture of the seeds of stramonium 
(stramon. sem. §iv.; alcohol, dilut. Oj.) in the dose of twenty drops thrice 
a day, adding a drop to the dose each day, and continuing it till it 
produces either dizziness and vertigo, or the catamenia. 
Part xviii., p. 300. 
Japanese Pemedy for.— Vide Art. “ Sterility.” 
Case of Successful Administration of Key- Tse-Sing, or Japanese 
Emmenagogue.—The patient was a stout girl, twenty years old. The 
catamenia appeared at the age of thirteen, but ceased about the age of 
sixteen, previously to which she had epileptic fits for three months. For 
three or four years previous to the administration of the remedy, she had AMEN ORRHCEA* 
53 
regular attacks of haemoptysis or epistaxis every three or four weeks, 
though no sign of tubercle could be detected in the chest. Every means 
was tried to restore the discharge, but, says Dr. White, under whose care 
the case occurred: 
All having failed, after six months’ time I resolved to make an experi- 
ment with the key-tse-sing. On November 6th, she commenced taking 
three drachms of this medicine every six hours, in a little hot gin and 
water, and continued to do so for three days, wrhen, not having expe- 
rienced any effect from it, except some pain in the back, she omitted it for 
two days. I urged her to persevere with the medicine a little longer, and 
she recommenced taking it every four hours. On the second day 
(November 13th) the catamenia appeared, and flowed normally for three 
days. 
She felt no inconvenience from the medicine, except some slight pain in 
the back. 
This remedy will prove one of the most certain and valuable additions 
to our materia medica; and the only fear I have in its introduction is, 
that it may be abused, and become the too ready instrument of procuring 
abortion. Part xxiii., p. 303. 
Amenorrhoea.—In a stubborn case where the catamenia had never ap- 
peared, with constant severe uterine and lumbar pains, the key-tse-sing 
was given, and after thirteen doses the discharge was ample, first of a 
brown sandy color, afterward a free, florid, healthy discharge. 
In anemia, depending on amenorrhoea, the general characters of the 
blood are very similar to those met with in cases of anemia arising from 
other causes. Loss of blood from any cause appears to lead to the same 
morbid condition of that fluid as the defective secretion or elimination of 
certain principles which ought to be separated from it. This latter con- 
dition is always fulfilled in amenorrhoea, which disease is by far the most 
frequent cause of anemia in girls of the age of twenty ; and it appears the 
more remarkable, when the great similarity of composition of ordinary 
blood and of the menstrual secretion is taken into consideration. So that 
the same alteration in the constituents of the blood may be brought about 
by loss of blood, as in menorrhagia, or by the opposite condition of amen- 
orrhcea, or suppressed menstruation. In these cases the amount of water 
is usually much increased, and the quantity of solid matter proportionately 
diminished 
Chlorotic Amenorrhoea.—Employ the galvanic cataplasms of Professor 
Recamier. They are described as follows : “ Each of these cataplasms, or 
disks, if a scientific term be preferred, is a galvanic pile composed of 
twelve couples. The couple is formed by a ribbon of zinc and copper, 
and each couple is separated by a piece of flannel. On the colored side 
is cotton wool; on the other, a piece of gutta percha tissue to insulate 
the apparatus. The only difference between the two disks is, that, in 
the pink one, the copper stands first, Avhile the zinc comes first in the one 
covered with blue. The electrical force generated in the apparatus is 
sent through the copper rings, to which the insulated copper wire can 
be attached when the more energetic effect of the two cataplasms is 
required. In some people the acid perspiration of the skin is sufficient 
to increase the intensity of the electric action; but more active effects 54 
AMMONIA 
are produced by wetting the flannels with diluted vinegar, or a weak 
solution of common salt, as is seen by the action of the apparatus on 
the electrometer. When one of these cataplasms is tightly bound to 
the surface of the skin, it gives an unusual sensation of warmth—a 
pricking sensation is felt, and the skin is made red; and, when two of the 
cataplasms are connected by the arm, and applied to the same surface, but 
at some distance from one another, a stronger effect is produced when 
one is applied to the organ we wish to influence, and another to the oppo- 
site portion of the spine. Such are the modes of application ; and it may 
be worn day and night without inconvenience, though, in ordinary cases, 
it is only under application at night.” Part xxiv., p. 347. 
Headache in Amenorrhcea.— Vide Use of Nickel, Art. “ Headache.” 
Part xxvi., p. 338. 
Amenorrlioea.—Dr. Mikschik says he has derived great advantage from 
the tincture of iodine, as an emmenagogue, applied daily to the os uteri. 
Part xxxiii., p. 296. 
AMMONIA. 
Muriate of Ammonia—Use of Internally.— Vide Art. “ Congestions.” 
Medical Uses of Urate of Ammonia.—Dr. Bauer is convinced that this 
is a most valuable medicine in chronic cutaneous diseases, and in tubercu- 
lar diseases of the lung. An ointment containing one scruple to the ounce, 
is applied by a pencil to the eruption night and morning, the cure being 
effected in from one to three weeks. In tubercular disease the ointment 
is rubbed in alternately night and morning on the back and front of the 
chest. No inflammatory complication should be present during its em- 
ployment. 
In reference to this substance it is interesting to observe, that in Colum- 
bia, South America, where lepra prevails so extensively, the benefit de- 
rived from the external and internal use of guano has been placed beyond 
all doubt: and Dr. Lallemand has found it of great utility in the treatment 
of morphasa in the Brazils. The urate of ammonia, which is found in this 
substance in great abundance, is probably the chief medicinal agent. 
Part xxvi., p. 293. 
Medicinal Effects of Ammonia and its Preparations.—Ammonia had 
never been considered to be a normal constituent of the blood, as its 
presence had not been detected except after death in cases of typhus, 
cholera, melasna, and other diseases of a putrid character, until Dr. Rich- 
ardson’s recent discovery that healthy blood owes its fluidity to the pre- 
sence of ammonia, which is given ofl" during its coagulation, which process 
may be arrested, and the fibrin redissolved, by the restoration of the 
alkali. An interesting inquiry here suggests itself: how does the ammonia 
escape from the body during the coagulation of the blood, and how is it 
retained in those instances in which the blood remains fluid after death ? 
Assuming the truth of Dr. Richardson’s views, the author examined and AMMONIA. 
55 
compared the therapeutic effects of the various preparations of ammonia; 
and he has found that, whether applied externally or taken inwardly, they 
possess in common the property of dissolving the protein elements of the 
blood, whether in the vessels or effused into the tissues, and thus confirm 
the experiments of Dr. Richardson. This similarity in the effect of 
ammoniacal medicines is owing to their ready decomposition, the ammonia 
being separated, and forming the chief curative agent, though it is aided 
by the other substances originally combined with it. Thus its stimulant and 
solvent action is similar in kind, if not in degree, when used either exter- 
nally or inwardly in the form of gas, liquor ammonia, or combined with 
carbonic acid, etc. From the utility of these preparations in the treat- 
ment of venomous bites and stings, inflammatory swellings, diphtheritis, 
croup, etc., we may suppose that they will be equally efficacious in urti- 
caria, erithema nodosum, and erysipelas, in which there is an effusion of 
fibrinous elements of the blood. In these and other inflammatory diseases 
and conditions, it is probable that the ammonia is carried out of the system 
in the form of urea or lithate of ammonia contemporaneously with the 
increase of fibrin in the blood; and that the benefit of the salts of ammo- 
nia, in such cases, is owing to their preventing or removing the effusion of 
fibrin from the inflamed parts. In this way, although the primary action 
of ammonia is stimulant, its remote effects are sedative or debilitant, as it 
not only arrests inflammatory action, but by its resolvent and secernent 
power, carries the products of inflammation out of the system, and hence 
its utility in all active febrile complaints. It is to this attenuating pro- 
perty that its use as an antidote to drunkenness and to the stupor of opium 
is to be ascribed. Its stimulant powers are of use in poisoning by hydro- 
cyanic acid, in the cold stage of ague, and in the retrocession of gout, 
rheumatism, and the exanthemata, as well as in syncope, hysteria, epi- 
lepsy, and convulsions. The hydrochlorate, which is the least easily 
decomposed, is probably the most useful of the salts of ammonia, as it 
not only possesses the stimulant, resolvent, secernent properties of the 
others, but owing to its combination with chlorine, is endued with tonic 
powers, by which its prolonged use, unlike that of the other preparations, 
is attended with invigorating effects, both to mind and body; and thus it 
forms an excellent substitute for mercury in cases where this medicine is 
inadmissible from its tendency to produce cachexia. Part xxxv., p. 289. 
Ammonia.—Dr. Richardson’s discovery, that healthy blood owes its 
fluidity to the presence of ammonia, which is given off during coagulation, 
and which process may be arrested and fibrin redissolved by the restora- 
tion of the alkali, suggests the utility of ammonia in all diseases accom- 
panied by or depending on effusion of fibrin, as croup, diphtheritis, ery- 
sipelas. Thus ammonia has two actions—primary stimulant, secondary 
debilitant. Its stimulant powers in hysteria, ague, syncope, and poisoning 
by hydrocyanic acid, are too well known to need mentioning. Of all the 
salts of ammonia, the hydrochlorate is the most useful when its antifibrin- 
ous property is required. Part xxxvi., p. 273. 56 
AMPUTATION. 
After amputation of the limbs, affections of the chest often supervene. 
When apprehended, recourse to blistering over the chest advised. 
Part iii., p. 116. 
Amputations—Primary and Secondary.—In primary amputations, 
as in cases of accident to healthy persons, try to obtain union by the first 
intention. 
In secondary amputations, and in those performed for diseases of the 
limbs, and when the incisions are made through diseased tissues, there is a 
disadvantage in bringing them together. They will almost invariably open 
again, and place themselves in the position in which they should have been 
left from the first. This is especially liable, when limbs are amputated for 
diseases which have been attended with considerable discharge. In all 
these, it is dangerous to stop the discharge suddenly. 
Mr. Alcock advises passing a skein of silk through the lower part of the 
wound, to maintain for a time constant irritation and discharge of matter. 
Part iv.,p. 91. 
Amputation and 3IocIe of dressing the Stump.—Preference given to the 
flap amputation. The instrument used for the operation is a straight- 
backed knife, with an edge gently curving toward the point, and of a 
length varying with the size of the limb to be removed. 
With only one exception (in which the ordinary tourniquet was 
applied), the artery of the limb was commanded by the fingers of an 
assistant, compression being made with moderate firmness over the axillary 
or brachial arteries in amputations on the upper extremity; and over 
the upper part of the femoral artery in operations on the lower limb. 
It is found that very little blood is lost when this plan is adopted, and 
where a tourniquet is used, the retraction of the flaps is interfered with 
to a great extent. 
Mode of dressing the Stump.—When ligatures have been tied around 
the principal arteries of the stump, the hemorrhage from the smaller 
vessels is arrested by covering the recently-divided surfaces with lint, 
soaked in cold water. 
This is removed and re-applied every few minutes at first, and then at 
longer intervals, until all bleeding has ceased; and in order to insure the 
actual application of the cold water to the bleeding surface, the coagula 
are from time to time gently removed. 
When all oozing of blood has ceased, and when the divided surfaces 
become glazed over (which happens generally in from four to seven hours 
after the operation), the wet lint and small remaining coagula are removed, 
and the dressing of the stump proceeded with. The flaps, which are in 
the most favorable state for union, are now brought accurately together, 
and retained by several points of interrupted suture. The number of 
sutures requisite for this purpose varies from two to four; but more than 
three are seldom used, even in amputation of the thigh. They are 
removed frequently in twelve or twenty-four hours; but if the flaps are 
large and heavy, and the threads cause no redness in the neighboring 
skin, they may be left for several hours longer, to prevent any dragging 
on the recent adhesions. When the flaps are thus in apposition, the edges 
are more closely brought together by means of strips of plaster applied 
AMPUTATION. AMPUTATION. 
57 
u/ver the face of the stump, at a little distance from each other, so as to 
allow of the ready escape of discharge, and the abstraction of the sutures 
when necessary. 
A plaster formed of oiled silk, spread with a solution of isinglass, is pre- 
ferred to resinous plaster. 
No bandage is applied at first, but the stump is left uncovered and cool. 
When suppuration is fairly established in those parts of the stump which 
have not united by the first intention, the plaster is usually removed, either 
entirely or in part, and the end of the stump dressed with lint dipped in 
tepid water, or in a gently-stimulating lotion, and covered with oiled silk. 
The bandage also is then brought over the end of the stump in such a man- 
ner as to support the flaps together, as the plaster hitherto has done. 
Part v., p. 119. 
Hemostasis.—To prevent hemorrhage in certain cases of amputation, 
the employment of hemostasis is recommended. 
This consists in the application of ligatures to the extremities, sufficiently 
tight to arrest the venous circulation, while they allow the arteries to pul- 
sate. A large proportion of the blood may thus be temporarily withheld 
from the general circulation. Vide “Hemorrhage.” Part vii.,p. 67. 
Amputation at the Ankle Joint.—Case cited from disease of the astra- 
galus, os calcis, and other tarsal bones. It has been too frequently the 
custom for surgeons to amputate the leg below the knee in cases where 
neither Mr. Iley’s amputation between the tarsus and metatarsus, nor that 
of Chopart’s, which leaves only the astragalus and os calcis, could be of 
use. So long as the disease exists in the foot below the astragalus and os 
calcis, Chopart’s operation would be invaluable, and when it exists still 
lower down, that of Mr. Hey’s must be equally, if not more so, but even 
where the astragalus or os calcis, and even where the ankle joint is impli- 
cated, amputation of that joint, and taking off the diseased extremities of 
the tibia, is now practised with success ; thus enabling the patient to walk 
with very little artificial assistance, and to a very considerable extent 
diminishing the danger of amputation below the knee. When we consider 
that the diseases which have hitherto required amputation of the leg below 
the knee seldom affect the leg itself, because when they do so, amputation 
above the knee is generally required, we shall see at once that an opera- 
tion by which the leg is saved, is not only practicable, but of the greatest 
consequence: and this observation extends also to diseases of the foot for 
which amputation at the ankle joint will often be found exceedingly useful. 
In cases, therefore, of compound dislocation of the astragalus and caries 
of this bone, with its adjoining articulating surfaces, amputation at the 
ankle joint ought generally to supersede the old practice of amputation 
below the knee : and even when the whole ankle joint is diseased, and the 
articulating extremities of the tibia and fibula are implicated, these dis- 
eased portions may be safely removed by the saw, as the caries seldom 
penetrates to any great depth into the cancellated texture, and milch more 
frequently exists almost exclusively between the astragalus and os calcis, 
and not between the astragalus and bones of the leg. Three very impor- 
tant advantages, therefore, result from this operation : 1st. A more com- 
fortable stump is formed. 2d. The risk of life is much less. 3d. The limb 
will be much more useful and seemly. Part vii., p. 126. 
Hemorrhage after Amputation.—Two cases mentioned, of venous 58 
AMPUTATION. 
hemorrhage occurring immediately after the arteries had been tied, from 
obstruction to the venous circulation by the retraction of the fascia or 
integument, a free incision through which caused an instant cessation of 
the loss of blood. Part ix., p. 178. 
Disarticulation at the Ankle.—This operation, which has been so strongly 
recommended by Mr. Syme, is certainly a great improvement in surgery, 
and will be available when neither of those recommended by Hey and 
Chopart can be useful. It will, in fact, leave the patient a very useful leg. 
How many cases do we now see in the country, in whom amputation 
below the knee has been performed for disease and accidents below or at 
the ankle joint, when amputation of this joint, and the preservation of the 
hard skin on the heel might have secured to the patients the use of limbs 
almost as useful as the perfect ones. We have to thank Mr. Syme for bring- 
ing this subject repeatedly and prominently before the profession ; and 
more especially for making such a flap of the under part of the foot and 
heel, as to enable the ends of the bones to bear the necessary degree of 
pressure. In his earlier operations, Mr. Syme seems to have made the flap 
too long, and now gives directions to perform the operation somewhat 
different. “ The incisions across the instep and sole of the foot should be curv- 
ed, with the convexity forward, and exactly opposite each other. A line drawn 
round the foot, midway between the head of the fifth metatarsal bone, and 
the malleolar externus, will show their extent anteriorly, and they should 
meet a little further back, opposite the malleolar projections of the tibia 
and fibula. If the ankle joint is sound, the malleolar processes should be 
removed by cutting pliers; but if the articulating surfaces of the tibia and 
fibula be diseased, a thin slice of these bones should be sawn off,” The 
stump is conical, and has for its apex the thick skin of the heel. When we 
consider how rarely amputation beloAV the knee is performed for disease of 
the leg, and how much oftener for diseases of the foot and ankle joint, we 
may expect to see this operation come into much more general use. 
In compound dislocation of the ankle joint, for example, will it not be 
safer to have recourse to disarticulation, than to attempt to preserve the 
whole limb ? Many lives have been lost in attempting to retain the foot 
in these cases; only two out of thirteen cases in the Royal Infirmary of 
Edinburgh recovered ; and even when the foot is saved it is so still* and 
weak as to be rather an incumbrance. There is some reason in running 
considerable risk, when the only alternative "would be amputation below 
the knee, but none when we remember that amputation at the ankle would 
not only considerably diminish the risk to the patient, but would secure as 
good a limb as in the other case. 
Mr. Lyon, of Glasgow, points out the risk of sloughing to the under or 
posterior flap when it is made too long, as in some of Mr. Syme’s earlier 
cases, and hence the necessity of adjusting its edges very carefully to those 
of the anterior flap, in order that it may receive blood from this as early 
as possible ; and hence also the necessity of keeping up the temperature of 
the parr by carded cotton, warm water dressing, or the like. It seems 
that in many cases the head of the femur itself may be excised, instead of 
having recourse to amputation at the hip-joint. Dr. Bonino draws the at- 
tention of the profession to this subject. Part x.,p. 107. 
Amputation at the Knee.—There are few operations in surgery which 
have excited much more discussion, or afforded room for the exercise of 
more ingenuity, than amputation of the thigh. And although the various AMPUTATION. 
59 
modifications which have been introduced have certainly had the effect of 
restraining the hemorrhage, diminishing the suffering, and promoting union 
of the wound, the average frequency of deaths is still not less than from 50 
to 70 per cent., whilst protrusion of the bone is a frequent sequela. Mr. 
Syme says that: 
Having seen the circular incision give place to the flap operation, and 
having witnessed the results of these methods variously modified in the 
hands of many surgeons possessing every degree of operative skill, I am 
at length led to the conclusion, that there is something radically wrong in 
the principle of the operation. This error I believe to be, dividing the 
thigh-bone through its shaft instead of the condyles or trochanters. 
The most frequent occasion for amputation of the thigh is afforded by 
disease of the knee-joint. Next to this may be ranked compound fractures 
of the leg and thigh ; and then tumors growing from the bones of the leg 
and thigh. Now, in regard to diseases of the knee-joint, it is well ascer- 
tained, that the warrant for amputation lies in the bone, and not in the 
soft parts, which, however much altered through scrofulous degeneration 
or suppuration, readily admit of restoration to their natural condition, as 
is clearly shown by what happens after excision of the elbow, or amputa- 
tion at the ankle joint. In so far, therefore, as removal of the disease is 
concerned, it is plain that amputation through the condyles of the thigh 
bone would in this case prove sufficient. As to compound fractures of the 
leg, it will be admitted that if the integuments and muscles admit of the 
limb being removed at the middle, or loiver third of the thigh, they cannot 
present any obstacle to a few inches more of the bone being preserved, 
while similar injuries of the thigh obviously require amputation at the 
trochanters. The same observation will apply to tumors of the bones, 
those of the tibia and fibula not requiring any more of the thigh-bone to 
be removed than may be suggested by convenience, and those of the thigh- 
bone itself demanding the highest practicable point of section. From this 
analysis it appears that taking merely the morbid condition into account, 
all the cases admitting of amputation at or below the middle of the thigh- 
bone, would admit of the operation being performed through the condyles. 
The superiority of this operation to the one formerly practised, consists 
in the less amount of liability to exfoliation of spongy in comparison with 
dense bone ; the medullary membrane, not being interfered with, is not 
likely to inflame and suppurate, and phlebitis is not likely to occur, and 
thus the chances of a favorable issue of the operation are very much in- 
creased. Proti*usion of the bone, we may expect, will hereby be avoided, 
and thus the neatness of the stump will not be interfered with. 
The first case was a young man, 21 years of age, admitted January 
29th, 1844. The left knee had occasionally been painful for five years, and 
for the last twelve months had increased rapidly in size. A large abscess, 
pointing on each side of the ligamentum patellae, was opened, but the local 
uneasiness continued to increase, and the general health declined. The 
operation was thus performed : 
Having applied a tourniquet, so as to compress the femoral artery where 
it enters the popliteal space, I made an incision across the knee on a line 
with the upper edge of the patella—then pushed the knife from one side to 
the other under the joint—cut a flap from the calf of the leg—and finally 
sawed through the condyles of the thigh-bone, so as to remove the whole 
articulating surface which was ulcerated and carious. On bringing tho 60 
AMPUTATION. 
edges of the wound together, I found the flaps were scarcely sufficiently 
long, as they required a little stretching to meet, and when stitched 
appeared more tense than is usually consistent with adhesive union. It 
was, therefore, with considerable surprise, and no less pleasure, that we 
saw the healing process proceed without retraction of the covering from 
the bone. The edges of the skin indeed separated from each other to the 
extent of nearly two inches, but the subjacent textures remained adhe- 
rent, until the superficial sore gradually contracted and cicatrized. The 
recovery, though thus rendered slow, was ultimately completed, and the 
patient returned to his distant home on the 31st of May. 
The result of this case tends to confirm the expectations that had been 
previously formed with regard to the advantage of amputating through 
the cancellated extremity instead of the shaft of the thigh-bone, since 
there could be no doubt that exfoliation of the suiflace to any extent, how- 
ever small, would have been attended with separation of the flaps and 
projection of the bone. 
The second case was a young woman, 22 years of age, with disease also 
of the left knee, of nearly three year’s standing. Frequent apjflication 
of the moxa and other means having failed of affording relief, and the 
general health rapidly declining, amputation was resolved on. 
Profiting by former experience, I on this occasion made the anterior 
semilunar incision on a line with the lower edge of the patellae, and had 
the integuments retracted, before cutting into the joint above this bone. 
In other respects the operation was conducted as the first one had been, 
and when the edges of the wounds were approximated, they came easily 
together, presenting a proper degree of fullness, without any straining or 
tension. The union was nearly completed by the first intention without 
any local or constitutional disturbance; the flaps, instead of showing any 
tendency to retraction, rather becoming more full and soft; and the 
patient presenting the aspect of one who had sustained some trivial injury, 
rather than undergone a capital operation. On the 14th day she was sit- 
ting by the fire, and took the dressings off without any assistance. This 
case should, I think, remove any doubt that may have existed, as to the 
safety of amputating at the knee, and consequently as to the expediency of 
doing so with a view to avert the danger of operating through the shaft of 
the thigh bone. It is upon this ground that I wish to found the operation, 
and I therefore have said nothing of some other advantages which might 
be mentioned—such as the greater length of stump which, especially in 
females, must be desirable for the sake of appearance, and may, perhaps, 
be made available for using a support admitting of flexion at the knee—or 
the facility afforded to employ the tourniquet, which causes serious embar- 
rassment in removing the limb at any higher point. I may remark, that 
the posterior flap must be made very long, and indeed to the full extent 
of the fleshy part of the gastrocnemii muscles—care being taken, however, 
to avoid preserving more than a moderate portion in regard to thickness. 
Fart xi.,p. 111. 
Amputation of the Elbow and Shoulder Joints.—In many of the dis- 
eases of the elbow and shoulder joints, amputation is not required. The 
diseased bones may easily be taken out, and a considerable degree of 
motion may be retained. Park and Moreau first adopted this valuable 
mode of operating, and it is now become pretty general. AMPUTATION. 
61 
Mr. Liston says : It is a troublesome thing to separate the articulation 
in a sound state and get the bones out; but when the joint is in a diseased 
condition, the parts may be easily separated from each other. You are 
not entitled to operate unless the joint is disorganized, and you are then 
able easily to thrust out the bones of the humerus and forearm, and cut 
them off. The principal point to be attended to is, to avoid including in 
your incision the ulnar nerve. You so make the flap that you guard 
against interfering with it, and at the same time expose the joint through- 
out. All sort of flaps have been madg, but the most simple plan is -to 
make an incision along the nerve toward its radial side. In this way you 
turn the nerve over the condyle, and then make a cross-cut right into the 
joint. In this operation you cut at once through muscles and everything 
else, fairly down to the diseased joint. Having exposed the joint thor- 
oughly, you have no difficulty in opening it. There is no looking for the 
lateral ligaments ; you cut them across ; and in the living body there is, 
as I have said, no trouble whatever in getting out the end of the humerus, 
applying the saw, and cutting off its extremity. You then denude the 
other bones, always taking care to cut toward them, thus saving the mus- 
cles and their tendons, the vessels and nerves; you will forthwith saw off 
the ends of these bones. In operating on a young subject, you can cut 
these bones with pliers, and in very young subjects there is no occasion 
whatever for the saw under any circumstances. 
After the removal of these bones you bring the wound together, having 
put the bones of the forearm at right angles with the humerus, and in a 
state betwixt supination and pronation. After the wound is in a great 
measure healed, you may employ passive motion; and in young subjects 
the motion of the joint may, as I have said, be to some extent preserved. 
The shoulder-joint is sometimes affected with a similar disease. The 
apparatus of the joint is destroyed, the upper part of the humerus is, per- 
haps, in a great measure, denuded by an abscess, and sometimes there is a 
corresponding disease in the glenoid cavity. Your object must be to get 
the patient out of the hectic condition into which he has fallen, and this 
you cannot effect without removing the diseased bones. 
Here you will make the incision at the back part of the joint, and carry 
it fairly down to the articulation, pretty nearly along the posterior border 
of the deltoid. Having thus cut down at once upon the diseased head of 
the bone, there is nothing to prevent you from displacing it and taking it 
out of the socket. The capsule is all destroyed, the head of the bone is 
probably a good deal diminished in size, and by cutting open the joint you 
at once dislocate it. You carry the limb across the chest, and by pushing 
it up a little you get to the neck of the bone, and by applying your saw 
you may take away all the diseased articulating surface. You have thus 
made a large cavity, and if on examining the surface of the scapula you 
find that also diseased, you can easily, by detaching the soft part, and 
applying cross-cutting pliers, cut that off. By this means you get rid of 
the disease, the cause of the discharge and hectic. It is of great conse- 
quence to take away all the diseased bone, and the probability is, that if 
you succeed in doing so, the discharge will cease, and the sinuses heal up 
permanently. And you may be told, or you may have read in books, that 
you ought to be guided, in making your incisions, by the sight of the 
openings—that you ought to lay the various papillae and sinuses into one 
wound. This, however, is a cruel and unnecessary course; the fact is, 62 
AMPUTATION 
that upon removing the cause of the discharge, the openings will all heal 
up without your troubling yourselves about them. The same remark 
applies to operations in other parts of the body, to amputations of portions 
of the hand, foot, etc. The patient, after losing the head of bis humerus, 
though he may not be able to use his arm above his head, will still have 
all the motions of his hand and forearm. Part xi., p. 114. 
Amputation at the Ilip-joint.—Mr. Struthers reports a case of success- 
ful amputation of the liip-joint, for osteo-medullary sarcoma of the os 
femoris, which occurred in the practice of Dr. Ilandyside. 
The mode in which Dr. H. operates is by the formation of antero-pos- 
terior flaps, as improved by Mr. Liston. 
It is commonly believed, that this operation is in itself much more 
severe and dangerous than that of amputation through the trochanters, or 
at the upper fifth of the thigh; but the difference between them is not so 
great as might at first sight appear. The flaps formed, the vessels 
divided, and surface exposed, are nearly the same in both ; whereas in the 
former, the operation is much more easily and more rapidly executed, and 
the removal of a few inches more of the bone is attended with less shock 
and danger to the patient, than is the division of the bone by the saw, in 
its tronchanteric region. Lastly, any greater fatality which may have 
followed the former, is due to the fact that the cases in which it has been 
performed, have been much more complicated and dangerous, as well as 
more hopeless, than those in which the latter operation has been practised. 
The superiority, also, of the operation of disarticulation, in a case of disease 
of the bone, where there is suspicion of the upper end being affected, is 
sufficiently evident. 
In regard to the easiest, safest, and best method of performing an ope- 
ration of such magnitude and importance as amputation of the hip-joint, 
surgeons are not yet entirely agreed. Very many different methods have 
been proposed and practised, but these may be referred to three principal 
methods, with their modifications; excluding that by the circular incision, 
which was recommended and even practised by Mr. Abernethy. It is also 
almost unnecessary to notice the old preliminary practice of securing by 
ligature the common femoral artery, as practised by Baron Larrey, this 
being now superseded by compression, effected by the fingers of an 
assistant. First, There'is the method of making directly lateral flaps by 
transfixion and cutting from within outward; the disarticulation being 
effected between the formation of the flaps, as practised by Larrey—the 
internal flap being first formed. This method has been varied by different 
surgeons. Thus, Langenbeck reverses the order of forming the flaps, by 
beginning with the external; and Dupuytren begins with the formation 
of the internal flap by cutting from without inward. Secondly, The 
method by the formation of postero-external and antero-internal flaps, 
effected also by transfixion, and then cutting from within outward, begin- 
ning with the external flap, but leaving the disarticulation till the end. 
This method is practised and recommended by Lisfranc, and has been 
followed by Mr. Syme. It has also been varied by cutting from without 
inward. Thirdly, The formation of antero-posterior flaps, the disarticula- 
tion being effected after the formation of the anterior flap. The anterior 
flap is derived partly from the inner side of the thigh, and the posterior 
one partly from its outer side. AMPUTATION. 
63 
The last described method was practised by various surgeons, so far 
back as the year 1806, but in such a manner as not to have been generally 
adopted by subsequent operators, the anterior flap having been made of 
great length, and the posterior one cut very short. An improvement on 
this method, adopted by Mr. Liston, is that which was practised in the 
present instance. As to which of these methods the preference should be 
accorded, the surgeon must be guided principally by the nature of the 
case. However, when circumstances will allow of it, the antero-posterior 
flap method will be found, I believe, to be the preferable one. The 
vessels divided are the same, and they are more easily secured than when 
the surfaces exposed are lateral—the flaps are of more equal dimensions, 
and lie afterward more accurately in apposition—the articulation is more 
rapidly reached, and is exposed at a more favorable part for being opened 
—the head of the bone is more easily dislocated, and the division of the 
ligaments more easily effected ; the removal, too, of the limb is completed 
with one instrument only, and, Anally, by this method the whole operation 
can be much more easily and rapidly completed, than by practising any of 
the other methods. Part xi., p. 115. 
Amputation at the Knee.—J. R. set. twenty-four, had for seven years 
had disease of the left knee-joint. About a year before admission into 
hospital, an abcess formed, which burst, and has since continued to dis- 
charge matter. He was kept four or five months in hopes of a change for 
the better, but instead of that he grew worse, so it was resolved to 
amputate, in accordance with the man’s own wishes. This was done as 
follows: 
The operator, standing on the outside of the limb, placed the heel of a 
common flap amputating-knife upon the skin on the inner side of the joint, 
immediately over the condyle, and made a semi-lunar sweep across the 
front, extending below the apex of the patella until the point of the blade 
was opposite the external hamstring, when it was thrust straight across 
the limb, through the popliteal space, and made to appear at the part 
where the incision in front was commenced; the blade was then carried 
downward so as to form a flap, from the muscles on the calf of the leg ; 
the skin in front was now drawn above the level of the upper margin of 
the patella; the quadriceps extensor was next divided; a circular sweep 
was then made round the bone, immediately above the condyles, and the 
saw Avas-used to complete the separation of the limb. A tourniquet had 
been applied previous to the operation, and little blood was lost during 
the incision ; a good deal was lost, however, before all the bleeding 
vessels could be secured, and this seemed principally on account of the 
difficulty of applying a ligature to the popliteal artery, which, owing to 
the thickened and hardened condition of the tissues around it, could not 
be seized and drawn out with the forceps in the ordinary manner. At 
last, after the application of sevex-al ligatures, the bleeding here seemed 
arrested, and the other smaller vessels were next secured; the large pos- 
terior flap was then brought forward, and a few stitches were employed 
to hold the surface and margin together. The wound was lightly covered 
with lint wetted with cold water, and the house surgeon was desired to 
bring the edges more accurately together in the course of six or eight 
hours, when it might be concluded that there xvould be no more bleeding. 
Nothing very unusual occurred; the ligatures were discharged at the usual 
time; the flaps, which were at first thick, hard, and nearly inflexible, from 64 
AMPUTATION. 
their proximity to tlie disease, speedily assumed a more healthy condition, 
and appeared as if they had been cut originally from parts perfectly sound. 
Union by the first intention took place throughout the greater part of the 
wound, the open sores were left gradually to close, and although there are 
still several small points of open surface, and the cicatrix is slightly cedema- 
tous, the patient moves about, is greatly improved in appearance and 
health, and has no complaint whatever connected with his former ailments. 
In his clinical remarks on this case, Mr. Fergusson stated that he had 
been induced to select the site of this operation chiefly by the published 
recommendation of Mr. Syme, of Edinburgh, in its favor. 
Mr. Syme favored this operation chiefly on the supposition that in con- 
sequence of the femur being cut across so close to the epiphysis, there 
would be less risk of inflammation of the medullary canal, and consequent 
necrosis of the bone ; and it was well known that this result (necrosis) 
was more likely to follow an injury of the hard portion of the shaft than 
of its spongy extremity, there was on this account great inducement to 
apply the saw thus low down. But there were other good reasons for 
choosing such an operation, and not the least of these was, that amputation 
for certain injuries and diseases in the leg, necessitating the section above 
the knee, might nevertheless be done so low down—so far from the trunk, 
comparatively, as to lessen the risk on that account as well; for it was a 
maxim, that the danger of amputations increased as they approached the 
trunk. Hitherto, when an operation of this kind had been done above the 
knee, the knife had been so applied as to reserve all the soft parts to form 
the stump from the thigh alone; but here it would be remarked, that the 
flap for a stump of the thigh had been taken from the leg, where in such 
an instance as that which was at present under notice, there was ample 
material for making a flap of any extent that might have seemed desirable. 
The swelling of a joint, wherein the articular surfaces and ends were in a 
state of ulceration and caries, had been proved to depend entirely on these 
diseased conditions, as had been evinced by excisions of such parts, and 
it was a doctrine of modern surgery, that in removing caries, there was 
no necessity for reaching beyond the actual seat of the disease. There 
were many examples of incurable affection of the knee-joint whioh might 
possibly be best treated by such a mode as had been followed in this 
instance. 
One objection to the operation was apparent at the time it was done, 
and that was, of securing the popliteal artery. The vessel 
Avas so surrounded by effused lymph, and condensed cellular tissue, that 
he had to slit up the tissues ere lie could seize the vessel with the forceps, 
and even then it was with no inconsiderable ti’ouble that he could get a 
ligature placed so as to stop the flow of blood. Part xii., p. 144. 
Mode of Amputating the Superior Maxillary Pone.—The following 
plan of operation is recommended by Mr. O’Shaughnessy, in performing 
amputation of the upper jaw : 
The patient is to be placed in a strong arm-chair, with his head resting 
against the breast of an assistant, or on a crutch attached to the back of 
a chair. A second assistant stands at the patient’s side, preparing to make 
pressure on the carotid artery, should it be necessary to do so in the course 
of the operation. The operator then takes his place in front of the patient, 
and should the extent of the disease require the removal of the whole of the 
malar and maxillary bones, he makes an incision commencing at the zygo- AMPUTATION. 
65 
matic arch, and terminating in the angle of the mouth. This incision should 
be first drawn over the zygoma as far as the malar eminence, then down- 
ward over the surface of the tumor, to within half an inch of the angle 
of the mouth and into the cavity of the mouth, through the centre of the 
commissure of the lips, the knife being guided by the fore and middle finger 
of one hand, placed for the purpose in the mouth. By dissecting this flap 
upward, the whole of the attachments of the tumor may be laid bare; by 
detaching the upper lip and ala of the nose, the nasal process and hard pa- 
late are exposed. The zygomatic process is to be freed from the temporal 
fascia superiorly, and from the masseter muscle inferiorly at the point to be 
divided by the nippers. The orbital process is next exposed by raising the 
conjunctiva of the eye with the inferior oblique muscle. All these incisions 
and dissections, except the last, should be made with rapidity, as there are 
no parts of any importance endangered before arriving at the orbit. The 
cheek is next dissected downward and backward for a little way, and then 
the hard attachments are severed with the bone nippers in the following 
order: The zygomatic arch is first to be cut through; the malar bone is 
next to be separated from its connection with the external angular process 
of the os frontis, by cutting backward into the spheno-maxillary fissure, 
taking care to guide the forceps with the fore-finger, so as to save the eye 
from injury. The nasal process must now be cut through by inserting one 
blade of the nippers into the nostril, and the other into the angle of the or- 
bit ; from this the floor of the orbit may be divided by cutting it across with 
a strong knife to the spheno-maxillary fissure. An incisor tooth or two, if 
necessary, is next to be extracted, and the palate process as far back as its 
junction with the palate bone, cut through with the nippers, keeping close to 
the tumor, in order not to remove more healthy bone in this situation than 
is absolutely necessary. The whole of the hard attachments being now 
divided, the tumor is found to be movable, and in general, slight pressure 
is found sutticient to displace it; when the knife is again resumed, and the 
external pterygoid muscle posteriorly, and the masseter muscle anteriorly, 
and the mucous membr ane at the back of the mouth and cheek cut through, 
and the tumor removed. No matter how large the tumor, and how great 
the consequent distention of the cheek may have been, I recommend most 
strongly that no portion of the skin of the face, if healthy, be cut away. It 
almost invariably contracts to very nearly, if not completely, its natural di- 
mensions, and if any of it have been removed with the tumor, no matter 
how small that portion may be, the want of skin enough is much more likely 
to be complained of when the cure is completed, than of there being too 
much if the whole has been left. 
Mr. Liston’s directions for forming the flap are, to make an incision over 
the external angular process of the frontal bone, to be carried downward 
through the cheek to the corner of the mouth. A second incision is made 
along and down the zygoma, falling into the other. Then the knife is 
pushed through the integuments to the nasal process of the maxilla, the car- 
tilage of the ala is detached from the bone, and the lip is cut through in the 
mesial line. With great deference to so high an authority on all points of 
operative surgery, and particularly with reference to this operation, I ven- 
ture to differ with Mr. Liston as to the necessity of making three incisions- 
through the integuments of the face, at least in the generality of cases, 
viz., one from the os frontis to the mouth, a second meeting this at right, 
angles over the malar bone, and a third along the side of the nose, and 66 
AMPUTATION. 
through the upper lip. I think the single incision described above, will be 
found to answer all the purposes proposed. By it the zygoma can be ex- 
posed with ease, a little dissection upward will lay bare the frontal and 
malar bones, and with the cheek, the ala of the nose and upper lip may 
be raised, and the alveolar and nasal processes exposed to the fullest 
extent. Of course cases occasionally present themselves, requiring addi- 
tional incisions, but I think wThen they can be avoided (and I believe in 
the majority of cases they are not necessary), it will be found of advantage 
not to make them. 
Mr. Lizars and Mr. Fergusson recommended that the saw should be 
applied to all the bony processes before attempting to cut through them 
with the nippers; but this I think quite unnecessary, as with the latter in- 
strument they may be divided with perfect ease and smoothness, and 
certainly with far greater dispatch, and less pain to the patient, than by 
using the saw, whose action can with great difficulty be confined to the 
hard parts, and in fact its use is only necessary in the case before pointed 
out, viz., to divide the malar process where the malar bone may be saved. 
In all the cases detailed the tumor was of a large size. In the first, a 
fibro-cartilaginous tumor of the upper jaw, the mass removed weighed 
four pounds ; and in the last, a case of osteo-sarcoma of the lower jaw, the 
tumor was as large as a child’s head, necessitating the amputation of all 
the lower jaw, excepting the left ramus. All the patients did well. 
Part xii., p. 146. 
Excision of the Upper End of the Femur in Morbus Coxarius.— 
A lad of fourteen had suffered fifteen months from hip-disease, and was 
in the last stage of hectic. The head of the femur was displaced on the 
dorsum ilii, and could be felt by the finger to have passed into a large 
sinus. The affected limb was four or five inches shorter than the other, 
and much bent at the knee and hip. There was no indication of pelvic 
disease. 
Mr. Fergusson made a longitudinal incision on the hip over the head and 
neck of the bone, and those parts, with a portion of the shaft, including 
the trochanters, were removed, the bone being cut across with a common 
saw. The patient bore the operation well; the previous bad symptoms 
soon disappeared, and in two months he was able to move about the wards 
of the hospital on crutches, the tvound being nearly closed. 
Part xii., p. 147. 
Pe-section of the First Metatarso-Phalangeal Articulation.—In 1836, 
Dr. Pancoast removed the entire metatarso-phalangeal joint of the first 
toe, preserving two-thirds of the first, and the whole of the second pha- 
lanx. The case was one of caries from a nail run through the joint; which 
was much swelled, and had two fistulous openings low down on the sides 
of the foot. 
“ I made a semicircular incision, which traversed these openings, and 
dissected the flap, the base of which was toward the heel, so as to turn it 
backward upon the foot. This exposed completely the inner surface of 
the joint, and about half the length of the metatarsal bone. The joint was 
next opened, the metatarsal bone isolated from the tendon and the sur- 
rounding parts, and divided across near its middle with the metacarpal 
saw. On the removal of the fragment, the end of the phalanx was found 
carious ; this was pushed out through the wound, and a portion a quarter AMPUTATION. 
67 
of an inch long removed with the saw. The interior structure of the ad- 
joining part of the phalanx, which was soft and spongy, was scooped out 
with the end of the scalpel. The ends of the divided bones were then put 
in contact, and the flap brought down and secured with adhesive straps 
and a retaining bandage. Some suppurative discharge continued for three 
weeks at the posterior angle of the wound; but it ultimately healed up 
well. Solid union took place between the divided bones, and the patient 
preserved his toe, which Avas found after the cure about three-quarters of 
an inch shorter than the other. The only difficulty encountered in the 
after-treatment, Avas the tendency of the extensor muscle to elevate the 
point of the toe. Should I again have occasion to excise this joint, I 
Avould prefer to divide this tendon, in case I approximated the bones, inas- 
much as the necessity for its use Avould be greatly diminished aftenvard, 
the middle phalangeal joint, in regard to position and office, supplying the 
place of the one excised; and there would be reason to expect that the 
reunion of the divided tendon Avould be sufficiently perfect to prevent (in 
conjunction with the dressing) the flexor muscle from drawing the point 
doAAmAvard.” Part xii., p. 148. 
Remarkable Change in the Pones of Stumps.—Mr. Adams mentioned 
to the Pathological Society of Dublin, some remarkable and interesting 
facts connected with the pathological anatomy of stumps. Mr. A. has 
found that when amputation of the foreai'm is performed Avhilst the patient 
is young, and the stump be used, a strong osseous union is formed betAveen 
the radius and ulna, Avith its convexity downward, by which they are 
firmly united together. In another case, Avhere the hand had been taken 
off at the wrist-joint, a similar formation Avas found. The same condition 
is figured in the Sandiforts’ Avork, as above mentioned, but theirs are of the 
tibia and fibula, near the knee-joint. Part xii., p. 149. 
Prevention of Venous Hemorrhage during Amputation.—The occur- 
rence of venous hemorrhage in amputations, is in some cases attended 
with the most serious results. Dr. Hannay considers the tourniquet as 
rather favoring than preventing venous hemorrhage, and he recommends 
the application of a skillful and experienced hand, where practicable. Dr. 
H. also adopts another mode of preventing this hemorrhage. 
It is the application of a roller or bandage, Arery equally and neatly, 
very firmly and perfectly, so as to compress, Avith all bearable firmness, 
the limb from its very extremity up as high as the points of amputation 
will admit. Part xiii., p. 205. 
Circular Amputations—Hint on Dissecting back the Skin.—The most 
painful and tedious part of circular amputations is the dissecting back the 
skin to form a sufficient covering to the stump. Dr. Hannay recommends 
that an assistant should dissect back the skin on one side, Avhile the opera- 
tor does that of the other, and thereby shorten materially that most pain- 
ful and unseemly part of the operation. 
Sutures after Amputation.—Whenever, says Dr. Hannay, stitches are 
put in the edges of flaps that are rather short, and so made to effect a 
stretching or dragging of the parts, they are inevitably mischievous. 
I therefore offer it as the result of my observation, that when a flap is of 68 
AMPUTATION. 
sufficient length to meet without the least dragging or stretching, then 
and there are stitches beneficial, and seldom to be omitted; but on the 
other hand, if the flaps be scanty, and if the employment of a stitch would 
keep them on the stretch in the least degree, then will they prove mis- 
chievous, and should not be employed. I need hardly say, that the intro- 
duction of the stitch through the muscular structure of the flap is never 
admissible. 
An Opiate before the First Pressing after Amputation.—Dr. Ilannay 
recommends a larger dose of laudanum (30 or 40 minims), to be given 
before the first dressing after amputation, particularly of a large extremity. 
There is no doubt the shock to the nervous system is very great, and we 
should endeavor by every means to alleviate it. Part xiii., p. 206. 
Excision of the Head of the Ilumerus.—Dr. Stratton describes an 
interesting case of excision of the head of the humerus. His patient, an 
Indian boy, about six years of age, received the contents of a musket, 
loaded with swan shot, in his left arm, he being at the time about six feet 
from its muzzle. 
In the upper half of the arm, the soft parts are much injured, part of 
them seem to have been shot away, and in the margin of the wound there 
are several shot-holes in the integuments; two inches of the shaft of the 
humerus is destroyed ; there is a thin glairy discharge from the upper part 
of the wound; a part of the shaft of the humerus two inches long, and 
several other loose pieces of bone, were removed, and also a quantity of 
moss, which the Indians had applied to stop the bleeding, which they say 
was not great at the time of the accident. There is but little constitu- 
tional disturbance ; the skin is cool, the tongue moist, and the appetite 
moderate. The patient was laid on a table, with his left shoulder project- 
ing over its edge. Of the lower part of the humerus the projecting 
extremity had been broken very obliquely, and on bending the arm at the 
wound, this sharp and almost pointed end was removed, partly with a saw, 
and then with the nippers. I then took hold of the lower extremity of 
the upper part of the humerus, and with a small double-edged scalpel cut 
along it upward toward its head, from the side of vvliicli a small splinter 
was removed. The head was then turned out of the socket by using the 
scalpel around it, and turning the other end toward the chest; the part 
thus removed measured two inches; no vessels required to be tied. 
Search was made in the soft parts for any pieces of bone that might have 
been driven in by the shot; lint, wet with water, was for the day put in 
the socket, the soft parts were adjusted so as to make the breach as small 
as possible; with a sling the elbow was raised up so as to aid nature in 
shortening the arm, in order that the loss of bone might be less felt; a 
single turn of a bandage confined the arm to the side, and a cloth, dipped 
in cold water, was applied over the wound. 
In one hundred and twelve days after the operation the wound was 
closed, the left arm being a little shorter than the right. Eight months after 
the operation, he could use the left arm as well as the right, but could not 
elevate it quite as high : its motions were free, and he could use it with 
ease in lifting weights. The left shoulder was a little flattened, which 
was quite concealed by his dress. Part xiii., p. 207. AMPUTATION. 
69 
Amputation of the Thigh.—Mr. Syme says lie is now satisfied that there 
are circumstances in which the circular incision ought to be preferred. The 
perfect condition of the stump, where there is nothing but integuments to 
protect the bone, as at the ankle, led him to conclude, that if the circular 
operation could be performed with the certainty of providing such a cover- 
ing, it might be employed with advantage in the lower third of the thigh. 
There is plenty of skin and plenty of room to employ the tourniquet, Avith- 
out impeding the incisions or retraction of the muscles, and the size of the 
wound is much smaller than at the middle of the thigh. Apply the tour- 
niquet close to the groin; use a middle-sized knife, such as is employed for 
the flap operation. Make the incision of the skin as near the knee as 
possible ; not in a circular direction, but so as to form two semilunar 
edges, which may meet together in a line, from side to side, without pro- 
jecting at the corners, and divide the fascia with the integuments. Draw 
these up by firmly clasping the limb, and not by dissecting and turning 
back. Divide the muscles by a circular sweep of the knife down to the 
bone, and retract with the utmost care. This should be at least two 
inches ; and, before using the saw, protect the muscles, and freely expose 
the bone by means of a split cloth. 
Mr. Syme adds, as the soft parts required to form the stump in amputa- 
tion at the knee, are apt to be so deranged, in their texture, as to 
delay, though not prevent, recovery, and thus in some measure counter- 
balance the advantage of exposing the cancellated instead of dense bone, 
together with the contents of the medullary cavity, “ I do not persist 
in advocating amputation at the knee, now, when satisfied that the ope- 
ration by circular incision, if performed with due care on proper prin- 
ciples, may be employed at the lower third of the thigh safely and advan- 
tageously.” Part xiv., p. 155. 
Quain’s Method.—In amputation, Mr. Quain makes the flaps short in the 
first instance, and adds to their length, subsequently, by circular incisions 
through the deeper muscles. Modifications, are, however, required, 
according as the parts to be amputated are not clothed with muscle, e.g., 
the leg and fore-arm. Part xiv., p. 158. 
Flap Amputation.—According to Mr. Bulley, the disadvantages of flap 
amputation are: 1. It is more painful from the extent of integument 
divided, and oblique division of nerves. 2. More protracted in its per- 
formance, in consequence of the difficulty of obliquely cut arteries collaps- 
ing. Part xiv., p. 158. 
Comparison of the Circular and Flap Operations.—In the thigh and 
leg, after amputation, it not unfrequently happens that everything looks 
well for a few days, but that then some matter forms, or the limb 
jerks, or is hot, or the skin gets just a little tight at one part over the 
bone. In these cases the flap operation succeeds better than the circu- 
lar, for it rarely happens that the skin of the circular operation can be got 
well forward again after it has once begun to retract, or become tight, 
whilst the mass of muscle and soft parts of a flap can often be brought 
down again after they have retracted very considerably. In the thigh, 
puncture of the artery, above its division, is readily avoided in the flap 
Deration, and cannot well be done in the circular. In the leg, the 
rtery may readily be punctured in passing the knife behind the limb, 70 
AMPUTATION. 
and wounded above its division; still this is no real objection to the 
flap operation below the knee, as the same accident may happen from 
the use of the catlin. The rapidity of the flap operation, as compared 
with the circular, is some advantage, but the whole operation is not 
necessarily shorter, for the number of arteries to be tied in the former 
case is generally greater than in the latter. During the last few years, 
the double-flap operation has been performed upon a large number of 
patients at St. Bartholomew’s, by Mr. Stanley, and with the best result. 
In many of these cases, at their termination, the full soft condition of 
the face of the stump, the complete depression of the bone in the line 
of the union of the flaps, or beneath the front flap of the thigh, have 
been most marked, whilst the effects of inflammation, in rendering the 
stump tense, have been very much less than where the same accidents 
occurred after a circular operation. Part xv., p. 176. 
Amputation of the Thigh.—Dr. Cotton observes: In largely developed 
muscular limbs, from the extent of surface requiring to be exposed, and 
the difficulty I have sometimes witnessed and experienced in securing the 
vessels, particularly in amputations immediately below the knee, it has 
struck me that in forming the flaps the muscles might be advantageously 
transfixed less deeply, and the operation completed by circular incisions. 
Whether circular amputation at the lower third of the thigh, “ where cir- 
cumstances afford room,” ought to supersede the division at its centre, as 
advised by Mr. Liston, for securing the most efficient and convenient 
stump, time and experience must decide. Part xv., p. 177. 
Question of Amputation in Mortification.—Professor Cooper says: 
With respect, first, to amputation, all practical men agree that, in cases of 
had mechanical injuries, this is best done early, before mortification 
begins, or even inflammation comes on. The usefulness of this practice 
must be obvious; for, if you defer amputation till mortification comes on, 
you take the patient just when his system is least able to bear the opera- 
tion ; whereas, by prompt action you may anticipate these effects, and 
give the patient the best chance of recovery. 
Another rule is to attend to the line of demarcation. Where mortifica- 
tion arises from internal causes, you would never be justified in amputating 
until tliis line is clearly marked, because by the absence of this line the 
system is shown to be still in that unfavorable state which induced disease 
in the limb, and, should you operate under these circumstances, you would 
have the stump attacked; it is therefore a rule in surgery, that where 
mortification arises from internal causes, you must never amputate till this 
line is formed. When the line exists you can see that the parts are dead 
on one side, and that the other exhibits a bright red color, as if from the 
presence of the arterial blood. You will then endeavor to strengthen the 
patient with nutritious diet; he will go through the operation better, and 
the results will be more likely to be favorable. At the same time, you 
should distinctly understand that this rule of waiting for the appearance of 
the line cf demarcation is intended to apply only to mortification from 
internal causes: if we were to act on it in cases of mortification from 
external injuries, as gun-shot wounds for instance, the patient would either 
die before mortification had ceased, or sink into a low state, in which 
amputation would not be practicable—a state which very rapidly follows AMPUTATION. 
71 
these injuries. Now and then the gangrene will go down to the bone, 
and no operation will be required at all. Bart xvi., p. 179. 
New Mode of Bandaging TVounds and Stumps.-—M. Baudens sub- 
mitted a method which he had lately devised, of bringing together the 
edges of wounds in order to unite, and which he is now daily employing 
with success at the hospital. For instance, in order to unite the two flaps 
of integument, after the operation for removing the foot at the ankle, as 
practised by him, a bandage is fixed circularly above the stump, and in it 
are inserted two strong pins, one in front, the other behind, leaving their 
heads and points free. Around the two ends of the pins thus left exposed, 
a long and thick cotton thread is looped; the threads from both sides are 
next brought down to the edge of the stump, and crossed over the lips of 
the wound, which are held together by the fingers of an assistant. The 
thread being crossed over to the opposite side, is now passed under the 
ends of the pin of that side, from which, again, it may be made to recross. 
By this crossing of the threads of both sides over the wound a support is 
given to it similar to that afforded by a bandage. The crossing of the 
threads may be repeated as often as is deemed necessary ; and the course 
of the threads of opposite sides may be parallel, or across, so as to make 
a figure of eight. The ends of the ligatures applied to the arteries, being 
also made fast to the pins, are in no danger of being torn away in remov- 
ing any applications from the stump, as will sometimes happen with the 
old plan. 
The advantages this plan offers are—the gentle pressure exercised by 
the thread ; the avoidance of impregnation by the discharged matter, 
which cannot long remain in contact with the end of the stump; the open 
spaces left between the threads allows of a ready discharge of fluid mat- 
ters from the wound; and the constant pull upon the circular bandage 
above the stump tends to draw the flesh toward its extremity, and so 
render it conical. This mode of bringing about the union of parts is, 
according to M. Baudens, applicable to all kinds of wounds, a suitable 
support being first contrived for the pins, on which the traction is exerted. 
The bandage should not be tight enough to obstruct the circulation. 
Bart xvi.,p. 181. 
Case of Excision of the Ankle-Joint.—The patient, a man twenty-three 
years old, had the astragalus and os calcis affected with caries, and as he 
objected to amputation either below the knee, or at the ankle, Mr. Wakley 
resolved to dissect out the diseased bones. The operation was performed 
with the patient under the influence of chloroform. 
The diseased foot (the left) having been drawn forward so as to be free 
of the operating table, Mr. Wakley standing directly in front, and holding 
the scalpel in his left hand, made an incision from the prominence of the 
internal malleolus, backward and downward to the middle of the heel. A 
similar incision with the right hand was then made from the external mal- 
leolus, downward and backward to join the foregoing. A third incision 
was next carried along the edge of the sole, from the middle of the first 
to a point opposite the astragalo-scaphoid articulation; and a fourth on the 
opposite side of the sole, from the vertical incision to the situation of the 
calcaneo-cuboid joint. These latter incisions enabled the operator to make 
a, flap of about two inches in length from the under part of the sole. In 72 
AMPUTATION. 
the next place a circular flap of integument was formed between the two 
malleoli, posteriorly, the lower border of the flap reaching to opposite the 
insertion of the tendo Achillis. This flap being turned upward, the ten- 
don was cut through, and the os calcis having been disarticulated from the 
astragalus and cuboid bones, was removed, together with the integument 
of the heel included between the two incisions. The lateral ligaments con- 
necting the astragalus with the tibia and fibula were now divided, and the 
knife was carried into the joint on each side, extreme care being observed 
to avoid wounding the anterior tibial artery, which was in view. The 
astragalus was then detached from the soft parts in front of the joint, and 
from its articulation with the scaphoid bone, and the malleoli of the tibia 
and fibula were removed with the bone-nippers. The only artery requir- 
ing ligature was the posterior tibial. During the few minutes the opera- 
tion occupied, the patient did not manifest the slightest symptom of pain 
or uneasiness. 
The case did well, and in a few months the man was able to walk very 
well with the aid of a stick and a higli-heeled boot, and returned to his 
employment. Fart xviii., p. 161. 
Compound Fracture and Dislocation of the Astragalus.—The patient, 
a lad 14 years old, was riding a vicious horse, which fell over on its side 
and crushed his left ankle. 
The astragalus was dislocated from its connection with the os calcis, and 
this articulating surface turned outward through the lips of the wound. 
The bone was not separated from its attachments to the tibia and fibula, 
nor from the scaphoid anteriorly, but to allow the bone to turn half round, 
the neck had given way transversely. Both the anterior portion of bone 
which remained i?i situ, attached to the scaphoid, and the other larger 
portion, were clipped or broken more or less. 
Treatment.—After a very careful examination of the parts, the foot, the 
vessels, and the boy’s state generally, it was resolved to try and save the 
limb. The dislocated portion of the astragalus (amounting to four-fifths of 
the whole of that bone), was carefully detached from the tibia and fibula, 
and these bones let down upon the calcis. The edges of the wound were 
brought together with three or four stitches and plaster; a compress of lint 
was placed over them, covered with oiled silk, confined with a turn or two 
of the bandage, and the whole secured in Macintyre’s splint. During the 
first week he suffered from irritative fever, but much less so than might 
have been anticipated. He took salines and aperients, etc., as required. 
There was very little oozing of blood after the first few hours, but synovia 
was discharged in considerable quantities. The treatment was persevered 
in, the wound being dressed still with dry lint under oiled silk, as often as 
necessary until about fourteen days, and the splint itself was of course re- 
applied. This was done continually until about seven weeks from the date 
of the accident, when it was discarded, and an inside wooden splint with a 
foot-piece substituted for it, and a bread-poultice employed. At the expi- 
ration of another week this support was removed, the limb bandaged (a 
pad of lint only being used for dressing) and a stirrup of pasteboard passed 
under the foot, and continued up either side of the leg. He now got up 
and walked about, aided with crutches, the foot being supported in a sling. 
Seven days after this time he began to try and accustom himself to bear 
slightly on the foot. lie soon left off one crutch and used a stick. The AMPUTATION. 
73 
wound was touched with sulphate of copper from time to time, and only 
covered with lint. 
November Cth.—He now walks with a crutch and stick, when going any 
distance, and walks well. The ankle is almost motionless as regards flex- 
ion and extension. 
April 10, 1848.—Walks well with a stick, frequently without one ; the 
limb is nearly an inch shorter than the opposite one. Flexion and exten- 
sion movements of joint increase. Part xviii., p. 162. 
Amputation of the Fingers and Toes.—If a portion of a finger is to be 
removed at the articulation of the phalanges, a common narrow, sharp- 
pointed bistoury is pushed from one side of the finger to the other, in 
front of the joint, and the flap made ; the knife is now laid perpendicularly 
upon the lateral ligament, then brought across the joint, and the 
other lateral ligament cut; by this proceeding the joint is at once 
opened, and nothing remains but to divide the skin posteriorly. In ampu- 
tating between the first and second phalanges, transfixion is made opposite 
to the large fold in the integuments in front, and the joint is at once come 
upon, as the two exactly correspond. The articulation between the second 
and third phalanges is one line in front of the fold. By cutting into the 
joint posteriorly, there is always considerable difficulty in getting the 
knife between the bones, so as to make the flap in the palmar aspect; in 
consequence of the extensor tendon having been divided, the flexor con- 
tracts and drags the phalanx which is to be removed in front of the one 
which remains. The flap in the palmar aspect being made first, that diffi- 
culty is avoided, and the operation is performed with more rapidity and ease. 
In removing the whole of the finger, the method adopted is this : The 
point of the knife is laid on the skin, half an inch above the articulation, 
carried down straight over it, and then brought by the side of the finger 
into the large fold in front, and continued upward on the opposite side to 
join the incision on the dorsum. This incision is performed by one 
continuous sweep from left to right, without removing the knife. The 
finger is now pressed well out, so as to put the ligaments on the stretch, 
the joint entered, and the operation concluded. 
Having determined previously to remove the head of the metacarpal 
bone along with the finger, the same mode of proceeding is adopted, with- 
out, however, opening the joint. The incision is commenced on the 
dorsum, about an inch and a half above the joint, carried straight down, 
then brought round into the large fold in the palm, and continued up- 
ward to where it began ; the blade of the knife is now placed parallel with 
the metacarpal bone, and carried round its head from right to left, 
and brought back in the reverse manner, and the bone divided by the 
forceps. By this method there is no cicatrix in the palm, the flaps 
are smooth and regular; the operation is also quicker in its perform- 
ance, and leaves a much better and neater covering than by the mode 
usually followed. 
When amputating the thumb and metacarpal bone, Mr. Williamson 
considers it more convenient to stand on the inner side of the arm. 
The point of a long, narrow, straight bistoury is entered opposite 
to the articulation of the metacarpal bone and the trapezium, passed 
under the adductors, and its point made to appear in the folds 
of integuments betwixt the thumb and fore-finger, and by cutting 74 
AMPUTATION. 
outward a flap is formed; the knife is now laid upon the angle of the 
incision, between the thumb and finger, and continued over the dorsum 
of the bone to the part where it was entered to transfix. The thumb is 
then firmly grasped by the operator, and the soft parts divided down to 
the articulation, which is now disarticulated writh great facility. 
For the removal of a whole toe, the same oval method, as it may be 
called, is adopted. It is here of still greater advantage, as there is no 
cicatrix left in the sole of the foot to annoy the patient when walking. 
The metatarso-phalangeal articulations of the small toes are deeply seated 
in the ball of the foot, and the knife must be carried, by the method usu- 
ally practised, to the extent of two inches into the sole, to reach the joint, 
and, on disarticulating the bone, the integuments are notched and cut in 
a very awkward manner; in the method recommended, these objections 
are removed. 
In amputating the finger, the head of the metacarpal bone should 
always be removed; but in the toes it ought, if possible, to be preserved, 
especially that of the great toe, for the purpose of giving greater support 
in walking. The toes, with the whole of the metatarsal bones, can be 
removed in the same manner; the great and little toes are those that most 
frequently require to be amputated; this can be effected by making a 
straight incision along the dorsum, brought down into the fold in the sole, 
and terminating in an acute angle near its commencement. The bone is 
then cleared and disarticulated. Part xviii., p. 163. 
Amputation at the Ankle Point.—The following modification of Mr. 
Syme’s operation lias some advantages. After making the anterior incision 
from one malleolus to the other, mark out the form of the flap by carrying 
the knife deeply across the plantar aspect of the heel from the internal to 
the external malleolus: then disarticulate the joint, divide the tendo 
Achillis, and turn out the os calcis from the plantar flap by carrying the 
knife closely around the back and sides of the bone : lastly, remove the 
malleoli with the saw. This method is more easy and rapid than the usual 
plan of dissecting the flap from below upward, before disarticulating. 
Part xix., p. 131. 
Amputation.—In dressing the stump, instead of compresses and ban 
dages, apply two long and broad strips of wetted lint, in a crucial manner, 
and support them by a circular strip, so as to support and press the flap 
against the bone. Part xix., p. 132. 
Military Surgery •— Mr. Guthrie's Lectures on. — Mr. Guthrie com- 
mences some very important observations upon this subject, by consider- 
ing the necessity of a tourniquet. He says: 
As a tourniquet cannot be applied in amputation at the hip.joint, nor 
even at that of the shoulder joint, without doing harm, its inutility is 
proved in the greatest operations; and recourse should not be had to it in 
the smaller or less dangerous ones, provided sufficient assistance can be 
obtained. When the surgeon has only one assistant, he should apply a 
tourniquet; or even if he should have several bad ones on whom he can- 
not depend. 
There is always more blood lost, and particularly in secondary amputa- 
tions, when a tourniquet is used, than when the principal artery is com- 
pressed by one assistant, and two others are ready to press on the outside AMPUTATION. 
75 
of the flaps, or upon the divided vessels, with the ends of their fingers; the 
force necessary to prevent the passage of blood through the common 
femoral, or the axillary artery, being merely that of the finger and thumb, 
applied in a very gentle manner, or even of the end of the fore-finger of a 
competent person. I have rarely applied a tourniquet since 1812, and few 
persons have done more formidable operations under more difficult cir- 
cumstances. 
A tourniquet is useful when loosely applied after an operation, and the 
attendant should be taught how to turn it, so as to suppress any serious 
bleeding which may take place until the surgeon can be procured. It may 
be, although it rarely is, necessary on the field of battle. A thoroughly 
useful tourniquet can be made in a moment with a pebble and a pocket- 
handkerchief, or a roller. The great point is to know where and how to 
apply it. 
If after a fracture in course of treatment, the principal artery should bo 
wounded by some accidental motion of the bone, amputation should in 
general be resorted to. A ligature on the artery higher up would fail, and 
the operation of seeking for both ends of the injured vessel would cause so 
much mischief in an unsound part, that the consequences would in all pro- 
bability be fatal. 
When the femur is suffering from a malignant disease, commencing in 
the periosteum, or its cancellated internal structure, I am reluctantly 
obliged to say that the removal of the whole bone at the hip joint offers 
the best, perhaps the only, chance of success. In such cases, tflie operator 
has in general the power of selecting his mode of proceeding. 
It may be laid down as a principle in all cases of accident, whether from 
shot, shell, or railway-carriages, that no man should suffer amputation at 
the hip joint when the thigh-bone is entire. It should never be done in 
cases of injury when the bone can be sawn immediately below the tro- 
chanter major, and sufficient flaps can be preserved to close the wound 
thus made. An injury warranting this operation should extend to the 
neck or head of the bone, and it may be possible, as I have proposed, even 
then to avoid it by removing the broken parts. 
The principle being established, as a general rule, in all cases of recent 
injury, that the femur must be broken at least as high as the trochanter to 
constitute an imperative case for this operation, the next point of import- 
ance relates to the manner of forming the first incisions. 
My first successful operation, performed in 1815, was done from without 
inward, the flaps being anterior and posterior, the artery being compressed 
against the pubes. 
Professor Langenbeck, when lately in London, informed me he had per- 
formed amputation at the hip joint, in the Holstein war, several times, and 
he believed more than once successfully, making the anterior flap by the 
pointed knife, cutting from within outward, but the posterior one by cutting 
through the integuments from without inward, as I have recommended, in 
order to make it of a more equal and proper thickness. One point to be 
attended to is to leave as little as possible of the internal tendinous struc- 
ture of the great glutaeas muscle, which does not readily unite with other 
parts; a second, not to leave too much muscle behind: and a third, to 
remove as much as possible of the ligamentous structure about the joint. 
The after treatment will be the same as in other formidable cases. The 
shock, however, of the injury, and of the amputation, will rarely render 76 
AMPUTATION. 
blood-letting necessary. Cordials, in small quantities, with opiates and a 
light nourishing diet, should be given. The wound should be wetted with 
cold water, and the patient constantly watched. 
A protrusion of bone is a disagreeable occurrence after amputation ; it 
will sometimes happen after sloughing of the stump, without any fault in 
the operator. If, on completing the operation, it is evident the bone can- 
not be well covered, a sufficient portion should be at once sawn off, and the 
error remedied. 
When the bone protrudes at a subsequent period to the extent of an 
inch or more, it should be removed by opei-ation, an incision being made 
on, and down to, the bone, and the saw applied where it is sound. The 
cliain-saw, when at hand, answers well, and some should be supplied for the 
use of the principal hospitals with every army. The protruded end of bone 
should be held steadily by pincers, or it may be introduced into a hollow 
tube, which fixes it firmly. 
When the bone is badly sawn through, or split in the act of dividing 
the last layer, or the periosteum is unduly separated, the end will often 
exfoliate with the split, which may extend up for three or more inches, 
causing much suffering, and occupying a great length of time before the 
stump becomes quite sound. A splinter of this kind may even require to 
be removed at a late or even distant period, from the nervous irritation 
and suffering it may occasion. 
Wounds of the knee joint, with fracture of the bones composing it, from 
musket-balls' require immediate amputation ; for although a limb may 
be sometimes saved, it cannot be called a recovery, or a successful result, 
where the limb is useless, and is a constant source of irritation and distress 
after several months of acute suffering have been endured, to obtain even 
this partial relief from impending death. For one limb thus saved, ten 
lives will be lost; and the sufferer is often glad, after months and years, 
to lose the limb thus saved, more particularly when the ball has lodged in 
the articulating surfaces of either of the bones. Amputation at a secondary 
period, in these cases, does not afford half the chance of success, for many 
will not outlive the inflammation and the fever which ensue. The 
amputation should therefore be immediate, unless excision can be substi- 
tuted for it. 
Compound fractures of the patella, without injury of the other bones, 
admit of delay, provided the bone is not much splintered. If the ball 
should have pierced the centre of the patella, and passed out in nearly an 
opposite direction behind, the limb will not be saved. If the ball have 
struck the patella on its edge, and gone through it transversely, opening 
into the joint, it will very rarely be saved ; but if it be merely fractured, 
there is hope under the most rigorous antiphlogistic treatment, and delay 
is proper. A ball will occasionally penetrate the capsular ligament, and 
lodge in the knee-joint, without fracturing the bone; if it cannot be 
extracted without opening extensively into the cavity of the joint, and the 
extraction of the ball is absolutely necessary, amputation had better be 
performed at first, for it will be ultimately necessary. The condyles of the 
femur and the lower part of the bone being spongy, a ball may pass 
through them or between them, and fall into the knee-joint, or it may 
make a prominence on the side of the patella, without passing out, or 
immediately interrupting the motion of the leg, for the soldier may walk 
some distance afterward. The popliteal artery may also be divided in AMPUTATION. 
77 
addition, and either of these oases will render amputation necessary; for 
the ball must be taken out on the forepart, and the general inflammation 
of the joint will either destroy the patient in a short time, or, after much 
distress and hazard, leave him no alternative but amputation. If a ball 
lodge in the condyles of the femur, within the capsular ligament, and can- 
not be easily extracted, amputation is advisable ; for the limb, if preserved, 
will not be a useful one. If the ball, on the other hand, lodge without the 
capsular ligament, and cannot be readily extracted, the wound should be 
healed as soon as possible ; and although it may cause some little incon- 
venience to the knee-joint, the limb and life of the patient may be saved, 
as I have seen in many instances, when a continuance of persevering efforts 
to extract it would have exposed both to great danger. Many cases of 
wounds of the knee joint, in which the capsular ligament is wounded, and 
the articulation opened into without injury to the bones, do well, such as 
simple incised wounds made with a clean cutting instrument. The success 
attending all wounds of the knee joint depends entirely upon the antiphlo- 
gistic mode of treatment being rigidly enforced, and to a very great extent. 
The limb is to be placed in the straight position, a splint is to be put 
underneath it, in order to prevent any motion, and cold or iced water is to 
be applied, especially in summer, to diminish the increasing, heat. Gene- 
ral bleeding may be had recourse to in sufficient quantity to keep all 
general inflammatory action in due bounds; but, it is on local blood-letting 
that the surgeon must principally rely for the prevention of inflammation. 
Cupping can sometimes be performed with marked effect; but leeches are 
more serviceable when they can be procured in sufficient numbers; from 
twenty to forty, or more, may be applied at a time ; and whenever the 
sensation of heat is felt, and is accompanied by pain, they should be 
repeated until these symptoms subside. The necessity for the local abstrac- 
tion of blood is so great, that it should never be lost sight of for a moment; 
for if suppuration take place throughout the cavity of the joint, it is fol- 
lowed, in most instances, by ulceration of the cartilages and caries of the 
bones. By local and general bleeding, the application of cold, rigid 
abstinence, and the straight position, a recovery may sometimes be 
effected ; but wounds of the knee joint, however simple, should always be 
considered of a very dangerous nature, infinitely more so than of the 
shoulder, the elbow, or the ankle. When a poultice is applied to a gun-shot 
wound of this kind, I consider it the precursor of amputation. Colonel 
Donnellan, of the 48th Regiment, was wounded, at the battle of Talavera, 
in the knee joint, by a musket-ball, which gave him so little uneasiness 
that he could scarcely be persuaded to proceed to the rear. At a little 
distance from the fire of the enemy, we talked over the affairs of the 
moment, when, tossing his leg about on his saddle, he declared he felt no 
inconvenience from the wound, and would go back, as he saw his corps 
was veiy much exposed. After he had staid with me a couple of hours, I 
persuaded him to go into the town. This injury, although at first to all 
appearance so trifling, proceeded so rapidly as to prevent any relief at last 
being obtained from amputation, and caused his death in a few days. 
When the nature of the injury renders amputation necessary at or 
immediately below the tuberosity of the tibia, the operation may be done 
with safety. Baron Larrey recommended the removal of the head of the 
fibula in such cases, which I have done with impunity, and made thereby a 
better stump than if it had not been done; but as the articulating surface 78 
AMPUTATION. 
of the head of the tibia does sometimes enter into the composition of the 
knee joint, and this cannot be known beforehand, the removal of this por- 
tion of the fibula is not advisable, neither must the tibia be sawn above the 
tuberosity, lest the capsular ligament be implicated. As an operation by 
which the knee joint is saved, it is important, tor although the stump is 
very short, it forms a solid support for the body, and enables the patient 
to walk without the aid of a stick, and admits of the adaptation of an arti- 
ficial leg. The skin, in these cases, must be saved, in every direction, by 
flaps, to form a covering. When in sufficient quantity, the operation may 
be done by the circular incision, as much muscle as possible being saved, 
to aid in forming a covering on the under and outer sides. The posterior 
tibial artery will be found to have retracted behind the head of the bone, 
from whence it, or others which may bleed, must be drawn out. The 
nerves must be cut as short as possible. 
A musket-ball will seldom pass through the foot without injuring a joint 
of some kind, or wounding a tendon or nerve ; and the injury to the fascia, 
which is very strong on the sole of the foot, and frequently covered by 
much thickened integument, is always attended with inconvenience. The 
extraction of balls, of splinters of bone, of pieces of cloth, and the dis- 
charge of matter, become more difficult, and often cause so much disease 
as ultimately to render amputation of the foot necessary. Tetanus is a 
frequent consequence of these injuries, and is a disease, in its acute form, 
certainly remediable by no operation or medicine at present known. 
Amputation has always failed in my hands, although it was strongly 
recommended by Baron Lai-rey. The operative surgery of the foot 
should be doxxe as soon after the injury as it can be conveniently accom- 
plished ; for a large, clean, incised wound is a safe one, compared with a 
torn surface and splintered bone, with extraneous substances, of much less 
extent; and as a ball lodged in the foot is always very dangerous, great 
attention should be paid in the examination of even slight wounds. A 
cannon-shot can seldom strike the foot without destroying it altogether; 
it may, howevei-, strike the heel, and destroy a considerable part of the 
os calcis, without rendering amputation necessary, if the ankle-joint be 
untouched ; for by due attention in removing the spicula of bone at first, 
and by making free openings for the discharge of matter in evei'y direc- 
tion in which it may appear inclined to insinuate itself, the limb may be 
preserved in a useful shape. 
Wounds from cannon-shot injuring the fore part of the foot are better 
remedied by amputation at the joints of the tai-sus with the metatarsus, 
than by sawing these bones across; but when the injury affects only one 
or two toes, they may be removed separately, recollecting that it is of 
greater importance to preserve the great toe than any other, and this toe 
is worth preseiwing alone, when any of the others would be rather trouble- 
some than useful. Musket-balls seldom comxnit so much injury as to re- 
quire amputation as a primary operation, although they frequently render 
it necessary as a secondaxy one. The splinters of bone are to be l’emoved, 
the ball and extraneous substances are, if possible, to be taken out; and if 
the bones, tendons, and blood-vessels are so much injured as to render the 
attempt to preserve them useless, amputation is to be performed; but if 
the preservation of the limb be thought practicable—and it generally will 
be so in wounds from musket-balls—the attempt must be made xmder the 
most rigid antiphlogistic treatment, the local application of leeches and AMPUTATION. 
79 
cold water from the first, and with free openings for the subsequent dis- 
charge. Musket-balls seldom injure the metatarsal bones so as to require 
their removal with their toes, and under the treatment above mentioned, 
these wounds will in general be healed without further operation. Wounds 
from grape-shot occasionally render the removal of the metatarsal bone of 
the great toe at the tarsus necessary, although much should be done to 
save it. The little and adjacent toes are also sometimes removed at the 
tarsus, the middle ones but seldom, as it is not an easy operation to per- 
form, in consequence of the naturally close attachment of these bones, and 
the additional compactness they have acquired from the pressure of the 
shoe. Hemorrhage from the arteries of the foot authorizes in a very 
slight degree amputation, even when superadded to other causes; for the 
incisions necessary to secure the bleeding vessels will not, in general, add 
much to the original injury, unless they are very extensive; on the con- 
trary, they will render the wound less complicated and more manageable. 
Amputation of the foot, leaving the astragalus and calcis, may, in certain 
cases of injury anterior to these bones, be performed with advantage, care 
being taken to make the under flap so large that the line of cicatrization 
may be on the upper and anterior edge of the stump, rather than trans- 
versely across the face of it, in order to render it firmer and better able to 
resist and sustain any pressure which may be applied to it. 
As the posterior tibial artery must be divided, the preservation of the 
anterior one is essentially necessary; the success of the operation depends 
upon it. This artery, accompanied by its vein and nerve, lies close upon 
the astragalus ; the artery may be said to be even attached to it, a point 
requiring the greatest attention in dissecting out the bone without injuring 
this vessel, which is seen under the scalpel. 
Amputation of a single metatarsal bone, on the outside or inside of the 
foot, is to be done by an incision round the root of the toe, terminating in 
a.line on the outside of the foot, which is continued down to the joint of 
the tarsus. The integuments are turned back above and below from the 
metatarsal bone, which is to be dissected out, with the toe attached to it, 
and the flaps brought together, so as to leave but one line of incision. In 
military surgery there is always a wound ; and when the removal of the 
bone is necessary, it is in general an extensive one, and with loss of sub- 
stance, so that a covering cannot be saved in this way, especially on the 
upper part of the foot, where the ball or piece of shell strikes. The sur- 
geon, therefore, must be prepared to look for his covering on the under 
part, where he will occasionally not be able to procure it in sufficient 
quantity, and it must not be forgotten that the neighboring parts will 
often be injured. The object must then be to save the integuments from 
such parts as are uninjured, so as to cover in the wound as nearly as pos- 
sible when the bone is removed. In doing this'the first incision should 
commence at the upper and inside of the toe, and be carried round so as 
to separate the toe from its attachment to its fellow. If the injury be 
entirely on the upper part, the continuation of this incision must be so 
regulated as to form the whole of the flap from below, and the commence- 
ment of it above must be continued round the injured part, so as to meet 
the lower end near the articulation of the bone with the tarsus, and vice 
versd. If the ball have gone directly through, destroying the integuments 
above and below, the incisions must surround the injured part in such 
manner, on the upper and under side of the foot, as to allow the flaps to 80 
AMPUTATION. 
be formed in every other part, except where the injury was inflicted, and 
from whence granulations must arise. By saving skin everywhere else, 
the wound will be much diminished in size, will heal sooner, will be less 
liable to suffer from external violence, and less obnoxious to the subse- 
quent pain, which generally at intervals attends wounds of this kind. 
An upper extremity should not be amputated for almost any accident 
which can happen to it from a musket-shot; and there is scarcely an inj ury 
of the soft parts likely to occur which authorizes amputation as a primary 
operation. 
If the head or articulating extremity of the bone entering into the com- 
position of the shoulder joint be merely or slightly injured by a musket- 
shot, the arm ought to be saved with some defect of motion in the joint. 
The wound should be enlarged in the first instance, to allow of a sufficient 
examination with the point of the finger, and any loose pieces of bone 
should be removed. Inflammation is to be restrained within due bounds 
until suppuration has been established, when, if a clear depending opening 
should not exist for the discharge of the matter poured out, it should be 
made, and any loose portions of bone removed. The principal points to at- 
tend to are, the prevention of sinuses around the joint, by the formation of 
dependent openings, position, perfect quietude, due support, the methodical 
application of bandages, and occasional mild stimulating injections into the 
wound. A simple incised wound penetrating the joint, and even injuring 
the bone, does not call for any immediate operation. An attempt should 
be made to effect a cure by the first intention, which can only be effected 
by means of a proper position and support. 
If the head of the bone be much splintered, or if a ball have gone 
through it, that portion should be sawn off; for a part thus injured has 
often been a source of great inconvenience and suffering for many years 
afterward—during, in fact, the remainder of the life of the sufferer ; which 
misery would have been avoided by the excision of the bone in the first, 
instance—an operation which ought, in fact, to be done even at a later 
period, if it has not been performed at the time when the injury was 
received. 
When the splinters extend far into the shaft of the humerus, it may be 
proper to amputate the whole extremity, especially if the great artery be 
also wounded; but the shaft is seldom broken in such accidents to any 
great extent, and amputation should be confined almost to injuries from 
cannon-shot or shells, or heavy machinery, destructive of the soft parts as 
well as of the bone. 
When the injury done to the upper arm is so extensive that it cannot 
be saved, although the head of the humerus is not injured, the amputation 
should take place immediately below the tuberosities, and not at the joint, 
which latter operation always renders the shoulder flatter, and the appear- 
ance of the person more unseemly, than when the head of the bone is left 
in its place. 
It will frequently happen that the arm may be irrecoverably shattered, 
and the thorax partake in a less degree of the injury, there being apparent 
only some slight contusion or grazing of the skin ; if low down, the elasti- 
city of the false ribs may have prevented the integuments being much 
injured in appearance, although the blow has been violent, yet the force 
of the large shot may have ruptured the liver or spleen. If higher up, it 
may perhaps fracture the ribs, in addition to a more severe contusion of AMPUTATION. 
81 
the integuments. When these accidents occur, the symptoms arising from 
the wound or contusion of the trunk of the body are to be first considered. 
If they do not indicate a speedy dissolution of the patient, or the prospect 
of such an event in two or three days, the operation ought to be per- 
formed, and a chance of recovery given the sufferer, which he would not 
have, the arm being retained, and the injury of the chest remaining the 
same. The danger to be apprehended in the more favorable cases is from 
inflammation, and this will be rather diminished than increased by the 
operation; the danger of deferring which is manifest and certain, whilst 
the injury committed in the thorax or abdomen is not ascertained, and its 
effects may be obviated. If the termination should be unfavorable, it can 
only be a matter of regret for the sake of the individual, and not for the 
non-performance of a duty. If the cavity of the chest be laid open, or 
several ribs beaten in, or a stuffing of the lungs take place from a large 
ruptured blood-vessel, all of which circumstances are obvious, and cannot 
be mistaken, the operation would, in all probability, be useless. A hemor- 
rhage of short duration, or the expectoration of blood in moderate quanti- 
ties, although a dangerous symptom, is not to be considered as depriving 
the patient of a reasonable chance of life, for it frequently follows blows 
from more common causes, and from which many people recover. If the 
operation be delayed to ascertain what injury may have been done to the 
chest, from the symptoms that will follow, the danger resulting from both 
will be increased; and even when it is ascertained that there is but little 
mischief existing in the thorax, the operation can no longer be performed 
with the same propriety, in consequence of the inflammation which has 
supervened; and the patient will probably die, when he would have re- 
covered under a more decided mode of treatment. 
A round shot or flat piece of shell may strike the arm, after rebounding 
from the ground, or when nearly exhausted in force, without breaking the 
skin, or only slightly doing it, yet all the parts within may be so much 
injured as not to be able to recover themselves: the bone may be con- 
siderably broken or splintered, the muscles and nerves greatly contused. 
The injury may not, perhaps, be quite so extensive. The bone may be 
merely fractured, and yet the soft parts will often be so much destroyed as 
not to be able to carry on their usual actions. A ruptured blood-vessel 
may, with an apparently slight external wound of this nature, pour out its 
blood between the muscles, and inject the arm to nearly double its size, 
all of which are causes that render an operation necessary, and require 
decision, for inflammation will, and mortification may, ensue in a short 
time, when the most favorable moment for operation will have been lost. 
Amputation at the Shoulder Joint is an operation of little surgical im- 
portance. The fear formerly entertained of loss of blood has passed away, 
and every surgeon now knows that if he should happen to cut the axillary 
artery unintentionally, it can be held between the forefinger and thumb, 
without difficulty or danger, until a ligature can be placed upon it. No 
accomplished surgeon of the present day should give himself the least 
concern about compressing the subclavian artery. It is, on the contrary, 
better, when the arm is raised from the side preparatory to entering or 
using the knife, that the surgeon should then feel the pulsation of the ar 
tery in the axilla, that he may the more easily avoid, and subsequently 
command it. The axillary artery does not throw out much blood at each 
pulsation, and a little pressure with the end of the forefinger will always 82 
AMPUTATION. 
prevent bleeding until tlie surgeon is prepared to take hold of the vessel 
with the tenaculum or forceps. 
The great point to be attended to in performing the operation is, to 
save skin to cover the stump. The directions, therefore, which are usually 
given for doing it after any particular method, can only be occasionally 
useful, for the surgeon may not always be able to select the parts to be 
divided or retained. In cases of malignant disease of the bone and 
periosteum of the middle of the arm, the operation should be for the 
removal of the whole of the bone at the joint, and not the amputation of 
it below the head, although the appearance of the integuments, and of 
the bone itself, would seem to encourage the attempt to preserve the 
roundness of the shoulder. In such cases the removal of the extremity 
at the joint may be done by any one of the many ways which have been 
recommended for its performance. In none should the acromion or cora- 
coid processes be exposed, unless previously injured. Neither is it neces- 
sary to lose time, or to give pain, by depriving the glenoid cavity of its 
cartilage ; but it should always be borne in mind, that if the nerves are 
not shortened after the removal of the arm, they may be included in, or 
adhere to the cicatrix, and cause, during a long life, much distressing 
pain to the sufferer. 
Amputation at the shoulder joint, performed immediately after the 
receipt of an injury, is now a very simple operation. 
As a secondary operation, or done at a later period, when the parts are 
all impacted together, it is somewhat less so. In both stages it is abso- 
lutely necessary to remember—1st, that except in cases of disease, and 
not of injury, the shaft of the bone must be broken; and that all the 
directions usually given for rotation of the arm inward and outward 
during the operation, are unnecessary cruelties not to be attempted 
with a broken bone; 2d, that the arm should always be raised from 
the side and supported by the hand of an assistant, who can feel, if 
he pleases, at any time of the operation, the pulsation of the axillary 
artery ; and all operative methods are condemned, in which this precau- 
tionary measure is not the first step. 
Amputation of the Arm immediately below the Tuberosities of the 
Ilumerus is similar to amputation of the joint, which, in many cases it is 
intended to supersede. 
Excision of the Head of the Humerus.—The point governing the modus 
operandi of this operation is, and ought to be, the fact that under the most 
favorable state of recovery which can take place, the shoulder joint usu- 
ally becomes so stiff that its ordinary motions may be considered to be lost. 
Operative processes which have for their principal object the sparing of 
the deltoid muscle are unnecessary, for, if spared, it is as useless as if it 
had been cut; and it seems to have been forgotten that, when cut, it 
reunites, and becomes nearly as strong as before it was injured. It is the 
joint which cannot be moved, not the muscle which has lost its power. I 
prefer, therefore, in doing this operation, where the injury will permit of 
it, to make a short crescentic flap by an incision across the anterior part of 
the shoulder, as in the operation of amputation, which, on being turned 
up, leaves the joint exposed. The edge of the knife being applied to the 
head of the bone in a line below, but immediately under the acromion 
process, divides the capsular ligament, and with it the long tendons of the 
biceps, on Avhich the arm drops from the socket, or glenoid cavity, and AMPUTATION. 
83 
allows the finger to be introduced, when the three muscles inserted into 
the great tuberosity may be cut through, and the sub-scapularis, inserted 
into the small tuberosity, should also be divided. The head of the bone 
is then readily brought out, and may be readily detached from any sur- 
rounding connections, and sawn off with little or almost no loss of blood. 
The elbow is to be supported, so as to bring the end of the sawn bone in 
apposition with the glenoid cavity. The flap may be allowed to unite 
with the parts below as soon as it will, the shot holes, if any, being in 
general sufticient to allow of such discharge as may be necessary. 
In cases, of recent injury, some aid will be obtained in keeping the sawn 
end of the humerus in apposition with the glenoid cavity, by not dividing 
the long tendon of the biceps. This must be done by dissecting it out of 
its groove in the humerus, between the tuberosities, and by cutting 
through the capsular ligament vertically, so as to follow it up to its attach- 
ment to the upper edge of the glenoid cavity, when it is to be drawn aside 
with a blunt hook, until the operation has been completed: a proceeding 
difficult of accomplishment in old cases of disease or injury, and in them 
not necessary nor advisable. 
Whenever the head of the humerus is broken, with even considerable 
injury to the soft parts around, it will be always better to saw off the broken 
part of the bone in the first instance, and to retain the remaining portion 
as closely as possible in apposition with the glenoid cavity. The suffering 
will in the end be less, and the cure be effected, in general, without the 
loss of the arm. 
If, from some complication of injury, the axillary, or other artery should 
give way during the treatment, the extremity is not to be amputated. 
The artery is to be secured by one ligature applied above the opening in 
it, and another below it; the surgeon always bearing in mind the fact, 
that the proper way to get at the axillary artery is by cutting across the 
fibres of the pectoral muscle, and not in the direction of them; and that 
the ligature of the subclavian is not to be resorted to until nothing 
else remains to be done by which the hemorrhage is likely to be 
suppressed. 
Amputation of the Arm by the common circular incision should only 
be practised in the space between the lower edge of the insertion of the 
pectoralis major and the elbow joint; and rarely in cases of injury from 
musket-balls. No common flesh-wound, made either by cannon or musket 
shot, even including a division of the artery, absolutely demands this ope- 
ration, the bone being uninjured. If, in addition to such a destructive 
flesh-wound, the bone be broken, or if it be mashed with the muscles by 
an oblique stroke of a round shot, or the fore-arm be carried away or 
destroyed, it is admissible. 
Excision of the Elbow Joint.—An incised wound into the elbow joint, 
of moderate extent, cutting off with it a part of the condyle of the 
humerus, or the head of the radius, or a part of the ulna, demands the 
removal of the injured piece of bone only. The fore-arm should be bent 
and the antiphlogistic treatment fully carried out. A ball fracturing the 
olecranon, or other portion of a single bone, although opening into the 
joint, does not immediately require any operation. 
If a ball should lodge in the lower part of the humerus, or in either of 
its condyles, it should be removed, if necessary, by the trephine, or other 
appropriate instrument. 84 
AMPUTATION. 
When the articulating ends of the humerus, radius, and ulna are wholly 
or in part injured by a musket ball, it was formerly the custom to ampu- 
tate the arm, in such instances of great mischief—an operation which 
should be superseded by that of excision of the joint, by which the fore- 
arm will be saved, and considerable use of it retained. 
Amputation of the Fore-arm is seldom required after wounds from 
musket balls. The bones can be readily got at, and large pieces removed 
with case. The arteries can be cut down upon and secured without diffi- 
culty, except at the upper part, and even there with some little sacrifice 
of muscular parts, which are not to be spared. The fascia may be divided 
freely in every direction, and as mortification from defect of nourishment 
rarely takes place in the fingers, as it does in the toes, when the great 
arteries are injured, every effort should be made to save a fore-arm, how- 
ever badly it may at first appear to be injured. 
The flap operation is to be preferred to the circular, particularly when a 
little above the wrist; to which operation Baron Larrey and the surgeons 
of France particularly objected during the late war. Having done it most 
successfully since 1806, however, it is recommended as preferable to any 
other, even when the injury admits of it being done near the carpus. 
When the nature of the injury does not admit of two equal flaps being 
formed, it must be done by two unequal ones, or even by one, it being 
important for the fixing of an artificial hand or other help, to have 
a long stump. 
When the operation is to be performed above the middle of the arm, it 
may be done by the circular incision. 
In all Injuries of the Hand, the value of a thumb and a finger, or of 
two fingers, or even of one, should be borne in mind, and no part should 
be removed that can be saved, and appears likely to be of use. When 
cannon-shot, large splinters of shells, or grape-shot have struck the hand, 
amputation will often be necessary, but the foregoing precept should never 
be forgotten. 
A musket-ball fairly passing through the hand, generally fractures two 
metacarpal bones, although a small ball may pass between without breaking 
either. The wounds should be enlarged, and the broken ends of the bones 
sawn off, or the splinters removed, and the points of bone smoothed off, 
the tendons to be carefully preserved, and vigorous antiphlogistic 
measures adopted. The tendency to tetanus or trismus will be best 
obviated by such measures, the incisions, when necessary, being made in 
the direction of the bones and tendons. Any hemorrhage which can 
ensue will be readily commanded by ligature, by torsion of the vessel, 
or by a small graduated compress and bandage, when these are inap- 
plicable. 
When one or more fingers are destroyed, and the metacarpal bones 
injured, they are to be sawn or cut off, but not removed at the carpus, 
although an opening into the joint of the carpus will generally do well, if 
skin can be saved to cover it. In all cases of amputation of one or more 
fingers, the metacarpal bones, if injured, should be left as long as possible, 
and particularly that of the index-finger, when the thumb remains. In all 
cases it is better, if possible, to leave the heads of the metacarpal bones in 
their places, rather than open into the joint of the carpus, if it can be 
avoided. If the articulating heads must come out, a strong, thin scalpel 
is to be pushed in between the bones, the ligaments cut through above, AMPUTATION. 
85 
below, and at the sides, and care should be taken in removing one or two 
of these bones, not to dislocate the others, and the joint should be covered 
by a flap or flaps made for the purpose, the sides of the remaining fingers 
being covered in a similar manner. This succeeds admirably, when the 
two outer bones and fingers only are taken away. 
The phalanges of the fingers may be removed by making a flap from 
the upper or under part, or from both, or from the sides. The square 
flap from the upper part of the finger is preferable, when the joint with 
the metacarpal bone is to be operated upon, the commencing points of the 
flap being united by a transverse incision on the under part of the joint. 
It should be recollected, that in all these incisions the larger end of bone 
belongs to that which is not removed, as may be shown by bending the 
finger, and that the ligamentous attachment between the metacarpal 
bones, connecting a middle one to its fellows on each side, should be cut 
through, when the joint will be easily dislocated. Attention should be 
paid to the division of the lateral ligaments in the removal of any of the 
bones of the fingers. 
Professor B. Langenbeck has operated in some instances, and he says 
successfully, without the loss of the finger, by sawing off, in the first case, 
the articulating ends of the first phalanx and of the metacarpal bone of 
the fore-finger, in consequence of an injury from a rotating piece of 
machinery; in another, the ends of the first and second phalanges of 
the middle finger after a severe laceration; and in a third case, by 
sawing off the end of the second phalanx, and removing the whole 
of the bone of the third of the fore-finger from the soft parts, leaving the 
nail; the man recovering with a shortened but useful finger. In all 
these cases, the flexor and extensor tendons were, from the first, 
uninjured. 
M. Langenbeck has also removed the metacarpal bone of the thumb; 
a new bone as a substitute being subsequently formed in its place, 
although the periosteum had been removed with it, which, however, he 
is always desirous of separating from the bone, and leaving behind, if 
possible, although he does not consider its remaining in the wound to be 
essentially necessary for the reproduction of the bone. To do this 
operation, he directs an incision to be made along the whole length of the 
bone toward the palmar aspect, thus avoiding the tendons. Then free 
both articulating extremities, and separate the soft parts from the body 
of the bone. 
If the thumb were to be left to itself, it would be drawn inward 
toward the palm and shortened, but this is to be prevented by a 
splint and apparatus to keep the thumb extended until the wound is 
healed. 
But little reliance can be placed on the means indicated for separating 
the periosteum from an otherwise healthy bone after an accident. When 
bones are softened by inflammation, it may, perhaps, be done. 
Part xxvi., p. 141. 
Secondary Amputations.—According to Mr. Guthrie, these are not so 
successful in military as in civil hospitals, because in the former they gene- 
rally take place within a short time after the primary operation, while the 
parts are still in a very irritable condition. Besides, the inflammation of 
the veins and sloughing of the stump are in some degree dependent upon 86 
AMPUTATION. 
the season; viz., the autumn, in which military operations are usually 
conducted. 
In secondary amputations in parts which have partaken of the exten- 
sive irritation which accompanies the original injury, a larger portion of 
the flaps will require to he preserved, although the integuments and mus- 
cles cannot he said to he unsound. In other words, the bone must he cut 
shorter, or the stump will he conical and had, and particularly if sinuses 
containing pus are found to run up between the muscles, or between 
them and the hone itself—a state very likely to give rise subsequently to 
caries. 
In sawing the hone, it may he again stated, the point of the saw should 
incline downward, and when two-thirds of the hone are divided, it should 
be made to cut perpendicularly, whereby the side next the operator is the 
last part divided ; and the hazard of splintering the bone at that moment 
will he avoided, particularly if the limb to he removed is held with great 
steadiness. 
In secondary amputations, twice, nay three times the number of 
arteries will bleed as in primary ones. In the thigh, the femoral artery 
should be drawn out with a tenaculum or spring forceps, and tied firmly 
with a single thread of dentist’s silk, one of the two ends being cut off 
close to the knot. The smaller the vessel, the smaller the thread required. 
Torsion or twisting the smaller vessels, so as to rupture their inner coats, 
answers very well in cases in which many small ones bleed. When a 
nerve is known to accompany an artery, it should be carefully separated 
from it. 
If bleeding should continue from above the ligature on the extremity 
of an artery, it is generally caused by some small branch given off from it, 
and which has been cut so close to the trunk of the vessel as not to have 
been observed. In this case the artery itself is to be drawn out by the 
tenaculum or spring forceps until the bleeding point can be seen, and a 
ligature placed above it, when the piece below should be cut off with the 
first ligature applied. This inconvenience will be in general avoided by 
taking care to divide the principal artery at one stroke of the knife, and 
with it half an inch at least of the surrounding substances, if the operation 
is done by the circular incision. If by flaps, the extent of the exposed 
arteries should be carefully examined, and the ligature applied at the 
highest point of exposure, when all below should be removed. 
When a tourniquet is used, and applied close to the incised parts, it 
often prevents, even when loosened, the principal vessel from being found, 
from having pressed on the ends of the muscles. If one is used, it should 
be removed as soon as possible after the principal artery has been secured. 
The repeated tightening and loosening of the tourniquet will cause more 
vessels to bleed in the end, and more blood to be lost, than if it had not 
been used, and it ought not to be resorted to when good assistance is pro- 
curable. In cases of this kind, in which the stump may not cense to ooze, 
the circulation being good, and sponging with cold water is not effectual, 
the wound should not be finally closed for two, four or more hours, until 
the oozing has ceased, and the parts can be freed from the coagulated blood, 
and brought together. 
In cases in which union is not expected to take place, both ends of the 
ligature should be cut off; for union is not to be desired of the external 
parts in many instances of secondary amputation, particularly after serious AMPUTATION. 
87 
injuries; the inflammation consequent on which has in some degree im- 
plicated the structures divided in the operation, rendering them less liable 
to take on the healthy action of adhesion. The soft parts should be simply 
approximated by two or more sutures, the edges of the wound having a 
piece of lint between them. This precaution should be particularly at- 
tended to after a great battle, when it is perceived that from the air, the 
crowded state of the hospital, or the season of the year, the stumps, al- 
though they may appear to unite in the first instance externally, do not in 
reality do so internally. Part xxvi., p. 163. 
Amputation at the Ankle.—Professor Syme states his having performed 
this operation above fifty times with complete success, the essential point 
of success being, his preserving entire the nourishment of the flap. As 
this can only be effected by the anastomosing branches of the integuments, 
the greatest possible care should be taken not to divide them. To the 
neglect of this caution Mr. Syme attributes the want of success which has 
attended some of the London surgeons in performing this operation. 
Part xxvi., p. 164. 
Amputation above the Knee.—In making the flaps in this operation, Mr. 
Luke makes the posterior flap by piercing and cutting from within out- 
ward ; but the anterior flap is made in the opposite manner, by carrying 
the knife in a curved direction antero-posteriorly through skin and 
muscle down to the bone. The flaps can be thus made with the greatest 
regularity, exactly to the size best calculated to make a good stump, 
forming a thick, symmetrical, and clean, cushion for the bone. 
Part xxvi., p. 165. 
Excision of the Proximal Phalanx of the Thumb.—In this case an ab- 
scess formed on the palmar side of the first phalanx, which was opened 
and the bone found to be bare. 
Mr. Teale proposed to remove the diseased phalanx, and to leave the 
terminal one. For this purpose, he made an incision, rather more exten 
sive than the phalanx, along its radial border. The ligaments and capsule 
connecting it with the terminal phalanx were next cautiously divided ; the 
shaft of the bone was then separated from the surrounding soft parts; and, 
lastly, it was detached from the metacarpal bone. The thumb was 
dressed with wet lint, and the patient confined to bed. The case pro- 
ceeded well, without any unfavorable occurrence. 
The disease in this case was caries, and not necrosis; and at the time of 
the operation what remained of periosteum being adherent, was removed 
with the bone. The latter circumstance accounts for there having been no 
reproduction of an osseous shaft. The success of the operation with so 
unhopeful a form of disease is the more satisfactory. In some cases of 
diseased metacarpal or phalangeal bones, a genuine necrosis of the shaft 
takes place, and a thin shell of new bone is formed by the periosteum. The 
success of an operation is of course much more probable in such a condi- 
tion than in one of caries. Part xxix., p. 196. 
Amputation by flaps.—If the circumference of the limb be twelve 
inches, for example, the anterior flap should be three inches, and the pos- 
terior six inches long; the knife having transfixed the soft parts, so as to 
make the anterior, or shorter flap, seven inches at its base; and the pos- 88 
AMPUTATION. 
terior, or longer flap, five inches. By this method the measured cut sur- 
faces of the two flaps are exactly equal. 
Stumps—Rules for the Formation of.—In the leg, amputation should 
he performed at the upper portion of the lower third, so that the patient 
may have a complete command over the artificial limb, without the stump 
being too long. The leg should not be amputated above the upper third, 
and where one-third cannot be saved it is better to amputate at the lower 
third of the thigh; so that a stump may be left of sufficient length and 
power. A good stump above the knee is far preferable to an indifferent 
one below. In the thigh the lofrer third is the best part. As a rule, in all 
cases, the larger the stump the better, unless, as in the case of the leg, the 
extreme length might interfere with the mechanical arrangements. The 
leg should never be amputated in children, but the lower third of the 
thigh always selected, because the amputated limb ceasing to grow in 
proportion with its fellow, the knee-joint will in time be elevated some 
inches above the other, imparting to the gait a peculiarly grotesque ap- 
pearance. Fart 198. 
Thigh—Amputation of—The longer the stump the better, and, if cir- 
cumstances warrant, operate at the knee-joint. Progression is greatly im- 
proved by the long stump thus left, the limb does not describe the semi- 
circular curve which it does with a short stump. The walk is altogether 
better. Fart xxx., p. 113. 
After-Consequences of Amputation.—The first and most pressing 
danger after amputation, says Dr. Hamilton, is hemorrhage. “ It may arise 
from half an hour after the operation to any number of hours or days, till 
union in the stump is effected. It is this that makes the surgeon careful to 
have his patient watched by an assistant always at hand. If the bleeding is 
only trifling, I would have you not interfere; compression on the face of the 
stump and the application of cold is often sufficient to check an in- 
considerable bleeding, which your opening of the stump would only tend 
to render a considerable one; but should the blood flow freely, the stump 
be swollen, and clots appear between the spaces of the sticking-plaster, 
you must open it forthwith, and search for the bleeding vessel. Before, 
however, the dressings are removed, firm pressure should be applied over 
the femoral artery, by a steady assistant. This is much better than the 
tourniquet; it causes the veins to become turgid and add to the bleeding, 
which sometimes even comes from the femoral vein itself. When you 
have no one to help you, there is no choice but to apply the tourniquet. 
Then carefully clean the face of the wound of the clots which you will 
nearly always see covering it. The blood will now be found to come in 
three ways : first, in a general oozing from the stump. In this case, if there 
are one or two spots whence the blood flows with more rapidity, you 
may take up the vessels; but, in this general bleeding, it is best to cover 
the part with shreddy lint, and press steadily with your fingers on it for 
some time. The bleeding will usually stop, or at least that bleeding which 
comes from small branches, temporarily increased or excited by the inflam- 
matory action which has begun in the end of the amputated limb. Those 
of larger size will then be more readily found and secured. Then put 
together the sides of the wound with sticking-plaster, or compress and 
bandage, giving up all hope of union by the first intention. AMPUTATION. 
89 
“ A more serious hemorrhage, though happily very rare, is from the fe- 
moral artery itself. This may occur early, from the slipping otf of the 
ligature, from its not having been tied sufficiently tight; or at a later 
period, when the ligature has been drawn off, but no proper clot or union 
exists at the end of the vessel. 
“ The third kind of hemorrhage is from the femoral vein, and is some- 
times very profuse. At the time of the operation there is occasionally 
troublesome bleeding from the femoral vein, which ceases on the slacken- 
ing of the tourniquet and removal of the tourniquet bandage ; or is readily 
restrained by putting a small compress of lint over the cut end of the vein. 
Most surgeons dislike applying a ligature* round a vein, but if the other 
means fail this must be. done. I removed the leg of a young man below 
the knee, for disease of the tarsus and ankle-joint; on the twentieth day 
after the operation, when all the ligatures had come away for several days, 
he was seized in the middle of the night with violent hemorrhage, not per 
scdtum, but in a free flow, and of a dark color. Pressure on the femoral 
artery did not stop it. All the stump had united except a small portion 
in the ham, which went like a large listula high up, and from which the 
hemorrhage came. Pressure over this part with lint saturated in a strong 
solution of alum and in turpentine, stopped the hemorrhage, which, how- 
ever, returned again and again, but was finally completely arrested by 
laying open the unhealed cavity from whence the hemorrhage came, and 
laying the compresses over an ulcer in the popliteal vein, from which the 
blood was seen to flow. 
“ The smaller ligatures come away about the tenth day ; the ligatures on 
the larger arteries, as the femoral, humoral, or posterior tibial, after the 
fourteenth, or longer; I have know even a month elapse before the last 
ligature came away. 
“ If the wound does not unite by the first intention, its progress is pretty 
much as follows : for the first two days all goes on well, but the third 
day you hear that the patient has passed a restless night; he complains of 
pain in the stump, and his face is flushed, skin hot, pulse quick, and the 
tongue loaded. After removing the lint dressing, the stump appears 
swollen and red, and the bandage looks too tight; you slit it up and 
remove one of the strips of plaster, when the Avound at once gapes, no 
union having taken place, and a quantity of thin, bloody matter gushes 
out; the patient complains of much tenderness, and can scarcely bear the 
gentlest compression by the sponge. Two things should be observed; 
first, not to put too many strips of plaster on, or too tightly, as room 
should be left for the matter to escape; and second, not to put the ban- 
dage on too tightly, or it will cause much uneasiness; let it be applied 
merely firmly enough to give support. 
“The Bone.—The usual course is for a lymphy exudation to cover the 
surface of the bone, whicli becomes adherent to the soft parts—this is 
Avhen the greater part of the stump heals by the first intention ; Avlien it 
does not, the surface of the bone, particularly the cancellous structure, 
throws up granulations, and union by the second intention is accomplished. 
Finally, the end of the bone is covered by a firm, fibrous material, its 
edges are absorbed, and it becomes conical. There is, however, trouble 
from the bone in two ways: first, the action of the saAV sometimes seems 
to kill the sawn surface of the bone ; and after the stump has refused to 
heal for a long time, the centre remaining open and discharging thin mat- 90 
AMPUTATION. 
ter, the bone can be felt hard and distinct at the bottom of the wound. 
At length it is perceived to be loose, and can, with a forceps, be with- 
drawn through the unhealed opening, or if not, an incision should be made, 
and it should be withdrawn. It sometimes presents a curious appearance ; 
a perfect flat l ing of exfoliated bone, about one-eighth of an inch or less of 
the end of the bone having become dead or separated entire. Another 
way is this ; you see that the end of the bone is pressing against the upper 
part of the stump, and that the integument there is strained and tense in 
consequence; the bone being drawn upward and forward by the action 
of the psoas and iliacus muscles, while the soft parts are drawn downward 
and backward, partly by their own weight and also by the powerful trac- 
tion of the hamstring muscles. You will best counteract these forces by 
putting a splint of tvood, either flat or scored, at the under and back sur- 
face of the limb, Avith a Avell applied bandage, and the tension against the 
end of the bone is at once relieved. If you do not do this or it does not 
answer, the part against which the end of the bone projects and presses 
becomes Avhite and glossy, then red and painful and very tender, then fluc- 
tuates, and finally ulcerates, and the end of the bone can be felt Avith a 
probe ; but though you Avould think the bone would exfoliate, it generally 
does not, but unites by granulation with the neighboring parts, and all 
goes on Avell. A stump that unites by the first intention, or, at least, that 
heals soon, is more likely to be a good plump one; when the healing is 
tedious from unhealthy action, or diseased bone, no matter Iioav Avell the 
operation has been done, the stump will be conical. 
“ jStow, Avithregard to the nerves—they rarely give any trouble. Nerves 
in a stump are, as Avas ascertained long ago by Mr. Langstaff, found, after 
the lapse of some time, to have bulbous extremities. 
“ If therefore, you find the ends of the nerves in an old stump ending 
in bulbs, you are not to consider them as diseased; nor, if any pain has 
been felt, that they are the cause of that pain ; nor can I say that cases 
Avhere they have been removed by operation haAre been satisfactory. 
Stumps are usually not Arery sensitive; but occasionally, from a con- 
stitutional, I belieA'e, rather than a local cause, the most violent pain is 
experienced,—a pain, apparently the most intolerable, and resembling 
tic-douloureux—absent for a time, but returning in paroxysms of dreadful 
severity. 
“ The case of the Marquis of Anglesea, AAdiose leg Avas amputated at 
Waterloo, will be familiar to you ; nothing that Avas tried gave him any 
permanent relief. The great Nelsou, also, suffered from this nervous affec- 
tion, after removal of the arm above the elboAV, and many years of his 
life Avere rendered miserable by it.” Part xxx., p. 118. 
Amputation of the Thigh.—In the upper part of the thigh the flap ope- 
ration answers well, hut at the lower third, the circular, or a modification 
of it, is preferable. Mr. Syme often modifies the circular operation as 
follows: form two short flaps of skin by semi-lunar incisions on the anterior 
and posterior surfaces—then retract the skin so as to expose two inches 
of the muscles above the angle of union of the flaps, and divide the 
muscles in front as high as they are exposed, and those behind as low as 
they are exposed, to compensate for their greater contraction. Take care 
to retract the muscles an inch and a half or two inches before sawing the 
bone, as it is not the length of the flaps that prevents the future pro- AMPUTATION. 
91 
trusion of the bone, but the height at which the bone is divided above 
the angle of union of the flaps. Part xxxip. 119. 
Amputation at the Ankle—-Prof Syme's Operation.—Make a transverse 
incision across the sole of the foot, from the tip of the external malleolus, 
or a little posterior to it (rather nearer the posterior than the anterior 
margin of the bone) to the opposite point on the inner side, which will be 
rather below the tip of the internal malleolus. If the incision be carried 
further forward, considerable inconvenience is experienced from the 
greater depth of the flap, the operator, getting into the hollow of the os 
calcis, cuts and haggles in striving to clear the prominence of the bone. 
Another incision is then to be carried across the instep joining the ends of 
the former. In separating the flap of skin from the os calcis, you must 
cut parallel to the bone. This is of the greatest consequence, as the flap 
is supplied with blood only by those vessels which run through it parallel 
to the surface—consequently if you are not careful you divide these 
vessels, and deprive the flap of nourishment. In dressing the wound 
afterward, be careful to avoid all pressure, as this will kill the flap. In 
this operation don’t leave the astragalus, but take it away, as it is very 
likely to be involved in the disease, and even if not carious then, it is very 
disposed to be so, and you had better remove all the bones which are 
liable to caries, not excepting the os calcis. Part xxxi,p. 120. 
Amputation of the Peg—Prof. Syme advises this to be done about an 
inch and a half below the tuberosity of the tibia. Take the head of the fibula 
or the tuberosity of the tibia as your guida, and make a short, anterior and 
posterior flap of integument only, entering your knife about a hand’s breadth 
below the bony prominence at the point which is to form the angle of junc- 
tion of the flaps at one side. Having dissected up the integuments to an 
inch and a half below the tuberosity of the tibia, divide the muscles behind 
about an inch lower down, to allow for their retraction, and then saw 
through the bones as high as the skin has been dissected up. The nicest 
kind of artificial leg is made of tin with a icooden pin—something like an 
inverted quart-bottle without a bottom. Part xxxi., p. 122. 
Hip Joint—Amputation at the.—Of the several modes of operating, 
that by a large anterior flap is considered by Mr. Tatum the best, because the 
artery can be grasped with the flap, by an assistant, before the vessel is divided. 
The flap falls by its own weight into its proper place, purulent collections 
escape more readily, and the wound consists of one continuous surface. 
During the operation the nates of the patient must project over the edge 
of the table, and the thigh must be slightly flexed on the abdomen : then 
take a knife fourteen or sixteen inches long, and transfix the limb to form 
the anterior flap, by making the knife enter about two inches below the 
anterior superior spine of the ilium, carrying it beneath the vessels to 
emerge immediately above the tuberosity of the ischium. The limb must 
now be forcibly abducted and everted, and the capsule opened, when the 
head of the femur will start out of the acetabulum. The remainder of the 
capsule is then cut, and the posterior flap made by carrying the knife 
downward and backward. A good deal depends upon the assistant 
slipping his fingers under the anterior flap as it is being formed, and com- 
pressing the femoral. Part xxxii., p. 107. 
Painful Stumps after Amputation.—From considerable experience we 92 
AMPUTATION. 
know that painful stumps are much more common after flap amputations 
than circular amputations; in the latter the nerves are cut off short and 
buried in the stump, while, in long flaps, the nerves are cut obliquely, and 
are more likely to be pressed upon. When very troublesome you must 
dissect out the bulbous extremity. Part xxxiii., p. 147. 
Amputation after Injuries.—The main artery of a limb may be 
suddenly obliterated, or the chief nerve be rent asunder without 
danger to the vitality of the limb. But if the muscles at the seat of the 
injury are very much contused, and the collateral channels for arterial as 
well as venous blood, are involved in the injury, it is more than probable 
that the limb will fail in nourishment, the indication of which is the loss 
of its temperature. Several hours, or even a day may be required to 
determine the affirmative on this evidence. To justify amputation for 
muscular injury, this must be very great, and the investing integuments 
not capable of replacement. Undue importance has been attached to 
exposure of the cavity of a joint and fractures into joints, although these 
must always be considered as serious complications, yet they often recover 
with good motion. Part xxxiv., p. 121. 
Amputation through the Ilnee Joint.—The French have recourse to this 
mode of operating only in those cases in which the heads of the bones of 
the leg are fractured into the articulation, but in which the injury has not 
extended to the femur. In many cases which occurred in the English army 
the operation performed was not strictly through the knee joint, but the 
low amputation recommended by Mr. Syme in disease of the articulation. 
The practical advantages of this are such as would seem to recommend its 
more general adoption in any future campaign. 
The obtaining of a longer and firmer stump, and one to which a false 
limb can be more easily attached, than when amputation in the continuity 
of the bone has been performed, is in itself no small advantage, presented 
by this operation. Few now participate in Liston’s opinion of along thigh 
stump. The rectus, with its point of insertion remaining entire, is a mat- 
ter of vast importance to the power of progression. The non-interference 
with the medullary canal obviates many of the dangers of amputation, ac- 
cording to Cruveilhier; while the extremity of the femur, which is largely 
supplied with blood-vessels, being retained, there is less risk of exfoliation 
than when the dense substance of the bone has been opened by the saw. 
There is little fear but that the flaps will adhere over the cartilaginous ex- 
tremity of the bone. 
Of the many ways of performing this operation, none appear so good as 
the old one of Idain. Part xxxiv., p. 126. 
New Operation in Surgery—Disarticulation of the Scapula.—The entire 
scapula, with its processes and glenoid cavity, were removed, in the Royal 
Infirmary of Edinburgh, on the first instant, by Mr. Syme, on account of 
a systic-sarcomatous tumor. The patient, an elderly female, is doing well, 
and the arm promises to be wonderfully little diminished in usefulness 
through the absence of the shoulder-blade. Part xxxiv., p. 128. 
Knee Joint—Amputation at the.—This amputation has lately been per- 
formed by Mr. Fergusson several times, and he believes that of all the thigh 
amputations it is really the best, as such a good flap and stump are obtained. 
Part xxxv., p. G9. AMPUTATION. 
93 
Flap Amputations—Cut from without inward, hut at first only down to 
the fascia, to allow for the greater retraction of the skin than of the mus- 
cles. Separate these superficial flaps from the subjacent muscles to a suffi- 
cient extent; then divide the latter by two incisions so as to form flaps. 
In the after-treatment of the part, Mr. Paget bandages the stump from 
above downward, the soft textures being at the same time drawn by an 
assistant over the ends of the bone. Part xxxvi., p. 124. 
Amputation at the Ankle Joint.—In performing this operation, after 
making an incision from malleolus to malleolus under the os calcis, at first 
suggested by Professor Syme, make a straight incision at right angles with 
the first to the back part of the heel, on the outer side of the foot, a little 
above and parallel with its outer margin, between, therefore, the point of 
the outer malleolus and the margin of the foot. By this means the opera- 
tion is considerably facilitated, and pus does not subsequently collect in 
the cup-shaped flap. The principal bloodvessels lie at the fore part and 
inner side of the ankle joint, and beneath the foot. Part xxxvi., p. 147. 
Turpentine as a Detergent.—We noticed hi use at the Dreadnought, 
the oil of turpentine as a wash for stumps, etc., which may have got coated 
with plaster or other adhesive material. It is, we believe, also used at 
several other hospitals for the same purpose. The part is freely washed 
with tow dipped in turpentine. It does not appear to unduly irritate, but 
restores a healthy glow to the cutaneous surface, and the patients describe 
its effect as being pleasant rather than otherwise. Part xxxvii., p. 267. 
Amputation by a Long and Short Dectangidar Flap.—The excellence 
of a stump is not to be judged by its seemly form and its being not offen- 
sive to the sight; we ought to inquire whether it is well adapted to loco- 
motion, by being able to bear a considerable portion of the weight of the 
body on its end. Now as a general rule, it may be stated that stumps 
are not able to bear even the slightest pressure on their extremities where 
amputation has been performed by the circular or ordinary double-flap 
transfixion methods. Mr. Heather Bigg and Mr. Grossmith, of London, 
and Mr. Thomas Eagland, of Leeds, surgical mechanicians, who have had 
extensive experience in the adaptation of artificial limbs, state that press- 
ure can never be borne upon the end of the stump formed by the 
circular or transfixion methods, on account of the pain produced ; and that, 
as a general rule, the cicatrix is found adherent to the end of the bone. 
To procure a more useful stump, and in the hope of somewhat diminish- 
ing the mortality of amputations (which in the London and Provincial 
Hospitals together is nearly one case in three for the last thirty years), at 
the Leeds General Infirmary amputation has been performed by a long 
and short rectangular flap. “ The size of the long flap is determined by 
the circumference of the limb at the place of amputation, its length and 
its breadth being each equal to half the circumference. The long flap is 
therefore a perfect square, and is long enough to fall easily over the end 
of the bone. In selecting the structures for its formation, such parts must 
be taken as do not contain the large blood-vessels and nerves. A flap so 
formed will be for the most part anterior in position as far as regards the 
general aspect of the body, but superior when the patient is in the recum- 
bent posture, as during the after-treatment. The short flap, containing the 
chief vessels and nerves, is in length one-fourth of the other.” Thus, if the 94 
AMPUTATION, 
limb be 16 inches in circumference, the long flap will be 8 inches by 8, 
and the short flap 8 inches broad by 2 long. The flaps are united lightly 
by sutures, one or more of which may be subsequently removed if tension 
come on. ]STo dressing whatever is required in the early part of the treat- 
ment ; thus disturbance of the stump is avoided; for in all these kinds of 
cases the non-disturbance of the plastic process is the chief point on which 
the future safety of the patient depends. Stumps obtained by this method 
of operating have a soft mass of tissues, devoid of large nerves, movable 
over the sawn end of the bone, which enables them to bear pressure on 
their extremity. This operation has been performed 56 times altogether, 
with a mortality of 1 in 7. Amputations of the leg for disease show a 
mortality of 1 in 27 : in the London hospitals these amputations are 
attended with a mortality of 1 in 3|. 
Mr. Teale strongly recommends the surgeon, on first practising this ope- 
ration, to mark out the lines of intended incision, in ink, lest the long flap 
should be made too small. Part xxxviii., p. 127. 
Pesecticn and Excision of the Phalanges.—In appropriate cases, such 
as caries of the head, ungual phalanx, or of the Avhole bone, excision 
of the head, is the proper treatment. In removing the head of a phalanx 
for disease of the joint, do not use the bone nippers, but a fine watchspring 
saw, as the parts will heal more rapidly, and take care to extend the parts 
whilst healing, to prevent anchylosis. Supposing the whole of the ungual 
phalanx to be diseased, do not amputate, but remove the whole bone; the 
sides of the tip of the finger should then be slightly compressed against 
each other, and the part retained in an extended position. 
Part xxxviii., p. 141. 
Amputation at the Carpo-metacarpal Articulation—By amputating at 
the carpo-metacarpal articulation, instead of at the wrist joint, as generally 
done, you preserve uninjured the motor power of the wrist joint, which 
is lost in the latter operation; the flexion and extension is perfect, and 
a useful substitute for a hand may be adapted to it. Mr. Iludall says : 
I have performed this operation between the years 1828 and this time, 
on four different occasions, the results of injuries from fire-arms and 
machinery. The last case will suffice for the present notice. A boy, 
aged thirteen years, on the 20th of January of this year, sustained an 
injury of the right hand, from its passing between two wheels of a power- 
ful machine, by which the fingers and lower portions of the metacarpal 
bones were literally ground to atoms. The shock upon the system was 
intense ; ten hours elapsed, during which stimulants were freely admin- 
istered, before I felt myself warranted in operating. I feared the use of 
chloroform, and proceeded to the operation, which of itself is very simple, 
and may be done four or five times while describing it once. I made my 
first flap on the thenar and palmar aspect, commencing on the dorsal half 
of the articulation of the thumb with the trapezium, carrying my flap so 
far into the palm of the hand as was well savable; the dorsal flap was not 
so large. Having divided the integuments of each flap with the muscles, 
tendons, etc., disarticulation was effected, by bending the hand on the 
wrist, and separating the articulations from the dorsal aspect of the joint. 
Ligatures are not necessarily required in this operation, torsion effected 
with Liston’s common artery forceps being sufficient. The flaps were 
brought together by three sutures, and cold^water dressings, which were 95 
ANAEMIA, 
the only means resorted to for the perfection of the cure. Duration four- 
teen days. Part xxxix.}jp. 145. 
AN2EMI A. 
Treatment of Anaemia.—In treating anaemia, Dr. Turnbull recom- 
mends the use of remedies which improve the general health and strength 
of the patient, arid tend to increase the quantity, and improve the quality 
of the blood: these are, the vegetable bitters, the sulphate of quinine, 
and other tonics, but especially the preparations of iron, which have a 
powerful effect in increasing the quantity of that constituent of the blood 
which is deficient in anaemia. 
Iron forms the chief part of the haematosin which is contained within 
the external envelope of the red globules; therefore, this is one of the 
most important medicines by which to increase the quantity of the glo- 
bules. It is better to give iron in small quantities for a long time, than in 
large doses for a short time. 
The sulphate of iron is one of the most useful and active preparations, 
and it may be given in the form of pill, with a bitter extract, such as that 
of gentian, or a sedative, such as hyoscyamus or conium, or with an 
aperient powder or extract, such as aloes or rhubarb, or with any of these 
combined. It may also be given in ‘solution, with a bitter infusion, to 
which a little sulphuric acid has been added, to hold the iron in solution ; 
or it may be exhibited in combination with the sulphate of magnesia or 
potass, the solution being acidulated with sulphuric acid. It may thus be 
given in combination with several of the medicines required in ana3mia; and 
from this circumstance have I used it more frequently than any of the other 
preparations, and I have also found it one of the most efficient. The ses- 
quioxide of iron is a convenient form when we have to treat aneemia in 
children, to whom it may be given with compound cinnamon powder, or 
with rhubarb, or mercury with chalk, where the secretions are deranged. 
I have also given it to adults along with the confection of senna, bitar- 
trate of potass, and sulphur. This combination possesses several 
advantages, inasmuch as it increases the secretions from the skin, kidneys, 
and intestinal canal, while it exerts a tonic effect by the introduction of 
iron into the system. The compound mixture of iron is a good prepara- 
tion. It is milder than the sulphate, but it scarcely equals this, and the 
tincture of the muriate, in efficacy. This last preparation is one of the 
best, but it does not admit of being administered in so many forms as the 
sulphate. Several of these preparations seem to me to be often given in 
larger doses than is necessary, where we wish to obtain little effect 
beyond the absorption of the iron which they contain into the blood. 
This observation applies especially to the sulphate and the muriated tinc- 
ture. 
That the efficacy of the preparation is not in proportion to the quantity 
of iron it contains, is proved by the fact, that many mineral waters are 
very powerful, though they contain less than a grain in the pint. 
The preparations made from combination of iron with the vegetable 
acids are less efficient than those with the mineral acids, and Dr. Williams 96 
ANAEMIA. 
observes that the citrate and tartrate are more tardy in their operation. 
These are, however, milder in their action. 
The potassio-tartrate of iron may be given, along with the bitartrate of 
potass, when there is oedema of the ankles, or of the cellular tissue gen- 
erally, and when we wish, therefore, to produce a diuretic effect. 
Dr. Williams states, that in many comparative trials he found the iodide 
of iron, in solution with syrup, the most speedily efficacious of the prepa- 
rations of iron, and that by its use he has seen females restored from 
extreme pallidity to a rosy hue of health in less than three weeks. 
There are other tonics which are useful in anaemia, such as the vegeta- 
ble bitters, gentian, eascarilla, caliunba, which may be given in conjunction 
with iron. In many cases, too, where there is much irritability of the sys- 
tem, the preparations of iron cannot at first be borne, as they cause heat of 
skin and thirst, or sickness, or headache; and when this occurs, it is neces- 
sary to promote the secretions, and to give the vegetable tonics with seda- 
tives, in order to prepare the system for the exhibition of iron. Quinine 
is very useful in many cases: 
It is most useful in the anoemia from lactation and from profuse men- 
struation, and in some of these cases it may be given in solution along with 
sulphate of iron and sulphuric acid. In most cases of profuse menstrua- 
tion the preparations of iron are hurtful, and in these, quinine and the 
shower-bath are preferable. 
When there is much depression or irritability of the nervous system, we 
must administer stimulant and antispasmodic, or sedative medicines; such 
as carbonate of ammonia, camphor, valerian, hydrocyanic acid, and hvo- 
scyamus. The carbonate of ammonia is exceedingly useful in equalizing 
the circulation, which is very often irregular in anaemia, and in restoring 
the temperature of the extremities when they are cold. 
The first organ to be attended to will often be the stomach and diges- 
tive organs. 
When the tongue is pale and clean, without redness at the point, and 
there is only weight and uneasiness during digestion, with or without 
eructation, but without sickness and vomiting, and the extreme sensibility 
of the nerves of the stomach, we may commence with the compound iron 
mixture, or with the muriated tincture in a bitter infusion, or with pills ot 
the sulphate of iron, constipation being, however, in all cases, removed by 
some of the means that have been pointed out. In many such cases the 
preparations of iron in a short time remove the dyspeptic symptoms. In 
those where the sensibility is greater, where there is severe pain after 
taking food, and occasional sickness and vomiting, and when there is 
an extremely anaemic state, it will be well to lessen the sensibility, and res- 
tore, in some degree, the tone of the stomach, by sedatives and stimulants, 
combined with the vegetable bitters, before exhibiting any of the prepa- 
rations of iron. The infusion of calumba may be given with carbonate of 
ammonia, or with soda and hydrocyanic acid, or with tincture of liyoscya- 
mus or the muriate of morphia. The addition of compound tincture of 
cardamoms, or of some aromatic tincture, will also, in many instances, 
prove useful. In this way we shall gradually lessen the sensibility of the 
stomach, and prepare it for the milder preparations of iron, or for the sul- 
phate, which, in these cases, may be given in the form of pill with hyo- 
scyamus and aloes, and in this way its action will be exerted less upon the 
stomach than upon the intestinal canal. AN.EMI A. 
97 
Where there is pyrosis, a similar plan of treatment must be adopted, 
but the secretions from the liver and intestinal canal must be more fre- 
quently promoted by rhubarb, magnesia, or carbonate of soda and mercury 
with chalk, or by colocynth and blue pill at night, followed in the morn- 
ing by a draught with the infusions of senna and gentian, and the sulphate 
of magnesia, or tartrate of potass. In the cases of gastrodynia, with pain 
of neuralgic severity occurring at intervals, especially after taking food, 
hydrocyanic acid and the muriate of morphia are the remedies most gen- 
erally useful. The nitrate and the oxide of silver are also of service ; and 
a plaster of belladonna applied over the stomach will often remove, and 
will almost always relieve, the pain : belladonna, in fact, alfords relief from 
almost all the neuralgic pains of anaemia, and is a most valuable remedy. 
Stimulating liniments, blisters, and the external application of croton 
oil, and tartar emetic, may also be tried when the pain is severe and 
obstinate ; but leeches, though they may occasionally give a little tempo- 
rary relief, should never be employed, unless there be some inflammatory 
irritation of the mucous membrane. 
When there is irritative dyspepsia, with redness at the tip of the tongue, 
thirst, feverishness, and pain, or rather soreness at the stomach, it some- 
times becomes necessary to apply a few leeches, and even to repeat the 
application in order to prepare the stomach for tonics. The nitrate of 
potass, and the muriate of ammonia, when given in these cases along with 
hydrocyanic acid, produce a feeling of coolness at the stomach, and assist 
powerfully in removing the inflammatory state of the mucous membrane. 
These medicines may be given at first in water, and afterward in infusion 
of calumba or quassia, until the stomach can bear the milder preparations 
of iron in solution, or the sulphate in the form of pill. Milk and farinace- 
ous food constitute the most suitable diet in the early stage of these cases. 
When, from the severity and persistence of the pain at the stomach, or 
from the occurrence of hematemesis, we have reason to suspect the pre- 
sence of ulceration of the gastric mucous membrane, our treatment will not 
differ materially from that recommended for gastrodynia. Chalybeates 
should still, if possible, be given, and counter-irritation should at the same 
time be employed. Sulphate of iron, given according to the formula of 
Dr. Abercrombie, is, perhaps, the best remedy we possess; two grains of 
the sulphate of iron to be taken three times a day, in combination with five 
of aromatic powder and one of aloes. Much will also be gained by attention 
to diet, which should be easily digestible, and at the same time nourishing. 
In cases where there is relaxation and increased secretion from the bron- 
chial mucous membrane, the combination of the mineral acids with the other 
tonics is desirable. I have occasionally found the tincture of cubebs usefull 
in checking the secretion, and have been in the habit of giving it, com- 
bined with oxymel of squill and compound tincture of camphor. Coun- 
ter-irritation should also be used ; and the following is the formula I 
employ : One drachm of croton oil, with four and a half of olive oil, and 
half a drachm of cajeput oil, made into a liniment, and rubbed upon the 
chest twice a day. Little modification of the general plan of treatment is 
required for palpitation of the heart, and for anmmic pulsation of the aorta. 
The removal of any complications connected with the digestive organs, 
and the use of chalybeates are generally sufficient to take away these 
symptoms. The compound galbanum pill may be given to remove flatu- 
lence ; and when the circulation is feeble, with disposition to faint, the 
1 98 
ANJEMIA, 
carbonate of ammonia, with valerian or ether, will counteract this, and 
tend to restore the circulation in the extremities. 
When the nervous system is in a very irritable and easily excited state, 
so that the slightest noise is sufficient to startle the patient, camphor, in 
combination with the extract of hyoscyamus, with be found serviceable, or 
the carbonate of ammonia may be given with tincture of valerian in cam- 
phor mixture or a bitter infusion. Sulphate of quinine in solution, along 
with sulphuric ether, may also be found of use. The vertigo, noises, and 
headache, are in general removed only by degrees, in proportion as the 
quality of the blood is improved, and unless unusually severe, they do not 
require any special treatment. It has been already observed, that in some 
cases the preparations of iron increase the head symptoms, and when this 
occurs to any considerable extent, or when the pain in the head is unusually 
severe, or the vertigo so great as to endanger the patient falling, we must 
proceed, in the exhibition of chalybeates, in the same gradual manner as 
where there is much irritability of the digestive organs. These symptoms 
of congestion are too often treated by depletion with leeches, which fre- 
quently increases the pain and feeling of giddiness, and necessarily proves 
always more or less injurious in a state of anaemia, owing to the removal 
from the system of a portion of all the constituents of the blood. In 
these cases, if the symptoms are urgent, or if a mild stimulant plan of 
treatment with purgatives, and followed by the cautious use of some of the 
preparations of iron, do not remove the unpleasant symptoms, a blister 
should be applied to the nape of the neck. This will seldom fail to give 
relief, and it is the remedy best suited to these cases, as it removes con- 
gestion of the vessels by producing depletion, without, however, taking 
from the blood the part which is deficient in anaemia. I may also ob- 
serve, that in all cases of congestion, and even acute inflammation, occur- 
ring in anaemic persons, we should be sparing in the use of blood-letting, 
general or local, which is the most direct means of lessening the globules ; 
and we should give preference to the application of blisters. A spirit lo- 
tion is a suitable application in cases of pain in the head from anaemic con- 
gestion of neuralgia. 
The periodic neuralgic pains of the face are to be treated by the ex- 
ternal application of belladonna, and by quinine, and the carbonate and 
other preparations of iron. The pains in various parts of the body, in the 
spinal column, and in the nerves issuing from it, are to be treated by stim- 
ulating and anodyne liniments, the belladonna plaster, and occasionally, 
blisters. We have still to notice those cases of anaemia in females, where 
suppressed, irregular, or scanty menstruation forms a prominent symptom. 
The secretions from the intestinal canal having been first evacuated by 
means of mild mercurial medicines, the bowels are to be kept open once or 
twice daily by means of the aloes and myrrh, or compound aloetic pill, or 
by the compound decoction of aloes. 
Dr. Ashwell regards the combination of cordials with asperients as im- 
portant, and recommends the following draught to be taken twice or 
three times a week : Powdered rhubarb; carbonate of magnesia; of each 
half a drachm; aromatic confection, one scruple; cinnamon water, nine 
drachms ; compound tincture of cardamoms, one drachm, lie recom- 
mends that the sulphate of iron should be taken three times a day, in the 
dose of one or two grains, combined with extract of hops, aromatic con- 
fection, and a single grain of poppy or hyoscyamus extract. I frequently ANJ2MIA, 
99 
prescribe pills made with sulphate of iron, powder or extract of aloes, and 
extract of hyoscyamus, of each, one scruple, divided into twelve pills, and 
one taken three times a day. The superior efficacy of the iodide of iron 
in many of these cases has been already adverted to. 
Where other preparations of iron have been injurious, Dr. Ashwell has 
found the carbonate in the following combination agree with the patient: 
Carbonate of iron, eight grains ; powdered ipecacuanha, one grain ; mer- 
cury, with chalk, two grains. This powder to be taken once or twice a 
day. He also recommends, when the general health is somewhat re- 
stored, the use of the mustard hip-bath, or the local salt shower-bath, or 
the injection into the vagina of a drachm of liquor ammonia to a pint of 
milk. Where the uterus has seemed to require to be stimulated, after the 
restoration of the general health, I have in many cases found effectual, a 
draught with turpentine and castor oil. 
The slight cedema of the ankles and of the cellular tissue generally, 
which is occasionally met with in anaemia, and chiefly in that form under 
consideration, viz., chlorosis, requires that the treatment should have 
especial reference to this complication. Our first object must be to increase 
the secretions from the bowels, the kidneys, or the skin, or from all of 
them, so that the specific gravity of the liquor sanguinis may be increased, 
and the natural relations between this fluid, the chyle, and the fluid of the 
globules, restored. The aperient best suited to these cases is the com- 
pound powder of jalap, alone or with calomel, or the bitarti-ate of potass. 
The potassio-tartrate of iron may also be given, along with the bitartrate 
of potass, to act as a diuretic. The sulphate of magnesia or of potass, 
given along with sulphate of iron, will act upon the bowels and kidneys, 
besides introducing iron into the system. Where the bowels have been 
very obstinate, I have combined a small quantity of elaterium with the sul- 
phate of iron and aloes, in pills. The restoration of the healthy action 
of the skin is of the first importance in these cases, and the cutaneous 
transpiration should be promoted by baths, friction and exercise. 
In several cases of chlorosis I have seen a single warm bath completely 
remove the cedema of the ankles. Part xiii., p. 69. 
Diagnosis of Chlorotic Anaemia.—Every instance of anaemia is not 
always discoverable upon inspection of the tints of the skin, nor upon a 
survey of the state of the-patient as to her embonpoint, since in some 
anaemic individuals, the cheek and the lips retain a considerable degree of 
freshness and vivacity of color from a natural exuberant vascularity of 
the tissues composing them ; and there are not a few anaemic patients who 
even grow fat during the malady. 
Dr. Meigs would test the state of the lungs by asking the patient to 
make several forced inspirations, in order to discover whether the capacity 
of the lungs for atmospheric air were at all lessened by disease; and should 
she appear to be able to inhale fifty or sixty cubic inches at an inspiration, 
would have a right to conclude that the air-cells of the lungs were free 
from pressure or obstruction, and duly expansible. This view might be 
confirmed by percussion and by auscultation of the chest. Still the respi- 
ratory difficulties remain to be accounted for, especially those resulting 
from every muscular effort. 
Dr. M. would next examine the frequency of the pulse, which, in a state 
of rest, might be sufficiently quiet—as at 70, 80, or 90, beats per minute. 100 
ANJEMIA, 
If now the patient be requested to walk to the head of the stairs, and re- 
turn immediately to her seat, she will, if anaemic, be found to have the pulse 
greatly accelerated and beating in the most troublous manner, to the 
number of 120,and even 160 pulsations per minute, while the respiration may 
amount to 40 and even to GO £>er minute. Part xiv., p. 69. 
Remarkable Form of Anaemia. — At a meeting of the South London 
Medical Society, Dr. Addison described a form of anaemia which has not 
hitherto attracted much attention. It affects adult males, and comes on 
most frequently in an insidious manner. 
Its approach is first indicated by a certain amount of ianguor and rest- 
lessness, to which presently succeed a manifest paleness of the counte- 
nance, loss of muscular strength, general relaxation or feebleness of the 
whole frame, and indisposition to, or incapacity for, bodily or mental exer- 
tion. These symptoms go on increasing with greater or less rapidity : the 
face, lips, conjunctive and external surface of the body, become more and 
more bloodless, the tongue appears pale and flabby; the heart’s action gets 
exceedingly enfeebled, with a weak, soft, unusually large, but always 
strikingly compressible pulse ; the appetite may or may not be lost; the 
patient experiences a distressing and increasing sense of helplessness and 
faintness; the heart is excited, or rendered tumultuous in its action, the 
breathing painfully hurried by the slightest exertion, whilst the whole sur- 
face bears some resemblance to a bad wax figure; the patient is no longer 
able to rise from his bed; slight oedema perhaps shows itself about the 
ankles; the feeling of faintness and weakness becomes extreme, and he dies 
either from sheer exhaustion, or death is preceded by signs of passive 
effusion or cerebral oppression. With all this, the emaciation or wasting 
of the body, though sometimes considerable, is not unfrequently quite dis- 
proportionate to the failure of the powers of the circulation—relaxation 
and flabbiness, rather than wasting of the flesh, being one of the most re- 
markable features of the disorder. 
Dr. Addison next proceeded to give the details of several cases which 
had fallen under his own immediate observation. In only two of these did 
the patient recover: the one, a man below the middle period of life, who 
was looked upon as past all hope, and suspected to be suffering from some 
latent malignant disease, slowly but steadily recovered under the free use 
of brandy, but with the singular result of the hair on one side of the head 
turning permanently grey, whilst the other retained its original brown 
color. The second case of recovery occurred in a gentleman above middle 
age : it was by no means far advanced, but was sufficiently well marked to 
excite alarm. He left his business, quitted London, and sought recreation 
in the country. After a time he returned, and appeared to have shaken 
off the disorder entirely. In three cases only was there an inspection of 
the body after death, and in all of them teas found a diseased condition 
of the supra-renal capsules. In tAvo of the cases no disease whatever could 
be detected in any other part of the body. Dr. Addison inquired if it 
Avere possible for all this to be merely coincidental? On the contrary, he 
could not help entertaining a very strong impression that these hitherto 
mysterious bodies—the supra-renal capsules—may be either directly or 
indirectly concerned in sanguification; and that a diseased condition of 
them, functional or structural, may interfere Avith the proper elaboration 
of the body generally, or of the red particles more especially. 
Part xix.,jp. 38. ANAEMIA 
101 
Relation between Anaemia and Goitre.—Dr. Begbie states, that in coun- 
tries where bronchocele prevails in an endemic form, the 
countenances, protuberant eye-balls, and other signs of bloodlessness mani- 
fested by those infected with the bronchocele, render it probable that both 
are effects of the same cause—anaemia. 
Bronchocele, wre are also told, develops itself rapidly during confinement 
in childbed, and undergoes a temporary augmentation during the flow of 
the menses. Dr. Parry has often seen goitre follow functional disorders 
of the heart—disorders known to depend very frequently on deficient san- 
guification. It is a form of the hydropthalmia of systematic writers—per- 
haps that form of dropsy denominated buphthalmus, or ox-eye, which 
accompanied the enlarged thyroid gland as a concomitant symptom of 
anaemia, in the cases related by Dr. Begbie. He found this enlargement 
of the globe of the eye the result of congestion and effusion, intimately 
connected with that condition of the system in which the blood is deficient 
in fibrin and coloring matter ; and yielding to a plan of treatment adapted 
to such a state. 
This treatment consisted in the use of carbonate of iron with aloetic pur- 
gatives, and soothing doses of hyoscyamus; with sea-side residence, full diet 
of animal food, and exercise in the open air. 
With regard to the treatment of anaemia and its secondary disorders, 
first ascertain the exciting cause ; and having arrested or removed this, 
give the preparations of iron freely, and for a great length of time, with a 
liberal allowance of animal food, and porter or ale, in preference to wine. 
Recommend also change of air and travelling. Part xix., p. 39. 
Treatment of Anaemia.—Give nourishing diet, with as much animal 
food as the patient can hear; let the patient be exposed to the pure air 
and light of heaven as free and as long as the strength and sensibility will 
bear; promote the natural excretions by appropriate means; and give 
tonics, especially iron, the syrup of the iodide, preceded or not by some 
mild bitter. Employ diffusible stimulants, sedatives and narcotics, external 
stimulants, rest in the horizontal posture, and warmth to the extremities, 
when special circumstances point out the necessity for these means. And 
if the nervous symptoms do not cease with the removal of the anaemia, 
give the metallic tonics, zinc, silver and copper. Part xx.,p. 32. 
Anaemia as a Consequence of Rheumatism.—In commenting on some 
cases of acute rheumatism at St. Vincent’s Hospital, Dr. O’Ferrall stated 
that he was induced to believe that this disease had a tendency, in its 
latter stages, to produce phenomena connected with a diminution of the 
globules of the blood. The attention of Dr. O’Ferrall was first called to 
the subject by observing that, in cases with endocardiac complications, 
after the employment of depletion and mercury, a cardiac bruit of a differ- 
ent character from that which originally presented itself,, continued to 
persist, notwithstanding the steady employment of the usual means for 
subduing inflammatory action. By and by, cases terminating fatally came 
under his observation, in which, although this bruit was present to the 
last, no morbid appearances could be detected in the heart upon post- 
mortem examination. Afterward, he found that a rale musicale in the 
cervical vessels very constantly accompanied this peculiar cardiac bruit; 
and he was led to suspect, that after the subjection of the inflammation by 102 
ANAESTHESIA. 
bleeding and mercury, an anaemic condition followed the use of these 
remedies, which would require a very different treatment for its subdual, 
lie accordingly ordered chalybeates, as in an ordinary case of chlorosis, 
and found the cervical and cardiac bruits to disappear under the use of 
this remedy.. 
This observation is one of very great practical importance, teaching us 
the necessity of discriminating between those cardiac sounds produced by 
the participation of the heart in the general rheumatic disease, and those 
arising from deterioration of the blood. The treatment in the two cases 
must obviously be of a totally different nature. Part xx., p. 34. 
Employment of Manganese in Anaemic Affections.—In those cases of 
anaemia which are not benefited by iron, give salts of manganese. The 
carbonate or phosphate may be given in the form of pill, to the extent of 
three or four grains daily; or the phosphate or iodide may be given in the 
form of syrup, according to the formula. Vide “ Manganese.” 
Part xx., p. 35. 
Tannin in Anmmia.—Give a grain or two of tannin twice or three times 
a day, dissolved in water or any simple vehicle, flavored with syrup to 
conceal the taste. The use of tannin does not prevent the employment of 
other remedies, such as iron, cod-liver oil, etc., but rather promotes their 
efficacy. Part xxi., p. 326. 
Chlorotic Anaemia.—In chlorotic anaemia especially, give the saccharine 
carbonate of iron and manganese. This preparation is much more power- 
ful than the simple carbonate of iron. In the chronic anaemia of children, 
the extract of bullock’s blood, in doses from 9j. to 5j., may be given with 
great benefit. In infantile anaemia we may give 15 grains of this extract 
with three grains of the above double salt with great advantage. 
Part xxix., p. 324. 
Anaemia.— Vide Selections from favorite prescriptions, Art. “Medi- 
cines.” 
Anaesthesia treated by Electro-magnetism.—This patient had been 
laboring under a slight leucorrhoeal discharge, for which she had been 
directed to use a cold hip bath every morning. Every time she left the bath 
there was a loss of feeling in the skin, which gradually subsided in about 
half an hour ; after the twelfth bath, however, it became permanent. She 
was in good health when Mr. Christophers was called to her, and had 
taken a walk that day; she had no feeling from her toes upward as far as 
the -water had extended ; she complained of not being able fully to eva- 
cuate the rectum, and of the urine slowly dribbling away. The tempera- 
ture of the parts was below that of the rest of the body; numerous 
remedies were resorted to without benefit, when the application of electro- 
galvanism was resolved upon. 
The method adopted was—first to pass a current down the whole spine 
for half an hour ; then from each side of the sacrum to each foot for half 
an hour; then from the spine to the abdomen for the same period. At 
ANESTHESIA. ANAESTHETICS. 
103 
the end of the twenty-two days the patient was quite restored ; no trace 
of the malady remained. Part xiv., p. 58. 
Anesthesia.—Dr. T. Cattell thinks the following principle, being in all 
cases acted upon in the induction of anaesthesia, would obviate most of 
the dangers attendant thereon, viz., that no anaesthetic agent should be 
allowed ingress to the lungs, of a higher specific gravity than the air we 
breathe. Part xxiii., p. 340. 
Anesthesia—Arrest of.—Anaesthesia is a momentary disturbance of the 
cerebro-spinal system. To remedy it, apply electricity to various parts of 
the body, especially over the cerebro-spinal axis. Part xxv., p. 328. 
Action of Anesthesia.—Dr. Detmold favored the 1ST. Y. Academy 
with a written exposition of his views of the rationale of the action of 
chloroform, sulpli. ether, and nitrous oxide, the three agents employed for 
the purpose of producing anaesthesia. He attributes the action of all of 
them to the production of carbonic acid gas in the system. The first two 
supply the carbon, which absorbing oxygen from the blood, and the last 
supplying oxygen, which absorbing carbon, in either case carbonic acid is 
the result, which by its action on the living organism produces anaesthesia. 
This theory, though not absolutely susceptible of demonstration, is yet 
apparently based on a logical foundation, and finds a seeming confirma- 
tion in a number of well-known facts. Part xxxvii., p. 263. 
AN51STHET ICS. 
Anesthetics—Chloroform.—The use of chloroform in operations is not 
contra-indicated by any state of the patient as to age or constitution, nor 
by any disease which does not itself forbid the operation. In administer- 
ing chloroform, always use an inhaler, and watch carefully the effects pro- 
duced ; and do not seek to produce insensibility in less time than two or 
three minutes. When the margin of the eyelid can be touched without 
causing contraction of the orbicularis muscle, or even when it causes but 
slight contraction, any operation can be performed without pain. At this 
time, as the effects of chloroform continue to increase for a few seconds 
after the inhalation is discontinued, it is advisable to intermit the vapor 
for a few inspirations, or to dilute it with more air, so as not to carry the 
insensibility too far. When the operation is over, do not disturb the 
patient prematurely, but await the complete return of consciousness. 
Part xix., p. 338. 
Dutch Oil.—The chloride of olefiant gas, or Dutch oil, is a safe and 
efficient anaesthetic. The dose required is smaller that than of chloro- 
form, and its effects are more agreeable. Part xix., p. 340. 
Anesthetics.—Bromoform, Dutch liquid, and common coal gas, are safe 
and powerful anaesthetics; and the latter, as being cheap, deserves a 
further trial. Sulphuric ether should be given when there is much con- 
stitutional debility, or where the operation is likely to be long and tedious, 
or where it is likely to produce considerable shock and depression. Chlo- 
roform, though very agreeable and powerful, requires more care in its 104 
ANAESTHETICS. 
administration than lias usually been employed. The principal precau- 
tions to attend to in its administration are : not to give too much at once, 
and not to let the temperature be too high, to take care that the air can 
pass freely in and out of the lungs—not to give the vapor in too concen- 
trated a form at first—to withdraw the anaesthetic as soon as there are indi- 
cations of unconsciousness and insensibility being jwoduced—and then to 
give the vapor much more diluted, so as just to keep uj> the condition 
of insensibility. 
Remedies for an Overdose.—Remove the anaesthetic; dash a small 
quantity of water upon the face and chest, possibly alternating with heat 
to the latter; use moderate interrupted compression of the lungs, so as to 
change the air in the lungs, and so get rid of the vapor there remaining; 
or, with the same intention, blow a stream of air, not too forcibly, through 
a small tube into the larynx for a minute or two. It is important, in the 
present state of our knowledge, not to attempt to do too much. 
Part xx., p. 244. 
Dutch Liquid.—According to Dr. Snow, Dutch liquid possesses no 
advantages over chloroform but such as are connected with its slower 
action and more persistent effects. It is, therefore, only on a few occa- 
sions that its use is to be preferred. Part xx., p. 300. 
N~ew Anaesthetic.—This agent, which Dr. Snow has been recently using 
with great success, and which he believes had not been administered be- 
fore, is the ehlorureted hydrochloric ether. “ The substance is called by 
its discoverer, M. V. Regnault, Vether hydrochlorique monochlorure. It 
is the first of a series of five bodies which he formed by decomposing mu- 
riatic ether by means of chlorine gas in the sunshine. A liquid which is a 
mixture of these bodies, has been used for some months in Paris by M. 
Aran, a very zealous experimentalist, as a local application to relieve and 
prevent pain. Dr. Snow having procured a quantity of this through the 
kindness of Mr. Morson, chemist, of London, separated the first and more 
volatile of the liquids by distillation, and he thinks that it possesses some 
advantages over chloroform.” Part xxiv., p. 349. 
Carbonic Acid as an Anaesthetic.—iEther, chloroform, and carbonic 
oxide determine anaesthesia by robbing the arterial blood of its oxygen, so 
as to produce carbonic acid, thus making the blood venous. Carbonic 
acid itself maybe respired (if sufficiently diluted with air) with safety. 
An animal was put to sleep for 87 minutes by it; the sleep was perfectly 
tranquil; directly the inhalations are stopped the animal awakes. Death 
has never resulted as yet from this proceeding, as its approach is slow, pro- 
gressive, and can be predicted for some time by observing the condition 
of the heart and pupils. Part xxxviii., p. 260. 
Anaesthetic Properties of the Lycoperdon Proteus, or Common Puff- 
ball.—Mr. Richardson’s attention was first directed to this subject from a 
friend mentioning to him that bees were sometimes stupefied with the 
smoke of this fungus before the contents of the hive were removed. They 
gradually recover from the insensibility, and thus the cruel necessity was 
obviated of destroying them by the fumes of sulphur. He then com- 
menced a series of experiments, illustrating its effect upon animals. He 
says: 
A gentleman had a favorite dog, which was very old, was constantly ANAESTHETICS. 
105 
troubled with cough, and had a large and painful tumor over the abdomen. 
As the owner of the dog wished to have this tumor removed, Dr. Willis 
thought there would be a good opportunity for trying the anesthetic 
power of the fungus during an operation. He therefore kindly undertook 
to cut out the growth, if I chose to produce narcotism. I did so with the 
impure smoke of the fungus. The animal was narcotized in six minutes ; 
and the operation, which occupied ten minutes, was done without the 
merest sign of pain until the last suture was being put in, when wincing 
took place. Neither the heart nor the respirations seemed much affected 
in this instance. The recovery was so rapid, that, in six minutes, it would 
have been impossible to tell, without previous knowledge of the fact, that 
the animal had been subjected either to narcotism or operation. 
I need not occupy time in giving the details-of several more similar 
experiments. 
To sum up the results of these experiments: There is, it is evident, a 
principle in the fumes of the puff-ball capable of causing anaesthesia in 
animals. The physiological effects brought out by this anaesthetic are also 
very marked. In a liberal dose, it narcotizes rapidly and effectually, 
without unpleasant symptoms; and the narcotic effect soon passes off, 
leaving the animal in perfect health. In diluted doses, it produces in- 
toxication and convulsions; is longer in causing anaesthesia; sometimes 
excites cough and vomiting, and leaves the animal for a long time stupid 
and unwell. When it is carried to the extreme, the respirations cease 
before the beat of the heart. Indeed, in observing animals under the in- 
fluence of the narcotic, it is only necessary to watch the respiratory move- 
ments ; if these remain, even though reduced to the lowest, the animal will 
certainly recover on removing it from the cause of the narcotism. In this 
respect the narcotic principle of the fungus resembles the Woorali poison. 
Experiments with the fungus may be performed in various ways. If the 
impure smoke is to be used, it is only necessary to let it pass freely into a 
box, through a hole in the bottom. A large tin funnel fixed, beneath the 
box in an inverted position, will readily convey the smoke. The box 
having been filled with the smoke, the animal is placed in it, and the lid 
is laid lightly on. Narcotism will generally take place in eight or ten 
minutes, often sooner. 
To clarify the fumes arising from the fungus, two small tin funnels are 
made to fit mouth to mouth, and the nozzle of one funnel is connected with a 
Wolff bottle containing a solution of caustic potash. Another tube, con- 
nected with the Wolff bottle, will convey the clarified fumes away. If, 
now, a piece of the fungus be placed in a burning state between the 
funnels, the smoke can either be drawn by the mouth from the exit tube 
of the bottle through the ordinary double valve apparatus for chloroform, 
or it can be driven over into a bell jar, by fixing the nozzle of a pair of 
bellows to the free end of the funnels, and blowing gently. The glass 
bell into which the vapor is received should be placed on a nicely fitting 
board, and the animal must be passed into the bell quickly, after it is 
charged with the narcotic vapor. Part xxviu., p. 322. 
Remedial and Anaesthetic Uses of Intense Gold.—First make a freezing 
mixture as follows: Pound a piece of ice as big as an orange, and put the 
material on a sheet of paper; mix this thoroughly, with a paper folder, 
with half its weight of common salt. Put this mixture into a net of the 106 
ANCHYLOSIS. 
size required, and as soon as it begins to melt it is ready for use. The net 
is now to be placed upon the part required, and frequently to be raised in 
order that fresh particles of the mixture may be brought into contact 
with the skin. The skin is benumbed by this application in a few seconds, 
it first becomes white, showing that the skin is influenced ; if prolonged, the 
adipose matter under the skin begins to freeze, and the part becomes 
hard as well as white. The freezing may be extended even to deeper 
parts if necessary. 
Remedial Uses.—In acute lumbago, chronic rheumatism, sciatica, acute 
rheumatism, except where the head is implicated, ophthalmia, glandular 
inflammation in the neck and groin, orchitis, erysipelas, painful nodes, 
neuralgic headache, cancer, etc. Part xxx., p. 247. 
Amylene as an Ancesthstic.—Sulphuric ether is perfectly safe in what- 
ever way it is used, because the dose of ether occupies so much space in 
the form of vapor that it cannot enter the system except by degrees, and 
its effects are necessarily produced gradually. A fatal dose of chloroform, 
however, occupies a very small space in the form of vapor, and unless 
largely diluted with air it may act with dangerous rapidity, and the point 
of safety be easily overstepped. The quantity of amylene vapor which 
requires to be inhaled occupies a volume intermediate between that of the 
vapors of chloroform and that of ether. Amylene has the advantage of 
preventing pain with a less deep stupor than is occasioned by other 
agents, and a further advantage is the almost entire absence of struggling 
and rigidity. 
Amylenefor Children.—1. It is respired more easily. 2. The effect is 
more rapid. 3. The sleep is more natural. 4. They return more rapidly 
to their former condition. 5. There is no after inconvenience. 
Part xxxv., p. 283. 
ANCHYLOSIS. 
Effects of Immobility on the Articulations.—Cases mentioned of 
anchylosis of the patella with the femur, to which naturally there is no 
predisposition. Hence 
1st. It is dangerous to imprison for several months, in an immovable 
apparatus, the articulations of a fractured limb. 
2d. That the joints should be left free to execute movements sufficient 
to induce the synovial exhalation. 
3d. That we should commence gentle motion as soon as the callus is 
formed. Part iv.,y>. 110. 
Anchylosis of the Hip and Knee Joints.—Cured by operation. In the 
first case, the operation was performed on the person of a sailor, whose hip 
joint was perfectly anchylosed, and the limb so situated as to overlap the 
unaffected one. The thigh bone was divided with a saw, through the 
great trochanter and a part of its neck. This being done, the limb was 
readily straightened, and bony union having been prevented by daily 
movement ot the limb, ligamentous attachments were formed, and an arti- 
ficial joint resulted. After the lapse of sixty days, the patient stood 107 
ANCHYLOSIS. 
erect upon his feet, and finally did well, having a very tolerable use of his 
limbs. 
Second case, a man whose leg was bent backward upon the thigh so as 
to be completely useless, the knee joint being quite destroyed. The last 
operation consisted in cutting down upon the thigh bone a little above the 
knee, and removing a portion of it of a wedge shape with the saw—the 
base of the wedge shaped portion being anterior and the apex posterior, 
so that when the leg was brought gradually downward and forward the 
edges of the two extremities of the femur would be in a tolerable state of 
juxtaposition, which approximation, however, was not accomplished all at 
once, but very gradually, and apparently without much force or extension 
being at any time employed. Part vi., p. 132. 
Anchylosis—Peculiar Mode of obtaining.—In cases of diseased joints, 
attended by suppuration, and also in chronic diseases of the joints, namely, 
where destruction of the articulation has taken place, and nothing can be 
obtained (supposing amputation be not performed) but a stiff joint, the best 
plan is that of freely opening the joint at once. In the first place, the con- 
sequences of opening diseased joints are not so serious as are usually repre- 
sented, but, on the contrary, are so slight as scarcely to deserve notice; in 
the 2d, the process by which nature cures a joint in which the cartilages 
are removed by disease, is anchylosis, but this eventual result demands tk-? 
absence of cartilage; and lastly, the articulation is placed in the condition 
of a sinus which has been slit up. 
The after treatment consists in fixing the joint in the most useful posi- 
tion, and keeping it steady by bandages, etc. Part xxii., p. 197. 
Treatment of Contractions of Anchylosis by forced Rupture.—In true 
anchylosis, the callus may be broken up. Langenbeck’s plan was as 
follows : The patient is placed upon his back, and chloroform administered 
until complete anesthesia is induced; until, in fact, the muscles cease to 
offer any resistance. As soon as the muscles become entirely relaxed, the 
patient is turned round on his belly; an assistant holds the head in a raised 
position, to prevent respiration being impeded, and to facilitate the further 
-nnalation of chloroform, if necessary. 
If the anchylosis be of the knee (the most favorable joint for the opera- 
tion), an assistant, or assistants, fix the pelvis, and the surgeon commences 
gradual flexion, if the joint be in an extended state, or extension if in a 
Hexed state. The patient must be so placed, that the patella of the bent 
knee rests on the anterior margin of the operating table. The pelvis is 
fixed by the hands of assistants. The operator then clasps with one hand 
the femur just above the popliteal fossa; with the other, the leg, just above 
the ankle, and by alternate flexion and extension, practised with more or 
less power, according to the nature of the case, restores the mobility and 
the normal position of the joint. A loud crepitus attends the rupture of 
the adhesions. Should the strength of one hand of the operator prove 
insufficient, the femur is held down by an assistant. The operator clasps 
the leg with both hands, and produces, either by strong gradual pressure, 
or by sudden jerking movements, the rupture of the more powerful impe- 
diment. Even firm osseous bridges are thus made to yield with a loud 
snapping sound. This was once, in a case of undoubted osseous anchy* 
losis, so loud as to cause the mother of the patient, who was sitting in an 
adjoining room, to swoon. If, in course of the operation, the tibia 108 
ANCHYLOSIS. 
threatens to luxate backward, and particularly, as is often the case, a con- 
secutive subluxation is already present, especial care must be taken.to sup- 
port the joint by pressure on the posterior surface of the upper end of the 
tibia. Still, luxation is often unavoidable, its mechanism depending or 
pathological conditions of the part, which art is unable to change. Wo 
refer to those cases where, in consequence of large defects of the inferior 
and posterior surfaces of the condyles of the femur, consecutive sublux- 
ation has supervened during the course of the inflammatory disease. A 
perfect luxation is in these cases more probable during the violent forced 
extension, if the is so firmly anchylosed with the femur as to pre- 
sent an invincible impediment to the pressure of the anterior surface of the 
tibia against its inferior margin. 
The force to be employed must be regulated by the surgeon himself. 
In cases of many years’ standing, the force required, as might be Opposed, 
is considerable; sometimes the whole weight of the body is necessary, but 
it must always be applied with care. When the.callus yields to the ex- 
ternal force, the amount of flexion is preserved until the next trial, the 
limb being exercised, passively, during the interval. A great degree of 
flexion is not to be desired at once; and the more cautiously and patiently 
the limb is managed, the less danger of violent reaction, and the greater 
probability of success. When managed with due care, the inflammation 
set up is very trifling, indeed seldom sufficient to retard the cure. Fre- 
quently no reaction is perceptible. Every two or three days the patient 
is again subjected to the same treatment. Sometimes a couple of months 
are necessary to restore the functions of the joint perfectly, but three or 
four weeks are frequently sufficient. Although many years have elapsed 
between the occurrence of the anchylosis and the attempt at restoration, 
yet in most cases the callus may be broken up, and the integrity of the 
joint restored. It is absolutely requisite, however, that the patient should 
exhibit no tendency to scrofula, and this the more especially if the anchy- 
losis be the result of scrofulous inflammation or ulceration. 
From the want of exercise of the joint, the limb is usually much smaller 
than the sound one. Sometimes almost total atrophy of the muscles is the 
consequence, but a short time suffices to restore them to their original 
volume. 
The after-treatment is- based on two indications: the first, to preserve 
the degree of extension obtained; the second, to endeavor to restore the 
normal functions of the joint. After forced extension has been practised, 
the muscles have a decided tendency to return to their former condition. 
We have seen, that muscles which have been contracted during a space of 
ten years, are not exempt from this tendency—a fact which sufficiently 
refutes the opinion of those who assert that muscles under prolonged con- 
traction utterly lose their vitality. 
In most cases we have to have recourse to a bandage of gutta percha, 
or to what is better still, St romeyex-’s apparatus for the extension of the 
knee joint—an apparatus which, in the further treatment, is as indispens- 
able as it is efficacious. 
Where a subluxation of the tibia backward existed, the apparatus of 
Bonnet lor extension of the knee joint was applied with obvious success. 
In the two cases where the luxation was perfect, and in others where it 
was very considerable, all attempts at reposition proved in vain. 
Mr. Langenbeck has expressed it as his opinion, that the subcutaneous ANEURISM. 
109 
division of the t vo lateral ligaments might be of some service in these 
seemingly hopeless cases. 
Should an evident contraction of the external lateral ligament be present, 
a subcutaneous division which we have several times seen practised with 
eminent success by Mr. Langenbeck, in the treatment of genu vulgum, is 
here advisable. In those cases where large defect in the articular surfaces 
of the external condyles of the tibia or femur exist, every treatment 
directed against the abduction will of course prove ineffectual. 
Part xxviii.,/>. 161. 
Old Contractions and Anchylosis.—Place the patient under chloroform 
to relax the muscles, then forcibly bend or extend the limb; it will most 
likely crack, as the ligamentous structures and adhesions are broken 
through, but there is no danger. The limb must then be put in a splint, 
kept quiet, and evaporating lotion applied. Generally this plan suffices, 
though in some very obstinate cases it may be necessary to divide the 
hamstring tendons before the limb can be straightened. 
Part xxxn., p. 137. 
Partial Anchylosis of the Hip.—Even in a strumous patient, partial 
anchylosis, the result of inflammation of the hip joint, may be successfully 
removed by rupture of the uniting medium, provided the case be favor 
able. All pain must have ceased and the disease be quite quiescent. In 
a case operated upon by Mr. Brodhurst, the pelvis being fixed with one 
hand, the thigh was suddenly flexed, the limb being jerked without much 
force being used. Very slight pain followed, and passive motion was 
not commenced till the expiration of eight days. Ultimately the patient 
entirely regained the use of the leg, when before she was only just able to 
touch the ground with the toes of the affected limb. The patient was a 
girl of 13 years of age, light haired, and of a strumous complexion. 
Part xxxviii., p. 13G 
ANEURISM. 
Popliteal Aneurism.—Recommended, upon opening the sheath of tno 
femoral artery, instead of the iisual mode of drawing the saphenous nerve 
outward and then passing the aneurismal needle, armed with the ligature, 
between the artery and vein, to pass an aneurismal needle, unarmed and 
blunt-pointed, so as to avoid wounding, under the whole of the contents 
of the sheath, and then gradually tilt the nerves over the exposed end of 
the aneurismal needle, leaving only the artery and vein lying on tho 
needle. 
Having insiniiated between these the blunt edge of a small probe, 
remove carefully tho needle from its former position and pass it through 
the space thus made. In this situation the needle may be armed by an 
assistant and the ligature secured in the usual way. 
The artery, in various operations requiring exposure, is not always seen 
to pulsate. The carotid has been seen to lie so perfectly quiescent after 
exposure, that a surgeon has thought, from the total absence of pulsation, 
that it could not be an artery. The whitish-colored vessel which is ex- 110 
A.NEUKISM. 
posed iu these operations is only discovered to pulsate by being pressed 
between the finger and thumb. 
As to the tightness with which the ligature should be drawn, the sur- 
geon should exercise his discretion, and is best taught by experience. It 
is frequently stated, that the inner and middle coats of the artery should 
be felt by the operator to give way under the ligature; but in a very 
great majority of cases this cannot be detected. 
In old persons, where the coats are more likely to be indurated or ossi- 
fied, a less degree of force will of course be proper. Part v.,p. 127. 
Aneurism of the External Iliac Artery— Use of Trant’s Aneurismal 
Needle.—The recovery of the patient in this case shows that a large artery 
may be successfully tied at the distance of half an inch from the point at 
which a branch nearly of equal magnitude comes off. Another circum- 
stance connected with this case is the value which attaches to Mr. Trant’s 
aneurism needle, which instrument will be found of essential service where 
a ligature has to be applied to any deep-seated vessel. When the instru- 
ment, armed with the ligature, has been passed under the vessel, a spring 
hook is gradually projected from the handle by the operator, and passes 
direct to the point of the needle, where it takes hold of the ligature, which 
is then drawn up from the bottom of the wound by the surgeon and tied 
in the usual way. Part vii., p. 117. 
False Aneurism.—Case cited of a child nine years old, in whom there 
seemed to be an abscess over the carotid artery at the angle of the jaw on 
the right side. “ Its most prominent point was posteriorly and superiorly 
at the outer border of the sterno-mastoid. Indistinct fluctuation could be 
felt, and there was slight pulsation in it immediately over the carotid ar- 
tery, but on grasping the sides of the tumor no pulsation could be disco- 
vered, nor could any be felt inside the mouth.” On puncturing this tumor 
a gush of blood issued out, and Mr. Liston then detected the mischief, and 
next day determined to tie the carotid artery. The patient ultimately 
died. Part vii., p. 154. 
Popliteal Aneurism—Cured by Compression.—Three cases successfully 
treated, from which it would appear that this plan of treatment has been 
too hastily abandoned by the profession, probably from the compression 
employed being so excessive as to render it quite insupportable to the 
patient. The least possible pressure which may be sufficient to close the 
vessel should be used, and when this cannot be sustained, it will prove of 
use to partially compress the artery, so as to lessen the impulse of the cir- 
culation. Part vii., p. 172. 
Simulated Aneurism.—Case of hysteria mentioned, in which there was a 
strong local pulsation of the aorta, in the epigastric region, simulating 
aneurism, which disappeared as the general health improved. 
Part viii., p. 61. 
Cure of Aneurism by Compression.—The application of well-regulated 
pressure on the artery, between the aneurismal sac and the heart, recom- 
mended. 
The pressure should be so regulated that the current through the ai-tery 
would not be completely arrested, it having been found that a partial cur- 
rent through an aneurismal sac leads to the deposition of fibrin in its 
interior, and to cause it to fill and become obstructed. 111 
ANEURISM, 
Valsalva’s treatment should also he conjoined, viz.: perfect rest in the 
horizontal position, very low diet, and frequent blood-letting. 
Part viii., p. 114. 
Aneurism of the External Iliac Artery.—A remarkable feature in this 
case was the extreme and unusual rapidity of its progress, only three weeks 
having elapsed from its first appearance, of the size of a hazel-nut, before it 
occupied the whole of the left iliac fossa, itsbase projecting considerably below 
Poupart’s ligament interiorly, and superiorly extending to within less than 
an inch and a half from the navel, being six inches across from above to 
below, and six inches and a half from side to side, projecting also from the 
plane of the abdomen fully three inches. 
It was decided to take up the common iliac artery. Mr. Iley describes 
the modus operandi as follows: The patient was placed on his back on a 
mattress, his shoulders moderately raised. The incision was commenced 
two inches and three quarters above the navel, and exactly three inches to 
the left of the median line. This was carried down, moderately curved, to 
the base of the tumor about six inches, and was afterward enlarged by an 
angular continuation, one inch and a half in length. The fibres of the ex- 
ternal and internal oblique muscles and transversalis being successively 
divided, the transversalis fascia was readily raised by means of a director, 
and carefully opened out through the whole length of the incision. The 
peritoneum now protruded in some measure; it was, however, kept down 
without much difficulty, and being gently drawn toward the opposite side, 
I was enabled slowly to insinuate my fingers behind the peritoneum, gra- 
dually separating it from its cellular attachment to the parts beneath. The 
common iliac artery was easily reached, and upon compressing it with the 
fingers, the pulsation in the tumor ceased at once. A little time was occu- 
pied in scratching through the sheath of the artery with the point of the 
aneurism needle; this being accomplished, the needle was passed under 
the artery from within outward, armed with a double ligature of stay- 
maker’s silk, waxed. By holding aside the peritoneum and viscera, we 
now obtained for a moment a view of the artery, and ascertained that 
nothing else was included in the ligature; this being tied with the fingers 
close down upon the artery, all pulsation in the sac entirely ceased, and 
never afterward returned in the slightest degree. The exact position of 
the ligature was, I believe, an inch below the bifurcation of the common 
iliacs. The wound was closed Avith six sutures and strips of adhesive 
plaster, and over the whole a coating of lint dipped in strong mucilage. 
Time, twenty-five minutes. 
The subsequent treatment was upon general principles. 
Particular attention is directed to the situation of the incision, as in this 
case the operator was relieved from all chance of embarrassment by the 
chord. 
Suggested, that in any case in which it might be advisable, to take the 
chance of tying the aorta. This mode of doing it will be found in every 
respect far more safe and facile than that adopted by Sir Astley Cooper. 
Part ix., p. 142. 
Aneurism of tlxe Aorta.—When aneurism arises from the posterior 
part of the aorta, we generally want the evidence of a palpable tumor to 
indicate the disease. When the tumor is resisted in its development by 
unyielding structures (as is the case when it arises from the posterior part 112 
ANEURISM. 
cf the aorta), it produces a peculiar character of pain, which, if not exclu- 
sively confined to this disease, exists so much more frequently in it than 
in any other, as to be enough at all times to awaken a suspicion of aneur- 
ism. If this pain be connected with the lower dorsal and lumbar verte- 
brae, and depend upon abdominal aneurism, there will be bruit de soufilet 
in the course of the artery. 
If the pain be connected with the upper, or thoracic dorsal vertebrae, 
and be owing to aneurism, it seldom occurs that there is not some diffi- 
culty in deglutition, or some obstruction in the respiratory apparatus. 
The character of the pain consists in a constant, aching, boring sensa- 
tion, and a sharp, lancinating pain. To relieve the agonizing pain of 
aneurism, there is scarcely a limit to the amount to which we may exhibit 
opium, without producing narcotism. In the treatment of aneurism, low 
diet should be avoided, as lessening the prospect of a radical cure of the 
disease, and as increasing a nervous irritability—the constant accompani- 
ment of it. The interval between the fatal termination and the bursting 
of an aneurism is various, and is much influenced by the importance of 
the organs which the hemorrhage may affect. If it burst into the peri- 
cardium, and compress the heart, such interval will, of course, be shorter 
than if it compress a less vital organ. If there have been an adhesion 
between the laminae of the pericardium, the effusion will be more gradual, 
and therefore the interval will be longer than if no such adhesion existed. 
Part ix., p. 175. 
Treatment of Aneurism by Compression.—Dr. Bellingham, one of the 
surgeons of St. Vincent’s Hospital, when he first brought this subject 
before the Surgical Society of Ireland, had only met with three cases in 
which compression had been employed; that number has now increased 
to twelve. Of these, eight were treated in Dublin, and in all the cure 
has been permanent. With regard to this mode of treatment, he says: 
The principal improvement which has taken place in the treatment of 
aneurism by compression, consists in the mode of applying the pressure ; 
that is, instead of employing a single instrument, we employ two or three 
if necessary; these are placed upon the artery leading to the aneurismal 
sac, and when the pressure of one becomes painful, it is relaxed, the other 
having been previously tightened, and by thus alternating the pressure, 
we can keep up continued compression for any length of time. By this 
means the principal obstacle in the way of employment of pressure has 
been removed; the patient can apply it with comparatively little inconve- 
nience to himself; time will not be lost, owing to the parts becoming 
painful or excoriated from the pressure of the pad of the instrument; and 
as the pressure need not be interrupted for any length of time, the dura- 
tion of the treatment will be necessarily considerably abridged. 
Some of the success of the improved method of applying pressure must, 
however, be referred to the improvement of the instrument used. 
It consists of an arc of steel covered with leather; at one extremity is 
an oblong padded splint; the other extremity terminates in a nut, contain- 
ing a quick screw, to which a pad similar to that of the tourniquet is 
attached. The principle of this instrument is exceedingly simple, so 
much so, that the patient can regulate its application himself, and it can 
be made of every size, so as to compress any vessel within the reach of 
compression. ANEUKISM. 
113 
The following conclusions embrace, in a few words, the chief things to 
be remembered on this subject: 
1st. That the arteries to which pressure is applicable, being far more 
frequently the subject of spontaneous aneurism than those to which it is 
inapplicable, compression promises to supersede the ligature in the great 
majority of cases. 2d. Pressure has several obvious advantages over the 
ligature, being applicable to a considerable number of cases in which the 
ligature is contra-indicated, or inadmissible. 3d. The treatment of aneur- 
ism by compression does not involve the slightest risk; and even if it 
should fail, its employment not only does not preclude the subsequent 
operation by ligature, but renders the chances of the operation by ligature 
more favorable. 4th. Such an amount of pressure is never necessary as 
will cause inflammation and adhesion of the opposite surfaces of the vessel 
at the point compressed. ’5th. Compression should not be carried even so 
far as completely to intercept the circulation in the artery at the point 
compressed; the consolidation of the aneurism will be more certainly and 
more quickly brought about, and with less inconvenience to the patient, 
by allowing a feeble current of blood to pass through the sac of the 
aneurism. 6th. Compression, by means of two or more instruments, one 
of which is alternately relaxed, is much more effectual than by any single 
instrument. 7th. Compression, according to the rules laid down here, is 
neither very tedious nor very painful, and can be maintained, in a great 
measure, by the patient himself. 8th. An aneurism cured by compression 
of the artery above the tumor, according to this method, is much less 
likely to return than where the ligature has been employed. 
Part xi., p. 141. 
Spontaneous Cure of Tubular Aneurism.—Mr. Luke gives the fol- 
lowing: 
The patient was a stout, healthy man, of temperate habits. About a 
year before his admission into hospital, a tumor appeared on the upper part 
of the wght thigh, which extended from Poupart’s ligament, three or four 
inches down the course of the femoral artery. Pulsation was strong and 
uniform over the whole surface. The tumor was compressed with ease, 
and emptied, but refilled on the withdrawal of pressure. There was no 
pain, nor bruit, but weakness of the limb of the affected side, which was, 
however, equal in temperature to the sound limb, and the arteries low 
down pulsated with equal strength on both sides. It had not increased in 
size from its first appearance, and for six months produced no uneasiness. 
Cramp and pain in the groin were then brought on by running, and are 
since easily induced by slight exercise. 
With a conviction that the tumor was aneurismal in its character, it 
was thought improper to place implicit credence in the patient’s state- 
ment, that it had not increased in size since its first discovery. He 
was therefore placed in bed, with the intention of determining by 
personal observation whether or not it underwent any increase in its 
dimensions; the determining of this point being necessary to guide the 
opinion and the advice as to the course best to be pursued in his case. It 
was thought that the application of a piece of adhesive plaster spread on 
leather, and of a spica bandage over it, was quite compatible with these 
intentions. They were accordingly applied over the tumor, March 3d, 
and not again disturbed until the 8th. On their removal, on this day, it 
8 114 
ANEURISM. 
was found that a considerable change had been effected in the tumor. 
Instead of being soft and compressible, and capable of being emptied of 
its contents, it was hard and unyielding, and slightly painful on pressure. 
It was further observed that its pulsation had entirely ceased, as well as 
the pulsation of all the arterial trunks of the limb; the femoral, popliteal, 
and anterior and posterior tibial arteries, having in turn been examined. 
The foot and leg felt colder to the hand than the opposite, although the 
thermometer did not indicate any actual diminution of temperature. 
While collecting information respecting a state of things so unexpected, 
the patient stated that when the plaster and bandage were first applied, 
he experienced considerable pain in the tumor for about half an hour, 
attended by an unusually violent throbbing, which perceptibly raised the 
bandage. At the end of that time the throbbing ceased, and there had 
not been any return. The plaster and bandage were reapplied, and the 
limb was wrapped in wool. On the 22d of March, the tumor was still 
hard, consolidated, and without any pulsation. There was apparently an 
obliteration of its cavity, the contents of which had undergone some 
diminution from absorption. Mercurial ointment, spread on lint, was 
applied, and the patient allowed to move out of bed. April 2d.—He Avas 
walked about, and, he states, with greater ease and freedom than when 
admitted ; but the pain in the calf remained. 19th.—Has left the hospital 
for about ten days, but, as requested, paid the hospital a visit to-day. He 
still complained of pain in the calf, especially when going up-stairs. 
There was almost numbness of the foot at times. The circulation was 
apparently restored sufficiently for the proper nourishment of the limb, 
yet pulsation had not returned in any of the arterial trunks. The size of 
the tumor had undergone very considerable diminution, and the aneurism 
had been without doubt cured. 
[Mr. Luke then notices the indefinite nature of the terms true, false, and 
diffused, as applied to aneurisms, and thinks they may with advantage be 
allowed to become obsolete, as others more distinctive may easily be sub- 
stituted.] - 
Thus the different kinds of aneurisms, may conveniently be thus desig- 
nated : 1st, To the most common kind, characterized by the existence of 
a sac, the term “ saccated ” may with propriety be applied as simply indi- 
cative of that fact, without entering into any speculations as to the means 
by which the sac is produced. If we wish to make distinctions of the 
saccated form, we might use the term “ traumatic ” for those forms of it 
which are the result of wound. 2dly, There is a form of aneurism char- 
acterized by a pretty nearly uniform dilatation of the tube of the artery, 
of which the case above related forms an example. This, by some sur- 
geons, has been considered not to be aneurism at all; while by others it 
has been regarded as the true form of that disease. From the circum- 
stances of the tube of the artery undergoing a pretty uniform dilatation, 
I think that the term “tubular” would not be inappropriate, and would 
express adequately the kind of disease meant to be designated. 3dly and 
4thly, The terms “ dissecting aneurism ” and “ varicose aneurism ” are suf- 
ficiently expressive of the forms of disease to which they are at present 
applied, and need no further observation. But 5thly, the term “ aneurism 
by anastomosis,” as it involves a hypothesis, may be advantageously 
changed for “ capillary aneurism,” as merely conveying an idea that the 
minute or capillary vessels are the structures affected. Thus we have— ANEUKISM. 
115 
1. Saccated aneurism, including traumatic. 2. Tubular aneurism. 3. Dis- 
secting aneurism. 4. Varicose aneurism. 5. Capillary aneurism; under 
which terms maybe embraced every known variety. Part xii.,p. 155. 
General Principles of Treatment of Aortic Aneurism.—Dr. Clievers 
considers the following to be the chief general indications which it is 
necessary to fulfill in conducting a rational plan of medical treatment in 
cases of aneurism of the aorta. To encourage, as much as possible, the 
deposition of thin layers of plastic coagula within the aneurismal sac; to 
render the circulation through the visceral arteries, general capillary sys- 
tem, principal venous trunks, and lungs, as free as possible ; to diminish, 
as far as practicable, the volume of the circulating fluids, but in such a 
manner as to reduce the proportion of their watery constituents without 
impoverishing the fibrin, or producing debility in the system; to main- 
tain the muscular power of the heart. 
Valsava’s plan of treatment was calculated to prove eminently benefi- 
cial under the direction of able surgeons, and even to obtain a cure; but 
when practised by the incautious and unscientific, instead of tranquillizing 
the system, etc., it had the directly opposite effect, “ impoverishing the 
blood, rendering the heart weak and irritable, and exchanging the proba- 
bility of a sudden death for the certainty of a painful and lingering one.” 
The only natural process by which the cure of aneurisms of the aorta 
can bo effected is, of course, by procuring the obliteration of the sacs by 
firm layers of adherent coagulum. In aneurisms of the limbs it appears to 
be merely sufficient that the sac should become completely plugged with 
clots, it matters little of what form, providing only that they be firm 
enough entirely to prevent the flow of blood through the diseased part, 
and to divert its course to the collateral arteries; but in aneurisms of the 
aorta, or, at all events, of its upper portion, a far more delicate process 
requires to be effected, as here the sudden formation of loose coagula in 
an aneurismal sac will always be liable to occasion rupture of the walls of 
that cavity, for when the pouch has already become filled to distention— 
the passing current of blood still maintaining its pressure upon the mouth 
of the sac—every additional drop of fluid added to its contents.will begin 
to act upon its walls with the distending force of the water in a Bramah’s 
press. Such loose coagulation will also be liable to stop the flow of blood 
through the aorta (an occurrence which, it is needless to say, is all but cer- 
tainly fatal, whether suddenly or gradually produced), or, at all events, it 
can scarcely fail to cause fatal obstruction and embarrassment to the heart’s 
action, as coagulation of this kind would never be limited merely to the 
interior of the sac. The trial should be, by tranquillizing the circulation 
and preserving the blood in as highly fibrinized a state as possible, to pro- 
cure the obliteration of the sac, and of the sac only, by layers of coagu- 
lum so firm, organized, and even, that they may resist the infiltration of 
the blood, and present internally a smooth but resisting surface past which 
that fluid may glide easily in its passage through the vessel. 
The importance of removing all congestion of the liver, spleen, and 
kidneys, and keeping up a healthy action, cannot be too strongly enforced. 
The reduction of the volume of the circulating fluids has long been con- 
sidered as a necessary means in the treatment of all organic diseases of the 
heart and its appendages; but, unfortunately, depletion has too often been 
the course adopted to effect this nurpose. In a person reduced by organic 116 
ANEURISM. 
disease, a full bleeding, to say nothing of its influence in depressing and 
rendering irritable the functions of the nervous and vascular systems, has 
the effect of removing from the body a quantity of vitalized and organic 
matter, which, it is probable, the weakened powers of nutrition may never 
succeed in reproducing; and, so far from this plan of treatment having 
the effect of relieving the blood-vessels from distention, I doubt much 
whether, in a weakly person, whose absorbents are active, the vascular 
system does not, in a few hours after a free depletion, either by the lancet 
or by purging, contain as large, nay, it may even be a larger, bulk of 
fluid than it previously did, much watery matter having been rapidly 
absorbed to supply the place of that which was removed. Still, in 
these cases, as much as possible of the thinner part of the blood must be 
drained off. 
In every instance of arterial and cardiac disease, the weakened struc- 
tures become oppressed with the load of fluid which they have to convey, 
and nature often attempts to relieve them by visceral engorgements, 
dropsical effusions, and hemorrhages. The desired effect may be far 
more successfully produced by gradually diminishing the quantity of the 
fluid ingesta, than by the employment of any system of active depletory 
evacuation. 
It is, of course, by no means requisite that a patient suffering from arte- 
rial or cardiac disease should be suddenly deprived of either fluid or solid 
food, or should at any time submit to absolute privatiom by hunger or 
thirst, but no injury can be done by reducing the quantity of the ingesta 
to the smallest reasonable standard, while care is taken that their quality 
shall be of the most nutritive kind. 
I believe that by far the best mode of removing fluid in these cases is by 
keeping up a gentle action upon the skin and kidneys. 
Diminution of the fluids, rest and gentle tonic treatment, tend to pre- 
serve the muscular power of the heart, and to maintain the due capacity 
of its cavities, and may, to a certain degree, restore these properties when 
they have failed in consequence of disease. 
The administration, under these circumstances, of digitalis, the acetate 
of lead, apd other medicines which have a direct tendency to lower the 
action and depress the power of the heart, cannot, I submit, be too 
earnestly deprecated. I believe that the former of these medicines is 
generally used in organic diseases of the heart and great vessels, with very 
mistaken views of the pathology of those affections. The great error 
appears to be still often committed, of regarding palpitation as though it 
were itself the disease, and not, what it really is, the sole means by which 
an obstructed and overloaded heart is enabled to propel its contents—and 
hence of employing medicines which check the palpitation without remov- 
ing its causes. But the rational plan of treatment here obviously is, to 
remove the causes of obstruction from which the heart suffers, where 
they are not of a permanent nature, or, if that be impossible, to diminish 
the load of fluid which embarrasses the heart, and then the palpitation, 
being no longer requisite, will abate of its own accord. Part xii., p. 160. 
Operation for Femoral Aneurism.—The following is a different mode 
from that usually adopted for securing the external iliac artery in cases of 
femoral aneurism. 
H. S., set. 51, healthy-looking, spare, of phlegmatic temperament, ad- ANEURISM. 
117 
mitted into hospital with aneurism of the right femoral. The disease 
began about four months before, in the usual way, after a heavy stumble; 
pain for a while, and afterward the appearance of a pulsating tumor, which 
gradually increased. 
The tumor, at the period of his admission, was raised about two inches 
above the level of the thigh, and it was about five inches in diameter, 
entirely occupying that triangular space, the apex of which is formed by 
the junction of the sartorius and rectus, and the base by Poupart’s liga- 
ment, which the tumor slightly overlapped. The pulsation is equally dis- 
tinct in every part, and can be checked by pressure upon the external 
iliac artery ; but the tumor, from the solid nature of its contents, cannot be 
emptied. Upon auscultation, a loud whizzing sound is heard accompany- 
ing each pulsation, which also communicates a vibratory sensation when 
pressure is made with the fingers. He complains of pain in the tumor, 
especially at night, and of numbness down the fore-part of the thigh and 
inside of the knee. Mr. Cooper thus details it: 
In this operation an incision is made through the skin and superficial 
fascia of the abdomen, commencing immediately on the outer side of the 
external ring, and terminating within an inch of the anterior superior 
spinous process of the ilium, and no part of this incision should be more 
than half an inch above Poupart’s ligament. In depth it should extend 
only to the tendon of the external abdominal oblique, without dividing any 
of its fibres. In this step some hemorrhage may occur from the circum- 
flex ilii, external epigastric, or external pudic branches, which, although 
naturally small, may have become distended from the obstruction of blood 
through their parent trunk ; and should the bleeding be troublesome, the 
vessel ought to be at once secured. 
The next object is to lay open the inguinal canal, which is effected by 
cutting through the tendon of the external abdominal oblique to the full 
extent of your first incision. The spermatic cord is then to be drawn 
upward and inward toward the linea alba, and the cremaster muscle 
pressed downward toward Poupart’s ligament. When this is effected, the 
fascia transversalis is completely exposed, partly passing down beneath 
Poupart’s ligament to form the anterior layer of the sheath of the femoral 
vessels, and on the outer side firmly attached to that ligament. The next 
step is to open the cavity of the abdomen, and this should be effected by 
dividing the fascia on the outer half of your incision, where it will be found 
that the peritoneum is very easily pushed upward ; while, on the contrary, 
if you make your opening on the inner side of the internal ring, the peri- 
toneum, in its course to the scrotum, where it forms the tunica vaginalis, is 
so firmly united to the fascia as to be with difficulty separated, and liable 
to be torn in the attempt. All that remains now to be done, is to separate 
the artery from the vein, by dividing with your finger-nail the fascia iliaca 
which covers them ; and then, passing your aneurismal needle between the 
two vessels, its point is directed from within to without, and the ligature 
tightened with that degree of force necessary to cut through the two inter- 
nal coats of the vessel. What is the precise degree of force to be em- 
ployed is impossible to be described by words, and is only to be acquired 
bv practice. I would dwell particularly on the necessity of passing the 
aneurismal needle from within to without, for if an attempt be made to 
pass it in the opposite direction, the vein is almost sure to be wounded. 
The edges of the wound are now to be brought together, either by liga- 118 
ANEURISM. 
ture or strapping, and the patient placed in bed with the aneurismal lime 
well wrapped in flannel. Some surgeons recommend hot water to be ap- 
plied to the foot, which, in my opinion, is wrong, as it excites too rapid a 
flow of blood through the capillaries. Part xii., p. 172. 
Popliteal Aneurism—Gangrene following Operations for.— Vide Art. 
“ Gangrene.” 
Treatment of Aneurism by Compression.—According to Dr. Belling- 
ham, such an amount of compression is not necessary as to cause inflamma- 
tion and adhesion of the opposed surfaces of the vessel, nor should the 
circulation in the artery at the point where it is compressed be entirely 
intercepted. To apply it successfully, the velocity of the current should 
be diminished, and the amount of blood in the sac be diminished, so as to 
encourage the deposition of fibrin, until the sac is quite filled. It has this 
advantage over the cure of aneurism by ligature, that the artery is oblite- 
rated at the seat of the aneurism, by which the chances of gangrene are 
diminished. The cure is also more effectual, as the sac and also the artery 
leading from it, become filled with fibrin, whereas, after ligature, a loose 
coagulum remains which does not fill the sac. Part xiii., p. 209. 
Popliteal Aneurism—Compression of the Arterial Trunk on the Car- 
diac Side of the Tumor.—It is not unfrequently found that the artery and 
its accompanying vein have become adherent, which is a great source of 
embarrassment to the operator, when tying the artery ; this is avoided by 
adopting the treatment by compression. A moderate degree of pressure 
is all that is necessary throughout, so as not entirely to intercept the cur- 
rent of blood through the vessel. Part xiii., p. 211. 
Aneurism of the Carotid Artery.—The patient in this case was a deli- 
cate man, 34 years of age, and of intemperate habits. A small tumor 
made its appearance three or four months ago, which had gradually 
increased in size. In consultation it was agreed that it was an aneurism 
of the carotid, and that it was possible to tie the vessel below the tumor. 
The patient being laid on a table, in such a position that the light fell 
directly on his neck, an incision, about two inches long, was made through 
the integuments in nearly a perpendicular direction, and terminating at the 
inner margin of the attachment of the sterno-mastoid muscle to the ster- 
num, the upper part of the incision being between the tumor and the tra- 
chea. This exposed a large vein, round which two ligatures were placed, 
and the vein divided between them. The fascia and some loose cellular 
tissue were next divided, and the edge of the sterno-hyoideus brought into 
view. Crossing the upper angle of the wound was just seen the omo- 
liyoideus. At this stage of the operation, very moderate pressure with the 
point of the finger at the bottom of the wound arrested the pulsation of the 
tumor ; but the beating of the carotid could not be felt. The sides of the 
wounds were held asunder by blunt hooks, and the wound kept clean by 
small bits of sponge, put to the botton of it by means of forceps. With 
forceps and scalpel the sheath of the artery was now scratched through, a 
nerve (descendens noni) was seen, and pulled aside by the blunt hook, and 
the artery was fully exposed. An armed aneurism-needle was, with some 
difficulty, passed behind it from the outer side. The artery, as it now lay 
on the aneurism-needle, was compressed with the tip of the finger, and tho 
tumor’s pulsation was found to be commanded. The needle being with- ANEURISM. 
119 
drawn, and the ligature firmly tied, the edges of the wound were brought 
together by two points of suture, and some strips of Macord’s plaster. 
The patient was then put to bed, and the wound and tumor kept covered 
by pieces of linen wrung out of cold water. Scarcely an ounce of blood 
was lost during the operation. The ligature employed was a firm round 
hemp one of moderate thickness. Before commencing the operation, the 
patient was desired to exhale completely, and to keep his chest as empty as 
possible. While in this state, the upper part of the chest was closely sur- 
rounded with a very long firm bandage, and he was instructed to respire, 
as much as practicable, by the diaphragm and abdominal muscles. 
Part xiii., p. 218. 
Aneurism by Anastomosis of the Scalp.—The aneurismal condition of 
the extreme blood-vessels, named by the older surgical writers ncevus ma- 
ternus, is, by the moderns, still so called in its superficial forms ; in its 
deeper seated, aneurism by anastomosis, tumeur erectile, tumeurvariqueuse, 
placentary tumor, and in all its forms talangiectasis. Previous to the 
time of John Bell, the deeper forms, or such as lie beneath the skin with- 
out involving it, were neither designated by name, nor was their nature 
understood; they were, probably, confounded with a variety of other 
diseases, or described as anomalous. Mr. Bell first pointed out their dis- 
tinctive properties, and denominated them aneurisms from anastomosis: 
this appellation I, on the present occasion, retain, not because I think it 
the most proper, but because by it the disease is best understood. 
[Dr. Fraser’s case is chiefly interesting in relation to the question of 
treatment. The patient was a young man, twenty years of age. lie first 
consulted Dr. F. on the 19th of June, on account of a small tumor situated 
over the posterior and superior angle of the right parietal bone.] 
About twelve years previously he fell on his back, that part of the head 
occupied by the tumor striking a log, which produced a bruise of the scalp. 
This spot became very hard, then commenced throbbing, and has been 
gradually enlarging; during the year preceding the above date, it had 
increased more than during any former one, and so troublesome had the 
whizzing pulsation he then experienced become, that it occasionally pre- 
vented him from sleeping; in other respects he enjoyed good health. 
To the eye, pulsation in the tumor was very apparent; the scalp cover- 
ing it was thinner than natural, but not discolored ; to the ear, aided with 
the stethoscope, the aneurismal bruit was distinctly perceptible; to the feel 
it was soft, communicated a peculiar thrill to the finger, and could be nearly 
emptied by pressure, when the bone beneath felt deeply and irregularly 
indented; on removing the pressure it filled almost immediately. The oc- 
cipital and temporal arteries on the same side were greatly enlarged, and 
imparted a vibrating sensation to the finger placed over them. The bone 
beneath them also was channelled out, evidently by the continued stream 
of blood passing through the enlarged and excited vessels, having caused 
its absorption. 
In consultation with sevei'al eminent men, Dr. Fraser determined to 
treat this tumor by means of setons, and small ones were passed on the 19th 
of June: next day he passed another through, and two through the occipital 
artery, between the tumor and mastoid process. 
Dr. F. next endeavored to obliterate the occipital and mastoid arteries 
by twisting around them a hare-lip suture, and painted the tumor with 120 
ANECEISM. 
iodine. "When the setons were removed, hemorrhage took place, which 
was arrested by pressure. As there were still several large branches of 
arteries supplying the tumor, and a bruit could still be detected in it, he 
treated them in the same way, by needle and hare-lip suture. The tumor 
now became flaccid, and was strapped down with a compress of sheet-lead 
and a bandage. By the 27th of September there was scarcely any percep- 
tible enlargement of the part. Part xiii., p. 225. 
Traumatic Aneurism of the Temporal Artery.—Electro-galvanic action 
has been successfully employed to eflect the consolidation of aneurism, by 
Dr. Petrequin, chief surgeon to the Hotel Dieu at Lyons. 
Case.—I)., aged nineteen, a locksmith, was brought to the hospital sense- 
less, on the 4th of August, 1845, immediately after a violent fall on the 
head. The lower maxilla was fractured at the symphysis and the left orbit 
was the seat of considerable ecchymosis. The symptoms of cerebral com- 
motion had given way in a great measure, when variola declared itself. 
The rupture fever accomplished its periods in the usual manner, and it was 
only on September 9th, five weeks after the accident, that M. Petrequin 
could direct his attention towards a tumor occupying the left temporal 
region, and which he had noticed long before. The swelling was of the 
size of an almond, soft, and almost indolent on pressure ; it was seated on 
the course of the temporal artery, and presented pulsations isochronous 
with those of the arteries. These pulsations ceased when pressure was 
exerted on the temporal artery below the tumor, and reappeared on the 
pressure being removed. These signs left no doubt of the nature of the 
case, and aneurism of the temporal artery, probably due to the injury ex- 
perienced by the vessel during the accident, was diagnosed. On the 10th 
of September, galvano puncture was performed by the introduction of two 
sharp steel pins crossing each other at right angles in the tumor; the heads 
of the pins were then placed in communication with the wires of a voltaic 
pile, and a shock and a sharp pain were experienced by the patient, the 
pain increasing with the intensity of the electrical action. The operation 
lasted ten minutes, and fifteen plates were employed. The pulsations 
gradually diminished in the tumor during the operation, and at its close 
had nearly disappeared. No accident followed the experiment, but a solid 
indurated swelling took the place of the tumor, the temporal artery ceasing 
to beat above the aneurism, while its pulsations remained distinct below. 
On the 20th of September, absorption had achieved the cure, and neither 
tumefaction nor pulsations could be detected in the spot where the malady 
had existed. M. Petrequin gives the following precepts, which he deems 
will insure the complete coagulation of the blood contained in aneurismal 
tumors: 1. Compression of the artery between the aneurism and the 
heart during the application of the galvanic agency. 2. The pins intro- 
duced into the tumor should be numerous, cross each other at right angles, 
and their surface should be protected by a coat of varnish, in order to 
prevent unprofitable loss of the electric fluid. 3. After the operation, ice 
should be applied to the tumor. This is the first case on record of aneu- 
rism cured or even treated by this method, which has been of late em- 
ployed in the treatment of a lai*ge number of diseases. Part xiii., p. 230. 
Case of false Aneurism.—The patient was twenty-eight years of age, 
and exceedingly corpulent. On the 23d of May, 1845, he received a 
pistol-shot in the upper and outer part of the right thigh; the ball tra- ANEURISM, 
121 
versed the course of the femoral vessels, and passed out at the left groin. 
The hemorrhage was very profuse, and it was with great difficulty he 
could be roused from a state of syncope into which he had fallen. A large 
tumor formed at the lower part of the abdomen, from the extravasation 
of blood ; as this increased in size, a pulsation could be detected in it; it 
was of an oval form, firm, but elastic ; the skin covering it was discolox*ed 
and thin; the opening in the groin had closed with a very thin cicatrix. 
The appearance of the patient indicated extensive loss of blood. Mr. 
Liston observes: 
The nature of the case was very apparent. A large false aneurism, not 
well bounded, rapidly increasing, and arising from a wound of the 
femoral artery, or some branch divided close to . its origin, had to be 
arrested, otherwise the patient must be left exposed to the risk of perish- 
ing suddenly, and at no distant period. After consultations on the even- 
ing of the 30th, and morning of the 3lst, the external iliac artery was tied, 
with the loss of not more than a tablespoonful of blood, and with the imme- 
diate effect of arresting the pulsation, and removing, in a great measure, 
the tension of the tumor. Symptoms of peritonitis supervened the 
evening of the second day, and on the following afternoon the patient 
sunk. 
The author subjoined an account of the post-mortem examination by 
Dr. Allen. The course of the bullet was traced from the outside through 
a dense* layer of fat, about two inches in thickness. It had divided one of 
the superficial branches of the femoral artery, about half an inch below 
Poupart’s ligament, and about an inch from the main body of the femoral 
artery, which had caused a false aneurism. The sac contained about three 
ounces of blood. No other artery appeared to have been wounded. A con- 
siderable quantity of sero-purulent fluid was found in the abdominal cavity, 
and patches of acute inflammation were observed on the intestines. The 
peritoneum adjoining the wound of the operation was inflamed. It had not 
been injured by the knife. The ligature had been properly applied to the 
external iliac artery. The abdominal viscera were healthy, but loaded to 
an extraordinary degree with fat. There was some enlargement of the 
right limb, apparently no mortification. The femoral artery was pervious. 
The blood in the aneurismal sac was firmly coagulated, and there was no 
mark of recent oozing from the injured artery. The ball had passed 
immediately over, and along the course of the artery for about half an inch 
before dividing it. The artery, although not actually detached, would 
not have borne a ligature. Part xiii., p. 231. 
Diagnosis of Aneurism.—Recent events have no tendency to increase 
our confidence in the diagnosis of aneurism. Dr. Kerr and Dr. Engel- 
liardt have lately erred in their diagnosis. Perhaps it arises from too 
great reliance being placed on one or two diagnostic signs, such as a dias- 
tolic impulse felt in all parts of the tumor, and a diminution in its size, 
when either it, or the artery on its cardiac side, is compressed. The 
former symptom occurred in a malignant tumor of the foot—described 
by Dupuytren, and the latter in a pulsating tumor of the femur, lately 
under the care ofM. Nelaton. Mr. Teale adds: 
In a case, under my own care, of a large serous cyst of the neck, extend- 
ing downward behind the clavicle in the vicinity of the large vessels, there 
was such a strong and apparently distensile impulse perceptible in all 122 
ANEURISM, 
parts of the tumor, as to induce myself and several other surgeons, for a 
considerable time, to regard it a3 aneurism. In this case, the hands 
applied to the sides of the tumor were forcibly separated at each pulsa- 
tion ; and, by compression, the tumor Avas diminished in size (undoubtedly 
from a portion of its contents being forced below the clavicle toward the 
chest.) and when the pressure was discontinued, the tumor gradually 
resumed, by pulsatile stages, its original size. Hypertrophy of the left 
ventricle, and dilatation of the abdominal aorta, tended still further to 
obscure the case. After the tumor had been reduced in size, its true 
character became apparent. The exploratory puncture, hitherto regarded 
as a test of aneurism, can no longer be received as such, since I have 
shown that a malignant cysto-vascular tumor of the femur, on two occa- 
sions, after an exploratory puncture, gave issue to a pulsatile column 
of florid blood, which was projected to the height of several inches. 
Part xiii., p. 234. 
Pain as a Diagnostic Symptom, of Aortal Aneurism.—1st. Intense 
pain in cases of internal aneurism is the most certain symptom of erosion 
of the bodies of the vertebrae. 
2d. In addition to its severity, the pain presents two other well-marked 
characters—viz., 1st. It is referred not to the exact size of the lesion but 
to parts at some distance. 2nd. The patient suffers more from it at night 
than during the day. 
3d. That unless erosion of bone occurs, the pain maybe absent or com- 
paratively slight, except in the cases already alluded to, where large 
nerves are compressed. 
4th. That in aneurism of the descending thoracic, or of the abdominal 
aorta, where the pain has the characters mentioned, the aneurismal 
sac almost always springs from the posterior Avail of the aorta, and has 
caused erosion of the vertebrae ; Avhereas, Avlien pain is absent, or com- 
paratAely slight, the sac Avill be found to spring from the anterior Avail 
of the vessel, and the bodies of the vertebrae will be little or not at all 
engaged. Part xiv., p. 177. 
Galvano-puncture in Aneurism.—The galvanic current should be 
directly transmitted through the blood itself by two opposing points. 
Employ fine steel needles, three inches long, and as they burn or cauterize 
the skin, or lose their electricity, coat them, before application, Avith gum 
lac or cutler’s varnish. The extremities of the needles should cross each 
other in the tumor, and Avhen the latter is of large size, multiply the 
points, so that the nuclei of coagulation may pass into one common clot. 
They should pass into the tumor obliquely or perpendicularly, opposed to 
the current of blood. The application of the galvanic current may be 
made each time ten or twelve minutes ; by this time the tumor will feel 
hard, and the pulsation cease : after this, apply compression, or a bladder 
of ice, to complete the cure. It is suggested for the cure also of varix, 
erectile and sanguineous tumors, etc. Part xiv., p. 182. 
Galvano-puncture in Aneurism.—Mr. Hamilton has tried it in a case 
of carotid aneurism. He passed fine gold needles coated Avith shell lac, an 
inch long, through the inner and outer sides of the tumor, and made them 
to touch in the centre; then used Smee’s battery, Avith tAvelve pairs of 
plates, gradually applied. After fifteen minutes, pulsation became less, the ANEURISM. 
123 
tumor firmer, and, at the end of twenty minutes, complete coagulation 
was evident, as the tumor was solid and the pulsation was imperceptible. 
Part xiv., p. 184. 
Ligature of the left Subclavian Artery within the Scalenus Muscle, for 
Aneurism.—Although this case proved unsuccessful, yet Dr. Rodgers 
was convinced that the operation is practicable and proper. 
Directions.—Lay the patient on a low bed, with the head and shoulders 
raised, and the face turned to the right side. Make an incision three and 
a half inches long, on the inner edge of the mastoid muscle, terminating 
at the sternum, and dividing the integuments and platysma myoides. 
Make a second incision from the last, horizontally, toward the sternal 
extremity of the clavicle, two and a half inches long. Dissect the flap of 
integuments and platysma upward and inward, so as to lay bare the sterno- 
inastoid. Pass a director under this muscle, and divide the sternal and 
half the clavicular attachments with a bistoury. Turn these portions up, 
so as to show the sterno-hyoid and sterno-thyroid muscles, and the jugular 
vein beneath the fascia ; also a portion (in this case) of the aneurismal sac, 
strongly pulsating. Divide the fascia with the handle of the scalpel and 
fingers, and pass down the inner side of scalenus anticus, carefully avoiding 
the internal jugular vein, thoracic duct, and phrenic nerve, until the finger 
reaches the artery and recognizes well its pulsation. Detach the artery 
very deliberately, so as to avoid wounding the thoracic duct and pleura, 
and pass the aneurismal needle (in this case, Sir Philip Crampton’s) under 
it, with the point and ligature upward. Catch and secure the ligature 
(tying it securely with the point of the fore-finger, in the bottom of the 
wound), and, to be satisfied that the artery is secured, take care to examine 
the distal part of it for the cessation of all pulsation. 
Part xiv., p. 187. 
Treatment by Compression.—Dr. Bellingham gives the following sum- 
mary : 
1. The arteries to which compression is applicable being far more fre- 
quently the subject of aneurism than those to which it is inapplicable, 
compression is calculated to supersede the ligature in the great majority 
of cases. 
2. The cure of aneurism by compression upon the artery between the 
aneurismal sac and heart, according to the rules laid down here, is accom- 
plished by the gradual deposition of the fibrin of the blood in the sac, 
until both the latter and the artery at the part is completely filled. The 
process is in fact exactly similar to that by which nature effects a spon- 
taneous cure of aneurism. 
3. Such an amount of pressure as would cause inflammation and adhesion 
between the opposite sides of the artery at the point compressed is never 
required. 
4. The pressure should not bo so great as to interrupt the circulation in 
the artery at the point compressed ; an essential agent in the cure being 
that a current of blood should pass through the sac. 
5. Compression by means of two or more instruments, one of which is 
alternately relaxed, is much more effectual than by any single instrument, 
and in many instances the pressure can be maintained by the patient 
himself. 
6. The treatment of aneurism by compression does not involve the 124 
ANEURISM. 
slightest risk to the patient, and if persevered in cannot fail of effecting 
a cure. 
7. A cure of aneurism effected by compression, according to the rules 
laid down here, must necessarily he permanent; and in every case in 
which a cure has been accomplished, the patients have remained well 
subsequently. 
8. The femoral artery remains pervious after the cure at the point at 
which the pressure has been applied, and no morbid change of any kind is 
to be detected in either the artery or vein at the site of the compression. 
9. When a cure is effected by compression, the vessel is obliterated only 
at the seat of the aneurism, and the artery at this part is eventually con- 
verted into an impervious ligamentous band. 
10. Compression effects the cure of aneurism by more simple and safer 
means than the ligature, while it is applicable to a number of cases in 
which the operation is contra-indicated or inadmissible. 
11. Compression is not necessarily a more tedious or more painful 
method of treating aneurism than the ligature, while it is much more cer- 
tain, more likely to be permanent, and is free from all danger. 
12. Compression, according to the rules laid down here, has little ana- 
logy with the old method which went by this name, and, in fact, has no 
greater resemblance to it than the Hunterian operation had to the opera- 
tion for aneurism which it superseded. Part xv., p. 187. 
Treatment of Popliteal Aneurism by Ligature.—Mr. Syme gives the 
following instructions regarding this operation : 
With regard to the ligature, it appears that this operation admits of 
being performed so as to be nearly, if not entirely free from danger. I 
have undertaken it in every case that presented itself, although the 
circumstances were often very unpromising, and even when erysipelas as 
well as hospital sores invested the clinical wards of the Royal Infirmary. 
There is now, I believe, no difference of opinion as to the proper princi- 
ples of the operation. They are—1st. To dissect with the knife and 
forceps, instead of tearing or scratching with a blunt instrument, to expose 
the artery. 2d. To denude no more of the vessel than what is requisite 
for passing the needle. 3d. To use for ligature the smallest silk thread 
possessing sufficient strength, and tying it as tightly as possible. 4th. To 
treat the wound so as to favor union by the first intention. As to the 
performance of the operation, I believe that there is no arterial trunk in 
the body which requires for its ligature so little anatomical skill, or manual 
dexterity, as the femoral artery. The angle formed by the sartorius and 
adductor longus affords a sure guide to the vessel; and in the event of-any 
error as to the position of the external incision, the fibres of these muscles 
by their different directions at once show the operator on which side he 
has exceeded. But while the mere detection of the artery is abundantly 
easy, it must be admitted that the subsequent part of the operation is 
beset with extreme danger from any want of caution or nicety, since, if the 
vessel be roughly detached from its connections, hemorrhage will probably 
result; and if the vein be wounded, the patient will almost certainly perish 
from inflammation of the vessel, or mortification of the limb. Care is 
always required, and must be emjfioyed in a degree proportioned to the 
intimacy with which the artery is connected to the neighboring parts. I 
have completed the operation in less than a minute, and on other occasions ANEURISM. 
125 
have found nearly half an hour requisite for the purpose. If all operators 
had paid as little regard to the time occupied, I believe that the unfavor- 
able results on record would not have been so numerous as they are. The 
operation, therefore, I believe, being performed upon proper principles 
and with sufficient care, may be regarded as perfectly safe. 
Part xv., p. 189. 
Aneurism by Anastomosis in the Anterior Nares.— Vide Art. “Nose.” 
Sounds of Aneurism of the Aorta.—[The following conclusions respect- 
ing the sounds of the heart and of aneurism of the aorta, have been arrived 
at by Dr. Bellingham :] 
1st. That a double, not a single sound, characterizes aneurism of the 
arch of the aorta, which closely resembles the double sound of the heart, 
and may be termed its normal sound. 
2d. That the normal double sound of aneurism of the arch of the aorta 
has its cause in the friction between the blood and the lining membrane of 
the orifice and parietes of the sac, because there is no other agency to which 
it can be referred. 
3d. That the normal second sound of aneurism of the arch of the aorta is 
caused by the regurgitation of the blood into the sac from the aorta and 
large vessels which arise from it. 
4th. That the first, or the second, or both aneurismal sounds, may be re- 
placed by a murmur, which may have either a blowing, sawing, or filing 
character, and that such murmurs may be regarded as the abnormal sounds 
of aneurism of the arch of the aorta. 
5th. That the first aneurism sound is much more frequently superseded 
by a murmur than the second, because the force with which the blood is 
transmitted to the sac by the left ventricle is much greater than that 
with which it regurgitates into the sac at the period of the ventricular 
diastole. 
6th. That the abnormal sound of the aneurism of the arch of the aorta, 
equally as its normal sounds, are caused by friction between the blood and 
the orifice or parietes of the sac ; and that they are nothing more than ex- 
aggerated normal sounds—exaggerated, because the degree of friction is 
then increased. 
7th. That in aneurism of the arch of the aorta pointing externally, the 
sound is not only always double, but a double impulse is frequently also 
perceptible to the hand. 
8th. That the second impulse of aneurism of the arch of the aorta has 
its cause in the same agency which gives rise to the second sound; conse- 
quently neither a double sound nor a double impulse is perceived in aneu- 
rism of the abdominal aorta, or of any of its branches. 
9th. That the phenomenon known under the name of fremissement 
catairc, or purring tremor, whether it occurs in an aneurism or a large ar- 
tery, is nothing more than the pulse of aortic regurgitation on a large scale, 
consequently that it is a sign of regurgitation into the ventricles of the 
heart, into an aneurismal sac, or into a large or dilated artery. 
10th. That the remarkable resemblance between the normal and abnor- 
mal sounds of aneurism of the arch of the aorta, and normal and abnormal 
sounds of the heart, renders it probable that the mechanism of their pro- 
duction is the same. 126 
ANEUKISM. 
11th. That the abnormal sounds of the heart, having their seat at the 
orifices of the ventricles, and being the result of increased friction between 
the blood and the parts through which it passes, are (like those of aneurism 
of the arch of the aorta) to be regarded as nothing more than exaggerated 
normal sounds. 
12tli. That the impulse of the healthy heart, like that of aneurism of the 
arch of the aorta pointing externally, is double, not single; and that in 
certain abnormal conditions of the heart, this second impulse becomes very 
distinct, when it has been termed “ the back stroke of the heart,” or “ the 
diastolic impulse.” 
13th. That the second impulse of the heart (like that of aneurism of the 
arch of the aorta), is felt exactly at the period of the second sound; and 
both sound and impulse appear to be produced by the same agency. 
14th. That as sounds almost precisely similar to those of the heart are 
developed in an aneurismal sac, which has neither muscular walls nor 
a valvular apparatus at its orifice, the latter do not appear to be as 
essential to the production of the normal sounds of the heart as most writers 
suppose. 
15th. That the ordinary theory of the heart’s sounds, which refers the 
normal sounds to one cause, and its abnormal sound to a totally different 
cause, fails to explain several phenomena connected with the heart’s action 
and sounds. 
16th. That the theory of the mechanism of production of the heart’s 
sounds laid down, satisfactorily explains every phenomenon connected with 
the normal and abnormal sounds of this organ. 
Part xviii., p. 165. 
Aneurism—False, of the Bend of the Elbow.—If the brachial artery is 
unfortunately wounded in performing venesection, the proper practice is by 
no means to cut down upon the artery immediately, but apply a compress 
over the aneurismal sac, letting it extend upward in the course of the 
artery, and carefully bandage the entire limb, beginning with the fingers 
and thumb, and extending to the axilla; and let the limb be kept elevated 
on an inclined plane, and perfectly quiet. If this does not succeed, cut into 
the sac, and tie the artery above and below ; or what is better, tie the 
artery above the tumor, and then, the impetus of the blood being taken 
off by the ligature, employ slight pressure upon the tumor. 
. Part xx., p. 118. 
Aneurismal Varix.—Aneurismal varix, or a communication between 
an artery and vein, occurs, Mr. Cooper observes, not merely from acci- 
dent, as in venesection, but may arise from disease, and may be found be- 
tween any artery and vein lying in close proximity. Tie the brachial 
artery in the middle of the upper arm, and apply gentle compression over 
the tumor, and in the course of the radial and ulnar arteries. If this plan 
fails, the following operation, a much more dangerous one, must be per- 
formed : place a tourniquet on the brachial artery, so as completely to 
compress it, and then make a free incision into the aneurismal sac; turn 
out the clot of blood, and seek for the upper and lower openings of the 
artery. Pass the end of a probe into the upper opening, to serve as a 
guide in separating the artery from the surrounding parts, and secure the 
vessel ; then repeat the same process upon the distal end. 
Part xx., p. 123. ANETJKISM. 
127 
Aneurism of the Radial Artery.—[Prof. Syme gives the following 
case of a man who had, at the root of the thumb, a tumor about the size 
of a flattened gooseberry, and stated that ligature of the artery at the 
wrist had been recommended as the remedy.] 
The swelling looked so much more like a ganglion than an aneurism, 
that I supposed there must have been a mistake as to its nature ; but, 
upon a more attentive examination, finding that there was a distinct 
expansive pulsation, I could not doubt that there was a sac communicat- 
ing with the radial artery, pressure upon which instantly lessened the 
swelling, and deprived it of the pulsating character. I therefore had a 
little spring constructed, upon the principle of a rupture truss, so as to 
press upon the vessel at the wrist, and at the end of twenty-four hours 
after it had been applied could not detect any trace of pulsation. 
It may appear inconsistent in me to apply pressure at the wrist, instead 
of tying the radial artery, as I have strenuously contended against the 
substitution of pressure for ligature of the femoral artery. But the two 
cases are very different, since the latter-mentioned vessel has accompany- 
ing it the great venous trunk of the limb, which the utmost extent of 
human skill and care cannot prevent from being compressed along with 
the artery, and necessarily occasioning a degree of suffering to the patient 
which must, if at all prolonged, infinitely exceed the trivial disturbance 
which attends ligature of the artery—while the radial artery lies directly 
under the skin, rests upon the bone, and has no associate disposed to 
resent the effect of compression. I may add, that it has always been an 
established principle with me, that the radial artery and its branches at 
and below the wrist are completely under the command of pressure. 
Part xxiii., J0..149. 
Novel Treatment of Aneurism.—Displacement of the fibrin in the clot 
of an aneurism sometimes happens with consequent interruption to the 
current of blood, and sometimes spontaneous cure. Mr. Fergusson, in 
imitation of this process, by manipulation, dislodged a portion of fibrin in 
the case of an aneurism of the subclavian, with the effects of instantaneously 
stopping all pulsation of the upper limb. In four days a slight pulsation 
was perceptible at the wrist, but all pulsation had ceased in the axillary. 
The tumor was diminished considerably in size, and became firmer to the 
touch, so that there is ground to hope it may be successful. 
Part xxv., p. 193. 
Treatment of Aneurism.—Recorded facts seem to prove the following 
conclusions: 1. That in popliteal aneurism, skillful compression of the 
femoral is capable of curing the disease, and that with comparative and 
almost absolute safety to life and limb. 2. That the time expended in cure 
is, on an average, not greater than in the treatment by ligature. 3. That 
failure by compression does not compromise subsequent recourse to deli- 
gation. 4. And that consequently, compression, when skillfully employed, 
being equally certain, far more safe, and not more tedious than the liga- 
ture, should, in the great majority of cases, be preferred. The only dis- 
advantage of compression is the care and trouble necessary on the part of 
the attendant, with irksomeness and sometimes suffering on the part of the 
patient. The obvious and only advantage of deligation, on the other 
hand is the facility and dispatch of its execution, with probable ex- 128 
ANEURISM, 
emption from suffering afterward by the patient, in the successful cases. 
The formidable disadvantage is, its proved risk to life and limb. 
Part xxvii., p. 119. 
Injection of a concentrated Solution of Perchlorule of Iron into 
Aneurismal Tumors.—It has recently oeen attempted to cure aneurismal 
tumors by injecting into them a few drops of a concentrated solution of 
the perchloride of iron. Several cases have been recorded in which the 
operation was successful. Part xxviii., p. 171. 
False Aneurism of the Posterior Tibial Artery, from a Wound.—The in- 
jection of perchloride of iron caused coagulation of the blood in the spurious 
aneurismal sac, produced by division of the posterior tibial artery in a 
child aged four weeks. The firm clot squeezed out the serum, which was 
seen oozing from the surface of the wound. The instrument used for in- 
jection was a glass syringe, with a long and slender tube, which was made 
to penetrate the clot, and convey the perchloride to the fluid blood below. 
Part xxviii. p. 172. 
Cure of Aneurism of the Subclavian Artery, by the External Applica- 
tion of the Chloride of Zinc.—M. Bonnet announces the complete cure 
of an aneurism of subclavian artery by the application of chloride of zinc 
paste. The caustic penetrated by imbibition into the deeper part of the 
tumor, and produced complete coagulation of blood, which was detached 
without any hemorrhage. The eschar separates in about eight days after 
the application of the caustic, but by successive applications it may easily 
be retained for a month or longer, or the superficial portions may be re- 
moved by a bistoury. Part xxviii., p. 173. 
Treatment of Aneurism by Peroxide of Iron.—Dr. Pavesi, of Bergamo, 
has lately injected a strong solution of the above-named salt into an 
aneurism of the temporal artery affecting a young man. The sac was 
about one inch from above downward, eight lines transversly, and might 
contain a drachm of fluid. A puncture was made into the tumor, and 
bright arterial blood escaped ; the glass pipe of one of Charriere’s syringes 
was then introduced, and about sixteen drops of the solution thrown in. 
The tumor was ten minutes afterward quite solid, and in one month no 
trace of the aneurismal tumor was left. Part xxx.,p. 131. 
Aneurism, Popliteal—Treatment by Ligature.—Take if you please, half 
an hour, or a whole forenoon about it, but do not pass the needle till the 
artery has been sufficiently separated from the contiguous structures to 
enable you to avoid all risk of injury to the vein, which is the great source 
of danger to be dreaded. The femoral vein is more intimately connected 
with the artery than most veins. If, therefore, you do not separate the 
one from the other with the greatest nicety, you will very likely either 
pierce or bruise the vein, and Mr. Guthrie says, that the artery alone might 
be obstructed without death of the limb, but that this was the invariable 
result if both artery and vein were obstructed together. The femoral 
artery varies in its origin from the common femoral, and it is very im- 
portant that the ligature should be considerably below its lowest origin. 
Therefore, always tie low enough, i. e., where the artery has become over- 
lapped by the sartorius muscle. If, however, you go below this muscle, 
you will be too near the aneurism. Part xxxi., p. 143. ANEURISM. 
129 
Treatment of Aneurism by Compression.—It is not necessary to cut 
off the entire flow of blood to the tumor, neither is it necessary to con- 
tinue the pressure always in one spot, but it may be shifted from one 
place to another. In many cases, it is only necessary to modify the flow 
of blood through the main artery. Carte’s circular compressor is a good 
instrument. It has an ingenious addition to the common screw, in form 
of bands of caoutchouc, whereby a certain resiliency is acquired, which 
keeps up effectual pressure and modifies the screw. 
JSlastic-pressure is the latest improvement in the treatment by compres- 
sion. The screw apparatus seems to have been discarded in popliteal 
aneurism. The elastic spring seems to be quite enough to restrain the 
current of blood, which is sufficient. Tart xxxi., p. 146. 
Aneurismal Tumor (JTcevus).—Puncture the tumor, and immediately 
plunge into it the canula of a glass syringe filled with acetate of lead, and 
inject eight or ten drops or more. Then withdraw the syringe, and apply 
the finger to the wound for about a minute. Tart xxxi., p. 148. 
Aneurism and Varix.—Make use of galvano-puncture, acupuncture with 
zinc, or with needles covered with a layer of this metal instead of steel. 
Insert a certain number of needles into the aneurism or varix, and connect 
them with the positive pole of the galvanic battery. The negative pole 
should be supplied with a plate of platinum, which must be put upon the 
skin adjacent to the aneurism, after having augmented the conductibility 
of the epidermis by moistening it with a saline or acidulated solution. 
Tart xxxi., p. 151. 
Subclavian Aneurism.—"When the usual method of treatment is inad- 
missible, you may succeed by pressing the sides of the aneurismal sac toge- 
ther with the thumb, so as to displace a portion of the lamellated fibrin 
in the aneurism ; these clots will be directed forward by the current into 
the axillary and brachial, so as to block up the distal end of the artery. 
If followed up by local pressure, most striking and satisfactory results may 
be obtained. Tart xxxii., p. 138. 
Aneurism of the Innominata.—These are cases where you can do no 
good by operative interference. If the tumor projects, you must apply 
steady firm pressure over it, by means of a suitable pad; the effect of this 
will be to thicken and strengthen the coats of the artery, and may be very 
beneficial in preventing its increase. Tart xxxiii., p. 167 
Aneurism, Topliteal.—There are few or no cases of popliteal aneurism in 
which the cautious use of pressure is not justifiable. The contra-indications 
to its continued use are: a shattered, irritable constitution, its close prox- 
imity to the knee-joint, and a very free communication with the artery by 
a large opening, which may be judged of by the loudness of the murmur 
and the time which the tumor requires to fill. Tart xxxiv., p. 134. 
Sub-Arterial Cysts of the Wrist.—M. Chassaignac calls attention to a 
form of ganglion which, placed beneath the radial artery, unless properly 
understood, may give rise to very serious errors. From excess of labor, 
or the exertions necessary to raise heavy burdens, the small tumor may 
acquire considerable development. The fingers of the surgeon when ap- 
plied over the cyst, are raised by the pulsations, which are remarkable for 
their energy, and the breadth of space they extend over. This extent of 
pulsatile surface immediately suggests the idea of radial aneurism, and if 130 
ANEURISM, 
the examination he continued, with the limb remaining in its ordinary at- 
titude, an error can scarcely be avoided. The differential diagnosis may 
be established by bringing the wrist into a state of forced flexion, when, 
whether it is that the artery is displaced, or that it ceases to be stretched 
over the eminence formed by the cyst, the pulsations no longer exist, and 
it is evident that no aneurism is present. Iu treating these cases, M. 
Chassaignac employs the iodide of potash ointment, rubbing it in every two 
hours during a week. On the dorsal surface we may treat ganglia with 
advantage by crushing them, by subcutaneous puncture, seton, or iodine 
injection ; but in the case of these sub-arterial cysts of the wrist, which are 
in communication with the radio-carpal articulation, these means of treat- 
ment are not applicable. The iodine frictions give rise to no accident, and 
seem possessed of all desirable efficacy. Part xxxiv.,y>. 136. 
Treatment of Aneurism by Manipulation.—In cases in which both the 
operations of Hunter and Wardrop have never been successful, as in aneu- 
rism of the subclavian artery, between and outside the scaleni, in which 
there is much known danger in the usual modes of treatment, Mr. Fer- 
gusson’s plan of compression may be tried. The flat point of the thumb 
must be laid on the aneurism, and when the sac is emptied of fluid blood, 
the surfaces and supposed contents must be forcibly rubbed against each 
other; the fibrin will be displaced, and block up the distal end of the 
aneurism, and so a cure be effected. Part xxxv., p. 88. 
Superficial Aneurisms and their Treatment.—M. Broca has cured seve- 
ral cases of those congenital ntevi, known vulgarly under the name of 
wine spots, and which it is well known are refractory to all modes of treat- 
ment. The proceeding consists in removing the epiderm by a blister, and 
then touching the denuded derm with a pencil of charpie, wetted with 
perchloride of iron, at 30° of the aerometer of Beaume. By one applica- 
tion of the perchloride on the denuded dermis he rendered definitively 
solid a circoid aneurism of the scalp, that had already existed four months 
and was making alarming progress. On the fifth day the tumor was ob- 
literated, and the patient, who wa§ seen seven months after, continued per- 
fectly cured. Part xxxvi.,p. 169. 
Aneurisms— Cases in which their Treatment by Compression and Ma- 
nipulation is proper.—In his observations on a case of popliteal aneurism, 
successfully treated by compression and manipulation, Mr. Teale, surgeon 
to the Leeds General Infirmary, said : 
“ Let me guard you against adopting this practice in aneurism of the ca- 
rotids or of the innominate artery ; or, in other words, in aneurism of arte- 
ries leading to the brain. In such cases you might run the risk of detach- 
ing small portions of fibrin, which being carried along the current of blood 
to the brain, might then produce the serious mischief of that organ, and 
the consequent paralytic affections described by Dr. Ivirkes in a paper of 
great value published in the ‘Medico-Chirurgical Transactions’ for 1854. 
And this is not a mere speculative evil, as you will perceive from the follow- 
ing case which I will briefly notice. 
“In the year 1847 I was one of a numerous consultation on a doubtful 
case of carotid aneurism. The subject of it was a middle-aged female, in 
good health in other respects. She was seated in a chair while the tumor 
was examined by several persons in succession, and subjected by them to 
repeated handling and compression. While this was going on, she sud- ANTIMONY. 
131 
denly became pale and slipped off the chair. On being raised she was found 
to be hemiplegic. After lingering in this state for a few weeks she died. 
The tumor was found after death to be aneurismal. It was not, however, 
until I read the paper by Dr. Kirkes, that I fully appreciated the patholo- 
gical bearings of this case. Now that we do understand it, let me urge upon 
you to bear it in your minds, and let it be a warning to you, in carrying 
out Mr. Fergusson’s valuable suggestions, to limit the treatment by mani- 
pulation of the tumor to aneurism of the extremities. I may also add that 
in one of the two cases of aneurism of the subclavian artery, which are 
published by Mr. Fergusson, hemiplegia occurred very shortly after mani- 
pulation.” Part xxxix.,p. 161. 
ANTIMONY. 
Preparations of Antimony.—[The following practical remarks are 
made in a communication to the Pharmaceutical Society, on some of the 
preparations of antimony. It seems to he the general impression among 
medical men, that most of these preparations are inert and nearly useless; 
and owing to the expense of Dr. James’s fever powder, that preparation 
is seldom used. Mr. Tyson makes the following observations on this sub- 
ject :] 
After torturing antimony in all ways, and trying, in the course of my 
practice, all its forms, in all doses, in all febrile diseases, in patients of all 
ages and all temperaments, I became satisfied that we had only two pre- 
parations worthy of notice, and that these two were invaluable, viz.: the 
tartrate and protoxide ; and that the protoxide was the base of every use- 
ful preparation of antimony: proving the truth of the remark in “ Dun- 
can’s Edinburgh Dispensatory,” that “ oxide of antimony, with phosphate 
of lime, is one of the best antimonials we possess.” 
In comparing the effects of James’s Powder with Pulvis Antimonialis, I 
sometimes found their virtues so alike, in all their combinations, as not to 
be distinguished. Sometimes I had occasion to prefer James’s Powder to 
the Pulvis Antimonialis, at other times I had reason to give the Pulvis 
Antimonialis the preference, finding that in the James’s Powder there was 
considerable variation. 
Profiting by the idea set forth by Chenevix, I began with his prepara- 
tion, which I soon found would not do, for I never was certain of the 
quantity of antimony. I then tried the oxide procured from emetic tartar, 
and mixing it with phosphate of lime, I found I had a very useful antimo- 
nial, but it did not quite answer my expectation. At length I made my 
experiments on the pulvis algarothi, as ordered by Duncan; and upon 
adding to it, while in a state of hydrate (that is, after the supernatant 
liquor had been poured off), a solution of carbonate of ammonia, I was 
surprised to find a considerable effervescence, showing me that the beau- 
tiful white pulvis algarothi still contained a quantity of muriatic acid. I 
therefore continued to add solution of carbonate of ammonia, as long as 
any effervescence continued, and thereby deposited a straw-colored 
protoxide, Avhich I washed with distilled water upon a filter, and carefully 
dried. 132 
ANTIMONY. 
The next thing I had to do was to ascertain the effect of this, and I soon 
found that in this straw-colored oxide I had a medicine of great power and 
efficacy, and that I could only give it in dose from one-tenth of a grain to 
a grain; that a grain often vomits and purges; that half a grain, combined 
with five grains of calomel, given at the commencement of all febrile dis- 
eases, and followed by the neutral salts, cut short those diseases; that 
smaller doses, given every six hours, after proper evacuants, proved a 
mild but certain sudorific, without the nausea which emetic tartar pro- 
duces ; that when combined with small doses of calomel, it proved a 
powerful alterative. Comparing these effects with the best samples of 
James’s Powder, I found it easy to form a compound similar thereto ; and 
by experience I found I had obtained a preparation far superior, as being 
always the same and always certain. The following No. 1, and No. 2, are 
the forms in which I use it: 
No. 1. fit Protoxidi Antimonii, gr. ij.; Phosphatis Calcis,gr. xviij. Misce. 
Dose, from five to ten grains, if taken alone; but if combined with calomel, 
one grain to five grains. 
Here we have a preparation totally soluble in dilute muriatic acid, ten 
grains containing one grain of protoxide of antimony. 
No. 2. $ Protoxidi Antimonii, gr. ij.; Sulphatis Potassaj, Phosphatis 
Calcis, aa. gr. ix. Misce. Dose the same. 
Another form may be made in the same proportions, with calcined 
hartshorn shavings; but I prefer the above, as being entirely soluble in 
weak acids. 
To the second form, you observe, I have added sulphas potass®, for 
three simple reasons: 
1st. Because, in the best analyses of James’s Powder, sulphate of potass 
has been found, which probably arises from fusing together sulphuret of 
antimony and nitrate of potass. 
2d. Because it is more economical, in saving my phosphate of lime, 
which being procured by solution, is troublesome to obtain, and ex- 
pensive. 
3d. The third reason is the most sound of all: it acts with more cer- 
tainty, and gently, upon the secernents of the alimentary canal. The 
practitioner may use which form he pleases; but, after many years’ expe- 
rience, I prefer that with sulphas potassae. 
PULVIS ANTIMONIALIS. 
PEOTOXYDUM ANTIMONII. 
$ Sulphureti Antimonii, §j\ 5 Acidi Muriatici, §iv.; Acldi Nitrici, gss. 
Misce. 
Boil together for an hour, in a glass vessel; filter through paper; pour 
the filtered solution into water ; pulvis algarothi, i. e., submuriate of anti- 
mony, is precipitated; pour off the supernatant liquor, and add to this 
precipitate a solution of the carbonate of ammonia, as long as any effer- 
vescence continues; wash upon a filter with distilled water, and dry by a 
gentle heat. 
Here we have about five drachms of beautiful straw-colored protoxide. 
Tk Cornu Usti (vel, Earth of bones), §iv.; Acidi Muriatici, §iv.; Aquae 
Purae, gx. Misce. 
PHOSPHAS CALCIS. -ANTIMONY. 
133 
Let them stand together for several days, occasionally shaking the 
vessel; filter, and then add to the filtered liquor, Liquor Ammoniae 
Purse, §iv., vel. q. s. Wash upon a filter Avith distilled Avater, and dry. 
When giving my Pulvis Antimonialis Avith calomel, every six hours, as 
an alterative, 1 have been occasionally obliged to reduce the dose to one 
grain of the compound, as mentioned before; for such is the deoxygenat- 
ing poAver of this protoxide, and such is its affinity for acids, tlisxt Avhen 
made into a pill Avith calomel, it decomposes the calomel, turns it black 
by taking up the muriatic acid, and will occasionally excite vomiting and 
diarrhoea. To obviate this inconvenience, I am noxv in the habit of giving 
it in combination with the blue pill. But my blue pill is not the blue pill 
of the Pharmacopoeia, which, under the best management, is a very uncer- 
tain preparation. I make pilulaj hydrargyri Avith the protoxide, and to 
complete the usefulness of this communication, I Avdll give you a form of 
that also. 
B Hydrargyri Protoxydi, 3j.; Confectionis Rosie Gallicse, 5iij-; Pulvis 
Florum Anthemidis, 5ss. M. s. a. et fiat massa. 
Here we have a preparation with only half the quantity of mercury, far 
superior to, and of the same color, as the blue pill; always the same in 
effect, and always certain, and made in a few minutes. I have been obliged 
to leave out half the quantity of mercury, in order to approximate it to the 
strength of the blue pill of the Pharmacopoeia, finding that the whole 
quantity Avas too active. I use the powdered chamomile, instead of the 
liquorice poAvder, as it keeps better, and sits more pleasantly upon the 
stomach : four grains and a half contain one of protoxide. 
But the great secret that remains, is to procure the slate-colored pro- 
toxide. Aqua calcis Avill not do, as it produces an asli-color, from a 
mixture of the muriate of lime: liquor potassae alone will not do, nor 
will liquor ammonite. 
PILUEA3 HYDEAEGYEI PIIOTOXYDI. 
PEOTOXYDUM HYDEAEGYEI. 
B Calomelanus, §iv.; Liquoris Potassse Purse, §iv. vel q. s. tere simul, 
et adde Liquoris Ammonise Purse, §ss.; Aquae Destillatse, q. s. 
Wash well upon a filter; dry with a gentle heat, and use immediately. 
The liquor potassae produces a brownish-black powder, but there still 
remains a portion of submuriate of mercury undecomposed, which no ad- 
dition of liq. potassae will act upon, but by the addition of a small quantity 
of liq. ammonise, the slate-colored protoxide is immediately produced, and 
the calomel completely decomposed. 
HYDEABGYBUH CUM CEETA. 
$ Hydrargyri Protoxydi, p. j.; Cretoe P. p. ij. M. 
Always the same, and always certain, a form which can never be pro- 
duced by trituration. 
Hydrargyri Protoxydi, gij.; Adipis Suillae, lb j. M. s. a. 
Equivalent, for most purposes, to the ung. hydr. fort., and a great saving 
of mercury. But, N.B., for this purpose, the protoxide should be obtained 
from the hydrargyri muriatis mitis of the old Pharmacopoeia, washing 
the precipitated submuriate while in a state of hydrate, as above. The 
UNGUENTUM HYDEAEGYEI. 134 
ANTISEPTIC—ANUS. 
color completely resembles mercury, but for internal use, I prefer the 
decomposition from calomel. 
Equal parts of protoxide of mercury and sulphur, unite and form a fine 
black powder, similar to iEthiop’s mineral, for which I originally intended 
it; but finding it too active for internal use, I now employ it as one of the 
best applications to chancre. It is a sulphureted protoxide. 
The above forms of Pulvis Antimonalis and Pilulae Ilydrargyri Pro- 
toxydi, I have now used upward of twenty years ; and such is my estima- 
tion of their value in the cure of diseases, that if I wished to leave a legacy 
to my country, I think I could not bequeath to her a greater boon. I 
have long found it unnecessary to use either James’s Powder or the Pulv. 
Antim. of the Pharmacopoeia. Part v., p. 26. 
Cautions Regarding the Use of Antimony.—Never give tartar emetic 
to a child under a year old ; never give it to naturally delicate and scrofu- 
lous children, and never give continued doses. It is the sedative effect 
which is injurious, therefore the drug should only be employed in diseases 
which will bear this, as croup and pneumonia. 
Dr. Beck says : Emetics are very efficacious, and may be given safely to 
the youngest child, if ipecacuanha is used. Part xv., p. 123. 
ANTISEPTIC. 
Employment of Sulphate of Zinc as an Antiseptic.—M. Falcony states, 
as the result of his experimental researches, that sulphate of zinc is not 
only eminently antiseptic, preserving animal substances from decay, but 
that it actually arrests the progress of putrefaction which has once com- 
menced. The injection of four or five quarts of the solution of this salt in 
wTater, through the arteries, suffices for the preservation of a human body, 
in a state of perfect flexibility, for upwards of forty days. Anatomical 
preparations thus made, will serve for dissection for a considerable period, 
the use of the solution not affecting the steel instruments employed. 
M. Falcony has also found, that preparations which have undergone change 
by maceration, resume their original character when immersed in a solu- 
tion of sulphate of zinc. Part xxv., p. 343. 
Fissure of the Anus—Treatment of, by Phatany Foot.—The mode in 
which M. Trousseau employs the rhatany root is the following: He ad- 
ministers to his patient every morning a clyster of marsh mallows decoc- 
tion, or simply of water, with the addition of olive or almond oil, in order 
to clear out the intestines. Half an hour after the intestine has been 
emptied, he gives an injection composed of thirty-eight drachms of water; 
one to two drachms and a half of the extract of rhatany; and five drachms 
ANUS. ANUS, 
135 
and a half of alcohol, which the patient is desired to retain, if possible. 
The same styptic injection is repeated in the evening. 
When the pain is once moderated, only one clyster is given daily ; and 
when the cure appears to be completed, every alternate day only, for a 
fortnight longer. 
He says he has derived considerable advantage from the employment of 
an ointment composed of one or two parts of the extract of rhatany to five 
of the butter of cacao. Part iii., p. 110. 
Artificial Anus—Operation for.— Vide Art. “Intestinal Obstruction.” 
Formation of Artificial Anus.—M. Araussat would extend his opera- 
tions to almost every variety of malformation of the rectum. He would 
apply it in every case of true imperforation of the rectum, in which it was 
possible to reach the gut, with the exception of those only in which the 
anus, otherwise well formed, is obstructed by a mere superficial membrane ; 
but if the septum, however thin and yielding, however it may be distended 
by the accumulation of meconium, is situated above the anus, he insists 
that it is insufficient to destroy the septum, which method fails because of 
the difficulty of keeping an opening above the anus dilated; and M. Anius- 
sat therefore lays it down as a rule, that in such cases we should operate 
as if there w*as no anus, as if the rectum was completely deficient through- 
out the entire extent of its anal extremity ; and cut backward, and draw 
the rectum, not downward to the anus, but directly backward. When 
there is any considerable interval between the gut and the external parts, 
it would be difficult, if not impossible, to draw the rectum downward, so 
as to make it adhere to the external orifice, but the sigmoid flexure of the 
colon will enable it to be drawn down more or less from one to two 
inches. This elongation, therefore, will frequently extend to the neigh- 
borhood of the coccyx, and M. Amussat, in his third memoir, recommends 
that the artificial orifice should generally be made as near the coccyx as 
possible. The reviewer of his work, however, does not agree with this 
opinion, but maintains that whenever the natural situation can be taken 
advantage of, it is better to do so, in order to make use of the sphincter 
muscle. Another mode of forming an artificial anus is that which is com- 
monly called Callisen’s, which consists in opening the colon in the left 
lumbar region, where it is not entirely covered by peritoneum. M. Amus- 
sat has also improved this method, as well as extended it to the ascending 
colon. Instead of making a verticular incision in the left lumbar region, 
he makes a transverse one, four or five fingers’ breadth long, midway 
between the last false rib and the crest of the ilium; and he divides the 
deeper parts, or even the skin, if the patient is fat, crucially, in order to 
gain room. The advantages of this mode of operating are—1st, that it 
makes the operation easier and more certain, and avoids the danger of 
dividing the lumbar vessels and nerves; 2d, that it facilitates finding and 
opening the intestine without wounding the peritoneum; and 3d, it enables 
us to establish the artificial anus more anteriorly ; with a view to which 
the opening in the intestine should be drawn forward and secured to the 
anterior angle of the wound. M. Baudens, another French writer, objects 
to this mode of operating, and recommends an oblique incision instead of 
a transverse one. He also speaks of having discovered a certain way of 
ascertaining which is the colon, a step which is sometimes exceedingly 136 
ANUS. 
difficult. Ilis method consists in introducing a very fine needle, furnished 
with a canula, and on withdrawing the needle, either the gas escapes or 
the canula is soiled with faeces. Part x., p. 101. 
Artificial Anus.—The operation for artificial anus has excited as much 
interest as most other points of operative surgery; especially the opening 
of the colon in the lumbar region. In a very able review of the whole 
subject, written by Dr. Williams, of Dublin, in the “British and Foreign 
Medical Review,” a very important question was left undecided, viz., 
when an artificial opening into the rectum was made in the perineum, or 
on one side of the sphincter muscle, would the patient be able to retain 
his feces ? Sir P. Crampton, in an interesting discussion at the Dublin 
Surgical Society, supplies this desideratum by giving the result of a case 
operated on by Amussat nine years ago, at a point between the coccyx 
and anus. In this case the artificial anus contracted to such a degree that 
it was necessary at last to enlarge the orifice, and even daily to employ 
dilatation to keep the passage open; so that the danger in this case was 
not in the opening being too large, but, ultimately, in being too small; 
and we suspect that this must generally be the case unless the greatest 
care be used to keep the orifice dilated. Part xi., p. 109. 
Peculiar Ulcer of the Anus.—The symptoms which characterize this 
disease may be summed up in a very few words. It is ushered in by an 
uneasy sensation at the anus, increased on going to stool; as the disease 
progresses, the sufferings during the act of defecation become daily more 
aggravated, conveying to the patient a sensation of scalding, or of a red- 
hot iron being introduced into the gut; on the completion of the act of 
defecation some relief is felt by the patient, but after the lapse of a few 
minutes the sufferings are renewed, and continue unmitigated for a length 
of time, varying, in different cases, from four to nine or ten hours, when 
they gradually abate, and at length leave the patient at perfect ease, until 
a renewal of the necessity for the passage of the feces causes a return of 
the sufferings. 
On proceeding to the examination of the anus, we are first struck by 
the absence of that permanently contracted state of the orifice which is an 
almost invariable accompaniment of fissure. Generally speaking, in the 
disease under description, the orifice is as lax as in the healthy state, or if 
it be in any case contracted, it is but slightly so; this lax state of the ori- 
fice allows the examination to be made with much less pain to the patient, 
and equally less difficulty to the surgeon, than in the case of fissure—cir- 
cumstances which cannot fail to attract the attention of any one tvho has 
had experience in those diseases. 
If the finger be now introduced sufficiently far to be on the level of the 
upper part of the sphincter, laid flat on the mucous membrane, and carried 
over its lateral and posterior parts, its extremity will sink into an ulcer, 
rather deep, and of a size varying from half an inch to an inch in diameter; 
the dipping of the extremity of the finger, and the sensation which the 
rough surface of the ulcer conveys to it, indicate satisfactorily the existence 
and situation of the ulcer, which is confirmed by the sensations of the 
patient. We also find in this disease, that, immediately on the pressure 
being made on the surface of the ulcer, the finger is grasped by the con- 
traction of the sphincter muscle. 
The treatment which this ulcer demands is identical also with that so sue- AJSTUS, 
137 
cessfully practised in cases of fissure, the symptoms of which it so closely 
resembles, namely, division of the sphincter muscle, an operation, the per- 
formance of which is devoid of danger, and, in the present disease, owing 
to the laxity of the anal orifice, of difficulty also, the only instrument re- 
quired being a long probe-pointed bistoury, either slightly curved or 
straight, which, having been placed flat on the index finger of the left 
hand, is, by the introduction of the finger, carried into the rectum; the 
extremity of the finger having sunk into the ulcer, is carried to its upper 
edge, where it is allowed to rest; with the right hand the bistoury is now 
pushed upward, until it also touches the upper edge of the ulcer, the bis- 
toury is then carried boldly downward and outward, cutting completely 
through the substance of the muscle, and making the wound and the ulcer 
one continuous surface, as recommended by Mr. Colies. The after-treat- 
ment is sufficiently simple; a dossil of lint dipped in oil, or smeared with 
simple cerate, is to be introduced into the gut, which, in a few days, should 
an ichorous discharge, which in some cases occurs, demand it, is to be re- 
placed by a lotion of ol. olivar. et. liq. plumbi subacet. This will, generally 
speaking, be sufficient to complete the cure; in some cases, other mild 
applications may become necessary, but never any of a severe character. 
Part xii,,p. 205. 
Artificial Anus.—After the bowel has been strangulated so long that 
gangrene of a portion has taken place, and an artificial anus is formed, 
either by the knife or by sloughing, and the stools are passed out of the 
opening, try the very ingenious method adopted by Mr. Trant, of Dublin, 
which consists of introducing a small silver tube (made by Mr. Millikin, 
of Dublin), and pressing back the intermediate portion of the intestine 
lying between the abdominal and anal position of the artificial opening, 
and thus bring the parts into such relation that the stools can pass 
into the natural channel. In this way the opening may be gradually closed, 
and the functions of the part restored to the normal state. 
Part xiii., p. 2G2. 
Anus—Fissures of \ with a Condyloma.—This was a most satisfactory 
and efficient cure of a most troublesome affection by nitrate of silver. A 
daily application was made of the solid nitrate, from the 29th of May, to 
the 19th of June, when the case was cured of both the fissures and the 
condyloma. Part xiv., p. 205. 
Fissure of the Anus in Children.—Give an enema daily for six or eight 
days, composed of extract of rhatrany, one scruple; and water, three 
ounces. Part xiv., p. 20G. 
Prolapsus Ani.—Dr. Hake advises the employment of Weiss’s instru- 
ment—an ivory nipple upon a coil of wire of moderate power ; this fixed 
upon an understrap and attached to a belt. 
Or, carefully return the bowul after the daily motion, and place upon 
the anus a pad formed of a piece of sponge, four inches by one and a half, 
and half an inch thick, rolled up tightly into a coil; and immediately 
bring the nates together with a broad strip of plaster. Vide “Prolapsions.” 
Part xv., p. 215. 
Treatment of Fissures of the Anus.—M. Diday recommends the patient 
to apply to the anus, night and morning, with the end of the finger, a por- 
tion of ointment, about the size of a cherry stone, composed as follows: 138 
ANUS. 
Axungise 15 grammes, tannin 1 gramme, increasing the portion of tannin 
gradually to three grammes or more, according to its effect on the sensi- 
bility of the part. To apply it efficiently, the patient should push his 
linger as far as possible without forcing the sphincter, and there leave the 
ointment. 
Where fissures are situated higher, a solution of tannin may be injected 
into the rectum with a small syringe. The quantity of liquid introduced 
should be as small as possible, in order that it may be retained for some 
time. In both cases, the patient should experience some degree of heat, 
and smarting, continued for some time after the application. 
Part xvi., p. 331. 
Treatment of Prolapsus Ani.—Keep the patient in bed, and daily after 
cleansing the bowel out, let a small quantity of solution of sulphate of iron, 
a grain to the ounce, be injected and retained. If the stomach will bear 
them, give balsams. Part xvii.,p. 171. 
Treatment of Prolapsus Ani.—Apply a ligature round a portion of the 
mucous membrane, for about twenty minutes, and then release it. Give 
then an anodyne every night and an aperient every third day, the 
bowels being kept confined in the meantime. Afterward the rectum 
pessary may be used for five or ten minutes after each motion. 
Part xvii., p. 171. 
Prolapsus Ani.—Some cases will be benefited by destroying a portion 
of the mucous membrane with the strongest nitric acid. Or remove a fold 
or two with curved scissors, and immediately touch the surface of the 
wound with the acid; care having been previously taken to compress the 
base of the portion removed, so as completely to prevent any of the divided 
vessels from bleeding. When an operation from any cause cannot be 
undertaken, use frequent ablution with cold water, or apply the following 
ointment: R. Pulv. hydrarg. nitr. oxyd. 3iij.; pulv. capsici, gr. v.: ung. 
cetacei, § j. M. In many old cases, however, mechanical support is the 
only means that will afford relief. Part xviii., p). 188. 
Prolapsus Ani.—[In mild cases the improvement of the general health 
by tonics, and attention to diet and regimen, together with the use of mild 
aperients, and astringent injections into the rectum, will afford relief. But, 
Mr. Cooper observes:] 
In very protracted cases of prolapsus, palliative means may not prove 
sufficient, and mechanical contrivances may be requisite to return the pro- 
truded membrane within the anus; bougies or the finger may be employed 
for this purpose ; but in some instances, the tone of the sphincter may be 
so completely destroyed that it would be incapable of retaining the intes- 
tine even after it is returned ; a pessary should in that case be passed into 
the rectum, and allowed to remain there for a few hours, so as to maintain 
the loose portion of membrane sufficiently long in situ to allow of its 
recovery from the congestion arising from its protrusion and exposure to 
external agency. I have seen an instrument which is worn by the Chinese, 
who are very liable to prolapsus ani, for the purpose of retaining the bowel 
within the anus. It consisted of a ball of silver, perforated with holes, to 
permit of the escape of flatus, and made to unscrew in the middle, so that 
it could be easily cleaned; this instrument appeared to me to be admirably 
suited to the purpose for which it was intended. When a pessary is ANUS, 
139 
employed, it should be passed into tlie bowel above the sphincter muscle. 
And at the same time that mechanical contrivances are made use of, con- 
stitutional means should also be adopted for the purpose of improving the 
tone of the health. A radical cure may be attempted by pinching up 
several small portions of mucous membrane, at about equal distances from 
each other, a little above the sphincter, and tying a ligature round each. 
In obstinate cases, the anal extremity of the sphincter may be divided, 
with a view of diminishing the opening of the anus. The after-treatment 
consists in keeping the patient in the recumbent posture, and maintaining 
for a few days a constipated state of the bowels, to enable the parts to 
recover from the effect of the operation. Part xviii., p. 194. 
Anus—Fissures of.—Having introduced the left fore-finger into the 
rectum, make a small opening at the verge of the anus, and through this 
wound introduce a straight knife (Blandin’s knife), guarded at its point 
and edges, into the submucous cellular tissue, between the mucous mem- 
brane and sphincter. Turn the cutting edge toward the muscle, retract 
the guard, and cut through the muscle as the blade is withdrawn. Then 
close the external wound, and keep the bowels lax by means of conf. senna3. 
Part xx., p. 145. 
Anus—Imperforate.—If it could be ascertained beforehand that the 
rectum was absent in a case of imperforate anus, it would be easiest to per- 
form Amussat’s operation, and open the colon in the left lumbar region. 
But as the absence of the lower part of the rectum, or its distance from the 
surface cannot be known before operating, the perineal incision is the ope- 
ration that ought to be chosen. One point in the operation ought especially 
to be attended to, viz., to bi’ing doAvn the mucous membrane of the gut, 
and fix it to the lips of the external wound, if it be possible to do so. 
Part xxi., p. 204. 
Prolapsus Ani.—The disease so called generally depends upon morbid 
enlargement of the mucous membrane of the bowel. It is easily, safely, 
and effectually remedied by the use of the ligature; in the application of 
which it is only necessary to remember that the whole of the diseased 
growth should be comprehended, and that the threads should be drawn so 
tightly as completely to arrest all circulation through the included parts. 
Part xxi., p. 205. 
Anus—Fissure of.—It is now well known that a small incision, slightly 
exceeding the length and depth of the little ulcerated fissure, is sufficient 
for its remedy, without any after treatment, or restriction from exercise, 
beyond a day or two of quiet. Part xxvii., p. 348. 
Artificial Anus, treated by Mechanical Pressure within the Pectum. 
.—In a case where the operation for artificial anus had been performed as 
a temporary resort, the greatest discomfort arose from the faeces passing 
invariably through the artificial opening, and not through the rectum. 
At length, when life had become a burden to the patient, it was suggested 
that some substance, as a piece of brown soap, introduced into the rectum, 
might induce the return of peristaltic action, and the necessary tenesmus 
for the expulsion of the contents of the canal. The expedient was per- 
fectly successful, and at the end of two weeks the artificial opening was 
quite healed and the faeces passed by their natural outlet. 
Part xxviii., p. 200 140 
ANTS, 
Fistula in Ano.—The opening into the rectum from the fistula will 
generally be just above the internal sphincter, although the probe may 
easily pass upward to a considerable distance outside the gut; about five 
or six lines high up will generally be the situation of the orifice through 
the bowel—we might, therefore, almost detect it with the eye by separat- 
ing the sides of the anus sufficiently. In operating, pass a director 
through the fistula into the rectum, and wdiere the internal aperture is 
near the anus, the director, by being a little curved, can be brought out 
again at the anus. Then pass a probe-pointed bistoury along the director 
and divide all the parts between the two openings, including the sphincter. 
Then stop up the wound for forty-eight hours with dry lint. If the wound 
heal indolently touch it with a solution of nitrate of silver (3j. to §j.) In blind 
internal fistula, it is best to make it a complete fistula, by making an open- 
ing at the side of the anus, in the hard, tender, red part, and then operate 
as for complete fistula. Sometimes the external point where the fistula 
exists is not well marked; in this case, a probe or curved director can 
sometimes be passed through the opening from the rectum till its point is 
felt through the skin, so as to guide the knife accurately. In blind exter- 
nal fistula a probe bistoury with the front of the end a little sharp and 
projecting, is passed up the fistula till its point presses against the wall of 
the rectum, the nail of the fore-finger in the rectum scratches against the 
end of the bistoury till it pierces the bowel, and then is drawn downward 
wi+h the finger on the end, dividing the sphincter and all the parts below 
it. Part xxx., p. 141. 
Diagnosis of Fistula in Ano by means of Iodine.—To ascertain 
whether the fistulous opening communicates with the rectum, inject a 
little tincture of iodine up the orifice, and at the same time introduce a 
finger up the rectum. If there be a communication the finger will pro- 
bably be stained with the tincture. Part xxx., p. 144. 
Fissured Anus.—Introduce a speculum into the anus so as to bring the 
fissure into view. Then make an incision through the ulcer, beginning a 
little above its upper edge and carrying it through its base to a little 
below its lower edge. These fissures are in reality narrow oval ulcers at 
the margin of the anus, which look like fissures in consequence of the 
plicated arrangement of the end of the rectum. In slight cases, touch the 
fissure with a solution of the nitrate of silver, a drachm to the ounce, or 
touch it slightly with solid nitrate. This should be done every second 
or third day, soon after the morning motion; and a bit of dry lint applied 
well to the fissure after each application. The bowels should be kept 
open by rhubarb or some mild laxative. 
In those very painful ulcerations and fissures of the anus, which used 
formerly to he relieved by division of the sphincter muscle, Mr. Copeland 
merely divides or cuts through the mucous membrane by a slight incision; 
a few "of the muscular fibres of the sphincter are necessarily divided. 
Part xxx., p. 157. 
Prolapsus Ani.—When the integuments around the anus are relaxed 
and thickened, remove the redundant folds of skin by repeated applica- 
tions of the scissors, not in a circular direction, but pointed from the 
circumference toward the centre of the orifice. The horizontal position anus. 
141 
must afterward be strictly maintained, the bowels kept quiet for some 
days. By the contraction which will take place in the treating of the 
wounds the bowel will be retained. Part xxxiv, p. 164. 
Artificial Anus—AmussaVs Operation.—The region in which the ope- 
ration is performed is bounded above by the last false rib; below, by the 
crest of the ilium ; behind, by the lumbar spine ; and in front, by an 
imaginary mesial lateral line. In this oblong quadrilateral space, a hori- 
zantal incision should be made, commencing two fingers’ breadth to the 
left side of the spinous processes of the lumbar vertebrce, and carried hori- 
zontally outward for about four inches, midway between the last rib and the 
crest of the ilium. The dissection is carried down until the transversalis 
fascia is reached: the anterior and middle lamella} of this are opened, and 
the edge of the quadratus lumborum exposed. The real difficulties of the 
operation now commence: the layers of cellulo-adipose tissue which cover 
in the colon, and the contiguous reflexions of peritoneum must be carefully 
dissected. If the gut is distended, this tissue will be pushed well aside, 
and the intestine may easily be reached; but if it be contracted and 
empty, it will be found to recede somewhat from the surface and to lie at 
a great depth. The gut can at once be recognized from any other, struc- 
ture, by its greyish-green hue, the longitudinal strice on its posterior surface, 
and its thicker feel. When exposed, a needle, carrying a strong whip- 
cord, should be passed through it in a vertical direction, and the gut 
being thus drawn well to the surface (that its contents may not be extra- 
vasated into the loose cellular tissue around it), may be properly opened 
and stitched to the edges of the wound. Part xxxv., p. 105. 
Imperforate Anus.—The rectum having been opened, two modes of 
procedure have hitherto been in vogue : either to leave the parts to granu- 
late and a passage established when the mucous membrane is not directly 
continuous with the skin outside,—or to seize the gut (which may be situat- 
ed an inch or two in depth from the sui'face) and drag it down to the 
external parts. In the first case, gradual contraction takes place, and the 
passage often again becomes obliterated. In the second case, death often 
ensues, from peritonitis, or pelvic cellulitis. You will avoid both these 
evils by extending the process of drawing the rectum downward over a 
considerable time, using gentle traction, introducing the forceps at certain 
intervals, and gradually endeavoring to accomplish the end. 
Part xxxvii., p. 152. 
Treatment of Pruriginous, Papulous, and Eczematous Eruptions of 
the Anus, etc.—Modern observers have classed resinous and empyreumatic 
substances, so extensively employed by the ancients, among the most pow- 
erful local applications in the treatment of herpetic eruptions. Thus, puri- 
fied tar, mixed with lard, in the proportion of from fifteen to forty-six 
grains of the former to an ounce of the latter, is daily used in the wards of 
the Hospital St. Louis, as the resolvent, par excellence, of scaly eruptions, 
and as a valuable desiccative in chronic, eczematous, and impetiginous 
affections. Since the introduction of glycerine into therapeutics, M. Gibert 
employs this substance as an excipient, in preference to lard. To facilitate 
its use, the mixture is thickened by the addition of starch. This prepara- 
tion possesses the advantage over ordinary ointments made with a fatty 
excipient, that it is removable by water. 142 
APERIENTS, 
The following is the formula of. the glycerole de goudron: Glycerine one 
ounce; purified tar, half a drachm; and, with the aid of heat, powdered 
starch, half an ounce. With this quantity of starch, we obtain an oint- 
ment of thin consistence, and easily spread. The mixture should be per- 
fectly homogeneous. 
This application allays itching, dries up excoriations, checks exhalation, 
dissipates slight cutaneous phlegmasice ; it acts, in a word, as an astringent 
and resolvent, without producing irritation. Thus, eczema rubrum, im- 
petigo, intertrigo, prurigo of the scrotum and anus, acne rosacea, and 
subinflammatory mentagra, are, under its influence, most advantageously 
modified. 
Another product, the huile de cade (oil of pitch) M. Gibert uses fre- 
quently ; but as the empyreumatic properties which this resinous oil possesses 
in a much higher degree than tar, are such, that it can seldom be applied 
in a state of purity, he usually mixes it with oil of sweet almonds, or with 
cod-liver oil. The following preparation is used, under the name of huile 
cadee, in the Hopital Saint Louis: Cod-liver oil, two parts; oil of pitch, 
one part. This .application possesses very efficacious resolvent and drying 
properties. M. Gibert has seen eczemas, which had continued for months 
in a stationary, red, excoriated, and oozing condition, notwithstanding the 
external and internal use of preparations of sulphur, heal under the influence 
of this combination. 
It is particularly in cases of obstinate pruriginous, papulous, and eczema- 
tous eruptions of the anus and genitals, which are so often such a source 
of annoyance to both the patient and the practitioner, that M. Gibert has 
most frequently derived benefit from the local use of oil of pitch. He 
adds, in such cases, the diligent use of cold hip-baths, and, in order to alter 
the diathesis on which the eruption depends, the internal employment of 
Dr. Boudin’s arsenical liquor, modified in the following manner: Distilled 
water, one pint, arsenious acid, three quarters of a grain ; dissolve with the 
aid of heat. The mixture is divided into six vials, each of which is marked 
for two days; half a bottle to be taken for a dose each morning, fasting, 
with the addition, at the moment the medicine is swallowed, of a cup of 
chicory, sweetened with honey. M. Gibert states that he has seen erup- 
tions of several years’ standing, and which had resisted the use of thermal 
waters, and of many other remedies, yield in a few weeks to this mode of 
treatment. Part xxxix., p. 185. 
Aperient Biscuits.—$ Scammonine, 5j.; Saponis Venet., gr. v.; Sacchari 
Albi, gr. ix. M. These ingredients are to he rubbed down to a fine pow- 
der, and mixed with one ounce of powdered biscuit. The mass is then to 
be kneaded, with the aid of a few drops of water, to a stiff paste, then dried 
in the air, and weighed out into portions of 5x. Of this mass 5j. contains gr. 
vj., of scammony resin. Scammony resin is not unpleasant to take, 
rubbed down with sugar. Eight grains of the resin are sufficient to 
produce several evacuations in an adult; six grains are sufficient for an 
individual of about fifteen years; four grains for a child of seven or eight 
APERIENTS. APHONIA, 
143 
years ; tAvo grains for a child of tAvo years. Scammony is one of the best 
anthelmintics. Part xii. p. 94. 
Agreeable Mode of talcing Senna.—Dr. Linthner says, that senna 
leaves (one or tAvo drachms to one or tAvo cups of water) should be 
alloAved to infuse all night in cold Avater. With the strained infusion 
coffee is prepared next morning, as if with Avater; and an aperient 
which does not taste of senna, and does not cause griping, is thus pro- 
duced. Part xxxv. p. 307. 
Aperient.—Employment of Phammus Frangula. Vide Art. “ Con- 
stipation.” 
APHONIA. 
Hysterical Aphonia.—Allusion is made to various forms of hysterical 
paralysis; you may have numbness in the course of particular nerves, or 
paralysis of motion, in some cases putting on the features of hemiplegia 
—in others of paraplegia. Hysterical aphonia must be regarded as of 
the same kind, the palsy or weakness affecting the muscles of the larynx. 
The patient is unable to speak, except in a whisper, and even then not 
without effort. It often begins and ends suddenly. Sometimes it remains 
after a severe hysterical paroxysm has passed away. This is a form of 
local hysteria of very common occurrence, and not likely to be mistaken 
for any laryngeal disease, for respiration remains quite unimpaired. 
Treatment similar to other forms of hysteria. Part viii., p. 62. 
Treatment by Galvanism.—Case cited of entire loss of voice, fol- 
lowing a violent fit of epilepsy, in which other means having failed, 
at length, about sixteen months after the attack, the voltaic pile was 
thought of, and a battery of fifty pair of plates was employed. The posi- 
tive pole was placed over the cervical vertebrae, and the negative upon 
the parts affected. On the first day two hundred shocks were given, and 
on the second three hundred, but no perceptible effect followed. Two 
days were suffered to elapse, and a battery of seventy pair of plates Avas 
then used, with which about three hundred shocks were given. The pa- 
tient Avas found acutely sensitive to the action of electricity, and a 
lapse of five days Avas permitted to intervene before its fourth application, 
which consisted of four hundred shocks with the latter-named battery. 
After six more days the battery of fifty pairs Avas again employed, and 
three hundred shocks Avere given. The same treatment Avas repeated 
every two or three days, and then, at similar intervals, four hundred 
shocks were given Avith the seventy-pair battery. The voice, meanwhile, 
and the motive powers of the tongue and larynx, gradually returned to 
their normal condition, and after the twelfth application the patient had 
completely recovered. The deduction drawn by the surgeon Avho has re- 
ported the case, is, that no nervous affection Avhatever should be regarded 
as incurable till the electricity in some form has been tried and found to 
fail. Part viii., p. 76. 
Causes and Treatment of Aphonia.—A cold or moist atmosphere very 144 
APHONIA 
frequently induces this affection in weak and relaxed habits of body, par- 
ticularly in females. Other causes, as well as humidity, may bring it on, 
as over exertion of the vocal organs, nervous excitement, etc. 
The disease is evidently of an asthenic character, hence antiphlogistic 
treatment is contra-indicated. Stimulants and astringents are mostly to 
be depended upon, and Mr. Bishop recommends a strong solution of nitrate 
of silver, applied with a camel’s hair brush, before every other application : 
and he illustrates its beneficial action by the following case, in which he 
made use of it: 
Mrs. II., a professional singer, suffered occasionally from loss of voice, 
which often lasted from six to eight weeks. On one occasion she was en- 
gaged to sing at a concert in the course of a few days, when one of these 
attacks came on ; and she was greatly alarmed at the prospect of not being 
able to fulfill her engagement. Under these circumstances, I applied to the 
fauces a solution of nitrate of silver, of the strength of ten grains to one 
ounce of distilled water, and repeated the application the following morn- 
ing. Under this treatment the power of the voice returned, and she was 
enabled to sing at the concert on the third day. 
When aphonia arises from nervous excitement, we must look for the 
origin of the affection beyond the mere office of the soft parts of the vocal 
tube. This condition may often be traced to the nervous centre, most 
commonly arises from an asthenic state, and is often associated with a 
hysterical disposition. In some hysterical cases, however, an opposite 
state to that of aphonia presents itself. A patient was placed under my 
care, who uttered a constant involuntary bark, like that of a dog, very 
loud and discordant. It need scarcely be mentioned that no benefit can 
be expected to result, in such a case, from merely local treatment. Sud- 
den alarm and over excitement will often cause aphonia. When this is 
produced by an altered state of the nervous functions, galvanism is said to 
be beneficial. Part xiii., p. 45. 
Loss of Voice—Lnhalation of the Fumes of Ammonia for.— Vide 
Art. “Bronchitis.” 
Aphonia of Five Months' Duration, Successfully treated.—The pa- 
tient was placed under medical care, January, 1846, for catarrh, which 
terminated successfully, except for the entire loss of voice ; for which she 
was treated with emetics, aperients, mercurials, iodide of potassium, cin- 
chona, and astringent acidulated gargles, until June 25th; and on being 
sent to the sea-side, the inhalation of the vapor of iodine, from a Wolffs 
bottle, for fifteen minutes twice a day, and the following mixture : 
R. Quinize disulph., gr. j.; acid iodic, gr., iij.; tinct. aurant., §ss.; syr. 
aurant., 3j.; aq. destillat. Sviss. M. ft. liaust. ter die. 
July 2d. Voice audible. 10th. Voice natural, and enunciation full 
and clear; after this, the voice continued permanently good. 
Part xiv., p. 132. 
Case of Loss of Speech Cured by Galvano-puncture.—In 1813, R. P., 
then aged forty-seven, was affected with a loss of sensation and movement, 
in consequence of a great fright. Recovering by little and little, she re- 
gained the use of her legs, but did not recover that of her arms and head, 
which remained paralyzed from that time. From that moment she could APHONIA. 
145 
not articulate a single word. The tongue, which remained immovable 
between the teeth, appeared also to be atrophied. 
On the 21st of May, 1836, a metallic needle was introduced into the 
neck, directing its point toward the occipital branch of the first cervical 
nerve ; then it was brought into connection with the zinc pole of a voltaic 
pile; and holding the tongue, elevated and stretched out on a sheet of 
the same metal, the circle was closed by presenting to that organ the knob 
of a brass director. The patient showed, by quickly drawing herself 
away, that she had felt the shock. The experiment was repeated and 
the effect was more marked than before. She gained immediately the 
power of lifting her tongue. At the end of three other shocks the patient 
exclaimed: “Oh, Dieu!” and could answer some questions in an intelli- 
gent manner, although with some difficulty. She also became able to 
move her tongue from side to side. 
The next day, after some shocks given in the same manner, M. Camino 
commenced to vary the points of contact, and to give the electricity 
different directions. 
Two days of repose employed in exercising the organs, sensibly ren- 
dered the faculty of pronouncing and articulating sounds easier and more 
accurate. 
On the 10th of June, she complained, without obvious cause, of pain in 
the head and a general feeling of weight, an ailment which was dissipated 
by a bleeding. After some more sittings, not only was her speech re- 
covered, but also the activity of the other paralyzed parts, which became 
quite fit to exercise their functions. Part xvii.,p. 61. 
Aphonia Cured by Inhalation of Benzoin Fumes.—[A lady who had 
never been able to speak above a whisper for more than twelve years, the 
larynx at the same time appearing to be quite healthy, was advised to in- 
hale the fumes of benzoin burnt upon a card. After a most persevering 
continuance of the remedy for nearly four months, she spoke in a good 
laryngeal tone, not sweet indeed, but tolerably strong.] 
The fumigating cards are made in this manner: A sheet of thick white 
blotting paper is brushed over with a saturated solution of nitre until it is 
thoroughly wet, and when dry the compound tincture of benzoin is applied 
in the same manner. Each of these applications is repeated more than once 
if necessary. When thoroughly dry, the paper is cut into slips, three inches 
long by one and a quarter wide. One of these being lighted at the cor- 
ner, burns without flame like tinder, emitting a dense white smoke, con- 
sisting principally of benzoic acid and some particles of nitre, which are 
thrown off by the crepitation of the crystals. When used for remedial 
purposes, this smoke should be inhaled by holding the head over the burn- 
ing card. Partfxvii., p. 93. 
Aphonia.—In cases of aphonia arising from chronic inflammation of the 
larynx and fauces, paint over the throat, externally, a strong alcoholic 
solution of iodine (3j. to §j.). Where there is a thickened and mammillated 
state of the pharyngeal mucous membrane, a solution of silver, topically, is 
more preferable. Part xxviii., p. 96. 
Aphonia.—If you have reason to believe that it depends upon paralysis 
of the genio-glossi and the muscles connected with the chordae vocales, you 146 
APHTHA—APOPLEXY. 
may derive wonderful benefit from inductive electricity, one pole being 
placed on the tongue and the other on different parts of the neck. 
Part xxxiv., p. 30. 
Aphthous Ulcers of the Mouth.— Vide Art. “ Mouth.” 
Treatment of Aphtha.— [Speaking of that form of aphtha which depends 
upon impaired nutrition of the system generally, and often arises as a con- 
sequence of artificial feeding, Dr. West says :] 
“ One point of considerable moment, and to which less care than it de- 
serves is usually paid, is the removing from the mouth, after each time the 
infant is fed, all remains of the milk or other food which it has taken. For 
this purpose, whenever the least sign of thrush appears in an infant, the 
mouth should be carefully wiped out with a piece of soft rag, dipped in a 
little warm water, every time after food has been given. Supposing the 
attack to be but slight, this precaution will of itself’ suffice in many instances 
to remove all traces of the affection in two or three days. If, however, 
there be much redness of the mucous membrane of the mouth, or if the 
aphthous spots be numerous, some medicated topical application is useful. 
Various detergents have been recommended, among which the mel 
boracis, and a mixture of the Armenian bole, with honey, are very fre- 
quently employed. An objection, however, has been raised to any appli- 
cation into the composition of which honey or other saccharine matters 
enter, on the ground that the tendency of those substances to pass into 
a state of fermentation will make them favor rather than prevent the for- 
mation of confervae in the interior of the mouth. Without determining 
the precise value of this objection, it will yet, I think, be found that water 
is the best menstruum for any local application to the mouth. It is my 
custom to dissolve Bj.-5ss. of borax in gj. of water, and to direct that 
after the mouth has been carefully cleansed with warm water, the lotion 
should be applied to it on piece of lint or soft linen. In the milder forms 
of the affection, this borax lotion usually answers every purpose. Should it, 
however appear insufficient, a solution of gr. v. of the nitrate of silver in 
gj. of distilled water, may be employed in the same way twice a day, while 
at other times the solution of borax may be used in the manner just di- 
rected. Part xviii., p. 111. 
APHTHA. 
In no case of apoplexy or paralysis should a careful examination of the 
heart’s action he omitted. 
If we are called to a case of diseased brain, accompanied by hemiplegia, 
or symptoms which would at first sight indicate congestion or inflamma- 
tory action, it is our duty immediately to ascertain if these symptoms may 
not be owing to disease of the heart or valves; and if we suspect that 
there is disease of the aortic valves, causing hypertrophy of the left ventri- 
APOPLEXY. APOPLEXY. 
147 
cle, and preventing the blood reaching the brain with sufficient ease; or 
if we suspect either a too open or a too contracted state of the mitral 
valves, causing in the former case a regurgitation of blood from the ventri- 
cle, and in the latter case a difficulty in its course into the ventricle from 
the auricle—we must be on our guard not to deplete but to stimulate; as 
is very clearly shown to be correct practice by Dr. Law in several cases 
which he relates. He affirms that if there be obstruction to the flow of 
blood before the arteries going to the brain are given off, that disease of 
that organ will not be owing to a fullness of blood in it, but to a deficiency; 
but, on the other hand, if obstruction exist beyond the origin of the cere- 
bral arteries, then the regurgitation of the arterial blood may very proba- 
bly be toward the brain. Part i., p. 67. 
Treatment of Certain Diseases of the Drain.—There are no cases 
which require more careful discernment of pathological condition than 
those which simulate apoplexy from compression of the nervous centre. 
Dr. Corrigan was the first to point out that many cases which were usually 
treated by antiphlogistic means were in reality better cured by stimulation. 
These cases were chiefly owing to a diminution of blood in the brain, from 
valvular disease of the left ventricle, and other diseases of that viscus. 
From his cases Mr. Copeman draws the following inferences: 
1. That apoplectic and paralytic affections may take place in an extreme 
degree without organic disease of the brain. 
2. That they often occur from ottier causes than pressure on the brain. 
3. That bleeding, so far from being always necessary, is in many in- 
stances prejudicial. 
4. That the effort of vomiting is not so prejudicial in these diseases as is 
generally supposed. 
5. That counter-irritation, both external and internal, is a valuable 
means of affording relief to the symptoms immediately succeeding the 
attack. 
Mr. C. offers the following opinion: “ If I may be allowed to give an 
opinion, I should say that bleeding is unnecessary or prejudicial where the 
patient is 60 years of age or upward; where the pulse is feeble, very fre- 
quent, intermitting, slow, or large, and inclined to double beat; (I have 
always found a pulse with double beat indicative of a state of system best 
relieved by diffusible stimuli;) where the respiration is labored and accom- 
panied with cold perspiration; where there is great mobility of the nerv- 
ous system with weak muscles, whether the body be thin or corpulent; 
and when the attack comes on soon after a full meal, or after great bodily 
or mental fatigue.” • Part iii., p. 34. 
Apoplexy Caused by Inanition, Dyspepsia, Gout, Diseases of the Heart, 
Diseases of the Capillaries, etc.—The intimate connection between plethora 
and apoplexy which exists so often, has too long blinded the eyes of practi- 
tioners to the fact that exactly opposite causes may produce similar effects; 
and hence we too often find, that when a patient is seized with a fit of 
apoplexy, whatever be the cause, whether owing to plethora or exactly 
the reverse, the practitioner thinks he is neglecting his duty if he do not 
bleed the patient copiously, and employ other means of depletion. It is 
now, however, becoming better known, that inanition and anaemia, morbid 
conditions of the stomach and intestines, dyspepsia, cachexia, gout, hyper- 
trophy with augmented impulse given to the arterial blood, or indilatation 148 
APOPLEXY. 
of the heart and disease of the valves impeding the reflux of the blood 
along the veins, may all be causes of the affection, and will require differ- 
ent modes of treatment. 
Even in cases of injury of the brain, as in concussion, too much vene- 
section may give rise to symptoms which it will be difficult to distinguish 
from those produced by the accident itself. Sir Benjamin Brodie remarks 
on this subject, “Where bleeding has been carried to a great extent, 
symptoms frequently occur which in reality arise from the loss of blood, 
but which a superficial observer will be led to attribute to the injury itself. 
Repeated copious blood-letting, is of itself adequate to produce a hardness 
of the pulse which we shall in vain endeavor to subdue by depletion.” 
And almost every practitioner is aware, how many cases of paralysis, appa 
rently resulting from apoplexy, arise from a waste of nervous matter, or 
from a too great exertion of the mental power. The treatment, then, 
should consist in carefully restoring the system to its state of equilibrium 
by recourse to those means adapted to the particular cause. Part vi., p. 37 
Apoplexy Dependent vpon Disease in Remote Organs.—The depend 
ence of apoplexy upon disease in remote organs is a subject of much 
interest. Its occurrence in this kind of connection with pneumonia, ia 
illustrated in the following case: 
A. B., a large, full, healthy-looking man, aged 54, in the spring of 1843, 
was brought into Carroll’s ward of the Marylebone Infirmary, in a state of 
insensibility, and died almost immediately. It appeared that he had been 
employed in the workhouse in bodily labor, and seemed in good health up 
to the moment of his seizure with apoplexy, that morning. He was described 
as having the day before eaten an enormous dinner of pork, etc. He went 
to bed apparently well. 
Autopsy.—The membranes of the brain were healthy, but the convolu- 
tions flattened. A very large coagulum, with some fluid blood, distended 
the lateral ventricles. The basilar artery was of great size; slight appear- 
ances of ossification in many arteries of the brain. The aorta was of great 
size, but healthy; the heart normal. The right lung almost uniformly in 
a state of red hepatization ; portions from every part of it sinking in water 
The left lung gorged with blood, but perfectly crepitant. The stomach 
very large; no solid contents in it: its walls thin: its surface having a 
color exactly similar to that of coffee-ground vomiting. The other viscera 
healthy. Part ix., p. 26. 
Apoplexy of New-born Di fan ts—May arise from want of duly oxygenat- 
ed blood in consequence of imperfect closure of the foramen ovale. 
After birth, then, a portion of the lungs alone becomes filled with air, 
while the remainder continues in a foetal state. 
In cases of this kind, and indeed in all, there is one general rule to be 
observed, never to tie the cord as long as pulsation exists in it, until respira- 
tion is well established; and never to rest satisfied in any case, until the 
child, by its loud cry, the “ vagitus intra muros ” of the Scotch law, con- 
vinces us that its lungs are fully able to perform their function. At a later 
period, in instances such as those recorded, our treatment must consist in 
the use of stimulants internally' and externally, together with remedies 
directed against the apoplectic and inflammatory consequences to which 
the brain and lungs are both liable. In detracting blood from the chest, 
the best situation to apply leeches is under the axilla, as the subcutaneous APOPLEXY. 
149 
venous plexus there communicates directly with the vessels of the thoracic 
cavity. Vide Art. “ Asphyxia.” Part\x.,p 39. 
Asthenic Pulmonary Apoplexy.—Dr. Byron advocates the treatment 
of cases of asthenic pulmonary apoplexy by tartar emetic combined with 
opium 
“ It is well known to medical men,” says Dr. Curry, “ that Avhen either 
emetic tartar, antimonial wine, or ipecacuanha in powder is given, joined 
with opium, each counteracts the effect which the other would have had, 
if administered alone; the opium generally, preventing the emetic tartar, 
etc., from exciting vomiting, and the latter, in their turn, entirely suspend- 
ing the stupefying power of the opium. The consequence generally is, 
that they operate upon the skin, and occasion a very copious sweating.” 
Part xi., p. 49. 
Congestive Pulmonary Apoplexy.—This form of pulmonary apoplexy 
usually falls upon individuals who have passed the meridian of life, those 
whose constitutions have been more or less impaired by over exertion ; by 
intemperance, or by the inhalation of damp, noxious, or unwholesome 
atmospheres. 
A gentleman, set. 43, of sanguineous temperament, accustomed to violent 
exercise, suddenly changed his mode of life, discontinued all but carriage 
exercise. The first indication of this mode of life disagreeing with him, 
was the appearance of furunculi on the hands and body. After about four 
years his legs felt less strong, and he had general lassitude, with aching 
pains about the knees and ankles. 
lie one night awoke shortly after falling asleep, finding his mouth full 
of blood; this was followed by five or six discharges of the same kind in 
quick succession: the entire amount of blood discharged was probably 
about three ounces. His pulse at this time was 70, moderate and regular; 
had no heat of skin, hurried respiration, nor the slightest indication of 
indisposition beyond what has been mentioned. His chest wTas perfectly 
clear on percussion ; his respiration natural, except a mucous rattle in the 
large bronchi, owing to portions of blood which were discharged in a 
coagulated manner during the night. About fourteen ounces of blood 
were taken from his arm without producing any sensible effect upon his 
pulse, or in any other way; his bowels were open and a blister laid upon 
his chest; the acet. pluinbi, with P. ipec. C. and mineral acids, were also 
given. Animal food and wine were laid aside ; he was confined to bed for 
the following week; his head and shoulders were elevated, and his apart- 
ment ordered to be kept cool. In this way he progressed most favoi'ably. 
On the second and third days there was a slight return of fresh bleeding; 
but although pieces of coagula were thrown up for about a fortnight, they 
appeared to be portions of coagulated blood which lodged in branches of 
the bronchi; this was evident from their bearing the impress of the air- 
tubes which contained them. Small bleedings from the arm were resorted 
to every eight or ten days, followed by a small blister for upward of two 
months, when he gradually resumed his ordinary avocations. The bleed- 
ings, however, and the blisters, were resorted to from time to time, but at 
longer periods of intermission, for six months afterward. Little more 
than twelve months from the first seizure, a second discharge of blood, in 
all respects resembling the former one, took place ; he awoke as he did 
then, with his mouth filled with blood, which also soon coagulated. 150 
APOPLEXY, 
1STo fresh discharges of blood took place at the end of three weeks, and 
only three previously; and on no occasion did the quantity spit up 
amount to more than two ounces. Fearing the existence of some organic 
disease, of which the hemoptysis was but a symptom, his chest was 
closely examined by almost every medical man of eminence in Dublin, but 
no disease could be discovered. In addition to the plan of treatment 
adopted on the first occasion, wine and beer were altogether prohibited; 
he was ordered to remove his dwelling to a dry, elevated locality ; avoid 
fatigue or great bodily exertion; and should a sense of pain, formication, 
or constriction arise in any part of his chest, a moderate bleeding should 
be taken from his arm; a blister laid upon the affected part, and the 
other means of relief formerly resorted to, derivatives, etc., resumed and 
repeated as might seem to be necessary. An occasional blister was laid 
upon his chest during the following year; no Avine nor malt liquor was 
used by him for five years, and then but sparingly. The foregoing rules 
were strictly adhered to ; and now, thirteen years from the date of the 
first attack of hemoptysis, he is in the enjoyment of perfect health, and 
possesses greater vigor of mind than at any former period of his life. 
Part xi., p. 50. 
Prevention and Treatment of Apoplexy.—[There are few diseases, the 
pathological diagnosis of which is of more consequence than apoplexy; 
the different kinds of this affection requiring diametrically opposite modes 
of treatment—sometimes an antiphlogistic, and at other times a stimulat- 
ing kind of management. In speaking of the causes of apoplexy, and its 
effect, Dr. M. Hall first mentions mental emotion, and illustrates it by the 
following cases:] 
A lady parted with her son, on his appointment to India; she became 
afflicted with apoplectic symptoms, and most complete hemiplegia. 
Another lady watched a daughter in a dangerous illness ; she was seized 
with hemiplegia of the arm. A gentleman under the immediate influence 
of painful tidings in reference to property, was seized with ptosis, para- 
lysis of the rectus externus, and immobility of the pupil of one eye. 
[Muscidar effort is next mentioned as one of the causes of cerebral 
seizure—also a morbid condition of the stomach—and in illustration of the 
latter, Dr. M. Hall observes:] 
A short time ago I was requested to see a young man, who, after eating 
heartily of pork at supper, had gone to bed and risen the following morn- 
ing free from ailment, but suddenly lost the mental powers, the power of 
articulation, and the use of the arm and leg. It was a case of severe 
hemiplegia. In many cases, the effect follows the exciting cause more 
speedily: in this instance, the hemiplegic seizure occurred soon after 
rising. 
[A constipated and loaded state of the large intestine is also to be 
classed among the exciting causes—of the predisposing causes Dr. M. Hall 
classes hyperaemia, or a state of plethora, as the first; but it may also be 
caused by just the opposite of this, viz.: anaemia, or more correctly, 
hypoaemia ; in speaking of this state of the system as a cause of apoplexy, 
he observes :] 
A lady, who was a patient of the late Dr. Denman, was absolutely 
blanched by the hemorrhage proceeding from a polypus uteri of an in- 
tractable character: in the midst of this anaemia she suffered from an APOPLEXY. 
151 
attack of apoplexy, and hemiplegia, which terminated fatally ; and on a 
post-mortem examination, it was found that laceration had taken place in 
one of the hemispheres of the brain, with the effusion of blood ! A patient 
of Mr. Ilammond, of Brixton, had severe uterine hemorrhage during par- 
turition, succeeded by hemiplegia. A lady, drained by intestinal hemor- 
rhage, has greatly lost the use of the left arm and leg. 
It is plain that a state of general anaemia does not protect the patient 
from local congestion of the brain. 
Of all the secretions, the inefficient or abnormal separation of which from 
the blood induces the most marked predisposition to the apoplectic seizure, 
that of the urine is the most momentous. 
In diabetes, in albuminuria, the patient frequently passes suddenly 
into the apoplectic state. In other affections of the urine, there are 
other scarcely less formidable tendencies to cerebral disease. And if 
the blood may be in an abnormal condition for want of the processes 
of purification, it is also subject to be unhealthy in those cases in which 
the supplies are not healthy. Such are those states of defective and 
abnormal digestion and assimilation which occur in dyspepsia, with its 
effects, gout, furunculus, carbuncle, and urinary deposits, and other 
affections, etc. In all these cases there is danger of apoplexy and para- 
lysis from cacoaimia. 
[On the preventive treatment, Dr. Hall remarks :] 
The real principle of prevention of the apoplectic or paralytic seizure, is 
that of inducing a state of equilibrium, in regard to plethora or inanition ; 
and of health, in regard to the general tone, habits, and secretions. 
[With respect to actual treatment, we must pay especial regard to the 
cause of the malady ; under this head Dr. M. Hall observes:] 
Besides that of the condition of the general system, the questions— 
whether the cerebral affection be one of intravascular congestion or extra- 
vascular effusion—whether the substance of the brain be compressed or 
lacerated—is of the utmost moment. In the former case, there is great 
tolerance of loss of blood, and the detraction of much blood is requi- 
site ; in the latter, blood-letting is neither well borne nor required; the 
system is under the influence of shock, and much cautious watching and 
treatment are requisite. When there is plethora or hypersemia as the 
cause of the threatening of an attack of apoplexy or paralysis, the remedy, 
the safety of the patient, consists in—depletion. TIow are we to be cer- 
tain of the fact ? 
There is a symptom of great importance, when it can be clearly ascer- 
tained to exist. It is the occurrence of vertigo—1, in the stooping, or, 
2, in the usually erect position, especially when these are suddenly as- 
sumed. One patient turned giddy when he pulled on his boots ; another 
could not bear to look up to the ceiling of the room. In both these cases 
the diagnosis was pretty distinct; but in another case, no such event has 
been noticed. What is then to be done? 
There is a resource, in such a case, which is of immense value. There 
is no case in which the patient, if bled from a good orifice, in the erect 
posture, bears to lose so much blood before syncope takes place, as that 
of real hypertemia and congestion of the cerebral vessels: there is no case 
in which the full, not to say the lavish, detraction of blood is so urgently 
necessary. On the other hand, the case of vertigo, and other symptoms 
of cerebral affection arising from dyspepsia, neither bears the loss of much 152 
APOPLEXY. 
blood, taken under similar circumstances of posture, etc., nor requires it. 
In a doubtful case I propose to adopt this mode of blood-letting : 1st, as a 
guard at once against the inefficient and the undue loss of blood; and, 2d, 
as a diagnosis, and as a prompter of our 'ulterior proceedings. 
Part xiii., p. 46. 
Threatenings of Apoplexy and Paralysis.—These threatenings consist 
in a seizure of vertigo, loss of recollection, confusion of ideas, with a tumid 
purple countenance, which may pass off and be forgotten, or may again 
and again recur, until it ends in the organic apoplectic seizure. 
When these “ threatenings of apoplexy ” occur, corresponding to what 
Dr. Hall terms “ paroxysmal apoplexy ”—in the actual attack, bleed in- 
stantly, and give an effectual emetic, enema, and purgative. Afterward 
let the diet be more carefully regulated, any discoverable source of irrita- 
tion removed, business entirely suspended, and all emotion avoided. “ The 
remedy of remedies is travelling.” Part xviii., p. 92. 
Treatment of Apoplectic Symptoms arising from Pisordered Liver.— 
When we review the comparative analysis of the effete matter thrown off 
by the liver and kidneys, and observe the large amount of carbon and 
nitrogen which these organs separate from the circulation, it need not 
be matter of surprise that similar disturbances arise in the head and 
the nervous system, generally from a gorged and torpid liver, as are 
seen to occur from urea and other elements of urine being pent up in 
the system, from degeneration of structure in the secreting portions of 
the kidneys. 
Why should not the elements of bile, so long as they circulate in 
the system, and are not duly and actively eliminated by the lobules of 
the liver, be considered equally as poisonous to the nervous system 
as is urea in ischuria renalis, or is laudanum when taken for a suicidal 
purpose ? 
It has repeatedly happened that a bulky, strong, and perhaps plethoric 
laborer seeks relief amongst the casual patients in the out-door department, 
complaining of a distressing sense of giddiness, fear of falling down in the 
streets, tinnitus aurium, sleepless nights ; or else the very reverse, heavi- 
ness, and disposition to sleep at all hours of the day, if he only sits down 
for a few minutes. Such symptoms, it must be acknowledged, are too 
often assigned as the precursor of apoplexy, and the man is actively bled, 
cupped, and blistered. No observing practitioner will deny that such 
alarming features of a case demand some vigorous and active treatment; 
but the question at issue is simply this: do such symptoms fade away 
under the active antiphlogistic treatment so readily pursued by many ? 
Doubtless they do not. Whereas, if, as is usually the practice here, the 
patient is ordered to take a full dose of calomel, for instance ten grains, 
and the same quantity of extract of colocynth, and that the latter is re- 
peated three or four times a week in smaller quantities, followed by a 
cathartic draught; and, further, if the alvine secretions are observed to 
pass from a dark mahogany color to that of an ochrey tint, the usual result 
is the disappearance of all the cerebral symptoms in proportion to the 
clearing of the loaded gall-bladder and its adjoining ducts. 
Part xviii., p. 97. 
Apoplexy, Simulated.—When symptoms simulating those of apoplexy 
arise from mere cerebral irritation, or from ansemia, treat them (after re- AKSENIC. 
153 
moving the cause, when practicable) by giving tonics, and especially 
chalybeates, with good diet. Let the patient take moderate open-air ex- 
ercise, and use such purgatives as will secure gentle and regular action of 
the bowels. In extreme cases even give stimulants. When the symptoms 
are of doubtful origin, blister and purge for a few days, at the same time 
allowing a generous diet, until the exact nature of the disease is ascer- 
tained. Vide Art. “ Brain.” Part xix., p. 52. 
Apoplexy.—As there are evidently two distinct kinds, plethoric and 
antemic, we must judge, in a great measure, from the distinctive charac- 
ters. But if neither of these indications are present, it will be most pru- 
dent to use local bleeding. Apply cold to the head, administer an active 
purgative, and, above all, enjoin quietude. Part xxiii., p. 68. 
Apoplexy.—Dr. Todd cautions us against being led away by the popu- 
lar opinion that in all cases of apoplexy we must bleed. If the patient be 
full and plethoric, with a strong heart, you may bleed; but if he has been 
intemperate, or has organic disease of the heart or arteries, or of a gouty 
or rheumatic disposition, do not bleed. In the majority of cases bleeding 
is improper ; they may be better treated by purging, shaving the head, 
keeping it cool, and perhaps blistering it. Part xxxi., p. 04. 
ARSENIC. 
Medicinal Action of Arsenic.—The unfavorable states of the system to 
the administration of arsenic are: 1st. A febrile state, especially the 
sthenic form of pyrexia, indicated by the usual signs. 2d. A condition the 
very reverse of this febrile state is likewise unfavorable. 3d. A syphilitic 
taint. 4th. The existence of organic visceral disease, as a complication of 
eruptions, an attack of diarrhoea, bronchitis, cynanche, coryza, or severo 
irritation in any mucous membrane. Certain conditions of the nervous 
system, especially those connected with dyspepsia, and nearly all other dis- 
orders of the general system, generally contra-indicate the use of arsenic ; 
but if the health can be restored by other means, it may afterward bo 
administered with advantage. Mr. Hunt also gives some cautions as to 
the mode of giving it. He says, as we wish it to enter the general circu- 
lation, it should be taken on a full stomach, as it then directly enters the 
circulation with the chyle, being absorbed by the lacteals ; if it is taken on 
an empty stomach it would be chiefly absorbed by the venous capillaries, 
and enter the portal circulation. It should be taken after a meal, also, to 
obviate any irritation it might produce in the stomach and bowels. Again, 
as arsenic is a cumulative medicine, it should never be administered in 
increasing doses, otherwise a sudden and sometimes an alarming develop- 
ment of its toxical effects will necessitate an entire suspension of the 
medicine. The best plan is to begin with five minims of Fowler’s solution 
three times a day, and continue the dose steadily until the conjunctiva or 
tarsi become slightly affected ; then reduce the dose again and again, as tho 
cumulative action becomes apparent in the state of the tarsi. 
Part xxii., p. 250. 154 
ARTERIES. 
Arseniate of Soda.—It is stated by many who employ the officinal pre- 
paration of arsenic that it is uncertain in its action, a small dose in some 
cases acting with violence, and in others a larger dose producing little 
effect. This is rather referable to peculiarities of constitution in the pa- 
tient than differences of preparation of the drug. 
Mr. Bullock recommends the employment of the arseniate of soda, a 
salt which has all the required characters of great solubility, definite form, 
and the additional pharmaceutic advantage of being readily made into 
pills, in such a manner as to insure every pill containing any given frac- 
tion of a grain with perfect accuracy. Moreover, it may be kept in a 
crystalline form, and dissolved readily, as it is required. 
The use of arseniate of soda in medicine is nothing new. It is the basis 
of Pearson’s solution, which consisted of one grain of arseniate of soda to 
one ounce of water. 
The best method of administering the arseniate of soda is in the form 
of pills, made up with crumb of bread, or some inert powder. 
Fart xxiii., p. 283. 
Arsenic-Therapeutical Uses of.—The lameness and deformities of 
chronic rheumatism frequently disappear under a prolonged use of arsenic. 
It is generally given up too soon. Two cases of this nature are related, in 
which the most marked benefit was derived from this mode of treatment. 
About five drops of the liquor arsenic-alis should be given after each meal, 
and continued till the characteristic effects of this drug are produced, when 
it may be intermitted for a time. Many and obstinate forms of neuralgia 
are in a similar manner found to yield to arsenic. Arsenic holds the 
“ foremost place ” amongst the remedies employed for the cure of chorea. 
Besides the various forms, of skin disease in which its use is so well known, 
it has been used very extensively and successfully by Dr. Simpson in 
amenorrhoea and other disorders of the uterus, where iron appeared to be 
contra-indicated, as well as in that peculiar affection of the bowels which 
he has described as prevalent among females, and characterized by copious 
discharge of membranous shreds, and accompanied by great emaciation 
and a long train of neuralgic and other nervous symptoms. Dr. Simpson 
places most reliance upon small and very long-continued doses of arsenic, 
as two drops of Fowler’s solution, or a pill containing the sixtieth of 
a grain of arsenite or potass, taken three or four times a day. 
Part xxxvii., p. 282. 
ARTERIES. 
Torsion of the Arteries.—Dr. Remak recommends a modification of the 
operation of torsion of the arteries, which consists in seizing the vessel 
transversely with a pair of sharp wedge-shaped forceps, and then pressing 
forcibly, so as to divide the internal coat. The extremity of the artery is 
then seized with another pair of forceps and twisted, while the torsion is 
prevented from extending up the artery by the first pair. The vessel is 
thus less injured than in the common proceeding, and the internal coat, 
which shrinks after being divided, offers an effectual barrier to the blood. 
The operation was tested experimentally upon a horse; the carotid was ARTERIES, 
155 
divided, and torsion, performed as recommended above, was sufficient to 
restrain the hemorrhage, even when the horse was made to trot briskly. 
Part ii., p. 128. 
Bleeding from the Temporal and other Arteries.—Mr. Hugh Carmichael 
suggests a very simple method of obtaining as much blood from the tem- 
poral artery, and other small arteries, as we desire. We know that all 
divided arteries have a strong disposition to contract, and that the divided 
extremities separate and retract within the sheath, while the orifices ulti- 
mately close altogether; at the same time the blood clots both in the 
vessel itself as far as the next branch, and also in the sheath, so that a 
complete stoppage is put to the flow of blood. The artery should now be 
fillipped in different parts with the finger, and at the same time pressed 
along its course with the back of the nail, so as to squeeze out any clot 
which may be lodging ; the jet of blood will be again renewed, and will 
again diminish as at first; the same course must be again adopted, and 
repeated so long as it may be required. In opening the artery, it is neces- 
sary to divide it completely across. 
When a sufficiency has been procured, nothing more is required than to 
wait the next stop, which, if necessary, may be expedited by a gentle 
pressure with the thumb on the bleeding section of the artery. A small 
dossil of lint then placed over the wound, and secured with a light band- 
age, is all that is required to prevent further bleeding. 
Part v., p. 124. 
Ligature of the Carotids.—It seems to be a general opinion that the 
carotids and vertebrals may all be tied with safety, provided that sufficient 
time intervene between each operation, so as to allow of the formation of 
the anastomosing circulation. But “ may both carotids be tied at once with- 
out immediate danger to the brain, and with the prospect of a favorable 
result?” The French Academy have answered this question in the 
affirmative, and have, moreover, stated that the danger is not with the 
brain but the lungs. M. Robert states that the vertebral arteries are suf- 
ficient for the cerebral circulation, and that ligature of both carotids 
produces no disturbance, either primary or consecutive, of the nervous 
system of the senses. Hr. John Reid also proves that “in asphyxia, 
cessation of the sensorial function does not arise from diminution of the 
arterial supply of the brain, but from the circulating blood being of a 
venous character, and so failing to afford to that organ the excitation 
requisite for the performance of its functions.” M. Robert concludes 
from his experiments that one great object in treating these cases is 
in venesection, provided the patient is sufficiently strong. This practice 
diminishes, in a great measure, the risk of extensive lesion of the lungs 
In horses, the ligature of the carotids caused death in a few hours, owing 
probably to the vertebral arteries diminishing remarkably in size in these 
animals as they enter the cranium, being there no larger than those of tho 
dog. The result is a congestion of the lungs, which, unless relieved by 
bleeding, produces fatal apoplexy of these organs. 
This prophylactic principle need not be confined to deligations of the 
carotid alone. In operations on other vessels of the first class—subcla- 
vians, iliacs, femorals—important internal organs may be saved, and the 
number of successful issues materially increased, by a precautionary bleed- 
ing to a moderate extent, before the operation, and by a more watchful 156 
ABTEKIES 
and better directed surveillance than heretofore, during the after-treat- 
ment. Part v., p. 130. 
Points connected with the Ligature of Arteries.—Mr. Spence, of Edin- 
burgh, has pointed out an important omission, by ditferent authors and 
experimenters, on the process which nature adopts, after the application 
of a ligature, to close the divided ends of an artery. The use of the exter- 
nal coagulum and the deposit of coagulable lymph has never been insisted 
on as particularly essential to the success of the process. While all 
writers are now convinced of the utility of the divided internal coat, many 
of them disagree as to the use of the lymph or coagulum outside the vessel, 
some, as Mr. Allan Burns, supposing that it is necessary, up to a certain 
stage of the process, viz., until by its pressure it shall have excited such a 
degree of irritation as to give rise to adhesive inflammation between the 
opposite surfaces of the internal tunics of the vessel, to a greater extent 
than the presence of the ligature alone could produce; others, as Jones, 
Travers, Guthrie, etc., look upon the clot as merely an adventitious circum- 
stance, which, when it takes place, may assist, but is not essential to the 
completion of the process. Now although these opinions are more or less 
correct, we think with Mr. Spence that sufficient stress has not been laid 
upon the changes which take place outside the vessel. If the changes are 
attentively observed, it will be found that on the 13th day, when the 
ligature has fairly come away, the lymph has assumed the appearance of a 
Arm connecting medium uniting the divided ends of the vessel, not unlike 
the exuberant callus in a fracture; on the 28th day this lymph has 
become firmer, and the vessel has the appearance of a firm impervious 
cord. So that we may perceive that this deposit of lymph is not only 
useful in connecting the divided ends of the vessel, and thus supporting 
the adhesion of the internal coats at the period of separation of the 
ligature, but by its pressure it will also diminish the calibre of the vessel, 
and thereby lessen the impulse of the blood in the neighborhood of the 
ligature. The conclusion becomes more obvious when we remember the 
success which attended the application of a ligature at a very short distance 
from the point where a large branch was given off’ (case of Dr. Belling- 
ham), where it was applied to the external iliac within half an inch of the 
bifurcation of the common iliac. Part viii., p. 120. 
Arched Tourniquet for Wounds of the Pracliial Artery.—A man 
presented himself to. Dr. Craig, who had had the brachial artery wounded 
the previous day in bleeding; the usual signs of aneurismal varix were 
present. Compression and bandaging were tried to no purpose. Mr. C. 
wished on principle to avoid operating, which in this case would have 
been easy. 
By pressing the artery with the finger in its course, about the middle 
of the inside of the arm, pulsation at the tumor and in the wrist, was quite 
suspended. As the patient could bear the necessary pressure, all that was 
needed wTas a substitute for the finger. 
With this view, says Dr. C., I made a quadrangle with four pieces of 
wood, sufficiently large to encircle the arm; also a piece of wood two and 
a half inches broad, and long enough to reach from the shoulder to the 
elbow. This was laid on the outer aspect of the arm. One side of the 
quadrangle was fixed to the wood thus placed, at a point opposite to that 
where compression was to be made on the vessel. A pad was placed over A.RTERIES, 
157 
the artery a little below where the superior profunda is given off, care 
being taken not to involve the nerve in the compression. The pad was 
pressed firmly there by means of a rude sort of screw passing from the 
side of the quadrangle opposite to the one fixed to the wood placed along 
the arm. The patient was put to bed and placed in a recumbent position, 
and the arm raised in a perpendicular direction, and supported there by 
being suspended to the bed-post, and the pad made to press with such 
force as to suspend pulsation both in the tumor and at the wrist. The 
pressure was unremittingly maintained during twenty-four or thirty hours, 
at the end of which time the pulsation and bruissement had completely 
subsided. The arm was kept raised for some days afterward, with a pad 
over the tumor, and all excitement and stimulation avoided. One pecu- 
liarity of this application is, the provision for preventing any compression 
of the limb except that which is indispensable over the artery. The piece 
of wood placed along the arm on its outer side, extending from the shoul- 
der to the elbow, causes the counter-pressure to be diffused over a large 
surface of the arm, thereby rendering it nearly imperceptible to the patient. 
jPart xii., p. 165. 
Punctured Wound and Ligature of the Posterior Tihial Artery.—Dr. 
Arnott advises to take the wound as a centre, and cut down upon the 
vessel, and tie it both above and below the seat of injury. 
Mr. B. B. Cooper advises, if it be a case of secondary hemorrhage and 
there is a good deal of coagula in the parts surrounding the vessel, to tie 
the femoral artery. When there is a wound in the calf of the leg, with 
sufficient bleeding to warrant a belief that the posterior tibial artery is 
wounded, separate the soleus from its attachment to the tibia, cut through 
the deep fascia, and secure the vessel. Part xiii., p. 216. 
Subclavian Artery—Ligature of.—When there is extensive swelling and 
suppuration, after the lesion of an artery, it is not advisable to cut down 
upon it, to tie it at the seat of injury; and when this is the case after 
wound of the subclavian, it is better to secure the artery beneath the 
scalenus, before it approaches the tubercle of the rib; it is much higher 
and more accessible there. Part xiii., p. 222. 
Application of Ligatures to Arteries.—Mr. Guthrie gives the following 
conclusions, as being a bird’s-eye view of his extensive experience on one 
of the most important subjects connected with surgery : 
1. The Hunterian operation for the cure of an aneurism is not appli- 
cable to the treatment of a wounded artery, inasmuch as the wound of 
the artery communicates with the external pai’ts, and nothing intervenes 
to prevent blood flowing from the wound in its side, or from its cut 
extremities. 
2. When a large artery is divided and bleeds, the wound should be en- 
larged if necessary, and a ligature placed on both the divided ends ; but 
if the artery be only injured and not quite divided, the ligatures should 
be applied, one immediately above, the other below the injured part. 
The artery may or may not then be cut across, at the pleasure of the 
operator, but the limb or part should be placed in a relaxed position. A 
bandage should not be applied, and the edges of the wound should be 
simply brought together by adhesive plasters, which do not extend com- 
pletely round the limb. 
3. No operation is to be performed on any artery unless it bleeds at the 158 
ARTERIES. 
moment of its performance, inasmuch as hemorrhage once sujipressed may 
never return. 
4. The intervention of muscular fibres, or of "whole muscles, is not a 
sufficient reason for tying the artery at a distant part. They must he 
divided, if it be possible, to the extent required for a due exposure of the 
injured artery and its accompanying veins and nerves. 
5. If the wound pass indirectly to the principal artery, from the back 
of the thigh, for instance, to the femoral artery in front, or from the out- 
side of the arm to the humeral artery on the inside, the surgeon may (on 
satisfying himself of the part likely to be injured by the introduction of a 
probe) cut down on the vessel opposite that supposed to be wounded, by 
the most simple and approved method. When the artery is exposed, the 
probe will point out the spot at which the vessel has in all probability been 
wounded. Pressure made below this spot on the artery will cause it to 
be distended and to bleed, if the flow of blood be not prevented from 
above ; the artery is then to be secured by two ligatures, and the lower 
one should, if possible, be applied first. 
6. The tourniquet should never be applied in an operation for aneurism 
or for a wounded artery. Compression by the hand in the course of the 
wounded vessel is allowable. 
7. The blood from the upper end of a divided artery, or that nearer the 
heart, is of a scarlet arterial color. 
8. The blood from the lower end of a divided artery, or that which is 
further from the heart, is of a dark or venous color, when it happens to 
flow immediately after the division of the vessel. At a subsequent period 
it may assume more of the color of arterial blood, but it rarely does so for 
several days after the receipt of the injury, and always flows, or at least 
until a very late period, in a continued stream. 
9. This regurgitation or flow of blood from the lower end of a di- 
vided artery is a favorable sign, inasmuch as it shows that the collateral 
circulation will probably be sufficient to maintain the life of the extre- 
mity. 
10. The collateral circulation is in almost every instance capable of main- 
taining the life of the upper extremity when the axillary artery is divided, 
and the color of the blood which flows from the end of the artery, on its 
being divided, is not always as dark as in the lower extremity, and it 
sooner resumes its arterial color. 
11. The collateral circulation is not always capable of maintaining the 
life of the limb when the femoral artery is injured. The best assistance 
which art can give is to rub the foot and leg in the gentlest manner 
between the hands for several hours, or even for the first three or four 
days; relaxing this process very little, even during sleep. When the 
vein is divided at the same time, or rendered impervious, the limb usually 
mortifies. 
12. The collateral circulation is sufficient to maintain the life of an ex- 
tremity in almost every case in which an aneurism has existed for eight or 
ten weeks, although it may be incapable of doing this if the principal artery 
have been suddenly divided, without any previous disease having existed 
in the part. 
13. The theory and the operation for aneurism are never to be ap- 
plied to the treatment of a wounded artery which has caused a diffused 
or circumscribed aneurism, whilst the external wound communicates with 159 
ARTERIES. 
the artery, unless it be impossible or impracticable to tie the bleeding 
vessel. 
14. When an artery has been wounded, and the external opening has 
healed for weeks or months, so as to give rise to a diffused or circum- 
scribed aneurism, it may be treated according to the theory of aneurism 
occurring from an internal cause, if the case will permit it without danger, 
although with this difference, that as the artery is sound the operation 
may be performed close to the tumor. If any doubt exist as to the 
capability of the collateral circulation to support the life of the lower 
extremity, when the external iliac is secured by ligature, the operation 
should be performed at the injured part by opening the swelling and en- 
larging the wound, as in the case of a wounded artery. 
15. When a circumscribed or diffused aneurism which has formed after 
a wound has been opened, whether by accident or design, it is placed in 
the situation of a wounded artery, and should be treated as such. If the 
aneurism has arisen from disease of the vessel, and the wound or opening 
into it cannot be permanently closed, the limb is in a worse state than if 
the artery had been wounded by accident; because a ligature or ligatures 
placed on a diseased artery are little likely to be successful. They are 
liable to all the difficulties and inconveniences attendant on the old opera- 
tion for aneurism. If a case of the kind should occur in a popliteal or 
femoral aneurism, situated at or below where the artery passes between 
the triceps and the bone, amputation, if it can be done low down, will be 
the best remedy. If the aneurism should have formed higher up, and the 
opening can be closed with any prospect of its healing, a ligature may be 
placed upon the artery above it; but on the recurrence of hemorrhage, 
which cannot be restrained by moderate pressure, the artery must be tied 
below, or recourse had to amputation. It is, however, to be observed, that 
amputation under these circumstances, when resorted to as a third opera- 
tion, rarely succeeds. 
10. When an artery is wounded with a simple fracture of a bone, or with 
a comminuted fracture of the smaller bones, with an external communicat- 
ing opening, both ends of the artery should be secured, and the limb 
treated in the usual manner. 
17. When the bone broken is the femur, and the artery divided is the 
femoral artery, the operation of amputation will generally be advisable. 
It will always be so if the fracture is a comminuted one, or the shaft of the 
bone is- extensively split. 
18. When the broken bone injures the artery and gives rise to an aneu. 
rism, the treatment is to be first of the fracture and then of the aneurism, 
as soon as circumstances render it advisable or necessary to have recourse 
to the operation for aneurism, and which can only be after time has been 
given for the collateral branches to enlarge, so as to maintain the life of 
the limb. 
19. When mortification takes place in addition to, or as a consequence 
of, a wounded artery, amputation should be had recourse to forthwith. 
20. The place of operation should be in almost all cases at the seat of the 
original wound ; but there may be an exception, viz.— 
21. When the injury has been a mere cut, just sufficient to divide the 
artery and vein immediately below Poupart’s ligament, and mortification 
of the foot supervenes, amputation should be performed below the knee, or 
at the part where the mortification more usually stops for a time. 160 
ARTERIES, 
This rule is founded on the observation, that great efforts are made by 
nature to arrest mortification a little below the knee. Sometimes they 
succeed; when they fail, death is almost inevitable. The advice to 
amputate at this part is founded on the fact of its being infinitely less 
dangerous, when done there, than on the thigh, independently of saving a 
joint. 
22. When mortification has continued for several days, and is spreading 
without having once stopped, the constitution of the patient being impli- 
cated as marked by fever, amputation should not be performed until the 
mortification has been arrested and the line of separation has been well 
formed. In many cases, where there is great weakness or irritability of 
constitution, it will be advisable to defer the operation to a later period, 
particularly if there be hope of the patient’s becoming stronger and more 
tranquil. 
23. If the mortification has once stopped and then begins again to spread, 
it will never again cease to extend, and amputation may give some chance 
of life. 
24. Amputation of the arm should never be had recourse to, in conse- 
quence of a wound of the axillary artery, unless mortification takes place. 
25. When mortification takes place after operation for aneurism, the sur- 
geon must be guided by the state of the patient’s constitution, in resorting 
to or refraining from amputation. 
26. When hemorrhage takes place from the surface of a stump, the ar- 
tery should be tied at the part from which the blood comes in the first 
instance, if it can be easily done. If this should not suffice, the artery must 
be tied higher up, just at such distance as to afford a fair hope of its not 
having been affected by the derangement of the stump, which has led to 
the failure of consolidation in the extremity of the artery, and yet not too 
high to admit of the junction of any large collateral branches. If the 
bleeding proceeds from several small vessels, and cannot be arrested, the 
principal trunk should be tied above the diseased part, and the patient re- 
moved to a purer atmosphere, without which the operation rarely succeeds 
in any case. 
27. When an aneurismal tumor mortifies, it is unnecessary and improper 
to tie the artery above the tumor, because it will be obliterated if the mor- 
tification be arrested by the efforts of nature, which the operation may 
interfere with, and even prevent, whilst, if the mortification spreads, it will 
be a matter of supererogation, and only hasten the patient’s dissolution. 
When an aneurism inflames, is opened by ulceration, and bleeds profusely, 
it is a proper case for amputation, if such an operation can be performed. 
Part xiv., p. 160. 
Hunterian Method of tying Arteries.—Mr. Wilkinson King shows that 
the Hunterian method of tying vessels was not really by cutting ligatures, 
as are now generally used, and that the operations were not the less 
successful. 
Mr. Hunter observed, “ that in dogs, the mere exposure of the tibial 
artery to the air for about an hour, excited such a degree of inflammation 
and thickening of its coats, as completely to obstruct its canal.” 
We see inflammations, granulations, and contractions, closing up wound- 
ed arteries of limited size, and shutting up the vessels in vomical cavities. 
A certain hypernutrient action, or a subsequent contraction, may, in spite ARTERIES. 
161 
of aortic distention, close up the orifice of the coronary artery, the carotid 
or intercostals, and narrow the aorta itself as well as its main branches. It 
has a similar effect when the tissues of organs become condensed almost to 
the exclusion of blood, and it is a momentous reflection that very little 
more than granulations about an artery may contract to the blocking up 
of the channel. Part xiv.,p. 162. 
Ligature of Arteries, icithout dividing the Middle and Internal Coats. 
—Chelius considers it unnecessary to draw the ligatures so tight as is 
commonly recommended, but only so much so, that the whole of the inter- 
nal coat be brought in close contact, and that the ligature should indent 
the external coat of the vessel. Part xiv.,p. 167. 
Torsion of Arteries.—Torsion, by producing obliteration of the vessel, 
either by coagulation and simultaneous assimilation of all the three coats 
at the spot, or by the slow and insensible contraction, as by ligature, con- 
verts the arterial tube into an impervious cord. It is adapted to small 
arteries of the fourth or fifth order, radial, ulnar, tibial, intercostal, cervi- 
cal, thoracic, external pudic, spermatic, digitals. Seize them with forceps, 
close the instrument, and twist in the fingers, three, four, or six times in 
the same direction, and then abandon them, or return to the operation if 
not sufficiently twisted. Care must be taken to seize the whole calibre of 
the vessel; to take sufficient hold ; not to include the surrounding texture ; 
and so to twist them that the proper coats are ruptured, but not so much 
that the cellular coat is also broken. Its advantages are simplicity and 
celerity, no assistance being necessary, and its not leaving foreign bodies 
in the wound. Part xiv.,p. 177. 
Wounds of Arteries—Ergotine suggested as a Styptic.— Vide Art. 
“ Wounds.” 
Ligature of the Subclavian Artery for Axillary Aneurism.—Pi ofes- 
sor Syme thus describes his method of tying the subclavian : 
In performing the operation I made an incision along the clavicle, so as 
to extend over the edges of the sterno-mastoid and trapezius muscles, and 
another from the centre of this upward, parallel with the edge of the latter 
muscle. The dissection was conducted entirely by the knife and forceps. 
The needle was passed under the artery, with its convexity upward, and 
the ligature was tied by the unaided effort of the fingers. It has been ad- 
vised to pass the needle with its convexity downward, or toward the 
clavicle, with a view to protect the vein from injury. But this vessel is 
not at all in the way, while the cervical nerves are so situated in regard to 
the artery, as in general to render it nearly, if not quite, impossible to 
convey the ligature from below upward. It has also been advised to em- 
ploy the assistance of some mechanical contrivance for tightening the knot. 
But I feel persuaded that the thread will always be within reach of the 
fingers, and may be more safely tied by them simply, than with the inter- 
vention of any instrument. Part p. 182. 
Opening the Temporal Artery.—The best mode of performing the oper- 
ation is to make an incision into the skin, so as carefully to expose the 
artery, which must then be raised from the aponeurosis of the temporal 
muscle by a probe passed beneath the vessel, which is then punctured by 
a lancet, as in venesection. When the necessary quantity of blood has 162 
ARTERIES, 
been withdrawn, the artery is to be completely divided by a probe-pointed 
bistoury, and the truncated extremity compressed by a dossil oflint, so as 
to prevent the recurrence of the bleeding. If the artery be not divided, 
but a compress merely applied over the puncture, an aneurismal tumor is 
almost certain to form, rendering a surgical operation necessary for its 
cure. The treatment consists in applying pressure on the temporal 
artery, both on the proximal and distal side of the aneurismal sac, which 
is to be laid open, so that the whole of the coagulum can be turned out, 
after which each end of the artery is to be secured by ligature. 
Part xviii., p. 168. 
Treatment of Wounded Arteries.—When bleeding cannot be restrained 
by moderate compression on the trunk of the vessel, and perhaps on the 
injured part, apply a ligature to both ends of the divided artery, or, if the 
artery is not completely divided, one above and one below the wound. 
(The search for the lower end of the divided artery will be facilitated by 
remembering that the blood flows from it in a continued stream, and is, in 
the lower extremity, of a dark color.) If the lower end of the vessel can- 
not be found, try compression upon the track of the artery below the 
wound ; but if this fails to arrest the bleeding, expose the vessel and tie it 
as near to the wound as practicable. Part xix., p. 135. 
Secondary Hemorrhage Treated by Ligature at a Distance from the 
Seat of Injury.—In cases of secondary hemorrhage, where the parts are 
covered by granulations which conceal the bleeding point, and break down 
under the forceps—where there is an inflamed and sloughy condition of 
the parts, and the patient is so enfeebled by previous hemorrhage that fur- 
ther loss of blood would be fatal—and where uncontrollable arterial he- 
morrhage occurs in a case of compound fracture which is, in other respects, 
likely to do well, pass a ligature round the main artery where it is in a 
healthy state. Part xix., p. 137. 
Ligature of the Subclavian.—In performing the operation of tying the 
subclavian artery internal to the scaleni muscles, after exposing the vessel 
and encircling it with the ligature in the usual way, carefully saw through 
the clavicle, at its middle, taking care to guard the subjacent parts with a 
spatula. The intention of this is to allow of the approximation of the 
shoulder to the trunk, that there may be no tension upon the artery. 
Part xix., p. 141. 
Arteries— Wounds of.—Many arteries should be tied at once when 
wounded, but this does not apply to all. When the brachial artery is 
wounded in venesection, squeeze the edges of the wound accurately toge- 
ther, and place over it a sixpence or similar firm body, rolled up in apiece 
of soft rag; then apply something to press upon the radial, ulnar, and hu- 
meral arteries, a little below and a little above the wound, and apply a 
bandage. Bandage the arm to a splint, and keep the patient perfectly 
quiet. By this means the wound of the artery will sometimes heal; at any 
rate the wound in the integuments will, and then, if aneurism form, can be 
treated subsequently. Part xx., p. 118. 
Deep Punctured Wounds of the Palm.—In deep punctured wounds of 
the palm, where it is wished to stop the bleeding by compression, apply a 
bandage round each finger separately, and then continue it round the ARTERIES. 
163 
hand, placing a compress immediately over the wound. Continue the 
bandage up the forearm, having placed small compresses of cork over the 
radial and ulnar arteries, and make sufficient pressure to diminish, without 
wholly stopping, the supply of blood. Lastly, carry the bandage with a 
moderate degree of tightness up to the shoulder, keep the patient recum- 
bent, and apply cold to the arm. Part xx., p. 120. 
Employment of Forced Flexion for arresting Hemorrhage in Wounds 
of the Palmar Arch.—Mr. Durwell, in a case of wound of the palmar 
arch from the fragments of a broken bottle piercing the palm, found him- 
self, on arriving at the cottage of the patient, with no means of securing 
the artery; and— 
While controlling the hemorrhage by pressure on the brachial artery, 
the following sentence in M. Malgaigne’s “ Anatomie Chirurgicale ” oc- 
curred to his mind : “ The only points at which obliteration of an artery 
can be obtained by position alone, without the aid of external compression, 
are at the bend of the arm and knee—a fact which is of great importance 
in reference to the arrest of hemorrhage.” Acting upon this statement, 
Mr. Durwell immediately bent the arm on the forearm at an acute angle; 
the hemorrhage was instantly arrested. Advantage was taken of the cir- 
cumstance to effect a definite cure. The arm was retained in its flexed 
position by bandages, so that the pulsation of the radial artery was com- 
pletely intercepted. The wound of the hand was treated as an ordinary 
wound, and for the sake of precaution, compresses were laid over the 
course of the arteries of the forearm. The cure progressed favorably. On 
the third day, as the patient complained of the posture, the arm was 
slightly extended, and it was noticed that a small portion of florid thin 
blood oozed from the wound. The arm was restored to its flexed position, 
and in a short time the vessels and the external wound had perfectly 
healed. . Part xxii., p. 212. 
Method of making the Incision for the Exposure of Arteries.—Mr. 
Skey almost invariably adopts an oblique incision, generally at an angle 
with the artery of 45°. His reasons for doing so are : that in fat subjects 
it is difficult to ascertain the exact line of the vessel, and that, however 
true the first incision may be, it does not follow, in the course of a slow 
and bloody operation, that the same line will be preserved ; that if, from 
accidental circumstances, the precise position of the artery be lost, the 
operator is equally uncertain whether he is dissecting on the inner or on 
the outer side of the vessel, or upon it; that, by dividing across the di- 
rection of the vessel, he acquires a confidence, from the conviction that 
the artery is really under his knife; and, lastly, that he makes an external 
wound, within which the ligature needle is more readily carried round the 
artery in a fat subject, in which the vessel lies deep, than in a wound 
parallel to it. Ilis objection to a directly transverse wound is, that the 
artery is exposed only in a transverse line, by which nothing is gained, but 
much may be lost. In the femoral, brachial, radial, ulnar and posterior 
tibial, indeed, he considers the oblique incision to be an important element 
of success in finding the artery with facility. Part xxiii., p. 150. 
Treatment of Wounds of the Palmar Arch.—From the writings of Sir 
Astley Cooper, we find that in cases of this kind he recommends steady 
and continued pressure on the brachial artery. If this fails, he says it may 164 
ARTERIES. 
be necessary either to secure the radial or ulnar artery, or both. Mr. Lis- 
ton recommends us to enlarge the wound, and tie the vessels divided above 
and below. If inflammation and sloughing come on, then the humoral 
must be tied ; because if both the radial and ulnar are secured, bleeding 
will still continue from the interosseous communication. Mr. Skey’s 
opinion is, that the trunks of the radial and ulnar should be tied above the 
wrist. This was the opinion of Mr. Abernethy also. Mr. Butcher gives 
a case of a strong athletic man who was admitted into the hospital bleed- 
ing profusely from the right hand. The wound was inflicted by a pen- 
knife, which had been thrust deep into the palm—three-quarters of an inch 
internal to the cleft between the thumb and index finger. Mr. Butcher 
advises, when an artery is dived in the palm, to apply pressure as follows: 
Let each finger and the thumb be separately bandaged to the metacarpal 
bone, then, the finger of an assistant being still kept upon the divided ves- 
sel, apply compresses to the remaining space in the palm, reserving that 
over the bleeding vessel for special pressure. Press a small dossil of lint 
into the wound; over this a compress; over this another, and so on, until 
these are elevated over the surrounding integuments. Then let a roller 
be applied over the compresses, and carried as far as the elbow, placing a 
small compress over the radial and ulnar arteries to moderate, but not in- 
terrupt, the flow of blood. It is important that the palmar aponeurosis 
should be flexed so as to allow the pledget of lint to come in contact with 
the divided artery. The treatment by pressure to be successful should be 
applied early, and the bandaging be evenly employed over the entire 
limb ; at the same time the arm must be kept constantly elevated. 
Part xxvi., p. 167. 
Wounds of Blood-vessels, of the Loioer Extremities.—When arteries 
under the calf of the leg are wounded it is difficult to follow the Avell- 
founded and generally-received rule of exposing and securing the injured 
vessels, even under the most favorable circumstances; that is, if we see 
the case at an early period, when no considerable swelling has occurred, 
and the natural relations of the surrounding parts are not obscured by 
ecchymosis. Frequently we do not know what vessel is wounded, nor the 
precise locality of the mischief. Sooner or later, and often very quickly, 
the whole limb becomes swollen by extravasation of blood, while all the 
soft structures may be lacerated, contused and infiltrated with blood. 
Exploratory incisions for discovering the injured vessel, would be under- 
taken with very little chance of success ; in such a state of limb, they might 
be attended with dangerous loss of blood, and would certainly involve the 
necessity of extensive and deep incisions in the injured parts. Thus we 
come to the conclusion, that amputation is necessary in some of these 
cases, in order to prevent worse consequences. Part xxviii., p. 168. 
Palmar Arch— Wounds of the.—In primary hemorrhage, ligature is gen- 
erally effectual, but if moderate exploration fail to discover the bleeding 
vessel, it may be completely controlled by properly-adjusted pressure. If 
secondary hemorrhage occur, exploration ought not to be attempted, 
judicious and properly-applied pressure will be found quite effectual; 
and under no circumstances whatever is deligation of the arterial trunks on 
the cardiac aspect to be deemed necessary or attempted. Apply the 
tourniquet to the brachial artery, strap up the wound with plaster, and 
place upon it a firm compress of lint, bandaging the hand and forearm 165 
ASPHYXIA. 
moderately tight; also keep the tourniquet sufficiently pressing upon the 
brachial artery to moderately check the impetus of the circulation through 
the limb. Vide Art. “ Hand.” Part xxxii., p. 140. 
On Asphyxia, and on tlie Resuscitation of Still-born Children.—The 
experiments of Dr. Edwards of Paris, respecting asphyxia, are already 
known to many members, though not probably all of the profession, and 
have proved that asphyxia takes place much sooner in a warm than in a 
cool medium. He has found that new-born mammiferous animals die 
most slowly in water at about 60°, which is ordinarily cold water; and 
that they die more rapidly as the water approaches blood heat. He advises 
that persons in a state of asphyxia should be exposed to the cool air, and 
that the application of heat should be avoided. Mr. Snow very inge- 
niously explains this circumstance by supposing that the deleterious 
effects of heat in suspended respiration depended on “ its stimulating the 
capillary circulation, and thus promoting the deoxygenation of the 
blood ” in a more rapid manner than would be the case when the surface 
was cool; in other words, when the surface is cool the capillary circula- 
tion is less energetic than usual, and consequently there is a preservation 
in some degree of the oxygen of the system. When we consider the 
great number of still-born children, some writers affirming that one child 
in twenty is so, it is of the greatest consequence that a safe mode of prac- 
tice be adopted in these cases, and we are strongly disposed to think that 
hitherto, the practice of applying heat, and especially in the form of hot 
baths, is pernicious; for we must remember that the hot bath has not only 
the bad effects of heating the surface, but prevents that surface from being 
acted upon by the oxygen of the atmosphere, which it will be more or 
less when exposed freely to its influence. 
Dr. Marshall Hall does not agree in this practice. Although he 
approves of the sudden application of cold to the warm surface us an 
effectual means of exciting respiration, he does not recommend the con- 
tinued application of it. On the contrary, he says “ That it is not the 
mere application of cold, but the sudden application of cold to a warm 
surface, which is the effectual means of exciting respiration. It is the 
sudden alternation. To apply cold to a cold surface would only be to sink 
the general powers of life. The infant should be kept warm ; the warm 
bath may be required ; and then cold water must be applied, in moderate 
quantity, but with forced He recommends what must strike every ono 
as being a truly practical method of accomplishing resuscitation, namely 
—exciting respiration by stimulating the excitors of that function, the 
trifacial, the pneumogastric, and the spinal nerves—the trifacial by 
forcibly blowing or dashing cold water in the face, stimulating the nostrils 
by ammonia, snuff, pepper, or the point of a needle, etc.; the spinal 
nerves, by forcibly dashing cold water on the chest, thighs, tickling the 
sides, soles of the feet, and verge of the anus. M. Baudelocque states that 
since he has followed the ojhnions of Smellie, Scoret, Chaussier, etc., with 
respect to tying the navel string, he has not lost a single case from 
ASPHYXIA. 166 
ASPHYXIA. 
asphyxia. This opinion is to delay tying it for some time, when asphyxia 
is present; as the blood circulates for some time in the umbilical vein 
when it has ceased to be perceived in the arteries. Part iv., pp. 47, 126. 
Acupuncture of the Heart suggested in Asphyxia.—This experiment 
was performed on a cat. It was kept under water till apparently quite 
dead, and after remaining in this state three quarters of an hour, without 
the least signs of reanimation, a needle was pushed through the heart: in 
live minutes it was observed to move, which showed the heart had recom- 
menced its action ; it rapidly recovered. Dr. Carraro recommends this 
as a safe operation, and trusts that it may be tried in cases of asphyxia. 
But we should certainly hesitate before we adopt such an experiment in 
the human subject. Part iv., p. 53. 
Further Observations on Asphyxia—Treatment after Frowning by 
Artificial Respiration and Moderate Cold.—We cannot but agree with 
Dr. Edwards and Mr. Snow in their views respecting the best mode of 
resuscitating drowned persons, and children that have been still-born. 
Dr. Edwards has certainly shown, that asphyxia takes place more rapidly 
at blood-heat than at inferior temperatures ; and he has, moreover, shown, 
“ that the quantity of oxygen consumed, and the necessity for respiration, 
keep a direct ratio with the development of natural heat; and, likewise, 
that the application of heat to the body increases its power of developing 
caloric, whilst the abstraction of heat by any cold medium had a contrary 
eifect.” By putting a patient into a warm bath during a state of 
asphyxia, therefore, we cause the system to require more oxygen, and 
must, therefore, increase the asphyxia and hasten death, unless respiration 
is, by the stimulus, reestablished. This seems to be very much confirmed 
by the want of success in the Royal Humane Society, where warmth is 
generally employed; whereas, some time ago, when less energetic mea- 
sures were taken to restore the warmth of the surface, persons were fre- 
quently restored Avho had been submerged ten minutes, and in one case 
even twenty minutes. And, in the report of a society at Amsterdam, 
persons are said to have been restored who had been a quarter of an hour, 
half an hour, and one a whole hour, under water ; this is reported by a 
scientific society ; and when we remember that when a person has been 
only five minutes under water, and may be often ten or fifteen minutes 
without breathing, Ave may easily suppose it possible for him to be this 
length of time under water and still be restored. To promote respiration, 
therefore, ought to be the great object in resuscitating drowned persons 
or still-born children, and this ought to be done immediately, by perform- 
ing artificial respiration; and, at the same time, the surface of the body 
should be kept cool till respiration is reestablished, in order that as little 
as possible of the oxygen that remains in the system may be consumed. 
Part v., p. 48. 
Treated by Galvano-puncture.—While on the subject of asphyxia, Ave 
may refer to the experiments of M. Leroy d’Etoiles, Avho has suggested 
galvano-puncture in a manner Avhich at first sight appears formidable. 
“ lie introduces an acupuncture needle on each side, between the eighth 
and ninth ribs, until it reaches the fibres of the diaphragm. lie then 
establishes a galvanic current between the needles, by means of a pile of 
25 to 30 pairs of plates, an inch in diameter. In his experiments the ASrilYXIA. 
167 
diaphragm was instantly made to contract, and an inspiration Avas taken, 
then by interrupting the circle and gently pressing on the abdomen, the 
diaphragm again ascended, and an expiration Avas accomplished. Leroy 
Avas thus successful in restoring animals Avhich had been under Avater above 
five minutes; but, upon the w hole, the experiments Avere more interesting 
than really practical, and could only be brought forward in aid of the 
more usual means of inducing artificial respiration. Part v.,y>. 63. 
Treated by Tracheotomy.—A \Tery extraordinary case of resuscitation 
is related by M. Trousseau, where the patient had breathed his last a feAV 
moments before the operation of tracheotomy Avas commenced. The 
heart commenced beating in about a quarter of an hour, and in 57 minutes 
a deep inspiration Avas taken. This operation Avould, no doubt, be advis- 
able as a last resource in many cases of droAvning, as well as in those cases 
of asphyxia caused by actual disease. When the practitioner is called in 
haste to such a case, he may adopt the practice of M. Maslhieurat, of 
drawing aside each lip of the division of the cricoid cartilage Avith a bent 
pin, to Avhich a string may be attached, and tied behind the neck so as to 
keep the Avound open. The cricoid cartilage and three rings of the tra- 
chea may be divided Avith a probe-pointed bistoury, introduced through a 
wound previously made in the thyroid membrane ; or, the trachea having 
been laid bare, “ it may be punctured at the inferior angle of the Avound 
Avith a sharp-pointed bistoury, and the rings and cricoid cartilage may be 
immediately divided by directing the same instrument upAvard. 
Part v.,p. 137. 
The Effects of Caloric.—The instantaneous application of a burning 
match along the spine, suggested in cases of asphyxia while Avaiting for 
other remedies. Part vi., p. 86. 
Electro-Magnetism—Considered useful in cases of asphyxia, especially 
A\There death seems to be caused by an obstruction of the functions, or 
organic movements Avhich support life, more than by an exhaustion of 
the organic functions, or of life itself. 
In such cases, electro-magnetism might communicate an impulse Avhich 
wmuld reneAv the sympathetic actions betAveen the organs (if no positive 
lesion exist in any of them), upon Avhich the continuance of life depends. 
Part vii., p. 34. 
Congenital Asphyxia.—The sudden alternation of the cold douche with 
warmth, recommended as valuable auxiliaries to other measures, in cases 
of congenital asphyxia, poisoning by prussic acid, etc. Part viii., p. 45. 
Asphyxia from Hanging.—The cause of asphyxia in such cases, is 
stated to be a combination of suffocation and apoplexy. 
So much pressure is made by the cord round the neck as to prevent 
inspiration, so that immediately the lungs, right side of the heart, and veins, 
become congested ; part of the venous blood sent to the lungs through the 
pulmonary artery is oxygenated during the first inspiration, but Avhen the 
next systole of the heart takes place, it is venous, and when throAAm out of 
the left Arentricle, it acts as a poison to the brain, and prevents the respira- 
tory nerves from exciting the muscles of respiration ; at the same time the 
ligature round the neck prevents the venous blood returning from the brain, 
and thus produces apoplexy. 168 
ASPHYXIA. 
The great object in such cases is to bleed the patient as soon as possible 
from a vein so as to relieve the brain of some of its poisoned venous blood, 
and to relieve congestion of the lungs. 
By opening a vein at the bend of the arm, and immersing the arm in hot 
water, together with hot water fomentations and brisk frictions to the sur- 
face of the body and extremities, the stagnant circulation may be roused 
and the congestions relieved. If you cannot get blood from the vein, 
open an artery. 
Cold applications should be kept to the head, especially during the con- 
tinuance of the hot fomentations and friction to the other parts of the body. 
Suggested, also, to stimulate the mucous membrane of the bowels by 
croton oil. 
Care is requisite to regulate and restrain the violence of the reaction, 
when established—which, in the cases here cited—resulted in phrenitis. 
Part ix., p>- 27. 
Congenital Asphyxia.—In the treatment of asphyxia in new born infants 
we ought accurately to discriminate between that produced by actual con- 
gestion in the vessels of the brain and that produced by the violent shocks 
and actions of the womb, the first causing the symptoms of compression, 
and the latter concussion of the brain. When a child is born with its face 
of a purple or blue color, its features bloated, and slow or totally impeded 
respiration, we suspect the cause to be congestion, and by allowing a little 
blood to escape from the cord, the symptoms are often relieved in a re- 
markably short time ; on the other hand, when the child is born pallid and 
relaxed, with a very feeble circulation, we must be careful not to take away 
blood till the circulation has been stimulated to increased activity by the 
alternate use of the warm bath, and the cold douche, quickly followed by 
friction with ■warm flannels; also, ammonia applied to the nostrils, galvanic 
shocks passed through the cardiac region, etc., and as Joerg has pointed 
out, that in a rapid delivery the lungs will sometimes not have time to be 
prepared for their new function, we ought in such cases never to tie the 
cord, so long as pulsation exists in it, till respiration be established. He 
conceives that in such cases, in consequence of the inferior degree of com- 
pression to which the placenta is subjected, a sufficient tendency is not 
given to the foramen ovale to close, nor is a necessity for respiration felt 
by the system. After birth, then, a portion of the lungs alone becomes 
filled with air, while the remainder continues in a foetal state, a condition 
to which he has given the name of atelectasis, and which may, amongst 
other ill consequences, give rise to apoplexy, depending on the want of 
duly oxygenated blood. Part ix., p. 35. 
Inflammation and Gangrene of the Lungs produced by Partial 
Asphyxia.—A case is related by Dr. Heaton, which shows very remarka- 
bly the power of partial asphyxia, by whatever cause produced, in causing 
that state of congestion of the lung which must frequently end in inflamma- 
tion. The partial asphyxia in this case was produced by a woman taking 
a large dose of laudanum. The immediate effects of the poison were 
counteracted, but in a few days pneumonia appeared in the right lung, 
which ultimately ended fatally. Part ix., p. 59. 
* Asphyxia from Various Causes.—Asphyxia by Vacuum, Strangtda- 
tion, and Occlusion.—The first and the most pressing demand is to remove ASPHYXIA. 
169 
the obstacle which opposes itself to the introduction of the air; to cut the 
cord which strangles, or withdraw the foreign body or parasite which 
blocks up the trachea. An emetic, in these cases, is often successful. 
This result obtained, we must hasten to rub the body of the patient, the 
neck, between the shoulders, on the chest and abdomen with an aromatic 
ointment (camphor ointment, for instance), and place a compress of sedative 
water over the region of the heart, on the cranium and around the neck. 
Our sedative water, which has ammonia for its base, has the property of 
penetrating speedily into the circulatory current, and there dissolving the 
coagulated albumen ; in fact, of impregnating the blood with ammonia 
and sea-salt, which are two of its most powerful vehicles. We may, also, 
gently inflate the lungs with hot air, containing the vapor of myrrh, cam- 
phor, etc., to reestablish the respiratory movements, and obviate all ten- 
dency to decomposition. Directly the patient gives a sign of life, make 
him swallow hot broths and strongly spiced liquids. 
Asphyxia by Submersion.—Dry the body ; then bathe it with the strong- 
est camphorated spirits. The alcohol, which passes by imbibition through 
the living tissues, removes from the blood the aqueous quality which it ac- 
quires from too long a stay in the water ; now, the circulation is arrested 
as much by excess as by deficiency of its menstruum. Also, inflate the 
lungs with air impregnated with camphorated spirits, etc. 
Asphyxia, by the Vapor of Charcoal and by Acid Ema7iations.— 
Abundant lotions of the sedative water, so as to re-dissolve, by the vehicle 
of the ammonia, the congestions caused by the chemical action of the acid 
vapor. Constant frictions along the course of the spinal marrow, and the 
abdominal region, with camphorated liniment; insufflation of air rendered 
slightly alkaline with ammonia. 
Asphyxia by Ammoniacal Gas, Sulphureted Hydrogen and other 
Basic Gases.—General frictions with camphorated or aromatic vinegar; 
application of camphorated spirits, to absorb the aqueous portion of the 
blood and diminish its liquidity; acid lotions to neutralize the exaggerated 
effects of the alkaline vehicle, and to decompose the poisonous gases by 
precipitating their bases. 
Acid Exhalations and Emanations—Marsh Miasmata.—In the new 
process of gilding by dipping, and in the manufacture of vitriol and other 
acids, the workman is constantly surrounded by an atmosphere of nitric ox- 
hydrochloric acid, which he respires through all his surfaces. The trades 
in which mercury is employed are perhaps less injurious than this. Mer- 
cury attacks the nerves ; acids corrode the parietes of the intestinal canal 
and of the chest. The men shoixld here take care to work only under low 
and glazed chimneys, and to be surroupded by free currents of air. They 
should also frequently bathe their hands with ammoniacal water, and wear 
a cravat impregnated with it ax-ound the neck, so that the mouth and nose 
may be constantly enveloped with a vapor capable of saturating the acid 
emanations, and neutralizing their effects. A mask might also be worn, in 
such cases, containing similar antidotes. Those who labor in sewers, and 
on marshy grounds, shoixld adopt similar precautions, or employ cigarettes 
containing particles of chloride of lime. The smoking of tobacco, 
otherwise very hygienic, can here serve only as a vehicle and auxiliary 
to the corrosive action of the acids and the miasmata. Fires on the 
borders of marshy grounds purify the air, not only by decomposing the 
chemical principles of the miasm by the flame, but also by converting 170 
ASPHYXIA. 
them into a saponaceous compound by the essential oil, and neutralizing 
them by the pyroligneous acid which is disengaged. 
Part x., p. 188. 
Treatment of Asphyxia.—In giving the outlines of the treatment of 
asphyxia, as described in Mr. Eriehsen’s paper, it will not be necessary to 
do more than refer to those points which may be called for in practice. 
It may be useful to remember that asphyxia may be caused or attended by 
two circumstances : 1st, When the impression is first made on the nervous 
system causing syncope rather than real asphyxia. In this case, the heart 
will continue to pulsate feebly for some time, sending the blood through 
the lungs slowly to consume the remains of the oxygen which there exists; 
this state finally terminating in real asphyxia, the blood being no longer 
able to stimulate the heart to action. This accounts for those cases of 
recovery after a submersion of four minutes and upward. The face is 
pale and bloodless, the features sunk and contracted, and the eyes partially 
or entirely closed. 2d, When the impression is first made on the respi- 
ratory and circulating systems, the brain and medulla oblongata being only 
secondarily affected. In this case the blood rapidly becomes venous, and 
the -heart seldom continues to pulsate above four or five minutes : the face 
is livid and bloated, the lips swollen and the eyes open. But in actual 
practice it is often impossible to draw these distinctions, both kinds 
running into each other. It is obvious that when a distinction of causes 
is evident, “ in the one case we should endeavor to re-oxygenize the 
blood ; in the other, to rouse the sensibility of the brain and medulla 
oblongata.” 
Mr. Erichsen first recommends that a certain degree of warmth (from 
85 to 90 degrees) be applied, but not the high temperature of 98 or 100 
degrees, which is too often used. This advice is agreeable to the experi- 
ments of Edwards, who has proved that the higher the temperature of the 
body, whether natural or artificial, the more oxygen is consumed—and 
therefore in a case of asphyxia, a low or moderate temperature will cer- 
tainly be safer than a high one. Moreover the hot bath is not so favorite 
a mode of applying heat as it used to be. Both Dr. Kay and Dr. Carpen- 
ter disapprove of it, considering that as the skin is a valuable medium of 
conveying oxygen to the blood, the bath renders this adjunct compara- 
tively useless. The hot-air bath is, therefore, a better mode of accom- 
plishing the purpose ; and with this, friction in various ways may be 
better applied than when the hot bath is used. There are two facts which 
seem to be so far established, viz., that artificial respiration' cannot cause 
reaction of the ventricles of the heart when they have entirely ceased, but 
that by means of this operation the circulation through the lungs them- 
selves can be reestablished to some extent after it has entirely ceased, and 
after they have become congested with asphyxial blood. By means of 
artificial respiration, however, Mr. Erichsen has several times observed the 
auricles to contract regularly and forcibly. This process ought therefore 
never to be neglected, as it can do no harm even if the action of the ven- 
tricles has ceased, and, by supplying the left side of the heart with a fresh 
quantity of oxygenated blood, it is one of the most likely means of exciting 
it to increased action. Now the experiments of Mr. Erichsen clearly prove 
that even when the lungs are loaded with asphyxial blood, artificial respi- 
ration is able, in some measure, to decarbonize it, and to excite the pul- ASPHYXIA. 
171 
monary circulation to some degree of activity, even when that circulation 
has ceased. Perhaps the best mode of causing artificial respiration is by 
compressing the chest and abdomen and allowing them again to expand— 
a certain quantity of air is sucked in, and by the well-known law of the 
diffusion of gases, if fresh air be only taken into the larger bronchi, it 
becomes rapidly diffused. In several experiments it was found that even 
when the contractions of the heart had entirely ceased, they could be 
reexcited by making use of oxygen gas in the inflation of the lungs—an 
important fact to be known. It seems evident that if we had a large and 
ready command of this gas, many lives might be saved. Dr. George 
Wilson, lecturer on chemistry, Edinburgh, points out a method by which 
this may be accomplished. It consists in a modification of the well-known 
process of preparing oxygen from chlorate of potass. It consists in mixing 
the chlorate with a tenth of its weight of the black oxide of manganese, 
the black oxide of copper, or of certain other oxides, and applying heat as 
is done in the ordinary process with the unmixed chlorate. Dr. Wilson 
states “ that with a small glass retort heated by a single spirit lamp, con- 
taining the chlorate of potass mixed with a tenth of its weight of oxide of 
manganese, it is easy to obtain 200 cubic inches of oxygen within four 
minutes of the first application of the flame. The gas begins to come off in 
a few seconds after the light is applied, and literally gushes in a full stream 
till the whole is evolved. This subject has been discussed in the recent 
part of “Taylor’s Scientific Memoirs.” It has been estimated that 100 
cubic inches of air may be thrown into the lungs each time, so that if 300 
or 400 cubic inches of oxygen could be supplied each minute, the process 
could be kept up artificially for a considerable time. But we suspect that 
a much less quantity would be very useful and even sufficient. Owing to 
the diffusibility of gases, it would be sufficient to force a quantity of 
oxygen into the larger tubes of the lungs : this would soon be diffused 
through the remotest air cells, and in a much more rapid manner than is 
generally supposed. The mixture of chlorate of potass and metallic oxide, 
should be kept ready for use at all public hospitals, lying-in institutions, 
police offices, and wherever cases of asphyxia may be readily conveyed. 
“ There should also be provided glass or metallic retorts, with suitable 
arrangements for heating them, and one or more gas holders to receive the 
gas.” It would be advisable “ to pass the gas through an intermediate 
vessel containing a little caustic potass in solution, both to detain any car- 
bonic acid resulting from the presence of combustible matter in the 
original mixture, and to arrest any of the latter carried over mechanically 
in the current of the oxygen.” A complete apparatus for this purpose 
would be especially useful in lying-in hospitals. It might also be useful in 
cases of poisoning by opium. 
“ The best form of gas holder, I believe, would be that adopted at the 
gas-works, viz., a cylinder or drum of sheet metal, closed at one extremity, 
suspended with the mouth downward in a cylinder like itself inverted, 
filled with water. The drum being hung with chains passing over pullies 
and terminating in counterpoising weights, is filled with water by sinking 
it in the lower cylinder or well, while the air is permitted to escape. When 
oxygen or any other gas is poured into the drum, the latter rises out of 
the well to a height proportionate to the quantity sent into it. The con- 
venience of this form of arrangement is, that gas can be drawn off* by a 
properly arranged tube from the upper part of the drum, while it con- 172 
ASPHYXIA. 
tinues to be thrown in from below. To the exit or delivering tube a flex- 
ible pipe of convenient length and dimensions should be attached at one of 
its extremities, and at the other made to screw or otherwise fit into the 
aperture provided for the entrance of air in the bellows to be used for in- 
flation. A valve in the pipe of the bellows opening outward, would pro- 
vide a complete security against any return of the oxygen when the 
handles of the instrument were separated, so as to produce a vacuum 
within it; but it would not be absolutely necessary. With gas holders 
of the construction recommended, kept full of water, and the rest of the 
apparatus and the mixture ready for immediate use, inflation with oxygen 
might be commenced within a few minutes after a case was brought in, 
and might be carried on for any length of time.” Part xi., p. 41. 
Asphyxia by Strangulation—Immediate Treatment—Sir B. Brodie 
resolves the treatment into the following simple indications, observing 
that there are necessarily but few cases in which the surgeon has an op- 
portunity of hopeful interference. 1. If the ligature is removed before the 
efforts of the diaphragm have ceased, “all that you have to do is to watch 
the patient carefully; if natural respiration continue, leave him to himself; 
if it cease, supply the want by inflating the lungs artificially.” 2. If the 
efforts of the diaphragm have already ceased, have recourse to artificial 
respiration without delay. There is no time to lose. In two or three 
minutes, after the last heave of the chest, the heart’s action will have 
ceased, and then all hope is over. 3. In successful cases, so soon as normal 
respiration is established, inflation is desisted from. But treatment is not 
to cease. The patient is not safe. Dark blood has been circulating in the 
brain ; and symptoms like those of poisoning by a narcotic may exist. 
Coma may remain. By and by the respiration may cease. Then has 
arrived a second period at which artificial respiration may be necessary 
to preserve life. And, in truth, the practitioner may expect to be called 
upon to inflate the lungs more frequently at this second period than at 
the first. 
As to the mode of inflating the lungs, it is obvious that in the hurry and 
excitement of the emergency, we are not to trust to syringes, bellows, 
tubes, elastic gum bottles, or other contrivances which may be constructed 
very ingeniously and suitably for this express purpose. They are not to 
be had. And the surgeon is lucky if he can secure a common bellows. 
And if that cannot be had, look for a tube of any kind which may be in- 
serted into the nostril—a large elastic catheter is very suitable ; if this 
cannot be got, roll up a piece of card into a cylinder, and with this and 
one’s own lungs a tolerably efficient substitute for bellows may be put in 
play. Then the following practical points require attention: 1. Avoid 
undue forcing of air into the lungs; otherwise the air-cells may be burst; 
air may enter the blood-vessels, and the result is certainly fatal. 2. Inflate 
at proper intervals, imitating as clearly as possible the rhythm of natural 
respiration. 3. There is no necessity for warming or oxygenating the air; 
the attempt is just time lost. And it is fortunate that such manoeuvres 
are not essential, seeing that the surgeon is not likely to be provided with 
either a pocket-stove or a portable gasometer. 4. The upper part of the 
body is exposed, so that the movements of the chest may be accurately 
noted. 5. The inflating tube is introduced into one nostril. There is no 
necessity for opening the trachea; that is only required when previous ASPHYXIA. 
173 
disease has obstructed the larynx. 6. The other nostril and mouth should 
not he closed. They are safety-valves, by which over-distention of the 
lungs is prevented. 7. An assistant presses the box of the larynx against 
the vertebra, so as to prevent inflation of the stomach.. Were this cavity 
filled, the descent of the diaphragm would be prevented, and no air could 
enter the lungs. 8. Electricity and galvanism are inferior to the bellows, 
for they waste time in application. And the following assertion—repeat- 
ing more broadly the opinion already stated—hurries him who believes it, 
to the best employment of the very few moments he has to spare. 
If that action of the heart by which the circulation is maintained should 
cease, as a consequence of the suspension of respiration, it can never be 
restored. This 1 positively assert, after having made it the subject of a 
very careful investigation. If others have held a different opinion, it is 
because they have confounded those feeble and irregular contractions of 
the heart, which may last for a long time, but which mean nothing, with 
those regular and powerful movements which are necessary to propel the 
blood through the system. 
After-treatntent.—In the after-treatment—natural respiration having 
been restored—it may be necessary to abstract blood, on account of conges- 
tion ; but this must be done with extreme caution, seeing that the powers 
of life have been brought low by the faulty circulation in the brain. The 
warm bath is not essential. But the patient should be kept in an atmos- 
phere of a moderately warm temperature, “ to compensate for the insuffi- 
cient generation of animal heat, which is the consequence of the impaired 
state of the functions of the brain, whether arising from the influence of a 
narcotic poison, or from another cause. jPart xiv., p. 77. 
Suspended Animation.—[An interesting case in which recovery took 
place after artificial respiration had been kept up for five hours and a half, 
is related.] Part xxi., p. 359. 
Treatment of Asphyxia Infantum.—Dr. Tott states, that he has often 
succeeded in restoring life in the asphyxia asthenica infantum after the 
failure of the usual means, by causing a person to stand on a table, and 
pour cold water from a tea-kettle on the pit of the stomach. In this way, 
Professor Ilasselberg saved many lives. Part xxv., p. 109. 
Asphyxia of Infants.—Galvanism is most useful in exciting respiration 
in this condition. Part 260. 
Asphyxia.—The term asphyxia, which ought to be exchanged for 
apnoea, designates that condition of the animal system which results from 
the suspension of respiration. 
Respiration involves two processes—the inhalation of oxygen, and the 
exhalation of carbonic acid. 
The remedy for the suspension of respiration is, on every principle of 
common sense, the restoration of respiration. This view might be consi 
dered, irrespective of physiological inquiry and proof, as self-evident; but 
that proof is amply supplied by physiology. 
Of the two functions suspended, it is certain, from physiological inquiry, 
that the retention of the carbonic acid is by far the more fatal, and that, in 
a word, asphyxia is the result of carbonic acid retained in the blood, which 
becomes, in its excess, a blood-poison. 
If this view be correct, it is evident that restored respiration is to the 174 
ASPHYXIA, 
blood-poison in asphyxia what the stomach-pump is to poison in the 
stomach ; and that it is the special remedy, the sine qud non, in asphyxia. 
But this blood-poison is formed with a rapidity proportionate to the 
circulation, which is, in its turn, proportionate to the temperature. To 
elevate the temperature, or to accelerate the circulation, without having 
first secured the return of respiration, is therefore not to save, but in rea- 
lity to destroy life ! 
The only remedy is artificial respiration ; and the only method of effect- 
ing this properly is to place the patient on his belly, in the prone position, 
so that the tongue may fall forward, and not obstruct the passage through 
the glottis, which it would do in the supine position, by falling backward. 
Again, when the body is in the prone position, the thorax and abdomen 
will be compressed, and expiration will take place; let the body be now 
turned gently on the side, through rather more than the quarter of a 
circle ; by this the pressure will be removed, and effectual inspiration take 
place. 
Instead of the rules adopted by the Royal Humane Society, the following 
are proposed by Dr. Marshall Hall: 
1. Send for medical aid, clothing, etc. 
2. Treat the patient on the spot. 
3. Place the patient gently on the face, to allow any fluids to flow from 
the mouth. 
4. Raise the patient, and endeavor to excite respiration by snuff, harts- 
horn, tickling the fauces, etc.; if these fail, lose no time, but— 
5. Replace the patient on his face, that the tongue may fall forward, and 
leave the windpipe free, then turn the body completely on the side and a 
little more; and then again on the face, alternately, to induce inspiration 
and expiration, sixteen times in the minute. Rub all the limbs and trunk, 
energetically, with the warm hands, upward, making firm pressure. 
6. Omit the warm-bath, until respiration is reestablished. 
Part 88. 
Linear Cauterization in Asphyxia.—M. Faure’s proposal is founded 
upon numerous experiments on animals asphyxiated, in a variety of modes, 
and on one case of asphyxia by charcoal, occurring in a girl. The actual 
cautery, he observes, has long since been employed in distinguishing real 
from apparent death, and for the purpose of resuscitation; but it has not 
succeeded, owing to the absence of proper method and due perseverance. 
When properly used, however great the danger, as long as even the 
feeblest respiratory movements continue, it will establish a favorable reac- 
tion, and to this end is far superior to all other means. The following are 
the conclusions arrived at: 1. When the heart has entirely ceased to beat, 
or when the pulsations are fewer than three in five seconds, death is cer- 
tain, whatever may be done; but, except in these very extreme cases, cau- 
terization may restore life. 2. Deep and long parallel lines must be traced 
by a strongly-heated iron, along the upper and lateral parts of the chest, 
opposite the four or five first ribs, this being the part of the body that 
longest retains the faculty of being stimulated. 3. The first effect is a mus- 
cular contraction, which is quite local and without a sign of pain: the ribs 
then move, the thorax enlarges, and inspiration becomes more ample. 
Sometimes more than a minute elapses before any sign of sensibility can be 
induced, even by the most intense burn. 4. When the general sensibility ASPHYXIA. 
175 
has become aroused, it is of the highest importance to keep it excited for 
a long time; and to this end flagellation is the easiest and most certain 
means. It must be persisted in for a longtime, and the patient must be 
well watched. 5. Frequently asphyxiated persons die after having been 
restored ; but this must be referred rather to the shock sustained by the 
economy, in consequence of the suppression of respiration, than to the in- 
troduction of any poisonous principle, inasmuch as such death has occurred 
in persons who have not been exposed to any toxical influence, as in those 
drowned. Part xxxiii., p. 91. 
Suspended Animation.—A very convenient and useful instrument for 
inflating the lungs of newly-born infants, is a vulcanized india-rubber ball, 
about the size of an orange, to which is attached a German-silver tube, five 
inches long, slightly curved at the end, with two eyes like a female cathe- 
ter. This must be introduced into the larynx, and by compressing the 
ball, the air will rush into the lungs: on removing pressure, it becomes in- 
stantly refilled with air, but to prevent its being the same wThich has been 
into the lungs, there must be a hole in the tube near to its connection with 
the ball, to admit fresh air. This opening must be guarded by the finger 
during compression. Part xxxiv., p. 249. 
Asphyxia of Still-born Infants.—Dr. Marshall Hall gives the following 
directions : 1. Place the infant in the prone position. 2. Sprinke the sur- 
face briskly with cold water. 3. Make gentle pressure on the back; re- 
move it, turn the infant on the side, and again place it prone with pressure. 
4. Rub the limbs with gentle pressure upward. 5. Repeat the sprinkling 
with cold and hot water alternately. 6. Continue these measures, or 
renew them, from time to time, even for hours. 
Dr. Ramsbotham says: If the vessels of the funis are beating, do not 
divide it, but give the infant a few smart smacks on the back ; if there be 
no pulsation, separate immediately, and immerse for two or three minutes 
in warm bath of 96° or 98°. It is dangerous to keep the infant in warm 
water for any length of time together; for it has been proved that animals 
will drown much more quickly in hot than in cold water. While in the 
bath, place a drop of spirit on the root of the tongue. If in three or four 
minutes these means do not succeed, artificial respiration must be resorted 
to. Wrap the child in warm flannel, put a bit of flannel over its mouth, 
and inflate the lungs by breathing into them, taking care that the nostrils 
are closed; then all hands must be removed, and gentle pressure made on 
the chest: this alternate action must be continued so long as there is the 
least tremulous pulsation of the heart. Part xxxv., p. 43. 
Danger of all Attempts at Artificial Respiration, except in the Prone 
Position.—According to Dr. Marshall Hall, artificial respiration can only 
be certainly, effectually, and safely performed in the prone position. In 
the supine position the larynx is apt to be obstructed by the falling back 
of the tongue and epiglottis. Fluids may be fatally inhaled into the wind- 
pipe from the stomach or mouth, when inspiration is mechanical. All 
other measures are subsidiary: all which exclude respiration are destruc- 
tive, and warm bath is doubly fatal, first, by excluding rotation, and 
secondly, by promoting the circulation of carbonic acid. 
Part xxxv., p. 47 176 
ASPHYXIA. 
Asphyxia from Chloroform.—In a case where the usual means had 
failed to excite respiration, the prone position and rotation were after- 
wards tried with almost immediate success. When ammonia was inhaled 
and cold water now sprinkled on the face, inspiration was excited. It is 
very evident, that if the patient is to breathe, we must cause the fluids to 
flow out and the tongue to fall forward, and this can only be accomplished 
with the patient in the prone position. Part xxxv.,p. 01. 
Jugular Venesection in A sphyxia.—In asphyxia the brain is poisoned 
by the circulation of venous blood within its structure, and artificial respi- 
ration, which is the great resuscitating means, must be performed till the 
brain is again arterialized. But restoration of the action of the heart does 
not quicky follow well-performed artificial respiration, because the pulmo- 
nic heart is paralyzed by a mechanical cause : it is distended and engorged 
with venous blood. Artificial respiration partly tends to relieve this, but 
it is generally possible to relieve it more quickly by jugular venesection ; 
this should be performed as early as possible, and the vein should be 
opened about an inch above the clavicle. The great danger is the entrance 
of air into the veins : this is only likely to occur during respiration, and it 
cannot so long as the veins are distended and full; therefore, as soon as 
the active regurgitation ceases (which the valves permit) the wound must 
be carefully closed, and artificial respiration immediately commenced. 
The escape of even 1 oz. of blood would afford very material relief. 
Part xxxv.,p. 52. 
Permeation of Gases.—Mr. Osborn gives the following: When a per- 
son has been exposed to the fumes of a charcoal fire, asphyxia may be pro- 
duced either by carbonic acid or carbonic oxide. The former gas having 
a powerful affinity for ammonia, we may succeed in removing a portion of 
it from the lungs by means of that alkali; but if asphyxia be caused by car- 
bonic oxide, ammonia would only act as a stimulant, but not as an anti- 
dote. In that case, Dr. Marshall Hall’s valuable process for restoring sus- 
pended animation might, in all probability, be advantageously adopted. 
Some years since, I had an opportunity of trying ammonia in a case of 
asphyxia caused by exposure to the fumes of ignited charcoal. A baker 
had been engaged for some hours in his bakehouse over a charcoal fire, 
and fell down suddenly in a state of insensibility. I was sent for, and hear- 
ing the nature of the case, procured a bottle of dilute solution of ammonia, 
free from carbonic acid, of course. On my arrival, I found a man about 
twenty-seven years of age stretched upon liis back, quite insensible; coun- 
tenance pale, and somewhat shrunk. I poured a little of the ammonia on 
his tongue, and applied it to his nostrils. In less than a minute, he jumped 
up like one suddenly roused from a sound sleep, walked a few yards up 
the passage, and then fell back with a dead weight in the same state as I 
found him. I applied the ammonia as before, and he rallied again, but 
went off. the third time, and afterward recovered with no other treatment 
than the ammonial, and a little cold water which I gave him to drink. 
In this case, no twitchings of the muscles were observable, and there 
was no irritation about the glottis exciting cough. When carbonic acid 
gas is disengaged from a lime-kiln, I believe no irritation of the glottis 
takes place, but a sense of oppression about the chest; and that arising 
from a coarcoal fire causes constriction across the forehead, or a sensation 
of dryness about the throat—at least such are the early symptoms ob- ASTHMA, 
177 
served. But whenever I have accidentally inhaled carbonic acid disen- 
gaged from chalk by means of an acid, irritation of the glottis and cough 
are instantly produced. It would appear, then, that carbonic agid gas acts 
as an irritant in the cold state, but when its temperature is raised, no irri- 
tation is produced, thus rendering it more insidious. 
Part xxxv., p. 305. 
ASTHMA. 
Nature and Treatment of Asthma.—It seems now generally acknow- 
ledged, that the phenomena attending a fit of asthma are to be attributed 
to spasm—to a spasmodic action, especially of the different fibres which 
encircle the air-tubes, and which may be distinctly seen, when hyper- 
trophied, encircling the larger bronchi, and which have been traced by 
Reissessen in tubes of a very small diameter. Laennec states that he has 
seen them in tubes less than one line across. Some anatomists doubt their 
musculiarity; but we must attribute to them the action of muscles, and 
suppose that they are slender muscles like those which surround the in- 
testines and urinary bladder; this view is corroborated, not only by the 
experiments to prove the contractility of the lungs and air-tubes, as men- 
tioned by Dr. Watson, but also by the cii’cumstance mentioned by 
Valentin, who found that the rings of the trachea could be made visibly 
and distinctly to contract, by irritating the par vagum. A fit of asthma, 
therefore, may be considered a spasmodic affection, during which it is very 
difficult to inflate the lungs: hence, the respiratory murmur is generally 
absent. An ingenious method of expanding the chest, in cases of spasm, 
is that recommended by Mr. G. Robinson, who orders the patient at the 
end of every inspiration, or just before he is about to empty his chest, to 
close his nostrils and mouth so as to prevent the act of expiration; the 
patient will be instantly compelled to inspire again, when the fingers are 
withdrawn from the mouth and nose, and thus the chest will be effectually 
expanded. But this practice is not yet sufficiently corroborated by the 
experience of other practitioners, to allow of full confidence being placed 
in it; it may, however, be tried with impunity. Narcotics, perhaps, are 
our best remedies; opium is generally used in one form or another, but 
some patients place the greatest reliance on stramonium, provided that it 
be taken at the very commencement of the attack; but if the spasmodic 
action be once fairly established, neither stramonium nor any other anti- 
spasmodic will have a very powerful effect. Perhaps the lobelia inflata 
will be found a valuable addition to our remedies, not only from its pos- 
sessing the soothing properties of tobacco, but from exciting that copious 
expectoration, which is sure, in many cases, to give relief. 
Formula.—Take 3 ounces of the lobelia inflata, and macerate it for 14 
days in 3 pints of proof spirits. Give from 15 minims to half a drachm to 
an adult, and about 10 drops to an infant of a year old, every few hours, 
and if no sickness is produced, the dose may even be gradually increased. 
In the later stages of bronchitis, especially, the combination of a few grains 
of carbonate of ammonia with each dose will be a valuable addition. 
Part v., p. 22. 178 
ASTHMA. 
Narcotism.—A woman, afflicted for many years with nervous asthma, 
recovered from the first day she took a jiill composed of extract of opium, 
and extract of belladonda. Part v.,jt>. 62. 
Inhalation of Ammonia Gas—Suggested in chronic asthma. Vide 
“ Bronchitis.” 
Treatment by Nitrate of Potass.—On the approach of a paroxysm, in- 
hale an atmosphere impregnated with the fumes of nitrate of potass, 
having prepared the following: 
Immerse thoroughly, sufficient thick, porous paper in a saturated solu- 
tion of nitrate of potass, and hang it up to dry. When required, roll up 
a sheet of proper size, place it in a candlestick, and, the end being then 
ignited, it gradually burns, and the vapor diffuses itself through the room ; 
or if preferred, may be smoked in a tobacco pipe, as suggested in 
the use of stramonium leaves under similar circumstances. 
Apyrexial Asthma.—The following combination of iodide of potassium 
has been found very serviceable in certain forms of apyrexial asthma, dys- 
pepsia, chorea, etc.: 
It. Iodide of potassium, 5 grains; sesqui-carbonate of soda, 10 grains; 
camphor julep, one and a half fluid ounce. 
This dose to be taken three times daily for a month or six weeks. 
Its good effects in these cases is attributed to its power of invigorating 
the system. The iodide of potassium is always inadmissible when there 
is any febrile disturbance, or when the tongue is coated. 
Part ix., p. 62. 
Treatment of Asthma.—Dr. Debreyne says: For the last twenty- 
five years we have seldom prescribed any other formula but the follow- 
ing : 
R. P. inuke elecamp. §ss.; flor. sulphuris §ss.; p. rad. belladonnas 9iv.; 
p. rad. scillae 3j.; kermes min. 9j. M. To be divided into ninety powders, 
of which one is to be taken three times a day. 
Dr. D. assures us that he has witnessed excellent effects from this 
remedy, not only in asthma, but also in a variety of chronic pectoral 
affections, when they are unaccompanied with fever or inflammatory irrita- 
tion : as, for example, in what has been called catarrhal phthisis. To 
allay the cough in such complaints, he combines the use of the Iceland 
moss jelly with the anti-asthmatic powders. When these fail—which, 
according to his report is not often the case—he advises a trial of the 
stramonium inhalation, and also of a strong infusion of the camphree of 
Montpellier (camphorasma monspeliaca)—with the medicinal virtues of 
which he was first made acquainted by a writer in the “ Revue Medicale ” 
for March, 1821. During the paroxysms of asthmatic dyspnoea, he recom- 
mends a mixture containing the extract of belladonna, oxymel of squills, 
kermes mineral, and orange flower-water. Part x., p. 27. 
Spasmodic Asthma—Inhalation of the Fumes of Nitrate of Potass. 
The patient, subject to spasmodic asthma, made use of a piece of blotting- 
paper, about the size of his hand, dipped in a saturated solution of the 
nitrate of potass, and afterward dried. This was placed on a common 
plate, and being ignited, the fumes were speedily sensible in the room. 
He described its operation “ as clearing the passages and gradually open- 
Part vii., p. 85. ASTHMA. 
179 
ing the air-tubes.” The effect was always produced in about a quai’ter 
of an hour, and though he had used the same remedy nearly twenty 
times, he had never been disappointed in the result. Part xi., p. 55. 
Iodide of Potassium in Asthma.—Dr. Casey describes the effects of 
this remedy as being highly satisfactory ; he has administered it in more 
than five-and-twenty cases, and in no one instance, where a fair trial has 
been made, has it failed to afford unequivocal and decided relief. The 
dose varies from two to five grains three times a day. A long-continued 
use of the iodide of potassium will in some subjects occasion an eruption, 
generally of a pustular form (almost always ecthyma); and I have been 
twice disposed to attribute to it the occurrence of a slight conjunctivitis; 
the omission of the medicine for a few days, together with a few doses of 
rhubarb and soda, will be found sufficient for the removal of these incon- 
veniences. Part xii., p. 76. 
Ammonia in Asthma.—M. Guerard has used ammonia with success in 
a hundred cases of asthma. 
M. G. applies the remedy in the following manner: He dips a small 
pencil of charpie into pure liquid ammonia, and then instantaneously into 
a glass of water, after which he immediately passes it to the back of the 
throat, touching rapidly the velum, uvula, and (esophagus to a greater or 
less extent. He seldom has occasion to repeat the operation; when there 
is merely simple emphysema the improvement has been permanent. The 
pencil should be neither carried too deeply into the throat, nor allowed to 
remain too long in contact with the soft parts, more especially the pos- 
terior wall of the pharynx ; the reaction resulting from such an application 
is, at times, followed by the most frightful symptoms, menacing instant 
death. The inhalation of the fumes of ammonia may be used in poisoning 
by prussic acid, when the patient cannot swallow. 
The same remedy may also be used in asphyxia, and in many other 
cases where its influence is required in the lungs, as for example, in cases 
of chronic pneumonia and bronchitis, where the parts will often be bene- 
fited by its stimulation. In cases, too, where the voice is almost lost, we 
have found that the fumes of ammonia have acted most beneficially, even 
when, probably, at the same time we were giving tartar emetic. 
Part xiii., p. 89. 
Asthma—Spasmodic.—Give tincture of lobelia, with hydrocyanic acid. 
For an adult the following will do: R. Tr. lobeliae infl. 3j.; acid, hydro- 
cyan. gtt. j.-ij. ter vel quatuor in die. But if the paroxysm be severe, 
larger doses of the lobelia may be given. Part xvi., p. 134. 
Chloroform in Spasmodic Asthma.—Mr. Chandler relates the case of 
a lady 56 years of age who had been subject for twenty years to attacks 
of spasmodic asthma, for the relief of which “ the resources of the Phar- 
macopoeia had been exhausted in vain.” 
Having had the prevailing influenza, she was attacked by her old com- 
plaint, extreme dyspnoea, with great sense of constriction, and acute 
darting pains through the chest and epigastric region. Mr. C. admi- 
nistered half a drachm of chloroform on a sponge, hollowed to fit the 
mouth and nostrils, and held it at first close to, but not touching the face. 
In less than half a minute she became excited, waving the arm about, and 
uttering incoherent expressions, accompanied with loud hysterical laughter. 
He then placed the sponge in contact with the face, when the limbs gra- 180 
ASTHMA. 
dually relaxed, the arms dropping on the bed, quivering of the eye-lids 
and twitching of the muscles of the face took place, and she fell back on 
the pillow, drawing deep and prolonged inspirations, between each of 
which, perhaps eight could be counted. lie now withdrew the sponge, 
opening the curtains to admit air. Respiration gradually became more 
regular, and she lay without motion, the body well thrown back on the 
bed, not the slightest vestige of spasm remaining. She enjoyed a quiet 
sleep of some hours’ duration, and the following morning she was quite 
quiet, no return of spasms, and no ill effect from the inhalation; she is 
now comparatively well. Part xvii., p. 92. 
Asthma of Old People.—[Pure nervous asthma is said to he hardly 
ever met with in old people; asthma in them, according to Dr. Day, 
depending either on organic change in the heart or lungs, or on impurity 
of the blood. The latter is thus described by Dr. Day:] 
Cachectic Asthma.—The impurities contained in the blood seem here 
to be the exciting cause of the paroxysm. There is an attempt on the 
part of nature to make the bronchial mucous membrane eliminate the 
effete matter of the blood in the form of expectoration. Asthma is very 
often associated with a deficient or morbid action of the kidneys. I have 
seen so many cases of this form of asthma, that I cannot doubt the inti- 
mate connection between the state of the respiration and the morbid con- 
dition of the kidney, and, for the sake of convenience, shall term this 
urinous asthma. The term has been already used by Schonlein, Canstatt, 
and other continental writers. 
Urinous asthma seldom occurs before the sixtieth year, and is most 
common at and beyond the seventieth year. On examining a patient 
with this affection, we usually find a general suppression of the secretions, 
the skin being dry and rough, and the bowels acting slightly about twice 
a week. The urine is scanty, rather turbid, of a reddish-brown color, and 
so acrid as to produce a sensation of scalding in the urethra, and to 
give rise to frequent calls to make water. There is usually a feeling of 
dull, deep-seated pain about the loins. The skin is the seat of intolerable 
itching, and presents the appearance of prurigo, which, like the asthma, 
arises from the retention of the urinary constituents in the blood. The 
eyelids are red, and discharge an acrid humor, and ulcers often form on 
the lower extremities. The paroxysm of asthma usually occurs an hour or 
two before midnight, and lasts some hours, terminating most commonly 
in a copious expectoration of viscid and very salt mucus, which frequently 
has a strong urinous odor. 
Another cachectic form of asthma is connected with the gouty diathesis. 
It sometimes comes on as early as the fiftieth year, in persons suffering 
from asthenic or anomalous gout. The premonitory symptoms are the same 
as those of a fit of regular gout. The patient is led by these symptoms to 
expect a fit of gout; but instead of this he is seized, usually about mid- 
night or a little before, with a feeling of intense and terrible suffocation. 
The paroxysm lasts, with slight remissions for some hours, and toward its 
close a considerable amount of thick mucus, frequently mixed with 
blood, is ejected. The fit is often succeeded by other efforts to depurate 
the blood by copious sweats, urinary sediments, etc. If they do not 
occux-, a second paroxysm of asthma may be shortly expected. 
Part xix., p. 89. ASTHMA, 
181 
Asthma, Spasmodic.—Let chloroform "be inhaled during the paroxysm, 
so as to produce a moderate degree of anaesthesia, when the breathing will 
become easier. Part xix., p. 91. 
Tartar Emetic in Asthma.—M. Bernardeau advises very minute doses 
of tartar emetic (from three to six pills, each containing l-25th of a grain 
of tartar emetic, every twenty-four hours). Part xxii., p. 146. 
Asthma.—Dr. Todd winds up his lecture on this subject with the fol- 
lowing conclusions: 
That asthma is primarily humoral; that it is caused by a poison or mor- 
bid matter acting on that portion of the nervous system which ministers 
to the function of respiration ; that it leads to dilatation of the lungs and 
walls of the chest, to emphysema, and ultimately to dilatation of the heart; 
that the habit may pass off, the morbid matter being no longer created, 
the patient ceasing to be asthmatic, just as a person ceases to be gouty or 
epileptic ; and that, ceasing to be asthmatic, the patient may remain, or may 
not remain, emphysematous, according to the severity and duration of his 
previous attacks. 
Treatment.—Give a quarter to three grains of the extract of stramo- 
nium, or from ten to thirty minims of the tincture, or the various parts of 
the plant may be smoked in a pipe, or the leaves alone rolled up in the 
form of a cigar. Ether, in combination with opium, will often prove of 
great service. Part xxiii., p. 112. 
Hay Asthma.—With regard to the pathology and treatment of hay 
asthma, it may be remarked that little is known; and in many cases all 
treatment has proved of no avail. From the state of the mucous mem- 
brane, in the case of a gentleman who consulted Dr. Mackenzie, he 
was led to employ arsenic, from the analogy which appeared to him to 
subsist between its pathological condition and that of the skin in some 
forms of prurigo. 
In six days nearly every vestige of the complaint had disappeared. The 
cases of hay fever chiefly benefited by arsenic, are of a catarrhal, rather 
than of an asthmatic character. Five drops of the solution may be given 
three times a day. Dr. Fowler recommends the following rules for its 
administration: Patients from 2 to 4 years old, may take two to four 
drops of the solution ; from 5 to 7 years, may take from five to seven 
drops; from 8 to 12 years, may take from seven to ten drops; from 13 to 
18, may take from ten to twelve drops; and from 18 and upward, may 
take twelve drops as a dose. If the medicine fails to do good, it may 
then be alternated with quinine, or they may be given concurrently. 
Part xxiv., p. 27. 
Thymic Asthma.—[Mrs. M., residing in London, was sent to Gravesend 
with her child, aged five months, for change of air. A short time after- 
ward, Dr. Armstrong was sent for, in consequence of the child being 
seized with something like a fit. Three weeks before, the child was sud- 
denly seized with great difficulty of breathing, while out of doors, becom- 
ing almost livid in his countenance, and seeming as if he would be strangled 
before he could get his breath; on the present occasion there had been 
some slight “crowing.” A few weeks after, the child had a similar 
attack, apparently brought on by cold.] 
The child—continues Dr. A.—was attacked with symptoms of catarrh, 182 
ASTHMA, 
which were slight, and were not considered to require medical attendance. 
After a few days he experienced another and more severe seizure than any 
former one, and I was sent for in great haste. The history given was the 
following: The child became suddenly dark about his mouth, held his 
breath, his eyes seemed starting from their sockets, and his limbs became 
violently stretched. He appeared to recover his breath, began to cough, 
and when I arrived the attack had passed away. He looked frightened ; 
his face pale and bathed in perspiration; pulse weak, intermitting, and 
quickened; skin cold. There was considerable fullness of the veins of the 
neck ; the chest resonant throughout; sibilus and rhonchi heard over the 
left lung, and partly over the right; most distinctly heard on each side of 
the dorsal spine. 
That night I was summoned to the little sufferer, who was stated to be 
dying. The attack was much the same : he had been sleeping, awoke up, 
became livid, convulsed, and apparently gasping for breath. I found him 
pale, with his head and face bathed in perspiration, with a feeble intermit- 
tent pulse, a loose, frequent cough, troublesome at the termination of the 
attack. There had been no crowing respiration. The attacks of dyspnoea 
now became frequent; he rarely went to sleep without an attack on awak- 
ing. They were now invariably accompanied with convulsions of an 
epileptic character. The countenance during the attack, lips especially, 
was quite livid, the tongue protruded, eyes turned in toward the nose, 
and nearly constant carpo-pedal contractions. The sides and centre of ’ 
the lower part of the throat swollen, the jugular veins much distended ; 
and the respiratory murmur was harsh or indistinct at the posterior part 
of the thorax. As each convulsive attack subsided, there was a peculiar, 
harsh, incessant, convulsive cough, by which small portions of frothy 
whitish phlegm were expelled from the trachea; and after some time about 
a teaspoonful or two was discharged, and the child seemed relieved. The 
difficulty of swallowing, especially of semi-fluid substances, continued, ap- 
pearing always to excite coughing. Nothing gave relief; he continued 
to get worse, and died after an attack—about a fortnight after the catarrhal 
seizure. 
Post-mortem Examination Sixteen Hours after Death.—In the examina- 
tion of the body, the chest chiefly attracted attention. Tliei*e was a large 
thymus gland, extending from the thyroid gland to the pericardium, and 
laterally filling the space betwmen the trachea, clavicle, and first rib. It 
was dense, firm, lobulated, of a fleshy color; contained no fluid ; it was 
upward of an ounce in weight; its greatest density and development ap- 
peared on the left side ; the large veins almost flattened by the pressure ; 
the par vagum and recurrent were pushed aside from their usual course, 
and must have been much pressed. The heart was of ordinary size, nearly 
empty. The foramen ovale closed. Internally the larynx and trachea 
were pale, except at the part where the thymus pressed, which was red- 
dened ; the remainder was natural; and without inflammatory appearances. 
The lungs, anteriorly, were natural; posteriorly, extensively carnified. 
Abdominal viscera healthy. The head was not examined. 
Treatment.—Apply leeches occasionally on the upper part of the chest, 
and iodine externally and internally ; pay strict attention to every source 
of irritation with a view to its immediate removal, causing the child to lie 
writh its head well raised during sleep. Select light food and a healthy 
atmosphere ASTHMA, 
183 
Diagnosis.—Dr. Copland says male children are chiefly liable to it; 
pale, white, soft countenance; permanent fullness about the upper part of 
the sternum, extending upward nearly to the thyroidal region ; an almost 
constant fullness of the veins of the neck, particularly after any effort, dull- 
ness on percussion over that part of the sternum. Signs of congestion of 
the lungs, and from an early period, difficulty of swallowing ; the crowing 
sound is either entirely absent or only partial, the pulse is weak and inter- 
mittent, and there are copious perspirations over the head. 
Part xxiv., p. 90. 
Spasmodic Asthma.—Under this head, Dr. Walshe states the following 
remarkable and important fact, with regard to the hygienic treatment of 
the disease. “ Change of air is most important; but the kind of change 
that shall prove most beneficial can only be learned by experience. Some 
sufferers lose their paroxysms south of the olive line, others are easiest in a 
cold atmosphere ; moisture, the bane of some, greatly mitigates the disease 
in others. The air of towns suits some, that of the country others; the 
clear suburban air of London is infinitely more noxious to some asthmatic 
persons than the foul atmosphere of the worst cleansed and most densely 
peopled localities of the metropolis ; occasionally an individual will be found 
who is tortured with asthma in one room of a house, free from it in others; 
and this without any distinct explanation being found in the aspect, the 
drainage, or any other known condition.” Part xxv., p. 109. 
Asthma.—Twenty drops of chloroform inhaled in the handkerchief and 
repeated carefully, taking care not to produce stupefaction, produced 
marked relief in a case of severe asthma. Part xxix., p. 93. 
Use of Lobelia in Asthma.—Ten minims of tincture of lobelia, with 
sedatives, expectorants, or stomachics, is very useful in chronic bronchitis, 
with tendency to paroxysmal asthma. If the nausea be very excessive, 
combination, with a few drops of hydrocyanic acid is often useful. 
Part xxix., p. 93. 
Nervous Asthma.—Brown paper soaked in a solution of nitrate of pot- 
ash and burnt in the room of an asthmatic patient will give instant relief. 
The following pharmaceutical paper is still better: pasteboard broken 
down in hot water, four ounces; nitrate of potash, two ounces; belladonna, 
stramonium, digitalis, lobelia inflata, all in powder, each twenty grains; 
myrrh and olibanum, of each two and a half drachms. Incorporate all 
these with the paste, divide the mass into sheets of the thickness of three 
lines; dry and divide in little square pieces. Burn them in little saucers 
in a well shut-up room. Part xxix., p. 93. 
Spasmodic Asthma.— Vide Selections from favorite prescriptions, Art. 
“ Medicines.” 
Anti-asthmatic Cigarettes.—Add nitre to the leaves of belladonna and 
of stramonium, by watering these plants, dried and conveniently spread 
out, with a solution of nitrate of potash, in the proportion of three ounces 
of the salt to rather more than two pounds avoirdupois of the plants. It 
will be easily understood, that as this solution penetrates the entire vege- 
table tissue, the latter will, when dry, burn completely, without the forma- 
tion of pyrogeneous products. 184 
ASTHMA. 
M. Dannecy, of Bourdeaux, prepared cigarettes according to this for- 
mula, and the benefit derived from their use by a great number of patients 
induced him to publish it, and to call the attention of practitioners to the 
mode of treatment, consisting in the smoking of narcotic plants combined 
with nitre. Part xxxvii.,p. 252. 
Asthma.—The remedies at our command, either remove the exciting 
cause (as emetics to empty the stomach of an undigested meal), or dimin- 
ish nervous irritability (stramonium), or directly lower nervous and mus- 
cular power (ipecacuan, tartar emetic, tobacco), or stimulate to activity 
the cerebro-spinal and voluntary nervous action, and proportionally 
diminish the organic and reflex (strong coffee, violent emotion), or seem 
to act as specifics, which some way or other diminish the asthmatic ten- 
dency, but whose true modus operandi is obscure (the airs of certain 
localities). Remedies may be applied indirectly, that is, through the 
medium of the blood, or directly to the mucous membrane of the bronchi 
by inhalation. 
In cases of a purely spasmodic nature, relief from the agonizing parox- 
ysms will frequently be derived from the inhalation of the fumes of burn- 
ing nitre-paper. The paper used should be blotting-paper of moderate 
thickness, and free from any ingredients which would cause the smoke to 
be of an irritating kind. The strength of the solution of potash employed 
should be about four ounces to half a pint of water. If a piece of paper 
saturated in this solution and dried, be burnt in the bed-room of a patient 
before going to sleep, a threatened attack may frequently be warded off*. 
Tobacco, which acts as a depressant, of all remedies gives the most 
speedy and complete relief, and would be much more extensively used but 
for the profound depression and collapse which it is liable to induce. But 
the mere sedative influence of tobacco is of no use whatever unless some 
degree of collapse is induced. ' An asthmatic may cut short the attack, by, 
directly the symptoms supervene in the early morning, overcoming the 
tendency to drowsiness, getting up and inducing a slight degree of tobacco 
nausea. 
Ipecacuan given in a large dose, never less than twenty grains, will 
frequently relieve the paroxysm directly a slight degree of nausea comes 
on. It maybe taken in the form of lozenges, which can be made so strong 
that three will induce vomiting. Antimony acts in the same way as ipeca- 
cuanha, but the nausea and collapse it induces are long and tedious. If 
an attack be promptly treated it will generally yield, whilst, if allowed to 
proceed for an hour or two before treatment is adopted, great difficulty 
will frequently be experienced in relieving it. Part xxxviii., p. 52. 
Connection between the Stomach and Asthma.—From a careful con- 
sideration of the relation of the stomach to the asthmatic paroxysm, the 
following simple rule is most important: Let no food be taken after such 
a time in the day as icill allow digestion being completed and the stomach 
empty before going to bed. Certain articles of diet have a special tendency 
to oppress and tighten the breathing of those liable to asthma, as anything 
in any way preserved—as potted meats, seasoning, etc.; cheese is bad, 
especially if old and decayed; also heavy malt liquors. The quantity of 
food the asthmatic takes should be small; therefore it should be highly 
nutritious, but still of the plainest kind. Part xxxviii., p. 325. BALDXESS—BATHS. 
185 
BALDNESS. 
llemedy for Baldness.—As a remedy for baldness which follows herpes 
or pityriasis, Dr. Xeligan recommends the following pomade, from which 
he has found great benefit: Prepared lard, two ounces; white wax, two 
drachms; melt together, remove from the fire, and when the mixture is 
beginning to thicken, add, with constant stirring, balsam of tolu, two fluid 
drachms, and oil of rosemary, twenty minims. In very chronic cases, or 
where the baldness has long existed, a drachm of tincture of catharides 
may be added. Part xix, p. 209. 
Baldness—Treatment by Fumigation.—In cases resulting from atony 
or disordered nutrition of the hair bulbs. Vide Eruptive Diseases of Scalp, 
Art. “ Skin Diseases.” 
Steam Apparatus.—The apparatus in appearance is somewhat elegant, 
is comprised in so small a space that it may readily be carried in the hand, 
and may be applied either locally or generally, as circumstances may re- 
quire, with equal facility. It consists of a reservoir for the water, capable 
of containing a little more than a pint, supported upon three metallic rods, 
and having a coverlid which is furnished with two openings, one at the 
centre and one toward the side. From that in the centre arises a tube, 
terminating in a hollow globe, having attached to it, and communicating 
with its interior, three short branches furnished with moveable lids. A 
similar branch is connected with the opening at the upper edge of the 
reservoir. Beneath, on a pan supporting the parts already described, is 
placed a spirit-lamp, having four burners, and these, when lighted, quickly 
vaporize the water in the reservoir above. The steam is then conducted 
to the globe, and thence, by means of short pipes slightly curved, and 
which may be connected with any one or all of its branches at pleasure, 
to the part of the body required. The force and the quantity of vapor 
expelled, is regulated by a key at the side of the principal cylinder, and 
which will diminish or enlarge its diameter much on the principle of the 
ordinary stopcock, while its escape upward is entirely and instantly pre- 
vented by exposing the opening at the edge of the reservoir. The way 
in which it has been used for affections of the joints is simply this: the 
patient covers the wrist, for instance, with a piece of flannel, large enough 
for its edges to fall on a pillow, which is placed to support the fore-arm. 
The nozzle of one of the tidies is then placed beneath the flannel, and the 
steam allowed to escape. The joint thus enveloped in steam, has usually 
been allowed to remain for about half an hour; the application being made 
once a day, or oftener, as the circumstances require. Various modifica- 
tions of the tubes for different purposes are capable of being adjusted to 
the openings in the reservoir. 
The apparatus is thus used: The patient lies supine in bed, and three or 
four slender arches of wood, or other convenient material, are placed 
across the body, so as effectually to raise the blanket from any contact 
BATHS. 186 
BATHS, 
with it. The apparatus is supported on a stool at the foot of the bed, and 
one of the pipes allowed to project into the arched cavity, which soon 
becomes filled with the vapor. In this way all the inconveniences attend- 
ing a removal to and from the bed are of course got rid of. 
Part iii., p. 108. 
Local Paths.—M. Mayor, of Lausanne, presented to the Royal Aca- 
demy of Sciences in Paris, an apparatus for bathing any limb, or any part 
of one, separately, and in any possible position. This apparatus consists 
of a hollow cylinder of copper, the two extremities of which are provided 
with caoutchouc discs, each of which has at its centre a large opening 
through which the limb is introduced. Varied according to the parts to 
which they are to be applied, these apparatus form a kind of sleeves, or 
gloves, or. boots, according as they have to inclose the arm, the hand, or 
the foot and leg. 
This kind of portable bath has, M. Mayor states, numerous advantages. 
It is cheap. It permits the limbs to be bathed without obliging the 
patients to keep in an irksome position. When, for instance, the elbow 
joint is to be bathed, two pieces corresponding to the arm and the fore- 
arm may be articulated together (by caoutchouc tube, we suppose), so as 
to be capable of movement on each other, and the patient suspending the 
apparatus in a sling may walk about, and even make use of the movement 
of flexion and extension of his arm. Only a small quantity of water is 
needed, and this advantage, though unimportant in the case of simple 
baths, is considerable when medicated baths are ordered. The liquid will 
preserve its temperature a long time, and this, added to the convenience 
of employing it, will enable the bath to be used longer than is customary. 
The fluid may be removed or added to by small openings made above and 
below through the wall of the cylinder. The apparatus may also be used 
for constant irrigation by making one of these openings communicate with 
a tube conveying water to the cylinder, and the other one to carry it otf. 
Part iv., p. 55. 
A Cheap Substitute for a Vapor Path.—Dr. Serre (d’Alais) recom- 
mends the following means of inducing abundant transpiration: Take a 
piece of quick-lime, about half the size of your fist, and wrap around it a 
wet cloth, sufficiently wrung to prevent water running from it. A dry 
cloth is to be several times wrapped around this. Place one of these 
packets on each side of the patient when in bed. An abundant humid 
heat is soon developed by the combination of the lime with the water, 
which quickly induces copious transpiration ; the effect of the apparatus 
lasting for two hours at least. When sweating is fully established, we 
may withdraw the lime, which is now reduced to a powder, and is easily 
removed. In this way, neither copious drinks, nor loading the bed with 
coverings, is required. Part xiv., p. 140. 
IIot-Air Path.—A convenient and efficient hot-air bath may be thus 
extemporized : The patient being in bed, fasten a blanket loosely round 
the body ; place two chairs upon the bed, so that their backs form an arch 
over the person, tie them side by side, and over them throw several 
blankets. A spirit lamp, held beneath the arch for a few minutes, will 
raise the temperature to 130° or more. If a spirit lamp is not at hand, 
one may be made out of a tea-pot, letting the wick pass through the spout. 
Part xx., p. 322 BEBEERINE BED-SORES. 
187 
Turpentine Batli.—Dr. Moreau speaks highly of a bath of turpentine 
vapor in catarrhal affections, rheumatism, and severe neuralgias. The 
patient is shut in a room, into Avhich the vapor is introduced from without, 
varying in temperature from 45° to 102°. It produces copious perspira- 
tion, which greatly diminishes the temperature of the body. Vide Art. 
“Turpentine.” Part xxxii.,p. 85. 
BEBEERINE. 
Bebeerine.—Another communication on the same subject has been made 
by Dr. Maclagan, in which the experience of several eminent practitioners 
is given, which seems to confirm the good opinion which was entertained 
respecting its virtues. Its powers may, perhaps, in some cases, be inferior 
to quinine, but in others it is more to be relied upon; and what is of some 
consequence is, that it is only about half the price, being manufactured at 
about six shillings the ounce. Dr. Watt thinks that the bebeerine is supe- 
rior to quinine, in its not affecting the head or causing irritation of the 
stomach, even when given in very large doses, as much as 96 grains hav- 
ing been taken in three and a half days. It is found, also, that the bebee- 
rine is tardier in its operation as an anti-periodic, acting more particularly 
on the blood, Avliile quinine, perhaps, acts more on the nervous system. 
Its tardy operation, however, renders its effects more permanent, some- 
what like the slow but durable action of arsenic in ague. Another ad- 
vantage is, that bebeerine is gently cathartic. Dr. Anderson, another 
respectable physician, has also tried this remedy Avith advantage, as an 
anti-periodic in intermittents. When the time of the paroxysm Avas 
known, the medicine was given in three grain doses every hour, till from 
18 to 24 grains Avere taken. It Avas managed so that the last dose Avas 
taken immediately before the expected return of the fever, and Avas found 
to be nearly equal in its power to quinine. At any rate, although it may 
not be quite so powerful a remedy as the latter medicine, it Avill prove to 
be a very valuable substitute in many cases; and in some cases of utero- 
gestation, Avhere neither arsenic nor quinine Avould be advisable, Professor 
Simpson has been able to give the bebeerine with confidence and success 
n some very severe attacks of neuralgia of the face and forehead, and has 
bund that it did not possess the irritating and stimulating effects of qui- 
nine. Part xi., p. 94. 
BED-SORES. 
As soon as any part which we suspect may he the seat of such sores, 
exhibits the slightest appearance of inflammation, a solution of the nitrate 
of silver, ten grains to the ounce of water, should be applied to it by 
means of a camel hair brush, two or three times a day, until the skin has 
become blackened, and afterward only occasionally. Part vii., p. 167. 
Treatment of JBed-sores.—Dr. Graves recommends a nutritious diet, 188 
BED-SORES 
wine, and the sulphate of quinine. The sores to he Avashed night and 
morning with a solution of chloride of soda, in the proportion of 20 or 30 
drops to an ounce of water. A liniment composed of two ounces of cas- 
tor oil and one of balsam of Peru, is to be applied on pledgets of linen, 
and covered with a poultice of linseed meal two or three times a day. A 
writer in the “ Medico-Chirurgical Review ” recommends as a prophylac- 
tic a solution of creasote, one part in eighty of water; if the skin should 
break, the zinc or lead ointment, to which camphor has been added ; and 
in still more obstinate cases, an ointment composed of four parts of fresh 
prepared tannate of lead and thirty of lard. A German writer recom- 
mends equal parts of camphorated spirit and liq. plumbi subacetatis. 
Part xi., p. 189. 
Means of Preventing Bed-sores.—The thicker the cuticle, the more it 
will protect the parts beneath ; you may, if you attend to it in time, add 
to the thickness of the cuticle by stimulating the surface of the skin. 
Nurses know this very well, for when patients are bed-ridden, they wash 
the parts subjected to pressure with brandy. What is still better, is a 
lotion composed of two grains of bichloride of mercury to an ounce of 
proof spirits. When you think that a patient is likely to be confined so 
long in bed that sloughs may be formed on the os sacrum, begin at an 
early period to wash the parts two or three times a day with this lotion. 
I have found it useful in other cases where a patient sutlers from pressure. 
For example, in a case of hernia, which requires to be supported by a very 
powerful truss, the truss galls and frets the skin, and may at last cause 
inflammation and sloughing ; but, under the use of a stimulating lotion, 
a thicker cuticle is generated, and such mischief is avoided. 
Part xiv., p. 325. 
Mortification from Pressure—Bed-sores.—[This occurs, as is well 
known, in patients who are reduced to a bad condition by typhoid or 
scarlet fever, or by long confinement to bed for compound fractures or 
diseases of the hip joint. Mr. Cooper says:] 
When you consider the cause of this kind of mortification, you will see 
the difficulty of curing it, as it not only proceeds from pressure, but also 
from a low state of the constitution, and hence you may remove the press- 
ure and yet not be able to stop the disease. Still you must endeavor to 
take away the pressure, and you may employ for this purpose pillows or 
air-cushions, placed under the patient so as to relieve the prominent parts, 
or better still, the hydrostatic bed—Mr. Arnott’s water-bed—which acts 
upon the principle of equalizing the pressure. When long confinement 
has taken place, you must be on your guard: examine the parts of the 
skin, see that they are washed well with astringent lotions—the lead 
lotion, liquor plumbi, and also a preparation of camphor—camphorated 
spirit. By altering the position of the patient, you may sometimes suc- 
ceed in preventing this mortification. I have often applied the soap- 
plaster—either white or brown—which is a very good application, though 
not so good as bathing the parts frequently during the day with strong 
astringent lotions. When sloughing comes on, the modes of treatment 
are very different amongst different practitioners. Some poultice, some 
apply camphorated spirit, and some the liquor plumbi lotion ; others 
a strong solution of the chloruret of soda. These are only secondary 
means in the treatment of this kind of mortification. Part xvi., p. 304. BED-SOKES. 
189 
, Bed-sores.—In order to prevent bed-sores, moisten and oil a bladder, and 
partially distend it with air; wrap it up in a soft napkin, and place it un- 
der the part subjected to pressure. In the case of fractures, to preserve 
the heel from the effect of pressure, a bladder may be introduced beneath 
it in a flaccid state, and then inflated. Bart xvii., 294. 
Prevention and Treatment of Bed-sores.—When the first blush of un- 
healthy inflammation makes its appearance (which is indicated by a livid 
color in the integuments) we should take care that all pressure from the 
parts be immediately removed. This can be done either by the patient’s 
position being changed, or by the aid of bolsters or air cushions. M. Purefoi 
uses a cow’s bladder softened in warm water; this being oiled, and partially 
inflated, is placed under the part suffering from continued pressure. The 
effect of this support (in a case of fractured leg) exceeded his expecta- 
tions. 
What renders this contrivance valuable, is its simplicity and cheapness; 
it forms a very manageable substitute for the hydrostatic bed of Arnott. 
In addition to these preventives, others, to stimulate the surface and 
excite the dormant capillaries to more healthy action, should be diligently 
used. The lotion recommended by Sir B. Brodie is admirable for this pur- 
pose. It consists of two grains of bichloride of mercury to an ounce of 
proof spirit. These two contrivances, if used at the same time, will be 
found invaluable in the prevention of bed-sores. 
If, in spite of our efforts, sloughing takes place, we may divide the pro- 
gress of the case, for practical purposes, into three parts. The first is the 
period before the slough is detached, during which we must employ stimu- 
lating applications, as a carrot poultice morning and evening, sprinkled 
with a solution of chloride of soda. Pressure must also, of course, be pre- 
vented. 
When the slough falls out, a deep, unhealthy-looking ulcer is presented 
to our notice, forming the second stage of these sores. This ulcer is gene- 
rally round or oval. The integuments at the circumference are undermined, 
so that you can readily pass a spatula beneath them, showing that the sub- 
jacent cellular tissue has lost its vitality even to a greater extent than the 
cuticle. The margin of the ulcer is consequently found to overlap its base 
The base presents a flabby, uneven surface without granulations, and in- 
terspersed with shreds of adherent slough. From this surface a thin sero- 
sanguineous or ichorous discharge is secreted, having a most foetid odor. 
In order to promote healthy granulation, and stimulate the parts to cast 
off the remaining shreds of slough, warm dressings, consisting either of 
equal parts of gum elemi and spirits of turpentine, or of castor oil and Pe- 
ruvian balsam, may be applied, dipped in lint, to the bottom of the ulcer, 
and a linseed meal poultice, spongio-piline, or a carrot poultice, placed 
over them. After a few days, the ulcer will assume a more florid appear- 
ance, and show a disposition to form granulations. It will now be neces- 
sary to make a change in the dressings. 
This should consist in applying every morning with a camel’s-hair brush 
a solution of nitrate of silver (ten grains to an ounce of distilled water) to 
the flabby granulations, then covering the surface of the ulcer, and filling 
it up with fine carded cotton. A piece of oiled silk, lai*ge enough to cover 
both hips and sacrum, should then be placed over the dressings. The 
oiled silk thus applied serves a double purpose ; it will, by preventing the 190 
BENZOIC ACID. 
evaporation of the discharge, keep the cotton soft, and permit its easy re- 
moval at eacli dressing; it Avill also add to the cleanliness and comfort of 
our patient, by preventing the bedclothes being soiled. Under this sim- 
ple treatment, the surface of the ulcer soon begins to assume a more 
healthy appearance, the granulations at the margin become amalgamated 
with those at the base, until the cavity is filled up by luxuriant granula- 
tions. 
We have now the third stage of these bed-sores to treat. As in the 
second stage our object was to stimulate the surface to healthy action, in 
this we have to control inordinate action, and repress luxuriant granula- 
tions. A concentrated solution of sulphate of copper (applied every morn- 
ing) will be found most useful for this purpose. The carded cotton and 
oiled silk, as above recommended, may be also continued until the ulcer is 
perfectly healed. Part xviii., p. 235. 
Use of Collodion in Bed-sores.—Air-cushions and water-beds are not 
obtainable by the poor, and it has been the practice to protect parts sub- 
jected to injurious pressure either by powdering them with some inert 
substance, or covering them with diachylon. The first of these measures 
is of little use, and the other does more harm than good, as by softening 
the tissues to which it is applied, it only renders them more susceptible to 
the influence of pressure, especially if the leather on which it is spread gets 
into folds. Collodion adheres far more closely than diachylon, and is 
quite exempt from moisture; and in the cases in which it has been tried in 
the French hospitals, has answered well. Part xx.,p. 177. 
Bed-sores—Tannate of Lead.—Mr. LecLerc, senior physician of the civil 
hospitals at Laon, indicates a method which is calculated to prevent mortifi- 
cation over the sacrum. As soon as the skin reddens or becomes painful, 
he prescribes a layer of tannate of lead in a humid state, to be spread over 
the threatened part, and the following is the formula for its preparation : 
Corticis quercus contusae, 1 oz.; aquas, 8 oz.; reduce by boiling to 4 oz.; 
strain ; add liq. plumbi diacetatis q. s. until no further precipitate is formed. 
The deposit is collected upon a filter. 
Mr. Leclerc asserts that of all the topical remedies which he has used for 
the treatment of this most troublesome complication of protracted disease, 
none is preferable to tannate of lead employed as described. 
Part xxxix., p. 232. 
Benzoic Acid.—Benzoic was formerly administered in the expectation 
that it would prove a preventive of gout stones or tophaceous deposits: 
but as it has no influence in preventing the formation of uric acid, it can- 
not, of course, prevent these deposits. We are informed by Dr. Garrod 
that it is very serviceable in increasing the acidity of the urine, to which it 
imparts slightly irritating properties, and is often of use in cases where 
there is a deposition of a granular kind of mucus mixed with phosphates. 
Dr. Golding Bird has long since ascertained that benzoic acid is incapable 
of converting uric acid into hyppuric,and is, therefore, not a chemical remedy 
BENZOIC ACID. 191 
BITES BLADDER. 
for gout. He thinks it may be of benefit in some forms of uric acid de 
posits, by combining with the azotized elements of the blood to form hip- 
puric acid. It is, he says, of no value in phosphatic deposits, but is often 
of service in catarrh of the bladder. Part xi ,,p. 88. 
BITES.—(Vide “Snake Bites”) 
Bitefrom an Adder.—In a case in the General Hospital, Birmingham, 
the parts were excised, and the surface cauterized by a strong solution of 
ammonia. Dry cupping Was afterward resorted to, and the parts well 
smeared with olive oil. The pain and swelling still continuing, he was or- 
dered sesquicarbonate of ammonia 3iss.; decoction of cinchona, gviij., §j. 
every half hour. A tablespoonful of brandy to be taken every ten minutes; 
a mustard cataplasm was applied to the abdomen, followed by fomentations 
of chamomile and poppies. The patient recovered. Part xxiv., p. 349. 
Alcoholic Stimuli in Snake Bites.—Dr. Addy writes, that on the 
western frontier, where rattle-snakes are numerous, and where physicians 
are often called upon to treat poisonous wounds by these and other venom- 
ous reptiles, they almost exclusively rely upon alcoholic stimulants, given 
in quantities sufficient to produce intoxication. The patient is not consi 
dered safe until drunkenness is produced, this being regarded by the prac 
titioners as evidence of the effects of the poison being overcome. 
Part xxxix., p. 57. 
BLADDER. 
Irritability of the Bladder.—When benzoic acid is combined with bal- 
sam copaiba, it has been found to be superior to nva ursi and pareira brava 
in many cases of great irritability of the bladder, accompanied with muco- 
purulent discharge. 
Formula.—$. Benzoic acid, one drachm; balsam copaiba, half an ounce; 
yelk of egg, enough to form a mixture with seven ounces of camphor mix- 
ture. M. Two tablespoonfuls to be taken thrice a day. 
Part vi., p. 140. 
Catarrhas Vesicce.—The decoction or infusion of the leaves of matico, 
half an ounce to a pint, suggested in catarrhus vesicte. Dose—A table- 
spoonful thrice daily. Part viii.,£>. 37. 
Hysterical Paralysis of the Bladder.—Sir B. Brodie lays down the 
rule that in these cases the catheter should not be had recourse to, and the 
only exception to it is in those extreme cases in which actual paralysis has 
taken place and the bladder is likely to become diseased if not artificially 
relieved. A similar want of power over the rectum may occur in hysteri- 
cal women. Vide “ Hysteria.” Part viii., p. 62. 
Paralysis of the Bladder cured by Cantharides.—A patient was ad- 192 
BLADDER. 
mitted into the Hopital de la Pitie with paralysis of the bladder, for the 
relief of which all ordinary methods of treatment had failed. M. Lisfranc 
ordered the direct application of tincture of cantharides to the bladder by 
the following mode: One drop of the tincture was let into the organ 
through a catheter, and followed by an injection of simple lukewarm water. 
Next day two drops were similarly instilled, and the like operation was 
repeated night and morning for several succeeding days, an additional 
drop of the tincture being added on each successive occasion. By this 
method of treatment a cure was soon effected. M. Lisfranc found no per- 
ceptible local irritation to result from the use of the tincture in an undiluted 
form, while the direct application of the remedy to the organ affected was 
clearly preferable, in every respect, to its internal administration. 
Part viii., p. 75. 
Case of Rupture of the Bladder—Recovery.—[There are few cases of 
recovery from rupture of the bladder on record. The following case oc- 
curred in the practice of Mr. Chaldecott. At midnight on the 7th of April 
last, a very respectable, temperate, and healthy man, after passing two or 
three hours at a concert ran across the street to empty his bladder; he 
came in contact with a post, the top of which hit against the lower part of 
the abdomen. Mr. Chaldecott observes:] 
I saw him about half an hour after the accident. He was faint and suf- 
fering severe pain over the stomach and belly, with desire but no power to 
pass his urine. I ascertained that none had escaped into his clothes, and 
my suspicions as to the nature of the mischief were confirmed by the cir- 
cumstance of nothing escaping through a full-sized catheter which was 
passed easily and completely into the bladder. He was placed in bed, and 
hot fomentations were used to the belly until reaction took place, with 
which came increase of pain over the stomach and abdomen. Twenty 
leeches were also applied ; and I now passed a gum catheter, but with the 
same unsatisfactory result as before, not a drop of the urine escaping 
through it. 
The catheter -was passed every three or four hours, although up to two 
o’clock p.m., fruitlessly. 
[The friends of the patient were apprised of the extreme danger of the 
case, and Mr. Key was called in. When he arrived, sixteen hours after 
the accident, there were most decided and alarming symptoms of perito- 
nitis ; the belly was painful, swollen, and tender ; pulse rapid and feeble, 
and the countenance anxious. A catheter was passed, and nearly an ounce 
of bloody urine was drawn away. Mr. C. observes :] 
At ten o’clock, I gave him two scruples of liquor opii sedativus, which, 
after a few hours, produced some comfortable sleep; and about four hours 
from the time of Mr. Key’s visit I again passed the catheter, and drew off 
about four ounces of clear urine. From this time, the pain, swelling, and 
heat in the stomach and abdomen gradually lessened, and it was evident 
that the bladder now held, as on each introduction the catheter brought 
away clear urine. Fr©m this time until the 13th (that is the sixth day from 
that on which the accident happened), all went on Avell, excepting that a 
smart attack of gout occurred on the 10th, although the patient had never 
before suffered one ; but on the 13th, from a strong desire to become inde- 
pendent of the catheter, he made straining efforts to pass his water, and he 
had scarcely passed a tablespoonful, when he felt (to use his own expres- 193 
BLADDER. 
sion) something give way, and a burning pain all over his stomach and 
bowels, as if boiling water had been poured over them; and the same 
symptoms of faintness and distress occurred as when the accident first hap- 
pened. I saw him within a few minutes of this reopening of the wound of 
his bladder, for I could not doubt but such had been the consequence of 
his attempts to pass his water. On using the catheter, not more than a 
teaspoonful came through the tube. He had now again the symptoms of 
peritonitis, with the addition of incessant sickness. The same plan of 
treatment was again adopted—viz., fomentations, leeches, and a full opiate 
with calomel. 
In about four hours after, on the introduction of the catheter, urine was 
found in the bladder; and by passing the instrument for a fortnight, amend- 
ment gradually occurred; a second attack of'gout came on, probably from 
the absorption of the urine into the system. This case may range with 
many, in proof of what severe injuries the peritoneum may sometimes sus- 
tain, and the patient yet survive. Indeed, out of the evil of peritonitis, 
which usually renders this accident fatal, came the good of such an effusion 
of lymph, as no doubt glued the bladder where wounded to the contiguous 
viscera. The fact of gout occurring upon the absorption of the urine which 
first escaped into the peritoneum, and its aggravation upon its second ex- 
travasation, is interesting as connected with the pathology of that disorder. 
Part xiv., p. 235. 
Treatment of Chronic Cystitis.—This disease, by whatever cause excited, 
is one of the most painful and miserable affections which we have to deal 
with. In consequence of the difficulty of successfully treating it, the 
highest authorities have considered it the opprobrium of surgery. 
Dr. Macdonnell recommends the following ; ft. Infus. buchu, gvss.; tinct. 
buchu, §j.; bals. copaibas, liq. potassas, tincture liyosciam. aa. §ss.; an ounce 
thrice a day. And inject the bladder thus : the patient being either erect 
or recumbent, inject warm water at 98° Fahr. through a No. 9 or 10 elas- 
tic catheter, by means of a caoutchouc bag, or a syringe with a three-way 
valve. When the bladder is cleansed, inject in the same manner a solution 
of from eight to sixteen grains of nitrate of silver in four ounces of dis- 
tilled water (at 98), with or without two drachms of tincture of liyoscia- 
mus. Compress the urethra so as to keep the injection in for one minute. 
Then give the patient a warm bath; and if the pain, etc., remain long, 
employ fomentations and anodynes. If required, repeat the injection at 
intervals of two or tln-ee weeks. Part xvi., p. 202. 
Cystitis—Scrof ulous.—Be particular to rectify any disorder of the di- 
gestive organs, and enforce great care as to the diet. Then give, especially 
if the urine is alkaline, small doses of mineral acids hi bitter infusions, of 
iodide of potassium, or chalybeates. If the disease is obstinate, apply a 
perpetual blister, or, still better, insert a seton above the pubes, or in the 
loins. Part xxi., p. 25. 
Strychnia in Paralysis of the Bladder.—M. Lecluyse has published 
some cases in which all ordinary means appearing useless in removing this 
affection, he gave strychnia internally, but without any benefit to the paraly- 
sis. He then dissolved six grains in alcohol, mixed it with a pint of water, 
and ordered four injections of §ij. each to be introduced through the catheter, 
the bladder being previously emptied. It was followed by complete sue- 194 
BLADDER. 
cess. But in another case under M. Robert, this gentleman ordered three 
grains in six ounces of water. This not being soluble, the pupil in charge 
substituted the sulphate of strychnia for the alkali itself. The injection 
was given, but symptoms of poisoning soon came on, and the patient ulti- 
mately died from the effects of the strychnia upon the system. No appre- 
ciable change was remarked in the muscular coat of the bladder; it remained 
perfectly paralyzed. Part xxii.,/>. 187. 
Electricity in Paralysis of the Bladder.—Great benefit will be found 
to result in this disease from the application of electricity as follows : A 
silver catheter is introduced into the bladder, and a female catheter intro- 
duced into the rectum, and made to rest upon the recto-vesical parietes ; 
each of these catheters is connected with one of the poles of an electric 
machine, which is put at first into gentle action, and then continued briskly 
for two or three minutes. Part xxii., p. 188. 
Bladder, Chronic Catarrh of.—M. Ricord uses caustic injections, 5ij. 
of nitrate of silver to §iv. of distilled water. He repeats the injections 
every three, four, or six days. Part xxii., p. 263. 
Paracentesis Vesicm in Petention of Urine from Stricture of the 
Urethra.—[Mr. Cooper, in a clinical lecture delivered at Guy’s Hospital, 
remarks, that although the operation of puncturing the bladder per rectum 
is recommended as the most simple and safe operation for the relief of re- 
tention of urine depending upon stricture of the urethral canal, yet its 
indiscriminate use would be highly prejudicial. He then proceeds to point 
out the cases in which he considers it ought, and in which it ought not, to 
be resorted to. He says :] 
Surgeons admit three ways of performing the operation of paracentesis 
vesicas, namely puncturing above the pubis; puncturing through the rec- 
tum—or vagina in the female ; and, lastly, cutting through the perineum. 
Of these three, I shall exclude the first, as being in my opinion, the most 
dangerous, the most liable to lead to extravasation of urine, and the 
consequent formation of abscesses, and the most likely to be followed by 
injurious consequences, from the pressure of the canula on the coats of the 
posterior parts of the bladder, when allowed to remain for some time, as is 
frequently requisite. If the stricture have existed for a long time,—if the 
walls of the urethra have become thickened and cartilaginous, so as per- 
manently to constrict and destroy the function of the canal—if, indeed, 
from the circumstances of the case, you believe the stricture likely to per- 
sist, although the patient be, pro tempore, relieved of his retention—I say, 
in such an instance, I recommend cutting through the perineum. If, on 
the contrary, you have reason to believe, that, by alleviating his present 
symptoms, you may afterward be able, by proper medical treatment, to 
overcome the stricture, then I advise the operation per rectum; so that 
your conduct must be guided by a consideration of the nature of the case 
you have to treat. 
In describing the operation, it will be necessary just to advert to, and 
bring to your recollection, the anatomical relation of the parts in the pelvic 
region. The posterior surface of the bladder is entirely covered by peri- 
toneum, the continuation of the layer descending on the anterior wall of 
the abdomen, which, being prolonged to the posterior portion of the base 
or fundus part of the bladder, is reflected backward to the anterior part BLADDER 
195 
of the rectum, thus forming a cul de sac, known as the recto-vesical pouch. 
In front of this reflected membrane, the base of the bladder comes closely 
in contact with the rectum, being separated only by fibro-cellular tissue 
and recto-vesical fascia, a portion of the pelvic fascia which descends into 
the pelvis to retain its contained organs in place. The bladder here pre- 
sents a triangular surface corresponding in its situation to the trigon in its 
interior, the apex of the triangle being directed forward to the prostate 
gland and its sides bounded by the vasa deferentia and vesicuke seminales. 
It is in this triangular space that the trocar and canula should be intro- 
duced, and where, it will be seen, it can be employed with scarcely any 
danger of wounding the peritoneum ; for, as the bladder becomes distended 
in retention, it carries with it the peritoneum, thus placing it almost out 
of the reach of the instrument, and there will be little fear of injuring the 
vasa deferentia or vesiculse seminales, if the point of the trocar be kept in 
a direction toward the median line. Bearing these considerations in 
mind, place your patient on a table, with his pelvis well raised before you, 
and in the same position as that required for the operation of lithotomy; 
then, introducing the index finger of the left hand into the rectum, pass 
along it the canula, furnished with a “ jnlot-plug,” until it reach opposite 
the triangular space of the bladder which I have just described to you ; 
withdrawing the pilot, and depressing the canula, until it assumes the 
direction of a line with the umbilicus, pass in the trocar, and force the two 
onward into the bladder. The operation is attended with but little pain, 
indeed, the chief pain is occasioned in endeavoring to introduce the canula 
without the “ pilot-plug,” an addition to the instrument which is of great 
practical advantage; for, without it, the end of the canula seems to catch 
in the mucous membrane, and to produce such contraction of the bowel as 
to prevent its onward progress; with it, however, no such difficulty exists, 
for its smooth, rounded extremity readily passes within the rectum, and 
pilots the way for the canula. To insure success in the operation, the chief 
circumstance to be attended to is, in thrusting the trocar and canula for- 
ward, to keep the point well elevated or the handle depressed; otherwise, 
it may pass between the bladder and rectum, and, on withdrawing the 
trocar, the operator may be extremely mortified to find no fluid following it. 
Part xxiii., p. 196. 
Retention of TJrine in a Child twenty Months old, from Injury— 
Puncture of the Bladder above the Pubis.—[The ordinary cases of reten- 
tion of urine are chiefly arising from obstinate strictures in adults, and 
have certain rules of treatment. But if it is produced from injury, the 
treatment must be determined by the circumstances of the case, and more 
especially so, if, as in this case, the patient is a child of tender years. Two 
days previously the child had fallen down an area, the perineum coming 
in contact with the ground. On admission, the countenance is described 
as being full of anxiety, the limbs motionless, and the pulse 115 and weak. 
All the ordinary means to favor the introduction of the catheter were of 
no avail, and the instrument could not be passed.] 
The child was now quite insensible ; the respiration rapid and labored; 
the pulse 125, very weak, and almost imperceptible. Mr. Wakley there- 
fore considered that no more time should be lost in attempts to render the 
urethra pervious, and determined to puncture the bladder above the 
pubis. A glance at the situation of the child will show that the pubic 196 
BLADDER. 
operation was almost the only one which could he selected. As there was 
no stricture, there existed, of course, no distended membranous portion of 
urethra which could conveniently be punctured, and as for the rectum, 
the “ soft mass at the commencement of the prostate gland,” which 
stopped the catheter, was no encouragement to resorting to the rectal 
operation. 
Mr. A\rakley, therefore, punctured the bladder over the pubis in the 
usual manner. A very considerable quantity of high-colored offensive 
urine was drawn off, and the canula kept in its place by a bandage running 
round the waist. A large poultice was placed over the abdomen and peri- 
toneum, and the child carefully placed in bed. 
In the evening the little patient became conscious and restless for two 
or three hours, but he soon fell asleep, and slept nearly the whole night. 
The canula was kept in the bladder for three days, and the urine drawn 
off at intervals. After this period a catheter was easily introduced into 
the bladder, and the canula being now no longer required, was withdrawn. 
The wound healed very rapidly, the urine continued to flow through the 
urethra, and in eight days the child left the hospital. Part xxiii., p. 198. 
Chronic Inflammation of the Bladder.—In obstinate cases of chronic 
cystitis, Air. Acton has recourse to the following plan of injecting the 
bladder with nitrate of silver. To effect this, pass a gum elastic catheter 
into the bladder, and draw off the urine, and then, with a glass syringe, 
which fits accurately to the instrument, inject the whole of the following 
solution into the viscus: $. Argent, nitrat. 5ij.; aquae destill. §iv.; M. ft. 
inject. The immediate consequences are, increased pain, which for the 
moment is very severe, the urine that is first passed is bloody, and some 
tenesmus is experienced. In a short time, however, these symptoms abate, 
on the patient keeping his bed, and paying great attention to his diet; at 
first no liquids should be taken, nor for the first few hours preceding the 
operation; subsequently the usual quantity of tea or barley-water may be 
indulged in, and the various balsams, particularly turpentine or spruce, 
should be prescribed. In a very few days the urine will contain less of 
this ropy mucus, and ultimately none will be noticed; in other cases, the 
injection may again be resorted to, at the end of four or five days, and 
repeated until a complete cure is effected. AVe very rarely observe any 
of the ill consequences which probably might be expected to arise when 
injections are thrown into this important organ. Part xxiv., p. 241. 
Dilatation of the Bladder.—Hypertrophy is the great change to which 
the prostate gland is obnoxious, and is so common after the age of fifty, 
that Mr. Adams says it may be almost regarded as one of the necessary 
contingencies of old age, supervening in a manner wholly independent of 
inflammation. The condition of the bladder varies remarkably in this dis- 
ease ; occasionally it is so contracted and thickened as to hold but a very 
small quantity of water, and in other cases is so much expanded as to hold 
many pints. 
In the first of these conditions, Mr. Adams believes that there has been 
inflammation of the prostate, extending to the bladder, and sudden increase 
in the size of the gland ; and in the second that the increase has been 
gradual, and accompanied by compensative dilatation of the bladder. This 
dilatation, proceeding in every direction, presses sometimes on the rectum, 
and produces obstinate constipation, giving rise to that pouch which is so BLADDEE, 
197 
convenient a receptacle for small putrefying quantities of urine, or for cal- 
culi. There often happens, also, a hernia of the mucous coat of the blad- 
der through its thickened muscular fibres, which materially aggravates the 
patient’s danger; for these cysts, or supplementary bladders, answer 
admirably to contain the urine, but, being destitute of muscular fibres, 
are unable to expel their contents, which, rapidly decomposing, inflame 
the bladder, and not unfrequently set up the peritoneal inflammation, 
which finally kills the unfortunate patient. The author lays particular 
stress upon what is called the fluttering blow of the bladder, as a pathogno- 
monic sign of this condition; and as this is an important practical point, 
we shall present our readers with his exact words: 
“ As this is a subject in a great measure passed over by writers on dis- 
eases of the urinary organs, I shall take the liberty of dwelling somewhat 
upon it. So far as I have observed, these cases are usually attended with 
pain about the region of the pubes, and in the perineum, and along the 
urethra, especially after the evacuation of the bladder; there is generally 
more or less irritability of this viscus evinced by a frequent desire to pass 
water; hence the surgeon’s attention is directed to the state of the blad- 
der ; the catheter is introduced—it may be without difficulty, or at any 
rate with no more difficulty than commonly attends its introduction when 
the prostate gland is hypertrophied; and on the escape of some urine, the 
flow of water suddenly stops, and a fluttering blow is struck against the 
point of the instrument, as if a solid body came in contact with it: the 
surgeon, believing that he has drawn off the whole of the urine, is about 
to withdraw the catheter, when a small quantity more escapes, and perhaps 
the blow is repeated. The impression first conveyed to the mind of one 
unaccustomed to it is, that there is a stone in the bladder; but the expe- 
rienced hand at once detects the nature of the case, or at any rate the idea 
of the existence of stone is at once removed from his mind. 
“ It is not long since that I was in attendance on a valued medical friend, 
who was laboring under all the symptoms of hypertrophied prostate, with 
its concomitant horrors, the disease approaching rapidly a fatal termina- 
tion, when his medical attendant in the country assured me that he had 
detected the cause of his disease in the existence of a stone in the bladder. 
On introducing the catheter, I was at once convinced that the opinion was 
erroneous: I felt the fluttering blow upon the catheter, and ventured to 
diagnosticate a considerable pouch in the bladder: my opinion was veri- 
fied on the examination of the body after death, which took place soon 
after.” JPartxxv.,}t?. 216. 
Treatment of Nervous Affections of the Bladder.—Irritability and neu- 
ralgia of the bladder have many points in common; indeed, few authors 
devote a distinct chapter to the latter affection. Neuralgia of the bladder 
is described by Dr. Gross to have many symptoms in common with neural- 
gia affecting other parts; sometimes the pain is located in one spot, at 
other times it extends to neighboring organs. There is frequent desire to 
pass water, and the urine is thrown out in jets, and in small quantity; a 
distressing soreness is left behind in the urinary passages. A systematic 
course of cathartics seems most beneficial. If the disease be complicated 
with amenorrhcea, the cathartics should be combined with aloetic and 
emmenagogue preparations. 
A systematic course of purgation is valuable also in neuralgic affections 198 
BLADDEK, 
of other parts of the body, accompanied by inflammatory symptoms. Then 
carbonate of iron may be employed; but if arising from malarious influ- 
ence, quinine and arsenic are to be preferred ; gr. iv. of quinine may be 
taken every three hours, until 15 or 20 grains have been taken. To eradi- 
cate both vesical and other forms of neuralgia, employ the following:— 
Acid, arseniosi, gr. ij.; strychnine, gr. j.; ext. aconiti, gr. viij.; pulv. 
opii, gr. v. M. These ingredients are to be carefully incorporated and 
divided into 16 pills of equal size, of which one may be given every 6 
hours, or 4 in the 24 hours. When nausea begins, the pills must be given less 
frequently, or or f- of a pill may be employed at a time. The exhibition 
of the pills also should not be continued longer than a week or ten days at 
a time, to allow the stomach a short recess, wdien they may be again 
resumed. 
To moderate the violence of the paroxysms, large doses of narcotics are 
frequently indispensable. Of these the best are the salts of morphia, 
either alone or in combination with nauseants, according to the state of the 
vascular system. When the pain is very violent, or when narcotics can- 
not be taken by the mouth, opiate injections or suppositories should be used. 
An emetic of ipecacuanha, or tartrate of antimony, at the approach of 
the paroxysm, will sometimes have the effect of cutting it short, or mate- 
rially abridging it. The remedy is particularly indicated when the disease 
is associated, as it often is in malarious districts, Avith gastric and biliary 
disorder. » 
Much benefit may also accrue, in many cases, from the warm bath, or 
the application of steam to the affected part. This can be readily effected 
by connecting one end of a gum-elastic tube with the spout of a tea-kettle, 
filled with hot water, and placing the other under the bed-clothes. Fomen- 
tations with hops, opium, or laudanum, will also be highly serviceable. 
Part xxvi., p. 109. 
Treatment of Paralysis of the Bladder.—A clear and practical distinc- 
tion can be established between paralysis of the neck of the bladder and 
paralysis of the body of that organ ; the first form being attended with 
incontinence, the second with retention. 
Dr. Gross cautions the surgeons against evacuating the whole of the 
urine, accumulated in an over-distended bladder, at one time, as he is 
satisfied that he has seen several patients die from the severe depression 
induced by the sudden removal of the distention. In all such instances, 
he allows a small quantity of urine to remain in the bladder; and also 
applies a bandage to the abdomen, as after tapping or parturition. Cathar- 
tics he considers to be of the utmost service in all descriptions of paralysis 
of the bladder; and of these, calomel, with castor oil and turpentine, is 
his favorite. Emetics also are not to be neglected. Of remedies acting 
especially on the nervous system, strychnine, cantharides, and arnica, are the 
most potent, and are best given in the following formula: Strychnine 1-16th 
of a grain, cantharides l-8th of a grain, arnica from 3 to 5 grains three 
times in the 24 hours. Of arnica in paralysis of the bladder from fever, 
masturbation, and general exhaustion, Dr. Gross speaks very favorably, 
lie prefers the tincture, in doses of from forty to sixty drops thrice daily. 
Counter-irritation, such as a succession of blisters over the dorso-lumbar 
region, is useful in almost all but the inflammatory form of vesical paraly- 
sis. The actual cautery is also a proper remedy. Part xxvi., p. 110. BLADDER, 
199 
Paralysis of the Pladder.—In a case of this affection from over-disten- 
tion, the patient, a female, was ordered to be electro-galvanized three times 
a week, and to take ten minims of the tincture of the sesquichloride of 
iron, three times a day, in infusion of quassia. The catheter to be used 
twice a day. In a fortnight the patient was able to pass the urine volun- 
tarily, and in a few days more was completely recovered. 
Part xxvi., p. 342. 
Puncture through the Rectum for Retention of Urine, from Stric- 
ture.—After detailing cases in which the bladder was punctured through 
the rectum with perfect success, Mr. Hilton concludes thus: 
“Let me now, in a few words, place before you the objections which 
have been brought against an operation, the useful application of which 
these lectures have been intended to exemplify. 
“ 1st. It has been alleged that there is a great danger of wounding the 
peritoneum and of causing peritonitis; but you know, at present, that, in 
puncturing the bladder through the rectum, the peritoneum is not wounded 
at all. 
“ 2d. Wounding the vesicuke seminales or the vas deferens. The expe- 
rience of Guy’s Hospital shows that this accident happens very seldom, and 
when it does occur, it is not of much importance. 
“ 3d. It is objected that it is very difficult to retain the instrument in the 
bladder and rectum ; but this apprehension need not be entertained, for 
you have seen how steadily our patients now retain the canula in the rec- 
tum, thanks to the improvements in our instruments. 
“ 4th. The operation is opposed, because a communication between the 
bladder and rectum may persist for an indefinite period. This, indeed, 
may happen, but is very rarely the case. Indeed, I may safely say, that 
most of those who uprightly and without prejudice find fault with the 
operation, are but very imperfectly acqxiainted with the actual results of 
the numerous cases which have thus been treated. Between twenty and 
thirty operations of this kind have been performed in this hospital within 
the last few years, with a success as to result, the most encouraging; and 
I whether a like success could have been attained in cases of equal 
severity by any other mode of treatment; and that, after all, is the impor- 
tant point for our consideration. 
“ If the operation of puncturing the bladder through the rectum be, as 
I believe it to be, devoid of most of the dangers which have been, perhaps, 
only theoretically attached to it, and also free from many of the dangers 
and difficulties of the other or substitute operations, it is surely time that 
surgeons should give it more consideration and more credit for good on 
its own merits than it has received of late years.” Part xxvii. p. 148. 
Paralysis of Pladder from over-Distention after Delivery, Simulating 
Peritonitis.—In this case, twenty-four hours after delivery, symptoms 
resembling peritonitis supervened. The labor had been tedious and pro- 
tracted, but no manual or instrumental interference had been required. 
Hr. Lever passed the catheter and drew off seven pints of urine, by which 
the symptoms were speedily relieved. The bladder, however, from over- 
distention, was afterward found to have lost its contractile power, and 
the catheter was required twice daily for its relief. Nine weeks after her 
confinement she was admitted into the hospital. 
She was ordered to be electro-galvanized three times a week. Water 200 
BLADDER. 
to lie drawn nocte maneque. R. Tinct. ferri sesquichloridi, minim, x., ex. 
inf. quassiae, t. d. The patient was restored to health. 
Dr. L. was afterward called to this patient, her attendants supposing 
she was suffering from puerperal peritonitis, but the diagnostic symptoms 
were wanting; pain there was and increased by pressure; the pulse 
quickened, but not wiry / the skin moist, and the perspiration had a 
urinous smell; her position was peculiar, but was that which is often 
remarked in over-distended bladder ; the hand pressed upon the perineum. 
The introduction of the catheter soon solved the doubt, and her recovery 
of the power of micturition was due to that valuable agent recommended 
by Dr. Radford of Manchester. Part xxvii., p. 217. 
Bladder—Gout in the.—In this disease the mucous membrane of the 
bladder readily secretes pus. If this is not freely evacuated, the urine be- 
comes alkaline from the retention of a small portion of it, and the subse- 
quent formation of ammonia by the decomposition of the urea. This 
alkaline urine again keeps up the irritability of the bladder, which 
thus goes on secreting pus. There is also, in this disease, frequently 
incontinence of urine, not because the sphincter vesicas is paralyzed, but 
because the bladder will not allow the accumulation in it of even a small 
quantity of urine. In other cases there is an opposite condition; the 
patient may have retention of urine. This is easily explained : in the 
former case, the gouty poison was irritating the mucous membrane; in 
the latter it has affected the muscular coat. Now, if, in these cases, we 
find it clearly proved that the man has the gouty diathesis, and that there 
is no stone in the bladder, we may consider the eruptions to arise from 
gouty inflammation attacking the bladder. In the treatment, we must first 
counter-irritate, but not with turpentine or cantharides, for obvious 
reasons, but with mustard or strong ammonia. To relieve pain, if it be 
that form of the disease in which pus is generated, we may apply opium 
endermically, or apply an opiate liniment over the bladder, or we may 
give an enema containing opium by the rectum, repeated or not according 
to the relief obtained. In these ways all kinds of irritability of the 
bladder, even that produced by cantharidine, may be relieved. It should 
be borne carefully in mind, that, whenever gout attacks internal organs, 
it is a disease of an asthenic character, and therefore depletory measures 
should in no case be employed. Part xxviii., p. 141. 
Irritability of the Bladder treated by Nitrate of Silver Injections.— 
A patient, of nervous temperament, with soft and flabby muscles, had 
irritability of bladder, which ordinary remedies had failed to relieve. A 
solution of nitrate of silver, twenty grains to the ounce, was introduced 
into the bladder, and so great was the relief that the symptoms entirely 
disappeared for six months. At that time the same treatment repeated 
completely removed the symptoms. Part xxviii., p. 208. 
Irritable Bladder.— [The bladder is frequently made irritable by differ- 
ent states of the urine and various concretions, but it may be irritable 
without these being the primary cause. Dr. Jones gives us some of the 
most interesting examples of direct and of sympathetic irritation of this 
organ.] 
The most simple instance of direct irritation may be observed when 
some irritating liquid substance, as cantharides, turpentine, or copaiba, BLADDER. 
201 
exists in the water, or when some solid body, as a calculus, is lying in the 
bladder. These act as, for example, chlorine or a foreign body in the 
bronchial tubes would do in producing cough. I need not read you ex- 
amples of irritation thus produced; I may, however, repeat, that simple 
excess of acid or alkali in the urine alone, rarely, by itself, causes irritable 
bladder, though most decided instances of their effect may be observed. 
Here, for instance, is an example of the effect of acidity. I was sent for 
one evening to a gentleman who was suffering intense abdominal pain, 
which came on at intervals of a minute, and which he attributed to indi- 
gestion. The tits of pain, on reaching to the greatest intensity, relaxed, 
soon again to recur. With a full dose of calomel and opium, ether and 
sal volatile, in three hours this colic subsided; but he began then to com- 
plain of scalding and difficulty of passing the water. During the night he 
had constant calls, passing only a teaspoonful of urine at a time. For this 
he took nitre, carbonate of potass, and barley-water. The following morn- 
ing the irritability of the bladder had diminished very much, and during 
the day it disappeared. On examining the urine made during the time 
the bladder was so irritable, I found no trace of blood-globules, mucus, 
or pus-globules, but only a state of very high acidity, which, in twelve 
hours, gave rise to a very large deposit of uric acid. I believe this ex- 
cessive irritability of the bladder arose only from the intensely acid state 
of the urine. 
Sometimes, instead of the direct irritant being applied inside the blad- 
der, it acts from the outside. As examples of this, I may mention the 
irritable bladder of pregnancy, of abdominal tumors, and even of faeces 
which have accumulated in the bowels. 
In a case of irritable bladder arising from this last cause, the patient’s 
general health being good, except irregular action of the bowels, Dr. 
Jones advised some camphor and henbane at night, with cold water enema, 
and an aloetic aperient. A month afterward, the patient considered him- 
self cured. 
Dr. Jones next proceeds to consider that direct irritation which depends 
on idiopathic inflammation, independent of the irritating qualities of the 
urine. 
Idiopathic inflammation of the bladder is the. most common in advancing 
years, when the prostate gland ceases to be healthy; then some very 
slight cause is sufficient to determine the commencement of the inflamma- 
tory action which gives rise to most urgent symptoms of irritable bladder. 
Exposure to cold, the fatigues of a journey, inconvenience causing volun- 
tary retention of the urine too long, each of these I have known to be the 
immediate cause of acute inflammation of the bladder, in consequence of 
which the water has been passed every hour, and even oftener. At first 
it is scanty, high-colored, with blood-globules, and quickly pus-globules 
are found ; and these continue when the inflammation is subsiding, and 
the frequency and urgency of making water are much lessened. Such an 
attack I have watched through its whole course ; the symptoms rapidly 
becoming more and more serious, constant hiccough and nausea, producing 
prostration, which threatened the life of the patient. These symptoms, 
however, I have seen yielding after treatment; and in two months no 
trace of blood or pus remained in the urine, and the patient in all respects 
entirely recovered. More commonly the acute attack passes into chronic 
disease, and then with more difficulty is removed; or, after months and 202 
BLADDER, 
sometimes years of suffering, the kidneys become affected, and the patient 
sinks. 
[He illustrates this irritability by some very interesting cases, such as by 
crushing a calculus, cutting for stone, and from a stricture.] 
In most cases, as the mucous membrane becomes diseased, the urine 
gradually becomes so also, and then it also acts on the bladder, greatly 
increasing the suffering and the difficulty of the cure. Thus the two 
causes acting together, react also on one another. The same result is pro- 
duced when the irritable bladder is caused at first by the state of the urine 
alone, as, for example, when it is highly acid or alkaline, then it slowly 
acts upon the mucous membrane, and finally, both the state of the mem- 
brane and the state of the urine together hasten on the disease. 
In distinction to these cases of direct irritation, there are others which I 
may class together under the head of sympathetic irritation, in which ap- 
parently neither the urine nor the mucous membrane of the bladder are 
perceptibly different from the healthy state. 
The most frequent cause of this sympathetic irritation is probably dis- 
ease of the kidney itself, although it is by no means the fact, that in all 
diseases of the kidney irritation of the bladder is produced. Most com- 
monly the irritation occurs when some calculus or inflammatory action 
exists in the pelvis of the kidney; then a small quantity of purulent matter 
mixed with the urine may indeed pass into the bladder, but this usually 
bears no proportion to the amount of irritation which occurs. The first 
explanation of this irritation that presents itself is that the inflammation 
extends down the ureter to the bladder; but on post-mortem examination 
this cannot usually be proved, and hence these cases must be classed under 
the head of sympathetic, and not of direct irritation. Hysterical irritation 
of the bladder belongs to the class of cases of which I am now speaking. 
In all supposed hysterical diseases, the first thought should be, whether 
the hysteria is the cause or the consequence of the disease. Is the hysteria 
idiopathic or symptomatic ? Often it will be found that hysteria is but one 
symptom of a complaint, which, in addition to other effects, produces irri- 
table bladder; but occasionally no other complaint can be detected, and 
no cause for the irritable bladder can be found except the hysteria itself. 
The previous history will often assist in giving the true answer to the 
question which you must ask before you can commence your treatment on 
reasonable grounds. 
Moreover, whatever may be the cause of the irritable bladder, yet in all 
cases, whether of direct or sympathetic irritation, both in men and in 
women, a smaller or a greater part of the irritability may be always traced 
to nervousness. This is usually seen in the fact, that in such patients a 
passing thought will suddenly cause the most urgent desire to empty the 
bladder, and that while the mind is fully occupied, the irritability will be 
less distressing. 
In irritable bladder, more perhaps than in most diseases, it is requisite 
that, before any method of treatment is begun, you should endeavor to 
obtain clearness as to the cause of the disease. It is produced by so many 
different causes, that specific treatment of the irritation will rarely suffice. 
You may palliate it as you would a cough by opiates and sedatives ; but 
to effect a cure, the cause of the disease must be found, and be capable of 
removal. Ask yourselves, then, first, is the irritation direct or sympa- 
thetic ; if the former, is it simple or compound, internal or external ? BLADDER, 
203 
While endeavoring to remove the cause, you will often find palliatives of 
great importance. Of these, the most important are camphor and opium. 
Three grains of camphor and half a grain of opium made into a pill, taken 
twice or three times daily, will often prove beneficial. In#some cases, 
palliatives fail, and cure is impossible. In these, mechanical contrivances 
of the present day do away with much of the discomfort and annoyance 
which otherwise would have to be endured. Part xxx.,p. 78. 
Irritability of the Bladder.—1. As a Consequence of Gonorrhoea.—Give 
iodide of potassium, and active tonics, as cinchona, with doses of Plummer’s 
pill; or colchicum, combined with blue pill; or ten grains each of pow- 
dered guaiacum and calcined magnesia once or twice a day. 
2. As a Consequence of Diseased Prostate.—Pass a catheter occasionally, 
i.e., with intervals of two or three days or longer. If there be some little 
purulent discharge, apply a little nitrate of silver to the prostatic portion 
of the canal. 
3. When accompanied by more or less Mucus in the Urine, or Muco- 
purulent Deposit.—Apply stimulating injections to the bladder. Nitrate 
of silver from half a grain to two grains to the ounce, increased, if need be, 
to ten and even fifteen grains to the ounce. Give half a grain to a grain 
of acetate of lead, with two grains of extract of opium. Give nitric acid, 
one or two minims to the ounce of water, when the urine is loaded with 
earthy phosphates. Creasote and copaiba are also recommended in some 
cases. The injection of simple warm water is often useful, and when the 
urine is very offensive, a solution of chloride of soda, from six to ten grains 
to the ounce of water, used once a day, is recommended. The vulcanized 
india-rubber bottle, fitted with pipes and valves, is the best instrument. In 
non-inflammatory cases, give infusions of diosma or buchu, or uva ursi, 
combined with hyosciamus or camphor, and even copaiba or chios turpen- 
tine. Pareira brava is also strongly recommended, but often disap- 
points us. Part xxx., p. 83. 
Bladder—Apparatus for Injecting.—Adapt a short bit of india-rubber 
tubing to the end of the catheter before its introduction. After intro- 
ducing it, the conical nozzle of a common ear-syringe is easily admitted 
into the other end of the elastic tubing, and the thing is ready for use. 
This keeps the catheter more steady. It prevents joggling. It saves the 
use of a stopcock, as the tube is compressible, and lastly, it connects any 
sized catheter with the syringe. Part xxxi.,p. 168. 
Bladder—Injection of—Take a piece of elastic tubing, the diameter of 
a quill, and about four feet long. To one end must be attached a small 
india-rubber funnel, the other end grasps the end of the catheter. When 
ready, the funnel end is held up at arm’s length, and water poured in; the 
pressure of the column of fluid fills the bladder, which may be emptied 
again by depressing the tube. This tube might conveniently be attached 
to the end of the female catheter to prevent the need of having any utensil 
in bed. Part xxxii., p. 176. 
Method of Removing Foreign Bodies from tlieUrethra and Bladder.— 
Mr. M. H. Collis recommends incision in the mesial line, in front of the 
anus, for the removal of foreign bodies from the bladder. He says : “ The 
membranous part of the urethra is not more than an inch to an inch and a 
half distant from the verge of the anus ; hence we can strike it with ease 204 
BLENORRHAGIA. 
and certainty, when the perineum is in a healthy condition. By drawing 
the rectum down with the forefinger, while an assistant raises the bulb 
toward the pubis by the staff, the knife can be inserted with safety to the 
depth of an inch or so in the mesial line, and then, by depressing the curve 
of the staff, the point of the knife comes directly in contact with the mem- 
branous portion. If the incision be made accurately in the mesial line, no 
vessels will be wounded; and as the membranous portion only is opened, 
there can be no extravasation of urine forward. The incision in the integu- 
ments might be enlarged by commencing it further forward, if necessary, 
to give room for the extraction of a larger substance, or for the introduc- 
tion of the finger and forceps together Even when the fragment 
of catheter or foreign body has slipped into the bladder entirely, the central 
incision would seem to be the easiest and least dangerous operation for 
extracting it.” Part xxxii., p. 177. 
Irritable Bladder.—Where there are all the worst symptoms of stone, 
without any appreciable cause, if the usual remedies fail, you may perform 
cystotomy, by making an incision in the mesian line of the perineum, in 
the manner of Allarton’s operation for stone, the object being to cut across 
the nervous plexuses and irritable parts of the neck of the bladder. 
Part xxxiii., p. 209. 
Bladder and Uterns—Reciprocal Sympathies of. — Vide Art. “Uterus.” 
Irritable Bladder.—The greatest relief will often be obtained from the 
injection of the bladder with carbonic acid gas. This may, if desired, be 
combined with the vapor of chloroform. A caoutchouc bag holding four 
ounces, and an ordinary catheter, may be conveniently used for this pur- 
pose, a space being left in the neck for a piece of sponge soaked in 
chloroform. Part xxxviii., p. 161. 
B L.ENORRHAGIA. 
Monesia.—The extract of monesia, in the form of pills, in doses of from 
twelve to forty grains, during the day, recommended in cases of Menor- 
rhagia. Part ii., p. 77. 
Seat of Blenorrhagia in Females.—“ In females,” says Dr. Gilbert, 
“ the seat of election of blenorrhagia is the meatus urinarius, as in the 
man; but in all cases where I have used the speculum, I have seen a uter- 
ine discharge accompanying that of the urethra, and continuing after the 
latter is cured, so that the neck of the uterus may be considered the prin- 
cipal source of the blenorrhagic fax in women. Nevertheless, some 
modern writers have designated the female clap by the term vaginitis or 
inflamed vagina; but in the immense majority of cases, the vagina does 
not secrete the discharge, and if it be sometimes red, this appearance is 
transient, and yields rapidly to repose and cleanliness. It is only in a few 
rare cases that we meet with a milky or purulent discharge, really fur- 
nished by the vagina; on the contrary, in every woman who has con- 
tracted a clap, there exists, during the two or three weeks, a characteris- 
tic suppuration, together with a discharge, originating in the neck of the BLOOD-LETTING. 
205 
uterus, which last, by its continuance after the cessation of the urethral 
symptoms, maybe confounded with leucorrhoea.” Part ii.,p. 137. 
Blenorrhagia of Vulva.— Vide Art. “ Vulva.” 
Blenorrhagia of the Excreting Duct of the Video- Vaginal Gland.— 
Dr. Salmon directs attention to the affection very common among prosti- 
tutes, yet little known to the generality of practitioners, namely, purulent 
hyper-secretion of the excretory duct of the vulvo-vaginal gland, a disease 
first pointed out by M. Iluguier, and described by him as the occasional 
source of blenorrhagia in the male. It is now universally known, that 
there exists on each side of the vagina, at the orifice, and imbedded in the 
labia, a glandular body, the duct of which, half an inch long, opens just at 
the base of the hymen, or by the carunculse myrtiformes. Dining erotic 
excitement, a viscid fluid, similar to the prostatic fluid in the male, is 
abundantly poured forth to lubricate the female external organs. 
The signs by which the disease may be known are derived from exami- 
nation only. The woman experiences no inconvenience, nor does she 
think that she needs medical aid. Moreover, she may, if she pleases, con- 
ceal her disease, by making water, or by using as an injection a strong 
solution of alum, shortly before the visit of the inspector. This discharge 
of pus may be easily overlooked, owing to the narrowness of the duct. It 
is necessary that the surgeon should first make moderate pressure of the 
labia against the rami of the ischia, by the thumb applied in front of the 
anus, that it may be ascertained whether the gland be tumefied. In the 
natural state, it cannot be detected by the touch; if swollen, it feels like 
a rounded body, the size of a nut, or larger. Firmer pressure made 
against the ischium from within will cause the contents to escape. The 
normally constituted fluid is thick and clear, and appeal’s at the extremity 
of the duct in not larger quantity than a drop or two. The fluid from the 
inflamed gland is either thick, more abundant, and mixed with mucus, 
when the girl should be put under surveillance; or yellow and puriform, 
when she should be removed to a hospital. 
The treatment resembles that of blenorrhagia in other situations. The 
result is much more rapid. Absolute rest; injections of nitrate of silver, 
with Anel’s syringe; cauterization with the tincture of iodine; baths. 
The duration is about twenty days. Part xxxi,,p. 208. 
BLOOD-LETTING. 
A low feverish state is apt to be induced by a too long protracted use 
of depletory and debilitant remedies. Part i.,y>. 23. 
Effects of Excessive Ploocl-letting in cases of Injury of the Brain, 
as in Concussion.—Sir B. Brodie remarks, that where bleeding has been 
carried to a great extent, symptoms frequently occur which in reality arise 
from the loss of blood, but which a superficial observer will be led to 
attribute to the injury itself, and concerning which, indeed, it is some- 
times difficult even for the most experienced surgeon to pronounce, in the 
first instance, to which of these two causes they are to be referred, lie 206 
BLOOD-LETTING, 
pcated copious blood-letting is of itself adequate to produce a hardness of 
the pulse, which we shall in vain endeavor to subdue by persevering in 
the same system of treatment. In many individuals it will produce head- 
ache and confusion of_ the mind, not very different from what the injury 
itself had previously occasioned. The pallor of the countenance, the 
effects of position, the effects of fasting or of an active purgative, the his- 
tory of the case, must be carefully considered in forming our diagnosis. 
The treatment would then consist in carefully restoring the system to its 
state of equilibrium. Part vi., p. 38. 
Pain in the Head.—Advised not to bleed an old person merely be- 
cause the pulse is hard and full, in cases of pain in the head, as it is pos- 
sible that this state of arteries may arise from ossification of their coats. 
Effusion.—Bleeding in a moderate degree prevents effusion, but when 
carried to extreme depletion, it has a decided tendency to promote effusion. 
Part viii., p. 66. 
In detracting blood from the chest, in cases of apoplexy, congestion of 
the lungs, etc., in new-born infants, the best place to apply leeches is un- 
der the axilla, as the sub-cutaneous venous plexus there communicates 
directly with the vessels of the thoracic cavity. Part ix., p. 39. 
Blood-letting, and other general antiphlogistic remedies, says Dr. Wil- 
liams, if they do not remove inflammation, may render its products more 
injurious, by lowering their plasticity, and approximating them to tubercu- 
lous and other aplastic deposits. Thus chronic inflammation continuing 
after the full application of the antiphlogistic treatment, almost surely 
tends to produce degenerated changes of structure, over which remedial 
art has little power. In connection with this subject, therefore, we see 
how desirable it is that inflammations should be removed before they be- 
come chronic ; and when there is a risk of their becoming so, it should be 
an indication to improve the condition of the blood by a tonic and nutri- 
tive plan, at the same time that local antiphlogistic measures may be neces- 
sary for the lingering inflammation. Part ix., p. 75. 
The Ilcemospasic Method of Treatment suggested as a Substitute for 
Blood-letting.—Haemospasia is a means of producing a powerful revulsion 
of the blood from the one part, and an equally powerful derivation of the 
blood to another part of the body, by removing the atmospheric pressure 
from a large extent of surface, as from one or both extremities at the same 
time. It is, therefore, so to speak, quite the same as dry-cupping ; only 
on a large scale. “ To produce an intense raptus of the blood from the 
deep-seated to the superficial parts of the body, to dissipate congestions, 
to counteract morbid fluxionary accumulations, and to relieve any organ 
or organs that may be oppressed with a surcharged circulation—such ie 
the aim and object of the new therapeutic agent. By its means, we are 
enabled to withdraw, or displace, or accumulate, or concentrate a part of 
the mass of blood, according as the varying circumstances of the consti- 
tution, age, existing disease, and so forth, may render expedient.” 
Part ix., p. 79. 
Blood-letting.—On this subject Mr. Travers says: The choice of mea- 
sures, i. e., local or general blood-letiin£, is determined partly by the rela- BLOOD-LETTING. 
207 
tion of the parts affected to the centre of the circulation, and in part by the 
more or less urgent necessity that exists for disembarrassing the general 
functions, and arresting destructive inflammation. In visceral inflamma- 
tion, venesection is indicated to the utmost extent that the powers of life 
will bear; for here the mass of blood is so altered and spoiled for its pro- 
per and healthy purposes, by the direct implication of the blood-making 
and blood-preparing organs in the disease, that relieving the system of its 
presence to the extent that can be borne, is the main resource we possess 
for its preservation. As we would remove a poison, a materies morbi, in 
such cases we take away blood. Its altered condition is palpable when 
eliminated from the body ; it undergoes a peculiar separation of its parts, 
and presents other appearances not manifested by healthy blood. The dif- 
ference of the blood within the vessels from that of health, is not less, 
if we could fully appreciate it. If inflamed blood be transferred into the 
vessels of a healthy animal of the same species, as his own is withdrawn, 
instead of supporting, it rapidly destroys life. A freer circulation through 
the smaller vessels, and those of the excretory glands especially, ensues 
almost immediately upon a full blood-letting ; the sense of overwhelming 
oppression is relieved, and the inflammation, if not abridged by its effects, 
is disposed to a kindlier termination. 
There are two false doctrines concerning blood-letting for inflammation, 
which cannot be too strongly condemned: the first, anticipatory blood- 
letting, by which I mean, the large and repeated detraction of blood be- 
fore inflammation, being considered inevitable, has actually manifested 
itself—on the hypothesis of starving the action, and thus rendering it trac- 
table—which is a direct attack upon the vitality, and fatally prevents the 
action, if it do not destroy the resisting powers of the system. The 
second, continuing the employment of the lancet so long as the last drawn 
blood exhibits the signs of inflammation, which, if drained to the last 
drop, it would do ; or, in other words, not reflecting that there is a line 
beyond which the practice becomes destructive instead of remedial; and 
that there are many inflammations which do not admit of arrest by deple- 
tion, and upon which other modes of treatment are efficient to this end, 
even though not an ounce of blood be drawn. Many lives have been 
sacrificed to the prevalence of these irrational and absurd notions, and 
many preserved in their extremity by being fortunately placed beyond 
the reach of the surgeon; especially, I am induced to believe, in military 
practice. Part xi., p. 36. 
Mode of Diagnosing Buffy Blood.—Mr. Wharton Jones has pointed 
out a very ingenious method of determining whether the blood is buffy, 
or not, from the examination of a vei-y minute portion of this fluid. It 
consists of quickly inclosing a drop between two pieces of glass, and ob- 
serving with the naked eye the quickness with Avhich it assumes a mottled 
appearance, and the smallness or largeness of the interspaces. In huffy 
blood the mottling is almost instantaneous, and the interspaces large, while 
in healthy blood it is delayed for half a minute or more, and the reticu- 
lation is minute. Part xii., p. 254. 
Venesection from the Foot, is capable of affording great relief in many 
affections of the generative organs, the portal system, etc., when its ab- 
straction from a vein in the arm is either difficult or impossible. Immerse 
the foot in hot water to swell the veins. Put on a bandage an inch 208 
BOILS. 
above the ankle. In puncturing either of the veins1 before the malleoli, be 
careful not to touch the bone with the point of the lancet. If the vein 
bleed in a stream, catch the blood in a vessel; but if it only dribble, the 
foot should be put into the hot water, and judge of quantity by the color. 
Part xiv., p. 193. 
Criterion for the Regulation of Blood-letting.—The time for the dis- 
continuance of blood-letting should be determined not by the blood drawn 
ceasing to be bully, but by its coagulating more rapidly than in the nor- 
mal state. Part xvi.,p. 111. 
BOILS. 
Use of Yeast in the Treatment of Boils.—To an adult afflicted with this 
painful furunculoid eruption, give a tablespoonful of yeast with some water 
three times a day. Smaller doses may be given for children. 
Part xxvi., p. 294. 
Treatment of Boils and Acne—Mr. Startin's Treatment.—We have 
classed these diseases together because they appear to depend very fre- 
quently on similar states of the constitution, and are also amenable, for the 
most part, to similar plans of treatment. The great degree of success which 
we have observed to accrue from that pursued at the Hospital for Diseases 
of the Skin, makes us desirous of attracting to it the attention of the pro- 
fession. It consists, essentially, in the combination of ferruginous salts with 
saline aperients. In the common forms of acne, as acne simplex and punc- 
tata, Mr. Startin usually prescribes ferri sulphat. gr. ij., magnes. sulph. 5j., 
ter die sumend.; ordering also a small portion of an ointment, containing 
the ammonio-chloride of mercury, gr. x. ad §j., to be applied to each pim- 
ple every night. The acne indurata is characterized by much more of in- 
flammatory condensation of tissue, for the removal of which it is usually 
necessary to excite the absorbents to increased action, and the iodide of 
iron, in doses of gr. iij., three times daily, appears to be its most efficient 
remedy. All who have attentively watched the phenomena attendant on 
the furunculous epidemic which has been so rife of late years, will be aware 
that its outbreak in individuals has been very frequently preceded by head- 
ache, giddiness, lassitude, dyspepsia, and other evidences of a disordered 
state of the circulating fluids. This granted, and we have at once a scien- 
tific basis on which to ground the requisite treatment. By the exhibition 
of full doses of iron, in combination with saline purgatives, the blood is at 
once depurated and renovated. The usual prescription at this hospital is mist, 
ferri acid. 5iij. ter die, and under its use the improvement in the general 
health is often no less manifest than the rapid subsidence of the local dis- 
ease. With greater care in regard to purgation, the same plan may be 
adopted in cases of small carbuncles. Part xxvii., p. 161. 
Boils— Use of the Acid Nitrate of Mercury.—A solution of the nitrate of 
mercury in strong nitric acid is in very common use at the Hospital for Cuta- 
neous Diseases, and constitutes a very convenient form of caustic. Its for- 
mula is—Hydrargyri §j., acidi nitrici (specific gravity 1.50) §ij.; solve. 
The solution produced is a clear, colorless fluid. 209 
BOILS, 
M". Startin thinks there can be little doubt as to the superiority of the 
caustic treatment over that by the knife, even in the case of very large 
boils. The pain of the incision, the large sore caused, and the unsightly 
scar which follows, constitute very formidable drawbacks to a prac- 
tice for which there is no real necessity. At this hospital, where 
cases of boils are very common, the knife is never resorted to. The general 
treatment consists in giving aperients and steel conjointly, and the local in 
applying to the apex of the furuncle a full-sized drop of the acid nitrate 
solution. The morbid action generally terminates coincidentally with the 
application, and the core is thrown off through a comparatively small open- 
ing, the resulting cicatrix being insignificant. Part xxxi., p. 240. 
Observations on Anthrax.—Mr. Lloyd, who acted a long series of years 
with the late Mr. Abernethy, stated that anthrax and boils were almost 
unknown in Mr. Abernethy’s time, but that, of late years, from the impor- 
tation of much bad corn into England, he is inclined to believe, and per- 
haps from meteorological causes, anthrax has assumed almost the character 
of an epidemic. Like Mr. Syme, he thinks anthrax, or carbuncle, to be a 
circumscribed inflammatory condition of the true skin, attended with con- 
siderable constitutional derangement, as well known to most practitioners; 
Mr. Lloyd disapproves of the stimulating plan of treatment, and prefers 
salines, with Mindererus, to diminish fever, with large free crucial incision 
made early in the inflamed part. 
The object of the incision is to diminish the inflammatory action, which, 
he believes, is of a low specific kind, and that by plugging the parts subse- 
quently with lint, this carbuncular inflammation gives way to common 
healthy inflammation and granulation. He does not advise the external 
use of either caustic or what are called warm digestive ointments; they are 
very old-fashioned, and merely protract unnecessarily the period of reco- 
very, and destroy more of the skin than is expedient. In cases of anthrax 
as well as large boils, the evil is aggravated, Mr. Lloyd believes, by giving 
patients too much food of a stimulating kind. The core of an anthrax, or 
boil, is perhaps not so often dead cellular matter, as a new morbid deposit, 
like the morbid deposit in the pleura, or in or around joints, and pointing 
to an inflammatory action going on in the system. Simple milk diet, poul- 
tices, salines, and diaphoretics, with free crucial incisions, answer every 
purpose, with the subsequent exhibition of a light bitter, with iodide of 
potassium, during the period of convalescence. Part xxxiv., p. 196. 
Polls and Carbuncles.—As these depend on a constitutional cause, the 
constitutional treatment must be combined with the local. The application 
of concentrated tincture of iodine rarely fails to abort an incipient boil. 
Nitrate of silver and sesquichloride of iron have been used for the same 
purpose. If gangrenous, apply strong nitric acid to the sloughing margin. 
If there be a large amount of sloughing, but not unless, make a free crucial 
incision. Water dressing is the simplest and most soothing application, 
and the most scrupulous cleanliness must be observed. 
The best way of treating all these boils and carbuncles is to pinch up a 
little of the skin when the carbuncle is just commencing, and to carry a 
sharp-pointed bistoury, with the cutting edge upward, through the base 
14 210 
BOILS, 
of the little hard substance, and so divide it completely. This is almost a 
never-failing mode of arresting carbuncle, if done early enough. 
Part xxxv., p. 149. 
Treatment of Boils and Carbuncles.—Dr. Shillitoe gives his plan of 
treatment as follows: 
“ My plan is to order a thick solution of the aqueous extract of opium, 
of the consistence of treacle, to be painted on and around any suspicious 
spot that may arise. This soon dries, forming a coating, which requires 
renewing three or four times a day. Generally twenty-four hours’ appli- 
cation is sufficient to arrest the further spread of the inflamed spot. I then 
order a plaster of equal parts of soap, mercury, and opium, spread on thick 
leather, to be placed on the spot. If there is a pustule, I evacuate it, and 
leave a small hole in the centre of the plaster to allow of the escape of any 
matter, or if painful, for the application of the opium and poultice. When 
it is desirable to poultice, I take care that the plaster is large enough to 
protect the surrounding skin, and I discontinue the poultice as early as 
possible. In this way, with early attention to small spots and a limited 
amount of poulticing, combined with ordinary care in diet, occasional ape- 
rients, and tonics, of which last I prefer bark and nitric acid, I seldom 
find any difficulty in preventing the successive crops of boils now so com- 
mon. 
“ When called in at a later period, or if in spite of treatment a boil or 
carbuncle will have its course, I think strong nitric acid to be the best ap- 
plication, using it freely two or three times, removing the dead tough 
slough before each application, supporting the margins with the plaster, 
and poulticing freely.” Part xxxvii.,p. 270. 
Boils and Carbuncles.—Paint the whole mass of indurated tissue with 
at least three coats of the common pharmacopoeia tincture of iodine for 
several nights in succession, and unless the boil has been on the point of 
bursting, the progress will be arrested in nearly every instance, and the 
hardness, swelling, and tenderness of the part will quickly subside. 
The local use of belladonna to carbuncles or boils, and other painful 
cutaneous affections, will be found to afford the greatest relief to the 
patient. 
The great pain arising from carbuncles is in many cases relieved with re- 
markable rapidity by the application of the following ointment spread upon 
a linen rag: Take of opium half a drachm, white ointment two ounces, 
and mix. This treatment is applicable to any stage of the affection. Vide 
Art. “Carbuncle.” JPart 175. BONES, 
211 
BONES. 
Difference between Syphilitic and Scrofulous Affections of Done.— 
[M. liicord enumerates the following points of difference:] 
Syphilitic Affections of Bone. 
1. Very rare with young people. 
2. Syphilitic precedents. 
3. Compact texture of bones attacked. 
4. Superficial part of the bone. 
5. Little tendency to hyperostosis. 
6. The pains which precede the develop- 
ment of the affection increase and become 
very intense, until they decrease again, and 
entirely disappear in the latter periods of the 
disease. 
7. A tendency to circumscription. 
8. Exostosis. 
9. Tendency to ossification and eburna- 
tion, but very little to suppuration. 
10. A chain of syphilitic symptoms, either 
concomitant or antecedent. 
11. Rapid cure under appropriate treat- 
ment. 
Scrof ulous Affections of Bone. 
1. Very frequent in youth. 
2. Scrofulous precedents. 
3. Spongy or cancellated texture of bones 
attacked. 
4. Deep parts of the bone. 
5. Much tendency to hyperostosis. 
6 The tumefaction precedes the pain, but 
the latter soon increases and becomes more 
and more intense as the disease advances. 
7. A tendency to diffusion. 
8. Hyperostosis. 
9. Tendency to softening, to suppuration, 
caries, and necrosis, and not to ossification. 
10. A chain of scrofulous symptoms widely 
differing from those of syphilis, either con- 
comitant or antecedent. 
11. Very difficult cure, often incomplete, 
and sometimes impossible. 
Syphilis may, however, be superadded to scrofula; we must, then, in 
combating any lesion, endeavor to find out to which of the two diatheses 
it is mostly owing, and select our therapeutic means accordingly. 
Part xviii., p. 151. 
Suppuration in Pone.—In every healthy inflammation the process of 
adhesion precedes that of suppuration, and pus when formed is conse- 
quently limited and circumscribed by lymph previously effused; but in 
unhealthy constitutions, the requisite power may bo wanting to carry out 
the process of adhesion ; and should suppuration then take place, the puru- 
lent fluid may permeate from cell to cell in the surrounding parts. These 
two processes are exemplified on the surface of the body by a common 
abscess and a diffuse cellular inflammation. In the cancellous structure of 
bone, the actions are strikingly analogous, though somewhat more tardy 
in their development. The products of the inflammation may be limited 
by the effusion of bony matter, which fills up and obliterates the surround- 
ing cancelli; or the secretions of the part (when the adhesive process is 
imperfectly developed) may infiltrate the structure of the bone to an un- 
limited extent. We have thus a natural division of the cases of suppuration 
in bone into those which are circumscribed, and those which are not; into 
cases of abscess, properly speaking, and into those of purulent infiltration. 
These two classes of cases differ in their causes, progress, and termina- 
tion. The simple abscess usually originates in young and healthy persons: 
the infiltration of purulent matter rarely takes place without some present 
depressing influence, or some former cause of constitutional weakness. 
The simple abscess is marked in its progress by excessive pain, and may 
continue in much the same condition for many months and even years. 
Diffuse suppuration, on the other hand, may be attended with little local 
suffering, but very soon becomes the cause of much general excitement, 212 
BONES. 
and leads to the formation of disease in other parts. The termination of 
circumscribed abscess is generally favorable, however long it may have 
lasted, provided the matter be evacuated externally; whereas purulent 
infiltration in bone is usually fatal. 
Chronic abscesses require, moreover, to be carefully distinguished from 
cases of softened tubercle, with which they appear to have been con- 
founded. M. Nelaton published the following description of encysted 
tubercle in the extremity of long bones: “ When an encysted tubercle is 
developed in the extremity of a long bone, it is at first confined in the 
centre of the cancellous structure, not far from the articular extremity. 
It gradually increases, and approaches on one hand the cartilage, and on 
the other the circumference of the bone, external to the joint. If in the 
progress of its development it reaches the exterior of the bone, it escapes 
into the surrounding cellular tissue; an abscess is there formed, which 
increases and empties itself externally, leaving a fistulous communication 
with the interior of the bone. But if, on the contrary, it makes its way 
toward the articular surface, the cartilage with which it comes in contact 
is perforated, and the tubercular matter empties itself into the joint.” 
M! Xelaton says that he has seen several examples of this unfavorable ter- 
mination of the disease. But the cases of crude tubercle in adult bone to 
be found in our museums are so rare, we cannot but think that the fre- 
quency of its occurrence has been greatly exaggerated, and that M. Kela- 
ton, and other continental writers, have included cases of softened tuber- 
cle and chronic abscess under one common description. 
Chronic abscess may probably occur in any bone of the body. In the 
museum of the College of Surgeons there is a specimen where it had 
taken place in the clavicle ; and Mr. Arnott has mentioned an instance of 
its having occurred in the femur. At King’s College Hospital a case 
lately presented itself, where a circumscribed abscess had formed in the 
lower jaw, the bone around being greatly condensed and thickened. By 
far the majority of cases of chronic abscess, however, occur in the tibia, 
and almost always in the upper or lower extremity of that bone. 
When an abscess is formed in bone, important changes occur in the sur- 
rounding parts. The periosteum and adjacent bone become inflamed and 
thickened. This is followed by the formation of new bone, both in the 
cancellous structure, and on the surface of the original bone. The bony 
matter thus secreted corresponds to the deposition of lymph around an 
abscess in soft pai-ts. 
This deposition may go on, as the bone in immediate contact with the 
pus is absorbed ; so that, although the abscess is gradually making its way 
externally, it remains covered with the same thickness of bone as before. 
Deposition of new bony matter occurs much more readily around the 
spongy extremities than upon the compact shafts of bone. In the former 
situation, it may take place to such an extent as to render it very difficult 
to say precisely what part of the bone was originally affected, and a trephine 
applied under these circumstances may fail to reach the seat of the disease. 
After a circumscribed abscess is formed in bone, the parts around appear 
to accommodate themselves to its presence. This is accomplished, not by 
the fibres of the bone being pressed asunder, but by an actual absorption 
of the osseous substance. The intense pain experienced depends, doubt- 
less, upon the extreme tension maintained upon the unyielding structure, and 
every fresh accession of pain results from a fresh secretion of fluid. The BONES, 
213 
influence of some medicines in restraining the symptoms may probably 
depend upon their power of promoting the absorption of the more fluid 
part of the abscess. Thus we find that the iodide of potassium, given in 
doses of three or four grains, will sometimes be followed by a temporary 
abatement of the pain ; and it would appear from the cases recorded, that, 
after the first attack of pain, the symptoms may remain in abeyance for 
almost an unlimited period, until some accidental cause produces a fresh 
secretion of fluid. The cavity of the abscess then again becomes distended, 
and the pain of compression returns. A process analogous to the pointing 
of an abscess in soft parts not unfrequently takes place; the ulceration 
affects one point of the walls of the abscess particularly, and an opening 
may thus be formed, through which its contents are evacuated externally. 
In other cases, the process of deposition goes on in the whole circumfer- 
ence of the bone as rapidly as that of absorption, and the abscess cannot 
then make its way externally. The compact structure of the shaft of the 
bone also prevents its extending in that direction; the articular surface is 
then the only one toward which the abscess can extend. No fresh layers 
of bone can here be deposited, and the fluid consequently makes its way 
toward the joint. 
The cartilage has been observed, in such cases, to be affected in two 
ways: either perforated, so as to allow the matter to escape directly into 
the articulation, or absorbed over a large surface without suppuration. In 
a case of the latter kind, recorded by Sir B. Brodie, the cartilage cover- 
ing the head of the tibia in some places was perfect in its structure, but it 
existed only in narrow stripes; in other parts it had degenerated into a 
substance something like condensed cellular membrane; in others, the only 
vestige of it was a kind of membrane, so thin, that the bone could be seen 
through it; and in other parts, the surface of the tibia was completely 
exposed, but not carious. Part xxv.,p. 187. 
Simple Mode of applying Pressure in Chronic Enlargement of certain 
Pones, etc.— [Dr. Inman records the following case: M. C., a delicate girl, 
three years of age, had a swelling of the left knee-joint, which was three- 
quarters of an inch larger than the right, due to an enlargement of the 
head of the tibia and condyles of the femur.] 
I directed the mother to procure a piece of thin vulcanized india-rubber 
cloth, which she was to shape to the knee, allowing an interval in front of 
about three-quarters of an inch. The edges were to be bound by a piece 
of thin leather, and a piece of wash-leather was to be placed as a tongue 
between the laced portion and the knee. Holes were to be made in the cloth 
behind the binding, and the whole was to be laced like ladies’ stays. The 
elastic was to be worn during the day and night. Exercise was not pro- 
hibited, and no medicine was ordered. I saw her again in ten days. The 
bandage had been worn for fourteen hours daily, and taken off at night. 
The knee was reduced a quarter of an inch in circumference. 
In ten days she called again, complaining of pain and oedema of the leg, 
"in the evening, from pressure. On removing the elastic, whose edges now 
overlapped, I found the knee restored to its normal size and shape. The 
child could run about without pain or inconvenience. I directed the dis- 
use of the bandage, unless the swelling should return ; and told the mother 
that, though I could not promise that there would be no return of the 
complaint, I considered the child as cured. • 214 
BONES. 
It is unnecessary to make any long comments upon this case. The fact 
of a morbid deposit in bone being absorbed, or, I might almost say, a 
threatened white-swelling, cured in three weeks, without blisters, issues 
or caustics, without confinement, or even complete rest, is sufficient to 
speak for itself. Of course, such a plan can only be adopted when there 
is no reason to believe that active inflammation or purulent deposits are 
present, and where there is no severe pain. Part xxvi., p. 140. 
Pathology and Treatment of some obscure Cases of long-continued 
Pain in Pone.—It appears that long-continued pain in bone may arise 
from a variety of different pathological conditions, and that the chronic 
irritation, which precedes the deposit of new bone, may depend, among 
others, upon the following local causes: 1. Upon the formation of pus 
within the bone. 2. Upon the deposition there of more solid material 
arising from the poisons of mercury, or syphilis. 3. Upon a collection of 
tubercular matter in bone ; or, 4. Upon the presence of a necrosed portion 
of cancellous structure. 
Whenever there is reason to suspect that pain in a bone is kept up by 
the presence of some morbid or foreign matter in its interior, or by the 
pressure produced by a redundancy of bony deposit, it appears evident 
that the removal of a piece of the shell of the bone is the rational mode of 
treatment. An opportunity is thereby afforded at once for the escape of 
any confined matter, and the tension of the parts is relieved; and it ap- 
pears not improbable, from the favorable effects hitherto obtained by this 
mode of treatment, that it may hereafter be extended to the relief of many 
cases of protracted and obscure affections of the osseous system. 
Part xxvi., p. 141. 
Pedunculated Exostosis of the Pong Pones.—Prof. Syme remarks as 
follows: As the expression exostosis literally implies merely an inordinate 
growth of bone, it has been employed to denote a great variety of morbid 
conditions in which this circumstance happens to exist. The “callus” 
that repairs a fracture, the new osseous shell which supplies the place of a 
dead shaft, the spina ventosa or expansion caused by the accumulation of 
pus or other fluid, the spicular of foliated excrescences that shoot into the 
substance of an osteo-sarcomatous tumor, and the bony prominences of 
morbid growth resembling the natural processes connected with the origin 
and insertion of muscles, have all been included within this comprehensive 
title. It is to a particular form in which the last mentioned of these pro- 
ductions appears, that I now wish to direct attention. 
[Puberty is the period of life when these simple growths are chiefly 
developed. Indeed, in young and growing persons, the symmetry of the 
bone is often lost from the processes and articulating extremities growing 
more rapidly than the other parts, but as a rule we may always express 
an opinion, that in time the proper proportions will be restored.] 
The constitution of these growths is quite similar to that of the spongy 
extremities of the long bones, being composed of a thin, osseous lamina 
externally, and a more or less compact, consolidated texture within it. 
While enlarging, they have an incrustation of cartilage, whence they 
have been called by Sir A. Cooper and others—in my opinion, very 
improperly—the cartilaginous exostosis, since any bone in the body might 
with equal propriety be designated cartilaginous: and as this nomenclature 
is sure to occasion confusion between the truly osseous growths and those BONES. 
215 
of a fibro-cartilaginous nature, which anatomically, pathologically, and 
practically require to be carefully distinguished. Thus Sir A. Cooper 
describes, under the same title, well-marked cases of these two most dis- 
similar conditions, and in his lately published work, Mr. Paget has 
pursued this course, with, if possible, still less regard to the diversity of 
the tumors thus associated together. Anatomically, they differ in consti- 
tution, which, in one case, is the simple bony texture incrusted externally, 
so long as it is growing, by a plate of cartilage ; and, in the other, it is a 
fibro-cartilaginous growth inclosed within the expanded bone, or dispersed 
through the interstices of its honeycomb-looking structure. Pathologi- 
cally, they differ in the one sort of growth being limited in its tendency 
to increase, and producing no inconvenience except from the peculiarity 
of its position, as when seated under the nail of the great toe, while the 
other has no bounds to its enlargement, which depends upon the fibro- 
cartilaginous substance, and not upon tbe bone. Practically, they differ 
in this important respect, that while the one may be removed by division 
of its neck or base, the other cannot be extirpated except by taking away 
the whole bone, or dividing it at a sound part beyond the confines of the 
disease. It was from not attending to these distinctions that Mr. Liston, 
who first drew professional attention to the exostosis of the toe, insisted 
upon amputation as essential for the patient’s permanent relief; while due 
regard to them led me to practise removal of the growth alone, as suffi- 
cient for attaining the object'in view—a procedure which, though for a 
time reprobated by Mr. Liston and his followers, has long since become 
the established rule of practice. On the other hand, a knowledge of the 
depth to which the fibro-cartilaginous growth strikes its roots into the 
bone affected, has put an end to those painful scenes which surgeons of 
the present day witnessed in their youth, when attempts were made, of 
course in vain, to dig out such tumors from the upper and lower jaws. 
By disarticulation or division of the bone, where ascertained to be sound, 
tbe patient is now effectually relieved in a few minutes, instead of being 
subjected to the prolonged torture of hours, without the chance of benefit 
to his case, and with the greatest risk of its aggravation. 
Under the title of cartilaginous tumor, have been comprehended two 
morbid conditions of the osseous system, of the most different natures, 
which require to be distinguished for the establishment of their proper 
treatment. In regard to the osseous growths, associated with malignant 
tumors, serous cysts, and abscesses—as the new-formed bone is always per- 
fectly sound in its textures, and owes its production to the influence of 
another morbid condition, I think the disease in such cases should be 
named, not from the exostosis, but from tbe cause which has occasioned 
it, whether this may be a growth, a cyst, or an abscess. The expression 
exostosis would thus be restricted to its proper sense of denoting the 
change effected in the bone itself, and would only require to be further 
divided into the solid, hollow, and spicular forms. Attention would thus 
be directed to the disease essentially requiring remedy, and not to an 
accidental concomitant. 
I may now proceed to the special object of this communication, which 
is to explain a circumstance in the constitution of the simple exostosis 
when it proceeds from the long bones of the extremities, which may be of 
considerable consequence in regard to both its diagnosis and treatment. 
The most frequent situations of this growth are the inner side of the thigh 216 
BOXES. 
bone a little above the condyle, and the neck of the humerus just below 
the tuberosities into which the scapular muscles are inserted. It has a 
neck from half an inch to an inch in length, which is usually placed 
obliquely in relation to the shaft, and beyond this expands into an irregu- 
larly rounded form, nodulated on the surface, which is covered by a thin 
incrustation of cartilage, that presents a shining pearly lustre, and has no 
communication with the surrounding parts. 
About five-and-twenty years ago I was consulted by a gentleman resid- 
ing in this city, on account of a very large exostosis, in the usual situation, 
on the inner side of the thigh. lie was a tall, strong, active man, and, in 
consequence of over-exertion, was sirfFering from swelling, redness, and 
pain of the limb at the seat of enlargement. I advised soothing measures, 
and expressed the opinion that an operation would not be requisite if he 
abstained from undue exertion in future. I frequently afterward saw this 
gentleman, apparently in the enjoyment of perfect health, and had no 
reason to entertain any doubt as to his being so for more than twenty 
years, when Dr. Ilandyside asked me to see him, on account of an alarm- 
ing change that had taken place in the condition of the tumor. The thigh 
was considerably swelled and painful, especially when pressuro was applied 
on the seat of the exostosis, which could not be felt distinctly in conse- 
quence of the thickening around it that had taken place, together with the 
effusion of some fluid that was detected by a deep fluctuation. In expla- 
nation of this circumstance, it was stated that the patient had lately been 
leading a life of much greater exertion, particularly in walking, than he 
wras previously wont to do, and Dr. Ilandyside enjoined rest, and, after a 
time, applied a blister. We thought that there was something seriously 
wrong, and were not free from the apprehension of cerebriform degenera- 
tion, but resolved to try the further effect of rest, with gentle pressure. 
In the course of a few weeks the swelling and tenderness disappeared, the 
fluctuation could no longer be perceived, and the exostosis was felt no less 
distinctly defined than in former times^ 
I felt quite at a loss to account for this case, until the following one 
completely explained it: Dr. Duncan asked me to take under my charge, 
in the hospital, a female servant who had received a blow, which was sup- 
posed to have detached an exostosis from its usual seat of attachment, 
above the knee, on the inner side of the thigh bone. As the limb was 
very much swelled and extremely painful, I feared that delay might lead 
to suppuration, and therefore cut freely down to the exostosis; but in 
doing so was surprised to find a quantity of serous fluid, tinged with blood, 
lying between it and the surface immediately surrounding it. The whole 
truth at once appeared, and I no longer felt any difficulty in accounting 
for the smooth shining surface presented by growths of the kind in ques 
tion, or for the fluctuation which, in the former case, had so much per- 
plexed Dr. Ilandyside and myself. It was plain that a synovial mem- 
brane surrounded the exostosis, and was reflected from its neck, so as to 
afford a double covering, just as on the joints—the half of one being thus 
represented by the osseous growth, its crust of cartilage, and investing 
membrane. 
I hope that the condition of what may be called the pedunculated exos- 
tosis, thus fully ascertained, may be of service, not only in its diagnosis, 
but also with reference to the means of remedy, since the complete insula- 
tion from surrounding textures, except at the comparatively small point BOSHES. 
217 
of its attachment to the bone, affords great encouragement to attempt 
removal, even under circumstances apparently much opposed to success. 
Thus, in the case of a young lady I saw lately with Dr. Simpson, there 
■was an exostosis at the neck of the humerus, which pressed upon the axil- 
lary nerves, so as to occasion great and increasing distress; and, from this 
position, had been deemed beyond the reach of removal. But, having 
ascertained that the point of attachment was at the posterior surface of 
the bone, I made an incision between the deltoid and triceps, exposed the 
neck, detached it by cutting pliers, and extracted the exostosis, with 
hardly any bleeding, and no injury to the neighboring parts. 
Part xxix., p. 161. 
Deformed Bones.—In cases of deformity of the bones, whether from 
accident or disease, perform what is called subcutaneous osteotomy, which 
is a much less dangerous operation than resection of bone exposed by a 
large external wound. Make an incision rectangular with the longitudi- 
nal axis of the bone, dividing the integuments and periosteum—apply a 
fluted chisel-drill (two lines in breadth, attached to a centre-bit) in the 
centre of the incision, and perforate the bone (the tibia, for example,) 
transversely from within outward. The cessation of resistance safely 
denotes the accomplishment of the perforation—a narrow saw is now 
introduced into the aperture drilled through the bone, and the greater 
part of the bone divided. The bone is directly straightened by fracture 
of the remainder. The normal position need not be restored at once, but 
can be accomplished during the consolidation of the bone. 
Part xxxi., p. 126. 
Diseases of the Bones.—[In this paper Mr. Bishop enters on the subject 
of exostosis, such tumors as are situated immediately under the periosteum, 
and are at first disconnected with the bone, but nevertheless, after having 
been formed for some time, become sooner or later firmly united with the 
contiguous bone. They are liable to form on the internal table of the 
bones of the head.] 
A tumor of this kind presents to the eye the appearance, and to the 
touch the form, of a nodule, with an abrupt margin, and is frequently 
separated at its base from the subjacent bone, by a furrow of variable 
thickness ; and sometimes there is a deep fissure between the nodule and 
the bone lying beneath. The density of these compact nodules is very 
great, and in this state the disease is termed the ivory exostosis. These 
ivory tumors are of greater density and specific gravity than the normal 
bone with which they are associated, unless they happen to be connected 
with bone already in a state of induration. They are always composed of 
laminae, and seem never to be intermixed with spongy tissue. The density 
of the tumor is owing to the greater number of laminae contained in a 
given space, when compared with the number of laminae found in the 
same space in normal bone. The Haversian canals are small and few in 
number, but a well-defined lamellar system is found surrounding them. 
The bone corpuscles are irregularly scattered in the substance of the tumor, 
and in some places they are clustered together, while in other parts larger 
tracts are found entirely destitute of them. The color of these exostoses 
is of a yellow-white, and they are of a lighter hue than the bone to which 
they are attached. 
Rokitansky appears opposed to the hypothesis that the origin of these 218 
BONES, 
tumors has any relation to syphilis, and he believes the cause of their ap- 
pearance to be entirely unknown. When the exostoses are of a 
texture, they are connected with a rarefaction or expansion of the spongy 
bones, termed by the German pathologists osteoporosis. They present 
many varieties in their structure, and may arise either from the spongy 
or from the laminated structure, or from both together; they are then 
compounded of an internal spongy, and an external laminated layer of the 
compact tissue. These mixed osseous tumors are not unfrequently found 
near the joints, at the head of the tibia, or on the shin, and on any of the 
other long bones of the skeleton. In the skull, the disease is accompanied 
with an expansion of the diploe, in which case there may be an exostosis 
on both the external and internal tables corresponding in situation with 
each other. In the spongy forms of exostosis, the structure may remain 
permanent after its development; but more commonly new matter is 
formed in the interior, and the structure of the bone is more or less 
condensed ; but this altered structure is often succeeded by the bone 
being again rarefied, and thus the growth of the spongy exostosis out- 
ward may be affected, and may increase to a considerable size. When 
this disease affects the spongy bones of the face, it has been known to 
produce the most hideous appearance. Some examples of these cases 
are to be seen in the Hunterian Museum. When the exostoses have 
acquired a certain magnitude, they usually continue through life un- 
changed. The ivory texture of the excrescence, in this disease, some- 
times diminishes in size by condensation, or it may become necrosed, 
and thrown of. 
The spongy exostoses sometimes degenerate into caries, and in this 
way disappear. These appear to be the processes by which the system 
may be spontaneously released from the osseous growths of exostosis. 
Independently of exostosis, the bones, during inflammation, exude a 
fluid which ossifies, and forms a layer on their compact surface ; this 
substance has received the name of osteophyte. At the commencement 
of this process, the exudation is soft and gelatinous; it afterward becomes 
tough and elastic, resembling cartilage, and in the end it ossifies. It ap- 
pears that this exudation is associated with nearly all inflammatory con- 
ditions, whether of abscess or necrosis of the bones. There are many 
variations of form assumed by these osteophytes, as well as differences in 
structure. 
They sometimes appear to be composed of “ delicate fibrils and lamellae, 
which are fixed at acute angles on the surface of the bone, and give it the 
appearance of velvet, or felt with a very fine nap.” Though these osteo- 
phytes are at first in contact with the bone, yet they may be easily raised 
from it in large pieces, and although for some time separated by a layer 
of cellular substance, they become fixed to the bone when this membrane 
disappears. 
The exudations which terminate in osteophytes, sometimes form plates, 
and often anchylose some of the vertebrae, by the ossification of the 
anterior common ligament. They occur also in the inner table of the 
skull, and, indeed, wherever inflammatory processes are going on in the 
bones. 
Osteophytes have been known, in a few cases, to cover large portions, 
or nearly the whole of the skeleton ; they are sometimes associated with 
atrophy, and at others with hypertrophy, of the bones. Although we BONES. 
219 
generally find the exudations accompanied with an inflammatory condition 
of the bones and periosteum, the precise condition of the system that gives 
rise to the inflammation and exudation, is not yet determined. In the 
imperfect union of fracture, these plates then constitute the union of the 
ends of the bone. 
The bones of the skeleton are likewise liable to anomalies in number, 
size, and form. The absence or addition to the number is not very com- 
mon, but is coincident with conditions of the system in a state of perfect 
health, and not referable to any pathological conditions : it is not, there- 
fore, my purpose to give any detail of cases of variations of number. 
With regard to variations in size depending on pathological states of the 
bones, the case is quite different, and deserves a few remarks. In hyper- 
trophy of the bones, they may increase in size by the addition of new 
osseous matter deposited on their surface beneath the periosteum, without 
any change taking place in their density or specific gravity; the size of 
the medullary canal remains the same, but the compact substance acquires 
a considerable augmentation of thickness. When the increase of sub- 
stance takes place in the interior of the bone proceeding from the Haver- 
sian canals, and involving the whole of the medullary system, the bone be- 
comes more dense, both in the compact and cancellous tissues. In the 
latter, the walls of the cells increase in thickness, and the medullary cavity 
diminishes in size; the diploe disappears, and the whole bone becomes in- 
durated. When the hypertrophy takes place both internally and exter- 
nally, the bulk and density of the bone are both increased. The increase 
of the bones, both internally and externally, is preceded by the deposition 
of a superabundance of cartilaginous matter, in which the salts of lime are 
deposited, as in normal bone. 
When the disease attacks the bones of the skull, or when it affects con- 
siderable portions of the skeleton, it becomes a serious disorder. It is a 
remarkable circumstance, that when the bones of the skull become hyper- 
trophied, those of the face often diminish, so that there are actions oppo- 
site in their effects—namely, hypertrophy and atrophy, going on in the 
system at the same time. 
The conditions of the system that give rise to these changes in the bone 
are not yet determined, nor do the bones themselves give any premoni- 
tory signs of the advent of the disease. The surface of the bone continues 
smooth, and the periosteum natural, even Avhen the bone has acquired the 
compactness of ivory. In other cases, the increase in the volume of the 
bone is preceded by an inflammatory condition. The seat of the inflam- 
mation may be either the periosteum and the compact tissue, or the 
medullary membrane. When the external surface is affected, an exuda- 
tion takes place on the surface of the bone, which becomes ossified into 
laminae : this forms a layer, which is sometimes separated from the surface 
of the bone by a layer of spongy tissue. When the inflammatory process 
has its seat in the medullary membrane, it leads to increased density either 
of the compact or of the spongy tissue, or of both these structures. It 
may be easily imagined that these organic changes cannot take place with- 
out affecting the texture of the diseased bone ; and it is found accordingly, 
that the substance of the bone becomes hypertrophied in consequence of 
the expansion and infiltration of the tissue connecting the capillaries of 
the medullary canals and cells. The result of these organic changes is a 
thickening at the affected portions, the other sections of the bone remain- 220 
BONES. 
ing free, so that the surface often presents a rough and uneven appearance. 
The inflammatory state of the bones under consideration is frequently ex- 
perienced by persons laboring under a rheumatic, syphilitic, or gouty con- 
stitution, and the treatment must depend on the nature of the causes that 
are associated in the production of the disease ; the local treatment is that 
common to other organs alfected with chronic inflammation. 
The opposite state to that of hypertrophy, is atrophy of the bones. 
Whatever causes lead to the undue nutrition of bone, tend at the same 
time to diminish its volume. There are, consequently, many states of the 
system which may lead to atrophy, such as indifferent diet, want of action, 
exhausting diseases, palsies, fractures, anchylosis, and, indeed, anything 
which tends to impede the flow of blood to the bones, are all accompanied 
with atrophy. From the nature of the various causes just mentioned, any 
of the bones of the skeleton may be affected. In many cases, the bones 
diminish both in length and thickness, and the medullary canal becomes 
contracted ; this condition of the bone is termed concentric atrophy. 
Independently of special causes, the bones of aged persons often become 
atrophied; they are then brittle, and break with a comparatively slight 
force. It appears that atrophy always begins in the medullary canals and 
in the diploetic structure, the cells of which enlarge, and the walls and 
lamella? of the cancellous structure become attenuated, and finally disap- 
pear. The compact tissue becomes changed, and resembles the spongy 
diploetic structure ; and the outer layer only remains unaffected, but 
almost as thin as paper. As the atrophy of the spongy substance 
advances, the external layer only remains, and incloses a cavity, with 
mere traces of spongy tissue at its periphery, or a soft substance with large 
cells. When the spongy substance is entirely removed, the thin external 
walls of the bones approach each other, and form a single plate. When 
the cavity within the bone is enlarged, it is called by Mr. Curling ex-centric 
atrophy. 
The con-centric form of atrophy occurs in the larger medullary canals, 
the ex-centric in the bones of the pelvis, ribs, and vertebra}. It will be 
easily imagined, that when such great organic changes take place in the 
bones, their physical characters alter in proportion ; and accordingly, the 
bones thus affected become flexible, and crack when they are bent. As 
the loss of the internal portion of the bone proceeds, the external portion 
becomes diminished, and hence the skeleton, in senile atrophy, together 
with the whole weight of the body, is less than in the normal state. The 
volume of the bones may be also diminished by continual pressure, such as 
that produced by tumors and aneurisms ; but to these purely mechanical 
causes I do not wish to engage your attention. 
Having now given a description of the nature and growth of osseous 
tumors, I shall occupy a few minutes with some very brief remarks on the 
nature and diagnosis of the soft tumors affecting the bones. Perhaps there 
is no subject in which the microscope has been of greater utility to the 
practical surgeon, than in determining the structure of the soft tumors of 
the osseous system. Up to a very recent period, tumors of the bones of 
the most heterogeneous and diversified character have been assembled 
together, and no distinction has been made between those of the mildest 
and those of the most malignant tendency. Thus, the older writers 
grouped together, under the term “ osteo-sarcoma,” the cartilaginous and 
osseous, the osteoid, the myeloid, and tie enchondromatous tumors, and 221 
BONES. 
confounded these non-malignant with the scirrhous, medullary, and 
alveolar tumors. Under these circumstances, we cannot wonder that 
much discussion should arise amongst surgeons on the propriety of, and 
the varied success resulting from, the removal of these mixed forms of 
tumors. 
When we look into authors on osteo-sarcoma, we find that they had no 
very precise idea of the nature of the tumors comprised under this term. 
Some wished to restrict the term to those which are decidedly scirrhous, 
while others describe them to be of a cartilaginous texture, and none seem 
to have satisfactorily determined whether they are or are not wholly malig- 
nant. With such a state of confusion and complication, we need not be 
surprised that some operations have been attended with complete success, 
while in other cases the diseases have returned and destroyed the patient. 
To give an idea of the complete difference in the views entertained by 
surgeons on this subject, it is only necessary to refer to one or two of those 
who have confounded together the malignant tumors with those of the non- 
• i o • o 
malignant character. 
Thus, according to Callisen, osteo-sarcoma is a disease by which the tex- 
ture of the bones is converted into a lardaceous substance, having a ten- 
dency to carcinoma. Boyer considers it a disease analogous to cancer. 
Dr. Cuming, of Glasgow, considers that though all varieties of osteo- 
sarcomatous tumors are highly formidable, yet he says “ they are not all 
really cancerous.” Mr. Mayo observed of these tumors, that they have 
not “ much malignity so that if all the portion of the bone involved, 
with part of the adjacent sound bone, be removed by amputation, the 
complaint seldom reappears, either in the part, or in another bone. It 
would be an almost endless task to enumerate the different opinions, with 
the various results, of these tumors ; but we see how little dependence can 
be placed on the results respecting the cases that have been'detailed, unless 
we could be secure of the real nature of the tumor removed. But the 
diagnosis of the character of the tumor is in some cases by no means easily 
made, and I have occasionally been in consultation with the most dis- 
tinguished surgeons of the metropolis without arriving at anything like a 
satisfactory result. 
The diagnosis of the nature of many tumors connected with the bones 
is one of the problems in surgery most difficult to solve; the data in many 
cases are not sufficient for the purpose. The hereditary tendency to dis- 
eases of an organic type, the aspect of the patient, the situation of the 
tumor, its character to the touch, and the history of its formation, are all 
circumstances to aid in the research ; but all these are often insufficient to 
enable the surgeon to arrive at more than a hypothetical conclusion. An 
example will suffice to show the truth of these remarks. 
A few years ago I was solicited by a gentleman to remove a tumor 
situated at the back of the thigh. On examination, I found it was deep- 
seated, soft to the touch, and apparently movable on the bone; it was of 
a considerable size, and had only been recently detected by the patient. 
Having some suspicion of its character, I advised his having another opinion 
before its removal, and Mr. Guthrie was consulted; but that gentleman 
being of the same opinion as myself—namely, that it presented a formida- 
ble aspect, it was agreed to take the opinion of the late Sir Astley Cooper. 
In this consultation, Sir Astley stated, that although he was of opinion it 
was very likely to turn out malignant, yet that "ts removal would give the 222 
BONES. 
patient a greater chance of a prolonged life. However, considerable alarm 
having been excited in the minds of the patient and his family by these 
consultations, he was advised to take the opinion of Mr. Lawrence, and 
subsequently that of the late Mr. Earle. The result of their several 
opinions was, that it was a tumor of uncertain character, but all agreed on 
the propriety of its removal. 
At length the family decided that Mr. Earle should be selected to per- 
form the operation. On cutting down on the tumor, it was found to be a 
medullary cancer connected with the bone, with ramifications so extensive 
that its complete removal could not be accomplished. The consequence 
was that the wound did not heal, and the patient sunk from exhaustion at 
the end of about three months. In this case it will be observed some of 
the best surgeons in London were consulted, notwithstanding which 
nothing but an uncertain knowledge could be formed of the character and 
connections of the tumor, and it was, as the result proved, a case which 
required either amputation at the hip-joint, or to be left unmolested. 
In order to assist us in forming a correct diagnosis of the nature of 
tumors, it has been suggested, and attempts have been made, to ascer- 
tain their character by means of a grooved or hooked probe, but with 
what success this plan has been attended I am not prepared to state ; still 
it seems to hold out a feasible prospect of enabling us to form a better 
opinion of such cases before operating for their removal. It is the opinion 
of many surgeons that malignant diseases in the bones are not so liable to 
return after operation, as those of the soft parts; but these opinions 
were given when the real nature of tumors was less understood, it will re- 
quire further investigation to determine this question. Myeloid and 
enchondromatous tumors were, until very lately, considered malignant; 
and this may have given rise to many of the opinions formed of the cura- 
bility of the patient suffering under malignant tumors of the bones by 
means of their removal. Part xxxi., p. 128. 
Case of Malignant Disease of the Ilium.—[The following interesting- 
case gave rise to some valuable clinical remarks by Mr. Fergusson.] 
Present condition : The patient is in a state of great debility, which has 
been slowly coming on for the last two years. Bowels much confined; 
appetite good ; sleeps well; pulse 90 and weak. There is a tumor situated 
on the posterior part of the left dorsum ilii, above and slightly over the 
great sacro-sciatic foramen. The crest of the ilium can be felt distinctly 
above it. The dimensions are, five inches in one direction, and four in the 
opposite ; its circumference is nearly circular, and it stands out from the 
surface of the body about an inch. When the fingers are placed upon the 
tumor, it may be distinctly felt to pulsate, each pulsation being synchron- 
ous with one at the wrist. If the stethoscope be applied to it, a blowing 
sound in successive puffs is plainly audible. It is not tender to the touch. 
The skin over it is freely movable, and not discolored. A bladder 
filled with ice is kept for two or three consecutive hours over the tumor, 
till the skin becomes quite numbed. This has a very decided effect on the 
tumor, causing it to become hard, with the pulsation diminished. 
From the history, I think you would naturally suppose the case to be one 
of aneurism of the gluteal artery; and for such it was taken by the sur- 
geons who sent the patient to me from Birmingham; indeed, so certain 
were they, that it was -considered a proper instance for ligature of the BONES. 
223 
internal iliac artery. I have never seen an aneurism of the gluteal artery, 
and I believe spontaneous aneurism of that artery to be extremely rare. 
After the admittance of the patient into the hospital, I made a careful 
examination ; and this is what struck me,—here was a man lying in bed, 
with a large pulsating tumor, resembling in many ways an ordinary aneurism; 
pallid, thin in the limbs, hardly able to walk, and experiencing great pain in 
and about the region of the tumor. Now, contrast this with a case of 
spontaneous aneurism of the popliteal or other large artery of the extrem- 
ities, but especially with one situated within one of the large cavities. 
The patient laboring under the disease is much annoyed at being kept to 
his bed ; he imagines that little is the matter with him, for he may be 
capable of undergoing great fatigue, perchance walking great distances to 
seek opinions regarding his malady. In fact, it is not a feature in ordinary 
aneurismal disease for the patient to be out of health. I mentioned that 
great pain was very early complained of in the tumor, whereas it is rare 
for those laboring under an aneurism of a large artery to make such a com- 
plaint at so early a period. 
Regarding the character of the tumor: when I made pressure in the 
site of the gluteal artery, as it leaves the sciatic notch, and turns up on 
the outside of the pelvis, all pulsation in the tumor ceased, which fact cer- 
tainly seemed very strong in favor of the supposition of a gluteal aneurism, 
and an indication which, taken by itself, was not unlikely greatly to bias 
the surgeon in his diagnosis; but I confess this had little or no weight 
with me, for I have met with malignant tumors of bone in various parts of 
the body possessing great pulsation, which could be arrested by pressure on 
the main artery supposed to lead to the disease. 
The size of the tumor and its situation were very much against it being 
considered an aneurism of any one branch of the gluteal ; indeed I could 
not fancy such constitutional disturbance to be dependent upon such a 
source. It is seldom that the surgeon is consulted about an aneurism at 
so early a period as this case came under notice; but, if he should meet 
with such a disease, at what is termed its first stage, it is generally possi- 
ble to empty the blood out of the tumor; but, as you saw during my 
visits to the patient, I frequently tried so to do, but was always unsuccess- 
ful. In the earlier stage of the disease, the crest of the ilium could be 
distinctly traced above the upper border of the tumor; but, after a short 
time, the part bepame entirely involved in the disease. There was one fea- 
ture in which common-place anatomy greatly assisted me. I noticed that 
the insertions of the long extensor muscles of the back, as the disease in- 
creased in its dimensions, became elevated above the surface of the tumor; 
whereas, if the swelling had been an ordinary aneurism of the gluteal 
artery, they would doubtless have been beneath. These were, then, the 
principal points from which I framed roy diagnosis, in the early stage of 
the disease ; and I came then to the conclusion, that the man was not the 
subject of a gluteal aneurism, as was at first supposed, but that he was la- 
boring under malignant disease of the ilium, and that the tumor was what 
is commonly called a pulsating tumor of bone, possessing more vascularity 
than was usual in such cases ; and hence the well-marked pulsation. 
This so-called aneurism of bone is, in my opinion, nothing more than 
aneurism by anastomosis in hard structure, somewhat modified in its con- 
dition and symptoms, and which might, in many instances, be called me- 
dullary sarcoma, or fungus hematodes. There is generally a very large 224 
BONES. 
expansion of bone, seeming as if the bone itself had been blown up, the 
interior of which may contain a quantity of medullary or melanotic matter, 
or resemble a sarcomatous mass, containing cysts with fluid blood, and pos- 
sessing great vascularity. Though thoroughly satisfied in my own mind 
as to the nature of the disease, I was anxious, nevertheless, to avail myself 
of the advantage of other opinions ; and, accordingly, after requesting the 
opinions of my colleagues, I invited surgeons of the highest eminence in 
London to see the case, the majority coming to the same conclusion that 
I have already expressed. 
It was quite evident that an operation could in no way benefit the pa- 
tient, and that the only treatment that could avail wras rest and kind 
attention to his wants. He daily grew weaker, until at length, becoming 
delirious, he ultimately died from pure exhaustion. Here let me impress 
upon you how important it is to avoid all surgical interference in those in- 
stances in which such a proceeding is unlikely in any way to better the 
the patient, but which, on the other hand, is calculated to bring discredit 
on the surgeon, and the worst possible result to the sufferer. Tliis disease 
so nearly resembles gluteal aneurism, that surgeons of experience have 
actually mistaken its true nature, and treated the case as if it really had 
been an ordinary aneurism. 
Some time before the patient’s death, while paying my visit one day, I 
found that the left thigh-bone had spontaneously broken just below the 
trochanter, no cause being assigned for the accident. Now, in malignant 
affections, or certain forms of cancer, it is not by any means uncommon for 
bones to become friable, and break with the least possible exertion. This 
was, therefore, another very conclusive proof in support of the malignant 
nature of the disease. 
These were the principal points of interest in this remarkable case ; and 
thq post-mortem examination proved the correctness of the leading opi- 
nions that had been formed during life. Most of you saw that examination ; 
but I will briefly detail the morbid appearances which were presented. 
When the body was put on the table, you saw the extreme emaciation to 
which the patient had been reduced by the malignant tendency of the dis- 
ease. On reflecting the skin from the left buttock, and dissecting back 
the gluteus maximus, which was greatly wasted, a large tumor was found, 
reaching from the sciatic notch to the brim of the pelvis—in fact, covering 
the whole of the haunch bone, and resembling more the substance of brain 
than any I remember to have seen. The tumor, I think, might with pro- 
priety be called by half a dozen different names, each being equally appli- 
cable, as medullary sarcoma, encephaloid disease, soft cancer, etc. 
The disease had evidently commenced in the cancellated structure of 
the ilium, and found its way into the cavity of the pelvis, as well as out- 
wardly. That part projecting into the pelvis had elevated the iliac ves- 
sels, and put upon the stretch the large nerves of the sacral plexus, which 
fully accounted for the constant pain complained of in the thigh, extend- 
ing to the foot. That portion of the ilium in which the disease commenced 
was entirely destroyed, the free margin of the bones being left rugged 
and bare. 
The gluteal artery, much enlarged, could be traced, shortly after leav- 
ing the sciatic notch, winding over the lower part of the tumor, and dis- 
tributing large branches which ramified freely over the surface, and fully 
explained the reason of the well-marked pulsation during life. The large BKAIJt. 
225 
sacro-sciatic nerve "was pressed upon by the lower part of the tumor, which 
doubtless caused the excessive and frequent pain to the patient. The dis- 
ease had extended to the left side of the two lower lumbar vertebrae, sac- 
rum, crest of the ilium, and upper part of the femur. The remaining 
bones of the body were not found similarly affected, but the kidneys and 
lungs presented well-marked specimens of cancerous deposits. 
Part xxxi., p. 133. 
Pulsating Tumors of Bone.— Vide Art. “ Tumors.” 
Extract of Gonium.—Recommended by Mr. Judd as likely to prove a 
valuable remedy in the treatment of three very fatal diseases for which we 
possess no specific, viz.: hypertrophy, of the heart, phrenitis, and inflam- 
mation of the medulla spinalis. “ The latter disease is one that, like 
Atropos in the dark, cuts the thread of life in many cases wherein the 
cause of death (the theca not being opened) is never discovered. In the 
treatment of such disease, after depletion, I should recommend that small 
doses of the extract of conium, without waiting for the action of purga- 
tives, be steadily repeated every two hours, until the action of the remedy 
is manifested in the system, or mitigation of the symptoms ensue. In 
hypertrophy of the heart, the remedy should be given rather more 
cautiously; and by properly-graduated doses, I imagine we might regu- 
late the hurried and forcible contractions of that viscus, and bring its 
action almost to nature’s standard. Lastly, habitual costiveness, and want 
of secretion in the bowels, may often be remedied by two or three grains 
of extractum conii, with as much pilula hydrargyri given at bed-time; this 
will be slowly followed by regular evacuations. The above combination 
of drugs acts particularly upon the rectum; and, when the dose is too 
often repeated, produces in some, a sort of chronic dysentery. I throw out 
these hints to the profession after having witnessed the power of conium 
in reducing the action of the heart, to exsanguine the brain and medulla; 
and may safely assert, if physiological experiments teach us anything as to 
the nature of remedies, that then is conium a valuable auxiliary in these 
diseases.” Part i., p. 59. 
Diseases of the Drain dependent on Diseases of the Heart.—Dr. Law 
brings before the profession his views of those diseases of the brain which 
are chiefly owing, not, as is generally supposed, to the excess of blood in 
the brain (which excess may arise either from too great a determination 
to it, or from a congested state of it, owing to obstruction of the blood in 
the lungs or other parts, from diseases of the heart), but to the deficient 
supply of it, arising from diseases either of the sigmoid or mitral valves. 
He affirms that if there be obstruction to the flow of blood before the 
arteries going to the brain are given off, that disease of that organ will 
not be owing to a fullness of blood in it, but to a deficiency : but on the 
other hand, if obstruction exist beyond the origin of the cerebral arteries, 
then the regurgitation of the arterial blood may very probably be toward 
the brain. 
BRAIN. 226 
BRAIN. 
Recommended, when called to a case of diseased brain, accompanied by 
hemiplegia, or symptoms which would at first sight indicate congestion 
or inflammatory action, to ascertain if these symptoms may not be owing 
to disease of the heart or valves ; and if we suspect that there is disease 
of the aortic valves, causing hypertrophy of the left ventricle, and prevent- 
ing the blood reaching the brain with sufficient ease: or if we suspect 
either a too open or a too contracted state of the mitral valves, causing 
in the former case a regurgitation of blood from the ventricle, and in the 
latter case a difficulty in its course into the ventricle from the auricle—we 
must be on our guard not to deplete but to stimulate and employ a tonic 
mode of treatment. Dr. Law says: We selected our tonics from among 
chalybeates with which we associated, but very sparingly, digitalis. The 
stimulants we employed were camphor, ammonia, infusum arnicse, our 
hospital formula of cardiac mixture, composed of camphor mixture, carbo- 
nate of ammonia, and Hoffman’s anodyne, etc., etc. We combined James’ 
powder (as recommended by Dr. Cheyne in cerebral affections), with car- 
bonate of ammonia. But the combination which seemed to us especially 
useful in these cases was that of James’ powder, and extract of nux 
vomica ; the former ingredient being determining to the surface, produc- 
ing an equalization of the circulation, while the latter stimulated the heart, 
as a muscular organ. Part i.,p. 67. 
Purgatives in Inflammation of the Brain and its Membranes.—Bleed- 
ing and the application of cold to the head are well known and valued in 
inflammation of the brain and its membranes. The use of strong and con- 
tinued purgatives is perhaps as well known but not so regularly adopted. 
Dr. Watson observes: There is a great tendency to obstinate consti- 
pation in most cases; and this must be overcome, and free and frequent 
evacuations from the bowels obtained: five grains of calomel and fifteen 
of jalap should be followed in three or four hours by a strong black dose ; 
and after that I should give, in such cases, three or four grains of calomel 
every four hours, and repeat the black dose at least every morning, until 
the symptoms gave way. If the mercury thus exhibited affects the gums, 
so much the better; but we must not, in this disease, combine it with 
opium, to prevent its passing off by the bowels. Dr. Abercrombie uses 
this strong language in reference to the value of purgative medicines in 
acute inflammation of the brain. “ In all forms of the disease active purg- 
ing appears to be the remedy from which we find the most satisfactory 
results; and although blood-letting is never to be neglected in the earlier 
stages of the disease, my own experience is that more recoveries from 
head affections of the most alarming aspect take place under the use of 
very strong purging than under any other mode of treatment. In most 
of these cases, indeed, full and repeated bleeding had been previously 
employed, but without any apparent effect in arresting the symptoms.” 
lie has found the croton oil the most convenient medicine for this purpose. 
Part 59. 
Aphorisms of Practical Surgery.—Hemorrhage from the ear, accom- 
panied with coma (consequent upon severe injuries), almost invariably 
indicate f racture of the base of the skull. 
Generally in affections of the brain, the effects of purgatives on the 
bowels are much less powerful than usual. 227 
BE AIN. 
Five or six grains of tartar emetic and several ounces of epsom salts 
will often not produce either vomiting or purging. In these cases the 
oleaginous purgatives, as castor oil, croton oil, etc., succeed better. 
Part iii., p. 115. 
Concussion of the Brain.—Bransby Cooper observes: When one or 
both pupils remain contracted, I am induced, from my experience, to con- 
sider this as an unfavorable symptom, characterizing lesion of the brain. 
In those cases in which I have observed contraction of one pupil, and have 
had an opportunity of making a post-mortem I have invari- 
ably found injury of the brain on the side opposite to that ot the contracted 
pupil. The same violence which produces concussion, may cause fracture 
of the base of the skull; and although the constitutional treatment em- 
ployed may subdue the symptoms of concussion, during the progress of 
reparation effusion may take place, and evidence of compression super- 
vene. Such a complicated injury, however, is generally denoted by bleed- 
ing from the ear at the time of the accident; and I have known a discharge 
of serum from the external meatus continue for many days after the acci- 
dent ; and yet these cases ultimately did well. Even when this discharge 
is profuse, it is to be regarded as a favorable symptom, and therefore should 
not be checked by astringents. The case alluded to was treated success- 
fully, by general and local bleeding and calomel. Part v.,p. 128. 
Cerebral Lesion—State of the Iris.—In the examination of cases of in- 
jury to the brain, it is considered extremely important to enter minutely 
into all those signs which indicate the extent and nature of the injury. 
First, the mental condition; next, the state of the pupils—the iris is 
placed before that expanded surface of the optic nerve, the retina, as an in- 
telligent curtain to guard it from injury. The vital contrivances by which 
it acts, and by which its action is directed, are so beautifully perfect that 
the extent of the opening of the curtain is indicative of the state of the 
nervous apparatus it is destined to protect, by preventing such an amount 
of light impinging upon it as would be liable to injure it. In diseases of 
the globe of the eye, the dilated pupil indicates more or less pressure on 
the retina by some cause in the globe itself, such as a permanently turgid 
choroid, etc. But if with a healthy eye, but in connection with a blow on 
the head, we find a dilated pupil, then we have the sign of some pressure 
or injury to the nerve in its course within the skull, or the ganglia in which 
it terminates. The dilated pupil, then, indicates very serious injury to the 
optic nerve, or the nervous centres with which it is connected, though it 
may happen, as in the case of very severe concussion, the injury is reme- 
diable. The contracted pupil, on the contrary, indicates an irritability of 
the nervous instruments, an undue excitement of their natui'al function— 
not an obliteration of it. You will sometimes see, in the case of injury to 
the brain, dilatation of one pupil and contraction of the other; where this is 
the case, you will find the most severe injury of the brain on the side op- 
posite the dilated pupil. Part viii., p. 73. 
Powerful Counter-irritation, especially the Long Issue on the Calva- 
rium.—Dr. Wallis received the first hint on this subject from Mr. Richard 
Smith, the present senior surgeon of the Bristol Infirmary, who, in many 
cases of severe injury of the head, is accustomed to make an incision through 
the scalp, whether or not there be symptoms of fracture or depression; 228 
BRAIN. 
and this he does for two reasons, viz., to cause a local loss of blood, and to 
produce an advantageous counter-irritation. Dr. Wallis has used the 
same means in a variety of cases of organic affections of the brain, both 
chronic and acute ; in paralysis, impending effusions, convulsions, erysipe- 
las of the head and membranes of the brain, in fever in the very advanced 
stages, etc. He says that “its effects are more permanent and its disad- 
vantages are fewer than those of any other remedy now in use.” It is not, 
however, to be used in the first onset of disease, but when all the ordinary 
means have been fairly tried, and have failed to produce relief. In acute 
diseases, the greatest discrimination will be required to make use of this 
remedy at the proper time ; for if, in serous effusions, for example, it be 
delayed till the ventricles are filled with fluid and pressure has commenced, 
it rarely happens that absorption can be promoted sufficiently to effect a 
cure. 
The circumstances which are necessary to be attended to in making the 
longitudinal incision or issue on the calvarium are these: Let the head be 
shaved entirely, and have the patient brought near the right side of the 
bed ; raise the head by a hard pillow, and put a towel round his neck to 
receive the blood; let an assistant keep the head steady; at the same time 
draw the scalp downward in all directions, so as to strain the calvarium as 
much as possible; the scalp will divide with so much more ease. In this 
your own left hand will materially assist, by placing it at the upper and 
back part of the head, commencing the incision between your thumb and 
fore-finger as far back as the lambdoidal suture; press the scalpel sufficiently 
down so as to divide the scalp entirely through at once ; carry on the in- 
cision directly along the sagittal suture as far as the hair grows on the 
scalp, and which will cover the cicatrix after the issue is healed up. The 
length of the incision thus made will be in the adult about seven or eight 
inches; take care that the scalp be divided entirely and perfectly through, 
so that the edges of the incision will separate so far as to enable you to in- 
troduce a dossil of lint, rolled up hard, as thick as two fingers, and which 
should be well soaked in spirits of turpentine ; this answers the double pur- 
pose of increasing the effect of the incision, and makes suppuration come 
on earlier, and will usually assist in stopping a further loss of blood. The 
arteries very soon retract and cease to bleed ; there is seldom more than 
six or eight ounces of blood lost, and this quantity may be very readily 
curtailed if it be desirable to do so, by applying the actual cautery for an 
instant to the arteries. By means of poultices, spirits of turpentine, blis- 
ter ointment, and other irritants, suppuration may be maintained as in any 
other issue. In a few days, a double row of peas, seventy or eighty, strung 
together, may be used to prevent granulations filling up the issue. The 
repeated use of caustic may be necessary to effect this. Part viii., p. 122. 
Disease of the Drain folioicing the Application of a Ligature to the 
Carotid Artery.—This patient was a young man, twenty-eight years of 
age; he was admitted to St. Bartholomew’s Hospital, April 9, 1845. 
Whilst smoking a pipe, a few hours previous to admission, he stumbled 
against a door, and drove the stem of the pipe into the tongue, a little 
anterior to the left tonsil. The bleeding was trifling; no foreign body 
could be found in the wound, but the parts were much swollen, which for 
five days increased so as to interfere with deglutition and respiration. 
On the 16th, hemorrhage took place to the amount of twenty-four ounces; BKAIN\ 
229 
it was arrested by pressure, and Mr. Vincent proceeded to tie the carotid 
artery. 
It was observed during the operation that the patient made violent ef- 
forts with his right side, but that he never moved the left extremities. 
During the night the left extremities were frequently convulsed. Ilis 
pulse, which had been 132, sunk to 96. During the next two days, the 
twitchings of the right side and paralysis of the left side continued. About 
midnight of the 18th, whilst coughing, about an ounce of arterial blood 
flowed through the nose and mouth, and from the wound in the neck. He 
was sensible. On the 21st, a fit of coughing, with hemorrhage, to the 
extent of two or three ounces, from his nose and mouth, terminated his 
existence. 
On examining the brain, the convolutions on the right side were flat- 
tened and softened, and in its substance there were cavities filled with ash- 
colored effusion, with shreds of a greenish hue. 
Mr. Teale, in his “ Retrospective Address,” mentions two instances in 
which hemiplegia followed the tying of the carotids. The one occurred to 
M. Sedillot, the other to Dr. Fairfax; in the former the patient became 
paralyzed on the left side, and died in nine days; a post-mortem examina- 
tion showed that the right side of the brain had been deprived of its due 
supply of blood. In the latter, the right side was paralyzed, and death took 
place on the fifth day. Part xiii., p. 221. 
Hypertrophy of the Brain in Children.—Let the child’s head rest upon 
a horse-hair cushion, with a hole cut out to receive the occiput, and let it 
wear a thin linen cap, changed as often as the perspiration demands. Do 
not use counter-irritation to infants; but older children may have tartar- 
emetic ointment rubbed into the back of the neck. Leech when cerebral 
congestion requires it; but tonics are rather indicated, as extract of bark, 
vinum ferri, syrup of iodide of iron; or where there is marked tendency 
to rickets, cod-liver oil (a drachm twice a-day for a child three years old). 
Sponge the child with salt and water, or sea water, or immerse in a tan- 
bath made by boiling three handfuls of bruised oak bark tied up in a linen 
bag, in three quarts of water, for half an hour, and adding the decoction 
to the water of the child’s bath. Get a healthy wet nurse; and, after 
weaning, give milk diet with an egg once or twice a day, and a little veal- 
broth or beef tea. Part xvi., p. 77. 
Application of Cold in active Congestion of the Brain in Children.—- 
We sometimes wish to use the sedative effect of cold, when the shock is 
not needed. Dr. West tells us that few methods of applying cold to the 
head are better than that which consists in half-filling two bladders with 
pounded ice or cold water, and placing them, each wrapped in a napkin, 
the one under, and the other upon, the child’s head. By pinning the 
corners of the napkins to the pillow, you can secure them from being dis- 
placed, and can also prevent the weight of the upper bladder from resting 
too heavily on the child’s head, while all danger of the bed or of the dress 
becoming wet is avoided. Part xvi., p. 78. 
Cerebral Affections simidating impending Apoplexy.—After mentioning 
the hydrocephaloid disease of children, Dr. Hughes refers to a similar 
affection in adults. He says: 
Every practical surgeon of large observation, and every practical ac- 230 
BKAIN 
coucheur of extensive experience, is well aware that giddiness, headache, 
dimness of vision, singing in the ears, throbbing of the temples, restless- 
ness, sopor, and even the disposition or approach to coma, are symptoms 
which occasionally follow extensive hemorrhage as well as accompany 
plethora, or “ determination of blood to the head.” 
We are reminded by Dr. George Barrows, that even Hippocrates ob- 
served that repletion and depletion of the vascular system were accom- 
panied with similar symptoms of disturbance to the nervous centres. I 
shall quote a few well-authenticated instances, illustrative of this fact. 
A lady, aged 25, had been frequently bled on account of symptoms in 
the head which had supervened upon an injury. Considerable relief had 
followed each bleeding, but the symptoms had soon returned, so as to lead 
to a repetition of the bleeding at short intervals for several months. When 
Dr. Abercrombie saw her, “ she had a death-like paleness, and her pulse 
was very rapid, and as small as a threadbut still she complained of. fre- 
quent headache, violent throbbing in the head, confusion and giddiness. 
“ It was agreed as a last experiment to make a trial of an opposite system 
—nourishing diet and tonics. In a fortnight she was restored to very 
tolerable health.” The same author reports the case of a lady who, after 
leeching and other depletory treatment employed with benefit for a pain- 
ful abdominal hardness following delivery, was, after three weeks, when 
reduced in strength, alarmed and agitated, and began to talk wildly and 
incoherently, and, “ after a restless night, was in a state of high excitement, 
talking incessantly, screaming and struggling, with a Avild expression of 
countenance, and a small, rapid pulse.” Leeches, cold applications and 
purgatives, were employed with little or no benefit. A full glass of white 
wine was afterward given every hour, and after the fourth hour she was 
found composed and rational, her pulse 90 and of good strength, and from 
this time there was no return of the symptoms.” He also observes, “that 
in the last stages of exhausting diseases, patients frequently fall into a state 
resembling coma ; and I have frequently seen children lie for a day or two 
in this kind of stupor, and recover under the use of wine and nourishment. 
It is scarcely to be distinguished from the coma which accompanies dis- 
eases of the brain. It attacks them after some continuance of exhausting 
diseases, such as tedious and neglected diarrhoea.” “I have seen in adults 
the same affection, though it is perhaps more uncommon than in children. 
A man considerably advanced in life, in consequence of a neglected diar- 
rhoea, fell into a state closely resembling coma.” An elderly lady, from 
the same cause, had loss of memory and squinting. “Both these cases 
recovered by wine and opiates : in the former blistering on the neck was 
also employed.” lie adds the very remarkable case of a gentleman, about 
thirty years of age, who had been reduced to a state of extreme weakness 
and emaciation. As debility advanced he had become considerably deaf; 
and “when I saw him,” says the doctor, “he was affected in the following 
manner: he was very deaf while sitting erect or standing, but when he 
lay horizontally he heard perfectly. If when standing he stooped forward 
so as to produce flushing in the face, his hearing was perfect; and upon 
raising himself again to an erect posture, lie continued to hear distinctly 
so long as the flushing continued; as this went off, the deafness returned.” 
Dr. Marshall Hall states that “ he is persuaded that the loss of blood is by 
far the most frequent and influential source of delirium and mania occur- 
ring in the puerperal state.” BRAIN, 
231 
Richter and Mr. Travers relate cases of amaurosis resulting from loss of 
blood ; and the latter author says, “A country lad, of robust constitution, 
became the alternately favored paramour of two females, his fellow- 
servants, under the same roof. He was the subject of gutta serena in less 
than a twelvemonth.” He refers to another lad who had palsy of retina 
as a consequence of secret indulgence. “ When bleeding,” says Sir Ben- 
jamin Brodie, u has been carried to a great extent, symptoms frequently 
occur which in reality arise from loss of blood, but which a superficial 
observer will be led to attribute to the injury itself (concussion of the 
brain), and concerning which, indeed, it is sometimes difficult even for the 
most experienced surgeon to pronounce, in the first instance, to which of 
the two causes they are to be referred.” Many quotations bearing upon 
the same point might be added ; but it may be presumed that sufficient, 
and perhaps more than sufficient evidence has been adduced from authors 
of high repute, to show that a great variety of symptoms which are com- 
monly, and under certain circumstances, correctly considered to be indica- 
tive of the consequences of inflammation of the brain, or of oppressed 
cerebral circulation from repletion or pressure, may, and not unfrequently 
do accompany conditions of the brain which are the direct reverse of 
these—such as loss of blood, or anaemia and debility, from whatever cause 
arising. 
It is of importance to recollect that, before deciding upon a plan of 
treatment, the heart as well as the pulse should be always examined ; and 
that the force of the two should be compared ; otherwise serious mistakes 
may arise and injurious consequences may result; as the heart may be 
beating with unusual force while the pulse is feeble, or the strength of 
both heart and pulse may be diminished, though serious organic disease 
may exist in the former; and the brain may be seriously, gravely, and 
even dangerously oppressed with blood, though the impulse of the central 
organ of the circulation may be diminished. 
The treatment will consist in the removal of the cause when practicable, 
the administration of tonics, especially chalybeates, and moderate purga- 
tives to secure gentle and regular action of the bowels, good diet, fresh 
air and moderate exercise. In very advanced cases direct stimulants will 
be needed. In cases which are of a doubtful nature, we should blister the 
nape and purge, while we allow a generous diet; until we are able to 
ascertain the exact character of the affection. Part xix., p. 52. 
Cerebral Diseases of Infancy.—In taking a general view of what has 
been written on cerebral diseases, we shall be struck, not so much with a 
deficiency of knowledge as to their character, pathology, or symptoms, as 
with the indefinite and unsatisfactory methods of treating them. This 
defect is probably due to the excessive desire manifested to base principles 
of treatment upon post-mortem appearances; but, whilst the latter, 
although fully known and accurately described, vary so much in relation to 
the symptoms they are supposed to occasion, how can the former be 
depended upon for safely averting the great dangers we have to encounter? 
There is yet much—very much, to be learned in the treatment of these' 
diseases. In what manner can such knowledge be most readily and: 
perfectly obtained ? The investigations hitherto made upon this subject,, 
enable us to determine certain generalizations, and to state a few esta- 
blished facts, which afford useful hints for practical application. 232 
BRAIX, 
1. Cerebral diseases occur most frequently in children of a scrofulous 
habit, or born of scrofulous parents. 2. Scrofula greatly modifies the char 
acter of cerebral as well as other diseases. 3. Cerebral diseases may exist 
independently of scrofula. 4. Headache, vomiting, constipation, and more 
or less pyrexia, are a combination of symptoms denoting, in children, 
serious, and often unmanageable cerebral disease. 5. A species of hydro- 
cephalus, chiefly indicated by the preceding symptoms, is generally accom- 
panied with, or depends upon, tubercular disease of the brain or its mem- 
branes. 6. There exists another species of hydrocephalus, attended with 
the usual symptoms of phrenitis, of a strictly inflammatory nature, and 
curable by strictly antiphlogistic remedies. 7. Hydrocephalus resulting 
from tubercular disease may assume an active inflammatory type, and be 
scarcely distinguishable from the last variety, except from its not being so 
amenable to antiphlogistic treatment. 8. Symptoms similar in many 
respects to those of acute hydrocephalus in one or other of the above forms, 
may arise from a system diametrically opposed to inflammation ; these are 
curable only by a nourishing and mildly-stimulating plan of treatment. 
9. Hydrocephalus, generally speaking, does not occur before the age of 
two years; and boys are more liable to it than girls. 10. Treatment, to 
be effectual, must be commenced at an early period of the disease. 11. The 
symptoms of cerebral diseases in children, and the post-mortem appear- 
ances, have not a definite or constant relation to each other; and the for- 
mer are more to be depended upon than the latter for indications of treat- 
ment. 12. Constipation is not essential to the phrenitic variety of hydro- 
cephalus. 13. Certain cases, accompanied with symptoms so constantly in 
connection with tubercular encephalitis as not to be distinguishable from 
the latter form of disease, admit of being cured ; and may, therefore, be 
fairly considered as instances of the curability of a disease which is gene- 
rally supposed to be incurable. 
The treatment of diseases of children requires considerable tact and dis- 
crimination, both as to the nature of the remedies to be used, and the 
mode of employing them. "NVe have tender bodies to deal with ; their 
period of life greatly modifies the action of medicines ; errors of judgment 
in prescribing are of more serious consequence, and life is altogether in 
greater jeopardy. It is often necessary to reduce arterial action, and 
blood-letting is sometimes attended with success, but in very young children 
this is a dangerous remedy, and probably not a few have fallen a sacrifice 
to its depressing influence. The usual method of drawing blood in children 
is to apply leeches, and children have bled to death from leech-bites. 
Cupping is an operation not easy to perform in children, but it is prefer- 
able to leeching, because by it the quantity of blood to be abstracted can 
be regulated, and the bleeding can be stopped as soon as enough blood has 
been removed. Blood-letting, as a remedy, is fortunately seldom indis- 
pensable at the period of life in which children are most frequently affected 
by cerebral diseases, my own experience would almost say never • for in a 
period of more than fifteen year’s, I have never myself drawn blood, either 
locally or generally (save by scarification of the gums or eyelids), from a 
child under six years of age, for any complaint whatever. How then are 
inflammatory complaints to be treated ? What are we to do in a case of 
phrenitic hydrocephalus, if we are not to bleed ? Are we possessed of any 
other effectual means of combating inflammation? Yes, we have many 
other resources for lessening vascular action in children which will often- BKAIN. 
233 
times enable us to spare a fluid so necessary to existence, and so often 
wanted in later periods of diseases, when it is difficult, if not impossible, to 
supply it. The warm bath is a powerful agent for relieving the circulation 
in infancy ; antimonial medicines will reduce power to almost any neces- 
sary amount in children ; purgatives also ; but owing to the extreme sus- 
ceptibility of the intestines of children to take on irritation with which the 
brain very quickly sympathizes, it is not often advisable to use them freely; 
we may, however, safely employ enemata, which have the effect of reducing 
the pulse and lessening heat of skin in a very satisfactory manner, as well 
as removing offending matter, and encouraging a flow of bile. But there 
is another class of medicines both safe and effectual for abating inflamma- 
tory affections in children, provided the stomach be not too irritable to 
retain them. I mean diuretics, and I have repeatedly observed, whether 
in fevers or inflammations, that promoting a copious flow of urine has, in a 
striking manner, produced an antiphlogistic effect. These measures may 
be employed also in combination, and when they are thus combined and 
judiciously applied, I have yet to learn that they are not capable of effect- 
ing as much for the removal of febrile action with scarcely the possibility 
of doing harm, as is usually effected by blood-letting. In the more 
advanced stages of inflammation, calomel for the removal of lymph, and 
iodine (liq. potassii iodidi comp.) for the absorption of effused fluid, are 
well known and trustworthy remedies. 
[Dr. Copeman remarks upon the difficulty there often is in distinguish- 
ing those cases which require stimulants from those which require an 
antiphlogistic plan of treatment, and recommends a minute attention to 
symptoms, as the only means by which this difficulty is to be overcome, 
lie considers that the occurrence of febrile disturbance is generally a very 
good indication that simple remedies will not be sufficient, and that active 
treatment is required. After referring to the symptoms in thoracic and 
abdominal affections, he says :] 
In head affections, unattended with fever, we ought not to resort hastily 
and actively to depletory measures, however much we may be inclined to 
suspect the existence of certain pathological conditions supposed to require 
antiphlogistic treatment. But there may be febrile excitement in a case 
where antiphlogistic treatment would be fatal. How are we then to 
judge? If the fever be of an intermitting character, leaving the patient 
feeble and depressed in the intervals, the pulse being unsteady and variable, 
it behooves us to be guarded in our employment of lowering remedial 
measures. 
The following circumstances seem especially deserving of attentive con- 
sideration in the treatment of the diseases of infancy and childhood: 
1. The delicate, perhaps only partially developed, structure of the vital 
organs, the intolerance, for the most part, of powerful medicines or doses, 
and the great restorative powers of nature at an early period of existence. 
2. /The necessity for adapting our remedial agents to the delicacy and 
susceptibility of the structures they are intended to influence, and fulfilling 
any given indications of treatment by the least possible violence or preci- 
pitancy, by the gentlest means. 
3. Whilst entertaining a just idea of the nature and history of the disease 
we have to treat, we must at the same time observe particular symptoms 
minutely, and vary our plan of treatment according to the information 
which those symptoms are capable of affording. 234 
BRAIN, 
4. The importance of endeavoring to the very last to preserve life, how- 
ever desperate the circumstances may appear, keeping always in remem- 
brance that “ whilst there is life there is hope.” Part xxi., p. 74. 
Cerebral Disturbance resulting from Uterine Disorders.— Vide Art. 
“Uterus.” 
Syphilitic Meningitis.—[Among the most remote and latest, but exceed- 
ingly important signs of constitutional syphilis, are those of a cerebral 
origin. Little notice, however, appears hitherto to have been paid to this 
fact. M. Ricord, speaking of “the action of the osseous affections on 
neighboring parts,” says, that one consequence of this species of compres- 
sion is epilepsy, the fits seizing the patient as the osseous growth gets 
more considerable and irritating. lie also mentions paraplegia as a casual 
effect of tertiary syphilis in the bones. Mr. Acton quotes this extract 
from M. Ricord, but upon the disorder of the mind they are both silent.] 
Dr. Thomas Read, of Belfast, gives the following: 
Case.—Syphilitic Meningitis / Paraplegia ; Hemiplegia/ Amaurosis/ 
Difficulty of Articulation, with Mentcd Hebetude.—Mr. F., in July, 1847, 
was accompanied to my house by a surgeon of Belfast, who was naturally 
alarmed by the rapid advances of paralytic and other cerebral symptoms 
in his case. The patient required to be supported on his feet while his 
clothes were removed from the upper part of his person. Ilis speech, 
from difficulty in articulation, Avas very imperfect; his powers of arranging 
his ideas and memory were slow and defective; vision Arery imperfect in 
both eyes. The gentleman who accompanied him had known him for some 
time. lie had been treated for years by another surgeon for secondary 
syphilis—chiefly intractable ulcers on the limbs, face, and head; and on 
these parts there Avere seAreral large cicatrices. lie had placed himself 
under the former gentleman’s care for progressively increasing amaurosis; 
the paralytic symptoms supervened, and rapidly advanced until he exhibit- 
ed the aggravated and almost hopeless state of general paralysis in A\diich 
I saAV him. The history of the case, his countenance, and general appear- 
ance, led me to the impression that all the symptoms might be assigned to 
compression of the brain by development of syphilitic tumors of the dura 
mater; but as this could not be a certain diagnosis, and to guard against 
an error in judgment, I considered the rapid exhibition of mercury to be 
the safest course. I therefore advised the entire scalp to be shaAred, a 
blister applied immediately over it, and one drachm of strong mercurial 
ointment to be rubbed in on any convenient surface tAvice a day. But I 
apprehended a speedy appearance of coma, and a necessarily fatal result. 
Some eight days afterward I saw his surgeon, Avho told me that our 
patient had made a rapid reco\rery, and Avras then able to run up and down 
the steps of a \Tery steep staircase. To my additional surprise, a Avell- 
looking dark man, Avith clear and expressive eyes, addressed me one day 
in the street, and, asking me if I did not knoAV him, brought to my recol- 
lection the visit of himself and his medical attendant to my house, less 
than three weeks before. He Avas completely recovered, looked in full 
health, had perfectly regained his poAvers of motion, vision, and articula- 
tion, and Avas in full possession of all his faculties. Mercury here released 
every oppressed organ, gave flesh and strength by restoring the animal 
functions, and afforded one of the happiest triumphs of medical art over 235 
BRAIN, 
disease I ever witnessed. Death must rapidly have closed the scene, had 
not this powerful and efficient agent arrested its course. 
The practical conclusions deduced by Dr. II. from this and other forms 
of syphilitic cachexia, are : 
1st. That a single symptom of cerebral disturbance, such as some form 
of mental disorder, may alone indicate the intra-cranial organic mischief in 
progress; a cachectic countenance may excite suspicion of its nature, but 
a close investigation of the patient’s antecedents is required to affix its true 
character. 
2d. That the employment of mercury in this late stage of syphilis is 
unattended with those formidable consequences particularly liable from its 
use in the primary forms. 
Dr. li. believes that no measure of bodily exhaustion should deter from 
the prompt employment of mercury, once the disease is discriminated, and 
that the more advanced the stage—the wider the range of involvement— 
the more signally does mercury, if appropriately and judicially employed 
at the right juncture, exhibit its strange conversion into a tonic, and its 
decided action as a restorative. Part xxv.,p. 63. 
Vital Spot of the Medulla, Oblongata.—At a meeting of the Academy 
of Sciences of Paris, M. Flourens took occasion to speak of the actual 
locality of the vital spot, or primum mobile of the respiratory act. By 
several experiments he has now determined that that spot is situated ex- 
actly at the point of the calamus scriptorius, between the ventricle of 
Aurentius and the junction of the V-shaped grey matter of the pyramids. 
This spot is, according to M. Flourens, about the size of a pin's head; 
above or below the same a sharp instrument maybe thrust in without caus- 
ing the respiratory movements to cease; but when the exact spot is trans- 
fixed, life ceases immediately. M. Flourens had made this communication 
in order that the precise locality of the nodus vitaa should be well under- 
stood. Part xxv., p. 83. 
Diagnosis of Cerebral Diseases.—1. When a person suffers from con- 
stant and dull pain in the head, with or without convulsions, the pain being 
limited to a certain region, the external surface of the head being cool and 
the pulse regular, the digestive system not much or not at all disturbed, 
and the intellect unimpaired; if any thickening of the bony structure can 
be perceived, or if the patient has suffered from syphilis, it may be conjec- 
tured as probable that there is thickening of the skull, and that the symp- 
toms are due to that cause. In such a case, a moderate diet should be 
enjoined; leeches maybe occasionally employed; the bowels should be 
kept gently open; but our chief reliance should be upon the internal 
administration of iodide of potassium in increasing doses, and continued 
for a long period. 
2. When there is pain and heat of the head, vomiting, nausea, want of 
appetite, foul tongue, derangement of bowels, rapid and full pulse, squint- 
ing, delirium, thirst, and subsequent coma, and if the blood drawn be 
buffed and cupped, there can be little doubt that the case is one of menin- 
geal inflammation. In such a case, there is no time to be lost; the warm 
bath must be used in the case of a child; cold must in all cases be applied 
to the head ; leeches are always necessary; calomel is to be freely admin- 
istered, and alterative aperients must be given at the same time. By the 
adoption of Such measures many valuable lives may be saved. 236 
EKAIN. 
3. When the head is cool, the pulse moderate, the tongue clean, the 
motions healthy, then, although there may be the most violent and long- 
continued convulsions, squinting, drawing in of the thumbs toward the 
palms of the hands, and all other symptoms indicating deranged action of 
the nervous centres, there is nevertheless an absence of serious centric 
disease. We may here reasonably hope for a favorable termination by the 
nse of ordinary hygienic means ; such as lancing the gums, if the patient 
be undergoing the process of dentition; attending to the quality of the 
breast-milk in very young infants ; correcting any acescences in the prim® 
vim; change of air, and the judicious use of stimulants and tonics; and 
the adoption of all such other means as are calculated to improve the 
powers of the system in general. 
It cannot be urged in too strong terms, that the mere existence of con- 
vulsions, however alarming they may appear, does not indicate, alone, a 
serious disease of the brain; these movements are merely the external 
manifestations of cerebral irritation, and are often caused by circumstances 
comparatively trivial. On the other hand, it must be remembered that, at 
all periods of life, the cerebral membranes, especially the pia mater, are 
apt to take an inflammatory action ; and that, slight and web-like as this 
membrane is, and insignificant in appearance as are the lesions which it 
exhibits to the scalpel or to the microscope, yet upon its integrity or its 
unsoundness often depends the brightness, the perversion, or the obscurity 
of the intellect; and that an inflammatory disease of its texture is one of 
the most frequent causes of death. The most energetic treatment often 
fails to rescue the patient from the grave ; but it is nevertheless of para- 
mount importance to detect the malady during life, and, if possible, to 
arrest its progress. Part xxix., p. 59. 
Cerebritis.—When fever is present, of a typhus character, don’t be 
afraid of the symptoms of inflammation in the exhibition of wine. When 
typhus is present, there may seem to be local inflammation either in the 
brain, heart, or other organs, but this is not real inflammation, and will 
really be aggravated by depletion. Part xxix., p. 21. 
Cerebral Diseases.—There are three different states of the muscles in 
hemiplegia, indicating different conditions of brain, and requiring different 
treatment. If the paralyzed muscles be perfectly flaccid, the cerebral 
lesion is atrophic in its nature, the very opposite to inflammatory; the 
vital powers are below par. If the muscles exhibit any resistance to 
motion, the lesion is of an irritative kind, as a small apoplectic clot, with 
lacei*ation of healthy brain tissue around. When the muscles are hard and 
rigid, the brain lesion is decidedly irritative, sometimes inflammatory. In 
the first, a supporting plan of treatment is required; ammonia, wine, and 
quinine. In the last, bleeding, or, at all events, mercury is necessary. A 
clot, however small, will invariably give rise to coma ; if very small indeed, 
it may be merely a lethargic state; if large, the coma will be long and 
profound, and accompanied by snoring. If the hemiplegia be from white 
or atrophic softening merely, there will be no prolonged, if any, loss of 
consciousness, and the intellect will generally speedily recover. 
Part xxxvii., p. 30. 
Value of Tonic Treatment in some Diseases of the Drain.—The fol- 
lowing is an abridged lecture, delivered by F. C. Skey, Surgeon to St. 
Bartholomew’s Hospital: BRAIN, 
237 
I wish to speak of what is called “ ramollissement,” or softening of the 
brain. I do not wish to speak of its pathology ; I know very little about 
that, as to whether it is inflammatory or febrile, or what not. All that I 
pretend to know or to tell you is that the disease, as we see it, begins 
insidiously by loss of muscular power, and it occurs most frequently in 
men about the middle period of life ; the gait or walk of such a patient is 
unsteady, and it seems natural to ask a surgeon what may be the cause of 
this unsteadiness or irregularity. A banker or a banker’s clerk finds his 
style of writing changes ; he has power, quoad power, he can use a dumb- 
bell, but he cannot regulate this power so as to write a letter, as he pre- 
viously had done ; his urinary system becomes affected, and his urine drib- 
bles away, and even the rectum, from forgetfulness on the part of the 
patient, becomes partly paralytic ; there is loss of memory or incoherence 
of ideas; small eccentricities appear. This man will spell some words 
badly ; these are signs of recent cases : there is little or no implication of 
the reasoning power, at least to any extent, but the loss of power, as in 
handling a pen to write, is most peculiar, as 'well as the irregularity of 
spelling of monosyllables badly or backward in what is written. But if 
you wish for a more minute description of the disease, you will find it in 
the works of Rostan and others. Now these cases are common; this 
train of symptoms occurs in men who have undergone long anxieties in 
business, or this disease will occur in men who have had exhausting fevers 
or other maladies; or again, in the case of a man who rides with hounds 
five days a week, four hundred miles a week, and it may be, drinks wine, 
eats very little, marries late in life, suffers from venereal exhaustion !—his 
nervous system becomes “ broken down,” as it is called. What is the con- 
dition of the brain then ? Is it a condition of excess of vascular or vital 
force, or the opposite ? Can any of you recall a case of “ ramollissement” 
as it used to be treated a few years ago ? Happily for yourselves, per- 
haps not; but the principal point was to keep always in mind, “ chronic 
inflammation,” and to treat it accordingly. This poor gentleman must 
first be reduced, made to keep quiet, his diet regulated, his wine and fox- 
hunting stopped, and three grains of grey powder with rhubarb given at 
clock-work intervals, for what were called the “ secretions,” or to touch the 
gums for this chronic (?) inflammation. Next, his skin was steadily looked 
to, and that great catholicon of surgery lads, mindererus spirit, with anti- 
mony, was ordered, spoiling what little appetite the unfortunate patient 
may have had. He was rigidly confined to the house—but, mind you, 
with all this excellent drugging, his speech does not improve; he progresses, 
but it is from bad to worse. Very well! Now that is one view—now for 
another. Mark that there is a slow pulse, everything is below par, as I 
call it. In this, then, “ chronic inflammation,” some people count on their 
ten fingers all the drugs I use or adopt. I am very glad of it, for we have 
too much routine and rubbish in what is called “ general practice.” The 
eyes of the public are upon us; are you then justified in lowering this 
man with your antimony and your grey powder, and your mindererus spirit ? 
Oh, no ! But some Solon says you weaken the patient in order that he 
may get strong. In these cases I could never understand that kind of 
logic; believe me, if you wish to succeed in practice, you must give up 
such an idea; you must study nature a little more, and books and journals 
less. All the medical world of Europe is progressing; but we are still 
tied down to grey powder, and oceans of physic, and bleeding, whereas 238 
BRAIN. 
what is required is that we follow the vis medicatrix and take advantage 
of the hints she affords us ! Well, then, so much for that; now for a case 
of “ ramollissement” as it is called. About two years ago, a physician 
called on me ; he said, “ You are wanted down to so-and-so (150 miles in 
the country). Mr. So-and-so (a rich country nobleman) has forced a 
catheter through his urethra; the poor gentleman has got ‘ ramollissement 
you know that we are not so uneasy about; that is incurable of course ; if 
you can do any thing for it, well and good ; but his faculties are com- 
pletely gone.” Well, to make a rather long story short, Sir B. Brodie 
and I saw him, and a fortnight after he came up to town, to his residence 
in Belgrave Square, and I had nearly the entire management of the 
case. 
It is exactly in this sphere of life, of rich noblemen, merchants, or politi- 
cal men in the fashionable West End squares, that we can alone catch 
glimpses of these two opposites—viz., the excess of high living, and the 
excess of Sangrado bleedings and starvation or low living of us the doc- 
tors ! Many of these cases are probably “ heart disease,” and a patient 
dies of a fainting tit, called weak brain, but it is weak heart! Well, the 
more I came to look at this case of this gentleman, the more I said to my- 
self, the man is dying of exhaustion. I noticed he was better after dinner; 
I heard that he had had convulsions; this did not frighten me. Now, I 
want to ask you a curious question ; have you ever seen a sheep killed ? 
If not, I would advise you the next time you are near Aldgate market, just 
to look at the thing for yourselves. Just before all the blood is gone from 
the sheep, it is horribly convulsed ; remember that fact also in weak children 
who are convulsed. Convulsions, in fact, as you will meet them in prac- 
tice, are eight times out of ten the result of a very irritable state of the 
medulla oblongata or chord, which causes very slight irritations elsewhere 
to excite violent reflex or convulsive movements; thus, worms or indiges- 
tible food will cause convulsions where the nervous centres are weak or 
irritable. This condition of convulsions to my mind is almost always one 
of “exhaustion” rather than congestion ; just mind that fact when you go 
into practice—convulsions, as caused by amemia, or “ exhaustion.” 
But to go on with the case, I could not find that this gentleman had had 
any tonic treatment. I knew that if the brain be anaemic, it cannot go on 
long in a normal manner, for nine out of ten cases of “ ramollissement” 
are due to anaemia; so I decided to let him go back to his old mode of 
living. I gave him a pint of claret a day, that he was accustomed to, in 
place of water-gruel! lie seemed to improve on it. The i-atiocinations 
of his friends did not come true that it would kill him, so we let him have 
also quinine and iron in place of leeches and water-gruel, and grey powder, 
and antimony, and mindererus ! 
I studied the case for a short time ; there was a manifest improvement 
every week. I was called on one day; he was a little worse ; did I bleed 
him ? No : I had the experiment with the sheep in my mind ; he is a gen- 
tleman of very great eminence. It would have appeared very brilliant in 
a “ bulletin,” like the brilliant operations elsewhere, that we came up the 
fifty-ninth minute of the last hour of his sad existence and opened the 
carotid or temporal, but I did nothing of the kind : I increased his wine. 
Well, at the expiration of three months, that gentleman made a political 
speech that utterly astonished his constituents. He can now ride to the 
fox-hounds as well as ever he did, and in the changes and chances of Par- BKEAD, 
239 
liament has filled a very important place; he is in fact, to all intents and 
purposes, cured! 
I have had now nine or ten of these cases of ramollissement; they all 
have had slow pulse—a condition always improved by tonics. The heart 
is perhaps at the root of the disease rather than the brain ; some of these 
patients had alarming syncope—that is heart, depend on it, not brain. I 
met Dr. Latham and Dr. Fergusson with one case, and we had a good deal 
to do to give force to the heart and pulse. 
Now, 1 do not want at all to say—that in some of these very cases we 
may not have had “ ramollissement.” I merely contend for the position, 
that leeches, oceans of physic, and starvation, are not the proper remedies. 
I will only say a few words relative to another case, which was seen by 
three of our ablest physicans in London—two pronounced it “ ramollisse- 
ment,” and the third “ tubercle.” I think tubercle in the brain is a very 
rare disease in adults; this patient had excessively weak pulse; he had 
married late in life. 
I gave him wine and the ferro-citrate of quinine in large doses—a 
remedy I have great faith in. Well, in three months he was quite recovered. 
I have said already I do not believe this disease to be of the nature of 
inflammation; with heat, pain, redness, swelling, etc., it strikes me as 
rather of the nature of gangrene, and as arising from anaemia, not hyper- 
aemia. This last gentleman, I ought to say, had an issue ordered for him 
in Dublin. Well, I have no objection to an issue in these cases, nor am I 
frightened at stopping an issue. There is something of the fabulous about 
what is written and taught in lectures as to stopping issues. This gentle- 
man’s issue healed up, or rather I took off the plaster, and never had that 
abiding faith in its efficacy that would induce me to put it on again. In 
the earlier stages an issue may do good; it can at least do no positive 
harm, like other things which have had more than a questionable charac- 
ter, as specifics for “ ramollissement;” indeed, specifics so called, which 
unquestionably have hurried many patients to their graves, and which I 
would implore you to consider well in all their bearings before you adopt 
them. Part xxxvii., p. 34. 
BREAD. 
Pharmaceutical Bread.—ft. Flour 3 lbs. Imperial; cold water, 11-2 
pint Imperial; sesquicarbonate of soda, 1-2 oz. (troy weight) ; hydro- 
chloric acid, 5 fluid drachms ; a small quantity of salt, if required. 
Mix the soda perfectly with the flour, and the acid with the water, then 
the whole intimately and speedily together, using a flat piece of wood or 
spaddle for that purpose, in preference to the hand. It may be made into 
two loaves, and put into a quick oven immediately. It will require about 
an hour and a half to bake. Part v., p. 81. 
The Bran Loaf for the Use of Diabetic Patients.—Dr. Garrod, in his 
lectures on diabetes, recommended the following formula : 
Take a sufficient quantity (say two or three quarts) of wheat bran, boil 
it in two successive waters for ten minutes, each time straining it through 
a sieve, then wash it well with cold water (on the sieve), until the water 240 
BKEAST. 
runs off perfectly clear; squeeze the bran in a cloth as dry as you can, 
then spread it thinly on a dish, and place it in a slow oven—if it be put in 
at night let it remain until the morning, when if perfectly dry and crisp, 
it will be fit for grinding. The bran thus prepared must be ground in a fine 
mill, and sifted through a wire sieve of sufficient fineness to require the use 
of a brush to pass it through ; that which does not pass through at first, 
must be ground and sifted again, until the whole is soft and fine. 
Take of this bran-powder 3 ounces Troy, 3 fresh eggs, 11-2 ounce of 
butter, rather less than half a pint of milk; mix the eggs with part of 
the milk, and warm the butter with the other portion; then stir the whole 
well together, adding a little nutmeg and ginger, or any other agreeable 
spice. Immediately before putting it into the oven, stir in first 35 grains 
of sesquicarbonate of soda, and then 3 drachms of dilute hydrochloric 
acid. The loaf thus prepared should be baked in a basin (previously well 
buttered), for an hour or rather more. 
Biscuits may be prepared as above, omitting the soda and hydrochloric 
acid, and part of the milk, and making them of proper consistence for 
molding into shape. 
If properly baked the loaves or biscuits will keep several days, but 
should always be kept in a dry place, and not be prepared in too large 
quantities at a time. Part xxxv., p. 303. 
BREAST. 
Engorgement of.—Iodide of potassium, recommended by Lisfranc. 
Vide Art. “ Iodic Preparations.” 
Painful Affections of the JBreasts—Acetate of Lead.—Dr. Smyth, in 
directing the attention of the profession to the use of acetate of lead in 
certain cases of obstinate diarrhoea, remarks as follows : 
It has been found, that a solution of acetate of lead is capable of almost 
immediately stopping the vermicular movement of the intestines, if brought 
in contact with their coats; and it is well known that it possesses also the 
power of allaying the pain of inflammation when directly applied to an 
inflamed surface. Indeed, the quietude, and immediate relief from suffer- 
ing, which I have occasionally observed to follow its application in some 
painful affections, especially of the mamma?, occurring in women about the 
middle period of life, have often astonished me. Even the lancinating 
and burning pain of carcinoma is sometimes greatly mitigated by the 
steady application of the diluted solution of diacetate of lead of the Phar- 
macopoeia. These effects, then, it must be admitted, are evidently the 
result of a sedative action exerted directly on the nerves of the parts to 
which the remedy is applied. 
The officinal preparation is decidedly much too weak. For painful 
affections of the breasts, it should be made at least double or treble the 
strength of that ordered by the colleges; and it is likewise of great ad- 
vantage to apply it a little 'warm. If these precautions be attended to, it 
will be found much more effectual as a sedative. Part xiv., p. 87. 
Lymphatic Tumor of the JBreast.—The absorbent vessels on the upper 241 
BREAST. 
part of the breast leading to the axilla, are subject to a disease character- 
ized by a painful, tender, and irritable swelling, and consisting of several 
cord-like indurations, at some times disposed in parallel rows, at other 
times connected after the manner of an anastomosis. parts of the 
breast are occasionally the seats of this affection ; and in whatever situa- 
tion it occurs, the swelling is transverse, following the direction of the 
absorbents toward the axilla. On a superficial examination, the tumor 
may escape detection; but it can always be discovered by taking the sus- 
pected parts between the fingers and thumb. When the pain and tender- 
ness are extreme, the absorbent glands in the axilla, and more rarely be- 
Ioav the clavicle, become enlarged from irritation. These glandular en- 
largements always disappear after the original disease has subsided: the 
lymphatic swelling in the breast also frequently retires, leaving no vestige 
behind it. In extreme cases, however, a permanent thickening takes 
place, occasioned by the deposit of lymph in the cellular membrane. This 
disease usually attacks females between the ages of fifteen and thirty-five, 
and is liable to recur repeatedly, where the constitution is in the peculiar 
state predisposing to it. 
The condition to Avhich I allude is that of comparative emaciation, ac- 
companied with irregular or deficient menstruation, depression of spirits, 
and general debility. Hence suckling and chlorotic women are most fre- 
quently the subjects of attack. In some instances the patients are inclined 
to attribute the origin of the disease to external violence ; in the majority 
of instances, however, if not in all, it has appeared to me to proceed from 
imperfect menstruation. 
The size of the tumor in the mamma varies from that of an almond to 
that of an adult thumb; and the pain and tenderness attending it are of a 
remittent character. In some rare cases it attains nearly the size of a pul- 
let’s egg in large and plethoric mammae. 
The natural termination of the disease, in severe cases, when the special 
treatment adapted for its cure is not employed, is in a painful and obsti- 
nate ulceration, which, in external appearance, has a considerable resem- 
blance to that proceeding from scrofula, the absorbent glands in the 
vicinity being enlarged, tender, and painful, and the discharge copious. 
Before ulceration commences, the cellular membrane subjacent to the skin 
becomes indurated ; this induration is gradually softened, the skin assumes 
an inflamed appearance, and a small chronic, scrofula-like abscess is the 
result. The ulcer which follows resists all local treatment until the proper 
constitutional remedy is adopted. 
Diagnosis.—The discrimination of this disease from others resembling 
it is not difficult. From the chronic mammary tumor, described by Sir A. 
P. Cooper, it may be distinguished by the pain and extreme tenderness, 
by the vitiated state of the patient’s health, by the absence of lobes and of 
any cyst, and by the disease invading the breast of suckling women, more 
frequently than those of virgins. The condition of the uterus, too, is 
widely different; in the mammary tumor, a state of excitement prevails, 
in the lymphatic tumor, a deficient circulation takes place in that organ, 
manifested by the discharge of an imperfect secretion, or false membrane, 
from its mucous surface. 
From the irritable tumor, and neuralgic state of the breast, this disease 
may be known by the transverse, parallel, or anastomosing, cord-like 
bands, which are always present, by the remission of the pain and tender- 242 
BREAST. 
ness, and by the latter symptoms being confined, as far as regards the 
breast, to the immediate locality of the tumor. The diagnosis in the ex 
animation of very large breasts is sometimes difficult. 
Treatment.—When the pain and tenderness are excessive, leeches and 
evaporating poultices may be applied to the integuments over the tumor. 
In general it will be found unnecessary to adopt any local remedies, as the 
pain is not acute, but usually of an aching kind, like that accompanying 
rheumatism or phlegmasia dolens. The patient should take some prepa- 
ration of iron twice daily, have the bowels relieved by an aloetic aperient, 
if needful, and use a generous diet, and gentle exercise in the open air. 
Should suckling have been long continued, the infant should be weaned, 
especially if the patient has been the mother of many children. By attend- 
ing to these directions, the tumor will entirely disappear in a few weeks, 
or all uneasiness will be so far removed that the patient will feel no incon- 
venience from it, unless the constitutional and uterine derangement should 
recur. . Part xviii., p. 304. 
Sero-cystic Sarcoma of the Mammary Gland.—In this case, Mr. Law- 
rence states, a lady aged 55, of naturally pale complexion and nervous 
temperament, noticed, 30 years ago, a small tumor in the right breast, the 
size of a filbert, which remained stationary, however, causing no inconve- 
nience, until four years ago, when it slowly increased, and became occa- 
sionally painful. About the spring of the present year it had attained 
considerable size, the integument covering it being raised into irregular 
prominences, and discolored. Then ulceration ensued, and from the open- 
ing protruded a red fungous mass, from which rather free bleeding took 
place on three or four occasions. Mr. Lawrence removed the tumor, which 
he describes as follows : 
The right breast is enormously enlarged, the increased bulk being caused 
by a diseased state of the mammary gland. About one-half of the swell- 
ing at its base is covered by integument, thinned by distention, but not 
unhealthy nor morbidly adherent. The other half is a vast fungous pro- 
trusion, measuring about eight inches, in its transverse diameter, by five 
or six in the vertical direction. This is bounded by a raised collar, the 
thickness of the thumb, in which the integument and the diseased mass 
are completely blended. The exterior and the convexity of this elevated 
boundary are covered by a thin and perfectly smooth epithelium. The 
interior surface, and the excavation which it bounds, are nearly smooth 
and raw. Before removal it was a pinkish red, and not very sensitive; it 
yielded a thin yellow discharge, not offensive, but so abundant as to re- 
quire change of dressing three or four times in the day. The mass, being 
pendulous, lay over the lower part of the chest and neighboring portion 
of the abdomen, of which the integuments, constantly wetted by the dis- 
charge, were bright red and partially excoriated. 
The breast, which was not painful when examined, was movable upon 
the subjacent parts, and there was no glandular enlargement, nor any trace 
of disease in the axilla. The health was good ; the patient slept well, had 
a fair pulse, and ate and drank with appetite. 
The patient having assented, the operation was performed October 9. 
She was placed on a couch in the recumbent posture, and chloroform was 
administered. The breast having been drawn up and well supported, in 
consequence of its size and overhanging position, by a folded towel, the BKEAST. 
243 
under incision was first made and the skin turned back: then followed the 
upper incision, carried along the body of the swelling, so as to form a flap 
nearly three inches wide, when the whole mass was readily separated, by 
a few strokes of the knife, from the loose and healthy areolar tissue which 
connected it to the subjacent pectoral muscle. Several arteries bled 
freely, but were quickly secured, so that there was no considerable loss 
of blood. The edges of the wound came nearly together, and the patient 
was put into bed. There was some bleeding in the evening, caused by 
sickness, with vomiting; but it ceased on the application of cold, and she 
passed an excellent night. 
The breast, which weighs 2 lb. 6 oz., presents, at its base, a firm lobu- 
lated mass. I now cut into it through the middle, to show you the 
internal structure. You see that it has undergone that morbid change 
called cystic sarcoma. It is a firm lobulated mass, composed of various 
sized cysts, filled, in the specimen now before you, with a soft, friable, 
vascular substance of light yellowish grey color. The cyst-walls, having 
been distended and thinned, have given away, and have allowed the pro- 
trusion of the red fungous growth, which, with everted edges, occupied 
the front of the patient’s breast. The nipple is concealed amongst the 
folds of integument. 
The disease, which is of innocent nature, commences by enlargement of 
the lactiferous tubes in the substance of the gland. These become tortuous 
and varicose, and the naturally oily secretion which they contain is con- 
verted into a thin watery fluid. 
Upon dividing a breast so degenerated, we observe escaping from the 
different cysts fluids differing in consistence and color—in some parts thick 
and glutinous, in others oily, in others limpid and watery. The fluid may 
be either clear and transparent, or of various shades, from a light yellow to 
a deep brown tint, from admixture of blood. 
As contrasted with the extirpation of a breast affected with scirrhus, the 
operation of removing one of these innocent tumors, which are always 
loosely connected to the neighboring structures, is compai-atively easy. In 
the present case, the diseased parts were firmly connected only in one spot, 
where the areolar tissue was thickened, probably from the weight of the 
mass. In malignant diseases, the infiltration of morbid deposits always ex- 
tends beyond the structures first affected. Hence it is often necessary to 
make the incisions at some distance from the obvious circumference of the 
tumor, and to include a considerable portion of integument, the removal 
of which prevents the approximation of the edges of the wound, and in- 
volves the necessity of our leaving an open surface of considerable extent— 
a condition which adds to the patient’s danger, especially when the wound 
is situated over a cavity containing such important organs as those of the 
chest. Part xxii., p. 295. 
Scirrhous Degeneration of the Mammary Gland.—The patient in this 
case was a nervous irritable woman, aged 45, a sufferer from rheumatism. 
The disease in the breast was discovered by accident, giving no uneasiness 
for some time; at length, occasional darting pains were experienced, extend- 
ing toward the shoulder. External examination detected partial indura- 
tion of the gland, extending from the nipple upward and inward; the rest 
of the organ seemed of healthy appearance. Mr. Lawrence extirpated the 
whole breast in the usual manner. He remarks: 244 
BKOMENE. 
My object in directing your attention to this case is especially with re- 
ference to the question, whether in partial scirrhus of the mammary glands, 
we should extirpate the entire breast, or only that portion of it which we 
feel to be affected. 
There exists, in my opinion, sufficient grounds to lay it down as a rule, 
that in all cases of cancerous degeneration of the mammary gland, in which 
an operation is a proper measure, the entire breast should be extirpated. 
If a portion only be removed, we run the risk of leaving behind some part 
which, though small in size, is either equally diseased, or is in a state likely 
to take on this morbid action, although there may be no cancerous matter 
absolutely deposited at the time. Part xxii., j-j. 296. 
Ulcerated Cancer of the Preast—Dr. James ArnotVs Freezing Pro- 
cess.—Place equal parts of salt and well-pounded ice in a gauze bag, hav- 
ing the margins attached to a gutta percha ring. By gently touching the 
part to be rendered insensible for a minute or two with the bottom of the 
bag, the surface becomes suddenly frozen, and the pain of course disap- 
pears. To obviate the tingling sensation which is apt to ensue upon the 
return of sensibility, ice without salt is to be used, and thus no uneasi- 
ness whatever is experienced. 
Dr. Arnott has proposed that his process should, in certain operations, 
take the place of chloroform; but it is plain that insensibility can hardly 
be carried deep enough for the generality of operative purposes. Where, 
however, a thin stratum only is to be implicated, it might certainly be used 
with advantage. To relieve the pain of cancer, it seems to deserve atten- 
tion at the hands of those who have to prescribe the palliatives which are 
so indispensable in that melancholy affection. Part xxv., p. 300. 
Chronic Abscess of the Preast and Milk Fistula3.—The sinuses from 
this disease usually run in several directions through and behind the gland, 
and are very difficult to close. In a case under Mr. Birkett, poultices were 
applied until the irritation was diminished, and then three grains of iodide 
of potassium in § j. of infusion of gentian was taken three times a day. The 
breast was wrapped in lint spread with ung. plumbi iodidi, and the whole 
supported by a bandage. In a fortnight afterward all these sinuses were 
injected with the tinct. iodini, by means of a tube carried to the end of the 
sinus. In three weeks afterward the sinuses had completely healed. If the 
skin of the nipple in a pregnant patient should be found delicate, Mr. Bir- 
kett advises the application daily of alum wash, or some other astringent. 
This plan will prevent irritation following. Sometimes milk abscess de- 
pends on the non-development of the nipple. In this case a shield should 
be provided beforehand, and the patient properly instructed as to its use. 
Part xxvii., p. 203. 
Mammae—Galactagogue and Emmenagogue Effects of Warmth and 
Stimulants to.— Vide Art. “ Galactagogue.” 
BROMINE. 
Bromine and its Preparation*.—Bromine and its preparations havo 
been shown by the experiments of Magendie, Barthez, Brame and others, BRONCHITIS. 
245 
to possess therapeutical properties as nearly as possible identical with 
those of iodine and the iodides. 
Mr. O’Reilly having had his attention called to the peculiar properties of 
the mother waters of many brine springs in the United States—the result 
of their evaporation for procuring common salt, found by experiment that 
they contained bromine in large quantities—nine drachms in every gallon. 
The forms in which it has been used on the continent are, in the simple 
state much diluted, and combined in the form of bromides with potassium, 
barium, calcium, iron, and mercury. These preparations are made by 
processes exactly similar to those used for procuring the corresponding 
combinations of iodine. As a substitute for the tincture of iodine, 
M. Pourche has employed the following solution; bromine, one part; dis- 
tilled water, forty parts; dose, from five to six drops in some aqueous 
vehicle, three or four times daily. For external use he employs a solution 
four times as strong as this. The bromide of potassium is very soluble in 
water, sparingly soluble in alcohol; the dose of it is from four to eight 
grains three times a day: to prepare an ointment from it, four parts are 
rubbed up with thirty-two parts of lard; and if a stronger ointment or 
one resembling the compound iodine ointment be wished for, six drops of 
bromide are added to this. The bromide of barium is also souble in 
water; the dose of it is from one to five grains three times a day ; the 
ointment is prepared by combining it in the proportion of one part to ten 
of lard. The bromide of calcium is prescribed in the form of pill made 
with conserve of roses ; the dose of it is from three to ten grains. The 
bromide of iron is a brick-red deliquescent salt, very soluble in Avater; it 
is not so easily decomposed as the iodide of iron, and is given usually in 
the form of pill made with conserve of roses and gum arabic; the dose of 
it is from one to three grains ; it has been employed externally, also in 
the form of ointment, prepared with one part of the bromide to fifteen of 
lard. Two bromides of mercury have been used ; the first, a sub-bromide, 
is white insoluble powder : the dose of it is one to two grains daily: the 
second, a bromide, is fusible and volatile, and soluble both in water and 
alcohol: its dose is one-sixteenth of a grain, gradually increased to one- 
fourth of a grain, daily. All the preparations of bromine may be readily 
known from those of iodine by their not disengaging violet-colored 
vapors when concentrated sulphuric acid is poured on them. In France, 
bromide of potassium has been of late fraudulently sold for iodide of 
potassium, in consequence of the high price of the latter; a sophistication 
of but little importance, if, as we are inclined to believe, the medicinal 
action of both be identical. Part, xiii., p. 1*72. 
Bromine— Uses of.— Vide Art. “ Hepatic Affections.” 
BRONCHITIS. 
Acetate of Lead, Lobelia, etc., in Bronchitis.—The administration of ace- 
tate of lead is recommended by Ur. Henderson, in that period of bronchitis in 
which evidences of abundant secretion exist. The acetate may be alternated 
with antimony, ipecacuan, calomel, or such remedies as the exigencies of 246 
BRONCHITIS 
each case demand. The common doses for children have been, according 
to the severity of the case, a quarter, half, or whole grain, from eight to 
ten times a day. In chronic, mucous, and muco-purulent bronchitis, the 
acetate of lead may be given in pill, combined with squill, and extr. of 
hyoscyamus, three or four times a day. 
In reference to the relative merits of act. of lead, and tincture of lobe- 
lia, in the treatment of bronchitis, the editor observes : 
If the acetate of lead is capable of thus checking the great secretion of 
mucus in bronchitis, of course we need not have recourse to expecto- 
rants to get rid of it; but we doubt whether the powers of this medicine 
are quite equal to what Dr. Henderson here relates. At any rate, we 
feel convinced that in many cases, expectoration is highly conducive to 
the recovery of the patients, and it would be highly injudicious to check 
it. “ Inflammation of a mucous membrane,” says that eminent physician, 
Dr. Williams, “ involves a certain structural change, probably interstitial 
effusion, that can be relieved only by a free secretion from the inflamed 
membrane—expectoration is a necessary process.” And for this reason we 
would strongly recommend to the profession the lobelia inflata, which, 
from many years extensive use, we have found to surpass all other medi- 
cines as an expectorant. In our opinion it is far superior to ipecacuan, 
squill, tartarized antimony, and all other expectorants now in common use. 
The way we prepare the tincture, is by macerating for 14 days, three 
ounces of the lobelia inflata in three pints of proof spirit. We give from 
15 minims to half a drachm of this tincture to an adult every few hours, 
and in the latter stages of the attack, when the system is sinking, and the 
peculiar blue appearance of the skin is increasing, we combine small, and 
gradually increased doses of the carbonate of ammonia, which enables the 
patient more effectually to clear his bronchial surfaces. In this effect of 
ammonia, we agree with Dr. Williams, who says that he “ is disposed to 
think that it is more than an ordinary stimulant, and acts in an especial 
manner upon the bronchial membrane.” 
The dose of this tincture of lobelia to an infant is about 10 drops, gra- 
dually increased till vomiting is produced; we have frequently been 
astonished at the ease with which the mucus is expectorated after this 
medicine has been taken. It seems to have the soothing effects of to- 
bacco, as well as its expectorant virtues, after the peculiar irritation which 
it invariably produces on the fauces has subsided. We have found it more 
especially useful in infants and young children who are so liable to bron- 
chial affections. It seems to act like a charm when the early acute symp- 
toms have in some measure subsided, and when the membrane is so 
loaded with mucus, or otherwise thickened, that decarbonization of the 
blood is no longer properly performed; the blue, livid color of the sur- 
face will often rapidly disappear, and a more healthy hue take its place. 
We have not perceived the same powerful effects produced so regularly 
and invariably by ordinary emetics, and this we have accounted for, by 
supposing that it must be both an expectorant and a sorbefacient, com 
billing as it were, the effects of opium and ipecacuan. Part i., p. 76. 
Counter-irritation.—-As a counter-irritant in bronchitis, recommended, 
a liniment composed of one ounce of strong acetic acid, and two ounces of 
spirits of turpentine, shaken together, and freely rubbed upon the chest, 
pro re natd. Part ii., p. 23. EROTTcnrns. 
247 
Extract of Monesia.—The preparation of monesia, which has been 
most frequently used, is the extract in the form of pills, in doses of from 
12 to 36 grains during the day. Part ii., p. 77. 
Poultices.—In the bronchial irritation attendant upon the exanthema- 
tous fevers, poultices to the chest are recommended ; also to the extremi- 
ties, when want of energy appears to exist in the system, preventing the 
coming out of the eruption. Part iii., p. 42. 
Colchicuni Autumnale.—Dr. Lewins observes : It is reasonable to infer, 
from the powerful influence which colchicum possesses in diminishing vas- 
cular and nervous exitement, and from its effects on the excretory organs 
of the body, and probably in the way of equalizing the circulation, that it 
may be useful in many local inflammations, both acute and chronic, so as 
to become a valuable auxiliary to the lancet; and in some instances en- 
tirely to supersede its use. So long ago as 1820, Mr. Iladen published a 
work on this subject, in which he has related cases which prove, as we 
might have expected, the meadow-saffron to be a remedy possessed of 
great power in relieving such states of the system. He employed it prin- 
cipally in pulmonary and laryngeal inflammation with decided advantage ; 
and in such cases, he seems almost entirely to have trusted to its effects, 
to.the entire exclusion of blood-letting. Although I am not so sanguine 
as to expect that, in acute forms of such diseases, we can depend upon col- 
chicum alone, yet, from what I have seen, I speak with confidence when 
I state that, with the exception of depletion, there is no remedy capable 
of producing more beneficial results; and in many sub-acute inflammations, 
more particularly, the evacuation of blood need be very limited in extent, 
if promptly followed by the judicious administration of colchicuni. In 
pleurisy, pneumonia, bronchitis, and croup, I have seen the most decided 
benefit result from its employment. Part iv., p. 13. 
Treatment of Pronchitis.—Dr. Williams remarks as follows: In the 
sthenic form, where there is a hard, full pulse, with heat of skin, there is 
no doubt of the propriety of using the great remedy for inflammation— 
that is, blood-letting, both general and local; but it is not to be used ex- 
tensively, for the patient does not bear the loss of a large quantity of blood. 
Moderate bleedings give relief, but it is not permanent. Small blood-let- 
tings from the arms, and cupping between the shoulders are necessary. 
W e must, in fact, rather consider that the true termination of this inflam- 
mation is by expectoration, as this is the natural mode in which the ves- 
sels relieve themselves. And it is very rare that we can stop this termi- 
nation by any kind of blood-letting. The remedy most useful, and perhaps, 
even above blood-letting, because it is more safe, is tartarized antimony, 
given in doses of from a quarter of a grain to half, or even a whole grain, 
every three or four hours, in combination with hydrocyanic acid, to pre- 
vent the cough, or digitalis, if the pulse is frequent and hard, or colchicum, 
if the urine is particularly scanty ; and generally combined with narcotics, 
to quiet the severity of the cough. -It is not advisable to give narcotics in 
the first stage. The effect of opium is to check the expectoration and in- 
crease the pulmonary congestion. You must not, therefore, combine 
opium with tartar emetic as an expectorant. Opium should be given with: 
belladonna and stramonium. It may be given in combination with calo- 
mel, in the sthenic as well as the asthenic form, where the stomach is too 248 
BRONCHITIS. 
irritable to bear antimony, and where there is great tenderness at the epi- 
gastrium, and some signs of fullness, a very much loaded tongue, and dis- 
ordered evacuations. Here calomel or mercury, together with small doses 
of opium, are often highly useful. Blisters are not suited to the sthenic 
state of bronchitis, where the heat of skin continues, and the pulse is very 
strong and hard ; but even in this stage some forms of irritation may be 
useful. I have seen tartar emetic in this case rubbed over the surface of 
the chest, produce a copious pustulation, affording more decided relief 
than blisters. After rubbing in the tartar emetic with a piece of flan- 
nel, place a bit of flannel, soaked in the solution, on the chest; then 
place a piece of macintosh cloth over it: this has the effect of keeping 
up an action like a warm poultice. This is actually an irritating poultice, 
and causes pustules in great quantity. This may be used where the 
strength is too low to bleed ; and where you do not like to apply blisters, 
which often increase the fever, until the blisters rise. But when 
the inflammation has given way, in some degree ; when the pulse has 
lost its hardness, and the skin has lost its heat; and something like 
lividity begins to appear; when the expectoration becomes somewhat 
opaque, then blisters may be used freely, and give most effectual and 
permanent relief. Small blisters often cause quite as much irritation 
as large ones, but they do not produce that effectual discharge on which 
the great efficacy of the blister depends. In this case, too, as the acute 
stage begins to decline, and the symptoms become more asthenic, then it 
is of great consequence to give remedies to promote the act of expectora- 
tion. The remedies most useful are salts and senna, citrate of ammonia, 
and, where there is great difficulty in the expectoration, carbonate of am- 
monia and squill, and various other means to keep up the strength. It 
becomes sometimes necessary to give not only carbonate of ammonia and 
ether, and other stimulants, but, where the patient is gasping for breath, 
you must give brandy and wine to keep the patient alive. The good 
effects of this treatment are genei'ally manifest in the general symptoms 
before they become perceptible in the physical signs. The pulse becomes 
firmer, and the countenance improves—becoming less livid, the breathing 
less laborious, and the expectoration more easily thrown off; after a time 
the improvement is indicated by the physical signs. The greatest care 
should be observed in the employment of the antiphlogistic treatment, in 
the asthenic form of bronchitis. Cupping, or a few leeches, or blisters, in- 
stead of drawing blood, may be used in the early stage. Tartarized anti- 
mony, too, may be given with some stimulant expectorants—salts of am- 
monia and others. Opium may be more freely used in the asthenic form 
of bronchitis. A succession of blisters applied to the chest is often useful, 
where the expectoration is excessive, and of a somewhat purulent charac- 
ter, and without fever; it is sometimes also useful to employ mineral 
acids, and in these cases it is often found that the inhalation of iodine va- 
por is useful. In most cases it is proper to use purgatives and expecto- 
rants. Narcotics may be given from time to time. It is of great conse- 
quence, in chronic cases, to attend to the general state of the functions, 
and if there is anything like gastro-enteric disorder, to give small doses of 
mercury to conduce to the proper action of the liver and keep the bowels 
open ; and to remove any gouty tendency that often occurs in combina- 
tion with chronic bronchitis, one of the best remedies is colchicum. It is 
important to observe carefully the diet. Chronic bronchitis, in young BRONCHITIS. 
249 
persons, may follow measles, small-pox, and scarlatina, and this is a more 
serious form of disease, because the inflammation is here more intense. 
Part vii., p. 79. 
Inhalation of Ammonia Gas.—The inhalation of ammonia gas in cer- 
tain states of the mucous surfaces, has-been recommended by Mr. Smee. 
When we allow the fumes of ammonia to come in contact with the eye or 
nose, we are aware of their stimulating property; there instantly follows 
an increased secretion from the mucous suiffaces. When the same vapor 
is admitted into the mouth, we find that the glottis does not resist its in- 
trusion, and it is found to pass into the innermost recesses of the lungs, 
and instead of producing disagreeable effects, causes sensations which are 
extremely grateful. The effect of this inhalation is to cause the dry pas- 
sages to be lubricated with an increased secretion of mucus, and the pre- 
viously inspissated phlegm is now loosened and easily expectorated. This 
seems to be a valuable suggestion in many cases of chronic bronchitis, 
where wo are in the habit of combining the sesquicarbonate of ammonia 
with the several expectorants. The liquor ammoniae in common use, is 
generally strong enough, but it is perhaps better to commence with a 
weaker solution. If the liquid be placed at the bottom of a common 
bottle, the patient may apply his lips to its mouth, and draw in his breath, 
when he will inhale a certain quantity. Two, three or four inspirations 
will in general be sufficient at one time; but this may be repeated several 
times a day. A more convenient apparatus, however, is the common in- 
haling bottle, sold in most shops, and now generally used for the inhalation 
of the vapor of iodine, conium, and other medicines. Since the publication 
of Mr. Smee’s paper, we have tried the same thing in that peculiar dryness 
of the fauces, which often accompanies affections of the kidneys, and 
especially diabetes, and we may add that it has been attended with con- 
siderable though temporary relief. It may also be used in chronic 
hoarseness, in a relaxed, swollen, and oedematous state of the mucous mem- 
brane resulting from various causes; in cases of incipient cynanche ton- 
sillaris, in syphilitic ulcerations of the throat, in old standing cases of 
asthma. Of course we need not add that it would be deleterious in all 
cases where acute inflammation is going on. Part vii., p. 64. 
Bronchitis complicated with Mheumatism.—The following mixture 
advised: 
Almond emulsion, eight ounces ; vinegar of colchicum, half an ounce ; 
acetate of morphia, one grain; nitrate of potash, half a drachm; mix. 
Dose—half an ounce every hour, or every two hours. 
If colchicum does not relieve in two or three days, advised to have re- 
course to mercury. Part viii., p. 25. 
Naphtha and Naphthaline.—It is considered quite probable that many 
cases which have been related as phthisical, in which naphtha was found 
so beneficial, were cases of acute or chronic bronchitis, of more or less se- 
verity, in which many of the physical signs of phthisis might be present, 
but where the real disease was absent. 
The dose cf naphtha, as stated in Mr. Wilson’s paper, was ten drops, 
gradually increased to twenty, three times a day. In cases of chronic 
bronchitis this remedy may prove valuable. 
When a little naphthaline is applied to the tongue, it causes a peculiar 250 
BRONCHITIS. 
heat and pricking sensation, which extends down the throat and bronchial 
tubes, and, exciting a spasm of the latter, ends in inducing a cough. It 
may be used in the form of a syrup, composed of fifteen grains of naphtha- 
line, suspended by a small quantity of boiling alcohol in about four ounces 
of syrup, of which the dose is a teaspoonful every quarter of an hour till 
expectoration is produced; or an electuary may be made, consisting of 
eight grains of naphthaline in half an ounce of any simple electuary, and 
the dose proportioned so as to give half a grain or a grain of the naphtha- 
line every quarter of an hour as before. Part viii., p. 47. 
Counter-irritants in Bronchitis—Recommended to be applied not 
merely over the chest, but to the nape and along the sides of the neck, 
over the epigastrium, and in the course of the cervico-spinal and pneumo- 
gastric nerves generally. 
Dr. Graves thinks that the spirit of turpentine exercises something more 
than a mere counter-irritant action, and proposes the following formula 
for imitation: 
Strong acetic acid, 3ss.; spirit of turpentine, 3iij-; rose water, §iss.; 
essential oil of lemon, a few drops; yelk of egg, sufficient to suspend the 
turpentine. Part viii., p. 80. 
Naphtha in Bronchial Affections.—Whether or not the opinion of dif- 
ferent writers on the use of this medicine in phthisis be perfectly correct, 
there seems to be no doubt that in many cases of chronic bronchitis, which 
frequently bear a strong resemblance to phthisis, it will be found a valu- 
able medicine. A case is related by Mr. Proctor, of Witham, in which, 
after an attack of acute bronchitis, difficulty of breathing, cough, with ex- 
pectoration of a well-marked purulent character, and nocturnal perspira- 
tion existed. There was also great emaciation, with occasional hemopty- 
sis. The following medicine was prescribed: 
R. Naplith. rect., §j.; liq. op. sed., 3ij. M.— of which he took fifteen drops 
three times a day, in a little water. The naphtha was continued for 
about two months, when he reported himself well. Part ix., p. 33. 
Alum in Bronchitis.—Dr. Andrews strongly recommends the use of alum 
in acute as well as in chronic bronchitis. His usual formula is forty-eight 
grains in five ounces of half boiling water, with half an ounce of syrup. 
The dose varies from half a drachm to half an ounce three or four times 
a day, according to the age of the patient. Part xii., p. 76. 
Ipecacuanha in Emetic Doses, a Restorative in Cases of Sinking, 
etc.—Dr. Higginbottom says: I have found an emetic dose of ipecacuanha 
a very valuable remedy at that stage of bronchitis where a sudden low 
or sinking state has come on with oppression at the chest, and the expec- 
toration difficult, endangering suffocation. Vomiting with ipecacuanha 
has not only soon relieved these symptoms, but has roused the whole sys- 
tem, and has produced such a decided change, as to render the patient 
convalescent in a few days. I have never seen the same good effects in 
such circumstances produced by any other remedy. Part xii., p. 136. 
Bronchitis—In Infants.-—Dr. Miller directs, when very severe, to make 
use of the warm bath, and give one grain of calomel and two of ipeca- 
cuanha with a little compound tragacanth powder, every four hours; if 
less severe, three times a day, and lengthen the period as improvement 
takes place. After the first or second dose, the ipecacuanha does not act BEONCHITI8. 
251 
as an emetic. When necessary to apply a blister to an infant, place a 
piece of tissue paper between it and the skin, or dip a piece of blotting- 
paper into acetum cantharidis; apply it to the part, and in ten or fifteen 
minutes you will have a blister. Part xiii., p. 88. 
Bronchitis.—Sometimes there is little or no expectoration during or 
after an attack of bronchitis; but there is a most teasing cough. In such 
case, an opiate is indicated, and may be safely given ; but you must be very 
careful how you prescribe opiates in bronchitis. If the cough is excited 
by the mucus contained in the bronchial tubes, and not by an irritable 
condition of the nerves or their lining membrane, it is nature expelling an 
injurious thing. The mucus must be got rid of somehow, and I do not 
know how it can be got out of the tubes except by coughing. If you 
give an opiate, you paralyze the sensory nerves. You paralyze the mus- 
cular fibres; and, at last, when the mucus has accumulated to such an 
extent that your patient must cough or die, he cannot cough! Old people 
are often complaining of their violent morning cough—as soon as they 
awake they begin ; but it is because mucus has accumulated in the bron- 
chi during the night, and it is only perceived by their mucus membrane 
when sleep ceases—the sentinels have been dormant. But the mucus 
must be expelled, and, therefore, the patient must cough. The plan in 
these cases is to reduce the blenorrhcea; first, by taking care that the 
membrane is not irritated by cold air, and then by suitable remedies. In 
the meanwhile preach patience to your patient, and tell him his cough is 
his safeguard so long as the lungs are clogged with phlegm. Sometimes 
mothers go to a druggist for “ something for a cough ” that their children 
had : they get oxymel of squills and syrup of poppies, give a good dose 
to quiet the babe at night, and in the morning send for the doctor—its 
cough is stopped, it is “ closed in the chest,” its lips become livid, and you 
have to repair the mischief done by the opiate. Part xv., p. 97. 
Chronic Bronchitis and Bronchial Asthma.—Dr. Thompson proceeds 
to notice the remedial treatment recommended by authors, and to show 
that the results are too often unsatisfactory. Antimony given alone is not 
altogether useless; but it is inadequate, and may be carried to such an 
extent as to injure the constitution, without permanently improving the 
condition of the tubes. Counter-irritation, although strongly recom- 
mended, produces only temporary advantage, and superadds to a trying 
malady a painful annoyance. Acids check expectoration, and often occa- 
sions tightness of chest. Opiates, so often given to allay the incidental 
cough, not infrequently induce severe pleurodyne. The plan which Dr. 
Thompson first adopted, some years ago, he has, with certain modifica- 
tions, very extensively employed. It consisted mainly in establishing on 
the bronchial tubes, gently, but rather rapidly, the influence of mercury. 
The formula which Dr. Thompson is accustomed to employ consists of 
blue pill, half a scruple; antimonio-tartrate of potass, one grain ; extract 
of coniurn, one scruple, divided into eight pills. The duration of treat- 
ment varies with the severity of the disease, and the susceptibility of the 
patient; but it is often sufficient to administer one pill thrice daily for 
four days, then twice daily for four days, and afterward every night for a 
week. Under this treatment, the sonorous rhonchus usually disappears in 
a few days, or becomes audible only when the patient takes a deep inspira- 
tion, and the expectoration is rendered less tenacious and more opaque. 252 
BRONCHITIS. 
When the breathing becomes comparatively easy, and the only rhonchus 
heard is the mucus, the mercurial pill may be given less frequently, and 
ipecacuanha, or, in debilitated subjects, compound squill pill, substituted 
for antimony. When all rhonchus has disappeared, some roughness of 
respiratory murmur is often observable, and till this is removed the mer- 
cury must not be suspended, or a relapse would be probable. An occasional 
purgative may be advantageously employed, and when the mercury is 
discontinued, iodide of potassium is often of value in establishing a 
healthy condition of the bronchial membrane. 
Mr. Ilird, as long as he recollected, had been in the habit of employing 
similar remedies to those mentioned by Dr. Thompson in a like class of 
diseases. In chronic cases he abstained from the use of antimony, and 
commenced the use of blue pill, in half or one grain doses, and two grains 
of conium. In young subjects he gave one grain of conium for a dose; 
and when there was a tendency to dropsical effusion, two or three grains 
of squill pill wrere added to each dose. Latterly, in addition to these 
remedies, he had employed dry cupping with the greatest possible advan- 
tage. In old persons, where the expectoration was free, but the body 
debilitated, he used a decoction of senega with ammonia. Mr. Stedman 
had employed the lobelia inflata, in doses of twenty minims of the common 
tincture, as an antispasmodic, in cases in which there w7as but little expec- 
toration. He found, that if there was much expectoration, it was checked 
by the lobelia. Part xv., p. 08. 
Treatment of Bronchitis in Children.—In a mild case, give James’s 
powder with a little calomel and ipecacuanha every four hours, and when, 
as perhaps in twenty-four or thirty-six hours, the child is relieved, omit 
the calomel, and give small doses of antimonial and ipecacuanha wine in a 
mixture. In severer cases, where the child is strong, apply leeches 
beneath the scapulae ; give an emetic dose of tartarized antimony, and 
then by repeated doses keep the child under its influence for a day or 
two. Be very careful, however, not to depress too much by the use of 
antimony, which is not borne so well by children as adults; when the 
medicine ceases to vomit, or is merely regurgitated without effect, and 
especially if the face should be livid, or the pulse faltering, discontinue the 
use of this medicine, or give it at longer intervals with ipecacuanha in an 
emetic dose. Emetics are of great use, especially in the evening exacer- 
bation of the disease, and in the morning when the bronchi have become 
filled with mucus. Nervous dyspnoea may be relieved by a mustard poul- 
tice, and the hot or warm bath, according to the strength of the patient. 
If the disease becomes chronic, give tonics, especially the extract of bark, 
apply a stimulating liniment to the chest, and give an emetic of ipeca- 
cuanha eveiy night; or if there is much secretion, give decoction of 
senega, with ammonia and tincture of squill. Part xvii., p. 83. 
Use of the Seeds of Shellanclrium Aquaticum in Phthisis Pulmonalis 
and Chronic Bronchitis.— Vide “ Phthisis Pulmonalis.” 
JDr. Todd’s Views and Treatment of.—The alterations in the lung which 
chronic bronchitis tends to produce are—first, the immediate changes, and, 
secondly, the remote ones. The immediate changes are those which affect 
the mucous membrane and muscular fibres of the bronchial tubes, as well 
as the tubes themselves; such as inflammation, thickening, altered secre- BRONCHITIS. 
253 
tions—perhaps even ulceration—and also more or less dilatation of the tubes. 
The remote changes are a still further dilatation of the tubes—a dilatation of 
the air-cells; and when that dilatation goes beyond a certain point, a stretch- 
ing, and even a rupture of many of the bands of elastic tissue which are 
found in the lobules. This stretching of the bronchial passages and cells 
gives rise to a corresponding change in the air-cells. The expansion of the 
air-cells causes an extension of the meshes of the capillary net-work distri- 
buted upon and within them; and the rupture of many of the intersecting 
bands of fibrous tissue causes obliteration of their blood-vessels. Thus the 
capillary system of the lung becomes diminished in its capacity, and thus 
is explained the fact long known, that emphysematous lungs are apt to be 
pale, and to look as if they contained but little blood. 
Now, the state to which the lung is thus brought by a long continuance 
of chronic bronchitis, is that which we call emphysema, in which there is 
more or less dilatation of a greater or less number of air-cells, and a conse- 
quent diminution in the area of the capillary system belonging to them. 
Chronic bronchitis, however, is not the sole cause of emphysema, although 
certainly the most frequent. That state of lung will follow repeated at- 
tacks of asthma: and it may be caused by great and prolonged efforts; and 
there are those who believe that it may arise even in the absence of any 
such exciting causes, in persons who have a certain constitutional weakness 
of the lungs, which may be inherited. 
In both the acute and chronic forms of bronchitis one of the most valu- 
able remedies is counter-irritation. This I employ very freely in these 
cases, not so much by blisters as by turpentine or mustard, and there is 
this great advantage in this mode of counter-irritation, that you can apply 
it frequently and at short intervals, and moreover it is immediate in its 
effects, whereas a blister takes several hours to produce vesication, and 
it cannot be speedily reapplied. Dry cupping is also a useful form of 
counter-irritation, and very applicable to such cases as I have mentioned. 
Generally speaking, patients laboring under bronchitis, and especially 
those who have had many attacks, are not very tolerant of a depleting or 
depressing treatment. General bleeding by venesection is, in many instan- 
ces, highly dangerous ; topical bleeding is borne better; Avhen tried, only a 
small quantity of blood should be taken. 
The medicines most applicable to these cases are those which produce a 
free diaphoresis, and expectorants, sometimes sedatives. When the expec- 
toration is viscid, and sticks to the tubes so as to make it difficult of dis- 
lodgment, great benefit often results from the cautious use of tartarized an- 
timony in small doses ; but this must be used only for a very short time, 
as it tends to produce a profuse watery expectoration, and very much to 
weaken the patient; as soon, therefore, as the very viscid character of the 
expectoration is overcome, it should be given up. 
When you wash to promote expectoration without causing any undue 
increase in the quantity of secretion, you will find nothing better than am- 
monia. In bronchial catarrhs, if there be fever, it may be given freely 
with the liquor ammonioe acetatis, and you thus get a copious diaphoresis 
also. I am also in the habit of using the chloric ether pretty freely in 
bronchial attacks, either alone or conjointly with ammonia. It is a valuable 
stimulating expectorant, and has some sedative influence likewise; if not 
given in too large a dose it is an agreeable medicine to take, and forms a 
pleasant ingredient for a cough mixture. The decoction of the polygala 254 
BUNION. 
senega is much lauded for its influence on bronchial affections; I have given it 
very freely, and, except for its unpleasant taste, can find no fault with it, 
nor can I bestow upon it any very strong encomiums. 
With the use of sedatives you require caution, especially with opium. 
Conium, hyoscyamus, hops, etc., are well borne on the whole; but nothing 
relieves irritable cough so effectually as opium ; yet when there is much 
bronchial congestion, you will beware of using it too freely, as it unques- 
tionably tends to increase that, and to endanger the life of the patient. On 
the other hand, when expectoration is free or too profuse, a moderate dose 
of opium often exercises the most beneficial influence, procures sleep, mo- 
derates expectoration, and relieves the cough. The reputation of the old 
paregoric elixir, modernized into compound tincture of camphor, is likely 
to last even through these days of skepticism. 
In the more advanced stages, and especially if there be sweats, tonics 
are useful, and sometimes astringents containing tannin, or even the tannic 
or gallic acid. Part xxv., p. 91. 
Chronic.— Vide Selections from favorite Prescriptions. Art. “ Me- 
dicines.” 
Chronic Bronchitis.—We believe the attacks of this disease to be often 
nervous and spasmodic rather than inflammatory, and the aim of our treat- 
ment should not be to increase the secretion, but to remove the nervous 
condition on which the cough, secretion, dyspnoea and tightness depend. 
For this purpose, banish expectorants, and give small doses of morphia, 
say the one-sixteenth of a grain, four times a day. As a preliminary step, 
remove all sources of irritation, and attend to the liver and bowels. 
Part xxxiii., p. 101. 
Chronic Bronchitis.—In cases of bronchitis of long standing, the follow- 
ing mixture is very useful: Take of tannin three grains ; extract of bella- 
donna three quarters of a grain; extract of conium two and a half grains ; 
infusion of senna three ounces ; fennel-water and syrup of marsh-mallows 
of each one ounce and a half: M. A tablespoonfnl to be taken every two 
hours. Part xxxvi., p. 55. 
Chloroform in Bronchitis.— Vide Art. “ Chloroform.” 
Chronic Bronchitis, Asthma, etc.—In a considerable number of cases 
of chronic bronchitis, asthma, irritable cough, etc., striking relief has fol- 
lowed the inhalation of carbonic acid, and “in several chronic instances 
the benefit has been at once both speedy and permanent.” A common 
wine bottle, with a perforated cork and caoutchouc tube attached, and con- 
taining crystallized tartaric acid, and carbonate of soda, with a little water, 
are the materials required. The end of the tube may be placed in the 
patient’s mouth and respiration be freely performed. The carbonic acid 
acts as a local anesthetic. Part xxxviii., p. 256. 
BUNION. 
Treatment of Bunion.—Recommended that the bunion be kept con- 
stantly covered with lint dipped in warm water, this being well defended BUNION. 
255 
also by oiled silk. The best mode of applying the latter is to cut a strip 
about half an inch in width, and three or four inches long, turning it round 
the affected member. The lint should be changed night and morning, 
and any hardened cuticle should be gradually peeled off. When matters 
are improved, the continued application of the lint will not be necessary, 
but the oiled silk should be constantly worn, to prevent a return of the 
disturbance. Part ix., p. 187. 
Bunion, Ganglion, gte.—Diagnosis and Treatment.—In certain situa- 
tions in the body, says Mr. B. Cooper, it is extremely difficult to form a 
diagnosis of bursae mucosae ; they are sometimes so hard as to be mistaken for 
small exostoses; and by the enlargement of the bursa between the latissimus 
dorsi muscle and the inferior angle of the scapula, a tumor may be formed 
which might be readily mistaken for chronic abscess, steatoma, or even 
malignant disease ; but a surgeon conversant with the character of ganglia 
in their natural state would soon discover the real cause of the swelling. 
On the feet, aud more particularly on the inner side of the root of the 
great toe, an adventitious bursa, termed a bunion, is very frequently 
formed; it is produced by tight and ill-made shoes, which force the great 
toe into an unnatural position, out of the line of the axis of its metatarsal 
bone and under the other toes, in such a manner that the bone of the first 
phalanx presses forcibly on the capsular ligament of the joint, and induces 
the inflammation and acute pain inseparable from this distortion. Unless 
the deformity be remedied, the continued pressure of the bone tends to 
increase the inflammatory action, and ulceration would be the ultimate 
result, were it not for the compensating provision of nature, which leads 
to the formation of a ganglion between the capsular ligament and the skin. 
If, however, the pressure be still continued, it may induce inflammation of 
the adventitious bursa, and an inflamed bunion is the consequence; this so 
completely cripples the sufferer, and the pain is so excessive, that surgical 
aid is here usually sought, although, however, various mechanical con- 
trivances have been px*oposed, and also many different kinds of plasters, 
the object of all being to remove the pressure which has been the original 
cause of the disease. No treatment can prove successful unless the great 
toe be restored to its natural relative position parallel with the others, 
and the most simple and effectual means of effecting this is the one 
adopted by Mr. Key; he recommends that the stocking of the patient 
should be furnished with a division or compartment resembling the finger 
of a glove, to receive the affected toe, a similar compartment being also 
constructed in the inside of the shoe ; into these the toe passes, and is 
preserved in a direction parallel to that of the others; but it may be 
necessary before resorting to the use of this contrivance to subdue the local 
inflammation by the application of leeches, blisters, or evaporating lotions. 
A ganglion on the dorsum of the foot or instep sometimes produces even 
a more serious form of the disease than the bunion. It may cause contrac- 
tion of the extensor tendons of the small toes, permanently extending the 
latter, so that the whole of the weight of the body falls during progression 
upon the first phalanges, in which situation ganglia are found precisely 
similar to that just described as occurring at the point of the great toe. 
If these become indurated by neglect or continued pressure, so that the 
effused contents cannot be let out by puncture, the only alternative left to 
the surgeon is to divide the implicated tendon or tendons, so as to relieve 256 
BUKNS SCALDS. 
the permanent extension of the phalanges, and to restore the toes to their 
natural position. I have known exfoliations of the phalanx to occur as 
the result of this affection, but immediately upon the removal of the ex- 
foliating bone the deep ulcer which had been produced in the sole of the 
foot healed, and the patient at once recovered. Vide Art. “ Bursal Affec- 
tions.” Part xvii.,j!?. 131. 
BURNS —SCALDS. 
Mode of preventing Contraction after Burns.—Mr. Earle remarks: 
To take the upper extremity as an example, I will suppose a case where 
the whole integuments on the inner and front part of the arm and forearm 
have been destroyed. If such extremity be kept carefully extended on a 
splint, not only during the whole process of healing, but long subsequent 
to the perfect cicatrization, you will find that the cicatrized surface will 
diminish in a circular direction, drawing the healthy integuments together 
from side to side, but that no contraction will take place in the long axis, 
in wrhich alone it can impede the due motions of the limb. This permanent 
extension should be persevered in during the day and night, until all 
changes have ceased and the cicatrix has contracted to its smallest dimen- 
sions. Care, however, should be taken during this time to give passive 
motion to the different joints, by which the proper secretion of synovia 
will be kept up, and the eventual free use of the limb will be insured. 
This plan of maintaining the limb in a state of permanent extension should 
be commenced as soon as the wound has begun to granulate. 
Part iii., p. 106. 
JJnguentum PEruginis in Burns and Scalds.—Recommended by Mr. 
Gaozey as follows: The best treatment that I have found, as the first to 
be adopted in the above injuries, is the application of the unguentum aeru- 
ginis, spread thickly on linen and the injured parts to be completely 
covered with it. This ointment affords immediate relief, taking out the 
fire (as it is in common parlance called) sooner than any other application; 
and if early applied will prevent vesication. 
My second application is either equal parts of olive oil and lead plaster, 
chalk ointment, or lead liniment. This latter I have successfully used in 
extensive burns as the first application, but shall now abandon it for the 
unguentum seruginis, to which it bears no comparison. The formula for 
the lead wash liniment is as follows: 
R. Superacetate of Lead, 9ij.; Water, Ibj.; Olive oil, Ibss. M. 
To be spread with a feather over the part and covered with a linen cloth, 
and renewed occasionally; the granulations to be touched daily with a 
caustic lotion. This is also an excellent application to the injuries of hands 
when burnt by the explosion of gunpowder. Part iii ,,p. 111. 
Aphorisms of Practical Surgery.—The sudden extension of the fingers 
when they have been long bent, as from contraction of the cicatrized in- 
teguments after a burn, is frequently followed by gangrene. The exten- 
sion should therefore be slow and gradual, and we should avoid dividing 
or excising the bridle caused by the contracted cicatrix. BTTKNS—SCiLDS. 
257 
Very severe burns often induce fatal tetanic symptoms. 
Part in., p. 114. 
Aphorisms of Practical Surgery.—Patients suffering from extensive 
and severe burns, have almost always a very constipated state of bowels. 
We should not be too anxious to remove this state, as it does not seem to 
give rise to any inconvenience, and when strong purgatives are used, a 
most troublesome diarrhoea often ensues. 
In the majority of cases of fatal burns, the internal surface of the 
stomach and intestinal canal is found to be highly injected. In the treat- 
ment of severe injuries of this sort, the surgeon’s attention should be 
directed to the condition of these parts. Part iii., p. 117. 
Treatment of Burns by Soap.—The mode in which Dr. Williamson has 
been in the habit of employing soap, in the treatment of burns, has not 
only been found to be successful, but, on account of its simplicity, and of 
its being at hand in cases of emergency, will no doubt be generally 
adopted. 
A common shaving-box may always be procured, from which a good 
lather may, in the course of a minute or two, be easily obtained. This 
lather is then gently laid over the burnt surface by means of a shaving- 
brush, and repeated as soon as the first coat begins to dry, or the pain re- 
turns. This practice ought to be repeated occasionally during the day, or 
until such time as the pain is relieved. The benefit accruing to the patient is 
immediate, and the result of the practice highly satisfactory ; for in the 
most superficial burns, if early applied, vesication is prevented, and, in the 
course of a few days, desquamation of the cuticle follows, without leaving a 
raw surface. Of course, this, as a remedial measure, is most applicable to 
superficial burns ; but even in such cases as involve destruction of the more 
deep tissues, is not used without advantage, in so far as the personal com- 
fort of the patient is concerned. In such cases, after a lapse of a few days, 
the crust formed by the soap is easily removed, so as to permit the em- 
ployment of other medicines, if necessary. Part iv., p. 101. 
Treacle and Water.—Recommended in equal parts, spread on rags, and 
kept constantly applied, as a lotion to burns and scalds. Is serviceable in 
excluding air, affording relief, expediting cicatrization, and in preventing 
the unsightly puckering and contraction which so often follow. 
Part v., p. 142. 
Operation of Autoplasty for the Belief of Contraction from Burns.— 
Dr. Mtitter makes the following observations on autoplasty: The opera- 
tion which is most entitled to our confidence, especially in cicatrices of the 
neck, cheek, eyelids, nose, and lips, is that in which “ autoplasty ” is 
brought into service. In all such operations we are governed by the same 
principles, and pretty much the same mechanical details. They consist in : 
1. Dividing the cicatrix so as to produce a raw surface, in some part of 
its extent; or cutting it out entirely, as proposed by Hildanus. 
2. In applying to this raw surface a piece of healthy skin, taken from, 
the neighboring parts. 
3. In attaching this skin by suture to the margins of the wound in which, 
it is inserted. 
4. In approximating the edges of the wound, from which the skin has 
been removed. 258 
BURNS SCALDS. 
5. In separating, by appropriate agents, the parts too closely approxi- 
mated, and keeping them in this condition, some time after the flap has 
united. 
6. In applying oleaginous frictions and motion to the new made parts, 
to give them flexibility and softness. 
Many shocking deformities from burns have been relieved by the per- 
formance of operations conducted on these principles; for example, the 
eye-lid, the cheek, the nose, and the lip, have all been restored. 
Part vi., p. 130. 
Solution of Gum Arabic in Scalds and Burns.—Amongst the various 
ingenious methods of protecting the injured surface from the contact of 
the atmosphere, in cases of scalds and burns, the application of a solution 
of gum arabic, from its simplicity and readiness of application, is worthy 
of notice. It is, perhaps, not so readily and universally obtained as the 
solution of common soap, or the treacle and water, yet when it can be 
readily and quickly obtained, it will no doubt prove equally serviceable. 
When the skin is not destroyed, the parts are to be repeatedly smeared 
over with a solution ; as often as one layer is dry, another is to be applied, 
and this may be repeated several times. Mr. Rhind says : 
In those distressing cases of the extensive burning of the bodies of 
young children, I would not hesitate applying the solution over the whole 
body, at about the warmth of 96°. It does not cool down the system by 
sudden evaporation, or sudden abstraction of heat, like a common cold 
fluid, a circumstance in most cases to be dreaded, for gum is a bad con- 
ductor of heat; neither does it preclude an exposure to moderately cool 
air, which seems to keep down the excessive irritation consequent upon 
extensive scalding of the skin. 
I am inclined to think that the exclusion of atmospheric air influences 
very much inflammatory action, and in this way, perhaps, the gum solution 
checks the inflammation of the skin in burns. Inflammation caused by 
touching the skin with the nitrous acid and other irritants, appears to be 
suddenly allayed by a solution of gum arabic; erysipelatous spots on the 
skin seemed also, in some trials, influenced by this application. And I may 
here suggest, that it might be tried in the first stages of the pustules of 
small-pox, especially those of the face, with a view to modify their devel- 
opment, and prevent pitting. Part vi., p. 145. 
Nitrate of Silver.—Mr. Jackson mentions its great utility in the treat- 
ment of burns and scalds, in which he had found great benefit resulting 
from its application, and instanced several cases of superficial burns in 
children, in which he found that in a very short time after its application 
the pain ceased, and vesication was totally prevented. In the deeper burns 
he uses it, not that he finds that it can produce any effect upon the charred 
parts, but that, as Mr. Higginbottom has said, he finds the superficial burn 
healed, and the extent consequently circumscribed. 
The form which he uses is in the proportion of ten grains of the nitrate 
of silver to one ounce of water, applied by means of a camel’s hair brush 
over every part exhibiting the slightest appearance of inflammation, two 
or three times a day, until the skin has become blackened; afterward only 
occasionally. Part vii., p. 167. 
Chloride of Soda.—Lisfranc strongly recommends a solution of tho BURNS SCALDS. 
259 
chloride of soda, which, he affirms, acts as an astringent and sedative, 
affording rapid relief to suffering, preventing an increase of inflammatory 
action, and dissipating this when it already exists. The strength of the 
solution is to he regulated according to the irritation produced. This 
should be but slight, subsiding in ten minutes or a quarter of an hour. It 
acts tar more efficaciously when the mucous substance of the skin is laid 
bare than through the epidermis. Part vii., p. 212. 
Greasote in Burns.—Dr. Sutro having witnessed the very valuable 
effects of creasote applied in cases of burns and scalds, recommends 
the following preparation to be kept ready under the name of “ Burn 
Ointment 
R. Creasot. draclimam dimidiam ; carbon, anitn. praep. drachmam; spir. 
vin. drachmam et dimidiam; ung. spermacet. unciam et dimidiam; m. ft. 
ung. for adults. 
This might be modified, according to age, in the following manner:— 
For children under five years, the ointment should be weakened by mix- 
ing it with four times its bulk of spermaceti; for children from five to ten 
years, with twice its bulk of spermaceti; and so on, gradually increasing 
the strength of the ointment, according to the age of the patient. In cases 
requiring protracted treatment, the dose of creasote should be gradually 
and carefully increased in the successive applications. 
Part xi., p. 188. 
Greasote in Burns.—Creasote is one of the most valuable of those 
remedies which the ancient writers designated as incarnatives, i.e., pro- 
moting cicatrization. 
M. Mascharpa has used it also in several cases of burns with the most 
satisfactory results: it soothes the pain of the injury at the time, and 
accelerates the subsequent progress of the cure. The best mode of using 
it is in the form of lotion—made by adding twenty or thirty drops of it to 
two or three ounces of water, and applied with pledgets of linen to the 
injured surface. Part x., p. 172. 
Treatment of Burns by Ammonia.—M. Guerard recommends in burns 
the application of caustic hartshorn ; the application of cloths steeped in 
ammonia immediately relieves the pain, and must be continued for one 
hour after the accident. When the burn has produced any destruction of 
the skin, ammonia should not be used; but in the erythematous form, or 
when phlyctense are present, it is of the greatest advantage. 
Part xvi., p. 225. 
(Edema of the Glottis, from swallowing Boiling Water.— Vide Art. 
“ CEdema.” 
Treatment of Burns.—According to Prof. Cooper, burns may be 
classed in six varieties. In the first there is just a redness of skin where 
the degree of heat which has been applied has not been intense, and there 
is little or no sloughing, and some erythema ; and in a very few hours, or, 
at most, in a day or two, the effects will subside, and the cuticle peel off, 
leaving no remains of injury in the part. It is very true that even this 
degree of heat may produce great injury, and even danger where it is very 
extensive, as it suspends the functions of the skin, very much to the loss of 
the whole system; the pulse is quickened, the tongue red, and the mucous 
membrane of the alimentary canal is excited. In the second variety, the 260 
BURNS SCALDS, 
degree of heat has been greater, the redness is darker, and sloughing more 
considerable, but what marks it more particularly, is the formation of 
vesicles, which sometimes rise immediately after the application of heat, 
and in other instances, within twenty-four hours afterward, contain serous 
fluid. In the third class, the surface of the cutis suffers, and is more or 
less destroyed; the vesicles attending this injury contain turbid blood and 
serous fluid ; you may know it by the appearance of the part, it having a 
yellowish or light-brownish discoloration. These parts are converted into 
eschars, from which the patient suffers no pain, unless pressure be applied, 
which produces suffering by affecting the living parts between the eschar. 
In the fourth class, the whole surface of the cutis is destroyed, and more 
or less of the subcutaneous texture is injured; the discoloration of the 
eschars is also of a deeper color. You may observe that these eschars 
are stiffer than those in the preceding classes and also more brittle, and 
the skin around them is puckered and wrinkled. Upon the separation of 
these eschars, you find ulcers, from which granulations are formed, and 
they spread in great luxuriance ; there is also profuse discharge of pus. 
In the fifth class of burns, the textures more deeply situated are 
involved, as the fascia and muscles; sometimes nerves and vessels, not 
destroyed, are included. The eschars are thicker, cold, black, and brittle; 
they are longer in separating, but when they do separate, there is a very 
rapid discharge of pus, and quick granulations. In consequence of 
the muscles being involved, their action is impeded, and it often happens 
that the whole functions of a limb are suspended by a burn of this 
kind. In the sixth class, the limb itself is turned into a black, insensible 
mass, as sometimes occurs in large iron foundries, where the hot metal 
comes in contact with the lower extremities; the foot, for instance, 
is placed in the groove or gutter where the hot metal runs, and is at 
once converted into an eschar, when, indeed, it is not at once annihi- 
lated. I need not tell you that in the former case, you must amputate the 
member. 
The constitutional symptoms of burns may vary much ; I may tell you 
they are divisible into two classes ; those arising from the shock and irri- 
tation of the system produced by the action of heat; and those which come 
with the reaction that takes place, such consequences implying hectic dis- 
turbance and its usual- concomitant circumstances. 
A burn may be only superficial, and yet, from the extent of its surface, 
highly dangerous, and perhaps fatal, from the shock experienced by the 
system. It may produce such depression of the circulation, that you can 
scarcely feel the beating of the arteries of the wrist, and the whole body 
may be in a state of utter prostration. Now, all the danger arising from 
the first and second variety of burns, is in the first stage, a fact which you 
will take notice of, as it does not apply indiscriminately to the rest; and, 
if the patient get over the first stage, there is small danger to be appre- 
hended from the rest; resolution will take place, and within twenty-four 
hours the danger will have passed away. Not so with burns of the third, 
fourth, and fifth degree ; involving the deeper textures, they are not at 
once attended with all that constitutional danger attending burns of the 
first and second degree ; but in three or four days, when the process com- 
mences by which the eschars are separated from the living parts, a great 
degree of constitutional disturbance takes place. This process may take 
three or four weeks for its accomplishment, but it commences within BURNS SCALDS. 
261 
three or four days of the injury; and that period is always one of 
great danger in burns of this degree. Dupuytren called this dangerous 
disturbance, the irritation from the injury, or, as we should say, the 
shock. 
The second period of danger is during the inflammatory stage. The 
third period of danger is when suppuration is going on, and the great dis- 
charge tends to produce hectic. 
The following is an abstract of the treatment which Professor Cooper 
recommends: Burns of the first degree, except when occurring on the 
head and face, or extensively on the trunk, may be treated by cold appli- 
cations, or flour, or carded cotton may be applied, and suffered to remain 
until cleanliness, or the patient’s sensations, dictates their removal. Burns 
of the second degree may be treated with the same applications: and if the 
vesicles are large, the fluid may be let out by a puncture with a very fine- 
pointed instrument. When burns are of the third and fourth degree, they 
should be treated with lime-water and oil liniment, turpentine liniment, 
or poultices, until healthy pus begins to be secreted, and granulations form, 
when a mild astringent ointment, as the calamine cerate, should be used. 
When there are high fungous granulations, nitrate of silver should be 
applied, or a powder of myrrh and calamine sprinkled on the part, or straps 
of adhesive plaster applied. The great point in the local treatment of burns 
is, to prevent the access of air to them, by keeping the parts well covered, 
and removing the dressings as seldom as possible. When the dressings of 
a large burn are to be removed, only one part of the surface should be 
exposed at a time. As to constitutional treatment, it consists, in the period 
of shock, in the administration of opium and stimulants, with external 
warmth ; and, for children, the warm bath. When reaction takes place, it 
must be moderated, if requisite, by antiphlogistic treatment: opium being 
still however useful. Again, in the period of profuse suppuration, bark, with 
acids, opium and wine, together with mild purgatives, are to be employed. 
Mr. Erichsen says: “ On taking, then, a general review of the consti- 
tutional treatment of burns, it may be stated that the first object should be 
to relieve the system of the abnormal quantity of fluid that must have accu- 
mulated in it, in consequence of the arrest, to a greater or .less extent, of so 
important a secretion as the perspiration. This may be accomplished either 
by the administration of diuretics, by guarded blood-letting, or by encou- 
raging the process of suppuration, if it be deemed prudent to wait till this 
be established. Secondly, that any appearance, however slight, of the 
supervention of inflammation in the organs contained within the head, chest, 
or abdomen, should be watched with the utmost anxiety, and treated, if it 
do occur, as the circumstances of the case will admit. And, thirdly, that 
the process of suppuration should be maintained or arrested with a due 
regard to the state of internal organs, and the condition of the powers of 
the system.” 
Mr. T. M. Greenhow, senior surgeon to the Newcastle Infirmary, 
observes: 
When slight and superficial, any plan will prove successful. When very 
extensive and deep, none will succeed in saving life, though suffering may 
be alleviated ; and it is in intermediate cases chiefly that discrimination is 
required in the choice of remedies. 
To slight burns, cold applications, flour, or cotton, are equally useful. 262 
BURNS—SCALDS. 
To more severe ones, apply lawn paper dipped in warm turpentine thick- 
ened with ung. resina3; where there is free suppuration, use chalk ointment; 
and when the healing process goes on very slowly, apply a lotion with 
camphor mixture one pound, tincture of opium and solution of lead, each 
one drachm. Never apply escharotics. When the injury is so severe as 
to forbid all hope of recovery, envelop the entire ]3erson in cotton, as the 
most comfortable and convenient application. During the stage of shock, 
give stimulants and opiates ; afterward liberal diet and quinine. 
Mr. Doming recommends to apply flour of the best quality with a 
“ dredger,” and allow it to “ cake,” when detached, repeat the process 
till a healthy surface is left. When the burn is on the back, keep the 
flour in apposition by means of long flakes of carded cotton applied round 
the waist. Treat the ulceration remaining after severe burns by cer. cala- 
minas, except on the hands and face, where the use of flour may be con- 
tinued. 
According to Mr. Iligginbottom, we should make the surface as clean 
and dry as possible, remove any vesications or loose cuticle; then apply, 
with a small sponge, secured to the eye of a silver probe, a concentrated 
solution of nitrate of silver (arg. nitr. 9iv. acid, nitric, gtt. vj., aq., destil. 
3iv.) so as to form an adherent eschar. If on the back, after applying the 
nitrate, cover with plasters of ung. plumbi comp., and dress every third 
or fourth day. Reapply the nitrate, if the eschars fall off too soon. 
Dr. H. Barker, as dresser and house surgeon under Mr. Liston, used to 
apply the best flour with a dredger, as above described, and when the 
caked masses came off, apply wetted lint and oiled silk. If cicatrization 
is tardy, use a weak solution of sulphate of zinc, instead of water; and if 
there are exuberant granulations, rub them lightly with a piece of sulphate 
of copper. Muriate of morphia is the best anodyne. 
Mr. Newnham, of Farnham, thinks the dressing by cotton more useful 
than by flour, “ because it more effectually covers and protects the ex- 
posed nerves.” When the sensitive nerves of the skin are exposed to any 
great extent, he thinks a fatal result inevitable. 
Dr. G. Black, of Torquay, remarks that the great point in the treat- 
ment of burns with cotton wool, is never to remove that which covers the 
surface of the sore : he says “ the outer portions which are saturated with 
the discharge may be cut oft', and clean applied, but that covering the 
wound never.” Part xvii., pp. 189-195. 
Burns— Contraction from.—[In this case, in which there was extensive 
contraction of the integuments on the front and side of the neck, 
Mr. Grantham divided the cicatrix thoroughly. And afterward.] 
The treatment consisted in the application of folds of lint dipped into 
hot water, and secured by a roller passed round the throat, over the head, 
and under each axilla, at the same time securing a layer of wool wadding 
over the wound, so as to maintain a temperature of the wound equal to 
the temperature of the adjacent integuments. This dressing was con- 
tinued, varied only occasionally with zinc ointment, for upward of two 
years, a period no doubt, seeming long to those who may not have expe- BURNS SCALDS. 
263 
rienced the great difficulty of healing such wounds as have the derma 
imperfect. As is my usual practice where there is much purulent dis- 
charge, I endeavored to support the patient on a milk diet, the utility of 
which practice has been attested in the cure of the most extensive burn 
ever published in the annals of surgery—in which case is also proved the 
necessity of maintaining an equilibrium of animal heat, with a firm and 
easy pressure on the granulating surfaces, believing, as I do, that these 
two principles are the chief essentials as external agents, in the healing 
process of wounds generally. I wish this remark to be understood as 
only applicable after the reaction of the part has taken place, and all dead 
portions removed by exfoliation. Part xviii., p. 236. 
Contraction from Burns, cured by Division of the Cicatrices.—Mr. 
Whitehead brings forward this case as an example of the good effects 
(apparently permanent, for the case remains in a satisfactory state at the 
end of four years) of careful division of the contractile tissue of the 
cicatrix. 
The right fore-arm was immovably contracted upon the arm to the 
degree of an acute angle, in which posture it was maintained by a web of 
cicatrix extending between the distal extremities of the two portions of 
the limb, and occupying, of course, the whole intermediate space. The 
corresponding limb was similarly fixed, the displacement being, however, 
less considerable. The skin of the neck was also deeply furrowed, and 
the head distorted. At this time (14 years after the accident), the head 
was dragged down to the right side, and the right arm rendered almost 
useless. Mr. Whitehead says : 
The fibrous band subtending the angle at the elbow-joint, was equal in 
thickness to and tangibly as firm as, the tendo Achillis. The first opera- 
tion was performed upon the neck, the incision commencing below the ear, 
the lower part of which organ was merged in the folds of the cicatrix ; it 
was thence continued below the line of the jaw to a point opposite the 
middle of the chin. Division of the skin simply appeared to afford no 
relief whatever to the distortion, there being immediately beneath numbers 
of bands of a bright fibrous aspect, which effectually prevented the parts 
from resuming their natural position. These being successively divided 
with the bistoury upon a grooved probe, and the head raised, other sets 
presented themselves to view, which, when extended, still produced a 
tractive effect upon the cicatrix below. Bundle after bundle was in turn 
dragged forward and divided, from one extremity of the wound to the 
other, until caution suggested a cessation. The wound, which appeared 
dreadfully large, was cleansed and covered with simple dressing ; it was 
quite healed in four weeks. 
The relief afforded by the above operation encouraged confident hopes 
of a successful issue from a like procedure upon the arm ; this was accord- 
ingly practised. The bistoury was plunged through the structure at the 
angle of flexure, as close upon the joints as safety to the neighboring parts 
would admit, and thence carried forward, emerging at the free edge.. 
But this incision, which might, a priori, have been looked upon as all that 
was necessary, constituted comparatively but a small share of the opera- 
tion. The divided parts immediately retracted considerably ; but when 
extension was attempted, even but to a limited degree, a number of 
shining fibrous bands started forward, completely hindering further move- 264 
BURN’S—SCALDS. 
inent. These were also divided and extension again attempted, Avhen 
others of similar character Avere brought into ATieAAr, occupying an elevated 
position in front of the joint, and opposing like resistance. In this manner 
successive groups of fibres had to be separated, layer after layer, before 
the limb could be brought into a straight line, which Avas not accom- 
plished until all the deep-seated bands reaching across the joint on each 
side of the large A'essels, and outAvard toward the condyles, had been com- 
pletely divided, including, of course, the fascial insertion of the biceps 
muscle. During the operation, the median basilic Arein Avas accidentally 
Avounded; this it Avas found necessary to ligature on each side of the 
puncture, before further steps could be taken. 
The wound, Avhich measured eight or nine inches in the long direction, 
and upward of four inches transversely, was cleaned and covered Avith 
simple dressing and a bandage. A splint Avas applied to the back part of 
the limb on the fourth day, but this appeared unnecessary, as there Avas 
no difficulty in easily maintaining an extended position ; the apparatus Avas 
altogether abandoned at the end of three Aveeks, and never afterAvard 
required. The wound Avas completely cicatrized in six weeks. About 
three months afterward, I divided, in a similar manner, the cicatrices 
bounding the axilla, on the same side of the body, with nearly equal 
success. 
The successful issue of the operation Avas undoubtedly attributable, 
mainly, to the perfect division of all the facial fibres traversing the elbow- 
joint anteriorly from the arm to the fore-arm, or at least, all that could 
be exposed Avith safety. It is not a little remarkable that the elboAAf-joint 
which had been almost totally unused for twelve years, appeared in no 
Avay injured, as no pain Avas complained of, nor difficulty experienced, in 
the attempts that Avrere made to move it. The limb is iioav plump and 
Avell shaped, and apparently as strong and useful as though it had not been 
materially injured. Part xviii., p. 237. 
Burns and Scalds.—In burns and scalds of the first and secend degree, 
apply solution of nitrate of silver as directed for erysipelas. See “ Ery- 
sipelas.” 
Employment of Charcoal.—For the suppurating sores which folloAv 
extensive burns, one of the best applications is poAvdered charcoal. If 
the burn is on the back, the charcoal may be freely streAved over the bed. 
Part xxi., p. 200. 
Contraction from Burns.—When a web of cicatrix exists in the axilla, 
or between the fingers, or in similar situations, pass a needle carrying a 
skein of silk through the base or proximal extremity of the Aveb, and 
alloAV the silk to remain as a seton. When sufficient inflammation and in- 
duration has been excited, the Aveb may be divided in the usual Avay with 
great hope that the contraction will not return. Part xxi., p. 263. 
Scalds and Burns.—If there be the feeling of burning heat in the part, Ave 
can understand Iioav cold applications Avould be grateful, and hoAV the case 
Avould get Avell, even though they were not the best, for the poAvers of the 
nervous system Avould, in this case, be intact. But no one Avould recom- 
mend the continued application of cold to a patient laboring under the 
depression attendant upon a severe burn. It has been held that external 
applications do good by excluding atmospheric air; but the injury arises BUENS—SCALDS. 
265 
not from the irritation of the air as air, but from its coldness. Warm air 
soothes and is beneficial. It is from their effects in soothing the nervous 
irritability of the injured part, by preserving the nerves from feeling the 
variations of temperature in the currents of the air which would act upon 
the surface, that such applications as cotton, treacle, flour, etc., are of such 
great value. Part 333. 
Use of Collodion in Burns.—This fluid, when applied to burns, pro- 
motes healing and prevents suppuration. Blumhardt has tried it, with 
great success, in three cases, one of them caused by explosion of gunpow- 
der, and two by the ignition of spirits of wine, where the breast, neck, face 
and hands were all severely scorched. Collodion was applied to the skin 
an hour and a half after the accident, by a hair pencil; the redness, pain 
and swelling were thereby diminished, and the patients soon experienced 
no inconvenience save the tension occasioned by the firmly adherent pel- 
licle. The inflammation completely subsided and the recovery was rapid. 
Part xxix., p. 251. 
Deformities from Burns.—The chief attention ought to be paid to these 
cases just at the time when they are most usually withdrawn from treat- 
ment ; it is then that splints, bandages, and other mechanical contrivances 
should be resorted to and rigidly persevered with, in order to preserve the 
part or limb in its natural position. Operations for the relief of these con- 
tractions generally fail, because the surgeon’s attention has been directed 
more to thfe cicatrix itself than the newly-formed structure underneath, 
which is really the active agent in the production of the contraction. 
Part xxxiv., p. 209. 
Burns and Scalds.—Having cleansed the parts, and punctured the 
vesications, paint over the entire surface an application of two parts of 
collodion and one of castor oil, which repeat three or four times the first 
day, so as to form a covering entirely excluding all contact with the at- 
mosphere. When suppuration sets in apply a linseed poultice over the 
whole surface, and when the slough has separated, an ointment, composed 
of an ounce of prepared chalk, two drachms of olive oil, and half an ounce 
of spermaceti ointment, spread on lint. The above is an outline of the 
treatment at present pursued at King’s College Hospital. 
Part xxxvii., p. 179. 
Gunpoicder Burns—Treatment of.—When a charge of powder is fired 
near an exposed part of the body, a portion of the unburnt powder is de- 
posited in the skin, proportionately to the imperfection of the combustion 
and the coarseness of the granules. The inflammation which results is not 
sufficient to procure the elimination of the grains, and the person remains 
tatooed for life. Hitherto the only means for preventing such a deformity 
has consisted in the picking out by the fine point of a knife or needle each 
separate granule. This, though a very tedious and painful process, answers 
well enough in burns of a limited size; but in a recent case, in which the 
whdle side of the face was completely blackened, Professor Busch resolved 
to try a plan he had seen Hebra adopt for the removal of freckles, viz., 
exciting an eczematous inflammation by means of a solution (5 gr. ad 8 oz.) 
of corrosive sublimate. This was kept applied during several hours for 
five days, with the effect of exciting a smart eczema, and detaching the 266 
BUKSAL AFFECTIONS. 
granules. The burn was quite recent, and whether the means used is 
applicable to burns of an older date, remains to be tried. 
Part xxxix., p. 232. 
BURSAL AFFECTIONS. 
Treatment of Enlarged Bursae Mucosce and Synovial Sheaths of 
Tendons.—Professor Williams, of Dublin, has cured several cases of 
chronic tumors of the bursae mucosae and synovial sheaths of tendons “ by 
the subcutaneous division of the sac of the tumor and the subsequent ap- 
plication of pressure.” 
A cataract needle was passed into the tumor (an enlarged bursa over 
the knee), and the entire thickness of the sac divided by several parallel 
and longitudinal incisions. A portion of the fluid escaped into the cellular 
tissue, but the greater part found exit externally on the withdrawal of the 
needle. The knee was then strapped with adhesive plaster, and the limb 
kept at rest. ( Part iii.,y>. 86. 
Enlarged Patellar Bursa dispersed by Subcutaneous Incision.—An in- 
cision, to the extent of one-eighth of an inch, was made along the outer 
margin of the tumor ; then a very small bistoury was introduced obliquely 
into the cyst, at such a distance from the superficial cutaneous incision as 
prevented the escape of the fluid. 
The sac was then cut in several places, chiefly on the anterior surface, 
and the instrument withdrawn, all the fluid having been evacuated. 
A small compress was then applied, and several straps of adhesive plas- 
ter, and a roller which extended from the toes to the knee. 
A splint was also applied, which extended from the middle of the back 
part of the thigh to the same point of the leg. 
If the incision, or rather puncture into the sac, be made with care, the 
internal surface of the cyst then cautiously scored after it, the fluid evacu- 
ated by firm pressure, so as to prevent the ingress of air into the cavity, 
no danger need be apprehended of unpleasant effects succeeding to this 
measure. 
The only instances in which the subcutaneous incision might fail, are those 
where the sac is much thickened, its interior loculated, and the cells filled 
with a thick gelatiniform substance; still, in such instances, it is a means 
which should be kept in view. Part vi., p. 150. 
Patellar Bursa.—In some cases of enlarged bursas we may adopt all the 
usual and simpler modes of treatment, and fail in dispersing them, or the 
treatment may be so tedious as to weary the patience of both surgeon and 
patient. We may blister and compress them, or pass a seton through, or 
make a valvular opening into them, and, after letting out the fluid, incise 
the inner surface of the sac, or we may extirpate them with the knife. 
One of the best and safest plans of treating these bursas is by blistering 
them, or by using the tincture of iodine as a counter-irritant. Where they 
are small, as over the wrist, the fluid may be let out with a needle and 
compression applied. In a case of inflamed bursa of the patella, in which 
the usual treatment had failed, Mr. Hale Thompson cut down upon it, and BURSAL AFFECTIONS. 
267 
carefully dissected it away. The coats of the bursa were at least a quarter 
of an inch thick. Pari viii., p. 188. 
liar sal Swelling of the Wrist and Palm of the Hand—Pi vision of 
the Annular Ligament.—Prof. Syrae gives the following case : 
j— p—, aged 20, was admitted on the 13th of February, complaining 
of pain and weakness in her left hand. The wrist and palm of the hand 
were much swelled, but not discolored, and pressure on these parts caused 
distinct fluctuation, with the jarring sensation that characterizes effusion 
into the bursal sheaths. She stated that pain had been first felt about two 
years before, and that for the last twelve months she had had hardly any 
use of the hand, in consequence of the swelling, and weakness attending it. 
I made a free incision from the wrist into the palm of the hand, dividing 
the annular ligament. This gave vent to a quantity of glairy fluid, Avith 
many small flat cartilaginous-looking bodies, and exposed to view the 
flexor tendons, separated and surrounded by thickened bursal membrane. 
The cavity Avas filled with dry lint, supported by a bandage moderately 
compressing the hand and wrist. In the subsequent treatment, care Avas 
taken to "prevent protrusion of the tendons, by drawing the edges of the 
Avound together, and applying a compress over the seat of the annular lig- 
ament. Not the slightest disagreeable symptom folloAved the operation, 
and three days after it the patient Avas able to seAV, Avhich she had been 
prevented from doing for many months previously. In the course of afeAV 
Aveeks the Avound healed, and the limb Avas in every respect perfectly 
sound. Part x., p. 160. 
Bursal Swellings of the Wrist and Palm of the Hand.—Till lately, 
incision, followed or not by the use of the seton, Avas the chief mode prac- 
tised for the cure of enlarged bursae. Dupuytren contented himself Avith 
merely slipping a seton under the annular ligament, but the effects Avere 
much the same as the former mode. Mr. Syme more lately proposed 
making a free incision into the bursae and through the annular ligament. 
He has related one case treated in this Avay, but it is evident that even 
this is not free from danger. A neAV mode of treatment is noAV proposed 
by tAvo Parisian surgeons. 
On the one hand M. Gerdy has tried subcutaneous puncture, preceded 
and followed by the application of leeches and methodical pressure; the 
result has been successful, but we cannot state Avhether or not there has 
been relapse, the patient having left the hospital before there Avas suffi- 
cient time to ascertain if the cure were permanent. On the other hand, 
M. Velpeau has been trying injections with iodine, and has obtained 
speedy cures, free from all accidents. Others have folloAved the prac- 
tice, and have had reason to be satisfied Avith it. M. Chassaignac informs 
us that he has cured one case by this method, and has operated on 
another. 
The case is that of a man, aged 40, aaAio for some years has had a double 
tumor on the palmer surface of the right hand; it is fluctuating, and Avith- 
out change of color on the surface. One of these tumors, of the size of an 
egg, Avas above the annular ligament; the other, of the size of half an 
orange, Avas situate in the palm of the hand. The fingers could not be 
extended ; on pressing alternately on either tumor, that sensation of jar- 
ring peculiar to hydatid cysts was not present; but this negative character 
arose from the circumstance of the two tumors not freely communicating, 268 
BURSAL AFFECTIONS. 
in consequence of which the displacement and friction of the corpuscles on 
each other was prevented. The hydatic bodies, however, may be alto- 
gether wanting, but this does not in any way change the nature of the 
disease ; besides, they are sometimes present in small quantity. In this 
case there was no doubt of the true nature of the complaint. M. Chas- 
saignac operated in the following manner: After causing the tumor to 
project, by means of lateral pressure, he plunged a trocar into the palm of 
the hand; a small quantity of viscid fluid escaped. By means of strong 
pressure on the two tumors a prodigious number of hydatic corpuscles 
escaped through the canula; several of these were larger than the diame- 
ter of the instrument, which proved them to be elastic and compressible. 
Examined by the microscope, these productions appear to be true hyda- 
tids with vesicular bodies, and not merely those hard, simple, albuminous 
concretions usually found, which would lead us to believe in the existence 
of two varieties of these tumors, the one truly hydatid, the other only 
hydatiform. After having completely emptied the tumor, M. Chassaignac 
washed out the sac twice or thrice with warm water; he then injected a 
solution, composed of one-third tincture of iodine and two-thirds of water. 
After allowing it to remain a few minutes, the fluid was completely with- 
drawn. It was remarked during the process of these injections that the 
subannular opening serving as a communication between the two sacs was 
very small, so that the fluid passed from the palmar sac into the superior 
only when the former was full; and this appears to explain the obscurity 
of the fluctuation between the two sacs. The tumors were again filled a 
few days after the operation, but in a much less degree. 
M. C. is of opinion that the cure will be effected by spontaneous absorp- 
tion of the fluid, as in hydrocele; and he founds this opinion on a case he 
lately observed, in which there was a large serous cyst in the left groin; 
the tumor reappeared after injection with iodine, but was gradually ab- 
sorbed ; in its latter stage the tumor felt like a compact knot, but at length 
entirely disappeared. 
At the last scientific congress in Italy, a case was communicated by 
Gherini, surgeon to the great hospital at Milan, of a large bi-lobular hyda- 
tid cyst, situated at the posterior part of the elbow, cured by incision 
alone, and from which there escaped fifty-two barley-shaped corpuscles. 
The sac suppurated, it is true, but the cure was complete, without any 
unfavorable symptom. The bi-lobular form in this case was remarkable 
from the absence of the annular ligament, which is sufficient to account 
for it, at the wrist; it may be also remarked that the barley-shaped con- 
cretions are not confined to the latter region. Gherini states that he is 
certain that neither of the cavities communicated with the articulation. 
The extraction of the hydatid corpuscles is, of course, essential to the cure 
of these affections. Part xii., p. 248. 
Treatment of Effusion into the Bursa Patellae.—Effusion into the bursae 
patellae is a very common affection, familiarly known by the name of 
“ housemaid’s knee.” In its usual form the effused fluid is pellucid, and 
the walls of the sac are thin. Having remarked on the division into vesi- 
cular, or cyst-like, and vaginiform, or complicated bursae, Mr. Johnson 
proceeds: 
The former compose the majority of the subcutaneous bursae; the latter 
are bound up with tendons. They are especially seen in connection with BUKSAL AFFECTIONS. 
269 
the flexor and extensor tendons on the wrist and ankle, are of considerable 
extent, imperfectly divided into several compartments, and placed beneath 
the annular ligaments and fascia, so as to plunge deeply amidst the ten- 
dons of the limb. It is obvious that inflammation in the vaginiform bursas 
is a very different affair from inflammation in the simple ones. In the 
latter, if suppuration ensues, it is superficial, accessible, limited, or if it 
escapes the precincts of the bursa, it is into the subcutaneous cellular 
membrane. In the former, the inflammation is in a larger cavity and in- 
volves a deep and inaccessible one; if suppuration ensues and is confined 
within the bursa, it is still deep and hard to be got at; but if it extends, 
as it is apt to do, among the neighboring parts, it is in the deep cellular 
membrane, stretching under the fasciae and between tendons and muscles, 
where it defies the most skillful and daring surgeon. 
Need it be said, that suppuration of the vaginiform bursae is a thing to 
be religiously avoided, that it is always dangerous, and too often fatal. 
Mr. Johnson warned the pupils against puncturing these bursae, or resort- 
ing to any measures calculated to give rise to inflammation in them. He 
mentioned some cases illustrative of the dangers of operative interference 
with them, and deprecated it in the most earnest terms. At the same 
time he advised, if suppuration did occur, as prompt and as bold an open- 
ing as could be ventured on. The principal object, however, of this re- 
port, is to point out the advantage of puncturing the subcutaneous vesi- 
cular bursae, especially that on the patella, when enlarged from simple 
increase of secretion, without much inflammatory action, or consolidation 
of their walls. The plan adopted by Mr. J. consists in introducing a 
grooved needle, perpendicular to the surface, into the cavity, the bursa 
being rendered prominent and tense by properly directed pressure. The 
needle having entered the cyst, its convex side is kept pressed against the 
sides of the opening, which, of course, tends to free the groove from 
obstruction, and to render the channel more patulous. The exit of the 
fluid is assisted by maintaining firm compression on the swelling, and 
holding the handle of the needle low, so as to direct the stream down- 
ward. In this manner, without pain, and with great rapidity, the bursa 
is emptied of its fluid. A dose of senna is directed to be taken immedi- 
ately, its repetition is prescribed as circumstances may require, and the 
patient is ordered to apply a blister to the knee the same evening, and is 
cautioned against more exercise that day than is absolutely indispensable. 
In slight cases, one puncture, and a blister or two, followed by strap- 
ping and a bandage wdien the effusion has nearly disappeared, are 
usually sufficient for a cure. But when the case is of longer standing, or 
the disease has proceeded further, a repetition of these means is required. 
Part xii., p. 250. 
Treatment of Bursal Disease of the Knee Joint.—[Mr. Skey’s remarks 
relate to that form of disease which affects the bursa placed anterior to 
the patella, and the ligament below it, commonly known under the title 
housemaid’s bursa. The bursal disease of the knee presents itself for 
treatment in the form of a general swelling of the sac, containing serous 
or puriform fluid. If unattended with pain, the contents will probably be 
serous merely, and the tumor soft. It is in this stage that blistering may 
be objectionable. As the disease advances, the mass consolidates by re- 
peated attacks of inflammation, more or less acute, till the swelling be- 270 
BURSAL AFFECTIONS. 
comes a large tumor of nearly solid consistence. As to the communication 
of bursae with the contiguous joint, any operation, in such case, would be 
very objectionable. But such communications are exceedingly rare, nor 
can Mr. Skey call to mind any example of the kind, except that between 
the tendons of the subscapularis and the shoulder joint, which might 
rather be deemed an extension of the synovial membrane of the joint under 
the tendon.] 
When not communicating with a joint, they may be opened without 
danger in all situations and in every stage. The effect of a seton is like that 
through a hydrocele or ranula, viz., the secretion is absorbed without 
being discharged by a wound, and the sac is obliterated. In a hard 
and consolidated form of the disease, it breaks down into a common 
abscess, which, Avhen punctured, discharges its contents and heals. 
Pass the thread (common silk) through the centre of the tumor, and 
keep it in until the end is accomplished. If inflammation supervene, re- 
move the thread, foment or poultice ; when sufficient inflammation has 
been set up, it is indicated by the oozing of pus from the punctures, 
and may be continued four or five weeks. If the morbid bursa be too 
deep for the application of the above treatment, injection and pressure 
may be used. 
For ganglions or adventitious cutaneous cysts, puncture with the lancet 
is a less painful and more certain remedy than a blow. Let the punctui e 
be no larger than to evacuate the contents of the cyst. Bind down the 
part afterward with a pad of lint and adhesive plaster, to promote the ob- 
literation of the cyst. Part xiv., p. 151. 
Bursoe,, Diseased.—Dr. Adams recommends to make a longitudinal in- 
cision from above downward, throughout the whole extent of the bursa; 
inspect the cyst, and detach any small adherent bodies where the cyst is 
thick and capacious, and bulges from the incision, remove an elliptical 
portion. Introduce an oiled dossil of lint as a dressing, and apply light 
compresses and a bandage. When suppuration is fairly established, apply 
poultices if necessary. The advantages of this method over puncture, 
subcutaneous incision, injection, seton, extirpation, etc., are: 1. It is 
easily and quickly done. 2. It is less painful. 3. It produces little or 
no constitutional disturbance. 4. It is more satisfactory in its results, 
producing a radical cure, and removes all foreign bodies at once. 
Bart xiv., p. 152. 
Consolidated Bursa.—Rub in a strong solution of iodine, and cover 
the part with lint and sticking plaster, to prevent the volatilization of 
the iodine 
Introduce a seton of eight or ten threads, and poultice. 
Bart xv., p. 172. 
Acutely Inflamed Bursa.—Keep the limb quiet and in an elevated po- 
sition, apply poultices, and rub in the tartar emetic ointment combined 
with mercurial ointment. Bart xv., p. 174. 
Treatment of Enlarged Subcutaneous Bursae.—When matter has 
formed in them, the only means is the evacuation of the fluid by a free 
opening : this is unattended with danger, and followed by a rapid and 
complete cure. When, however, the bursa is recent, the skin thin, and 
the fluid probably a mere increase of the natural secretion of the cavity, BURSAL AFFECTIONS. 
271 
the employment of blisters, or the external application of the tincture of 
iodine, is the best means of lessening the swelling, but it will probably 
return. For a complete cure, or in those cases where the swelling does 
not yield to the application of blisters, or to the external application of 
iodine, more especially if the swelling be not large, the best plan of treat- 
ment is to introduce a fine thread through the swelling, and use it as a 
seton. On the second day, this thread generally causes considerable pain, 
and requires withdrawal. A small quantity of puriform fluid passes, for 
a few days, through the opening, after which the swelling gets gradually 
less, and contracting, is completely cured. Very frequently the bursa 
suppurates so freely as to require a free opening, the hole for the thread 
having closed. Although this is an extra source of pain, yet the cure 
is more complete, and quite compensates for this accident. Removal 
of bursae simply for their inconvenience is a serious matter. 
Part xv., p. 175. 
Death following the Removal of a Bursal Tumor from the Patella.— 
Dr. Smith relates a case of the above description which terminated fatally 
from the supervention of erysipelas. It is this circumstance which has 
determined many surgeons to be very chary about using the knife in 
cases of diseased bursa of the patella. Mr. Samuel Cooper, in his “ First 
Lines,” says : “We ought not to open bursae mucosae without a real ne- 
cessity for it, for we occasionally hear of cases in which patients lose their 
lives in consequence of the limb being attacked with phlegmonous erysipe- 
las. Part xv., p. 175. 
Vaginal, or Deep Bursae Mucosae.—Mr. Coulson explains his meaning 
of the term “ deep bursae mucosae ” to be the synovial membranes, usually 
vaginiforrn, interposed between two or more tendons, between tendon 
and bone, or between tendon and ligament, for the purpose of protection 
from the effects of friction, and for facilitating motion. 
In the treatment of tumors of these synovial sacs, the plans recommended 
for their cure have been extirpation ; incision, either simple or combined 
with irritation of the surface of the cyst; subcutaneous puncture ; and 
iodine injections. Mr. Coulson has generally contented himself with in- 
cising the tumor longitudinally, and evacuating the contents. Some 
amount of inflammation ensues, with obliteration of the cavity, but some- 
times the inflammation proves very severe, inducing great constitutional 
disturbance, and in some cases even death has ensued from the attack. 
Part xxiv., p. 172. 
Treatment of Bursal Tumors.—In a case of enlarged bursa over the 
wrist joint, after the usual vesicant and stimulating applications had been 
employed with no good effect, Mr. Stanley made a free incision into the 
swelling, the glairy fluid was evacuated, tents of lint were introduced into 
the wound, and the whole hand enveloped in a poultice. In the common 
enlarged bursa patellae, perhaps the best plan is to draw off the contained 
fluid by means of a small trocar, then apply a small blister or a strong 
solution of iodine, and ultimately support the part with a mercurial plaster 
and bandage. The practice, by means of setons, of converting these en- 
largements into acute abscesses, very often produces disagreeable conse- 
quences, and it would appear that recently formed cases are especially ill 
adapted for this mode of treatment. The most suitable are, perhaps, the 272 
CACHEXIA. 
very chronic ones which have resisted ordinary measures. In all cases of 
enlarged bursa where the knife is resorted to, it is important to remember 
that the incision can scarcely be too free. Part xxvi., p. 121. 
Enlarged Superficial Bursa and Ganglion.—Make a free incision into 
the bursal tumor and let out the contents, and then apply a strong solution of 
iodine by means of a camel’s hair pencil to the interior of the sac. Insert 
a strip of lint into the wound, and keep it there, so that inflammation and 
suppuration may ensue and the cavity be obliterated. Part xxvi., p. 122. 
Bursa of Flexor Tendons of Wrist.—This affection sometimes renders 
the fingers quite useless; its removal was formerly considered impractica- 
ble. It may be cured easily and certainly by making an incision about an 
inch or a little more in length, through the integuments and subjacent 
textures, including the annular ligament of the wrist. Part xxvii., p. 352. 
Inflamed Bursa of the Patella—Evacuation of the Fluid.—This patient 
presented herself with effusion in the bursas of both knees ; the distention 
was considerable and painful, and distressed the patient very much, wholly 
incapacitating her for her usual avocation. She was in good general health, 
but rather plethoric. Mr. Cooke having introduced the grooved needle, 
at the same time rotating it, and pressing gently upon the swelling, an 
ounce and a half of unctuous, synovial-like fluid was obtained from one 
bursa, by which procedure it was totally emptied. A bandage was applied 
very lightly, and she expressed herself as being much relieved by the tap- 
ping. A blister was ordered to be applied the same evening to the knee, 
and the patient desired to take a purgative. The other dropsical bursa 
was subjected to the same treatment. 
At the end of a month the patient returned to her occupation, with a 
caution always to use a pad when kneeling. 
If a strumous or otherwise unhealthy tendency exist, a second tapping 
and blistering are occasionally required, with the addition of the applica- 
tion of iodine ointment to the blistered surface, and of course, if necessary, 
constitutional treatment. Part xxix., p. 184. 
Housemaid'1s Knee.—There is no form which this disease assumes that 
is not amenable to treatment, by means of a single thread of silk passed 
through its centre. Sooner or later (from two to ten or fifteen days), sup- 
puration in the cyst will follow, and the case assumes the form and charac- 
ter of an ordinary abscess, which the lancet will effectually relieve. 
Part xxxiii., p. 147. 
Enlarged Bursae.—Mr. Coulson, of St. Mary’s Hospital, believes—even 
when bursae are inflamed, and the skin over them red, instead of making 
any incision into them it is preferable merely to puncture them with a 
grooved needle. After evacuation of the contents, apply pressure by means 
of soap plaster and bandage, renewing this from time to time and repeat- 
ing the puncture of the sac also if necessary. The result is generally a safe 
and permanent cure. Part xxxvii., p. 269. 
CACHEXIA. 
Cachexia.—In the treatment of that class of cases so frequently seen in 
children, characterized by large heads, tumid bellies, and pasty com- 273 
(LESARIAN SECTION-. 
plexions, nothing is so efficacious as a simple combination consisting of from 
five to ten grains of phosphate of lime three times a day, in chalk mixture. 
Where there is palpable anaemia, some simple chalybeate must bo added. 
. jPart xxxvi., p. 39. 
Cachexia JEczematosa in Children.— Vide Art. “ Skin Diseases.” 
Case of Caesarian Section.—Mr. James Whitehead gives the following 
description of the steps of this important operation. In a consultation of 
several of his professional friends, regarding the subject of the following 
operation, Mr. W. stated his opinion to be, that the greatest available 
space at the upper aperture of the pelvis, in its antero-posterior diameter, 
was not more than one inch and a quarter. In this opinion, several who 
had also seen the patient before, fully coincided. It was with great diffi- 
culty, however, that an efficient examination could be made, as the con- 
traction in the cavity of the pelvis, and at its outlet, precluded the 
introduction of the hand to a sufficient extent. The tuberosities of the 
ischia were found to approach anteriorly to within a very short distance 
of each other, and the outlet was much encroached upon by the apex of 
the sacrum, which had advanced considerably toward the arch of the 
pubes. After each had again made a careful examination, the conclusion 
was, that the dimensions of the pelvis were too small, not only for instru- 
mental interference by the natural passages, but also for the fragments of 
the foetal cranium to pass, had perforation and separation of the bones 
been practicable. The Caesarian section was therefore decided upon, and 
recommended to be performed without delay. 
Catheterism, and other necessary preliminaries, having been attended 
to, the patient was placed upon her back, her shoulders a little raised on 
pillows, and the knees flexed over the edge of the bed. 
Mr. W. placed himself in the kneeling posture. Assistants were 
stationed to keep her still—supply instruments, sponges, etc. 
The external incision was made in the line of the uterine axis, commenc- 
ing about four inches above, and extending nearly the same distance below 
the umbilicus, and running a little obliquely from within outward; its 
upper extremity being half an inch, and its lower an inch and a half to 
the left side of the linea alba. A short incision was first made through 
the whole thickness of the abdominal parietes, which were extremely 
attenuated, and continued by means of a director and probe-pointed 
bistoury. The cut into the uterus corresponded in direction with the 
external one, and was about seven inches long. A small incision was first 
made with the scalpel, and continued with the probe-pointed bistoury, the 
fingers being used to direct it instead of the grooved probe. The placenta 
being attached at this part of the womb was immediately torn through 
with the fingers, and the child and it extracted without the slightest diffi- 
culty. The uterus, the parietes of which, in its distended state, were not 
thicker than shoe-leather, immediately contracted to the size of a child’s, 
head, and its walls became about three-quarters of an inch in thickness.. 
Some of the small intestines now protruded at the upper part of the- 
CESARIAN SECTION. 274 
CJSSARIAN SECTION. 
wound, but were immediately replaced, and held in. The parts were then 
sponged, the external wound brought together, and secured by six inter- 
rupted sutures, adhesive plaster in long straps, and a broad, circular band- 
age. The lower fifth of. the wound was left uncovered by adhesive 
plasters, in order to allow any discharge to pass freely from the interior : 
a piece of spread lint, and a fold of the bandage being all that was 
thought necessary at this part. The loss of blood amounted to about 
eight or ten ounces; it issued principally from the placenta while being 
torn through. There Avas very little discharge, indeed, scarcely an oozing 
of blood from the divided edges, either of the abdominal parietes or the 
uterus. 
The woman bore the operation almost Avithout a murmur, and said she 
had not suffered more than she should haAre done from tAVo or three ordi- 
nary labor pains. The child, Avho Avas alive and healthy, was extracted in 
less than two minutes after the first incision Avas made, and the Avhole 
operation completed, and the patient in bed, in tAvelve or fifteen minutes 
alier the commencement. The pulse Avas not materially affected, and the 
patient Avas lively and talkative directly after being put to bed. A quar- 
ter of an hour after the operation, which was nine o’clock, p.h., three 
grains of solid opium Avere administered, and directed to be repeated 
every four, fhre, or six hours. She parsed a comfortable night: slight 
uterine pains came on three or four hours after the operation, and she had 
some lochial discharge at the same time per vias naturales. There has 
been a little oozing from the loAver part of the Avound. 
[For. some time the case seemed to be going on favorably, but 
eventually ended fatally, thirty-two days after the operation.] 
Part iv., p. 122. 
Caesarian Section Successfully performed.—A Avoman, thirty years of 
age, had already been three times delivered by means of the perforator 
and crotchet. Pregnant for the fourth time, and having suffered ex- 
tremely from the 12th to the 15th of August, Avithout a prospect of the 
head passing the pelvis, the patient consented to the Caesarian operation, 
which had been proposed to her early in the course of the 14th. The 
operation was done in the usual Avay, in the linea alba, and the only diffi- 
culty experienced Avas in disengaging the head from the isthmus of the 
pelvis, into which it Avas firmly Avedged. The child, Avhen sprinkled Avitli 
cold Avater, began immediately to cry, and moved freely. The mother 
declared the pain of the operation nothing, Avhen compared with the 
suffering she had already endured. It Avas begun and completed in a 
quarter of an hour. 16th.—Belly distended AA'ith flatus; some pain; no 
fever. A suppository Avas folloAved by the discharge of much flatus, and 
complete relief to the pain. A little soothing electuary Avas all the medi- 
cine that was prescribed or required. The mother nursed her child, and 
in four Aveeks Avas going about her ordinary household affairs. 
Part vii., p. 182. 
Caesarian Section.—A woman, aged thirty-one, Avho had borne five 
children naturally, Avas attacked Avith ATiolent arthritis, during her sixth 
pregnancy. The pelvis became so deformed that the finger could scarcely 
be introduced betAveen the tuberosities of the ischium and the ascending 
rami, on either side; the pubes also formed a A'ery prominent angle, the 
sacrum projected much forward, and the os uteri could not be reached. CALCULI, 
275 
On the 27th of July, 1840, labor having commenced, and the contraction 
of the pelvic diameter being well ascertained, the Caesarian section was 
determined on, and Avas performed in the linea alba by Dr. Arnoldi. 
The results were most fortunate : the mother nursed the child herself, 
and the wound healed by the beginning of September. 
Part viii., p. 168. 
Caesarian Section.—At a meeting of the Royal Medical and Chirurgi- 
cal Society, Dr. Lee, after enumerating many cases, all of which showed 
the dreadful fatality of this operation, dwelt on the great advantage to be 
derived from the induction of premature labor in such cases, as proved by 
the experience of the best midwifery practitioners. Dr. Lee himself 
induced it twelve times in one woman, with perfect safety ; and had read 
that morning an account of fifty other cases similar in result. Dr. Merri- 
man remarks, respecting the induction of premature labor, that nothing is 
more easily done, and that it renders the Caesarian section unnecessary and 
unwarrantable. Dr. Lee, in continuation, observed that Dr. Denman 
mentions a whole family in the Strand born by this process, and remarked 
that it is not a thing well knoAvn, viz., its induction in cases of high dis- 
tinction. 
He said, in cases where the pelvis was so much distorted that the child 
could not pass at the seventh month, labor should be induced at the fourth 
or fifth; for that it was consistent with reason and humanity to preserve 
the life of the mother and produce abortion. He (Dr. Lee) did not con- 
sider pelvic deformity the only case applicable to this line of practice, but 
also cases where tumors or cicatrices obstructed delivery as well as in 
cases of organic disease of the heart. Dr. Lee said his object Avas to 
shoAV the society that the operation of inducing premature labor A\ras 
both safe and easily performed. Part xxiii., p. 232. 
CALCULI. 
Solution of Urinary Calculi.—Dr. Charles Petit has made numerous 
experiments on the solvent powers of the waters of Vichy over urinary 
calculi. The result of these researches is, that calculi of uric acid, and of 
the ammoniaco-magnesian phosphate, when placed in this mineral water, 
lose, the first 53 per cent, and the last 60 per cent, of their weight. The 
loss is in the inverse ratio of their hardness and their cohesion. A very 
important result, however, is that the calculi of the ammoniaco-magnesian 
phosphate suffer from this mineral water a true disintegration of particles, 
and become more friable. M. Berard has repeated these experiments, and 
arrived at the same conclusions. Numerous experiments were also per- 
formed on patients afflicted with vai'ious calculous complaints, the result of 
which was highly satisfactory. Those afflicted simply with gravelly com- 
plaints were, by the use of the mineral water of Vichy, relieved of all their 
uneasy feelings, and the formation of calculi was prevented. In those, 
again," who presented all the usual symptoms of urinary calculi, but the 
presence of which were not ascertained by sounding, the waters of Vichy 
caused the expulsion of gravelly detritus, speedily followed by the disap- 276 
CALCULI. 
pearance of the symptoms of stone. In those in whom a urinary calculus 
of considerable dimensions was ascertained to exist by sounding with a 
catheter, the use of the mineral water appeared to cause a diminution of 
its volume ; a fact, in one case, ascertained by an examination after death. 
It may be stated, that the waters of Yichy consist of a pretty strong solu- 
tion of carbonate of soda in a water highly charged with carbonic acid. 
Part i., p. 73. 
New and Natural Method of Bemoving Calculi from the Bladder.— 
The method now proposed, is to furnish a defensive sheath to the irritable 
coats of the urethra, so as to admit of its distention by instruments gradu- 
ally increased in size, by which means the greater number of cases of cal- 
culi may be relieved without any further operation; whilst others, in 
which the stone is large, will admit of the easy application of the instru- 
ments of lithotrity. 
The method in question consists in introducing a portion of the intestine 
of some animal upon a curved tube or catheter, which is open at the ex- 
tremity, but fitted with a flexible metallic stilet, having a rounded head, 
which serves both to direct the instrument and keep the sheath in its place 
till it enters the bladder. Attached to the stilet is also a piece of gut-skin, 
which falls over the end of the instrument. The stilet is then withdrawn 
(which releases the sheath), and afterward the catheter, and one of larger 
size is introduced. The sheath, remaining in the urethra, is so exceedingly 
smooth and slippery, that it gives a facility to the use of large instruments 
—guarding the tender coats of the urethra against all irritation, and allow- 
ing it thus to be dilated by the successive introduction of instruments of 
larger dimension, through which numerous calculi will be discharged. 
This may be varied as circumstances require : at times used in form of a 
ccecum, or closed at the inner extremity, so as to be filled with Avater, to 
facilitate the entrance of instruments, especially in cases of malformation 
or distortion of the part. 
This instrument is considered the best form of a catheter for general 
purposes. Part i.,p. 106. 
Calculi may form in the kidneys in great numbers and of considerable 
size, Avithout furnishing any signal except that of hematuria. 
Part vi., p. 49. 
Decomposition of Calculi by Galvanism.—Mr. Donovan observes that 
Orioli, an Italian of great eminence, and Dr. Harle, of Norwich, first con- 
ceived the idea of resolving a calculus in the bladder, by means of a cur- 
rent of galvanism transmitted doAvn a metallic sound, A’arnished except at 
the point. He says: 
M. Bouryes des Morticre dissolved a calculus out of the body, weighing 
one grain, perfectly, in twenty-four hours, by galvanism. But MM. Prevost 
and J. Dumas have gone far to Award proving the possibility of successfully 
employing galvanism as a means of destroying a calculus in the bladder. 
A fusible human calculus, placed in water, was submitted to the action of 
120 pairs of plates during tAvelve hours. The bases and the phosphoric 
acid Avere liberated at their respective poles, but, OAving to the nature of 
the arrangement, they reunited in a fine powder. The Aveight in this period 
was reduced by twelve grains. Other trials were made during sixteen 
hours, and at the end of this time the calculus was reduced to a mass so CALCULI, 
277 
friable that the slightest pressure reduced it to little crystalline grains, 
which could easily pass through the urethra. MM. Prevost and Pumas 
conceive that it is almost always possible to introduce into the bladder 
two conductors which shall be spread out at the extremity by means of a 
slight spring, so that they may touch the calculus by their internal surface, 
which, in this part, is deprived of its insulating envelope. The calculus 
would be thus decomposed without injury to the bladder, since the current 
takes the shortest distance between the two poles. Part xv., p. 227. 
Effects of Reagents upon Urinary Deposits—Griffith's Table.—The 
characters in the iirst columns, combined with the microscopic appearances, 
will serve to distinguish one from the other, and being readily applied, 
will be sufficient for the use of those who have not opportunities for their 
minute investigation: 
Ordinary 
Color. 
HOW AFFECTED BY 
Blowpipe 
Deposit. 
Boiling 
Sol. of 
Sol. of 
Acetic 
Characteristics. 
W ater. 
Ammon. 
Potassa. 
Acid. 
Foil. 
Lithic acid 
Yellowish 
01 
02 
Dissolved. 
0 
Dissipates it 
When evaporated to dry- 
entirely. 
ness with dilute nitric 
acid and ammonia subse- 
quently added, a pink 
color is developed. 
Lithate of 
Whitish, 
Dissolved. 
Instantly 
Idem. 
04 
Idem. 5. 
Idem. 
ammonia 
pink, 
dissolved. 
brown and 
red brown. 
. 
Phosp. of 
White, 
0 
0 
0 
Is dis- 
Unaltered. 
Nitrate of silver causes a 
lime. 
amorphous 
solved 
yellow precipitate in the 
without 
acetic solution, which is 
efferves- 
also precipitated by oxa- 
cence. 
late of ammonia. 
Ammonia- 
White, gen- 
0 
0 
The 
Is dis- 
Ammonia is 
Nitrate of silver precipi- 
co-magne- 
erally crys- 
odor of 
solved 
evolved, 
tates the acetic solution 
sian phos- 
talline. 
ammonia 
without 
otherwise 
yellow; this, however, is 
not precipitated by oxa- 
phate. 
is evolved 
efferves- 
unaltered. 
by heat. 
cence. 
late of ammonia. 
Oxalite of 
White, gen- 
0 
0 
0 
0 
Leaves an 
The solution is precipi- 
lime. 
erally crys- 
alkaline ash, 
tated by oxalate of am- 
talline. 
which efferv. 
monia. 
with, and 
dissolves 
in dilute 
muriatic 
Cystic ox- 
White, 
0 
Is dis- 
Is dis- 
0 
Entirely dis- 
Crystallizes from the am- 
ide. 
bluish, or 
solved. 
solved. 
sipated. 
moniacal solution on eva- 
greenish, 
poration. When boiled 
with hydrated oxide of 
lead, the black sulphuret 
is formed. 
Carbon, of 
White. 
0 
0 
0 
Is dis- 
Leaves an 
This ash is soluble in 
lime. 
solved 
alkaline ash. 
acetic acid, and the solu- 
with 
tion precipitated by oxa- 
efferves- 
late of ammonia. 
cence. 
1. 0 signifies no effect. 
2. Those effects which take place at once or within a few minutes only are noticed. 
6. When lithate of soda is present 
the reagents mentioned act much more slowly and imperfectly. 
4. Acetic acid decomposes lithate of ammonia, and throws down the lithic acid, so that one denosit occu- 
pies the place of the other, and no apparent change occurs. 
5. If lithates of soda or lime are present an alkaline ash is left. 
The lithic gravel is greyish, reddish, or brownish, insoluble in diluted 278 
CALCULI. 
muriatic acid, and easily soluble in aqua potassre, commonly with evolution 
of ammonia. It consists of variable proportions of lithic acid and lithate 
of ammonia, the former of which generally abounds most in the crystalline, 
and the latter in amorphous forms of it. The corresponding urine is 
scanty, usually high in density and color, always at first acid to litmus 
paper, prone to deposit an adherent sand on standing, and often yielding 
with a few drops of nitric acid a cloud or flaky precipitate, which disap- 
pears under a boiling heat, accompanied commonly with a reddish or pur- 
plish change of color. Phosphatic gravel is usually white or pale grey, 
and amorphous or crystalline ; and it is insoluble in aqua potassaB, but 
easily soluble in diluted muriatic or acetic acid. It consists very rarely of 
phosphate of lirnQ alone, sometimes of the phosphate of magnesia and am- 
monia, and often of both compounds. If ammonia be evolved under the 
action of potash, it contains the ammoniaco-magnesian phosphate; if not, 
it contains only phosphate of lime. The corresponding urine is copious, 
pale, low in density, ammoniacal from the first or very soon afterward, 
prone to decay, and often rendered turbid by boiling, a white flaky preci- 
pitate being separated, which is easily soluble on the addition of nitric 
acid. Oxalic gravel is commonly brown, ash-grey, or bluish, compact, 
occasionally crystalline, sometimes smooth, sometimes tuberculated; and 
it is soluble in diluted nitric acid, scarcely soluble in diluted muriatic, in- 
soluble in acetic acid, insoluble in aqua potassaB. The corresponding urine 
has been little studied. It is clear, probably pale and low in density, and 
if it contains, as seems not unlikely, a little oxalic acid, it will give with 
solution of muriate of lime a white precipitate not soluble on the addition 
of a few drops of muriatic acid. Cystic gravel has a crystalline, somewhat 
waxy appearance, and it is soluble in diluted muriatic acid, insoluble in 
acetic acid, soluble in solution of carbonate of potash, from which it is 
precipitated by carbonate of ammonia. The corresponding urine is green- 
ish-yellow, of a peculiar odor, like that of the brier mingled with that of 
decayed urine, and it remains turbid after some hours’ rest. 
Part ix., p. 12. 
Calculus of the Urethra and Prostate Gland,, with Obstinate Stricture 
of the Urethra.—[This was the case of a joiner, aged 57, of intemperate 
habits, and in his youth having had gonorrhoea frequently. Has suffered 
from difficulty of making water for thirty years, but eighteen months ago 
was seized with retention of urine, followed by extravasation into the 
scrotum and perineum. Free incisions were made, and the urine passed 
by the openings. The sloughing of the scrotum was extensive, almost ex- 
posing the left testicle. Ho instrument could be passed into the bladder.] 
On March 2nd, whilst endeavoring to pass a sinall-sized catheter, it came 
in contact with a calculus anterior to the bulb. An incision was made 
down upon it, at the junction of the scrotum and perineum, which latter 
was densely hard, and almost cartilaginous in its whole length. A calculus, 
of the size of a filbert nut, was extracted, giving considerable relief. 
From this time the man’s general health improved, yet it was found impos- 
sible to pass a catheter beyond the bulb, where the instrument seemed to 
be resisted by a dense, unyielding contraction ; in fact, the urethra appeared 
to be obliterated. It wTas now resolved to make a passage to the bladder, 
of sufficient size to admit a full sized catheter, if possible. 
Dr. Barkus performed the operation on the 13th of March, eleven days CALCULI. 
279 
after the first operation. He was placed in the position for lithotomy, and, 
after having been rendered insensible by chloroform, a catheter was intro- 
duced as far as the bulb of the urethra, and an incision made down to the 
point of the instrument; with the aid of a director and the catheter, 
gradually advanced, the incision was carried to the prostate gland, 
where the instrument came in contact with another calculus, which occu- 
pied almost the whole of the prostate. An incision was then carried 
through the lower part of the prostate, and a stone about the size of a 
large filbert nut extracted, and the catheter now glided into the bladder. 
From this time the man has gone on well; the catheter was at first allowed 
to remain in about a week, but it is now only introduced occasionally for 
a few hours in the day. Part xxiv., p. 238. 
Decomposition of Phosphatic Calculi by Solutions of Lead.—[From 
cases which have occurred under his notice, Dr. Hoskins says, that not 
only does the bladder, under irritation, tolerate the presence of solutions 
of lead, but also that they act as sedatives, and exert a favorable influence, 
directly and indirectly, on the morbid secretion of mucus which generally, 
in such cases, exists. Dr. Hoskins proceeds :] 
After having made trial of most of the vegetable supersalts of lead, all 
of which act, more or less, as unirritating decomponents, I have returned 
to the use of that originally proposed, the nitro-saccharate, as by far the 
most effective. 
One grain of the salt, superacidulated with five drops of strong acetic 
acid, is the proper proportion for admixture with each fluid ounce of water. 
It is essential that the salt and the acid should be incorporated before the 
addition of the water, and that the whole should be brought to the boiling 
point. Superacidulation is necessary on many accounts ; it secures perfect 
solution, increases the decomposing activity of the liquid, and prevents 
the formation of any carbonate of lead. 
As the salts contained in the urine tend to decompose the solution, and 
lessen its effects on the concretion, the bladder should be evacuated, and 
washed out with tepid water before the lead fluid is introduced. A double- 
current caoutchouc catheter is the best for this purpose, as it enables a 
continuous stream to be employed; and as, on account of its flexibility, it 
is less liable to irritate the urethra, which should be sedulously avoided. 
From four to eight fluid ounces of the solution may be thrown into the 
bladder at a time, and renewed every ten or fifteen minutes, as often as 
may be deemed proper. By renewing the liquid at short intervals, much 
greater effect on the calculus is insured, than when it is allowed to remain 
longer; for the precipitate formed by decomposition soon envelops the 
stone, and puts a stop to further action, until a fresh surface is exposed. 
Exercise during the retention of the injection increases its effect. Some 
slight revulsion may be effected by the first introduction of this, or any 
other fluid, into the bladder ; when such is the case, the operation should 
be remitted for a day or two, and cautiously renewed. The injection may 
be either warm or cold, as may be most agreeable to the sensations of the 
patient. Warmth favors the decomposition of the calculus. The lead 
solutions act upon the mucus, which is so abundantly formed in cases of 
this nature, coagulating it into short curdy flakes, which are easily passed 
through the urethra. 
When the urethra itself is inflamed, or abraded, the injection will be 280 
CALCULI. 
injurious ; for the lining membrane of the canal is, I believe, more sensitive 
than that of the bladder. The introduction therefore of decomponents 
should be had recourse to, either before lithotrity, or after the urethra has 
recovered from the effects of the instruments employed, but can never be 
irsed, with any prospect of success, where organic disease of the bladder 
or prostate exists. The injection should not be employed during the 
internal exhibition of hydrochloric acid, although it may be freely used 
when nitric acid is administered. When the bladder is not very irritable, 
a dilute nitric acid injection, alternating with the lead solution, will hasten 
decomposition. 
The two facts established with respect to the lead salts, viz., first their 
toleration by the bladder ; and, secondly, their chemical action on calcu- 
lous concretions, induce me to hope that they may become useful agents 
in the treatment of various other affections of the urinary organs. I have 
never presumed to imagine they would prove specific solvents for the 
stone ; but, I trust that, where surgical operation is inadmissible, they will 
be of some avail for relief, if not for cure, by smoothing asperities, and 
removing the outward phosphatic coating of calculi, so as to bring them 
within the verge of the crushing forceps ; in short, that they may avail for 
partial, if not for entire disintegration. The latter is more likely to hap- 
pen where layers, composed of the urates or oxalates, are bound together 
by phosphatic cement. On this species of calculus, they are calculated to 
act as highly carbonated waters do on those of another description. 
Besides the kind of cases already adduced, there is one variety for which 
decomponents seem to be peculiarly adapted: viz., concretions in the 
prostate gland. Part xxiv., p. 240. 
Corpus Spongiosum, Inflammation of.—The following symptoms were 
produced by the frequent passage of too large sounds along the urethra, 
in a case of calculus in the bladder; excessive hardness of the corpus 
spongiosum, tenderness on pressure, pretty constant discharge of mucus 
from the urethra, frequent desire to pass urine, great expulsatory efforts 
being required to insure even its slowly draining from the penis, and appa- 
rently almost obliteration of the canal, notwithstanding the size of the 
instruments forced along its passage. Mercurial and iodine ointment were 
prescribed, to be rubbed along the perineum and whole course of the 
urethra, and the patient put under mercury constitutionally. The dilata- 
tion of the urethra was recommenced gradually, always keeping within 
No. 8. . Part xxvi., jt>. 211. 
Calculus— Uric Acid.—In a case of stone in the bladder, in which the pa- 
tient occasionally passed a gritty sediment, considered to be lithic acid, Mr. 
Bulley ordered the following: R. Potassoe bicarb, gr. x.; sodse carb. gr. xij. ; 
potassae nit. gr. viij.; ft. pulv. To be dissolved in a tumbler of tepid 
water, and taken twice a day. In six months all attempts to discover the 
stone proved vain, and the gritty deposit had entirely disappeared. The 
greatest advantage may also be derived in these cases from taking two to 
four drachms of bicarbonate of potass, dissolved in thirty or forty ounces 
of water in twenty-four hours. Part xxviii., p. 216. 
Sounding for Stone.—If it be a noisy struggling child, always give 
chloroform and inject the bladder; you will thus, by a little extra trouble, 
be saved the annoyance of pronouncing that no stone is present (and in CAMPHOR, 
281 
these circumstances a small and light stone might be easily overlooked), 
when subsequently, perhaps, by another person, one is discovered and re- 
moved. Part 28V. 
Calculus—Medical Treatment of.—The use of alkaline remedies as sol- 
vents is of great importance ; these should be given in much larger doses 
than are ordinarily exhibited, as, for instance, three drachms of carbonate 
of potash daily. Strong alkaline injections should also be frequently and 
perseveringly used. This medical treatment may be successfully combined 
with surgical—the stone having been reduced to fragmentsby the iithtorite, 
the solution of the fragments should be attempted. The stones most readily 
acted on are those composed of earthy phosphates or cystine. 
Part xxxviii., p. 152. 
Penal Calculus, Passage along the Ureter.—What is the cause of the 
agonizing symptoms accompanying the passage of a renal calculus ? Pro- 
fessor Simpson says that the great distention of the tube by urine above 
the impacted calculus is the cause, and he has succeeded in relieving seve- 
ral cases by inverting the body and manipulating the aifected side, on the 
same principle as you would invert a person with a shilling in his trachea. 
Part 154. 
To Pemove a Calculus from the Urethra.—Get the scoop of a small 
silver director passed into the urethra; and, when you once feel the stone, 
manoeuvre to get the scoop beyond it; you then have it safe; alter the 
angle of the instrument, and it readily comes forward. It is a far superior 
plan to the use of forceps of any kind. It is like what is seen in removing 
a pea from the ear of a child ; if you attempt to do it with forceps, you will 
do what was done with the bougie; instead of poking it out, you will poke 
it in. But if you get a little scoop beyond it, you will soon have it out. 
Part xxxix.,p. 209. 
Concentrated Camphor 3Iixture.—The principal points to be attained 
in preparing a “mistura camphor® concentrata” are three: 1st. It must 
be perfectly colorless. 2d. It must contain as little spirit as possible. 3d. 
When mixed with the due quantity of water, it must approximate as closely 
as possible to the camphor mixture of the London Pharmacopoeia. After 
repeated trials of various formul®, to all of which there appears some ob- 
jection, Mr. Fordred found the following to be the best adapted for prac- 
tical purposes: 
CAMPHOR. 
MISTURA CAMPHORS CONCEXTRATA. 
Tinctur® camphor®, P.L., f| j. 3v.; * tinctur® myrrh® pallid®, 
m. xxx.; f spirittis vini rectificati ad f §iv. M. f3iv. ad f §xvj. aqu® pur®— 
mist, camph. 
Tinctura Myrrhs Pallida. — 5- Tincturae myrrhaa P.L. § iij.; P. Carbonis ani- 
nialis, 5j. 
■j- If absolute alcohol is employed, a less quantity will be required. 282 
CAMPHOR. 
Digest for fourteen clays, frequently shaking; then filter. 
The best method of mixing this, is to measure the requisite quantity of 
and then add the solution of camphor to it. Those who object 
to the addition of the myrrh, though in so small a quantity, may omit it; 
though a solution so prepared does not mix so readily Avith Avater—it is 
some time before the whole of the camphor is taken up. Undoubtedly 
there is something mysterious in the action of myrrh on camphor, AArhich 
has not yet been satisfactorily explained. We knoAv for a certainty 
that the large quantity of spirit present in all concentrated camphor 
mixtures is the immediate cause of the ready solution of the camphor in 
the Avater, but still the myrrh, in some Avay or other, materially assists the 
rapidity of the action. A camphor mixture, made Avith the foregoing 
essence, contains '76 of a grain of camphor in the fluid ounce, equivalent to 
rather more than f of a grain. Part vii., p. 45. 
Efects of Camphor.—M. Raspail, in his lectures on the physiology of 
health and disease, says on this subject: During the last five years, I have 
been in the habit of smoking and inhaling camphor, under the form of a 
cigar, both day and night; I have also placed every night, under my bol- 
ster, a certain quantity of purified camphor. My nights, instead of being 
agitated, have been passed in a calm and uninterrupted sleep. Indifferent 
dreams, recalling but the ordinary scenes of life, succeeded to terri- 
fic nightmares, Avhich used to torment me, almost every night, for at least 
a quarter of an hour. Whenever I aAvake, I chew from fifteen to tAventy 
centigrammes (3 to 4 grains) at least of camphor, Avhich I afterward swalloAv 
along Avith a small quantity of water; this sometimes amounts, in the course of 
the night, to as much as 60 centigrammes (12 grains) of camphor, Avhich I 
ha\Te accustomed myself to SAvalloAving ; in the day time, I often take a dose 
of similar strength ; as a hygienic precaution, I also use frictions of camphor- 
ated spirits, Avhen rising or going to bed, and whenever I perceive the least 
lassitude of spirit or the slightest exhaustion of body. And Avith this inflam- 
matory treatment according to the BroAvnian, the Rasorian, and physiolo- 
gical doctrines, I never Avas better in my life, nor, in fact, so Avell for a 
long time together. I am more disposed to labor, and am less incon\re- 
nienced than ever by it. I therefore consider myself justified in recom- 
mending others to partake of the benefits derived from this long and con- 
clusive trial. I should add that constipation is, generally speaking, pro- 
duced by medicines of this class. Part ix., p. 70. 
Essence of Camphor.—R. Tr. myrrhae gss.; sp. vini camph. giss.; sp. 
A7ini rect. giv. M. The myrrh renders the spirit of camphor miscible Avith 
Avater, Avithout which it would be decomposed. To deprive the myrrh of 
its color, add to it some animal charcoal. About fifty drops will make a 
pint of ordinary camphor julep. 
The mode of administering camphor in suspension of mucilage, is entirely 
obviated, by the myrrh suspending the camphor in the minutest state of 
division, and in a perfectly miscible state. Part xii., p. 255. 
Uses of Camphor.—At a meeting of the Medical Society of London, 
Sir James Murray, after alluding to the disadA'antages attending the exhi- 
bition of camphor in the usual form, exhibited to the Society a solution of 
camphor in his fluid magnesia. In this preparation it is administered more 
easily ; it is almost tasteless, the flavor of the magnesia being also masked CAMPHOR. 
283 
by it. One ounce contains three grains of camphor ; an ounce of it forms 
a very convenient and efficacious dose as a stimulant; if frequently re- 
peated, and in larger doses, it acts as a sedative. Sir James mentioned 
that the solution could easily be increased in strength. He found this pro- 
portion of soluble camphor of great use in the fever then generally pre- 
vailing, which was characterized by great prostration, mental confusion, 
oppression and despondency, owing to previous debility from bad food, 
impure air and privations, the blood being thin and dark-colored from 
imperfect arterialization. Diarrhoea was a general symptom, attended with 
severe pain over the stomach and colon on the slightest pressure; even 
when subacute inflammation existed in the alimentary cavities, and where 
wine and ordinary stimulants would be hurtful, Sir James found this fluid 
camphor admirably adapted to support the general strength. He had 
found it very useful in some cases, where, on account of delirium and 
cerebral excitement, leeches and local depletion were at the same time 
necessary. Under its use the tongue became moist, the skin softened, the 
pulse was reduced in frequency, and it seldom failed to relieve that op- 
pressed breathing which is so often the result of debility. This prepara- 
tion also enables us to distinguish between delirium from exhaustion, and 
delirium from an inflammatory state of the brain. In the former it con- 
tinues to exhibit an improvement which cannot be mistaken, and in the 
latter, it sustains the vital powers, until suitable depleting means can be 
carried out. Again, where weakness is caused by diarrhoea, the moderate 
proportion of fluid magnesia, which forms part of this liquid camphor, pre- 
vents acids and crudities in the alimentary passages, and forms a very val- 
uable vehicle in which to administer opiates and other remedies. The low 
degree of vitality prevalent in these fevers greatly augmented the disposi- 
tion to gangrenous sores and sloughing ulcers—in these cases the aqueous 
solution of camphor presents many advantages over its spirituous applica- 
tions ; the watery solution, not being volatile, remains fixed and durable 
where applied in poultices, lotions or embrocations; it also forms an 
excellent collyrium in scrofulous affections of the eyelids, and a soothing 
application to painful swellings, sprains or bruises; for removing the 
fcetor of bed sores and ulcerated surfaces, it is particularly well adapted. 
Prof. Hart, of Dublin, assured Sir James that it was one of the most 
effectual medicines for the prevention of cramps and collapse, and that 
camphor was always a most useful stimulus in the extensive cholera hospi- 
tal under his charge. It does not, like other stimulants, augment the 
danger of congestion. Fluid camphor is a very valuable agent in abating 
nervous or spasmodic constriction during fits of asthma, where there is not 
any organic alteration. The liquid magnesia combined with this fluid, 
tends to preserve a more healthy condition of the alimentary organs, a 
precaution always to be observed in the treatment of asthmatic ailments. 
From the known properties of camphor in destroying white-blooded ani- 
mals, Sir James Murray was induced to administer the fluid camphor both 
by the stomach and by enema, for the destruction of intestinal worms, 
with considerable success, the worms being expelled dead. 
Dr. Copland said he had given camphor in every dose. When he was 
in Germany, soon after the peace, low fever was very prevalent, and cam- 
phor was the remedy usually adopted, three grains being administered 
every four or five hours. One ounce of this solution, containing three 
grains, would generally prove a sufficient dose, frequently repeated; 284 
CAMPHOK. 
but in low fever it is sometimes necessary to give fifteen-grain doses three 
or four times a day, combining it with calomel and opium. This prepara- 
tion seems an excellent one ; for, when given in a solid form, it irritates 
the stomach, and, in the ordinary solutions the camphor soon separates, 
and spirituous tinctures cause unpleasant eructations. There is nothing 
empirical about it, as the mode of preparation is known by the profession. 
In asthma he had found camphor a most effective remedy dissolved in 
spirit of aniseseed. In these cases the fluid camphor will most likely prove 
very useful. 
l3r. Copland had given camphor in fifteen-grain doses, and up to forty 
grains in twenty-four hours. In small doses it is a cooling, refrigerant 
medicine ; in three-grain doses it is restorative and soothing, and slightly 
soporific; above five grains are a stimulant; in large doses it produces 
delirium and cerebral excitement—hence its benefit' in coma and the last 
stage of fever. Crude camphor will produce ulceration wben in contact 
with a mucous surface. When mixed with mucilage, etc., it is quickly 
absorbed, and passes off by the lungs and skin; very little by the kidneys. 
When injected into the bowels, it produces its effect very rapidly. When 
the puerperal fever was so fatal twenty years ago in the lying-in hospital, 
camphor was tried in large doses, from ten to fifteen grains, repeated 
every five or six hours, and only three deaths afterward took place. 
Opium was combined with it, and turpentine injections occasionally ad- 
ministered. Camphor is a capital remedy in worms, particularly when 
they are thread-worms. He has often been in the habit of giving camphor 
with carbonate of magnesia, rubbed up with or without mucilage. But in 
this state of permanent solution, the remedy can display its efficacy at 
once; it is, therefore, an important improvement. Part xvii,,p. 18. 
New Preparation of Camphor with Chloroform.—The formula is as 
follows: Three drachms of solid camphor are dissolved in one fluid drachm 
of chloroform. This is, perhaps, one of the most remarkable cases of solu- 
tion the whole range of chemistry presents to us. The solution is most 
rapid and complete, and the bulk of the liquid is now increased from one 
to fully four fluid drachms. The solution, rubbed up with the yelk of one 
fresh egg, may be formed into an extremely elegant emulsion by the addi- 
tion of water, without the separation of the camphor or chloroform ; in 
fact, no separation of any kind takes place. If to the proportions given 
above as much water be added as to make a four-ounce mixture, each tea- 
spoonful of the mixture when formed will contain about five and a half 
grains of camphor, and about two minims of chloroform. The capability 
of the formula being varied so that either the camphor or chloroform may 
constitute the predominating ingredient, must be obvious. 
We have tried the effect of several medicinal substances on the mixture. 
With none of them has any separation beeii caused. 
A weak saline solution, composed of common salt, phosphate of soda, 
and an alkaline carbonate, mixed readily, as well as a solution of muriate 
of morphia and sulphate of zinc. With the volatile alkali, and acid liquids 
—such as a weak solution of acetic and muriatic acids—the mixture seems 
to become more intimate and stable. The mixture with ammonia has stood 
since its preparation—now fully a week—without any separation. With 
water alone, however, the chloroform solution of camphor separates in a 
few days, but they readily unite again when slightly agitated. The solu- CANCEKOUS AFFECTIONS. 
285 
tion of camphor in chloroform, although insoluble in water alone, appears 
in this mixture to be in as complete a state of mixture as the butter in milk 
when newly drawn from the cow. Part xviii., p. 344. 
Lupus—Use of Precipitated Carbonate of Iron.—Mr. Carmichael 
makes the following observations: The precipitated carbonate of iron is, 
perhaps, as good a preparation for internal use as any other, and the best 
mode of exhibiting it is, in my opinion, at the moment of precipitation, 
for a knowledge of which I feel indebted to my friend, Sir James Marray. 
The formula is to add to one drachm of the bi-carbonate of soda, dissolved 
in four ounces of spring water, a drachm of muriated tincture of iron. 
The draught to be taken during effervescence, and repeated thrice a day. 
Although the quantity of carbonate of iron thus formed is not consider- 
able, yet it is in such a state of minute subdivision, and combined with a 
solution of muriate of soda equally minute (the saline most congenial to the 
system of red-blooded animals, as it renders the hematosine active and 
vivifying), that I always found it to answer the object of a chalybeate 
thus given much better than the large doses of from one to two drachms 
of the carbonate of iron, that have of late been recommended, and which 
I found few stomachs could bear. If there is ulceration, it is very gene- 
rally improved by the same medicine ; and I have seen many instances of 
that form of malignant disease termed lupus, which attacks the face, per- 
fectly cured by the conjoined use of the internal and external exhibition 
of this preparation of iron. Part i., p. 33. 
Cancerous Affections of the Uterus.—Dr. Osbourne recommends co- 
mum. Even the extract, imperfect as it is, has an effect in appeasing the 
pain in cancerous affections of the uterus, and that without exerting sensi- 
ble narcotic powers, which almost excuses Stoerk for the error into which 
he fell, in proclaiming it as a cure for cancer. I have applied it externally, 
and given it in such cases, sometimes without effect, but sometimes with 
remarkable alleviation of pain, after opium had failed ; and never observed 
any ill effects, except in one case of a woman laboring under scirrhus uteri, 
who obtained great relief from pain by it, but when the dose was increased 
to four grains three times daily, had headache, black motes in vision on 
sitting up, and saw two persons instead of one: all which disappeared 
when the remedy was discontinued. Part i.,p. 35. 
Treatment of Cancerous or Malignant Diseases—Lupus.—Mr. Car- 
michael cured a case of lupus, qf many years standing, and which had de- 
stroyed the greater part of the nose, in four weeks after commencing the 
administration of Donovan’s solution. 
“ Of this liquor hydriodatis arsenici et hydrargyria each drachm mea- 
sure consists of: water, one drachm; protoxide of arsenic, one-eighth of a 
grain ; protoxide of mercury, one-fourth of a grain ; iodine (converted into 
hydriodic acid), four-fifths of a grain. 
“ The color of the solution is yellow', with a pale tinge of green: its 
taste is slightly styptic. It cannot be properly conjoined with tincture of 
CANCEROUS AFFECTIONS. 286 
CANCEROUS AFFECTIONS. 
opium, or with sulphate, muriate, or acetate of morphia ; for all these pro- 
duce immediate and copious precipitates in it. Hence, if opiates are to be 
used during the exhibition of this arsenico-mercurial liquor, they must be 
taken at different periods of the day. Tincture of ginger produces no bad 
effect. The following formula is proper : 
“ R. Liquoris hydriodatis arsenici et hydrargvri, drachmas duas; aquae 
destillatae, uncias tres cum semisse ; syrupi zingiberis, semunciam. Misce. 
Divide in haustus quatuor. Sumatur unus mane nocteque. 
“ Thus one-sixteenth of a grain of protoxide of arsenic, and one-fourth of 
a grain of protoxide of mercury, would be taken in each dose, along with 
two-fifths of a grain of iodine, which being in the state of combined hydri- 
odic acid, will be much diminished in energy of medical effect. This, no 
doubt, is the proper dose to begin the exhibition of arsenic with ; but it 
will be very soon necessary to increase it. 
“The division into draughts is here necessary: first, to insure accuracy 
of the dose, so essential in. the case of this active medicine: and next, to 
prevent injury to the ingredients by the use of a metallic spoon as a mea- 
sure—the general way in which, unfortunately, the dose of a medicine is 
determined.” Part i., p. 107. 
Incipient Cancer of the "Womb.—Dr. Montgomery is of opinion that 
there is a stage of cancer of the womb which is remediable, and the germs 
of which may be destroyed, a stage which precedes the two which are 
usually described by authors; “ and. the reason why this stage is not more 
generally recognized, is that the accompanying symptoms are frequently 
so light as to attract very little the attention of the patient, and thus are 
suffered to remain without treatment, until a profuse hemorrhage or some 
violent fit of pain sounds the alarm, and then, on examination, the disease 
is found to have passed into its second stage ; the surrounding tissues are 
indurated and consolidated with the organ concerned.” There is no 
doubt that many of these cases are entirely overlooked by practitioners, 
simply from not properly examining the organ. 
The margin of the os uteri is found hard, and often slightly fissured, 
and projects more than is natural into the vagina, and is irregular in its 
form. 
In the situation of the muciparous glands, there are'felt several small, 
hard, and distinctly defined projections, almost like grains of shot, or 
gravel, under the mucous membrane. Pressure on these, with the point 
of the finger, gives pain, and the patient often complains that it makes her 
stomach feel sick. 
The cervix is, in most instances, slightly enlarged and harder than it 
ought to be. The circumference of the os uteri, especially between the 
projecting grandulge, feels turgid, and to the eye presents a deep crimson 
color, while the projecting points have sometimes a blueish line. The 
only affection of the uterus for which this disease could be mistaken is 
the irritable uterus, from which however, it is essentially different. 
Treatment should be begun by the local abstraction of blood, either 
by cupping, or by leeches applied directly to the os uteri, or as near as 
possible to the organ, accompanied by the free use of anodyne fomen- 
tations. 
Except there be something especially to forbid its use, mercury should 
be given in some form, so as to bring the system very gently, but de- CANCEROUS AFFECTIONS. 
287 
cidedly, under its influence; for which purpose it may be combined with 
iodine in very minute proportions, with camphor, opium, hyoscyamus, or 
hemlock. 
Afterward, iodine or hydriodate of potash may be used both internally 
and externally; and iron will be found a most beneficial and powerful 
agent. 
The iodide of iron, which combines to a certain degree, the powers of 
both remedies, may also be used with advantage in most cases, and will 
be best administered in the form of Dupasquier's syrup. 
Arsenic has received the testimony of many able practitioners in its 
favor, as an agent capable of giving great relief in these affections. 
Counter-irritation is an agent of great influence in this complaint, and 
may be established in a variety of ways. 
The warm bath and the warm hip bath are means of great value 
throughout the treatment of this affection. 
After the removal of the congestion and organic changes from the os 
uteri, there remains, occasionally, a sensitiveness of the part, which causes 
the patient much discomfort, and which will be best relieved by the use 
of the bath, as above directed: conjoined with anodyne applications to 
the part, or the nitrate of silver in solution ; the best mode of applying 
which, is by means of a bent glass tube, of about an inch in diameter, 
which the patient can introduce and manage for herself; all that is neces- 
sary is that she should lie on her back, and introduce the tube as far as its 
curvature, and then pour into the upper end the medicated solution, which 
will immediately pass to the os uteri, and can be retained there as long as 
necessary, the tube filling the vagina sufficiently to prevent its flowing 
away. Part v.,p. 35. 
Palliative Treatment.—In a case of cancerous ulcer which had de- 
stroyed the greater portion of the nostrils, accompanied with the most 
lancinating pains, over which neither local applications nor internal medi- 
cines, except for a short time, had any control, the following were 
ordered: 
R. Inspissated ox-gall, two drachms; oil caraway, ten minims; carbonate 
of magnesia, sufficient to form a mass. Mix and divide into 36 pills. Dose 
—2, three times a day. 
The effect was almost entire relief from pain, over which, however, the 
pills of ox-gall soon lost their palliative influence. Part vi. p. 66. 
Lupus—Iodide of Arsenic.—Dr. James I. Ross says the first time 
he had an opportunity of seeing this substance used as a local application, 
was in a case of lupus, extensively affecting the nose and upper lip. It 
was ordered by Dr. J. J. Nicol, of Inveimess, and with excellent effect. 
Three grains were made into an ointment with §j. of lard, and a portion 
applied daily to the sore, spread on lint. The surface soon became of a 
dark iron-grey color; in fact, sloughed and formed an eschar. When this 
slough came away, it left below a healthy sore, which soon healed under 
the black wash. During the progress of the case, one or two spots 
showed signs of progressive ulceration, but by a timely application of the 
same ointment, their action was changed in the same way, and at last the 
whole affected surface cicatrized. Part vi., p. 124. 
Cancer—M. Lisfranc on.—That cancer is not contagious, M. Lisfranc 288 
CANCEROUS AFFECTIONS. 
is entirely convinced. He also denies that there is any general infection 
of the system in this disease. He supposes the disease arises from the 
development of a greater or less number of tubercles of a malignant na- 
ture, which, like ordinary tubercles, may be more especially confined to 
certain organs. As suppuration attacks and removes tubercles, not simul- 
taneously, but in successive attacks, so cancer might be removed by seve- 
ral successive operations. 
From observation upon man and experiment upon animals, M. Lisfranc 
believes that cancer may be produced solely by common irritating agents. 
Thus, ulcers, cicatrices, accidental tissues, frequently become cancerous 
when irritated, Avhile instances of relapse, after the removal of such, are 
very rare. Many persons are very liable to the formation of pimples upon 
the face, consisting of accidental tissue. No change usually occurs in 
these until old age approaches, when they either spontaneously ulcerate, 
or do so in consequence of the irritation of external causes. The pus is 
scanty in quantity, and, concreting into a thin crust, the patient takes no 
notice of it. But sooner or later the cancerous condition supervenes, if it 
have not already commenced with the first ulceration. Persons who are 
liable to the production of permanent pimples upon the nose, should be 
careful in not exciting their cancerous degeneration by a too rough use of 
the pocket-handkerchief. Razor wounds, in such subjects, often produce 
dangerous ulcerations. As soon as ulceration occurs, if it be not yet can- 
cerous, apply the nitrate of silver, following its use up by mildly stimulat- 
ing dressings. Even when the ulcer is cancerous, caustic is sometimes 
used with good effect; but the author has seen such frightful aggravation 
result from its employment, that he prefers at once removing the part with 
the bistoury. If a superficial ulceration of a cancerous aspect be seated, 
not on accidental tissue, but upon a normal texture, somewhat indurated, 
it may be touched lightly with a liquid proto-nitrate of mercury, with the 
intention, however, rather of changing its mode of action, than of effecting 
the destruction of the tissues upon which it is seated. In this way you 
will usually effect a cure, especially if you have premised depletion, or 
afterward employ it, if any inflammatory action seem to demand it. Fis- 
sures of the lips, which, when neglected, so frequently degenerate, rarely 
do so if they are touched with the nitrate of silver. The same substance 
is also very useful in the case of a slight erosion of the cheek, covered by 
a thin, greyish crust. The irritation produced in the faces of old persons, 
by the accumulation of the matter of the sebaceous follicles, may eventu- 
ally terminate in cancer. 
M. Lisfranc maintains that all experienced surgeons must deny that can- 
cer is always well characterized. In this way he explains Desault’s sup- 
posed cures of cancer of the rectum, and cites cases of apparently incur- 
able cancer yielding to means seemingly inefficient. He observes, also, 
that we pronounce many ill-looking sores to be cancerous, merely from 
the localities whereon we find them, and that we should never so consider 
them if seen on other parts, e. g., the leg. It is well known, also, that 
syphilis frequently simulates cancer, and the author has often, in doubt- 
ful cases, employed anti-syphilitic remedies with the best effect. 
Lisfranc places more reliance on an operation for the removal of the 
diseased portions than most surgeons. He operates occasionally in the 
advanced stage; and even when the neighboring lymphatic glands are 
enlarged, he will not always allow them to be an impediment to the CANCEROUS AFFECTIONS. 
289 
operation, trusting to their dispersion by antiphlogistic treatment: as all 
enlarged glands are not cancerous, or even scirrhous. 
After the operation for cancer, the fingers must be carefully passed over 
the whole surface of the wound, by which .means small tubercles, easy of 
removal, may be often felt—they sometimes being completely imbedded 
in the pectoral muscles. When very numerous, they can rarely be com- 
pletely extirpated, and when left they frequently give rise to the repro- 
duction of the disease. 
Observation proves that cancer is liable to relapse, in proportion as its 
progress has been active, or it has been complicated with acute inflamma- 
tion. This last is to be met by local depletion, continued for some days 
prior to the operation. Relapses will be less likely to occur, also, if half 
an inch of sound skin be included in the incision—leaving, however, 
enough integument, when it is sound, to procure union by the first inten- 
tion, thereby diminishing the extent of irritation of the wound and subse- 
quent cicatrix. 
In persons of a sanguine temperament, or when suffering from the ob- 
struction of some flux, let bleeding be practised ; and, if the parts in the 
vicinity of the cicatrix become congested, a revulsive bleeding of three 
or four ounces must be employed. The vitality of the susceptible organs 
must be modified by the use of powdered hemlock (the extract usually 
being very bad), for many months. Beginning with a grain every 
morning, the dose may be gradually augmented to four. Lisfranc has 
a very high opinion of this remedy, as a solvent and anti-nervine—and 
its utility is also well seen as the latter, in the gastralgise of women 
suffering from uterine affections. Occasional mild aperients, exutories, 
in case of retrocession, and, after omitting the hemlock, the external or 
internal use of iodine, are other useful means. Much good also results 
from compression, employed by means of agaric and a bandage, and 
extending beyond the cicatrix. The cicatrix must not be irritated, es- 
pecially by too early a movement of the parts. The mildest diet, and, 
if debility be not present, even abstemiousness should be enjoined. 
Part vii., p. 161. 
Lupus affecting the Eyelids, Nose, and Cheek—Chlorate of Zinc.— 
The chlorate of zinc, as an escharotic, is, perhaps, not so generally used 
as its merits would warrant. 
This substance, however, would often be more useful than potassa 
fusa or nitrate of silver; according to Yogt and Cauquoin, it exercises 
an influence over the vital actions of neighboring parts, and to this 
circumstance is probably owing its efficacy and the healthy appearance 
of the sore when the eschar has separated. When used for this pur- 
pose, a paste is readily made, on account of its deliquescence, by mix- 
ing one part of the chloride, and from one to four of wheaten flour; 
or it may be used externally as a lotion, in the strength of two grains 
to the ounce of distilled water. Dr. Byron, of Meath Infirmary, has 
used it with success in some obstinate cases of lupus affecting the eye- 
lids, nose and cheek. He applied it in the solid form to the whole sur- 
face of the sore. The pain was excessive, and the heat and redness 
continued two days. The sore assumed a much healthier appearance 
after the separation of the eschar. It was applied every three or four 
days to those parts which again assumed an unhealthy appearance, and 290 
CANCEROUS AFFECTIONS. 
in one case it was repeated ten times before cicatrization was completed. 
The same treatment Avas adopted in eight cases with great benefit, and 
is thought worthy of more extensive trial in these obstinate cases. 
Part V\\.,p. 215. 
Lupus.—A pill containing one-twelfth of a grain of iodide of arsenic, 
gradually increased to one-sixth of a grain, one-sixth of a grain of bin- 
iodide of mercury, and two grains of extract of conium, recommended 
twice a day in lupus and syphilitic squamous eruptions. The biniodide 
of mercury may be omitted when it has affected the gums. 
Part viii., p. 11. 
Cancrum Oris and Phagedcena of the Cheek.—Considered identical 
when the former has been neglected. 
To prevent being misunderstood as to the particular disease in which 
the chlorate of potash has been successfully used by Dr. Hunt, he gives the 
following description: 
It commences by small ulcers, either on the inside of the cheek, or at the 
point of conjunction of the mucus membrane of the cheek and gums, or in 
the gums themselves, separating them from the teeth: they are very 
tender and painful, and attended with profuse salivation ; the breath soon 
becomes tainted with an offensive smell, not unlike the mercurial feetor : 
if the disease is neglected, the ulceration goes on to destroy the gums, the 
teeth loosen and fall out, the alveoli are laid bare; at the same time the 
brown ragged ulcer spreads rapidly on the inside of the cheek, the integu- 
ments over the spot corresponding to the ulcer become hard, swollen, at 
first white, and afterward of a dull red color, and shortly a black spot 
appears in the centre, which quickly spreads and destroys more or less of 
the cheek; and if the child survive, it is sadly disfigured, and not unfre- 
quently loses the power of opening its mouth, from the unyielding nature 
of the cicatrix; but more commonly, if the disease has extended its rava- 
ges to this extent, it sinks and dies. 
In reference to the treatment, Dr. Hunt remarks: 
Before giving the chloi-ate of potash, Avhen it has been possible to induce 
the child to swallow an aperient, I have given, in the first place, a dose of 
rhubarb and sulphate of potash with a grain of calomel; but generally the 
pain and tenderness of the mouth has been so great, that it has not been 
feasible. I have, therefore, given the chlorate at once, and have waited a 
day or two, until the mouth has become less tender, and then have 
ordered the aperient. The quantity of the salt that I have been in the 
habit of prescribing, varies from twenty to sixty grains, according to the 
age of the child, in divided doses in twenty-four hours, dissolved in water; 
the b3neficial effect is often observed on the following day, almost always 
on the second ; the disagreeable feetor soon lessens, the sores put on a 
healthy reparative action, the dribbling of saliva diminishes, and if there 
is mere ulceration, it very speedily heals, if there is an eschar, it soon 
separates, and the sore granulates kindly. In no other disease did I ever 
see the beneficial effects of any medicine so manifested, as that of the 
chlorate of potash in these diseases. It is sometimes advisable, indeed 
necessary, that the aperient should be occasionally repeated. 
Part viii., p. 148. 
Tev-chloride of Carbon in Cancer and other Piseases.—The ter-chloride 
of carbon has been used for some time past with success in the Middlesex CANCEROUS AFFECTIONS. 
291 
Hospital as an internal and external remedy in cancer and some other 
diseases. Mr. Tuson publishes an interesting paper on this practice, 
which, if corroborated by further experience, will be a valuable addition 
to our remedies in such cases. It was first ordered as a local application 
in a case of cancer of the breast, one drachm being mixed with a pint of 
water. The pain was relieved immediately. It was then given internally, 
one drop increased to two or three drops in a little water three times a-day. 
The effect was sedative, procuring sleep for twenty-four hours. The can- 
cer afterward sloughed, and considerable pieces came away, the surface 
left having a healthy granulated appearance. In another case, it was used 
for a cancer in the groin. The same sedative effect was produced, fol- 
lowed by similar sloughing. Its sedative effects were confined to patients 
laboring under cancer and one or two other diseases, having no such power 
in other cases. It is also recommended in gangrena senilis, its antiseptic 
property being here as remarkable as in cancer, the foetor being completely 
destroyed by its use. Also in sloughing ulcers, in uterine affections, carci- 
noma, scirrhus, ulcerated surfaces with profuse discharge, its use as an 
injection has produced the greatest benefit. It may also be useful in neu- 
ralgic affections. Part viii., p. 149. 
Chloride of Zinc in Phagedenic Ulcer of the Septum Nasi.—In a case 
of phagedenic ulcer of the septum nasi, which threatened to destroy the 
whole nose, Dr. Zwerina, of Vienna, arrested the disease by the chloride 
of zinc. One grain and a half of the salt was dissolved in one ounce of 
distilled water, and the scabs being removed, the sore was pencilled over 
several times a-day with the solution. At the end of a fortnight, a healthy 
granulating surface was found underneath the thick crust which now 
covered the sore, and this being removed occasionally, and the solution re- 
applied, it cicatrized in five weeks. Part viii., p. 155. 
Scirrhus of the Female Preast.—On scirrhus of the female breast, 
Sir B. Brodie gives us the following: 
If there be a scirrhous tumor imbedded in the gland of the breast, and 
you remove the tumor together with the affected part of the breast in 
which it is situated, leaving the remainder of the breast, according to my 
experience, the disease is certain to return ; and this corresponds to a rule 
which I think applies to all cases of malignant disease—that is, that you 
have no security against the return of the disease unless you remove the 
■whole of the organ in which it is seated. 
For instance, if there be fungus hematodes of the bone of the leg, the 
patient may have some chance if you amputate the thigh above the knee, 
but none if you cut through the tibia below the knee. If there be malig- 
nant disease of the femur, you have very little chance at all, unless you 
think it expedient to take out the thigh bone at the hip joint. I say, there- 
fore, in cases of scirrhous tumor of the breast, if you perform the operation 
at all where the tumor is imbedded in the breast, you must remove the 
whole of the organ. You may imagine that this is a thing very easy to be 
done, but you will not find it so in reality, for in amputating the breast in 
a thin person, you will be very apt, if you are not extremely careful, to 
leave a small slice of the gland of the breast adhering to the skin, and I 
have no doubt that this small portion may, in some cases, form the nidus 
of future disease. The color of the gland of the breast varies little from 
that of the surrounding adeps, the hemorrhage causes confusion, and you 292 
CANCEROUS AFFECTIONS. 
must be careful in the dissection to keep the knife near the skin, not near 
the breast. But, in addition to this, in every case, when you have taken 
out the tumor, you should examine the surface, and see whether every part 
you have removed is covered by healthy adeps. If it be not, look on the 
middle of the flap of the skin, and see whether any small portion of the 
breast has been allowed to remain there. 
So far, then, the success of the operation may depend mainly on what 
you do. Where the skin is perfectly sound ; where the nipple is not 
retracted; where there is no diseased gland in the axilla ; where there is 
no sign of internal mischief; where there is no adhesion of the breast to the 
parts below; and where the patient is not very much advanced in life, I 
should say that there is a reasonable chance of an operation making a cure. 
I do not intend to say that in all the excepted cases there will be a per- 
manent cure—far from it; but there will be in some instances, and the 
chance of it may be sufficient to warrant you in recommending the patient 
to submit to the operation. 
Scirrhous tumors sometimes take place in the nipple, and I believe they 
are to be distinguished from similar tumors in the breast itself, and that 
there is a much greater chance of a permanent cure where they originate 
in the nipple than where they have their origin in the breast. 
An operation is a shock to the system, making a great demand upon the 
vital powers, and if you Avithhold the sustenance and stimulus to which the 
patient is accustomed, the constitution probably will not be able to bear 
the shock. 
I have thus spoken of the operation for the removal of a scirrhous tumor 
of the breast, but this organ is liable to other malignant diseases. The 
observations that I have made apply to the one case as well as the other, 
but I think that where malignant disease of the breast has the form of 
fungus hematodes, the chance of ultimate success is even less than where 
it has assumed the form of scirrhus. Fungus hematodes is a worse form 
of malignant disease than scirrhus, and in the few cases which I have seen 
of it in the breast, where the tumor has been removed by operation, the 
patient has always died within a short time afterward from some disease 
of the lungs and effusion into the pleurae. But, after all, I believe that 
malignant disease is essentially of the same character, whether it assumes 
the form of scirrhus, or fungus hematodes, or pancreatic sarcoma. 
Part ix., p. 113. 
Effects of Chloride of Zinc, and Chloride of Lead in Cancer.—Mr. 
Tuson has published some new cases to show the value of certain prepara- 
tions of chlorine in cancerous affections. The use of chloride of zinc 
externally is well known, but Mr. Tuson administers it internally; he also 
places confidence in the chloride of lead and other chlorides given inter- 
nally. In one case which he publishes, there was an extensive cancerous 
disease of the right breast and neck, which was treated unsuccessfully for 
a long time, till a paste was applied, made of one part of chloride of zinc 
and three of flour; this was well mixed and moistened with water, and 
then applied over the whole of the ulcerated parts. The chloride of zinc 
was also given internally: half a grain was ordered every morning in a 
wineglassful of caraway water. The chloride of zinc paste was applied 
again, and when the slough separated, the ulcerated surface healed 
kindly. CANCEROUS AFFECTIONS. 
293 
The cancerous disposition continued for some time, and the dose of the 
metal was increased to three-quarters of a grain, and continued for two 
months. The improvement, although very striking, was not permanent, 
as the patient suffered a relapse, which ended fatally. The case, however, 
W’as sufficient to show that the treatment had made considerable impres- 
sion on the disease, and especially in healing the open cancer, which Mr. 
Tuson has found to be the result in several other cases. A solution of one 
drachm of the chloride of zinc, to a pint of water, injected upon a can- 
cerous ulcer, or applied with linen rags, will be found a very useful appli- 
cation. Another case is related in which the chloride of lead was used. 
The case was one of large, irregular, open cancer of the right breast, 
extending deeply into the axilla, so that the pulsations of the vessels could 
be seen, with a foul, yellow, excavated surface, copious discharge, with 
much fetor and severe pain. A solution of the chloride of lead (one 
drachm to a pint) was ordered to be applied and kept constantly wet; and 
ten grains of chloride of potassium were administered in caraway water 
three times a day. Under this treatment there was considerable improve- 
ment. The solution of chloride of zinc was afterward substituted for the lead, 
and although, as in the other case, the result was unfavorable, the life of the 
patient seemed to be prolonged. The relief, also, is sometimes very great, 
arising, probably, from the application acting upon the nerves, and paralyz- 
ing them. The same relief may be procured from the ointment in some 
hysterical affections of the breast, or nervous irritability of the gland, and 
in some cases where a tumor may be pressing on, or involving a nervous 
filament. The ointment may be made with one drachm of the chloride 
of lead, and one ounce of common cerate. Part ix., p. 168. 
Treatment of Lupus, etc.—We have to deal with ulcers of the face, and 
they are of different kinds. We do not often meet with simple ulceration 
here except from accident. Ulcers in the upper part of the body heal 
very rapidly; the blood flows freely away, and this is very essential to the 
healing process. Wounds in the upper part of the body heal in one-fourth 
part of the time that they do in the lower. 
Many ulcers here assume a specific character, and sometimes commence 
from very slight injury. A man has cut himself in shaving, and the 
wound has become poisoned, as the saying is, somehow. Some corrosive 
or irritating stuff has been applied to it by accident or design, the oxide 
of some metal, such a panacea as brown soap and sugar; or a small, soft- 
ish wart appears, or a little eruption, and from this ulceration takes place. 
These ulcers arise about the aim of the nose, sometimes at the corner of 
the eyes, and sometimes on the cheek. Occasionally they begin as hard 
tubercles, and go on extending. Perhaps the sore heals at one place, and 
spreads at another. Although these sores are troublesome to the patient, 
and intractable, they can scarcely be looked upon as thoroughly malig- 
nant. They may.go on and destroy all the parts with which they come in 
contact; skin, muscles, cartilages, and bones, all perish before them. 
Cases which are neglected may proceed from bad to worse for a number 
of years, until scarcely any vestige of the bones of the face or their cover- 
ings is left. I have over and over again, says Mr. Liston, seen patients 
who had lost all their features, lips, nose, and eyes; nothing remained but 
the brain-pan and tongue, and they required to be fed by a funnel intro- 
duced over the base of this organ and into the pharynx. 294 
CANCEROUS AFFECTIONS. 
These ulcers have a sharp edge ; the integument around them is some- 
times slightly tuberculated, and the edges are doav and then, as it were, 
Avorm-eaten, but there is no inflammation around ; they are glazed on the 
surface, and there is no appearance of granulation in them; they may 
continue for a great many years, causing the destruction I have mentioned 
Avithout the lymphatics being at all affected, without the constitution 
suffering much, and Avithout the disease appearing in other tissues or 
organs of the body. 
ISToav, this affection, which has been termed lupus, or noli me tangere, 
or herpes exedens, etc., may be at once put a stop to by appropriate treat- 
ment. It has been supposed that internal medicines do good; arsenic is 
said to be efficacious, but it is by local treatment that you principally suc- 
ceed. There may be some slight swelling in the part, and the parts 
underneath may be healed, but Avhenever you see the edges assume a 
sharp appearance they must be destroyed by an active escharotic. You 
may employ arsenical paste, but the constitution is apt to be dangerously 
affected by it. The best application is the chloride of zinc, mixed up dry, 
with an equal quantity of flour, and then moistened by adding a little Avater 
to it. It must be mixed up to the consistence of bird-lime, and you may 
spread it on lint; but the better plan is to put it on a spatula, dip your 
finger in water, then lay it on with accuracy round the sore, and then 
OArer the whole of it. It subjects the patient to some pain, but that ceases 
after a time, and the paste becomes elevated at the edges. You then find 
that an extensive slough has formed, and immediately that separates, 
instead of the old eating ulcer you have substituted a healthy granulating 
surface, the part furnishes good matter, and there is soon the commence- 
ment of cicatrization all around. The surface is then poulticed to remove 
the scabs: and if, subsequently, any portion should continue to present an 
unhealthy aspect, the cauterization ought to be repeated. This may be done 
in all the stages of the disease; even Avhere the greater part of the 
features are destroyed, you may in this Avay check the disease ; and Avhere 
the affection is not so far advanced, you may destroy it altogether, and 
obtain a healthy cicatrix without much deformity. 
The chloride of zinc used thus, is a most actual and effectual remedy, 
but it causes, as might be expected, seA'ere pain for some hours after its 
application. Part x., p. 163. 
Lupus Superficialis—Use of Proto-chloride of Mercury and Quina.— 
Mr. Hamilton reports several cases treated by him in the Richmond 
Hospital, by means of this salt. We give one as an example: 
The first case Avas that of a laborer, aged forty, Avho had suffered from 
lupus superficialis of the left arm for a twelvemonth; it occupied the 
loAver half of the arm, and the upper part of the forearm, and presented the 
usual characteristics of that disease, a dull, red, shining surface, Avith many 
superficial ulcers having a tendency to burroAV under the skin ; there Avas 
also a small oblong patch of the same on the sternum. lie had been 
treated by tA\ro medical men without any benefit. One grain of the proto- 
chloride ofmei'cury and quina Avas given three times a day. When he had 
taken twenty-one grains, rather profuse salivation set in. A marked 
improvement had taken place in the local disease; the redness had paled, 
most of the ulcers Avere healed, or become superficial. The medicine was 
omitted for a few days, and then resumed, a grain night and morning. He CANCEROUS AFFECTIONS. 
295 
was dismissed cured, having been a little more than three weeks in the hos- 
pital. Nothing but simple dressing was applied to the ulcers. Part x.,p. 98. 
Iodide of Potassium.— Vide Therapeutic Action of, by Lisfranc. Art. 
“ Iodic Preparations.” 
Caustic of Sulphuric Acid with Saffron.—M. Velpeau has found that 
sulphuric acid with saffron forms an admirable caustic. The powerful 
cauterizing effects of the acid are not destroyed, but by the combination a 
black paste is formed, which hardens into a crust shortly after exposure to 
the air. The peculiar properties of this caustic are its combining great 
power, with facility of circumscribing its action, and it is stated also that 
the eschar thus formed, though deep, is quickly thrown off. In cancerous 
affections, the peculiar and disgusting fetid odor was quickly destroyed, 
nor did any bad effects, indicating its absorption, arise during its use. 
Part xii., p. 301. 
Sea-Bathing in Cancerous Affections.—Suggested as likely to be use- 
ful from the chlorine present. The use of salt, internally, it has been 
observed, is almost universally disliked by patients suffering under cancer- 
ous affections. Part xii., p. 302. 
Compression in the Treatment of Cancer.—Apply perfectly smooth 
disks of agaric, laid over each other, and retained in situ by a roller. 
(Recamier.) Use a laminated plate of lead, modelled to the tumor, sur- 
mounted by graduated compresses. (M. Begin.) Dr. Arnott’s plan of 
applying pressure by means of an air cushion and spring, is the best, as it 
makes equal and regular pressure on the tumor, and is applicable whenever 
a bony .or other solid support exists behind the growth, where a point for 
counter-pressure can be had. Give the following internally : R. Arsenici 
iodureti, gr. j.; ext. conii Bij.; M. in pil. xvi. dividend ; j. bis die s. Diet 
should be light and nutritious, and exercise moderate. Part xiii., p. 165. 
Diagnosis of Cancerous Groioths in the Living Subject.—[Lancinating 
pains, unequal surface, and the other local and general symptoms usually 
ascribed to cancer, are not sufficient for the purpose of diagnosis. As Dr. 
Bennett says :] 
All these symptoms have, at various times, been proved to be connected 
with epidemic, fibrous, fatty, or cystic growths. In the living subject it is 
clear that the anatomical arrangement of the fibrous and cellular elements, 
observed in morbid specimens, can seldom be seen. We have no oppor- 
tunity of obtaining a section. Still there are certain places where the 
detection of such cells as have been described, exhibiting their peculiar 
change under the action of acetic acid, will enable us to diagnose a malig- 
nant growth with certainty. Over most of the surface generally, for 
instance, where the diagnosis most concerns the surgeon, a group of such 
cells cannot leave us in doubt, because the epidermic scales in such cases 
never resemble them, as they do in internal organs, as the bladder, 
stomach, or brain. Thus, although anatomically, and in all cases, we can- 
not depend upon the form or even structure of the cell, as connected with 
the epidermis alone we can. Ilence, to the surgeon, a minute examination 
is a more precious means of diagnosis than to the physician. Various ulcer- 
ated and fungoid tumors of the surface may be diagnosed with certainty, 
from an examination of the cells alone, whilst in fluids discharged from the 
stomach, bowels, or bladder, this means of diagnosis is not so certain. 296 
CANCEROUS AFFECTIONS. 
Many instances are now on record, where in doubtful cases such an exami- 
nation lias determined the nature of the growth. Several have been lately 
published by M. Sedillot of Strasbourg, and others may be found in the 
works of Lebert and Vogel. There can be no doubt that many tumors 
and ulcerations exist, which, to the naked eye, and according to the ordi- 
nary symptoms, resemble cancer, although they are perfectly innocent. 
To all such growths, Lebert has given the name of cancroid. Among 
them may be placed many so-called cancers of the lip, which, on examina- 
tion, are often found to be fibro-epidermic; many tumors of the breast 
which are either fibrous, fibro-epidermic, or cysto-sarcomatous; fungoid 
swellings of the dura mater; the ordinary fungus of the testicle, which 
Messrs. Goodsir and Syme have shown to consist of healthy granulations; 
and probably the so-called chimney-sweep’s cancer of the scrotum. 
Part xvi., p. 320. 
Cancer of Lip.—Apply chloride of zinc to the sore, in the following 
manner: Mix together two parts of chloride of zinc and three parts of 
gypsum, spread the powder over the surface of the sore, protecting the 
edges of the healthy skin with vinegar, and in about a quarter of an hour 
apply a soft poultice. Part xix., p. 205. 
Cancer of the Uterus.—With a view to restrain the continued draining 
of blood, try the tincture of Indian hemp. Begin with five drops of 
Donovan’s tincture of the resin, thrice a day, and gradually increase the 
dose to ten drops. Part xix., p. 329. 
Cauterizing Cancerous Tumors with Solidified Nitric Acid.—When 
cauterization is employed, it is recommended to perform it thus: A gela- 
tinous paste having been procured by dropping highly concentrated nitric 
acid upon lint, a portion of this, of an appropriate size, is placed upon the 
part, and allowed to remain for fifteen or twenty minutes; it is then 
removed, and the part dressed with lint dipped in a solution of alum. The 
cauterization is to be repeated daily, first removing the eschar previously 
made. Part p. 24. 
Lupus.—Give phosphorus, in the form of phosphorated oil or ether, 
mixed up with powdered gum and mint water; or apply it externally in 
the form of ointment made with camphorated lard. Part xxi., p. 250. 
Remedial Efficacy of a very Low or Anaesthetic Temperature in Can- 
cer.—Dr. Bennett has remarked that “ in a cancerous growth, the tendency 
is to excessive cell-formation. We evidently retard its advancement by 
the application of cold. Were it possible, indeed, to bring down the 
temperature of an entire growth below the vegetating point, we must 
inevitably kill it; but supplied as it is through the warm blood within, 
this is impossible.” The practice of congealing the parts, as a cure for 
cancer, has been attended with great success. Five minutes is the usual 
time to apply the congealing agent to the exterior of the body, when the 
skin and subjacent tissues are in their normal state; but it may be applied 
for fifteen or twenty minutes in the case of uterine cancer, and probably 
not with half the effect as when it is applied to the exterior, on account of 
the higher vascularity and natural heat of the part subjected to it. Con- 
gelation may be locally effected by mixing quickly half a pound of ice with 
half that quantity of common salt. This may be poured into a net of the 
thinnest silk gauze, and immediately applied to the part. The brine, as it 
trickles from the net, may be absorbed by a moist sponge. 297 
CANCEROUS AFFECTIONS. 
Dr. Arnott gives the following case, illustrative of the benefit which 
may be derived from congelation in cases of uterine cancer: 
The patient, M. R., was admitted at the Brighton Dispensary on the 
25th July, 1849. Of short stature, thin,•Sallow complexion, and about 42 
years of age. Her principal symptoms were frequent and severe parox- 
ysms of pain, chiefly in the back and hips; a profuse and most offensive 
discharge and occasional hemorrhage from the vagina, and derangement 
of the digestive organs. On examination, the neck of the womb was found 
hard and ulcerated. 
For six months, the usual palliative treatment was pursued—viz., the 
exhibition of the preparation of opium and the application of leeches. She 
complained that the opium made her constantly drowsy and unfit for her 
occupation as a needlewoman ; and the pain was, notwithstanding its use, 
occasionally so severe as to oblige her to rise from bed and roll on the floor 
of her room. 
In January, I determined upon a trial of congelation, having previously 
made another careful examination of the uterus. The disease had by this 
time considerably extended: the neck of the womb was now completely 
destroyed, and there were several warty excrescences in the upper part of 
the vagina. Congelation was effected by means of a frigorific mixture of 
two parts of finely pounded ice and one part of chloride of sodium, intro- 
duced through a wide speculum of gutta percha, having the lower part of 
its upper opening of a cup-like form ; and in order that the temperature 
might be maintained at the requisite low degree, or below zero of Fahren- 
heit, the dissolved ice was continually drawn off by a siphon of peculiar 
construction. This peculiarity consists in a large two-necked bottle being 
connected with or constituting part of the long arm of the siphon ; and 
the purpose of it is, that a stream of water may continue to flow along this 
part of the siphon, and keep up the suction at its proper extremity, not- 
withstanding any interruption in. the supply. A tube of vulcanized india- 
rubber forms the remaining part of the siphon, with a small glass tube 
where it enters the speculum, in order that the rising column of liquid may 
be seen and regulated by a stop-cock. 
The success of this application exceeded my expectation. So soon as I 
had learned to apply the frigorific properly, I was able to give immediate 
and entire relief, and this has generally continued complete for about a 
week. The discharge was soon diminished, and became much less offen- 
sive, and the tendency to hemorrhage ceased. From twenty to thirty 
applications of the frigorific have now been made, and scarcely any other 
remedy has been used. No advance of the disease appears, on examina- 
tion, to have taken place, and in other respects there is decided improve- 
ment. The patient is not so thin; her appetite is tolerably good ; she is 
stronger, and able to occupy herself in the usual household affairs. 
She is directed to call whenever the pain returns. The speculum is 
genei’ally introduced by herself while in the supine position, and she covers 
her extremities with a sheet before I enter the apartment. The nates are 
raised, in order that the speculum may be sufficiently upright to contain 
enough of the frigorific, which has usually been kept applied for a period 
varying from a quarter to half on hour. There is a slight sensation of 
smarting produced for a minute or two, and the pain from the disease has 
generally ceased within the first five minutes. If the womb be now in- 
spected by removing the frigorific from the speculum, the greater part of 
its visible surface will be found perfectly white and hard. The application 298 
CANCEROUS AFFECTIONS. 
is terminated by allowing about a quart of cold water to run rapidly 
through the speculum and siphon, for the purpose of gradually restoring 
the natural temperature and washing away any remaining salt. 
Part xxii., p. 28. 
Cutaneous Cancer of the Anlde—Amputation of the Leg.—The pa- 
tient, a girl aged 24, suffered about fifteen or sixteen years ago, from a 
tumor about the size of a marble, on the right foot under the inner ankle, 
which Avas removed by Mr. Liston, but the cicatrix remaining from the 
operation never became white and firm, but Avas ahvays covered with a 
thin dry scab. About four years ago, a second tumor formed above the 
first, Avhich gradually increased in size, and at last burst, discharging some 
matter. The part Avas poulticed, but no relief being obtained, Mr. Holt 
removed the tumor, which Avas about the size of a walnut. 
But it soon began to manifest greater activity, and to display its malig- 
nant and dangerous nature. The granulations, instead of being small and 
healthy, increased in size, and although attempts Avere made to destroy 
them by means of escharotics, they still greAV larger, and a cherry-colored 
nodulated mass arose as large as an egg : in Avashing it she constantly re- 
moved small, black coagula. Yet up to a late period she Avas able to 
Avalk; she could not bear a boot to be laced on the ankle, and setting the 
foot to the ground Avhen she rose to begin walking Avas very painful, but 
this over, she could go pretty Avell. As there appeared no probability of 
saving the foot, she Avas made an in-patient on the 7th of May, and on the 
23d of June, Mr. Holt removed the leg between the upper and middle 
thirds. On examination, the disease was found to be confined almost en- 
tirely to the skin, having attacked none of the deeper-seated tissues, except 
the adductor pollicis. 
No untOAvard symptom occurred after the operation, except a gland 
which suppurated on the inner and upper part of the thigh. 
Part xxii., p. 247. 
Chimney-Sweeper's Cancer.—It is stated that this disease is seen, per- 
haps, to a greater extent in the hospitals of London than in any other in- 
stitutions in the world. Although it is supposed to proceed from soot 
irritating the scrotum, yet there are reasons to doubt Avlicther the pre- 
sence of soot, or any other dirt, is essential to the disease, as it is stated to 
have been seen in persons unexposed to the influence of soot; and the dis- 
ease is unknoAvn in Paris, where the lower orders of the population are in- 
finitely filthier in their persons than the same class in London. In the 
following case, hoAvever, the patient had certainly been exposed to the 
action of soot. 
The disease first appeared like a small pimple, the top of which he re- 
peatedly scratched off; by and by a little fluid oozed from the abraded 
surfaces, Avhich gradually increased in extent till about four months ago. 
At this time its development seems to ha\re received a sudden impulse, 
and it speedily increased in size. He began to dress it with poultices, 
Avhich produced free suppuration, and gave him great relief. He never 
applied to any one for advice, so that the progress of the disease was quite 
uninfluenced by any foreign applications. He Avas admitted into the hos- 
pital, under Mr. Holt, on the 2d of July, the growth having, by this time, 
attained the size of the tips of three fingers, and become very painful; the 
pain was of a lancinating character, and accompanied by beatings AA'hich 
gave him the sensation of the ticking of a clock. CANCEROUS AFFECTIONS. 
299 
As Lis health had now suffered considerably, he was operated on four 
days after admission, the incisions being made transversely. Some he- 
morrhage took place on the 8th, which impeded the progress of union by 
the first intention, but, by the 20th, the cicatrix had formed firmly, except 
over a minute line ; the case may, therefore, be considered as having ter- 
minated favorably, though only a long period of time can assure us that 
there is no danger of relapse. The patient, however, leaves the hospital 
in a most gratifying state of improvement. 
Respecting the mode of growth by which the scrotum is replaced, there 
seems some obscurity. Mr. Liston says, “ it is astonishing how completely 
and in how short a time these glands (the testicles) receive a new cover- 
ing at the expense of the surrounding healthy skin.” The fact is well 
known, but we have not been able to meet with any very satisfactory 
account of the manner in which it occurs. In cases like that we have just 
recorded, where a small portion of the scrotum is removed, it is very easy 
to imagine how this structure, loose and extensile, may be greatly stretch- 
ed by the pull of the ligatures; but there are facts which tend to show 
that, independent of this, the scrotum would of itself cover the testicles. 
Mr. Lynn, on one occasion, removed the whole of the scrotum, and yet 
the testicles were soon covered. Part xxii., p. 248. 
Treatment of Lupus.—Dr. Thomson relied on three medicines—iron, 
iodine, and arsenic, with biniodide of mercury, and the occasional use of 
cod-liver oil and quinine. If the general health was at all lowered, and if 
there were any anaemic symptoms, cod-liver oil and iodide of iron were 
given for ten or fourteen days. After this, the alternate treatment was 
commenced, by giving the biniodide of arsenic in one-twelfth of a grain. 
If gastrodynia came on, the medicine was left off, and opium and hydro- 
cyanic acid administered. Conium was also found useful, and frequently 
mixed with the biniodide. If the latter could not be borne, then the liq. 
potassoe arsenitis was given in small doses, from four to eight minims, and 
iodine was rubbed in over the healthy skin, to promote absorption. Dr. T. 
occasionally applied the strong nitric acid to the edges of the ulcer, or a 
strong solution of the nitrate of silver (3ij. or 5hj- to §j. of water) over the 
tubercle, and subsequently acetate of lead wash, to lessen the temporary 
heat and swelling which followed. If unhealthy pale fungous granulations 
arose, an ointment of iodide of sulphur, or a very weak ointment of the 
biniodide of arsenic, or of either of the iodides of mercury, was employed. 
Part xxii., p. 255. 
Effects of a Bread and Milk Diet on a Supposed Malignant Tumor of 
Eight Years Standing.—This case occurred in the person of Dr. Twitchell, 
one of the most celebrated medical practitioners in New England. Car- 
cinoma had prevailed in his family, and during his studentship he had suf- 
fered first from dyspepsia, and then from severe asthma, which entirely 
left him after he had abandoned the use of meat, and confined himself to 
a vegetable diet on account of an acne with which he was troubled. After 
nine years of such abstinence, he gradually resumed the moderate use of 
meat. The local disease in question commenced about eight or ten years 
since, as a small hard tumor at the inner angle of the eye, which slowly 
but gradually enlarged so as to become very conspicuous. The greater 
part was excised, but the wound did not heal, and another operation, fol- 
lowed by the use of nitrate of silver, was performed. Eventually the 
ulcer which resulted assumed a decidedly malignant aspect, and the gene- 300 
CANCEROUS AJFFECTIONS. 
ral opinion of the eminent men he consulted at the meeting of the Medi- 
cal Association of Philadelphia, in May, 1847, was, that the disease was ot 
a very serious character. A variety of local applications having been 
tried, Dr. Twitchell, starting from the theory that malignant diseases 
arose from the taking too much carbon into the system, resolved to limit 
himself to a bread and milk diet, and to this he henceforth strictly ad- 
hered. He took from four to six ounces of cream, or the richest milk, 
and as much white or brown bread, three times daily. The immediate 
results Avere a cessation of the pain, a diminution of the discharge, and an 
arrest of the spread of the ulcer—this eventually diminishing, and then 
altogether disappearing. When Dr. BoAvditch saw him, August, 1849, no 
difference could be discerned in the angles of the tAvo eyes, unless by a per- 
son already aAArare of the former existence of the ulcer, who would then 
perceive a small soft cicatrix. A perfect cure of what all thought to be a 
malignant disease of ten years’ duration had thus been accomplished by 
this diet, commenced Avhen the patient Avas 68 years of age. 
Part xxii., p. 258. 
Lupus Exedens.—Mr. Hunt, imagining that from the improvement in 
this disease, by the local application of arsenic, being only of short dura- 
tion, it must ha\Te arisen from the absorption of the drug, AA’as led to ad- 
minister the remedy internally, and the experiment AA'as attended by the 
best results. In lupus non-exedens the internal use of arsenic AA’as by no 
means so Avell marked. Part xxiii., p. 285. 
Treatment of Lupus by the Topical Application of the Pi-ioduret of 
Mercury.—M. Cazenave, after trying a variety of local applications in 
lupus, has come to the conclusion that none is more efficacious than the bi- 
ioduret of mercury. After a certain number of applications of this drug, 
AATith the transient local inflammations AA’hich it excites, he has seen the 
hypertrophied tissues, as it were, dissolved, the tubercles disappear, and 
soft cicatrices form. He has, in fact, seen the most repulsive cases heal, 
with no more disfigurement than arises from a patchy discoloration of the 
integuments. 
The application in general is not painful at first, but it is soon folloAAred 
by seA'ere suffering, which lasts from six to tAA'elve hours. The pain is ac- 
companied by erysij>elatous redness of the parts adjacent; but the redness 
and SAArelling subside in three or four days. The iodide of mercury then 
forms a crust Avith the exudation which it occasions, and on falling off dis- 
plays a smooth cicatrix. The same effects folloAv the application to lupoid 
ulcerations. 
The bi-ioduret of mercury may be dissoh’ed in ether, incorporated in an 
ointment, or suspended in oil. M. CazenaA’e prefers the latter. As the 
application is painful, and requires to be repeated five or six days, he 
recommends that only a small space should be touched at once. 
Part xxiv., p. 259. 
Epithelial Cancer.—The skin and mucous membranes are their seat; 
and the disease generally attacks those parts most liable to abrasion of the 
cuticular surface : thus the seAreral narrow parts of the mucous canal, as the 
oesophagus, behind the larynx, the pylorus, and the rectum. The disease 
runs a peculiar and almost constant course; it commences as a tubercular 
eleAration, Avhich spreads slowly along the mucous tract, interfering AA'ith 
the functions of the part, and sooner or later taking on an ulcerative ac- 
tion. The disease progresses by extension, and often remarkably slowly; CANCEROUS AFFECTIONS. 
301 
but frequently it will assume a more rapid course, if any local irritation 
be set up ; it generally kills by its local influence, and not by constitutional 
contamination. In the inspection of all the cases of this class that Dr. 
Barlow, at Guy’s Hospital, had an opportunity of seeing, there has been 
found no trace whatever of malignant disease in any part of the body, thus 
at once characterizing the disease as one of purely local cancer. 
Part xxiv., p. 323. 
Epithelial Cancer of the Female Genitals—Operation—Recovery.— 
[No history of syphilis. Menstruation had ceased a year. Ten years be- 
fore, a numbness had been felt in the external genitals, and afterward 
upon the upper and inner surface of the left labium, a small, hard swelling, 
of the size of a pea, was noticed, which slowly spread, softened, and be- 
came an ulcerated surface. Latterly it had become so painful as almost 
entirely to prevent sleep.] 
Dr. Oldham writes: “There is a deep excavated ulcer, of the size of a 
crown piece, with a rough, hardened and uneven base, which has destroyed 
the clitoris, and has extended to the upper part of both external labia, 
leaving the lower part quite free. The upper margin of this malignant 
sore has a hard elevated edge. The nymphae are not implicated, but this 
structure bounds the lower edge of the ulcer. The vagina and uterus are 
free from disease ; and on the most careful examination, there is no evi- 
dence of malignant disease either in the neighboring lymphatic glands or 
elsewhere.” Ordered: 
It. Potass, iodid. gr. iv.; liq. potassse, minim, x. ex inf. cascaril., ter 
die ; lot. liv. calcis c. opio ; morph, acetat. gr. % o. n. 
Dr. Oldham thought that the parts might be removed; and Mr. Po- 
land proceeded to the operation. 
The patient was placed on the operating table, in the position for 
lithotomy, and under the influence of chloroform. The whole of the mass 
was grasped with the left hand, and the entire disease removed with one 
sweep of the knife. Not much hemorrhage ensued, and only five arteries 
required tying. Pressure wdth a T bandage applied. On the following 
day the urine had to be drawn off; but considerable difficulty was expe- 
rienced in finding the orifice of the urethra, as its upper margin had been 
just shaved by the knife, and the urethra had retracted and was hidden by 
the wound. The woman progressed favorably, she had not a bad symptom, 
and the wound healed up by granulation very rapidly. 
Remarks.—Epithelial cancer is an exactly similar disease to that of chim- 
ney-sweeper’s cancer ; the one being an epithelial disease of the skin, the 
other of the mucous membrane. Both, if unchecked, progress by exten- 
sion and destroy life, either by exhaustion, in the shape of a large, ulcerat- 
ing, serous-discharging sore, or by extension along the lumber glands. 
They are purely local diseases, but unfortunately liable to a return. 
Part xxiv., p. 324. 
Cicatrization after Precision of Cancerous Tumors.—M. Grusell has 
lately intimated to the French Academy of Sciences, that charpie sus- 
pended in a decoction of oak bark for some days and then dried, forms an 
admirable dressing after the excision of cancerous tumors, as it preserves 
the simple condition of the wround, and obtains rapid cicatrization. 
Part xxiv., p. 343. 
Lupus Exedens.—Apply a solution of nitrate of mercury in concentrated 
nitric acid with a glass brush over the whole diseased surface, including all 302 
CANCEKOUS AFFECTIONS. 
the surrounding tubercles, and over this paint a thin coating of prepared 
collodion. The above solution is prepared by dissolving one ounce of 
mercury in twyo ounces of pure nitric acid. A teaspoonful of cod liver oil 
may be taken three times a day; and a pill every night containing one 
grain of calomel, with one-third of a grain of opium. 
Part xxvi., p. 292. 
Treatment of Cancer.—M. Devay, of the Hotel Dieu, Lyons, has long 
been engaged in investigating the therapeutical properties of conium in 
cancer, being of opinion that Storck’s experiments should be resumed, 
with the aid of the improved chemical knowledge of the present period. 
He finds the best preparations to be an extract and balsam, containing 1 
per cent, of conicine, made from the seeds of the plant, gathered when at 
maturity, of full weight, and of ash-grey color. As the result of his re- 
searches he states: 1. That an ointment applied externally, in chronic en- 
largements of scrofulous glands, possesses a resolvent power greater than 
that of any other substance. 2. In engorgements of the uterus, or inflam- 
matory hypertrophy of the organ—so frequently complicating its prolapsus 
or deviation—this medicine, employed internally and externally, is of 
great service. 3. In cancerous affections it exerts remarkable calming ef- 
fects, and in some cases even cures seem to have resulted from its employ- 
ment, especially in the atrophied form of scirrlius. Its use is less satisfac- 
tory in soft and rapidly increasing tumors, but the progress of some of 
these has seemed to be retarded. In other cases, it has diminished the size 
of secondary tumors, rendering the primary ones more amenable to surgi- 
cal operation. As a means of assuaging suffering, whether used topically 
or taken internally, it is invariably preferred by the patients to opium and 
all other narcotics. 
M. Manec, surgeon to the Salpetriere investigated the action of Frere 
Come’s arsenical paste in more than 150 cases of cancer, in some of which 
he obtained unhoped-for results. Ilis experience leads him to these con- 
clusions : 1. That the arsenical paste penetrates the cancerous tissue by a 
sort of special action which is limited to it. This action is not simply es- 
charotic, for beneath the superficial, blackish layer, which the caustic has 
immediately disorganized, the subjacent morbid tissue seems struck with 
death, though it may retain its proper texture, and almost its ordinary ap- 
pearance. Later, the cancerous mass is separated by the eliminatory in- 
flammation which is set up around its limits. The same paste, which ex- 
tends its action more than six centimetres deep in a cancer of close tex- 
ture, when applied to superficial gnawing ulcers, usually only destroys the 
morbid texture, however superficial this may be, and respects the sound 
parts. 2. The absorption of arsenic is proportionate to the extent of 
surface to which it is applied ; and as long as this does not exceed a two- 
franc piece in size, there is no danger from this source. A large surface 
should only be attacked by successive applications. 3. Arsenic which is 
absorbed is chiefly eliminated by the kidneys, during a space of time of 
not less than five, and no more than eight days, as amply demonstrated 
by Pelouze. Thus, if we allow' nine or ten days to intervene betv'een suc- 
cessive applications, all danger from absorption may be avoided. 
M. Gozzi strongly recommends the following caustic for the destruction 
of cancerous growths : Corrosive subh, Bj.; caustic potass., 5ss.; arsenic 
and cerussa, aa., gr. vj.—to be made into a paste with starch and white of 
egg. While using this or other caustics, emollient poultices, ointments, CANCEROUS AFFECTIONS. 
303 
etc., should "be avoided, as diminishing their effects, unless the irritation 
produced by their application has been excessive. M. Gozzi objects to 
the usual plan of destroying the tumor, layer by layer, from the apex to 
the base, the latter becoming very indurate after these repeated applica- 
tions, and offers great obstacles to the approximation of surrounding 
granulations and their cicatrization. He prefers applying the caustic 
laterally, in the direction where the tumor seems most inclined to separate. 
M. E. Cazenave speaks very highly of a caustic formed by pouring 
hydrated sulphuric acid on powdered saffron. Part xxvii., p. 41. 
Epithelial Cancer of the Tongue.—M. B., aged 69, thin and pallid, but 
not markedly cachectic,was admitted into University College Hospital, on 
account of a gradually increasing tumor at the tip of the tongue, which 
she had first noticed as a firm pimple two years previously. It was nearly 
circular, an inch and a quarter across, and extremely hard. No actual 
ulceration existed, but its surface was smooth and red, and its edges very 
irregular. On the left side of the tongue, near the root, was a patch of 
superficial abrasion, the size of a shilling, presenting a healthy surface, and 
unattended by induration. None of the submaxillary glands were sensibly 
enlarged. She had lost all her teeth, and been restricted to soft food for 
a long time ; her pulse was feeble, 96 ; and, during the last few weeks, her 
strength had perceptibly declined. The malignant character of the disease 
had been recognized from the first, and its removal recommended, but she 
had declined to submit to it; finding, however, that it increased in size, 
and was becoming the seat of aching pain, she was now anxious to get rid 
of it. As the indurated lump was the part alone productive of discomfort, 
and as the other patch possessed no cancerous characters, it was decided 
to remove only the former. 
A needle, armed with a double ligature of thin whip-cord, was passed 
through the middle of the tongue, a little behind the diseased mass, and 
the two halves of the string tied as tightly as possible on the opposite sides 
of the organ, so as to strangulate the whole of its distal portion. The 
operation was conducted under chloroform, and was productive of very 
slisfht hemorrhage. 
For the removal of tumors of the tongue, the surgeon has choice of 
three methods, each possessing peculiar advantages: amputation by the 
knife gets rid of the whole mass at once ; strangulation by means of ligature 
prevents any loss of blood; excision performed carefully with a wire 
heated by galvanism accomplishes both these objects at the same time. 
As the latter instrument appears to be easily manageable, it is not improba- 
ble that it mav, when better known, in a large proportion of cases, super- 
sede the othei two. It must, however, be admitted, that, unless handled 
carefully, and made to cut its way very slowly, the risk of the bleeding is 
not obviated, as it is necessary to that effect that it should have time to 
cauterize the parts as it divides them. Part xxvii., p. 30V. 
Arrest of Consecutive Hemorrhages in Cancer of the Neck of the 
Uterus, by the Perchloricle of Iron.—W e have employed, observes M. 
Kemilly, the perehloride of iron to arrest the uterine hemorrhages which 
so frequently accompany cancer of the neck. It is administered by injec- 
tions, in the strength of 15 of the perehloride to 250 of water. The dose 
required is usually 15 grammes of the perehloride (5 drachms English). 
A woman, aged 60, suffering from cancer uteri, voided daily large clots of 304 
CANCEROUS AFFECTIONS. 
blood from the vagina, some as big as the fist. Two injections (Sept. 12), 
at the interval of five minutes, sufficed to arrest the hemorrhage for three 
days. On the 15th, the blood flowed again, when two fresh injections 
were administered with success. On the 16th and 17th, the injections 
were continued without any recurrence of hemorrhage. On the 18th, the 
patient, who had lost no more blood, became pale and faint after the second 
injection,—symptoms which seemed referrible to the remedy, as the exter- 
nal organs of generation were temporarily swelled. She soon, however, 
recovered ; and, from October 26 to November 19, has remained free from 
any return of the bleeding. 
M. Remilly remarks, that not only does the injection relieve the patient 
from troublesome and often offensive discharges, but that it retards the 
progress of ana3mia, and prolongs her existence. Part xxix., p. 300. 
Cancerous Affections of the Os Uteri.—[In a paper read before the 
Surgical Society of Ireland, Dr. Johns draws the following deductions from 
his investigations into the best modes of treating these diseases.] 
1. That cancerous affections, when confined to the cervix uteri, are in 
many cases successfully treated by removal. 
2. That the only chance of preventing a return of the disease is to remove 
in a healthy part of the cervix from which it grows. 
3. That the best and most expeditious operation is amputation of the 
cervix in a part free from disease. 
4. That as hemorrhage is very likely to follow such an operation, a liga- 
ture ought to be thrown around the cervix, as high as possible, for twenty- 
four or thirty-six hours before amputation. 
5. That cauliflower excrescence is a disease to which this treatment is 
very applicable, as it rarely if ever extends beyond the neck of the uterus, 
and as it is one of the forms of cancer which is least liable to return after 
the excision of the parts. 
6. That amputation of the cervix, in hypertrophy and such like affec- 
tions of this part, which are curable by simpler means, is not justifiable. 
7. That extreme prostration alone, or enlarged superficial inguinal glands, 
ought not to be a bar to operation. 
8. That as inflammation in many forms is likely to follow this operation, 
an appropriate preventive treatment ought to be adopted. 
9. That the use of the actual cautery expedites cicatrization after the 
removal of the cervix. 
10. That as amenorrhcea and dysmenorrhcea are likely to follow on exten- 
sive ulceration of the os and cervix uteri, and also when these parts have 
been removed, the uterine sound ought to be passed from time to time 
during cicatrization, and for some time afterward. 
11. That with a view to correct the cancerous diathesis, the patient 
might be put under a course of treatment for some time previous, and 
subsequent to, the operation. 
12. That a particular form of vertigo is a frequent symptom, and an im- 
portant diagnostic of uterine disease. 
13. That as females suffering from uterine affections are very prone to 
intercurrent affections, which sometimes prove fatal, every means should 
be adopted to prevent their occurrence. 
14. That in all cases of suspicious vaginal discharge, manual examination 
at least ought to be employed. Part xxix.. p. 301. CANCEROUS AFFECTIONS. 
305 
Cancer of the Womb.—For the prevention of fetor use arsenical injec- 
tions of the strength of from two to eight grains of white arsenic in a 
pint of water. Charcoal and other disinfectants destroy fetor; arsenic pre- 
vents it. 
The extraordinary influence of arsenical applications in cleaning cancerous 
ulcers is well known to those who have tried them. It is not necessary 
that they should he made to act as escharotics, since repeated dressings 
with a paste only strong enough to stimulate will effectually serve the end. 
The following prescription is that of the powder used by Mr. Startin at 
the Hospital for Skin Diseases for the purpose mentioned, and it differs, 
we believe, not very materially from one which was a great favorite with 
Dupuytren: 
1i. Hydrarg. chloridi giiss.; hydrarg. bisulpliureti 9ij.; acidi arseniosi 
3j. M. 
This powder, made into a paste with water, is more or less lightly, as 
required, to be brushed over the sore, the application being repeated once 
a week, or fortnight, or month, as may be necessary. Mr. Lloyd’s injec- 
tion, in all probability, acts in the same manner on the sloughy, cancerous 
ulcerations concealed within the vagina. It must be borne in mind some 
real good is probably produced in addition to the prevention of fetor, since 
the diminution of discharge and sloughing will save the patient’s powers, 
and perhaps, also, somewhat retard the growth of the cancer. 
Part xxx., p. 209. 
Frigorifc Mixture.—Apply a frigorific mixture of ice and salt, for four 
minutes, so as to destroy the vitality of the cancer cells. Repeat this every 
few weeks or month. This may not remove the hardness, nor the tumor 
of scirrhus, but may destroy its life and its malignancy. 
Part xxx., p. 251. 
Use of Acid Nitrate of Mercury, in I/upus.—The acid nitrate is one 
of the most efficient and convenient forms of caustic in this disease. Mr. 
Startin does not, however, employ it solely, but uses also the biniodide of 
mercury, and a paste of which arsenic is the principal ingredient. The acid 
nitrate is chiefly used in indolent tubercles, and to indurated patches not 
actually ulcerated. After ulceration has occurred the arsenical paste is 
preferred. Part xxxi., p. 240. 
.Diagnosis of Cancer and Cancroid Growths.—[The clinical features to 
which the deposit of the cancer cell gives rise, are varied considerably by 
the age of the patient, the locality of the growth, and by the activity of its 
life. Cancers are divided into encephaloid, scirrhus, and colloid.] 
The last has been of late discarded as a distinctive variety. It is now 
considered to be rather a condition, or stage of degeneration, in certain 
tissues, and is not absolutely confined to cancer, although it is generally 
associated with it. It consists of a gelatinous substance, devoid of organi- 
zation, or possessing only the remains of it along with cancer cells; some- 
times the latter are deficient, and the colloM substance appears to be merely 
the degenerated remains of fibrous tissue ; hence, some suppose it to exist 
in cancer oi'.y, as the debris of the stroma of the tumor. These are 
speculations into which we need not enter here, for colloid tumors generally 
occur in the internal organs, intestines, etc., where they are beyond the 
reach of surgery. Small cysts, or granules of it, are met with frequently 306 
CANCEROUS AFFECTIONS. 
in external scirrhous tumors, but do not in any way influence our diagnosis 
or treatment. The two other forms of cancer have been sub-divided, ac- 
cording to the fancy of writers, into many varieties: most of them present 
clinical features, and may be useful for the sake of description, but are not 
to be considered as fundamentally different from each other. Even encepha- 
loid and scirrhus are terms rather of clinical than scientific import. The 
difference which these two forms of cancer present are similar to those 
presented by the acute and chronic types of other diseases, and they refer 
entirely to the amount of activity in the development of the cancer cell. 
The terms are, however, so ingrafted into our systems of surgery, that it 
would be mere pedantry to discard them, although the terms acute and 
chronic cancer have been adopted by some writers. 
Dr. Collis continues: 
Encephaloid cancer consists of an aggregation of cancer cells, actively 
and rapidly developed; hence, in proportion to its rate of growth, we find 
the cells small, round, or oval, with comparatively few nuclei, and an 
abundance of the blastemal fluid. Free organic granules, and compound 
granular cells, are also observed, in proportion to the activity of growth. 
Hence, a section of such a tumor pours out a large quantity of light 
3rellow, or pink milky fluid, in which all these elements are readily found. 
The fibrous stroma, or proper tissue, of the seat of disease is pushed on 
one side by the rapid accumulation of masses of these cells; it therefore 
appears to have a curvilinear arrangement, and is not abundant or dense. 
The whole tumor is lobulated, the margins of the lobes being curved and 
composed of this fibrous tissue stretched and displaced ; a filamentous net- 
work, of varying density, intersects the lobule; the cut surface is pulpy, 
easily scraped down, or crushed into a pinky creamish fluid; and the 
entire tumor has a soft elastic feel, in the most acute cases almost amount- 
ing to fluctuation. Blood-vessels abound through the tumor, but not with 
regularity; for minute observations show that large masses, composed 
wholly of cells, must derive their supply from vessels in contact with their 
outer layer, by a process of endosmosis or percolation. 
The external surface of such a growth will be nodulated and uneven, 
but with curving outline; the integuments covering it will become tense 
and discolored; their minute veins will be dilated, producing varicosities, on 
the most prominent points, with the enlarged veins ramifying over the 
surface, and running in a direction from the tumor. At a later period the 
skin may give way ; as it does, it becomes incorporated with the tumor, 
that is to say, cancer cells are deposited in the interstices of its fibrous 
tissue. From the orifice thus caused, fungous granulations sprout forth, 
composed of cells (as all luxuriant granulations mainly are); from their 
surface a foul sanious or ichorous discharge is poured forth, which is com- 
posed of large quantities of broken-down cells floating in serum, or blaste- 
ma! fluid, all in a state of rapid decomposition or putrefaction ; pus cor- 
puscles are also sometimes found, but not invariably, and they Avould 
appear to depend upon some accidental condition. Hemorrhage occurs 
as the result of violence of even a trifling nature, when the tumor is pf 
rapid growth and soft. Occasionally, large masses of the diseased struc- 
ture die by a process resembling sphacelus: the tumor arrives at a size in 
which the process of endosmosis seems insufficient to carry the nutritive 
fluid to those parts which are not in contact with vessels, while at the 
same time the force of the circulation is weakened by the destructive CANCEROUS AFFECTIONS. 
307 
influence of the disease, and by the waste which it occasions in the sys- 
tem; hence, large portions of the tumor seem suddenly to lose their 
vitality, and are cast off as sloughs. Unfortunately, this process does not 
check the disease: cancer grows most effectively, not in the centre, nor 
toward the surface, but in the circumference, where it is in contact with 
the sound parts; so that the part possessed of most destructive energy is 
left behind, and the disease spreads with increased force under the influ- 
ence of the vascular excitement which the sloughing process has engen- 
dered. 
Encephaloid cancer is, from its acute nature, essentially a disease of 
early and adult life. In the child, it most frequently attacks the contents 
of the orbit and the bones: in the adult, the glands, viscera, and genito- 
urinary organs. The female breast is, comparatively, rarely the seat of 
this form of cancer—at least in England; in Franee, and to a certain 
extent, in Ireland, it appears to be less rare. When acute cancer attacks 
the old or the feeble, it seems to be peculiarly rapid and destructive in its 
character: it prostrates the strength and destroys the energies of the 
wretched patient; it seems as if the vital force were concentrated on the 
morbid action, to the interruption of all healthy nutrition, and the disease 
runs its course with great rapidity. Scirrhus differs from encephaloid in 
many particulars, such as size, form, density, etc., all differences are, how- 
ever, referrible to its chronic nature. The cancer cells are more rapidly 
developed, and attain a larger size; nuclei, which have not yet become cells, 
abound ; cells of every variety and shape, but more particularly fibriform 
and cuneate, are observed, as well as fragments of cells, shrivelled or filled 
with oil globules. There are few organic or compound granular cells, and 
but little fluid ; the fibrous tissue of the gland, or other seat of the dis- 
ease, is hardened and condensed by the long-continued irritation, and its 
contractile force tends, in some measure, to check the amount of interstitial 
deposit: hence, a section of scirrhous tumor presents a surface intersected 
by straight, or radiating white lines, especially in the breast, where the 
fibrous remains of the milk-ducts run in all directions from the nipple; 
the loculi, or interspaces, are small, and somewhat angular; their contents 
are of a firm texture, of a pale, bluish grey color, semi-transparent, like 
horn, and glossy, and exude a small quantity of thin, milky fluid when 
pressed or scraped. The entire mass is remarkably tough, hard, and 
heavy. 
Small collections of greenish yellow colloid or jelly-like matter are 
sometimes interspersed through cancerous tumors. Sometimes, also, 
larger masses of a yellow, cheesy, or sebaceous material are to be seen; 
the latter is found to consist of the remains of the contents of the gland 
ducts, such as the salts of milk and fat, broken np epithelial cells, etc.; 
while the former is probably a form of degeneration of the fibrous basis 
of the tumor mingled with cells. Sebaceous matter and colloid are 
found in both aente and chronic cancer, but the sebaceous is found in 
larger quantities in the acute, and the colloid more frequently in the 
chronic tvpe among external cancers. The external characters of scirrhus 
in situ are those of a tumor, in which condensation of structure and inter- 
stitial deposit are progressing with a certain amount of antagonism. 
Compared with the encephaloid, it is small and less elastic, becoming 
finally of even stony hardness and weight. At first it may appear isolated 
and rolling among the neighboring tissues, but it soon sends out processes 308 
CANCEROUS AFFECTIONS. 
which draw in and fix the fibrous structure of the integuments, fascia}, or 
muscles near it. The skin becomes rough and seamed with lines, or 
indented in points; sometimes it has a hypertrophied appearance, such as 
it has when viewed through a pocket lens of low magnifying power. This 
is owing to cancerous infiltration, and is found genex-ally in fat persons, 
the fibres of whose skin are not closely woven ; such a cancer gets the 
name of lardaceous, the skin is dotted over with small granules of cancer; 
or it may be only of a waxy pallid hue, and deficient in elasticity; all these 
alterations of the integument are elements for an unfavorable prognosis. 
The tumor becomes fixed to the subjacent structures, and send processes 
which can often be felt toward the neighboring lymphatic glands. These 
at an early period are enlarged, and become the seat of cancerous de- 
posits. It is a curious fact, of which no adequate explanation has yet 
been given, that engorgement of neighboring glands is more common in 
proportion to the chronic nature of the cancer. You may find large 
masses of encephaloid isolated in the tissues and not affecting the lympha- 
tics, while even a small scirrhous growth rapidly poisons all the neighbor- 
ing tissues of every kind. 
(Edema of the skin in the vicinity is another symptom of advanced 
scirrhus. We see this in scir'rhus of the breast, in which we have the arm 
and side hard and cedematus. Ulceration commences in different ways, 
not often by tensioh of the integuments, more by a crack or fissure, or by 
an excoriation in a fold of skin, where secretions, perhaps somewhat acrid, 
lodge and excite inflammatory ulceration ; this is common in the breast 
around the retracted nipple. Sometimes a large portion sloughs off as in 
encephaloid, and from a similar cause, viz., inadequate supply of nutrition. 
In whatever way it commences, ulceration soon destroys all the less active 
and central parts, and leaves a foul irregular cavity, the depressed surface 
and elevated edges of which are hard, undulated, and inflamed. Can- 
cerous deposit goes on in a constantly widening circle, and with rapidity 
proportioned to the inflammatory or excited action of the part. Ulcera- 
tion follows in a somewhat narrower circle, and destroys the older parts 
of the infected tissues. A foul and copious discharge wastes day by day 
the strength of the patient, who, overcome by pain, at length falls into a 
hectic state, which puts a period to his misery. The pain of cancer is 
variable in degree, but always of a lancinating character. Sometimes it 
resembles the sudden dart of a fine needle at rare intervals; sometimes 
severe and constant pangs, as of the sharpest knife. There is another 
kind of pain complained of, when the tumor has been much disturbed by 
handling ; this is of a deep, dull, aching character, and supervenes in an 
hour or two, lasting for the greater part of a day. The lancinating charac- 
ter of the pain is of value as a diagnostic symptom, when you are sure 
that your patient does not misapply the term, as is often the case. Other 
symptoms, which either belong or have been ascribed to cancer, will be 
considered, when we are treating on the differential diagnosis of cancerous 
and other tumors. 
Vie shall now pass to cancroid growths. These are growths which 
possess a minute structure different from cancer, with external signs and 
symptoms more or less characteristic, and which resemble cancer in their 
clinical features, without being altogether so destructive. They hold a 
midway place between simple tumors and cancers. The former are mere 
redundancies, isolated hypertrophies; the latter are destructive interstitial CANCEROUS AFFECTIONS. 
309 
deposits, destroying not merely by pressure, but by an inherent tendency 
to convert the neighboring structures into their own substance. 
Cancroid growths are as yet imperfectly known. Anatomically, they 
appear to be more hypertrophic than interstitial; even the epitheliomata, 
when carefully studied, bear out this assertion. Clinically, they resemble 
cancers, but are more slow of returning, or if they return rapidly, are con- 
lined to the immediate neighborhood of their original seat, and are accom- 
panied with less waste of tissue and less constitutional disturbance than 
cancers. This is the general rule of such growths. Individual cases occur 
of great virulence and rapid destruction of life, and of general infection in 
distant organs, either after or without operation, and relapses after the 
most complete removals are frequent, sometimes at very short intervals, 
sometimes after the lapse of years. 
The commonest form of cancroid is the epithelial tumor or epithelioma. 
This growth is found in all regions where mucous membrane and skin 
approach each other. It may be situated on the mucous membrane, the 
skin, or on both; it is also found on the skin in parts where moisture 
abounds, as in the genital organs; occasionally on the general cutaneous 
surface, as in that form of ulcer called the chimney-sweeper’s cancer; 
never, according to Velpeau, in the female breast; and certainly very 
rarely in any gland as a primary affection. Its anatomical element is the 
common epithelial cell, arranged with an amount of regularity strikingly 
in contrast with the irregular disorderly grouping of the cells in cancer ; 
this irregularity is only disturbed, when, by the accumulation of a great 
number of cells in a tube, follicle, or other cavity, those first formed are 
pushed into the centre; but a little care will always unravel the primary 
arrangement. When the growth occurs on mucous or moist surfaces, the 
rows of cells generally lie in parallel bead-like lines with marked regu- 
larity, and have a great resemblance in anatomical structure to simple 
warty growths. The characters of the epithelial cell are—small nucleus, 
small size and round-shape of cell when first formed, with subsequent 
enlargement and flattening when brought nearer to the surface, so that it 
comes to be the largest of all cells. Add to this, great delicacy and 
transparency of both cell-wall and contents, and perishable nature of the 
entire cell, and you have sufficient marks by which to distinguish it from 
any other cell, whether the result of healthy or morbid action. 
Part xxxii., p. 43. 
The alleged Cure of Cancer.—The topical use of chloride of bromine 
for tlxe cure of cancer, has lately attracted much attention on the 
continent. 
The formula of the paste used by M. Landolfi, is the following: 
Chloride of bromine, three parts ; chloride of zinc, two parts ; chloride of 
antimony, one part; chloride of gold, one part; powder of liquorice, 
sufficient to make into a paste. The principal agent is the chloride of 
bromine, which has lately been used by itself. Cancers of the skin, the 
epithelial variety, lupus, etc., are treated by a combination of chloride of 
bromine with basilicon ointment. M. Landolfi’s view is to change a 
malignant ulceration into a simple one. For this purpose, he formerly left 
a piece of linen, spread with the paste, as long as a fortnight upon the 
part, but now lie uses imbricated pieces of lint similarly spread, and leaves 
them only twenty-four hours. The surrounding parts are protected by an 310 
CANCEROUS AFFECTIONS. 
ointment composed of one drachm of chloroform to an ounce of axunge. 
The author considers that the chloride of bromine acts, not only topically, 
but that the specific is absorbed and aids the cure, lienee he gives, 
as an adjuvant, a certain number of pills which contain a minute pro- 
portion of the chloride. When the pledgets spread with the caustic paste 
are taken off, after the above-mentioned twenty four hours, a line of demar- 
cation is observed which separates the altered from the healthy tissues. 
Bread poultices are then applied, or else lettuce leaves, or basilicon oint- 
ment, which should be changed' every three hours, until the eschar is 
thrown off, which event takes place from the eighth to the fifteenth day. 
Dart xxxii., p. 46. 
Diagnosis of Cancer and Cancroid Growths.—Dr. Collis gives the 
following: 
Epithelioma commences on the skin as a dry and scabby wart, which 
falls off' from time to time, and exposes on each occasion an increasingly 
wide surface of ulceration. At the junction of skin and mucous membrane 
it begins as a chap or fissure with indurated edges, and has a similar ten- 
dency to scab and ulcerate. When it originates on a mucous surface, it is 
either as a flat condylomatous wart, or as a deposit in the mucous follicles. 
Thus it is always as a local hypertrophy of the investing epithelium that it 
commences; and from first to last it frequently retains this strictly local 
character. Many of these growths upon the skin are nothing more than 
hard horny masses of dry epithelial cells, which occasionally tall off, and 
are slowly replaced. These may be either prominent or flat; we have 
frequent examples of them along the edge of the lip upon that part which 
is covered with colored skin, external to the line of moist membrane; 
these are very harmless, and may last for many years unaltered in extent 
or depth, until accidental violence or inflammatory action excite them to 
spread. However, in the majority of epithelial growths, ulceration of the 
integument and deposit of epithelial cells in its substance takes place 
sooner or later. The skin splits into papillas as in a wart, and the ever- 
increasing deposit of cells upon the surfaces of these papillae, separates 
them more deeply and more widely apart. As these cells are wholly 
extravascular, and dependent on percolatiqn for what fluid they draw from 
the economy, a process of disintegration is continually going on in them, 
and the surface of parts not subject to evaporation is soaked in the putrid 
remains of cells. IIow far this aids in the spread of the disease, by excit- 
ing inflammatory action and ulceration of the sound structures, it is hard 
to say. On mucous membranes, this tendency to ulcerate is very marked; 
cauliflower growths from the uterus, for example, although prominent on 
the surface, and consisting of hypertrophies of the epithelial cells, have 
their seat on ulcerations, which may destroy large portions of the organ. 
The ulcers, when exposed, present jagged irregular margins and surfaces; 
enlarged papillae are visible during the early period of the disease when 
the surface is wiped free from discharge ; at the edges they may be 
detected at any period. The neighboring glands are affected irregularly ; 
sometimes not at all; sometimes at an early stage. Upon the Avhole, the 
impression on my mind is, that the tendency to infect neighboring glands 
is greatest when the disease has its seat on the mucous membrane ; and 
least when it is on the skin; but no positive rule can be laid down at present 
as to the local infection. General infection must be extremely rare, for CANCEROUS AFFECTIONS. 
311 
tliose who oppose the classification into cancer and cancroid, can bring 
very few satisfactory cases of general poisoning from genuine epithelioma. 
The disease often kills by local destruction and general wraste, but 
without anything which can be called special or peculiar cachexia. 
When removed, even completely, it will sometimes return in an aggra- 
vated form and with rapidity; but this is quite exceptional; in the majority 
of cases in which the disease is removed completely, it either does not 
return, or does so only after a very long interval. All these facts show 
that there is much less tendency to general poisoning than in cancer, and 
justify us in classing it apart, especially as it is found to possess a different 
anatomical structure. • 
Another class of cancroid tumor, to which the general name of fibro- 
plastic is rather incorrectly given, includes several tumors of rare occur- 
rence, and with slightly diversified peculiarities. The fibro-plastic cell is 
not the special element of any tumor of a cancroid nature, but the elements 
of these fibro-plastic growths resemble it more than any other cell. The 
fibro-plastic cell is found in all lymph which is undergoing the process of 
organization, and is consequently often found in tumors of any kind. The 
class of growths to which I now allude, are called by Mr. Paget fibro- 
nucleated, recurrent fibroid, etc. The microscopic elements of which they 
are composed, are small and very pale, they vary in diameter from the 
1.1500 to 1.2200 of an inch. They contain a small nucleus, and have a 
tendency to' become elongated into imperfect fibres, arranged in a radi- 
ating manner and little organized. There is no juice obtained from a 
section of these tumors ; and although they bleed freely when cut, it 
would seem to be rather from some want of power in their arteries to con- 
tract, than from the number or size of the vessels contained in them. If 
squeezed or torn up, they break readily into little acini, which are indi- 
vidually remarkably tough and resistant. The minute fibro-cells appear 
to radiate from the point in each acinus by which it is attaclmd to the 
rest. The tumor, which is situated under the skin, and I believe always 
unconnected with it, is firm, moderately elastic, irregularly lobulated, 
movable among the tissues, and solitary ; it does not affect the skin nor 
neighboring glands, except by direct contact through the lymphatics, nor 
does it produce general cachexia independent of waste, as cancers do. Its 
strongest and most unaccountable peculiarity, is its frequent and rapid 
recurrence after the most complete ablation, after even amputation at a 
considerable distance from the original seat. It inevitably returns 
in from three to six months in the cicatrix, and requires repeated 
removal, which should therefore always be complete, but very sparing 
of the healthy tissues, and repeated early on the reappearance of the 
growth. 
There are many other sub-varieties of both cancer and cancroid, but as 
we have not met Avitli specimens of them during the present session, we 
must defer the consideration of them for the present. The main features 
of both classes of morbid growth I have endeavored to lay before you as 
fully as was consistent with brevity. I will now conclude these lectures 
with some remarks on the diagnosis of tumors, with a view to your guid- 
ance in the important points of operation and prognosis. 
When a patient is presented to you with a tumor, you must note, first, 
certain circumstances relating to the individual; secondly, such properties 
of the tumor as manifest themselves to your senses; and thirdly, the effects 312 
CANCEROUS AFFECTIONS. 
of the growth upon the patient. Then comparing these with each other, 
and with the anatomical structure and known characters of the various 
growths, you will eliminate such as are incompatible with your examina- 
tion, and thus arrive at what the tumor is by ascertaining what it is not. 
First, then, you will note such circumstances about the individual as the 
age, sex, history, etc. As to age—infancy and childhood are liable to 
acute cancer, enchondroma, and strumous swellings. Adult life is the 
period for all hypertrophies, such as fibrous and fatty tumors, for the can- 
croids, and for the acute cancers in organs which are late in arriving at 
maturity, as the organs of generation. As the patient advances in age, 
slow-growing epithelioma and scirrhus become predominant. Cancer and 
cancroid form the vast majority of the tumors that are met with, if age be 
excluded from our consideration. 
Sex exercises still greater influence on our diagnosis. When we glance 
at statistical tables, we find that cancers of the female breast and of the 
uterus surpass in numbers all other tumors in all situations put together. 
Of these, scirrhus of the breast and uterus form the bulk. We have a 
small proportion of acute cancer of the uterus, and smaller still of the 
breast. Women are also subject to innocent chronic mammary tumors of 
the breast; both sexes to epithelioma of the rectum and genitals ; and 
men more than women to epithelioma of the lips and face generally. As 
regards temperament and appearance, thin, sallow,' unhealthy-looking 
people are supposed to lie more subject to cancer; but the lardaceous 
variety shows that the fattest people are not exempt from it. A melan- 
choly, brooding disposition is often connected with cancer, as it is with 
any disease of perverted or deficient nutrition ; but, on the other hand, to 
whatever amount cheerfulness of temper may be an item in favor of recov- 
ery after operation, it is little protection against the primary development 
of disease. There are sufficiently numerous and remarkable cases on 
record of both cancer and cancroid occurring in successive generations, to 
prevent our denying the influence of their hereditary transmission; but, 
at the same time, these are few in comparison to the total number of 
cases. I have seen curious and marked instances of the repetition of 
encysted tumors, which have just as much weight for hereditary influence 
as the facts adduced in its favor in the case of cancer. Accidental violence 
is in much the same category ; it may give an impetus to a latent tendency, 
and a locus to the deposit, but no more. It seems to me very doubtful 
whether the statement is correct, that the adenoid or chronic mammary 
tumor has its origin in effusions of blood. 
We now come, secondly, to the properties of tumors themselves. On 
this point I have said much that need not be repeated. The situation, 
size, weight, shape, and mobility or fixedness of the tumor; its duration 
and rate of progress ; the color and alteration of the integuments; the ap- 
pearance of the ulcer, if one exists, and the nature of the discharge ; the 
solitary or multiple nature of the tumor ; glandular irritation or infection 
in the neighborhood or at a distance—must all be carefully examined into 
and weighed. Acute cancer is rapid, and attains often a very large size, 
is heavier than any noil-cancerous growth, is seldom multiple, implicates- 
in time all neighboring structures, though it seldom poisons the glands 
when primary; and it almost always returns rapidly and extensively in the 
glandular and visceral organs after removal. Adenoid tumors are much 
smaller, very chronic, very movable, perfectly harmless, and never affect CANCEROUS AFFECTIONS. 
313 
the glands or the system, though they are sometimes multiple in the same 
breast or in both breasts. Scirrhus is small, chronic, of stony hardness, 
drawing in the skin, and all the fibrous tissues, into itself, and finally the 
muscles, and every other structure. Cancer in any shape does not ulcer- 
ate early. This distinguishes it from epithelioma, as the preceding symp- 
toms do from adenoid, fatty, or fibrous tumors, and from the recurrent 
fibro-nucleated. Fatty tumors are easily known by their lightness, and 
largely lobulated surface, and scalloped edge. The most puzzling of all 
its physical characters is the cystic tumor of the breast, when combined 
with cancer, as it frequently is. Except in the plainest cases, it is impos- 
sible to diagnose by the hand and eye. The presence of cysts may be 
readily detected in many instances in which the cancerous deposit is small 
in amount, and veiled by the fluid contents of the cysts; and, on the other 
hand, the deposit of cancer may conceal the presence of cysts. Alterations 
of the integument, and the general symptoms, must guide us to the dis- 
covery of cancer; and, in the other case, if we are sure of the presence of 
cancer, we need not be so careful to diagnose the coexistence of cysts. I 
have seen simple cysts, the result of varices, mistaken for small fatty 
growths, and 1 really do not know any certain means of diagnosing them; 
but, fortunately, a mistake would be of no practical importance, as both 
tumors are harmless. . To overlook cancer, in combination with cysts, 
Avould be more serious. 
The last points to be considered in aid of our diagnosis, are the effects 
of the growth upon the individual: these are pain, cachexia, wasting. 
Pain we have already spoken of. Cachexia is of value in the diagnosis of 
tumors, if it appear before they ulcerate, as it generally does in cancers. 
In other diseases, inclusive of the cancroid, it does not appear till the 
patient is worn and wasted by discharge ancl loss of blood, by deglutition 
or absorption of foul matters, and inhalation of noxious gases, the results 
of ulceration and decomposition. Wasting may be included in these re- 
marks on cachexia. 
With regard to operation. Encephaloid is more often removed with 
temporary, or even permanent success, than scirrhus, but success is very 
rare, and when it returns it is with extreme violence. In the young, you 
will give every chance by removing early and freely. A respite of years, 
if not a recovery, is in a few cases secured; and where a premature and 
horrible death is otherwise certain, the duty of endeavoring to secure this 
chance is plain. In the old, or even in the adult, you have less hopes of 
success ; still, operation is justifiable and proper, when the powers of life 
are not depressed, and the tumor easy of complete removal, without such 
loss of integument as will delay recovery from the operation. Scirrhus, 
though often removed, is not often, if ever, permanently cured. When it 
is adherent to the deeper parts, when the lymphatic glands are the seat of 
deposit, when the glands of the skin are the seat of small disseminated 
beads of cancer, or when its interstices are infiltrated, as in the lardaceous 
form, it is worse than useless to operate: relapse is certain and rapid. 
When the growth is very chronic and very small, in a weak atrophied 
individual, the chances are, that an operation will convert into an active 
agent of destruction a comparatively harmless tumor, which, if let alone, 
would have lasted for years, with little local alteration, and little injury to 
the patient’s life. In these very chronic cases, removal does no good, and 
may do much harm. In epithelioma, the general rule is to operate if you 314 
CANCEROUS AFFECTIONS. 
can remove all; relapse often occurs locally, but does not prevent a second 
or third removal. When the disease originates in lxiucous membrane, 
as in cancroid of the genitals or rectum, the tongue, or gums, you have 
little chance of permanent cure. In many of these cases, the addition 
of actual cautery to as complete removal as possible is a valuable aid. 
The cicatrix of a burn is not a favorable nidus for epithelial growths, 
and by its great contractility, it seems to check the hypertrophic de- 
posit in its neighborhood. With regard to recurrent tumors, I have 
already said they must be removed as often as they appear, and with as 
little loss of healthy structure as is consistent with their complete enuclea- 
tion. Part xxxiii., p. 43. 
Sprouting Cauliflower Cancer.—[The subject of these clinical remarks 
was a married woman, aged 44, who had had eight children. The dls 
ease had commenced eight months after her last confinement, and eigh; 
months before her admission into hospital, by pain in the axilla anc. 
shoulder ; in the course of time a swelling was discovered in the breast, 
which gradually increased and became mpre painful. The mamma, though 
enlarged, was soft and elastic, very like chronic abscess; it ulcerated, 
and then the bleeding fungous mass sprouted out and increased rapidly; 
the axillary glands were enlarged—nothing gave her any relief, and, 
under these circumstances, Mr. Solly thought it best to remove the 
entire diseased mass, not with the hope of curing hex*, but simply to 
relieve her of her agony and the profuse foul discharge.] 
This form of cancer has been called by some writers the soft cancer, 
in distinction to scirrhus, or hard cancer; by others, carcinoma medul- 
lare, or brain-like cancer; fungus hematoides, or bleeding fungus. It is 
that form of malignant disease which is more certain to return after an 
operation than any other ; yet, notwithstanding this, it is often our duty to 
operate, not with the hope of saving life, but with the cei’tainty of remov- 
ing a loathsome mass, which makes life wretched. In many of these cases 
the operation prolongs life, though not to the natural period of man. The 
rule which I have found, on the whole, the most safe and judicious, in 
regard to amputation of the breast for malignant disease, is this: to ope- 
rate in all cases in which your advice is sought in the eaify stages of 
growth, before the surrounding glands are implicated, and tlie* patient’s 
health not so much impaired as to render the immediate effects of the 
operation dangerous; to operate in cases like the present, where the 
growth of the disease is more rapid than the inroads upon the health of 
the sufferer ; where a loathsome mass goes on sprouting, bleeding, ulcerat- 
ing, discharging, and sloughing, to the infinite disgust and distress of the 
victim ; where there appears no prospect of death putting a speedy end to 
her agony; and where the powers of life are so unequivocal that the 
operation does not threaten any immediate danger. 
The cases in which I would not operate are those cases of scirrhous, stony 
cancer, which have been advancing slowly, silently, and painlessly for 
years, without much observation or anxiety on the part of the patient, and 
without any knowledge on the part of the friends; where a mass has gra- 
dually been formed, implicating not merely the whole mamma, but also 
the glands in the axilla, and sometimes the glands above the clavicle; 
attached to the pectoral muscle, and even to the intercostal muscles and 
ribs, before the surgeon sees it at all. In such instances, it is no charity CANCEROUS AFFECTIONS. 
315 
to operate. The disease often remains dormant for years, or it extends 
inwardly, with little outward ulceration; the patient at last sinks gently 
into the grave, from the constitutional depression of the disease, and not 
from a local drain. I would not operate when the patient is old and 
feeble, when the immediate etfect of the operation is doubtful. 
In the performance of these operations, you must not attempt to save 
much skin with the idea of getting the wound to heal rapidly with the 
first intention. When the disease returns externally, it is generally on the 
skin which forms the edge of the cicatrix, looking as if we might have 
prevented it if we had taken a little more of the integument. You must 
also be very careful to dissect the pectoral muscle very cleanly; do not 
leave any cellular tissue over it. In making your first incision, remember 
that you make it below the mamma, and then the blood flows away from 
your knife, so that you see each tissue more distinctly as you expose it. 
Examine carefully the surface of the wound, in order to satisfy yourself 
that you have left no palpable piece behind. Also make a section of the 
tumor. This enables you to see if you have removed a circle of healthy 
cellular tissue beyond its margin. 
These cases, in private practice, are the most disagreeable and unsatis- 
factory that you can have to do with. Of course, your conduct will have 
to be guided alone by a strict sense of duty: you will neither be tempted 
to operate on account of the fee, nor tempted to refuse on account of the 
discredit which follows in consequence of a return of the disease. You 
will calmly consider what is on the whole best for your patient, swayed 
neither by her fears nor those of her friends, nor by the prejudices of the 
practitioner in attendance, if such there be to contend with. It is most 
important that the patient herself should not know all your fears and all 
your doubts ; it is most important that one or more judicious friends 
should know your real opinion. In these melancholy cases, the husband 
is seldom the person who can be trusted. Fortunately for us, as no man 
living can say positively that the disease must return and must be fatal, 
we are justified in giving the sufferer the benefit of the doubt, particularly 
when hope itself may be the means of prolonging, if not of saving life. 
Part xxxiii., p. 46. 
PandoljV s Method of Treating Cancer.—Landolfi’s treatment consists 
in transforming a malignant tumor into an innocent one by cauterization. 
His specific formula is composed of equal parts of the chlorides of bromine, 
zinc, gold, and antimony, mixed with a sufficient quantity of flour ter form 
a viscid paste. The chloride of bromine is the essential ingredient. Before 
applying it, the healthy parts surrounding the tumor are covered with 
strips of cloth, smeared with cold cream ; the specific paste must be spread 
on lint and applied to the part affected ; it may be kept on for 24 hours, 
and when removed it must be replaced with a poultice, or dressed with 
basilicon ointment. Part xxxiii. p. 48. 
Cancer of the Oesophagus.—The following case, which terminated fatally, 
at St. Bartholomew’s, deserves to be placed on record, as a well-marked 
instance of infiltrated scirrhus of the oesophagus, arising suddenly, without 
assignable cause, yet suspected by Dr. Farre before the death of the pa- 
tient : 
G. K., aged 55, was admitted into St. Bartholomew’s, with symptoms 
of general ill health, and complaining more particularly of excessive dys- 316 
CANCEROUS AFFECTIONS. 
phagia, or inability to swallow. He stated that up to five months ago he 
was quite well; he might have been taken, indeed, as a model of good 
health ; “ he never knew what a day’s sickness was,” and would now be 
quite well, but that he was starved on account of his loss of food caused 
by the excessive pain in swallowing. Scattered over his skin were several 
raised molluscous-looking spots, which first aroused the suspicion of Dr. 
Farre and Mr. Lloyd that the disease was of a cancerous kind. A probang 
was passed into the oesophagus, but was stopped by a very evident narrow- 
ing of the channel, and the use of the instrument was followed by hemor- 
rhage, so that it did not seem advisable to repeat the operation. The patient 
had the usual nutritious food prescribed, with milk and mild demulcents, 
but after much suffering, gradually sank. 
The post-mortem examination, carefully conducted by Mr. Callender, 
was particularly interesting. The lower third of the oesophagus, as it joins 
the cardiac orifice of the stomach, was almost entirely obliterated by amass 
of infiltrated scirrhus or cancerous disease. The lungs, though the man 
was stated to have been previously in perfect health, were filled at several 
points with healed or obsolescent tubercle; the liver also was tilled with a 
similar deposit. The small intestines, at one or two spots, were also obli- 
terated by cancerous growths, leaving the canal of the gut not much larger 
in calibre than a common quill. 
This form of disease in the oesophagus is somewhat rare. A similar case 
occurred at St. Bartholomew’s in 1851. The disease, singular to say, 
began with pain of a severe kind, about the shoulder and lumbar region, 
ending in the most excessive difficulty in swallowing, which was found 
after death to depend on cancerous degeneration of the oesophagus. A 
case of marked encephaloid is noticed by Dr. Handheld Jones, which had 
proceeded to a considerable extent without producing any symptoms ; as 
well as another instance of a man who had died of peritonitis, in which, at 
the post-mortem examination, a thick mass of encephaloid, ulcerated on 
the surface, just above the cardiac orifice, was accidentally found, extend- 
ing for an inch and a half. 
These cases, and some few others which might be cited, corroborate 
the suddenness with which the results of malignant disease make their ap- 
pearance in this part, which is, as a general rule, free from any other 
morbid affections. Part xxxiii., p. 103. 
Cancer Removed by a Rainless Method.—Besides the common mineral 
escharotics which are used in these diseases, there are others of a vegetable 
origin which have the advantage of painlessness. Among these may be 
mentioned oakbark, the sanguinaria canadensis and tannic acid. With 
local treatment, chlorine, either simply or in combination with soda, must 
be given internally as a tonic, and to stimulate the absorbents. The 
strength of the tannin solution may be about one ounce of the acid to half 
an ounce of water. This must be applied daily and freely to the ulcerated 
surface : it will not cause any pain, and in a week or ten days the slough 
will be cast off, leaving a granulating surface behind. The cavity left will 
not be so large as might be expected, because the application draws the 
sound parts so close around the slough, that they push it out further and 
further, so that the hollow is not so big as the tumor. Internally you may 
give fifteen minims of the chlorinated soda solution, in water three times a 
day. Part xxxv., p. 254. CANCEROUS AFFECTIONS. 
317 
Treatment of Cancer by Dilute Solutions of the Chloride of Zinc.—The 
destruction and enucleation of an ulcerated cancerous tumor may be effected 
by the use of solutions of chloride of zinc, so weak as to be all but painless, 
and without necessitating the confinement of the patient to bed for a single 
day. The proper strength of the solution is about one part of Sir W. 
Burnett’s solution of chloride of zinc with six parts of distilled water. Two 
more parts of water may be added if much pain is caused. Pieces of lint 
soaked in this shonld be applied and renewed every two hours. 
Part xxxv., p. 269. 
Use of Chloride of Zinc in the Treatment of Cancer.—Chloride of zinc 
should be made into a thick paste with some absorbent powder, such as 
gypsum, flour, starch, or the pow'der of althaea, or gum acacia, in the pro- 
portion of equal parts of chloride and powder; or two or even three of the 
former to one of the latter. It must be sufficiently viscid to prevent run- 
ning, on account of the highly deliquescent nature of the chloride. Then, 
as to the mode of employing this remedy, mark out the extent of the dis- 
ease, and if the skin be entire, destroy it by the acid nitrate of mercury or 
strong nitric acid, and afterward apply the paste; spread on lint of the 
proper size, covering the whole with cotton wool to absorb any moisture 
occasioned by the running of the dressing. The surrounding parts must be 
protected by a dressing thickly spread with spermaceti ointment, which 
may be mixed with as much chloroform as it will take up, to allay the 
burning pain caused by the action of the escharotic; an opiate will be re- 
quired internally with the same object. Generous diet will be required, 
with Avine or malt liquor, together with cod-liver oil and tonics, especially 
quinine, and the iodides of iron and arsenic, the latter with the vieAV, if 
possible, of altering the cancerous diathesis. The folloAving day vertical 
incisions must be made through the Avhitish eschar, and the dressing, spread 
on narrow strips of lint or calico, introduced by means of a probe to the 
bottom, and this must be continued daily, until the \\Thole is destroyed. 
The tumor will thus be enucleated in about thirty days from the commence- 
ment, and the Avound Avill heal ATery rapidly Avith a little simple dressing. 
Part xxxv., p. 272. 
Treatment of Cancer.—The hygienic measures necessary in the treat- 
ment of the non-ulcerated tumor are plenty of good Avholesome food, a Avell- 
drained, Avell-ventilated house, pure country air, extreme cleanliness of 
person and clothing, with sufficient exercise and mental occupation and 
amusement; these Avill do much toward establishing a more healthy state 
of the system. Deficient action of the skin, kidneys, and digestive organs 
must be corrected, and if pain exists it must be relieved by opium or hem- 
lock. A combination of iron and iodine, and the iodide of arsenic have 
both been exhibited Avith excellent effect in this disease, but the bromide 
of potassium given in doses of five or ten grains with cod-liver oil, is the 
most useful, the effects on the tumor being “ really remarkable.” The 
local applications Avhich are of value are preparations of lead, iodine, and 
bromine. A formula much used in the Cancer Hospital is equal parts of 
liquor plmnbi, almond oil, diluted acetic acid, and water. This preparation 
allays pain, and apparently hastens the absorption of the indurated tissues 
around the tumor. The use of solutions of iodide of lead or iodide of po- 
tassium in glycerine is A'ery beneficial, and the solution of bromide of potas- 
sium in glycerine appears to be even more so. Dr. Arnott’s freezing pro- 318 
CANCEKOUS AFFECTIONS. 
cess has reduced many large adherent tumors to a small, movable, indolent 
condition. Mechanical pressure is often very useful in the non-ulcerated 
tumor. This is best applied by an air-truss as invented by Ur. Neil Arnott, 
for by this means the support is perfectly uniform over the whole surface 
of the tumor. The amount of pressure must be regulated by a spring 
pressing on the back of the truss. When the tumor is ulcerated, Dr. 
Marsden recommends carrot poultices, to arrest the fetor ; but their appli- 
cation is rather painful. Should bleeding take place from the ulcerated 
surface it is best arrested by a solution of perchloride of iron. Except in 
cases of very free bleeding it should only be of sp. gr. 15°, as above this it 
acts as a caustic. To the unhealthy fetid surface left after the separation 
of a cancerous tumor, a lotion of chlorate of potash is the best application. 
To relieve pain, opium given internally is the most effectual means; or an 
ointment of lead and a little morphia may be used, if the former means is 
not thought advisable. The sulphate of zinc is the most safe and effectual 
mode of destroying malignant growths about the female genital organs. 
Part xxxvi., p. 33. 
Manganese cum Potassa.—To obtain a healthy granulating surface to 
ulcerated cancerous tumors, having attachments to bone or to vital parts 
(and for this purpose alone is the use of caustics in this disease advisable), 
manganic acid, in combination with potassa as a base, is a most invaluable 
agent. The “ manganese cum potassa ” caustic is a dark-green powder, 
and may be applied very readily by means of a small pepper-caster. When 
used to reduce an exuberant growth, it must be applied in a layer as thick 
as the tissue to be destroyed, and then formed into a paste by dropping a 
little water upon it, after which some simple dressing may be applied. By 
means of carrot poultices the eschar drops off in three or four days. It is 
less powerful than other caustics, and it at once removes all fetor from the 
ulcer. Crops of warts may also be conveniently removed by its agency. 
Part xxxvi., p. 36. 
Pr. Fell's Treatment.—If non-ulcerated, the skin must first be removed 
by some liquid caustic, as nitric acid. The tumor so exposed must be 
covered by a layer of chloride of zinc paste spread on linen. The follow- 
ing formula is used: $ Sanguinarise canadensis, §ss. vel §j.; chlor. zinci, 
§ss. vel gij., aqute, §ij.; pulv. sem. tritic. hibern., q. s. Mix, and form a 
paste the consistence of treacle. Through the slough so produced, inci- 
sions are to be made with the knife, and strips of cotton spread with the 
jtaste introduced daily, till the whole tumor is seriatim converted into one 
large eschar, which drops out entire in about twelve or fourteen days. To 
any secondary tumor, or enlarged lymphatic gland, the following ointment 
may be applied : # Sulph. zinci, §vj.; sanguinarise, §ij.; myricse ceriferse, 
§j.: extr. opii (aquos.), extr. conii, aa 5vj.; ungt. cetacei, §vj. Misce et 
fiat ungt. With this ointment, one containing iodide of lead may be ap- 
plied alternately every twelve hours. Part xxxvi., p. 37. 
Glossal Cancer.—In those distressing cases of glossal cancer where deep 
and unhealthy ulcers exist, the best treatment is to apply powdered sul- 
phate of copper by means of a camel-hair brush, about twice a day. Allow 
it to remain four or five minutes, then let the mouth be washed out with 
tepid water. A wash of borax may also be used frequently during the 
day. Under this treatment the ulcers sometimes slowly heal up and cioa 
trize. Part xxxvi., p. 39 CANCEROUS AFFECTIONS. 
319 
Eschar otic Treatment of Cancer.—Prof. Syme considers it a settled 
principle in surgical practice, that malignant tumors or sores should either 
be allowed to remain free from disturbance or completely removed, since 
tampering with them by irritating applications is the most certain means 
of exciting disease in the lymphatic glands or other textures. If caustic 
is ever used for destroying malignant textures, it should be, therefore, of 
such power and so employed as to strike at once to the root of the evil. 
Of all escharotics the best is sulphuric acid, made into a paste with fine 
sawdust. A solution of gutta percha in chloroform is applied to the skin 
for some distance round the part to be attacked; then a thick piece of the 
same material, with an aperture cut in it of the requisite size, and softened 
by exposure to heat, is pressed firmly so as to adhere everywhere to the 
surface thus prepared; a thin piece is next glued round the edge of the 
opening, so that, when supported by a stuffing of lint, it may form a wall 
inclosing the diseased part. Concentrated sulphuric acid, with about an 
equal wreight of sawTdust stirred into it, until the mixture assumes a homo- 
geneous consistence equal to that of thin porridge, is lastly applied, in 
quantity proportioned to the extent of thickness concerned. In the first 
instance, as the pain is acute, opiates or chloroform maybe used; but 
after a short while, so little uneasiness is felt, that the patient can easily 
allow the caustic to remain for ten or twelve hours, when it will be found 
that the whole diseased mass, though covered with skin and several inches 
in depth, has been reduced to a cinder, presenting the appearance of 
strongly compressed tow. Under poultices, the slough separates in the 
course of days or weeks, according to its depth, and the sore then heals 
without any trouble. If, therefore, patients, from an unconquerable dread 
of cutting, should prefer the escharotic treatment, or if the circumstances, 
on any other account, should seem to render this method eligible, the 
procedure just described may be found useful. Part xxxvii., p. 26. 
Painless Extirpation of Cancerous Growths.—In the combination of 
long-continued congelation with caustic, we have a means of speedily ex- 
tirpating cancerous growths, unattended with pain, and producing neither 
shock, inflammation, nor permanent debility. This mode of treatment has 
been fully tried in the cancer wards of the Middlesex Hospital. 
In a case detailed to illustrate the mode of removal of cancerous growths 
by congelation, the following was the mode of procedure: The tumor (in 
the right breast) was congealed for two hours by a frigorific mixture, at 
a temperature ranging from eight to twelve degrees below zero, Fahr. 
This mixture, which was frequently renewed, was confined to the part by 
a cup or broad flat ring of gutta percha, having a short flexible tube, 
closed by a stop-cock issuing from its lower border. Immediately after 
removing the mixture, nitric acid was applied to the skin, and after the 
acid, a thin layer of chloride of zinc paste was placed on it and allowed to 
remain until the next day. There was no pain caused by these proceed- 
ings beyond a sensation of tingling on the application of the cold. The 
caustic was daily inserted (incisions having been made through the slough), 
yet the patient’s general health remained undisturbed till she left the hos- 
pital. By this mode of removal, all shock or excessive inflammation are 
entirely avoided, besides the absence of pain. Part xxxvii., p. 2t. 
Cancer of the Tongue.—In a case which lately occurred at the Cancer 
Hospital, where the tongue was much enlarged, of an irregular mottled 320 
CANCEROUS AFFECTIONS. 
color, with purplish discolorations here and there, and superficially ulcer- 
ated in two or three places, by means of careful attention to diet and the 
use of tonic remedies, together with the local application of powdered sul- 
phate of copper, and the occasional use of a mild borax lotion, not only 
have the ulcers all healed, but the tongue is greatly reduced in size. 
Part xxxvii., p. 29. 
Epithelioma of the Prepuce spreading to the Gians.—It is of great 
practical importance to distinguish between two forms of cancer of the 
penis, for the reason that in the removal of one of them the patient may he 
altogether exempt from a recurrence of the disease, a matter not to be 
disregarded in the prognosis. Many patients have had the organ removed 
for cancer, which has not returned, most certainly, for many years. An 
instance of the kind is at present in University College Hospital, wherein 
the penis was removed six years ago, without the recurrence of the 
disease. 
The two forms of cancer, then, which affect the penis are these: one is 
epithelioma, or epithelial cancer, which attacks the prepuce ; the other is 
true scirrhus, which involves the penis itself. On careful examination of 
the cases which remain exempt for many years, they turn out to be epi- 
thelioma. On the other hand, when recurrence does early take place, the 
scirrhous form has been present. These distinctions were particularly in- 
sisted on by Mr. Erichsen, on the 2d of December, when a case of ejnthe- 
lioma affecting the entire prepuce, and encircling the glans penis like a 
collar, was submitted to the operation of removal. The disease had spread 
to the glans, having commenced in the prepuce, and had assumed con- 
siderable dimensions, of a fungous character. The man’s general health 
was good, and no glands of the groin were affected. He had had a con- 
genital phymosis, which he had slit up himself some years ago. Amputa- 
tion of the organ was performed by Mr. Erichsen, with, the removal of a 
good portion of penile integument, to prevent undue retraction of the 
stump within it. Part xxxvii., p. 165. 
Epithelial Cancer near the Eye removed hy Caustic.—In this case, the 
tumor was so close to the eye, that it appeared that the knife could not 
be used. A strong escharotie paste, consisting of strong sulphuric acid 
and powdered exsiccated sulphate of zinc, was employed. The exsiccated 
sulphate of zinc is the preparation used by Dr. Simpson of Edinburgh, and 
has proved in the hands of many surgeons a very powerful caustic when 
made into a paste with glycerine. It has, however, no power to act on 
sound skin, which requires previously to be abraded by means of a blister. 
The strong sulphuric acid, on the other hand, has been employed by Vel- 
peau and others, when made into a paste with charcoal, which is inert, and 
is added merely to give consistency to the mixture. It occurred to Mr. 
Thompson to employ the two active agents in combination—viz., to thicken 
the sulphuric acid with the exsiccated zinc, and thus obtain a more power- 
ful compound, and at the same time one which required no preliminary 
blistering. 
In this case a thin layer of the paste had been applied six times, at about 
seven or ten days’ intervals, with the result of most‘completely removing 
the diseased mass. In order to limit carefully the action of the caustic, 
which formed a paste of the consistence and appearance of mortar, the 
parts around were first covered with a thick layer of stiff cerate. In this manner the application of the active agent could be managed Avith pre- 
cision and nicety, and the margins of the eyelids protected. 
Part xxxvii., p. 187. 
CANCEROUS AFFECTIONS. 
321 
Cancer.—In a great number of tumors there is a natural ebb-tide ; at 
first they grow rapidly, then slowly, then remain stationary, and at last 
begin to waste, and may even almost disappear; sometimes the whole 
tumor may slough out. This is favored most of all by a hopeful state of 
mind of the patient, and is aided by certain hygienic measures; a good 
nourishing diet, with beer or wine; bark and hydrochloric acid or iron, as 
a tonic. The best local application is lead, either in the form of plaster or 
lotion, according to the state of the tumor. Do not Avaste time Avith look- 
ing after impossible specifics. The tumor is the natural reservoir of the 
morbid matter ; if this reseiwoir be removed by the knife or caustics, the 
morbid material is distributed over the Avhole system, provoking a return 
of the disease in a more aggiwvated and uncontrollable form. 
Carcinoma.—Professor Simpson recently removed a carcinomatous 
growth by applying around it, with a common pointed goose-quill, a 
thickish paste made of sulphuric acid and sulphate of zinc. The whitened 
and decomposed tissues were scraped through with the point of the pen, 
and the application made as before, so that in a few minutes the skin and 
a portion of the underlying cellular tissue were cut through. Two days 
afterward the remainder of the tumor was detached in the same way. 
The edges of the tumor rapidly cicatrized, and pushed the tumor out in a 
mushroom-like form, leaving a small circular sore. Part xxxviii., p. 26. 
Cancerous Tumor Treated by Chloride of Zinc.—If for any reason the 
use of caustics be preferred to that of the knife, by the following means re- 
moval may be accomplished in half the time ordinarily occupied by such a 
process: Mix one part of chloride of zinc with two parts of arrowroot, and 
whilst the paste formed by the addition of a little water is still soft, roll 
into a thin sheet, which divide into arrow-shaped pieces of almost three 
inches long, and tapering to a fine point at one extremity. After drying, 
these pieces become quite hard. Whilst the patient is under the influence 
of chloroform, make a series of deep punctures round the circumference of 
the tumor about an inch asunder, and forcibly insert one of the arrows into 
each, taking care that the points from opposite sides meet beneath the base of 
the tumor. The vitality of the tumor is very rapidly destroyed, owing to 
the caustic being applied to the root, and not to the surface, of the tumor. 
Part xxxviii., £>. 26. 
Cancerous Ulcers.—In a case of foul cancerous ulcer, at the Royal 
Fi •ee Hospital, the following lotion was used with great benefit; half an 
ounce of chloride of potash, forty minims of hydrochloric acid, two drachms 
of the sedative solution of opium, and a pint of water (twenty ounces). 
Part xxxviii., p. 28. 
Lupus.—There may„pVobably be suspected, in most of these cases, a taint 
of hereditary syphilis. The greatest benefit will frequently be derived 
from the use of mercury, or calomel and opium pill, combined with the 
simultaneous use of cod-liver oil. Part xxxviii., p. 173. 322 
CANCEROUS AFFECTIONS. 
Fungous Hematodes—Gallic Acid in.—[The following case by C. 
Hunter, house surgeon at St. George’s Hospital, is an interesting instance 
of the effects of an internal remedy on malignant growth: The patient 
was only eight years of age, and was admitted with a tumor about the size 
of the eye itself, and situated behind, and consequently protruding forward 
that organ. It had only been apparent two or three weeks, and after his 
admission to the hospital rapidly increased—no operative measures being 
had recourse to, owing to its situation.] 
As it grew larger, the eye being pushed before it, gradually dwindled, 
and became at last a shrivelled-up and hardened excrescence on the outer 
part of the protruding mass. 
In the course of four months (from time of admission), the tumor had 
become as large as the head of a seven months foetus, and of such a size as 
to overlap the mouth, so that he had to be fed by a pipe at the further 
corner of it. 
At this period the surface of the tumor was irregular but rounded, the 
greater part of the surface was in a raw, ulcerated condition, exceedingly 
vascular and constantly bleeding, often to such an extent that every attack 
appeared likely to be the last. 
These hemorrhagic attacks were generally treated by cold, by pressure, 
and by the local application of blue lint. The boy was living on generous 
diet and wine. After one of these attacks, more serious than usual, which 
quite bleached the face, and much weakened the pulse (always weak and 
rapid), I gave him gallic acid in four grain doses, in infusion of bark, to 
try, if possible, to arrest the bleeding. 
Curious as it may appear, one month afterward, the gallic acid had been 
productive of the most marked effect, the tumor from that time had never 
bled once, nor even had there been the least oozing of blood. The surface 
of the mass became more healthy, less vascular, more solid, and considera- 
ble diminution of the tumor had taken place. 
In recording this case, it is only meant as an instance cf the palliative 
effects of a remedy on malignant disease; it is the more curious that the 
gallic acid has had the striking effect it had, because of the exceedingly 
vascular and raw state of the surface. Part xxxviii., p. 2C3. 
Cancroid Tuberculosis.—Dr. Bubb reports the case of a man, aged 72, 
of temperate habits and good general health, who first perceived, 14 years 
before, a small pimple on the left side of the upper lip. It soon increased 
in size, began to ulcerate, and became very painful and irritable. 
After having been unsuccessfully treated by other surgeons, and several 
times threatened with the “ knife,” he consulted the late Mr. Aston Key, 
who applied chloride of zinc to the ulcer. 
This treatment appeared at first to be successful; but after a time the 
affection became as bad as ever. 
On examination, Mr. B. found an ovoid-shaped and very cancerous- 
looking ulcer, with jagged edges, and somewhat hardened base, extending 
from the angle of the mouth to the left side of the nose. There was no 
discharge. He complained of pains “ shooting upward to the eye, and 
downward to the throat, and great itching.” * 
Mr. B. removed the scab with which the ulcer was thickly covered, and 
touched the surface freely with nitrate of silver, and continued this treat- 
ment until three months ago, with little or no result. He then had recourse CARBUNCLE. 
323 
to the acid nitrate of mercury, applied weekly. The effect has been extra- 
ordinary. The nicer is now quite skinned over, and appears to be cured. 
Part xxxix., p. 43. 
Cancer of the Tongue Removed by the Ecraseur.—Dr. Reddy, physician 
to the Montreal General Hospital describes the appearance of the tumor 
as follows: It is of a dusky red color, irregular in shape, about the size of an 
ordinary walnut, occupying the right lateral half of the tongue to tip, a 
small superficial abrasion being near its centre ; it has a nodulated \meven 
feel, presenting considerable resistance on pressure, and is most painful to 
the touch. None of the glands about the throat or neck are affected. By 
the aid of the microscope, well-marked cancer-cells were discovered in the 
juice, and in a minute portion of it that came away in the groove of the 
needle. 
“ The patient being chloroformed, a ligature was passed through the 
centre of the tumor, and the chain of the ecraseur being made to include 
all the diseased part, I commenced the operation, a minute being allowed 
to elapse between each movement, at the expiration of minutes the 
part was divided and bloodless ; a few minutes after she was able to speak 
indistinctly, but was free from pain. Visited her at nine o’clock, p.m., was 
free from pain, no signs of hemorrhage, tongue a little swelled, feels inclined 
to sleep.” 
[In the reports of progress on subsequent days, it is noticeable that no 
subsequent fever appeared, relief from pain, and tolerably rapid healing of 
the wound followed.] 
Many object to the use of the ecraseur, on account, as they say, of its 
not making a very surgical-looking operation, but in such cases as the 
above, it has decided advantages over every other means, and its chief 
value consists in its not incurring any risk of the free hemorrhage which 
often attends the use of the knife, while compared with the ligature it en- 
tails little or no suppuration, and you obtain your object at once. When 
operating, the person should be kept as steady as possible, since any sudden 
movement might cauge the chain to tear the part, and thus give rise to 
bleeding; at least a full minute is necessary between each movement of 
the instrument. The ligature that isolates or that may pass through the 
tumor must be kept free of the chain, as at the close of the operation it 
may cause delay by preventing the divided part dropping off. 
Part xxxix., p. 44. 
Local Treatment of Carbuncle and Furuncle.—Mr. Flint has followed 
the method of treating the above diseases now advocated more than 
twenty years, and thinks the remedies may be almost termed “ specifics.” 
He says: 
Considering these morbid actions as manifesting want of power in the 
vascular system of the parts affected, I sought for an application that 
would, if possible, assist or increase it, and at the same time not interfere 
with the natural excretions from the skin. This I found in the common 
lead or litharge plaster, spread on the white leather of the shops. There 
CARBUNCLE. 324 
CARBUNCLE. 
is in lead plaster, besides its unirritating quality, a valuable property—that 
of promoting or inducing perspiratory exhalation from the skin. I always 
prefer using the plaster without any admixture or combination; and, if 
fresh, it has every requisite adhesive property. 
The mode of application is the following: After spreading the plaster in 
the ordinary manner, it is to be cut in dimensions according to the size of 
the carbuncle or boil to be dressed; carefully observing that it is large 
enough to include from half an inch to two or three inches of the surface 
around the tumor. Where this is large and deep, as in a carbuncle from 
four to six or eight inches in diameter, the circumference to be embraced 
should be proportionately large; and the leather, in such a case, should be 
chosen soft and strong, in order to obtain an amount of adhesive mechani- 
cal support to the surrounding and subjacent parts, so as to enable them 
to originate and establish a new action. It must be well remembered that 
it is not enough, in any of these dressings, to cut the plaster the exact size 
only of the tumor. It is expected that some of the surrounding surface 
should be taken in also. 
In twenty-four hours after dressing, favorable change in the appearance 
of the jDarts is generally discernible ; and—what will be allowed to be a 
highly important result, in those cases where the local irritation is fast 
inducing a state of cerebro-spinal distress and lesion, likely soon to end in 
coma and death—it will often, in a less period of time, aflord a mitigation 
of suffering which comes upon the patient like a charm, and restores him 
the rest and sleep to which lie had long been a stranger. If the tumor be 
prominent or pointing in any part, a crucial incision is to be cut in the 
plaster, and placed directly over it, that the discharge may have free egress. 
If the tumor is not disposed to slough or suppurate, the application deci- 
dedly hastens the resolution or absorbtion of the effused matter. 
In a boil the dressing is precisely the same as in a carbuncle; taking 
care that the plaster has sufficient hold of the tissues around—perhaps from 
half an inch to an inch. In general, no other dressing is required to the 
end of the treatment. The plaster must be reduced in its dimensions as 
the tumor lessens in size, whether it be by suppuration, slough, or absorp- 
tion. In some instances toward the close, simple or calamine cerate may 
be desirable. The solution of the nitrate of silver, of the strength of 3j. 
to §j., will also be found of great value as a cicatrizer; for I concur with 
Mr. Higginbottom, that there is no agent in surgery so useful for promot- 
ing healthy cicatrization or removing excoriations as lunar caustic.' It 
likewise excels all other means in giving increased vigor and strength to 
a new cicatrix. Part xxviii., p. 237. 
Carbuncle.—Part Affected.—Xo single part of the body could perhaps 
be named on which carbuncle may not occur. Instances have presented 
themselves of late years in the hospitals on almost every possible locality. 
The feet, as far as our personal observation has extended, have been 
exempt, but Mr. Coulson has mentioned to us a case in which he was 
recently consulted, where the disease, in a severe form, was located on the 
dorsum of the foot. Its great rarity on the scalp is still observed. On the 
face, however, of late, the frequency of the carbuncle has been far greater 
than appears formerly to have been the case. When seated on the face, 
there is often present a more severe form of inflammatory fever, and the 
inflammation is less asthenic than in other regions. A series of most severe 325 
CARBUNCLE. 
cases of this description occurred abort three years ago in St. Bartholo- 
mew’s Hospital, and since then we have chanced on several other isolated 
examples of the same kind. A case in St. Mary’s Hospital ended fatally after 
herniotomy, from the outbreak of an acute carbuncle of the lip. It was an 
observation of Sir Astley Cooper’s, that when carbuncle attacked the head, 
it generally caused death. Though it must undoubtedly be admitted that 
the disease is by far more dangerous in this locality than in any other, yet 
recent experience does not support so sweeping a statement. In ten out 
of the thirty-five cases tabulated, the disease was seated either partially 
or wholly on the face, and the whole of them, notwithstanding, re- 
covered. 
The favourite seats of carbuncle are those in which the skin is thickest; 
the nape of the neck, the back and the nates, standing prominent in the 
list. Of the cases mentioned, in 12 it appeared in the nape, in 10 on the 
back and 2 on the buttock. 
Constitutional Symptoms attending the Outbreak.—In very exceptional 
cases the disease was unattended by general disturbance, but in the large 
majority, inflammatory fever of a more or less severe kind was present. 
In these the patient lost appetite, became heavy and depressed, had a 
somewhat furred tongue, a quickened pulse, costive bowels and high- 
colored urine. In some of the more cachectic and elderly patients the 
depression was severe, and the fever tended to what is familiary known as 
“ typhoid ” in type. It is but fair to attribute part of the constitutional 
disturbance present during the progressive stage of carbuncle, to the 
extreme pain almost constantly present. This will not, however, account 
for the whole, and the greater part is doubtless symptomatic of the car- 
buncular dyscrasia. 
Duration, etc.—Carbuncle does not appear to observe any determinate 
course as to the length of its stages. The time occupied in attaining its 
maximum size varied in the cases before us from three to sixty days, its 
average being rather more than fifteen days. 
Nature of the Slough.—Rokitanski has asserted, contrary to the general 
belief, that the core of boils and the shreddy slough of carbuncles do not 
consist of dead tissue, but are inflammatory exudations, like the false 
membrane of croup. Without at all denying that they may be in part so 
formed, we cannot avoid expressing an opinion that their bulk is really a 
slough. 
General Treatment.—Give purgatives and alteratives, with stimulants 
or salines according to the constitutional disturbance. Incisions give 
great relief, especially when the carbuncle is spreading and painful; 
but if the pain has subsided, incisions are not required, but are even inju- 
rious. 
Apply a solution of the nitrate of mercury in strong nitric acid (hydrarg. 
§ j.; acidi nitric., sp. g. T50, § ij.; solve) to one central spot about the 
size of a shilling or sixpence. It produces an eschar from beneath which 
the slough separates. For boils, the caustic answers even better than 
the knife; apply a full-sized drop to the apex of the boil. 
Part xxxi., p. 186. 
Turpentine in Carbuncular Diseases.—Dr. Thielmann slates that lie has 
employed this substance with great success in a case of malignant pustule, 
and in a great number of cases of carbuncle, amounting to 342 since 1837. 326 
CARBUNCLE. 
The treatment has been merely local, unless suppurating fever or other 
general symptoms called for interference. The turpentine was applied in 
every stage of the disease on a thick pad of charpie, evaporation being 
prevented by oiled silk. In most cases, a slight burning is at first pro- 
duced, which only lasts for a few minutes. The epidermis becomes soft- 
ened, and the mortified parts are quickly separated, without the necessity 
of the crucial incision. After the separation, it is still continued, as under 
its influence the healing is rapid. Ifj after each dressing (these being 
repeated night and morning), the patient complain of a continual burning, 
the lotion is to be sufficiently diluted with chamomile tea, or the dressing 
is to be performed with this alone. The turpentine is suitable to all 
sloughy and atonic ulcers. The following is the formula for the prepara- 
tion of the application : Mix gj. of oil of turpentine with the yolk of an 
egg, and then add spirits of camphor § j., chamomile tea lb.j. 
Part xxxii., p. 188. 
Carbuncle and Boil.—Prof. Syme says: 
Carbuncle is a circumscribed inflammatory condition of the true skin. 
It begins with a small red point, which gradually and rapidly extends, 
with a peculiar tingling and pungently-painful sensation, much greater 
than might be expected from the degree of morbid change apparent to 
sight. The skin becomes loosened in its texture, and swollen, so as to be 
an inch or an inch and a half in thickness. Small yellow points appear on 
the surface, and are presented by a section of the dermoid texture, inter- 
spersed in the interstices of its substance. These local changes are attended 
with a more than corresponding amount of constitutional disturbance, the 
patient being unable to sleep or eat, having an anxious expression of 
countenance, and presenting all the characters of excessive irritation. If 
the evil be permitted to pursue its course, it terminates in sloughing of the 
affected skin, and either death of the patient from exhaustion, or a very 
tedious recovery from the loss of substance which has been sustained. All 
sorts of internal remedies and local applications have little or no control 
over the progress of a carbuncle, and the only effectual method of cutting 
6hort its advance is to make a free crucial incision completely through the 
whole extent of inflamed skin. Immediately upon this being done, the 
redness disappears, and the pain ceases, the constitutional disturbance soon 
subsides, and the affected skin, unless already deprived of its vitality, 
quickly resumes its natural thickness and healthy action, so as to remove 
all obstacles from the healing process. 
The patient now before you, tells us that, about a fortnight ago, a small 
red speck, like the head of a pin, appeared on his back, and quickly ex- 
tended, so that at the time of his admission, the day before yesterday, the 
circumference of inflamed skin was equal to that of a small plate. The 
aflected surface was slightly elevated, and of a fiery-red color, with yellow 
points interspersed. I made a free crucial incision through the thick and 
soft integument, which was studded with numerous yellowpoints, similar to 
those on the surface, placed pieces of lint between the cut edges, desired 
that a poultice should be placed over them, and restricted the diet to milk 
with farinaceous food. You now'see that all the carbuncular characters 
have disappeared, and the patient says that he “ has been mending every 
hour ” since the incisions were made. 
Reason and experience being so decidedly in favor of the practice here CARBUNCLE. 
327 
employed, I should consider it unnecessary to say a word now upon the sub- 
ject were I not aware that the most erroneous ideas in regard to the 
pathology, as well as treatment, of the disease, are extensively diffused. I 
deem it necessary to warn you against the four following errors, which are 
very generally entertained: 
In the first place, I beg to remind you that the disease is not subcu- 
taneous, but seated in the skin itself. Secondly, that the object of incisions 
is not to allow room for the escape of matters confined under the skin, but 
to extinguish the inflammatory action, through the discharge of blood and 
the relief of tension, by dividing the texture in which it is seated. Thirdly, 
that the application of caustic is the extreme of absurdity, since it directly 
insures what the great object of treatment should be to prevent, and by 
destroying the skin affected, instead of restoring it to a healthy condition, 
necessarily protracts recovery, and renders it less perfect. Fourthly and 
lastly, I beg to warn you against giving the patient wine and nourishing 
food, or employing local applications of a stimulating kind, so long as the 
inflammatory tendency continues in operation. The rapid progress which 
the poor starved creature you have just seen is making on his spoon diet 
must satisfy you that the weakest condition does not then require support, 
while the disease, so far from being limited to an impoverished state of the 
system, is more frequently met with in persons suffering from repletion. 
In both of these conditions the disease depends upon a peculiar morbid 
tendency, and so long as it continues, the effect of stimulants will certainly 
be to aggravate the evil. 
It may here not be out of place to say a few words in’regard to boils, 
which are very nearly connected with carbuncle. Like it they are seated 
in the skin, begin by points so small as to be hardly perceptible, and ex- 
tend from the centre in a circumscribed form, with local and constitutional 
symptoms of disturbance greatly disproportioned to their extent. They 
are distinguished by being restricted to a smaller size, by presenting a 
more convex surface, and by tending to suppuration rather than slough- 
ing. It is true that they contain a white substance, named their core, 
which looks like, and is often mistaken for merely dead cellular substance, 
but is chiefly the result of a morbid deposition. Fomentation and poultices 
may soothe the uneasy symptoms proceeding from boils, but the only 
effectual mode of checking their progress is to make a free crucial incision 
through the whole extent of inflamed skin which constitutes their base. It 
is often said that “ opening ” boils does no good, and this may be true, 
since the incision, like that for the remedy of carbuncle, must be directed, 
not wfith a view to evacuation, but to free division of the affected skin. 
The opinion generally entertained at present is, that boils should be allowed 
their course, under palliatives, with a liberal diet, and patients are fre- 
quently met with who have suffered for months, and even years, from their 
successive formation. Now it seems to me that nothing can be more in- 
judicious than such a procedure, since each boil, instead of being ex- 
tinguished by a timely incision in its infancy, is allowed to go through the 
whole of its irritating course with attendant constitutional disturbance, 
which instead of benefiting the patient’s system must increase its 
derangement and liability to similar formations. Part xxxiii.,j». 231. 
Carbuncles ancl Boils.—According to Mr. Travers, the manner of 
operating by incision is neither requisite nor safe, and is much surpassed in 328 
CARIES. 
efficacy by the use of potassa fusa for this purpose. It should be fresh, 
and unaltered by exposure to the air, and may be inserted into a goose 
quill by way of handle. The best time for opening is when the skin has 
become dusky, and is perforated by pin-hole orifices, whence issues an 
ichorous oozing. To prevent the caustic running and destroying healthy 
skin, a dossil of dry llocky lint should be applied upon and around the 
part to which the caustic has been applied. The carrot poultice is the best 
that can be applied afterward, with a view of cleaning the sore, and a solu- 
tion of chlorinated soda is very useful at particular stages of the sore. A 
weak caustic, like nitrate of silver, is of no use, but even prejudicial imthese 
cases. Part xxxvi., p. 189. 
Carbuncle—Incisions.—The great point to be observed in making 
incisions in anthrax or carbuncles, is to make them sufficiently deep to go 
through the inflamed skin and areolar tissue to the healthy parts beneath. If 
properly done, the flaps made by a crucial incision will be quite loose when 
taken hold of by the forceps, and will curl up and leave a wudely gaping 
wound. Part xl.,jt>. 150. 
CARIES. 
Local Treatment.—Caries, being a local disease, requires in addition to 
the internal use of cod liver oil, some special treatment. Burrowing 
sores, fistulous passages and particularly the ulcerations and swellings 
of the soft parts are so many obstacles against which internal treatment 
can do nothing. Compression, and stimulating the ulcerated surfaces by 
the solution of ioduret of potassium in alcohol and water, have been the 
means with which Dr. Taufilied has always succeeded in getting rid of 
these obstacles. Part i,,p. 43. 
Aphorisms of Practical Surgery.—Of all cases of caries, the most 
dangerous are those in which the sternum is alfected, for, when once the 
spongy texture of this bone becomes diseased, very troublesome fistulse 
are formed, and the patient generally sinks under the effects of the disease. 
Caries of the crest of the os ilii is a frequent cause of symptomatic ab- 
scess in the lumbar and sacral regions. Part iii., p. 116. 
Removal of one of the Rones of the Metacarpus, the corresponding 
Finger being Preserved.—31. Blandin presented to the Academy of 
Medicine two patients from whom he had removed one of the bones of the 
metacarpus, but preserved the corresponding finger. The first case was 
that of a woman, the first metacarpal bone of whose right hand was 
affected with caries. The affected bone was cut out; and when the wound 
was healed and the cure completed, the thumb was found to be much 
shortened, but very useful, quite mobile, and sufficiently strong for most 
purposes. She was able to use the thumb for holding the pen or needle, 
and used it easily both in writing and sewing. The hand, indeed, was 
both less mutilated, and much more useful than if the entire thumb had 
been removed. This was the fifth time that M. Blandin had successfully 
performed this operation. Part iii., p. 95. 
Rheumatic Caries of the Spine.— Vide Art. “Spine.” CAKIEB 
329 
Scrofulous Caries.—Dr. Cotton remarks : 
I have witnessed and experienced such excellent effects from the use of 
the trephine in cases of scrofulous caries of the shaft and extremities of 
the tibia with implication of the joints, that I think this instrument maybe 
frequently and advantageously employed in such cases, as well as in those 
of thickening of the bone with severe intermitting pain, etc., recommended 
by Sir B. Brodie. In the case of a boy about to leave the hospital 
“ cured,” with an apparently sound limb, having been under treatment 
since September, 1845, and twelve months previous to entering it, for 
enlarged head of the tibia, effusion around the joint thought to be within 
it, partial necrosis of the shaft, ulceration of integuments, greatly 
thickened periosteum (a condemned knee), I pierced the shaft with the 
trephine twice, and removed portions of carious bone, and applied 
it once also to the head of the tibia, and gave exit to a perfect pool 
of sero-purulent matter, apparently proceeding from an abscess within the 
cancellated structure. A seton carried close to the side of the joint, 
supporting the constitutional powers, etc., in spite of an attack of phleg- 
monous erysipelas, served to complete the at present cure. 
Part xv., p. 178. 
Protein in the Treatment of Caries.—Mr. Tuson, in recommending 
P rotein as a remedial agent in the treatment of caries, says : 
Caries of the spine, pelvis, bones of the inferior extremity, superior 
extremity, head and face, have frequently been under my care. Various 
remedies and different applications have been employed ; it is only within 
the last few years, however, that I have been able to find a medicinal 
agent to produce a permanent and beneficial effect upon caries of the 
bones; I am able now to state that I have been successful in this respect, 
owing to the researches of Liebig in the furtherance of organic chemistry, 
and the progress made in our knowledge of the formation of several parts 
of the human frame. The close identity and chemical composition of 
several parts of the animal body, according to the best authorities we are 
able to consult, clearly point out that dried blood, dried flesh, and other 
parts of the animal textures, correspond very closely in their chemical 
composition with protein, or that chemical basis which is essential to 
the formation of the various parts of the human frame, and which enters 
into the composition of the structure of every part, combined with other 
elements. 
A boy was admitted under my care at Middlesex Hospital, with exten- 
sive caries of the metatarsal bones; it was considered necessary, upon con- 
sultation, to remove the bones by amputation ; but, as the patient had 
enlarged glands of the throat, it was deemed advisable to improve his 
general health previously to the operation, and for this purpose I pre- 
scribed ten grains of protein twice a day. In the course of two months, 
the caries of the bones, for which amputation was considered necessary, 
was completely cured, and solely by the administration of protein, as the 
disease had resisted the action of all other fneans which had been employed 
for a considerable time previously. A youth was admitted with caries of 
the tibia and bones of the foot; it was considered by the surgeon who 
sent him into the hospital, that he must lose his leg; protein was pre- 
scribed, and he was discharged cured. Thus, then, from carefully watch- 
ing the effect of this remedy, I was able to discover a very beneficial agent 330 
CARTILAGE. 
for the relief of one of those diseases of the bones which few remedies 
accomplish; and, from repeatedly observing the result of the exhibition 
of protein in public as well as private practice, I entertain a very favorable 
opinion of it, as I have seen it successfully administered in very many cases 
that have fallen under my notice. Difficult cases of caries of the spine 
have been under my treatment, and have been cured by the exhibition of 
protein. 
I have prescribed it extensively with very beneficial results, and can 
recommend it as a medicinal agent and one calculated to produce a favora- 
ble termination in most cases of caries; also in some cases of scrofula, 
extensive ulcers, debility, diseases of the gums and teeth, rickets, undue 
lactation, and insufficient secretion of milk. In infancy, where debility 
exists, and where the functions are not duly carried on, and in some 
affections of the spine, five grains once or twice a day will be sufficient for 
a child, and ten or twelve grains for an adult; and I have ordered it to 
be taken as a powder, dry or upon bread and butter. 
In one or two instances, I must mention that I have found its effect 
rather inflammatory, and, should this result, it ought to be discontinued, 
active aperients administered, and such other remedies as the case may 
require. I have tested its tonic qualities, by administering it instead of 
quinine, wine, or beer, not in a solitary instance, but on several occasions; 
and where Nature has to restore the loss of any part, caused by extensive 
sloughing of the soft structure, I have found by its exhibition that the 
cases have rapidly improved and terminated favorably in a much shorter 
period than under the administration of other remedies. 
Part xvii., p. 298. 
Osteotrite.—For the removal of carious bone, either from the surface or 
from the interior of cavities, use the osteotrite, invented by Mr. Marshall; 
it consists of a handle similar to that of the common gouge, into which is 
fixed a steel shaft, terminating in a round somewhat conical head, which 
varies in size, but which possesses a series of spiral cutting edges, radiating 
from two points on the sides of the vertex. It is used by a rotatory 
motion, and cuts like a saw or rasp, and removes diseased structure with 
perfect ease. It does not leave behind it any loose splinters, and from its 
strength is not liable to break or slip. Part 152. 
CARTILAGE. 
Ulceration of Cartilage.—This disease is hardly ever met with in the 
hall and socket joints, it is nearly entirely confined to the hinge-joints. 
The symptoms are deep-seated pain, generally increased during the night, 
uneasy sensations in the next joint, or even the whole limb, more or less 
swelling of a firm unyielding kind confined to the seat of the articulation. 
These symptoms may continue for weeks or months, and terminate either 
in recovery, with more or less stiffness of the joint, or in suppuration with 
caries. The treatment has generally been by leeches, fomentations, 
blisters, caustic, issues, but all these will often fail. The only remedy 
which may be depended upon with perfect confidence, is the actual CASTRATION—CATALEPSY. 
331 
cautery, which may be drawn crosswise over the joint. The result ia 
often surprising and satisfactory. Dart xxxiii., p. 298. 
CASTRATION. 
New Operation to Supersede Castration.—Mr. Taylor having observed 
that the process of “ sow-gelding ” consists not in the removal of the 
ovaries, but in the simple division of the fallopian tubes, advises a parallel 
operation, viz., the division of the vas deferens (or the removal of a portion 
of it), to supersede castration in the male. He states that he has per- 
formed this operation successfully upon a dog. Dart xx., p. 165. 
CATALEPSY. 
Catalepsy, or Trance.—Catalepsy is undoubtedly more a lesion of func- 
tion than of structure. 
Diagnosis.—This disease has been confounded with hysteria, ecstasy, 
asphyxia, apoplexy and syncope, tetanus and the state of death. The 
older physicians also mistook death from cold for catalepsy, and described 
cases of soldiers in a state of catalepsy riding into the camp on horseback, 
lirmly seated like statues on their saddles. Here, death from intense cold 
formed a source of error. 
From true ecstasy, catalepsy is distinguished by the patient labouring 
under the former disease being occupied in profound and sustained medi- 
tations. The faculty of thought, instead of being annihilated or suspended, 
is found exclusively directed towards the contemplation of a single object, 
entirely absorbed by one idea, with some imaginary pleasant object, 
the powers of imagination being augmented by an enthusiastic exaltation. 
Again, there are no convulsive movements, no rigidity, partial or complete, 
of the muscles; and, above all, the limbs, if placed in any position by the 
physician, do not retain that position, as they will in simple, andoftentim.es 
in complicated catalepsy. 
In hysteria the muscles are convulsed clonically,—that is, with motion; 
in true catalepsy they are convulsed tonically, that is, without motion; 
and in this rests the principal difference between the two. 
Asphyxia is accompanied with suspension of the functions of respiration 
and circulation ; the countenance is also ordinarily livid and swollen, the 
mucous membrane of the lips having a very dark hue. 
Syncope is distinguished from catalepsy by the state of the muscular 
system, the limbs being extremely flexible—and this pertains also in a 
great degree to asphyxia—and by the general pallor of the countenance 
and surface of the body, consequent on the suspension of the heart’s action. 
Apoplexy is known from it by the stertorous or sonorous breathing, by 
the more or less profound lethargy, by the lax state of all the muscles of 
the body, and also by the co-existence of paralysis. 
Although tetanus has been mistaken for catalepsy, in consequence of the 332 
CATALEP6Y. 
tension and rigidity of the muscles, yet the fact that neither sensibility nor 
the intellectual functions are interfered with, should have prevented such 
a mistake from being committed. 
Patients laboring under an intense and prolonged paroxysm of catalepsy 
have been supposed to be dead, and have been interred alive. 
There are numerous cases of this kind on record, and many more where 
the individuals, after being laid in their coffins, have fortunately recovered 
from the attack before the period of interment. In such cases, the respi- 
ration is insensible, and the heart’s action is almost in abeyance; the sur- 
face of the body is nearly cold, and presents the pallor of death; and the 
articulations are stiff. Although it is no doubt a difficult task to distin- 
guish this state of trance from the state of death, yet a careful examination 
of the body, and time, Would lead to a correct diagnosis. The limbs, after 
death, are lirst lax, then stiff, and ultimately lax again. The stiffness of 
the limbs, known as the cadavern rigidity, or rigor mortis, lasts for a 
longer or shorter time, according to circumstances; the sooner it super- 
venes, the shorter is its duration, and conversely. Now, the stiffness of 
the limbs accompanying this intense form of trance, supervenes at once, 
and lasts as long as the paroxysm continues. This is consequently a valu- 
able diagnostic sign. 
Again, as the heart’s action most certainly continues in a slight degree 
during the attack, the stethoscope may be used with advantage to detect 
the impulse and murmurs. The state of the eyes and the expression of the 
countenance, as well as the circumstance that the temperature of the body 
may be sustained in a slight degree, also furnish means by which a diag- 
nosis may be made. 
If pressure be made on the eye-ball a few hours after death, the cornea 
becomes opaque ; and this occurs invariably. But if the least spark of life 
remain, that effect would not be produced. This may, therefore, be said 
to be a sign at once distinguishing the state of trance from that of death— 
one of ready application, and thus rendering wholly unnecessary the car- 
rying out of the suggestion that inhumation should never be proceeded 
with until the body has shown unmistakable signs of decomposition. 
Catalepsy is a disease which is often feigned, sometimes for the purpose 
of exciting the sympathies of the charitable, occasionally by soldiers to 
procure their discharge from the army, often by females in good circum- 
stances, merely from a desire of creating an interest in their behalf, and by 
itinerating mesmeric impostors. To detect the imposition is oftentimes a 
matter of great difficulty, all the symptoms and signs of trance being exhi- 
bited with great truth. Such persons require to be carefully and vigilantly 
watched, and their character inquired into, when some inconsistencies will 
be noticed, and their imposition detected. Perhaps the inhalation of chlo- 
roform, where malingering is suspected, and is necessary to be known, 
would be of great service. 
With regard to the treatment, Dr. Milner says the cold bath is injurious, 
but hot baths and pediluvia have been found useful. The most effective 
means, however, seems to be hot pediluvia and the cold douche applied to 
the head at the same time. The patient cannot swallow medicines ; but if 
there should be any sensibility remaining, ammonia and other stimulants 
might be applied, held near the nostrils. Fiiction of the surface of the 
body with rubefacients might be useful. Stimulating enemata might also 
be of service by relieving the bowels, and acting as a stimulant to the cir- CATAKKH. 
333 
culation in the parts. It is during the interval between the attacks that 
therapeutic remedies are likely to be of any avail. The treatment may be 
summed up in a few words—the cause must be searched for and removed, 
if possible. If a hemorrhoidal hemorrhage has been suppressed, leeches 
must be applied round the anus. If there are worms in the intestines, 
anthelmintics must be given ; or if it be caused by the retropulsion of an 
exanthematous eruption, everything must be done which can remove the 
irritation caused thereby. Part xxii., p. 90. 
Lobelia In flat a—Recommended in the catarrh of both children and 
adults, especially if inflammatory. Tincture or infusion of lobelia is much 
better than either ipecacuanha or emetic tartar; being at once a decisive 
and safe nauseant, and not irritating the bowels. Part xvi., p. 134. 
Catarrh, Chronic.—In old and weakly people, where there is much ex- 
pectoration, and when there is no disease of the heart or great vessels, 
give tannin, one, two, or three grains, twice or thrice a day. 
Part xxi., p. 326. 
Treatment of Catarrh.—Dr. Lombard, of Geneva, suggests that catarrh 
should be treated as follows : 
A piece of metal is heated in a spirit lamp, and a few grains of powdered 
opium having been sprinkled upon it, the patient is directed to hold his 
head in the fumes, and to make a few forced inhalations. It is said to 
afford most marvellous and speedy relief to the distressing pain and sense 
of weight so commonly felt in the frontal sinuses. As addressed to this 
particular symptom, the expedient might be advantageously combined 
with “ orange-juice treatment,” so useful in allaying the fever, restlessness 
and general disturbance which often attend this common and most dis- 
agreeable complaint. Part xxxi., p. 88. 
Catarrh.— Vide Selections from Favorite Prescriptions, Art. “Medi- 
cines.” 
Catarrh.—Let the patient drink freely of some warm fluid, put on a 
warm great coat, and walk smartly till he feels himself perspiring, then 
turn homeward, continuing his pace quite up to his own door, and let him 
have a bed to get into the moment he gets home ; or let him use the hot 
air bath, which is one of the most convenient and manageable of all dia- 
phoretic remedies: all that is wanted is a spirit or gas lamp, and a roomy 
cloak of some air-tight material, fastened close at the neck. If these means 
fail, use in conjunction with them, opium in the form of Dover’s powder— 
of all drugs, the best; let the patient take about ten grains: with many 
persons it acts as a specific. Lastly, stimulant diaphoretics, such as ammo- 
nia, ether, ammoniacal salts and camphor, especially the latter, often pro- 
duce astonishing effects. A few drops of spirit of camphor may be taken 
on a piece of sugar, every four hours or so, or it may be given in the form 
of a draught, combined with salts of ammonia and potash. 
Part xxxv., p. 33. 
CATARRH. 334 
CATARRH. 
Catarrh and its Treatment.—Dr. C. IT. J 3nes gives the following: 
A point which I think is not yet sufficiently understood is the almost 
invariable tendency to aggravation of catarrhal disorders during the night. 
I have observed this in catarrhs of various parts. It is commonly supposed 
to depend upon the accumulation of mucus, but I believe it is rather due 
to a lowering of the nerve-power during the night, and consequent dilata- 
tion of arteries, the vaso-motor nerves partaking in the general debility. 
From this cause the hypercemia of the affected part becomes increased, 
more irritation is set up, and more exudation takes place. There are 
many acts of a like import. Asthmatic paroxysms are apt to come on after 
an hour or two of sleep. Those of pertussis are aggravated often at night. 
Fever patients are apt to sink during the night. Epileptic attacks, when 
the disease is yielding, often happen only at night. Malaria affects the 
system much more severely at night than by day. When I have had 
cachectic pustules on my fingers from dissecting, I have often observed 
that they suppurated afresh at night, after they had appeared to be heal- 
ing during the day. In a communication made by Mr. Clarke to Dr. 
Graves, it is stated that the electricity of the atmosphere is at its daily 
minimum at three a.m., and that the atmospheric pressure has one of its 
two daily minima an hour later. All these facts, especially when regarded 
in connection with the manifest depressing influence which the catarrhal 
poison exerts on the nervous system at large, seem to me to give much 
probability to the opinion above expressed. 
It seems to me very possible that various causes, operating after the 
manner of depressing poisons upon the nervous system, may give rise to 
the phenomena of catarrh. The pain and general depression of a severe 
catarrhal attack manifestly indicate the operation of a poison on the ner- 
vous system, and the pains are, in fact, actually so many neuralgia?. 
If we suppose the morbid influence of catarrh affecting the mucous sur- 
faces, transferred to the vaso-motor nerves of the limbs and of the synovial 
membranes, we should certainly have results identical with those of 
rheumatism. The etymology, in fact, is correct, and catarr/t is a rheuma- 
tism of the mucous surfaces. Another point, in which catarrh has an 
evident affinity to neuralgia and aguish disorder, is that instances are not 
unfrequent in which attacks of neuralgic character are accompanied by 
exudation. Such are asthmatic paroxysms, passing off with free expecto- 
ration ; lachrymation and salivation occurring with neuralgia of the trifa- 
cial; gastralgia, with its watery flux (pyrosis) ; sudden attacks of abdomi- 
nal pain and diarrhoea taking place in some cases of remittent fever, and also 
as an independent affection ; and certain cases of violent paroxysms of 
sneezing. Here the nerve disorder is temporary, and with it the vascular 
congestion subsides, and the exudation ceases. If it were more persistent, 
the result would be catarrh. 
Treatment.—The treatment of catarrh is sufficiently rational and satis- 
factory. In cases where the local disorders are wanting, or nearly so, and 
the general depression and prostration, without much pyrexia, are the 
prominent phenomena, I find carbonate of ammonia, five grains, in casca- 
rilla infusion, three or four times a day, of great service. In somewhat 
more pyrexial states, the ammonia is better given in equal parts of cam- 
phor mixture and liquor acetatis ammonia?. Tincture of hyosciamus, or 
tincture of cannabis indica, or (if there be diarrhoea) Battley’s solution, 
may be added to tbo +'^,'^^nin,j. Camphor and henbane, or morphia, or 335 
CATARRH. 
Dover’s powder, may procure comfortable rest in many cases at night. 
As improvement goes on, citrate of iron and quinine, with tincture of nux 
vomica, or quinine alone, may be substituted tor the ammonia. If in any 
case there should be much pyrexia, citrate of potash, with bicarbonate of 
potash, and dilute hydrocyanic acid, guarded also, perhaps, with a little 
Battley’s solution, will be very appropriate. In many cases, rest in a 
warm bed for a day or two, with wine negus as a gentle stimulant, and 
equalizer of the circulation, will alone do very much to restore the system 
from its depression. There is no need for any rigid diet, nor for any 
attempts at elimination of the catarrhal poison. 
In all local catarrhal affections, the general indications are the same— 
viz., in the early period, to reduce sthenic inflammatory action (supposing 
it to exist), and, in the later, to give tone to weakened vessels and nerves, 
and to calm irritation. In catarrh of the air-passages, ipecacuanha, half 
a grain to a grain, combined in a pill with one or two grains of extract of 
conium, and a little morphia, if there be much nervous irritation, and 
given every one or two hours, so as to maintain a degree of nausea for 
some time, is very effectual in combating sthenic inflammation. The saline 
and alkaline mixture, with hydrocyanic acid, mentioned above, should also 
be taken every three or four hours. There seems to me a decided advan- 
tage from giving the pill and mixture separately, as the nauseating influence 
of the ipecacuanha can thereby be regulated more easily, without interfer- 
ing with the saline. Very decided cases of bronchitis maybe conve- 
niently dealt with in this way; some, however, occurring in the more 
vigorous and robust, may require the more potent influence of antimony. 
Mustard poultices or turpentine stupes, and in the later periods blisters 
(if necessary), may all be of much service. In cases of tracheal catarrh, 
where the cough is very distressing and obstinate, small blisters, applied 
just at the top of the sternum, are often of much avail. If there be much 
constitutional depression, together with the local catarrh, the skin cold, 
and the pulse feeble, ammonia, with the compound spirit of sulphuric ether, 
in cascarilla infusion, is very appropriate. Tincture of cannabis indica is a 
good sedative, which may be given with the above, or the extract in a 
pill at night; it certainly has a notable effect on the cough in not a few 
cases. In some cases of this character, there are symptoms of constriction 
of the air tubes (asthma), to meet which liquor of the arsenite of potass 
may be added with advantage to the ammonia mixture, or extract of stra- 
monium be given in a pill two or three times a day, or at night only. 
When the catarrhal affection is clearly asthenic, the rales moist, the expec- 
toration free, and the pulse weak, the greatest benefit will accrue from the 
use of nervine tonics, as nitric acid, strychnine, quinine. With these, 
sedatives may be also employed, as well as cod-liver oil, to aid in improv- 
ing the various nutritive processes. It is not unfrcquently a cause of some 
perplexity to determine, at the commencement of the treatment, whether 
a tonic or contra-stimulant plan is to be adopted. Sometimes, I believe, 
only the result of a trial will show. Senega, preceded by an emetic, is 
most appropriate to cases of obstructive bronchitis, or, as it has been 
termed, suffocative catarrh. I have seen it turn the balance in a grave 
and most perilous Case, when all other means had failed. Dry cupping is 
a most useful aid in chronic bronchial catarrh; it is more cleanly and con- 
venient than mustard poultices, and the patient’s attendants can soon be 
tatfglit to do it themselves, if the practitioner cannot the time. The 336 
CATARRH. 
balsams and squill I regard as milder forms of nerve-toners, appropriate 
to cases where either the stronger tonics cause irritation of the tissue, or 
the morbid action remains at a grade intermediate between sthenic and 
asthenic inflammation. I cordially agree with Dr. Copland in his repro- 
bation of the practice of maintaining a copious expectoration for an indefi- 
nite time, which the mere routine administration of these drugs is apt to 
keep up. 
In nasal catarrh, when the flux is asthenic, though it may be most copi- 
ous, I can answer for the good eflects of bottled stout and strychnine, 
and the experience of others is to the same purpose. The dry plan of 
treatment (albeit I hold it in abhorrence) is by no means unscientific ; 
it regards the need of diminishing the strain from within upon the 
weakened bloodvessels. I think it, however, better and pleasanter to 
try to tone them. 
In conjunctival catarrh, even the most severe, the case is nearly the 
same as in nasal. We possess no contra-stimulant drug to be depended on 
for subduing the sthenic inflammation. We are, therefore, obliged to re. 
sort to direct means, as local blood-letting, and the application of nitrate 
of silver. The arrest of severe conjunctivitis by Mr. Guthrie’s ten-grain 
ointment, or by the use of solid lunar caustic, is certainly a striking thera- 
peutic effect, even if it cannot be relied on as a constant one. When the 
sthenic period has passed, nerve tonics (quinine, etc.) have the best eflects, 
as elsewhere. 
In the treatment of gastric catarrh, I do not know that we have any 
contra-stimulant drug to be at all ranked with ipecacuan and antimony in 
their action upon the bronchial tubes. I think I have seen good from the 
administration of mercurials, as grey and Dover’s powder, of each two 
grains and a half three times a day, for a few days; but I am not so clear 
about their good eflects in gastric as in intestinal catarrh, where they are 
most marked. Leeches, followed by a continued poultice or fomentation 
to the epigastrium, will be of much benefit in the earlier periods, and a 
blister in the later. Lumps of ice, and a saline and alkaline mixture with 
hydrocyanic acid every two or three hours, will be very grateful as long 
as there is active inflammatory movement. When this has quite, or 
nearly, passed by, tannin, in pills, with muriatic acid either alone, or con. 
joined with dilute hydrocyanic acid, forms an excellent tonic, and this 
again may be followed by the stronger ones, as quinine or strychnine. 
Bismuth appears to me to find its opportunity in the intermediate grades 
of inflammation, or those which contain a good deal of the neuralgic ele- 
ment. It certainly arrests pain and muco-watery profluvia, and seems to 
act, in part, at least, as a nerve sedative. I have generally given it with 
soda or magnesia in mucilage, together with hydrocyanic acid. In many 
cases tannin may be given at the same time with bismuth, but I regard it 
as a grade nearer to the tonics. Nitrate of silver does not seem to me to 
belong properly to the remedies for gastric catarrh ; it finds its exact 
opportunity in gastric hvpersesthesia. Lactic acid, or pepsin, with the 
meals, are of course to be recommended if there be any abiding debility 
of the stomach, and failure of digestive power after the above means have 
been fairly tried. Certain conditions of the stomach, by no means unfre- 
quent at the present time, when there is pain and soreness, nausea, and 
rejection of muco-watery fluid, mingled sometimes with blood, and which 
are cured by quinine with opium, or citrate of iron and quinine with nax CATHETERISM. 
337 
vomica, form a transition stage between catarrhal and neuralgic affections. 
I strongly suspect that cases allied to these, where there has been a good 
deal of bleeding, are often wrongly set down as gastric ulcer. I have 
little doubt that, especially in conditions of aguish disorder, when internal 
congestions are apt to occur, the mucous membrane of the stomach may 
bleed like that of the nose, without any ulceration. 
The treatment of catarrh of the small intestine is very similar to that 
of the stomach, but salines are generally to be avoided. Repeated small 
doses of grey and Dover’s powders are of very great benefit; and if the 
urine is turbid with lithates, carbonate of soda should be given in infusion 
of lemon or orange peel. As long as there is anything like tenderness, 
warm fomentations should be applied to the abdomen. In some cases, 
repeated small doses of castor oil seem to modify beneficially the irritable 
state of the mucous surface; they should be given with a few drops of 
tincture of opium. Bismuth and tannin may be of much value after the 
earlier stage has passed away, and in protracted cases nitric acid and 
liquor of per-nitrate of iron are found efficacious. 
Catarrh of the large intestine is identical with the milder forms of 
dysentery. Its treatment is remarkably similar to that of bronchial catarrh. 
Ipecacuanha frequently administered is of great avail in subduing the 
sthenic inflammatory state in each, and the asthenic is benefited by very 
much the same tqnics. 
The bladder is one of those regions of the body which seem to be less 
under the control of remedies than many others. Except blood-letting 
and opium, there seems to be no remedy known which has any effect in 
subduing sthenic inflammation of its mucous lining. Copaiba has often 
great power in diminishing the secretion of muco-pus, and I have found 
benefit also from strychnia, in chronic cases, as a tonic to the relaxed ves- 
sels. But it is most difficult to arrest the morbid action completely, and, 
except in the young, where the vital powers are more elastic and capable 
of recovering themselves, I doubt whether it is to be done. The prin- 
ciples of action are, however, the same as in other catarrhal states. 
In uterine catarrh there is rarely any opportunity for dealing with the 
state of sthenic inflammation, and the task of the practitioner is mainly to 
give tone again to the weakened, relaxed, and congested vessels. An 
occasional blister to the sacrum may be of much service, but reliance is 
chiefly to be placed on cold astringent injections effectually employed 
(vide Dr. Tyler Smith’s directions, pp. 198-200 of his work), on the alum 
tampon, and on various astringents and nerve tonics administered inter- 
nally. Dr. F. Churchill mentions ergot, tincture of muriate of iron, de- 
coction of hseinatoxylum, and balsam copaiba, and to these may be added 
quinine and strychnia, which I have found of decided efficacy. 
I have desired to maintain and illustrate the view that the treatment of 
catarrh is to be directed simply to meet and obviate the effects of a de- 
pressing, or irritating poison, without in any way endeavoring after its 
elimination. Part xxxvi., p. 51. 
CATHETERISM. 
Improvement in Catheterism.•—Mr. Spong proposes the following simple 
contrivance in those cases where from the rupture of a vessel in case of en- 338 
CATHETERISM. 
larged prostate or of stricture near the neck of the bladder, the eye of the 
catheter becomes plugged with coagulated blood, and the urine is pre- 
vented from passing. 
The coagulated blood may be either dislodged or prevented from enter- 
ing the eye of the instrument. While the instrument is in the bladder, it 
may be dislodged by applying a common syringe to its orifice, and firmly 
pinching the point of junction of the two instruments between the finge 
and thumb. If the piston is now briskly drawn up, the clot of blood if 
sucked into the cylinder of the catheter, and the urine flows freely. A good 
syringe, capable of holding a fluid ounce, is sufficiently powerful. This 
manoeuvre is applicable to either a silver or a gum-elastic catheter. The 
clot might be dislodged by injecting; but that process is out of the ques- 
tion, for the bladder is too full already. Part xviii., p. 202. 
Catheterism.—Never use gutta percha catheters. However carefully 
they are used, they are liable to break, simply from the mode of their con- 
struction. Part xx., p. 162. 
Catheters, .Lubrication of.—Castor oil is the best: when cold, it is viscid 
and adheres well to the instrument, losing its viscidity just at the proper 
time, when it arrives at the stricture. Olive oil should never be used. If 
the urethra be very irritable, it ought first to be well lubricated by passing 
a large instrument down to the stricture, then withdraw it and j)ass a 
second, also well greased. Part xxxii.,/>. 176. 
Catheterism—Precaution.—When the bladder is greatly distended, do 
not draw off the whole of the urine at once, especially if in a debilitated 
person, for it has occasionally happened that a fatal syncope has occurred, 
or depression from which the patient has never rallied. After removing 
thirty or forty ounces, withdraw the remainder in the course of half an 
hour or an hour. Part xl., p. 143. 
Mode of Introducing the Catheter in difficult Cases.—Dr. Charles Pat- 
erson, of the Rathkeale Infirmary, has suggested and made use of a very 
ingenious method of passing the catheter in difficult cases; and especially 
in those in which the third lobe of the prostate gland is the obstructing 
body. He attaches a common bladder to one end of a common catheter, 
in the same way as we affix it to an enema pipe; having a bit of a cork and 
a string attached to it, just in the form of a common enema apparatus; the 
catheter is then passed down to the stricture, or as far down as the patient 
can bear; the fluid is then injected along the catheter, which should be as 
large as can be admitted, in order as much as possible to prevent the escape 
of the fluid at the sides. The bladder being filled with urine at the time, 
opposes a considerable resistance to the entrance of the fluid, and the 
urethra in consequence becomes distended, but the distention chiefly acts 
on the neck of the bladder and the parts nearest to that part, and, “ from 
the circumstances of their connections, the distention principally takes 
place in the direction of the rectum, forcing the tumid middle lobe of the 
prostate backward and downward, and so diminishes the obliquity of the 
passage.” It may be also that the bladder admits some of the liquid, and 
becoming still further distended in the way which Sir Everard Home de- 
scribes to occur about the third day after the obstruction, its posterior part 
bulges backward, and draws the swollen lobe with it. The urethra thus 
acquires a moro normal direction, the tumid lobe of the prostate becomes CAUSTICS. 
339 
altered, and the instrument generally now glides into the bladder with much 
more ease. A pig’s bladder is found to answer perfectly well. 
Part iii., p. 97. 
Practical PemarTcs on Caustics.—Sir B. Brodie observes as follows: 
Some caustics act very slowly upon the part to which they are applied, 
while others cause the part to slough rapidly; some are productive of great 
pain, which last for a longer or shorter time; others again destroy the j)arts 
to a great extent; the effects produced by others are local. In some cases, 
granulations rise above the surface and prevent new skin forming over 
them ; it is important that they should be destroyed. For this purpose you 
should use nitrate of silver; this causes the destruction of some and the 
absorption of others. There are some cases where there exists a great 
number of fungous growths, and it is necessary to get rid of these. You 
will find this ointment useful: AErugo asris, cupri sulph., hydrargyri nitrico- 
oxidi, aa. 5ij.; Hydrarg. perchloric!!, 5j. Adeps q. s. ut fiat unguentum. 
This may be spread upon lint, and applied to loose fungous growths. One 
mode of making issues is by applying caustics. You should use for this 
purpose caustic potass until it has just penetrated through the skin. If 
you rub on this caustic often, you get considerable bleeding; caustic potass 
too frequently continues to spread after its application. The concentrated 
nitric acid does not spread so much as caustic potass. I have seen nitrate 
of silver pounded and rubbed up with lard, applied to make an issue; its 
action, however, is slow, and causes much pain. Other caustics produce 
much less pain, and accomplish the object more rapidly than this. When 
an issue, or Wound, or sinus is open, and you wish to keep it so, lest the 
orifice heal, and matter should form and produce abscess, you should touch 
the margin with caustic potass, which causes a slough, and this is a long 
time coming away. I have seen lunar caustic applied in these cases gently 
give pain, and cause even cicatrization of the orifice. You will frequently 
have to apply caustic, when it is material to use it well, as in the case of a 
bite from a mad dog; whether he be mad or only supposed to be so, the 
treatment is the same; it is better to excise the part where this can be 
easily accomplished, but in the bite of the palm of the hand it would be a 
serious thing to cut out tendons, vessels, nerves, etc.; or it may be that 
when you think you have cut out all, you cannot follow the wound, you 
will find it necessary to cauterize it. The best caustic on these occasions 
is the caustic potass, because it dissolves and penetrates through to where 
the saliva may have penetrated. The best mode of applying it is to melt 
the potass in a silver or platinum cup, and dip into it a blunt probe ; you 
thus get a layer of potass upon the end ; by'carrying the probe thus armed 
into the wound as far as the dog’s tooth has penetrated, you may be sure 
of the caustic penetrating further. You may use caustics to destroy dis- 
eased lymphatic glands. A man has an inflamed gland, which suppurates, 
and the wound will not heal, because at the bottom of it there is a diseased 
gland ; and no ulcer will heal without a healthy basis. You may destroy 
these by nitric acid or lunar caustic, but the potass destroys them entirely. 
CAUSTICS. 340 
CAUSTICS. 
This was used by Mr. Pearson : an ounce of crumb of bread, perchloride 
of mercury, 5j., red lead, 5j.; this mixed and kneaded with the fingers 
should be rolled into conical troches, and these you may stick into the 
gland ; they soon act, and continue acting until the whole gland is destroyed. 
If the application of the first troches be not sufficient, more may be in- 
serted afterward. I do not know whether the red lead does much good 
in this prescription, but I have employed this remedy as I found it. Warts 
on the penis or pudenda may be easily destroyed; sometimes where a great 
mass exists on the penis or pudenda, the lunar caustic is too weak: you 
should then use nitric acid till the whole is destroyed. The following will 
answer well: a drachm of nitric acid to two drachms of the muriated tinc- 
ture of iron. A useful escharotic for warts on the penis or pudenda is pow- 
dered savine and aerugo aeris sprinkled opon them, which causes sloughing. 
Another is this : nitric acid §ss., white oxide of arsenic 5j., which has the 
double action ofarsenic and nitric acid. To destroy fungous granulations 
such as are frequently generated over an old carious surface of bone, the 
following ointment is advised: The ointment consists of verdigris, sulphate 
of copper, nitric oxide of mercury, of each two drachms, oxymuriate of 
mercury one drachm, with as much hog’s lard as is necessary to blend them 
together. This may be spread on lint, and one or two applications will 
be sufficient to destroy a very large mass of fungous granulations. 
Part iii., p. 71. 
The Preparation of Fine Points of Caustic for Ophthalmic and other 
purposes.—Dr. Hunter states that on being called on to stop several leech- 
bites on the scrotum, and finding the sharp point of his caustic to be soon 
blunted, he tried the following method. He says : 
I wrapt the nitrate in a bit of paper, crushed it with my heel, and 
placing some of the fragments on a silver half-franc piece, I held it over 
the flame of a candle, and then dipt the triangular-pointed flat end of a 
silver probe, previously roughened on a stone, in the melted salt, which 
adhered, and on cooling, formed a fine coating. This being inserted quite 
into one or two of the bites, they immediately ceased to bleed ; to get 
another point of caustic on the probe, was the work of an instant, and, in 
this way, a most alarming hemorrhage (the patient being almost in 
articulo) was speedily arrested. 
Since the above incident, I have been in the frequent habit of employ- 
ing the same method to get a fine point of lunar caustic for various 
ophthalmic purposes, such as touching small sloughy ulcers of the cornea, 
penetrating to the membrane of the aqueous humor, and in many other 
cases. I have also in this way got a fine coating of the nitrate on a probe, 
to be passed into the nasal duct in some cases of fistula lachrymalis ; and I 
conceive it might be found useful in many cases in general surgery, such 
as sinuses, affections of the nose, ear, etc., where caustic would often be 
introduced, but for the fear of serious consequences from the breaking of a 
common stick of it in such situations. The plan just recommended 
answers equally well for caustic potass, when a fine point or globule of it is 
required, as for producing eversion of a misplaced eye-lash, or for destroy- 
ing the remains of cysted tumors in the eyelids, or other purposes. The 
potass may be applied to the roughened surface of any common metal; but 
for the nitrate of silver, the probes must be of silver or gold, else the salt 
is rapidly decomposed, and the probe destroyed. A fine point of tartar CAUSTICS. 
341 
emetic, sulphate of copper, and similar salts, may be got by chipping their 
crystals, and then fixing the fragment on the end of the probe with sealing- 
wax ; but another plan, and the only one, when a long bristle, as it were, 
of these substances is required, is to take a wire, or the point of an old 
lancet, and heating it, and giving it a very thin coat of sealing-wax, to 
push it whilst hot amongst the powdered salt. In this way a probe, which 
is to be introduced into a sinus, or into the nasal duct, may be coated with 
sulphate of copper or any other metallic salt; and this is the method I 
employ to prepare the fiat points of tartrate of antimony for inoculating 
the bulbs of inverted eye-lashes, using for the purpose a bit of platinum 
foil shaped like a lancet. Part iii,,p. 92. 
Caustic Vienna Paste is made with five parts of lime and six of pure 
potash, mixed together with alcohol. Part ix.,p. 186. 
Caustic Paste of Sulphate of Copper.—M. Payan, senior surgeon to 
the Hotel-Dieu, of Aix, speaks favorably of a new caustic paste, made of 
sulphate of copper. A sufficient quantity of the sulphate, reduced to 
powder, is mixed up with the yolk of an egg, so as to form a soft paste of 
a deep green color. It is applied on a piece of lint, and when removed, 
does not leave behind it the loss of substance or unsightly scars, which 
commonly follow the use of other escharotics. Its use is suggested in 
certain cases of lupus. Part vii., p. 168. 
Black Caustic.—M. Velpeau prefers the black caustic to any other. 
He says: 
The black caustic, composed of sulphuric acid and saffron incorporated 
together so as to form a homogeneous paste, appears to me to have an 
incontestable superiority over all the others. It destroys the whole of the 
surface with which it comes in contact; occasions no sanguineous oozing 
even where the skin is ulcerated and fungous ; causes but little pain ; the 
tissues attacked dry up, and suppuration commences with the eliminating 
inflammation. It is true its application is rather difficult, owing to its 
adhering more to the spatula than to the tissues. 
As it burns everything, diachylon plaster cannot circumscribe it, and can 
only be conveniently applied on a horizontal surface; in other situations, it 
would in all probability run. Still these faults, which I am far from 
wishing to conceal, by no means counterbalance its good qualities. 
Indeed, I believe the black caustic is better than any other. 
Part xvi., p. 294 
Solidified Nitric Acid.—For the purpose of cauterizing cancerous 
tumors, etc., use a preparation made by gradually dropping a certain 
quantity of highly concentrated nitric acid upon lint, until a gelatinous 
paste is formed. A portion of this paste is to be applied upon the part 
until an eschar is formed. Part xxi., p. 24. 
Potassa cum Calce.—For cauterizing the uterus, employ cylinders of 
potassa cum calce, made with two parts of potassa to one of lime, fused 
together and run into iron molds. While this preparation is quite 
as powerful as pure potassa, it may be used with much greater ease 
and safety, as it does not deliquesce like the latter. Part xxi., p. 293. 
Chloride of Zinc.—To prevent this caustic from running, mix it with 
plaster of Paris, in proportions to suit the case in hand. 342 
CAUSTICS. 
Potassa Eusa.—To prevent this from deliquescing, mix two parts witn 
one part of lime. Cylinders of this may be made nearly as manageable as 
nitrate of silver. Part xxix.,p. 326. 
Nitric Acid and Sidphur as an Escliarotic.—The combination of nitric 
acid and sulphur, is much superior to nitric acid alone ; it gives less pain, 
acts longer, and produces more eschar. The strongest nitric acid must be 
mixed with sublimed sulphur until of a sufficient consistence to form a 
paste. When applied, it does not run like the chloride of zinc, etc.; but 
it will be best to protect the surrounding parts by plaster. 
Part xxxii., p. 194. 
Sulphate of Zinc.—This is one of our most powerful and manageable 
caustics. It may be employed in the form of a simple powder, dried or 
anhydrous, and finely levigated, or in the form of a paste made with 
glycerine, in the proportion of one drachm of glycerine to an ounce of the 
dried sulphate of zinc—in this form, it will keep for any length of time 
ready for use ; or an ointment may be formed by pounding together two 
drachms of axunge with an ounce of the dried sulphate of zinc. When 
applied in any of these forms to an open or ulcerated surface, the part to 
which it is applied is rapidly destroyed, and the slough usually separates 
on the fifth or sixth day: if any yellow or unhealthy tissue remains behind, 
it will require to be repeated immediately, until the whole morbid tissue 
is removed, and a red, granulating, healthy wound remains, which will 
rapidly heal under any common application. Sulphate of zinc, like chloride 
of zinc, will not act as a caustic when the epithelium is entire, so that when 
we wish to apply it to a non-ulcerated structure, we must first remove the 
epithelium by a blister or a paste made with sulphuric acid and the sul- 
phate of zinc: this will at the same time remove the epidermis, and also 
give the action of the mineral caustic. If this be too liquid, it may be pre- 
vented from spreading by inclosing the spot within a circle of oxide of zinc 
powder. The local suffering which it produces, generally disappears more 
rapidly than that produced by arsenic or the-cliloride of zinc, and it may 
always be relieved by the temporary use of ana3sthetics or opiates. The 
eschar from the sulphate of zinc separates sooner than after most other 
caustics. The eschar made by arsenious acid seldom separates before the 
sixteenth day, that made by the chloride of zinc usually separates by the 
tenth day, while that made by the sulphate of zinc separates as early as 
the fifth or sixth day. But besides the application of the sulphate of zinc 
to malignant growths, it may be used in many other cases where caustics 
are usually resorted to, and with equal success. The first of these which 
we will mention, is the indurated inflammatory ulcer of the cervix uteri: 
here it should be applied through a speculum, or in the form of a medicated 
pessary, made up with axunge or glycerine. It may also be used in cases 
of lupus (alternating with other caustics) in the annoying and intractable 
ulcerous forms of impetigo rodens, in eating down the small, red, sensitive 
tumors so common at the orifice of the female urethra, and also in destroy- 
ing ulcerated condylomata. Part xxxy.,p. 266. 
Permanganate of Potash.—This substance in solution possesses the 
property of removing all noxious and foetid odors, and in the solid form it 
possesses caustic properties. It may be used as a lotion, twenty grains to 
the pint, to ulcerated cancerous tumors, when it removes the foetid odor CIIAPS AND FISSURES. 
343 
and causes the place to assume a much more healthy character. In the 
solid form, it may be used to destroy cancerous masses. If a little of it, 
mixed with water, and spread over a plate, be placed in a sick chamber, 
all offensive odor will disappear. Part xxxvi., p. 261. 
Sulphuric Acid and Sulphate of Zinc as a Caustic.—The ordinary 
sulphate of zinc is to be dried in an oven or sand-bath, so that the water 
of crystallization is driven off, and a whitish powder remains. Enough 
of this is to be added to some strong sulphuric acid, in order to make a 
semi-fluid mass of consistence sufficient to prevent its running beyond the 
spot on which it is placed. The mixture should be kept in a stoppered 
bottle, and be applied with a small glass spatula or rod. Before using it, 
the surrounding parts should be protected by a thick layer of cerate or 
firm ointment, so as to form an embankment limiting the surface to be 
destroyed, and a layer of the caustic may be made upon this of about the 
eighth or tenth of an inch in thickness. This is allowed to remain. 
Part xxxvii., p. 265. 
CHAPS AND FISSURES. 
Pomade for Chaps and Fissures of the Toes.—One of the most annoying 
effects of secondary syphilis is the formation of fissures on the internal surface 
of the toes ; they are usually very painful, are surrounded with a red areola, 
and secrete a syphilitic matter. In a few cases, gangrene has been known to 
supervene, and destroy one toe after another. An ointment, containing 
litharge, white precipitate, and a few drops of laudanum, has been used 
with very marked success in such cases, in many of the hospitals of 
Germany. It is also much recommended in the serpiginous and phage- 
dienic ulcers, which occasionally supervene upon vaccination in children 
of a scrofulous or syphilitic constitution. The process of cicatrization is 
often promoted by bathing the sores, at the same time, with a decoction 
of hemlock and marsh mallows. Part ix., p. 192. 
Excoriations about the Anus and Scrotum.—For the itching excoria- 
tions about the anus and scrotum, which sometimes affect old men, Mr. 
Druitt has used a solution of pure tannin with benefit, as a local applica- 
tion, but prefers lemon-juice. Part x.,p. 139. 
Chapped Hands, Face or Nipples.—Apply a wash with glycerine and 
sixteen times the quantity of rose water, with a few grains of borax. 
Part xvi., p. 226. 
Use of Collodion.—Recommended by Mr. Erasmus Wilson as a local 
application for chaps, fissures, and various affections of the skin. 
Part xviii., p. 227. 
Anal Fissures.—The favorite ointment of St. Mark’s, for small fissures, 
irritation, etc., about the anus, consists of five grains of calomel to one 
drachm of elder-flower ointment. The ointment so warmly recommended 
by Copeland is made of the black oxide of mercury. Part xxxv., p. 115. 
Chaps and Excoriations.—An excellent application is a mixture of 
glycerine and tannin, equal parts by weight. The tannin readily dissolves 
in the glycerine. Part xxxvii., p. 239. 344 
CHARCOAL. 
Fissure of the Aims.— It is unnecessary to divide the entire sphincter, 
as several examples have lately occurred which have been effectually cured 
by the division of a few of the muscular fibres of the sphincter at the 
situation of the fissure. Part xl., p. 113. 
CHARCOAL. 
Charcoal.—This body should be perfectly dry before being used. If 
moist or wet, place it before the fire, and gradually dry it. By doing so 
it may be usecHover and over again. Charcoal has a most surprising 
power of rapidly absorbing sloughs. It hastens decomposition. In 
infectious diseases, bolsters and mattresses may be made of it. It com- 
pletely destroys smells of all kinds even when placed near their source. 
Part xxxi., p. 255. 
Charcoal as a Disinfectant.—As the most powerful disinfectant, it may 
be used in various ways. It should be perfectly dry. Heat it 
thoroughly in a covered crucible, with a small hole in its lid to allow any 
oxidized material which it may contain to escape, taking care not to have 
the hole sufficiently large to allow the charcoal to undergo combustion. 
When thoroughly heated allow it to cool. Next place it in shallow vessels 
where wanted to deodorize or disinfect. It will lose its power in a few 
days, and ought then to be heated again in the same way. 
Part xxxi., p. 258. 
Medicinal Properties of Charcoal.—As charcoal is not chemically 
affected by either acids or alkalies, and is quite insoluble, its admixture 
with other substances is not incompatible, so that it may be combined with 
any other kind of medicine, ad libitum. 
It is a powerful absorbent of fluids, whether aqueous or aeriform; and 
as it undergoes no change in the human stomach, it may with great truth 
be described as the only pure absorbent we possess, for the same cannot be 
said of either lime, magnesia, bismuth, or any other mineral absorbent, all 
of which form salts with the acids they meet with, sometimes to the com- 
plete subversion of all their original properties, while the vegetable or 
farinaceous absorbents, such as flour, starch, gum, etc., are changed by 
digestion, giving off frequently offensive gaseous emanations as the results 
of mal-assimilation. 
Pure charcoal is very useful in acute disorders of the mucous surfaces 
of the alimentary canal, and also of those of the uterine passages, and 
particularly in those instances where the secijptions are inordinate in 
quantity, or offensive in condition. 
It may, perhaps, induce a more extended trial of charcoal powders if a 
few instances were named in which the remedy has proved eminently 
serviceable. In the exquisitely-painful small ulcers within the mouth, on 
the inner surface of the lips or cheek, which, at irregular intervals, prevail 
to some extent, and are extremely troublesome, the following wash will be 
found an excellent remedy: 
R Pulv. carb. ligni pur. 5ij.; mel. roste §j.; decoct, cydoniae §iij.; aq. 
dest. |iv. M. Ft. lotio saepe adhibenda. CHILBLAINS. 
345 
The lotion is also useful in excessive ptyalism; it speedily moderates the 
discharge, and instantly corrects its fetor, and its application is extremely 
soothing and agreeable. The same may be said of it when used as a 
gargle in ulcerated sore throat, the sloughs separating rapidly and easily, 
leaving a healthy surface underneath. 
In the earlier stages of diarrhoea, a mixture composed somewhat as 
follows speedily gives relief: 
$ Pulv. carb. ligni pur. 5j. ad 9iv.; mucil. acacia) gij.; syr. aurantii, 
tr. cardam. co. aa. 5iv.; aq. dest. giij. M. Sumat 4 drachmas 3tia vel 4ta 
q.q. hora. 
In the bowel affections of children, accompanied with Avorms, powdered 
charcoal in doses of 10 to 15 grains, with one grain of ipecacuanha poAvder, 
and from 3 to 5 grains of rhubarb, taken at bed-time, acts like a charm, cor- 
recting disordered secretions Avith certainty and comfort, and promoting a 
healthy tone and action. In gastralgia and gastrodynia, charcoal powder, 
in doses of 30 or 40 grains, three times a day, in water, seldom Pails to give 
relief; and, in cases of severe tenesmus, accompanied by bloody or mucous 
stools, an injection into the loAver bowel of one drachm of charcoal poAvder 
in a small quantity of thin arroAA'-root or gruel has been found to give 
almost instant relief. Part xxxiii., p. 120. 
CHILBLAIN'S. 
Nitrate of Silver.—In cases of chilblains in which the tincture of cam- 
phor has failed to effect a cure, recommended to use a solution of nitrate of 
silver. The strength being varied from 10 grains to the ounce of water, 
to a saturated solution, according to effects. Part v., p. 44. 
Treatment of Chilblains.—According to Professor S. Cooper, exposure 
of a part to intense cold while in a state of perspiration is more likely to 
be followed by chilblains than its exposure to the same degree of cold 
when it is simply warm. Of itself cold cannot produce true chilblains. 
The treatment is pretty well understood, and generally agreed on. If 
you have them in the first and second degree of severity, you are to use 
friction, and rub well with camphor liniment, or the soap liniment, to every 
five parts of which you may add one part of the tincture of cantharides ; 
the liquor plumbi diacetatis, or a mixture of two parts of sp. vini camph. 
and one part of liquor plumbi diacet. Abroad, they immerse the parts in 
ice-cold water two or three times a day, rub them dry and cover them 
with a leathern sock; but this method is not universally applicable, and 
must not be used with patients disposed to phthisis or gout, nor with deli- 
cate females. I have already observed that the inflammation which accom- 
panies chiblains is rather languid, and, as they have not much power of 
reparation, they therefore require stimulants. Ulcerated chilblains should 
have stimulating dressings, as a solution of the nitrate of silver, Peruvian 
balsam, a mixture of liquor plumbi acetat. and liquor calcis, or a lotion of 
chloride of lime, which is recommended by Lisfranc; this may be applied 
by means of lint. Some practitioners are very partial to a poultice in the 
first instance, made of oatmeal with some port wine, and they think it is of 346 
CHLOROFORM. 
great benefit. The treatment of chilblains in a state of mortification is 
conducted upon the same principles as in other instances of gangrene. 
Part xvii,,p. 197. 
Treatment of Chilblains.—In the earliest stage, friction, either employed 
dry or with brandy or sp. camphor, is the simplest and best means; but 
when the parts have become red, swollen, shining, and even covered with 
phlyetenoe, but prior to ulceration, the formula recommended by M. Goflin 
may be used with the greatest advantage: camphor, 4 parts; ess. oil tur- 
pentine, 30 parts. When the practitioner is only consulted after ulcera- 
tion has for some time taken place, M. Devergier’s ointment is then the 
best application: lard, 1 oz.; liq. plumb, subac., 12 drops; thebaic extract, 
3 grains; creosote, 10 drops. Part xx.,p. 177. 
Use of Tincture of Capsicum for Chilblains.•—Rub the part well with 
a sponge or piece of flannel saturated with concentrated tincture of capsi- 
cum (capsic. bacc. §iv.; sp. vin. rect. §xij.,) until a strong tingling feeling 
is produced. Repeat the application daily. Part xxi., p. 263. 
Palms for Chilblains, Prohen.—Use the “ Baume Chiron de Lausanne,” 
which is made as follows : olive oil, 10 oz.; Venice turpentine, 2 oz.; yel- 
low wax, 1 oz.; boil together, strain, and add balsam of Peru 2£ drachms ; 
camphor, 91 gr.; stir constantly until cold. 
Unbroken.—Rub unbroken chilblains with the following balm night and 
morning: Rectified sp. turpentine 1 drachm, sulphuric acid 15 grains, olive 
oil 21 drachms; mix. Part xxvii.,ja. 161. 
Employment of Tannin and Tannic Acid.—Dr. Berthold draws atten- 
tion to the great efficacy of a very simple mode of treating chilblains, and 
preventing their relapse. Twelve drachms of bruised galls are boiled for 
a quarter of an hour in half a pint of water, and strained. The fluid is ap- 
plied to the parts two or three times daily for a quarter of an hour. The 
itching and burning diminish in two or three days, and ulcers heal in about 
a week. The same effect results from an infusion of oak bark, made with 
lb.j. of water lb.j. of bark, and standing twenty-four hours. The solution 
of half an ounce of tannic acid in half a pound of water may also be used. 
For preventing the occurrence of relapse, any of these may be employed 
once a day, or if the chilblains are not broken, tincture of galls may be 
used. Part xxxii., p. 286. 
Chilblains and Chaps.—Protect the parts from the air by an application 
composed of 30 parts of collodion, 12 parts of Venice turpentine, and 6 
parts of castor oil. Part xxxv.,p. 170. 
Ulcerated Chilblains—Use chlorate of potash lotion. Vide Art. 
“ Sores.” 
CHLOROFORM. 
Use of Chloroform and Ether.—Employ an inhaler; and do not let 
complete insensibility be produced in less than two or three minutes. 
Let the vapor be largely diluted with air for the first few inhalations ; CHLOROFORM. 
347 
and do not continue the inhalation one instant after the pupils, previously 
contracted, have begun to dilate, remembering the cumulative property 
which the vapor possesses. In neuralgia it is unnecessary to produce un- 
consciousness, if the pain previously disappears; in chorea, delirium tre- 
mens, etc., the state of sopor should be produced; while in hernia, disloca- 
tions, or tetanus, where complete muscular relaxation is desired, the inhal- 
ation must be continued till coma supervenes, but then discontinued as soon 
as the necessary effect is secured. 
Do not apply the handkerchief quite close to the face; and remember, 
that as soon as slowness of respiration or a degree of snoring is produced, 
it is only necessary to continue the inhalation at intervals, so as to keep 
up the sopor. In midwifery, a profound state of insensibility is not needed, 
except when we wish to turn, etc. The best way is to give a large dose 
at first, so as to get the woman fully under its influence, and then by with- 
drawing the handkerchief, diminish the sopor, till the head is passing the 
vulva, when a deeper anaesthesia is required. 
Do not exhibit chloroform Avhen there is any disease of the heart, aneu- 
rism of the great vessels, threatening dyspnoea, or tendency to engorgement 
of the lungs. 
Do not give chloroform in a state of extreme shock. 
When alarming symptoms arise from the use of chloroform, remove the 
handkerchief, or inhaler, and admit air freely to the face; do nothing 
else, except sprinkling cold water on the face, or otherwise trying to excite 
inspiratory acts; above all, do not try to make the patient swallow any- 
thing when in a state of insensibility. If further means are required, resort 
to artificial respiration. 
If respiration becomes suspended from the use of chloroform, we must 
establish artificial respiration, and, in some cases, abstract two or three 
ounces of blood from the jugular. 
Ether.—Ether is much preferable to chloroform for producing anaesthe- 
sia in children. 
Ether is more suitable than chloroform, in persons whose powers are 
much depressed, and in those cases in which we desire to prolong the 
insensibility for some time, or in which we wish to obtain muscular relax- 
ation. 
In extreme exhaustion from hemorrhage, ether is more applicable than 
chloroform. Part xvii., p. 305. 
Chloroform—Use of \ in Midwifery.—Do not give chloroform in natural 
labor, except in cases where the pain is unusually severe, or where a severe 
nervous pain is superadded to the ordinary pain of labor. And do not 
give it indiscriminately, even in obstetric operation: thus in cases of retained 
placenta from inertia, the uterus would be more likely to contract upon the 
introduction of the hand, if the patient were not under the influence of 
chloroform. 
Begin the administration of chlorofoi’m toward the end of the first stage 
of labor, when the os uteri is well dilated; except the pains are very severe, 
when it may be given earlier. Do not give such large doses as in surgical 
practice, except when operative proceedings are to be resorted to; in which 
case the anaesthetic state should be as deep as in surgical operations. 348 
CHLOKOFOKM. 
Do not give chloroform in natural labor, except when there is severe 
pain. Always, if possible, use an apparatus for its administration. Give a 
smaller dose than is given during surgical operations, except when it is 
wdshed to stop uterine action in order to turn the child. 
The use of chloroform relieves rigidity of the os uteri. 
Part xix., p. 338. 
Use of Chloroform in Midwifery.—Chloroform should be given in all 
turning, forceps and crotchet cases, but especially the first. When there 
is no organic disease present, there is little danger to be apprehended 
from giving it in any case of labor, especially when it is remembered that 
immunity from pain may be secured without giving the chloroform to such 
a degree as to take away reason or consciousness. Part xx., p. 238. 
Chloroform—A good sign of the production of insensibility is a kind of 
trismus which affects the elevator muscles of the jaw, so that the teeth are 
pretty firmly pressed together. Part xxi,,p. 364. 
Chloroform Ointment.—Some forms of neuralgia resist almost all the 
means used to subdue them, and anajsthetic agents may naturally be 
expected to be beneficial in such cases, both internally and externally. 
The “Journal dePharmacie” gives the following formula for a chloroform 
ointment: chloroform, sixty drops; hog’s lard, one ounce. Mix in a 
mortar, and use two or three frictions a day upon the painful spot. As 
this ointment turns yellow when exposed to the light, it should be placed 
in a colored, wide-necked and well-stoppered bottle. Part xxii., p. 85. 
Chloroform.—Never administer it to a patient with a full stomach. 
Take particular care the vapor is diluted with plenty of atmospheric air, 
and never proceed to stertorous respiration if it can be avoided. Operate 
as soon as the patient becomes insensible to sound, or the pupils dilate. 
Death from chloroform takes place in cousequence of the density of the ad- 
mixed with the heavy vapor of the chloroform being nearly equal to, or 
greater than that of the carbonic acid to be expelled from the blood. The 
nearer the two densities correspond, the less carbonic acid escapes from 
the blood, and the function of respiration no longer goes on. The specific 
gravity of carbonic acid is 1’523 ; the specific gravity of atmospheric air at 
60°, saturated with the vapor of chloroform, is 1’355, and is, therefore, 
perfectly respirable: but if we increase the temperature of the air to 70°, it 
will take a much larger quantity of the vapor, by which the specific gravity 
will be increased to 1-533. If this is neglected, danger will ensue. In 
restoring a patient from the influence of chloroform, galvanism is the only 
chance. A current of electricity must be kept up through the fifth nerve, 
medulla oblongata, phrenic nerves and diaphragm, as long as respiratory 
movements can be produced, and let the patient have plenty of fresh air or 
oxygen gas, and the case must do well, for the blood will remain fluid for 
a long time, and circulation will go on as long as respiration can be car- 
ried on artificially. Part xxv., p. 319. 
Chloroform—Test for.—When a few drops are rubbed between the 
palms of the hands, a fragrant odor is emitted, in no way pungent. If 
there is any pungent odor present, we may suspect its impurity. CHLOROFORM. 
349 
Topical use of Chloroform,—To obviate the volatile character of chlo- 
roform when employed topically, Dr. Rauch combines it with olive oil and 
some liquor ammonia), forming an emulsive liniment. This is less expen- 
sive, relieves sooner, and is not so volatile as chloroform. The ingredients 
were at first employed in equal parts; but were afterward used in other 
proportions, according as to whether a counter-irritant effect (when more 
ammonia and chloroform must be added) were desired or not. It is applied 
on a wollen cloth, so folded that the inner layer is saturated by the lini- 
ment, and the outer kept dry, so as to prevent evaporation. When first 
applied, it feels cool, then smarts and burns for ten minutes so as hardly to 
be borne; and then an agreeable coolness, with relief of pain, succeeds. 
When it causes too much irritation or vesication, it should be removed, or 
applied to another locality. The skin is made red by it, and often vesi- 
cated ; and if a mere rubefacient is required, it should be applied by fric- 
tion, or the cloth should remain on only for a short time. When a speedy 
vesicant effect is required, it is more useful than a sinapism or blister, and 
is easier of application, especially in children, who often fall asleep during 
its application. Dr. Rauch found it of great use, combined with other 
means, in cholera; and in relieving the painful affections of the abdomen 
in children, it is preferable to any anodyne. In the case of superficial 
burns, a compound of equal parts of chloroform, olive oil and lime water, 
has been found highly useful. Part xxv.,p. 328. 
Resuscitation from.—In a case of great danger from the inhalation of 
chloroform, after all other remedies had failed, galvanic shocks were 
passed over the chest and top of the spine, at the origin and insertion of 
the phrenic nerves, and continued during two or three minutes. This 
produced the happiest results. The tendency to relapse into insensibility 
after the use of galvanism, was prevented by dashing cold water occasion- 
ally in the face, together with the internal administration of the same fluid. 
Part 164. 
Local application of.—When applied to any painful part, the phial con- 
taining it should be inverted upon a handkerchief, so as to Avet a spot upon 
its centre. Having done this two or three times, it should be applied to 
the seat of pain, with moderate pressure, and without friction. Some 
redness and tingling in the parts are produced, but these soon disappear 
when the handkerchief is removed. To prevent evaporation or inspiration 
of the chloroform, the cloth should always be covered with another dry 
one. Part xxvi., p. 322. 
Mode of Administering.—Mi'. Le Gros Clai'k, assuming that sensation 
and volition are simultaneously suspended, gives his patient to understand, 
that when he ceases (after being commanded to do so) to make some 
voluntary effoi't, such as squeezing the hand of an assistant or raising his 
hand, the opei-ation will be commenced. This, he thinks, is the best plan 
of affording a sure and simple criterion of what is a sufficient dose of the 
anaesthetic. Part xxvi., p. 324. 
Asphyxia from Chloroform.—In using artificial respiration in asphyxia 
from chloroform, it is very important to notice that the tongue should be 
drawn forward to insure the free entrance of air to the dungs, as when the 
patient is laid on his back, the tongue is particularly liable to fall back 
and close the orifice of the glottis. 350 
CHLOKOFOKM. 
Artificial respiration, as recommended by M. Ricord, in cases where the 
fatal effects of this drug are manifesting themselves, cannot be too strongly 
insisted upon ; but it must be well done, and steadily persevered in. In a 
case mentioned by Mr. Lowe, full eight minutes elapsed before the success 
of the treatment was made certain. Part xxviii., p. 315. 
Chloroform—Artificial Pespiration after the use of.—In cases of poi- 
soning by chloroform, before having recourse to artificial respiration, draw 
forward the tongue. As soon as breathing ceases in these cases, the tongue 
falls back and closes the orifice of the glottis. Pull the tongue Avell out of 
the mouth, and pass a hook through the tip, so as to command it while 
artificial respiration is carried on. Part xxx.,p. 301. 
Chloroform.—This may be given in various diseases, and in larger doses • 
than has generally been done. For example: In painter"1 s colic, give half 
a drachm every two or three hours; increase this to a drachm, if necessary. 
In delirium tremens, give at first one drachm, increased to two drachms. 
Combined with opium, it may prove still more valuable, but don’t give it 
by inhalation. You may give large doses by the stomach, but not by 
inhalation, in these cases. In neuralgia, a liniment composed of equal 
parts of chloroform and olive oil will act most beneficially. 
Part xxxi., p. 260. 
Exhibition of Chloroform.—Don’t be guided by the circulation, but bv 
the respiration, in your exhibition of this remedy. Take a folded towel 
or handkerchief, presenting a pretty large surface, instead of a small bit of 
lint, or any other apparatus held to the nose, and don’t stint the quantity, 
but get the patient under its influence as rapidly as you can. The moment 
the breathing is stertorous, cease the administration. Attend also care- 
fully to the tongue, open the mouth if the respiration is difficult, seize the 
tip of the tongue with the artery forceps, and pull it well forward. Always 
give chloroform in the horizontal posture. Part xxxi., p. 262. 
Formida for the Internal Use of Chloroform.—M. Dannecy, pharma- 
cien, at Bordeaux, recommends the following formula: 
Pure chloroform, half a drachm; oil of sweet almonds, two drachms; 
gum arabic, one drachm; syrup of orange flowers, one ounce; distilled 
water, two ounces ; mix the chloroform with the oil, and make an ordinary 
oily draught. The author also gives a very ready mode of testing the 
purity of chloroform. Mix the latter with some oil; if the chloroform be 
quite pure, the limpidity of the oil will not be destroyed; whereas, any 
chemical impurity, however small, will give rise to a cloud. 
Part xxxii., p. 293. 
Simple Method of Preventing Accidents from Chloroform.—As a 
simple method of preventing accidents, it is recommended to give a glass 
of spirits previous to the administration of chloroform, to keep up the 
action of the heart and prevent sickness or sinking. In case an overdose 
should be given, an injection of brandy and water into the rectum will be 
valuable. Part xxxv., p. 2S7. 
Anti-Hemorrhagic Action of Chloroform during Operations.—The 
diminution of hemorrhage which it produces during operations, renders it 
of real service in cases where a great number of vessels are opened. In 
all cases in which chloroform has been given, it is advisable not to apply CHLOROFORM. 
351 
the dressings until some time after the operation, as the chances of 
hemorrhage when reaction takes place are much greater. 
Part xxxv., p. 288. 
Chloroform—State of the Pulse.—The finger of the practitioner should 
be kept constantly on the pulse from the moment when inhalation begins, 
and from this alone can the amount and duration of anaesthesia be regu- 
lated with perfect safety to the patient. Should spasm or rigidity of the 
muscles prevent the pulse being distinctly felt, the inhalation must be in- 
stantly stopped, until the spasm subside. Should the pulse become 
irregular or intermitting, which, however, is very rare, inhalation should 
be suspended. The volume of the pulse is no value as a guide; unless the 
pulse tails very much in quickness its volume is seldom much affected. 
The velocity of the pulse is lessened by chloroform, especially if long con- 
tinued and in large quantities. Double caution is necessary where much 
blood is lost during an operation : here also the pulse is the sole and 
unerring guide. Part xxxvi., p. 297. 
Ether and Chloroform Gelatinized.—Professor Rusponi has succeeded 
in turning ether and chloroform into gelatine, by shaking them with white 
of egg in a closed receiver. The compound obtained with the ether is 
semi-transparent; with the chloroform it is white and opaque. This gelatine 
is soluble in water, and may be spread on linen in the form of a poultice. 
It will likewise mix with morphine, cantharadine, conicine, etc., and may 
thus become of great therapeutical use. Part xxxvi., p. 299. 
Chloroform as a Narcotie.—Chloroform has lately been much em- 
ployed to procure sleep in those cases where opium is contra-indicated or 
tails to act. It is administered in doses of thirty or forty minims, suspended 
in a little acacia mixture, or some other mucilaginous fluid; and, given at 
night, generally succeeds in procuring for the patient two or three hours 
of tranquil sleep. In this way it has been used very successfully in cases 
of old bronchitis attended with profuse secretion ; and in hemicrania, or 
other painful nervous affections, where opiates have lost all power of 
alleviating the patient’s misery, the use of chloroform internally, in the 
doses above mentioned, has been attended with great and immediate relief, 
which allows the patient to obtain that repose of which he stands so much 
in need. 
Cautions in the Administration of Chloroform.—If the operation is a very- 
slight one, the minimum amount of anaesthesia necessary ought to be the 
practitioner’s study. If the operation will probably occupy some time, give the 
chloroform more slowly, but more thoroughly, that its effects may be more 
lasting. Although, as it is well known, chloroform should never be given 
on a full stomach, yet, if given after a prolonged fast, as of six or eight 
hours, alarming symptoms may supervene, from the exhausted state of the 
system. The use of Dr. Snow’s inhaler is preferable to that of only a 
sponge or a handkerchief, as the poisonous vapor is introduced less rapidly, 
and is mixed with air much more uniformly and certainly. The only fatal 
case which has occurred to the author was one in which there was a weak, 
flabby heart. Part xxxviii.,p. 254. 352 
CHLOROSIS. 
CHLOROSIS. 
The Lactate of Iron.—The authors adduce several cases of chlorosis 
and other states of the system which are usually relieved by steel medi- 
cines, in which the lactate wras administered with excellent effects: in some 
it succeeded after the usual ferruginous preparations had been fairly used 
without benefit. 
Several reasons have induced us to select the combination of the pro- 
toxide with the lactic acid: this acid is widely diffused through the 
economy ; there is, perhaps, not one part of the body which does not con- 
tain a notable quantity of it. Berzelius has detected it in muscle, in milk, 
and in all the secretions; the perspirable matter owes its acidity to its 
presence, and a considerable quantity is found in the urine. The solvent 
power of the gastric juice is perhaps mainly attributable to the presence 
of the lactic acid; the traces of the hydrochloric are, it is now generally 
admitted, very feeble. 
It must, therefore, be the lactate that is formed in the stomach, when 
any steel medicine is swallowed. 
It is easily prepared by treating iron filings with diluted lactic acid. 
The water is decomposed, hydrogen is evolved, and the oxygen combines 
with the iron. When the evolution of the gas ceases, the solution is 
filtered and then evaporated until a pellicle forms on the surface; the salt 
crystallizes on cooling. 
The lactate is not very soluble in water, and a high heat decomposes it. 
It is not readily affected by exposure to the air. 
It may be administered in the form of pastilles, drops or lozenges: the 
sugar which enters into the composition of these prevents the further 
oxydation of the salt. The dose is from four to fifteen grains. 
jPart ii., p. 77. 
Treatment of Chlorosis.—Dr. Ashwell remarks : 
Our first attention must be directed to the improvement of the state of 
the digestive organs, for, how shall we amend the deteriorated condition 
of the blood, until the organs of nutrition are in a fitting state for its 
elimination. But here a prudent hand must guide the means : our object 
is not to excite excessive purging, as a direct mode of cure, but to secure 
the due relief of the bowmls by aloes and rhubarb, sulphate of soda and 
manna, and, where alteratives are required, the hyd. c. creta. Mild 
cordials should be combined with the aperients. Warm clothing, regular 
exercise, and when the state of the appetite will permit, meat diet and 
mild malt drink, are to be recommended. If we succeed in improving the 
state of the digestive organs, the general vigor is in some degree restored, 
and the complexion partially cleared, but the catamenia are seldom by 
this alone induced. Xow is the appropriate period for the administration 
of iron, especially the sulphate, while, had this remedy been employed 
prior to the due regulation of the secretions of the alimentary canal, the 
symptoms would have become aggravated, and not relieved. Its effect, 
when given judiciously, is sometimes magical. In some cases the sub- 
carbonate is better borne, and occasionally other tonics, as quinine, 
sarsaparilla, zinc, etc., effect the purpose. 
As to emmenagogues, they are best employed when the pallor has be- 
come diminished, the bowels more regular, and the blood both more 353 
CHLOROSIS. 
abundant and of richer quality. Iron (and especially the iodide, when the 
strumous diathesis is associated with chlorosis) is often alone a sufficient 
emmenagogue. The use of the mustard hip-bath, and of the local salt 
shower-bath across the loins, are excellent adjuvants. The injection of the 
vagina with the strong ammonia (liq. ammon. 3j. lactis Ibj.) has proved 
useful in the hospital. Dr. A. has great doubts of the utility of applying 
leeches and cataplasms to the mammae; he has often seen electricity use- 
ful. Travelling, with the change of scene and of habits it necessitates, as 
also a visit to chalybeate waters, and a sea voyage, have often cured 
chlorosis. The treatment requires to be early adopted, and most perse- 
veringly continued, perhaps for months. As the cure progresses the diet 
should be improved, and the patient permitted to take mild ale or porter, 
or, if these are disagreeable, a little negus with her meals. 
Part iii., p. 40. 
Local Emmenagogues.—The author does not believe that there are any 
medicines which exert a specific effect upon the menstrual secretions, but 
that there are several, which, by reason of their stimulating the uterus, 
become important auxiliaries. These means are contra-indicated in 
amenorrhcea and chlorosis, arising from malformation or absence of the 
generative organs, as also in cases of mere absence or slow development 
of puberty, or when the amenorrhcea is connected with phthisis or plethora. 
They are found useful in inactivity of the uterus, occurring after the 
establishment of puberty, where neither plethora, or marked delicacy of 
constitution is present, as also in hysterical irritable women, in whose cases 
cordials and tonics have been tried in vain. In chronic suppression they 
are especially indicated. Their exhibition should be preceded by local 
depletion, regulated diet, and purgatives. 
The only powerful emmenagogue by which the uterus can be directly 
stimulated, is electricity. Although employed with some success of 
late at Guy’s, it is am uncertain remedy, and should be very cautiously 
used. 
Leeching the Os Eteri.—If some leeches be applied by means of a 
glass, a few days prior to the period, and repeated several times, by 
removing the congestion, they will frequently reproduce the secretion. 
Stimulant Injections of the Vagina.—Dr. Ashwell speaks highly in 
• favor of the ammoniacal injection. It should be commenced three days 
prior to the expected period, and should be retained in the vagina for ten 
or fifteen minutes, by closing the vulva with a napkin. It should produce 
a sense of heat, tingling, or even of pain, and should not be employed 
when congestion is present. He reprobates, as risking the excitement of 
peritonitis, the injection of the uterine cavity itself. 
Mustard Hip-Path is often very useful, but the patient should remain 
in it an hour each time. The exhibition of mustard by the mouth 
(gr. 8-12 ter quaterve ex M. camph.), just prior to the menstrual period, 
is often attended with excellent effect. Part 41. 
Secale Cornutum.—Dr. Fyfe recommends the ergot as an emmenagogue, 
combined with valerian, if nervousness predominate, and with Barbadoes 
aloes, where the alvinic system is torpid. Dose of the powder, from 
10 to 20 grains. Of the concentrated tincture, from half a drachm to a 
drachm. 
As it is a direct stimulant to the uterus, producing a wonderful increase 354 
CHLOROSIS. 
of muscular contraction during parturition, and probably a contraction of 
its tissues, even in the unimjwegnated state, it seems likely to be of great 
use in many diseases of the womb, resulting from a want of power, as well 
as for the purpose of expelling foreign bodies, such as polypi. We shall 
thus find it exceedingly useful in menorrhagia, when not combined with 
inordinate action of the general system'—in leucorrhoea when independent 
of inflammatory action—and also in chlorosis with amenorrhoea, and k. 
dysmenorrhoea ; bearing in mind that it directly stimulates or excites the 
organ, and is therefore inadmissible when the womb is already in a state 
of excitement or inflammation. There is no doubt of its good effects ir 
both menorrhagia and leucorrhoea when given with the preceding limita- 
tions, and Dr. Fyfe has also found it of value in cases of dysmenorrhoea, 
that troublesome affection which often baffles the effects of our most pow- 
erful remedies. In one case of this kind, where the pain amounted to 
torture, it appeared almost magical in its effects. Part iv.,p. 14. 
Pills of Proto-Iodide of Iron.—The following is the formula for the 
pilula3 proto-iodidi ferri: 
Take of Iodine 121 grains. 
Iron 242 
Distilled water 378 
Proceed with these to form a normal solution; filter, and pour the solu- 
tion into an untinned iron vessel; add Narbonne honey, 302 grains; 
evaporate rapidly, until a great part of the original water be dissipated, 
and a sirupy consistence shall be attained; then add at intervals, con- 
tinually agitating with an iron spatula, powder of gum tragacanth 184 
grains. Form amass, and divide it into 200 pills. Each pill will contain 
almost exactly three-quarters of a grain of proto-iodide of iron. These 
pills remain a long time unaltered. Dr. Dupasquier says that they may 
be used in place of the pills of Yallet or those of Blaud in the cur« of 
chlorosis. Part iv., p. 58. 
ClinJcers.—“Clinkers” is the refuse of the blacksmith’s forge, and 
differs from common ashes and coke in its greater specific gravity, com- 
ponent parts, and external appearance. As a medicine in cachetic dis- 
orders, particularly those of females, it has been used, and the success 
which attends its exhibition, particularly in chlorotic disorders, is such as 
to have won for it the title of “specific.” 
The following is the formula for its preparation: The bluest and heaviest 
clinker, being selected from the mass, is reduced to an impalpable powder 
(a work of no small difficulty, on account of its metalloid nature). Any 
quantity of this powder may be mixed, with a sufficiency of treacle, to form 
a stiff paste; and to every eight ounces of the mass, half an ounce of mag- 
nesia, and the like quantity of ginger, must be added. Thus formed, it is 
anything but inviting to the eye; but this can be remedied by using 
honey in lieu of treacle, and adding half a drachm of the peroxide of iron 
to the compound. It must be administered successive days and nights 
(twice a day), for three days; omitted for a like period, and so continued 
until the course which has been decided upon should be finished. The 
dose is a teaspoonful. Experience has demonstrated that constitutional 
irritation supervenes, unless some decided interval is allowed at stated 
periods during a course of this remedy. Part v., p. 57. 355 
CHLOROSIS. 
Treatment of Chlorosis.—In treating chlorosis, our first object should 
be to endeavor to get the viscera into a more healthy state of action, and 
this will be best done by mild aperients. The compounds of aloes, as the 
decoct, aloes comp.; pil. aloes comp.; pil. aloes c. myrrha; will all be 
found desirable remedies for this purpose; or a few grains of the blue-pill 
at bed-time, followed by a draught with the decoct, aloes comp., in the 
morning. 
Violent purging must be avoided. After the full evacuation of the 
bowels, any of the preparations of iron, as the ferri sulphas, ferri ammonias, 
ferri carbonas, the mist, ferri comp, ferri iodid., may be prescribed, as being 
valuable remedies in chlorosis. We have found the following formulae of 
great benefit: 
R Ferri sulphatis, gr. xxiv.; quinae disulphatis, gr. xij.; extr. genti- 
anse, qss. 
M. Ft. pilulae, xij.; cap. j. vel ij., ter die. Or: 
R Quinte disulphatis, gr. xij.; ferri sulphatis, gr. xxiv.; pulv. opii, gr. 
iij.; extr. gentian., qss. 
M. Ft. pilulae, xij.; cap j. vel ij., ter die. 
Dr. M. Ilall recommends, after the evacuation of the bowels, pills con- 
sisting of two grains of the Barbadoes aloes, and the same quantity of the 
sulphate of iron, taken daily during dinner, as most efficacious; indeed, he 
has found them almost specific. Dr. Copland recommends the following 
should be taken either during or after dinner : 
R Aloes, socot, ferri sulphatis, aa. gr. ij.; gum mastic., gr. j.; pulv. 
capsici, gr. ij.; syr. simpl., vel olei caryoph., q. s. 
M. Ft. piluloe duae. Or: 
$ Aloes, 5ij-; assafoetidae, myrrhae, aa. 5ss.; ferri sulphatis, 5j.; 
caryophyllorum in pulv., 9j.; pulv. capsici, gr. xxvi.; balsam, canad., q. s. 
M. Ft. pil. lxvi.; quarum capiat i. vel ij. pro dose. 
In addition to the above remedies, warm clothing, regular exercise in 
the open air, particularly on horseback, nutritious diet with a moderate 
quantity of wine, must be enforced. Patients suffering under this disease, 
and residing in large cities, will often more rapidly recover by removal to 
a country residence, or a visit to the sea-coast. Sea-bathing, when a suf- 
ficient reaction to the skin follows, will be also serviceable. The above 
means are often sufficient to remedy the disease. In the more protracted 
cases, attended with difficult or scanty menstruation, Dr. Copland recom- 
mends the tinct. ferri ammoniati, or the tinct. guaiaci ammoniati, and 
phosphate of iron, in preference to the sulphate of iron. The decoct, 
aloes comp, as the most suitable aperient. The ammoniacal injection, com- 
posed of one drachm of the pure liquor ammonite, to a pint of milk, and 
injected daily into the vagina, is sometimes useful in promoting the cata- 
menial secretion. Part 77. 
Various Modes of Treatment.—The treatment of this affection, with 
scarcely an exception, consisted in the administration of the sesquioxyde 
of iron, in doses from half a drachm to a drachm, twice or three times a 
day, with or without an equal quantity of the compound spirits of ammonia. 
The bowels were regulated by aloetic aperients, conjoined with the sul- 
phate of iron, and occasionally with calomel. Gastric and head symptoms 
were relieved by an emetic, and local pains by warm plasters, opiate and 
irritant embrocations, mustard poultice, or <? blister. The diet was dry 356 
CHLOROSIS, 
and nutritious, and everything done to invigorate the general health. One 
great practical difficulty is to secure regularity and perseverance in taking 
the medicine, and the bulk of the sesquioxide forms the principal objection 
to its use. 
It may not be unprofitable to glance briefly at some other preparations 
of steel which experience has sanctioned. The muriated tincture is a 
cheap, convenient, and efficient form, in doses from twenty to sixty drops 
twice or thrice daily, given in water, infusion of ginger, or quassia. 
Dr. McDivitt, in his report of the Kent and Canterbury Hospital, is 
very partial to the following draught: 
R Muriated tincture of iron, half a drachm; tincture of hyosciamus, 
one drachm; tincture of aloes, half a drachm or a drachm ; infusion of 
quassia, ten drachms. Mix. Three times a day. 
The acid solution of the oxysulphate of iron is a still more agreeable 
form, and has been extensively used by the practitioners of Derbyshire 
and the nortlr of England, and admits of convenient combination with the 
sulphates of magnesia and soda. 
Mr. Dyson gives the following formula: 
R Sulphate of iron, two or three drachms; nitric acid, three drachms; 
distilled water, one ounce and a half. Mix. 
Rub the acid and salt together in a glass mortar for a quarter of an 
hour, then add the water gradually, and strain through paper; of this the 
dose is from five to twelve drops twice a day. 
The persesquinitrate of iron is an elegant form, and, like the muriate, 
and probably also the preceding, is well adapted for cases where the 
bowels are irritable, and other chronic mucous discharges are present. It 
is particularly recommended by Drs. Graves, Ivopp, and Adam, under 
these circumstances. 
The “ aqua chalybeata” of Messrs. Bewly and Evans, Dublin, contains 
thirteen grains of the citrate to the pint, dissolved in water highly charged 
with carbonic acid and flavored with orange peel. It is highly recom- 
mended as a most grateful and refreshing chalybeate. 
The acetate of iron of the Dublin Pharmacopoeia, made by digesting for 
three days one part of the carbonate of iron in six of acetic acid, is a fa- 
vorite preparation with many practitioners in Ireland. Dr. Percival, who 
was much attached to it, used to prescribe it in asses’ milk. 
Dr. Lane, in his compendium of Materia Medica, insists on the value 
of giving alkalies with steel. The following powder, he says, will secure 
all the good effects of a chalybeate, and more certainly than in large quan- 
tities when uncombined: 
R Sesquioxide of iron, five to ten grains ; sesquicarbonate of ammonia, 
two to three grains; sesquicarbonate of soda, ten grains. Mix. 
Dr. Ashwell has, in a “ variety of cases,” where the sulphate and other 
preparations of iron disagreed, given the subjoined powder, once or twice 
a day, with success : 
R Blue sulphate of iron, in fine powder, half an ounce; calcined 
magnesia, two scruples; water, six ounces; tincture of quassia, two 
drachms. Divide into six draughts, one to be given night and morning. 
The ferri carbonas saccharatum of the Edinburgh College (“ Christison’s 
Dispensatory,” p. 425) is a powerful and excellent medicine. Dr. Clarke 
found it to surpass greatly the sesquioxide in energy. The close is also 
smaller ; from five to thirty grains. CHLOEOSIS. 
357 
The “ ferri iodidi sirupus ” is deserving of adoption both as regards 
accuracy and elegance of prescription. A saccharine iodide, obtained by 
drying up the sirup, Dr. Christison considers should replace the present 
preparation. 
We are indebted to the same source for an improved formula of the 
celebrated JEthiops martial, under the name of “ ferri oxydum nigrum,” 
which has not yet been subjected to a practical trial. 
It is also probable that the anhydrous sesquioxyde of iron, recom- 
mended as an antidote against arsenic, would prove a very excellent 
chalybeate. 
There is much evidence in favor of the following pills, which are similar 
to Bland’s antineurotic pills, forty-eight of which were considered sufficient 
for the cure of a chlorotic patient: 
R Powder of tragacanth, six grains; mucilage of acacia, seven drops. 
Mix, and add powdered sulphate of iron, a drachm and a half; rub well 
together, and then add a drachm and a half of subcarbonate of potash. 
To be made into twenty pills. One to be taken night and morning. 
Part viii., p. 30. 
Inspissated Pile.—The following is suggested in cases of chlorosis 
attended with defective biliary secretion : 
R Two or three grains of the inspissated bile of swine; one grain of 
ipecac, and two grains of carbonate of potass. Form a pill. 
Part viii., p. 71. 
Saffron.—In several cases of obstinate chlorosis that had not yielded to 
preparations of iron, in one case of puerperal fever in which digitalis and 
bleeding had failed, and in two cases of chronic artero-phlebitis, Dr. Mor- 
gante, of Verona, reports that he has employed saffron with the greatest 
success, commencing with doses in the form of pills, amounting to sixteen 
grains in the twenty-four hours, increasing the doses until the quantity is 
doubled. As to the manner in which this medicine acts—it is reported 
to be particularly effective in cases of increased action of the capillary ves- 
sels, and analogous in its effects to the more active preparations of iron. 
Part viii., p. 77. 
Treatment of Chlorosis.—[Dr. Ashwell recommends iodide of iron in 
cases of chlorosis, attended with strumous habit of body. The form in 
which he employs this remedy is the following:] 
R Ferri iodidi, gr. xvj.; tinct. calumbas vel gent. co. §j.; aquae destil- 
latse, §vij. ft. mist.; sumat cochl. ij. magna bis terve quotidie. 
The supposed frequency of affection of the os and cervix uteri in con- 
nexion with the leucorrlioeal discharges, which has been regarded as fur- 
nishing one of the most valid reasons for a far more general use of the 
speculum than is accordant with English feelings, is regarded by Dr. Ash- 
well as a mistaken notion. The cervix uteri indeed is occasionally soft, 
and the os patulous, or, at least, these tissues are all found to be relaxed, 
in several instances in which he used the speculum, the cervix was pale; 
in more acute cases slightly red; twice he found it of a deep crimson hue; 
but he never observed either erosion or ulceration, except when there was 
suspicion of venereal taint. Part xi., p. 228. 
Treatment of Chlorosis.— Vide Art. “Anaemia.” 358 
CHLOROSIS. 
Chlorosis.—There are cases of chlorosis marked by an increase rather 
than a diminution of the total amount of blood ; it is not a necessary con- 
dition, but it is more certainly and frequently a change in its quality. It 
is identical with anaemia. 
When there is increase of blood, blood-letting, leeches, or cupping are 
recommended. 
When pain on pressure in some region of the spinal cord, cup or apply 
leeches, or repeated blisters on either side of the spine. Moderate pustu- 
lation; use anodynes sparingly and cautiously, and this may apply also to 
the use of aconite or cannabis indica. The local application of these ano- 
dynes may be tried with much advantage, by means of soaked lint, either 
with or without the removal of the cuticle. Sulphate of veratrine £)j. to 
|j. of axunge is very efficacious. Where the pains are very obstinate and 
sever % firing lightly applied may be tried. 
Where there is great disturbance of the digestive functions, give warm 
cordial cathartics; one or twyo drops of creosote in pill thrice daily, alone, 
or with compound galbanum pill; finely pow'dered charcoal (of which that 
from boxwrood is the best); or the following: Fine charcoal, calcined 
magnesia, aa. gr. x., powdered nutmeg, five grs. Mix. This, mixed cau- 
tiously with, and taken in, milk and v'ater, two or three times a-day. 
The essential treatment, as it has special regard to the normal character 
of the red particles of the blood, must consist in the administration of iron 
(if no contra-indicating conditions). If idosyncrasy prove a constitution 
intolerant of iron, then make trial of bismuth, either alone, or in combina- 
tion with carbonate of ammonia, and the salts of Peruvian bark. If iron 
can be tolerated, then the muriated tincture; the acetated tincture of 
Dr. Percival, of Dublin ; vinum ferri; or Bewley’s solution of the super- 
carbonate ; mist, ferri comp.; bark, iron, and ammonia; citrate of iron 
and quinine; comp, ferri pil. with sulpli. of quinine; and the saccha- 
rine proto-carbonate. 
When a mild aperient is necessary during the use of iron, the following 
is recommended: Sodae bicarb, gr. xv.; acid, tartaric., gr. x.; sulph. ferri 
(siccat.) gr. j. ad gr. v.; sacchari albi, 5ss. to be kept dry, dissolved in a 
wine-glassful of water, and swallowed whilst effervescing. 
Dr. Freke recommends the hydro-sulphuret of ammonia to diminish the 
number of red corpuscles in the blood, on the supposition that it appro- 
priates a portion of that iron which would otherwise contribute to the for 
mation of the red globules. Part xiv., p. 310. 
Tannate of Iron in the Treatment of Chlorosis.—This substance, ac- 
cording to M. Benedetti, excels all other medicines in the treatment of 
chlorosis. In evidence of this, he cites cases from his own and from the 
practice of Majocchi, affirming that the treatment by the tannate of iron 
is successful in from twrelve to twenty-five days, according to the severity 
of the case. It is to be administered in doses of from eight to thirty 
grains in the day. It acts more rapidly in persons of sanguine tempera- 
ment. Part xiv., p. 315. 
Chlorosis.—Salts of manganese are recommended, especially in those 
cases which are not much benefited by iron. The sulphate, carbonate, or 
phosphate of manganese may be given in the form of pill, to the extent 
of three or four grains daily; or the phosphate or iodide may be given in 
sirup. Part xx., p. 35. 359 
CHOLEEA. 
Chlorosis.—Wheaton bread is said to be rendered much more nutritive 
for chlorotic patients, by adding a small quantity of sulphate of iron. 
Part xxiii., p. 304. 
Chlorosis.—In those tedious cases where a girl eats heartily, takes plenty 
of sleep and exercise, has nothing on her mind, yet derives but little benefit 
from good food and judicious treatment, Professor Recamier recom- 
mends his galvanic poultices; one of the disks being applied to the epi- 
gastric region, the other to the spine. Part xxiv., p. 348. 
Sulphate of Nickel—Use of in Chlorotic Headache.— Vide Art. 
“ Headache.” 
Deficient Menstruation commonly termed Chlorosis.—Dr. Oke ob- 
serves : In ordinary cases one of the following pills (a) is to be taken 
every other night, and two of the pills (b) three times a day : 
(a) R Hydrargyri chloridi, gr. xij; piluke aloes cum myrrha, gr. 
xlviij ; sirupi, q. s. Misce et divide in pilulas xij. 
(b) R Pilulae ferri comp, yiij. Divide in pil. xxxvj. 
If there be diarrhoea, the pills (c) are to be taken instead, leaving out, 
of course, the aperient: 
(c) R Pilulse ferri comp. 3iij.; pulveris opii gr. iv.; sirupi, q. s. Misce 
et divide in pilulas xxxvj. quarum capiat duas ter die. 
It constantly happens that an individual cannot swallow medicine in the 
form of pills, in which case (d) may be prescribed with equal success. 
(cl) R Misturse ferri comp. gviij.; dscocti aloes comp. giv. Misce. 
Capiat giss. ter quotidie. 
If necessary, the bowels may be regulated by the powder (e) taken in 
jelly : 
(e) R Hydrargyri chloridi gr. j.; aloes socot. pulv. gr. iij.; pulv. 
cinnamomi comp. gr. ij. Misce. Fiat pulvis noctibus alternis sumendus. 
This treatment will bring about convalescence in six weeks or two 
months, without any change of locality. Part xxviii., p. 286. 
Chlorosis—Vide Selections from Favorite Prescriptions, Art. “Medi- 
cines.” 
CHOLERA. 
Enema of Nitrate of Silver.—Recommended in cholera. 
Part i., p. 15. 
Tincture of Indian Hemp.—Recommended in cholera, in doses of ten 
drops, every half hour, to check vomitting and purging, and restore 
warmth to the surface. Part ii., p. 31. 
Diacetate of Lead.—Case of Asiatic cholera cited, in which the patient 
recovered, under the administration of one grain of diacetate of lead 
dissolved in a teaspoonful of acidulated water, repeated every ten minutes. 
Part v., p. 15. 
Ipecacuanha in Emetic Doses, a Restorative in cases of Sinking, etc. 
—Mr. Higginbottom first witnessed the good effects of ipecacuanha 360 
CHOLERA. 
as an emetic in a woman sinking in the last stage of cholera. Having lost 
two patients in a similar condition to whom he had given opium and 
brandy, he was induced to try Bj. of ipecacuanha as a last resource, from 
having seen it of benefit in the early stages. Two or three hours after, 
when he again saw her, the warmth of the body was restored, the 
dangerous symptoms had disappeared, and she was soon convalescent. 
Part xii., p. 135. 
Cholera (Asiatic).—Three objects, according to Mr. Clark, are to be 
observed in its treatment, viz.: 1. To moderate the morbid action estab- 
lished for expelling the poison, by replenishing the fluids. Give the patient 
a fluid for drink, consisting, as nearly as possible, of similar elements to 
the serum, as albumen, muriate of soda, and carbonate of soda in a very 
dilute state; give also effervescing salines. 2. To prevent local engorge- 
ments, particularly of the liver and vena portae. Remove a quantity of 
blood proportionable to the exigency of the case, and the organ congested. 
3. To promote healthy secretion, and allay pain, irritation, and spasm. 
Give calomel and Dover’s powder freely, until the vomiting and purging 
are restrained. Part xiv., p. 83. 
Treatment of Cholera.—On first visiting a patient in this disease Dr. 
Ollapod, of Madras, gives calomel, ten grains; rhubarb, ten grains; com- 
pound powder of aloes, ten grains; mixed and formed into a bolus. This, 
he says, I folloAv up with ten or fifteen minims of liquor ammonia, mixed in 
a little cold water, and I repeat this dose in half an hour, if rejected; 
otherwise, I give a second, and even a third dose. To quell the stomach’s 
irritability, effervescing draughts of carbonate of soda and tartaric acid, 
in small and repeated doses, are given, and soda water is prescribed to 
allay the intolerable thirst. The liquor ammonise, I at the same time use 
undiluted, externally, over the chest, abdomen, and upper and lower 
extremities, as a rubefacient, while I pay attention to the head by cold 
applications of water or vinegar and water. 
The after-treatment is simple enough—namely, the exhibiting a laxative 
after the second or third day, and tonics for a week afterward. Opium in 
any shape, given in cholera—too universally resorted to—I have remarked, 
tends to embarrass the cerebral functions, causing pervigilation, and, by 
consequence, commotion of the vis vita.” Part xiv., p. 86. 
Prophylactic and General Treatment of Cholera.—Prophylactics : live 
regularly, avoid fatigue and exposure, use flannel clothing, and take 
quinine and tonics. 
Treatment.—Encourage vomiting by warm diluents; keep the body 
enveloped in flannel, especially the abdomen and loins. Rub the epigas- 
trium well with liq. lyttse, and then apply a blister, which is the most 
important part of the treatment. Give effervescing draughts for the 
thirst. If the dyspnoea is urgent, bleed or apply leeches to the chest; 
and if it then continue, apply the liq. lyttoo and the blister. 
Part xv., p. 113. 
Vomiting of Cholera—Asiatic.—For the vomiting give a scruple of 
epsorn salts, with five grains of magnesia, and two or three drops cf lauda- 
num, in a tablespoonful of water, every three or four hours or oftener. 
Bismuth has been used with good effect to relieve the spasms. Vide Art. 
“ Vomiting.” Part xvi., p. 151, CHOLEKA. 
361 
Treatment of Cholera.—Dr. Massy says: If the disease commences 
like common bilious cholera, give acetate of lead and opium, or chalk 
mixture with opium and aromatic confection; give effervescing draughts 
with laudanum to allay the vomiting, keep the patient warm in bed, and 
the next day give a large emollient injection. But if the more severe 
and characteristic symptoms come on, or if there is great debility from 
the first, and cramps or coldness of the skin are observed, bleed largely, if 
the pulse will allow, and give a scruple of calomel with a grain of opium; 
after twenty minutes, give ten grains of calomel and half a grain of opium. 
When the calomel has acted well on the bowels, and large quantities of 
bile have been passed by stool, opium alone may be given, but not till 
then. If the disease is very far advanced when the patient is first seen, 
or if the attack has consisted in sudden collapse, almost without cramps, 
vomiting, or purging, apply stimulant liniments, sinapisms, etc., to the 
legs and stomach, rub hot turpentine along the spine, or apply a blister to 
the nape ; give turpentine injections or mustard emetics, and bleed; giv- 
ing also internal stimulants, punch, brandy, or carbonate of ammonia. 
Part xvii., p. 108. 
Dr. King’s advice is, use neither internal nor external stimulants, nor 
artificial heat; but give calomel, and let the patient drink cold water. The 
first appearance of bile in the ejections from the stomach and bowels, is 
evidence of recovery. Part xvii.,p. 111. 
Dr. Turnbull directs the patient to be rubbed well with a preparation 
of capsicum, over the abdomen, heart, and calves of the legs, several 
times a day, or at any time when there is coldness of the surface, or 
spasm; continuing the rubbing each time, till the patient feels the heat 
intolerable. The advantage of capsicum is that it does not blister. 
Part xvii., p. 112. 
Asiatic Cholera—Treatment of the Precursory Diarrhoea.—Do not 
instantly check the diarrhoea, as it is probable that the poison is passing 
off by the intestines. But moderate the irritation by gentle opiates; act 
upon the skin and kidneys ; give plenty of demulcent drinks, and free 
pure air ; take care not to irritate the gastro-intestinal mucous mem- 
brane ; and as an antidote to the poison in the blood, give a few doses of 
quinine, or the vegetable acids. Perhaps the best formula would be, a 
grain or two of amorphous quinine with two or three grains of tartaric 
acid and a few minims of laudanum, every six hours. (Dr. Lacock.) 
If the diarrhoea is without pain, give from four to eight drops of naphtha; 
not the naphtha of the shops, or acetone, nor the petroleum or Barbadoes 
tar, but a pure white or rose-colored naphtha (not distilled), which is pro- 
cured, it is supposed, on the borders of the Caspian. It should be given in 
brandy, white wine, or mint tea, taken cold. A single dose is usually suf- 
ficient, but it may require repetition in two or three days. If, however, 
pain accompanies the diarrhoea, treat the case simply with opium. 
If the attack begins with nausea, give a gentle emetic, as pulv. ipecac, 
yij.; but if there is only relaxation and uneasiness of the bowels, give four 362 
CIIOLEKA. 
grains of calomel and two of extract of opium followed in two hours by a 
dose of castor oil. And in about two hours after this, give two table- 
spoonfuls of the following mixture every two, three, or four hours: 
$ Ammon, sesquicarb., Bj.; sodoe sesquicarb. 3j.; conf. aromat. 5j.; tinct. 
capsici raxxx.; liq. opii sedat. mxxx. ; mist, eamph. ad §vj.; misce. And 
give three grains of hydr. creta. and three of powdered capsicum every 
four hours ; always taking care not to carry the mercurial too far. 
Treatment of the fully-formed Disease—Calomel.—Give calomel in one 
or two grain doses with one or two drops of laudanum every five or ten 
minutes for several successive hours, with an occasional omission of the 
laudanum at intervals. An immense quantity of calomel may thus be 
taken with the most beneficial effects, and without ptyalism resulting. 
No auxiliary means are required, beyond supporting the strength of the 
patient, and applying friction for the cramps. (Dr. J. Avre.) 
Nothing can be trusted but calomel, when once the stools have assumed 
the rice-water character; therefore live grains are to be given every four 
hours until a large bilious evacuation is produced. But it is necessary, in 
the meantime, to restrain the discharge from the bowels, and the best 
remedy that can be used for this purpose, is the compound sulphate enema, 
composed of sulphate of copper, sulphate of zinc, and alum, a scruple of 
each dissolved in two ounces of cold water. A wineglassful of this solu- 
tion is to be thrown into the rectum, and the patient instructed to retain 
it as long as possible: it will probably be returned almost immediately, 
accompanied by a large discharge of watery fluid. Another wineglassful 
is to be instantly thrown up : and if this comes away accompanied by a 
watery discharge, the enema is to be again repeated, until it either returns 
without any addition, or is retained. Two or three enemata are usually 
sufficient to check the discharge; they generally occasion considerable 
tenesmus, which may be relieved when the patient is freed from the 
graver symptoms, by an enema of starch and laudanum. If the watery 
discharge should return, the sulphate enemata are to be again immediately 
resorted to. If there is discharge of pure blood, or bloody fluid, solution 
of alum must be injected. Each injection should consist of three drachms 
of alum dissolved in half a pint of cold water; and as fast as one injection 
comes away, another must be instantly given, so long as there is any 
appearance of blood. (Dr. C. Patterson.) 
Give a pill composed of acetate of lead and opium ($ Plumbi acet. 
Bj.; opii gr. j.; pulv. glycyrrhiz. gr. vj.; mucil. acacise q. s. M. ft. pil. xij.) 
every half hour, till the rice-water diarrhoea begins to diminish, when the 
intervals between each pill may be gradually prolonged. (Dr. Graves.) 
Give two grains of acetate of lead and a lialf a grain of opium, every 
hour or two for a few times. Apply mustard poultices, hot bottles, and 
frictions of warm turpentine. And give mustard emetics every hour or 
two, with a view to bring on reaction. 
Give oil of turpentine, which is almost a specific in passive hemor- 
rhages, and which will exercise a similar power over the serous effusion 
from the mucous membrane of the bowels. CIIOLFEA. 
363 
Give one-eighteenth part of a grain of strychnine, made into a pill with 
conserve of roses, every quarter of an hour, and let it be washed down 
with copious draughts of cold water. The first three or four pills will 
probably be rejected. 
The most important remedies are copious diluents, which relieve, in the 
gentlest manner, the irritation of the stomach and bowels; and of these, 
the common effervescing draughts seemed to answer the purpose admir- 
ably, and are extremely grateful. They should be taken ad libitum, as 
the thirst prompts. Treat the cramps in the legs by applying hot fomen- 
tations to the loins and stomach. As to other remedies, bleeding alone 
will not cure the disease, and if the diluent system is resorted to early, 
bleeding will be unnecessary; but in some neglected cases may require 
the abstraction of blood, which must always be accompanied by the free 
exhibition of diluents. 
Dissolve five grains of tartarized antimony in half a pint of camphor 
mixture, and give an ounce every two hours; and urge the patient to 
drink freely of toast water. As soon as vomiting begins, encourage 
it with the toast water; and keep the patient drinking and vomiting 
until the stomach becomes tolerant both of the antimony and the fluid, 
when the quantity of the toast water drank may be diminished. When 
cramps attack the abdomen, apply sinapisms. As soon as a bilious stool, 
or similar favorable sign occurs, omit the medicine, apply warmth to the 
feet, and give a little arrow-root flavored or not with brandy. The 
patient will usually fall into a quiet sleep, and the next morning a little 
castor-oil may be given. (Dr. Hall.) 
Give about six drops of chloroform, with about forty of oil of tur- 
pentine, in a little brandy and water ; apply sinapisms; and allow the 
patient to drink freely of water. In half an hour after the chloroform, 
give five grains of calomel, and ten of ox-gall, made into pills. Ilepeat 
the draught and pills in an hour or two if necessary. 
Employ the warm bath, and use vigorous frictions of all parts of the 
body. And give from fifteen to twenty drops of naphtha, and if it is 
vomited, repeat the dose; a second is rarely required if the first be re- 
tained. The naphtha is not the ordinary naphtha of the shops, nor yet the 
petroleum, or Barbadoes tar ; but a pure Avhite or rose-colored fluid, not 
distilled, but found native, it is supposed, on the borders of the Caspian. 
Give petroleum (petroleum Barbadense), or pure hydrocarbon, in the 
following form : Take the yolk of an egg, and mix intimately with it a 
tablespoonful of petroleum ; add forty drops of aromatic spirit of ammo- 
nia, and equal quantities of brandy and water to fill a wine-glass; and 
this dose may be repeated according to the emergency of the case. 
Give naphthaline in one or two grain doses, in the form of pill, along 
with opium or aromatic confection. The cases in which this remedy i 
applicable, are chiefly those in which great flatulence and a tympanitic 
state of the bowel exists. (Dr. Atkinson.) 364 
CHOLERA, 
When a case is verging into the stage of collapse, it is proposed to 
take from a vein as much blood as can reasonably be abstracted, and 
then to transfuse warm blood from a healthy subject, and to keep up 
respiration with a mixture of equal parts of oxygen and atmospheric 
air, by means of a modification of the mouthpiece of Sibson’s chloro- 
form inhaler. 
Camphor and laudanum in small doses, antiseptic fumigations, and stimu- 
lating frictions, are recommended. 
Hot air and vapor baths are recommended. 
Dr. Wood says: “I have been in the habit of recommending a cheap 
and easy mode of applying the vapor bath, for many years, by placing a 
hot brick in a tub of water, the patient being enveloped in a flannel gown 
or blankets round it, of course the head external. I have found this con- 
venient, expeditious, and of great comfort to both rich and poor. At the 
same time, I beg to observe, that I think medical men lose sight, in many 
cases of debilitated patients, of the great advantage of the vapor bath over 
the hot bath, the latter sometimes losing its beneficial effects by the patient 
being exposed to its influence too long.” 
Dr. It. Chambers suggests a spirit-lamp incased in a double cylinder of 
wire gauze, and inclosed in a light wooden framework. 
“ About one ounce and a half of rectified spirit will keep it in action for 
an hour. When desirable, the vapor of camphor may be conjoined with 
it, by placing about two drachms of camphor upon the top of the gauze- 
cylinder, the heat of which volatizes it. 
“ For application it only requires to be trimmed as an ordinary spirit- 
lamp, and when ignited, to be placed between the patient’s lower extremi- 
ties, an extra blanket being placed upon the ordinary bed-clothes. From 
fifteen to thirty minutes will be sufficient for a single application, and so 
powerful is it, that I have known the perspiration to drop through the 
bed.” Part xviii., p. 305-336, 
Asiatic Cholera.—On the first appearance of premonitory symptoms, 
give a Seidlitz powder, or if the patient has a sense of sinking, without 
diarrhoea, add three drachms of Epsom salts to the Seidlitz; and, when it 
begins to act, let the patient drink freely of thin beef-tea, well salted. If 
there is vomiting, apply a sinapism to the epigastrium; if intense thirst, 
allow Seltzer, soda or plain water, ad libitum. (Dr. Stevens.) 
When the purging is not restrainable by opium, kino and chalk, in full 
doses, give a pill containing a grain of nitrate of silver, and a quarter of a 
grain of opium, every hour, to the extent of five or six doses, or even 
more, if necessary. (Dr. Ross.) 
Give opium fearlessly, but judiciously, unless collapse is approaching, 
when it must not be given. To children give the following: ext. hema- 
tox., Dij.; vin. ipec., 3j.; vin.opii, mxx.; aq. cinnam. §iv. Of this, give 5j., 
after eveiy motion, to a child six months old ; 5ij. to a child one year; 
and gss. to one of two years. Feed the child on milk mixed with a little 
lime water, keep it in bed and cover the abdomen with hot linseed-meal 
poultices. (Adopted at Guy’s Hospital.) CHOLERA. 
365 
Nitro-hydrochloric acid has been found useful, when the stomach would 
bear nothing else. (Adopted at St. Thomas Hospital.) 
Give the following draught every hour or every two hours: Strong 
nitric acid, two and a half to eight minims; tincture of opium, four to 
eight minims; syrup of saffron, a drachm ; water, an ounce and a half. 
Give two table-spoonfuls of the following mixture every two hours, and 
no astringents whatever: R Creasot. gtt. xvj.; mist, acaciae, gss.; sp. am- 
nion. co., sp. camph. aa. 3ij.; ether, chlor. 5iij.; aquae gviss. M. 
Give sirup of pernitrate of iron (which is make with clean iron wire 
5vj.; nitric acid §iss.; water gviij.; sugar §xiv). To each ounce of this 
sirup, add tinct. opii 3j-; sp. camph., gtt. xxx.; and give sixteen or 
twenty drops in a little water every hour till relief is obtained. If there 
is very much pain, add tinct. capsic. 5j. to the ounce of syrup, and give 
the dose in a little burnt brandy. (Dr. Reynolds.) 
Give the liq. chlorinii of the Edinburgh Pharmacopoeia, in doses of 3 j. 
or 5iss. in water, every hour, until the symptoms are relieved. 
Give from mv. to mxv. of chloroform internally, every hour or two, mixed 
with mucilage; and let the patient drink freely of milk and cold water, 
with a little sesquicarbonate of soda in it. 
Developed Cholera.—Give two grains of calomel, and two drops of 
laudanum every ten minutes; employ a hot air bath, and place a drachm 
of strong mercurial ointment in each axilla; and give ten drops of chloro- 
form with every alternate dose of the calomel. Omit the opiate and chlo- 
roform, and give the calomel at longer intervals, when reaction commences. 
The readiest way of administering the calomel, is to put two drachms on 
a sheet of paper, and divide into sixty parts; one of these to be given for 
a dose, from the point of a table-knife. And as to the opiate, bale out 
any number of spoonfuls of wTater, and add twice the number of drops of 
laudanum: then, by giving a spoonful of the mixture, using the same 
spoon, exactly two drops of laudanum will be given. (Dr. Ayre.) 
Place on the tongue two grains of calomel, mixed with a little sugar, and 
let it he washed down by an effervescing draught. If it is rejected, repeat 
the dose immediately; if retained, repeat every five or ten minutes till 
reaction commences, when the period between each dose may be gradu- 
ally extended to an hour or longer. Large doses, at long intervals, are of 
no use. (Dr. Niddrie.) 
Give twenty or thirty grains of calomel at once; repeat it in ten minutes; 
and employ such auxiliary means as warmth, friction and gentle stimu- 
lants. 
Complete recovery from the state of collapse has followed the adminis- 
tration of a scruple of calomel every hour for three times. 
Iii the stage of collapse give small and frequent doses of chlorate of 
potash, bicarbonate of soda, and hydrochloric ether, largely diluted in 366 
CHOLERA, 
camphor Avater, or with the patient’s drink; or aqua chlorinii Avith hydro- 
chloric ethei*, in the same vehicle ; and persist in giving them though the 
vomiting continue. If reaction follow, give calomel and camphor ; and in 
this stage, if the kidneys do not act, give diuretic salts, and employ em- 
brocations with turpentine to the loins, or give an enema containing a 
little spirit of turpentine. (Dr. Copland.) 
Use saline injections in the stage of collapse. A quart of water at 98° 
Fahr., Avith a drachm of common salt and half a drachm of sulphate of 
potash, maybe injected into a A’ein in the arm. As soon as the pulse is 
established, envelop the patient in a sheet wrung out of cold water, cover 
him Avith several layers of blankets, and apply hot bottles to the epigas- 
trumand calves. After the profuse perspiration Avhich this occasions has 
continued for, say, upAvard of an hour, remove the blankets and sheet, 
and put the patient in hot blankets. If any fever folloAVS, give calomel 
and opium. (Dr. Howlett.) 
Transfusion of blood ought to be employed. If sufficient blood cannot 
be obtained, inject what blood you can get, first, and aftenvard water 
containing saline substances. 
Inject into the veins six ounces of water at blood-heat, with thirty drops 
of a solution of morphia of the following strength : crystallized muriate of 
morphia, five grains; pure hot water, one ounce. When the discharges 
have been checked by the morphia, give calomel by the mouth, or intro- 
duce mercury into the veins in one of the following forms: one grain of 
corrosive sublimate, five grains of iodide of potassium, an ounce of warm 
water; or crystallized cyanide of mercury one grain, warm water one 
ounce. A fluid drachm of either of these solutions may be injected mixed 
with six ounces of warm water, and repeated if required. (Dr. M’Gregor.) 
In the stage of collapse, Avrap the patient completely, except the head, 
in a sheet Avrung out of boiling Avater, cover him Avith eight or ten blank- 
ets, and give shortly a little Aveak brandy and Avater. After keeping him 
in the blankets an hour, put him into a clean Avarm bed. Then give nitro- 
liydrochloric acid Avith syrup of poppies, either in Avater or infusion of 
catechu, every hour or so, if the stomach will bear it. 
Wrap the patient in a blanket which has been wrung out of the hottest 
water, and sprinkled with a handful or two of salt, and put four or five 
blankets closely round him ; this may require renewing in an hour or two. 
Give cold water ad libitum, and beef-tea frequently, but no medicine, ex- 
cept there is much sickness, when a little carbonate of ammonia, and soda, 
and hydrocyanic acid may be given. (Dr. Garrington.) 
Though the wet sheet, when fairly tried at the London hospital, had the 
effect of producing reaction, yet all the patients died. 
Give an emetic of sulphate of zinc, and repeat it quickly. If it is not 
followed by reaction, use the warm bath, apply sinapisms to the epigas- 
trium, and, an hour after the emetic, begin to give an effervescing solution 
of citrate of soda every two or three hours. Give ice and iced water to CIIOLEKA 
367 
allay the thirst, and give enemata of beef-tea, with or without brandy. 
Stimulants and astringents are both useless. (St. Bartholomew’s.) 
Chloroform was tried at the London Hospital, given both by the 
stomach and by inhalation, but all the patients died. 
Give a pill containing a grain of nitrate of silver and a quarter of a grain 
of opium, every hour, to the extent of five or six doses, or even more if 
necessary. Or, if the evacuations are very profuse, give two or three pills 
at a dose, and repeat them until the evacuations are wholly or partially 
arrested. 
Give matico in the following manner : Take of tinct. of matico, as strong 
as it can be prepared, from 3ij. to gss.; tinct of opium, 3ss. to 5j.; sp. of 
camphor, mxv. to mxx.; water, §ss. M. Give a fourth part whenever the 
sickness or purging comes on. Two doses generally suffice to arrest the 
disease : but if there is any return, it must be given again. 
Give creasote, according to the following formula: R Creasot, mxxiv.; 
mist, acaciae, §ss.; sp. amraon. co., sp. camph., aa. 5ij.; ether, chlor., 5ii. ; 
aquae, gviiss. M. Cap. §j. omni hora. (Dr. Spinks.) 
In slighter cases, in the more tractable stages of the disease, and in other 
cases as an adjunct, give a draught containing from two and a half to eight 
minims of strong nitric acid, four to eight minims of laudanum, a drachm 
of syrup of saffron, and an ounce and a half of water, every hour or two. 
But in confirmed forms of the disease, give phosphorus, in doses of one 
grain made into a pill with white wax. It may be necessary to give one 
of these pills at intervals of an hour or two, for two or three times, and 
afterward a dose of the acid mixture. (Dr. Batten.) 
At an early period, give six grains of quinine, four of calomel and two 
of opium, followed by a wine-glass of brandy diluted with a little warm 
water. If given within the first hour or two of seizure, this will generally 
check the disease. 
Employ galvanism, placing one pole of the machine over the heart, and 
the other over the region of the solar plexus. 
Transmit electro-magnetic shocks, so arranged as to imitate the fre- 
quency of the respiratory movements, or not more than twenty-five in the 
minute, from the nape of the neck to the upper part of the epigastrium. 
Rub the whole region of the spine with a solution of croton oil and tur- 
pentine—one drachm to the ounce—for twenty minutes, and then apply a 
hot and moist bran poultice, contained in a bag, large enough to cover the 
whole back. (Dr. Reeves.) 
Let warm water be plentifully injected into the bladder. 
Part xx., p. 310-345. 
Cholera, Asiatic.—Give one grain of acetate of lead every ten minutes. 
Part xxiv., p. 114. 368 
CHOLERA. 
Asiatic Cholera—Prevention.—During the prevalence of cholera, per- 
sons in connection with cholera patients should carefully wash their hands 
before taking food. The soiled linen should be immediately immersed in 
water as soon as it is removed. The greatest care should be taken that 
the water for drinking be not contaminated by cesspools, drains, or 
sewers. If suspected, it should be boiled and filtered. The provisions 
should be well washed with clean water, and, if possible, exposed to a 
temperature of at least 212°F. When a case of cholera appears in 
crowded neighborhoods the healthy should be immediately removed, 
except those absolutely necessary to wait upon the sick. (Dr. Snow.) 
Calomel Treatment.—Give grain-doses of calomel repeatedly, with one 
or two drops of laudanum with each dose, up to 24 to 30 drops, when it 
may be discontinued. Dr. Ayre speaks with the greatest praise of this 
simple mode of treatment. He says, that as soon as the secretion of the 
liver is restored a favorable change takes place. It would seem to be 
very difficult to salivate a patient in this disease. (Dr. Ayre.) 
In collapse pursue the following treatment. Give 15 grains of sulphate 
of zinc, and 15 grains of ipecacuanha, and repeat the emetic in ten minutes. 
In about twenty minutes place upon the tongue 20 or 30 grains of calomel, 
and repeat from 2 to 10 grains or more, every ten, twenty, or thirty 
minutes, according to the severity of the symptoms. Give beef-tea in- 
jections every half hour to support the strength. Allay vomiting or thirst 
by ice or very cold water, in teaspoonful doses, ad libitum. Avoid giving 
stimulants. When the stools contain bile, continue small doses of calo- 
mel for a short time, then give 20 grains of rhubarb and 30 of sulphate of 
potash, in peppermint water, or a castor-oil draught. Afterward reduce 
the fever by salines; and lastly, restore the strength by quina, am- 
monia, etc. (Dr. Richardson.) 
Counter-irritation, Calomel, Astringents, etc.—The author says he has 
tested the following plan of treatment in nearly all parts of the world. 
Turpentine epithems, or mustard poultices, to be applied to the abdomen 
frequently. Give ten grains each of calomel and prepared chalk, in 
treacle, every hour, along with half an ounce of the following mixture 
Take of compound powder of chalk with opium, powdered acacia, and 
white sugar, each two drachms; sesquicarbonate of ammonia, one and a 
half drachm; cajeput oil, twenty minims; tincture of catechu, three 
drachms ; with camphor mixture, eight ounces. When the stools become 
feculent, substitute the following until the purging stops. Take of acetate 
of lead, half a drachm; Battley’s sedative solution of opium, fourteen 
minims to one drachm ; oil of cinnamon, four minims ; tincture of ginger, 
three drachms; an infusion of quassia, eight ounces. An ounce may be 
given every two hours. (Dr. Chavasse.) 
Croton Oil.—Give one or two drops of croton oil on a small piece of 
sugar, and repeat it every two or three hours if the vomiting and purging 
continue. At the same time, apply hot bricks or bags of hot sand to the 
feet. The action of this remedy in this disease is not clear, but it certainly 
does not act as a purgative. (Dr. Hancox.) CIIOLEKA. 
369 
Sidphur.—In the ordinary diarrhoea preceding cholera, give a quarter 
of the following mixture every two or three hours: Twenty grains each 
of precipitated sulphur and sesquicarbonate of soda, two drachms of tinc- 
ture of lavender and six ounces of water. Hot fluids and vegetables 
should be avoided. If the disease has advanced to vomiting give the 
remedy every quarter of an hour until it stays upon the stomach. If 
diarrhoea has preceded the treatment by some days, give five or ten 
minims of tincture of opium with each dose. (Dr. Grove.) 
Sulphuric Acid.—Dr. Fuller sums up his experience as to the value ot 
sulphuric acid as follows: In Asiatic cholera, given in 3ss. doses of the 
dilute acid, he says it exercises a most favorable influence. In bilious 
diarrhoea he believes it to have little or no effect, but epidemic or autum- 
nal diarrhoea and in more decided cholera diarrhoea he has never known 
it to fail. To render it a certain and effectual remedy the above dose 
should be given every twenty minutes. 
u Maxwells Remedy”—Give one scruple of sesquicarbonate of soda 
with three grains of opium, in a bolus, washed down with another scruple 
of soda, in a wineglassful of water, as hot as the patient can swallow it. 
Repeat it in the evening, with two grains of opium if necessary, and after- 
ward give it in diminished doses. 
Pecoction of Catechu, etc.—When the cholera broke out in the 37th 
regiment, at Colombo, in Ceylon, in 1847, after trial of various systems of 
treatment the most successful plan was found to be a strong decoction of 
catechu administered both by the mouth, combined with laudanum, and 
by enemata (to the amount of two wmshhandbasinfuls) conjoined with 
laudanum, turpentine, ether, ammonia, etc., according to the circum- 
stances of the case, and the condition of the patient. The intense pain in 
the epigastrium, and the vomiting, are best relieved by applying hot 
spirits of turpentine to the stomach, and iced drinks, especially champagne. 
Excess of stimulants is fraught with great danger. The inhalation of 
ether was tried, but with questionable success. In some cases, however, 
a remarkable restoration of cuticular warmth took place, and increased 
fullness and force of pulse. (Dr. Chitty.) 
Saline Injections.—As the saline constituents of the blood in cholera 
are greatly diminished, keep ready for solution the following powder: 
Chloride of sodium, three ounces; phosphate of soda, one ounce; carbo- 
nate of soda, one ounce and a half; sulphate of soda, half an ounce. This 
powder should be dissolved in water until the fluid has a specific gravity 
of 1030, and then heated to 98°F. It is then ready for injection into the 
blood. (Dr. G. O. Reese.) 
External Stimulants.—Mr. T. M. Greenhow recommends a plan of pro- 
ducing external stimulation, which, though not quite so formidable as the 
application of the actual cautery, and which he says is often resorted to in 
India, is yet a sufficiently formidable operation. It is a brandy blister ; a 
linen rag dipped in brandy is applied to the abdomen and ignited, vesi- 
cation may follow, though it does not invariably. If needful, repeat it; the 
part to which it is applied may be varied. Part xxviii., p. 299. 370 
CHOLEEA, 
Use of Chloric Ether in Cholera.—The following formula was particu- 
larly efficacious in arresting the premonitory diarrhoea, cramps, etc., of 
Asiatic cholera, and even in advanced stages, bordering on collapse; 
R Ether, chlorici 3ij-; speciei pro confi arom. 3ss. mist.; cretae comp, 
ad §vi. Ft. mistura. Take a fourth part every half hour till relieved. 
Part xxx., p. 66. 
Vide Art. “ Diarrhoea.” 
Treatment of Cholera by Yeast and Turpentine.—Do not arrest the 
purging; it is eliminatory. Give turpentine and yeast as follows : yeast a 
tablespoonful, oil of turpentine a teaspoonful, cold water or barley-water 
two teaspoonfuls. Give this dose every second, third, or fourth hour, 
according to circumstances. (Dr. Crummey.) 
Treatment of Cholera by Oxygen Gas.—Don’t give opium. Give 
calomel freely, combined with camphor. Exhibit oxygen gas. This gas 
is easily given by shaking powdered chlorate of potash on a heated surface, 
and making the patient inhale the fumes. Or mix chlorate of potash with 
one-sixth its weight of black oxide of manganese, and throw the mixture 
on an iron shovel, heated to dull redness. Part xxx., p. 262. 
Treatment of Cholera by Eupatorium.—Make a strong decoction of the 
bitter bush, eupatorium, as follows: boil about two drachms in a pint of 
water, and give a small teacupful, cold, every half hour. It may be given 
alternately every half hour with some alkaline or saline powder. 
Part xxx., p. 263. 
Treatment of Cholera by Sulphuric Acid, Strychnia, etc.—The first 
stage may be generally relieved by the exhibition of a stimulant emetic, 
which, by evacuating the stomach, prevents any accumulation of irritative 
matter there, and by its revulsive power, produces a general alterative 
effect. This is to be followed by the following pills: chloride of mercury, 
five grains; ipecacuanha powder, half a grain; soap and opium pill, ten 
grains ; divided into three pills. 
This may be followed by an evacuant, consisting of rhubarb and mag- 
nesia, with compound cinnamon powder and water. 
This, even in the early part of the second stage, will be sufficient some- 
times to cure the patient; but if the serous fluid lost be considerable, or 
if the disease should run into its third stage, it is of importance to adminis- 
ter some astringent which can be depended upon, together with some 
medicine, so to uphold or stimulate the nervous power, as to prevent 
entire loss of control over the capillaries of the intestinal mucous membrane. 
In every case in the second stage, after the preliminary treatment, or 
immediately in the third stage, when from the copious action of the 
bowels, the preliminary treatment would be unnecessary—prescribe dilute 
sulphuric acid, half a fluid drachm ; strychnia in acid phosphoric solution, 
one-sixteenth of a grain. This medicine to be taken as frequently as the 
urgency of the symptoms might render it necessary. 
Part xxx., p. 263. 
Treatment of.—The saline injection in the worst cases of collapse has 
the certain effect of prolonging life, if it does no more. In some cases it 
has proved the means of recovery. With each pint of water mix 64 grains 
of chloride of sodium, 64 grains of carbonate of soda, and 32 grains of CHOLERA. 
371 
chlorate of potash—about five pints may be prepared, and to the five 
pints add half a grain of iodine. The whole five pints may be injected if 
necessary. (Dr. Ancell.) 
Rouse the sunken innervation of the ganglionic nervous system, and 
prevent its deeper prostration. Valerianic acid exercises a directly 
stimulating action on the abdominal ganglia, as ammonia does on the 
nervous centres and the whole organism. Thus valerianate of ammonia is 
one of the best stimulants, as it rapidly enters the circulating fluid. It 
must be given as early as possible. From 3 to 6 scruples will generally 
subdue the disease. The following formula will answer: $ Valerianat. 
ammon. 9j.; aquce destill. §iij.; syrup, simpl. §ss. Give a tablespoonful 
of this mixture every quarter of an hour, and when reaction sets in, give 
it seldomer; at the same time, rub the skin with hot flannels. 
Part xxxi., p. 265-276. 
Treatment of Cholera.—If in collapse, apply the hot wet sheets and hot 
turpentine frictions. During convalescence, mustard over the kidneys to 
promote the secretion of urine. Gallic acid, in five-grain doses, with one 
grain of calomel after every evacuation, is the staple remedy; for the 
severe vomiting, give the subnitrate of bismuth and carbonate of soda, or 
aromatic spirit of ammonia, sulphuric ether aud laudanum. At the same 
time support by new milk, broths, etc. Part xxxiii., p. 293. 
Charcoal in Epidemics of Cholera.—Dr. Wilson recommends the 
administration of charcoal in cholera, both internally and in the form of 
an enema, prepared by rubbing up with the white of an egg—a table- 
spoonful of common levigated charcoal, and diffusing the same in eight or 
ten ounces of chicken broth. 
He is convinced that, in all stages of the disease, it is a most beneficial 
adjuvant, and anterior to the asphyxial stage, and in that of reaction, most 
eminently curative. Part xxxv., p. 26. 
Premonitory Symptom in Cholera.—The Academy of Sciences has 
received from Dr. Poznanski an important communication, in which it is 
stated, that during the prevalence of cholera, it frequently happens that 
the pulse is extremely low, and reduced to 45 or even 42 in persons 
apparently in perfect health. That this diminution, which often occurs 
weeks before the regular attack, may be considered a pathognomonic 
symptom of the approach of cholera. That those who have experienced 
the diminution in question had always escaped the disease whenever they 
have followed a regimen calculated to accelerate the circulation. 
Part xxxvi., p. 96. 
Arsenic in Cholera.—Dr. Black believes arsenic to have a specific action 
in cholera, from an experience of nearly two hundred cases, in none of 
which has it ever failed to produce a speedy and permanent cure. It may 
in very severe cases, where the cramps come on every few minutes, and 
the vomiting and purging are all but incessant, be given in doses of five 
drops of the liquor arsenicalis every fifteen minutes until the symptoms 
abate, and then be given every hour. Part xxxvii., p. 248. 
Cholerine—Use of Sub-nitrate of Pismuth in.—The frequency with 
which gastro-intestinal disturbance precedes true cholera is well known, 
and the desirability of its suppression is evident; and to this end large 372 
CHOLERA INFANTUM CHOKING. 
doses of bismuth succeed better than any other means. It is most suita- 
ble in the cases in which with the diarrhoea there are nausea, vomiting, 
gastralgia, colicky pains, borborygmi, and anorexia. The cases are 
innumerable in which the author has been enabled rapidly to relieve these 
symptoms, without any aid from opium, by giving eight or ten drachms 
daily. The only inconvenience resulting is a certain amount of constipa- 
tion. Vide Art. “ Diarrhoea.” Part xx., p. 92. 
English Cholera.—For severe attacks of vomiting and purging, so very- 
common in autumn, there is no remedy so effectual in checking the disor- 
der as pills composed of creasote and opium. Part xxxiv., p. 73. 
Use of Coffee in Infantile Cholera.—Dr. Pickford states, that from 
the great importance which now attaches to the treatment of cholera, he 
feels it to he incumbent upon him to impart to others the experience 
which recent opportunities have afforded him of the effects of coffee in the 
cholera of infants. 
In the case of an infant at the breast, to which he was called late, to 
whom the usual remedies had been administered unavailingly for four 
days, the exhibition of coffee was attended with complete success. The 
incessant vomiting and purging had produced extreme emaciation: the 
abdomen was distended; the pulse was frequent and small; there was 
great restlessness, and sleeping with the eyes half opened; convulsive 
motions of the eyes when awake. Carbonate of ammonia, with nourish- 
ing diet, and external stimulants, having been fruitlessly exhibited, Dr. 
Pickford determined to have recourse to coffee, which he knew to have 
been recommended as a stimulating tonic, by Dr. Dewees. He began 
with a small dose, a scruple, infused in two ounces of water, with one 
ounce of syrup, giving a large spoonful every hour. The effect was 
surprising; the vomiting was arrested; the evacuations became more con- 
sistent, improved in color, and less frequent. The amendment progressed 
so rapidly, that by the tenth day the child was discharged as cured. 
Part xix., p. 94. 
Acetate lead and Opium.— Vide Dr. Batchelder’s treatment of Dys- 
entery. 
CHOLERA INFANTUM. 
“Ready Method” in Cases of Choking.—Dr. Marshall Hall advises: 
In cases of sudden choking, as from a morsel of food, place the patient, 
generally a child, between your knees, one knee (the right) pressing firmly 
on the stomach, and the other on the back; then place bne hand on the 
back part of the thorax, and give a firm blow with the other on the ster- 
num, the morsel will sometimes be expelled with force to a considerable 
distance. If in the midst of the asphyxia the excito-motor power fails, 
and the larynx is no longer spasmodically closed, employ the “Ready 
Method ” to sustain life until a bougie can be made to push the morsel of 
CHOKING. CHOKDEE CHOKEA. 
373 
food lower down in the pharynx or oesophagus. A firm scroll of cotton 
or linen, if carefully made and greased, or a thin bent tallow candle, 
might answer this purpose. Part xxxv., p. 49. 
CHORDEE. 
Treatment of Chorclee.—The following prescription is recommended by 
Mr. Gillott in a communication in the “ Lancet” for December 20th, 1845, 
for the cure of gonorrhoeal rheumatism: colchicumwine, two drachms; 
sulphate of magnesia, one drachm; carbonate of magnesia, one drachm; 
iodide of potass, half a drachm ; water, five ounces and a half. One tea- 
spoonful to be taken every fourth hour. Another correspondent of the 
“Lancet” recommends a combination of iodide of potass and decoct, 
sarsae comp. 
Mr. O’Connor recommends from twenty-five to fifty minims of vin 
sem. colchici, for several successive nights, to relieve chordee. 
Part xiii., p. 295. 
Lupulin.—Recommended in cases of chordee, in doses of five or ten 
grains, at bedtime—repeated pro re nata. Part xxi., p. 355. 
Chordee.—To relieve this condition no remedy is so efficacious as cam- 
phor. It may be given in the form of the spirit of camphor, in doses of 
3j. in a small quantity of water. The best plan is for a teaspoonful to be 
taken at bedtime; and every time the patient awakes with the chordee, 
let him arise at once and repeat the dose. Part xxiv., p. 271. 
Anaphrodisiac Properties of Promide of Potassium.—Thielman 
recommends this remedy as an excellent anaphrodisiac in satyriasis, in the 
frequent and painful erections during gonorrhoea, in spermatorrhoea, and 
in nymphomania. He administers it in doses of from two to three grains 
every two or three hours; and, at the same time, enjoins a mixed vegeta- 
ble and milk diet, and forbids all acid substances. Part xxxi., p. 222. 
Electricity in Chorea.—Dr. Golding Bird gives a list of 30 cases in 
nearly all of which it was remarkably successful; the only remedy com- 
bined in the treatment being purgatives. In most of these cases other 
remedial treatment had been previously adopted in the hospital, and were 
sent to the electrical ward as a last resource. In every case he “ confined 
the treatment to sparks taken in the course of the spinal column every 
alternate day for about five minutes each time, or until the papular 
eruption made its appearance.” With respect to passing the shocks along 
the affected limbs in chorea, it is particularly necessary to notice Dr. Bird’s 
words. He says: 
I have never seen any good effect to result, in cases of chorea, from the 
transmission of electric shocks along the affected limbs; on the contrary, in 
every instance the involuntary movements have been increased, often tr' 
CHOREA. 374 
CHOEEA. 
an alarming extent; and if employed when the patient was convalescent, 
it has invariably aggravated every symptom, and often rendered the pa- 
tient as bad as when first admitted under treatment. Part iii., p. 22. 
Purgatives and Tonics.—In relation to the treatment of chorea, Mr. 
Wardleworth says : 
The indications of cure are, I think, 1st, To unload the bowels, if a 
torpid condition of them exist; and, 2dly, To restore the tone of the 
stomach and intestines. The purgative formula which I have found the 
most efficacious, is the following : 
R Ext. elaterii gr. j.; pulv. jalap®, gr. xxxvj. ; pulv. zingib. gr. xxiv. 
Misce et divide in chart, xij. capt. j. quarta quaque hora donee alvus soluta 
fuerit. 
After the bowels have been fully acted upon, should the disease still 
continue, I then prescribe that important therapeutic agent, the ammo- 
niated tartrate of iron. Its ])leasant taste, and perfect solubility in water, 
render it exceedingly agreeable, even to the most fastidious. 
I commence by giving three grains three times a day (in quovis vehiculo), 
the dose to be gradually increased to five grains, which will generally 
be found sufficient to subdue the disease, care being taken at the same 
time to keep up a free action of the bowels, combined with a light yet 
nutritive diet. Free exercise in the open air, after the disease appears to 
decline, is essential to the patient’s perfect recovery. 
No doubt there are complicated cases of the disease, which render other 
treatment advisable, and which approach to epilepsy, so decidedly marked, 
as to leave no doubt of the propriety of having recourse to the antiphlo- 
gistic treatment. Though this is the case, I have not seen one instance 
where I thought it necessary to adopt the starving plan of cure. Neither 
blisters, nor any other external application have I prescribed, since I adopted 
the use of the ammoniated tartrate of iron in chorea. Part iv.,p. 37. 
Treatment of Chorea.—Dr. Babington says: 
lie has not found any one remedy so superior in efficacy to the rest, as 
to induce him to abandon all others in its favor. On the contrary, the 
most powerful will sometimes disappoint our expectations; and we are 
then obliged to try one after another; and in the end, perhaps, remain 
uncertain, should the patient do well, whether the recovery is to be 
attributed to the means employed, or to the power of nature herself. Dr. 
Babington, therefore, treats the cases rationally. 
When there is evidence of congestion in the head, marked by giddiness 
and headache, occurring in subjects of a full habit and florid countenance, 
the treatment should be commenced with moderate depletion. 
Attention to the state of the bowels is, of com*se, in all cases, indispen- 
sable, even though the general treatment should be of a tonic character. 
Where worms, and especially taenia, cause the irritation, turpentine, and 
other anthelmintics will prove most successful; and these cases also will 
swell the list of those who will be benefited by brisk and repeated purgatives. 
Where there is reason to believe that the disease is connected with the 
state of the uterus, occurring about the period when the catamenia should 
appear, and combined with symptoms of hysteria, those remedies will 
naturally suggest themselves which have a special power in causing 
this discharge, in obviating its irregularity, and in correcting its un- 
healthy character. The state of the teeth should be looked to about CHOREA. 
375 
the period of the second dentition ; and even on the cutting of the 
dentes sapientioe, as a probable source of irritation—and the gums should 
be lanced, or the decayed roots of the first set removed, according to 
circumstances. 
Where the disease has arisen from a metastatis of rheumatism to the 
fibrous structure of the theca of the cord, it ought to be treated in the 
same way as pericarditis—by depletion, general or local, antiphlogistics, 
and the employment of mercury, carried to slight salivation. 
The following are Dr. Babington’s opinions outlie subject and compara- 
tive value of tonics: 
“Various vegetable tonics have had their advocates; but bark and 
sulphate of quinine may be taken to represent them all. 
“ The most severe case I ever saw recover, was cured in a few days, by 
divided doses of port wine, in which enough of sliced rhubarb was steeped 
to render it gently aperient. 
“ The metallic salts and oxides have, however, of late years been gen- 
erally preferred. Sesqui-oxide and sulphate of iron, sulphate of copper, 
oxide and sulphate of zinc, nitrate of silver, and arsenite of potassa, have 
all been tried, and found, in different hands, to succeed. The testimonies 
in favor of sesqui-oxide of iron in large doses, and of sulphate of zinc, 
are perhaps the strongest. On the latter remedy I have generally 
relied. 
“ Sulphate of zinc, however, will not be borne by all stomachs, even in 
small doses. In such cases, I generally have recourse to the liquor po- 
tass® arsenitis, cautiously increased in its dose from three to twelve or 
fifteen minims, according to the age and strength of the patient, and 
other concomitant circumstances. I believe this the most powerful remedy 
of them all—at least, I have found it so, in several obstinate cases; but 
I am deterred from employing it where other remedies will succeed, 
from the sickness and griping pains which it is apt to cause, and from 
some fear that the constitution may be permanently injured by its con- 
tinued employment. 
“ As an external remedy, the shower-bath may be very often advantar 
geously used, in conjunction with internal means ; and I have even tested 
its efficacy with success, when used alone. In St. Petersburg, I am in- 
formed by a Russian physician, a new practice has, within the last year, 
been adopted with eminent success, in obstinate cases of chorea. The pa- 
tient is placed in a bath as hot as he can bear it; kept there for half an 
hour; and, when thus thrown into the most profuse perspiration, is sud- 
denly plunged into cold water. I have not ventured to try this method 
of producing a sudden shock; or rather, I should say, that opportunity has 
been wanting, since I have been made acquainted with it; but in an ex- 
treme case, and when other remedies have failed, I should, on the testi- 
mony I have received in its favor, not hesitate to employ it.” Part v., p. 40. 
Extract of Indian Hemp.—Case cited of chorea affecting the body with 
rigid spasms, relieved by half grain doses of extract of Indian hemp three 
times a day. Within ten days a cure was effected without the aid of other 
medicines. Part\\.,p. 28. 
Treatment of Chorea.—Dr. Todd believes the movements of chorea 
should not be forcibly restrained, while at the same time, provision should 376 
CHOREA. 
be made against the possibility of the patient being injured in the violence 
of the movements. 
Free ventilation, cleanliness, with frictions of the skin, warm clothing, a 
wholesome and nutritious diet, including animal food, porter or wine in 
moderate quantities, when there is much debility, or when the movements 
are constant and exhausting, are recommended as valuable auxiliaries. 
Attention is directed to the condition of the bowels. Calomel and jalap 
in combination, or, if there are worms in the intestinal canal, castor oil and 
turpentine are suggested. Purgation should not be pushed to excess. 
After the secretions of the bowels assume a healthy appearance, tonics are 
advised, especially the cold shower bath. Of the medicinal tonics, some 
one of the metallic salts, especially of the preparations of iron, may be ad- 
vantageously combined with sulphate of quinine. 
Or. Todd prefers the sulphate of iron in large doses, and in reference to 
arsenic, says, that if he can cure his patients with iron or zinc, he would 
rather not employ arsenic. 
Opiates and the whole class of sedatives are here discountenanced and 
considered liable to aggravate the disease although they may have pro- 
cured sleep, leaving a disturbed state of the brain. Antiphlogistics are 
also considered inadmissible. jPart viii. p. 68. 
Iodide of Potassium.—The following combination of iodide of potassium 
is recommended in certain cases of chorea, without fever or furred tongue: 
R Iodide of potassium, live grains ; sesquicarbonate of soda, ten grains; 
camphor julep, one and a half fluid ounce. M. 
This dose to be taken thrice daily. 
Dr. Oke has occasionally given four or five grains of blue pill every other 
night during the exhibition of the iodide, and thinks it sometimes forwards 
its success. Part ix.,£>. 62. 
Treatment of Chorea.—With regard to the treatment of chorea in chil- 
dren, it usually yields to purgatives and tonics; if the disease is very recent, 
purgatives will often succeed in curing the disease; but subsequently the 
addition of various tonics is required. Purgatives remove the irritation 
of the intestinal canal which tends to produce the disease. Derivants are 
useful in preventing the local determination of blood, which is connected 
with most cases of excitement of the nervous centres, but the remedies 
that answer most effectually in most instances are tonics. Sulphate of zinc 
and sesqui-oxide of iron, are the most useful; the former being adapted 
chiefly to the more plethoric subjects. In children who are active, and 
who exhibit a tendency to inflammation, without any weakness of consti- 
tution, it may be given in doses of ten grains, three times a day, gradually 
increased. Dr. Williams continues: 
The more effectual tonics are the more soluble ones; the sulphate of 
iron is a very good one, but the iodide of iron answers best; it pervades 
the system more rapidly than any other, and keeps the secretions more 
free. It may be given in doses of one grain three times a day, increased 
to four or five grains, taking care at the same time that the bowels are 
open. In obstinate cases, where there is functional disorder of the spine, 
and the membrane of the spinal cord, counter irritation by blisters along 
the costal spine, or tartar emetic ointment, or croton oil, or some other 
applications of that kind, are useful. In these cases, nitrate of silver has 
been found of service. If there are any symptoms of fullness, or any local CHOREA, 
377 
pain or tenderness in the region of the spine, local blood-letting should be 
practised; and if the disease has originated from rheumatism, it is proper 
to give colchicum and iodide of potassium internally, at the same time 
that counter-irritants are used. Part xii.,y>. 44. 
Strychnia in Chorea.—Some years since, Dr. Ross was induced to try 
this remedy in some cases which had resisted other treatment. 
“The first occasion on which I made trial of the remedy in this disease,” 
says he, “ was in the case of a delicate giiT of twelve or thirteen years of 
age, who came under my care as a hospital patient, with many of the ec- 
centric symptoms of this singular disease most distinctly marked. From 
having been very expert with her needle, she was grown incapable of using 
it, and her attempts to thread it were almost ludicrous. I prescribed for 
her the eighth or tenth of a grain of the alkaloid, to be taken twice a day. 
On the second or third day of the treatment, through a mistake of the 
nurse, she had an over-dose of the medicine, which produced more violent 
effects than I intended—viz., convulsive twitches, which, however quickly 
subsided, on the medicine being intermitted, and with them all symptoms 
of the disease. In a day or two after this I saw her thread a fine needle 
with a hand perfectly steady, and she was dismissed cured at the end of a 
week. I saw her more than a year afterward; she was quite well, much 
improved in appearance, considerably grown, and had no return of the 
chorea. Part xii., p. 45. 
Treatment of Chorea, with coexistent Ileart-Pisease.—Dr. Chambers 
does not find it necessary to modify the treatment of chorea, in conse- 
quence of its complication with heart-disease; provided the latter be not 
the more acute affection of the two. He finds gradually-increased doses 
of sulphate of zinc serviceable. By beginning with half a grain, and 
increasing it by a grain a day, he has seen fifty-two grains taken daily, not 
merely with tolerance, but with advantage. Part xv.,p. 77. 
Use of Electricity in Chorea.—Employ electricity, by drawing sparks 
from the spine. Do not transmit shocks through the limbs; but in girls, 
when the chorea seems to depend on amenorrhoea, after relieving the anae- 
mia, pass a few shocks through the uterus. Electricity, used in this way, 
comes next to, if not before sulphate of zinc, as a remedy in these cases. 
Part xvi., p. 102. 
Chorea associated with Pregnancy.—Chorea and other convulsive dis- 
eases are often associated with pregnancy, and are rarely removed until 
delivery takes place. In the treatment, avoid heroic measures, attend to 
the secretions, and endeavor to restore the tone of the nervous system by 
giving sulphate of zinc, one to five grains thrice a day, with or without 
ext. gentian, gr. iij.; or give ferri sulph. gr. j.; quin, sulpli. gr. j.; pulv. 
capsici gr. j.; pil. aloe, co. gr. j.; ter die; with the addition, occasionally, 
of pulv. vale'rianse, gr. xij., or the valerianate of zinc. Part xvi., p. 291. 
Tartar Emetic in Chorea.—Mr. Corfe relates the case of a woman, a3t. 
twenty-eight, with severe chorea, who was under the care of Dr. Thomp- 
son. He says: 
The violence of the symptoms rapidly subsided under the steady and 
repeated exhibition of tartar emetic, in large doses. The doctor commenced 
with half a grain every hour, for eight or ten successive doses, and then he 
continued it, in the same quantity, every four, and subsequently every six 378 
CHOKEA. 
hours, when she obtained tranquil and refreshing sleep, and gradually 
improved under this treatment alone, and left the hospital perfectly well. 
Part xvii., p. 55. 
Chorea.—Do not be misled by the urgency of the symptoms into the 
adoption of depressing treatment. But after correcting the secretions by 
the use of purgatives, let the cold bath be freely and frequently used, and 
give nourishing diet, with chalybeates, quinine, and metallic tonics. If, 
after the cessation of the spasmodic movements, paralysis or debility of 
the muscles remains, apply galvanism. Part xix., p. 05. 
Treatment of Chorea by Prussiate of Iron.—Give prussiate of iron 
(ferro-sesquicyanide of iron ?) in the following manner : Take, of prussiate 
of iron, grs. xv.; extract of valerian, grs. xlv.; make it into twenty-four 
pills. Give one pill three times a day, to be followed by a wineglassful 
of infusion of valerian. Part xxi., p. 96. 
Sulphate of Zinc in Chorea.—The sulphate of zinc has been extensively 
used as a remedy for chorea, in Guy’s Hospital, and it is stated with remark- 
able success. The dose has been increased even up to thirty-six grains, three 
times a day. “ Zinc has a similar peculiar influence on the nervous tissue, 
as iron has upon the blood.” Part xxiii.,/>. 75. 
Treatment of Chorea by Frictions with Chloroform.—M. Gassier has 
published cases of chorea cured by the topical application of chloroform. 
Among others was that of a child seven years of age, in whom the dis- 
ease was caused by fright. A liniment composed of equal parts of chloro- 
form and oil of sweet almonds was rubbed, night and morning, along the 
course of the spine. From its first employment the violence of the mus- 
cular movements was moderated, and in six days the patient was cured. 
Part xxiii., p. 77. 
Chorea.—Gymnastic exercises have been recently employed in the 116- 
pital des Enfans, Paris, with the most marked success, commencing with 
the most simple movements. At the twentieth lesson they were exercised 
in wrestling, and afterward in running. A marked improvement soon 
became manifested, their countenance becoming animated, their flesh firm, 
their voices stronger, their appetites keener and more regular; glandular 
swellings, which had resisted all treatment, were resolved, and fistulous 
sores, that had been open for years, closed up. 
Another valuable method of treating chorea is by means of the sulphu- 
reous baths, as devised by M. Baudelocque, fifty-eight rapid and decisive 
cures having been obtained in Go cases. Thirty drachms of sulphuret of 
potash are added to each bath, which is applied at least one hour daily at 
a temperature of 91°. Where the cure is retarded, it ordinarily depends 
on the patient’s powers being lowered by other remedies, or insufficient 
diet; upon irritation of the skin, induced by the bath, or upon acute irri- 
tation of the internal serous membranes—circumstances contra-indicating 
the baths while they continue. Part xxv.,p. 75. 
Chloroform in Chorea.—The inhalation of chloroform in the ordinary 
manner on a pocket handkerchief in a case of chorea, under Sir Henry 
Marsh, was followed by the most marked relief in the symptoms. 
Part xxvi., p. 34. CHOREA, 
379 
Treatment of Chorea.—The indications in this disease are to improve 
the state of the blood, amend general nutrition, calm the nervous system, 
and infuse tone into the muscular. If any irritation exists it must be 
removed. The most frequent source, perhaps, is from ascarides in the 
rectum, and these may be removed by an injection of a strong solution of 
salt in water, or an infusion of quassia into the rectum. The disease very 
frequently yields to attention to diet, and the cold affusion employed two 
or three times a day. Of the tonics, those of the metallic kind are the 
best, especially iron and zinc, or quinine may be employed, or some form 
of bark. Sometimes the muscles become slightly paralyzed; the best 
remedy for this is the careful employment of galvanism; a gentle and 
slowly interrupted current may be transmitted through the paralyzed part 
from a quarter of an hour to twenty minutes at a time. Friction, with a 
rough towel or a flesh brush may be also employed. Part xxvi., p. 35. 
Use of Ammonio-Sulphate of Copper in Chorea.-—Dr. Merei regards 
the ammonio-sulphate of copper as a sovereign remedy in chorea. Out of 
177 cases treated at Pesth, 170 had been restored by this drug to perfect 
health in an average time of 22 days. The prescription he employs is the 
following: Aq. menth. pip. §iv.; ammonio-sulph. cupri, gr. viij.; tinct. 
opii, gtt. viij.-xij.; syr. simplicis, gss. A teaspoonful may be commenced 
with, four or six times a day, gradually increasing the dose. A child from 
nine to fourteen years old might take a tablespoonful four or five times a 
day. If sickness is produced, cease for a day, then recommence in smaller 
doses. If chlorosis or anaemia is conjoined with the disease, then add 
some preparation of iron. Part xxvi., p. 39. 
Treatment of.—In children, under fourteen years of age, give from 
half a grain to a grain, three times a day, of the ammonio-sulphate of 
copper. It succeeded where the sulphate of zinc and the sesquichloride 
of iron had completely failed. It is not a novel remedy, but it is much 
neglected. Part xxvii., p. 248. 
Chorea.—In a most severe case of this disease (the patient being a girl 
aged sixteen), in which the symptoms were particularly aggravated, the 
following treatment proved very successful. She was ordered to inhale 
chloroform, and to have a suppository containing two grains of opium, at 
once, and a draught with four grains of camphor and some chloric ether 
every two hours. Afterward eight grains of quinine were ordered to be 
given as a suppository every hour for six times. The next day she was 
decidedly quieter, and the draughts and suppositories were given at inter- 
vals of four hours. From this time she rapidly improved, and in three 
weeks was discharged. Part xxviii., p. 68. 
Hysterical Chorea treated by the Syrup of the Iodide of Zinc.—In this 
case, the nervous derangement, depending on a uterine cause, took all 
the appearance of a case of chorea. The patient was sixteen years old, 
of a peculiar masculine appearance. The catamenia had appeared about 
three months, and the chronic symptoms about five days before admis- 
sion. 
On her admission, the patient presented a very excited condition; her 
arms were in constant motion, also the legs to a certain extent; the mus- 
cles of the face wrnre likewise very much affected, contorting the face in a 
hideous manner. The tongue was remarkably enlarged, and the head 380 
CHOEEA. 
very hot. Dr. Barlow thought that there was a mixture of hysteria and 
chorea in the case. The bowels being confined, colocynth and calomel 
were ordered. The patient afterward rapidly recovered under the use 
of 3ss. doses of the sirup of the iodide of zinc, and calomel night and 
morning. Part xxix.,/>. 61. 
Chorea.—Begin with sulphate of zinc in small doses (gr. j. to gr. ij.) 
and gradually increase the dose to five or eight grains. Sometimes liquor 
arsenicalis is very efficacious: give three minims to a child, and five or 
six minims to an adult in a bitter infusion three times a day. 
Part xxx., p. 40. 
Chorea treated by the Carbonate of Iron.—Cases must have come 
under the notice of all physicians in which, after iron had failed, zinc suc- 
ceeded, and in which, after perhaps both of these had been tried in vain, 
the ammonia-sulphate of copper, some preparation of arsenic, or perhaps 
the addition of valerian to the zinc, at once arrested the disease. Our art 
is fortunate enough to possess at least half a dozen mineral preparations 
of proved specific power against chorea, but as yet few, if any, trustwor- 
thy rules have been established for our guidance in preferring one to the 
other. 
In our present ignorance, however, we must be content to be guided 
by the knowledge obtained during the progress of the treatment, and to 
ring changes on the remedies until the right one is found. Perhaps, how- 
ever, in virtue of their blood-improving qualities, the preparations of iron 
have a claim to be tried before most of the others, and of those prepara- 
tions the saccharine carbonate is probably the best for the purpose. 
Part xxxi., p. 306. 
Chorea.— Vide Selections from Favorite Prescriptions, Art. “Medi- 
cines.” 
Treatment of Chorea by Blisters.—Blisters have often been beneficial 
when repeatedly applied to the extremities of the side most affected. If 
the chorea be intense or chronic, a blister may be applied to the back of 
the neck. Part xxxiii. p. VO. 
Chorea.—In cases where the usual antichoreic medicines fail, you may 
try splints; in some cases they act so favorably that the patient is well in 
the course of a few days. * Part xxxx.p. 32. 
Chorea.—In cases of chorea, if complicated with struma, administer the 
iodide of zinc; if no indications of this disease exist, the sulphate may be 
used. Part xxxvi. p. 44. 
Chorea.—Dr. Addison, of Guy’s Hospital, advises, whenever we see a 
case of chorea in a young person, to always suspect that it has had its 
origin in rheumatism. Disease of the heart is very frequently found in 
cases of this nature. Most reliance is to be placed on sulphate or oxide 
of zinc in the treatment of this disease. Part xxxvii., p. 50. 
Arsenic in Chorea.—Dr. Rice states that lie has of late treated severe 
cases of chorea with great success by means of arsenic, the treatment 
occupying only from two to six weeks, lie says : “ I am no believer in 
specifics, but I think arsenic is as sure to cure chorea as bark is to cure CICATRICES CLUB-FOOT. 
381 
ague ; the remedy must be watched and used with caution, and then it is 
entirely safe.” He employs Fowler’s solution, giving other medicines 
as adjuvants as the case requires them. Part xxxvii., p. 311. 
CICATRICES. 
Treatment of Cicatrices of the JSfecJc after Burns.—Mr. James, of 
Exeter, brought before the meeting of the Provincial Medical Associa- 
tion at Leeds several cases in which the severe contraction after burns had 
been considerably relieved by a regular system of extension. Dr. Mutter, 
of Philadelphia, relates several remarkable cases in which the old cica- 
trices were entirely dissected out, and a fresh and healthy portion of the 
neighboring skin introduced in their place. But even this, although a 
bold, and in many cases a successful operation, will sometimes fail. 
These remarks more especially apply to cicatrices of the neck. Mr. 
James’s treatment consists in dissecting the hardened cicatrix from the 
neighboring parts and covering the large exposed surface with moistened 
lint, and bread and water poultices confined by a pasteboard collar, until 
suppuration is freely established. He then applies what he calls a screw- 
collar, by means of which he can elevate the chin and keep it at any parti- 
cular degree of elevation till a fresh cicatrix has formed. 
Part viii.,y>. 119. 
Contractile Cicatrix.—To close preternatural openings which have lost 
all tendency to contract naturally, if the openings are small, with callous 
edges, apply the nitrate of silver. If they are large, pare the edges, and 
bring them together by suture; and if a small opening should still 
remain, then the application of caustic may complete the cure. 
Part xxii., p. 347. 
Cicatrices from Burns.—Professor Ferguson, in operating upon cica- 
trices after burns, after dividing the bands and dissecting them back, 
employs extension of the parts. In a case of the kind lately under his 
care, this mode of treating this unpleasant deformity was attended with 
complete success. Part xxvi., p. 294. 
Cicatrices from Burns.—Make a number of short transverse incisions 
in the cicatrized tissues; these gape much when made. The wounds are 
dressed with narrow pieces of strapping, so as to approximate the end of 
cut to each other, not the sides—and lengthen out the old cicatrix as 
much as possible. Part xxxvi., p. 187. 
CLUB-FOOT. 
Observations on Talipes.—Mr. Braid, of Manchester, affirms that the 
cause of malpositions constituting talipes is evidently the result of spas- 
modic paralytic seizures, of which there is ocular demonstration in the 
non-congenital cases. 382 
CLUB-FOOT. 
When a tendon has been divided, and the two ends separated from 
each other, he has ascertained that these two ends reunite by fresh tendon, 
or a substance very like it; and by this means a tendon may be elongated 
almost to any reasonable extent. He differs from most authors when he 
states that the best way is to divide all or most of the tendons which are 
implicated in the contraction; and in the course of four or five days the 
foot may be brought into its natural position and direction, without the 
trouble and pain of continuing the extension for the great length of time 
which often follows the simple division of the tendo Achillis. It will 
generally be found in a case of pure talipes equinus, with rigid contrac- 
tion, that not only are the tendo Achillis and plantaris contracted, but 
also the flexor longus pollicis pedis, and the flexor longus communis, 
tibialis posticus, and peroneus longus and brevis. Mr. Braid would, 
therefore, divide the whole of them at the same operation, or at least 
those which he found contracted: and his extensive experience warrants 
him in strongly recommending this mode of proceeding instead of divid- 
ing the tendo Achillis alone, and trusting to future long extension to com- 
plete the reinstation of the foot. It seems but reasonable that if other 
tendons are found proportionably contracted, they should be divided as 
well as the tendo Achillis, especially as the operation is so very simple, 
and fresh tendon will almost invariably be found to unite the dissevered 
portions. 
No doubt, in many cases Mr. Braid’s practice is admirable, for it must 
be remembered that the antagonistic muscles are in a weak and almost para- 
lyzed state, and can, therefore, offer but little resistance when the lately 
extended muscles are again allowed to have play: the consequence will be 
that the club-foot will either not be completely cured, or the cure will be 
very tedious. After thus dividing all the contracted tendons, extension 
is to be commenced in two days, and in four or five days the deformity 
will generally by cured. In a case of varus Mr. Braid divides the tendo 
Achillis, tibialis anticus, tibialis posticus, flexor longus pollicis pedis, and 
flexor longus communis, and abductor pollicis, if required; and if there 
should be much contraction of the sole of the foot, he even divides the 
plantar fascia as well as the short flexors. But there may be other kinds 
of talipes, which are owing, not so much to contraction of certain mus- 
cles, but to paralysis or weakness of the antagonistic muscles; and in these 
cases Mr. Braid seems to be the first who has excised a portion of such 
paralyzed or weak tendons for the sake of uniting them again, and thus 
making them shorter. This has completely succeeded in many cases. It 
is necessary, however, not to cut out too much, which would produce 
rigid contraction, nor too little to excite the tone and contractility neces- 
sary. Part iv., p. 80. 
'Varieties and Surgical Treatment of—Dr. Guerin, of Paris, states that 
the special forms of pes equinus are the product of retraction of the gas- 
trocnemii, solei, and flexors of the toes; those of varus of that of the 
anterior and posterior tibialis; those of valgus of the lateral and anterior 
peronei; those of talus of the anterior tibialis, the long extensor of the 
toes, and the anterior peroneus, with complete or incomplete paralyses of 
the gastrocnemii and solei. 
The surgical treatment of congenital club-foot ought to comprehend the 
section of the tendons of those muscles, whose retraction causes the patho- CLUB-FOOT. 
383 
logical form of the foot; when the heel i? elevated, the tendon Achilles; 
when the foot is turned on its external edge, the tibialis anticus; vrhen on 
its internal, the anterior peroneus and the whole or part of the extensor 
of the toes; for forced adduction of the foot, the tibialis posticus; for 
abduction, the peronei laterales; for curvature of its internal edge, the 
adductor of the great toe; for extension or permanent flexion of the 
toes, the section of the tendons of the corresponding muscles; and, 
finally, the simultaneous section of the tendons of those muscles, whose 
simultaneousness of retraction causes the different combinations of form 
which club-foot presents. Part iv., p. 112. 
Talipes Equinus.—Mechanical extension should he commenced on the 
third day after the division of the tendon; the foot must be bandaged 
and placed in a Scarpa’s shoe, or that modified by Mr. Adams; the rate 
of extension in a healthy infant should be such as to obtain the full 
length required in a fortnight, if practicable; in adults and paralytic 
limbs it will require a longer time. Our object must be rather to regulate 
the length of new tendon than to elongate or stretch the new material; 
care must be taken to carry the foot beyond the right angle with the leg, 
according to age and comparison with the healthy foot. During the latter 
period of treatment, passive exercise must be employed to prevent stiffness 
of the joint. When much resistance has to be overcome, most good is 
done by constant and regular, rather than intermitting mechanical exten- 
sion. In ordinary cases, flexion and extension may be used for a quarter 
of an hour or more each day. Part xxxiii., p. 158. 
Tenotomy.—In severe cases the operation must be divided into two 
stages, the second operation being performed after a few months. The 
inversion of the anterior portion of the foot must be overcome, and the 
case converted into equinus before dividing the tendo A chillis. At the 
first operation the tendons of the tibialis anticus, tibialis posticus, and 
flexor longus digitorum may be divided. If the tendo Achillis be also 
divided, too many objects are to be attained, and there is imperfect ever- 
sion ; it is, therefore, now an established rule that the tendo Achillis should 
be the last divided. The plantar fascia may be divided at either sitting, 
but if much contracted, it should be done at a separate stage in the treat- 
ment. In performing the operation, introduce the knife obliquely behind 
the tendon and close to it, with the flat surface parallel with the tendon, 
then depress the handle and cut from within outwards, as cleanly and 
neatly as possible, so as not to disturb the surrounding parts, then cover 
the wound with a compress of lint and a little plaster; this will exclude 
the atmosphere and prevent extravasation and inflammation. The foot 
may then be allowed to return to its deformed position. With respect to 
the kind of knife used, the best is the strong spear-pointed tenotome, with 
a cutting edge slightly curved. Part xxxv., p. Y6. 
Talipes Varus.—The theory of stretching the new material formed in 
the reparation of tendon, after division by the knife, is altogether erro- 
neous. The new material does not admit of being stretched like india-rub- 
ber, and then, unlike this material, of being retained at any required 
length. Our object must, therefore, be to regulate the length of the new 
material during its formation. In slight infantine cases, divide all the ten- 
dons necessary at one operation, and after the foot has been retained in its 384 
CLUB-FOOT, 
deformed position by a bandage and splint for three days, apply Scarpa’s 
shoe, and in the course of two or three weeks bring the foot into its 
natural position. In severe cases the treatment, both operative and 
mechanical, must be divided into two stages; the first to overcome the 
inversion of the anterior part of the foot, and thus convert the case into 
one of equinus—the second stage to cure this equinus. The first stage is 
accomplished by dividing the tendons which invert the foot, and then the 
cutaneous punctures being healed by the application of a bandage and 
splint to the outer side of the leg and foot, gradually to produce eversion. 
The second stage is accomplished by division of the tendo Achillis, and 
then by the use of Scarpa’s shoe, to produce flexion at the ankle joint. If 
at the end of the fourth or fifth week the tendo Achillis should still appear 
to be strong, the shoe should be worn only at night, and the frequent and 
regular employment of passive motion is more to be relied on than any 
mechanical aid. 
In all relapsed cases of talipes varus, in which the deformity can be 
removed, the relapse is owing to some defect in the after-treatment. 
Among defects in the primary treatment are, omission of the division of 
the posterior tibial tendon, division of the tendo Achillis at beginning 
instead of at the end of the operative treatment. Among defects in the 
after-treatment are omitting the use of such retentive mechanical means 
as the case may require, and of active and passive muscular exercise, in 
the right direction. The earlier the treatment is commenced the less is 
the tendency to relapse. In very rare cases there is a congenital defect 
in muscular development. Here some form of retentive apparatus must 
be worn by the patient during the remainder of life. In the treatment of 
these cases, where any marked degree of inversion remains, and is accom- 
panied with rigidity of the foot, treat the case throughout as if nothing 
had been done. In most cases division of the tendo Achillis, or of this 
and the plantar fascia, /will suffice. Part 154. 
Unnecessary Orthopcedic Operations.—Operations are resorted to fre- 
quently in the cure of talipes varus. As a consequence, though doubtless 
the cure is more speedy, we have various permanent ill effects which 
might have been avoided. Thus, the fleshy part of the calf is too small 
and too high up in the leg from contraction of the muscle, and the free 
motion of the ankle-joint is impeded by the prolonged rest which has been 
necessary to the success of the operation. Where, then, the foot can be 
abducted by the hand of the surgeon, and whilst so abducted can be bent 
to a right angle, by the use of gentle violence, a cure may be effected 
without tenotomy, before the usual age at which sound children attempt 
to walk, and even if an operation be performed, mechanical treatment 
cannot be dispensed with before this age. When the surgeon cannot per- 
form this movement with the child’s foot, and the imperfectly developed 
os calcis seems tied to the back of the tibia and fibula by deep ligaments, 
and a deep depression exists between the great toe and heel on the inner 
side of the foot, the case cannot be cured without operation. The secret 
of curing the case without operation consists in applying the bandage and 
splints (which may be made of gutta percha, molded leather, or tin) so 
as not to distress the infant. They should be removed at least three times 
a day, and manipulation practised, and reapplied more with a view of pre- 
venting relapse into a wrong position than of forcing the lapsed part into 385 
CLYSTERS, 
a better one ; and during this treatment recollect first to obtain eversion 
of the point of the foot before attempting depression of the heel. 
Although a case may be apparently cured, yet in the course of time 
deformity may again return, owing to the muscles and other textures on 
the originally contracted side of the limb not keeping pace in growth 
with the other. Such cases can generally be restored by due pains 
in efficient instrumental and manipulative treatment. 
Part xxxvi., p. 161. 
CLYSTERS. 
Use of Clysters.—Dr. Hall has long been in the habit of ordering large 
purgative clysters, to evacuate the whole of the large intestines, as far as 
the ileo-coecal valve. In consequence of some eminent practitioners in 
Glasgow doubting whether or not clysters could be made to pass through 
the sigmoid flexure of the colon, Dr. Hall commenced a series of experi- 
ments on dead bodies to decide this important practical question. 
In the first experiment on the dead body, by Dr. Hall threw into the 
bowel live or six pints of thin gruel, and on examination it was found to 
have even passed the ileo-ccecal valve. As far as the operation could go for 
anything on the dead body, this was decisive. The next experiment was 
upon the living subject, a man suffering from stricture of the rectum ; the 
pipe was passed through the stricture, and an injection of five pints of 
gruel thrown up, and on percussion afterward in the region of the colon, 
a dull sound was elicited; before injecting this it was clear. The third 
experiment was performed on a stout man. The abdomen was carefully 
percussed, and the whole of the colon gave a clear sound; the patient was 
placed on his left side, and three pints of injection thrown up into the 
bowel by Read’s enema syringe, and now there was dullness on percus- 
sion as far as the point where the transverse joins the descending colon. 
The man was then placed on his right side, and three pints more injected 
into the bowels. In a few minutes the man went to the water closet 
twice, and after the second time, percussion indicated the presence of 
fluid, as far as the sigmoid flexure of the colon. “ This case was marked 
by an important practical point, viz.: that the best position of the patient 
for the operation is lying upon the right side, not upon the left, as in the 
former cases, and with the pelvis considerably raised.” In the fifth expe- 
riment, seven pints of oleaginous gruel were injected into the bowels, and 
from percussion it was evident that the large bowels were quite filled, and 
probably some part of the small also. In another experiment on a dead 
body, in which eight pints of water were used, the fluid passed through 
all the intestines and even partially filled the stomach. 
Dr. Marshall Hall says, if we wish to wash out the colon, we should em- 
ploy Read’s syringe, and that three pints of warm water will be sufficient 
—his rule for the administration being, “ as slow as possible, and as long 
as possible.” “ In this manner,” says he, “ the intestine is filled before it 
is distended, its peristaltic action is at length excited by the stimulus of 
that distention, and it contracts energetically in a mass, which, by its bulk 
and rapid flow, carries away the feculent matters mechanically.” 386 
COLCIIICUM. 
Dr. Hall prefers purgative clysters, prepared with an admixture of com- 
mon salt and butter, with well-boiled oat-meal gruel. Attention is directed 
to the use of ox-gall in the preparation of enemata. Part xiii., p. 97. 
Nutritive, Enemata.—Perhaps this mode of conveying nutrition into 
the system in cases in which the patient either cannot or will not swallow, 
is not sufficiently resorted to. Mr. Ormerod gives the following case: 
A man of about twenty years of age was admitted with his pharynx 
opened and the glottis exposed. He was unable to articulate, and vomited 
frequently through the wound, for an hour and a half, the fluid mixed 
with blood. On the second day he had an enema of milk. From the 2d 
to the 41st day he took daily, in three enemata collectively, two pints of 
broth made from rather more than one pound of beef. His hunger was 
always appeased by the enemata. When his bowels were confined some 
salt was added, which was sufficient to open them. Once some wine was 
added to the injection. 
On the 41st day the wound was nearly healed, and the man looked 
well, and in tolerably good condition. lie could, however, only speak in 
a whisper. Part xv., p. 215. 
Colchicum—Uses of.—This is a plant of no small importance. In its 
properties it is partly diuretic, partly cathartic. It acts very decidedly 
on the liver, removing torpid states of that organ, and causing yellow or 
even dark stools to succeed grey or white ones. Dr. Dick says: 
In France, colchicum is ranked among diuretics, and undoubtedly it 
promotes the action of the kidneys, and by facilitating the secretion of 
uric acid, is proper in cases of gouty or rheumatic diathesis, and obviously 
controls the paroxysms of arthritis and rheumatism. In what manner does 
colchicum act on the kindey ? Not directly, we apprehend, but indirctly 
by promoting the action of the liver. We have elsewhere called attention 
to a fact of some importance, that often when the liver does not secrete 
duly, and when, consequently, the stools are pale and scanty, neither does 
the kidney act sufficiently, the urine being high-colored or turbid, and of 
diminished quantity—in such circumstances, anything that acts on the 
liver, as, for example, a few grains of calomel or blue pill, causes, very 
soon after, an improved action of the kidney. We believe it to be in this 
indirect manner that colchicum acts diuretically. 
Its action both on the liver and kidneys is satisfactory. When its 
diuretic effect is wanted, and that speedily, the acetum colchici is to be 
preferred. When its cholagogue and cathartic effects are more particularly 
desired, the extract, wine, or tincture, is to be selected. These, more par- 
ticularly the first of them, should rarely or never be given alone, and un- 
combined with some other more safe and certain purgative, as mer- 
cury, aloes, colocynth, scammony. Because colchicum, given by itself, 
sometimes entirely fails to act either as a renal or alvine evacuant, and 
being absorbed, operates alarmingly on the nervous system, causing the 
most marked prostration. 
In cases of gout in robust subjects, accompanied with much hepatic 
COLCHICUM. 387 
COLD. 
engorgement, and in whom the tongue and conjunctive are yellow, the 
most efficient combination is of that of the wine, tincture, or acetum of 
colchieum, given in draught, with from two to six drachms of sulphate of 
magnesia, and two to six grains of nitrate of potass. This may be 
repeated every three to six hours, until the bowels and kidneys are 
decidedly acted on. In these cases, the dose of the wine or tincture may 
be from ten to sixty drops. In old and worn-out gouty subjects, in whom 
any tendency to metastasis has manifested itself, and in the subjects of 
chronic rheumatism, we must be more guarded in the use of the neutral 
salts ; more careful to conjoin with the colchicum, cordials, aromatics, and 
even stimulants. In such subjects, the extracts or tinctures of rhubarb, or 
aloes are the best purgatives to combine with the colchicum. The com- 
pound infusion and tincture of senna may also be tried. Many persons of 
gouty or rheumatic habit or diathesis, but who have never had a fairly 
formed attack of either disease, are subject to innumerable neuralgic 
affections, of very anomalous and perplexing character. Both patient and 
practitioner are puzzled, and perhaps alarmed, by them, until either a 
regular fit of gout, or some rheumatic symptoms, both attended with more 
or less renal derangement, explain at once, and relieve the preceding ob- 
scure and troublesome lesions of sensibility and secretion. A quantity of 
uric acid is voided, and health is, for the first time at least, nearly or 
wholly restored. In subjects of this kind, the anomalous nerve-aches 
referred to may be often removed, and a regular attack of gout or rheu- 
matism prevented (a matter of great importance), by the timely use of 
colchicum. A little of it should be given nightly, or twice daily, Avith 
some ordinary aperient; the neuralgic and other precursory symptoms 
Avill subside, and a crisis be averted. A useful ordinary anti-gout pill (one, 
Ave mean, adapted to mitigate an actual paroxysm) consists of perhaps tAvo 
parts of the extracts of colchicum and colcynth and half a part of hydro- 
chlorate of morphia and repeated every hour or two hours, till boAvels and 
kidney are acted on ; which occurring, pain subsides. A solution of any 
of the preparations of iodine is said to form an antidote to an over-dose of 
colchicum. Part xv., p. 122. 
COLD. 
Effect of Temperature in causing Reflex Actions.—Mr. Barlow, of 
Oxford, draws our attention to many of the excellent effects of cold, when 
applied to the skin, in stimulating the incident nerves, and thereby acting 
as a very powerful agent in the treatment of some diseases. Most of 
these effects may be familiar to all of us, but it is wholesome to be 
reminded of practices and effects, which, sometimes, from their notoriety, 
are apt to be overlooked by the regular practitioner. For example, a 
dash of cold water will often rouse the system from a state of syncope, 
and in coma succeeding to convulsion, the effect will be equally striking, 
even when the respiratory, circulatory, and cerebral functions seem almost 
extinguished. And there is every reason to suppose that some cases of 
coma which depend more upon functional than organic injury, are changed 
from temporary into permanent death, from no adequate stimulus being 
applied to the incident nerves. In many cases of narcotic poisoning, the 388 
COLD. 
sudden application of cold may be repeated time after time with advan- 
tage ; the great source of danger consisting in the blood not being duly 
oxygenated through deficient respiration; the brain thus becoming doubly 
influenced primarily by the narcotic, and secondarily by venous blood. 
Mr. Barlow relates a case of this description. A child took a large 
quantity of opium; fearful coma was the consequence, accompanied by 
long pauses in the respiration and circulation. Cold water was dashed 
on the surface repeatedly, followed by friction, with the happiest results— 
“ the nerves of the skin were made to play that part which, under 
ordinary circumstances, the vagi nerves perform (through the stimulus 
of carbonic acid), and so life was continued, and a perfect recovery 
ensued.” 
In poisoning by prussic acid, and in congenital asphyxia, the cold douche 
will be found a valuable auxiliary to other measures. It occasionally 
happens that a sudden alternation from cold to hot applications, and from 
hot to cold, will be more beneficial than a continuance in the one or the 
other, exemplifying what Dr. Marshall Hall says, “ that it is not the mere 
application of cold, but the sudden application of cold to a warm sui'face, 
which is the effectual means of exciting respiration. It is the sudden 
alternation.” 
As a means of producing contraction of the womb, it is too familiar to 
dwell upon ; but it has not been sufficiently made use of as a stimulant to 
the expulsor fibres of the bladder, as is most interestingly illustrated by 
Dr. Currie, in a case of retention of urine, in which the patient’s feet were 
placed on a cold marble slab, and cold water was dashed over his thighs 
and legs. The effect was instantaneous; the urine burst from him in a full 
stream, although the common remedies had been tried in vain. 
Part viii.}jp. 45. 
Method of Applying Gold.—Dr. Arnott says: 
What I have found a perfect mode of applying cold, is to cover the part 
with a very thin bladder, of the requisite dimensions, containing a small 
quantity of water of the desired temperature, which is constantly renewed 
by establishing a current through the bladder, by means of two pewter 
tubes ; one connected with a reservoir, and having a stop-cock at its end 
to regulate the stream; the other leading to a waste-vessel. The elevation 
of the waste-pipe regulates the quantity of water in the bladder ; and as, 
from the change of position of the patient, this elevation must be frequently 
altered, it is convenient to rest the extremity of the pipe on a sliding ring 
of a common retort stand. By this apparatus, the temperature can be 
regulated with the greatest precision, and (when such a test should guide 
us) water of that temperature can be chosen, whether high or low, which 
is most agreeable to the patient’s feelings. If sudden and severe cold is 
desirable, very cold water running rapidly through the bladder will reduce 
the temperature much more rapidly than the application of ice. Cold and 
heat can thus be conveniently applied (by fixing the ends of the supply 
and waste pipes together, and tying them into one end of the bladder) 
to various internal as well as external parts; the cold to check 
hemorrhage, as in menorrhagia; the heat to promote the natural 
discharge of the part, as in amenorrhoea. When used to restrain hemor- 
rhage, the plugging of the passage by the distended bladder is an 
important part of the treatment, and is much better adapted for its 389 
COLIC. 
purpose than the irritating and less manageable expedients hitherto 
employed. 
A modification of this method of applying cold, contrived for the pur- 
pose of combining pressure with it, has been used, on my recommendation, 
and with great advantage, in a case of strangulated hernia. 
Part xi., p. 192. 
Lead Colic.—Cataplasms of tobacco to the bowels, suggested in cases 
of saturnine colic. JPart i., p. 122. 
Ileus cured by Injection of Air.—A dragoon wTas seized with violent 
colic and symptoms of intense enteritis. An antiphlogistic treatment was 
employed without any benefit. The bowels soon became obstinately con- 
stipated, and he vomited stercoraceous matter ; some mechanical obstacle 
was now supposed to exist. A quantity of air was thrown up the anus, 
and as soon as the intestines became well distended, a copious evacuation 
of solid heces took place. This was soon followed by other stools; the 
vomiting now ceased, and the man quickly recovered. Part iii., p. 57. 
Belladonna incases of Ileus.—M. Becker has employed an injection 
of belladonna w’ith the best effects in a case of ileus. A woman, forty- 
eight years of age, wras seized, without any apparent cause, with constipa- 
tion and vomiting; the ejected matter became gradually more foul, and 
at length fecal matter wras thrown up; this state had continued for five 
days, when M. Becker ordered a lavement, containing four scruples of the 
belladonna root. The pain of the abdomen, vomiting, etc., soon ceased, 
and in half an hour the woman passed a stool, with a good deal of blood 
in it. No narcotic effects were produced by the remedy. 
Part iv., p. 52. 
Treatment of Painter's Colic.—Dr. C. J. B. Williams’ treatment is not 
only the exhibition of powerful purgatives, but the combining them with 
oelladonna, in order to relieve the excessive pain, and following up this 
with alum, when the bowels have been freely opened. In this obstinate 
case, the bowels had not been opened for three or four days. The follow- 
mg was prescribed : 
R Hydrarg. chlorid. gr. iv.; extr. belladonnoe, gr. ss. Cap. statim. 
R Olei crotonis, mij.; extr. belladonnse, gr. ss. micae panis, q. s.; Fiat 
pilula 3tia quaque hora adhibenda donee plene soluta fuerit alvus. 
Abdomini admov. liirud. xij.; et postea foveatur abdomen. 
R Aluminse sulphatis, gr. x.; aqute menthae pip., §iss.; acidi hydro- 
cyan. dil. mv., fiat haustus, ter die sum. Part v.,p. 47. 
Colic during Administration of Acetate of Lead.—If colic arise from 
the use of this medicine, alum will be found very successful. Given in full 
doses, as from a scruple to two drachms every three or four hours, it will 
often allay vomiting, mitigate pain, and open the bowels better than any 
other medicar e. Part vi., p. 192. 
Sulpha,'is Acid a Preventive of Lead Colic.—Mr. Benson saw a 
statement time ago, that in France “sulphuric lemonade ” was very 
COLIC. 390 
COLIC. 
successful in preventing the prevalence of this malady. He has, therefore, 
been trying a mixture of treacle-beer, sulphuric acid, and bicarbonate of 
soda, for his workmen, who were allowed to drink it at pleasure. 
Take of treacle, 15 lbs.; bruised ginger, \ lb.; water, 12 gallons ; yeast, 
1 quart; bicarbonate of soda, 1| ounce; sulphuric acid (oil of vitriol) 
1} ounce, by weight. 
Boil the ginger in two gallons of water; add the treacle and the re- 
mainder of the water, hot. When nearly cold transfer it to a cask, and 
add the yeast to cause fermentation. When this has nearly ceased, add 
the sulphuric acid, previously diluted with eight times its quantity of 
water, and then add the bicarbonate of soda, dissolved in one quart of 
water. Close up the cask, and in three or four days the beer will be fit 
for use. As acetous fermentation speedily takes place, particularly in hot 
weather, new supplies should prepared as required. It is sujyposed that 
the highly poisonous carbonate of lead is by this means converted into the 
innocuous sulphate. The addition of soda gives a pleasant briskness to the 
beer, but is not added in sufficient quantity to neutralize above one-half of 
the sulphuric acid, so that quite sufficient of this remains to convert the 
carbonate into the sulphate of lead. Part vii., p. 48. 
Colica Pictonum.—Give alum, in doses of fifteen grains, every two 
hours. It should be reduced to an impalpable powder, and made into an 
electuary with treacle. Part xix., p. 313. 
Chloroform in Colic.—The internal and external use of chloro- 
form is recommended as a most valuable agent for removing the pain, 
calming the spasms, and facilitating the action of purgatives in cases of 
lead colic. 
The mode of external application, adopted by Dr. Aran, is to pour from 
one to two drachms of chloroform on a wet cloth, and keep it applied to 
the abdomen for a quarter or half an hour. He also gives it in mixture ; 
and in enemata, preceded by a common injection. It is on the local ap- 
plication, however, that he seems to place most reliance. The enemata 
have sometimes appeared to increase the pain. Part xxiii., p. 12G. 
Spasmodic Action of the Bowels.—This disease, so long as it does not 
exceed the limit of spasmodic action, generally terminates favorably; but 
if it should have assumed the character of inflammation, then the prognosis 
will be governed by such an aggravation. 
The indications of cure are: 1st, to relax spasm; 2d, to restore the nor- 
mal peristaltic action. The first will best be fulfilled by a full bleeding, 
opium and the warm bath. The second by purgatives. Fourteen or six- 
teen ounces of blood should be immediately taken from the system, fol- 
lowed by a pill, containing two grains of opium, and, if the continuance of 
the spasm render it necessary, one grain is to be repeated every three or 
four hours. This treatment will usually succeed in subduing the pain and 
vomiting, and sometimes act as an aperient also ; but if it should fail of 
the latter effect, the following pill is to be taken every hour till the bowels 
are acted upon: 
R Ilydrargyri chloridi, gr. j.; extr. coloc. comp., gr. iv. ; olei caryoph. 
q. s. Misce; fiat pilula, oinni hora sumenda donee operaverit. 
FORMULA FOR PREPARING THE SULPHURIC BEER. COLIC, 
391 
The warm bath may be used at this period—the temperature 100°, and 
the patient may be immersed twenty minutes, taking care that the 
temperature be not diminished. 
Sometimes the symptoms of saturnine colic are met with in persons 
not employed in the use of lead. In such a case the gums are to be in- 
spected, and if there be a blue line along their margin, we may be sure 
that the patient has been in some way or another exposed to the deleterious 
influence of this poison. Part xxvi., p. 82. 
Lead Colic.—The preliminary signs induced by the action of lead upon 
the system are more quickly perceptible after the poison has been taken 
in by the respiratory apparatus than by the digestive organs. The sign 
which first appears is a discoloration of the gums. Those parts nearest the 
teeth for one or two lines in length acquire a bluish, or greyish slate 
color, other parts of the gums also become slightly tinged with blue. In 
some cases there is evident congestion, and the slightest touch causes 
hemorrhage. The teeth also sometimes acquire a brown tinge, and be- 
come brittle, though these are uncertain signs. The next sign is the com- 
plexion; a transparent waxy tint being observable in the countenance, 
giving an appearance of excessive delicacy. The next change is that the 
face becomes more emaciated than the rest of the body, and assumes an 
anxious and depressed expression. All these signs may continue for a 
long time, and the workman may, though with impaired vigor, perform 
the duties of his calling. Before actual colic comes on, two new symptoms 
make their appearance, viz., pain and constipation, which are the most 
prominent characteristics of the disease. 
Compound extract of colocynth, with calomel and opium, is the best 
purgative. To prevent the constitutional eflects of the calomel, combine 
these remedies with croton oil. Acute cases are relieved by a bath con- 
taining the sulphide of potassium in the proportion of 4 ounces to 30 
gallons. In the paralysis f rom lead the same bath is valuable, along with 
the galvanic form of electricity. The way in which this is produced is as 
follows: The positive metal is to be considered the lead in the nerves, 
muscles and tissues, and the negative metal plates of copper attached to 
the limb itself, a weak solution of acetic acid forming the oxidating 
link. Acetic acid is chosen because the acetate of lead is soluble. 
Part xxvii., p. 229. 
Colic.—Whatever may be the kind of colic, the first thing is to get the 
bowels open. First put the patient in a warm bath, and while in it, let 
him have a warm water enema ; this is to be repeated after a time so as to 
distend the colon. Then give a pill every three hours, until the bowels 
act, composed as follows : one drachm of compound extract of colcynth 
and three drops of croton oil; divided into twelve. Leeches frequently 
do good, but the majority of cases do not require them. In the more 
obstinate and complicated cases, the use of opium will be of the greatest 
benefit. Part xxviii., p. 126. 
Colic, Painter’s.—Give half a drachm of chloroform every two or three 
hours, and increase this to a drachm, if necessary. It may be given in 
any liquid, such as water. Part xxxi., p. 260. 392 
COLLAPSE—COLLODION. 
COLLAPSE. 
To rouse the vital energies of the human frame in cases of cholera, 
suspended animation, and other causes of apparent sinking from threaten- 
ing collapse, apply scorching hot pillows along the spine every few 
minutes. Part xxiv., p. 335. 
Turpentine in Collapse.—Mr. Whitby relates the following case of 
collapse occurring in a case of measles. The patient was a little boy 
about three and a half years old. lie says : 
On putting my ear to his chest, the air entered both lungs, but crepi- 
tation was most diffuse throughout them, and toward the base of the lower 
lobes it entered but faintly. Under these circumstances, wishing, if pos- 
sible, to clear the bronchi from secretion, and yet fearing the lowering 
efiect of any emetic alone, I was induced to combine with two drachms of 
ipecacuanha wine about forty minims of sp. terebinthinae, having very 
lately seen the powerful manner in which this medicine acts in rousing 
parturient females when almost dead from hemorrhage. I also gave the 
child a mixture, consisting of vinegar, ammonia, and squill, and ordered 
brandy in small quantities. But the action of the ipecacuanha and tur- 
pentine was most surprising; the child seemed to rally immediately, 
vomited, and was much relieved. The next morning it was better, but 
toward the afternoon seemed to be relapsing into its former state. I then 
again administered the turpentine, with the same efiect, and from that 
period he has gradually progressed to convalescence—no strangury or 
unpleasant symptom followed the use of the medicine. 
Part xxvi., p. 325. 
COLLODION. 
Uses of Collodion.—The following is an abstract of the purposes for 
which collodion has been employed in surgery: f 
1. In wounds, ulcers, and other external lesions, it has been employed 
with great success. 
Dr. Whitney employed it in the removal of a wen from the head. To 
obviate the occurrence of erysipelas, from the presence of sutures, Dr. 
Whitney shaved the hair from the scalp, and by means of the cotton solu- 
tion, glued some pieces of sheep-skin on each flap, at a short distance from 
the wound. These straps were then brought together, and retained in 
their position by sutures. The wound healed favorably ; and pain, and the 
usual accidents arising from the presence and removal of sutures, were 
entirely obviated. 
Dr. Comstock employed this liquid as a dressing in a case of extensive 
laceration of the perineum, with a success that, he thinks, never attended 
any other mode of management. The dressings remained firmly attached 
and solid during the process of healing, notwithstanding they were, for a 
time, almost constantly covered by urine mucus, and subject to being dis- 
placed by the motions of the patient. 
Dr. Simpson employed collodion, with perfect success, in some cases of 
painful fissure at the base of the nipple. 393 
COLLODION. 
Dr Simpson also mentions that, in a case where Professor Miller had 
removed a portion of necrosed bone from the lower jaw, he (Dr. S.) 
dressed the wound with collodion, with the effect of retaining its edges in 
apposition. 
Dr. Crawford employed it in the case of a young gentleman who met 
with a severe burn of the face and hands. The burn was covered with a 
thin glazing, which completely excluded the air, and the pain almost im- 
mediately subsided. Its utility in burns has been confirmed by other 
practitioners. 
In idceration of the os and cervix uteri, Dr. Mitchell considers it greatly 
superior to nitrate of silver for forming an artificial covering to the ulcer, 
and permitting the healing process to go on underneath. The ulcerated 
surface being wiped clean and dry with soft lint, the solution is rapidly 
applied with a camel’s hair pencil, and allowed to dry; a second, third, 
and fourth coating, if necessary, can then be applied. The first applica- 
tion is attended with a slight burning sensation, caused by the ether, fol- 
lowed by a sensation of coldness, from its evaporation. The application 
requires to be renewed at the end of forty-eight hours, as the mucus col- 
lects beneath the dressing, and raises it. 
Dr. Yvonneau, ofBlois, communicated the particulars of a case in which 
he had employed collodion, with an amount of success exceeding his ex- 
pectations. The patient, a child of five years old, had extensive fistulous 
idceration of the right cheek, permitting the escape of saliva, as well as of 
food and drink; the cheek had also contracted very firm adhesions with 
the gums of both jaws. After an ineffectual attempt to remedy the mis- 
chiefj by a common mode of operation and dressing, he determined, as a 
last resource, to try the effect of collodion. Having obtained anaesthesia 
by means of chloroform, he carefully brought together the edges of the 
wounds, and retained them in their position by long and firmly aggluti- 
nated bandages, passing completely over the chin, upper lip, and alt nasi. 
Over the whole he applied a layer of collodion, which, besides its adhesive 
property, completely protected the dressings from the saliva and food, 
which had been the main causes of the failure of the former operation. At 
the end of three days, a slight displacement of the dressings rendered re- 
adjustment necessary, when the edges of the wound were found united to 
a considerable extent. On the eighth day, the dressings were again re- 
moved ; when, in place of the enormous fistulous opening, only a small 
cicatrix was found, which at length almost disappeared. The collodion, 
in this case, appears to have been of service, not only in preventing the 
dressings from imbibing fluid from without, but also by preventing the 
escape of saliva, externally, through the wound. 
2. Cutaneous Diseases.—Mr. Erasmus Wilson says: “The diseases of 
the skin in which I have hitherto used the collodion with advantage are, 
chronic erythema of the face ; intertrigo ; chapped nipples and chapped 
hands ; herp'es labialis, preputialis, and zoster; lichen agrius / lupus non 
exedens and exedens / acne vulgaris ; and several affections of the sebi- 
parous organs. Small superficial ulcerations of the corona glandis and 
prepuce, caused by excoriation, were cured by a single application ; and 
in a gentleman very susceptible of excoriation, it acted as a prophylactic. 
From the success of the latter trial, I am induced to think that it might 
be usually employed as a prophylactic, in cases of exposure to syphilitic 
contagion.” 394 
COLLODION. 
Dr. Ranking says: I have not had an opportunity of trying this prepa- 
ration in variola, but I would suggest it as a valuable application to the 
face, etc., for the purpose of excluding air, and thus preventing pitting. 
3. As a Stopping for Teeth.—The method which Mr. J. Robinson 
adopts is, to let the patient first wash the mouth with warm water, in 
which a few grains of bicarbonate of soda have been dissolved. lie then 
removes from the cavity any foreign substance likely to cause irritation. 
After drying the cavity, he drops from a point the collodion, to which 
have been added a few grains of morphia, after which he fills the cavity 
with asbestos, and saturates with collodion. Lastly, over this he places a 
pledget of bibulous paper. In a few seconds the whole becomes solidified, 
and forms an excellent non-conductor of heat and cold to the exposed 
nerve. Part xix., p. 317. 
Properties and Uses of.—Collodion, when properly prepared, is, at first, 
an opaline, adhesive fluid, smelling strongly of ether, and becoming per- 
fectly transparent, by the deposit of a tenacious shreddy material, when at 
rest. When a layer of this is laid on any surface, a transparent coating is 
left, by the evaporation of the ether, which possesses, in a marked degree, 
the properties of contractility and adhesion, as well as transparency, 
pliancy and impermeability. It does away with the necessity for sutures 
in incised wounds of almost any extent. It is sure to remain in intimate 
contact with the skin till union is complete; and, being quite impervious 
to water, and presenting a jmlished surface, it allows the surrounding 
parts to be washed, without regard to the wound or dressing. It is color- 
less and transparent; thus permitting the surgeon to witness all that goes 
on beneath, without involving the necessity for its removal. No heat is 
necessary for its application ; and the presence of a moderate degree of 
cold is only objectionable, in retarding the evaporation of the ether. It 
may be made at a trifling cost. 
Mode of Application.—Dr. Bigelow gives the following directions for 
the application of collodion: “ For straight incisions, of whatever length, 
provided the edges can be brought together without difficulty, it is better . 
to apply the solution in immediate contact with the skin, as follows: The 
bleeding should be arrested, and the skin thoroughly dried. If the lips of 
the wound are themselves in contact, the surgeon has only to apply a 
coating of the solution lengthwise over the approximated edges by means 
of a camel’s hair pencil, leaving it untouched after the brush has passed 
over it until it is dry, during, perhaps, ten or twenty seconds. This first 
film will of itself have confined the edges together ; but in order to increase 
the firmness of the support, more must then be applied in the same manner, 
allowing it to extend on either side of the incision, half an inch, or more.” 
When the wound gapes, the edges must be held together; and if the 
wound be long, the collodion must be first applied to the upper part, and 
allowed to dry. In such cases, something more than the film of collodion 
is required to counteract the tendency of the edges of the wound to sepa- 
rate. For this purpose, Dr. Bigelow recommends gold-beater’s skin, or 
oiled, silk, which maintains the transparency of the dressing; it should 
be applied to the wound after the solution has dried and firmly con- 
tracted. 
If, however, adhesion by the first intention be not desired, the collodion 
may be laid on transversely, like strips of plaster; and one strip should be COLLODION. 
395 
dried, and have the support of gold-beater’s skin, before the rest is applied. 
Room is thus left for the escape of pus, and for the surgeon to view the 
progress of the wound. Collodion answers particularly well after the 
operation for hare-lip, or cancer of the lip, where union by the first inten- 
tion, and a narrow linear cicatrix, are so desirable. The use of one or two 
sutures to the mucous surface is not obviated, as this will not permit the 
collodion to adhere with sufficient certainty. Part xix.,p. 319. 
Uses of Collodion, and Certain Improvements in its Application.—Mr. 
Startin finds that collodion acts rather as an irritant in the more inflamma- 
tory affections of the skin, owing to its contractile property ; but from this 
very property it is extremely useful in procuring the union of wounds by 
the first intention. It is particularly applicable after the operations for 
hare-lip, entropium, and ptosis. 
Pure collodion may also be advantageously employed as a palliative in 
the latter case, as also in various paralytic affections of the facial muscles, 
where the antagonist muscle has distorted the features, the parts being- 
adjusted by the finger to their normal position before the collodion is 
applied, and this position maintained until the solution is perfectly dry. 
As a bandage, also, to enlarged joints, of the fingers especially, the pure 
solution will be found useful; and its pellicle would seem to deserve a 
trial as an artificial tympanum, where such a contrivance maybe indicated, 
the edges of the new membrane being readily attached to the walls of the 
meatus by a small brush, armed with the solution in its liquid form. Other 
instances, where the contractile qualities of collodion may prove of advan- 
tage, will, doubtless present themselves to the surgical mind ; but it will 
not be found so applicable to discharging ulcers as has been stated (save 
in the case of chaps and fissures), unless applied after the following direc- 
tions: Dry the ulcer with bibulous paper; wash over its surface with a 
large, soft brush, wetted with ether ; dry a second time with the paper; 
apply by means of the same, or a second brush, the collodion in a circular 
manner, so as to cover the edges of the ulcer to a greater or less extent, as 
. may be deemed necessary, and varnish over so much of the ulcer itself, as 
to leave a small central opening for the escape of the discharges. This 
expedient at once reduces a large sore into a small one, and does not pre- 
vent any stimulus judged favorable to cicatrization being applied in the 
dry form, before the varnishing process is commenced. 
[Mr. Startin has been endeavoring, by the addition of other substances 
to collodion, to fulfill the following intentions:] 
1st, To render the liquid opaque, and of such a tint as not to be distin- 
guished from the skin on which it might be applied, whilst it should conceal 
defects; 2d, To remove its great contractility and render it opaque, more 
elastic, and more closely resembling the solution of gutta percha, without 
including the unfavorable properties of this solution; and 3dly, To produce 
a varnish which should be porous, and thus imitate, as nearly as possible, 
the natural scarf skin, and thus prevent much of the heat and tumefaction 
which attends the application of an impermeable covering on the skin. 
The first of these objects is readily attained by adding an ethereal tinc- 
ture of turmeric or saffron, and of red Sander’s wood, or alkanet root, so as 
to produce the required tint. The second, after numerous experiments, is 
found to be best accomplished by the addition of a drying, or a fat oil, as 
linseed, cocoa-nut, pure cod-liver, or lard oil, previously dissolved in ether; 396 
COLLODION. 
the proportion being half a drachm to a drachm of oil, to an ounce of col- 
lodion—the exact quantity being regulated by the greater or less degree 
of elasticity and opacity required. It is quite remarkable, how completely 
this simple procedure will accomplish the desired end; for by its means, 
and the colored collodion, so exact a representation of the cuticle can be 
obtained, that the varnish produced, when applied in a thin coat, cannot 
be distinguished from the surrounding skin without close observation and 
magnifying power. It would also appear to be equally elastic with the 
cuticle, whilst its contractility is much modified, or entirely lost, according 
to the proportions of the oil employed; care must, of course, be taken to 
use the best materials only, or the color will not be permanent, but liable to 
change to a yellow dirty hue, whilst it will prove an irritant instead of a 
soothing application. The third object, namely, that of rendering the var- 
nish porous, is also to be obtained by the addition of a small quantity of 
purified, highly concentrated, nearly anhydrous glycerine. By this sub- 
stance the collod. tinct. ppt. can be rendered as soft as a thin layer of oint- 
ment, which it resembles in most respects, save that it forms over the part 
a uniform covering which is coherent, and not liable to be washed away by 
slight discharges, or external gentle ablutions, whilst it does not require 
the support of lint or linen. 
As a simple varnish in cases of chaps, chilblains and other minor affec- 
tions of the cutis, the collod. ppt. will be found a panacea ; but in the bed- 
ridden, who are not provided with Dr. Arnott’s scientific hydrostatic con- 
trivance, it will be found no ordinary boon, as also in cases of inconti- 
nence of urine, and excoriations from the pressure of instruments, trusses, 
etc. As a prophylactic for practitioners in midwifery, in suspected cases, 
or where the hands are injured by disease or accident, it will be invaluable, 
as also in the dissecting room. It should not be applied in too thick a coat, 
and a large, soft camel-hair brush must be used, which should afterward be 
washed in ether. A bottle of ether, also, might always be conveniently 
supplied with collodion, so as to reduce the solution to the required thin- 
ness. Where ulceration is present, a portion in the centre of the ulcer 
should be left uncovered by collodion, in the manner I have already men- 
tioned ; and when any part concerned in motion is to be coated, the skin 
should be put upon the stretch, and marks, etc., should be concealed with 
a proper pigment, before the collodion is painted over the part. 
Part xix., p. 320. 
Mode of Preparing.—Collodion, prepared in the following manner, is 
better adapted for some purposes than that made in the ordinary way: 
Mix 4 lbs. of nitrate of potash with 8 lbs. of sulphuric acid in a glazed ves- 
sel, add the cotton, and agitate for half an hour with a glass rod; then 
wash and dry the cotton very carefully. Dissolve 1 oz. of this cotton in 
16 fluid ounces of rectified sulphuric ether, and when dissolved, add 1 oz. 
of absolute alcohol. When the solution has stood twenty-four hours, it 
will be ready for use. A little of this collodion, alloAved to evaporate till 
it becomes of the consistence of thick paste, answers well for stojqung 
teeth. Part xxi., p. 358. 
Medicated Collodion.—The good effects following the application of this 
substance to affected parts of the skin has induced M.Aran to recommend 
—collodion, 100 parts; tinct. of the perchloride of iron, 100 parts. Mix. 
Dr. Hannon, of Brussels (Presse Mcdicale, 1850), recommends the 397 
COMA. 
combination of collodion with the acetate of lead, by pouring, drop by 
drop, an ounce and a half of collodion into warm, concentrated alcoholic 
solution of neutral acetate of lead, continually stirring up the mixture. 
The saturnine collodion is very supple ; and, according to the ideas of the 
author, participates in the properties of the two principal constituents. 
Part xxxi., p. 238. 
Iodized Collodion, External Use of.—This will be found a very ready 
and efficacious way of applying iodine in very many forms of tumors. The 
quantity of iodine required is less than usual, as it is prevented from eva- 
porating by the pedicle of collodion. Ten or twenty grains to the ounce 
will be sufficient for all ordinary purposes, and often five grains to the 
ounce. It also produces a degree of pressure which, in some cases, is im- 
portant. Other agents, as the alkaloids, soluble in ether, may be applied 
locally through its agency, and soon produce their specific action. 
Part xxxii., p. 317. 
COMA. 
Coma, succeeding to Convulsion.—The sudden alternation of cold to a 
warm surface recommended, in the form of cold and warm affusions. 
Part viii., p. 45# 
Coma and Delirium.—The conclusions to which the facts detailed in Dr. 
Todd’s lectures have led him, with regard to the clinical history of delirium 
and coma, are thus recapitulated: 
1st. That the introduction of certain poisonous agents into the blood, 
either directly or through the digestive organs, is capable of producing de- 
lirium and coma. 2d. That a deteriorated and poisoned condition of the 
blood is favorable to the production of delirium and coma, as in the cases 
of rheumatic and gouty delirium and coma, and of the delirium and coma 
of typhus, erysipelas, and the exanthemata. 3d. That the same state or 
states of brain which are favorable to the production of epileptic convul- 
sions, are likewise favorable to the development of delirium and coma. 
4tli. That the anaemic state, or that state of blood in which the coloring 
matter is very deficient, is highly favorable to the production of delirium 
and coma. 5th. That a shock to the brain—concussion—may produce 
coma, and likewise delirium; and that compression of the brain will pro- 
duce coma, but not delirium. And, lastly, that in all these cases the deli- 
rium or the coma may occur in their highest degree without the slightest 
evidence of any inflammation of the brain or of its membranes. 
But although, in the vast majority of instances, delirium and coma, even 
in their most highly developed states, occur independently of inflammation, 
nevertheless inflammation of the membranes of the brain is undoubtedly 
capable of producing both delirium and coma, and it is often a matter of 
great difficulty to distinguish between the inflammatory and the non- 
inflammatory affections of this kind. 
Inflammation of the brain is, in adult subjects, at least, a rare disease ; 
and, therefore, the delirium and coma arising from this cause is of rare oc- 
currence as compared with other forms, and the inflammatory delirium is 
generally of a low kind, resembling that of typhus, and has a great tendency 398 
CONDYLOMA. 
to pass into coma; and further, is frequently ushered in by vomiting, and 
accompanied by a marked sluggish and slow state of the pulse. 
Part xxi., p. 364. 
Management of Coma.—Be careful in tne first instance, that the coma 
is not from pressure or from inflammation of the brain, or dependent on 
opium or alcohol in the system. Besides these, the coma may be trau- 
matic, epileptic, or renal epileptic, or hysterical, or rheumatic, or gouty. 
Always bear in mind, in cases of coma, to examine also the state of the 
renal and hepatic secretions ; if these fail, coma is the result. As to the 
traumatic form, or that from concussion, the system of non-interference is 
the best. In the epileptic form also, the expectant plan, with moderate 
purging, answers better than any other. In the coma of gout, rheumatic 
or scarlet fever, the treatment must be of the eliminating kind, as blister- 
ing and purging, holding up at the same time the powers of the digestive 
organs. If there is reason to believe the blood is poisoned by urea, the 
hot air bath is of service, giving also drastic purgatives, as elaterium, etc. 
At the same time, always remember, that as delirium is the slighter degree, 
and coma the more aggravated condition of the same state, the treatment 
of the two conditions must be similar. Part xxii., p. 80. 
CONDYLOMA. 
Condyloma, a Primary form of Venereal Disease Identical with 
Sibbens.—The flat and whitish elevations of the skin occurring on the verge 
of the anus, on the perineum, lahia, or scrotum, and occasionally on the 
thighs, or even in the axillae, and known under the names of condylomata. 
lubercules, muqueuses, etc., are in this country generally ascribed to one 
of two causes. By some of our most distinguished writers they are ascribed 
to inattention to cleanliness in persons laboring under chronic discharges 
from the genital organs. 
By others these condylomata are believed to be identical with the scaly 
eruption which follows the true syphilitic sore, modified in its appearance 
by the situation where it occurs. “ When the eruption,” says Mr. Carmi- 
chael, speaking of the scaly syphilitic eruption, “ affects a skin which is op- 
posed by another skin, as between the nates, or between the scrotum and 
thigh, or under the arms, or between the thighs, it is not scaly; but the 
skin becomes elevated into a moist, soft, fiat, or somewhat convex surface, 
which discharges a whitish matter. These are the appearances which, I 
believe, in authors are termed condylomata, fici, cristas, mariscae, etc., de- 
nominations applied according to their figure, or perhaps the fancy of the 
practitioner.” 
The opinion last cited is the one generally adopted by most of our sys- 
tematic writers on surgery regarding condylomata. By M. Ricord and 
other continental writers they are arranged with the secondary symptoms 
of syphilis. 
Dr. Wallace, of Dublin, was the first to point out that it was almost in- 
variably associated with a certain group of symptoms of a peculiar and 
definite character. Of this group the most remarkable pointed out by him 
v-"’s o peculiar morbid state of the mucous surface of the lips, cheeks, pala- 399 
CONDYLOMA. 
tine arches, or tonsils. This morbid state consisted in peculiar white ele- 
vated patches, having the appearance of parts touched with nitrate of sil- 
ver, or coated with milk; these patches are more or less elevated, irregu- 
lar in form, and presenting occasionally superficial ulcerations on their 
surface. 
Dr. Wallace further pointed out that these spots were associated with, or 
rather preceded in general by, an exanthematous eruption of a mottled ap- 
pearance, and of a red or brownish color, sometimes preceded by vesication 
or scaliness, but never by pustules; sometimes elevated and approaching 
in appearance, in various parts of the skin, to the mucous tubercles or 
condylomata commonly observed on the genital organs, and producing in 
the folds of the skin (as between the fingers, etc.) those linear ulcerations 
called rhagades; under the nails, onvxis; on the head, falling of the 
hair. 
From these and other facts, he inferred that condylomata, and the pecu- 
liar patches on the mucous membrane of the mouth and fauces, were parts 
of the same exanthema, modified in appearance by the tissue where they 
appeared, and constituting a group of “ constitutional,” to use his own 
words, “ or secondary venereal symptoms, of which condylomata, rhagades, 
onyxis, falling of the hair, and a peculiar state of disease of the mucous 
membrane of the mouth, are the most remarkable.” To this group of symp- 
toms he gave the name of “ exanthematic primary syphilis.” 
[Another view of the subject is now becoming prevalent, viz., “that 
condyloma is a primary form of venereal disease, distinct from both go- 
norrhoea and syphilis, but equally definite and specific in its character with 
the latter affection.” Dr. Skae having had his attention directed to this 
subject, investigated a great number of cases at the Lock Hospital.] 
The appearance presented on the genital organs and parts in the imme- 
diate neighborhood, were moist, indurated, and somewhat elevated patches, 
of a whitish, and occasionally yellowish-white color. Most of these patches 
were irregular in form, but a considerable number of them, especially of 
those on the labia and thighs, were rounded and prominent. They were 
situated most frequently along the opposite margins of the labia majora, on 
the perineum, and verge of the anus; less frequently on the outer surfaces 
of the labia and adjacent surface of the thighs, and on opposite and corres- 
ponding surfaces of the thighs, two or three inches below the labia. Many 
of them were the seats of superficial ulceration, or more frequently of vesi- 
cation, the surface of the condyloma discharging a thin muco-purulent se- 
cretion. Those which were situated on the opposite sides of the nates were 
less elevated, and presented a tendency to ulcerate in fissures as they ap- 
proached the verge of the anus. 
In two instances, three or four considerable condylomatous patches, white 
and elevated, although flat, were seen extending over the inner surface of 
the vagina, as high as the cervix uteri. 
In nearly all the patients the mouth or fauces presented the appearances 
described by Dr. Wallace as characteristic of this affection. 
In one or two instances only, and those were cases seen at an early stage 
of the affection, was the cutaneous eruption, described by Dr. Wallace as 
a concomitant of the disease, observed. In those cases it presented the red- 
brown stain, the irregular form, and the tendency to scale off, or rather to 
desquamate, which seems to have been regarded by him as characteristic. 
In only one instance did there exist a distinct condyloma in parts of the 400 
CONDYLOMA, 
body other than those enumerated. This occurred in the case of a patient 
who px-esented a very large condylomatous patch in the left axilla. 
My treatment consisted chiefly in the application of stimulants to the 
condylomata; the use of astringent injections and cold washing, for the 
cure of the vaginal and uterine discharges; and in cases of the latter kind, 
the internal administration of tincture of catharides. In several cases, 
when there existed cutaneous eruptions, the iodide of potassium was given. 
In no instance was any mercury administered, except in the case of the 
woman affected with iritis. 
The local application which I have found most advantageous is the sul- 
phate of copper. The condylomata were rubbed pretty freely with a crys- 
tal of this salt, moistened with water, eveiy second day, and in some cases 
daily; and a lotion of it, containing two or three grains in each ounce of 
water, was kept applied by the patient. Under this treatment the condy- 
lomatous excrescences disappeared with remarkable rapidity. In the cases 
where there were ulcers suspected to be syphilitic, these were touched 
occasionally with the nitrate of silver. The patches in the mouth were 
repeatedly touched with the sulphate of copper or nitrate of silver, more 
frequently with the fonner, and disappeared with equal rapidity with those 
on the labia and perineum. 
[Dr. Skae ends his paper with the following conclusions:] 
1. That condyloma is a primary form of venereal disease—specific in its 
character and its origin, and distinct from gonorrhoea or syphilis. 2. That 
it is identical with the disease described under the name of sibbens or 
sivvens. 3. That it is communicable by contagion and inoculation. 4. That 
the difficulty of producing it by direct inoculation, and the similarity of 
the affection of the mouth in cases produced by sexual intercourse, with 
that in which it has been supposed to be produced by contact of the lips, 
etc., render it probable that the affection of the mouth is always a constitu- 
tional symptom resulting from a venereal origin. 5. That it is curable 
without the use of mercury. 
[Sibbens was a disease which at one time ravaged Scotland to a great 
extent, but is now almost extinct.] 
Dr. Gilchrist, in an account published in 1765, of sibbens as it appeared 
in Scotland at a time when it was very prevalent, says : “ It first appeared 
here in the form of a sore throat, or an inflammation of the uvula or pap 
of the haicse, as it is termed, and neighboring parts. The tonsils were 
often superficially ulcerated, appearing either raw or covered with a white 
slough. Frequently there was a thrush, that is, white specks and sloughsy 
upon the roof of the mouth and inside of the clieeks and lips, which com- 
monly showed itself at the comers of the mouth in a small rising of the 
skin, of a pearl or whey color.” 
“ Sometimes there was a hoarseness.”—“ Scabby eruptions were often 
met with on the scalp, forehead, inside of the thighs, groins, and parts con- 
tiguous.”—“ The whole surface of the body appeax*ed mottled or flaked, of 
a dusky copper coloi*, or dirty red.”—“ Inflammation, soreness, and excres- 
cences about the fundament were frequent.” 
Dr. Rose Cormack advises the use of the bichloride of mercury, which 
is no doubt an admirable remedy in many cases, when judiciously given. 
It should be given “ in small and often repeated doses, dissolved ip a large 
quantity of water.” In doses of one-twelfth of a grain, repeated every 
three hours, Dr. Connack strongly recommends this form of mercury in 401 
CONDYLOMA. 
many other obstinate forms of skin disease. In condyloma he also advises 
the internal administration of the iodide of potassium, and ioduret of iron ; 
while his favorite local applications seem to be “nitric acid and chlorinated 
soda lotions of various strength, creasote in the form of ointment (from 10 
to 20 drops to an ouuce of ointment), pitch ointment and the acid tar 
liquid.” Part x., p. 144. 
Condylomata.—Those condylomatous growths arising about the peri- 
neum, scrotum and anus, in old cases of gonorrhoea, may generally be 
cured by the application of yellow wash. Part xxi., p. 270. 
Treatment of.—When these are about the anus and other parts, sprinkle 
a little calomel over them every two or three days. In children, use the 
grey powder, and for distant patients whom you seldom see, use the fol- 
lowing : Hydrarg. chlorid. gr. viij.; zinci oxyd. gr. viij.; mucilagin. 5ij.; 
aquae 5yj.; Ft. lotio. Part xxxi., p. 196. 
Condyloma.—In the removal of large condylomatous growths, where 
the peduncle is broad, it will be better to pass two double ligatures through 
the neck, so as to include a smaller portion in each ligature, and to avoid 
the risk of hemorrhage from the ligatures slipping. When the growths 
are large or numerous, the lithotomy position will be found much the most 
convenient for securing the vessels. Part xxxiv., p. 162. 
Condyloma.—Dr. Gillespie applies the name of condyloma to all those 
more or less rounded elevations of the skin so frequently met with on the 
genital organs, or in their neighborhood, in the course of venereal diseases, 
but which are also occasionally observed where no disease of a venereal 
character exists. 
These excrescences may be solitary or clustered together, either dry or 
moist, secreting a sero-mucous or muco-purulent fluid, and are almost in- 
variably situated,, or may be traced to have commenced, where there is 
friction between opposing surfaces—as the labia majora in the female, the 
root of the penis and scrotum in the male, the folds of the nates, the peri- 
neum and anus, in either sex. 
First remove the exciting cause and enjoin strict cleanliness, afterward 
apply a strong solution of the sulphate of copper, or the solid sulphate. 
This also forms an excellent gargle for the affection of the throat. When 
syphilis is present, a mild mercurial course may be necessary for other 
symptoms. Part xxxv., p. 161. 
Venereal Warts.—Instead of using the stronger caustics and escharotics, 
or removing them by operation, all of which cause exquisite pain, and often 
do not succeed, apply a solution of chromic acid in distilled water, in the 
proportion of 100 grains of the crystallized salt to the fluid ounce of water. 
It is best applied by aid of a pointed glass rod, or where a large quantity 
is needed, by means of a small glass tube drawn to a point. Only so much 
should be applied as will saturate the diseased growth, avoiding the sur- 
rounding healthy parts. If the warts are very extensive, only a part may 
be treated at once, and repeated applications are necessary. But little 
pain is caused by this application, and the warts waste and disappear. The 
best immediate dressing is dry lint, and after the first twenty-four hours, 
free ablution of the parts and a dressing of dry lint twice daily should be 
enjoined ; or to check any inflammation, the parts may be washed with a 
solution of lead, and the lint moistened in the same. Part xxxv.,p. 164. 402 
CONGESTION CONIUM. 
Condylomata.—In those raised patches of skin, known as mucous tuber- 
cles, or condylomata, existing about the verge of the anus, and around the 
genitals, but especially those which are wide spread and flat, the applica- 
tion of a powder, consisting of equal parts of savin and alum, will be found 
very successful in producing diminution of the swelling, and causing them 
to dry up. Part xxxix., p. 229. 
CONGESTION. 
Muriate of Ammonia Internally.—Its combination with the tartrate of 
antimony, in a solution of extract of liquorice, is a valuable prescription. 
The following is the form usually employed: 
R Ammonioe mur. ~j.; ext. glycyrrhiz. 3iij.; antim. tartar, gr. ij.; aquae 
destil. §viij. M. 
A large tablespoonful of this mixture is administered every two hours. 
The antimony forms no inconsiderable part in the operation. When its 
nauseating effects have made sufficient impression upon the disease, it may 
be withdrawn, and the muriate continued by itself. In many cases the 
latter is only administered. Should diarrhoea supervene, suspend the use of 
the muriate, pro tern. 
Where the tongue is loaded, it cleans rapidly under its use. A variety 
of affections of the mucous membrane, sore throats, enlarged tonsils, re- 
laxation of the uvula, etc., feel its influence. Part ix., p. 86. 
CONIUM. 
Use of Conium.—Dr. Neligan thinks that the almost ulniversal discre- 
dit of the medicinal powers of conium is owing, in a great measure, to 
the heat which is employed in preparing the extract. He tests the 
extract by what is called the potash test, a very simple and certain mode 
of ascertaining its value. 
This consists merely in triturating in a mortar the preparation we wish 
to test with a small quantity of strong caustic potash, when the peculiar 
odor of the active principle, conia, is in a few moments emitted; care, 
however, must be taken not to confound this odor with that of the plant 
itself, from which it differs most remarkably, the latter bearing a singular 
resemblance to the smell of mice, while that of the conia is a peculiar, 
penetrating, very disagreeable, somewhat alkaline odor, an acquaintance 
with which may be easily acquired by applying the test to the fresh green 
leaves, or to the recently gathered ripe fruit. 
[Dr. Neligan uses what is called the succus conii instead of the extract.] 
This is prepared as follows: 
Take of fresh hemlock leaves any quantity, express the juice in a tinc- 
ture press, set it aside for forty-eight hours, pour off the clear, supernatant 
liquor from the fecula and chlorophylle which it has deposited, and, lastly, 
add to it a fifth part, by measure, of rectified spirit. This preparation will 
keep well for two years, and its uniform strength, as well as the facility CONSTIPATION. 
403 
with which we can increase or diminish the dose we are administering, 
gives it a decided advantage over either the extract or powder of the fruit 
or leaves. The best time tor gathering the leaves is when the plant is in 
full flower, and previous to submitting them to expression, the stalks 
should be carefully picked out and rejected, the leafy part alone being 
used. 
The cases in which the sitccus conii was found most beneficial were 
obstinate rheumatic pains, severe chronic arthritis, subacute rheumatism 
of the muscles of the leg, and facial neuralgia. The dose was generally 
thirty minims three times a day, in a little water. This may be increased 
to forty or sixty minims, and decreased or left off according to the effects 
produced. The most unpleasant effect when given in full doses was a dis- 
agreeable sensation of dryness in the throat, accompanied with a feeling of 
constriction, and some difficulty in swallowing. When this is the case, 
the medicine ought to be omitted for a short time. Part x., p. 87. 
CONSTIPATION. 
Habitual Costiveness and want of secretion in the bowels may often 
be remedied by two or three grains of extractum conii, with as much 
pilula hydrargyri—given at bed-time. Part i., p. GO. 
Nitro-muriatic Mixture—Case.—“During the protracted ill-health of 
this young man, anorexia, indigestion, constipation of the most obstinate 
kind, low spirits, etc., were constant attendants. The constipation was so 
obstinate and constant as to resist the action of the most powerful and 
certain of the ordinary cathartic remedies in a very great degree. 
“ In this state of the case, after five weeks’ trial with internal cathartics, 
it occurred to us to make the experiment with the nitro-muriatic mixture. 
We formed the mixture of equal parts of nitric and muriatic acids and 
water; of this, from six to twelve drops, properly diluted with sugared 
water, were administered through a small canula of reed, to prevent its 
action upon the teeth, three times during the day, varying the doses so as 
to give the largest at noon and at night. At the same time, from thirty 
to forty drops, diluted in two or three times as much simple water, were 
applied with a sponge over the regions of the liver and epigastrium, and 
to the insides of the arms and thighs, having previously washed away 
from the skin, with soap and water, its unctuous secretion, to enable the 
acid mixture more readily to penetrate. In this manner the remedy was 
continued for three days before any decided impression was formed upon 
the constitution by it. About the close of the third day some improve- 
ment of appetite, and of the buccal secretions was manifested. But on the 
morning of the fourth, to the surprise and gratification of our patient, the 
bowels acted freely. For two or three days the remedy, although partially 
discontinued, acted rather too freely upon the bowels; after this time, 
however, they became more tranquil, and gradually acquired a state of 
solubility, of the most comfortable nature. It was found necessary, in con- 
sequence of the deficiency of the biliary secretion, as manifested by the 
appearance of the alvine discharges, to continue the use of the acid 404 
CONSTIPATION. 
mixture, both internally, and externally for some days after it had un- 
locked the bowels. His recovery from this time was progressive and rapid. 
“We believe the acid mixture is especially adapted to the treatment of 
morbid states of the human body, based in chronic inflammation, or 
engorgements of the capillary and parenchymatous structures of an indo- 
lent nature. 
Prof. Mettauer adds that in diseases of decided inflammatory character, 
the acid mixture is entirely inapplicable. Part i., p. 80. 
Constipation with Fissures of the Anus.— Vide “ Fissures of Anus.” 
Constipation accompanied icith Vomiting—Croton Oil.—In cases 
of constipation accompanied with vomiting, its combination with opium is 
often advantageous, exhibited in the form of a pill, viz., two or three 
drops of croton oil and one grain of opium. The opium tends to relieve 
the vomiting, but does not prevent the purgative operation of the oil, 
which generally takes place in a few hours after the dose is swallowed. 
We have found the oil a valuable addition to the compound colocynth pill 
as a laxative in very obstinate conditions of the bowels, in the proportion 
of one eighth of a drop to each pill. Part v., p. 45. 
Sidphate of Zinc in Constipation, and Flatulent Affections of the 
Colon.—“What Dr. Elliotson recommends for sulphate of copper, viz., to 
give it immediately upon a meal to prevent nausea, is ajjplicable to sul- 
phate of zinc, and where this precaution is not sufficient, I have found the 
addition of opium enable tiie stomach to bear the full dose, with the single 
disadvantage of occasionally inducing thirst. Thus: 
11 Zinc, sulph. gr. xviij.; pulv. opii gr. iij.; mucilaginis q. stiff. M. ft. 
pil. vj., cap. un. quinta quaq. hor. post cib. 
Where the stomach could dispense with opium, I have directed a pill to 
be made up with one grain of extract of rhubarb or of gentian, to three 
of sulphate of zinc, and taken four or five times in the twenty-four hours. 
It is a main object of this plan to throw at once a strong solution into the 
caecum and large intestines, and, since small doses only can be passed 
through the stomach, they must be made to succeed each other rapidly. 
Occasionally after fifteen or twenty grains have been taken, there is 
intolerance of a further dose, and vomiting occurs even when the medicine 
is qualified with opium.” Part vi., p. 31. 
Use of Ox-gall.—Cases of constipation, dyspepsia, acidity, etc., cited— 
cured by the use of ox-gall. The following formula, recommended by 
Dr. Clay: 
R Fel. bov. inspiss., 3ij.; ol. carui ntx.; magnes. carbonatis q. s. ut 
fiat massa. M. 
Div. in pilulas xxxvj., capiat ij. ter in die. 
Dl\ Clay further suggests, when necessary, the combination of two or 
three ounces of recent gall, diluted with as much tepid water, to be used 
as an injection. Part vi., p. 65. 
Constipation, Consequent on Paralysis.—Sir B. Brodie recommends 
the following: 
R Comp. ext. colocynth, two scruples and a half; soap, half a scruple; 
croton oil, one drop. Mix, and divide into 12 pills. Dose, one or 
two every night, as wanted. Vide Art. “Paralysis.” Part ix.,p. 100. 405 
CONSTIPATION. 
Constipation—Use of Colchicum in.—On this subject, Dr. Chapman, 
of Philadelphia, makes the following remark on the use of colchicum: 
Prom ten drops of the radical tincture of colchicum, repeated several 
times in the twenty-four hours, and persisted in for some time, as much 
may be anticipated with a view merely to the restoration of the lost 
susceptibility of the bowels, as from anything else within my experience, 
rarely, indeed, having seen it fail. It is essential, however, to its success, 
that the dose be small, and this is a precept to be observed in relation to 
all medicines in this form of constipation. The object being attained 
rather by gradual insinuations than by forcible impression. 
Peristaltic Persuader.—The laxatives from which Dr. Chapman has 
observed advantage are, extract of the butternut (juglans cinerea) the 
bile of the ox, brimstone with muriate of soda, and the sulphate of soda 
and magnesia in a considerable quantity of warm water, but his favorite 
remedy is the peristaltic persuader: R Rhei 5j.; ipecac, gr. x.; 
ol. caruigtt. x.; acacia q. s. ft. pil. xx.; cap. ij. o. n. Part xi., p. 62. 
Treatment of Habitual Constipation by Alum.—Mimosis acutus was 
first accurately described by Dr. Marshall Hall, though in reality a very 
common disease. The constipation in this disease, Dr. Aldridge thinks, is 
dependent on feeble nervous action, and accordingly finds alum of great 
benefit in its treatment. It usually occurs between the ages of thirty and 
fifty, and is more frequent in women than men, on account of their 
sedentary habits. 
The individuals who labor under it, are usually of a dusky complexion, 
or more exactly speaking, the skin always presents a dirty appearance. 
The face is frequently coated with a greasy-looking perspiration. The 
breath is foul; the gums spongy, and apt to bleed; the tongue broad, flat, 
flabby, indented at the margins by the pressure of the teeth, and coated 
with muco-purulent exudation. The bowels are usually constipated ; yet 
the patient may tell you that he has daily alvine evacuations, and yet the 
colon may be in a state of distention from foecal accumulation. The abdo- 
men is swollen, and feels unequal to the hand, the course of the ascending 
and transverse colon being more resisting than the other parts to pressure; 
in these situations there is also sometimes tenderness and even pain. 
Besides the foregoing symptoms, the patient almost constantly complains 
of headache; says he is very nervous, subject to tremors, and sudden 
flushings of heat upon excitement, as well as palpitation of the heart, and 
epigastric throbbings. 
Looking on mimosis acutus as a disease essentially consisting in a semi- 
paralytic state of the ganglionic nervous system, its analogy to colica pic- 
tonum seemed very evident; and in connection with this analogy, the 
medicine that was found useful in the one disease, would naturally suggest 
itself, as being likely to prove beneficial in the other. Accordingly, he was 
led to exhibit alum in comparatively large doses, in cases of habitual cos- 
tiveness accompanied by the symptoms described, and experienced its 
administration to be followed by advantages which could not be hoped for 
from the use of ordinary purgatives. It may appear paradoxical to give 
an astringent in cases characterized by constipation, but in the treatment 
of every disease, we should as far as possible ascend from the consideration 
of symptoms, to a contemplation of the lesions upon which they depend. 406 
CON STI PATTON. 
Combined with magnes. sulpli. he has found that the disagreeable taste 
of this salt is greatly disguised, while the tendency of the saline purgative 
to increase the formation of gas is controlled. In the dose of 9j. or 5ss. 
alum by itself will produce large and very solid evacuations. The contra- 
indications to its use are of course the existence of gastro-enteritis. 
For private practice, the following formulas may be employed: 
$ Infusi rosarum, gviij.; sulphatis magnesias, §j.; aluininis, 3ij. Misce. 
Sumat cochlearia duo ampla cum aquas cyathis vinariis duobus, primo mane, 
quotidie. 
fy Infusi rosarum, gvijes.; aluminis, 5ij.; tr. cardam. comp. §ss.; misce. 
St. cochlearia ampla duo, ter die. Part xii., p. 82. 
Ox-gall in Constipation during Pregnancy.—Dr. Allnatt reports the 
case of a patient of his three months advanced in her first pregnancy. 
She was habitually constipated, but at this time the stomach became so 
irritable as to reject all aperients which were given her. Warm water 
enemata also failed in relieving the bowels. Dr. A. adds: 
I then resorted to the inspissated ox-gall, a drachm of which I directed 
to be dissolved in about a pint of warm water, and used as an enema. 
The relief was instantaneous ; a mass of scybala being expelled Avhich 
had evidently lain impacted in the colon. Part xiii., p. 102. 
Constipation.—When it arises from obstruction near the junction of 
the ileum with the caecum, inject air into the bowels. 
This plan of treatment, Dr. Chevers observed, was recommended by an 
American writer, and had often been employed with success in the intus- 
susception of children. Part xiii. p. 103. 
Accumulation in the Colon.—In ordinary cases, the best evacuant of 
the colon, in its loaded and preternaturally offensive state, is a bolus, at 
night, of blue pill, aloes, and myrrh, followed, next, morning, by a dose 
of castor oil, with or without a turpentine enema. Turpentine has a most 
cordially stimulating and corrective effect in loaded, torpid, foetid, and 
flatulent states of the caecum and colon. In some cases it is necessary to 
repeat the above bolus, on alternate nights, for a week or ten days, before 
the desired subsidence and softness of the abdomen, in the track of the 
caecum and colon, are obtained; by which we are assured that the great 
bowel is disembarrassed of long-formed accumulations. A course of vege- 
table bitters and laxatives, such as aloes and taraxacum, and injections 
of cinchona and oak-bark decoction, are simultaneously to be employed. 
Part xv., p. 114. 
Hints on Constipation.—In all cases of constipation or torpor of the 
bowels, attention to the caecum is important. It is here that faecal accu- 
mulations are, on several accounts, apt to take place. The circumstance 
of the large bowel here forming a cul de sac, out of which, moreover, the 
faecal matter, during fourteen or sixteen of the twenty-four hours, can oidy 
escape by a course counter to gravity, disposes not a little to the collection 
there of excrement. 
There is no doubt that, in not a few cases, a state of chronic irritation, 
of (sub-)inflammation, and even of ulceration of the mucous membrane of 
the caecum, is induced, from the prolonged contact of hardened faeces, 
which, moreover, has become preternaturally foetid, and undergone certain 
irritating chemical decompositions. In such circumstances, either round 407 
CONSTIPATION. 
or irregular masses of a fatty-looking substance may often be detected in 
the evacuations. This consists of inspissated mucus, secreted by a surface 
highly irritated or sub-inflamed. A slight prolongation or increase of 
such irritation will convert this inspissated mucous discharge into a puru- 
lent one. 
The fact of accumulation in the czecum being ascertained, a bolus or 
pills, containing ten or fifteen grains of blue pill, aloes, and hyoscyamus, in 
equal parts, are to be given at bed-time, on one, two, or three alternate 
nights. Next morning, a dose of castor oil is to be taken, and means 
afterward are to be used, both dietetic and purgative, to keep the bowels 
patent, and prevent a recurrence of the impaction of the ccecum. Injec- 
tions are of much use in this complaint, though only, indeed, of temporary 
utility. They should be of an oleaginous quality, and be large in quan- 
tity, and either during, or subsequently to, their being administered to 
him, the patient should lie on his right side, so as to promote the passage 
of the injection to the ascending colon and the ctecum. The right groin 
should be gently, but effectually, kneaded, as it were, by the hand of the 
patient himself, or of an assistant. In this way, lumpy masses of faeces 
which had obviously accumulated in the caecum, may often be brought 
away, to the great relief of the patient. A tablespoonful or two of oil of 
turpentine added to the injection, adds much to its efiicacy. This oil 
seems to exert a most salutary influence on the colon. Part xv., p. 115. 
Constipation—Habitual in Young Persons.—There is a form of 
constipation which occurs in young persons, and is-the result of dryness 
and solidification of the faecal matters from active absorption in the small 
intestines. 
First try dietetic means; barley and oatmeal porridge, brown or rye 
bread, plenty of green vegetables, fruit, and lemonade or cider. In addi- 
tion to these means, give clysters of warm water, or of gruel with castor 
or olive oil, or turpentine. If these fail, give purgatives which act on the 
lower bowel; aloes, with myrrh, or galbanum, and sulphur, and next to 
these, castor or olive oils. Or give Pullna, Seidlitz, Vichy, or Aix-la- 
Chapelle waters. To children give phosphate of soda, which may be 
added to soup, instead of salt. Purgatives should be taken not once, but 
several times in the day, directly before, or during, or soon after the 
principal meals. Part xvi., p. 152. 
Constipation.—When dependent upon loss of tone in the muscular 
fibres of the bowels, give acetate of lead, three grains, with one-sixth of a 
grain of acetate of morphia, every four hours, and a turpentine enema 
every evening; or sulphate of zinc with opium may be tried. Vide Art. 
“Flatulence.” Part xvii., p. 114. 
Ox-gall in Constipation from Impacted Faeces.—When there are hard 
impacted faeces, give eight grains of inspissated ox-gall thrice a day, and 
enemata of diluted gall to the amount of two quarts, night and morning. 
Part xvii., p. 115. 
Employment of Nux Vomica in Habitual Constipation.—[Observing 
a recommendation of the extract of nux vomica, in habitual costiveness, 
Mr. Boult was led to give the alcoholic extract in doses of half a 
grain thrice a day, to patients of costive habits, with but slight effect, 
lie says:] 408 
CONSTIPATION. 
I was then led to add the same quantity of the extract (half a grain) tc 
a pill containing aloes, rhubarb, and scammony, and was surprised at the 
result. I found that this drug lias the power of increasing very sensibly 
the activity of purgative medicines. I ascertained that an aperient 
scarcely sufficient by itself to produce a single evacuation, when combined 
with this extract, caused active purgation. The dose must be varied 
according to the patient’s idiosyncrasy, but, generally speaking, a pill, 
containing three-quarters of a grain of Barbadoes aloes, three-quarters of 
a grain of extract of rhubarb, and half a grain of the extract of nux 
vomica (Pharmacopoeia Edinensis), if taken at bed-time, will produce one, 
or perhaps two, full evacuations the following morning. The addition of 
a single grain of calomel to this pill will cause two or three bilious mo- 
tions, thus showing that the drug possesses not only the property of stimu- 
lating the muscular fibres of the bowel, but also the power of increasing 
the activity of medicines that affect the secretions. 
There is an observation to be made with regard to the employment of 
this medicine, in order to prevent disappointment to those using it. It is 
essential that the extract should be good. Alcoholic extracts are trouble- 
some and expensive to make ; this preparation is particularly so, and con- 
sequently the common article of commerce is not always to be depended 
upon. Part xviii., p. 116. 
Uses of Electricity.—In constipation from paralysis of the intestinal 
canal, employ galvanism. Bring the conductor from the positive pole in 
contact with the tongue, and place that from the negative pole, previously 
covered with a thin piece of cloth, in the rectum, and pass a current 
through them for about twenty minutes. The patient may not be able to 
bear a battery of more than about eight pairs of plates. 
Part xxi., p. 85. 
Use of Calomel.—The best way of giving calomel as a purgative, is to 
mix it with a little table salt, and jfiace it dry upon the tongue ; it must 
not be combined with any other purgative, and the patient must abstain 
for some time from taking water and other fluids. Part xxi., p. 151. 
Aperient Solution.—Professor Mattauer, in an article on constipation, 
speaks in the highest praise of the following aperient solution: R Aloes 
soc. giiss.; soda? supercarb. §vj.; aquas Oiv.; sp. lavend. co., §ij. After 
digesting for fourteen days, the clear liquor may either be decanted off or 
allowed to remain. Age improves both the taste and power of the solu- 
tion. It should be given about half an hour after dinner, and supper. The 
common dose is 3j. although it may be increased to §j. 
Part xxiii., p. 300. 
Tartrate of Soda as a Purgative.—M. Delioux recommends the crys- 
tallized tartrate of soda as a most agreeable and certain purgative, being 
quite equal in power to the sulphate of soda or magnesia, and not repug- 
nant to the taste. The medium dose for active purgation, is ten drachms, 
little or no colic attending its action. The sulphate, phosphate, and tar- 
trate of soda, and the tartrate of soda and potassa, may indeed be substi- 
tuted for each other as regards their purgative action; but the tartrate of 
soda surpasses them all in pleasantness of taste. Part xxv., p. 122. 
Calomel and Soda as a Cathartic.—Give two grains of calomel with CONVULSIVE AFFECTIONS. 
409 
ten or twenty grains of bicarbonate of soda. After the bowels and liver 
have been well acted upon, the medicine loses its power and should be dis- 
continued. The soda seems to exert some influence in preventing the 
mercury acting upon the gums. Part xxvi., p. 325. 
Formula for the Administration of Elaterium.—The following pre- 
scription, copied from the Pharmacopoeia of the London Hospital, is a 
very convenient one for the administration of elaterium: 
R Elaterii extract, gr. iss.; pulv. capsici gr. vj.; hydr. chlorid. gr. xij.; 
ext. gentian. 5ss.; sacch. faecis q. s. Ft. pil. xij. Sit dosis j. vel ij. 
If needful, the proportion of elaterium may be increased to 2 or 3 
grains, according to the wishes of the prescriber. The capsicum is of the 
greatest use in preventing the distressing nausea which elaterium often 
causes. Part xxxi., p. 307. 
Nux Vomica in Constipation.—In obstinate cases of this kind you 
will find the following a very capital pill: Half a drachm of extract of hen- 
bane, one scruple of extract of*colocynth, and three grains of extract of 
nux vomica, made into twelve pills, one to be taken night and morning. 
Part xxxiv., p. 101. 
Constipation in Children.—The chief cause of constipation in nurs- 
lings is the insufficiency of sugar in the breast-milk. Speedy and full relief 
may generally be given by ordering some sweet sugar water to be taken 
every day besides the breast. Part xh, p. 244. 
Compression of the Carotids in Convulsive Affections.—The follow- 
ing cases illustrate the method of treatment: 
The first of these cases was that of a man 24 years of age, strong and 
vigorous, who had been subject to epileptic attacks for 5 years, and which 
were of daily occurrence, sometimes lasting two hours, and very violent; 
the compression of the carotids at the commencement of the attack always 
caused them to cease a minute afterward. The second case was that of 
a young person 15 years of age, epileptic from infancy, occurring every 
second day, and of six hours’ duration. The convulsions were confined to 
the right side of the face and the upper extremity of the same side. In 
this case he only compressed the left carotid, and the success was equally 
marked as in the former. It is necessary, adds M. Stroehlin, that the 
compression should be as circumscribed as possible, so that the returning 
current in the jugular vein be not interfered with. M. Stroehlin refers to 
cases where ligature of the carotid has been applied for the cure of epi- 
lepsy, for tumors of the face, for wounds of the artery itself; in which 
latter case the patient had been previously epileptic, but when the opera- 
tion was concluded the convulsive affection disappeared. JPart iii., p. 61. 
Oxide of Zinc in certain forms of Convulsions.—The good effects of 
oxide of zinc in cases of convulsion resembling epilepsy are brought for- 
ward in an interesting case by Dr. Hennis Green. He gives it in two 
grain doses twice a day; the closes to be increased two grains every day. 
CONVULSIVE AFFECTIONS. 410 
CONVULSIVE AFFECTIONS. 
In the case which Dr. Green relates twenty-four grains daily were at last 
given with great success. The fits, which occurred frequently before this, 
now disappeared, and did not return till the remedy was discontinued; 
on resuming the medicine the fits again disappeared as at first. 
Part iv., p. 25. 
Infantile Convulsions treated by Ice to the Spine—Case.—The child 
which gave rise to the following observations of Dr. Todd, was convulsed 
before admission into the hospital. When admitted, the following were 
the symptoms: 
Total absence of consciousness; powerful convulsive twitchings of the 
flexor muscles of the right side, and also of the muscles of the face on the 
right side ; internal squinting ; pupils natural; respiration heaving and dif- 
ficult ; deglutition impossible ; action of the heart very rapid. Such were 
the symptoms—they were symptoms of irritation—and the first inquiry of 
the medical man should be, What is the cause of the irritation ? 
The convulsions continued in spite of the usual treatment. The gums 
were freely lanced ; the warm bath, a turpentine enema, cold to the head, 
leeches, etc., were in vain tried. Mr. Pincott, the resident assistant, then 
suggested the application of ice to the back of the neck and spine, “ with 
the view of calming, by the sedative agency of cold, the irritable state of 
that portion of the cerebro-spinal axis which he rightly judged to be 
affected, the medulla oblongata and spinalis.” The happest results followed. 
Ice was applied in an ox-gullet along the course of the spine, extending 
from the occiput to the sacrum. Immediately on its application, the 
breathing became easier, the child sighed several times, the pulse fell 
rapidly, and in ten minutes the convulsions had entirely ceased. 
He would, however, impress that it would not have been good practice 
to have applied the ice, unless the gums had been previously freely scari- 
fied, and means used to clear out the bowels. Part v.,p. 67. 
Rapid Vesication and Counter-irritation by Burning Ether, etc.—In 
cases which require very rapid and energetic counter-irritation, the prac- 
tice of Mr. Edwards may occasionally be resorted to—viz.: that of rub- 
bing ether, spirits of wine, or any other spirituous application on the 
part intended to be blistered, and then setting fire to it; in short, it is 
another way of applying the actual cautery. In one case of the convul- 
sion, Mr. Edwards says: 
As a last resource, I rubbed the spine with gin, from the ceiwical to the 
lumbar region, and set it on fire; in less than half a minute the convul- 
sions ceased. The boy was now put into a blanket, carried to bed, purged 
freely, and in a few days was convalescent; he was about eight years old. 
Part v., p. 80. 
Use of Indian Ilemp in some Convulsive Disorders.—Mr. Ley relates 
some good cases in 'which it was very useful. In a case related by Mr. 
Ley, in which the slightest motion was attended with great pain and 
spasms of the muscles of the back, the latter being so violent as to draw 
the body into the form of an arch, it produced a remarkable degree of 
relaxation of the muscles. He gave a grain and a half of the extract 
every half hour, and its effects were strikingly evident after the fifth dose; 
the muscles became relaxed, and the patient fell into a tranquil, but over- 
powering sleep of ten hours’ duration ; she then awoke with little exhaus- CONVULSIVE AFFECTIONS. 
411 
tion, and pleased beyond exj>ression at tlie relief she had received. In a 
case of chorea, in a girl twelve years of age, Mr. Ley gave half a grain of 
the extract three times a day for three days, when the girl was over- 
whelmed with fear, the muscles, which had been affected with rigid spasm, 
became relaxed, the power of speech returned, and at the end of a week 
or ten days she was perfectly recovered. But although relaxation of the 
muscles followed the exhibition of the medicine in all cases, it did not 
always effect a cure of the disease which produced the muscular spasm. 
It generally, however, produced an alleviation of the painful symptoms. 
In a case related by Mr. Ley, in which a coachman, by the constant use 
of his arm, presented a swollen, hard, and stiff state of the muscles of 
that limb, with an enlarged bursa on the olecranon, three grains of the 
extract caused a wonderful abatement of the symptoms by the next morn- 
ing, together with considerable diminution of the enlarged bursa. In 
another case of severe sprain of both wrists, in which the patient had lost 
the grasp of his hand, and where the wrists were distended with very 
much fluid, both in the joint and under the flexor tendons, a grain of the 
extract was given three times a day for three weeks with considerable 
relief. In a case of the crowing-respiration in a child nine months old, 
the sixth of a grain of the extract was given, and the little patient fell into 
a tranquil sleep, and on awaking had not its usual spasmodic attack; the 
dose was continued three times a day for a week, with very considerable 
benefit. Part vi., p. 27. 
Mustard in Infantile Convulsions.—Dr. Tripler treated a case of con- 
vulsions from teething with mustard, which he employed for its emetic 
effects—he had previously employed antimony, sulphate of zinc, sulphate 
of copper, and the usual emetics, but without being able to make any 
impression on the stomach. In a few minutes after its employment it 
arrested a fearful attack of convulsions, which had lasted five hours, and 
that without vomiting the patient for some time afterward—he afterward 
used it in several other cases, and with equal success. Its efficacy seemed 
to have no relation to its emetic properties. Part x.,p. 31. 
Source of Convulsions.—Mr. W. King points out the intimate connec- 
tion which exists between the pons varolii and the whole muscular system, 
by reminding us that at this point all the motor tracts converge, and by 
one thrust into this portion Ave may stir up every muscle of the body. 
Disease may exist and advance to a considerable extent in some portions 
of the brain, without producing very evident symptoms; but as soon as 
the mischief approaches the pons varolii, the case becomes no longer 
doubtful. A tubercle may increase to a considerable size without excit- 
ing suspicion till it approaches this part, when convulsions more or less 
severe will come on. Part xi., p. 21. 
I 
Convulsive Diseases— Of Children.—Scarify the gums deeply, freely, 
and repeatedly; empty the stomach by tickling the throat, or by giving a 
dose of ipecacuanha: give large warm water enemata, and afterward mild 
aperients, especially antacids, such as one-fourth bicarbonate of potash 
and three-fourths of carbonate of magnesia, in an aromatic vehicle. Pre- 
serve the child with the utmost care from the slightest mental emotion : 
surround the bed, in cold weather, with three curtains of gauze or net, at 
intervals of a foot, and keep the atmosphere moist, and at 65°. Get a new 412 
CONVULSIVE AFFECTIONS. 
and healthy nurse, or feed the child on ass’s milk. If general convulsions 
have occurred, direct the treatment to preventing congestion in the cere- 
brum : leeches, purgatives, mercurials, alcoholic lotion to the head, and 
warmth to the feet, etc. If the larynx is closed, dash cold water on the 
face; and if asphyxia has taken place, excite respiration by compressing 
the chest and abdomen, and then suddenly removing the pressure. 
Part xvi., p. 78. 
Pathology of Convulsive Diseases.—Under the general term convul- 
sion, Dr. Todd includes all those irregular actions of sets of muscles 
which are wholly unrestrainable by the influence of the will, and which 
are excited and kept up by a physical irritant. 
Under this definition of the word convulsion he refers to three distinct 
kinds of convulsions, each of which denotes a different cause, and is pro- 
duced by an affection of the nervous system distinct in kind as well as in 
position. These are the jactitating, or chorea-like, or choreic; tonic, or 
tetanic; clonic, or epileptiform. 
Dr. Todd observes: Of all the movements which accompany chorea, 
that of the tongue is the most peculiar and characteristic; indeed I would 
call it pathognomonic. The patient protrudes the tongue with a peculiar 
thrust to the fullest extent of which it will admit; frequently this is done 
by one effort, at other times it requires two or three attempts before it 
can be accomplished. And the subsequent retraction is also peculiar; the 
tongue is drawn back, supported and guided by the pressure of the teeth, 
and often very slowly and with great caution. Sometimes this peculiar 
mode of protrusion of the tongue is the precursor of the other choreic 
symptoms; and if we had frequent opportunities of seeing the cases very 
early, I have no doubt that this symptom would be found more fre- 
quently the harbinger of the more extensive affection. I have from this 
symptom only, been able to predict with accuracy that an attack of chorea 
was coming on. 
[Paralysis frequently succeeds to the choreicf convulsion. It sometimes 
precedes it, but it is then accompanied, Dr. Todd says, by the peculiar 
and pathognomonic thrust of the tongue. Dr. Todd observes:] 
That paralysis may occur in this way is evidently a fact of the highest 
practical interest, whilst it is not devoid of importance as bearing upon 
the pathology of the disease. Nevertheless, I do not find it noticed in 
any of the descriptions of the disease in the practical works which I have 
consulted. The previous history of the case, the absence of any other 
symptom referable to the head, and the gradual mode of invasion of the 
paralysis, in addition to the peculiar mode of protrusion of the tongue, 
will always enable the careful practitioner to distinguish this paralysis 
from that caused by cerebral lesion. The heart is very frequently mor- 
bidly affected in chorea ; and this morbid affection shows itself, not in any 
disturbance of the rhythm of the heart, which, so far as my observation 
extends, never is disturbed, but in a derangement of its sounds. A bel- 
lows sound is frequently present, and is either aortic systolic, when it is 
almost always an accompaniment of the ansemic state of the patient, but 
much more frequently it is mitral systolic or regurgitant. 
[Turning now to the second class of convulsive diseases, Dr. Todd 
makes a few remarks on tetanus. The points to which he refers are the 
little variation of the symptoms, the want of post-mortem appearances, CONVULSIVE AFFECTIONS. 
413 
and the curious fact of the endemic appearance of the disease. Respecting 
the cause of death in tetanus, Dr. T. observes:] 
The tendency in tetanus is to death by exhaustion and asphyxia. The 
frequent return of the attacks of spasm, atfecting all the muscles of the 
trunk, have a most exhausting influence upon the patient; and as the 
respiratory muscles, and even the muscles of the larynx, are generally 
more or less involved, the respiratory functions become seriously impeded. 
Hence, the most fatal sign is a rapid recurrence of the convulsive attacks, 
and the most auspicious sign is the prolongation of the intervals between 
them. Practically the disease should be regarded as one of extremely 
fatal tendency, and therefore requiring the diligent interference of art to 
counteract its debilitating influence. 
Dr. Todd classes laryngismus stridulus with the tetanic diseases. 
[Dr. Todd next speaks of epilepsy, and classes with it the convulsions 
of children, convulsions induced by the retention of urea in the blood, 
and puerperal convulsions. The latter are truly epileptic, but the convul- 
sions of children have sometimes more or less of a tetanic character. In- 
fantile convulsions are often caused by the presence of a morbid poison in 
the blood ; and such cases as these form a connecting link with the con- 
vulsions of renal disease. Upon this subject, Dr. Todd observes:] 
So excitable is the nervous system of children, that the development of 
a fever, especially if caused by the introduction of a poison, is very apt to 
be ushered in by convulsions, which sometimes prove fatal, and certainly 
will be more likely to prove fatal if the treatment be conducted with the 
idea of suppressing the present evil, neglecting to look to what the child 
has to undergo after convulsions have ceased. All practical men are 
familiar with convulsions in connection with the early development of 
small-pox, measles, and especially of scarlet fever. An artificial epilepsy 
may be produced by the administration of certain poisons; as the cenanthe 
crocata, conium and prussic acid. In poisoning by this latter substance, 
the epileptic convulsions are frequently complicated to a very great extent 
with those of the tetanic kind. 
These facts prepare us for the doctrine that the retention of certain im- 
portant excretions in the blood, which their proper organs are incapable 
of eliminating, favors the development of a state exactly resembling 
epilepsy in the phenomena of the convulsive fits. When the liver or 
kidney are in such a state that the elements of the bile, or those of the 
urine, are not separated in their normal quantity, the patient is very apt to 
have several convulsive fits, which often terminate his existence. Renal 
disease is a much more fruitful source of convulsions than hepatic, and the 
form of disease in which they are most apt to occur is in that small con- 
tracted kidney, which by some is regarded as a stage of Bright’s disease, 
but which, in reality, is a special morbid state of the kidney, a chronic 
nephritis, frequently produced by gout, and, therefore, forming the finale 
of many a gouty patient’s career, but often resulting from other causes. 
In this state of kidney, the gland has shrunk chiefly at the expense of the 
cortical substance ; the growth of epithelium (the immediate agent in the 
separation of organic products) is greatly impaired, many of the renal 
tubes are stripped of it, and no development of epithelium at all takes place 
in them. Hence, while in many of these cases water is freely eliminated, 
and even a diuresis takes place of a urine pale, and of low specific gravity, 
the organic products, urea and uric acid, accumulate in the blood, and 414 
COPAIBA, 
act, especially the former, as a poison to the nervous system. Any state of 
kidney, however, if it be unfavorable to due elimination, may give rise to 
these symptoms ; and accordingly I have seen them in that acute affection of 
the kidneys which is associated with inflammatory dropsy, and with dropsy 
after scarlet fever, to which Dr. Geo. Johnson lias given the appropriate 
name, Desquamative nephritis / and also in fatty disease of the kidney, 
where the accumulation of fat has taken place to such a degree as greatly 
to congest the Malpighian bodies, and to interfere seriously with elimina- 
tion. Part xix., p. 40. 
Convulsions in Children.—Use warm water injections to a great ex- 
tent, even in infants (twenty-four ounces of warm water have been in- 
jected into an infant). The convulsions will often cease on the injection 
of the first few ounces, but may return again and again, until the bowels 
have been well washed out. Part xxxi., p. 60. 
Infantile Convulsions.—In cases of convulsions which seem to exist and 
continue without any acute or appreciable morbid action or lesion in the 
nervous centres, and without any recognizable point of irritation in the 
peripheral parts, Dr. Simpson highly recommends the use of chloroform. 
Several interesting and successful cases are related by him; in one case the 
inhalation was continued twenty-four hours, except when it was necessary 
to feed the child ; in another case it was found necessary to keep the 
child, more or less, under the influence of chloroform for fourteen con- 
secutive days, before all tendency to recurrence of the convulsions was 
eradicated. Chloroform probably acts as an antidote to that state of 
super-sensibility of the spinal system, which constitutes the essential 
pathological state upon which convulsions depend. Part xxxviii., p. 50. 
COPAIBA. 
How to Malce Copaiba into Pills.—Take balsam of copaiba, five parts; 
bicarbonate of magnesia, three parts. Ilub them together, and a mass is 
made exactly adapted for pills. 
This affords a very convenient means of administering this drug; the 
pills agree with the stomach better than the gelatinous capsules, or any 
other form. Part iv., p. 73. 
Copaiba Sugar Plums.—Take balsam of copaiba, 460 grains ; calcined 
magnesia, 18 grains. Intimately mix these ingredients, and in about 
twenty-four hours the mass may be divided into seventy-two parts, -which 
are to be rolled out between the fingers. These are to be covered 
with gum and sugar prepared in the following manner: 1st. A solution 
of gum arabic, containing a third of its weight of gum; 2d. White sugar 
in powder. Put the copaiva pills into a tinned basin, of a hemispherical 
form; pour in a little of the solution of gum to moisten them; then add 
some of the powdered sugar, and turn the basin so as to get the pills 
covered all over ; repeat this operation three times, and afterward place 
the sugar-plums on a horse-hair sieve, in a stove heated to 77° Fahr. The 
temperature of the basin, during the covering of the pills, should not be 
above 60° Fahr. Part ix., p. 75. COPAIBA, 
415 
Copaiba in Inflammation of the Mucous Membrane.—At a meeting of 
the Medical Society of London, Mr. Roberts related a case of nephritis, in 
which, after bleeding and the ordinary treatment of that disease, some 
inflammatory symptoms still remaining, and suppression of urine more 
particularly, he exhibited copaiba in ten drop doses three times a day, 
with the effect of restoring the secretions. Part xiv.,y>. 73. 
To cover Pills or Extract of Copaiba with Gelatine.—This process, in 
vented by M. Garot, is exceedingly easy and practical, and it much more 
effectually disguises the taste and odor, and interferes less with the solution 
of the medicine than the method of gilding or silvering usually practised. 
It is applicable to every substance capable of a pilular consistence ; such as 
balsam, camphor, musk, assafoetida, mercurial and ferruginous prepara- 
tions, etc. Two hundred pills can be coated with gelatine in an hour, and 
will be ready for use after the lapse of two hours. The pilular mass so 
coated remains soft for a much longer time than according to any other 
plan. The process is as follows: Fix the pills on long fine pins; plunge 
them into thick purified glue placed in a hot water bath; then remove 
them by a rotatory motion, and stick the pins in paste spread out on a slab, 
so that the pills may remain elevated in the air; as soon as fifty are thus 
treated, rotate them individually in the heat of a taper, to harden the ex- 
ternal pellicle ; pull out the point of the pin, and the process is complete. 
Part xiv., p. 138. 
Copaiba, Mode of Administering Balsam of.—Thirty parts of the bal- 
sam are stirred round in a glass mortar with four of sulphuric acid. The 
mass quickly solidifies, and may be made into pills, which may be after- 
ward covered with a coating of gum and sugar. If the copaiba be 
adulterated with castor oil, the solidification does not take place ; while, 
if adulterated with turpentine, although solidification does take place, 
the mass, when placed in water, becomes covered with a white, bitter 
resinous substance. The medicinal virtues of the copaiba are by no means 
impaired by the above proceeding, while its disagreeable flavor is de- 
stroyed. Part xxv.,/). 353. 
Copaiba, Substitute for.—"Wood oil, or gurjun balsam, has been recently 
imported in considerable quantities from Burmah, and sold for copaiba. 
Dr. O’Shaughnessy says that it is nearly equally efficient with copaiba in 
the treatment of disease. It may be given in doses of from ten to thirty 
drops. Part xxxiii., p. 244. 
Mode of Action of Copaiba.—Recent experiments and observations 
have sufficiently proved that the active principle of the balsam is chiefly 
eliminated by the kidneys, and exerts a healing influence on the inflamed 
mucous membrane of the urethra, by coming directly in contact with it 
dissolved in the urine. 
If further proof were needed that copaiba exerts its therapeutical in- 
fluence by acting locally on the mucous membrane in gonorrhoea, it might 
be found in the admitted inutility (by Ricord, Sigmund, and numerous 
other high authorities) of the drug in those cases of gonorrhoea in the fe- 
male, in which the disease is confined to the vagina, and does not affect, 
to any great extent, the urethra, and the parts surrounding it. 
Part xxxii., p. 181. 416 
COENS. 
Treatment of Sinuses when situated under Corns.—Dr. C. Hawkins, in 
one of his clinical lectures, relates the following case: 
T. 1ST., get. 43, admitted with a sinus at the under part of the right heel, 
leading deeply down toward the under part of the os calcis; a probe 
passed along it does not strike on exposed hone. The skin and parts 
around the sinus are very much thickened; the surface of the cavity is 
pale and without granulations. It came from cold, sixteen or eighteen 
months ago, as a small hole in the skin, with discharge of matter. 
Now, 1 believe that this has been, in reality, a case of suppuration in a 
bursa under a large corn ; and, without being aware of it, you will easily 
fail to recognize such a case; and yet you see, by this man’s abscess, which 
burst a year and a half ago, that there must be some reason for so small a 
cavity not healing in this time; and this reason is the peculiar nature of 
the bursa, which is incapable of forming granulations; and here, as the 
orifice is larger than usual, you can see the inner surface, which is pale, 
and thin, and white. Such a bursa not unfrequently forms under a corn, 
to defend the ligaments and joints from its pressure, either in this situa- 
tion, or under the ball of the great toe, or under the metacarpal joint of 
the little toe; and is liable to suppurate, and discharge by a small orifice, 
with a hard margin; on inserting a probe, you occasionally find that the 
ulceration has extended in the contrary direction also, and has destroyed 
the periosteum of the bone, or has even opened a joint, so that bone is felt 
by the probe, which exfoliates, or the joint is ultimately quite anchylosed. 
A similar appearance is thus produced to what you can see in another 
patient admitted on the same day, with anchylosis of a part of the joint of 
the metacarpal bone of the great toe with the first phalanx, while dead 
bone is felt in both of the exposed surfaces. 
"VVhat I have found it necessary to do, in such a case as this, is to en- 
large the orifice, and, if it is necessary, destroy the whole of the inner sur- 
face with strong nitric acid, inserted by means of a little sharpened piece 
of wood; then you will succeed in procuring a granulating surface, and 
you can afterward apply common remedies—red precipitate, solution of 
caustic or copper, and so on. You should, at the same time, cut away as 
much of the thickened cuticle or corn as you can from around the opening. 
The nitric acid gives little pain to the bursal surface, and is quite eflfectual 
in general. If the cavity or sinus is close to the bone, or to a joint, you 
must apply the caustic somewhat carefully, in order not to aftect those 
parts ; or if the bone is already denuded, the acid may be applied to its 
surface also, and, partly by its stimulant quality, and partly by its chemical 
action on the bone, this part will probably be absorbed, or become healthy 
and heal up. Part x., p. 170. 
CORNS. 
Corns cured by the Tincture of Iodine.—Painting inveterate corns with 
tincture of iodine three or four times a day, with a camel’s-hair brush, will 
remove them in a very short time. When the corns are situated between 
the toes, the tincture should be mixed with glycerine, and the resulting 
fluid be spread on some German tinder, which latter is then placed be- 
tween the toes. Part xxxviii., p. 175. COUP DE SOLEIL—COKYZA. 
417 
COUP DE SOLEIL. 
Coup de Soleil.—Apoplexy and coup de soleil are not identical, or even 
including the same conditions of body, and consequently quite different 
treatment is required. True, there are symptoms of congestion of the 
head, or rather stagnation of the capillary circulation; but these are the 
effects of nervous depression from exhaustion, and will not be relieved but 
aggravated by lowering remedies. The best treatment is to unfasten as 
gently as possible the man’s dress and accoutrements, expose the neck 
and chest, get him into the shade if possible, raise his head a little, com- 
mence cold affusion over the head, chest, and epigastrium, continuing this 
at intervals till consciousness returns. A mild stimulant mixture must now 
be given in small doses. Clothing for troops, whilst in tropical parts, 
should be suited to the climate: for the head, a light woollen forage cap, 
with a good peak, and protected by a good turban, the curtain extending 
more than it does on each side to protect the temples. No stock is ad- 
missible. The frock and trousers should be of some light woollen texture, 
and loose, except round the ankles. Flannel should be worn next the 
skin, and even in the hottest weather a good blanket should be taken for 
the night, which is always excessively chilly. Part xxxvii., p. 260. 
Sun-stroke.—Probably sun-stroke is attributable to the functions of all 
the organs that free the blood from those matters that are injurious to the 
system being entirely or partially suspended, viz., the lungs, liver, kidneys, 
and skin. The blood is imperfectly oxydized, the bowels are coniined, the 
liver torpid, the secretion of urine much diminished, and the skin hot and 
dry—the patient usually not having perspired for some days previous to 
the attack. No doubt this state of body is attributable to complete ex- 
haustion following over-stimulation of the nervous system. In the treat- 
ment, rouse the patient as much as possible; administer brandy, wine, or 
ammonia, liberally; dash cold water from a height over the head and nape 
of the neck. Calomel and croton oil should be administered, to act on the 
liver and move the bowels. Stimulant enemata and mustard cataplasms 
sometimes prove useful. The after-treatment must consist of nourishment 
and stimulants, together with cold applications to the head, blisters to the 
nape of the neck, and acting on the liver and bowels. The head-dress at 
present worn in India affords no efficient means of ventilation—the crown 
rests on the top of the head. It should be of thicker material, and made 
of strong, close basket-work, well padded, and should afford cover for the 
nape of the neck, and shade for the eyes, and be sufficiently strong to per- 
mit of its use as a support for the head when the owner is in the recum- 
bent position. Part xl., p. 300. 
CORYZA. 
A foil opiate recommended immediately in cases of coryza, or cold in 
the head. Also copious perspiration, kept up by warm drinks and ample 
clothing. Diet should be light. Ten grains of Dover’s powder may be 
given every hour. Part iii., p. 45. 418 
COUNTER-IRRITANTS. 
Coryza Maligna.—[This name is given to an affection of the mucous 
membrane of the nose in children, which differs from the common coryza, 
or “ snifflesf in the graver character of the symptoms. There is abund- 
ant secretion of very tenacious mucus, or even of false membrane, in the 
nasal passages, sometimes extending even to the tonsils and palate. As 
the respiration through the nose is impeded or altogether prevented, the 
child cannot suck; and from the mouth being kept constantly open, th* 
tongue and throat become dry, and deglutition is difficult. There is also 
usually extreme depression of the vital powers. These cases occur chiefly 
in the continental foundling hospitals, but they are sometimes met with in 
this country. In a case which came before Dr. West, as a complication of 
scarlatina, the Dr. tells us that,] 
A lotion was injected up the nostrils, composed of 5j- of alum to §ij. of 
water, with great relief to the child, the secretion from the nares becoming 
more decidedly puriform, but less adhesive; and the child became able to 
suck a little. Subsequently, however, the child’s powers seemed much 
depressed; it sucked eagerly, for the secretion from the nose had become 
almost watery, but it swallowed with much difficulty. A layer of false 
membrane of a yellowish-white color had now appeared on the soft palate 
and back of the hard palate, and on the tonsils. 
A lotion of three grains of the nitrate of silver to an ounce of water was 
applied to the back of the throat, and a mixture of the extract of bark with 
ammonia was given every six hours. The child improved, could swallow 
as well as suck well, and the false membrane entirely disappeared from the 
mouth, but the palate was still red, and presented some broad superficial 
patches of ulceration. The subsequent recovery was tardy, but the imme- 
diate danger was over, and no relapse occurred. 
In the simple coryza, no treatment is required beyond giving a mild 
diaphoretic with a little vin. ipecac., attending to the state of the bowels, 
and preventing the accumulation of the secretion at the opening of the 
nostrils. If there is much difficulty in breathing, do not let the child at- 
tempt to suck, but feed it with mother’s milk by means of a spoon. In the 
malignant variety of the disease, keep up the strength by tonics and nutri- 
ment, and inject a lotion with a drachm of alum to two ounces of water, 
or three grains of nitrate of silver to an ounce of water, into the nostrils, 
or apply it to the throat. If a mild catarrh continues long, it is probably 
syphilitic, and requires small doses of hydr. c. creta. Part xvii., p. VO. 
Cold in the Head.—It is a practical fact, not half so generally known as 
it deserves to be, that the common cold in the head, however severe, may 
_>e at once relieved by guaiacum. Part xxv., p. 63. 
COUNTER-IRRITANTS. 
Advantages of a High Temperature in the Preparation of Blistering- 
Plaster.—M. Donovan believes the common opinion to be erroneous, 
that blistering-plaster is injured by being heated, and authorizes the fol- 
lowing process: 
Introduce the resin and fats into a proper vessel ; melt them ; throw fj 419 
COUNTER-IREITANTS, 
the powder of cantharides; stir the mixture continually until a thermome- 
ter immersed in it indicates that the temperature has risen to 250°. 
Remove the vessel from the fire, and, if the cantharides are not to be 
strained off, continually stir the ointment. By these means, all the urater 
will have been expelled from the fats, the resin, and the cantharides: and 
a plaster will be obtained much less liable to injury from being kept than 
the common. 
The employment of a high temperature in the preparation of blistering- 
plaster, has several beneficial effects. It causes the solution of the vesi- 
cating principle in the fats, thus producing a blister more certain in its 
operation. It expels the water which naturally exists in all the ingredients 
of blistering-plaster, and endangers its spoiling, if long kept. 
M. Donovan alludes to a method of obviating strangury arising from 
the action of blisters. It consists in boiling cantharides in water previously 
to their being pulverized, and drying them. After this, it is said they no 
longer possess the injurious property. Part ii., p. 74. 
Rapid Vesication by Burning Ether, etc.—Recommended in certain 
cases requiring very rapid and energetic counter-irritation, to rub ether, 
spirits of wine, or any other spiritous application on the part to be blistered, 
and then set fire to it. It is, in short, another way of applying the actual 
cautery. Case of convulsions cited, relieved in less than half a minute, by 
setting fire to some gin which had been rubbed on the spine from the 
cervical to the lumbar region. Part v., p. 80. 
Counter-Irritants.—The following are the formulae adopted by Dr. 
Turnbull: 
TINCTUKA CAPSICI CONCENTEATI. 
R Capsici baccarum, §iv.; spiritus vini rect., §xij.; macera per dies 
septem et cola. (It may also be made with advantage by displacement.) 
This concentrated tincture is used as an external application, and is 
found to be a powerful rubefacient and counter-irritant. Four grains of 
veratria, dissolved in an ounce of the. concentrated tincture of capsicum, 
will be found as powerful in its effect as twelve or fifteen grains dissolved 
in alcohol. 
PULVIS ALUMINIS ET CAPSICI. 
R Aluminis sulphatis, partes tres; tinct. capsici concentrati, partem 
unum ; misce et sicca. 
A very small quantity of this powder, applied to the tonsils, is found 
more efficacious, in some cases, than an alum and capsicum gargle. 
R Pulvis ipecacuanhae, 5ij.; olei olivae, 3ij.; adipis, gss.; M. ft. 
unguentum. 
UNGUENTUM IPECACUANHA. 
UNGUENTUM EMETINE. 
R Emetinse, g. xv.; sp. vini rect., q. s.; adipis, §ss.; M. ft. unguentum. 
Dr. Turnbull states that he has found this ointment particularly 
efficacious as a rubefacient in pulmonary and rheumatic affections, pro- 
ducing little or no pain or inconvenience to the patient. 
Part v., p. 84. 
Blistering-Plaster.—In order to obtain a piaster more uniform in its 420 
COUNTER-IRRITANTS. 
operation, Dr. Muller recommends that the cantliarides be left to digest in 
the plaster, kept fluid at a moderate heat for five or six hours. 
Part v., p. 85. 
External Application of Croton Oil.—Whenever it is required to use 
this method of counter-irritation, M. Bouchardat strongly recommends a 
plaster which has been much used by M. Chomel at the Hotel Dieu, and 
which is thus prepared: Four parts of diachylon-plaster are melted at a 
very gentle heat, and while it is half liquid, one part of croton oil is mixed 
with it, and the mixture is then spread in a thick layer on calico. Pieces 
cut from this may be applied to the skin like ordinary sticking-plaster, and 
quickly produce an active irritation. Part vi., p. 84. 
Effects of Caloric applied to the Skin.—M. Gondret states that the 
flame of a burning match being instantaneously applied to the skin 
produces a sharp pain, which disappears as rapidly as it has been pro- 
duced. This flame forms upon the skin a small reddish mark, which after 
a few days leaves no traces behind it. The instantaneous application 
of this flame almost always speedily dissipates a rheumatic, gouty, or any 
other kind of pain. He has also found this result in most kinds of 
chronic pains; and he further thinks that it might be advantageously 
employed in asphyxia, while waiting till more appropriate remedies 
could be adopted ; he has in several instances more or less completely 
dissipated the pains and convulsive contractions of the aura epileptica, 
and prevented or considerably retarded the invasion of the epileptic fit by 
this means. The physiological effects of this agent have, he thinks, 
a great resemblance to those produced by electricity. Part vi., p. 86. 
Actual Cautery.—As a means of producing counter-irritation, is con- 
sidered too much neglected. Vide Art. “ Tibia.” 
Acetous Extract of Cantharides.—R Cantliarides in coarse powder, 
4 parts; concentrated acetic acid from wrood, 1 part; alcohol of 0.849, 
16 parts. Digest in the water-bath in a temperature of 48° to 50°, collate 
with pressure, filter, distill, and evaporate at a gentle heat. The product 
has a buttery consistence. M. Trousseau, who experimented with it, has 
been extremely well satisfied. It is only necessary to grease a little 
paper with this extract, and to apply it to the skin, to have in a very short 
time a blister formed. The consistence of this preparation, and especially 
the presence of acetic acid, prevent the crystallization of the cantharides. 
Part viii., p. 79. 
Method of causing Immediate Vesication.—This method, which 
M. Deaucq proposes to call blistering by the watch-glass, is effected as 
follows: Drop into a flattish watch-glass eight or ten drops of the strongest 
liquor ammonise; cover the liquid with a piece of linen, its diameter rather 
less than that of the glass; apply the glass containing the linen to the skin, 
previously shaved, and keep it in its place by moderate pressure with the 
fingers. As soon as a red zone can be perceived round the glass, we may 
be certain that the vesication is completed ; in most cases, thirty seconds 
are sufficient to obtain this result. There only remains, then, to remove 
the apparatus, wash the part, and take off with dissecting forceps, the 
epidermis, which comes off easily and in one flake. The subsequent dressing 
may be varied according to circumstances, wdiether counter-irritation or the 
endennic administration of medicines be the object. Part ix., p. 187 COUNTEE-IEKITANTS, 
421 
Exanthemic Liniment.—The following liniment is particularly recom- 
mended by Dr. Morris, when desirous of keeping up a mild rash upon the 
skin: R 01. crot. M. xx.; antim. tart., 9j.; liq. potassoe, 3j.; aq. puree, 
5vij. M., while Dr. Ilannay, of Glasgow, considers ipecacuanha one of the 
most manageable and efficient applications. His formula is pulv. ipecac, ol. 
olivse, aa. 5ij.; adipis suill. §ss. M. It requires to be rubbed in for fifteen 
to twenty minutes, and is, he thinks, peculiarly adapted to cases of cere- 
bral irritation in children, dependent on receded eruption. 
Part xii., p. 254. 
Ammonia as a Vesicant.—[The following is a recipe, with directions 
for the preparation of M. Gondret’s ammoniacal vesicant ointment, called 
“ Pommade de Gondret:”] 
In summer, take lard, C drachms; oil of sweet almonds, 2 drachms; 
tallow, 4 drachms. Melt by a gentle heat, and pour into a wide-mouthed 
vial with a glass stopper. Then add 12 drachms of liquid ammonia at 27° 
or 28°; put in the stopper, and shake it up. It should be kept in a cool 
place ; but as the temperature gets lower, put 2 drachms less tallow, and 
2 more of lard. This pommade produces vesication in three, four, or five 
minutes. Part xiv., p. 138. 
“ Firing,” as a Counter-Irritant.—Sciatica, lumbago, chronic rheuma- 
tism, paralysis of the deltoid muscle, neuralgia and hysterical pains, are the 
diseases in which Dr. M‘Cormack has found this form of counter-irritation 
serviceable. 
Case.—The Rev. Sir Wm. M‘C , after a very severe exposure to 
cold and wet, awoke the following morning with that painful affection of 
the muscles called “ crick ” in the neck. The pain was so unusually severe, 
and the distortion so great, that he was induced to apply for relief, having 
in vain tried the usual domestic remedies of hartshorn and oil, hot stupes, 
etc. The head was drawn down more than I ever saw in a similar case, 
and the slightest motion caused the most acute agony. I persuaded him, 
after much entreaty, to allow the application of the “ firing ” iron, and 
before I had finished the operation (having made altogether about fifty 
touches) he was enabled to move the head freely in all directions; the 
pain entirely ceased, and the distortion was completely removed; and he 
was much delighted to find that he had got rid so suddenly, and with such 
little suffering (as far as the operation was concerned), of so painful an 
affection. Vide Art. “ Firing.” Part xv., p. 82. 
Mode of Producing Rapid Vesication.—[This is a new application of 
Mr. Markwick’s Impermeable Piline.] 
A liniment was prepared according to the following formula: R Liq. 
ammon. fortiss. 3j.; ol. olivse, 3ij. Misce. Six drops of this liniment 
were applied to the woollen side of the piline, placed upon the skin, and 
gently pressed with a handkerchief. In ten minutes a perfect blister was 
produced, the size of a crown-piece. The piline is not in the least injured 
by such an experiment, and after being washed, may be used again, for the 
same or for other purposes. Part xvi., p. 294. 
Cantharidcd Collodion for Blisters.—[M. Hisch, of St. Petersburg, 
recommends the following preparation as a vesicatory, when it is needed 
to apply one where it will not be disturbed by the movements of the 
patient:] 422 
COUGH. 
The cantharidal collodion is thus prepared: Exhaust, by the displace- 
ment process, one pound of coarsely powdered cantharides by one pound 
of sulphuric ether and three ounces of acetic ether: in this way is obtained 
a saturated solution of cantharides, along with the green animal fatty mat- 
ter. Dissolve twenty-five grains of cotton-powder in two ounces of this 
liquid, and preserve it for use, in well stopped bottles. When a blister is 
required, it will be sufficient to smear with this fluid the surface to be vesi- 
cated. Part xx., p. 297. 
St. John Jong's Celebrated iAniment.—The yolk of an egg; oil of tur- 
pentine f §iss.; strong acetic acid, f§j.; pure water, fgiij.; first rub the 
yolk of egg, the water and the acetic acid together, then add the oil of 
turpentine, and agitate the whole until they are well mixed. This counter- 
irritant liniment is applied by means of a sponge; its effects vary with the 
force which is used in rubbing, and the length of time the application is 
continued. Part xxxii., p. 293. 
Blistering Plaster prepared with Chloroform.—Dr. Landerer, of Athens, 
recommends, as an improved mode of making blistering plaster, the preli- 
minary digestion of the powdered cantharides for several days at a gentle 
heat, in a sufficiency of chloroform to moisten it. The mass is then to be 
added to the plaster half cold, taking care to avoid inhaling the chloro- 
form, which becomes volatilized. Part xxxiii., p. 294. 
COUGH. 
Cough.—[Cough is “ a sudden convulsive expiratory effort.” Irritation 
of any kind upon the pulmonary mucous membrane will produce cough; 
irritation of the nasal mucous membrane will produce sneezing, another 
expulsive effort. It should be observed that the nasal branch of the mu- 
cous membrane is supplied by sentient branches of the fifth nerve, while 
the pulmonary surface is supplied by branches of the vagus; and it has 
been proved that irritation of the vagus, in any part of its course, will pro- 
duce cough similar to that which occurs in any disease of the respiratory 
organs.] Dr Todd continues : 
A common cause of cough—a much more common one than is generally 
supposed—depends on irritation of the pulmonary branches of the vagus, 
consequent on the pressure exerted on them by enlarged bronchial glands. 
Tumors, also, of various kinds are capable of exciting cough in a similar 
way, and the development of tubercles in the lungs may produce the same 
effect. Aneurisms not unfrequently give rise to a cough, which may baffle 
us in our endeavors to account for its production; and, indeed, cough is 
often a very important symptom in the diagnosis of aneurism, and one 
from which we frequently derive assistance in localizing the disease. An 
aneurismal tumor may press upon the branches of the vagus distributed to 
the trachea and bronchi, and thereby excite the most severe paroxysmal 
cough. Of this there is an excellent example now in Fisk ward. The 
patient is a man who was admitted for cough of this character. We care- 
fully examined his chest without being able to discover any indications of 
disease in the lungs; but at length we obtained evidence of the existence 
of an aneurismal tumor, which, most probably by pressing upon some COUGH. 
423 
branches of the vagus, excited the violent cough, that constituted so promi- 
nent a feature in the case. 
So, again, inflammatory ulceration of the trachea, whether primary or 
secondary, resulting from the pressure of an aneurismal tumor, especially 
about its bifurcation, where there are many branches of the pulmonary 
nerves, may cause a very distressing cough. 
Thus, then, in reviewing the various circumstances under which cough 
may occur, you may enumerate the following kinds of this affection : 1st, 
The throat cough, the exciting cause of which may be either in the fauces 
or in the larynx. 2dly, The tracheal or bronchial cough, when the trachea 
or primary bronchi are the irritated parts. 3dly, The pulmonary cough, 
when the smaller ramifications of the bronchial tubes or the lungs are the 
seat of irritation. 4thly, A cough dependent on gastric irritation ; and, 
lastly, in persons of highly nervous temperament, there is the nervous 
cough, which, in most instances, is no more than a convulsive affection of 
the throat muscles. 
Of these forms of cough, those which most frequently come under our 
observation are the throat cough and the pulmonary or lung cough. The 
former is the common cough of ordinary colds, and may be readily distin- 
guished by the absence of all abnormal phenomena, connected with the 
breathing sounds, and by the swollen and red condition of the mucous 
membrane of the fauces, and more or less of hoarseness. In more chronic 
cases, this membrane is less or not at all swollen, and assumes a dusky red 
hue and a lax condition. Coughs of this kind are repeatedly mistaken and 
treated for pulmonary coughs, and the patients condemned to take large 
quantities of nauseous drugs; Avhereas many of them are easily curable by 
local treatment. This kind of cough is often exceedingly violent and dis- 
tressing, and is not generally accompanied by any other sputa than throat 
mucus and saliva. 
The more common form of lung-cough is that which attends bronchitis. 
This occurs generally in paroxysms; it is accompanied with expectoration, 
which is the more abundant in proportion to the extent and severity of the 
bronchial affection. We find it likewise in connection with tubercular or 
other disorganization of the lung, and the more severe in proportion to the 
extent of pulmonary destruction and consequent bronchial irritation. Un- 
der these circumstances, an expectoration, generally copious and purulent, 
follows the cough; and, indeed, the presence of this matter in the bron- 
chial tubes very frequently aggravates the cough. Another form of lung- 
cough is short and dry, or accompanied by little or no expectoration, and 
apparently kept up by some permanent irritant in the lung’s substance, as 
crude tubercles scattered among the bronchial ramifications. Such a cough 
is a common precursor of confirmed phthisis, or, more correctly, an attend- 
ant on its early stages. 
Such are the ordinary causes and forms of cough. Part xxix., p. 79. 
Linctus for Chronic Cough.—The following is the formula for the linc- 
tus in common use in St. Bartholomew’s Hospital: 
R Conf. roses canime §ij.; tragacanth. pulv. 3j.; sirupi papaveris 5vj.; 
aceti scilke 3vi.; acidi acetici mxx.; aqrne ferventis §vj. Misce. Dosis 5j. 
ad 3iij. 
A less expensive preparation is used for the same purpose in very large 
quantities at the London Hospital, under the name of Lohoch : 424 
CRAMP, 
$ Sacchari fecis Ibxxviij.; ol. olivas §viij.; farinae tritici ibiv.; tinct. 
opii, aceti scillae, aa. gviij. Misce. Dosis 5j‘ ad 3iij. 
There are many forms of chronic cough, both in children and in adults, 
which are treated much more successfully, and fir more agreeably to the 
patient, by the use of preparations of this kind than by the commonly-pre- 
scribed “cough-mixtures.” Part 102. 
CRAMP. 
Cramp and Spasm.—Cramp is a sudden, involuntary, complete, and 
painful contraction of a muscle. All the voluntary, and some of the in- 
voluntary muscles, are liable to these contractions. Spasm is the term 
usually employed when this painful affection seizes on an involuntary 
muscle ; of the latter class, the most common sufferers are the heart and 
uterus ; the uterus can suffer spasm when enlarged only. It is question- 
able whether muscles of canals, or even those of the bladder, can suffer to 
such extent from spasmodic action as demands medical treatment. 
The involuntary contraction of muscles may vary in degree, from the 
painless form of subsultus tendinum or chorea, to the excruciating tortures 
of tetanus or epidemic cholera. The remote causes are various and dis- 
similar—irritation of the spinal cord; of the medulla oblongata; of the 
peripheral extremity of a nerve, mechanical or pathological; disease within 
the cranium, or a poison, as ergot of rye, circulating through the vessels. 
Involuntary contractions, attended with insensibility, are termed convul- 
sions. The observations here refer solely to what may be called local 
cramp or spasm, originating in, and restricted to, one muscle, as observed 
in the gastrocnemius ; in the uterus, as after-pains ; and to that alarming 
spasm of the heart, angina pectoris. Dr. Murphy continues: 
Cause.—The immediate cause of local cramp would appear to be a lan- 
guid circulation in the veins which traverse the substance of a muscle. 
This theory will explain why cramps attack most frequently the voluntary 
muscles furthest from the organ of circulation—the feet and legs ; why 
they are more common in cold weather; why the principal sufferers are 
females, especially those with weak pulse, pale countenance, and chilly 
surface; and therefore why they are so seldom absent in chlorosis. It 
will also explain why the seizure is most usual in the horizontal position, 
when muscular action, so favorable to the circulation, has ceased. Nearly 
one half of the young, growing females, with a tendency to chlorosis, suf- 
fer from this annoying complaint; and it is remarkable, that although we 
have many cases where the cramps are limited to the muscles below the 
knee, we meet with none where the remark will apply to those above the 
knee. No inquiry being made about this symptom, it is seldom mentioned 
to the physician, and yet it is almost pathognomonic of an enfeebled 
action of the heart, from which the anemic headache springs. When this 
affection is complained of, whether in the aged or the young, no matter 
of what sex, the necessity for chalybeates is indicated. Dr. Brady makes 
one proper exception—in cases of pregnant females ; but the cause of their 
languid circulation is mechanical, and therefore not remediable by medi- 
cine. It may very naturally be asked, if a feeble and delicate constitution CRAMP, 
425 
predisposes to cramp, why is it not an attendant on the last stages of dia- 
betes, phthisis, and other exhausting diseases? Because those diseases 
produce hectic fever, and hectic is accompanied with a pulse so rapid as to 
be incompatible with a slow venous circulation. Nor does it supervene 
in debility after profuse hemorrhage; the rapid pulse of reaction and the 
half empty vessels affording a satisfactory explanation of its absence. The 
severest cramps we witness from arrest of circulation in the veins of 
muscles, are those which add so much to the horrors of epidemic cholera, 
for these cramps, although general, in an exact sense must be considered 
local, no muscle contracting until the blood in its own veins is arrested. 
It is an error to attribute the cramps of epidemic cholera to a poisonous 
quality of the disease; and the recollection that our own autumnal 
cholera is accompanied with similar cramps, should disabuse us of this 
mistake. 
In neither form of cholera do cramps supervene, until the venous circu- 
lation through the muscles is almost impeded from the density of the 
blood, a natural consequence of the exudation of its serous portion. No 
person can doubt that in epidemic cholera the circulation is from this 
cause almost arrested ; for on puncturing a vein, the blood trickles down 
slowly, thick and dark as tar. Fatal cases of Asiatic cholera, it is true, 
are recorded, where few or no evacuations took place, yet cramps, 
although not violent, were noticed. Such cases might favor the opinion 
that the cramps depended on the inhalation of a specific poison, did not 
the post-mortem examinations discover the exuded serum still in the 
intestinal tube, consequently the cramps were present, but less severe 
than where the exuded serum was too abundant to be retained in the 
intestines. 
That there are poisons capable of coagulating the blood in its vessels, 
and that coagulation is attended with muscular contractions, cannot be 
denied. Dr. Pereira, in his last edition of “Elements of Materia Med- 
ica,” quotes the “ Journal de Chimie Medicale,” to show the physiological 
effects of bromide of potassium. Thirteen grains, dissolved in water, and 
injected into the jugular vein of a dog, coagulated the blood, and caused 
convulsions and death in a few minutes. But the same medicine taken 
into the stomach in larger doses produced vomiting only. As a clinical 
fact in English cholera, it is interesting to observe how much sooner the 
cramps cease when the stomach does not reject fluids; for the veins are 
soon refilled, and thus the proportion between the crassamentum and 
serum is quickly restored. The so-called secondary fever of Asiatic 
cholera arises solely from congestion of the venous system generally, and 
this congestion is peculiar, the fault existing in the blood itself being too 
thick, from having parted with its serum, to be influenced by the action 
of the heart. Rigors, or rapid involuntary contractions of muscles, are 
seen after exposure to cold, at the commencement of most fevers, and in 
the first stage of ague; for the first stage of these diseases is characterized 
by the desertion of blood from the superficial to the deep-seated veins, and 
these rigors or contractions are salutary; for by compressing the deep 
veins, the blood is restored to the superficial vessels, causing the pheno- 
mena of reaction. In fevers there can be nothing more alarming than the 
absence or prolonged delay of rigors. When scarlatina threatens to be 
unfavorable within twenty-four or thirty-six hours, from its invasion, there 
are no rigors, for the muscles seem to have lost this salutary contractile 426 
CREASOTE, 
power. A cramp may therefore be regarded as a painful but useful 
action of a muscle to assist in the circulation of venous blood. 
Part xxviii., p. 325 
/ 
Cramp—In the Legs and Feet.—It is often connected with a weakness 
of the digestive organs: let diet therefore be carefully attended to, and 
let the sufferer sleep on an inclined plane, the bed being twelve inches 
higher at the head than at the feet. Part xvi., p. 83. 
Therapeutic Properties of Creasote.—[Since the attention of the profes- 
sion was drawn to the value of creasote in cholera by Mr. Spinks, of War- 
rington, Dr. Richardson has given the remedy a fair trial in the treatment 
of ordinary diarrhoea, and as far as his own observation goes, there is no 
astringent remedy half so useful in certain cases of profuse purging. Dr. 
R. says:] 
The cases in which I have found creasote most valuable are of three 
kinds : 
1st. Cases where purging appears, and cannot be traced to the presence 
of foreign matter in the intestines, as so often happens dui’ing ordinary 
epidemics. 
2ndly. Cases where a diarrhoea follows the administration of purgative 
medicines given for the purpose of removing foreign matters from the 
intestines. 
3rdly. Cases where, after an acute diarrhoea, a state of passive purging 
continues—the patient being constantly troubled with sudden small liquid 
evacuations, not attended with great pain, or any considerable constitu- 
tional disturbance. 
With children the remedy is also useful; but, to secure success wjtli 
them, the dose must be very small—the one-fourth, one-sixth, or one- 
eighth of a drop to children under two years, is sufficient. With adults, 
from one to two drops is the dose I usually prescribe, and this may be 
repeated every two or three hours for several times if required. 
Its power to arrest vomiting depends upon the dose: given in a full 
dose, two drops, I have seen it even bring on vomiting; in which case a 
few minims of dilute hydrocyanic acid are usefully combined with it. At 
the same time, I may observe that I have seen diaphoresis follow its ad- 
ministration, and that it possesses very excellent antispasmodic properties. 
I have also found it very useful in arresting hiccough in cases of exhaustion. 
To disguise the nauseous qualities of creasote, no vehicle seems to me to 
answer so well as the sirup of tolu, to which compound tincture of carda- 
moms may be added. It is also very advantageously combined with 
opium, or with the preparations of ether, in cases where these remedies 
are indicated. Part xxv., p. 315. 
CREASOTE. 427 
GROUP. 
CROUP. 
Croup and its Cure.—Dr. Gralil calls attention to the employment of 
arm-baths in croup. They are indicated in the commencement of the stage 
of exudation, the existence of which is rendered evident by the difficult 
respiration. He regards the employment of leeches in this stage as of no 
avail, and the administration of sulphate of copper and emetics as likely to 
increase the exudation. His recommendation is, that the arms of the pa- 
tient be placed in a vessel sufficiently deep to admit them to a hand’s 
breadth above the elbow-joint and filled with water as hot as it can be 
borne. A cloth should now be thrown over the head of the patient, which 
falling down around the edges of the bath retains the vapor, and this the 
patient should be allowed to respire for a quarter of an hour together, re- 
peating it at short intervals. The first application usually induces some 
degree of moisture in the Shneiderian membrane, and diminishes the dys- 
pnoea. As it is repeated the cough usually loses its hoarse tone, and the 
patient expectorates the exuded lymph. In cases where the symptoms are 
extremely urgent, calomel in large doses should be given and a blister ap- 
plied to the throat, but in the great majority of cases the employment of 
the arm-bath is all that is necessary. Part iv., p. 5G. 
Papid Vesication and Counter-Irritation.—In a case of croup, the vesi- 
cation was produced by hot water. A piece of flannel was rolled to the 
thickness of the finger, dipped into boiling water, and immediately applied 
round the throat. The symptoms were subdued in a few minutes. 
Part v., p. 81. 
Extract of Indian Hemp.—Case of crowing inspiration reported cured 
by one-sixth of a grain of extract of Indian hemp, three times daily. The 
bowels were regulated. Patient’s age, nine months. 
Part vi., p. 29. 
Treatment of Croup following Ulcerated Sore Throat.—It seldom if 
ever happens that an attack of croup following cynanche maligna is cured. 
The following case illustrates the use of a saturated solution of nitrate of 
silver in such a disease. The child, four years old, had an attack of ulcer- 
ated throat which seemed to have passed away before the attack of croup 
came on. Croup followed, and on examining the throat there was seen an 
ulcer half an inch in diameter over the left tonsil, and the fauces greatly 
inflamed. The usual treatment was adopted, but the symptoms gradually 
increased in severity ; “ the stridulous breathing became constant and very 
shrill, the restlessness increased, and high fever set in with great thirst.” 
Twice was a vein opened in the arm until the pulse yielded. 
Two grains of calomel, four grains of antimonial powder, and half a grain 
of ipecacuan, were now given every hour for six hours, after which the 
ipecac was increased to one grain, and continued every second hour until 
thirty grains of calomel had been given, without apparent relief. Suffoca- 
tion impending, an emetic of sulph. copper afforded relief by producing 
vomiting—shreds of membraneous matter being thrown off. The mitiga- 
tion by vomiting being but temporary, a saturated solution of nitrate of 
silver was freely applied with a small sponge to the ulcer and fauces, thrust- 
ing it far back into the pharynx. Every application was followed by relief, 
and it was repeated every two hours where the albuminous accumulation 428 
CROUP. 
was found present. Constant redness of the cutaneous surface was kept 
up by turpentine on the sides and back of the neck. 
In a day or two the ulcer had contracted, the plastic exudation had 
ceased, and the patient soon recovered. Part vi., p. 83. 
Crowing Respiration.—In the crowing respiration of infants, sometimes 
called “ thymic asthma,” or “ laryngismus stridulus,” Dr. Marshall Hall 
recommends the daily lancing of the gums, whether inflamed or not. Dr. 
Henderson recommends an opium liniment with croton oil to be rubbed on 
the spine. In many of these attacks, as well as in many other convulsive 
diseases of children, the Indian hemp is recommended. Part vi., p. 89. 
Laryngotomy.—This is an operation which is certainly neglected in 
many cases where life might be saved by its means. Every surgeon ought 
to carry in his pocket-case some sort of an instrument by which he might 
be ready on any emergency to perform this simple operation. Even in the 
few cases of laryngitis or croup in which it is performed, it is too frequently 
delayed till too late ; for when asphyxia approaches it will have little chance 
of success. In all cases, therefore, in which blood-letting, antimony, mer- 
cury, etc., have failed to relieve the disease, and where the strength is evi- 
dently giving way rapidly, the difficulty of breathing increasing, and 
lividity showing the approach of asphyxia, bronchotomy ought to be per- 
formed without delay. We quite agree with Louis, that “ as long as bron- 
chotomy is considered an extreme measure, it will be always performed 
too lateand Dr. C. J. B. Williams judiciously remarks, that if in laryn- 
gitis “ free bleeding pi-oduce no relief, or be not borne, and sei'ious diffi- 
culty of breathing have become established, we would not wait for the 
appearance of pallor or lividity, as recommended by Dr. Cheyne, but we 
would urge the perfoi-mance of bronchotomy without delay. To defer the 
operation on account of the difficulty or danger attending it, is most un- 
reasonable; for experience has proved that these are inci’eased rather than 
diminished from delay; and the danger from the operation is at no period 
to be compared with the danger from the obstruction to the breathing that 
it is calculated to remove? Laryngitis destroys life—not by the extent or 
the vitality of the organ which it occupies, but by closing, as it were, the 
door of the breathing apparatus ; by opening another door, we render the 
disease comparatively trivial; and it may then be delibei’ately attacked by 
mercurial and other remedies, or, if slighter, even be allowed to run its 
course, which commonly ends in muco-purulent secretion.” 
The same remarks will apply equally well to all cases in which respiration 
is impeded. 
Mr. Hilton’s instrument is here recommended. It consists of “ a curved 
trochar aixd canula; the canula being oval from side to side ; and the tro- 
char lancet-shaped, much flattened above and below, and cutting at its 
point and edges. This instrument may be passed through the crico-thyroid 
membrane into the larynx, or through the trachea, with the greatest faci- 
lity.” It is better to divide the skin first with a lancet, and “ the forms of 
the cutting instrument and canula are so adapted that the canula presses 
upon the whole of the cut surface, and thus prevents any internal bleed- 
ing.” Part\'\.,p. 135. 
Treatment of Croup with Sulphate of Copper.—Dr. Schwabe generally 
begins the treatment by applying fi-om four to twelve leeches to the larynx 429 
CROUP. 
and then orders li, 2, 3, and occasionally even four grains of sulphate of 
copper, mixed with a few grains of sugar, to be taken every half hour or 
every hour, according to the urgency of the symptoms. Each dose is fol- 
lowed by vomiting, which, scanty after the first dose, is always copious 
after the second, and is continued so long as thick mucus or membraneous 
concretions are apparent in the matters ejected. The patient then takes 
half a grain of the sulphate every hour, until several dark green motions 
have been discharged, to effect which from eight to twelve doses suffice. 
Part viii., p. 72. 
Tracheotomy in the Last hit age of Croup. — At the sitting of the 
Academy of Sciences, M. Scoutetten, professor at the military hospital of 
instruction at Strasbourg, read a case of tracheotomy performed with suc- 
cess in the last stage of croup. He performed the operation on his own 
daughter, an infant six weeks old, to save her from imminent death. The 
operation was successful. According to M. Scoutetten, it is the only in- 
stance of tracheotomy performed on account of croup on an infant of this 
age ; and the only one in which such alarming symptoms lasted so long. 
He is of opinion that this case ought to encourage the timid, and show the 
surprising resources of nature at this tende&age. Part ix.,p. 181. 
Turpeth Mineral in Croup.—In croup, scarlatina maligna, etc., where 
great prostration exists, the stomach seems insensible to ordinary emetics, 
which only purge, and increase the prostration. In such cases, try the 
turpeth mineral (sub-sulphate of mercury). To a child, twelve years old, 
give five grains every fifteen minutes, accompanied with mustard whey, 
till vomiting is produced. The second dose will generally be sufficient. 
It vomits for an hour or two without causing purging, or subsequent pros- 
tration. It may be repeated twice or thrice in twenty-four hours. 
Part xiv., p. 134. 
Case of Tracheitis.—A child under three years of age was seized with 
hoarseness, dry cough, and great dyspnoea. Dr. Durrant says: 
The most prompt and energetic measures had been adopted; the 
trachea had been freely leeched, followed by a blister; calomel and anti- 
mony in full doses at frequently repeated intervals had been persevered 
in; and that most admirable plan of keeping up a constant supply of warm 
moist air throughout the apartment was in full operation. It was ascer- 
tained from the mother that she had lost two children from croup, but 
this child had been in apparently good health up to the period of seizure. 
The countenance was now anxious; the skin not very hot; voice ex- 
tremely feeble; cough stridulous; respirations panting and accelerated; 
pulse 120, small and jerking; tongue moderately clean ; bowels confined; 
evacuations healthy; urine very high-colored, without deposit; had been 
very sick from the medicine. 
[The energetic treatment at first adopted, was now considered to have 
been carried far enough; and the calomel and antimony were therefore 
laid aside. Dr. Durrant continues:] 
The diffusion of warm moist air to be unremittingly continued day and 
night; a roll of flannel dipped in boiling water to be applied as a vesicant 
to the throat; a saline mixture, containing the bicarbonate and nitrate of 
potash, with compound tincture of camphor, was prescribed every four hours, 
and an improved diet of arrow-root and mutton-broth. This treatment, 
with the addition of port wine to the arrow-root was persevered in, and 430 
CROUP. 
on the fourth day the patient expectorated about a tablespoonful of pure 
pus. From this date the patient rapidly recovered. The dilfusion of the 
warm moist air being unremittingly continued until convalescence was 
complete. Part xv., p. 95. 
Croup—Membranous.—Apply solution of nitrate of silver, seven or 
eight grains to the ounce, by saturating a ball of lint in the solution, con- 
veying it to the opening of the larynx by a long curved pair of forceps, 
and then squeezing out the solution by compressing the ball between the 
blades. Repeat this application every eight hours if required. 
Part xvi., p. 127. 
Pseudo-membranous Laryngitis, or True Croup.—Bleed to four or six 
ounces, and give a teaspoonful of finely powdered alum, mixed with its 
own, or twice its own bulk of honey, sirup, or treacle, and repeat it in ten, 
fifteen, or twenty minutes, if the first dose fail to produce free emesis. 
Use the warm bath; give calomel in three or four grain doses every few 
hours; if necessary, repeat the emetic, and the depletion by the lancet, or 
leeches ; and apply a ten grain solution of nitrate of silver to the fauces, 
twice or thrice a day. Partxxi., p. 129. 
laryngismus Strididus.—Give purgatives to remove accumulations or 
morbid secretions from the bowels. Lance the gums freely when they are 
swollen and inflamed, but not otherwise. Let the child be fed slowly, at 
short intervals, and with food of good quality. Dash a pitcher of cold 
water suddenly upon the back and shoulders, night and morning. And 
let the child be lightly, though sufficiently clad, and taken into country 
air, if possible. During the paroxysm, or when it is impending, dash cold 
water rapidly and liberally into the face. Part xix., p. 295. 
Piphtherite.—In diplitherite, or laryngeal croup, tracheotomy is applic- 
able, as the false membrane does not extend below the larynx. The 
operation should be performed early, before the patient becomes ex- 
hausted. Part xix.,y>. 153. 
Croup)—Membranous.—Besides giving calomel, apply solution of 
nitrate of silver, forty or sixty grains to the ounce, to the interior of the 
larynx, by means of a piece of sponge cut into a conical form, and firmly 
fastened to a curved piece of Avhalebone. Part xix., p. 301. 
Croup.—Give calomel and alum. To a child seven years old, two 
grains of calomel and three grains of alum may be given alternately, 
every hour. 
When the disease commences as diplitherite in the pharynx, mercury 
alone is useless, and may indeed be dispensed with, as the local treatment 
is the most important. The best way is to begin with an emetic of sul- 
phate of copper; then to cauterize the back of the throat well with 
fuming hydrochloric acid, daily; and to give alum mixed up with honey, 
every quarter or half an hour. Part xxi.,p. 130. 
Treatment of Croup by Warm Vapor and Emetics.—Place the child 
in a bed closed with a double curtain. Introduce into the bed a large 
earthenware pan nearly filled with all but boiling water. Into this occa- 
sionally submerge a heated brick, for the purpose of disengaging steam. 
By this means the atmosphere around the little patient will be kept at a 431 
CROUP. 
temperature of from 75° to 80° Fahr., and surcharged with vapor. In 
addition to this part of the treatment, give an occasional emetic whenever 
the breathing seems impeded, not to produce the constitutional etfect of 
the drug employed, but to facilitate mechanically the expulsion of the 
products of the inflammation. Part xxvi.,ja. VI. 
Chlorate of Potass in Croup.—In a case occurring in a child three 
years old, after leeches, calomel, salines, and ipecacuanha had been 
employed, chlorate of potass was administered, apparently with the most 
marked benefit. Part xxvi., p. 76. 
Use of Sulphate of Copper.—Sulphate of copper does not produce the 
depressing effects of other emetics, is equally safe, and much more sure in 
its action. Make a solution of eight grains in one ounce of distilled 
water, and give a teaspoonful to a tablespoonful every ten or fifteen 
minutes, according to the ease or difficulty with which vomiting is pro- 
duced, and until the more violent symptoms are abated. When improve- 
ment in the symptoms takes place it must be continued in smaller doses 
and at longer intervals. Part xxxii., p. 83. 
Diagnosis of Fibrinous Concretions in the Heart in Cases of Inflam- 
matory Croup.—The symptoms which mark the cases of croup about to 
terminate in syncope, the result of cardiac obstruction, are distinct from 
those arising from obstruction in the air-passages. 
The differences are these: In the cases of syncope from arrested circu- 
lation, the dyspnoea is not caused by obstruction in the larynx, but by the 
peculiar anxiety and gasping desire to breathe incident to the want of 
blood in the pulmonic circuit. In this case, therefore, if the stethoscope 
be carried from the upper part of the windpipe downward, and over the 
whole chest, the respiratory murmur is audible, and it may be clear 
throughout, so that the observer is prepared to say, there is here no such 
deficiency of respiration as will account for the severity of the symptoms. 
Again, the most common physical pulmonic sign in these cases is that of 
emphysema, which is often accompanied, in very young children, by a 
peculiar prominence in the anterior part of the chest. This emphysema, 
when present, is strictly diagnostic of fibrinous obstruction, and is altoge- 
ther subversive of the idea that the cause of the symptoms is an obstruc- 
tion in the windpipe. 
In addition, there are in these cases the definite signs which mark the 
cardiac obstruction. The body is cold and generally pale, almost marbly, 
but mostly so at the extreme parts. The lips are slightly blue; the cheeks 
are occasionally the same. The jugular veins are distended. The pulse 
is irregular. The body is painfully restless. The heart-beats are feeble, 
quick, and irregular; the sounds muffled with a bruit in some cases. No 
real convulsions of the limbs occur, but intense anxiety and constant 
movement. 
In those cases, on the other hand, wdiere the death is really due to 
apncea—the effect of obstruction in the air-passages—the symptoms are 
widely different. In these cases there is some point in the respiratory 
canal where an obstruction can be detected. The lungs show signs of 
congestion, but never of emphysema. The difficulty of respiration arises 
from an absolute inability to fill the chest. From the fact of the obstruc- 
tion being in the respiratory circuit, such blood as passes through it is not 432 
CEO UP, 
arterialized, and the surface of the body, instead of being pale, as in cases 
of cardiac obstruction, is generally of a dark hue, with the veins more 
decidedly turgid. The muscles are not simply restless, but actually con- 
vulsed violently, the patient being unconscious of the fact; the heart- 
sounds are clear, and its motions, though feeble, are rarely tumultuous. 
Lastly, the breathing is the first to stop at death, while, in the former 
case, the heart takes the precedence in this respect. 
These broad and definite diagnostic signs can never be mistaken, except 
in instances where there is a clot in the heart coincidently with obstruc- 
tion in the windpipe. Here some difficulty may arise, but a careful inquiry 
into all the facts will indicate the existence of the complication. 
The points of practice which are to be gathered from a clear diagnosis 
in cases of this character are numerous, but in none so important as in 
settling the question whether tracheotomy should or should not be per- 
formed. 
If in any given case the practitioner shall find the symptoms referable 
purely to obstruction in the trachea or larynx, and the circulation unem- 
barrassed, he will operate with good chance of success, granting that the 
point of obstruction is not too low, and that no further inflammation suc- 
ceeds. If, on the contrary, he should diagnose the symptoms of cardiac 
obstruction, whether or not complicated with constriction in the windpipe, 
the operation is worse than useless; it will, of necessity, fail, because 
there are other fatal influences at work which the knife cannot affect. 
Part xxxiii., p. 84. 
Propping a solution of Chlorate of Soda into the Trachea, to assist 
in the Treatment of Croup after Tracheotomy has been performed.—In 
dropping a solution of chlorate of soda into the trachea, M. Barthez 
states—“My only object is, to obtain a solution of the false membranes. 
I expect only to soften the adherent surface sufficiently to allow of the 
membrane becoming more easily detached by the fits of coughing, and so 
being expelled. 
In one patient, a portion of false membrane, which was adherent, and 
causing suffocation, became detached, and was thrown up in two hours 
after the drops had been commenced, they being used every quarter of an 
hour. This false membrane lined the trachea, and went down as far as 
the bifurcation of the bronchi. 
In another child, drops of cold water, used in the same manner for six 
hours, produced no result; while, after a warm solution of chlorate of 
soda had been used for one hour, fragments of false membrane became 
detached, and were thrown up, and continued to be expectorated abun- 
dantly for several hours. Part xxxviii., p. 82. 
Croup.—M. Jodin, in a recent communication to the Academy of 
Sciences, states his belief that croup and pseudo-membranous angina are 
merely parasitical diseases, due to the formation of fungi. The treatment 
which he recommends is the application of the sesquichloride of iron, 
which completely impregnates the fungus, and may be absorbed without 
danger. Part xxxix., p. 99. 
Croup.—The advantage of repeated vomiting to aid in the detachment 
of the false membrane of croup is admitted by most physicians. Some 
use antimony, others prefer ipecacuanha, the action of which is less CUPPING, 
433 
depressing. The sulphate of copper, in addition to its emetic action, pos- 
sesses a very remarkable property of acting locally, and this peculiarity 
makes it superior to both tartar emetic and ipecacuanha. When a solu- 
tion of this salt is employed, the secreting surfaces are so modified, that 
no more false membranes are formed, or if they are formed, they no 
longer present the plasticity which renders them so adherent to adjoining 
parts. The dose should be repeated frequently till vomiting is induced, 
and the solution tolerably concentrated. Part xl.,/>. 55. 
Cupping with the Aid of Hot Water.—Dr. James Orr has suggested an 
improvement in the common operation of cupping. Instead of using the 
ordinary apparatus with spirits of wine, he produces a vacuum by means 
of suction with the mouth. The cupping-glass is like the one in common 
use, with this exception, that at its top there is a small tube, terminated 
by a valve made by tying a bit of bladder over it, and well secured with a 
thread round the neck of the tube. By applying the mouth to this tube, 
and sucking in the way that is done when a woman’s breast is being drawn 
by the common sucking bottle, almost any required vacuum may be pro- 
duced, the little bit of skin being elevated to an extent that is sufficient to 
allow the air within the cup to escape ; and when the mouth is removed 
from the tube the pressure of the atmosphere forces the skin so close to 
the tube as to prevent the ingress of the air. Dr. Orr makes another sug- 
gestion which may prove an advantage. After the part has been scarified, 
he puts about an ounce of hot water into the cupping-glass before he 
causes the vacuum. The water may be made much hotter than could be 
borne in ordinary fomentation, owing to the insensibility of the skin pro- 
duced by the tightening of the cupping-glass. This form of cupping-glass 
with the addition of hot water may occasionally be very useful after the 
application of leeches. Part viii., p. 153. 
Simple Cupping Instrument.—At a meeting of the Suffolk District 
Medical Society, Dr. Gould exhibited a new instrument for cupping, 
formed of a thick, firm, hollow India-rubber ball cut in half. In applying 
it, all that is necessary is to place the concave surface on the part that is to 
be cupped, and press down the centre to exhaust the air, after which the 
fingers may be taken off, and the ball will be found to adhere—and quite 
firmly, too—by means of the vacuum created. For all the ordinary 
purposes of cupping, this simple contrivance will be found most effectual, 
and particularly in dry cupping. 
To the country practitioner, who cannot always have leeches at his 
command, this simple and cheap substitute will be most acceptable. 
Part xxv., p. 196. 
Caprones Ventouze, for Cupping and Dry Cupping.—This very useful 
and ingenious instrument is the invention of M. Capron, of Paris, and is 
another instance of the valuable adaptation of india-rubber to our surgical 
appliances. The india-rubber ball is an exhausting medium, which may be 
CUPPING 434 
CYNANCHE 
regulated to any required power by the hand of the operator. By turning 
the screw, the ball can be taken away, leaving the glass in active opera- 
tion upon the part. The Yentouzeis constructed for cupping, leech-bites, 
and as a breast-reliever; different glasses being added to fulfill these various 
purposes, which are accomplished most perfectly. Part xxxiii., p. 298. 
CYNANCHE. 
Treatment of Cynanche by Guaiacum.—Several very successful cases of 
this troublesome and painful disorder are delated by Mr. Bell, in which 
half drachm doses of the powdered guaiacum every four or six hours, 
either alone or mixed up in a suitable form, were attended with very re- 
markable success. 
Mr. Bell’s formula is as follows: 
R Pulv. Guaiac. 3iij.; mucil. g. arab.; syrup, simpl. aa. §ij.; aq. cinna- 
mom., aq. purse, aa. §iv. M. et solve, capt. §ij. 4ta. q.q. h. 
One or two days are only required for the cure. In other cases the 
powdered drug was given in some simpler vehicle. It will be found 
chiefly successful, if given before has taken place. 
Part iii., p. 36. 
Cynanche Tonsillaris—Case.—A' lady, rather subject to febrile cy- 
nanche tonsillaris, was attacked with rigors in the evening and sore throat 
during the night. Next day the right tonsil was much enlarged and red, 
and the posterior palate and velum red and thickened—the pulse at the 
same time being one hundred and twenty, and sharp, and the febrile op- 
pression considerable. In the evening, and therefore within the first 
twenty-four hours, ten grains of Dover’s powder were given at intervals 
of half an hour, till half a drachm was taken. Perspiration, which soon 
broke out gently, was kept up for fifteen hours by warm drink. In 
twenty hours after the powders were taken, the pulse was seventy, the 
pain in swallowing gone, and the swelling and redness insignificant; and 
on the subsequent morning she was able to leave her bed. This attack 
happened eight years ago at least, and the disease has not returned since. 
Part iii.,/>. 45. 
Cynanche Maligna.—Give powdered guaiacum in combination with 
chlorate of potash. Support the strength with beef-tea, mutton-broth, 
etc. Cause the patient to frequently gargle the throat with a solution of 
chlorinated soda; or, if he be too young or unable to use the gargle well, 
cause his throat to be mopped or sponged with it. The secretions of 
course must be attended to, and in the later stages of the disease, tonics, 
such as quina, or bark, and nitric acid will be beneficial. 
Part xxxvii., p. 77. 435 
CYSTS. 
CYSTS. 
Iodine injections in the Treatment of Serous Cysts.—M. Velpeau, from 
the success which attended the use of iodine injections in hydrocele, has 
extended the treatment to various kinds of serous cysts, enlarged bursae, 
etc., about the knee, in the axilla, breast, neck, and other parts. The cyst 
is punctured with a trocar proportioned to its size, thus emptying it; 
there is then injected through the canula, a mixture of one part of 
tincture of iodine, with two parts of water. It should be neai’ly all drawn 
off in a few seconds. In a day or two the cyst inflames, though never 
severely, and ultimately shrivels and disappears. Part v.,p. 143. 
Cysts of the Eyelids.—In reference to their treatment, M. Velpeau ob- 
serves. 
Of the two proceedings, extirpation and incision, the former, employed 
by most surgeons, appears to me a tedious operation. It is necessary to 
dissect with caution, and if it be a cyst, whatever care is taken it will be 
difficult to avoid opening it; it then is necessary to excise it entirely, and 
to apply cauterization, or there will be a considerable chance of return. 
If the contents of the tumor be concrete, the operation will be compara- 
tively easy; but otherwise, I think the incision is preferable: it is less 
painful and quite as successful. Some persons in practising this operation 
hold the tumor with the fingers, others place an elevator beneath the 
eyelid. I employ simply two pair of forceps, of which one is held by an 
assistant; I myself, holding the other in such a manner that the eyelid is 
rendered tense between them, and raised from the globe of the eye. I 
make the incision, expel the contents, and apply nitrate of silver to the 
interior of the cavity. There is sometimes slight consecutive inflammation, 
and the eyelid swells a little, and soon an eschar is detached, and the cure 
accomplished in eight days. A piece of lint dipped in saturnine lotion or 
cold water is the only dressing employed. I should, howevei', observe, 
that by extirpation the cure is more prompt; a piece of dressing is placed 
on the wound, and the whole is terminated. Part vi.,p. 14G. 
Decoction of Oak Bark.—This preparation has of late been strongly 
recommended by a French practitioner as an injection into dropsical cysts, 
as hydrocele, etc., after their previous contents have been drawn off. It 
is said to exert a marked tendency in preventing a subsequent accumula- 
tion of fluid. Its active astringent quality suggested to the above practi- 
tioner that it might be serviceable in promoting the contraction of the ring 
after the reduction of recent inguinal hernia; and the application for some 
time of compresses impregnated with a strong decoction of oak bark, kept 
in situ by a truss or bandage, has been in his practice attended with this 
result to the most satisfactory extent. Part viii., p. 76. 
Encysted Growths.—[Encysted growths arise from obstructions of the 
crypts and follicles of the skin and mucous membrane, and of the excretory 
ducts of various organs. Dr. Bennett says of them:] 
Encysted growths are composed of a cyst or membranous envelope, 
inclosing various kinds of contents. 
By some they have been divided into simple and compound, according 
as the tumor is formed of one cyst, or is composed of several. By others 
they have been arranged according to the nature of their contents into 436 
DEAFNESS, 
hygromatous, or aqueous ; atheromatous, resembling gruel; melicerous, 
honey-like, and steatomatous, or fatty encysted growths. The latter mode 
of division is very faulty, the atheromatous, melicerous and steatomatous 
varieties being all more or less fatty, whilst some kind of compound en- 
cysted tumors contain different contents in different cysts. 
An acquaintance with the structure and mode of development of these 
growths must convince us that there are only two modes of treatment ap- 
plicable—namely, 1st, entire extirpation, and 2d, destruction of the secret- 
ing surface in their interior. The idea that a dense fibrous envelope, often 
containing numerous secondary cysts, all richly furnished with blood-ves- 
sels, can be absorbed through the agency of mercury, iodine or any other 
drug, must be purely imaginary. Neither can it be supposed, that as long 
as any of the cysts remain intact a cure can be hoped for. But we have 
seen that the natural course of these secondary cysts is to open into each 
other, until at length only one large cyst nemains. Under such circum- 
stances a rupture, by exciting adhesive exudation, and thus destroying the 
secreting surfaces, or inducing adhesions between them, may cause a 
radical cure. It is in this manner that the occasional spontaneous removal 
of certain ovarian cysts are to be explained. Part xvi., p. 320. 
DEAFNESS. 
Treatment of Deafness.—After alluding to M. Petrequin’s opinion, that 
the use of the Eustachian tube is similar to that of the holes made in a 
drum, viz., to renew the air within the cavity of the tympanum, the fol- 
lowing important conclusions, drawn by M. P. from his experience, are 
given: 
1. That deafness is of very frequent occurrence in old people, in whom 
the mucous membranes do not perform their functions healthily, and who 
are subject to catarrhal congestions; also in those persons who have been 
subject to any of the numerous forms of inflammation of the pharynx. 
2. That the inspection of the throat furnishes a means of exploration 
which greatly facilitates the diagnosis, by often revealing a chronic and 
indolent inflammatory state of its mucous membrane. 
3. That Sir A. Cooper was mistaken in considering the existence of a 
humming noise in the ear as a symptom exclusively of nervous deafness; 
a form of the infirmity which is also of much less frequent occurrence than 
he supposed. 
4. That it is a serious error to consider as incurable all cases of deafness, 
in which the patient cannot hear the ticking of a watch placed between his 
teeth. 
5. That the diagnosis of obstruction of the Eustachian tube, easily estab- 
lished when redness of the pharynx exists, is much less so when this has 
disappeared, and when the lesion of the tube alone remains. 
M. Petrequin, however, is of opinion that we may suspect the existence 
of this lesion by the varying condition of the sense of hearing in different 
states of the weather, and when it is somewhat better, for a longer or 
shorter period of time, after a fit of coughing or sneezing. 437 
DEAFNESS, 
6. That the prognosis or chance of cure in this form of deafness is by no 
means so unfavorable as B. Bell and Sir A. Cooper have alleged; that 
often it may be cured by fluid or gaseous injections, or by cauterization of 
the opening of the Eustachian tube in the throat, or by the use of alum 
applied either in the dry or liquid foi’m to the back of the fauces—as a 
gargle, or as a powder mixed with sugar and insufflated upon the fauces, or 
lastly, the direct application of a stick of alum—recommended so strongly 
and used so successfully by M. Petrequin. He believes that this salt has 
a special effect on the pharyngeal membrane, independently of its merely 
astringent operation. However this may be, it would seem that it has a 
most beneficial influence on many maladies of the mouth and fauces. M.M. 
Bretonneau and Pommier have strongly recommended it in the treatment 
of diphtherite, Signor Bennati in various affections of the larynx, and M. 
Velpeau in diseases of the throat. Its administration is easy, and does not 
interfere with the employment at the same time of other remedies, as anti- 
phlogistics, revulsives, purgatives, cauterizations, the catheterism of the 
Eustachian tube, and the baths of compressed air, which have been so suc- 
cessfully used by M. Pravaz. 
Hitherto no trial has been made of injecting a weak solution of alum 
directly in the Eustachian tube; but it is more than probable that the 
practice will be found highly useful in many cases. 
“We would suggest the addition of tincture of capsicum to the alum 
gargle, as rendering it probably still more efficient in dissipating the 
chronic inflammatory state of the fauces and pharynx, which, according to 
his observations, is so frequent an accompaniment of deafness.”—liev. 
Part m.,p. 112. 
Treatment of Deafness by Puncturing the Membrana, Tympani.—Sir 
Astley Cooper showed that the cases likely to he relieved by this practice 
were those in which the Eustachian tube was permanently closed, or when 
blood had been extravasated behind the membrane. To those cases, other 
pathologists have added “ a morbidly thickened and cartilaginous condi- 
tion of the membrana tympani” itself. Dr. Mercer has performed the 
operation in fifteen cases. Of these, six were performed for chronic thick- 
ening of the membrane, and the remaining nine for obstruction of the 
Eustachian tube. One case alone, and that of the latter affection, suc- 
ceeded in the restoration of hearing. The operator then agrees with Itard 
in saying that “ nothing is more rare than the cure of deafness by perfora- 
tion of the membrana tympani.” He then details at length the history of 
an instance of idiopathic hemorrhage into the cavity of the tympanum. In 
this case, deafness, which was complete, was removed by the operation. 
“ The membrana tympani, instead of its normal, transparent, grey ap- 
pearance, had a dull brown color, and was slightly congested at the mar- 
gin ; the vertical line, indicating the handle of the malleus, was lost in the 
surrounding color, and the membrane, instead of presenting its concave 
appearance, seemed pushed oxitward into the meatus. On touching it 
with a probe, it was almost insensible, and pressure against it produced an 
elastic pitting. The head was carefully supported, with the left ear turned 
up, and the auricle drawn toward the vortex. The speculum being intro- 
duced as far as the second curve of the meatus, and then expanded, with 
a clear and steady light, the anterior and inferior part of the membrane 
was perforated, and a small portion of it removed by an instrument, which 438 
DEAFNESS, 
consists of a fine but strong steel needle, two inches and a half long, and 
the handle of an octagonal form, one and a half inches in length. The 
cutting or drill head is spear-shaped, one-sixth of an inch long, and one 
eighth in breadth at the shoulders, where the edges are turned over. The 
point and edges are very sharp. Each of these edges is hook-shaped, one 
turned forward and the other backward; and when thus viewed longi- 
tudinally at their broadest part, they resemble the italic letter f. On being 
brought in contact with the membrana tympani, the handle is made to 
rotate between the thumb and fore-finger, and this being communicated to 
the cutting point, it perforates the membrane similar to a drill, at the same 
time that the everted edges are causing a considerable loss in its sub- 
stance.” The subsequent treatment consisted chiefly of injections of warm 
water, and inflating the cavity with air, through the Eustachian tube. Dr. 
Mercer observed that the average time for reproduction of the membrane, 
when allowed to take place, was about four days. jPart xi., p. 128. 
Deafness, occurring in Scarlatina and Measles.—In the cure of deaf- 
ness produced by the exanthemata, sirup of sarsaparilla, made after the 
old formula—to which may be advantageously added the root of rumex 
crispus, and the tinctures of the bark of prinos verticillatus and chymaphilla 
umbellata—is a remedy of the first importance ; next, the muriate of lime, 
an old remedy now much neglected ; and lastly, iodine and its preparations 
as internal remedies. Blisters kept perpetually discharging, placed behind 
the ears or on the arms alternately, form the remedies to be applied ex- 
ternally. The fauces must be well rubbed with a smooth piece of alum 
twice a week, to be occasionally alternated with a solution of nitrate of 
silver, or when the tonsils are prominent, with the solid caustic, not too 
heavily applied. Lastly, the external meatus must be cleansed once a day 
with warm brandy, or warm brandy and water, or a solution of iodine, or 
a decoction of the bark of prinos verticillatus. Perseverance in this course 
for months, sometimes for more than a year, finally ends with complete 
success, if the treatment have commenced before disorganization of the ex- 
ternal or internal ear. Part xvii., p. 204. 
Mew Mode of treating Certain Cases of Deafness.—Mr. Yearsley ob- 
serves that hitherto there has been no successful mode of treating the 
deafness arising from perforation of the membrana tympani. The process 
of syringing out pus or mucus from the tympanal cavity, by passing air 
through the perforation by way of the Eustachian tube, M ill often indeed 
produce a temporary improvement; but in many cases it is of little or no 
service. 
Cases of deafness arising from perforation of the membrana tympani, 
may be immediately relieved in a most astonishing manner by adjusting a 
pellet of moistened cotton wool so as to the perforation. It is to be 
applied in the follov ing manner : use a pair of small forceps, weak in the 
spring and accurately made, and differing from common forceps in having 
the blades not rough at their extremity, but smooth and rounded off, so 
that when in apposition they may act as a probe. Having ascertained, by 
means of the speculum, the precise condition of the membrana tympani, 
take a small quantity of Mrool that has been moistened in some fluid with 
out any compression, and pass it by means of the forceps, doM7n to the 
bottom of the meatus; then disengage the forceps, close the blades, and 
use the points to adjust the wool at the spot where it produces the best DEAFNESS, 
439 
degree of hearing. The adjustment will require some management; but 
by repeated trials the patient will be able to do it himself, and should 
withdraw the dry wool and replace it with moist, night and morning, or 
morning only, as may be found necessary. Instead of using the forceps to 
adjust the wool, a small silver probe may be used ; and at the other end 
of the probe there may be a small screw, by means of which the dry wool 
can be withdrawn. As we have now a means of relieving the deafness 
which attends an open tympanum, perforation of this membrane may be 
resorted to with a better prospect of advantage than heretofore. It may 
be employed when there is—1st, great thickening of the membrane ; 2d, 
occlusion or obstruction of the Eustachian tube; 3d, extravasation of blood 
into the tympanum; it being provided in all these cases that there is no 
other way of relieving the disease, and that all the other parts of the ear 
are healthy. Part xviii., p. 238. 
Senile, Deafness.—Mr. Toynbee observes: 
It being now established by dissection that the most frequent pathologi- 
cal condition in the ears of elderly deaf persons consists of a thickened 
state of the mucous membrane, the presence of bands of adhesion, and a 
thickened condition of the membrana tympani—any one of which circum- 
stances is sufficient to prevent the passage of sonorous undulations from the 
membrana tympani to the expansions of the auditory nerve—it is highly 
important to inquire whether any remedial measures can be suggested 
which will tend to diminish these diseased conditions, and consequently 
improve the power of hearing. Practical experience induces me to believe 
that not only may the thick membrana tympani be relieved, but the thick- 
ened mucous membrane may be so reduced, and in some cases the bands 
of adhesion so far relaxed, that their presence will offer scarcely any im- 
pediment to the function of hearing. 
The local application most suitable for this purpose which I have tried, 
is that of a solution of argenti nitras, of a strength varying from half a 
drachm to two drachms of the salt to an ounce of distilled water. Pro- 
ceeding from the exterior orifice of the meatus externus, the passage may 
be touched to an extent varying from one-half to two-thirds of its length 
every third or fourth day. In some cases the membrana tympani also 
may be wrashed with a solution of argenti nitras, of six grains to the ounce. 
Where the noises are loud, and the symptoms indicate much congestion in 
the ear, leeches should be apjffied immediately below, not behind, the ears; 
and, where there is irritation of the external tube, an ointment composed 
of half a drachm of pulvis cantharidis, added to an ounce of simple oint- 
ment, and applied behind and below the ear, either daily, or every other 
day, will be found beneficial. 
The administration of alterative doses of pilula hydrargyri, hydrar- 
gyrum cum creta, or the hydrargyri bichloridum, is very useful; but it 
must be always recollected that the doses ought to be so proportioned, 
that neither debility nor any other unpleasant symptom shall be pro- 
duced ; in other words, so gentle should be the alterative, that no 
sensation should suggest to the patients that they are under a course of 
medicine. 
In addition to the medicines recommended, patients should be cautioned 
to avoid warm close rooms, and sitting very near the fire; no wine should 
be taken unless diluted with water; daily exercise, and wdien possible on 440 
DEAFNESS. 
foot, should be taken in the open air; together with a warm bath every 
week or ten days. This course of treatment has been productive of the 
greatest advantage in several cases of deafness of a most unpromising 
character. Part xix.,/>. 211. 
Use of Glycerine in Deafness.—In deafness caused by thickening of 
the membrana tympani, by deficiency of ceruminous secretion, or by a 
horny and dry condition of the auditory canal, and in many other cases, 
the application of glycerine will be beneficial. It is thus applied: wash 
the auditory passages carefully by means of cotton held between the 
blades of a pair of forceps adapted to the purpose, and dipped frequently 
in warm water, and dry them in the same manner; then apply the gly- 
cerine by the same means, passing the cotton, well soaked in it, repeatedly 
backward and forward in each meatus, and taking care to apply it to the 
tympanum. If a proper pair of forceps are not at hand, use a camel-hair 
brush. Part xx., p. 188. 
Guaco—Its Use in Deafness.—Dr. Pritchard, says, that the true guaco 
plant is named the “ Mikania Guaco,” classed by Dr. Lindley under the 
“ Aristolochiacece.” lie adds : 
The success which has attended its use in the cure of atonic deafness, 
especially that which appears in the post-meridian of life, will be best seen 
by presenting you with a case from my note-book. 
Mrs. V., aged 56, consulted me in the month of June, 1851, comjfiain- 
ing of being dull of hearing for the last ten years, which she attributes to 
the period of change. The cerumen was properly secreted, and the 
organ appeared perfect. It was only by shouting close to the head she 
could be made to understand; any very sudden noise or report produced 
a whizzing sensation, which completely confused all her ideas. 
Previously to seeking my advice, she had been under some very emi- 
nent aurist, without receiving relief; stated that syringing always made 
her quite incognizant of sound. Her general health seemed good, with 
the exception of suffering occasionally from severe constipation. Cathe- 
terism of the Eustachian tube had been tried, and vapors passed through 
that channel to the ear, but with the same result as injecting into the ex- 
ternal meatus. 
Five drops of the tinct. guaco were dropped into the right ear, and 
secured by a small plug of gutta percha, the latter having a coating of col- 
lodion painted over it. 
A pill of rhubarb and aloes was ordered every day after dinner; and 
three drachms of tinct. guaco, in six ounces of distilled water, for a mix- 
ture. Two tablespoonfuls three times a day. 
Four days afterward the plug was removed, and cotton wool, dipped in 
guaco, substituted ; the left ear was then plugged. In the following week, 
the clock striking in her parlor alarmed her, and I was sent for. The 
drops Avere noAv used every night for three Aveeks, and every day fresh 
proofs of returning function. At the expiration of tAvo months hearing 
Avas perfect, and has remained so to the present date. 
Part xxA’ii., p. 250. DEFORMITIES—DELIRIUM. 
441 
DEFORMITIES. 
jPrinciples of the Treatment of Deformities.—The principles laid down 
by Delpech, in his Orthomorphie, published at Paris in 1828, are com- 
prised in the following rules: 
1st. A tendon to be divided must not be exposed; and its divisions 
should be made by turning the instrument on one side, so that the line of 
the incision may not be parallel to the division of the skin; without this 
precaution risk of exfoliation of the tendon is incurred. 
2d. Immediately after division of the tendon, the divided ends should 
be brought into contact with each other, and kept in this position by a 
suitable apparatus during the entire period necessary for their union. 
3d. Inasmuch as it can only take place by the intervention of an inter- 
mediate fibrous substance, this substance, before it has become firm, can, 
and should be, extended gradually and carefully, until it has assumed a 
degree of length equal to the shortened muscle. 
4th. When this degree of extension has been effected, the parts should 
always be fixed in the position, and kept so until the new substance has 
acquired the requisite degree of consolidation. Part x., p. 161. 
DELIRIUM. 
Mush in certain cases of Delirium.—M. Recamier has most strongly 
advocated the use of this powerful antispasmodic in certain forms of deli- 
rium, occurring in the course of various febrile and inflammatory diseases. 
When pneumonia, as in certain constitutions, and in certain epidemics, is 
accompanied with marked symptoms of cerebral disturbance—a very 
embarrassing complication—the use of musk, either alone or in combina- 
tion with calomel, has been often found to be of decided advantage. It is 
also very useful in the delirium which not unfrequently attends the course 
of erysipelas, and several other exanthemata; more especially in small- 
pox, during the maturation and desiccation of the eruption. 
Musk is unquestionably one of the most potent, and least fallible anti- 
spasmodics that the Pharmacopoeia contains: the only drawback to its 
general use is its expense. Fortunately assafoetida, galbanum, and good 
castoreum may very generally be substituted for their more costly ana- 
logue. In all cases of nervous agitation, unconnected with plethoric and 
inflammatory excitement, this class of antispasmodic medicines may be 
used with advantage. Camphor also is a very potent member of the same 
family ; and few compounds are more beneficial than pills composed of 
musk or assafcetida and camphor—to which a few grains of calomel, and 
also some extract of henbane, may often be most judiciously added. We 
have witnessed most pleasing effects from this formula in several cases of 
puerperal mania. Part ix., p. 77. 
Treatment of Delirium.—In almost every form of delirium, antiphlo- 
gistic measures are unnecessary, or even injurious; and the occurrence of 
delirium in almost any disease, but especially in rheumatism or gout, ery- 
sipelas, or typhus, should be considered an indication that it is necessary 442 
DELIRIUM, 
to support the strength. With regard to the use of opium—it should be 
avoided, or used with the greatest caution, in those cases where delirium 
has a tendency to pass into coma, as in epileptic or hysterical delirium, 
and that from gout; but in wakeful delirium, such as the rheumatic, 
anaemic, and traumatic varieties, and delirium tremens, it may be given 
freely with great advantage. Part xxi., p. 364. 
Treatment of Delirium — Delirium e potu. — The object here is 
to promote the elimination of the poison without depressing the vital 
powers unduly. This is best done by emetics, purgatives and sudorifics. 
Give the first if you have reason to believe alcohol or undigested food 
remains in the stomach. If the patient is violent, you may use mechanical 
restraint, applying, at the same time, cold to the head. Be very cautious 
in using blood-letting, on account of the great tendency to depression. 
If the stomach is highly irritable or inflamed, do not give antimony, but 
apply mustard cataplasms to the epigastrium. Give ice or iced water, 
cold drinks, and prussic acid. If these fail, then leech the epigastrium, 
give morphia and creasote, effervescing draughts with potash, soda, or 
ammonia, keeping up, at the same time, a free action of the bowrels, by 
small and oft-repeated doses of sulphate of magnasia, dissolved in water. 
In cases where the true delirium tremens is complicated with the deli- 
rium e potu, we must combine, as far as possible, the two forms of 
treatment. Dr. Todd continues : 
Of Bronchitis and Pneumonia.—Depression of the vital powers favors 
delirium. If delirium come on after antiphlogistic treatment, immediately 
alter the plan, and adopt a stimulating one. There is great tendency to 
coma, especially after the antiphlogistic treatment. If coma come on, do 
not relax in giving support, and you may have to give stimulants. Apply 
also free counter-irritation to the back of the neck ; and it may be neces- 
sary to shave the head, and apply a blister to the scalp. 
Of Epilepsy.—There are no direct means of cutting short the par- 
oxysms of epileptic delirium. The more* innocent means, as introducing 
salt into the mouth, and applying cold water, may be tried. The main 
treatment consists in a cautious guidance through the prolonged fits. 
There is no necessity for local or general bleeding. If the pulse is strong, 
no stimulants are required ; if weak and irregular, or quick and running, 
then they are useful. The head may be shaved; and if hot, cold applied; 
and small blisters applied in succession to the scalp. All means must be 
taken to prevent the patient injuring himself, and the gentler these are 
the better. If there is extreme wakefulness, give hyoscyamus or hop 
rather than opium; and the cold douche or shower-bath is often very 
effectual in inducing sleep. The other drugs which may be administered 
are of the tonic kind, the most useful being the metallic tonics. 
Of Erysipelas.—The treatment of this form of delirium involves the 
treatment of the disease itself. Erysipelas is dependent upon the intro- 
duction of a morbid poison attacking the skin, and proceeding to the 
gastro-pulmonary mucous membrane, or vice versd, inducing the second- 
ary formation of abscesses, or the tertiary chronic inflammation and indu- 
ration of various glands, with the deposition of scrofulous matter. Can 
we eradicate this poison by a bold stroke at the outset ? If a large dose 
has been imbibed, the disease must pass through a certain course; and as 
there are no means of extracting it, we must guide the patient through 443 
DELIRIUM, 
the various stages of the fever, and counteract its depressing and destruc- 
tive effects. First, evacuate the bowels, with as little depression as possi- 
ble ; then give nutritious food, with stimulants, as brandy or wine, giving 
them frequently and at short intervals, and adding ammonia, bark, etc., if 
deemed advisable. If the stomach is irritable, or the patient opposes, or 
is disgusted with the medicines, give up the drugs and trust to food and 
brandy only. When delirium sets in, the patient wants more support and 
more stimulus; and the more freely they are given, the sooner the deli- 
rium will be subdued. If there is a tendency to coma, shave the head, 
and apply blisters freely; and if the delirium is decidedly of the active- 
kind, henbane, camphor, and hop are safer than opium, and may be cau- 
tiously given. 
Of Fever.—1st. Of the low, muttering kind, the patient apparently 
unconscious, but capable of being roused by loud speaking. 2d. Delirium 
of the active kind, patient being wakeful, talkative, and needing watching, 
or perhaps restraint. This generally comes on very suddenly, but the first 
generally very gradually. In the treatment of typhus fever itself always 
give nutritious food and stumulants early. As there is no inflammation 
present in the brain when delirium comes on in typhus fever, do not bleed 
even locally. True, there is congestion ; but it is only part of the general 
tendency, and therefore stimulate the capillary circulation, so as to pro- 
mote the flow of blood, which tends to stagnate in the fine blood-vessels. 
Apply, therefore, several small blisters to several parts of the shaven scalp 
in succession : if there is not time to wait, apply a large one, cutting it in 
slips, so as to apply it to all parts of the scalp. If there are clear reasons 
for taking away blood, do it rapidly by expert cupping over the temples. 
Be very cautious in giving opium; but if the state of congestion is not 
obvious, and the powers not very low, one or two doses well-timed often 
do great good. In the delirium of this disease, stimulants are of the 
greatest benefit; and give them in larger and more frequent doses. The 
pulse serves as a useful guide: if it does not quicken, but improves in 
quality, under their use, especially if it diminishes in frequency, let them 
be continued. 
Of Rheumatism and Gout.—This delirium occurs more frequently after 
bleeding than otherwise. But if the delirium does come on, it must not 
be allowed to continue, although the cardiac disease is present also. 
Opium is equally applicable to both, and it must be given to procure sleep, 
as in traumatic delirium tremens. Apply a blister to the region of the 
heart, and promote a free discharge from the blistered surface; avoid any 
bleeding or depressing treatment until all the delirious signs have passed 
away. Supply the patient constantly with food and with stimulants. Do 
not fear lest this plan should increase the cardiac affection ; it appears to 
be the most effectual plan to cause the termination of it to be in resolution. 
If the antiphlogistic plan is persisted in, the delirium is increased, the 
powers of the patient exhausted, and effusion into the pericardial sac takes 
place. The delirium of acute gout needs the same treatment; but as it 
has a greater tendency to pass into coma, we must not be so ready to 
administer opium, but wait to observe wThether there is any marked 
tendency to coma. Part xxii., p. 64. 
Ranger of incautiously moving Patients in Delirium.—Dr. Todd lays 
great stress upon the danger of moving patients in a state of delirium, or 444 
DELIRIUM TREMENS. 
recovering from it; and mentions some cases in which death immediately 
resulted from this caution not being observed. Part xxiii., p. 95. 
DELIRIUM TREMENS. 
Treatment of Delirium Tremens.—The results of the different methods 
of treatment by Dr. "Ware, will be more readily compared, if they are 
thrown together into a tabular form: 
TREATMENT. 
NUMBER 
OP 
CASES. 
BLED. 
DIED. 
RECOVERED. 
COMPLICATED 
WITH ACUTE 
DISEASE. 
Opii large doses 
8 
— 
4 
4 
1 
“ small 
7 
1 
2 
6 
1 
Emetics ... 
12 
1 
1 
11 
2 
Bleeding 
2 
2 
— 
2 
— 
Eclectic 
9 
5 
3 
6 
1 
Quinine 
1 
— 
— 
1 
1 
Mercurials 
1 
— 
— 
1 
— 
Expectant 
29 
4 
1 
28 
1 
69 
13 
11 
68 
13 
It appears, that of fifteen cases in which opium constituted the principal 
remedy, six died; whilst of fifty-four in which opium was not used at all, or 
only incidentally in small quantities, only five died. Still further, if we se- 
parate from these fifty-four, the nine cases in which the treatment was 
eclectic, and in which the mortality seems to have arisen from the combi- 
nation of acute disease, we have a remainder of forty-five cases, of which 
only two were fatal. Again, if we compare the mortality of those cases 
in which opium was pushed to the full extent advised by writers on this 
disease, with those in which no active remedy was employed, we have a 
mortality of one in two, against a mortality of only one in twenty-nine. 
Part iii., p. 65. 
Tartrate of Antimony with Opium.—Suggested in certain cases of deli- 
rium, in the advanced stages of nervous fever, and especially in delirium 
tremens. The following is the formula here prescribed, which may be 
varied in strength according to circumstances : 
R Tartrate of antimony, four grains; tincture of opium, one fluid drachm; 
camphor mixture, eight fluid ounces. M. 
Of this mixture, a tablespoonful was given every second hour, or until 
sleep was produced. Part vii., p. 10. DELIRIUM TREMENS, 
445 
Treatment of Delirium Tremens.—Although Dr. Watson agrees with 
all practitioners of experience, that opium, in some form or other, is the 
grand remedy; yet he properly warns his readers that it is not to be given 
indiscriminately, or trusted to alone. In some cases it must be adminis- 
tered cautiously, if at all; in others it must be combined with depletion in 
some form ; and in others, again, with strong drinks; while generally it 
must be combined with nourishment. 
“No particular rules can belaid down that will suit all cases. After 
clearing out the bowels by a moderate purgative, you may give three 
grains of solid opium ; and if the patient show no inclination to sleep after 
two or three hours have elapsed, you may begin to give one grain every 
hour till he does sleep. Or you may prescribe corresponding quantities of 
the acetate or muriate of morphia, or of laudanum, or of the black drop, or 
of Battley’s sedative liquor. His room, meanwhile, should be kept dark 
and quiet. If he sleeps for some time he will awake calmer and more sen- 
sible, perhaps perfectly so ; and you must withhold the remedy, or continue 
it in smaller or less frequent doses, according to the circumstances of the 
case. Sometimes the opiate treatment alone is quite enough; sometimes 
it is not. You meet with patients who resist very large doses of the drug ; 
but who presently sleep or become composed if you put their opiate dose 
into a glass of gin or a pint of porter. Nervous exhaustion goes along with 
and augments the nervous irritability 
“ If the patients pass many nights without sleep, they will die. I have 
tried various forms of opium; and I am quite satisfied with morphia.” 
Dart ix., p. >12. 
Treatment of Delirium Tremens — Cold Affusion—Tart. Emetic— 
Opium—Stimulants.—The most opposite plans of treatment occasionally 
succeed, in delirium tremens ; one practitioner succeeds by suddenly ab- 
stracting all the ordinary stimulants and pouring in large doses of opium 
instead; another succeeds by withdrawing the stimulants gradually, and 
giving more moderate doses of opium; and others employ no opium at all, 
or a very small quantity. It is certain that the powers of opium are very 
available in this disease, and will often be highly prejudicial if given too 
early. When the acute symptoms have abated, its effects will be best as- 
certained. Dr. Morehead, in common "with many others, believes that the 
disease generally runs a certain course, and requires a given time to sub- 
side, and that the great art of treatment consists not in forcing sleep by 
large doses of narcotics, but in conducting the patient through the period 
of delirium by withdrawing all sources of irritation, by moderating or sus- 
taining the circulation, and by calming the nervous excitement. For this 
purpose we may chiefly rely on the cold affusion, tartar emetic combined 
with opium, and the exhibition of stimulants in moderate quantities. The 
combination of tartar emetic with opium, as recommended by Drs. Law 
and Graves, of Dublin, forms one of the most powerful remedies which we 
possess, and has not yet been sufficiently appreciated by the profession. 
The tartar emetic may be given either to nauseate or not, according to the 
urgency of the case, and the degree of prostration already existing. We 
must remember that in many cases, instead of having high fever and con- 
gestion there is jwostration and exhaustion from the commencement; in 
which cases it would not be good practice to give tartar emetic, but, on 
the contrary, gentle stimulants. Where the case is, however, of a sthenic 446 
DELIRIUM TREMENS, 
character, we shall find that half grain or even grain doses of tartar emetic 
with half a drachm of laudanum every hour, will constitute a very power- 
ful means of subduing the excitement and conducting the patient through 
the earlier stages. Of course the antimony must not be continued too 
long. The combination of antimony or ipecacuanha with opium was a re- 
medy wrell known in the last century. Dr. Curry mentions the fact as 
well known in his time, that in this combination each ingredient counteracts 
or modifies very remarkably the effects of the other—the opium prevent- 
ing or subduing the emetic properties of the antimony, and the latter sus- 
pending the stupefying power of the opium. Part xi., p. 35. 
Delirium Tremens—Indications of Treatment.—Delirium tremens is 
usually defined as excitement with exhaustion. Excitement of the nervous 
system to an extent preventive of sleep, is frequently a leading feature 
in this disorder. 
But the excitement of the whole nervous system which exists in delirium 
tremens is not dependent alone on loss of sleep. In addition to continued 
irritation by the alcoholic stimulus to which the nervous system has been 
subjected, another cause generally cooperates in these cases—that is, the 
absence of a sufficient amount of nutrition. Habitual drunkards are always 
tippling, but they do not eat; they have no appetite, no powers of diges- 
tion ; and the consequence is, that while they are in a state of cont inued 
intoxication, they are in a state of perpetual starvation. Inanition is induced, 
another cause of the exhaustion of the bodily powers generally, and of ex- 
citement of the nervous functions in particular. It is well known that in 
all cases of inanition the bodily powers are depressed, but the nervous 
function is the last thus to suffer; it remains excited, in fact, in the midst 
of a general state of depression, as we see in cases of continued starva- 
tion, privation of food, and exhaustion from other causes. In excessive 
loss of blood, or drains of other kinds which exhaust extremely, we find 
that the nervous system remains excited even in the midst of weak- 
ness. Dr. Williams continues: 
The indications of treatment are three-fold. First, to compose that un- 
due excitement of the nervous system which prevails, and which is exhaust- 
ing the other powers. This is done by opium and other narcotics. Secondly, 
to support those functions which are failing, and which are already so much 
exhausted that life may be in jeopardy. Although sleep is needed, yet 
strength is required to support life, and although sleep be obtained, per- 
haps the excito-motory function may be exhausted so low, that it may 
prove the sleep of death—it may be a reduction to a state of sinking. 
Under such circumstances—and they often occur in extreme cases of ex- 
haustion in connection with delirium tremens—it becomes a leading indi- 
cation to support the system by stimulants, and food if possible. But there 
is a third indication which should never be lost sight of, in the treatment 
of delirium tremens ; that is, to purify the system from the poison that is 
in it. If it be a case of recent debauch, there is an alcoholic stimulant in 
the system, and the longer it remains there the more mischief it will do. 
And in these cases there are other poisons besides the alcoholic stimulant. 
The body is a'source of poison to itself; and if the vital powers are greatly 
reduced in their energy, the process of self-purification will not go on; 
the excretory functions are imperfectly performed ; the urine is no longer 
freely secreted ; urea, which is a poison in itself, accumulates ; the bile pro- 447 
DELIRIUM TREMENS. 
bably accumulates in like manner and the result of this in an extreme de- 
gree is to cause a poisoning of the system. 
It is therefore a leading object to purify the system by means of an in- 
crease of the secretions, and this is generally done practically by means of 
purgative and diuretic remedies. Part 48. 
Delirium Tremens treated by Ammonia.—Dr. Scharn recommends the 
employment of ammonia, in the form of the pyro-oleaginous solution, or of 
the succinate of the alkali. By means of this very simple and innocuous 
remedy, he has succeeded, he assures us, in curing a great number of very 
severe cases of the disease. 
Ammonia by itself will rarely suffice to subdue the excitement and allay 
the restlessness of this neurosis: opium must almost always be associated 
with it. We have often used, with good effect, the ammoniated tincture 
of valerian, and the liquor opii sedativus—not forgetting the application, 
at the same time, of warmth to the feet, and of cooling spirituous lotions 
to the head. When symptoms of febrile or inflammatory irritation are 
present, it may be necessary to resort to leeching, and the administration 
of effervescing saline draughts with antimonial wine. Part x., p. 31. 
Delirium, Tremens.—Whilst the tongue and mouth are moist, and urine 
abundant, don’t be afraid of giving opium for the purpose of procuring 
sleep when needed; but be careful if these symptoms are not present. 
Vide Dr. Corrigan’s “Treatment of Typhus Fever.” Part xiv.,y>. 26. 
Delirium Tremens.—Mr. Corfe says : 
This is a disorder peculiar to drunkards; it usually creeps on when they 
are deprived of their accustomed stimulus ; but I have repeatedly noticed 
that men who are in the habit of drinking freely, and who at the same 
time eat largely of animal food, twice, or even three times a day, rarely 
become the subjects of this disease ; but if they fall off in their appetite 
for this kind of food, and still continue to take their usual quantity of 
beverage, bilious diarrhoea, perhaps, supervenes; they become disordered, 
dose themselves with salts, etc., and perhaps get bled, and the disease soon 
sets in with its usual fierceness of excitement. Such is the case with the 
brewers’ draymen, and porters, potmen, etc., in London, amongst which 
class of persons the far greater number of these cases occur. Such is the 
fact, at least, with the idiopathic form of this disease ; but the traumatic 
variety occurs in the surgical wards continually, and even here, it may be 
observed, that if a drayman is brought in with a fractured thigh, and is 
able to continue to eat his accustomed quantity of animal food, with a fair 
allowance of porter, etc., he is most likely to escape the disease altogether. 
There is, at this moment that I write, a man in the accident ward, from 
one of the largest breweries, with severe laceration of the leg, and who 
has been allowed by Mr. Arnott, his surgeon, five pints daily ox the very 
best porter, and which is certainly equivalent to a gallon of the publican’s 
liquor in point of strength, and he has also been allowed full meat diet, 
extra bread, etc., and has hitherto escaped all symptoms of the disease. 
It should be observed that every case of threatening delirium tremens 
is preceded by more or less biliary derangement; and, as these men rarely 
enjoy active or healthy secretions from their alimentary canal, it does ap- 
peal-, from the observation of a large number of cases in this hospital, that 448 
DELIRIUM TREMENS. 
the disease is purely hepatic in its origin. This opinion is entertained by 
our talented physician, Dr. Seth Thompson, who has most successfully 
treated some of the worst cases of this disorder with large and repeated 
doses of calomel, followed by brisk cathartics; and he has never been 
obliged to resort to opium at all, sleep having succeeded the active unload- 
ing of the hepatic system. It has long since struck my mind that the inva- 
sion of the disease springs from a sudden, or, it may be, a gradual poison- 
ing of the blood, by means of a chemical alteration in the bile and urine; 
and that some of the elements of one of both of these secretions are car- 
ried through the circulation. My chief reasons for drawing these conclu- 
sions are the following: Since I have had the opportunity of watching 
the admirable practice of the above-named physician, the disease has given 
way, in a most decided manner, under sharp purgation with calomel, etc.; 
and the improvement is invariably coexistent with the passage of numerous 
dark, offensive and deeply-bilious evacuations. The onset of the disease 
is ushered in with loss of appetite, foul tongue, giddiness, nausea; and, in 
an effort to throw off some of the morbid cystic bile, sickness and bilious 
diarrhoea may probably set in also. Again, a very large number of cases, 
and those of the worst form, present themselves with symptoms of poison- 
ing by urea. It is stated that they have had one or more fits ; these fits 
are distinctly epileptic, and exactly resemble those attacks which some- 
times occur in persons laboring under albuminous disease of the kidney, 
and in whom the disappearance of urea from the urine, and its presence in 
the circulating fluids, has been repeatedly detected by Dr. Christison and 
others. In fatal cases of delirium tremens, an epileptic fit is often the fore- 
runner of death. 
Mr. Corfe speaks highly of the use of cold affusion in cases where there 
is very violent excitement, by means of a constant stream of cold water, 
poured from a height upon the head, face and chest of the patient, who is 
afterward to be rubbed dry with coarse towels. 
Mr. Corfe has always observed this cold affusion to be followed by a 
calm, long sleep, from which the patient awoke almost entirely well. In 
all cases of delirium tremens, however, take care to distinguish between 
that brought on in regular drinkers when they leave off their stimuli sud- 
denly from any dause, and the other kind, which is caused by a sudden 
and violent fit of drinking continued for a few days together. The first 
kind is from exhaustion, the second kind from congestion and even inflam- 
mation of the brain. The first kind is the true delirium tremens; the 
second kind may be termed delirium ebriosorum. 
Delirium tremens may be caused by other cerebral excitants besides 
intoxicating liquids. Dr. Gordon relates a case which was caused by 
tobacco. 
Delirium tremens has repeatedly been treated successfully by ether and 
chloroform, when all other treatment has failed. Such a powerful remedy 
must, however, in such cases, be used very carefully, when the brain is 
already over-excited. Dr. Anderson relates a very severe case which had 
resisted for several days the influence of opiates, purgatives, blister to the 
nape, ice to the head, etc., which was speedily relieved by the inhalation 
of chloroform. Part xvii., p. 50. 
Chloroform in Delirium Tremens.—[Dr. Rogan was called to visit a 
well-marked case of delirium tremens. lie says :] 449 
DELIRIUM TREMENS. 
I immediately gave him a drachm of laudanum in half a glass of brandy, 
and directed it to be repeated every hour till he slept; he was also to be 
well supplied with strong beef tea. He took three doses of the medicine 
without its causing any tendency to sleep or abatement of the delirium. 
His pupils were now so much contracted, that I hesitated to give more 
opium, and determined to try chloroform. I administered it on a hand- 
kerchief. In a short time he was under its influence, lying quiet, and 
breathing naturally. I kept up its effects for about three quarters of an 
hour, and then withdrew it. He roused up shortly after, quiet in manner, 
and evidently better. In about ten minutes he fell asleep, and slept for 
seven hours without intermission. When he awoke he was quite sensible, 
and much refreshed. He took some food, and again slept for some hours 
longer, and awoke quite well, and able to return to his work. The above 
is a good example of the benefit of chloroform after opium has been pushed 
as far as seems compatible with safety. Part xxvi., p. 43. 
Delirium, Tremens produced by Abstinence from Tobacco.—There is 
another very potent drug in common use among the lower orders, the 
probable effects of suddenly relinquishing which have been too little con- 
sidered, and respecting which the event of a case lately under the care of 
Mr. Curling, appears to offer a valuable hint to the practical surgeon. A 
withered old woman, a gin drinker and a habitual smoker, was admitted 
on account of a severe burn. Stimulants were from the first freely allowed 
her, and opiates administered, but in spite of them, she continued ex- 
tremely restless, wandering at times, and quite unable to sleep. Her 
manner and aspect, indeed, much resembled those of delirium tremens. 
At this juncture, several days after admission, Mr. Curling ordered that 
she should be permitted to smoke. The salutary influence of the measure 
was soon apparent—the woman became quiet and tranquil, and on the 
next night slept fairly. All tendency to delirium disappeared, and she 
afterward progressed steadily to recovery. Part xxviii., p. 67. 
Use of Chloroform in Delirium Tremens.—In delirium tremens arising 
from the leaving of of stimulants, which have been habitually taken in 
excess for a long time, give opium and moderate doses of alcohol, with 
good broth and nutritious diet. But in delirium tremens of a sthenic 
character, arising from the direct action of alcohol on the brain, taken 
lately but not habitually in excess, cases which are inflammatory and con- 
gestive, avoid both opium and alcohol, and try chloroform, but be careful 
of the above distinction in the two kinds of cases. Give half a drachm of 
chloroform in a draught every two hours. This may be increased to a 
drachm; but watch the respiration, and if slow and labored, give a little 
compound spirit of ammonia, to rectify the sedative effects of the chloro- 
form. We have seen chloroform given in this way in hysteria, have 
rather a serious effect on the respiration, the same as from inhalation. All 
bad effects, however, are rapidly obviated by a drachm of compound spirit 
of ammonia in water, and repeated in a quarter or half hour if necessary. 
Part xxx., p. 40. 
Delirium Tremens—Chloroform.—You may give chloroform with 
safety in those cases where stimulants have been suddenly left off. First, 
give half an ounce of wdiisky in the yolk of an egg, with a little sugar 
and nutmeg, and when well mixed, and just before being taken, add one 450 
drachm of chloroform. Give also strong beef tea, with a chop, and a little 
porter, according to the case. If the first dose of chloroform does not 
produce sleep, give a second, a third, and a fourth, and even a fifth and 
sixth, at intervals of an hour or so, according to the violence of the case. 
The great point is to keep the patient well up with food, such as egg and 
whisky, or broth, beef tea, chop and porter, etc.—all these to be used 
judiciously. You may begin to give the chloroform in half drachm dose? 
every three or four hours, till you feel your way with it, and then increase 
it, and give it, if necessary, every hour. Part xxxi., p. 70. 
DENTITION. 
Delirium Tremens—Chloroform.—A case of delirium tremens is re- 
corded : the subject, a stout, healthy man, in which laudanum and liyoscy- 
amus having completely failed in moderating the violence of the symp- 
toms, chloroform was administered; in five minutes he fell asleep, and 
continued sleeping for six hours, when he awoke* and the symptoms of the 
disease had vanished. 
“ We apprehend that the indiscriminate use of chloroform in delirium 
tremens would be highly dangerous. If a sly drinker, one who habitually 
gets nearly drunk, be compelled to leave off his stimulants suddenly, he 
will probably be attacked with delirium tremens ; but in this case the use 
of chloroform would be hazardous. You have an impoverished vital 
energy, an exhausted nervine force. Small doses of brandy, and constant 
administration of small quantities of beef tea are here called for. But 
where, as in the case mentioned above, the man is not a habitual drunk- 
ard, and the constitution is good—in fact, if we may use the term, when 
the disease is more sthenic, cliloroform will be found invaluable ; opium 
ajjd brandy injurious.” Part xxxix., p. 57. 
DENTITION. 
Diuresis as a Revulsive Action in Diseases of Dfonts.—Dr. Simon 
prefaces his remarks by alluding to the frequent inactivity, and, some- 
times, the almost complete suspension of the functions of the bowels and 
kidneys, while the system of the child is suffering severely from dentition. 
“ As long as the kidneys act freely, there is little or no risk in the 
symptoms of mere dentition, however severe and distressing these may 
be. The same remark is, we believe, strictly applicable to the prognosis 
of most cerebral affections in children. 
“ To promote this critical diuresis, a purgative, composed of senna and 
salts, and then frequently repeated doses of nitre, are the simplest and 
most efficient means that can be resorted to. 
“ The chief danger of dentition is referable to the vascular excitement 
of the brain. 
“Now it is a common observation that almost all headaches are most 
promptly relieved by whatever stimulates the kidneys to throw off a quan- 
tity of urine. 
“ Before closing these remarks, we may allude to the notable effects 
which diuretic medicines sometimes exert on the progress of hooping 451 
DIABETES, 
cough. The administration of nitred drinks, and of minute doses of digi- 
talis, seems often to promote the crisis of the disorder in its earlier stages; 
and, in its more advanced and chronic form, the use of tincture of cantha- 
rides has been recommended by Dr. Watts and others, as one of the most 
efficient antidotes. The practitioner will, therefore, do well to pay par- 
ticular and uniform attention to the condition of the bowels and kidneys 
in all the diseases of infancy and childhood.” Part i., p. 24. 
Scarification of the Gums during Dentition.—Dr. Marshall Hall says: 
“ There is no practical fact of the truth and value of which I am more 
satisfied than that of the effect and efficacy of scarification of the gums in 
infants, and not in infants only, but in children. 
“ It is to the base of the gums, not to their apex merely, that the scarifi- 
cation should be applied. The most marked case in Avhich I have observed 
the instant good effect of scarification, Avas one in Avhich all the teeth had 
-pierced the gums ! 
“ Better scarify the gums unnecessarily one hundred times, than allow 
the accession of one fit or convulsion from the neglect of this operation, 
which is equally important in its results, and trifling in its character. 
And it is not merely the prominent and tense gum over the edges of the 
teeth Avhich should be divided; the gums, or rather the blood-vessels, 
immediately over the very nerves of the teeth, should be scarified and 
divided, as you Avould divide the vessels of the conjunctiva in inflamma- 
tion of that membrane. 
“ ISToav, whilst there is fever or restlessness, or tendency to spasm or 
convulsion, this local blood-letting should be repeated daily, and in urgent 
cases even twice a day.” Part ix., p. 90. 
DIABETES. 
Diabetes Mellitus successfully treated by Ioduret of Iron.—[This case 
was admitted into the Hotel Dieu, having experienced the premonitory 
symptoms of diabetes three Aveeks previously, which were now com- 
pletely confirmed ; he passed fifteen quarts of urine daily, which contained 
a considerable quantity of sugar.] 
The treatment consisted in restricting him to animal diet, the adminis- 
tration of a bottle of claret daily, with a flask of Bagnols wine, broth 
without bread, and lemonade, etc., for drink ; he also took four pills, each 
containing five grains of the ioduret of iron, in the twenty-four hours. 
Under this mode of treatment the quantity of urine discharged soon 
diminished ; after the third day the man passed only twelve quarts; dur- 
ing the subsequent days the quantity underwent a still greater diminution, 
and the thirst, together writh the other symptoms of diabetes, subsided. 
[The ioduret of iron must have had considerable effect in this case, as 
the usual diet of animal food, etc., recommended in these cases had pre- 
viously failed in doing good till combined with this medicine.] 
Dart vii., p. 51. 
Inhalation of Ammonia Gas.—Suggested in Dryness of the Fauces 
accompanying Diabetes. Part vii., p. 64. 452 
DIABETES, 
Treatment of Diabetes.—Case cited in which the nitrogenizing plan of 
treatment recommended by Dr. Barlow, of Guy’s Hospital, was attended 
with excellent results. The treatment was commenced by giving five 
grains of the sesquicarbonate of ammonia every three hours, with coffee 
and bacon for breakfast, animal food and cruciferous vegetables for dinner.' 
The skin was stimulated by friction, and the patient well clothed with 
warm flannel. In four days the urine was diminished in quantity from 
twenty-four to fourteen pints daily. The ammonia was then increased to 
five grains every two hours, and very soon the quantity of urine voided 
was only eight pints daily; in thirteen days more only five pints, and in 
twenty-one days the drink taken in the twenty-four hours was two pints, 
and the urine four pints. Part viii., p. 74. 
Symptoms in common with Dright’s Disease.—“There are several 
points of view in which diabetes mellitus resembles Bright’s disease; in 
both there is a suppression of the functions of the skin; in both there is 
a tendency to secondary complication; in each there is a new element 
added to the urine; in both the serum is apt to become milky from 
admixture with a butyraceous fat; in both there is a tendency to increased 
watery secretion, in the one case a flux, in the other dropsy; in both 
there is a diminution of albumen in the blood.” Part ix., p. 8. 
Tests for Diabetic Urine.—Dr. Bird has placed before us the different 
tests which are generally the best and most easily adopted. He first men- 
tions Hunef eld's test, which, however, is too uncertain to be of any prac- 
tical value. Perhaps the best test is the one called Trommels test. This, 
which is the latest test suggested for the detection of sugar, is as follows: 
“Add to the suspected urine contained in a large test tube, a few drops 
of a solution of sulphate of copper; a very inconsiderable troubling gene- 
rally results, probably from the deposition of a little phosphate of copper. 
Sufficient liquor potass® should then be added, to render the whole 
strongly alkaline, a greyish-green precipitate of hydrated oxide of cop- 
per falls, which, if sugar be present, wholly or partly redissolves in an 
excess of the solution of potassa, forming a blue liquid, not very unlike 
the blue ammoniuret of copper. On gently heating the mixture nearly to 
ebullition, the copper falls in the state of sub-oxide, forming a red and 
copious precipitate. If sugar is not present, the copper is deposited in 
the form of black oxide.” This seems to be a most delicate test for the 
presence of sugar, and will readily detect it in the urine, even when very 
largely diluted. The other tests are, by the growth of torula, by the 
development of fermentation, and Range's sulphuric test. Part ix., p. 15. 
Diabetes—Effect of Climate in Treatment of.—Perhaps the treatment 
of diabetes by an animal diet has met with more success, at least as a pal- 
liative, than any other, and it would probably be still more successful if it 
could be rigidly followed up, which is next to an impossibility. The use 
of opium is another useful palliative. Diaphoretics are especially indi- 
cated by the dry, parched skin, which so generally exists, and which is 
often one of the earliest symptoms. A return of the natural functions of 
the skin is also one of the earliest symptoms of amendment. This has 
been remarked, many years ago, by Dr. Christie, who found the disease 
much more manageable in Ceylon than in this country. It is, moreover, 
seldom seen in very warm climates. Dr. William Hunter, during a long 
residence in Bengal, never saw a case; and Dr. Irnray, during a resi- DIABETES, 
453 
dence of seven years in the "West Indies, never saw or heard of a case 
commencing there. From several cases which this gentleman has pub- 
lished, we should say that a residence in a very warm climate is a most 
powerful means of restoring the healthy function of the skin, and curing 
the disease. Part xi„ v. 81. 
# 
Case of Diabetes Mellitus treated with Sub-acetate of Lead.—Mr. 
Kirby’s patient, twenty-one years of age, of nervous temperament, and 
affected with serious pulmonary disease, was passing nine quarts of urine 
in the twenty-four hours—it was saccharine; the thirst was not excessive, 
but the skin was remarkably dry and of a chalky feel. Mr. K. states: 
I prescribed one grain of subacetate of lead, with a minim of sedative 
opium, and a very minute portion of ipecacuanha, to be taken every 
second hour; with egg diet and mulled portex*, as his ordinary drink. In 
four days he announced a remarkable decrease in the quantity of urine, 
and a considerable improvement in his general feelings. In a month from 
this date, the pills which had been steadily used were laid aside, the 
urine being nearly healthy. Part xiii., p. 123. 
Treatment of Glucosuria {Diabetes).—[For a number of years, M« 
Bouchardat has been engaged in the study of the pathology and treat- 
ment of diabetes, and the numerous facilities he has enjoyed, being phar- 
macien en chef at the Hotel Dieu, at Paris, render the results of his 
researches of the utmost practical importance.] 
Diet.—Strictly forbid all farinaceous substances, as those into which 
starch in any way enters. Gluten bread is of great value ; that is, bread 
made of flour that has been deprived of the chief part of its starch. The 
flour of wheat is composed of gluten and starch, in the proportion of one 
of the former to three or four of the latter; and the two principles may 
De readily separated by washing out the starch from dough. It satisfies 
the cravings of the appetite. Animal food, with eggs, milk, buttei*, and 
cheese, are proper. Also the following vegetables: spinage, endive, let- 
tuce, sorrel, asparagus, haricots verts, cabbage of all kinds, along with 
fat pork or salt bacon; cresses with oil, and hard-boiled eggs. Fresh 
gluten, with butter, and cheese gi-ated upon it, is an excellent dish. For 
dessert, allow olives, almonds, filberts, and walnuts; occasionally, and in 
small quantities, allow apples, pears, cherries, curi-ants, gooseberries, 
strawberries, raisins, and pine-apples. Drinks: The French wines, Bour- 
gogne and Bordeaux, about a pint in the twenty-four houi-s; they are 
astringent; sometimes the quantity is to be increased, but the least 
approach to inebriety is injurious. Some patients are made woi-se with 
wine. Beer is injurious. Coffee is good, and should be taken with- 
out sugar, or the quantity of sugar should be very small. Lemonade and 
drinks of this class are injurious. Clothing: Protect the body from sud- 
den chills, by clothing it in flannel. Exercise should be carefully regu- 
lated; the patient should engage in those exercises in which he takes 
pleasure; but fatigue is to be avoided. Baths are not of much use; 
occasionally a tepid bath may do good; swimming in the sea has been 
found veiy useful. 
Medical Treatment.—Cai*bonate of ammonia, 77 grains; rum, 310; 
water, 1550 grains. One third to be taken half an hour before each meal; 
or give it as a bolus (eight grains), with treacle, from two to ten to be 
given every night. 454 
DIABETES. 
Give Vichy water. The alkaline biearbonates, particularly soda, are 
very useful. 
Dover's Powder and Opiates.—The former is very useful; ten grains at 
bedtime. Crude opium and morphia often disorder the stomach. 
Theriaca divina 5ss. to 5j., every night; a drachm contains one grain 
of opium. 
Chalybeates and Tonies.—When there is decided pallor of skin, resem- 
bling chlorosis, give tonic bitters with iron. The pulverized iron, or iron 
reduced by hydrogen, is the best form of chalybeate. 
Fvacuants.—Commence the treatment by giving an emetic and after- 
ward a purgative, to clear away anything injurious in the primse via. 
Evacuants are of no use afterward, except to combat certain symp- 
toms. 
Lime-water, calcined magnesia, alkalies, nitric, phosphoric, and sulphu- 
ric acids, alum, tannin, and other astringents, are of little if any use. 
Bleeding.—General bleeding is always injurious. Leeches or cupping 
to different parts, as the stomach or anus (as symptoms indicate), will 
be found useful, viz., where there is epigastric tenderness or suppressed 
hemorrhoids. 
The chief reliance must be placed on dietetic and hygienic means. 
Part xiv., p. 103. 
Diabetes.—Glucose, when in contact with alkalies, acquires great affinity 
for oxygen (as Ave find by its decomposing oxide of copper) ; by this 
means it is consumed in the blood, and converted into water and carbonic 
acid. Diabetes arises, M. Mialhe is of opinion, from a deficiency of alkali 
to effect this change ; therefore give alkalies freely; if this is done, amy- 
laceous food may be allowed. Part xv.,p. 139. 
Source of Fallacy in Testing for Sugar in Urine by Moore's 
Test.—Dr. liees has discovered a source of fallacy in Mr. Moore’s other- 
wise excellent test for sugar (that of boiling with Iiq. potassa>), which is 
that if the liq. potassae contain lead in solution, it will be united, in boiling, 
to the sulphur of any albumen contained in the urine, and thus produce a 
brown color. To guard against this, the liq. potassae should be kept in a 
bottle of green glass, which contains no soluble lead; and should be 
tested with hydrosulphuret of ammonia, from time to time. 
Part xv., p. 141. 
Turpentine in Diabetes.—[An anonymous contributor to the Lancet, 
stating that he has a patient who has had diabetes for ten months, during 
which the minimum quantity of water passed daily was nearly two gallons, 
goes on to say:] 
About six weeks since, alarming hemoptysis appeared (phthisis having 
supervened), to relieve which I administered spirits of turpentine. With 
the first dose the quantity of Avater diminished greatly, and after she had 
taken two or three doses of turpentine the urine Avas passed in its normal 
quantity, though not in its normal condition, as I could still obtain sugar 
by evaporation. I regarded this improvement in the diabetes as a mere 
coincidence, but on Avithdrawing the turpentine the Avater again increased, 
and that dreadful thirst, which had been absent, returned. 
As the quantity of urine passed continued in very large quantity, I 
again had recourse to turpentine in the form of Ohio turpentine. 455 
DIABETES, 
Instantly, as by magic, the quantity of urine decreased, has remained so, 
and I well know that were I to omit the turpentine for one day, two gal- 
lons and a half of water would be the result. Part xvii., p. 123. 
Bread for Diabetic Patients.—It appears to be now generally ad- 
mitted, that, in the treatment of diabetes mellitus, amylaceous matter 
should, in a greater or less degree, be excluded from the diet; but as is 
well known, under such restriction of the food, the diabetic patient soon 
becomes weary of the ordinary kinds of azotized matter, as beef, mutton, 
etc.; hence various substitutes for common bread have been proposed. 
Mr. Palmer’s recipe : Take the ligneous matter of sixteen pounds of 
potatoes, washed free from starch; three quarters of a pound of mutton 
suet; half a pound of fresh butter; twelve eggs ; half an ounce of carbon- 
ate of soda ; and two ounces of dilute hydrochloric acid. This quantity 
to be divided into eight cakes, and in a quick oven baked until nicely 
browned. 
It is, as must be obvious, an expensive article, but with many diabetic 
patients this will not be an objection of consideration. It is somewhat 
improved in taste by being slightly toasted. At first, gum arabic, in 
sensible quantities, was introduced into the bread, on the ground of the 
assertion of Professor Graham, that when that substance is taken by a 
diabetic patient, the proportion of sugar evolved from the system is not 
thereby increased, and that consequently, it might probably supply 
matter for pulmonary oxidation. However, it was found that it rendered 
the bread tenacious and disagreeable, so that its use was subsequently 
abandoned. 
Dr. Evans has suggested, that the bread might probably be improved 
by the addition of a certain proportion of bran; jyid accordingly, 
Mr. Palmer has already made some experiments upon the addition of bran, 
and with a satisfactory result. Part xix., p. 112. 
Deficiency of Alkali in the Blood, a Cause of—It is probable that a 
deficiency of alkali is the reason why the sugar in the blood is not con- 
verted in diabetes, as it is in health, into carbonic acid and water. This 
circumstance, then, gives one indication of treatment, and the emaciation 
and tendency to phthisis lead to another. In the fulfillment of these indi- 
cations, cod-liver oil and liquor ammonia have been given with advan- 
tage ; the patient beginning with half an ounce of the oil and five drops 
of liquor ammonia, thrice daily, and gradually augmenting the dose to five 
or six times the quantity. Part xxi., p. 104. 
Diabetes.—Alkalies have proved more valuable than any other kind of 
treatment. At the same time, substances should be given which cannot 
be converted into sugar, especially fatty substances, which can be used in 
the process of respiration. Alkalies have more power in those cases of 
stout subjects which bear some relation to gout, than in the more severe 
and confirmed cases where there is great emaciation. Part xxv.,p. 155. 
Diabetes.—The principal indication being to prevent the elaboration of 
the saccharine poison in the stomach and to restore defective digestion, 
Mr. Hogg endeavored to find some medicine which would effectually ar- 
rest the saccharine fermentation. This he tried to effect with the sulphuret 
of arsenic, which was prevented being converted into a soluble sulphuret 
by combining the liq. arsenicalis with the hydrosulphuret of ammonia, the 456 
DIABETES, 
following being the form : liq. arsenicalis, 3ij.; hydrosulphuret of ammonia, 
mxx.; tinct. henbane and lavender, each 3ij.; infusion of buchu, §viij. In 
two cases in which this remedy was applied it was successful. 
Part xxv.,/). 159 
Permanganate of Potash in Diabetes.—Mr. Sampson remarks, that in 
some cases of diabetes—long alter the sugar has disappeared Ifom the 
urine—the quantity of the urine remains too abundant, and its specific 
gravity too low. lie has attributed this to imperfect action of the diges- 
tive and assimilative functions. To remedy this, Mr. Sampson sought 
some remedy which would give out oxygen, when taken into the stomach. 
Chlorate of potash having failed, the permanganate was tried; speaking of 
which, Mr. Sampson found this medicine of essential service in several 
cases of obstinate dyspepsia, especially when there existed a profuse floxv 
of urine; its effect in speedily diminishing the quantity of that secretion 
has been strikingly marked, and has usually been followed by improvement 
in the general health. 
Give the permanganate of potash, beginning with 2 or 3 grains three 
times a day, and add one grain to each dose every third day, unless it be 
found to disagree. Part xxvii., />. 103. 
Treatment of Diabetes.—It maybe observed that porter increases the 
sugar in diabetic urine; but claret and spirits, as brandy, whisky and 
rum, do not; and what is more important still, milk scarcely increases it 
at all, even when the diet consists mainly of it, as the milk sugar is not 
easily converted into glucose within the body. As diabetic patients some- 
times go off’ phthisical, cod-liver oil is a valuable remedy, and large quan- 
tities of it may be taken in this disease. Part xxix., p. 131. 
Treatment of Diabetes.—The following treatment has proved very use- 
ful : A meat diet; a warm bath each alternate day, three grains of Dover’s 
powder three times a day, and five grains of the same with five of anti- 
monial powder at bedtime ; with saline draughts of the phosphate of soda 
and tartrate of potash to regulate the bowels. Part xxix., p. 134. 
Diabetes treated by Alkalies.—Give lime-water and hartshorn. This 
was a prescription of Dr. Colles of Dublin, and though unable to explain 
the reason of its value, it proved nevertheless in many cases successful. 
Part xxix., p. 136. 
Treatment of Diabetes Mellitus by Rennet.—The following was the 
treatment in a successful case of this disease. The diluted mineral and 
hydrocyanic acids were taken for some months. The diet was limited to 
butcher’s meat, fish, eggs, milk, and bran-bread. Fresh vegetables, such 
as cabbages, were taken occasionally. Brandy and water was allowed as 
a drink. A dose of rennet was taken after each meal. Part xxix.,/). 137. 
Employment of Torula Cerevisice in Diabetes Mellitus.—To prevent the 
arrest of the conversion of starch at the stage of sugar when xmdergoing 
the process of digestion, Dr. Herapath was led to employ the torula in a 
case of diabetes in which the patient, previous to treatment, had been void- 
ing urine of specific gravity 1044, and containing 850 grains of sugar in 
the imperial pint. Within two days of the employment of this substance, 
the specific gravity sank to 1020, and the sugar to 300 grains per pint. 
By steadily pursuing the same course during six weeks, the sugar event- 457 
DIABETES 
flail y disappeared altogether; the urine assumed its healthy character; and 
the patient lost all symptoms of his ailment, regaining his usual health and 
strength. Since that time, he has rapidly recovered his flesh. 
It was exhibited in this highly satisfactory case in that form in which it 
is usually employed by confectioners, and known by them as German 
yeast. 
The dose given in this case was one tablespoonful twice or three times 
daily, in milk. It was thus rendered very palatable. At first, the only 
inconvenience felt was a slight nausea, sometimes passing into actual vomit- 
ing, with eructation of carbonic acid probably; by giving the remedy after 
a meal, these disagreeable symptoms disappeared, and it was then borne 
very well. It was further serviceable in removing the obstinate constipa- 
tion which had previously existed, and produced regularity in the alvine 
evacuations. Part xxx., p. 75. 
Test for Sugar.—If a freely alkaline solution of chromate of potash be 
mixed with urine suspected to contain sugar, and boiled, the liquor will 
assume a deep sap-green color, arising from the decomposition of the chro- 
mic acid, the reduced oxide of chromium being held in suspension by the 
potass. Such is the sensitiveness of this test, that 5 or 6 drops of saccha- 
rine urine diffused through water is easily detected. Therefore, always 
have ready a mixture in equal jiarts of a solution of the neutral chromate 
of potass and liquor potassge. This should be labelled “ Test for Sugar.” 
A piece of white paper at the back of the test tube will allow the color to 
be better seen. Part xxx.,p. 77. 
Diabetes.—You cannot restrict patients exclusively to animal food. Let 
animal food, however, predominate, and mix with it such vegetable matter 
as will not yield much sugar. Give succulent vegetables and well fer- 
mented beer. Insist on regular exercise and warm flannel clothing, with 
sponging and friction of the skin, always remembering that the skin and 
kidneys are vicarious of each other to a considerable degree. Don’t give 
opium if you can avoid it, but mild mercurials occasionally; ox-gall also 
may be useful, given so as to mix with the food as soon as it lias been got 
out of the stomach. Creasote, half a minim, given at the time of taking 
food, has been very useful. Give also strychnine, quinine, or cascarilla. 
Part 95. 
Diabetes.—[An anonymous writer recommends that in this disease we 
should give the salts containing oxygen in feeble combination, such as the 
chlorate of potassa, or, still better, the permanganate of potassa. Dr. 
Goolden has, however, failed in seeing any advantage from these medicines. 
In his interesting paper read before the Harveian Society, he gives a series 
of cases, in which cerebral disease and injury were the direct causes of 
diabetes, and with the relief to the cerebral mischief by treatment directed 
to the brain alone the diabetes vanished.] 
The first case, which suggested all my subsequent experiments and ob- 
servations, was that of a railway guard, stunned by a blow from the handle 
of a break, when revolving with force. Concussion and diabetes ensued. 
Since then I have been able to trace the commencement of the disease to 
injuries. One patient had fallen downstairs, struck the back of his head 
and was stunned, nine months before admission; the same date he gave as 
the commencement of his diuresis. Another had been stunned by the fall 458 
DIABETES. 
of a piece of timber from Victoria Tower, which injured his arm, and he 
had been diabetic ever since. This man was improving, but left the hospi- 
tal, because he would not have a seton; but is, I understand, now in St. 
Bartholomew’s, with the seton. Another man, now in King’s Ward, 
traced his disease to a kick on the head from a horse, from which he suf- 
fered severely at the time. 
Another group of cases has presented itself, whose history does not 
record any accident, but which have been cured by treatment directed to 
the brain. I have only three of these, a small proportion to the whole, but 
invaluable as to their importance for induction. 
Another important group consists of cases where the cure has been spon- 
taneous or accidental. I have seen diabetes in its most aggravated form 
subside within a few hours ; but pulmonary deposit, ending in a vomica, 
supervened. 
Mr. Clapton, our very able resident assistant apothecary, who lias watched 
these cases with great care and interest, informs me of a case of a medical 
In an in the country who was obliged to part with a large practice on ac- 
count of being the victim of diabetes, and unable, from his consequent 
debility, to pursue his profession. After suffering great emaciation and 
debility, a large anthrax on the nape of his neck occurred, which extended 
toward the occiput and down the back, and was nearly fatal to him; but, 
thanks to port wine, brandy and quinine, he recovered not only from the 
carbuncle, but also from the diabetes, and is now quite well. 
Mr. Amphlett, of Birmingham, informed me of a case of diabetes in the 
person of a wealthy manufacturer, whom he treated upon the old plan of 
animal diet for some months, without much benefit, when he was suddenly 
seized with an attack of apoplexy ; for this he was purged and cupped, 
after which there was no more diabetes. 
I must also mention, that pulmonary disease, or congestion, is not an 
essential part of diabetes, though it does frequently coexist. In two ag- 
gravated cases now in King’s Ward, the lungs are quite clear. Dr. Bris- 
towe and myself took some pains in examining them, to ascertain the fact, 
in consequence of your correspondent’s assertion, which, if universally 
true, would be an important point. 
With regard to remedies, our attempt at specific treatment must prove 
a failure. 
Address your remedies to the brain, instead of the stomach or kidneys. 
Apply blisters, cold lotions, and setons to the head and neck. Apply a 
continuous galvanic current from the nape of the neck to the epigastrium. 
Use Strongfellow’s or Pulvermacher’s portable electro-voltaic battery for 
this purpose. Part xxxi,,p. 100. 
Diabetes Mellitus.—Gluten bread, made according to the following 
formula, contains the smallest possible quantities of the elements of sugar: 
Fresh moist gluten, 24 oz.; bicarbonate of ammonia, 5iij. gr. xij.; com- 
mon salt, 5iss.; powdered carraway, 48 gr.; wheaten flour, 4£ oz.; pow- 
dered bran, oz.; salt butter, 4 oz. 
The above quantities yield 24 oz. of bread, when baked. It should be 
baked in small and flat circular tin pans, placed on a moderately heated 
hot-hearth. Part xxxii., p. 300. 
Diabetes.—This disease is more under the control of regimen than 
medicine. Milk is very proper in these cases, as diabetic sugar is never DIABETES. 
459 
generated from milk sugar. Gluten bread lias recently been much recom- 
mended, but fine bran bread is preferable. Maccaroni is also highly 
praised. Among medicines, citrate of ammonia and opiates are, perhaps, 
the best. Some recent researches would point to diabetes as a peculiar 
form of nervous disease, rather than a renal or hepatic affection. 
Part xxxiii.,jc>. 237. 
Diabetes.— Opium has a most powerful effect in diminishing the quan- 
tity of urine, but does not cure the disease. Ammonia, in some cases, 
has the power of reducing the urine, the specific gravity, and the quantity 
of sugar. Cod liver oil improves the general condition of the patient, and 
reduces the urine. The combined use of cod liver oil, opium, and ammo- 
nia, effects the most prompt and permanent benefit. Plisters to the 
hepatic region are useful. A mixed generous diet is the best; restriction 
is rather baneful than beneficial. Part xxxiv., p. 112. 
Diabetes.—The essence of diabetes is an arrest of the normal changes 
taking place during the digestion of starchy matters at their second stage, 
or that of conversion into sugar, the cause being a deficiency or vitiation 
of the digestive fluids. Now, if this cause can be obviated or removed, 
we have a partial or total disappearance of sugar from the urine. We 
have in rennet or pepsin a remedy which effects a healthy digestive pro- 
cess in an unhealthy viscus. Under its use the sugar partially or entirely 
disappears, and there is consequent improvement in the condition and 
health of the patient. Part xxxvi., p. 117. 
Diabetes.—In a case lately treated by Dr. W. Budd, at the Bristol 
Royal Infirmary, the patient was allowed an unlimited amount of sugar, 
with the view of supplying the material, the loss of the elements of which 
from the body, causes the wasting and loss of strength. No remarkable 
alteration resulted from this treatment, either as to the increase or dimi- 
nution of sugar in the urine, but the patient gradually seemed to gain 
strength, and two months after the adoption of this new plan of treat- 
ment, although he was taking eight ounces of sugar and six of honey 
daily, he was only passing three pints of urine, of specific gravity, 1032. 
Part xxxvii., p. 98. 
Gly cogenesis—Formation of Sugar.—Sugar ingested directly as sugar, 
is, in its passage through the liver, converted into an emulsive substance, 
which much counteracts the tendency to emaciation in diabetic patients. 
(The sugar found naturally in the blood, is secreted by the liver from 
albuminous substances.) Now, glucose is much more readily transformed 
into this emulsive substance than cane sugar, and consequently substances 
containing glucose, as honey and fruits, should be administered to patients 
in preference to ordinary sugar, as, if too much of the latter be adminis- 
tered at once, part gets into the blood unaltered, and is subsequently 
excreted by the kidneys, aggravating the disease. Part xxxviii., p. 102. 
Treatment of Diabetes Mellitus.—In adopting a plan of treatment, 
Dr. Inman was guided by the following considerations: 
]. The liver naturally produces sugar in a definite quantity. In dia- 
betes there is an excess of sugar, and we may fairly infer that it comes 
from the liver. Opium has a decided effect in diminishing the bile-pro- 
ducing or secreting function of the liver, and it is reasonable to suppose 
that it will reduce the sugar-forming function. Experience has long told 460 
DIABETES 
us that no single remedy in diabetes has been so efficacious in diminishing 
the quantity, etc., of urine passed, as opium. Opium, therefore, should 
be one ingredient in the treatment. 
2. Again, Bernard has shown that the liver makes sugar, no matter 
what is the nature of the food employed. Dr. Budd has shown that some 
patients, at least, may be benefited by saccharine food. But my patients 
did not long for sugar; and they did enjoy their ordinary food; conse- 
quently, I neither restricted them to non-saccharine, or non-amylaceous 
diet, or prescribed unusual quantities of sugar. They were to have the 
ordinary full diet of the hospital, but more in quantity if they chose, 
either of bread, meat, or potatoes. 
3. Again, it seems to be clear that in diabetes, there was debility, im- 
plicating more or less the whole system; that there was danger of death 
by consumption ; that the digestive powers, notwithstanding their appa- 
rent energy, must be impaired ; at any rate, that opium was liable to dis- 
order the stomach, and that it could be tolerated in larger quantity if 
combined with quinine. 
The result of these considerations was the following prescription for a 
pill: 
Opium, one grain ; quinine, two grains ; to be taken every four hours. 
Full house diet, with porter daily. r 
The efiect of this was soon apparent. Both patients, laboring men, re- 
mained under notice, the one about three months, the other for six Aveeks. 
Both left the house of their own accord, as they considered themselves 
sufficiently cured, and competent to do their ordinary work. 
Part xxxviii., p. 111. 
Diabetes from Cerebral Disease.—Since the experiments of Claude 
Bernard have shown that irritating a limited portion of the cerebral sub- 
stance is followed in animals by the production of sugar in the urine, the 
attention of physiologists and pathologists has been drawn to the question 
of Iioav far some of the cases of diabetes met with in practice may be due 
to cerebral disease. As a slight contribution to the investigation of the 
subject, M. Leudet relates four cases, in Avhich he believes this relation- 
ship is Avell made out; and from a consideration of the particulars of these, 
and of observations made by other practitioners, he comes to the follow- 
ing conclusions: 1. Diabetes arises in certain cases from organic changes 
in the brain. 2. Its commencement may coincide Avith that of the disease 
of the brain, or it may take place subsequently. 3. Cerebral disease 
attended Avith convulsive movements are those which are especially 
accompanied by glucosuria. 4. The diabetes may be temporary, mani- 
festing itself during an exacerbation of the cerebral disease, and disappear 
with this. 5. The symptoms of glucosuria differ in these cases in noAvise 
from the ordinary disease developed under the influence of other causes. 
6. The diabetes does not derive any aggravation from its antecedent: 
7. The treatment should be that of ordinary diabetes. 
Part xxxviii., p. 112. 461 
DIAPHRAGM DIARRHOEA.. 
DIAPHRAGM. 
Wounds in the Diaphragm.—It is a singular fact, first noticed by Mr. 
Guthrie, that a wound in the diaphragm never heals, but remains a hole, 
even if the person should live for years. 
A soldier was wounded at Waterloo, by a sword, which penetrated the 
left side of the chest diagonally, and came through the opposite or right 
side below, having in its way, as was supposed at the time, injured the 
diaphragm. The man recovered, and returned to his duty. On the 6th 
of September, nearly fifteen months afterward, he was attacked, after 
cleaning his horse, by all the symptoms of a strangulated internal rupture, 
and died next day. On opening the body, the greater part of the stomach 
was found to have passed through a hole in the diaphragm, made by the 
sword, and had become strangulated, like any other part constituting a 
hernial rupture. 
When a man has recovered from a wound which has been supposed to 
have left a hole in his diaphragm, he must not clean a horse, nor tie his 
own shoes, nor even bend his back, if he can help it. He must eat spar- 
ingly at a time, drink less, and sleep as much as possible in a somewhat 
raised position. When, however, all possible precaution has been taken 
in vain, and he is distinctly suffering from the symptoms of an internal 
strangulated hernia of the part supposed to have been injured, and is likely 
to die unless relieved, what is to be done ? Why, you must make an inci- 
sion through the wall of his abdomen, just over the suspected spot; intro- 
duce your hand through this cut, feel with your fore-finger for the hole in 
the diaphragm, and withdraw the strangulated part, even if it should be 
necessary to enlarge the hole in the diaphragm by a blunt-pointed bistoury. 
If it should have formed attachments, and cannot be withdrawn, the 
strangulation may be relieved and the patient survive. It is an operation 
you can practise every time you open a dead body, and it will be a great 
triumph for surgery to save the life of even one person laboring under an 
infirmity otherwise at this moment invariably mortal. Part xxv., p. 200. 
The continued Use of Opium is liable to produce Diarrhoea, from its 
effect upon the nervous system, causing relaxation of the sphincter muscle. 
Part i.,p. 27. 
Oil of Ergot of Pye—Suggested in certain stages of diarrhoea. Mr. 
Wright, in a series of experiments with the oil, says: “I have twice 
administered oil of ergotfin troublesome diarrhoea, and with very marked 
advantage. The dose was 10 drops every three hours, and both the 
patients were cured on the following day. It must be understood, how- 
ever, that this remedy acts simply by subduing an inordinate irritability of 
the intestines, for it is not physiologically an astringent.” Part ii., p. 40. 
Extract of Monesia.—Suggested in diarrhoea, in the form of pills, in 
doses of from twelve to thirty-six grains in the day. Part ii., p. 77. 
DIARRHEA. 462 
DIARRHOEA. 
Treatment of Diarrhoea in Infants.—In tlie diarrhoea to which infants 
are often subject, when unaccompanied by fever or other signs of inflam- 
matory action, M. Trousseau recommends the following enema: nitrate of 
silver, one to three grains; water, twelve and a half ounces. Or the 
nitrate of silver may be given in solution, thus: nitrate of silver, one to 
two-fifths of a grain ; water, thirty scruples; simple sirup, thirty scruples. 
Five or six teaspoonfuls to be taken in the twenty-four hours. 
Fart iii., p. 57. 
Burnt Rhubarb in Diarrhoea.—Mr. Hoblyn says: 
“I have used it for seven years, and found it more serviceable in the 
diarrhoea, attendant on the last stage of consumption, than the chalk-mix- 
ture and opium, or any other of the usual remedies. 
“ I have known it used, with the same pleasing effects, for more than 
twenty years, in incidental diarrhoeas. After one or two doses, the pains 
quickly subside, and the bowels return to their natural state. The dose is 
from five to ten grains. 
“ The manner of preparing it is to burn the rhubarb powder in an iron 
crucible, stirring it until it is blackened ; then smother it in a covered jar. 
“ It loses two-thirds of its weight by the incineration. It is nearly taste- 
less. In no one case where I have known it given has it failed. I have 
given it in port wine, milk and water.” Fart iii., p. 60. 
Irish, or Carrageen Moss (Chondrus Crispy s.)—It has been long 
known in Ireland, and highly esteemed by the peasantry on the western 
coast, as a nutritive article of diet, and as a remedy for constipation, diar- 
rhoea, scrofula and diseases of the kidneys. It is usually exhibited in the 
form of decoction or jelly. 
“1. Decoctum Chondri.—Macerate half an ounce of carrageen in cold 
water, during ten minutes ; then boil in three pints of water for a quarter 
of an hour. Strain through linen. Milk may be substituted for Avater 
Avhen the decoction is required to be very nutritious. By doubling the 
quantity of carrageen a mucilage is procured. Sugar, lemon-juice, tinc- 
ture of orange-peel, or aromatics, as cinnamon or nutmeg, may be employed 
as flavoring ingredients. 
“ 2. Gelatina Chondri.—Prepared by concentrating the decoction, or 
by employing a greater quantity of carrageen. 
The following is M. Beral’s formula for preparing Avhat he is pleased to 
call analeptic or restorative milk: Take milk 24 ounces, Irish moss 4 
scruples, sugar half an ounce, canella or cinnamon I scruple; macerate 
the moss in cold water for a feAv minutes, then shake the water out of it, 
and boil until the liquid attains the consistence of warm jelly; when cold, 
it has the consistence of cream. In the Danish Pharmacopoeia the propor- 
tions given for making “ Carraghen-Mos-Gelee ” are 2 drachms of the moss 
to 12 ounces of milk. Fart v., p. 44. 
% 
The TInripe Fruit of the Diospyros Virginiana.—Dr. Mettauer, of 
Virginia, recommends, as a very powerful astringent, the unripe fruit of 
the persimmon (.Diospyros Virginiana). Dr. Mettauer Avas induced to 
try it as an astringent in a case of infantile cholera. It succeeded admir- 
ably, and has since been tried successfully in a variety of cases, Avhere an 
astringent Avas required. It may be used in the form of infusion, sirup, or 
tincture. The infusion may be made by infusing from one to tAvo ounces 463 
DIAERIICEA. 
of the fresh immature fruit, slightly crushed, in a common teacupful of 
boiling water, and of this, from one to three teaspoonfuls may be given to 
an infant every hour, if necessary: an adult may take from one to three 
tablespoonfuls every hour or two. The tincture is made by digesting one 
pound of the green persimmon, recently procured, and a little crushed, in 
one pint and a half of port or any other wine, exposed daily to the solar 
heat for 14 days, and then filtered. From two to four teaspoonfuls of this 
tincture is a dose for an adult; and half, or one teaspoonful for an infant. 
But it is more applicable to disorders of the adult than to those of the 
infant, on account of the wine which is used. An acetous tincture may 
also be made by digesting two pounds of the recent fruit, a little crushed, 
in two pints of strong, pure apple-vinegar, 14 days exposed to the solar 
heat. This acetous tincture is chiefly used externally, for gargles and cat- 
aplasms. It is valuable in tonsillary affections, and in chronic catarrh. In 
uterine hemorrhage and in menorrhagia we may find it useful, not only 
internally, but externally applied. Part 29. 
Puerperal Diarrhoea—Treatment of by Diacetate of Lead.—Dr. Oke 
relates two cases of inflammation of the mucous membrane of the bowel 
occurring soon after parturition, in which the most obstinate diarrhoea was 
continued, in one case to a fatal termination, and in another for sometime, 
notwithstanding the usual routine of practice by calomel and opium, 
catechu, morphia, leeches to the tender abdomen, fomentations, etc. The 
diarrhoea was frequent and exhausting, the stools were foul and thickened 
with slimy mucus, countenance anxious, eyes sunk, pulse 140, and the 
patient sleepless. The diacetate of lead combined with opium was now 
commenced. 
A grain of the diacetate and a grain of opium were immediately given, 
and the same dose repeated every two hours whilst the diarrhoea required 
it; at the same time, the cretaceous mixture was to be given after every 
liquid stool, as before. 
This treatment soon produced the happiest effect. From the moment 
the diacetate of lead was taken, the diarrhoea gradually subsided ; her 
sleep returned, and in forty-eight hours the pulse fell from 130 to about 96 
in the minute. The dose of the diacetate and opium was of course di- 
minished, and the intervals of giving it protracted as the symptoms 
yielded to its use ; in short, under the saturnine treatment she completely 
recovered. Part x 166. 
Obstinate Chronic Diarrhoea.—Oxyde of silver recommended. 
Part xi., p. 107. 
Acetate of Lead in Discharges from the Dowels.—Dr. Graves states that 
acetate of lead, when used in large quantities for any considerable time, 
invariably blackens the evacuations. 
You can, however, always distinguish this tinged mucus among the 
natural discharges, the color being mixed only, and not blended with the 
latter, as it is with the former. But if the evacuation be of a dark color, 
such as is seen in cases where blood has been effused into the intestinal 
tube, and changed by the acid juices of the canal into a dark coffee-ground 
or nearly inky appearance, it becomes very difficult to distinguish this 
from the tinge given by acetate of lead, unless you are accustomed to it. 
“ I may observe here that a considerable degree of error has existed 464 
DIARRHOEA. 
with respect to a peculiar greenish discharge from the bowels, composed 
of morbid matter secreted by the diseased mucous membrane. 
“ All jn-actitioners before me, and among the rest Dr. Cheyne, at- 
tributed this to an effusion of morbid bile. This error, I regret to say, is 
still prevalent: you will hear medical men, when they meet with this dis- 
charge in children, say that it is the result of a morbid secretion of bile, and 
that the child requires calomel purgatives to carry it off. It is true that 
morbid bile may irritate the intestinal mucous membrane so as to cause 
an effusion of this green secretion, but still this is not bile. Bile, when 
secreted in large quantities, is never green; it may present a lighter shade 
of yellow, but it is never green. This secretion comes from the surface of 
the small intestines, and is generally the result of irritation. What is the 
consequence of inflammation in other mucous tissues—in the eye, for in- 
stance, or in the urethra ? Do we not see the mucus assume a yellow- 
ish, and even a greenish color ? The discharge from an irritated mucous 
membrane may assume all shades from a pale white to a yellow or green. 
I dwell on this chiefly to point out the gross error of looking upon the 
discharges from the irritated surface of the intestines in children as con- 
sisting of morbid bile. It is not depraved bile, neither is it to be removed 
by calomel or strong mercurial purgatives. It is by changing the diet, 
keeping the child warmly clothed, and prescribing small doses of hydrarg. 
c. creta with Dover’s powder, that this diseased secretion is to be checked. 
What does calomel do ? It frequently produces exactly the same state of 
the digestive tube. You will have in a patient taking calomel a copious 
secretion from the intestines of a deep green color* resembling chopped 
spinach, accompanied with pain in the bowels and other symptoms of irri- 
tation, showing the source from whence the discharge proceeds. 
“In the case of a young woman, now convalescent, nature attempted 
the relief of the abdominal congestion, not by an effusion of blood, but by 
means of a copious watery diarrhoea. She passed enormous quantities of 
this secretion, which appeared to consist of aqueous fluid, mixed with 
coagulated and shreddy mucus, so as to resemble decayed vegetable 
matter, which had been chopped small and left to macerate in water, until 
it became intimately mixed up with it. 
“ We attempted, after the lapse of a few days, to check it by the use of 
acetate of lead and opium, with wine, and were so fortunate as to succeed 
completely. We gave her draughts, composed of acetate of lead and 
tincture of opium in camphor mixture—two grains of the acetate of lead, 
with live drops of laudanum, in each draught. Of these she took five the 
first day, four the second, and three the third. On the evening of the 
third day the secretion from the bowels was so much arrested, that it 
was deemed unnecessary to continue them any longer. Their use has not 
been followed by any unfavorable result. The patient has been improv- 
ing rapidly ever since, and now is able to sit up. 
“Dr. Bardsley recommends the trial of acetate of lead in that form of 
diarrhoea which comes on toward the termination of fever, and generally 
ends in ulceration of the Peyerian glands. 
“ I have experienced the best effects from its employment, not only in 
the diarrhoea which accompanies ulceration of the mucous glands, but 
also in that species of diarrhoea which occurs at an earlier period of fever, 
and by means of which nature attempts the relief of intestinal congestion. 
Of its great value in the treatment of cholera I have already spoken; DIARRHCEA. 
465 
indeed, I do not know of any remedy by which inordinate fluxes from the 
bowels, whatever may be their nature, are so efficiently treated. The 
same remarks will apply to super-secretion from the lungs. 
“ I have been in the habit of prescribing it in combination with lauda- 
num and wine vinegar.” Part xii., p. 88. 
Nature of the Green Evacuations of Children.—[At the conclusion of a 
paper on the green alvine evacuations of children, l)r. Bird thus sums up 
his opinions on the subject:] 
I regard the presence of green stools as indicative not of a copious 
secretion of bile, but of a congested state of the portal system, in which 
blood is exuded very slowly, and in small quantities, so as to allow of the 
color being affected by the gases and secretions present in the intestines; 
a state of things capable of readily ending in meloena, in which the effu- 
sion of blood is so copious and sudden as not to give time for the occur- 
rence of the changes alluded to. There is, moreover, a peculiarity in the 
green dejections in children and others whose portal circulation is con- 
gested, which, so far as I know, is quite distinct from any property pre- 
sented by mere bile under similar circumstances—I allude to the effect of 
exposure to the oxygenating influence of the air upon them. When first 
voided the “ chopped spinach ” stools are in the majority of cases of a 
bright orange color, and they assume their characteristic grass-green hue 
only after exposure to air. The time required for this change varies re- 
markably. I have seen an orange-colored stool become green in a few 
minutes; and in the .same patient, only a day or two afterward, many 
hours may have been required to effect the same change. 
Part xii., p. 90. 
Treatment of Bowel Complaints.—A simple and very effectual treat- 
ment of the less severe bowel complaints, so apt to prevail in October, is 
the following: 
R Sulph. magnesite, gss.; aquse menthse, §vj. Solve. A wineglassful to 
be used at intervals of an hour, till the bowels have been distinctly acted 
on by the medicine, and then a pill containing one grain of opium is to be 
taken. 
Even where the pain is considerable, and the case threatens to be se- 
vere, this simple plan often succeeds. Part x.,p. 188. 
Accumulation of Feculent Matter in the Colon—A Source of Diarrhoea. 
—[The accumulation of hard feculent matter in the bowels, more par- 
ticularly of the colon and caecum, is often very embarrassing to the young 
practitioner, as it frequently causes symptoms resembling peri-enteritis, 
and treatment is of no avail in alleviating pain and tenderness, until the 
scybalous matter is got rid of; but there may be just the opposite symp- 
toms present, viz., those of diarrhoea—hence the necessity for careful ex- 
amination of the abdomen, and also of the evacuations.] 
The accumulation of feculent matters in some parts of the intestinal 
canal is apt to be mistaken for schirrous and other tumors of the viscera. 
Dr. Shoenlein once saw a man whose case had been declared by an expe- 
rienced physician to be one of scirrhous swelling in the abdomen—in con- 
sequence of a hard immovable lump that was situated at the side of 
the umbilicus—but who, fortunately, was speedily relieved of all his in- 
convenience by the use of warm water enemata and castor oil. He sub- 466 
sequently died of another disease; and, on dissection, it was found that the 
ascending colon was contracted at one point, and that the gut, nearer the 
caecum, was much distended, and quite tilled with hardened fecal matters. 
In this case the swelling was not much bigger than a man’s fist; but in 
another it was as large as a child’s head, and the faeces were as hard as 
cannon balls. It has been frequently observed, that the faeces are apt to 
accumulate in the caecum; and it is well for the medical practitioner to 
be aware of the fact that, in such cases, there maybe no constipation ; but 
that even a diarrhoea may be present. A passage is then formed either 
through the substance of the hardened faeces, or between them and the 
walls of the gut; and along this passage the thinner matters may flow on, 
while the thicker and more consistent are retained. A case, therefore, of 
seeming diarrhoea may actually be one of inveterate lodgment. 
Part xiii., p. 102. 
Occurring in Infants.—Dr. Thomson believes there are but few cases 
of diarrhoea occurring in infants under a year old but what may be cured 
by castor oil, even when ulceration has taken place; as shown by a pre- 
dominance of blood in the evacuations—tenesmus, abdomen tumid and 
painful, mouth dry and aphthous, etc. He gives the castor oil with yolk 
of egg, and, according to circumstances, does or does not add a gentle 
opiate. He recommends, however, as accessory, the warm bath, liniments 
to the abdomen, and occasionally a mild mercurial dose. He observes:] 
No mercurial so quickly changes the character of the evacuation as the 
emulsion, which only requires to be steadily persevered in. The following 
is the form in which I generally prescribe it for infants: For an infant of 
from two to four months old, $ ol. ricini, 5j~5jss.; vitelli ovi semis; aq. 
aneth. feneculi, aa. gj. Ft. emuls. Sumat. cocli. parv. bis die. To the 
above, from two to six drops of laudanum may be added, or not; but, of 
course, this as well as the size and frequency of the dose, must vary with 
the case. The mixture is generally taken readily, and even liked. The 
same preparation is equally useful in that form of intestinal affection which 
is met with in children of from one to nine years of age, with tendency 
of the evacuations to become watery, brown, black, and very offensive; 
picking of the lips, nose, etc. Part xiii., p. 104. 
Disrnuth hi Diarrhoea.—M. Haver speaks in praise of the trisnitrate 
of bismuth when used in the diarrhoea to which pthisical patients are so 
liable, and in that which occurs during the progress of typhus. This 
remedy has for many years been employed, and often with great advan- 
tage, in the simple form of diarrhoea which affects young children. 
Part xv., p. 114. 
Treatment of Diarrhoea.—The first and simplest kind of Diarrhoea, 
named usually crapulosa, is that which results merely from an inordinate 
meal. 
Here the diarrhoea is not to be considered the disease, but rather the 
cause or causes producing it, of which it is at once the effect and the 
remedy. Diarrhoea of this species and origin is to be permitted, if not 
even encouraged ; certainly not to be checked, unless it ends in tenesmus, 
with stools purely mucous, and devoid both of feculent matter and undi- 
gested aliment. Then, and then only, we must step in with chalk mixture, 
or with opiate pills, powders, draughts, or suppositories. 
DIAKRIKEA. DIARKIICEA. 
467 
The second and next most usual form of diarrhoea is what is called 
bilious. 
Dr. Prout alleges, that in some diseases the biliary secretion is strongly 
acid. In other cases it is equally acrid; and not rarely this chemical 
change in the secretion is accompanied with a notable augmentation of 
its quantity, so that two causes, namely, morbid quality and quantity, 
cooperate in producing preternatural peristalsis of the bowels and bilious 
discharges, accompanied with what may be called ardor fcecium. 
Diarrhoea of this kind is also scarcely, if at all, to be interfered with. 
Astringents would be madness; purgatives are unnecessary. Diluents, 
however, to protect the mucous membrane and dilute the acrid bile; ano- 
dynes, such as tincture of hyoscyamus, to relieve spasm or griping; warm 
fomentations and opiate epithems to the abdomen: these, and some other 
like means, will ease the sufferer, and ward off fever. If, however, there 
is much tumefaction and growdng tenderness in the hepatic region, no time 
must be lost; but cupping, leeches, even blisters and phlebotomy, must, 
singly or successively, be employed. If febrile excitement succeeds the 
diarrhoea, we must give liquor ammonite acetatis, ipecacuan wine, or even 
the potassio-tartrate of antimony. 
Pancreatic diarrhoea naturally follows bilious.' In the few cases of it 
which have been noted, and were reported, and verified by a 
examination, there was deep-seated pain, during life, behind the pylorus, 
with mucous vomitings and “ spumous stools.” The treatment is similar 
with that of bilious diarrhoea. 
What may be called catarrhal diarrhoea is the next form ; or we may 
name it gastro-enteric influenza. It is, in short, an insidious kind of sub- 
inflammation of the small intestines, attended with no inconsiderable debi- 
lity, fever, and, for some time, at least, with a pretty copious muco-serous 
discharge. In this form, we must have recourse to camphor-mixture, 
musk-mixture, liquor ammonite acetatis, liquor ammonite sesquicarbonatis, 
with vinum ipecacuanhse, ammoniacum mixture, etc. To each of these we 
may add, infusion or tincture of hop, or the wine of opium, or half of a 
grain or quarter of a grain doses of the hydrochlorate of morphia. Warm 
diluents, such as tea, are also to be freely used; and in the aged or feeble, 
wine and tonics must be prescribed so soon as the pulse and the dryness 
and heat of skin subside. 
Diarrhoea of a purulent character, and accompanied or caused by ulce- 
ration of the glands and follicles of the small intestines, must be treated 
as dysentery. In France and Germany, ipecacuanha is much used and 
much praised in such circumstances. 
Ilelvetius, in giving a formula for an ipecacuanha decoction, very justly 
directs, that on the first day it should be given in such doses as to cause 
vomiting. Many cases, both of diarrhoea and dysentery, are caused by 
interruption (from chill, etc.) of the transpiratory function of the skin. 
Almost all cases, whether of this origin or not, are accompanied with a 
remiss action and dry and heated state of that integument; and all of 
them are greatly relieved by that dry and heated state being removed, by 
the establishment of free emesis. 
When diarrhoea is from the first of a purely passive character (without 
febrile excitement, quickened pulse, dry skin, thirst, etc.), or when it 
becomes so (having reached its chronic stage), we may, after a little time, 
and if it does not tend spontaneously to disappear, check it by astrin- 468 
DIARRHOEA 
gents. For this purpose, tannin, rhatany, catechu, kino, alum, tormentil, 
pomegranate, may severally be employed. If there are acid eructations, 
lime-water and the chalk-mixture may be used, separately or combined 
with any of the above. If there is a passive diarrhoea, with abdominal 
pain (depending on tenesmus not only in the rectum, but along the intes- 
tines), but without acceleration of pulse, etc., then a dose of morphia may 
be prudently hazarded, by which the disease will sometimes be at once 
removed. , Part xvi., p. 153 
Use of Nitrate of Silver.—Ilirsch, of Konigsburg, found the nitrate 
of silver to succeed in obstinate cases of diarrhoea on the failure of ordi- 
nary remedies. It proved specially useful in the diarrhoea of newly- 
weaned infants. In “ the advanced stage of such cases, when emaciation 
was extreme, the dejections being frequent, foetid, and consisting of a 
variously-colored, sometimes greenish, or bloody mucus, and wanting alto- 
gether the fecal character. When aphthous ulceration pervaded the 
mouth, and when prostration was extreme, the action of the nitrate was 
brilliant.” He gave it to children thus : $ Argent, nitrat. crystal!, gr. J-; 
aquae destill. §ij.; gum. mimosse, 9ij.; Sach. albi, 3ij. M. Ft. mist. A 
teaspoonful of this mixture was given every tAvo hours, and an enema con- 
htaining a quarter grain of the salt with mucilage and a little opium was 
The good effects of this treatment were occasionally 
visible in a few hours, sometimes not until the second day. He pro- 
nounces it a specific in the diarrhoea of infants. He found it almost 
equally efficacious in severe forms of diarrhoea and dysentery occurring in 
adults. He administered it to the latter in pills in doses \rarying from 
one-twelfth to one-twentieth of a grain every two hours. For this pur- 
pose he recommends liquorice powder as preferable to the vegetable 
extracts which effect its decomposition. He also ga\re enemata, con- 
taining half a grain, or a grain, with mucilage and opium. 
Part xvi., p. 157. 
Diarrhoea.—Dr. Duncan refers particularly to that form of complaint 
which is attended Avith tenesmus .and frequent inclination to go to stool, 
rather than great discharges. The disease being protracted, loss of 
health and spirits, anxiety, sleeplessness, and hectic supervene. Dr. 
Duncan observes: 
The Avhole of this train of symptoms may depend upon some irritation 
within the rectum, a small ulcer or bleeding pile, AAdiose presence is 
scarcely recognized by the patient himself, and of which, perhaps, he has 
never been questioned by his medical attendant. 
In eArery case of protracted diarrhoea, in Avhich a careful examination of 
a patient’s state fails to detect an adequate cause for the disease elsewhere, 
the attention of the practitioner shoiild be directed to the rectum with a 
vieAv to ascertain its real state, and remove any local irritation that may 
exist in it. 
[There is nothing of more consequence when we treat a case of diarrhoea, 
than examination of the stools: and one of the most important points to 
be ascertained by the examination, is the presence or absence of bile in 
the dejections. If the evacuations are bilious, opium may be given Avith 
safety, and Avill indeed form an essential part of the treatment. Dr. 
Duncan thinks that opium acts in these cases by diminishing the secretions 
which fioAV into the canal, rather than by lessening the peristaltic action DIAEEHCEA. 
469 
of the bowels itself. And it is on account of this property, that of dimi- 
nishing the secretions, that opium wrill be injurious if given when there is a 
deficiency of bile in the stools. Dr. Duncan says:] 
This leads me to notice the propriety of using strychine in those cases 
which present the features I have just alluded to—of absence or deficiency 
of bile in the evacuations. Of course I do not allude to this remedy as 
appropriate to the acute period of the attack. Most, if not all, of these 
cases commence as ordinary dysentery, and require to be treated as such, 
by bleeding, leeching, mercurial preparations, etc.; but after the febrile 
stage has passed away, you will find the diarrhoea remaining, with whitish 
stools, general relaxation, prostration of strength, etc.; and here you will 
find strychnine an admirable remedy. In whatever point of view you 
regard it, strychnine is the direct antagonist to opium. If opium numbs 
the sensibility, strychnine exalts it; if opium produces sleep, strychnine 
excites to wakefulness; if opium impairs muscular contractility, strych- 
nine induces spasms; if opium arrests secretion, strychnine promotes it. 
But it is especially from its effect in promoting secretion that it deserves 
our attention at present. I do not know that this property has been gene- 
rally ascribed to it, but I can state that in two cases of chronic diarrhoea 
of the kind described that I had under my care in this hospital last sum- 
mer, and which recovered—the change in the character of the evacuations 
was one of the earliest effects produced. From being white they became 
feculent, consistent, and full of bile; and whenever in such a case this 
change occurs, depend upon it, you have discovered the true method of 
cure. Until feculent discharges are procured, the morbid state cannot be 
considered at an end, even though the patient’s sufferings are mitigated, 
and the unnatural frequency of calls to stool removed. 
Part xviii., p. 117. 
Diarrhoea treated by Muriate of Barytes.—Dr. Walsh gives the case of 
a man, 22 years old, who had evacuations every ten or fifteen minutes, at- 
tended with great pain, thirst, dry tongue, and quick pulse. 
History.—Said he was seized with fever in July, 1847. He relapsed 
twice, and after last relapse he was attacked with bowel complaint, for 
wdiich he was under every variety of treatment in hospital without benefit, 
and was discharged. I ordered wine and arrow-root, with the following 
medicine: muriate barytes, one grain; muriate morphia, three grains, 
made into twelve pills, one to be taken three times each day. 
At the expiration of ten days a cure was effected without recourse to 
any other treatment. Part xviii., p. 119. 
P ersesqui-Nitrate of Iron in Diarrhoea.—[Mr. Kerr states that the 
persesqui-nitrate of iron is a remedy of great power in most cases of chronic 
diarrhoea, and in this way likely to be useful as a means of preventing 
cholera. He says:] 
After an experience of eighteen years, I can confidently recommend the 
persesqui-nitrate of iron as capable of curing most cases of chronic diarrhoea. 
The instances which do not yield to it are those where there is reason to 
believe ulceration of the mucous membrane exists. It is therefore gener- 
ally inapplicable in chronic dysentery, or the diarrhoea of phthisis, which, 
instead of checking, it aggravates. 
Dr. Graves states that he has lately used the persesqui-nitrate of iron 
with very considerable success. He proceeds to say, that “ you will bo 470 
DIARRIKEA. 
consulted by females of a very delicate and weakly habit, who frequently 
exhibit symptoms of nervous derangement, such as palpitations, sleepless- 
ness, and headache, who are easily excited or alarmed, have a tendency to 
emaciation and paleness, and have little or no appetite. Combined with 
these general symptoms, you find that they have been laboring under 
diarrhoea for weeks, and even months, and that this, with other causes of 
debility, has rendered their condition extremely uncomfortable. You will 
also be informed by the patient that she has tried many remedies without 
benefit, and that she is extremely anxious to have something done to give 
relief; and hence it is a matter of importance to be acquainted with any 
remedy which may be likely to prove serviceable. This form of diarrhoea 
is of an unmanageable character, and very seldom amenable to the ordi- 
nary modes of treatment. The common astringent remedies totally fail; 
chalk mixture, kino, rhatany root, and catechu are useless, and in such 
cases it has been observed that opium is generally injurious. If you pre- 
scribe opium, it certainly checks the disease for a time; but this temporary 
relief is accompanied by debility, malaise, restlessness, and many uneasy 
symptoms, and the diarrhoea soon returns and is as bad as ever. The medi- 
cine which I have found most effectual in such cases is the persesqui-nitrate 
of iron. With it I have succeeded in curing many cases which have been 
exceedingly obstinate, and of very considerable duration, the disease hav- 
ing, in one instance, resisted all the efforts of medical skill for seven months, 
and in the other for two years. Seven or eight drops of the liq. ferri per- 
sesqui-nitratis, increased gradually to twelve or fifteen in the course of the 
day, was the quantity prescribed in both cases. In the course of four days 
a slight diminution of the diarrhoea was perceived, in a fortnight the patient 
felt much better, and in a month or five Aveeks it had disappeared altoge- 
ther. This took place without being followed by any bad effects ; there 
was no swelling in the stomach, no tympanites, no tormina, no restlessness, 
or nervous derangement: the patients recovered their health and strength, 
and the cure was at once safe and permanent.” 
'Epilepsy and hysteria often exist together with along-continued relaxed 
state of the bowels, and do not yield till a remedy is obtained for the 
diarrhoea. I have seen these and other diseases cured chiefly in conse- 
quence of the persesqui-nitrate of iron checking the accompanying diarrhoea. 
Part xviii., p. 119. 
Diarrhoea of Children.—[When diarrhoea comes on in connection with 
teething, scarification of the gums is not necessarily to be practised; on 
the contrary, it should only be performed when some spot upon the gums 
is very tense and swollen. To relieve febrile excitement, the use of the 
tepid bath once or twice a day is serviceable. As to medicines, Dr. West 
tells us:] 
I usually employ in these cases small doses of ipecacuanha, in combina- 
tion with an alkali, and think that I have found great benefit from this 
plan. Three or four drops of liquor potasste, and the same quantity of 
vinum ipecacuanhse, mixed with mucilage, and given in a little milk about 
every four hours, is the dose for an infant a twelvemonth old. At the same 
time a powder of one grain of Dover’s powder, and one of the mercury and 
chalk, may be given every night, after the child is taken out of the warm 
bath, and will often be found to procure for the little patient, previously 
restless and fretful, some hours of quiet repose. If the child should appear 471 
DIAKKHCEA, 
much exhausted, a slight stimulant, such as four or five drops of the spirit of 
nitrous ether, may be advantageously combined with each dose of the mix- 
ture ; and in all cases of simple diarrhoea, it behooves us to watch most 
carefully against the powers becoming too much depressed, either by the 
profuseness of the purging or by its continuance. 
Supposing in any case that a considerable degree of looseness of the 
bowels were to continue after the lapse of two or three days, astringents 
must be resorted to ; and I know of none better than the extract of logwood, 
in combination with tincture of catechu. Five grains of the former and ten 
minims of the latter, three times a day, in some sweetened aromatic water, 
is a suitable dose for an infant a year old. The logwood, moreover, is 
something besides a mere astringent; it is a very valuable tonic in all cases 
where gastro-intestinal disorder has existed ; and it is one which children 
take readily. It is, however, not very popular in the nursery, because it 
imparts to the evacuations a deep pink color, which leaves an indelible 
stain upon the napkins: a circumstance which it is as well to mention when 
you prescribe the medicine. The mercury and chalk and Dover’s powder 
may be still continued at bed-time, if the evacuations, though less frequent, 
be still slimy and unhealthy. If either the evacuations or the infant’s 
breath have a sour smell, three grains of the sesqui-carbonate of soda may 
be added to each dose of the mixture; or, if the child be not wholly fed at 
the breast, a drachm of prepared chalk may be stirred up with each pint 
of milk given to it. You will observe that all the remedies mentioned oc- 
cupy but a very small compass: a point the importance of which is never 
to be forgotten in prescribing for children. 
But there are cases which wear a much more serious aspect. Even in 
true inflammatory diarrhoea however, depletion is but seldom needed, for 
either the abdominal tenderness is inconsiderable, or, if the attack set in 
with great severity, it will be generally found to have occasioned so much 
depression of the powers of the system as to contra-indicate the abstraction 
of blood. Still, in cases of recent date, when the abdominal tenderness is 
considerable, and when it is associated with much heat of the skin and 
febrile disturbance, a few leeches may be applied in either iliac region. 
The child should be carefully watched for some hours afterward, in order 
to prevent any excessive loss of blood. In the majority of instances the 
pain and tenderness of the abdomen are much relieved by the application, 
of a large hot bran poultice ; the frequent renewal of which often affords 
great comfort to the child. 
If the irritability of the stomach be not so great as to prevent its admi- 
nistration, no medicine is of such general application, or of such essential 
service in these cases as a mixture containing a small quantity of castor oil 
diffused in mucilage, with the addition of a few drops of tincture of opium. 
I was led to use this medicine in the inflammatory diarrhoea of children, 
from observing the great benefit which followed its employment by Dr. 
Baly in the treatment of dysentery among the prisoners in Millbank Peni- 
tentiary. The following is the form in which I should prescribe it for an 
infant a year old, and in which it is taken by most children very readily : 
R 01. ricini, 5j-; pulv. acacite 9j.; syrupi simpl. 3j.; trae. opii, miv.; aquae 
flor. aurant. 3vij. M. ft. mist. A teaspoonful to be given every four 
hours. 
Although the medicine may relieve all the symptoms considerably, and 
although the general state of the child may be much improved, yet it 472 
DIARRHCEA, 
sometimes happens that a considerable degree both of tenesmus and of 
purging continue. These symptoms will now be more effectually relieved 
by an opiate enema than by any other means. Four drops of laudanum 
will form an enema of sufficient strength for an infant a year old; and this 
should be given suspended in half an ounce of mucilage, since a more 
bulky injection is almost sure to be immediately expelled. Supposing the 
symptoms not to yield to these means, or that the case presented from the 
first a great degree of severity, small doses of hyd. c. creta and Dover’s 
powder may be given every four hours, in addition to the castor oil mix- 
ture, which, however, should now be given without the laudanum. 
Part xviii.,p. 123. 
Nux Vomica in Diarrhoea from Exhaustion.—Dr. Kevins mentioned 
the benefit derived from the employment of nux vomica in the treatment 
of the dian-hma from exhaustion, chiefly observed in pauper patients, and 
especially children. In these cases he had repeatedly found no benefit 
from astringents and ordinary tonics, but the patients had rapidly 
improved under the use of the following prescription: Alcoholic extract of 
nux vomica (not officinal, but prepared by most wholesale druggists), gr. 
ss.; rhubarb, gr. ss.; saccharated carbonate of iron, gr. j.; blue pill, gr. 
ss.; opium, gr. }; made into a pill, and taken three times daily. In many 
cases he omitted the opium altogether. 
lie attributed the benefit to the influence of the nux vomica, which, by 
stimulating the nervous energy of the bowels, enabled the lacteals to 
absorb the nutriment from the food, and the large intestines to retain the 
faeces; whilst, at the same time, the iron acted as a permanent tonic; and 
the very small doses of rhubarb and blue pill improved the character of 
the secretions, without acting as an aperient. Improvement was gene- 
rally perceptible in a few days, and he seldom had occasion to continue 
the prescription more than a fortnight. Part xix., p. 95. 
Proto-sulphate of Iron.—Recommended in obstinate diarrhoea. 
Part xix.,j9. 186. 
Diarrhoea.—In cases where there is much pain and mucous discharge, 
dependent upon a relaxed condition of the mucous membrane, give five 
or ten grains of the “ bisulphate of iron and alumina ” every two or three 
hours, dissolved in any aromatic water. Part xix., p. 312. 
Diarrhoea—Sub-nitrate of Bismuth.—Recommended by Mr. Mouneret. 
It is especially in the diarrhoea of infants, resulting from imperfect lacta- 
tion, that he has found it so very useful, large doses curing such in a few 
days. So, too, after weaning, and the injudicious diet so often adopted, 
the bismuth, in doses of three teaspoonfuls a day, soon removes all symp- 
toms of disordered digestion, especially the serious diarrhoea so often pro- 
duced in these cases. Simple diarrhoea is of much rarer occurrence in 
the adult; still, examples are met with in which we cannot attribute it to 
either phlegmasia or ulceration of the intestines, as in the granular dis- 
ease of the kidneys, in chlorotic women, in women become anaemic from 
cancerous degeneration of the uterus, and in some cases of chronic dis- 
ease of the heart, or in commencing phthisis. Those cases in which the 
diarrhoea is serious, and results from an atonic state of the gastrointes- 
tinal membranes, best yield to this medicine. It should be given in 
gradually increasing quantities from two drachms to twelve or more daily. DIAKKIKEA. 
473 
Administration and Action.—It should be given in powder, and best 
so with the first spoonful of broth or gruel. It excites no disgust, espe- 
cially if placed between two bits of bread, soaked in broth. Children 
take it readily with milk or ptisans. The author has never given less than 
from two to three drachms daily, nor more than twenty, and he has never 
observed the slightest inconvenience from these large doses; and it is his 
custom to give it to the children in his hospital by spoonfuls or table- 
spoonfuls, without observing more exactitude, so innocuous is it. So 
imperfectly is this fact known that the chemists hesitate in preparing pre- 
scriptions in which these large doses are ordered. Part xx., p. 92. 
Choleroid— Use of Oil of Turpentine.—Put the patient into a warm 
bed ; apply over the abdomen a large bran poultice, or a patent epithem 
moistened with infusion of chamomile, and occasionally sprinkled with 
laudanum ; and put hot bottles to the feet. Then give about ntxv. of rec- 
tified oil of turpentine, with a little laudanum or tincture of hyoscyamus. 
One dose sometimes suffices; but if it does not, repeat the medicine. 
The best way to give turpentine is to put about a drachm of tincture of 
hop into a wineglass, drop the turpentine into it, and then, just as the 
dose is to be taken, add half an ounce of cold spring water. 
Part xxi., p. 157. 
Choleroid Diarrhoea.—In choleroid diarrhoea, with rice-like stools and 
collapse, let the child be held in a mustard-bath, till the hands of the per- 
son holding it smart much, then wrap it in woollen cloths, and give a lit- 
tle ether and mint-water. When reaction sets in, give ipecacuanha in 
emetic doses, and Rochelle salts. If typhoid symptoms come on, and the 
diarrhoea persists, give enemata of nitrate of silver. Laudanum and 
astringents are of little or no use in this form of diarrhoea. 
Part xxi., p. 158. 
Diarrhoea— Chronic.—When it resists the usual remedies, give tannic 
acid, two or three grains twice a day, in the form of a pill. 
Part xxi., p. 326. 
Creasote in the Treatment of Diarrhoea.—In most cases this alone 
has been given, and chalk mixtures, etc., have been entirely discarded. 
The form in which it has been administered to adults has been as follows: 
R Creasoti, mj. ad inv.; spir. ammon. arom. ntxv. ad 3j.; aqute gj. ad 
giss.; where pain has been severe, tinct. camp. co. has been added. Mr. 
Spinks prescribed chloric ether; but the writer having had reason to think 
it produced headache, has omitted that article without detriment. 
Dr. Ivesteven found creasote more efficient than any other drug 
in stopping pain, vomiting, and purging, as combined in diarrhoea. 
Part xxiii., p. 124. 
Autumnal Diarrhoea.—Give the citrate of iron and quinine, especially 
when the affection assumes an intermittent type. Part xxiv., p. 110. 
Treatment of Diarrhoea and Dysentery by Sulphuric Acid.—Mr. Shep- 
pard says: 
The character of the epidemic which has been so prevalent in my 
neighborhood, during the last six weeks, has been as follows : Great pros- 
tration of the vital powers; severe griping and pinching pains in the 
bowels (not invariable), greatly aggravated by drinking anything hot, 474 
DIAERHtEA, 
greatly relieved by cold; tongue generally dry and furred, occasionally 
moist and red; distressing flatulence, the bowels being at times very 
much distended, burning thirst, and sensation of heat down the whole 
course of the alimentary canal, with (in some cases) incessant vomiting. 
Case.—J. Q., two years of age. Incessant pain in the bowels, and purg- 
ing for the last eight hours; skin cold and clammy; pulse extremely 
feeble, and rapid ; intense anxiety of countenance. In fact, the child ap- 
peared moribund, and the parents quite thought the case hopeless. They 
had given a little brandy, which had been immediately rejected by the 
stomach. I sent for a tumbler of cold water, which the child caught sight 
of, and requested to have. The little thing drank off the whole, and sunk 
back on the pillow quite exhausted. Ordered the following mixture: 
R Acid, sulph. dil. dr. j.; tr. cardamom, co., dr. j.; sacchar. alb., dr. ij.; 
aq. month, pip., ad oz. ij. M. A teaspoonful every hour. I called at 
two o’clock p.m., when the child was sitting up in its mother’s arms. The 
purging had quite ceased. 
Case.—Mrs. B., TO years of age. Great uneasiness in the bowels, 
hardly amounting to serious pain; constant vomiting and purging; 
tongue dry and ferred; foetid breath; pulse 100; abdomen tympanitic; 
great thirst. Ordered iced water ad libitum / and the following mixture 
and pill: R Sacchari albi, dr. iv.; acid, sulph. dil., dr. iss: tr. cardamom, 
co. dr. iij.; liq. morph, bimeconat., m. xl.; mist, camphorae, oz. vss. M. 
A fourth part every four hours. R Hydr. cum creta, gr. iij.; pulv. 
ipecac, co., gr. ij. To be taken as a pill immediately. On the follow- 
ing day I found that my patient had obtained relief in the course of two 
hours. Part xxvi., p. 84. 
Diarrhoea.—Give matico in doses of from eighteen grains to 3j- per 
diem. _Par£ xxvi.,y>. 87. 
Remarks on the Treatment of Diarrhoea by Sulphuric Acid.—In the 
hands of many this remedy has failed in diarrhoea. This is mainly owing 
to a want of discrimination in the choice of cases suitable for its use. 
When diarrhoea prevails extensively we may clearly recognize two 
forms of this affection, somewhat similar in their symptoms, but differing 
materially in their origin and requiring distinct methods of treatment. 
The one, simple diarrhoea, caused mainly by errors of diet, or some tem- 
porary derangement of the biliary system, and the symptoms of which are 
copious and frequent feculent evacuation, slight nausea, griping, and 
tenesmus; the disease frequently being cured spontaneously, in the course 
of a day or two, with no other ill effects than temporary debility, and sel- 
dom requiring any other treatment than mild oleaginous purgatives, and 
sometimes a few doses of chalk mixture and opium. 
The other form is the one most deserving of attention, as well from the 
severity of its symptoms as the tendency which it has to lapse into low 
fever. The following is the usual history of the case: The patient was 
either quite well a few hours before, or perhaps had suffered from slight 
relaxation of the bowels for a day or two, when, without having com- 
mitted any errors or irregularities in living, he was seized with profuse 
diarrhoea, the evacuations consisting at first of the contents of the bowels 
in a very fluid state, ultimately becoming like dirty water, and containing 
little if any solid matter; nausea and vomiting of large quantities of fluid; 
severe spasmodic pain in the stomach and bowels; cramps in the extre- 475 
DIARRHOEA 
mities, often very violent; the pulse smaL and frequent; tongue moist, 
and either clean or only slightly covered with a brownish fur; the surface 
cold and clammy; countenance anxious; these symptoms being followed 
by a continued fever, varying in duration from a few days to a week or 
two. 
The symptoms most worthy of note are the peculiarly fluid evacuations, 
the severe cramps in the extremities, and, above all, the consecutive fever; 
presenting various degrees of severity, from apparently simple diarrhoea, 
to an extent almost bordering on that of Asiatic cholera. 
It is in diarrhoea having this character that sulphuric acid is a most 
valuable remedy, frequently in a few hours restoring the patient from a 
condition of extreme distress to one of comparative comfort, administered 
in doses of half a drachm, with a drachm of compound tincture of carda- 
moms, in an ounce of water, at intervals of from one to three hours, 
according to the urgency of the case. 
When a few doses fail to relieve the patient, it is better not to perse- 
vere ; for a long continuance of the acid, in large doses, is of itself sufficient 
to set up a troublesome and unmanageable irritation of the mucous mem- 
branes of the stomach and bowels. If it is to act satisfactorily will be 
shown by the result of a few doses. Part xxvii., p. 85. 
Treatment of Diarrhoea by Chloric Ether.—[We often find that many 
cases of diarrhoea resist all ordinary treatment, opium amongst the rest. 
In 1846, ’7, and ’8, an epidemic prevailed at Bradford, Yorkshire, which 
was attended by a diarrhoea of an intractable nature.] 
This diarrhoea was combined in many cases with vomiting and spasmodic 
pain of a very distressing character. We had very little difficulty in 
treating those cases in which pain was absent, but we found a certain pro- 
portion in which the diarrhoea obstinately continued despite the use of 
a multitude of remedies; and the pains, though temporarily relieved by 
the use of opium, returned directly the narcotism passed off; the opium 
suspended, but did not remove, the spasms. At length we adopted the 
following formula: 
R iEtheris chlorici, 5vj.; speciei. pro conf. arom. 5ss.; misturse cretae 
composite ad §vj. M. Fiat mistura. 
The fourth part was directed to be taken directly by an adult, and re- 
peated every half hour, or at still longer intervals, according to the seve- 
rity of the attack, and its effect upon the patient. Occasionally, opium, 
either in the solid form or the tincture, added to the mixture, was given ; 
but this was seldom necessary, and pr.obably every case would have 
recovered without its use. The effect of the ether in every case was mar- 
vellous. The spasms and pains 'were relieved, as if by a charm; the 
diarrhoea ceased; warmth returned to the extremities; the pulse, before 
perhaps flagging, increased in force and volume. The relapses were infre- 
quent, and were generally checked at once by a single dose. It was 
equally effective in arresting the promonitory diarrhoea, cramps, etc.? of 
cholera. Part xxx., p. 66. 
Sulphate of Debeerine in Diarrhoea.—Mr. Mathews, of Manchester, 
recommends the use of sulphate of bebeerine as a remedy for severe 
diarrhoea, in fact, he states that he has found it “ a very near approach to 
a specific.” He generally first gives a pill, consisting of two grains of calo- 
mel and half a grain of opium, and if there is great pain, or the vomiting 476 
diarbikea. 
is urgent, orders a sinapism to the scrobiculus cordis, and then follows up 
with the following mixture: Sulphate of bebeerine, twelve grains; sul- 
phuric acid, and rectified ether, each, twelve minims; cinnamon water, 
six ounces. Mix. One ounce to be taken every four hours. 
Part xxx., p. 67. 
Use of Carbazotate of Ammonia.—In long continued cases where the 
usual remedies were given without effect, the carbazotate of ammonia 
given in grain doses, with the same quantity of gallic acid, and one sixth 
of a grain of opium, three times a day, continued regularly for a w*eek or 
fortnight, has been found to effect a complete cure. Part xxxii. p. 42. 
Porax Injections in the Diarrhoea of Children.—It may be sympto- 
matic of organic disease of the mucous membrane, or it may be an idio- 
pathic affection catarrhal in its nature. If this last, the action of borax 
lavements on the mucous membrane is regarded as analogous to the good 
effects of borax on the mucous membrane of the mouth. The following 
is the formula for this lavement: Borax 3iv. to 3vj.; sugar and water §iv. 
******* 
Give one or two ounces of the decoction of tormentilla every three 
hours. Part xxxii., p. 99. 
Chronic— Use of Tannin.—One scruple of tannin dissolved in four 
ounces of water, with the addition of one ounce of gum arabic, forms a 
good mixture for chronic diarrhoea and the third stage of dysentery. 
Part xxxii., p. 286. 
Diarrhoea of Phthisis.—M. Aran recommends the employment of wine 
in enemata, especially in the treatment of chlorosis, dyspepsia, pulmonary 
phthisis, and during convalescence from severe disease. 
Part xxxii., p. 290. 
Diarrhoea.—The best diet, as a general rule, is milk and lime-water, 
which is very readily absorbed, and sufficiently nourishing. When there 
are lumps of feculent matter in the stools, and a smell like that of normal 
excrement, give purgatives. When this is not the case, purgatives will 
not be found to be beneficial. When the products of acute inflammation 
are found mixed in the stools, such as white and opaque mucus, flakes of 
fibrin, epithelium, etc., leeches, fomentations, warm hip-baths, and poul- 
tices to the abdomen are the appropriate treatment, together with the 
administration of calomel, ipecacuanha, and carbonate of soda. In children 
it often arises from the irritation of teething. The gums must be lanced. 
Opium in the form of Dover’s powder (half a grain every three hours) is 
here of striking utility. When blood is passed from the bowels, and no 
fever is present, the most powerful means of checking it are turpentine and 
acetate of lead. When the diarrhoea is from ulceration of the ilia, adhere 
to the milk and lime-water diet, giving chalk and opium; or, if these fail, 
sulphate of copper. When there is a simple flux of transparent mucus, 
without fever or pain, or any fibrin or blood in the motions, use vegetable 
astringents, such as logwood, bark, kino and tannin. When the stools are 
bulky and copious, opium must not be given, but it is of great use in cases 
of tenesmus. Part xxxvi., p. 72. 
Use of Dover's Powder.—Dover’s powder, in five-grain doses, given in 477 
DIGITALIS. 
a teaspoonful of gruel, and repeated every loose stool, is one of the sim- 
plest and most effectual means of treating cases of ordinary diarrhoea. 
Part xxxvi., p. 91. 
DIGITALIS. 
Action of.—One of the most valuable medicines -which we possess in the 
treatment of diseases of the heart is digitalis. It is rather surprising to 
find that even on the value of this medicine there should be so much differ- 
ence of opinion among practical men. This will arise, we suspect, from the 
different preparations, the powder, tincture, and infusion, being used indis- 
criminately, without reference to the sedative powers of the one, and the 
diuretic powers of the other. 
Dr. Munk shows from a series of cases that this medicine has two very 
different effects on the system, one as a sedative and the other as a diu- 
retic ; and that the tincture acts most powerfully on the heart as a sedative, 
while the infusion acts chiefly on the kidneys as a diuretic. He does not 
value the powder highly either as a sedative or diuretic when given alone, 
being more uncertain and unmanageable in its effects; but when combined 
with squills and mercury its influence is more certain on the kidneys, but 
still not to be depended upon as a sedative. The administration of digi- 
talis in diseases of the heart requires more caution than is generally ac- 
knowledged, especially when the aortic orifice is implicated in the disease; 
but where a depressant or sedative really is required, we ought to ad- 
minister the tincture of digitalis in preference to any of its other prepara- 
tions ; and this may be given alone in tolerably full doses, at intervals of 
eight, ten, or twelve hours. This action of the drug has not been found 
to be particularly increased by combination with conium, hyoscyamus, hy- 
drocyanic acid, etc., as many have supposed. On the contrary, when we 
want to subdue tumultuous action of the organ, its effects will be increased 
by combination with the different antispasmodics, such as camphor, assa- 
feetida, galbanum, ammonia, and Hoffman’s anodyne. Dr. Munk gives the 
infusion in the dose of half an ounce to an ounce every six or eight hours, 
and occasionally recommends very gentle exercise, in order to prevent its 
action on the heart. If in the course of a week it takes no effect, he relin- 
quishes its use for the time; but if it take proper effect on the kidneys, it 
may be continued for a considerable time without injurious consequences. 
Indeed, both he and Dr. Pereira seem to deny altogether the dangerous 
effects attributed to this medicine by some writers. Part x., p. 5G. 
Pigitalis as a Local Remedy.—Mr. II. Jackson has been in the habit 
of applying digitalis, in the form of a liniment made with the powdered 
leaves and honey, first, to scrofulous ulcers generally, where the bones are 
not affected; secondly, to those ulcerations about the joints in which the 
bones are frequently implicated; and thirdly, to scrofulous sores, directly 
depending on disease of the bone. When there is an excess of inflamma- 
tory action, digitalis acts partly as a sedative and partly on the capillaries, 
improving the character of the discharge, and substituting pus for sdairy 
mucus. ' Part x., p. 175. 478 
DIPHTIIEMTIS, 
DIPHTHERITIS. 
Diphtherite compared with Scarlatina.—The commencement of diph- 
therite is hardly accompanied by any febrile affection, or the attack is 
quite ephemeral, and the pulse soon sinks to its natural standard. The 
organic and vital functions are often so little deranged, that children who 
are menaced with very severe attacks of the disease do not lose their appe- 
tite, nor are they prevented from pursuing their usual games. The scarla- 
tina is ushered in by commotion in the circulating system, similar to that 
produced by the bite of a venomous reptile, and the respiratory movements 
are equally affected. The digestive functions are for the most part de- 
ranged, and vomiting and diarrhoea, together with great nervous depres- 
sion, which increasing, rapidly announce a fatal termination. The diph- 
therite is not marked by any definite periods in its progress, as is the case 
with scarlatina. The diphtherite, if it does not cause death by its mechani- 
cal obstruction, degenerates into a chronic affection; whereas the progress 
of the other is very rapid toward a fatal termination at all periods of its 
duration. The former proceeds from a single point, and spreads with more 
or less rapidity over the surfaces, which it attacks gradually, and it mani- 
fests a peculiar tendency to attack the respiratory passages. The scarla- 
tinal inflammation diffuses itself over the mucous surfaces, but has no 
peculiar tendency to attack the air tubes. In the former case, if death 
occur within the first periods, it is from mechanical obstruction to respira- 
tion ; in the latter, no organic lesion justifies the cause of death. If topical 
applications modify the diphtheritic inflammation, the health is restored as 
soon as the local complaint is terminated. This is far from being the result 
in the scarlatinal inflammation, which, when relieved from all its local 
characters as affects the throat, is followed by a host of untoward symp- 
toms. Part xii., p. 17. 
J)iphtheritis.—[Mr. J. D. Brown remarks upon the insidious nature of 
the symptoms and the frequently fearful rapidity of its termination, lie 
has repeatedly seen children, apparently in good health, suddenly seized 
with croupy breathing and laborious respiration, denoting its attack upon 
the larynx, and die within four hours from such sudden invasions. In 
many cases these alarming symptoms would seem to be relieved entirely, 
and the favorable state might continue for a few hours, and then another 
similar attack terminate the case at once. In other cases the changes 
proved slow, hesitating, and doubtful for hours and days. Mr. Brown 
proceeds to speak of the] 
Treatment—General and Local.—Local treatment is the sheet-anchor. 
The only one I found of use was a strong solution of nitrate of silver, never 
less than 5j- to §j., sometimes 3ij., applied liberally three times a day, or 
oftener in very severe cases, to the tonsils and affected parts, with a piece 
of sponge fastened to a quill. 
Blisters and leeches were useless, often worse than useless: they ex- 
hausted and hastened death in every case. I found ext. bclladonnse and 
ung. hydrarg. fort., in equal proportions, of apparent use in relaxing the 
spasm of the laryngeal muscles, when laid thickly on the windpipe. It 
was only a palliative. 
General Treatment.—I depended on calomel, in combination with 
ipecacuanha, in doses of about half a grain each, every four or eight hours. 479 
DIPHTHEEITIS. 
I never lost a case, however severe, Avhere I had established ptyalisin. 
In three severe cases—a man of forty, a boy of twelve, and a girl of 
twelve—the croupy symptoms gave way, the false membranes, instead of 
maintaining their dangerous, blankety, continuous appearance, became 
patchy, and dissolved away like melting snow. The moment ptyalism 
was established, and not till then, I gave wine, and decoct, senegre, and 
ammonia, and iodide of potassium, at the same time. Emetics I found of 
great use in the first stages; they always relieved the distress in breath 
ing, and carried away large quantities of mucus ; in the last stages they 
only exhausted, and often would not act at all. The inhalation of vinegar 
vapor, and the vapor of hyd. c. creta, I have thought useful in desperate 
cases. They seemed to prolong life in all cases, but never saved it. 
I would in every case most unhesitatingly trust to the topical applica- 
tion of nitrate of silver in solution, and the internal administration of mer- 
cury, paying due attention to the powers of the system, supporting it with 
wine, quinine, and ammonia when required, taking great care not to de- 
bilitate nor exhaust by bleeding, warm baths, etc. 
I cato venture to assert that the above treatment, if commenced at any 
period of the disease before the larynx becomes implicated, will succeed. 
The only cases I lost were those where the larynx and pharynx were 
simultaneously affected, the disease having commenced primarily in the 
stomach two or three days before, as evinced by vomiting, rigor, and 
general indisposition, and those where the laryngeal implication had shown 
itself before aid was sought. I had the benefit of a post mortem examina- 
tion in two cases : the pharynx, tonsils, larynx, trachea, and bronchial 
tubes were more or less coated with false membrane, the larynx and tra- 
chea were thickly coated, the stomach showed symptoms of great irrita- 
tion also. Part xxiii., p. 117. 
Diphtheria.—The use of tincture of muriate of iron in this disease is 
much recommended, not, indeed, as a specific, but as a rational method 
of treatment. Its use should be commenced as early as possible, not de- 
sisting when the exudation has disappeared, but persevered with till the 
prostration has given way to the vigor of returning health. This treat- 
ment should be conjoined with the use of stimulants, and careful nourish- 
ment of the patient. A few drops of hydrochloric acid may be added to 
each dose of the tincture (about 25 minims every two or three hours), 
and the dilute acid may also be applied locally by means of sponges, and 
weaker gargles of the same may be used regularly. Part xxxviii., p. 73. 
Chlorate of Soda as a for Chlorate cf Potash.—M. Gueneau 
de Mussy states, in the “Revue Medicale,” that, struck by the little solu- 
bility of chlorate of potash, he substituted chlorate of soda for it, as tho 
latter salt is much more soluble than the former. The taste of the chlo- 
rate of soda is, besides, less disagreeable than that of the other salt, and 
can also be given in a small quantity of vehicle. M. de Mussy has given 
the chlorate of soda in several cases of diphtheria with uniform success. 
Part 276. 
Diphtheria.—Even in the mild form of this disease, except a brisk calo- 
mel purge, under no circumstances should any antiphlogistic measures be 
resorted to, but a liberal diet at once enjoined. In the severer form, if 
the practitioner be misled by the feverish excitement, and induced to 
adortt antiphlogistic measures, a fatal mistake would be committed. The 480 
DIPHTHEROTS. 
disease is analogous to adynamic erysipelas, and requires wine and nutri- 
tious diet. Chlorate of potash and tincture of sesquichloride of iron are 
the medicines most calculated to be beneficial, and in some cases quinine. 
Mercury seems to be especially contra-indicated, and blisters are worse 
than useless. Part xxxviii., p. 330. 
Diphtheria and Cynanclie Maligna.—Give the following : Pulv. guaiaci 
5ij.; sacch. pur. 3j.; pulv. acacice 3ss.; aquae §vj. Misce, et adde potassa) 
chlorati 3ss. Fiat mistura cujus sumantur coch. ij. magna 2da hora. In- 
stead of using the solid nitrate of silver, use the following gargle : Sol. sod. 
chlor. 3j.; sacch. pur. 3iss.; aquae §vj. Fiat gargarisma saepe utendum. 
Part xxxix., p. 28. 
Diphtheria.—The diphtheritic exudation depends on a parasitic fungus, 
the oldium albicans, and in the treatment of the affection “ antiseptics and 
parasiticides appear to be the most efficient remedies.” Of these the 
tincture of the sesquichloride of iron (an antiseptic) and the hydrochlo- 
rate of potass are the most efficient. The latter taken alone will sweep 
away the pellicle in a few hours. Hydrochloric acid is also useful. 
Part xxxix., p. 23. 
Diphtheria.—After clearing the bowels with calomel and rhubarb, 
order strong beef-tea, wine, and above all, Bass’s pale ale ; patients ex- 
press themselves much relieved in the throat as it is swallowed, and feel 
greatly exhilarated after taking it. One ounce of the compound tincture 
of quinine taken in wine and water every four hours, is a medicine of the 
greatest use. Apply nearly equal parts of honey and concentrated muri- 
atic acid by means of a probang about every sixth hour. After stripping 
off the false membrane, a gargle made with tannic acid and water affords 
great comfort. Part xxxix., p. 26. 
Diphtheria.—The local application of strong nitrate of silver solution is 
almost “ indispensable.” Internally, chlorate of potash and hydrochloric 
acid may be given according to the following formula : Chlorate of pot- 
ash, two drachms; hydrochloric acid, one drachm ; water, eight ounces. 
Half an ounce for a dose every one, two, or three hours, according to the 
urgency of the symptoms. The undiluted acid should be poured upon the 
powdered salt, whilst in the mortar, and as soon as the powder assumes a 
yellow color, and fumes of chlorine arise, dash in the water, by which the 
decomposition is arrested and the free chlorine retained in the solution. 
Where the disease extends to the larynx and trachea, and the symptoms 
become croupy, small doses of calomel and antimony are demanded, the 
system at the same time being supported by stimulants. 
Part xxxix., ja. 27. 
Diphtheria.—A case is related illustrative of several important points 
of treatment. On the third day, the disease progressing and considerable 
exudation existing, a strong solution of nitrate of silver was applied, the 
exudation being previously removed as far as possible without the use of 
force. In four hours the report states that the breathing had become 
“ noisy, not from implication of the larynx, but from blocking of the pos- 
terior nares from increased swelling.” Now in such cases the local treat- 
ment cannot be too soothing and gentle. One point more is particularly 
worthy of note, that inhalation of steam seemed always to give great re- 
lief, and two distinct attacks of laryngeal spasm were relieved by it; a hot 481 
DIPHTHEKITIS. 
infusion of chamomile was used. A carefully strained infusion of chamo 
mile used by means of a laryngeal or other syringe, to wash out the throat 
is peculiarly grateful—and in children, if there be much accumulation be- 
hind the nares, it is a useful plan to syringe the throat through the ante- 
rior nares, with the same infusion, and the throat outside may be 
surrounded by soothing warm applications. Part xxxix., p. 28. 
Diphtheria.—Many cases of diphtherite, seemingly the most trivial, 
prove unexpectedly fatal, and in these cases indications of impairment of 
the renal functions are constantly precursory of an unfavorable termination. 
Hence the necessity of, morning and evening, making an examination of 
the urine; if albuminuria be present, the prognosis should be carefully 
guarded, though not necessarily fatal. 
It will be found that chlorate of potash, used freely as a mouth-wash, 
acts just as well in xilcerative stomatitis (a diphtheritic atfection) as when 
given internally. Why not try the chlorate as a topical application in 
cases of pharyngeal and tracheal diphtheria ? By means of a sponge pro- 
bang and a larynx syringe, a solution might without much difficulty be 
brought into contact with these parts. A saturated solution should be 
used, and freely and frequently applied. Part xxxix., p. 32. 
Diphtheria.—The following plan of treatment has been found of the 
greatest use in this affection : 1. A temperate, dry, well-ventilated room 
as can be obtained, no one being allowed to sleep in it except an attend- 
ant. Crowded bedrooms and animal effluvia are an exciting cause. 
2. A calomel purgative, varying in strength according to the age and 
size of the patient; and in children, where symptoms of laryngitis appear, 
a rapid exhibition of the chloride of mercury, such as a grain to two 
grains every hour till the breathing is easier, and then every three or four 
hours, till the false membranes are loosened, the bowels evacuate green 
stools, or vomiting. 3. The decoction of cinchona with hydrochloric acid, 
varying the dose of the latter from one minim to ten every four hours, in 
from a teaspoonful to two tablespoonfuls of the former. 4. Gargle with 
chloride of sodium and vinegar, a tablespoonful of each in a teacupful of 
hot water; also inject this up the nostrils when they are becoming 
obstructed. This excels all other gargles; it relieves the breathing and 
the fcetor, and causes the ulcers to heal. 5. Apply the stick of nitrate of 
silver to every part where false membrane or exudation can be seen. 
When the disease spreads beyond the reach of the caustic case, a probang 
and clean sponge, well saturated with a strong solution of nitrate of silver, 
will answer 6. Rub the external fauces with compound iodine ointment 
night and morning; and where erysipelas may appear, apply the stick, 
and lay on a plaster of strong mercury ointment. V. Keep the room and 
all else sweet and clean. 8. A nutritious diet is necessary. A little 
mutton every day; boiled milk, rich gruels, and beef-tea, with hot port- 
wine and water (half wine with sugar and lemon), for all above ten years, 
and warm milk-and-water for minors. All things should be taken warm! 
Cold drinks are an exciting cause. Part xxxix., p. 33. 
Diphtheria.—Turpentine, in many cases, acts somewhat similarly to 
mercury, preventing effusion of lymph, but stimulating instead of debili- 
tating. It is frequently appropriate where mercury cannot be used, and 482 
DIPHTHERITIS. 
may be employed with much advantage in diphtheria. To a child of from 
two to six years of age, give ten minims of the spiritus terebinthinum every 
second hour, and five grains of the carbonate of ammonia every second 
hour, the child taking the turpentine one hour and the ammonia the next. 
The turpentine may be mixed up with egg and sirup. Besides this, the 
child should take port wine, porter, and beef-tea, or wine with the yolk of 
an egg, ad lib. This plan of treatment is most applicable to cases where 
decided croupy breathing and fits of suffocation have made their appear- 
ance. Part xxxix., p. 34. 
Diphtheria.—The following plan of treatment was found very successful 
during a severe epidemic of this disease last year, at an asylum for orphans 
at Croydon. There were fifty cases with only one death : R Solutionis 
chlorinii, §ss.; sirupi simplicis, §ss.; aquae destillatae ad §vj. M. Fiat gar 
garisma saepe utendum. R Solutionis chlorinii gtt. iv.; sirupi aurantii 
3j.; aquae destillatae ad §ss. M. Fiat haustus 2nda quaque hora sumendus. 
The dose was increased according to age. Calomel was given in doses of 
one grain and upward, according to age. The diet, too, consisted of con- 
centrated jellies, strong beef-tea, wine, etc. After the third day, quinine 
was added to the chlorine solution. The same mode of treatment was 
adopted in adult cases, except that, instead of calomel, the hydr. c. creta 
was given. Part xl., p. 20. 
Diphtheria.—The plan invariably adopted by Dr. Gennings, regardless 
of sex, age, or incubation of disease, has been to give an active emetic of 
antimonial wine, from half an ounce to an ounce, according to age; to 
freely cauterize the throat with solid nitrate of silver ; to have a mustard 
poultice applied from ear to ear; the feet and legs plunged in a hot bath; 
and the patient confined to bed. After the emetic action has ceased, from 
three to five grains of calomel with five of compound extract of colocynth 
were given (or, for a child, two grains of calomel with two grains of com- 
pound antimonial powder); and, four hours afterward, the following mix- 
ture : R Quinae disulph., 5ss.; potassse chloratis, 3j.; acidi hydrochlorici 
diluti, §ss.; aquae, gviij. M. Fiat mist, cujus sumatur pars sexta4tis horis. 
A gargle of chlorine solution must be frequently used to sponge out the 
fauces; it may be prepared by impregnating water as much as can he 
borne with the protoxide of chlorine. The diet should be at first 
farinaceous, and afterward consist of strong broths and jellies. Sherry 
whey may be given alternately with quinine, which latter is of the greatest 
use, and must be given in large doses. 
* 5)5 5(5 5)5 5)5 
It is of the greatest importance to arrest the local inflammation, and to 
that end nothing answers so well as painting the fauces over with a very 
strong solution of nitrate of silver (15 grains to the drachm). Later in 
the treatment, a weaker solution may be used, or Bretonneau’s applica- 
tion, one part of hydrochloric acid to three of honey. But where the 
inflammation is more sthenic, inhalation of steam and soothing applica- 
tions are desirable. Of all the medicines which present themselves for 
our choice, the tincture of the sesquichloride of iron is the one upon 
which Mr. T. H. Smith chiefly relies. Part xl.,/). 26. DISINFECTANTS. 
483 
DISINFECTANTS. 
Ledoyen’s Disinfecting Fluid.—Its efficacy is said to depend on its 
power of destroying the odor of sulphureted hydrogen. Many sub- 
stances, however, are said to be capable of doing this, such as sulphate of 
copper nitrate of copper, chloride of copper, nitrate of lead, etc. 
The editor of the “Dublin Quarterly Journal” comments on this 
report: 
“ A disagreeable odor does not constitute infection, although a stink 
may, under certain circumstances, afford a valuable index to infection; 
thus, in the wards of a hospital, if the medical attendant has his sense of 
smell unpleasantly assailed, it is a signal that ventilation has not been 
sufficiently attended to, and he can, accordingly, order this neglect to be 
remedied; but if the care-takers of the ward have at their disposal an 
agent for conquering this stink—a liquid, which, upon being poured into 
the chamber-vessels, or sprinkled on the ward, will remove all unpleasant 
effluvia—then the safeguard afforded by the senses becomes nugatory: the 
unpleasant odor is removed, but the contagious poison continues and 
accumulates. It is like taking away the beacon, while the rock remains. 
Such a substance may lessen the trouble of the nightmen and wardsmen, 
and dissecting-room porters, whose eulogistic testimony to the value of 
M. Ledoyen’s fluid, is published by the House of Commons in the paper 
before us, but we feel persuaded that its employment would prove very 
injurious in practice.” Part xvi., p. 45. 
Disinfection.—Pound the well-dried raw bean of coffee, and strew it 
over a moderately-heated iron plate till the powder assumes a dark-brown 
tint; it will then remove almOst any noxious effluvium. 
Part xvii., p. 304. 
A Comfort for Ded-ridden Patients.—Mr. Hovell adopted the follow- 
ing simple means in the case of a patient who had lost the use of the 
sphincters. They proved a great comfort both to the patient and surgeon. 
He says: 
Eleven days ago, I adopted the plan of placing beneath her a calico bag 
two feet square, partially filled with Irish peat-charcoal, so as to form a 
sort of cushion and absorbing medium. It has had the happy effect— 
which continues even now, without any necessity for changing the 
charcoal—of completely neutralizing all unpleasant odor; and if the bed 
becomes partially wet, all the offensive ingredients are absorbed and neu- 
tralized by the charcoal, which thus is a most simple means of remedying 
a great nuisance, and one that requires the most strict attention, at best, 
to prevent, and that attention is often difficult, and always expensive, to 
procure. In cases of incontinence of urine particularly, and, indeed, all 
attended with foetid discharges—cancer, compound fractures, etc., this 
plan, or some modification of it, might be adopted writh advantage. 
Part xxv., p. 340. 
Disinfectant.—In Carlisle, on the suggestion of the Rev. Mr. Dew, 
great comfort has been found in introducing a few shovelfuls of soot 
as a deodorizer in the removal of night soil and manure. 
Part xxviii., p. 3 SO. 484 
DISLOCATIONS. 
Charcoal.—This is an admirable deodorizer. Take two sheets of cotton- 
wool and between them put a tolerably thick layer of powdered charcoal, 
and quilt the Avhole together in small segments, the same as in making a 
cushion. This charcoal quilt is to be placed over any nasty smelling-sore, 
and will prove a good disinfectant. Part xxx., p. 176. 
Charcoal as a Disinfectant.—Mr. Turnbull, nine months ago, placed the 
bodies of two dogs in a wooden box on a layer of charcoal-powder of a few 
inches in depth, and covered them over with a quantity of the same 
material. Though the box was quite open and kept in his laboratory, no 
effluvia Avas ever perceptible; and on examining the bodies of the 
animals at the end of six months, scarcely anything remained of them, 
except their bones. 
Mr. Turner subsequently, about three months ago, buried two rats in 
about two inches of charcoal-poAvder, and a few days afterward the body 
of a full-grown cat Avas similarly treated. Though the bodies of these 
aifnnals are noAV in a highly putrid state, not the slightest odor is per- 
ceptible in the laboratory. From this short statement of facts, the utility 
of charcoal-powder as a means of preventing noxious effluAua from church- 
yards, and from dead bodies in other situations, such as on board ship, is 
sufficiently evident. Covering a churchyard to the depth of two or three 
inches Avith coarsely poAvdered-charcoal, Avould effectually prevent any 
putrid exhalations ever finding their way into the atmosphere. Charcoal- 
poAvder also greatly favors the rapid decomposition of the dead bodies with 
which it is in contact, so that in the course of six or eight months, little is 
left except the bones. Part xxx., p. 304. 
Extemporaneous Preparation of Chlorine as a Disinfectant.—The 
chloride of lime, usually employed as a means of disengaging chlorine, has, 
besides its price, the inconvenience of being rather rapidly exhausted. 
M. Lambossy substitutes for it a cheap and simple preparation, consisting 
of common salt, red-lead, sulphuric acid, and cold Avater. The red-lead is 
mixed with the salt, and introduced into a bottle full of water. The sul- 
phuric acid is added afterward gradually, and shaken at intervals. By this 
process, sulphate of lead is formed and precipitated, and sulphate of soda 
and chlorine remain dissolved in the water. The chlorine, which gives the 
liquid a yelloAv color, is disengaged as soon as the bottle is opened. To 
produce a more rapid disengagement, the liquid is poured into flat plates, 
so as to offer a large surface for evaporation. Part xxxAnii., p. 288. 
DISLOCATIONS. 
Cure of an old Dislocation of the Humerus, by division of the Muscles 
in its Neighborhood.—Professor Dieffenbach, of Berlin, relates the follow- 
ing case of reduction of a dislocated humerus of two years standing: 
The patient was of a gaunt, powerful form, with a pale complexion, and 
but little fat, and his muscles were strong and prominent under the skin. 
The injured right shoulder was an inch higher than the left; the acromion 
formed a short angle ; on the side, the shoulder was deeply hollowed, 
and the scapula lay flat. The right arm was thinner than the left, and DISLOCATIONS. 
485 
stood out far from the body. The head of the humerus lay on the anterior 
side of the chest, close to the clavicle, and two inches from the upper por- 
tion of the sternum. The patient had a constant sensation of cold in the 
limb, and the creeping which he had formerly felt had ceased. The 
pulse in the right radial artery was rather weaker than that in the left. 
The limb was useless, and only the hand could perform some slight 
actions. 
By moving the arm in different directions, severe pain was produced in 
the part where the head lay surrounded by a thick wall of dense ligament 
into which it had worked itself. In drawing the arm outward from the 
body the pectoralis major, latissimus dorsi, teres major and teres minor 
became tense with extreme pain. The last three of these muscles felt 
hard and tense, even when the arm was not drawn outward. An attempt 
to reduce such a dislocation without dividing these muscles and the new 
joint, would have been extremely dangerous, and had been found impos- 
sible ; but (says the professor) I anticipated success from the subcutaneous 
division of everything that resisted me. 
The patient being placed on the table, with one folded sheet passed 
under the right axilla, and held by six assistants, another fastened round the 
right hand and held by six more, and a third round the upper part of the 
humerus held by three more (in the manner usually adopted by me in old 
luxations), the first two sets of assistants were ordered to pull against each 
other. I next bade them make a slowly increased extension, and then 
stop; I then passed a small scythe-shaped knife through the skin, and 
divided the most tense portion of the pectoralis major close to its tendon, 
which yielded with a cracking sound. I then again introduced the knife 
at the posterior border of the axilla, and divided, one after the other, the 
latissimus dorsi, the teres major and the teres minor. All these muscles 
gave way with a cracking noise, which was increased by the resonance of 
the chest. I next passed my knife into three places by the head of the 
humerus, and divided, in a similar manner under the skin, the dense and 
hard false ligaments which surrounded the new joint, and lessening the 
extension, I loosened the head by a few rotations. 
A powerful extension was now again commenced on both sides, and the 
three assistants behind the patient pulled suddenly, while I conducted the 
humerus toward the joint, into which it slipped on a sudden, without again 
springing out. One shoulder looked now just like the other. The thorax, 
the shoulder and the arm were enveloped with bandages which were 
soaked with paste, and after a few hours they all became dry and hard, 
and prevented any motion of the right side. 
The bleeding from the wounds, which were not larger than those made 
in phlebotomy, was, at most, a few drops. No unpleasant symptoms 
ensued. 
On the ninth day I took off the bandage; both shoulders had exactly 
the same level and form, and there was neither swelling nor pain. The 
punctures in the axilla had completely healed, and scarcely a trace of them 
could be found ; there was no collection of blood or pus. The limb is now 
restored to perfect utility. 
The professor adds that he had lately occasion to reduce a luxation of 
the foot backward, of upward of a year’s standing, by dividing the tendo 
Achifiis, which forcibly drew the heel upward. This limb, also, became 
useful again. Part i., p. 112. 486 
DISLOCATIONS. 
The use of Tobacco or Tartar Emetic in Dislocations—Preferred to 
copious bloodletting, for the purpose of effecting relaxation of the muscular 
system. Part i., p. 121. 
Aphorisms of Practical Surgery.—The difficulty of reducing disloca- 
tions of the phalanges is attributable chiefly to the displacement of the 
tendons, and their escape from the grooves in which they play. 
There is one sort of luxation of the shoulder exceedingly difficult of 
restoration, viz.: that in which the head of the humerus is directed 
inwards and upwards, and which is usually occasioned by a fall down a 
staircase. The displacement is to a considerable extent, the head of the 
bone touching the clavicle, and being situated above the level of the cora- 
coid process. Dupuytren determined by numerous experiments on the 
dead body, that the main obstacle to the reduction is, that the beak 
of this process is often entangled in the substance of some tendon or 
muscle. 
When such is the case, no mechanical effort can overcome the resistance 
without danger. 
Luxation of the Astragalus may arise from falling with force upon the 
feet. Part iii., p. 115. 
Dislocations of the Astragalus.—This hone may be displaced in eight 
directions, viz.: 1, forward; 2, forward and inward; 3, forward and out- 
ward ; 4, upward and outward ; 5, outward; 6, inward; 7, backward; 8, 
outward, downward and backward. 
As a genera] rule, in the treatment of these cases, the bone ought to be 
replaced if possible. It is of great importance to distinguish between 
complete and partial dislocation of the bone, because in the latter case 
reduction is very possible, while in the former almost impossible, on account 
of the powerful approximation of the tibia to the calcis; and even if in the 
latter case the tibia and os calcis could be sufficiently separated to allow 
the bone to be rejdaced, it becomes very questionable whether or not the 
practice would be good, on account of the insufficient vascular connections 
which we may be sure would result from the severe laceration previously 
experienced. In one instance only has a complete dislocation been par- 
tially reduced; and it is evident that in such a case, if compound, the 
unreduced portion of the bone should be excised, to prevent the foot from 
becoming permanently fixed by the mechanical obstacle. In the cases 
published of dislocations forward, inward and outward, simple as well as 
compound, Mr. Turner states that, in many instances, the bone sloughed 
where extraction was not performed, but in all the instances of luxation 
backward, with one exception, the bone scarcely seemed to act at all as an 
extraneous body, i. e., it neither died nor did it excite any great amount 
of local or general disturbance. In the dislocations backward, therefore, 
extirpation of the bone is scarcely called for. In irreducible simple dislo- 
cations forward, inward and outward, Mr. Turner would not extract the 
bone in the first instance, but in some compound cases he would not hesi- 
tate to do so without a moment’s delay; at the same time he states that 
where the complete dislocation is simple, we may hazard the chance of 
allowing the bone to remain in its new situation, to be afterward extir- 
pated if necessary or left to slough away. In a case of partial, simple and DISLOCATIONS. 
487 
irreducible dislocation forward, outward, or inward, the best practice, per- 
ha])s, would be not to interfere, but leave the case to the resources of 
nature; but in partial and compound or compound and complicated (re- 
duction failing) excision, if practicable, of the protruded portion of bone 
should be performed; but not in partial and simple dislocation without 
any external wound. When the displacement is complete and simple, 
and cannot be reduced by moderate efforts, it ought to be left to nature; 
and should the skin inflame, and ulceration of the skin threaten, an inci- 
sion may be made over the bone, which may then be extricated by the 
efforts of nature or art, according to circumstances. Part viii.,/>. 81. 
Dislocation into the Ischiatic JSfoich—Diagnostic Sign of.—Mr. Syme 
has narrated, in the “London and Edinburgh Monthly Journal,” a case 
where the occurrence of the dislocation was determined by the presence 
of a particular sign, which appears to be of much importance in the 
diagnosis of a dislocation which Sir Astley Cooper has described as “ the 
most difficult both to detect and reduce.” There is less deformity and 
fixture of the limb than in any other of the displacements of the thigh- 
bone. “ This obscurity (says Mr. Syme) is much increased by attempts 
to effect reduction, since a moderate degree of extension almost entirely 
removes the shortening and inversion, which are usually considered the 
most. characteristic symptoms. I think it, therefore, of consequence to 
state, that there is another feature of the injury which, according to my 
experience, is never absent—always well marked—and not met with in 
any other injury of the hip-joint, whether dislocation, fracture, or bruise. 
This is an arched form of the lumbar part of the spine, which cannot be 
straightened so long as the thigh is straight, or in a line with the patient’s 
trunk. When the limb is raised or bent upward upon the pelvis, the back 
rests flat upon the bed ; but as soon as the limb is allowed to descend, the 
back becomes arched as before. By attention to this symptom, I have 
been enabled to recognize the existence of dislocation into the ischiatic 
notch, when it had been unnoticed by others ; and, on one occasion, when 
it was supposed that the replacement had been effected through powerful 
extension by the pulleys. Partyiii., p. 160. 
Deduction of Dislocations by the Power of Twisted Pope.—The mode 
of application is as follows: Place the patient and adjust the extending 
and counter-extending bands as for the pulleys; then procure an ordinary 
“ bed cord,” or “ wash line,” tie the ends together, and again double it 
upon itself; then pass it through the extending tapes or towel, doubling 
the wdiole once more, and fasten the distal end, consisting of four loops of 
rope, to a window sill, door sill, or staple, so that the ropes are drawn 
moderately tight; finally, pass a stick through the centre of the double 
rope, dividing the strands equally by it; then, by revolving the stick as an 
axis or double lever, the power is produced, precisely as it should be in 
such cases, viz., slowly, steadily, and continuously, which, with the aid 
furnished by the surgeon to the immediate seat of the lesion, and to the 
system in general, cannot fail to conduct the case to a happy issue. 
Part xii., p. 151. 
Compound Dislocation of the Astragalus.—On the 4th of November 
a laborer, set. 42, of stout and muscular conformation, was admitted into 
St. Thomas’ Hospital, with compound dislocation of the astragulus inward. 488 
DISLOCATIONS. 
On examination, the accident appeared of the nature of a compound dis- 
location of the tibia inward, with fracture of the fibula. The foot was 
everted ; the outer edge of the sole inclined upward, the inner edge down- 
ward. On the inner side of the foot there was a lacerated wound of the 
integuments, extending from below the internal malleolus, about three 
inches in length, forward on to the instep. The integuments were con- 
tused and lacerated to a great degree on the outer side, the wound ex- 
tending from above the outer malleolus across the foot to the metacarpal 
bone of the second toe, a large flap of skin having been torn up, and a 
deep chasm exposed beneath: on both sides the tendons were exposed. 
The anterior and posterior tibial arteries wmre not injured, and their pul- 
sation could be distinctly felt, though anteriorly only a narrow bridle of 
skin, about an inch and a half in width, was left between the two wounds, 
connecting the skin of the leg with that of the foot. 
The inner malleolus, though not bare, projected through the wound on 
the inner side. On the outer side, the fibula, which was fractured about 
two inches above the external malleolus, was completely exposed. Re- 
duction was attempted by Mr. Solly, who visited the man a short time 
after admission, but with no avail. On consultation between Mr. South, 
Mr. Mackmurdo, Mr. Solly, and Mr. Travers, it was determined that an 
attempt should be made to save the limb, to saw off the extremity of the 
tibia, and to reduce the dislocation. 
For this purpose the man was placed upon the table; the wound on the 
inner side dilated, and the internal malleolus laid bare. The tendon ofthe 
flexor digitorum communis was drawn aside by a retractor; while that of 
the tibialis posticus being so much on the stretch as not to allow of re- 
traction, was divided. At this stage it wras discovered that the prominent 
projection of bone on the inner side was a portion of the astragalus, in natural 
connection with the tibia, but separated from the os calcis and navicular 
bone. It was therefore determined to remove this bone, which was done, 
and the foot was then easily brought into its natural position. The in- 
teguments were now brought together by sutures, and strips of adhesive 
plaster ; the patient sent to bed, and the limb confined in a swing-box. 
[On the 11th there was inflammation of a low character about the Avound, 
and affecting the absorbents; on the 22d, he was requested to have the 
limb removed, and Mr. Solly amputated the limb below the knee; a con- 
siderable amount of blood was lost during the operation. 
Dec. 2.—The thigh much swollen, tongue red and tremulous, and pro- 
truded with difficulty. Next day an opening Avas made near the hip, and 
three pints of unhealthy pus evacuated ; stump appeared healthy. He 
gradually sunk and died on the 12th. Mr. Solly remarks on this case :] 
This form of dislocation Avas new to me, and in Aveighing the arguments 
pro and con amputation, I did not put this into the balance. I candidly 
confess that if avc had, I think it Avould have just turned it in favor of 
amputation of the limb; for the dissecting out of the astragalus from the 
socket of the tibia is certainly a more serious operation than sawing off 
the end of the tibia. It is true that the astragalus has been frequently re- 
moved in compound dislocations, and the patient recoArered; but I think, 
on looking back to all the circumstances of this case, that it added so much 
to the already extensive injury of the soft parts, that if a similar case Avere 
to come before me, I should not be tempted to try by such means to save 
the limb. DISLOCATIONS, 
489 
I would, indeed, advise you, in any analogous case, where you might 
consider it necessary to remove the astragalus, or saw off the end of the 
tibia, in order to return the bones to their place, never to make a fresh 
incision to effect it, if you have already an extensive wound in another 
direction. If you cannot remove the astragalus without so doing, then to 
remove the whole leg in preference. In the case we have just been con- 
sidering, there was an extensive lacerated wound on the outside of the 
foot; but this wound was not in a direction to admit of either the removal 
of the base of the tibia through it, or the astragalus; and though there 
was a wound on the inner side, still this wound did not communicate with 
either of the above-mentioned bones. In order to extract the astragalus, 
it was necessary to carry this wound down to them, which most un- 
doubtedly added much to the previous injury, and danger of constitutional 
irritation. 
I have remarked, that in those cases in which the astragalus has been 
successfully removed, it has been removed rather through an original 
wound, or a dilatation of the original one, or in cases of dislocation, where 
of course only one wound need be made for the purpose. 
[A practical point involved in accidents such as this, is the question of 
primary or secondary amputation. Mr. S. remarks:] 
In this individual case I must say that I think the man would have had a 
much better chance of recovery if the leg had been amputated in the first 
instance instead of removing the astragalus, and waiting. 
[The late Mr. Colles, of Dublin, was very much opposed to amputation 
for compound dislocation of the ankle; he made the following remarks on 
this subject:] 
If you must amputate, wait at least until the symptomatic fever has 
subsided. If there is a necessity to amputate after hectic fever has set in, 
which, as I have already said, may occur, the hectic will immediately sub- 
side after the operation, provided the fever be not owdng more to consti- 
tutional than local causes. A man, who is in perfect health the moment 
before he met with an accident, and from which he got a severe shock, is 
not a fit subject for an immediate operation. Part xiii., p. 200. 
Use of Ether in Dislocations.—Put the patient under the influence of 
ether to relax the muscles, and renew the inhalation upon evidence of pain 
being manifested. The patient may be bled to incipient syncope, and 
nauseating doses of antimony, together with the warm bath, may also be 
employed as auxiliaries, immediately preceding the inhalation of the ether. 
Part xv., p. 167. 
Dislocated Thumb.—Seat the patient with his back to the surgeon, and 
carry the arm, with the wrist and thumb bent, over the shoulder; then 
make extension. Part xv.,p. 168. 
Old Dislocations.—Old dislocations may be successfully reduced by 
proper management, even when alteration has begun to take place in the 
form of the bones. The proper method is to make gentle extension every 
day for a few weeks, so as to loosen the attachments of the artificial joints, 
and lengthen the muscles, nerves, vessels, and ligaments; so that when 
the final pull is given, there may be no risk of laceration. When this has 
been carried sufficiently far, reduce the dislocation, and keep the parts 
tied up for a fortnight or thereabouts; then employ passive motion. 
Part xvii., p. 125. 490 
DISLOCATIONS. 
Dislocation reduced under the Influence of Chloroform. [This was a 
case of dislocation of the left humerus into the axilla, of eleven days’ stand- 
ing, occurring in an athletic railway laborer.] 
An attempt was at once made at reduction by means of the heel in the 
axilla, but without any sensible effect being produced. Two hours after, 
lie was seen by Mr. Page, who directed that the same means should be 
again employed, the patient being placed under the influence of chloro- 
form ; accordingly, the man being placed on a couch, about a drachm 
sprinkled on a handkerchief wTas held before his face, which speedily in- 
duced a state of perfect unconsciousness. The heel was placed in the axilla, 
and extension made from the hand, the operator receiving no additional 
aid from pulleys, or any other person, and in two minutes the head of the 
bone resumed its lost seat on the glenoid cavity of the scapula. 
Part xvii., p. 127. 
Knee—luxation of the Semilunar Cartilage of—[The internal carti- 
lage is most frequently luxated, and the accident is marked by the joint 
becoming locked, on some quick motion of the trunk about the axis, on 
one leg; sometimes there is great pain, and a slight projection of the 
cartilage beyond the margin of the head of the tibia. With regard to the 
treatment, Mr. Vincent tells us that,] 
The true way of manipulating here is to place the patient on his affected 
side, with the limb bent, and then to rotate gently the tibia on its axis. 
In this position the joint is loose, making no pressure on the cartilage, and 
it has the best chance of quietly slipping into its place. I have often known, 
in this luxation, when left alone, that whilst the patient was asleep the 
cartilage has slipped into its place after a few days. 
I have seen great violence used in effoi'ts to reduce the cartilage to its 
place, but all to no purpose. If the gentle rotatory motion does not suc- 
ceed, the only thing is to keep the patient in bed, and in some of his slum- 
bers all will come right. Of course, if this accident has once occurred, it 
will be liable to happen often. Part xvii., p. 128. 
Dislocation of the Shoidder.—For the most part, this luxation is of easy 
reduction, but now and then it so happens that the patient is particularly 
strong and athletic, and the surgeon perhaps just the reverse. This being 
the case, his efforts may prove unavailing, and a further outlay of power 
be required. Supposing the common methods of reduction, as by the knee 
in the axilla, or the heel in the same, the extension by the hand, etc., to 
have failed, in such a case the same means can be applied as for dislocation 
of the femur, and reduction effected by torsion : or the following method 
will be found efficacious: 
The patient being placed on a sofa or bed, or on the floor, the heel is to 
be placed in the axilla (the same as for reduction by extension at the wrist), 
and a long towel, or narrow sheet, is to be applied immediately above the 
elbow, embracing the condyles of the humerus, by means of a noose similar 
to the clove-hitch, and the two ends brought forward and tied firmly 
behind the back of the surgeon, he leaning forward a little while doing so. 
The towel or sheet should be rendered damp at that portion which en- 
circles the arm, and it should cross the back, low down, over the lumbar 
region. The knee being kept straight, or nearly so, powerful extension 
can now be made, as the position of body is well adapted for the outlay of 
great physical strength, all the powerful muscles of the back being advan- 491 
DISLOCATIONS. 
tageously brought into play. At the same time, the arms and hands are 
free, and the patient’s fore-arm being bent to a right angle with the upper 
arm, can be used as a lever in manipulating the reduction. 
Part xviii., p. 156. 
Old Standing Luxations.—On this subject, Mr. Vincent observes: 
A case presented itself to me, in which the humerus had been luxated 
seven weeks. Extension was conducted in the usual way for a long time, 
and with the fullest force, and no reduction resulted. I then drew the 
limb across the chest obliquely, and by this means returned the head of 
the bone into the glenoid cavity with very little effort. A maid-servant 
fell downstairs and injured her shoulder; a practitioner living near was 
sent for, who was not aware it was a luxation. The mistress sent her to 
me at the end of six weeks; I saw the nature of the case and took her to 
the hospital. I first tried the usual plan in vain; I then placed a thick 
body just in front of the axilla; and by first drawing the arm down, and 
then carrying it across the chest over the body, the bone slipped easily 
into its place. The perfect use of the limb was ultimately recovered. 
Thus, it is not by the force of extension, but by the adaptation of appro- 
priate manipulation, that old cases are to be reduced. The bone is easily 
replaced, and as easily put out again, so that a long observance of immo- 
bility must be insisted upon after the reduction, before the limb will be- 
come quite restored. 
I consider that it is highly proper for the secui-ity of the joint that the 
limb, after a luxation, should be kept at rest for some weeks. 
Part xix., p. 122. 
Dislocation of the Head of the Femur Backward.—In making exten- 
sion for the reduction of this dislocation, let the thigh be placed at a right 
angle, or nearly so, with the abdomen, keeping it at the same time in a 
state of abduction, and having the knee bent. Part xix., p. 123. 
Dislocation of the Astragalus.—The following plan has succeeded in a 
case of dislocation inward. Chloroform being administered, and the limb 
being laid on its outer side in a semi-flexed position, extension is made 
from the heel and foot by two assistants, the hands of one superposed over 
those of the other ; and counter-extension is made by two other assistants 
from the thigh. The surgeon pushes the external margin of the foot with 
his knee, so as to produce great adduction of it, and then presses upon the 
astragalus with both his thumbs. 
In cases of simple dislocation, attempt reduction. Administer chloro- 
form, employ extension and counter-extension at the knee and foot respect- 
ively, and make direct pressure upon the dislocated hone. If the tendo 
Achillis is very tense and seems to hinder the reduction, divide it. 
Part 125. 
Dislocation of Lower Jaw.—It is not on the condyle that we must fix 
attention to find the cause which renders the dislocation permanent, but 
on the coronoid process and the malar bone, since it is in the contact of 
these two bones that almost all the difficulty of reduction resides. And 
therefore to succeed, according to the process of M. Nelaton, it is neces- 
sary to act either by the interior of the mouth, taking a point of support 
behind the mastoid processes, or externally, by the operator taking a posi- 492 
DISLOCATIONS. 
lion behind the patient and making pressure on the coronoid process, push- 
ing it downward and backward, to disen'gage it from contact with the 
malar bone, at the same time the patient opens the mouth. This is effected 
by pressing in the direction mentioned, placing the thumb upon the coro- 
noid processes. If this force is not sufficient, the head must be supported 
by an assistant; or a band may be passed around it, in which the operator 
can engage his index and middle fingers, while the thumb must be brought 
to bear on the coronoid process. Part xxii., p. 209. 
Dislocation of the Thumb.—The case which directed M. Demarquav’s 
attention to the subject, is the following: A lady, in leaving her carriage, 
fell upon the pavement with outstretched arms, and a dislocation of the 
thumb ensued. M. Demarquay thus describes the state of the parts: The 
thumb was forced backward, and formed an obtuse angle with the corres- 
ponding metacarpal bone, whose phalangeal articulation projected under 
the muscles of the thumb. The ungual phalanx wras flexed, and all move- 
ments of further flexion or extension were impossible. M. Demarquay 
used all known means of reduction without success, and M. Roux was 
called in previous to muscular section. The latter sui’geon used the same 
tractions as had before been done; but before flexing the thumb he 
rotated it inward, whilst he made forcible flexion, and reduction was thus 
obtained. 
M. Demarquay was struck with this result; he made several experi- 
ments on the subject, and found that in a complete luxation of the thumb 
backward, the following changes take place: The metacarpal extremity 
of the first phalanx comes to rest on the posterior portion of the articular 
surface of the first metacarpal bone ; and the phalangeal extremity of the 
latter projects under the skin, after having passed through the two 
portions of the flexor brevis pollicis, the external portion being frequently 
torn. This phalangeal extremity of the first metacarpal bone is thus 
caught in a loop formed externally by the outer part of the flexor brevis 
and the abductor, and internally by the inner portion of the flexor brevis, 
the abductor pollicis, and the strong tendon of the flexor longus pollicis. 
M. Demarquay gives the following rules: 1. To use a sufficient amount 
of traction (with Charriere’s forceps) on the luxated bone, in the direc- 
tion of the axis of the thumb. 2. To push back with the operator’s 
thumb, or left index-finger, the head of the metacarpal bone, and keep it 
quite steady, so that when flexion is made, the head may not be thrust 
further into the palm of the hand. 3. When extension is carried to a 
sufficient extent, rotation either tow*ard the outer or inner side should be 
made, so that the head of the metacarpal bone may be freed from the 
muscular loop which is keeping it strangulated. This being done, the 
traction should be continued until the posterior part of the first phalanx 
has reached the level of the head of the metacarpal bone. Flexion is 
then to be made, whilst at the same time the left thumb of the operator 
forces backward the displaced part of the first metacarpal bone. 
Part xxv., p. 186. 
Humerus, Dislocations of.—In whatever direction extension is made, 
whether downward and outward, directly outward or upward, you must 
fix the scapula, not by the heel in the axilla, but by the direct application 
of the counter force against the acromion process. Part xxxii., p. 122. DISLOCATIONS. 
493 
Femur Dislocations of.—Let the operator stand on the injured side, 
seize the ankle with one hand and the knee with the other, then flex the 
leg on the thigh, next strongly abduct it, carrying it over the sound one, 
and at the same time upward over the pelvis, by a semicircular sweep, as 
high as the umbilicus; then abduct the knee gently, turn the toes out- 
ward, and carry the foot across the opposite sound limb, making gentle 
oscillations of the thigh, when the head of the bone will slip into its 
socket. Traction on the femur is force misapplied, it is unphilosophical 
and absurd, contra-indicated both by the anatomy of the joint and by the 
plainest laws of mechanics. As muscles are the principal agents in pro- 
ducing dislocations, so they may be made our most efficient assistants in 
reducing by manipulation; consequently “ etherization to the extent of 
complete relaxation,” instead of being an advantage, is a detriment. 
Fart xxxii.,ja. 126. 
Dislocations of the Head of the Femur reduced by Manual Extension, 
Flexion, and Dotation.—The method of reduction by some American 
surgeons is to flex the leg on the thigh, carrying the thigh over the sound 
one, upward over the pelvis, as high as the umbilicus, and then abducting 
and rotating it. At Guy’s, the method is not so violent. In dislocation 
into the foramen ovale, adjust a towel around the thigh just above the 
knee, give chloroform, and when all muscular irritability has ceased, place 
the heel against the head of the femur, and make extension in a line paral- 
lel with the central axis of the body; if the limb now be slightly rotated, 
the head of the femur will be replaced. In dislocation on the dorsum ilii, 
give chloroform, place the foot against the pubes, grasp the limb above 
the ankle, make direct extension, with gentle rotation outward, and the 
reduction will be accomplished. Part xxxii., p. 131. 
Deduction of a Dislocated Femur icithout Extension.—If on the dor- 
sum, put the patient completely under chloroform; then take the thigh, 
flex it on the pelvis, bend it outward, and make a slight rotatory move- 
ment, when the head of the bone will slip into its socket. No extension 
whatever is required, simply lift up, bend out, roll in. Movements modi- 
fied according to the different positions taken by the femur, are equally 
effectual with the other varieties of dislocation at the hip. 
Part xxxii., p. 132. 
Lower Jaw, Dislocation of.—The surgeon will obtain a great advan- 
tage in position, if, instead of standing before the patient, he stands 
behind. The head placed against his chest can be pushed forward at the 
time he is pushing the jaw downward and backward, with the thumbs in 
the mouth, and the fingers under the bone in front. By standing behind 
the patient, the head is more secure and fixed; he can also assist his 
manipulations by pushing forward with his chest, and, if necessary, 
employ much more force than when standing in front. 
Part xxxii., p. 133, 
Dislocation of Femur.—On looking at the limb from the side, the front 
outline of the thigh will present a concavity, instead of the curved promi- 
nence natural to it. 
Another most useful diagnostic sign is the loss of support from behind 
to the femoral vessels. On pressing them with the finger, there appears 
a hollow behind them, and a deficiency of that firm support which they 
naturally possess. 494 
DIURESIS. 
The patient must be laid on the back and chloroformed. Then place 
the front of the knee of the affected limb in your axilla, and pass the 
right hand under the thigh from within outward. With the left hand 
grasp firmly the upper part of the displaced bone, at the same time taking 
the left wrist in the right hand, you must now bind the thigh on the pel- 
vis and rotate outward. By this the head will generally slip into the 
socket. Part xxxiv., p. 130. 
Dislocation of Ilumerus {old standing).—You must first place the 
patient under the full influence of chloroform. You may dispense with 
the counter-extending girth around the chest, if you only fix the scapula. 
This may be done by a strong bandage placed like a soldier’s belt across 
the shoulder, and meeting behind. This, by using strong force against 
the upper border of the scapula, at once fixes it. By careful manipula- 
tions and extensions, the head of the bone must now be directed to the 
glenoid cavity. Part xxxiv., p. 131. 
Ilumerus Dislocation of—In cases difficult of reduction, the following 
mode is worth having recourse to. Bandage a rectangular splint to the 
arm and forearm, so as to make the latter into a lever, by which to act 
upon the former. The operator’s knee must be put under the patient’s 
elbow as a fulcrum, the forearm must be depressed, and the bone lifted 
into its place. Part xxxv., p. 15. 
Dislocation of the First Phalanx of the Thumb.—[In a case which 
occurred under his care, at Guy’s Hospital, lately, Mr. Birkett sawed off 
the end of the protruding bone of the thumb, and cJosed the wound, 
which rapidly healed.] 
The practice adopted in this instance, in treating the compound disloca- 
tion of the first phalanx of the thumb on the metacarpal bone, is that 
generally recommended—namely, to saw off the head of the phalanx 
before reduction; and it is a proceeding which answers admirably. So 
far as wTe could judge, the man would have a good movable thumb, with 
all its powers of flexion and extension. Part xxxviii., p. 143. 
Dislocation of the Thumb.—Mr. Humphrey finds the difficulty so com- 
monly experienced in reducing dislocations of the thumb to depend upon 
the fact that the sesamoid bones or bodies are driven back with the dis- 
placed phalanx, and intervene between the articular surfaces, so as to 
prevent their coming in contact. In a case of compound dislocation of 
the distal phalanx, which had resisted attempts at reduction for more than 
an hour, he succeeded in quickly effecting the object by passing a probe 
beneath the sesamoid body, and tilting up its lower edge. 
Part xxxix., p. 138. 
DIURESIS. 
Diuresis.—The constant drain on the system deteriorates the health so 
that this affection sometimes becomes very serious; frequently it ends in 
phthisis, or may first pass on to melituria. Tonics, as iron and quinine, 
must be freely given, along with opium or Dover’s powder, and the health 
maintained in every way possible. Belladonna may be given with advan- 495 
DIURETICS. 
tage, in small doses, as in irritability of the bladder, with a view of con- 
trolling the irritability of the kidneys. Dart xl., 75. 
Diuresis of Irritable Bladder.—An interesting case of irritable bladder 
is related, which had existed nearly a year and a half, and, as usual, was 
chiefly noticeable in the night, two or three times the natural amount of 
urine being passed, pale and insipid, but otherwise normal. Many other 
remedies had been tried without benefit. Extract of belladonna was then 
given, at first in doses of the twelfth of a grain gradually increased to the 
third of a grain, and ultimately a grain and a half was given during the 
day. The specific symptoms were then quite established—there wmre 
nausea and dilated pupils. The irritability of the bladder was almost en- 
tirely subdued, and now, six months after, the patient remains perfectly 
free from any recurrence of her distressing complaint. The whole course 
of administration occupied rather more than six weeks. This is a disease 
which is chiefly met with amongst the upper classes of society, and seems 
to be in a great measure dependent on luxurious and enervating habits. 
Dart xl,,p. 147. 
DIURETICS. 
Nitrate of Urea as a Diuretic.—In two cases reported by Mr. Kingdon, 
of Musselburgh, he found that nitrate of urea acted as a very powerful 
diuretic, and reduced, in a comparatively short time, anasarcous swellings 
of some standing, when the ordinary diuretics had failed. In the first case 
he gave one grain of the nitrate of urea with one grain of calomel, in the 
form of a pill, every night and morning for twelve days, when the urine had 
been so copious for some days that the swelling disappeared. In the second 
case the urea was given alone, one grain and a half of the nitrate three 
times a day. The same success attended this treatment; as in ten days 
the anasarca disappeared. Dart x., p. 83. 
Employment of Urea as a Diuretic.—[The operation of diuretics is well 
known to be remarkably uncertain, and in no cases more so than for re- 
moval of dropsical effusions. This was the cause of Dr. Tanner’s employ- 
ing urea as a diuretic, forming, as it does, nearly half the solid constituents 
of the urine. Dr. Tanner observes:] 
In whatever way urea is procured, it appears in the form of delicate sil- 
very acicular crystals, which are seen by the microscope as four-sided 
prisms ; they are colorless when pure, free from odor, and generally re- 
sembling nitre in appearance, possessing also a similar cooling saline taste. 
The crystals are soluble in their own weight of cold water, and in every 
proportion of hot, their solution being neither acid nor alkaline. 
The preparation which I first employed was obtained from urine. It is 
of course, unnecessary to say, that whether this agent be procured from 
urine, or prepared artificially, it ought to possess the same properties, and 
consequently be capable of producing the same effects. I might, however, 
remark, that I prefer the preparation obtained from the urine, my reason 
for th is preference being, that in trying some experiments upon a dog, I found 
that the urea obtained from the cyanate of ammonia was less efficacious. 
It was unnecessary to resort to experiment to prove that urea medicin- 496 
DKOPSY. 
ally administered does not exert any deleterious or poisonous agency upon 
the system, because this had already been done by Dr. Todd. This gen- 
tleman injected half a drachm of urea into the vein of a dog, the only 
effect produced being an excessive seci’etion of urine, so that the place 
where the animal was kept was literally flooded in an hour or two by the 
frequency and quantity of his micturition. In the human subject a copious 
diuresis has been the only effect produced; in none of the cases in which I 
have employed it has it given rise to any unpleasant symptoms whatever. 
The ordinary dose, on its first being used, is ten grains every six hours, 
dissolved in water flavored with sirup; as its effects decrease, the dose 
may be augmented to a scruple or more. At the same time its action 
should be aided, as that of all diuretics should be, by the free administra- 
tion of diluents, as well as by keeping the skin moderately cool. Boer- 
haave, the great medical luminary of the 17th century, first pointed out 
that many diuretics may be so administered as to prove sudorifics; and Dr. 
William Alexander taught that “the salt of tartar and of nitre, though among 
the most powerful diuretics, when taken with large quantities of warm 
liquids, if the body be wTell covered, prove excellent sudorifics, and do not 
increase the quantity of urine.” 
None deny the truth of these observations: I would only intimate that 
they are not sufficiently attended to. 
In the first case, and the one in which I more particularly noted its 
effects, the quantity of urine secreted in the twenty-four hours previous to 
its administration was only fourteen ounces (high-colored, acid, sp. g. 1018) 
whereas, in the succeeding twenty-four hours, during which three doses of 
ten grains each were administered, the secretions amounted to forty-four 
ounces, (pale, acid, sp. g. 1013). The remedy was continued for the ensu- 
ing nine days, in doses of ten grains every six hours, during which period 
the urine varied in quantity from forty-nine to thirty-eight ounces. At 
the end of this time it was discontinued, as the dropsy had been tempora- 
rily removed ; and, on again having recourse to it three wrecks subsequently, 
its effects were as satisfactory. Part xxv.,y>. 162< 
Ca'inca Poot.—The root of cainca (chiococca racemosa) is highly extolled 
by M. Bruguier, as a diuretic. Vide Art. “Dropsy.” Part xxxii.,y>. 32. 
Asparagus as a Diuretic.—The tincture of asparagus alone, in water, 
is a very valuable diuretic; but it is most useful in producing the diuretic 
properties of other drugs, directing them at once to the kidneys. Half a 
drachm to two drachms will produce copious diuresis. Part xxxii.,y>. 106. 
Diuretic.—The “ erodium cicutarium ” or “ stork’s-bill,” an indigenous 
plant growing in sandy places near the sea-side, possesses great diuretic 
properties, and may be advantageously employed in many cases of dropsy. 
The mode of preparation is to infuse an ounce of the dried plant (every 
part of it) in three pints of water, stewing it in an oven, until two pints re- 
main. The dose for an adult is four or five fluid ounces, three times a day ; 
probably more may be needed in some cases. Part xl., p. 284. 
DROPSY. 
Dropsy of the Synovial Membranes—Treatment by Tartar Emetic.— 
M. Gimelle has found the administration of tartar emetic in large doses DROPSY. 
497 
very efficacious in curing dropsy of the synovial membranes; causing 
complete absorption of the fluid, with abatement of all inflammatory 
symptoms, if any exists. Twenty-seven cases of dropsy of the joints have 
been treated successfully by him. He, without any previous treatment, 
commenced by giving four grains of tartar emetic in the twenty-four 
hours, and increased the dose by two grains every day, till from eighteen 
to twenty grains were taken daily. As soon as toleration of the medicine 
was established, the fluid began to be absorbed, and the cure was in gene- 
ral complete in from eight to sixteen days. 
In only live of these cases was vomiting excited by the medicine, in two 
cases for three days. In eight cases it produced alvine evacuations ; but 
its most general and constant effects were diminution of the strength and 
quickness of the pulse, weakness of the voice, abundant nocturnal perspi- 
rations, and the appearance of a dark circle around the eyes. In almost 
every case the appetite remained unimpaired. M. Gimelle regards this 
plan of treatment as the most successful ever yet proposed for the treat- 
ment of dropsy of the synovial membranes. Part ii., p. 80. 
Dropsy of the Amnion—Curious Case of.—Since the publication of 
Mr. Toogood’s case of dropsy of the amnion, it behooves us to be more 
cautious how we proceed in supposed cases of dropsy during pregnancy. 
Some writers on midwifery do not seem to be aware of the fact that 
dropsy of the amnion may so resemble ascites as to mislead even an 
experienced practitioner: but when Mr. Toogood’s case is pointed out it 
will no doubt induce great caution in performing the operation of tapping. 
This patient was suffering from general dropsy and dyspnoea, to such a 
degree that tapping seemed absolutely necessary; “ the abdomen was dis- 
tended to the utmost: the fluctuation could not only be distinctly felt, 
but absolutely seen, the parietes of the abdomen had become so thin. 
Pregnancy having been ascertained, Mr. Toogood hesitated to tap her, 
and preferred bringing on premature labor, which he did by puncturing 
the membranes with a male catheter; two foetuses were expelled in due 
time with an immense quantity of water, ten or twelve quarts coming 
away with the second child. After this the abdomen completely subsided. 
Part iv., p. 125. 
Renal Dropsy—Use of Elaterium.—Dr. Clendinning advises a very 
judicious mode of administering it, viz.: in minute doses at intervals 
throughout the day, which is generally followed by copious evacuations, 
and the increased activity of the bowels is generally accompanied by cor- 
responding activity of the kidneys and copious evacuations of urine. By 
steadily persevering in this treatment, a constant flux is maintained which 
soon exhausts the serous eflusions. 
Bleeding and diuretics are, in their way, of great value in such cases, 
but the removal of serum from the abdomen and albumen from the urine, 
must generally be accomplished by the use of elaterium. 
It is well always between each day of purgation to have a refreshing 
night’s rest; which is of course the more wholesome when natural, but if 
necessary, opium must be resorted to, to procure the necessary rest. The 
use of opium at night, not only procures the necessary sleep when nature 
will not allow it, but induces in the patient a much greater tolerance for 
the drug. Part v., p. 54. 498 
DROPSY, 
Paracentesis.—Various instruments have been invented for the evacu- 
ation of fluid from the chest. Mr. Snow makes use of an instrument 
which draws off any liquid, and at the same time prevents the transmis- 
sion of air into the chest. “ It consists of trocar and canula, with a stop 
cock in it; the trocar to pass through the valve of the stop cock. A 
portion of the trocar must he made perfecly cylindrical, and to fit accu- 
rately the whole length of the canula. In withdrawing the trocar from 
the canula after their joint introduction, it must he brought so far as to 
he clear of the stop cock, which point is indicated by a mark on the tro- 
car, and then the stop cock must be turned before the complete removal 
of the trocar. The portion of elastic tube must now be screwed to the 
canula ; and to this tube must be screwed a double action syringe, with 
two distinct valves, like a stomach pump. The valve of the stop cock can 
now be re-opened, and by working the pump, the contents of the pleura, 
whether gaseous or fluid, will be withdrawn.” 
The grooved needle is also used by some practitioners to evacuate any 
fluid in the chest: Dr. Prichard of Bristol, uses a needle with a larger 
groove than in the common instrument, in ascites, and strongly recom- 
mends that both in this disease and in hydrothorax, it should be used 
much earlier than the trocar is generally recommended, being “ persuaded 
that the practice of deferring paracentesis in ascites, till all other means 
have long been tried, is one principal cause of the frequent return of the 
effusion. Dr. Babington has invented a very ingenious instrument for 
these cases, which in some instances may be even superior to the grooved 
needle, through which fluid will at times flow with difficulty. It consists 
of a very small trocar and canula, which, together, are not thicker than an 
ordinary grooved needle, and a probe which would pass through the 
canula. It is very possible for the grooved needle to mislead the prac- 
titioner in his diagnosis in some cases, and especially in empyema, which 
is seldom a true effusion of pus, but only a puriform-looking liquid ; “ and 
the grooved needle often separates the serum from the small secretions of 
albumen, and causes empyema to be thought a simple serous effusion. 
Both these instruments, however, may easily be used, and with perfect 
safety to the patient. In one case in which it was used by Dr. Bird, 
no fluid escaped, and on passing the probe through the canula the lung 
could be felt distinctly, without any ill effects to the patient. 
Part v., p. 111. 
Iodine.—Dr. Stokes recommends it as a diuretic for pleuritic effusions 
and dropsies: “ he advises the same rule to be observed with regard to it 
as with respect to other diuretics, which is to wait until all inflammatory 
symptoms have subsided. Iodine appears from what he says to be chiefly 
of use at the precise point where mercury begins to fail, which is when 
the disease has chauged from its acute to its chronic form.” . 
Part vi., p. 65. 
Nature and Treatment of Dropsy.—With the views of Dr. O’Beirne as 
to the nature of dropsy, it follows that the treatment will consist in reliev- 
ing the venous obstruction, and as this cannot easily be done by removing 
the pressure, we must relieve the distended veins by blood-letting; the 
immediate effects of the first bleeding are to relieve the absorbent system, 
and enable it to restore the effused serum to the circulating mass of blood, 
a proof of which we see in the sometimes rapid reduction in the swelling DROPSY. 
499 
and oedema of the external parts; but we ought to remember that the 
system is not reinvigorated by the absorption of serum in proportion to 
the previous debilitating effects which result from the loss of its fibrin and 
red globules—the blood-letting ought, therefore, to be proceeded with 
cautiously, and if necessary gin and water may be given at the same time. 
The bleeding may be repeated, when absorption and the secretion of urine 
become languid ; but it will rarely be required to do so more than three 
or four times during the treatment, the interval between each bleeding 
being about two, three, or four days, so as not to induce debility; and for 
the same reason, the quantity of blood taken should be reduced in succes- 
sion, from eight or ten to six, and from six to four ounces, the last being 
the smallest that can be of any decided benefit. The gin and water 
should be used in the proportion of one part of the former to four or five 
of the latter, and the gin should be Dutch, not English; this gin is selected 
on account of its well-known diuretic properties. If a case (of hydrotho- 
rax, for example) should occur in which the patient is evidently dying 
from difficulty of breathing, yet not comatose or paralyzed, the fluid 
should be partially evacuated, so as to relieve the symptoms, and wine 
and water, and every restorative means employed, and when absorption 
has gone on for a few hours, it is probable we might find a vein from 
which we might bleed, in the horizontal position. The venous obstruc- 
tion Avould thus be relieved, and we might at the same time support the 
patient by animal food and the occasional use of gin and water. When 
this kind of case follows an attack of inflammation of the lungs, the ani- 
mal food and spirit should be withheld for a few days, or longer, if neces- 
sary. Part vi., p. 54. 
Passive Dropsy— Treatment of.—As serous evacuations in the cure of 
dropsy pass off most frequently by the kidneys and intestines, M. De- 
breyne is of opinion that diuretics and purgatives employed to attain this 
end, ought to be combined; at the same time he recommends a dry diet, 
and that the patient should drink as little as possible. If the thirst is very 
urgent, it ought to be allayed by sucking oranges, grapes, citrons, etc. 
The following is the composition of what he calls his strong diuretic 
wine: 
ft Pulv. jalap, grammes viij.; pulv. scillse, grammes viij.; nitratis 
potassee, grammes xv. M. 
These substances are to be macerated for twenty-four hours in a bottle 
and a quarter of white wine, and he directs a tablespoonful to be given 
three times a day ; the dose is to be gradually increased until nine table- 
spoonfuls are taken daily. The stools, he says, ought never to exceed 
seven or eight per diem. If there is merely oedema of the lower extremi- 
ties, he gives his aveak diuretic wine, the ingredients of which are : 
Nitratis potassa3, grammes xij.; baccae juniperi, grammes lx. M. 
These are also allowed to remain for the same length of time in a simi- 
lar quantity of wine, and the dose consists of a wineglassful three times a 
day. M. Debreyne by no means avers that these remedies are specific. 
They are only to be employed in passive dropsy, which cannot be cured 
by a rational treatment directed either to attack the cause of the disease, 
or one had recourse to with that view. Part vii., p; 84. 
Chronic Dropsies—Elder Dark.—The decoction and extract of this 
vegetable substance are reported to be remarkably efficacious as hydra- 500 
DEOPSY. 
gogues, producing a speedy effect on the urinary and fecal secretions. 
The proportions for the decoction consist of a couple of handfuls of the 
bark to a quart of water; dose, a wineglassful a day. The extract is 
administered in France in the form of pills, of one and a half grains each, 
of which from six to ten are taken in the twenty-four hours. 
Part viii., p. 76. 
Ovarian Dropsy treated with Ioduret of Iron.—Case cited in which, 
nearly four years previous, the patient had perceived something hard on 
the left side of the body, from which she occasionally suffered great 
pain. The tumor continued to increase in size till it became a burden to 
her. She was much emaciated ; countenance pale and anxious, breathing 
laborious, a short, tickling cough, pulse 135 ; abdomen so large that it over- 
hung the knees to a considerable extent; at the umbilicus was a large 
tumor of an orange shape, and in appearance nearly transparent, in the 
centre of which were evident marks of ulceration taking place, with a 
view to the outlet of the fluid. Mr. Tutin punctured the abdomen midway 
between the umbilicus and pubes. A large flannel bandage was passed 
round the abdomen; she was ordered to keep perfectly quiet, and to take 
the following remedies: 
Blue pill, three grains; powdered squill, two grains; powdered digi- 
talis, one grain ; opium, half a grain three times a day. With two table- 
spoonfuls of a diuretic mixture. 
These she continued for three weeks without much benefit. He then 
ordered her to take fifteen drops of the compound tincture of iodine thrice 
daily, and to rub the ointment of iodide of lead over the abdomen night 
and morning. 
But from this proceeding she obtained little or no relief. The fluid 
began to increase rapidly, and she was tapped a second time, taking away 
seventy-five pints. He now prescribed for her the ioduret of iron in two 
grain doses three times a day, and ordered her to continue the ointment. 
After repeated evacuations of the fluid, and the continued regular use of 
the ioduret of iron for nearly a year, the patient was restored to perfect 
health. Part ix.,y>. 204. 
Hydrothorax and Ilydropericardium.—When patients object to the 
use of Dr. Debreyne’s diuretic wine, or when it appears to disagree with 
the stomach, we may have recourse to the use of the following pills: 
B Pulv. digitalis, 3iv.; pulv. scammonise, 5ij.; pulv. scilke, 3ij.; Ex- 
tract. Juniperi, q. s. Ut fiat massa in pil. cxx. dividenda. Dose.—From 
one to two pills three times a day, washing them down with three or four 
spoonfuls of white wine, in a bottle of which half an ounce of nitrate of 
potash has been dissolved. 
Dr. D. says that he has found these pills especially serviceable in cases 
of hydrothorax and hydropericardium. Part x.,p. 28. 
Treatment of Dropsy with Croton Oil.—[In some cases of this affection 
published by Dr. Fife, he found the croton oil much more useful than ela- 
terium. The first case was a young woman 25 years of age, who had suf- 
fered from ascites between five and six years, and for which paracentesis 
had been frequently performed. She underwent the usual treatment, in- 
cluding elaterium, which was pushed to the utmost justifiable extent, with- 
out diminishing her size, which was ten feet in circumference at the uni- 501 
DEOPSY. 
bilious. Croton oil was now given at the suggestion of Mr. Handley, of 
Howden.] 
The croton oil was commenced with in doses of three minims every night 
at bedtime, and had been taken a very few days when the tumor sensibly 
subsided, and became soft, instead of being, as formerly, as tense as a 
drum. The remedy was steadily and uninterruptedly given for at least 
ten or eleven weeks, and the swelling very rapidly diminished; pressure 
being at the same time made by means of a very broad bandage, which 
was constantly kept applied, its tightness being increased as the enlarge- 
ment required. One remarkable fact connected with the continued em- 
ployment of so harsh and drastic a purgative is, that it never, even when 
operating most powerfully, gave rise to any unpleasant symptom; but on 
the contrary, the patient daily improved both in health and appearance. 
The only complaint she ever made was of languor occasionally, when its 
action had been more severe than it generally was. In short, at no time 
was there either hypercatharsis or any dysenteric symptom present. As 
the quantity of fluid lessened, a tumor in the right iliac region became very 
distinct—evidently ovarian, and quite movable — in size equal to the 
mature foetal head. On the left side there is also enlargement of the 
ovarium, though to a much smaller size. 
This medicine has now been discontinued for many months, and no in- 
crease of fluid has ensued; the only medicine resorted to or required being 
gentle aperients, and this only to an extent infinitely less than requisite to 
many healthy persons. Her greatest circumference in the same situation 
as above-mentioned, and at a lower point where the projection is now 
greater, is no more than three feet. The diminution of size is, therefore, 
not less than seven feet. Part x., p. 80. 
Ascites— Use of Arsenic.—Dr. Cormack believes that when ascites de- 
pends upon hepatic or splenic congestion, much benefit will be obtained 
from the administration of small doses of arsenic. He recommends that 
the dose should not at first exceed the 16th or 20th part of a grain; that 
this should be taken in not less than four ounces of water, and with an 
empty stomach. The dose should be repeated four or six times—not sel- 
domer—in twenty-four hours. In skin diseases, intermittent fevers, en- 
larged spleen from intermittent fever, and, indeed, in every case in which 
arsenic is known to have specific effects, Dr. C. recommends that it should 
be given in the method above mentioned, and advises that all other drugs 
should, if at all possible, be suspended during its administration. In old 
cases of enlarged spleen and liver, the cure will be hastened by the use of 
a succession of blisters. Part xi., p. 105. 
Dropsy from Pheumatic Heart Disease cured by Elaterium.—A woman, 
aged thirty-eight, consulted Dr. Turnbull for cough and dyspnoea, with 
swelling of the face and legs. She had had an attack of rheumatism a few 
months before, since which she has had shortness of breath and some slight 
palpitation. In the report of the case, Dr. T. says: 
The pulse is 70, rather weak and small; impulse slightly increased ; the 
first sound is heard over the lower part of the sternum, and is accompanied 
by a bellows-murmur, which is most distinct at the apex and toward the 
left side, but is also audible at the lower part of the sternum, and slightly 
at the base of the heart; there is a very evident pulsation in the veins of 
the neck on both sides; the pulsation is double; the first precedes the 502 
DEOPST. 
pulse at the wrist, the second bears to the first a relation which may be 
compared to that betAveen the first and second sounds of the heart. On 
applying the stethoscope over the internal jugular vein, two very peculiar 
sounds are heard, which seem to be caused by the interruption, at each 
pulsation, of the venous murijiur, Avhich would otherwise be continuous, 
for on pressing the vein higher up with the finger, the sounds are entirely 
prevented. 
Diagnosis.—Insufficiency of the mitral and tricuspid valves.—Slight 
hypertrophy, Avith dilatation. 
Treatment.—R Elaterium, one-sixth of a grain; chloride of mercury, tAvo 
grains; bitartrate of potass, one drachm; compound jalap powder, two 
scruples. Make a powder, to be taken once or twice a day. R Compound 
camphor tincture, tAvo ounces; oxymel of squills, tAvo ounces; tincture of 
digitalis, tAvo drachms. A teaspoonful of the mixture to be taken Avhen 
the cough is troublesome. 
The poAvders produced a full effect, purging and vomiting freely, and 
the swelling diminished considerably. Digitalis and iodide of potassium 
Avere then ordered in a diuretic mixture, by which all oedema Avas removed 
and the frequency of the pulse diminished. The cough left her, and she 
was only liable to palpitation on great exertion. 
The rheumatic attack, Avhich here laid the foundation of valvular affec- 
tion of the heart, caused the disease in the most insidious manner; and it 
sIioavs, therefore, the importance of examining the heart Avith the stetho- 
scope in all cases of acute rheumatism. The existence of a beilows-mur- 
mur in the first sound, Avith its maximum of intensity at the apex, indicated 
mitral regurgitation ; and it is probable, from the strength of the impulse, 
and the loudness of the first sound at the loAver part of the sternum, that 
this had produced dilatation and hypertrophy of the cavities at the right 
side of the heart. The insufficiency of the tricuspid valve, indicated by 
the jugular pulsation, may have been occasioned by such dilatation, or it 
may have been caused, in common Avith the mitral affection, by the rheu- 
matic inflammation. The interruption of the venous murmur by the reflux 
of the blood in the A-eins, is Avorthy of notice. It is the first case in which 
I have observed this. Part xii., p. 59 
Dropsy with Albuminous Urine after Scarlatina.—[In this disease, the 
antiphlogistic treatment is the best in a majority of cases, whether Ave con- 
sider the presence of albumen in the urine symptomatic of Bright’s dis- 
ease, or of nephritis. The disease, however, may be partially subdued, and 
albumen still remain in the urine, with pallor of skin. Dr. O’Ferrall says] 
When these symptoms survive all the others, the patient is falling into 
the anamiic state. The phenomena of anoemia are quickly superadded, and 
if sought for, Avill generally be found. The blanched face will be accom- 
panied by a similar condition of the A'elum palati and fauces. The appear- 
ance of the urine has generally indicated a mixture, more or less consider- 
able, of the coloring matter of the blood. If nitric acid be added, the al- 
buminous precipitate Avill carry this coloring matter with it to the bottom 
of the vessel. 
The blood appears to undergo a gradual deterioration from the daily 
mss, and the indications are, therefore, 1st, to arrest this insidious drain upon 
the system; and, 2dly, to repair the anaemic state by the employment of 
chalybeates. The acetate of lead is the remedy which has fulfilled the first 503 
DEOPSY. 
indication. Two or three grains may be given thrice a day, with the addi- 
tion of a little acetic acid and distilled water. To this remedy should suc- 
ceed the iron, the best preparation of which, in this case, appeared to bo 
the muriated tincture. It is often surprising the rapidity with which the 
symptoms will yield to this succession of remedies. Dart 123. 
Treatment of the Dropsy following Scarlatina.—We have described 
the dropsy as coming in two different ways. In the one its invasion was 
intense and sudden; in twenty-four hours the body was distended with 
fluid, there was high lever, and a tolerably full, but very rapid pulse, 
■while the urinary secretion was almost entirely suppressed. In such cases 
free general venesection was found to be the most efficacious remedy, and 
it could the more easily be employed, as these intense attacks of dropsy 
usually supervened after the mildest forms of the exanthema, where the 
patient’s strength was quite able to bear the loss of blood. 
This was succeeded by the administration of a mixture of the nitrate of 
potass, liq. ammon. acet. and tart, antimon., in moderate doses every two 
hours, with calomel and compound jalap powder at night, and the latter 
repeated in large doses in the morning. Dr. Charlton continues: 
We occasionally had recourse to the treatment recommended by Dr. 
Golding Bird. The patient was kept in bed, wrapped in a large flannel 
bed-gown, hot baths were given every night, and he took the following 
mixture every four hours : 
R Vin. antimon. potass, tartr. m. x., julep, ammon. acetat. oz. iij., syrup, 
papav. m. x.; with pulv. ijjecac. comp. gr. iiiss. and pulv. hydrarg. c. creta 
gr. v. every evening. 
Elaterium and other drastic purgatives were likewise employed with 
success, as was also croton oil. 
In the other form of dropsy, where the swelling came on gradually with 
but little fever, we had recourse to nearly similar treatment, only that 
venesection was not required. But sometimes most dangerous head symp- 
toms unexpectedly supervened, or the respiratory organs were severely 
affected. Nothing was then found more efficacious than the free employ- 
ment of drastic purgatives. 
The favorite remedies of this kind were croton oil and elaterium, especial- 
ly the latter. Whether the fluid had accumulated in the pericardium, the 
pleura, or the peritoneum, or whether it had invaded the cellular tissue 
throughout the body, elaterium, in doses of from one-twelfth to one-sixth 
of a grain every three or four hours, often brought about the most rapid 
and unlooked-for amendment. We saw one child who had been in the 
most dangerous condition from dropsical effusion and pneumonia, and who 
regained his health in three days from taking small and frequently repeated 
doses of elaterium, squills, and calomel. He was in the most debilitated 
condition before these remedies were given ; but stimulants, chiefly gin and 
water, were freely administered during the operation of the drastic purga- 
tives, and with the happiest effects. 
Often when patients escaped the perils of the anasarca, they remained 
pale and leuco-phlegmatic, and seemed as though about to succumb to 
scrofulous disease. Many did indeed suffer in this way, swellings formed 
in the joints, or abscesses burst in the neck, and discharged the matter so 
characteristic of scrofula. Here the preparations of iron were of especial 
advantage, particularly the citi’ate and the iodide of that mineral. Lastly, 504 
DROPSY, 
change of air was, as it ever is, after-the exanthemata, peculiarly beneficial 
in restoring the patient to florid health. 
We are not quite sure that diuretics were always useful in the dropsy; 
they seemed sometimes to increase the already existing congestion and ir- 
ritation of the kidneys. Leeches applied over the situation of these organs 
seemed to succeed better. Part xvi.,p. 164. 
Duchu in Anasarca.—[An anonymous writer in the “Provincial Jour- 
nal” says:] 
In cases of general anasarca, consequent upon inflammatory affections, as 
well as those dependent upon organic disease, I have of late years found 
more unequivocal benefit to be derived from the use of the “diosma 
fcrenata,” than from any other single article of the materia medica. I 
have generally combined the fixed alkalies with it, and the form I prefer 
is: 
R Infus. diosmse, oz. vij.; sodae bicarb., potassre bicarb., potass® nitratis, 
aa. scr. ij.; syr. aurant., dr. vj.; tinct. scill®, dr. ij. M. 
That kind, the leaves of which are long and linear, is, I think, to be pre- 
ferred to the other, the leaves of which are lanceolate, although both pos- 
sess diuretic properties to a marked extent. Part xvii., p. 33. 
Treatment of Anasarca by Incisions.—M. Lombard advocates the use 
of incisions in cases of anasarca, and states that when ascites coexist with 
anasarca, not only is the latter palliated or cured, but in many cases the 
former also disappears. 
At an early period, make four or five deep incisions, a third of an inch 
in length, down to the fascia, in each leg: and keep the patient in an arm- 
chair near the fire, with the legs naked, and resting on cloths. When all 
the serum has drained away, support the legs by a roller. 
Part xviii., p. 51. 
Diuretics in some Cases of Dropsy.—[Dr. Toogood relates the case of a 
man who had tertian ague, and was generally anasarcous. After the ague 
had been cured by the use of bark, various purgatives and diuretics were 
administered for the anasarca, but without effect. Dr. T. tells us:] 
As every variety of diuretic had been repeatedly and ineffectually 
tried, I despaired of his recovery, when it occurred to me that the late Dr. 
Parry, of Bath, had recommended the fresh squill in a variety of cases, 
which he stated to have been successful in his hands. Six grains of fresh 
squill, in infusion of gentian, three times a day, considerably increased the 
flow of urine in four days, and, by gradually augmenting the dose, he was 
emptied, and recovered perfectly. I may add that this medicine was given 
by Dr. Parry, in some cases, to the extent of thirty and forty grains a day, 
and that he often prescribed it in asthma, combined with almond emulsion, 
occasionally adding to each dose a few grains of powdered myrrh, with the 
best effects. 
[Another case was that of an unmarried lady, fifty years old, whose feet 
became anasarcous after exposure to cold. Notwithstanding the exhibi- 
tion of various diuretics, especially squill and digitalis, the effusion 
increased, and extended to the abdomen, arms and face.] 
In this stage of the disease, a consultation with Dr. Blackall was held, 
who recommended that the capsules of copaiba should be taken two or 
three times a day, that the cream of tartar liquor should be drank very 505 
DKOPST. 
freely, and that she should use the vapor bath, beginning at 90°, and 
increasing it to 110° and upward, if it could be borne. A moderate diet 
was prescribed, with two or three glasses of hock daily. She rapidly im- 
proved under this judicious plan of treatment, and has continued free from 
any return of disease up to the present time. The urine was frequently 
tested during the progress of her recovery, and the coagulation gradually 
ceased, and ultimately disappeared entirely. Part xviii., p. 52. 
Treatment of Dropsy.—Acute Inflammatory.—Apply leeches, or cup 
from the loins, and let the patient use the hot-air or warm bath. Give 
purgatives, especially such as cause watery evacuations: sudorifics, as liq. 
ammon. acet. in doses of half an ounce twice or thrice a day; and diure- 
tics, as cream of tartar in doses of half a drachm or a drachm frequently 
during the day. Digitalis may be given, with due precautions, as may, 
also, decoction of broom ; but irritating diuretics must be avoided. Mer- 
cury is unnecessary and injurious. 
Following Scarlatina.—Give a warm bath every other day, or every 
day, or twice a day, if it does not depress too much; and give hydragogue 
purgatives, and unirritating diuretics, such as bitartrate of potash or liq. 
ammon. acet., especially the former. At the same time give nourishing 
food in such quantities as the patient can digest; or even stimulants—port 
wine, for instance. If under this treatment the affection does not yield in 
a few days, and especially if there is lithic acid or blood in the urine, take 
a little blood from the loins by leeching or cupping. If symptoms of head 
affection come on, apply free counter-irritation to the nape or scalp, by 
means of sinapisms followed by blisters. Part xix., p. 20. 
Treatment of Dropsy by the Juice of the Fresh Root of the Elder.— 
Boerhaave, Gaubius, Sydenham and, more recently, Martin-Solon, have 
recommended the juice of the inner bark of the common elder (sambucus 
nigra) as of great efficacy in dropsies. M. Rene Yanoye strongly recom- 
mends, for the same purpose, the fresh juice of the root. 
1. The fresh juice of the root of the elder may be administered in all 
serous accumulations and infiltrations, which require the use of drastics. 
2. It generally acts with greater energy and rapidity than the most active 
purgatives. 3. There is no advantage in combining it with drastics or 
diuretics ; its action is never more apparent than when used alone, and to 
the exclusion of other treatment. 4. The first doses ought to be pretty 
strong; when they cause vomiting, the use of the medicine must not be 
abandoned, but it ought to be suspended for some days, if the vomiting be 
continued and severe. It is rarely necessary to give more than from 120 
to 150 grammes, by the mouth, in spoonfuls. 5. Occasionally, this juice 
cures dropsies when other means fail. 6. The dangers connected with its 
employment are not serious. Part xix., p. 28. 
Case of Penal Dropsy produced by Copaiba.—[The patient was a man 
who was taking copaiba for a gonorrhoea; being anxious to get well soon, 
he took twice the quantity that was ordered:] 
When he presented himself at the infirmary, his legs and thighs were 
cedematous, besides a little effusion into the abdomen. His urine was of a 
smoky color and very albuminous. He was cupped on the loins, and 
ordered a drachm of compound jalap powder twice a day, and a warm bath 
twice a week. This treatment was continued, though less vigorously until. 506 
DEOPSY. 
the end of July, •when he was discharged well. I have since repeatedly 
examined his urine, and always found it healthy. I may remark, that all 
the information elicited from him tends to show that the drug with which 
he over-dosed himself had produced the disease. He had none of the early 
symptoms of granular disease of the kidney, though for many years, when 
obliged to do extra work, he has been subject to lumbago. At that time 
there was no scarlet fever near his house, though it was very rife in other 
localities of the town, nor had he been exposed to wet and cold. It may 
not be unreasonable to suppose that copaiba, when not producing purga- 
tion, may cause, in some mysterious manner, so much disturbance in the 
renal capillaries, as to bring on, like the scarlet fever poison, renal dropsy. 
Part xix., p. 113. 
Dropsy following Scarlatina.—Give a brisk purgative, and follow it by 
the liberal antimony, and the antiphlogistic regimen. In some cases 
leeches may be applied over the region of the kidneys. Part xx., p. 26. 
Dropsy following Scarlatina.—Let a flannel dress be wora, the wai*m 
bath be used occasionally, and antiphlogistic treatment employed. In the 
advanced stages, give tinct. ferri sesquichlor. Part xx., p. 31. 
Treatment of the Nephritic Dropsy which follows Scarlatina.—Give 
mild diuretic salts, as the acetates of potash and soda, with spirit of nitric 
ether; and use warm baths, and let the skin be rubbed with oil of turpen- 
tine. Take especial care that the child is kept wrapped in flannel, and in 
a warm atmosphere. If the child continues pale and weakly for some 
time, give iron, and recommend change of air. In severer cases, from six 
to ten leeches must be repeatedly applied to the lumbar regions. 
Part xx., p. 32. 
Colchicum in Dropsy.—Give wine of colchicum, beginning with 5ij. 
daily, and increasing the dose by about mxx. daily. When thus given, it 
is a powerful hydragogue. Part xx., p. 288. 
Dropsy—Ascites.—When there are no inflammatory symptoms, and the 
legs have not become cedematous, methodical compression may be used 
with the greatest advantage; and it will often be found that diuretics, 
though previously given in vain, will act beneficially as soon as the employ- 
ment of compression is adopted. 
When considerable ascites occurs with general dropsy, from a watery 
condition of the blood, and there are no evidences of inflammatory action, 
give small doses of sulphate of iron with sulphuric acid. It will both act 
as an unstimulating diuretic, and improve the condition of the blood. 
This “ martial lemonade ” is formed by dissolving six grains of sulphate 
of iron in a pound and a half of water, sweetened with an ounce of sirup, 
and adding a drachm of sulphuric acid—the period and continuance of its 
administration, and the dose in which it is given, being regulated by the 
practitioner, according to the exigencies of the case. Its use is contra- 
indicated in those cases in which the tongue is red and glazed, or has pro- 
minent papillas, and when a certain amount of febrile action indicates the 
presence of thoracic inflammation or of hepatic peritonitis. 
Part xxi., p. 32. 
Ascites.—Dr. Todd lays great stress on the success Avhich has followed 
the treatment of numerous cases of ascites from pressure on the abdomen, 
by means of strapping and bandages. Part xxii., p. 159. 507 
DROPSY. 
Treatment of Ascites by Diuretics applied Externally.—At the sugges- 
tion of a French journal, it has been found that, after all other means 
have failed, the application of diuretics locally, remove the iluid of ascites. 
A mixture of equal parts of tincture of digitalis, tincture of squill, and 
tincture of soap, was rubbed freely and diligently into the skin of the 
belly, morning and evening. A copious flow of urine soon took place, 
and in fourteen days the ascites had entirely disappeared. In another 
case, where the liniment could not be used, Dr. Duncan applied linen 
cloths, soaked in the pharmaceutical infusion of digitalis, with perfect suc- 
cess. The infusion may be applied by means of the spongio-piline. 
Dart xxii., p. 161. 
Dropsy.—In a case of general anasarca, with ascites, after all other 
remedies had failed, the patient was cured by the following liniment being 
applied three times a day to one-half the surface of the body: R. Volatile 
liniment, two parts; tincture of cantharides, tincture of colchicum, tinc- 
ture of digitalis, tincture of iodine, of each one part. The patient reco- 
vered in a few days. Dart 333. 
Colchicum in Dropsy.—In dropsy succeeding to scarlatina, Dr. 
Maclagan frequently found colchicum of much service, especially in cases 
where the urine is much suppressed, and where comatose symptoms are 
present. The accession of coma may easily be ascribed to the accumula- 
tion of urea in the blood; and the power which has been shown that col- 
chicum possesses of replacing the urea in natural, and often superabundant, 
amount in the urine, seems to point it out as a useful remedy in this and 
other diseases in which suppression of urine and coma co-exist. 
He says, in a case of scarlatina, where the urine was totally suppressed, 
and the symptoms of coma were present, the acetic extract of colchicum 
was used with complete success. Diluents and ordinary diuretics were 
freely employed when the case was first seen, with the effect of causing a 
slight secretion of urine of low specific gravity. I believe, in all cases 
where albumen and urea appear to be vicarious, and where com,a super- 
venes, evidently from the accumulation of the latter principle in the blood, 
that colchicum will prove to others of as great service as it has already 
done in the small experience I have had of it. Dart xxv., p. 41. 
Ascites.—Whenever ascites is complicated with gastro-intestinal irrita- 
tion, and where digitalis cannot be administered internally, the decoction 
applied as a fomentation acts as a most powerful diuretic, and may be used 
with great success. Dart xxvii., p. 48. 
Acute Denal Dropsy.—In commenting on the treatment Dr. Budd 
remarks that the first thing is to relieve the inflammatory or congested 
conditions of the kidney, and that the best means of doing this are: 
1. General bleeding or cupping on the loins; or, if the patient cannot 
well bear the loss of blood, large mustard-poultices applied daily to the 
loins, for the sake of drawing the blood to the surface. 
2. Compound jalap powder, or some other purgative of like action, in 
full doses, so as to cause copious watery discharges. These not only 
relieve congestion of the kidney, but probably serve to eliminate through 
the bowels noxious matters in the blood, which must always exist when 
the action of the kidneys is very defective, and which, indeed, sometimes 
exist previously, and conspire, with the influence of cold and wet, to pro- 508 
DKOPSY. 
duce the inflammatory or congested condition of the kidney in which the 
disease consists. No purgative is more generally suited for such cases 
than the compound jalap powder, and it is best given in a single dose, 
sufficient for the object desired, in the morning before breakfast. It then, 
in addition to the drain it causes from the mucous membrane, only sweeps 
away the refuse of digestion in the bowels; whereas, if it be given during 
the course of the day, it sweeps away food which the stomach has had the 
trouble to digest, but the nutritious elements of which are not yet 
absorbed. 
3. After the congestion of the kidneys has been somewhat relieved by 
these active measures, it may be further much lessened by promoting free 
perspiration. Suppressed action of the kidneys, by the influence of cold 
and wet, seems to be a frequent exciting cause of acute and renal dropsy, 
and afflux of blood to the extended surface of the skin and free perspira- 
tion greatly relieve the congestion of the kidneys. Perspiration may be 
promoted by warmth; by the liquor ammonias acetatis, given alone, or in 
conjunction with ipecacuanha and camphor mixture; and, if need be, by an 
occasional hot-air bath. 
4. A fourth means of relieving the kidneys is by keeping the patient 
strictly confined to bed. The warmth of bed promotes perspiration, and 
the horizontal posture tends to relieve congestion of the kidneys by facili- 
tating the return of blood from them, and by lessening the rate of the 
pulse. 
Lastly, when the albumen ceases to pass through the kidney, as the 
patient will be getting anasmic, give the citrate or some other preparation 
of iron. Part xxviii., p. 38. 
Treatment of Dropsy.—Dr. Toogood gives us the practice of Mr. Dawe, 
in the treatment of dropsy. He says: 
“ During my pupilage I have often seen patients who consulted him, 
with bloated and livid countenances, oppressed breathing, cedematous 
extremities, and other symptoms of great obstructions, with greatly 
diminished secretion from the kidneys, so much relieved that they have 
continued well for many months together, and by the occasional repetition 
of the same treatment, have lived for years in comparative health. His 
plan was to give a dose containing eight grains of calomel, with the same 
quantity of jalap, and one grain of emetic tartar in the morning. This 
acted violently on the stomach and boAvels. 
“During and after its operation he directed a little wine or other cordial; 
afterward the patient generally fell asleep, and woke relieved. He then 
prescribed three grains of powdered squills, with two of digitalis, every 
night for six successive nights, and a mixture with bitter infusion, and 
small doses of tincture of squills and spirit of nitre, twice a day. The 
digitalis was then omitted, and the other medicines continued for six nights 
more; and if the symptoms were not much relieved, the digitalis was 
resumed again. If the case was unusually obstinate, the drastic dose was 
repeated, and sometimes the dose of the digitalis was increased from two 
to three grains. But this was rarely done; very little attention was paid 
to the origin or cause of the disease; the great object was to ‘unload’ 
the patient.” Part xxix., p. 47. 
Dropsy.—Don’t be afraid of giving diuretics in renal dropsy, as most 
practitioners are. You may give digitalis, squill, and bitartrate of potash, 509 
DEOPSY. 
either singly or combined, without materially increasing the irritation of 
the kidneys. You may give the seventy-fifth part of a grain of digitaline 
three times a day. This dose may seem small, but the tenth of a grain 
will kill a little dog. Part 101. 
Cdinca Root in Scarlatinal Dropsy.—The root of Cai'nca (chiococca 
racemosa) is highly extolled by M. Bruguier, as a diuretic; he warmly 
advocates its use in divers dropsies, but especially in that following 
scarlatina. 
It Cainca root, bruised, 3ij; water, gviij. Macerate for twenty-four 
hours, and boil: to be taken in three doses, at intervals of two hours. 
This decoction causes an extremely abundant flow of urine, causing mictu- 
rition so frequently as even to interfere Avith sleep. Part 32. 
Diuretics in Penal Dropsy.—After having fallen into almost universal 
disuse, diuretics are again beginning to be prescribed in these cases; no 
other remedies effecting so much relief for the patient. The following is 
a very good formula: R Potassae tartrat. 5ss.; spt. aether nitrici, 3ss.; 
aquae piinent., §j. Ft. haust. ter die sum. Part xxxii., p. 106. 
Cellular Dropsy.— Vide Selections from Favorite Prescriptions, Art. 
“ Medicines.” 
Ascites—Paracentesis Scroti.—In the advanced stage of ascites, the 
continued pressure of the water sometimes breaks down or elongates the 
fibrous and cellular tissues, about the Cord, so as to open a communication 
between the abdomen and the tunica vaginalis, and enormously distend 
the scrotum. In such cases, where paracentesis is required, although tap- 
ping the abdomen is not dangerous, yet tapping the scrotum is much more 
simple and effectual. Part xxxiii., p. 213. 
Hepatic Dropsy.—[In a clinical lecture on this subject, Dr. Burrows 
first noticed the symptoms Avhich most commonly attend these cases. 
They may be briefly mentioned, as a swollen prominent abdomen, distinct 
fluctuation, salloAV complexion, slightly jaundiced conjunctiva, pain and 
tenderness in the right hypochondrium, hard mass projecting below the 
ribs toward the umbilicus, high-colored scanty urine, slight fever. Most 
frequently these symptoms will have been produced by intemperate habits, 
which generally bring on cirrhosis of the liver.] 
If there be pain in the right hypochondrium, a few ounces of blood may 
be taken, and followed by the application of a blister. Evacuate the intes- 
tines by a freely acting purgative, and repeat this once or tAvice a week. 
Having done this, you must bring thd system gradually under the influence 
of mercury; to do this you may give pil. hydrarg. gr. iv. Avith pulv. scilloe 
gr. j., night and morning, and rub on the abdomen the lin. hydrarg. tAvice 
a day. You may place dependence on this treatment, but it Avill be neces- 
sary to sustain the mercurial action for several weeks. Diuretics may be 
employed freely, if careful analysis assure you the urine is free from albu- 
men. The best diuretics are the salts of potash, combined with spt. seth. 
nit. and spt. juniper co. If these have not a very sensible effect in dimin- 
ishing the ascites in the course of three or four weeks, you must at once 
have recourse to tapping, before the internal organs become interfered with 
in their functions by pressure. Lastly, you must give dry nutritious food, 
with a small amount of some stimulus; as patients of this kind have gene- 
rally been intemperate, they will not bear Ioav diet. Part xxxiv., p. 106. 510 
DROWNING, 
Dropsy.—Among cathartics, elaterium and croton oil are in greatest 
favor. Elaterium is a hydragogue cathartic, but not so the croton oil, 
even when given in three minim doses; still it is by far preferable to ela- 
terium, because it not only diminishes the quantity of fluid effused, but at 
the same time exalts rather than depresses the power of the absorbents. 
Elaterium is the most potent hydragogue which we possess, and induces 
the most speedy diminution of dropsical effusion, but it as certainly de- 
presses the power of the absorbents, which more than outweighs its bene- 
ficial effect; croton oil, on the other hand, does more good by its stimulant 
effect upon the absorbents than by its mere cathartic power. It may be 
given daily in one minim doses for weeks together with the most salutary 
results. Dart xxxv.,p. Gl. 
Scarlatinal Dropsy.—That purgative which acts most directly as a hy- 
dragogue is the best adapted for use in the treatment of this disease; but 
it must be one which at the same time is not followed by any dispropor- 
tionate exhaustion, or by any torpid reaction. The combination of jalap 
and cream of tartar is most admirably suited to these ends. The develop- 
ment of that pigmentary condition, made apparent by adding nitric acid 
to the boiling urine, in combination with albumen, is of the greatest im- 
port. The presence of much fatty matter in the casts of the tubes seen 
with the microscope, also indicates an advanced state of degeneration. 
Dart xxxvi., p. 25. 
Ascites from Chronic Deritonitis.—This disease is especially liable to 
come on in young females. There is distinct fluctuation, emaciation, gene- 
rally diarrhoea, and frequently hectic fever; in some cases tubercular dis- 
ease of the lungs may be detected. In fact, the relations of the affection 
are decidedly with the strumous diathesis, and the treatment must be 
accordingly. Cod-liver oil must be given internally, and must form a sort 
of basis for the treatment; at the same time sirup of iodide of iron may be 
advantageously administered, if there is no diarrhoea, and the iodide of 
mercury ointment rubbed over the abdomen. Keep your patients as much 
as possible in the open air, and administer a nourishing but unstimulating 
diet. If there is diarrhoea or abdominal pain, opiates with or without as- 
tringents must be given. In two cases out of thirty-six tapping was re- 
sorted to; in one it materially assisted the cure, in the other it gave no 
permanent relief. Dart xl., p. 57. 
Albuminous Anasarca.—Tannin is useful in all cases where it is required 
to arrest hemorrhages, to give tone to the organism, or to remedy morbid 
secretions. Tannin given in doses of 3ss. to 5j- per diem will be found to 
cure anasarca or oedema developed passively and occurring simultaneously 
with albuminous urine ; its curative action is soon manifested in return of 
appetite, more normal state of urine, etc. Dart xl., p. 76. 
DROWNING. 
Apparatus for promoting Respiration in Cases of Suspended Anima- 
tion.—The principle on which Dr. Dalziel’s apparatus acts is, that the body, DEOWNING. 
511 
with the exception of the head, be in vacuo, or nearly so. This is easily 
done by putting the body to be operated upon in a box that can be made 
air-tight. On the top a large syringe is placed which communicates with 
the interior. By elevating the piston of the syringe, a partial void is 
created, to till up which the air of the atmosphere rushes into the lungs 
through the trachea, and distends the chest. Expiration is accomplished 
by depressing the piston. Part ii., p. 127 
Suspended Animation—Remarkable Case of Recovery of.—A very re. 
markable case of recovery after suspended animation is related by Mr. 
Douglas, of Havre. The man was immersed about fourteen minutes, and 
respiration did not commence for eight and a half hours: there was not 
the slightest appearance of animation on his being brought into the hospi- 
tal at Havre. The whole treatment consisted in the application of hot 
bags of sand round the body—lavements of hot water (to which was sub- 
sequently added spirits of turpentine and tincture of assafcetida), and fric- 
tion. Artificial respiration was tried, but not persisted in. The chief 
treatment, however, seems to have been by means of the most persevering 
friction, performed with dry flannel, by relays of four men every half hour; 
this was persisted in most indefatigably for eight hours and a half, when 
respiration commenced very feebly, followed in twenty-four hours by re- 
action to such a degree, that eight leeches were applied to the temples, 
and six ounces of blood taken from the arm. This slight depletion, how- 
ever, caused so great a collapse, that it was necessary to have recourse to 
stimulants. Typhoid symptoms set in and continued for six weeks, but 
the man ultimately recovered. Dr. Todd reminds us that in these cases 
electricity is very valuable, when brought to bear on the medulla oblon- 
gata, which can easily be accomplished by means of the electro-dynamic 
machine, by placing one wire on the back of the neck and the other at the 
diaphragm. The value of the application of heat in all cases of suspended 
animation, has been of late very much questioned by several eminent phy- 
siologists. Dr. Edwards asserts that the progress of asphyxia is much 
more rapid at high than at low temperatures ; and that when the body is 
heated artificially, or by exercise, it consumes more oxygen in proportion, 
and consequently requires a greater number of respirations : hence, if we 
wish the body to do with as little oxygen as possible till respiration is 
established, we ought to keep the surface cool, and not hot, as is usually 
done, in resuscitating drowned persons and still-born children. This 
theory, however, will require some modification, since the recent investiga- 
tions of M. Liebig. In these cases, the mode of applying electricity may be 
varied. Leroy cl’Etiolcs employs galvano-puncture, by introducing a fine 
needle on each side, between the eighth and ninth ribs, until they reach 
the fibres of the diaphragm. He then establishes a galvanic current be- 
tween the needles by means of a pile of twenty-five to thirty pairs of plates, 
an inch in diameter. The diaphragm is thus made to contract, and an 
inspiration is accomplished: the circle is then interrupted, when the dia- 
phragm, urged by the weight of the abdominal-viscera, and aided by gentle 
pressure made on the abdomen with the hand, returns to its former posi- 
tion, and an expiration is effected. In this way, the two respiratory acts 
are made to succeed each other, and regular respiration is reinduced. 
Part Yn.,p. 31. 
Asphyxia from Drowning.—In another lecture Sir B. Brodie treats of 512 
DROWNING, 
drowning {vide “ Asphyxia from Strangulation”). Death takes place as if 
by strangulation ; in both cases the “ want of due oxygenation or decar- 
bonization of the blood being the sole cause of the animal’s destruction.” 
After immersion, a deep expiration takes place, by which bubbles of air 
are expelled from the lungs. Then comes an ineffectual effort to inspire; 
but water does not enter, instead of air; spasm of the muscles of the 
larynx seeming to prevent this. The attempts to breathe are repeated 
several times, and after each attempt a small quantity of air is expelled 
from the mouth and nostrils, until the air-cells of the lungs are almost com- 
pletely emptied. Then insensibility occurs, and convulsive actions of the 
muscles mark the instant when the brain begins to suffer from the influx 
of the dark-colored blood. Soon all motion ceases; save in the thorax, 
where the heart may be felt yet feebly pulsating. Perhaps some further 
ineffectual efforts at respiration are resumed, and then all is still. The in- 
terval between cessation of respiratory effort and cessation of the heart’s 
action is brief in the case of strangulation; but it is still more brief in 
drowning. And the whole succession of events, in the latter case, suc- 
ceeding rapidly, are complete within a very few minutes. Our author is 
firmly of opinion, that in cases of complete and uninterrupted submersion, 
life has never been retained after more than five or six minutes have 
elapsed under water. All stories to the contrary, he holds to be apo- 
cryphal. 
The treatment of the drowned is similar to that of the strangled. If 
the removal from the water takes place before the diaphragm has ceased 
to act, respiration may be resumed naturally; if not, artificial inflation is 
to be employed. And at two periods such inflation may be necessary; 
first, during the short interval between the cessation of the natural efforts 
to respire and the cessation of the heart’s action; second, when the 
patient lies in a state of stupor, in consequence of the injurious effects pro- 
duced by transmission of dark-colored blood to the brain. During resus- 
citation, “ it must be of importance to supply the waste of animal heat, 
by placing the patient in a warm temperature the warm bath forms a 
simple and convenient method of attaining this object; and it may pro- 
duce another good effect, “ by promoting the natural efforts to respire.” 
Abstraction of blood is even of more doubtful propriety than in cases of 
strangulation. And there are other things which should not be done. 
“ We have been directed to employ friction of the surface of the body 
for the purpose of assisting the circulation of the blood ; as if this could 
do any real good when the action of the heart is ceased ; or as if it would 
not do actual harm by overloading (if I may be allowed to use such an 
expression) the right auricle and ventricle, when the action of the heart 
was still going on. The injection of tobacco, and the application of stimu- 
lants, belong to the same class of remedies which are either mischievous 
or useless, proposed formerly by those who did not know what to do, but 
who thought that they were expected to do something, but now rejected 
by a more enlightened physiology.” jPart xiv., p. V7. 
Artificial Respiration—New Method of.—Dr. Marshall Hall proposes 
the following: 
The patient must be placed in the prone position, so that the tongue 
may fall forward, and leave the glottis patent; the body must then be 
turned fully on one side, and again slowly replaced on the stomach. 513 
DEOWNING, 
These movements must be made alternately, gently, and equably, sixteen 
times in a minute. When laid on the stomach, pressure is made on the 
thorax and abdomen, and expiration takes place ; when turned on the 
side, pressure is removed, and inspiration follows; and thus respiration is. 
efficiently performed, and this without bellows, syringe, or any apparatus, 
all of which are not only unnecessary but dangerous. 
Part xxxiii., p. 90. 
Restoration of Persons apparently Drowned, or Dead from Intense 
Gold—Royal Ilumane Society's Instructions—Cautions.—1. Lose no 
time in sending for medical assistance. 2. Avoid all rough usage. 
3. Never hold up the body by the feet. 4. Nor roll the body on 
casks. 5. Nor rub the body with salt or spirits. G. Nor inject tobacco- 
smoke nor infusion of tobacco. I. Convey the body carefully, on its face 
with the head and shoulders supported in a raised position, to the nearest 
house. IT. Strip the body, and rub it dry; then wrap it in hot blankets, 
and place it in a warm bed in a warm chamber free from smoke. 
III. Wipe and cleanse the mouth and nostrils. IY. In order to restore 
the natural heat of the body, move a heated covered warming-pan over 
the back and spine. Put bladders or bottles of hot water, or heated 
bricks, to the pit of the stomach, the arm-pits, between the thighs, and to 
the soles of the feet. Foment the body with hot flannels. Rub the body 
briskly with the hand ; do not, however, suspend the use of the other 
means at the same time, but, if possible, immerse the body in a warm 
bath of blood-heat, or 100° of the thermometer, as this is preferable to 
the other means for restoring warmth. V. Volatile salts or hartshorn to 
be passed occasionally to and fro under the nostrils. YI. No more per 
sons to be admitted into the room than are absolutely necessary. 
If apparently Dead from intense Cold. Rub the body with snow, ice, 
or cold water.—Restore warmth by slow degrees, and after some time, if 
necessary, employ the means recommended for the apparently drowned. 
In these accidents it is highly dangerous to apply heat too early. 
General Observations.—On the restoration of life, a teaspoonful of warm 
water should be given; and then if the power of swallowing be returned, 
small quantities of wine, or diluted brandy, warm. The patient should be 
kept in bed, and a disposition to sleep encouraged, except in cases of apo- 
plexy, intoxication, coup de soleil. Great care is requisite to maintain the 
restored vital actions, and at the same time to prevent undue excitement. 
The Treatment recommended by the Society to be persevered in for 
three or four hours, as it is an erroneous opinion that persons are irre- 
coverable because life does not soon make its appearance, cases having 
come under notice of the Society of successful results even after five 
hours ; and it is also absurd to suppose that a body must not be meddled 
with or removed without the previous permission of a coroner. 
Part xxxvi.,j9. 256. 
Treatment of the Drowned.—In one of the instances of longest sub- 
mersion on record, the first signs of recovery followed the pouring 5ss. of 
sp. ammon. aromat. into the nostrils, and thrusting a feather dipped in 
ammonia as far as it would go. Dr. Wistar declared that the most suc- 
cessful treatment consisted in stimulating enemata, suppositories of mustard! 
and red pepper, and a plaster of these substances applied to the anus and 
perineum. Part xxxvii., j>. 308. 514 
DROWNING. 
New Directions to Restore the apparently Drowned on the Marshall 
Hall Plan—Issued by the National Life-boat Institution.—1. Treat the 
patient instantly, on the spot, in the open air—exposing the face and chest 
to the breeze, except in severe Aveather. 
2. To Clear the Throat.—Place the patient gently face doAvmvard, 
with one wrist under the forehead, in Avhicli position all fluids xvill escape 
by the mouth, and the tongue itself will fall forward, leaving the entrance 
into the windpipe free. Assist this operation by Aviping and cleansing tht 
mouth. 
If there be breathing—Avait and watch ; if not, or if it fail, then— 
8. To excite Respiralion—Turn the patient Avell and instantly on the 
side, and— 
4. Excite the nostrils Avith snuff, hartshorn, \rolatile salts, or the throat 
Avith a feather, etc., and dash cold water on the face, previously rubbed 
warm. 
If there be no success, lose not a moment, but instantly begin 
5. To Imitate Respiration.—Replace the patient on the face, raising 
and supporting the chest Avell on a folded coat or other article of dress. 
6. Turn the body very gently on the side and a little beyond, and then 
briskly on the face, alternately; repeating these measures deliberately, 
efficiently, and perseveringly about fifteen times in the minute, or every 
four seconds, occasionally varying the side. 
[By placing the patient on the chest, its cavity is compressed by the 
weight of the body, and expiration takes place; Avhen turned on the side, 
this pressure is removed, and inspiration occurs.] 
7. On each occasion that the body is replaced on the face, make uniform 
but efficient pressure, Avith brisk movement on the back betAveen and 
beloAV the sliouldei'-blades or bones, on each side, removing the pressure 
immediately before turning the body on the side. 
[The first measure increases the expiration, the second commences 
inspiration.] 
*** The result is—respiration, or natural breathing; and, if not too 
late—life. 
8. After respiration has been restored, promote the warmth of the body 
by the application of hot flannels, bottles or bladders of hot water, heated 
bricks, etc., to the pit of the stomach, the arm-pits, between the thighs, 
and to the soles of the feet. 
9. To Induce Circulation and Warmth.—During the whole time do 
not cease to rub the limbs upward, Avith firm grasping pressure and Avith 
energy, using handkerchiefs, flannels, etc. 
[By this measure the blood is propelled along the veins toward the heart.] 
10. Let the limbs be. thus warmed and dried, and then clothed, the 
bystanders supplying the requisite garments. 
Cautions.—1. Send quickly for medical assistance, and for dry clothing. 
2. A\roid all rough usage and turning the body on the back. 
3. Under no circumstances hold up the body by the feet. 
4. Nor roll the body on casks ; 
5. Nor rub the body Avith salts or spirits; 
6. Nor inject tobacco-smoke, or infusion of tobacco. 
7. Avoid the continuous warm bath. 
8. Be particularly careful to preA’ent persons crowding around 
the body. DROWNING, 
515 
General Observations.—On the restoration of life, a teaspoonful of 
warm water should be given; and then, if the power of swallowing have 
returned, small quantities of wine, or brandy and warm water, or coffee. 
The patient should be kept in bed, and a disposition to sleep encouraged. 
The treatment recommended should be persevered in for a considerable 
time, as it is an erroneous opinion that persons are irrecoverable because 
life does not soon make its appearance, cases having been successfully 
treated after persevering several hours. Part xxxviii., p. 299. 
Asphyxia from Drowning—The Silvester Method.—This new method, 
according to its advocate, Dr. H. R. Silvester, possesses many advantages 
over the “ ready method ” of Marshall Hall; it is easy of performance, 
and may be employed along with those other means in which so much 
confidence has hitherto been placed, This plan of resuscitating the 
drowned is a simple imitation of natural deep inspiration. It is effected 
by lifting the ribs and sternum by means of the muscles passing from the 
shoulder to the chest, by steadily extending the arms up by the side of 
the patient’s head. In this way the cavity of the chest is enlarged, a ten- 
dency to a vacuum is produced, and a rush of air immediately takes place 
into the lungs. Expiration is brought about by compressing the sides of 
the chest by the patient’s arms. The patient must be placed on his back, 
with the shoulders raised, and the tongue drawn forward, whilst the arms 
are used as above directed, as handles to open and close the chest. 
Part xxxviii., p. 300. 
Resuscitating Persons apparently Prowned.—The advantages of the 
Silvester method, as compared with that of Marshall Hall’s, as stated by 
its author, are the following, and may be thus studied in comparison : 
Marshall Hall’s Method. 
Silvester’s Method. 
Expiration is made to precede inspiration 
—the reverse of the natural order. In still- 
born infants forced expiration, at first (as 
they have never breathed) is, of course, 
impossible. 
The warm bath cannot be employed dur- 
ing its adoption. 
When the patient is turned on the face 
(pronated), and pressure made, the contents 
of the stomach are liable to pass into the 
oesophagus and trachea. 
In the opposite position, “ on the side, 
and a little beyond ” (supinated), the tongue 
is apt to obstruct inspiration by falling back 
into the throat. 
Both sides of the chest are not equally 
inflated. 
The amount of air respired is exceedingly 
small, the actual capacity of the chest not 
being enlarged (proved by experiment). 
Inspiration may be made to precede 
expiration, or vice versa, at the will of the 
operator. 
May be adopted when the patient is in 
the warm bath. 
Contents of stomach not liable to pass 
into trachea. 
Tongue effectually prevented from ob- 
structing inspiration. 
Both sides of the chest are equally in- 
flated. 
A larger amount of air is inspired than 
by any other method (proved by expe- 
riment). 
Lastly, we are told, that whilst the Royal Humane Society directs its 
attention mainly to the circulation, and Dr. Marshall Hall chiefly to the 
respiration, the new method of Dr. Silvester combines the advantages of 
both. Part xxxviii., p. 301. 516 
DYSENTERY. 
DYSENTERY. 
Epidemic Dysentery—Opium.—Dr. Robert Christison says: 
I doubt whether Mr. Pereira’s doctrine that “ in dysentery, opium can 
only be used beneficially in the latter stages, and then with great caution” 
(Mat. Med. 1$03) will be received at all as a general proposition. There 
is not a better way of treating an ordinary mild dysentery at the com- 
mencement, than by the familiar practice of alternate opiates and laxatives. 
But—what is more connected with the matter now chiefly under review— 
in severe ejndemic dysentery, as it occurs at times in this country, the 
cure, when early begun, may be commonly trusted, if I may rely on my 
own experience, to opium alone—not used, however, “with great caution,” 
but given boldly, and often. Part iii., p. 46. 
Chloride of Silver.—On the use of the chloride of silver, the following 
observations are made by Dr. Perry : 
It must be universally acknowledged that the nitrate of silver adminis- 
tered by the mouth can never act as nitrate of silver on the system, 
since any dose which could be ventured upon must, immediately on 
entering the stomach, be converted into the chloride of silver, from the 
chloride of sodium of our food, or the hydrochloric acid of the gastric 
juice. 
The chloride must then, a priori, be considered as efficacious equally with, 
the nitrate, while it will be found less uncertain in its effects, more con- 
venient for exhibition, less liable to decomposition, and free from its 
nauseous taste. It may be given, too, in any dose thought necessary to 
produce the alterative and tonic action of silver without danger. 
In less doses than thirty grains, no irritating or manifest effects result. 
Thirty grains given at once will generally produce emesis. The best form 
of exhibition is in pill. To children, it can be given as a powder suspended 
in sirup. 
Twelve grains administered daily for three months have produced no 
unpleasant symptoms, and none of my numerous and long-continued 
courses of the remedy have been followed by discolorations of the skin. 
In chronic dysentery, half a grain to three grains thrice daily, produces 
immediate diminution in the number of stools, and tormina, with ameliora- 
tion in the character of the stools and other symptoms. 
I have not ventured to use it freely in acute dysentery, but in a few cases 
in which it had been administered, its effects seemed equally beneficial. 
Part iv., p. 19. 
Acute Tropical Dysentery—Treatment of.—[Dr. Lcwins directs the 
reader’s attention particularly to Dr. Ilayn’s treatment, in Java, which he 
witnessed during a residence there.] 
His treatment consisted in administering, at the very outset of the 
disease, a scruple of the chloride of mercury. According to his experi- 
ence, this powerful pharmaceutical agent, when employed in small doses, 
acts as an irritant, but when given in large quantities, has so decided and 
immediate an effect as to merit the name of a direct sedative. I have seen 
soldiers brought into hospital in the most severe agony, discharging 
mucus and blood at very short intervals, and laboring under the most 
aggravated form of the disease. On administering a scruple dose of DYSENTERY, 
517 
calomel, the most marked and gratifying amelioration took place. The 
tormina, tenesmus and diarrhoea almost instantaneously cease, a feeling of 
comfort takes the place of the most intense suffering, the countenance 
brightens up, the pulse, heat of tongue, and thirst, when present, are 
diminished, and, in short, all the distressing symptoms are much alleviated. 
This remission is, however, often followed by an exacerbation at the end 
of six or eight hours. Reaction is established, the pulse beginning to rise, 
and if no steps are taken to prevent it, the whole train of symptoms return 
with almost undiminished violence. If the diarrhoea and tenesmus come 
on, no hesitation need be felt in repeating the scruple dose of calomel, but, 
if the physician be on his guard, he may often prevent this, by active 
measures whenever the tormina and borborygmus are apparent. This is 
the critical moment, and a scruple of calomel divided into four doses, 
administered every three hours, will often prove sufficient to prevent 
reaction, and overcome the disease. If the malady be obstinate, five 
grains of calomel should be given boldly every three or four hours, and 
under this treatment the medical man will seldom be disappointed. 
When the bowels have been quiet for thirty-six hours, a scruple of the 
pow’der of rhubarb was found to be most serviceable. The stools which 
followed* were fetid, dark colored, fluid, sometimes bloody, but voided with 
little or no pain. If symptoms of inflammation appeared in any of the 
abdominal viscera, which rarely happened, leeches were used; but a 
blister was almost invariably applied to act as a safeguard, and to relieve 
the remaining irritation in the intestines. Salivation comes on occasion- 
ally under this treatment, but is by no means necessary for the cure of the 
disease. 
Great care is requisite in the treatment of dysentery, that the patient 
be confined to an equable temperature; and it may be remarked, that 
seamen on board ship are very severely affected by small doses of 
mercury, owing to the exposure to which they are necessarily subjected, 
from the dampness of the atmosphere, occasioned by the evaporation from 
the surface of the vast expanse of water by which they are surrounded, 
and possibly in some degree from the nature of their aliment. 
Part iv., p. 71. 
Camp Dysentery— Use of Creasote Injections.—[By “ camp dysen- 
tery,” Dr. Wilmott means the epidemic form which often proves so deadly 
a scourge in large communities. 
Dr. W. made a post mortem examination of two fatal cases. In the 
first, there was injection and ecchymosis on the inner part of the ilium; 
the mucous membrane was so ulcerated that a mere tracery-work, like 
lace, was left of it. The caecum also was ulcerated; but not the colon. 
In the second case, the rectum and last three inches of the colon were 
much ulcerated.] 
Several cases had occurred. The most pressing was that of a man, aet. 
fifty-one, who was attacked on the 1 st, and in whom the remedies, up to 
this day (the 11th), had been of little or no avail. He was greatly ex- 
hausted—had constant evacuations of blood, with shreddy matter; no 
faeces; the smell was putrid and gangrenous; hot turpentine fomentations 
were ordered to the belly, and, in addition, the author was led to try an 
injection composed of 3j. of creasote in 12 oz. of starch. lie did not, he 
observes, use it empirically, but looking at the character of the fever, of 518 
DYSENTERY, 
the slow nervous kind, the inertness of remedies introduced by the 
stomach, the little control exercised by medicines locally applied to allay 
spasm of the gut, the local nature of the disease as shown by inspection of 
the bodies, the disposition to gangrene, as well as ulceration, and the anti- 
septic and stimulant powers of creasote—these considerations induced him 
to try the remedy. On the 12th, the patient was rather better; the in- 
jection had caused a tingling sensation, but no pain. On the following 
days he gradually improved ; and on the 18th the evacuations were copious, 
highly offensive, containing a quantity of hard scybala. USTo blood or 
shreds were passed. The turpentine had been applied four times, and the 
creasote injection used every night since the 11th. After this he soon be- 
came convalescent. In several other cases, either under the observation of 
the author or his friends, this remedy was used, and with evident advantage. 
[In discussing the merits of the above remarks, Dr. Baly says that the 
value of calomel in dysentery is unequivocal. He was surprised that 
Dr. Wilmott had found it of no service. In the epidemic dysentery which 
occurred in the Penitentiary in 1823, in combination with large doses of 
opium, it soon cut short the disease. He thinks that creasote may be 
occasionally employed as an adjunct, but that so purely a local remedy 
could not of itself arrest inflammatory dysentery. In answer to a question 
by Mr. Lloyd, Dr. B. stated that when starch and opium injections failed, 
three or four ounces of warm black wash, with laudanum, had occasionally 
* succeeded. When ptyalism occurs after its use, Dr. B. attributes it to the 
calomel given at the same time. Dr. Burrows fully agreed with Dr. Baly 
in his opinions. Dr. James Johnson had in no instance seen dysentery 
result from contagion. With Dr. Baly, he believed, when epidemic, that 
it depended on atmospheric causes. The use of calomel and opium, the 
recumbent posture, and anodyne injections, he had found most generally 
attended with success. Calomel and opium was our sheet anchor in hot 
climates. Recovery usually followed the production of ptyalism. He 
had lately used tannin with much success in this disease. It had the ad- 
vantage of being less irritating than creasote, was a powerful astringent, 
and could be easily injected into the bowels.] Part xii., p. 87. 
Ergot of llye in Pysentery.—[After using the ordinary remedies in the 
treatment of a case of dysentery, without any benefit to his patient, 
Mr. Gervis resolved upon giving the ergot of rye, in conjunction with 
tinct. of iron, which he did, as follows :] 
Battley’s solution of secale, one drachm; tincture of sesquichloride of 
iron, one drachm ; water six ounces. Mix, and give a quarter part every 
four hours. After the first mixture had been taken, I found a visible im- 
provement had taken place. The ergot had produced slight pains in the 
bowels; but after she had taken three of the above mixtures, the bloody 
discharge and other symptoms had entirely ceased. There was no return 
of the complaint after this period. 
The properties of ergot are invaluable in cases of hemorrhage arising 
in other parts of the body; and in a severe case I lately had under my 
care, in a young man, of hemorrhage from the urethra, which continued 
for days, I found that the ergot with the steel mixture succeeded most 
effectually. Part xiv., p. 87. 
Treatment of—Acute.—If there is tenderness of the abdomen, or if the 
other symptoms indicate inflammation of the large bowel, apply 12 to 24 DYSENTERY. 
519 
leeches, and repeat them as often as necessary. Give calomel, gr. iij., 
opii gr. one-tliird to a half every four or six hours until the active symp- 
toms are subdued, or the system is under the influence of mercury; if the 
calomel irritates, give hyd. c. creta and Dover’s powder instead. Give 
mild aperients: ol. ricin. 3j-3iij. especially if the stools are not feculent. 
Chronic.—Give astringents: opium, catechu, and ferri sulph.; but not 
to such an extent as to constipate. If there is great tenesmus, give a few 
ounces of black wash and a drachm of laudanum, per ano: and when the 
secretion of the lower bowel is purulent, inject a weak solution of sulphate 
of zinc. Part xv., p. 109. 
Employment of Matico in Malignant Dysentery.—[Dr. Hartle has 
communicated some cases of epidemic dysentery with intestinal hemor- 
rhage, which he has successfully treated with matico. The cases occurred 
in Trinidad, West Indies. Dr. H. says :] 
The disease was ushered in with pyrexia, and the most malignant con- 
comitant symptoms of the malady, accompanied by profuse hemorrhage 
from the bowels, Avith extreme relaxation of the sphincter ani. In 
some of the cases tenesmus Avas distressing, while in others there was no 
pain whatever; yet in all, the blood was constantly streaming from the 
rectum,' Avhile the anus Avas extensively dilated. The Spaniards, aborigines 
of this island, call this disease, where it assumes such a malignant type, 
Avith dilated anus, “ bischeoand they solely depend, as a restorative, on 
the use of lime-juice, taken as lemonade, ad libitum, clysters of lime-juice 
and Avater, baths of the same, and the dilated anus is plugged with a 
lime which is nicely peeled, then cut round from the core, inverted and 
introduced into the rectum. No inconvenience, pain, or difficulty, attends 
the introduction of the lime, for the sphincter ani appears to have lost all 
sensibility and poAver of contracting; for as fast as the one plug is ejected 
another is immediately introduced. 
The first patient I had suffering under this malignant type, Avas a youth, 
seven years old. My preliminary treatment consisted in clearing out the 
primse vise Avith an infusion of radix ipecacuanha, and immediately after I 
commenced the lime-juice treatment (until I could obtain my matico from 
the vessel), Avhich I persevered in until the fifth day, when finding my 
little patient Avas losing ground, that the hemorrhage was increasing, and 
that the dilatation of the rectum was more alarming, I instantly commenced 
Avith an infusion of the matico (one ounce to the pint of boiling-rainAvater), 
and gave a tablespoonful every third hour, and a clyster of the same in- 
fusion one hour after he had taken each dose of the infusion. Ilis recovery 
Avas rapid. 
[Dr. Hartle treated every case Avhich came under his care Avith the same 
medicine, and he reports that it proved successful in every instance. 
Part xat., p. 112. 
Use of Astringents in Dysentery.—Astringents given by the mouth are 
very useful in controlling the profuse diarrhoea that accompanies chronic 
dysentery. I have tried the vegetable and mineral medicines of this class 
upon a large scale, and have decidedly found more benefit from the decoc- 
tion of logwood, in conjunction Avith laudanum, as recommended by Dr. 
Stokes, than from all others put together. Astringent enemata also pro- 
duce a A’ery good eftect in cases Avhere there are profuse discharges Avithout 
pain. I have tried them composed of acetate of lead, nitrate of sil\rer, etc., 520 
DYSENTERY. 
and have seen more good done by enemata of sulphate of alum with tinc- 
ture of opium, than any others: and Dr. Parkes, in his remarks on the 
hepatitis and dysentery of India, says: “That in the adynamic form, alum, 
combined with catechu and camphor, is the best treatment.” 
Part xviii., p. 124. 
The Dysentery lately Epidemic in Dublin.—This epidemic appeared in 
two forms. In one, which Dr. Mayne terms the acute variety, the disease, 
though if neglected or mismanaged it became chronic or terminated fatally, 
yet, at the [irst, yielded readily to active treatment: while the second va- 
riety, which he terms chronic, was from the first complicated and unma- 
nageable, and generally ended in death. In the present paper Dr. Mayne 
treats only of the acute dysentery. 
The treatment which proved most successful may be summed up in a few 
words: dissection showed that the disease consisted essentially in a severe 
inflammation of the large intestine, tending rapidly to ulceration, and some- 
times even producing the death of the structures implicated; and, true to 
its pathology, it usually yielded to mercury and other antiphlogistic mea- 
sures, when this line of treatment was employed sufficiently early. 
Venesection was practised with the best results whenever the patient 
was young and vigorous, and came under treatment in good time, but in a 
vast majority of the workhouse cases, local detraction of blood was the 
only mode of depletion practicable; this was best effected by leeching the 
verge of the anus repeatedly, greater relief being obtained from twelve 
leeches so applied, than from triple the number placed upon the abdomen; 
the hemorrhoidal veins were in this manner most effectually unloaded, and 
at the same time the distressing tormina and tenesmus were with great 
certainty mitigated. 
Mercury, however, must be considered the principal remedy. 
As in other acute inflammations, the good effects of the mercurial treat- 
ment are sometimes first perceived simultaneously with its action upon the 
gums, but very constantly it produces a cure before any symptoms of sali- 
vation arise; so that a daily inspection of the evacuations alone enables the 
physician to determine when the remedy ought to be discontinued. 
The beneficial influence of the mercury is first recognized by the appear- 
ance of true fecal matter in quantity in the stools, accompanied by marked 
relief to the general uneasiness, and a decided decrease of the dysenteric 
discharges. As soon as the natural secretions are fairly restored, the mer- 
curial treatment may be safely laid aside, irrespective of the condition of 
the mouth. 
Next to mercury, alkaline medicines appeared to exert the most bene- 
ficial influence in acute dysentery. Unaided by mercury, their power to 
control the disease is but feeble, nor ought they ever to be depended upon, 
as a substitute for mercury, when the complaint is recent and the patient’s 
constitution healthy; but when the evacuations have resumed a healthy 
color, under the influence of mercury, the stools still continuing too fre- 
quent and too fluid; or when mercury has fairly affected the mouth, with- 
out improving the stools or materially alleviating the distress; or when 
the constitution is too feeble, or the dysentery too chronic, to afford a 
reasonable expectation of success from the employment of mercury, the 
most remarkable benefit is sometimes obtained from this class of remedies. 
[Astringents were found only to aggravate the disease; so likewise did 521 
DYSENTERY. 
full doses of opium. Smaller doses of opium, especially in the form of 
Dover’s powder combined with the mercury, seemed to relieve pain with- 
out exercising any injurious influence. When the active symptoms had 
subsided, there was often a tendency to scybalous stools; under these 
circumstances, the most effectual remedy was a draught containing one 
drachm of castor oil with twenty drops of oil of turpentine, given every 
three or four hours till the bowels were unloaded. With these were also*, 
combined astringent injections containing acetate of lead. When a relapse 
occurred, oil of turpentine was the most powerful remedy. 
Part xix., p. 304. 
Dysentery in the Course of Fever.—Give oil of turpentine in doses of six 
or eight minims, in the form of emulsion ; or Ohio turpentine in pills. 
Part xx., p. 23. 
Tropical—Treatment of.—In acute tropical dysentery, give daily ene- 
mata of tepid water—four to six pints—by means of O’Beirne’s elastic 
tube, introduced beyond the sigmoid flexure. This soothes the inflamed 
parts, and gradually softens and brings away the mass of hardened faeces 
which usually tills the large bowel in this disease. After the intestine has 
been freely cleared of the fecal matter, the tube need not be introduced 
so far. Free venesection will often be required in acute dysentery. In 
the chronic dysentery, employ astringent injections, such as fifteen grains 
of nitrate of silver dissolved in two or three pints of water, or a mixture 
of catechu and chalk, or a strong decoction of bark; taking great care to 
wash out the bowels with a large enema of tepid water (as above described) 
every day, before giving the astringent injections. Or, conjointly with the 
warm water eneinata, astringent medicines may be given by the mouth. 
Leeches will often be required; but very seldom mercury, except in the 
form of ointment. Part xx., p. 88. 
Treatment of Dysentery by Acetate of Lead.—[If there is much sympto- 
matic fever, with full, frequent, especially hard pulse, and the patient pos- 
sesses an ordinary constitution, Dr. Batchelder places blood-letting at the 
head of the treatment. The next remedy is the acetate of lead and opium. 
This remedy should be given immediately after the bleeding; or immedi- 
ately, whether venesection has been employed or not.] 
It is best that this dose should be sufficiently large and powerful to stop 
and effectually control the disease for the time being. It should consist of 
at least two grains of opium and four of the acetate—the patient being an 
adult, make the following prescription: R Opium, 6 grs.; acetate of lead, 
12 grs. Mix intimately and divide into six equal parts—one, two, three 
to be given at once, according to the severity of the symptoms. After an 
hour, if the discharges have not ceased, another is to be given; and if they 
still continue, another, perhaps two, as the case may require, after each 
discharge, without regard to time. 
By giving at first a large, or what might be deemed by some an over- 
dose, we may cure the disease at once, as by a blow; but if we fail in this, 
we are pretty sure to get, and are enabled to maintain, a perfect control 
over it in all its subsequent stages. 
When the discharges have been suspended some twenty-four, thirty-six, 
or forty-eight hours, a gentle laxative, as rhubarb and magnesia, or castor 522 
DYSENTERY. 
oil, with or without paregoric, may he ordered, especially if the patient 
feel a sense of fullness in the abdomen, or indeed any other sensation which 
he thinks would be relieved by an evacuation from the bowels. When 
the bowels have responded some two or three times to the laxative, and 
manifest a tendency to continue their movements, another powder should 
be given after the third motion, or after the second, if there be pain, or 
plainly indicated renewal of diseased action, in which case the dose should 
be repeated after each succeeding discharge. 
When the disease has been arrested in the manner desci’ibed, the cure 
may be often left entirely to nature, i. e., without even recourse to the 
laxative. When this has been withheld, the first motion from the bowels 
is generally natural, or nearly so, and the patient convalescent. An infu- 
sion of gentian or some mild tonic completes the cure. 
In the complications of fever with dysenteric symptoms, the writer’s ex- 
perience has led him to believe that the acetate of lead and opium, given 
as recommended in this paper, is the remedy which in such cases affords 
the most certain relief by correcting morbid secretions and controlling ab- 
normal action. 
The acetate of lead in solution applied topically to an inflamed part, we 
all know acts “ as a sedative, astringent, and desiccative,” from which pro- 
perties its utility as an enema in dysentery has been inferred. Thus ap- 
plied to the inflamed mucous membrane of the rectum, it seems to be a 
most appropriate remedy. If it has failed to produce the expected good, 
or has aggravated the symptoms, it is in consequence of having been im- 
properly used. If too strong, it will irritate the inflamed gut by its chemi- 
cal properties, and do quite as much harm as when the quantity is too 
large. The following proportions, it is believed, will be found adapted 
to most cases: It Acetate of lead, 6 grs.; pure water, 1 oz.; laudanum, 
from 30 to 50 drops. Mix for an enema—to be given and repeated 
according to the frequency of the discharges, and retained as long as 
possible. 
The recumbent posture should be most authoritatively enjoined and 
rigidly insisted on—from it the patient should not be allowed to depart— 
not even during a discharge fi’om the bowels. 
In addition to the recumbent posture, the writer is in the habit of direct- 
ing, in severe cases, or those in which the tenesmus is very harassing, and 
the difficulty of repressing or resisting it great, that the pelvis should be 
raised by putting a pillow or two underneath the hips. 
We have found cholera infantum more effectually and certainly cured by 
the acetate of lead and opium, than by any other means or remedies with 
which we are acquainted. To an infant, six months old, affected with this 
disease, we give one-twelfth of a grain of opium with one-sixth of a grain 
of the acetate after each discharge, up or down, more or less, or modified 
according to circumstances. Part xxiv.,p. 111. 
Dysentery.—In Ceylon it commonly appears as colonitis. There they 
support the patient from the first, depleting, however, by leeches applied 
to the abdomen; then Dover’s powder and ipecacuanha, three grains every' 
third hour, and afterward these combined with astringents. Quinine is 
combined with these remedies, twelve or sixteen grains being given in the 
twenty-four hours. Nitrate of silver injections thrown into the colon are 
sometimes very beneficial. Part xxviii., p. 133. 523 
DYSENTERY. 
Treatment of Chronic Dysentery.—In dysentery the large intestines 
are the parts principally affected. When the functions of the colon are 
performed in a healthy manner, the faeces are properly formed; but in 
dysentery, this character of the faeces is lost, owing to some fault of the 
colon. 
The compound tincture of benzoin is particularly useful in restoi*ing the 
loss of function of the colon. Twenty drops may be given on sugar three 
times a day. Part xxxiw, p. 101. 
Dysentery— Cholera.—Administer per anum a tablespoonful of common 
levigated charcoal, rubbed up with the white of an egg, which may be 
diffused in eight or ten ounces of chicken broth. This is often followed 
by perfect relief to the local symptoms, and consequently to the general 
fever. For this purpose, charcoal is deteriorated by exposure to the air, 
and probably that made from willow cork or sponge will be found most 
efficacious. In cholera, it is most beneficial at the commencement of the 
attack, but in all stages it is a beneficial adjuvant. Part xxxv., p. 26. 
Idiopathic Dysentery treated by Bismuth and Astringents.—Give a 
mixture consisting of a scruple of bismuth, ten grains of compound pow- 
der of kino, two drachms of mucilage, and an ounce of infusion of kra- 
meria, every six hours; at the same time attend carefully to the diet. 
Bismuth is also specially recommended in the diarrhoea of phthisis, typhoid 
fever, and of children. Part xxxv., p. 59. 
Dysentery.—In subacute and chronic dysentery confine the patient to 
bed, and in the recumbent position, that the bowels may be supported and 
kept quiet, and unirritated by the action of the abdominal muscles. Milk 
and farinaceous food are most applicable, as least stimulating peristaltic 
action, and being most likely to be assimilated. In the subacute and 
severer dysentery of this country no remedy is equal to Dover’s powder 
in ten grain doses, with an occasional dose of castor oil, guarded by a few 
drops of laudanum, for the removal of fecal matter. If there be a defi- 
ciency of bile, give a little liydr. c. creta; if there be much pain or 
tenderness apply a few leeches to the anus. In acute cases confined to the 
rectum, medicines administered by the mouth do little or no good; here 
give soothing injections with opium. 
In the purely chronic form of the disease, the treatment consists in the 
administration of mineral and vegetable astringents, combined-with opium, 
occasionally using aperients for the removal of faeces and foul secretions. 
When the ulceration is confined to the rectum or lower extremity of the 
colon, astringent injections of acetate of lead, nitrate of silver, sulphate of 
zinc, and gallic acid, will be most serviceable. But when the ulceration 
extends more or less throughout the entire extent of the colon, remedies 
administered by the mouth, especially the mineral astringents, act most 
effectually. In these cases slips of blistering plaster'should be frequently 
applied. In the more advanced stages of the disease, and in the milder 
cases where we have a healing but lax state of membrane, the stools being 
bilious and containing but little blood or mucus, the vegetable astringents 
will answer best. A strong decoction of the iEgle Marmelos, or Bael- 
fruit of Bengal, is very useful. A few drops of laudanum may be added 
to each dose of this. Dart xxxvii., p. 81. 524 
DYSMENOKKHCEA. 
Dysentery, Tropical.—Give large doses of ipecacuanha, from a scruple 
or half a drachm to ninety grains. Its action is speedy, certain, and com- 
plete—the disease being summarily put a stop to. A delightful ease and 
freedom from pain succeeds this dose, and there is no inclination to stool 
for twenty-four or thirty-six hours, when a perfectly healthy evacuation 
succeeds. But some treatment is necessary in order that the stomach may 
retain such large doses of an emetic substance. For this purpose apply a 
sinapism over the region of the stomach, and simultaneously give a 
draught containing a drachm of laudanum. By this means the sensibility 
of the stomach will be diminished, and the ipecacuanha safely adminis- 
tered. It is occasionally after all ejected. It must then be repeated till 
the stomach does retain it. By this method of treatment the mortality 
from dysentery in the regiment to which the author was attached, was re- 
duced from five or ten cases in every fifty treated to only one, and in this 
case death was owing to abscess occurring in the liver. 
Part xxxviii., p. 86. 
Belladonna in JDysmenorrhoea.—[Dr. Burne recommends the extract 
of belladonna in this painful affection. He says :] 
In the treatment of painful menstruation, I have found the belladonna 
most valuable. I have usually prescribed it in the dose of a quarter of a 
grain of the extract, made into a small pill, which may be taken twice a 
day, where patients suffer, but not very severely, for two or three days 
about the menstrual period. In the more urgent cases I advise it to be 
repeated in one hour; then again after an interval of two; then of three 
hours; till two, three, or four doses have been taken, according to circum- 
stances : and I have seldom been disappointed in the result. It may pro- 
duce giddiness and dimness of sight, but they soon pass away. Its 
unpleasant effects are less than opium, and its efficacy decided. 
Bart ii., p. 33. 
Secale Cornutum.—Dr. Fyfe, in speaking of the uses of ergot, says: 
In dysmenorrhcea the ergot has been most useful. In one case, accom- 
panied with what may, without exaggeration, be termed torture at each 
period, it appeared almost magical in its operation. It is right to state 
that it was given in combination with the valerian ; which medicine, how- 
ever, had been previously given, but without any apparent benefit. 
Bart iv., p. 16. 
Ointment of Veratria.—Dr. Bushman supposes that dysmenorrhcea may 
frequently be owing to perversion of the nervous action of the lower por- 
tion of the spinal nerves, and found good effects from the external appli- 
cation of the ointment of veratria. Vide Art. “ Spasmodic Affections.” 
Bart iv.,y>. 29. 
Beeches to the Knee in Dysmenorrhcea.—In three hospital patients 
under the care of M. Trousseau, the catamenia have followed the applica- 
tion of a leech to the internal surface of the knee. In one case a leech 
DYSMENORRHOEA. 525 
DYSilENOKEHGEA. 
was applied to the right knee; while it held on, the patient experienced 
nothing particular, but as soon as it fell off, pains in the loins came on, 
which lasted about an hour, and the discharge then appeared. The next 
day it was arrested again, and a leech was applied to the left knee ; and 
the discharge appeared as before, and continued as usual during three 
days. In another case the pains of uterine congestion commenced with 
the application of the leech, which adhered during an hour. The effect 
produced by one leech is not wonderful, says M. Trousseau, because if the 
bleeding is allowed to continue, as large a quantity of blood flows as the 
ordinary amount of menstrual discharge. Part v., p. 61. 
Ioduret of Silver.—Dr. Patterson, in his remarks on the ioduret of silver, 
suggests its use in cases of painful and scanty menstruation, in half grain 
doses twice a day, gradually increased to two grains twice a day—in the 
form of pill—during the ten or twelve days preceding the expected return 
of the menses; and upon the accession of the dischai-ge, and while it con- 
tinues, the patient is directed to take the ioduret three times a day; but 
as soon as it declines, to omit the medicine altogether for a fortnight. 
Part vii., p. 82. 
Belladonna in Painf ul Menstruation.—In a discussion in the Medical So- 
ciety of London, Dr. G. Bird drew attention to that form of dysmenorrhcea 
which was unaccompanied by organic change or attended by the discharge 
of shreds from the uterus, and in which the pain was referred to the lower 
part of the abdomen, immediately over the uterus. In these cases he had 
found belladonna, properly prepared, of the greatest efficacy. When the 
patient was of a leuco-phlegmatic habit, pale and chlorotic in appearance, 
he ordered five grains of extract of belladonna, and twenty grains of sul- 
phate of zinc, to be divided into twenty pills, and of these one was ordered 
to be given immediately on the accession of pain, and repeated every two 
or three hours, until the pain ceased. When the patient was plethoric, 
and of full habit, he substituted ten grains of ipecacuanha for the zinc, 
and the pills were given in the same manner. In the intervals of men- 
struation purgatives were administered, with medicines tending to im- 
prove the general health. This treatment he had scarcely ever known 
fail. 
Dr. Garrard has used belladonna in the forms mentioned by Dr. Bird, 
and in the second set of cases, attended by plethora, has, instead of the 
ipecacuanha, usually substituted colchicum. Part ix., p. 15. 
Treatment of Dysmenorrhcea.—Dr. Rigby, in his treatise on this subject, 
considers that it depends, in common with some other uterine affections, 
in derangement of the assimilating processes, which may be merely “ the 
local phenomena of a general condition of the system.” This general con- 
dition, he thinks, is chiefly dependent on a gouty or rheumatic diathesis. 
He generally begins the treatment with one active dose of calomel, from 
five to eight grains, followed by a mild purge of rhubarb or magnesia next 
morning. Leeches to the anus either immediately before the menstrual 
period or equidistant between the two periods, are very efficacious; but 
often require repetition before their full value is seen. 
The attention of the practitioner must now be devoted to the more spe- 
cific treatment of the case. If the circulation be plethoric and strong, the 
urine scanty, high-colored, with considerable excess of lithic acid and 526 
DYSMENORRIKEA. 
lithates, colchicum in the form of the acetous extract, with extract of hop 
or henbane, may be given at night, or night and morning, and some mild 
saline, with sp. aetheris nitrici occasionally during the day. 
Where the disease assumes the rheumatic or rheumatic-gouty character, 
we usually find it associated with less poA\rer of general circulation, and 
Avith local symptoms of less active character. Guaiacum and iodine are 
valuable remedies in these affections, either separately or combined. The 
tinctura guaiaci ammoniata may be taken in milk night and morning; or 
ten grains of pulv. guaiaci and of magnes. carb. every morning, and from 
two to five grains of potass, iod., with extract of hop or henbane at night; 
or if it be deemed unnecessary to use the guaiacum, the potass, iod. may 
b: given tAvo or three times a day in sarsaparilla, Avith liq. potassae, and the 
boAvels regulated by an alterative or laxative pill at night; or, if it be de- 
sirable to promote diaphoresis, by a dose of Dover’s poAvder. 
There are feAv remedies which keep up a healthy action of the liver so 
well as the taraxacum, especially Avhen preceded by a dose or tAvo of mer- 
curial medicine. It is prepared under a Arariety of forms, but I prefer the 
extract as being the most certain and convenient; half a teaspoonful at 
night, dissolved in a little warm milk, forms a by no means disagreeable 
cocoa-like drink ; or it may be taken with milk and lime-water if necessary. 
Besides its ordinary effect on the liver, and, therefore, indirectly upon the 
boAvel3, by supplying them Avith healthy bile, I have reason to think that it 
also acts upon the skin like sarsaparilla, and for this purpose may some- 
times be advantageously combined Avith it. Part x., p. 194. 
JJysmenorrhcea.—There are two varieties: the mechanical, where the 
catamenia are scanty; and there is contraction of the os uteri, either con- 
genital or acquired ; and the membranous, in Avhich the menses are natural, 
or profuse in quantity, and accompanied by the expulsion of a membrane 
from the womb, the uterus being large, hard and sometimes retroverted. 
This is primarily an affection of the ovary. 
In the first variety, if the womb itself is of the natural size, dilate the 
os uteri with Dr. Simpson’s concealed bistoury, and insert a sponge tent. 
After a day or two pass a German silver stem, and repeat this at intervals 
of a week, gradually increasing the size, until the normal condition of the 
opening is obtained. If the womb itself is not fully developed, division of 
the os will do no good. 
In membranous dysmenorrhoea, which is the most common, enjoin rest, 
and allow nutritive but unstimulating diet. Give pil. hydrarg. gr. ij. with 
ext. conii iij. night and morning; or Plummer’s pill, gr. v. night and 
morning, till the gums are slightly tender. Then give liq. hydrarg. 
bichlor. 3j. in sarsaparilla or bark. If the patient does not bear mercury 
well, give the latter preparation from the first, instead of the pills, as it is 
really not a bad tonic; and rub a little ung. hydrarg. with ext. belladon. 
over the inguinal region. Apply 3 or 4 leeches to the upper and back 
part of the vagina once a week, and use hip baths, or poppy fomentations; 
and when the size of the womb is thus reduced, blister the sacrum occa- 
sionally. 
When the gums have become sore, give small doses of potas. iodid. 
When the uterus is retroverted, replace it by pressing with the finger 
upon the anterior part of the cervix, and let the patient wear an elastic 
abdominal belt, Avith a perineal support. Lastly, if the womb is very hard, 527 
DYSMENORKHCEA. 
and has been long displaced, support it by Dr. Simpson’s metallic stem. 
The use of mercury and leeching are the most important parts of the treat- 
ment. Part xv., p. 313. 
Dysmenorrhoea Occasioned by Ulceration of the Os and Cervix Uteri. 
—[From independent investigations, Dr. Edwards has formed the same 
opinions upon this subject as Dr. Bennet. His conclusions are:] 
1st, That dysmenorrhoea is occasionally only a symptom of this disease 
resulting from congestion and ulceration of the cervix and os uteri. 2d, 
That sterility is a most frequent attendant, though not, as has been con- 
sidered, a necessary condition, the mechanical obstruction in the uterine 
neck being sufficient to account for it, as in dysmenorrhoea. 3d, That 
abortion is occasionally produced by it; when it does occur, the disease 
is commonly aggravated, sometimes altogether lit up by it. 4th, That 
when the os uteri, as well as the cervix, is ulcerated, the mischief extends 
from the former to the latter. The os uteri is generally the last part 
to yield to the remedies. In the treatment it is well to remember this 
fact. 5th, That in the generality of cases that have occurred to me, the 
nitrate of silver has answered all the purposes of an efficient caustic, and 
that I cannot but view the actual cautery, the Vienna paste, the perni- 
trate and acid nitrate of mercury, as well as nitric acid applications, of too 
violent a character for ordinary use to that portion of the body. 
Part xvi., p. 286. 
Chloroform.—The inhalation of chloroform is a valuable means of 
relieving the pain. The chloroform should be inhaled at bed-time, and 
then, if the patient remains perfectly quiet on recovering consciousness, 
she will have a good night’s rest. Part xxi., p. 315. 
Dysmenorrhoea.—Dysmenorrhoea may depend, says Dr. Bennet, on a 
physical imperfection of the uterine neck; on contraction of the os inter- 
num, or of the canal vThich constitutes the cavity of the cervix. This con- 
traction may be either congenital, or the result of inflammation. The 
peculiar character of the dysmenorrhoea, when caused by congenital 
contraction, is the absence of any uterine symptom during the interval of 
menstruation, and intense agonizing pain for a few hours before the flow 
of blood appears, either then disappearing or lasting throughout the period; 
these pains commencing with menstruation in early youth. If they are 
occasioned by inflammation, there are the same symptoms at the time of 
menstruation, but there is not the same immunity from uterine symptoms 
in the interval of the catamenia. 
The cause of the pain experienced under these circumstances is evident. 
The cavity of the non-pregnant healthy uterus not containing more than 
about ten or eleven drops of fluid, as soon as the catamenial secretion com- 
mences from the lining membrane of the uterine cavity, unless the blood 
find a free exit through the os internum and the cavity of the cervix, 
it distends the uterus, and gives rise to great pain. The obstruction may 
merely be at the os internum, spasmodically contracted ; in which case, as 
soon as it has been overcome, the blood escapes freely, and pain dis- 
appears. But if the os internum is permanently contracted, or the con- 
traction exists in the cervical canal, the pain may continue throughout the 
catamenial period. 
A contracted state of the upper part of the cervical canal, or of the os 528 
internum, is not, I believe, an unfrequent complication of inflammation of 
the cervix, from the swelling and hypertrophy of the substance of the 
organ which it occasions. This remark, however, does not apply to the 
inflamed region of the cervical canal, which is uniformly dilated by the 
existence of inflammation. 
It appears to me that a free communication between the cervical and 
uterine cavities, allowing the easy introduction of the uterine sound, is 
generally an anomalous condition, indicating the existence of disease, 
unless observed soon after menstruation, when the os internum relaxes, or 
soon after parturition, when it has not yet had time to recover its normally 
contracted state. The principal morbid conditions in which I have 
observed a free communication between the two cavities, are inflammation 
and uterine tumors. If the inflammation which exists at the os uteri, and 
in the lower part of the cervical cavity, ascends as far as the os internum, 
it appears to relax the muscular contractility of that region. The os 
internum is always open when the inflammation passes into the uterine 
cavity, and implicates its lining membrane. The same effect is also pro- 
duced by the development of the uterine cavity, through the formation of 
tumors in the substance of the uterus, or from any other cause, the os 
internum gradually opening as the uterus enlarges, probably by the same 
mechanism as in pregnancy. This is so generally the case, that the 
flict of the uterine sound penetrating easily through the os internum into 
an enlarged uterine cavity, may be considered a valuable symptom of the 
existence of such tumors, to add to those with which we are already 
acquainted. 
Extreme dysmenorrlicea from congenital contraction of the cervical canal 
and os internum, independent of inflammation, is, I believe, of rare occur- 
rence. This is a fortunate circumstance, as it is most embarrassing to 
treat, requiring an amount of interference with the uterine organs which 
it is very painful to have to propose to an unmarried female. Dilatation 
of the contracted cervical canal is* however, sometimes the only means we 
have of remedying an amount of suffering at the catamenial period, so ex- 
treme as to render life nearly a burden, and as to react deeply on the 
general health. 
Whatever may be the cause of dysmenorrlicea, the mode in which the 
menstrual secretion takes place is modified by its existence: instead of a 
flow of bright blood, regular and continuous, although generally increasing 
by exercise and diminishing by rest, we have a dark, interrupted, clotted 
discharge. After severe uterine pains, which may last many hours, and 
are often accompanied by tenderness and swelling in the ovarian regions, 
and pain in the back and down the thighs, more or less dark clotted blood 
is thrown out. Its expulsion is generally followed by relief, and by a freer 
flow for a while, when it again diminishes, and the same ordeal again takes 
place. Sometimes the interruption will be complete for one, two, or three 
days, the pains subsiding with the menstrual flux, and returning when it 
again makes its appearance. The venous condition of the menstrual secre- 
tion shows plainly that, either from inflammation, congestion, or some 
other cause, the uterine circulation is defective, the blood stagnating in the 
vessels of the uterus, remaining in its cavity, and distending it after it has 
been secreted. 
Treatment.—Constitutional dysmenorrhcea may be palliated in its 
attacks, and can seldom be removed by medical treatment. A great deal 
DYSMENOKKHCEA. DYSMENOKKIKEA. 
529 
of subsequent uterine disease would, however, be spared to those young 
females who unfortunately present it, were mothers more generally aware 
that its existence constitutes throughout life a strong predisposition to 
uterine inflammation, and that they cannot take too great care of such of 
their daughters as suffer from it. For such young females, the discipline 
of public schools may be said to be nearly always too severe, and often to 
lay the foundation for much future physical and mental misery. That this 
must be the case, will be easily understood when we reflect that the 
domestic treatment of this form of dysmenorrhoea consists principally in 
rest and toarmth. Females who suffer habitually from dysmenorrhoea, 
whatever their age, should remain quietly at home, taking care to 
preserve themselves from atmospheric vicissitudes during the first day or 
two of menstruation, which is the period during which the pain is mostly 
felt. A warm hip-bath will often be found useful. If the pains are very 
decided, it is even best to confine the sufferer to bed, and to apply warm 
linseed poultices to the lower abdominal region—a valuable and simple 
mode of soothing pain. 
Although' this is frequently a symptom of uterine disease, we are often 
obliged to treat it as the chief disease. If warmth and rest fail, inject 
from 15 to 20 minims of laudanum, mixed with a little warm water, into 
the rectum: this is of more value than double the quantity by the mouth, 
and its disagreeable effects are avoided. If the first injection fails, or is 
not retained, a second, half an hour later, will be more successful. Chloro- 
form, either inhaled or given in doses of 30 or 40 minims, mixed with 
mucilage or camphor, which favors its solution in water, is sometimes of 
use, though not so valuable as opiates. 
It is the fact of dysmenorrhoea being so frequently caused by inflam- 
matory disease, that explains the success which often attends blood-letting, 
both general and local, and which has induced so many authors to recom- 
mend it, although unaware of the pathological state which it relieves. 
General blood-letting acts by revulsion ; whilst local blood-letting directly 
relieves the congested and embarrassed abdominal circulation. I seldom, 
if ever, resort to general bleeding in dysmenorrhoea. 
A few leeches applied to the groin, or, better still, to the neck of the 
uterus, when possible, if the discharge is scanty or temporarily arrested, 
is much more likely to mitigate the pain, and with less loss to the 
economy. Purgatives, which are frequently useful, act in the same way as 
leeches, by depleting the abdominal circulation. Some authors, amongst 
others Dr. Gooch, have considered dysmenorrhoea to be frequentlyakin to 
rheumatism, and have recommended colchicum, guaiacum and other 
medicines usually given in rheumatic affections. That the uterus may be 
the seat of such an affection, is undeniable ; but I am persuaded that its 
frequency has been greatly exaggerated, as likewise that of irritable uterus. 
Indeed these two conditions may be said to have been, to a great extent, 
mere theoretical creations, destined to account for pathological conditions, 
the real nature and meaning of which have, until recently, been a mystery 
to the profession. Part xxv., p. 294. 
Case of Chronic Bronchitis, complicated xoith Dysmenorrhoea—Treat- 
ment of the latter by Biborate of Soda.—In Germany, the biborate of 
soda is used to produce uterine contraction, and to facilitate the excretion 
of lochia and the menstrual fluid. In the former case, it is given along 530 
DY SMEN OBRHCEA. 
with ergot, and in the latter, alone. From the frequency of the 
occurrence of dysmenorrhoea, and the difficulty of its management, it 
is important to ascertain whether it possesses any value as a remedial 
agent in this disease. The following case is selected as illustrating its 
efficacy: 
E. Y., aged 26, of dark complexion and florid appearance, was admitted 
on account of cough, attended with some dyspnoea. She stated that she 
had been losing flesh slightly for several months ; the respiratory sounds 
beneath each clavicle were somewhat harsh, but no decisive indications of 
pulmonary disease could be detected. It appeared, that although her 
cough had been the more alarming to her, yet she had in reality suffered 
chiefly from a very painful condition of menstruation. She had been 
married for two years, and during the whole of that period, the catamenial 
discharges had been regular in their recurrence, lasting usually for about 
a week, and attended throughout with such great suffering, that she had 
always been compelled to observe the recumbent posture for the greater 
part of the time. The matters discharged were usually very dark in color, 
and mixed with clots of blood and numerous flakes of whitish membrane. 
In the intervals, more or less of leucorrhoea was constantly present, accom- 
panied by a dull aching pain in the lower part of the back. Her tongue 
was redder than natural, covered at the tip and edges with prominent 
papillae, and somewhat fissured. Pulse 96, and a little sharp. Conformably 
with what is mostly observed in those who suffer from aggravated dysmen- 
orrhoea, she had never conceived. 
As it appeared probable that the pulmonary affection wras either mainly 
or altogether sympathetic, Dr. Bennet directed his treatment solely to the 
uterine affection, and prescribed his usual formula of the borax, in con- 
junction with a mild stomachic. 
R Magnes. carbon, gr. v.; pulveris rhei gr. ij.; sodte biborat. gr. x. ; infus. 
calumb. §j.; ter die sumend. Em pi. ammon. cum hydr. lumbis applicand. 
If sickness is produced, acid, hydrocyan. dil. mij., may be added to the 
dose. 
The following menstrual period was attended by scarcely any pain. 
The discharge lasted for five days: it was copious, and unmixed with 
either shreds or flakes. During the whole time she continued at her 
ordinary avocations, and enjoyed a degree of comfort to which at such 
times she had been for years a stranger. The aching sensation in 
the back has entirely disappeared, the chest symptoms have also all but 
vanished 
The class of cases to which the treatment by borax seems to be specially 
adapted, are those in wdiich no organic disease exists, but which, occurring 
in tolerably robust subjects, are attended by slight pyrexia, pain in the 
loins, the expulsion of flakes and shreds of lymph, and the other signs of a 
disease of active congestion rather than mere nervous derangement. 
Part xxvii., p. 199. 
Neuralgic Menstruation, commonly termed Dysmenorrhoea.—I)r. Oke 
observes: 
Frequently the menstrual secretion commences with and is accompanied 
by pain in the abdomen, back, and hips, varying in its degree of inten- 
sity. Frequently this may be alleviated by hip-bath, opiates, belladonna, 
digitalis, purgatives, electricity; or, if inflammatory, by cupping over DYSMENOKKHCEA. 
531 
the sacrum; in other cases, however, no relief is obtained from any of 
these measures. 
Case.—A lady, aged twenty-six, well formed, and of dark complexion, 
had become deficient in her menstruation; and the diminution was accom- 
panied with hysterical paroxysms, and the most intense pain of the uterine 
region, as soon as the secretion commenced. This state of extreme suffer- 
ing continued for some years, and rendered her existence quite wretched. 
She had consulted a variety of medical men, and many remedies had been 
tried, to remove or alleviate her pains. She had been locally bled, had 
frequently used the warm hip-bath, with purgatives, opiates, antispasmo- 
dics, etc.; but all these means had fallen short of any permanent relief. 
The only remedy which had given her any respite was large doses of the 
liquor opii sedativus, although it always disordered her system. In such 
a case as this, as all ordinary remedies had been found unsuccessful, and 
reflecting that the indication of cure was clearly to subdue the morbid 
action of the uterus, and restore its normal secretion, I resolved to com- 
bine some preparation of iron with a sedative which would not contract 
the secernent cavity of the uterus; accordingly, she was immediately 
placed under the following treatment: 
R Pilulse ferri compos. 3ij.; extracti conii 5j. Misce et divide in pilul. 
xl. quarum capiat duas ter quotidie. 
This plan was steadily observed through the interval up to the next period, 
which passed with an increased secretion, and without suffering or hysteria. 
The treatment Avas persisted in for some months with complete success; 
and two years have elapsed without any return of suffering. • 
I do not wish to be understood that the above treatment is recom- 
mended for the relief of all cases of dysmenorrhoea. When the symptoms 
indicate an inflamed condition of the internal membrane of the uterus, 
manifested by the discharge of fibrinous shreds and febrile disturbance of 
the system, such treatment is, of course, inadmissible and the case must 
be treated according to its indications by local bleeding, by the warm 
hip-bath, digitalis, saline aperients, etc. 
Dysmenorrhoea, as well as leucorrhoea, may be sometimes also caused 
by the local irritation of ulcers, either within or near the os uteri ; and has 
been successfully treated by the application of the nitrate of silver through 
the speculum—an instrument which has brought to light local causes of 
uterine disease which had long escaped detection by the ordinary means. 
When, therefore, in dysmenorrhoea, the symptoms are found to resist 
general‘methods of cure, and when the intermenstrual mucous discharge 
from the vagina is ascertained to be purulent and mixed with streaks of 
blood, it may be fairly inferred that the painful character of the menstrual 
period is kept up by epithelial ulceration, too far within to be discovered 
by common observation, and too superficial to be detected by the finger. 
When the symptoms are derived from induration and enlargement of 
the cervix uteri, the speculum might overlook what the finger will not 
fail to discover. Such cases are of no uncommon occurrence. The en- 
largement is most frequently found on the posterior part of the cervix, and 
in my experience is very difficult of cure, even when it is not of a malig- 
nant character. Part xxviii., p. 286. 
Dysmenorrhoea.— Vide Selections from Favorite Prescriptions, Art, 
“ Medicines.” 532 
DYSMENOEEIKEA. 
Dysmenorrhcea—Palliative Treatment.—The agent most serviceable of 
all, and that on which I chiefly rely for relieving the pain of dysmenor- 
rhcea, is morphia in one or other of its forms. This generally acts better 
combined with some strong diffusible stimulant, as chloric ether, which 
forms an admirable adjuvant to the action of the opium. The inhalation 
of chloroform, when the pain is severe, is often of the greatest use, for it 
is a singular fact that if you can bring the patient into the anaesthetic con- 
dition for only a short time at the very commencement of the attack, she 
will frequently remain free from pain whilst the discharge continues. 
There are only two local anodynes from which I have obtained much good 
results, these are carbonic acid gas and the vapor of chloroform. 
Part xxxix., p. 310. 
Preventive Treatment.—When dysmenorrhcea is kept up by a state 
of ovarian or uterine congestion or inflammation, we must try to reduce 
these states during the catamenial intervals, by repeated bleedings ap- 
plied to the hemorrhoidal vessels, by assiduous counter-irritation to the 
groins or sacrum, and by all the other usual internal remedies employed 
against the local inflammation and congestion of other isolated organs of 
the body. If chiefly neuralgic in character, alteratives, and especially 
mineral tonics, good diet and regimen, and whatever tends to raise the 
standard of health, will best cure the neuralgia. Part xxxix., p. 312. 
Gouty and Rheumatic.—For the gouty and rheumatic forms of the 
disease, xiseful results will be found from the administration of colchicum 
and guaiacum, either alone or in combination with alkalies. Bromide of 
potassium possesses a sedative action on the sexual organs possessed by no 
other drug in the Pharmacopoeia, and in many cases by its employment 
you may succeed in warding oft' attacks of dysmenorrhcea. 
Part xxxix., p. 313. 
Obstructive Dysmenorrhcea and Sterility from Contraction of the 
Cervix TJteri.—Prof. Simpson says: 
When dilatation is effected mechanically, whether slowly by sounds, or 
rapidly by sponge tents, relapse of the stricture or constriction is very 
apt to return after a time, just as so often happens after the treatment of 
bad stricture of the male urethra, by merely dilating instruments. The 
best and speediest mode of cure is to have recourse at once to dilatation 
of the os by incising it at both sides. For the performance of this opera- 
tion, a metrotome is required; this must be introduced as far as the os 
internum, where the incision begins, at first quite shallow, and then deeper 
as the instrument is withdrawn, till at the os externum the cervix is cut 
across in all its thickness. If you cut too deeply in the upper portion of 
the cervix, you run the risk of wounding some of the veins of the plexus 
uterinus, otherwise the hemorrhage is not of consequence. The wound 
must be opened up every two or three days with the finger to prevent 
union, or the corners of the wound may be touched with a piece of nitrate 
of silver, with a like good result. There are few operations in surgery 
“ so perfectly simple in their performance, and so entirely satisfactory in 
their results.” Part xxxix., p. 317. DYSPEPSIA, 
533 
DYSPEPSIA. 
Nitrate of Silver in some Affections of the Mucous Membrane.—[Dr. 
Hudson relates the two following cases as good examples of the efficacy of 
this remedy, and of the kind of case in which it will prove valuable.] 
M. M., aged 15, suffered for six months acute pain, with tenderness on 
pressure in the epigastric region; great distention of the stomach after 
eating; thirst, costiveness, and vomiting of sour fluid. Pain usually com- 
mences about an hour after dinner, and continues through most of the 
night, preventing sleep; it is generally accompanied by vomiting of sour 
fluid, without food. 
His sunken and anxious face presents a picture of extreme suffering. 
R Nit rat. argenti gr. £; opii gr. £; pulv. rhei; ext. humuli, aa. gr. j. 
Ft. pil. ter die sumenda. 
Bread and milk for diet. 
His further history is, that during his stay in the hospital he had but one 
return of the vomiting. The pain and tenderness subsided in the course 
of a week. The pills were discontinued on the tenth day, and on the 
twenty-eighth he was discharged free from complaint. 
M. D., aged 45, has had frequent attacks of pain in the stomach and 
vomiting tor the last fifteen years. She formerly enjoyed remissions of the 
complaint, but for ten months past she has had three or four attacks every 
day. Pain usually comes on in about an hour after taking food. She then 
throws up a large portion of the food, mixed with sour fluid; occasionally 
she vomits a quantity of fluid resembling the washings of flesh; the bowels 
are costive. 
She was ordered a milk diet and the pills, as in the last case. 
Left the hospital cured. Part i., p. 74. 
Ox-gall.—The following pills recommended in cases of dyspepsia at- 
tended with violent headaches, pain in the epigastric region, obstinate con- 
stipation, acidity of stomach. 
R Inspissated ox-gall, two drachms; oil caraway, ten minims; carbonate 
of magnesia, sufficient to form a mass. M. 
Divide into thirty-six pills. Take two three times a day. 
Part vi., p. 66. 
The Complication of Cutaneous Affections with dyspepsia, accom- 
panied with a sensation of heat and oppression at the epigastrium, increased 
by food, etc., contra-indicate the administration of arsenical preparations. 
Part viii., p. 14. 
A Modification of the Ipecacuanha Pill recommended in cases of 
gastro-intestinal derangement as follows: 
R Inspissated bile of the swine, two or three grains; ipecacuanha, one 
grain ; carbonate of potass, two grains. M. Make into a pill. 
Considered a valuable agent in dyspepsia, and in many chronic affections, 
attended with defective biliary secretion. Also in chlorosis, amenorrhoea, 
some forms of dysmenorrhoea, and constipation. Part viii., p. 71. 
Iodide of Potassium lias been found useful in certain forms of dyspepsia. 
Dr. Oke attributes its good effects in such cases to its power of invigorat- 
ing the system: 
R Iodide of potassium, 5 grains; sesquicarbonate of soda, 10 grains^ 534 
camphor julep, l£ fluid ounce. M. This dose to be taken thrice dally, 
for a month or six weeks. 
The iodide of potassium is always inadmissible where there is any febrile 
disturbance, or where the tongue is much coated. Part ix., 62. 
Dyspepsia.—A most excellent aromatic bitter is copalchi bark, which 
may be given in doses of a tablespoonful of the infusion (cort. copalchi §ss.; 
aq. fervent. Oj.;) thrice daily. Part xix., p. 310. 
Dyspepsia with Pyrosis.—When there is pyrosis, an excellent medicine 
is the new salt, “ bisulphate of iron and alumina,” given in doses of five or 
ten grains, dissolved in any aromatic water. Part xix., p. 312. 
Catarrh of the Stomach.—In cases described as “ catarrh of the sto- 
mach,” in which there is much vomiting of viscid ropy mucus, give alum, 
in doses of ten or twelve grains, three or four times a day. It must be 
reduced to an impalpable powder, and made up into an electuary with 
treacle and a little powdered ginger. A little supertartrate of potash may 
be added, if constipation is produced by the alum. Part xix., p. 313. 
Dyspepsia.—In obstinate cases, where there is great irritability, depres- 
sion of spirits and anxiety, examine the urine for oxalate of lime. If this 
substance is contained in the urine, give nitro-muriatic acid. 
Part xx., p. 84. 
Treatment of Nervous Gastro-Intestinal Affections by Charcoal.—In 
many forms of dyspepsia powdered charcoal is useful, given in doses of a 
teaspoonful or two before meals, twice or thrice a day. It may be given 
in the form of pills or lozenges, or made into a paste with water, or spread 
upon bread. 
This inert powder seems neither to be digested nor absorbed; it merely 
passes through the digestive canal, and takes hold of the gases and liquids 
hurtful to the economy. The charcoal powder keeps the bowels open 
with those patients where gastralgia is complicated by constipation, and its 
effect is not confined to rendering digestion better, but it likewise allows 
of more tonic and abundant food being used, whilst it renders the stomach 
more fit to bear such active remedies as were but ill borne before. 
Part xxi., p. 148. 
Heartburn and Indigestion.—[Dr. Hunt dwells particularly upon the 
connection of heartburn with the gouty diathesis. This fact was recently 
established by Dr. Garrod, who pointed out, that immediately before a 
gouty paroxysm, the blood became loaded with uric acid, which should 
have been filtered off by the kidneys; and that whatever be the source 
of the removal of the uric acid from the system, removes all this morbid 
phenomena altogether. The connection between this morbid condition 
of the blood, and constant heartburn, will be made more evident by the 
following remarks:] 
In the first place, it appears that when the kidneys fail to eliminate uric 
acid, the other secreting organs attempt to relieve the system by a sort 
of compensating action ; the perspiration becomes more than usually acid; 
this is attested by its odor and its action on litmus paper. The saliva 
then partakes of the same quality. This is made evident by the constant 
sour taste in the mouth, which is increased by everything that augments 
the flow of saliva; as, for example, the introduction of food into the 
DYSPEPSIA. 535 
DYSPEPSIA, 
mouth; each morsel, in this condition of the blood, will immediately 
appear to turn sour, even before it is swallowed ; whereas, there is reason 
to believe this sourness is caused by the additional supply of acid saliva. 
Sometimes, also, large quantities of acid matters are carried out of the 
system by a spontaneous diarrhoea. Now as all these secretions partake 
of the abnormal (acid) quality of the blood, may we not presume that all 
the fluids proper to the stomach, the gastric juice and others may also 
participate in it. Indeed, such is proved to be the case, by the fact, that 
when vomiting is excited under these circumstances, and in this state of 
the system, the matters ejected are always intensely acid. 
If this be admitted, it follows, that the flow of these sour secretions into 
the stomach being constant, the constancy of the heartburn is at once' 
explained, and the immediate increase of the latter on taking any espe- 
cially solid, hard, indigestible articles of food, is also explained by the 
increased supply of abnormally sour gastric juice the secernents are 
excited to pour out. So immense is the quantity of acid matter sometimes 
suddenly poured into the stomach in such cases, that it would also appear 
as if the secernents attempted to relieve themselves, the vessels that sup- 
ply them, and the whole system, by this vicarious discharge of the gouty 
virus with which they were loaded. 
By the aid of the discovery made by Dr. Garrod of the presence of 
urate of soda in the blood, we can also explain why some persons only 
suffer from constant heartburn, or from heartburn uninterruptedly for a 
few weeks or months, or for some definite period, while others are never 
perfectly free from it through a long series of years. 
The former are those whose kidneys only occasionally fail to excrete 
uric acid. The latter include those who are the victims of chronic gout 
with tophaceous deposits, in whose blood uric acid is always more or less 
present from a permanent cessation of the excreting function from organic 
disease of the kidney. The intimate connection between constant heart- 
burn and the urates in the blood is further confirmed by various other 
circumstances ; for example, it is always relieved by the transferrence to, 
or concentration of, the gouty matter on some external part, as by an 
attack of gout in an extremity. It is also diminished by the excretion of 
uric acid in the urine, whether induced by a natural effort, or under the 
influence of appropriate remedies. Again, as in this condition of the 
blood and system a slight bruise or sprain will provoke an attack of gouty 
inflammation in the injured part, so a slight irregularity of diet will create 
a fit of indigestion, and induce additional sufferings from heartburn, which, 
under a more healthy state of the body, it would have been unable to excite. 
Thus we see the phenomena of gout afford exceedingly clear evidence 
of what I wish to prove, viz., that the constant supply of acid, the cause 
of constant heartburn, is derived from the blood circulating in the vessels 
of the stomach. Part xxvi., p. 80. 
Remedy for Indigestion.—As much of the following compound, pro- 
perly diluted, as will not affect the taste of the food disagreeably, may be 
taken along with each meal: Solution of potash, chloride of sodium, of each 
one ounce ; phosphate of soda, a drachm and a half; water, three ounces. 
It is not intended to be resorted to as an occasional remedy for various 
forms of indigestion, but constantly, in like manner as common salt. 
Part xxvi., />. 81. 536 
DYSPEPSIA. 
General Pathology and Treatment of Dyspepsia.—Our knowledge 
with regard to the offices performed by the gastric, biliary, and pancreatic 
juices in digestion has of late years been much advanced. Thus the gastric 
juice more especially operates on the albuminous, and the pancreatic juice 
on the fatty compounds of the food. The function of the bile is perhaps 
more obscure, although it probably acts as a means of precipitating or 
separating some of the excretory matters from chyme, and so facilitates 
assimilation of the nutritive portions. Digestion may be deranged by all 
those causes which too much increase or diminish the secretion of these 
three fluids. Thus, excess of acidity in the stomach is one of the most 
common causes of dyspepsia, producing that form of it which accompanies 
scrofulous and tubercular diseases. It may be in such excess as to neu- 
tralize the alkaline action of the pancreatic juice, and render it difficult 
or impossible to emulsionize fatty matters. In such cases, alkalies, with 
bitter tonics and the direct introduction of animal oils in excess, are indi- 
cated. On the other hand, the gastric juice may be diminished in quan- 
tity, as frequently occurs in persons who suddenly overtask the powers of 
the stomach at feasts, or in old persons with feeble digestion. The sense 
of load after eating is generally indicative of slow digestion from this 
cause. In acute cases, a stimulant rouses the stomach to increased action, 
and hence the moderate use of drams and generous wines after dinner is 
occasionally useful. In old persons the sense of load and feebleness is best 
removed by giving up tea, and drinking at night a little weak brandy and 
water. In chronic cases, acids are indicated, especially muriatic acid. 
The tr. ferri co. of the pharmacopoeia is a useful preparation in chlorotic 
females. We have no distinct means of arousing the pancreas into action, 
and yet many cases are on record in which fatty matters have passed 
undigested through the alimentary canal in consequence of obstruction to 
the pancreatic duct. In such cases, and all those in which fatty matters 
are difficult to digest, alkalies, especially the liquor potassaj with vegetable 
tonics, are indicated. When the bile is deficient, constipation and dys- 
pepsia are usual results, and are to be relieved by gentle mercurial purga- 
tives, with extract of taraxacum, and by remedies, such as rhubarb and 
especially the compound rhubarb pill, which, by acting on the duodenum, 
also favor the flow of bile into the upper part of the alimentary canal. 
Dr. Clay, of Manchester, has recommended in such cases the administra- 
tion of ox-gall, a remedy which, although not extensively given, is evi- 
dently rational, and calculated by its purgative action to be highly service- 
able. Excess of bile, on the other hand,* ought to be treated by drastic 
purgatives, diuretics, and diaphoretics, according to circumstances, to 
cause excess of excretion. Exercise should also be insisted on to call the 
lungs into action, and thus relieve the liver in its office of separating 
liydro-carbon. Part xxvii., p. 82. 
Prolonged Dyspepsia.—Dissolve two grains of strychnia in gj. of phos- 
phoric acid (P. L.) ; five minims of this solution may be given three or 
four times daily in cases of prolonged dyspepsia, and where the nervous 
system requires tone. Part xxix., p. 54. 
Deficient Secretion of Gastric Juice—Dr. Budd says: 
When the stomach is empty of food, it contains no gastric juice. The 
secretion takes place when food is brought in contact with its walls. 
When there is food in the stomach, and gasti’ic juice is required, the DYSPEPSIA. 
537 
nervous influence exciting the secretion may be deficient in energy, and 
the juice may be poured out in too small quantity for complete and easy 
digestion. 
[The depressing passions, fear and anger, lessen the secretion of the 
gastric juice. Sedentary and indolent habits, and the habitual consump- 
tion of more food than the system with such habits requires, also produce 
the same effect.] 
It has been clearly shown, by the experiments of Spallanzani and Dr. 
Beaumont, that the quantity of juice required for digestion is propor- 
tioned to the quantity of food. When gastric juice has dissolved a certain 
quantity of food, it is saturated, and can dissolve no more. The digestive 
power may, indeed, be restored, in a certain degree, by the addition of 
water, or by the addition of muriatic or lactic acid; but to carry diges- 
tion much further, there must be a fresh quantity of the juice. If, then, 
a man eats too frequently or too much, the gastric juice may be inade- 
quate for the proper and easy digestion of food, without any fault fairly 
attributable to the stomach. The organ is simply over-taxed. 
A necessary effect of an insufficient secretion of gastric juice is, of 
course, slowness of digestion. The food, instead of being completely 
digested, and passing out of the stomach, in two or three hours, remains 
undigested, or only partially digested, for a much longer time—it may be 
for twelve, or even twenty-four hours. The undigested portions of food 
remain in the stomach, and, during the slow process of digestion, there is 
a sense of weight or uneasiness at the pit of the stomach, which gradually 
lessens, and at length ceases, as the food gets dissolved and passes out of 
the stomach. If any portion of the food remain solid, there is often, at 
the end of some hours, when the stomach is getting empty, a distressing 
feeling of spasm, or cramp, at the pit of the stomach. 
If portions of food remain undigested many hours, they irritate the 
lining membrane of the stomach, and cause headache, a slightly furred 
tongue, and feelings of general disorder. 
The remedies for this habitual slow digestion, in persons otherwise 
healthy, are to be sought in proper regulation of the diet and habits of 
life, and in medicines which tend to increase the secretion of gastric 
juice. 
The diet should consist of food easily soluble, the stomach should never 
be overloaded, and there should be a sufficient interval between meals. 
Care should especially be taken to avoid new bread and tough meat, and 
not to oppress the stomach by malt liquors, or to indulge in femiented 
drinks of any kind beyond the point which, from habit or otherwise, the 
state of the nervous system may require. Bodily fatigue and nervous 
exhaustion should be avoided. A certain amount of bodily exercise and 
agreeable occupation of the mind, promotes digestion, and improves in 
various ways the general health. 
Various medicines — ipecacuanha, rhubarb, cayenne pepper—taken in 
small doses, stimulate the lining membrane of the stomach, and cause a 
more abundant outpouring of gastric juice, and may often be taken with 
advantage just before the principal meals by persons whose digestion is 
habitually slow. For example, from half a grain to two grains of ipeca- 
cuanha and three or four grains of rhubarb, or a grain of capsicum with 
three or four grains of rhubarb, in a pill, may be taken before dinner, or 
before breakfast and before dinner. 538 
DYSPEPSIA. 
Salt and mustard have an action on the coats of the stomach of the same 
kind. A large quantity of salt taken at breakfast will sometimes relieve 
the headache and much of the other discomfort that follows a debauch. 
Mustard, as is well known, promotes, with most people, the digestion of 
beef and other rich meats ; and its habitual use will occasionally be found 
greatly to mitigate the discomfort that results from a habitual slow diges- 
tion. 
These stimulants for the stomach—ipecacuanha, salt, mustard—when 
taken in considerable doses, are all of them powerful emetics. As a 
remedy for habitual slow digestion, ipecacuanha seems to me to be more 
effectual than any of the others. The dose of it should, of course, be too 
small to cause a feeling of nausea. 
A glass of water and a lump of sugar, after a meal, will sometimes 
relieve the uneasiness. The muriatic and nitro-muriatic acid taken half an 
hour before meals, are also useful. Alkalies must not be given, as they 
weaken the gastric juice. 
It often happens when the stomach is weak and disordered, or when 
more food is eaten than the healthy stomach can readily master, and espe- 
cially when at the same time it secretes an unhealthy mucus prone to ferment, 
that the undigested food in the stomach undergoes putrefactive changes, 
or some unnatural fermentative process, instead of proper digestion. 
One of the most remarkable properties of the gastric juice is that of pre- 
venting the putrefaction of meat. It likewise landers the lactic, acetic and 
alcoholic fermentations, which consequently do not occur in the stomach 
during healthy digestion. 
In some cases, the food undergoes common putrefactive changes, and 
sulphureted hydrogen is evolved. Distention and uneasiness of the sto- 
mach come on, with frequent eructation of sulphureted hydrogen—belch- 
ings as of rotten eggs. This is attended with severe frontal headache— 
often with a feeling of chillness—and other disorders familiarly known 
as the effects of surfeit. All this disorder is speedily removed when the 
stomach is emptied by a vomit. 
This kind of indigestion is a common effect of ovei’-eating, even in young 
and healthy persons, and hence is popularly known as a “ surfeit.” It is 
more prone to occur in persons with carious teeth, when offensive saliva 
passes into the stomach. 
It frequently occurs, too, as we have seen, in cancer of the stomach 
where offensive secretions are poured into the stomach; while the food, in 
consequence of an obstacle in the pyloric orifice of the stomach, or of 
some impediment to the free action of its muscular fibres, is unduly detained 
there. 
When a “ surfeit ” occurs in a young and healthy person, the quickest 
and best way of removing the disorder is to give an emetic, and so free the 
stomach from the putrefying matter ; and afterward, if need be, to empty 
the bowels by some quickly-acting purge. 
In malignant disease of the stomach, in which this kind of disorder is 
especially apt to occur, emetics, which irritate the lining membrane of the 
stomach, and may cause violent efforts of vomiting, are unsafe, and an 
attempt should rather be made to prevent the disorder by proper regula- 
tion of the diet. As charcoal has antiseptic properties, toasted bread may 
be taken instead of plain bread, toast and wrater instead of plain water, or 
a small quantity of charcoal in substance may be given. DYSPEPSIA. 
539 
Should the disorder occur in spite of precautions such as these, and sul- 
phureted hydrogen is given off, producing belchings like rotten eggs, 
half a minim of creasote may be given in a pill at the time of meals. If the 
fermentative change be accompanied by distention and eructation of ino- 
dorous gas (carbonic acid), nitro-muriatic acid and the stimulant dinner 
pills named will be useful. 
The fermentative processes in the stomach give rise to products which, 
when absorbed into the blood, have an injurious influence on the general 
health, and the frequent repetition of the indigestion prevents the proper 
nutrition of the body. The patient is usually depressed in spirits, is less 
capable than in health of mental exertion, and has lost some of his custom- 
ary energy and strength. It often happens that oxalic acid is one of the 
products of the unhealthy digestion, and that crystals of oxalate of lime 
may be found in the urine. In many such cases the indigestion itself re- 
sults from a faulty state of the general health, or from over-work, or 
depressing influences of other kinds. 
When thus arising, the flatulent distention of the stomach may some- 
times be prevented by the pills composed of ipecacuanha and rhubarb, or 
capsicum and rhubarb; but a remedy which succeeds more frequently is 
the nitro-muriatic acid—ten minims of each of the dilute acids twice a 
day—taken half an hour, or three quarters of an hour before the principal 
meals. 
Much good will result, also, from horse-exercise, change of air, and 
other influences which tend to improve the general health. 
The diet should be light and nourishing, and the patient should eat spar- 
ingly of succulent vegetables, fruits and saccharine substances in general, 
and should carefully abstain from ill-fermented malt liquors. 
A more common kind of fermentation in the stomach is the lactic, by 
which the starchy principles of the food are converted into lactic acid. 
This kind of fermentation, if fermentation it can rightly be called, is most 
common in nervous persons with feeble digestion, in wlfom it not unfre- 
quently happens that acid collects in great quantity in the stomach after 
meals. They often familiarly tell us, that almost everything they eat 
turns to an acid. If vomiting occur an hour or two after meals, the mat- 
ter thrown up is very acid, and, on analysis, the acidity has been often 
found to be mainly due to lactic acid. 
This lactic fermentation is not, like the kinds of fermentation before 
spoken of, attended with evolution of gas. It causes, therefore, not 
flatulence, but heartburn and pain in the stomach, which is often very 
severe, and which is sometimes attended with a feeling of constriction, or 
cramp. 
The uneasiness that results from undue acidity thus arising, may be re- 
lieved for the time by alkalies, and may often be prevented by giving, 
before meals, medicines which have an astringent or bracing effect on the 
coats of the stomach—bismuth and magnesia, or, better still, the mineral 
acids, especially the sulphuric acid. 
There can be little doubt that the same changes occasionally take place 
within the intestinal canal. Hydrogen is one of the gases that have been 
found in the intestines, and now and then the matter vomited by persons 
of weak digestion has the sour rancid smell of butyric acid. 
The acid and unnatural products of digestion may pass into the bowels, 
fret their lining membrane, and excite griping pain and purging j some 540 
DYSPEPSIA. 
noxious matters may be absorbed, and cause headache and other disorder; 
and if the indigestion recur frequently, the general health must sufier. 
Severe attacks of vomiting and purging, commonly designated English 
cholera, seem often the result of fermentation or putrefaction of food in the 
stomach, by which some highly-irritating matter is formed. 
There is no remedy so effectual in checking the disorder as pills com- 
posed of creasote and opium. Part xxix., p. 93. 
Indigestion arising from Defective Action of one of the Excreting 
Organs.—[The state of the nervous system not only influences the action 
of the stomach, but it is also affected by the condition of the blood, 
because from the blood are derived the secretions which assist in diges- 
tion :] Dr. Budd remarks: 
The stomach is in more direct relation with the liver than wTith any other 
important excreting gland. The stomach and the liver are parts of the 
same great apparatus, whose office it is to supply from the crude matters 
taken as food, fit material for the sustenance of the body. The action of 
the one organ is in some degree complemental to that of the other. 
If the secretion of the liver be defective, in consequence of deficient 
power in the organ, or in consequence of the congestion of it that results 
from high living and indolent habits, the functions of the stomach are 
almost invariably disordered, and, in conjunction with a slight yellow tinge 
in the conjunctiva and skin, there is a coated tongue, an impaired appetite, 
nausea and especial disrelish of rich dishes, constipation; and often, with 
this defective action of the stomach and liver, there is disturbed or unre- 
freshing sleep, and great depression of spirits. 
The remedies for this condition are, a light and simple diet, with water 
for drink; fresh air; exercise, to promote perspiration, without fatigue; 
and medicines that increase the secretions of the liver, bowels and kidney. 
A moderate dose of blue pill, repeated two or three times on alternate 
nights, and a drachm of sulphate of magnesia in infusion of senna every 
morning, answers well for persons strong enough to bear it. To others, 
fifteen grains of sesquicarbonate of soda, twice a day, with enough of the 
potassio-tartrate of soda to act gently on the bowels, or some other medi- 
cines of similar action, may be given with benefit. 
Again, when the kidneys imperfectly perform their office, so that urea 
and other constituents of the urine contaminate the blood, the functions of 
the stomach are generally more or less disordered. 
This is especially seen in advanced stages of Bright’s disease, when the 
kidneys are atrophied. The prominent symptom of the stomach disorder 
in such cases is nausea or vomiting. The vomiting is sometimes so fre- 
quent as greatly to interfere with nutrition, and is the only disorder of 
stomach complained of. In other cases, the ordinary effects of slow* 
and feeble digestion—a sense of weight and oppression after meals, with 
flatulent distention of the stomach, or undue acidity—coexist with the 
nausea or vomiting; and sometimes these effects of slow and feeble diges- 
tion exist alone. 
In chronic granular disease of the kidneys there are several conditions 
which tend to disorder the functions of the stomach. 
First, there is, perhaps, in many cases, as when the kidney is irritated 
by a calculus, a purely nervous influence starting from the kidney, which 
is reflected upon the stomach, and tends to derange it. 541 
DYSPEPSIA, 
In the next place, the gastric juice becomes vitiated by admixture with 
urea, and probably with other hurtful excrementitious matters. The mu- 
cous membrane of the stomach must be regarded as an expanded gland, 
destined to furnish abundant secretions, and, by virtue of its active 
secreting function, occasionally instrumental in eliminating noxious prin- 
ciples from the blood. It has been found, indeed, on chemical analysis, 
that, in malignant cholera, and in those diseases of the kidneys in which 
the secretion of urine is very defective, the matters vomited contain urea, 
or the muriate or carbonate of ammonia derived from the decomposition of it. 
The elimination of these foreign matters, or the reflex nervous influence, 
may, moreover, excite the secretion of gastric acid when there is no food 
in the stomach to dissolve ; or may cause congestion of the stomach, and 
thus lessen the supply of gastric juice ; or may lead, directly or indirectly, 
to an inflammatory condition of its lining membrane, and so not only les- 
sen the supply of gastric juice, but also cause a secretion of unhealthy mu- 
cous, which, from its proneness to ferment, is an additional source of gas- 
tric disorder. 
A stomach-disorder caused by some noxious matter in the blood, is apt, 
if it exceed certain limits, to be followed by an analogous disorder of the 
bowels. The cause of disturbance acts alike, though in different degrees, 
on the different parts of the intestinal canal. An illustration of this is seen 
in granular disease of the kidney, in which diarrhoea not unfrequently 
coexists or alternates with the gastric disorder, and in which the matters 
voided by the bowels, as well as those ejected from the stomach, have been 
found to contain urea. 
In granular disease of the kidney, the blood is always impoverished, and 
there is a source of further exhaustion in the abiding drainage of albumen 
from the system. It is very important, therefore, to remedy the disorder 
of digestion, and, so, in the greatest possible extent, to supply the waste. 
Not unfrequently, indeed, more relief can be given by remedying the sto- 
mach disorder than by any measures in our power that directly affect the 
kidney itself. 
The vomiting or nausea may generally be controlled by the dilute hydro- 
cyanic acid, which may be given in doses of four or five minims three 
times a day, and which may be conjoined with small doses of potash or 
soda, if any indications of undue acidity likewise exist. 
Another remedy, very effectual in controlling the vomiting, is creasote, 
of which a minim or less may be given, in a bread pill, three times a day, 
before meals. 
If these means should fail, the vomiting, and much of the associated gas- 
tric disorder, may often be stopped for a time by a few purgative doses of 
cream of tartar and jalap, which probably relieve the stomach by causing 
a more abundant elimination of the noxious matter by the bowels. This 
medicine is best given, as are most others of similar action, in a single 
dose sufficient for the desired object, in the morning, before breakfast, 
since it will then, in addition to the drain it causes from the mucous mem- 
brane, only sweep away the refuse of digestion ; whereas if it be given at 
other times or in repeated doses during the day, it sweeps away food that 
has been more or less digested, but the nutritious elements of which havo 
not been absorbed. 
When such impediments to healthy digestion exist, very great care should 
be taken in diet. 542 
These states of faulty assimilation are in some instances revealed to us 
by the condition of the urine. 
One of the most important of them, as far as digestion is concerned, is 
that characterized by the formation of lithic acid in undue quantity, and in 
which an excess of this substance exists habitually or frequently in the urine. 
This particular derangement of the nutritive processes often has its 
origin, as you know, in a peculiarity of constitution—the so-called lithio 
diathesis—which is permanent, and which is especially frequent in the 
members of gouty families, and in persons of middle age who lead the kind 
of life that conduces to gout; who eat, that is, large quantities of animal 
food, and drink freely of malt liquors. 
In such persons, occasional indigestion is very common—indigestion 
marked chiefly by excessive acidity of the stomach and heartburn, and by 
the condition of the urine, which contains a sediment of lithate of ammo- 
nia or lithic acid gravel, or which, without this, is high-colored, and more 
than commonly acid. With this acid indigestion there is often insufficient 
action of the liver, a bilious tinge in the complexion, costive bowels, a 
coated tongue, which sometimes dries at night, and heavy or disturbed 
and unrefreshing sleep. 
In this form of indigestion, much relief is given by alkalies, which neu- 
tralize the excess of acid in the stomach when digestion is over, and thus 
stop or j>revent the uneasy sensations to which it gives rise. The soluble 
alkalies do good also, and more permanent good, by promoting the secre- 
tion of the liver and kidneys. The bicarbonate of soda and the bicarbon- 
ate of potash are, in most instances, the best forms in which these can be 
given, and the best time for giving them, as was pointed out by Dr. Prout, 
is two or three hours after the principal meals. Fifteen grains of either, 
two or three times a day, is, in most cases, a sufficient dose ; and, if there 
be a sense of heat in. the stomach, this may be conjoined, as Prout recom- 
mended, with a few grains of nitre. 
At the same time, a few doses of blue pill may be given on alternate 
nights, further to promote the secretion of the liver, and colocynth, or 
colocynth with henbane, to keep up free action of the bowels. 
The use of alkalies should be continued for some weeks, and, if any 
gouty symptoms exist, a grain of acetous extract of colchicum may be 
given at night. 
Persons who suffer from this kind of indigestion should endeavor to 
promote the action of the lungs and the skin, and, with this object, should 
take active exercise, be much in open air, and sleep in an airy bed-room ; 
and they should live on a simple and abstemious diet—not eating too 
largely of animal food, and carefully avoiding ill-fermented malt liquors, 
rich dishes, heavy pastry, and cheese. Where total abstinence is not fea- 
sible, the alcoholic drinks best suited to them are pale sherry, in small 
quantity, or brandy, largely diluted with water. 
By such means the indigestion may often be stopped, the excessive 
acidity of the urine corrected, and the general health greatly improved ; 
but the disorders have their origin in a peculiarity which is constitutional 
and abiding, and they are, therefore, very liable to recur. 
Another faulty state of the general health attended with indigestion is 
now and then met with, in which the urine is apt to contain oxalic acid in 
considerable quantity, and to precipitate, on standing, the well-known 
octahedral crystals of oxalate of lime. 
DYSPEPSIA. DYSPEPSIA. 
543 
Dr. Prout supposed that a more than common disposition to the for- 
mation of oxalic acid in the system is indicative of a peculiarity of con- 
stitution ; and he expressed this supposed peculiarity by the term, oxalic 
diathesis. 
Oxalic acid exists in many plants, and may come to be present in the 
urine in several ways. 
It may be taken in the food; may escape conversion in the stomach, and 
after, its absorption in the blood; and may thus pass off in the urine, in 
combination with lime. 
Many vegetables contain oxalic acid in combination with alkalies or with 
lime. The stalks of rhubarb and sorrel, which are largely eaten in this 
country, contain it in considerable quantity in combination with alkalies. 
In some persons, the oxalic acid taken in these articles of food is changed 
in the process of digestion, or undergoes conversion in the blood by the 
influence of oxygen, and consequently does not pass off1, as oxalic acid, in 
the urine. In others, whose power of digestion is weaker, or in whom 
respiration is less active, the oxalic acid escapes conversion, and passes off 
in the urine in combination with lime. 
This may happen in persons who are in perfect health, and who have no 
marked tendency to the formation of oxalic acid in the system. With this 
occasional, and, if we may so term it, accidental presence of oxalic acid in 
the urine, we have nothing here to do. It may lead to the formation of 
a small calculus of oxalate of lime, and so have very serious results; but it 
does not denote any abiding disorder of digestion or nutrition. 
Oxalic acid may be formed in the body, and, as Dr. Garrod has shown, 
its presence may be detected in the blood when none of it is taken in 
the food. 
To the patient nothing seems amiss in the urine. He complains only of 
his indigestion and its accompanying ailments. It is the form of this indi- 
gestion that we have now to consider. 
It presents no striking or distinctive characters. The appetite is often 
good, sometimes more craving than in health ; digestion is not slower than 
it should be; there is no pain, no sense of oppression or weight at the 
stomach immediately after meals; there is seldom vomiting or heartburn, 
but much discomfort is caused by flatulent distention of the stomach, es- 
pecially two or three hours after a meal, when the stomach is getting 
empty, and sometimes there is pain in the stomach at that time. With 
this flatulent distention of the stomach there are often uneasy sensations 
in the belly, which seem to result from flatulent distention of the duodenum 
or the colon. 
The disorder of digestion is usually associated with other symptoms of 
constitutional disorder, and especially with nervous symptoms. The pa- 
tient in most cases grows somewhat thinner, is weak and readily fatigued, 
sleeps badly, is troubled with palpitation, is irritable in temper and de- 
pressed in spirits, and often hypochondriacal in a high degree, and has, or 
fancies he has, deficiency of sexual power. Frequently, too, he has a 
wearing pain, or a sensation of uneasiness across the loins, and empties his 
bladder more frequently than in health—symptoms resulting probably 
from irritation of the urinary organs by the passage of the oxalic acid 
through them. 
In some cases there is evidence of defective or faulty nutrition of the 
skin in a scaly eruption or a succession of boils. 544 
DYSPEPSIA. 
These ailments vary greatly in degree in different cases. In some, they 
are very trifling ; in others, the restlessness at night and the mental de- 
pression unfit the patient for his usual occupations, and render his life 
miserable. They are none of them peculiar to the disorder we are 
considering. Taken together, indeed, they often form a group that is 
tolerably significant; but the only sure evidence that oxalic acid is in 
excess, is the presence of numerous crystals of oxalate of lime in the 
mine. 
The urine then is always acid, generally more acid than in health; in 
most cases of an amber color and transparent, and of moderate or rather 
high specific gravity. If allowed to stand in a conical glass vessel, a 
light cloud of mucus may form at the bottom, but there is often no other 
deposit. 
In some cases, however, together with oxalate of lime, the urine con- 
tains an excess of urea, and is of higher specific gravity than in health ; or 
it contains an excess of lithic acid, or of lithate of ammonia, and these 
substances are deposited at the bottom of the glass. 
The crystals of oxalate of lime are not visible to the naked eye, except 
when many of them are entangled in a dense cloud of mucus at the bottom 
of the glass, in which case they can sometimes be seen as minute glistening 
points: but may, as Dr. Golding Bird first showed us, in all cases be 
readily discovered by the help of the microscope. The detection of them 
is important, because it throws light on the nature of the disorder, and 
may determine the plan of treatment. 
A disposition to such recurring derangements of the general health, and 
to the formation of oxalic acid in the system, may—like the disposition to 
gout, diabetes, and other kinds of faulty assimilation—either be inherited, 
or be induced, where no inherited tendency to it exists, by cex-tain external 
conditions or habits of life. 
The conditions which Dr. Prout assigned as most conducive to it, are: 
residence in a damp or malarious district, the too abundant consumption 
of sugar, the depressing emotions of anxiety and grief, exhausting bodily 
or mental labor, long courses of mercury, excessive smoking, and, indeed, 
all other circumstances that seriously depress the vital powers. 
The indigestion, and the various other ailments that result from this 
general derangement of health, are much under control. 
The remedy of most efficacy, where the urine is free from a red 
deposit, is the nitro-muriatic acid, which often prevents the formation of 
oxalic acid after a few days, lessens the flatulence and the palpitation, 
and makes the sleep quiet and the spirits more cheerful. From eight to 
twenty minims of each of the dilute acids may be given twice a day in 
a glass of water, half an hour before breakfast, and half an hour before 
dinner. 
It was long ago known that niti'ic acid, or the nitric and muriatic acids, 
have occasionally great efficacy in indigestion; but it was Dr. Prout who 
rendered our knowledge on this point precise, and showed that it is in the 
particular form of indigestion we are considering, and in persons in whom 
there is a disposition to the formation of oxalate of lime in the urine, that 
they are especially of service. 
The mineral acids have a tendency to cause a deposit of lithic acid, or 
of lithate of ammonia, in the urine, and when such a deposit exists, it is 
seldom advisable to give them longer. DYSPEPSIA. 
545 
All ailments that result from faulty assimilation, and that depend pri- 
marily on peculiarity of frame or constitution, are very liable to recur. 
If, therefore, the mineral acids should prove of service, they may be had 
recourse to again and again on each recurrence of the same disorder. 
If the tongue be clean, some of the light bitter tonics may be given with 
advantage in conjunction with the mineral acids. 
When the urine from the first has a deposit of lithic acid or lithate of 
ammonia, the mineral acids should not be given. 
The best substitute for them is the carbonate or the aromatic spirit of 
ammonia. 
Where there is want of sleep, and great nervous irritability, and much 
flatulence and palpitation, the tincture of henbane, or the dilute hydrocy- 
anic acid, or some other sedative, may be given with advantage in con- 
junction with either of the medicines just mentiond. 
So much for the remedies which the Pharmacopoeia supplies. 
The proper regulation of the diet is equally important. Dr. Prout, con- 
sidering the excessive use of sugar as one of the causes of this disorder 
of health, laid it down as a rule, tha,t saccharine articles of food, and 
particularly sugar, should, as much as possible, be avoided; and that 
the diet should consist chiefly of animal food, and the stronger farinaceous 
matters. 
lie advises also, that the patient should abstain as much as possible from 
alcoholic drinks, and that, when he cannot abstain entirely, he should 
select, in preference to others, sherry or brandy, properly diluted with 
water. In some cases, however, these are too heating, and sound malt 
liquor, or hock, or claret, may be substituted for them. 
It is very important, also, that the patient should change for a time his 
habits of life. If he is an inhabitant of a large city, and exhausts himself 
with mental or bodily labor, country air, rest, and recreation, are often 
sufficient of themselves to restore the health. Part xxix., p. 98. 
Remedies for Indigestion.—Dr. Budd gives us some very good hints 
on the different medicines used in cases of dyspepsia; and first on the 
use of 
Ipecacuanha.—This medicine increases the secretions of the stomach, 
and is to be taken before meals in cases of slow digestion—where food lies 
heavy on the stomach, and there is an inability for mental or bodily ex- 
ertion for some time after meals—a kind of disorder which is especially 
common in men of middle age, or beyond it, who lead sedentary lives. 
Ipecacuanha owes its efficacy in such cases to its exciting peristaltic 
action in the stomach, and imparting an energy to its glands. It should 
be given in the morning fasting, and in quantity sufficient to occasion a 
slight feeling of vermiculating motion in the stomach, but without causing 
any sensation of pain or nausea. The quantity requisite to produce this 
effect varies in different persons, from a quarter of a grain to two grains. 
Small doses of rhubarb, ginger, and pepper, have a similar kind of 
action, and may be given singly or together for the same purpose. 
With many, a favorite remedy for the discomfort resulting from slow 
digestion is a grain of cayenne pepper, with three or four grains of rhu- 
barb. The best time for giving medicines for the purpose in question is 
iust before dinner, and before any other meal after which a sense of op- 
pression is usually felt. 546 
DYSPEPSIA. 
Bismuth.—[This medicine is useful in painful digestion, accompanied 
with cramp or violent pain in the stomach after meals.] 
It is often of signal service, as Odier remarked, in the functional dis- 
orders of the stomach that are so common in women who are ill fed and 
over-worked, or exhausted in any other way, and especially where the 
stomach is very irritable, so that pain and vomiting occur very soon after 
meals. 
It is an efficient remedy when pain in the stomach, with increased 
secretion of gastric acid, occurs from tuberculous disease of the lung, or 
from some irritation elsewhere ; and in infants, where this kind of disorder, 
with exhausting diarrhoea, results from the irritation of teething, or from 
improper food, or from the change of diet on Aveaning. 
Against the pain in the stomach and vomiting, that result from simple 
ulcer and other forms of organic disease, it is only of use occasionally 
when the stomach secretes an unhealthy mucus, or when there is an ex- 
cessive or untimely secretion of gastric juice. 
It is of little use in the indigestion that depends on gout, and that oc- 
curs in well-fed and plethoric men. 
It is of no use in the uneasiness of the stomach that results from slow- 
ness of digestion or a scanty secretion of gastric juice. 
It is best given, suspended in water, a short time before meals. Ten 
grains, three times a day, is, in most cases, an efficient dose ; but it may be 
given, as Odier discovered, in much larger quantity, without any ill effects. 
Bismuth may often be given with advantage with other medicines— 
with opium, or magnesia, or chalk—which allay pain or neutralize an ex- 
cess of acid, or restrain undue secretion. 
Chalk, and the vegetable astringents—kino, catechu, krameria, and 
logwood—are generally given to restrain diarrhoea. It does not seem to 
be generally known that they are just as effectual, perhaps more effectual, 
in restraining undue secretion from the stomach. 
Chalk, like bismuth, from its sparing solubility, has little direct action, 
except on the mucous membrane over which it passes. The vegetable 
astringents have a more remote astringent influence. This is clearly seen 
in the colliquative stage of phthisis; where, besides restraining the diar- 
rhoea, and stopping the vomiting with increased secretion of gastric acid 
that often occurs in this state, they restrain, often in a very striking de- 
gree, the profuse sweating. 
They seem all to have much the same effect. 
The most grateful to the taste is krameria; the most effectual is log- 
wood. Logwood has a mawkish taste, which is best corrected by cin- 
namon. 
An ounce of logwood shavings, and a drachm of powdered cinnamon, 
may be infused for four hours in ten ounces of boiling water, and then 
strained. An ounce and a half of the strained infusion may be given two 
or three times a day, a short time before meals. 
Hydrocyanic acid is also used when there is pain in the stomach, or 
vomiting, [but must not be given when inflammation or ulceration are 
suspected.] 
It is of most service in the gastralgia, and in the sympathetic vomiting, 
that occur in nervous persons from irritation elsewhere, without inflam- 
mation or ulceration of the coats of the stomach, and without undue secre- 
tion of gastric acid. DYSPEPSIA. 
547 
Given alone, or in conjunction with soda, it is the most effectual 
remedy we know of for the gastralgia that is apt to occur when the 
stomach is empty of food, in nervous persons who have been subjected to 
exhausting influences; and for the vomiting that results from granular 
disease of the kidney. 
It is of no use when pain or vomiting results from an inflammatory con- 
dition of the stomach. 
It aggravates pain and vomiting when these symptoms are caused by 
an ulcer, or when they depend on excessive or untimely secretion of gas- 
tric acid. It often, for example, increases the vomiting that occurs in 
phthisis, which alkalies and the vegetable astringents will prevent. 
When there is undue acidity of the stomach, it may, however, often be 
given with advantage in conjunction with soda or potash, when it would 
not be of service if given alone. The alkalies neutralize the excess of acid, 
and the sedative influence of the hydrocyanic acid is then exerted. 
Part xxix., p. 104. 
Dyspepsia, accompanied with Oxalate of Lime in the Urine.—A solid 
animal diet with little bread and vegetables, no fruit, very little sugar, or 
vegetable acid. Give the mineral acids. These do for oxalate of lime 
what the alkalies do for uric acid deposits. Give each acid separately. 
Give dilute sulphuric acid when an astringent is wanted, as in colliquative 
perspiration, menorrhagia, hemoptysis, and diarrhoea: hydrochloric acid 
when digestion requires assisting. The stomach liberates this acid for the 
purpose of digestion. Give both this and the dilute sulphuric acid before 
the meals. Give dilute nitric acid when the secretion requires to be in- 
creased ; it is the opposite of sulphuric acid in its action. Sulphuric acid, 
therefore, astringes; hydrochloric promotes digestion; nitric promotes 
secretion. To prevent these acids acting on the teeth, wash the mouth 
out with a teaspoonful of aromatic spirit of ammonia in a little water 
immediately after taking them. They should all be taken on an empty 
stomach. Part xxix., p. 318. 
Dyspepsia.—In cases of irritative dyspepsia of some standing, when the 
digestion is painful and imperfect, give from fifteen to twenty minims of 
lactic acid in half an ounce of water at meal times. Lactic acid may also 
be used to improve the tone and power of the stomach generally. 
Part xxx., p. 59. 
Dyspepsia, Atonic.—When accompanied by acidity and foul eructa- 
tions give chloride of calcium, liquor calcii chloridii, one drachm three 
times a day, in a little water. Part xxxi., p. 92. 
Treatment of Dyspepsia.—When there is a good deal of uneasiness 
about the arch of the colon, or lower part of the abdomen, two or three 
hours after taking a meal, owing to the passage of the food over the mor- 
bidly increased irritable mucous membrane in that part, the greatest 
advantage will be derived from the following medicine: R Tinct. cinchon. 
co., 3iss.; tinct. calumb., 3iss.; tinct. nucis vomica?, §ss. M. A dessert 
spoonful three times a day, an hour before meals. In children a combina- 
tion of soda with rhubarb will answer almost as well. Dr. Ross continues: 
When the only symptom is loss of appetite, without any discomfort at 
the stomach, sulphuric acid, with small doses of quinine, often suits well, 
or the infus. gentian, co. with liquor potassae. If there is also constipa 548 
DYSPEPSIA, 
tion, a mild aperient must be given daily, or it may be combined with the 
mixture: R Magnes. sulph., gj.; acid, sulph. dil., 3j-; tinct. gent, co., gj.; 
aqua? fo.j. Sum. gj. ter in die. 
Where the appetite is good, but there is a want of digestion, to restore 
the gastric secretion, nothing answers the purpose better than pulv. 
ipecac, in half-grain or grain doses, twice a day, or combined thus: R Pulv. 
ipecac., gr. ss-j.; pulv. rhei, gr. iij.; ext. gentian., gr. j. M. ft. pil. 
To be taken twice a day, shortly before breakfast and dinner. 
If there be simple acidity, give alkalies until relieved, and afterward 
vegetable tonics. The following are good formulae : R Inf. gentian, co., 
§ij.; aq. calcis, gij.; tinct. hyoscyam., 3j. M. two or three times a day. 
R Aq. calcis, 3vij.; sp. ammon. aromat., 3ss.; tinct. liyosc., 3ss.; magnes. 
carb., Bj. M. Draught twice a day. 
For pyrosis, bismuth proves an excellent remedy. R Bismuth, ox., Bij-; 
magnes. carb., 3j.; pulv. aromat., 3ss.; mucilag., gj.; t. opii, 3j.; aq. 
cassia?, gv. M. Take two tablespoonfuls when the pain is severe. 
When the eructations are tasteless or rancid, acids do most good; the 
nitro-muriatic acid, with half a drop of creasote, before meals, answers 
well. 
When there is morbid irritability of the stomach, prussic acid has the 
most decided good effect; it blunts the morbid sensibility, and may be 
given with bitter infusion, as the following; R Acid, hydrocyan. 
(,Scheele’s,) gtt. xvj.; tinct. calumba?, gss.; aq. font., giiiss. M. gss. three 
times a day. If with the pain there be also acidity or heartburn, give : 
R Acid, hydrocyan. (Scheele's,) gtt. ii-iij.; soda? carb., Bj-5 tinct. gentian 
co., 3ss.; aq., gj. M. Three times a day. If the vomiting be severe and 
continued, the following will be often found effectual: R Acid, hydrocyan. 
(,Scheele's,) gtt. ii.-iij.; creasot. gtt. i.-ii.-iij.; sol. morph., gtt. xx.; sodse 
carb., gr. xx.; aq., giss. M. In simple vomiting from atony, calumba is 
an admirable remedy: R Infus. calumba?, 3vj.; liq. potass., 3iss.; tinct. 
humuli, 3iij-; aq. piment., giss. M. One or two tablespoonfuls twice or 
thrice a day. The next best remedy to prussic acid is nitrate or oxide of 
silver, { or t a grain three times a day. If the pain does not come on 
until one or two hours after a meal,Dr. Abercrombie’s prescription answers 
admirably: R Ferri sulph. gr. ij.; pulv. aloes, gr. j.; p. aromat., gr. v. M. 
Three times a day. 
In anaemic dyspepsia, the usual treatment for ana?mia must be enforced. 
Sulphate of iron, as in Abercrombie’s formula, or in pill with quinine, 
camphor, and ext. aloes, answers very well. Of the sympathetic affec- 
tions, disorder of the heart’s actions is, perhaps, the most frequent; for 
this the principal remedies are iron and nitrate of silver: R Arg. nit., 
gr. iij.; p. opii, gr. iij.; pulv. rhei, gr. xij.; ext. humuli, gr. xij. M. Ft. pil 
xij. One three times a day. 
In flatulent dyspepsia, if it be not of an inflammatory character, you 
will effect much good by the following: R Pulv. Gregorii, p. aromat., aa. 
gss. M. Half a teaspoonful twice or thrice a day, stirred in a little hot 
water. But you must both regulate the bowels and strengthen the diges- 
tive organs by tonics; for this purpose the following answers very well: 
R Assafcetidas, gr. xxxvj.; p. rhei, gr. xij. ol. cajeput. gtt. xij. M. ft. pil. xij. 
R Infus. cliirettse, gxj.: tinct. zingib., gj.; t. hyosc., 3\j- M. Two of the 
pills to be taken every night at bedtime, and two tablespoonfuls of the 
mixture morning and midday. If the patient is distressed by the tyui- 549 
DYSPEPSIA. 
panitic distention, give half a teaspoonful of powdered ginger, in four 
ounces of hot water, and apply a hot flannel, sprinkled with turpentine, 
over the epigastrium. Part xxxii., p. 85 
Dyspepsia.—Lactic acid may be advantageously substituted for pepsine 
in many cases of dyspepsia. It reduces animal fibre to a pulpy state in a 
much shorter space of time than does the so-called pepsine. It must be 
of chemical purity and uniform strength. It should be taken during a 
meal, in doses of from half a drachm to two drachms, in infusion of 
calumba or a little cinnamon water. 
Pepsine, Lactic Acid.—Though lactie acid possesses no power of diges- 
tion by itself, it plays a very important part in acidifying the gastric juice, 
and should on that account be mixed with the pepsine given medicinally, 
in about the proportion of two grains of hydrated lactic acid to fifteen of 
Boudalt’s pepsine. Part xxxv.,p. 300. 
Dyspepsia.—In excessive acidity and flatulence of the stomach, regulate 
the quantity and quality of the food, keep the bowels open by some warm 
aperient, as a pill of rhubarb or capsicum, just before dinner. To afford 
temporary relief, give a few grains of bicarbonate of soda, about an hour 
after meals. Let the drink be water, and if a stimulant be required, a lit- 
tle brandy or sherry well diluted. In that form of heartburn or cardialgia 
which occurs in nervous persons and in depressed states of the system; to 
afford temporary relief, give a little carbonate of soda after meals, with 
bismuth, hydrocyanic acid, or morphia; but a permanent cure can only be 
effected by invigorating the system by preparations of valerian, iron, and 
quinine. If pyrosis be present, we can check it by astringent medicines, 
as bismuth, kino, etc. Nitrate of silver, or nux vomica, as recommended 
by Dr. Budd, is very useful. If the diet has been too poor we must 
improve it before we can expect any change. This symptom is often 
accompanied by severe pain, which is best relieved by sedatives, as hydro- 
cyanic acid, with which a little carbonate of soda may be combined. In 
all cases of dyspepsia no medicines can effect a cure unless great attention 
be paid to diet, which should consist of plain dressed animal food, chiefly 
roasted, and eaten slowly, with a small proportion of well-boiled vegeta- 
bles. Fat, fried, baked, or stewed meats should be avoided, also pastry, 
salads, acid or dried fruits, pickles, fermented liquors, and rich fish, as sal- 
mon or herrings. Sedentary habits should be avoided. 
Gastrodynia may ocour, 1st, When the stomach is empty. This depends 
on acrimony of the digestive fluids; it is relieved by taking food, or by 
alkaline remedies, as aromatic spirit of ammonia or magnesia. 2d. Imme- 
diately after taking food; then it generally arises from chronic inflamma- 
tion, or morbid irritability; or, 3d, it may begin from two to four hours 
after a meal; then it is generally from a similar state of the duodenum. 
(N. B. From the seat of the pain do not mistake it for disease of the 
liver.) This will be best relieved by the administration of aloes, lime- 
water, bismuth, and opiates, combined with rhubarb. 4th. It may occur 
at uncertain intervals, in most violent paroxysms, with a feeling of disten- 
tion, much anxiety, and great restlessness. This depends on over-disten- 
tion of the stomach, or may sometimes be seated in the arch of the colon, 
and is best relieved by carminatives, or by a strong injection. Ilydrocy- 550 
DYSPEPSIA. 
anic acid is a most valuable remedy in these cases, also opium, and hot 
stupes should be applied externally. 
A sense of fullness or flatulence of the stomach after meals will be pre- 
vented by taking a pill of four grains of rhubarb with one of capsicum, 
before meals. If the patient loathes the sight of food, give sulphate of 
quinine or pepsine. If the dyspepsia be accompanied by much debility and 
nervous irritability, sulphate of zinc, in doses of a grain, gradually 
increased, given three times a day, as recommended by Dr. Golding Bird, 
will be of most value. Part xxxvi., p. 82. 
Subcarbonate of Bismuth.—Instead of the insoluble subnitrate of bis- 
muth, use the subcarbonate, which is readily soluble in the gastric juice, 
and neutralizes the acids which are found in excess in the stomach, in 
which respect the subnitrate fails. The subcarbonate seems to be seda- 
tive in its action during the first days of its employment, and subsequently 
to have a tonic influence. It is peculiarly suitable in cases of dyspepsia in 
which the tongue is red and pointed, or the digestion laborious, and 
accompanied with putrid or acid eructations. In the vomiting and diar- 
rhoea of children it is of much use. It should be given before meals, and is 
perfectly insipid. Part xxxvi., p. 285. 
Dyspepsia.—Vide Selections from Favorite Prescriptions, Art. 
“ Medicines.” 
Dyspepsia—Saccharated Lime.—The ordinary lime-water in use is far 
too weak a preparation to develop to advantage the therapeutic properties 
of lin.e. Now lime combines with sugar, forming a soluble saccharate of 
lime, the solution of which is sufficiently strong to act as a valuable tonic 
and antacid. For practical use, the following is the best mode of prepara- 
tion : Slake eight ounces of quick-lime; rub up with it five ounces of white 
sugar; add one pint of water; stir for some time, till the hard stiff masses 
which the sugar and lime are liable to run into are as much as possible dis- 
solved : then filter. The product should be perfectly clear, and of only a 
slightly yellowish tint. A solution made in this way will contain eighteen 
grains of lime in every ounce by weight, and altogether about one hundred 
and six grains of solid matter to the ounce. This may be given in doses 
of from twenty or thirty to sixty minims or more, in a glass of water, two 
or three times a day. This solution is a powerful antacid, and probably 
the best we have, since it is stronger and pleasanter than magnesia, and 
instead of weakening digestion, like the alkalies, one of its most important 
uses is as a tonic of the alimentary system in cases of obstinate dyspepsia. 
As such, its action is much more powerful than that of the vegetable 
stomachic tonics. It is particularly serviceable in gouty constitutions. It 
is not in the least constipating like chalk, but affords a very valuable 
means of overcoming gradually that chronic constipation which is so fre- 
quent an accompaniment of dyspepsia. Part xl., p. 295. 551 
EAR. 
EAR. 
vcorrticea—Gruber’’s Ear Speculum—Lapis Divinus.—In our exami- 
nation of the ear we have frequently the greatest difficulty in obtaining a 
minute inspection of the whole of the membrana tympani. Mr. Curtis has 
introduced into this country the speculum used by Gruber, which differs 
from that of Kramer and Itard, in having the handles so made that they 
can be detached from the shield, which can be left in the meatus by itself. 
By this means the surgeon can make use of both his hands, and the 
speculum is a sure protection to the parts while the operator is manipulat- 
ing. By the assistance of Gruber’s lamp, which has a strong reflecting 
lens attached, by which the light is thrown powerfully into the passage and 
upon the membrana tympani, the condition of the parts can be more 
accurately ascertained than by any other means hitherto adopted. Mr. 
Curtis also brings before the profession a very excellent composition for 
curing discharges from the ear, called lapis divinus, composed as follows : 
“ Take of sulphate of copper, nitrate of potass and alum, of each sixteen 
parts, powder them separately, and then mix them well together; fuse 
them in a glass vessel in a sand bath, and add one part of powdered 
camphor ; break the mass into pieces when cold.” Mr. Curtis uses a so- 
lution, consisting of two drachms of this lapis divinus in one ounce of dis- 
tilled water; a drachm of the solution being added to six ounces of rose or 
distilled Avater constitutes the injections, which he generally uses twice a 
day. It is well to begin with a weak solution, and gradually increase the 
strength according to the effect. Thus used, it acts as a mild stimulant 
and astringent. Part iv.,p. 102. 
In deafness, owing to a relaxed and engorged state of the mucous lining 
of the eustachian tube, a gargle of alum produces retraction of the swollen 
mucous tissue—i. e., of its vessels—after which, on blowing the nose forci- 
bly, air is found to penetrate into the cavity of the tympanum. 
Part vi., p. 33. 
Otorrhcea.—The following recommended as an injection : 
R Creasote; Liquor potassae, aa., one drachm; water, six ounces. M. 
Use frequently. Part viii., p. 163. 
Otorrhcea.—Mr. Wilde, of Dublin, has written a most excellent treatise 
on the causes and treatment of otorrhoea, chiefly dwelling on the affections 
of the external tube and external surface of the membrana tympani. There 
are few diseases which are more frequently neglected and carelessly 
treated than those of the external ear; and few which, when allowed to 
proceed, entail more inconvenience on a patient during the remainder of 
his life. In simple otorrhoea Mr. Wilde paints over the surface with a so- 
lution of nitrate of silver, ten grains to the ounce, applied with a fine 
camel’s hair pencil, either to the whole or a portion of the surface according 
to the extent of the disease. This is repeated every third day, and in the in- 
terval the ear is syringed night and morning, and oftener if the discharge is 
copious, with plain tepid water, by means of a gum elastic bag, which, when 
used by friends, is much preferable to the usual piston syringe, and at night 
a slightly astringent lotion is dropped into the ear till it fills up the meatus, 
and allowed to remain there for a few minutes. For this purpose we may 
use liq. plumbi diacet. 3j. to one ounce of water or rose water ; or weak so- 552 
EAR. 
lutions of alum, copper, or chloride of lime. But otorrhoea is often ex- 
ceedingly difiicult to cure, owing to its being caused by morbid vascular 
growths, such as granulations on the membrana tympani, which are 
allowed to proceed undiscovered. In such a case the part appears quite 
red and vascular, and Mr. Wilde recommends the application of the solid 
nitrate of silver rubbed over the part about every second day, or oftener 
if necessary ; and for this purpose he uses a very neat little instrument 
which is five and a half inches long, consisting of a silver tube, cut sjfirally 
for three-fifths of its length, and having an aperture on the side near the 
extremity. In using this porte-caustic, a little nitrate of silver is melted 
over a lamp on a small platina ladle, and then, when about cooling, the 
end of the porte-caustic is dipped into it till the aperture and extremity are 
filled and coated over with the caustic. We often find, however, that dis- 
charges from the ear are kept up by polypi, which it becomes necessary 
to remove; and for this purpose Mr. Wilde recommends a little instru- 
ment, first recommended, we believe, by Mr. W. Robertson, surgeon to 
the Kelso Dispensary. It is a small snare-like apparatus, consisting of a 
fine steel stem, with a movable bar sliding toward the handle. It is so 
constructed that a noose made of fine silver or platina wire may be pushed 
down to the polypus, so as to surround and insnare it. The morbid 
growth may thus be safely and cautiously taken away, either in part or 
wholly, and by the regular application of the armed porte-caustic from day 
to day, all trace of the growth may ultimately be extinguished. 
Part ix.,/>. 158. 
Extraction of Foreign Bodies from, the Ear.—On this subject Mr. 
Chitty Clendon offers some ingenious suggestions as to the formation of 
the particular kind of forceps required. He says : 
In the cases I have referred to, it appeared to me that the difficulty was 
increased by the unsuitable form of the instruments employed. In many 
of them the extremities of the blades were flat on the grasping surfaces, 
and so thick and clumsy that it was difficult, even if were possible, to in- 
troduce them between the walls of the cavity and the substance to be re- 
moved; and in all of them the width of the blades increased toward the 
joint; the external orifice consequently pressed on them, and closed the 
instrument, by the time it reached the substance, and every attempt to 
grasp it rendered the difficulty still greater, by pushing it further into 
the passage. As I have given some attention to the construction of 
tooth-forceps, I thought I oould plan an instrument which would entirely 
obviate the difficulties I have enumerated. The forceps I have made for 
this purpose pass freely into the ear, until they meet the opposing sub- 
stance, and then, opening the handles, the slightly concave extremities 
act as dilators, and will securely grasp a substance which has previously 
choked up the passage; while the blades at the orifice diminish, rather 
than increase in width, even when open to the full extent. This instru- 
ment has been seen by Sir Benjamin Brodie, who was much pleased with 
it, and requested to retain it, in order to have one made for liis own use. 
It is equally well adapted to grasp a pea, a cherry-stone, or piece of slate- 
pencil, substances most frequently introduced by children, as large masses 
of indurated wax ; and I think it would also be found useful in removing 
small polypi from the nares. Part ix., p. 182. 
Nervous Peafness—Dr. Debreyne mentions a simple remedy for nervous 553 
EAR. 
deafness, which may deserve notice. Let the patient fill his mouth with 
the smoke of tobacco, or of any other dry aromatic plant—sage, for exam- 
ple—and then make a forced expiration, while the mouth and nostrils are 
closed: this should be done several times in the course of the day. The 
smoke enters the eustachian tube, and thus produces a slight stimulant 
effect upon the internal ear. The remedy can do no harm; and this is say- 
ing a good deal in its favor, considering the nature of many of the means 
of acoustic medication. It is best suited to those cases where the deafness 
has supervened on some catarrhal complaint, and whenever we have reason 
to believe that the pharygneal end of the eustachian tube has become thick- 
ened or obstructed. Part x.,p. 26. 
Electro-Magnetism in Tinnitus Aurium. — Cautiously pass a very 
mild magneto-electric current from the mouth of the eustachian tube to 
the external auditory passage. Part xvi., p. 109. 
Acute Myringitis.—In acute inflammation of the membrana tympani, 
the vascularity is generally seated in the true fibrous membrane of that 
structure, and is usually the result of cold, and often attributed to rheu- 
matic diathesis; sudden exposure to a low temperature, blasts of harsh 
cold wind, diving in the sea, foreign bodies, and irritating substances intro- 
duced into the external ear, etc. The auditory canal, and sometimes even 
the auricle, is engaged; and although we are not able to observe the pre- 
cise pathological condition of the cavity of the middle ear, or its investing 
membrane, there can be little doubt but these parts, sooner or later, par- 
ticipate in the general inflammatory action. 
The dermal structure of the membrana tympani also partakes of the ab- 
normal action, and, together with that of the auditory canal, pours out a 
muco-purulent secretion, or even pus itself, is occasionally raised into vesi- 
cles, becomes the seat of pustules, ulcerates, throws out granulations, and 
becomes thickened, etc., during the progress of this disease. The true 
fibrous membrane passes through all the pathological changes to which 
such structures are liable from inflammatory action or its results ; and al- 
though the precise anatomical condition of the two may not be analogous, 
yet the diseases of the cornea and of the membrana tympani bear a remark- 
able analogy, particularly in the subsequent appearances of vascularity, 
thickening, opacity, morbid deposits, etc., which they present, together 
with adhesions by bands of membrane to the parts within the chambers, to 
which they form the external boundaries. 
In these cases, besides heat, pain, and slight redness of the auricle, and 
in severe cases heat, pain, fullness and oedema over the mastoid region, we 
find by examination with the speculum, that there is slight tumefaction of 
the lining membrane of the external meatus, with cessation of its cerumi- 
nous secretion. 
The membrane also becomes swollen, and upon its surface we occasion- 
ally find vesicles, pustules, ulcers, or even small abscesses; there is exuda- 
tion of muco-purulent secretion, with detachment of the cuticle; and ulti- 
mately perforation of the membrana tympani may take place, from rupture, 
sloughing, or ulceration. 
Treatment.—Keep the patient in a warm room or in bed; cup from the 
nape, or still better, apply four or six leeches, by means of a leech-glass, 
immediately around and within the external meatus, having previously in- 
serted a morsel of cotton wTool; or to the mastoid region, or behind the 554 
EAB. 
ramus of the jaw. Hold the ear over very hot water, medicated with hy- 
oscyamus, opium, belladonna, etc. Or apply a warm linseed poultice, re- 
newing it every two or three hours. In the advanced stages apply blisters, 
and dress them with mercurial ointment. Together with these measures, 
give mercury ; and subsequently iodide or bromide of potassium, or bark. 
Never pour any liquid, either stimulating or sedative, into the ear. 
Part xvi.,y>. 236. 
Myringitis—Subacute.—Give mercury so as to produce a steady and 
gradual effect, and keep the mouth sore until there is a decided amend- 
ment ; give the preparations of iodine, and apply counter-irritation over the 
mastoid process. If there is ulceration, touch the part daily with a solu- 
tion of lunar caustic. To relieve the tinnitus aurium, give tincture of the 
flower and leaves of arnica, beginning with fifteen drops of the tincture in 
a tablespoonful of infusion of arnica, with a little cordial tincture, thrice a 
day; gradually increasing the dose to thirty drops, unless headache or gid- 
diness be produced, when the medicine must be discontinued. And for the 
arrest of secretion of the cerumen, apply the soft brown citrine ointment, 
in a melted state, to the external meatus, with a soft brush. 
Part xvii., p. 203. 
Deaf ness of Elderly Persons.—It generally depends upon thickening 
of the mucous membrane and membrana tympani. When this is the case, 
apply the solution of nitrate of silver (from half a drachm to two drachms, 
to the ounce of distilled water) to the meatus externus, to the extent of 
half or two-thirds of its length, every third or fourth day; in some cases, 
also, apply a weaker solution (six grains to the ounce) to the membrana 
tympani itself. When there are symptoms of much congestion in the ear 
apply leeches just below the meatus. If there is much irritation of the ex- 
ternal tube, apply tincture of iodine, or an ointment composed of half a 
drachm of powdered cantharides and an ounce of cerate, below or behind 
the ears, daily, or every other day. When there is relaxation of the 
mucous membrane of the fauces, use astringent applications. At the same 
time give very gentle alterative doses of pil. hydrarg., hydrarg. c. creta, or 
hydrarg biclilor. And let the patient take plenty of open air exercise, 
avoid close rooms, live moderately, and have a warm bath every week or 
ten days. Part xix.,y>. 211. 
Deafness, from Perforation of the Membrana Tympani.—Try the 
pellicle of collodion, as an artificial tympanum, where such a connivance is 
needed. Having got a portion of the pellicle of the required form, attach 
its edges to the side of the meatus, by means of a small brush, armed with 
the collodion in solution. Part xix., p. 318. 
Eustachian Tube— Obstruction of the.—To ascertain the condition of 
the Eustachian tube, it is recommended to use an instrument resembling a 
flexible stethoscope, one end of which covers the auricle of the patient, 
while the other is received into the ear of the surgeon. When the instru- 
ment is applied, the patient is to make a forced expiration; and by the 
sound produced, the surgeon judges of the patency or obstruction of the 
canal. Part xxi., p. 271. 
Meatus Auditorius—Foreign Bodies in the.—Do not attempt their ex- 
traction by forceps or director, but use a syringe large enough to hold two 
or three ounces of water. If such a syringe is used, and the water injected EAE. 
555 
with considerable force, the foreign body may always be removed from 
the meatus, and that without risk of injuring the wall of the canal or the 
membrana tympani. Part xxi., p. 272. 
Otorrhoea, with Perforation.—In the muco-purulent discharge which 
pours out in otorrhoea, if globules of air can be distinguished in it, it is a 
positive and unfailing evidence of an opening existing in the membrana 
tympani. Part xxv.,p. 261. 
Treatment of Deafness by Glycerine.—[Mr. "VYakley brings forward 
further proof of the efficacy of this remedy in certain forms of deafness. 
He says:] 
The class of cases to which I would draw attention in this report, are 
those of cuticular or epithelial thickening of the meatus, either partial, 
affecting the membrane of the tympanum, or complete, being continued 
over the entire auditory cul-de-sac. There is a greater or less degree of 
deafness corresponding with the amount of thickening; cessation of the 
secretion of cerumen ; frequently tinnitus, or a “ singing and hissing sensa- 
tion ” in the ears, and tickling irritation of the meatus. The causes are, 
constitutional predisposition, advanced age, chronic inflammation, long- 
continued discharge following eruptive fevers and the applications of escha- 
rotics and irritants. Amongst the latter, I would mention oily prepara- 
tions, the globules of which adhere to the sides of the meatus or membrana 
tympani and become rancid, thus producing a very frequent cause of in- 
flammation. Upon examination of the affected ear, we find the meatus 
.shining and inelastic, of a pearly whiteness, the membrana tympani either 
clouded or streaked, sometimes having small elevations upon it. The 
meatus is quite dry, the ceruminous glands being choked up by the epi- 
thelial growth. 
The mode of application of the glycerine, when treating this state of the 
ear, is as follows: The meatus is well cleansed with tepid water, and then 
dried by means of the forceps and cotton. Glycerine is now poured into 
the meatus, and a plug of gutta percha, softened in boiling ivater, made to 
lit the external opening; this takes the exact form of the ear, becomes 
hard, and effectually prevents either the entrance of atmospheric air or the 
exit of the glycerine. The ear should be examined daily, and the same 
process repeated. The lining membrane can be examined with a blunt 
silver probe, passed gently through the speculum auris, to ascertain the 
effect of the glycerine upon the cuticular thickening. The meatus will 
gradually lose its shining pearly appearance, and softened pieces will fall 
oft’, and can be removed either by the forceps or gentle syringing. The 
practitioner should never attempt to tear them away, but allow them to 
come away by the means just stated. The treatment occupies ordinarily 
from two to four weeks, and is generally without any pain or inconvenience 
of any kind to the patient, and the results, in some cases, have been very 
gratifying. In the after-treatment the patients are directed to moisten the 
auditory canal at least once a week with glycerine, applied by means of a 
camel-hair brush ; this will generally prevent a recurrence of the cuticular 
thickening. 
The modus operandi is simple enough—the glycerine being kept con- 
tinually in contact with the part, acts mechanically, either absorbing or 
penetrating the epithelial coating, and separating the individual particles 
The frequent introduction of the glycerine tends to restore the external 556 
EAB. 
meatus to a healtliy condition, and fit it for the proper transmission of 
sound. 
[Mr. Wakley warns us against procuring impure glycerine.] 
Part xxv., p. 262. 
jEar—Disease of.—Mr. Wilde gives the following: 
Condyloma of the External Meatus.—M. D. L., a female, 25, suffering 
from deafness, tinnitus, occasional pain, fetid and sometimes bloody dis- 
charge from left ear for eight months; is otherwise healthy; attributes her 
affection to cold. The external meatus is completely closed by several 
condylomata which grow around its margin, but particularly from its lower 
edge. They are rather sensitive to the touch, lobulated on their surface, 
project a considerable distance beyond the margin of the aperture, and are 
a little more florid in color than the natural skin. When the tragus is 
pressed backward with the finger, a muco-purulent and offensive discharge 
exudes between these growths. It is not possible to insert even a small- 
sized speculum into the meatus without causing great pain and irritation. 
She could only hear the watch on touching. The right ear was normal. 
They were touched with the solid nitrate of silver, after which a poultice 
was applied. The subsequent treatment consisted in washing over the 
morbid growths with a strong solution of nitrate of silver every second or 
third day, and in the intermediate time keeping a dossil of fine lint, wet 
with diluted liquor plumbi, applied to the concha, besides the internal ad- 
ministration of Plummer’s pill and sarsaparilla. By persisting in this treat- 
ment for upward of two months, the condylomata disappeared, leaving 
the meatus natural, when the membrana tympani was found unimpaired, 
and the hearing was restored. 
I have seen a case of cutaneous cancerous ulceration, extending from 
beneath the zygoma, which had quite eaten away the tragus, completely 
occluding the external meatus; but the most common causes of the dis- 
eases are eczematous and herpetic eruptions, and chronic erysipelas. 
Enlargement of the sebaceous follicles in the concha are frequently 
present in pale, cachectic persons, laboring under aural diseases. They 
are easily recognized by their dark heads, and can be pressed out with a 
pair of forceps. 
Besides eczematous eruptions, other cutaneous diseases affect the auricle, 
particularly in children. You are all aware of the excoriations which take 
place in infants behind the ears during dentition, and of the popular belief 
that they are salutary. Cleanliness is their chief cure, when it is advisable 
to heal them up. We have a disease in Ireland so prevalent that it would 
appear to be one of our national maladies—pemphigus gangrenosis. So 
fatal is this disease among children, that no less than 17,799 deaths have 
been attributed to it in ten years ; and as it is a disease very well known 
to the lower orders, I am inclined to think that the amount has not been 
exaggerated. It goes under different local names, but the most common 
are “ mortifying hive,” “ burnt hole,” and “ black ear;” the latter from its 
so frequently appearing behind the ears and upon the auricles. In the 
Irish it is styled ithcheadh, or the eating disorder, from its phagedaenic 
character. The vesicles, or bullae, peculiar to this affection, generally leave 
an indelible irregular lace-like depression, similar to that of vaccination. 
We meet with various other growths in the external meatus and audi- 
tory tube, independent of polypus or other morbid products, resulting 
from inflammation or its consequences. One" of the most frequent of these EAR. 
557 
is exostosis, of which I have seen very many examples. The projection 
generally grows from the posterior edge of the osseous portion of the tube, 
and slowly but gradually projects forward, so as to leave but a slight cres- 
cent-shaped fissure between it and the anterior wall of the meatus. The 
integuments covering such growth are generally very smooth, white and 
polished. I have never seen this disease affect both ears, but I have often 
remarked it in connection with inflammatory affections both of the external 
tube and the membrana tympani. We had lately at the hospital a young 
woman in whom the external meatus was closed by a dense membrane 
through which, when an incision was made, a probe introduced into the 
wound came in contact with the bone. As the patient had never heard 
on that side, and had never suffered from any aural disease in infancy, as 
well as from the circumstance of there being no bony meatus, we must 
consider that case as one of congenital defect, of which there are several 
similar examples on record. I have on two occasions, in private practice, 
seen a stricture of the auditory tube at the junction of the membrano- 
cartilaginous and osseous portions, in one instance so small as only to ad- 
mit the round extremity of an ordinary dressing probe. Hardened ceru- 
men having accumulated behind it, it was with great difficulty removed. 
Part xxvi.,y>. 306. 
Cause of Deafness not hitherto Described.—Prof. Syme relates the 
following: 
W. T., aged 17, was admitted into the Royal Infirmary on account of 
severe pain and deafness of his left ear. On looking into it, I saw at the 
bottom of the tube a small white body, apparently composed of bone, but 
so extremely sensitive of pressure, that a satisfactory examination could 
not be accomplished until the patient was placed under the influence of 
chloroform. It was then ascertained that the growth possessed on osseous 
consistence, and as it did not so fully occupy the cavity as to prevent me 
from introducing the point of the small polypus forceps, I by this means 
easily effected its extraction. It was similar in size and form to the half 
of a small split pea, and had adhered to the side of the cavity by a narrow 
neck. The patient sustained no inconvenience, and immediately regained 
his hearing; while the pain, which had been so severe for the preceding 
three months as to render him unable to follow his employment, completely 
ceased. Part xxvii.,y>. 164. 
Artificial Tympanic Membranes.—In 30 or 40 cases where the mem- 
brana tympani had been perforated, and in consequence of which the 
sonorous undulations did not strike the tympanum with sufficient force, 
Mr. Toynbee, with great benefit, closed the tympanum by artificial means. 
To construct these artificial membranes, he iised thin layers of vulcanized 
India-rubber or gutta-percha. The septum was passed down, and adjusted 
by means of a fine wire or stem of some other material. All symptoms of 
inflammation should be carefully reduced before they are applied. 
Part xxviip. 165. 
Simple Method of ascertaining, icithout the use of the Catheter, whether 
the Eustachian Tubes are Pervious.—The common mode of exploring the 
Eustachian tube by the catheter produces pain and discomfort, and requires 
great experience in its use. The plan also of attempting to distend the 
tympanum by a forcible expiration, while the mouth and nostrils are kept 
closed, is by no means always successful. 558 
EAB. 
Mr. Toynbee says: If the mouth be shut, and the nostrils be held 
closed by the finger and thumb, and then the act of swallowing be per- 
formed, a sensation of fullness or pressure is experienced in each ear ; and 
this sensation does not disappear upon the removal of the pressure from 
the nose, but it vanishes at once when the act of swallowing is again per- 
formed, while the mouth and nostrils are open. During the first act of 
swallowing, a small quantity of air was forced into the tympanic cavities 
through the Eustachian tubes, and it therein remained until the second 
act of swallowing again opened the tubes and permitted the air to escape. 
The muscles whereby the Eustachian tubes are opened, are the tensor and 
levator palati, which, it is well known, take origins from the cartilaginous 
walls of the tubes. As, during the act of swallowing with closed mouth 
and nostrils, air is forced through the Eustachian tubes into the tympanic 
cavities, it is evident that the permeability of these tubes can be ascer- 
tained by making the patient swallow some saliva while the mouth and 
nose are shut. Nor need the surgeon depend upon the statement of the 
patient respecting the sensation of distention felt in the ears; for by listen- 
ing with the otoscope, should the Eustachian tubes be pervious, the air 
will be distinctly heard to enter the tympanic cavities, and produce a gentle 
crackling sound. 
The treatment recommended is such as shall tend to reduce the 
thickened mucous membrane of the guttural orifice of the Eustachian tubes 
to a healthy state, so that their muscles may be able to open them. For 
this purpose, besides the use of general remedies, the solid nitrate of silver, 
or a strong solution of hydrochloric acid, may be applied to the mucous 
membrane of the fauces and to the apertures of the tubes, and gentle 
counter-irritation is to be kept up over the region of the fauces. By these 
measures, as a general rule, the mucous membrane can be reduced to its 
natural state, and the tubes become again opened by their muscles. 
Should this not take place, the Eustachian catheter may now and then be 
introduced and air be gently blown through it. A modification, in the 
shape of the Eustachian catheter, is suggested—viz., that it should be oval 
instead of round, the advantages derived being, that it not only can be 
passed through the nose with less discomfort to the patient, but its 
presence in the Eustachian tube is much less disagreeable, from the absence 
of the convex surfaces which, in the rounded catheter, press against the 
nearly flat surfaces of the tube. In conclusion, the author expresses his 
concurrence in the opinion of Harvey and Kramer, that enlarged tonsils 
are never the cause of obstruction in the Eustachian tubes, and that any 
benefit that may have followed their extirpation, has arisen from the 
loss of blood consequent upon the operation. Part xxvii.,jt?. 107. 
Treatment of Otorrhoea.—“ Otorrhoea,” a terra which Dr. Toynbee 
endeavored to abolish on account of its great ambiguity, has its most fre- 
quent origin in five different diseases of the ear, viz.: 
1. Catarrh of the dermoid meatus. 
2. Polypi. 
8. Catarrh of the dermoid layer of the raembrana tympani. 
4. Ulceration of the fibrous layers of the raembrana tympani. 
5. Catarrhal inflammation of the tympanic mucous membrane, with per 
foration of the raembrana tympani. 
Dr. T. says: The insertion of cotton-wool into the meatus, in any of the EAE. 
559 
four first-named diseases, is likely at once to aggravate the symptoms by 
pressing against the delicate parts, which are the seat of inflammation. 
In fact, any of these four affections may be produced by the irritation fol- 
lowing the presence of a foreign body in the meatus. A patient at the 
present time under my care, who had been suffering for some time from 
chronic catarrh of the dermoid layer of the right membrana tympani, had 
acute inflammation induced, accompanied by sexrere cerebral symptoms, 
by the introduction of cotton-wool down to the outer surface of the mem- 
brana tympani. The most active anti-inflammatory treatment was 
requisite to put a stop to the irritation. In the course of a few days, the 
surface of the dermis, which had become of a bright-red color, and 
was covered with granulations, assumed the appearance usual in this 
disease. 
The use of cotton-wool in any of the three first-named diseases, is still 
more irrational when, as is often the case, they are sympathetic, and 
merely the result of irritation in the deeper cavities of the ear. Thus, 
very frequently, chronic inflammation of the mucous membrane lining the 
tympanum, accompanied by chronic disease of the bone, produces catarrh 
of the dermis lining the external meatus, the membrana tympani remain- 
ing entire, the discharge being purely sympathetic. A case of this kind, 
ending in death, recently occurred, under Dr. Sibson’s care, at St. Mary’s 
Hospital. I have already published a case, in which death rapidly 
occurred from the internal inflammation produced by mechanically irritat- 
ing the meatus under such circumstances; and I have no hesitation in 
saying, that the introduction of any foreign substance into the meatus, in 
similar cases, is likely to be productive of the most serious results. Very 
frequently catarrhal inflammation of the dermoid meatus is a symptom of 
obstruction in the Eustachian tubes, and it ceases immediately that the 
tubes are made pervious. Such cases are, however, called cases of 
“ otorrhoea,” and the ears are filled with cotton-wool. 
But if the introduction of cotton-wool into the external meatus is an 
irrational and unsafe proceeding in cases where the discharge originates in 
one of the four above-named diseases in the external meatus, its use 
becomes quite unjustifiable when there is a perforation in the membrana 
tympani, and the discharge originates in catarrh of the mucous membrane 
of the tympanum. After careful study of the subject for some years, and 
after examining a very large number of diseased specimens, the conclusion 
to which I have arrived is, that the cause of death in cases of catarrh of 
the mucous membrane of the tympanum and mastoid cells is the retention 
of the discharge / so long as there is a free outlet for the discharge, the 
mucous membrane does not ulcerate, and the petrous bone does not 
become carious. I have placed upon record a large number of cases cor- 
roborative of this important fact, and its accuracy is daily becoming more 
manifest, yet, in face of it, a system of treatment is l'ecommended, which 
has the effect of shutting up the discharge in the tympanic cavity; for 
what other effect can the presence of a portion of cotton-wool in the lxaeatus 
produce ? Even in the use of so delicate a membrane as the artificial 
membrana tympani, where there is much discharge from the mucous mem- 
brane of the tympanum, I insist upon the removal of the whole of the dis- 
charge, by means of a syringe, twice or thrice daily. 
In conclusion, it must be palpable to every medical practitioner that the 
only rational way to treat the diseases attended with discharge from the 560 
EAK. 
ear, is in the first place to ascertain their cause and nature. Sometimes 
the affection is purely local, and the use of a slightly astringent lotion, of a 
solution of nitrate of silver, or the removal of a polypus, rapidly puts a 
stop to the affection. Other cases have a constitutional cause, and it is 
impossible to arrest the discharge, nor is it wise to attempt to do so, until 
the constitutional tendency has been successfully combated. 
Part xxxii., p. 215. 
.Artificial Membrana Tympani—New Form of.—Make a perfect model 
of the meatus in wood : its end should be flat, and cut obliquely. This, 
previously oiled, should be dipped six or eight times into a solution of 
gutta percha in chloroform, until a film of the thickness of oiled silk 
is formed, which must then be peeled off the model in one unbroken 
piece, and if properly made, it will fit the meatus comfortably, and may be 
readily removed and replaced when necessary to clean it. It should not 
be allowed to protrude, but cut so as to lie entirely within the meatus. 
Part xxxiii., p. 225. 
Erectile Tumor of the Ear cured by the external Application of the Per- 
chloride of Iron.—[From the following case, we learn that the external 
application of a solution of the perchloride of iron exercises a coagulating 
power on the blood, even when applied on the surface of an erectile 
tumor.] 
The tumor involved the greater portion of the external ear, and was 
rapidly increasing; pledgets of charpie dipped in a solution of the per- 
chloride, were applied to the surface, and maintained with a bandage. 
The fluid was thus brought in contact with the irregularities of the surface ; 
the application was changed three times a-day, and was persevered in for 
two months. First the tumor ceased to enlarge, then it gradually dimi- 
nished in size, and when the child cried, the tumor no longer swelled out. 
A cure was obtained at the end of two months; the skin remained of a 
dark-brown color. Part xxxiv., p. 195. 
Artificial Tympanum.—The introduction of cotton-wool into the ear 
frequently fails to give relief, owing to its not being properly applied. 
Mr. Yearsley recommends a piece of cotton to be attached to a thread and 
drawn through a silver tube, about two inches long, so as to bring the 
cotton against the extremity; then wet the cotton, introduce it, and move 
about at the bottom of the passage until it reaches the spot at which the 
hearing is improved; the thread may then be let go, and the tube with- 
drawn. Part xxxv., p. 146. 
Eustachian Tube—Obstruction of the.—When the tympanum is 
healthy, obstruction of the eustachian tube from a thickened and con- 
gested faucial membrane, can in several cases be removed by general 
measures. The patient must take abundant and active exercise in the 
open air; the throat must not be wrapped up closely by handkerchiefs; 
flannel should be worn next the skin, and the patient should have a cold 
plunge bath every morning, though, if it be a young child, the body may 
be rubbed instead with a coarse wet towel. The most efficient local treat- 
ment is the application of the nitrate of silver. This is best applied in the 
solid form, and a holder can be contrived so as to be bent at such an angle 
that the caustic may be applied directly to the opening of the tube. 
Though temporary benefit is derived from the use of the eustachian ECRASEUR. 
561 
catheter, yet its effects being rather to increase the congestion, its use 
should be avoided. But if after a time no benefit be derived from the 
above general and local treatment, the catheter may be introduced 
as it may facilitate a cure by removing mucus from the tube, or by sepa. 
rating the lips of the faucial orifice. Dart xxxvi., p. 210. 
Removal of Foreign Rodies from, the Ear.—Dr. Archibald recommends 
the following as a very effectual procedure: Upon the back of a circular 
piece of isinglass or court-plaster, two lines in diameter, a piece of thread 
twelve or fifteen inches long is to be attached by a very narrow strip of 
the same material, placed at right angles over the thread. When this is 
dry, a piece of muslin or cotton cloth is to be torn, two inches long, and 
broad enough to be rolled around both arms of the thread into a cylinder 
of required size and firmness. The ends of the thread should next be 
drawn so as to bring the plaster upon the extremity of the cylinder, 
around which one end of the thread may be wrapped, to keep it from 
unfolding. The meatus should now be freed from moisture, by means of a 
little lint or cotton ; and the surface of the plaster should be wetted and 
applied to the foreign body. Adhesion will take place in five or ten 
minutes, and then the body may be removed with the plaster. 
Part xl., p. 179. 
ECRASEUR 
Description of.\ and Uses.—This instrument consists essentially of 
a chain ligature and a constricting apparatus, by means of which it may be 
progressively tightened. It has been most successfully and extensively 
used in the removal of hemorrhoidal tumors. A strong ligature is first put 
round the base of the tumor; this done, the chain is applied, and made to 
cut its way through by gradually tightening. If the tumor completely 
surround the anus, an instrument, composed of six hooked branches, is in- 
troduced into the extremity of the bowel. The crotchets expand at plea- 
sure and stick into the tumor, by which it can be well brought down, and 
the ligature and chain applied as before. A considerable tumor may be 
removed in ten or fifteen minutes, with very slight loss of blood. It has 
been employed for the removal of cancerous affections of the tongue, by 
making a small incision in the mesial line under the chin, and introducing 
the instrument through this. Amputation of the neck of the uterus and 
removal of uterine polypi have been performed with the ecraseur; also 
amputation of the penis, circumcision, operation for the radical cure of 
varicocele, etc. The ecraseur is greatly superior to the ligature, its action 
is more rapid, the pain less, there is less inflammation, less suppuration, 
less risk; the wound heals rapidly, and there is an immunity from many 
dangers attending wounds, so says its inventor, but we have reason to 
doubt that this is always the case. In operations involving the whole cir- 
cumference of the anus there will be danger of occlusion if a pledget of 
lint be not introduced into the intestine, or there may be danger of stric- 
ture afterward from contraction of the cicatrix; these objections should 
make us hesitate to employ the ecraseur for the removal of tumors encir- 562 
ELECTRICITY. 
cling the anus. In many respects it is superior to the ligature, and for 
the removal of vascular tumors is superior to the knife, but it will never 
supersede either to any extent. ’ Part xxxiv., p. 285. 
Ecraseur—Mode of applying, etc.—The essential step in the use of this 
instrument obviously is, to form a peduncle, if the part does not already 
possess one. In a flat tumor on the surface, the best plan is, if possible, to 
raise it well up from the subjacent tissues, and pass several long, curved 
needles in different directions across and under its base ; a ligature must 
then be tied behind these, and thus a neck formed for the chain. 
If the mass be very large, or, if it be so bound to the underlying tissues 
that it cannot be raised up, or, if it extend into a canal, as into the rectum, 
then this chain is first carried under the part in one of its diameters, and 
made to split in two at its utmost depth, when each lateral part is, if ne- 
necessary, treated as a separate tumor, as above recommended. When 
the chain is firmly in its place, to avoid inconvenience, the ligature may be 
cut away. 
A superficial incision through the skin is sometimes advisable, as it offers 
great resistance. Or, to save integument, it may be reflected from the 
sides of the tumor, before the instrument is applied. Oiling the chain 
considerably facilitates its action. The instrument must be used with 
great gentleness, at the same time it must be held firmly, which is of much 
moment in the avoidance of hemorrhage, for which end it must likewise 
be used very slowly, allowing from a quarter of a minute to a minute to 
elapse between each movement. Part xxxv.,p. 81. 
Ecraseur.—In Paris, many surgeons, in using the ecraseur, substitute a 
soft cord of strong hemp, instead of the chain, as it is believed to cut with 
less contusion ; and an instrument with a screw is said to be preferable to 
one with a lever handle. Part xxxvi., p. 290. 
ELECTRICITY. 
Therapeutical Uses of the Electric Current.—This is an agent which 
has hitherto been prescribed empirically, and chiefly as a last resource, 
when other remedies have failed. M. Matteucci, from his researches, is 
induced to think that paralysis and tetanus are the diseases in which it is 
most likely to prove beneficial. 
Matteucci thinks that the electric current may be of great use in some 
cases of paralysis and tetanus. It is well known that an electric current, 
transmitted through a nerve for a certain time, destroys its sensibility. It 
will regain its sensibility by repose, but it has been ascertained by Matteucci 
that if an electric current be passed along the nerve in a reverse direction, 
the sensibility will be restored in a much shorter time. Another circum- 
stance noticed by Matteucci is this, that if the nerve of a living animal be 
submitted to the passage of the electric current, renewed at short intervals, 
tetanic contractions are excited, and if the experiment be continued for 
some time, the nerves entirely lose their sensibility. These facts may be 
usefully applied to some cases of paralysis, and it is possible that passing 
the electric current in a reverse direction to the usual course of nervous 563 
influence, may in some degree hasten the restored sensibility of those 
nerves which are only functionally disordered. Here, however, we must 
be aware that the current in nerves sensation and nerves of motion 
would be in opposite directions. Again, we must remember that to con- 
tinue the electric current too long would only increase the evil. 
Part xi., p. 83. 
JSfeio Electro-Magnetic Machine, adapted so as to give a Succession of 
Shocks in one Direction.—The ordinary galvanic machines have this dis- 
advantage : they give a rapid succession of shocks, which alternate in their 
direction ; for example, at each vibration of the armature, or at each make 
and break of the primary current, a shock is produced by reason of an 
induced or secondary one; but it happens that these two shocks pass in 
opposite directions ; that from the make, for instance, going one way, while 
that from the break goes in the other, so that in effect they just neutralize 
their remedial,powers. 
[Dr. Letheby says:] 
It will be always found that the break shock is felt more severely than 
the other, and this suggests its application to affections of the sensitive 
nerves; while the other may be used whenever motor action is impaired, 
or where the sensibility of the part is rather acute, as in the affections of 
the eye, etc. Another principle to be kept in view is, to pass the current 
in the route of the vis nervosa, that is, from the centre to the periphery, in 
motor paralysis, but from the extremities to the centres when the sensitive 
nerves are affected. If this important principle is not borne in mind, we 
cannot expect ever to do much good in the application of electricity or 
galvanism. Part xv., p. 81. 
Electrical Cloth.—A convenient form of application is by simple friction 
with “ the electrical cloth,” a species of pyroxyline, made by digesting 
cotton or linen cloth in nitro-sulpliuric acid. Part xvii., p. 289. 
Electro-Galvanism.—Electro-galvanism may be considered as a stimu- 
lant to the nervous system, a stimulant to the most minute fibrillm, to the 
most delicate nervous texture, and likewise to the neurilema, or sheath of 
the nerves, promoting speedy absorption, so that, should the sheath, or 
even investing membrane, of any nervous fibre be thickened or enlarged 
by extravasation, or any other means, by stimulating the nerves, promoting 
absorption, and removing the obstruction, the part will assume a healthy 
action. Sometimes chronic inflammation, or even disease, becomes estab- 
lished through the want of nervous energy to restore a healthy function, 
so as to bring the different tissues composing membranes, or even other 
portions of the frame, to a normal state and to a proper degree of healthy 
action. Such may be the condition of the parts after a sprain ; the liga- 
ments have been lacerated, the synovial membrane injured, the tendons 
and their thin sheaths more or less bruised, the cellular tissue distended 
by extravasation; and it requires a large, or an increased action of the 
nervous power to restore these several parts to their former condition; 
but, should the joints so sprained be previously in a weakened state, a 
larger quantity of nervous power still will be required to bring about a 
cure. 
Electro-galvanism is an agent which produces absorption quicker than 
any medical means that we are acquainted with ; and this can be clearly 
proved by its application to indolent tumors, as it very frequently causes 
ELECTRICITY. 564 
them to be absorbed most readily. After other means have failed, electro- 
galvanism will completely cure some indolent tumors. A lady residing 
near Harrow applied to me on account of an indolent swelling, situated be- 
neath the undei part of the right side of the lower jaw. The tumor occu- 
pied the space between the side of the inferior maxillary bone and os 
liyoides ; all the usual means were employed for the absorption of the 
swelling, but without success. The electro-galvanic spark was then applied 
about once in a week, or once in ten days, on account of the distance she 
resided in the country. In the course of a short time the tumor began to 
diminish, and ultimately she was quite cured. Many tumors have been dis- 
persed by the aid of this agent; but it may be here mentioned, that more 
success has attended its application after medicinal means have been pre- 
viously employed. In fatty tumors no benefit has been observed to occur 
from its use; but in glandular swelling, experience has proved to me that 
it may be of the greatest service. 
In cases of obstinate stricture, it has been employed with much advan- 
tage, producing more speedy relief than any other means that we can use 
in our surgical treatment. Not only do these observations hold good in 
stricture of the urethra, but also in some severe cases of stricture of the 
rectum. 
Indolent ulcers, and even scrofulous sores, frequently result from the 
want of a proper nervous energy in the part; a want of tone in the nerves 
to produce a power sufficient to cause them to heal and promote a healthy 
action. 
Ulcers may have a modified current passed through their whole surface, 
even if ever so extensive; and medicinal agents may, if necessary, be em- 
ployed by the same means, which will produce the utmost benefit. 
In cases of sciatica, after blisters, colchicum, morphia, warm baths, acu- 
punctui’ation, and where all the usual remedies have failed to give relief 
electro-galvanism may be safely recommended with every chance of suc- 
cess. Part xix.,j9. 308. 
ELECTEICITY. 
Electricity by Induction.—Formerly electricity could not be applied to a 
diseased" part without endangering the healthy organs, and sometimes the 
whole nervous system. By Dr. Duchenne’s method, electricity can be local- 
ized in one part, without irritating another; Dr. Duchenne has been pleased 
to call his method “ Faradization,” consecrating to this method of electriza- 
tion the name of Faraday, who discovered the important phenomena of 
induction. 
When the skin and the excitors are perfectly dry, and the epidermis 
very thick, as it is in many people whose professions expose them to the air 
and hard work, the two electric currents coming forth from an apparatus 
of induction reunite themselves on the surface of the epidermis without 
penetrating the skin. They produce sparks and a special crepitation, but 
no physiological effect whatever. When dry excitors are put on the skin, 
where it is sensible to electricity, the one subjected to the experiment 
feels a superficial sensation coining out of the skin, and varying according 
to the intensity of the current from simple tickling to the acutest pain. 
But when the skin and the excitors are wet, neither sparks, nor crepitation, 
nor sensation of heat, are produced, but different phenomena of contrac- 
tility or sensibility are obtained, according as one acts on a muscle, or on 
a nerve, or on the surface of a bone. In the last case a very strong pain of ELECTRICITY. 
565 
quite a peculiar character is produced, and it is not allowable to put wet 
excitors on the surface of the bones. When the excitors are put on the 
surface of one muscle, the contraction of this muscle is produced, together 
with a sensation, which is not peculiar to the skin, but always accompanies 
the electro-muscular contraction; for instance, when one acts on a muscle 
laid bare by a wound, and no more covered by the skin. Finally, when 
the excitors are put on the surface of a nerve, the contraction of all mus- 
cles animated by this nerve is produced. 
There are, therefore, two different modes of electrifying the muscles— 
either by concentrating the electric action in the nervous plexuses or 
branches, which communicate their excitation to the muscles animated by 
them (“indirect muscular Faradization”); or by directing the excitation 
on only one muscle (“ direct muscular Faradization”). In both ways the 
skin and the excitors must be wet. On the muscles of the trunk and most 
of the limbs wet sponges are applied, thrust in metallic cylinders, which are 
screwed on insulating handles. For limiting the electric power in the mus- 
cles of a smaller surface, as the muscles of the face, the interossei and lumbri- 
cales, conical metallic excitors are used, which are likewise screwed on 
insulating handles. These excitors are then covered by wet leather ; for ex- 
ample, fingers of gloves. 
Indirect muscular Faradization requires exact knowledge of the anato- 
mical position of the nerves. In the arm, the electric power can be limited 
to the median nerve on the inner and inferior third of the humerus; to the 
ulnar nerve on the interval between the olecranon and the internal condyle. 
The radial nerve is accessible to Faradization at the junction of the two 
upper thirds with the lower third of the humerus ; the musculo-cutaneous 
in the axilla. On the thigh indirect muscular Faradization is easier. The 
crural nerve is to be found in the groin, outside of the femoral artery; the 
two popliteal nerves in the popliteal space. The sciatic nerve is only ac- 
cessible to Faradization on its origin in the pelvis, through the posterior 
wall of the rectum. 
In the other parts of the body, indirect muscular Faradization becomes 
difficult and delicate. On the face, the trunk of the seventh pair, covered 
by the parotid gland, is inaccessible to electricity, whatever may be the 
intensity of the current. But it can be reached, where it passes out of the 
stylo-mastoid foramen ; here an excitor is to be placed in the external open- 
ing of the ear; in this point the nervous trunk is separated from the excitor 
only three or four millimetres. Its branches may be excited at the points 
where they emerge from the parotid gland. Contraction of the muscles 
being under control of these branches, is the certain signal of their electric 
excitation. 
In the supra-clavicular region, the excitors, placed immediately over the 
collar-bone, act on the brachial plexus. On the summit of the supra-clavi- 
cular triangle they are in connection with the external branch of the 
eleventh pair. This nerve, the respiratory nerve of Bell, is the most ex- 
citable of all the nerves of the human body. The lower half of the sterno- 
cleido-mastoid and the trapezius are very little excitable. But when a very 
feeble current is directed on the upper half of the sterno-cleido-mastoid, or 
on the external border of the upper half of the trapezius—a current, indeed, 
which would riot be expected to produce any movement in the muscles at 
all—the head is strongly inclined to the side acted upon, and the shoulder 
drawn up by a violent and sudden movement. 566 
ELECTRICITY. 
The muscles, like the nerves, do not all possess the same degree of ex- 
citability. 
Some muscles are so extremely sensible, that Faradization is occasionally 
impracticable. Electro-muscular sensibility is very lively in the muscles of 
the face, due to the ramifications of the fifth pair, which excite these mus- 
cles. It is important to avoid always the points corresponding to the infra- 
orbital and submental nerves, the excitation of which gives a very painful 
sensation. The most excitable muscles of the face are the frontal muscle 
and the orbicularis palpebrarum ; the least so, the buccinator and the mas- 
seter. Of the neck, the platysma myoides is just as excitable as the upper 
half of the sterno-cleido-mastoid and the external border of the upper half 
of the trapezius. The most excitable muscles of the trunk are the pecto- 
ralis major and the muscles of the fossa infra-spinata, chiefly the rhomboi- 
dei; then follow the deltoid and the muscles of the arm. The anterior are 
much more excitable than the posterior muscles of the extremities. The 
most excitable muscle of the leg is the tensor vagince femoris. 
It is quite certain that sufficiently wet excitors, in perfect contact with 
the skin, give rise to muscular sensation only ; but at the moment when it 
is applied to the skin, and before the contact is perfectly established, a cu- 
taneous sensation is mixed with the muscular sensation. Therefore, mus- 
cular Faradization, chiefly when applied by rapid intermissions, is much 
more painful at the moment when the excitors are applied to the skin. It 
is easy to spare this sensation to the patient. Before putting the excitors on 
the skin, one approaches them, so that they touch each other, and the cur- 
rent is neutralized. Then, when they are in perfect contact with the skin, 
remove the one from the other, so that the electric recomposition is effect- 
ed in the muscle to be excited. 
Many interesting facts have been evolved from the application of elec- 
tricity to the study of the functions of the muscles of the living body. It 
is become possible to create so, a kind of living anatomy. 
Dr. Duchenne has given a special study to the function of the muscles of 
the face, to know the mechanism of the physiognomical expressions. It is 
true, that although these muscles have a very small surface only, electricity 
can be localized in every one, so as to produce isolated contractions. The 
■way to show most clearly the part every muscle takes in the different phy- 
siognomical expressions, is, to electrify the muscles of the face of a man 
who has just died, and whose muscles have yet retained their irritability; 
for the living man, when electrified, always mixes involuntary movements, 
not connected contraction of the electrified muscle, an impediment, 
of course, to the observation of the individual action of the muscles. It is, 
indeed, very interesting to see on a dead body all the physiognomical ex- 
pressions produced, for it is only the muscles which are put into action by 
thoughts, passions, and character; they preserve, during the muscular re- 
pose, the predominance of tonic force, and stamp on every physiognomy its 
peculiar impression. If there was not in every face tonic predominance of 
this or that muscle, all physiognomies Avould be like each other, as the mus- 
cles have the same directions, attachments, and strength, and the bones 
only differ from each other by their volume. So the frontal muscle, when 
slightly contracted, cheers up the face ; more contracted it expresses doubt, 
surprise ; in the highest degree of contraction, and united with some 
other muscles, it gives the expression of an agreeable surprise or of terror ; 
it also wrinkles the forehead, and when paralyzed, the wrinkles disappear. 567 
ELECTRICITY, 
The pyramidales nasi, which are in intimate relation with the frontal 
muscle, and therefore considered by many anatomists as only one muscle 
with the frontal, in their physiognomical action too, nevertheless are the 
antagonists of the frontal muscle ; they give a sad expression, and, when 
more contracted, a threatening one. It forms a striking contrast to see 
these two opposite movements produced in so small a space as the level of 
the eyebrows. 
Isolated contractions of the orbicularis palpebrarum and corrugator su- 
percilii express reflection ; united to the pyramidalis, they express malice. 
The platysma myoides gives the expression of pain; united with the frontal 
muscle, it expresses terror; and, with the pyramidalis, rage. Contraction 
of the triangularis nasi gives the expression of lust. The zygomaticus 
major always expresses mirth, from simple smiling to the most extravagant 
hilarity; united with the frontalis, it gives the expression of an agreeable 
surprise; with the platysma myoides, the sardonic laugh. The zygomaticus 
minor, on the contrary, gives the melancholy air. The levator alte nasi and 
labri superioris is the real weeping muscle of children, and produces a very 
ugly grimace. By the contraction of the external fibres of the orbicula- 
ris oris, the lips are everted forward as for kissing and whistling ; the inter- 
nal fibres apply the lips against the teeth, as is done, for instance, by 
players of the clarionet for pinching the reed of their instrument between 
their lips. The levator menti is the only muscle in action in persons who 
repeat their prayers inaudibly in Catholic churches. The triangularis oris 
expresses sadness ; in children it is the precursor of tears; in the maximum 
of its contraction it expresses disgust. 
As electricity is able to produce muscular contractions without injuring 
either the skin or the muscles themselves, it may be applied, when muscu- 
lar contractility is weakened or lost—namely, in muscular paralysis, Avhe- 
ther resulting from wounds of the nerves or from lead-poisoning, or by 
hemorrhage into the brain, by rheumatism, by hysterics; in paraplegia, and 
in progressive atrophy of the muscles which terminates in their fatty dege- 
neration. 
In tic douloureux, irritable breast, and sciatica, the most wonderful 
results have been obtained by the local use of electricity, and by these 
means the entire removal of muscular rheumatism may be fairly reckoned 
upon, even in protracted cases, and when all other means have failed. The 
tympanum has been electrified with success in nervous deafness; and in 
loss of smell or taste, the Schneiderian membrane, or the tongue and palate 
may frequently with success be subjected to the same process.. In cases 
of involuntary stools and prolapsus ani, electricity may be applied to the 
rectum; or in paralysis of the bladder to that viscus itself. In cases of 
paralysis of the muscles of the pharynx, or aphonia, the pharynx or larynx 
may be electrified ; and in cases of asphyxia from any cause, the electric 
excitation of the diaphragm may easily be effected by acting on the phrenic 
nerve as it passes over the scalenus anticus. By this means artificial respi- 
ration may be maintained in a body even some time after death, the air 
rushing into the lungs with considerable noise. Part xxxvi.,£>. 248. 568 
EMMENAGOGUES EMPHYSEMA. 
EMMENAGOGUES. 
Emmenagogue Medicines.—Of emmenagogue remedies, or those medi- 
cines that are supposed to possess a specific power over the womb, and 
which have been resorted to by medical men in cases of amenorrhoea for 
reproducing the menstrual secretion in conjunction with the general treat- 
ment, the following appear to have proved most successful: 
Savine—from five to ten grains of the powdered leaves three times a 
day, or a drachm of the compound tincture twice a day. 
Dr. Locock recommends a combination of myrrh, aloes, sulphate of iron, 
and the essential oil of savine. 
Ergot of rye—five to ten grains of the powder two or three times a 
day, boiled in a little milk. In very irritable habits the ergot must be 
cautiously administered, as it has been found, after a few days, to produce 
sometimes violent and even highly dangerous and spasmodic attacks. 
Iodine, in form of tincture, with hydriodate of potash—ten to twenty, 
or thirty drops, two or three times a day. 
Strychnine—one-tenth to one-fourth of a grain, two or three times a 
day. This medicine must be suspended for a few days should headache or 
twitching of the muscles follow its exhibition. 
Madder, myrrh, guaiacum, mustard-seed, valerian, electricity, aloes 
have all had their advocates. 
In cases of amenorrhoea combined with epilepsy, Dr. Ashwell employed 
the following formula, recommended by Dr. Bright: 
$ Pulv. digitalis, gr. j.; pulv. myrrhce, gr. ij.; ferri sulphatis, gr. j.; 
sir. q. s. Ft. pil. ter die cap. 
“ tinder this treatment the fits became diminished in number, and the 
menstrual function normally established.” Part vi., p. 80. 
Treatment of Idiopathic Emphysema.—[The subject of the case was a 
girl of two years and a half. She had previously had good health; when 
suddenly emphysema occurred, after slight sickness and feverishness. Her 
state, when seen, is thus described:] 
“ The entire of the upper part of the body is swollen, so much so, as to 
give the appearance of excessive obesity. The thorax, arms, neck, face, 
and head, appear to be four times as large as natural. The slightest touch 
gives her much pain. The left eye is completely closed by the effusion 
into the cellular membrane. There is no crepitus whatever perceptible, 
nor any pitting on pressure, the entire of the skin appearing to be dis- 
tended to its utmost limits. The lips are livid ; the breathing greatly 
oppressed, in fact being mere gaspings, and countless in frequency; the 
skin is ver)> hot and dry ; bowels confined ; urine suppressed ; pulse small, 
thready, and quick, and felt with difficulty, owing to the swollen state 
of the arm. Ordered—hyd. submur. gr. vj.; pulv. scillce gr. vj.; pulv. 
digitalis gr. j.; inch. vj. Sumat. j. 2d. horis; app. emp. vesicat. inter 
scapulas.” 
EMPHYSEMA. EMPHYSEMA, 
569 
[A consultation was held as to the propriety of puncturing, but it was 
decided to wait until the effect of bleeding wps seen. Four ounces were 
accordingly taken from a vein in the foot, it being impossible to find one 
in the arm. The breathing was thereby much relieved, and the swelling 
much reduced ; the pulse could be felt, and the bowels and kidneys acted 
well. The after-treatment was simple; an expectorant mixture, and 
camphor liniment to promote absorption, and afterward slight aperients 
with the use of warm baths, soon completed the cure. This case is 
remarkable from its coming on without apparent exciting cause, the child 
having never had measles, scarlatina, or any affection of the chest; 
nor was there any typhoid state, in which such occurrence sometimes 
happens.] 
William Hunter states he observed an emphysematous state all over the 
body in cattle which had. the distemper. It may be asked, then, if the 
disease in question be not produced by accident, by violent expiratory 
efforts (and you are all familiar with the form of the emphysema produced 
during the violent expulsive efforts during labor), nor from decomposi- 
tion, from what does it proceed ? I answer, from secretion. On this 
question the words of Dr. Townsend are so very apposite, that I shall not 
hesitate in making use of them. He says (speaking of this morbid secre- 
tion) : “ That collections of air are sometimes found in the living body 
under circumstances where there is no appearance of their being gene- 
rated by fermentation or putrefaction, and that both in man and other 
animals, certain tissues possess the power of secreting gas, as, for instance, 
the swimming bladder in fish, the mucous membrane of the stomach and 
intestines in man, etc.” Dr. Bailie has recorded a very curious case in an 
adult, bearing a strong resemblance to the above, in which the emphysema 
was very extensive, and in which no disease or lesion near the lungs could 
account for it. And Frank mentions several cases from the effects of 
secretion, but the patients had more or less previous disease; but I am 
not aware of there being any case on record of the disease in question 
appearing in so young a subject.” Part xii., p. 74. 
Emphysema Pulmonum.—This disease, in the majority of cases occur- 
ring in our lai-ge towns, in vitiated atmospheres, and where the patient 
has been insufficiently nourished, is a blood disease in its origin, and is of 
an asthenic character. It is to be remedied by small doses of iron, 
quinine, and tonics, with a generous diet of animal food and porter. One 
grain each of sulphate of iron and of quinine may be given in infusion of 
roses with sirup of ginger. Dry cupping between the shoulders, the 
inhalation of creasote (twenty drops to a pint of boiling water) each 
night, a stramonium cigarette, or twelve drops of chloric ether, have all 
been used successfully for warding off an attack of nocturnal dyspnoea. 
A favorite remedy also is the fumes from a slip of lighted nitre touch- 
paper ; and a case is mentioned where a large dose of the hydrochlo- 
rate of ammonia gave great relief. Part xxviii., p. 90. 570 
EMPYEMA. 
EMPYEMA. 
Diagnosis of Empyema.—"We hardly need remind our readers that 
when serum is effused into the cavity of the pleura, the affection is named 
hydrothorax, when the effusion consists of blood, it is called hemothorax, 
when the effusion is of a gaseous nature, pneumothorax, and when consti- 
tuted of pus and other kinds of effusion, we have what is called empyema, 
especially when the liquid compresses the lung and impedes respiration. 
Mr. MacDonnell has written an interesting paper on the last named affec- 
tion, in which he relates cases wherein one or more tumors appeared on 
the surface of the chest, which, after pulsating for some time, became red, 
tense, and shining, and eventually burst, giving exit to large quantities of 
pus. When the empyema is attended with these pulsating tumors, he 
calls it “pulsating empyema of necessity.” 
Case.—A woman, aged 28, of dissolute and abandoned habits, was ad- 
mitted into the Meath Hospital, September 6. She had been laboring 
under symptoms of acute pleuritis for two months, for which she was 
actively treated. 
When admitted she was greatly emaciated, suffered from pain in the 
left side, a little below the mamma; she had cough, with bloody streaks 
through the expectoration, and inability of lying on either side, decubitus 
being for the most part on the back. Iler pulse was 108, small and weak. 
The physical signs were dullness of the left side, commencing a few inches 
below the clavicle, and extending downward both before and behind; the 
left lateral region was likewise dull; total absence of respiration all over 
this dull portion ; the upper part of the left side, both before and behind, 
was clear on percussion, with bronchitic rales accompanying the respira- 
tory murmur. The lower half of the sternal region Avas completely dull, 
and here the sounds and pulsations of the heart were more intense than in 
any other situation. The Avhole of the right side of the chest, both before 
and behind, sounded clear, and the respiratory murmur Avas loud, puerile, 
and free from rale. There Avas no dilatation of the side observed on her 
admission. 
For the next fortnight there Avas very little change observed; on the 
21st, however, the cough again became very troublesome, and Avas accom- 
panied by a copious muco purulent expectoration, and her breath became 
intolerably fetid; pulse 10G, Aveak and feeble; respiration 25, and very 
labored. She complained of slight tenderness a little below the nipple, but 
there Avas no discoloration or oedema of the part. On the 26th a small 
tumor became perceptible, every time she coughed, in the situation of the 
pain ; it Avas soft, and exquisitely tender to the touch, but not discolored 
or cedematous. On the 28th, bronchitic rales were very intense in the 
right lung, and those in the top of the left lung Avere much increased ; the 
expectoration had become quite purulent. When she reclined on the left 
side, the tumor became greatly enlarged, but receded when she lay on the 
right, and had a distinct fluctuation. On the 30th, the tumor had 
extended considerably, and the expectoration Avas still purulent, and very 
copious. Pulse 108, and Aveak. 
From the 1st of October till the 15th, she suffered seArerely from incon- 
trollable diarrhoea, and Avas reduced to such a state that her stools Avere 
passed involuntarily. The tumor had greatly increased, and Avas now 571 
EMPYEMA, 
about the size of an orange; it was red, shining, and fluctuating, and had 
a strong diastolic pidsation, which did not convey the idea of being tilted 
forward by a pulsating body, as occurs in the case of tumors lying on 
arteries; but it was of an expanding character, and in every part the p»ul- 
sation was equally strong. Though frequently examined with the stetho- 
scope, the least trace of bruit de soufflet was never discovered/ nor had it 
the peculiar thrill so frequently felt in aneurisms. On the 21st she expec- 
torated about a pint of green pus and the bowel complaint received a 
notable check. The tumor was still more red, tense, and pulsating, and 
on the following day it burst, and gave exit to about three quarts of 
extremely fetid pus, and she became exceedingly weak. After the evacua- 
tion of the pus, the sound on percussion assumed a clear tone. On the 
24th the respiration in the right lung was again healthy, and free from 
r&le. The tumor had receded, the respiration in the affected side was just 
audible, but without rale. All the metallic phenomena, except tinkling 
and amphoric breathing, were present, and the sound on percussion was 
quite tympanitic. When the aperture was uncovered a peculiar rustling 
or whistling noise teas perceived a,t each inspiration. From this time she 
began to rally, her strength increased, the diarrhoea ceased, and the puru- 
lent expectoration diminished, and she was able to sit up all day, the pus 
constantly trickling from the fistula which remained open, and for the 
next six weeks she had periodical discharges to the amount of two or 
three quarts every ten days or so. At last her strength again failed, 
the cough increased, the pulse became quick, but she remained free from 
sweating. The clavicle and spine of the scapula of the affected side 
became gradually dull, accompanied with feeble respiration, mixed with 
crepitating rales. The day before her death, which occurred on the 15th 
of December, a discharge of nearly three quarts of green and fetid pus 
escaped from the fistula. 
Post-Mortem Examination.—The right lung was in every respect 
healthy, not the least evidence of bronchial inflammation in any part of 
it. On the left side of the chest being opened, the lung was found bound 
by adhesions to the ribs, for about two-thirds of the pleural cavity, and the 
remaining third, i. e., between the compressed and shidvelled lung and 
diaphragm, was an empty cavity. The lung was also bound down to the 
spinal column by two strong bands of adhesion, and its inferior lobe was 
found red and carnified. The sac of the abscess passed behind the lung 
also, to a considerable distance; it was coated Avith a thin layer of 
organized lymph. The upper lobe of the left lung was the seat of nume- 
rous tubercles, beginning to soften, the anterior part of the lower lobe 
was healthy, but the posterior, as before stated, Avas solid. The fourth rib 
Avas quite carious near its cartilage, and the sixth Avas in a similar condi- 
tion, and the periosteum covering both Avas in a sloughy state.. Externally 
the integuments around the fistula Avere separated for a couple of inches 
from the subjacent muscles. The liver was enlarged to nearly half its 
normal size, engorged and full of blood. The intestines Avere examined 
with the greatest care, but no trace of disease could be discovered. 
Mr. MacDonnell relates tAvo cases of empyema in Avhich the pus made 
its Avav, not externally, but into one or more of the bronchial tubes, and 
Avas removed by expectoration. The first case commenced Avith acuto 
pleuritis, folloAved by copious purulent expectoration, tAvo large sputa-cups 
full of thick, yelloAV, “ well concocted ” pus being expectorated daily. The 572 
EMPYEMA. 
entire of the empyema was thus removed by expectoration, and in six 
weeks the patient quite recovered. 
[It might seem difficult to distinguish these cases from true pulmonary 
abscesses, but these latter affections “are not accompanied with very 
copious expectoration, but, on the contrary, are found to contain an 
exceedingly small quantity of pus.” Pneumonic abscess is, moreover, one 
of the rarest lesions met with in the lungs, and almost always occupies the 
base of the organ, while tubercular abscess is situated in the apex. The 
points discussed in this paper of Mr. MacDonnell are summed up by him 
as follows:] 
1. We are presented with a new form of empyema, which may be 
termed “ pulsating empyema of necessity,” exhibiting some features com- 
mon to that form of empyema and to thoracic aneurism, and encephaloid 
disease of the lung. 2. That it may be diagnosed from thoracic aneurism, 
by a. The history of the case. b. The dullness extending over the whole 
side, the pulsation being only felt in the external tumor, c. The absence 
of thrill, d. The absence of bruit de soufflet. e. The extent and nature 
of the fluctuation. 3. That it may be distinguished from encephaloid dis- 
ease of the lungs and mediastinum, by a. The absence of the expectora- 
tion resembling black currant jelly. b. The absence of a persistent bron- 
chitis. c. The absence of a varicose condition of the veins and oedema of 
the side effected, d. In cancer of the lung the situation in which the 
external tumors form, is not invariably confined to the thorax. 4. That 
copious purulent expectoration in empyema is not always indicative of 
cavities in the lung; but, on the contrary, is of frequent occurrence in this 
disease, and seems to be the result of an effort of nature to get rid of the 
purulent collection at the nearest and readiest outlet. 5. That this symp- 
tom, when it results from the above cause, is not attended with the usual 
symptoms either of abscess of the lungs, or inflammation of the bronchial 
mucous membrane. 6. That a true bronchitis of the sound lung frequently 
complicates empyema. 7. That still more frequently the sound lung 
becomes congested, and presents of the ordinary signs of bronchitis 
and pneumonia, from both of which it may be distinguished by attention 
to the rules laid down in the previous part of this communication. 8. That 
in addition to the depression of the liver from mechanical causes, that 
organ is likewise enlarged from engorgement icith blood in empyema. 
9. This enlargement is not confined to enq:>yema of the right side, but 
occurs also when the disease is seated in the left cavity of the chest. 
10. That this enlargement is identical with that which takes place in other 
affections of the lungs and heart, where, in consequence of their functions 
being impaired, an additional duty is imposed upon the liver, viz.: that of 
eliminating carbon from the blood, as proved by the researches of Tiede- 
man and Gmelin, Elliotson and Liebig; and as occurs in the former cases, 
so likewise we observe in this, that the increased size of the organ is due 
to an additional afflux of blood, whereby its structure becomes engorged, 
softer in consistence, and darker in color. 11. This condition of the 
liver has been observed by myself as proved by dissection, and its 
presence detected in cases that have recovered. It has also been men- 
tioned by many writers in their accounts of the appearances noticed at 
the autopsies of cases of empyema, who have recorded the fact, though 
unaware of its connection with the subject under discussion, and it must 
now be considered as constituting an additional feature in the diagnosis 573 
EMPYEMA, 
and pathology of empyema. 12. This condition of the liver when it 
occurs in the ordinary diseases of the heart and lungs, has been observed 
to disappear as soon as the obstruction to the circulation of the blood and 
want of proper aeration, which gave rise to it, had ceased. So likewise in 
empyema, its disappearance is one of the first signs which indicate the 
removal of the effusion, and the return of the compressed lung to the per- 
formance of its functions. Part ix., p. 1. 
Paracentesis Thoracis.—Mr. Uiff observes : 
Before entering upon the subject of the treatment by tapping, it maybe 
remarked, that instances are by no means rare in which N ature gets rid of 
the effused fluid independently of absorption. In some, this takes place 
through the substance of the lung, and on this head Hasse observes, that 
the perforation is generally at the inferior surface of the upper and middle 
lobes, where the part is least compressed, the perforations being either ob- 
long or rounded, not exceeding two or three lines in diameter, seldom more 
than one, and smooth at their edges. Paulus MSgineta refers to this, and 
considers it generally fatal. In other cases, the thoracic parietes give 
way; this is, perhaps, a more favorable result, though frequently a 
fistulous opening remains, and in some cases caries of the rib is said to 
follow. The situation of the opening is generally in front, and between 
the third and fourth or fourth and fifth ribs. A case is recorded by 
Hunter, where the matter pointed and burst beneath the scapula. 
In very rare cases, Hasse observes that the empyema may even have 
perforated the diaphragm, and he refers to three recorded cases, in one of 
which the pus descended behind the peritoneum, along the psoas muscle, 
with abscesses and fistulous channels in the thigh, as low as the knee. 
With reference to the stage of the effusion, or time when the operation 
should be performed, no decided rule can be laid down; much must 
depend on the indication its removal is required to fulfill—viz., with 
reference to cure or simple relief: in the former case it is generally con-, 
sidered that where pus is effused and pointing, it may be evacuated at 
once, and where the fluid be serous, not later than five or six weeks after 
the commencement of the attack, generally not more than two or three 
weeks after. 
With respect to the part selected, two chief situations are used, viz., the 
anterior lateral, and the posterior lateral. In the former, recommended by 
the ancients, and by Sharp, Laennec, Colles, and others, the opening, owing 
to the origin of the diaphragm, is generally not lower than between the 
fifth and sixth ribs, nor higher than between the third and fourth. Dr. 
Duncan, jun., and others, however, relate cases in which the matter 
pointed between the second and third ribs, while there are not wanting 
instances of the sixth intercostal space being selected. In the pos- 
terior lateral, practised by Lourd, Burserius, Mr. Cock, etc., the highest 
I have met with is between the seventh and eighth, the lowest between 
the eleventh and twelfth, in a case of Werner’s, quoted by Burserius; 
this, however, is a most dangerous and almost unjustifiable situation for 
paracentesis. 
It is not a matter of very great importance which position we select ; 
much must depend on the physical signs; so also with reference to the 
instrument used, whether scalpel, oval, or flattened, or the round 
trocar. I think that when the collection of fluid is not very great, 574 
EMPYEMA, 
and when it is situated low down, and especially when pointing, a valvular 
opening with the lancet or scalpel is to be preferred, otherwise the 
round trocar, as used by Mr. Cock, of about one-twelfth of an inch in 
diameter, and two inches in length, exclusive of the -handle, appears 
best adapted. The plan recommended by Hippocrates, of perforating 
a rib, arid pushing the trocar through, has not, I believe, met with any 
advocates. In all cases, I would urge the previous introduction of the 
explorator contrived by Dr. Babington, consisting of a needle contained 
in the smallest sized canula. Its superiority to the common exploring 
needle is great. 
With respect to the quantity drawn off, here again no rule can be laid 
down ; much must be left to the discretion of the operator, and must 
depend on the circumstances of the case. In large and chronic effusions, 
as much may be removed as can be without the admission of air, or 
faintness, or irritation of any kind to the patient. The admission of air 
should, if possible, be avoided. The bad consequences of its admission are 
owing, perhaps, not so much to its mechanical interference with the 
expansion of the lung, as to its action on the fluid effused, changing its 
character from a bland and inodorous to a highly irritating and fetid 
liquid. Several very ingenious instruments have been invented for the 
prevention of the ingress of air, as the trocar, canula, and stopcock with 
double-action syringe of Mr. Snow, etc.; but undivided attention to the 
flow of the fluid through the trocar will, generally speaking, be found to 
px-event any matei’ial entry. Part xv., p. 204. 
Case of Chronic Empyema treated Successfully by Paracentesis.—In 
this case II. X , aged 26, was admitted into the hospital on the 27th 
Oct., 1847, recommended by Dr. Alison to Prof. Syme for the operation 
of paracentesis thoracis. It appeared from the statement of the patient he 
had labored under pleurisy, from which he never perfectly recovered. His 
symptoms on admission were general debility, breathlessness, and pal- 
pitation on the slightest exertion, with cough on attempting to lie on the 
right side. The external appearances, with the various evidences of per- 
cussion and auscultation, left no doubt that the left side of the chest was 
filled with fluid, and on the right there was considerable dullness on per- 
cussion over the whole anterior surface; but particularly great between 
the sternum and mamma downward, the heart occupying this position. 
The respiration, except in this part, being very clear and puerile. Itbeing 
considered that paracentesis, cautiously performed, held out the only 
prospect of recovery, Mr. Syme, on the 31st of October, drew off 21§ of 
greenish colored pus, on the 7th of November, 50§, of a similar fluid were re- 
moved, and on the 14th, 34§, the chest being now apparently emptied. The 
instrument employed was a trocar about the eighteenth of an inch in 
diameter, and about two and three-quarter inches in length. The parts 
selected for puncture were different points between three or four inches 
external to the nipple, in the sixth intercostal space. No general 
treatment was pursued, except restricted diet, and an occasional purge, 
with the compound powder of jalap. A large blister, however, was 
applied on the side, and gr. ij. of the iodide of potass given twice a day. 
On the 9tli of April, he was again tapped, and 40§ taken away; and on the 
15th, 26§ were again removed. The situation formerly punctured was 
made choice of, and after each operation great relief was obtained. The 575 
EMPYEMA, 
patient now appeared at different times to have the operation of 
paracentesis performed. On the 8th of July, 79§ of pus were removed; 
on the 30th of September, 112§; on the 1st of February, 1848, 72§ were 
withdrawn ; and.from this period up to the 4th of January, the operation 
was performed four different times, draining off on the 18th of May, 1848, 
57§; on the 19th of August, 1848, 37§; on the 27th of February, 1849, 
075; and 011 the 4th of Janunry, 1850, 265. 
Thus he was operated on twelve different times, and in all 6215 of pus 
—equal to about four gallons—were taken from him. 
This patient finally recovered from the affection, and attained to the 
enjoyment of good health. Part xxii., p. 153. 
Empyema.—You may inject a solution of iodine into the pleural cavity. 
.The following formula was successful: 
Iodini 5j.; potassii iodid. 3ij.; spirit, rectificat. §j.; aquas §v. M. Let 
this injection remain in the pleural cavity a short time, moving the patient 
about so as to bring it into contact with all the pleural surface, and then 
.let out as much as will flow out. The greater portion, however, will re- 
main in the cavity. Part xxxi., p. 85. 
Empyema and the Panger of Paracentesis.—Nature, if assisted by 
proper remedies, as mild diuretics, composed of digitalis and squills, with 
alteratives and large blisters to the chest, will often remove serous 
effusions from the pleura. 
Dr. Addison now believes, from the numerous cases seen every year at 
Guy’s, that paracentesis thoracis is one of the worst and most deceiving 
operations in general practice. A serous cavity, he thinks, is almost 
invariably changed into a cavity pouring out purulent matter by the first 
operation, and the thick, leather-like false membranes lining the pleura, 
soon make the operation one of very great difficulty and danger. Nature, 
herself, if assisted by proper remedies, as those already indicated, will 
often remove serous effusions from the pleura; but if once interfered 
with by instrumental assistance, the amount of pus separated from the 
system is almost incredible, and beyond her power to get rid of. 
Cases are mentioned of twelve and fourteen pints of purulent matt er drawn 
from the chest, but its production is very possibly due to the first opening 
made in the pleura. 
During the post-mortem examination of a case in the dead-house, Dr. 
Addison drew the attention of his class to the roughened and thickened 
condition of the adhesions lining the pleura, those being not at all unlike 
softened leather or half-boiled tripe. This was also a great obstacle to the 
right performance of the operation of paracentesis of the chest, an obstacle 
of the most serious import sometimes in private practice. 
Dr. Addison further related a case inAvhich he had been called to see a 
gentleman whose pleura was full of fluid ; it was at a time that, guided 
more, perhaps, by the fancies of new books than by experience, he was led 
to believe paracentesis a good operation for lessening dyspnoea and reliev- 
ing the most urgent symptoms of extensive effusion into the pleura. The 
trocar and canula were boldly pushed into the chest; but nothing 
followed. It was then decided in consultation that the contents of the 
pleura were “ too solid ” to come out, and nothing more was done. The 
patient died some time afterward, the effusion and dullness having remained 
still unchanged, and on the post-mortem table the same operator tried the 576 
ENURESIS, 
operation again, but it was of no use. The chest was then opened, and it 
was found to contain some quarts of fluid, but the leather or tripe-like ex- 
udations inside the ribs were found to have closed up the canula, and 
pushed themselves before it like a valve. Even the lung may be so bound 
down by these thick membranes as not to be able to expand again. The 
dangers of the operation are to be considered of such a serious nature that 
they are by all means to be avoided. Part xxxiii., p. 100. 
ENURESIS. 
Treatment of Incontinence of Urine in Children.—The late Baron 
Dupuytren, and also MM. Baudelocque and Guersen, have recommended 
the use of cold shower-bathing as one of the most effectual remedies 
against this most annoying and frequently most obstinate complaint. 
M. Lallemand, of Montpellier, has great confidence in aromatic bitters, 
to which a small portion of brandy has been added, followed by active 
friction of the loins. 
Underwood recommended the use of sea-bathing, of dry cupping, of 
blisters on the sacrum, and of electricity. 
As internal medicines the Spanish fly and the nux vomica have been 
unquestionably the most efficacious. The preparation of the latter, which 
has been most successfully used, is the extract in doses of from half a 
grain to four grains in the course of the day. 
Case.—A girl, twelve years of age, had been affected from her infancy 
with incontinence of urine, her general health being unaffected all the 
time. It would seem that no remedial means had ever been tried. 
Dr. Ramauge, who accidentally saw the girl at a house where he was 
visiting, recommended her to take one of the following pills, along with a 
wineglassful of infusion of quassia, three times a day : 
It Extracti nucis vomicae, gr. viij.; Oxydi ferri nigri, 5j.; Pulv. Quas- 
sias 5j. sirupi absinthii, q. s. In pilulas xlviij. divide. 
A tonic nourishing diet was ordered, and also a glassful of wine two or 
three times a day. By persevering in this course for a month, the patient 
was quite relieved from her distressing malady. 
The treatment was however, continued for another month; and at the 
date of the report there had been no return of the complaint for upward 
of a year. Part, i., p. 72. 
Incontinence of Urine.—Tincture of cantharides, combined either with 
tincture of opium or tincture of hyoscyamus, recommended; also the 
compound rhei pill, pro re nata and blisters to the sacrum. 
Part vi., p. 30. 
Treatment of Incontinence of Urine.—Dr. Steinbeck, of Brandenburgh, 
administered ergot of rye to two women recently delivered, in whom in- 
continence of urine had been induced by paralysis of the sphincter of the 
bladder from pressure during labor. The internal administration of this 
medicament, coupled with the external use of an embrocation containing 
tincture of cantharides over the hypogastric region, having been followed 
by complete success in a few days, Dr. Steinbeck entertained the idea of ENUKE8IS. 
577 
employing the ergot for similar affections in the other sex. Accordingly, 
to three old men, in whom sudden chill had brought on incontinence of 
urine, he prescribed the following mixture: R Ergot of rye, half a 
draclnn ; water, six ounces; boil for five or six minutes, and add of bella- 
donna leaves fifteen grains. Suffer the infusion to stand till cool; strain, 
and add of phosphoric acid (medicinal strength), two drachms, extract of 
uux vomica, four grains, sirup of manna, one ounce. Mix, and take a 
tablespoonful every two hours. The patients improved in health and after 
a few days the above mixture was superseded by the following: R Ex- 
tract of belladonna, three grains; extract of nux vomica, four and a half 
grains; phosphoric acid (medicinal), an ounce. Mix and take fifteen 
drops three times a day. The treatment in each case was successfully 
concluded by a course of tonic with stimulant remedies. 
Part vii., p. 89. 
Incontinence of Urine—Nitrate of Potash.—Dr. Young has found that 
this medicine, given in ten-grain doses every three hours, has had a very 
excellent effect in checking this troublesome affection. In several cases 
where tinct. lyttse and other means had failed this medicine was given 
with complete success. He supposes that its good results may be owing 
to its increasing the irritating properties of the urine, thus making it 
more stimulating to the bladder or its sphincter. If so, he also thinks 
that other preparations of potash, soda, etc., may be used when the nitrate 
fails. Part viii., p. 75. 
Enuresis Cured by Electricity.—In many cases, these affections have 
been referred to affections of the spinal marrow; but M. Froriep refers it 
to a local affection of the bladder itself, to an affection of the nerves, or of 
the muscular fibre, or of both. Taking this view of the question, he re- 
solved to try the effect of the local application of electricity. A metallic 
stylet, terminating in a button point, is introduced into the bladder, with 
the aid of a gum catheter, which envelops the whole but the button point. 
The handle of the stylet is then connected with one of the wires of an 
electro-galvanic battery, while the extremity of the other wire is pressed 
against the pubes. The electric current is passed through the bladder 
for a quarter of an hour each day. The bladder in general retains 
the urine better the very first day after the application; but the appli- 
cation requires to be renewed at intervals, till the bladder recovers its 
full power. Several cases are related of this affection, in people of from 
,30 to 40 years of age, in whom the affection was completely removed by 
the electricity. 
M. Froriep found that, in weakly children, a few doses of iron con- 
firmed the cure. Part ix., p. 83. 
Incontinence of Urine.—Mr. Chabely recommends the use of balsams 
in this troublesome affection. Here are a couple of his prescriptions: 
R Styrax balsam, 6 grammes ; Peruvian balsam, 6 grammes; honey, 90 
grammes; powder of gum arabic, q. s. to make an electuary, of which a 
tea-spoonful is to be taken night and morning. 
R Styrax balsam, 6 grammes; balsam of tolu, 8 grammes. M. and 
divide into pills of 30 centigrammes (5 grains), which are to be silvered 
over and rolled in lyqppodium powder, ifrom four to eight of the pills to 
be taken daily. 578 
ENURESIS. 
The patient is at the same time to make use of tar water by way of 
ptisan. Part x., p. 82. 
Enuresis Nocturna, Nitrate of Potass, Benzoic Acid, etc.—Dr. Young 
was the first to make known to the profession the efficacy of nitrate of 
potass in enuresis nocturna. He succeeded in curing a lady in a week’s 
time, by giving it in doses of gr. x. every three hours. Dr. Delcour, of 
Belgium, has met with equal success. He gives it to children from four 
to twelve years of age, in doses of gr. x. three times a day; in some cases 
it succeeds immediately, but in most requires a few weeks; where this 
fails, he gives strychnine. In one or two very obstinate cases, where even 
this latter failed, he has succeeded by the use of benzoic acid in the form 
of pill, each containing gr. iij. of the acid; one to be taken twice or thrice 
a day. Part xi., p. 82. 
Incontinence of Urine in Children.—Incontinence of urine in children 
has been observed by Dr. Berenguier to have some connection with inter- 
mittent fever, being apparently a symptom of the debility which accom- 
panies the characteristic ansemia of malarious districts. The most appro- 
priate treatment was found to be a combination of copaiba, laudanum, and 
the protoxide of iron, made into pills. 
Belladonna has been also used successfully in this disease by Dr. Moraud, 
in the dose of one-fifth of a grain of the extract taken twice a day, and in- 
creased at the end of a week, if no effect be produced. Part xvi., p. 165. 
Incontinence of Urine.—Excoriation of the parts exposed to the flow 
of urine may be prevented by the application of collodion, and may proba- 
bly also be cured by the same means. Part xix., p. 320. 
Portable Urinal.—Dr. Gariel has availed himself of the remarkable pro- 
perties of the vulcanized caoutchouc (its unalterability by corrosives, its 
preservation of elasticity at all temperatures, its great strength, and its 
resumption of its original size after however great extension), for the con- 
struction of a vast variety of surgical apparatus, some of which exhibit 
great ingenuity. 
One of the most simple of these is a portable urinal, which is of such a 
trifling size and weight as to cause no inconvenience or ill appearance. 
The penis is adapted to the orifice of this, just as the wrist is to the India- 
rubber band of a glove, and the material being impermeable, no smell 
issues. When opportunity offers, without displacing the vessel, the patient 
discharges the collected urine by means of a little cock attached to it. 
Part xxi., p. 302. 
Incontinence of Urine.—In a case of this kind, which had lasted for five 
months, from paralysis of the neck of the bladder, after the internal ad- 
ministration of strychnine had failed, a solution Avas injected into the blad- 
der (0.50 centig. of strychnine to 500 centig. of water). Complete recovery 
was the result. Part xxvii., p. 104. 
Treatment of Enuresis.—As it is often desirable to have at hand various 
formulas for the treatment of this troubleoOme affection in children, we 
may mention that Dr. Blaschko, of Freyemvalde, recommends a mixture 
of equal parts of tinct. nucis vomicce and tinct. ferri acet., of which from 
10 to 15 drops are given tAvice during each evcaiing. Dr. Huber, of 
Ztirich, recommends ext. nucis vom. 1 p., oxyd. ferri nigr. 48 p., giving ENURESIS, 
579 
2 grains night and morning. Nagele gives 1 grain of tannin night and 
morning. 
Use of Cubebs in Infantile Enuresis.—This author has found cubebs 
more effectual than any other remedy in curing the incontinence of urine 
so common among children. This complaint may depend on atony of the 
bladder, or on the presence of intestinal worms. In the former case, the 
cubebs acts as a tonic; in the latter, as a valuable anthelmintic. The 
medicine requires to be given in considerable doses; two pinches (i. e. a 
few grains or zwei messerspitzvoll) for infants, and half a teaspoonful twice 
or thrice daily for children of a somewhat more advanced age. Its effect 
is speedy and permanent; and although occasionally it happens that dur- 
ing its administration the incontinence returns at periodical or irregular 
intervals, these occurrences gradually become less frequent, and eventually 
disappear altogether. To effect a radical cure, the author has often found 
it necessary to continue its use for a period of from three to eight weeks, 
and he has never observed any injurious effects from its administration. 
Deiters observes that he has found the same remedy most efficacious in 
checking nocturnal emissions in cases of spermatorrhoea. 
Part xxxi., p. 102. 
Incontinence of Urine in the Aged.—When not owing to diseased pros- 
tate, but probably to want of tone in the bladder, give the following: 
tinct. ferri sesquichlor. 5ij.; balsami copaibas, 5j.; strychniae, gr. j.; infusi 
quassias, §xij. M. fiat mistura cujus sumatur §j. ter die. 
Part xxxi., p. 168. 
Galvanism in Incontinence of Urine.—When incontinence of urine in 
children results purely from atony, and is not the result of irritation from 
urinary causes, apply galvanism by the aid of a catheter in the bladder. 
It has proved satisfactory in the hands of Mr. Simon. Part xxxvii., p. 165. 
Pella donna in Incontinence of Urine.—A case lately occurred to Mr. 
Pollock, of St. George’s Hospital, strikingly illustrating the efficacy of 
belladonna in incontinence of urine. The patient was a boy, aged 10 ; all 
the usual remedies had failed, no stone was detected, and the urine was 
apparently healthy. He was ordered one-twelfth of a grain of extract of 
belladonna three times a day, and five grains of calomel and scammony 
twice a week. The belladonna produced an immediate effect, marked im- 
provement being noted even after the first dose. After rather more than 
a month’s attendance, he was discharged quite cured. 
Part xxxvii., p. 272. 
Incontinence of Urine—Excoriation from.—In cases where, owing to 
incontinence of urine from any cause (as vesico-vaginal fistula), there is 
distressing excoriation of the skin, a mixture of zinc ointment and glycerine 
is the application generally used at the Samaritan Hospital. 
Part xxxviii., p. 162. 580 
ENTERITIS, 
• ENTERITIS. 
Extract of Monesia.—Suggested in cases of enteritis. Dose, from twelve 
to thirty-six grains of the extract during the day, in the form of pills. It 
is an astringent. Part ii., p. 77. 
Diacetate of Lead in Puerperal Enteritis.—( Vide Art. “Diarrhoea.”) 
Treatment of Enteritis.—The treatment of enteritis must be antiphlo- 
gistic, combined with medicines calculated to insure the opening of the 
bowels. Blood-letting may here be carried to a greater extent than in 
gastritis, as, in the early stage of enteritis, there is less prostration of 
strengtli and less disposition to sinking. Leeching should be combined 
with blood-letting, and also poultices and fomentations to the abdomen. 
When the attack is recent, Dr. C. J. B. Williams recommends that the 
bowels be evacuated before the antiphlogistic treatment is adopted; but 
when the inflammation has existed for some time, it is better to adopt the 
antiphlogistic treatment first, and follow this with a sufficient dose of calo- 
mel, which he regards as the best aperient in such cases. He gives from 
live to ten grains of calomel, combined with five grains of conium, and a 
little James’ powder, and if this does not answer in three or four hours he 
repeats the dose. Belladonna may be combined with the calomel instead 
of the conium. If this second dose fail, it is better to use injections of 
castor oil, three or four drachms, mixed with the yolk of an egg. Cases 
will frequently occur where these measures will fail in producing a good 
evacuation. Dr. Williams recommends very strongly the tobacco injection. 
A scruple of tobacco may be infused in halt' a pint of water, and the injec- 
tion may be retained for ten minutes. 
In combination with this antiphlogistic treatment, turpentine may some- 
times be used with success. Frequently it happens in these cases that 
there is a great deal of spasmodic action, but whether such is the case or 
not, turpentine does not appear to be so injurious a medicine in intestinal 
inflammations as one might be led to expect. 
Sometimes it is used in peritonitis, under the supposition that it is anti- 
phlogistic. At any rate, in the form of an injection it answers well and 
relaxes the spasm. 
The greatest exertion should be employed to open the bowels, for when 
this is effected a great part of the battle is gained; we should scrupulously 
look to this object, and not be content until it lias been effected. The 
remedial measures must be repeated again and again. After the bowels 
have been freely opened, then becomes the time for opium; it is of great 
efficacy and utility then, and it may be advantageously combined with 
mercury; or if opium cannot be borne, morphia may be given, the object 
being to remove the effects of the inflammation. The reason why opium 
is used is that it tends to bring the intestines into a quiescent state; they 
are unhealthy and highly irritable, and this constant irritation gives them 
undue action; and there is very apt to occur, after the constipation has 
been overcome, diarrhoea accompanied by great prostration of strength. 
It may also be necessary to use fomentations and blisters where there is 
considerable pain and tenderness of the abdomen. If the parts feel raw 
and sore on the passage of the feculent matter, the* local antiphlogistic 
treatment must be continued, so long as these sensations remain. EPILEPSY. 
581 
It frequently happens in enteritis that, besides tympanitic distention and 
obstruction, in the early stage, there is a hardness in some parts of the 
abdomen, a feeling of induration communicated to the touch. Usually, 
however, there is great soreness and tenderness felt, more commonly in the 
left iliac region than elsewhere. Dr. W. thinks that this must be the re- 
sult of the internal thickening of the intestine; and so long as it lasts there 
is a great tendency to a recurrence of the obstruction; and it is necessary 
to be extremely careful to administer medicines from time to time to keep 
up the regular action of the canal. The best medicines for this purpose 
are castor oil or mild salines, as sulphate of potash and sulphur. Castor oil 
is the safest of all medicines. It is of very great consequence, after an at- 
tack of enteritis, to avoid exertion too early, and particulai’ly to avoid any 
error of diet and the use of any irritating medicine. The great reason of 
this precaution is that there is a considerably impaired state of the func- 
tions of the canal, and so long as this is the case, all irritating things tend 
exceedingly to produce a relapse. The diet should be as plain, mild and 
simple, as possible; chiefly consisting of farinaceous articles of food. 
Part x.,y>. 63. 
EPILEPSY. 
Oxide of Silver.—Suggested in the treatment of epilepsy as a substitute 
for the nitrate of silver. Part ii., p. 35. 
Sulphate of Zinc.—In most of those cases of epilepsy which depend more 
on functional than organic change, Dr. Babington has found that a tonic 
mode of treatment is the most successful. In some cases, where the habit 
is gross and circulation forcible, depletion may be called for; but generally, 
as in tic douloureux, and other spasmodic states of the nerves of motion 
and sensation, dependent on nervous irritation, the opposite treatment may 
be useful. Sulphate of zinc is his chief remedy. In one case, the patient 
was enabled to take 36 grains three times a day for several weeks without 
producing any sickness. In another case, he gave the zinc till 5ss. was 
taken three times a day, and was then diminished to ten grains to a dose. 
The fits entirely disappeared from the commencement of the treatment. 
In other cases he gave two grains three times a day with similar success. 
He then says: 
It is a general belief that sulphate of zinc excites less nausea in the form 
of pill than in a liquid state. I find the difference to be scarcely appreci- 
able ; and as it is often desirable to increase the dose to an extent which 
would make it inconvenient in the form of pills, I frequently prescribe it in 
solution. It is soluble in two parts and a half of cold water; so that the 
dose is not inconveniently large, whatever number of grains it may be 
desirable to administer. I have frequently seen epileptic patients benefited 
by other tonics; as, for instance, by preparations of iron, by nitrate of 
silver, and by powdered mugwort-root. In so intractable a disease, we are 
often obliged to vary our remedy, the principle of treatment remaining the 
same. Part iii., p. 21. 
Croton Oil.—From several remarkable- cases of epilepsy, sciatica, etc., 582 
EPILliPSr, 
in which Dr. Newbigging found the croton oil very useful, while other 
purgatives did not exert the same beneficial effect, he is led to suppose 
there may be some peculiar properties in this drug independent of its vio- 
lent effects as a purgative. Sir C. Bell first brought it into notice in the 
treatment of tic douloureux. In one patient, at sixty, whose attacks of 
epilepsy came on regularly every six weeks for the last twelve years, a 
drop and a half was given with good purgative effects; its use was occa- 
sionally continued, and the fits did not return. In another patient, a boy 
five years old, in whom the fits came on twice or thrice in twenty-four 
hours, and who had been epileptic for two years, one drop was given, the 
fits soon abated, and the patient ultimately recovered. Those cases are 
chiefly benefited in which there is “ some irregularity in the cerebral 
circulation.” Those cases in which there is organic disease of the brain, 
or its meninges, were not much benefited by the oil. Part iii., p. 38. 
Compression of the Carotid Arteries.—Recommended in epilepsy and 
other convulsive affections. Part iii., p. 61. 
Chloride of Silver.—Recommended by Dr. Perry, of the Philadelphia 
Hospital. In epilepsy, three grains given four or five times daily, pro- 
duced effects similar to those of nitrate of silver, but more marked. 
Part iv., p. 19. 
Oxide of zinc.—The good effects of oxide of zinc in cases of convulsion 
resembling epilepsy are brought forward in a case by Dr. Green. He 
gives it in two grain doses twice a day; the doses to be increased two 
grains every day. In the case which Dr. Green relates twenty-four grains 
daily were at last given with great success. The fits which occurred fre- 
quently before this, now disappeared, and did not return till the remedy 
was discontinued; on resuming the medicine, the fits again disappeared as 
at first. Part iv., p. 25. 
Ilydrocyanate of Iron.—M. Janson has for some time been in the habit of 
giving the hydrocyanate of iron in cases of epilepsy with considerable suc- 
cess ; and especially in cases which he calls nervous epilepsy, as distin- 
guished from organic epilepsy. He gives it in doses of half a grain night 
and morning, gradually increased to ten grains for a dose. It is necessary 
to persevere in it for some time. • Part iv., p. 63. 
Ice to the Spine.—We need not remind the practitioner how necessary' 
it is to keep in view correct principles in the treatment of convulsions, 
which are symptoms of disease, and not the disease itself. It is particu- 
larly necessary to ascertain their cause. Convulsions cannot occur without 
some affection of the medulla oblongata, or spinal cord, direct or indirect. 
The irritation or disease may be either in the bx-ain itself, or in some 
remote part, as in the gums from teething, or in the bowels from a vai'iety 
of causes. 
The sedative agency of cold to the spine, in the form of ice, has been 
found, by M. Pincott, to be valuable in those cases of infantile convul- 
sions which depend upon an writable state of the cerebro-spinal axis. It 
may be applied in an ox-gullet along the course of the spine, from the 
occupit to the sacrum. In the case related by Dr. Todd, in which the ice 
was applied at the suggestion of Mr. Pincott, the convulsions ceased in 
ten minutes, although they had existed a considerable time, and had 
resisted all the usual means of treatment. Part v., p. 67, EPILEPSY. 
583 
Ioduret of Silver.—Dr. Patterson has advised that the ioduret of silver 
be used instead of the nitrate, which he states to be equally efficacious 
and free from all risk of discoloration, however long continued. His 
theory is, that the discoloration is most probably owing to the decomposi- 
tion of the chloride of silver circulating in the cutaneous tissue through 
the chemical action of the sun’s light, and the deposition there of its 
metallic basis—and, therefore, he thinks if we can procure a preparation 
of silver which cannot be acted upon by chlorine nor by the sun’s light, 
we shall be in the possession of a perfectly safe medicine: such he esteems 
the ioduret. 
The following is the formula: 
ft Iodureti argenti; nitratis potass®, ana, grana decern; tere simul ut fiat 
pulvis subtil,,.deinde adde pulv. glycyrrhiz®, 3ss.; sacchari albi, 9j.; mucil. 
arab. q. s. M. fiant pil. xl., quarum ®ger sumat unara ter in die. 
It is stated in systematic works on chemistry, that all the iodides are 
decomposed by chlorine. This is not true of the iodide of silver ; at least, 
neither strong nor dilute muriatic acid, nor solution of muriate of soda, 
has any effect on it. Part vi., p. 11. 
In cases of amenorrhcea combined with epilepsy, the following formula 
is recommended by Dr. Bright: 
It Pulv. digitalis, one grain; pulv. myrrh®, two grains; sulphatis ferri, 
one grain ; sirupi, sufficient to make a pill. Take three daily. 
Part vi., p. 80. 
The instantaneous application along the spine of a burning match, 
suggested to avert, in cases of the aura epileptica, the invasion of the 
epileptic fit. Part vi., p. 86. 
Digitalis in Mania and Epilepsy.—Dr. Sharkey gives an account of 
some cases of idiopathic epilepsy, in which very large does of digitalis had 
produced excellent effects; and he has since met with cases of mania 
combined with the former disease, in wdiich the same large doses of this 
medicine vrere equally beneficial. In the case of a young woman of 
twenty-seven, who had been the subject of attacks of idiopathic epilepsy 
from childhood, followed by mania, Dr. Sharkey gave 5ij. of the tincture 
prepared from the fresh leaf, after the woman had been attacked with one 
of these fits of mania for three, days. She had been sleepless for three 
days and nights, and talked incessantly; she had taken no food or drink 
during this time. On the night after this dose of digitalis she slept 
soundly, awoke composed, and made a hearty breakfast. She continued 
to do well. . ' Part ix.,y>. 66. 
% 
Indigo and Digitalis in Epilepsy.—[The foxglove has from time imme- 
morial been administered for epilepsy in the rural districts of Ireland. In 
many instances, success has followed on its exhibition, but the effects have 
been so violent, from the quantity administered (the formula is giv. to the 
pint of water, a quarter of this for a dose) that the profession has shrunk 
from using it. Sir P. Crampton, however, informed Dr. Corrigan, in 1828, 
that he had cured three cases out of four by it, though he did not venture 
beyond the first dose.] 
Preference is given to the infus. digitalis of the Dublin Pharmacopoeia. 584 
The greatest attention should be paid to see that the leaves are well pre- 
pared, and of the latest gathering. 
The mode of administering is to begin with gj. of the infusion every 
night at bed-time, increasing it, after a week, to giss., and after another 
week, to gij., beyond which it is rarely necessary to go, and continuing it 
until sickness of stomach and dilated pupils are observed, when the dose is 
to be diminished by gss. or gj., until the maximum dose that can be borne 
without inconvenience is ascertained, at which the administration is to be 
continued for two or three months. Given in this way, its exhibition is 
attended with no inconvenience beyond an occasional attack of slight sick- 
ness of stomach in the morning, or headache, etc., when the medicine is to 
be omitted, and a day or two is to be allowed to pass over before resuming 
its use. With the exception of these symptoms, there is no perceptible 
effect beyond slow action of the heart; and the patient, during its use, is 
able to follow his ordinary avocations. 
Dr. Cormack states that foxglove is mostly beneficial in cases of epilepsy 
where there is much arterial excitement, but as such is not usually present 
in this disease, it is not likely to prove extensively useful. He states that 
he has found indigo act more like a specific in epilepsy than any other 
remedy. Part xii., p. 32. 
Epilepsy with Secondary Syphilis—The patient was a healthy-looking 
seaman, 36 years of age. He had been subject to epileptic fits of an aggra- 
vated character, for the last 18 months. He was subjected to a variety of 
treatment, the disease appearing of a functional character. He had con- 
tracted syphilis in his youth, but had never suffered from secondary symp- 
toms ; some indications, however, coming on, he was ordered iodide of 
potass 3 grains three times a day, and the soreness of the mouth, which 
had previously been induced, to be kept up by blue pill. Under this 
treatment, the nocturnal pains and epileptic paroxysms disappeared toge- 
ther. Part xiv., p. 65. 
Secondary Epilepsy and Apoplexy in Children.—One of the most fre- 
quent effects of infantile cholera, according to Dr. Coley, is convulsion of 
the muscles of the extremities, accompanied with more or less suspension 
of the function of the brain and interruption to the process of inspiration. 
We find, during the paroxysm in general, a remarkable dilatation of the 
pupils, a pallid and contracted appearance of the face, and a comparatively 
cold state of the skin, which is succeeded by temporary warmth and copi- 
ous perspiration, the results of continued involuntary muscular action. 
This epilej)tic attack is usually preceded some hours by a shrill scream, 
and when this occurs, a convulsion of the adducent muscles of the eyes, 
constituting squinting, succeeds, and the case is apt to terminate in apo- 
plexy. As the cerebral disease advances from a state of congestion to that 
of inflammation, effusion of serum, accompanied with symptoms of apo- 
plexy, follows. The convulsion of the voluntary muscles is now interrupted 
by stupor and insensibility, and the sphincter muscles, and those of deglu- 
tition, become paralyzed. Stertorous and irregular respiration follows, and 
the capillary circulation partaking of the general enervation, animal heat is 
no longer generated, and the surface becomes inanimate and cold, and is 
covered with universal exudation. 
Caution is enjoined in the use of bleeding and the administration of 
calomel, as these increase the tendency to nervous effusion which is usually 
EPILEPSY, 585 
EPILEPSY. 
present in this disease. The best plan, when the face is pale and the skin 
cool, is to give digitalis promptly. Part xv., p. 68. 
Treatment of Epilepsy.—According to Dr. M. Hall, the indications are 
to relieve all gastric, enteric and uterine irritations, by emetics, enemata 
and emollient vaginal injections; prevent all mental and bodily excitement; 
do not suffer the patient to sleep too deeply, nor to be suddenly disturbed ; 
and order simple and nutritious diet, cold sponging and friction, and fresh air 
and exercise. Watch the patient narrowly, when an attack is threatened; 
if the paroxysm approaches, dash cold water in the face; and if the fit 
comes on raise the bead, expose the face and neck to the air, and dash 
cold water in the face to excite a forcible inspiration, by which the larynx 
may be opened; apply spirit lotion to the head, and warmth to the feet; 
and guard the patient against accident. Part xvii., p. 38. 
New Remedy for Epilepsy.—This remedy is the expressed juice of the 
cotyledon umbellicus. 
The plant may be used as long as the leaves remain green and succulent, 
and every part of it be employed for the expression of the juice, with 
which the leaves, however, are the most abundantly supplied. 
Give an ounce of the expressed juice, or half a drachm of Hooper’s 
inspissated juice, twice a day, and continue its administration for a length 
of time. 
In collecting the leaves of the cotyledon umbellicus, care should be taken 
not to confound it with an umbelliforous plant, the marsh pennywort (liy- 
drocotyle vulgaris), which it somewhat resembles. 
• A view of the entire plant, and a knowledge of the locality in which it 
grows—the cotyledon always being found in very dry, and the hydroco- 
tyle in moist places—will be conclusive. Part xix.,p. 56. 
Use of Cotyledon Umbellicus in Epilepsy.—Dr. Bullar says that those 
patients and those practitioners who are not disposed to give the medicine 
a long, patient and steady trial, will be disappointed. 
When, with an excitable nervous system (or without it), there is a yel- 
low eye, foul tongue, turbid acid urine, fetid and disordered secretions 
from the bowels on giving medicines, it is essential to purify the blood and 
fluids by a course of appropriate gentle aperients, which, acting like mine- 
ral waters, keep up a relaxed state of the bowels without exhausting, and, 
together with strict attention to food, air, exercise and habits, restore the 
general health—a step usually necessary before any specific remedy will 
act satisfactorily. It is too well known that setting the general health to 
rights will not alone cure epilepsy, but no remedy can be available if this 
step is neglected. 
In children, and especially boys whose general health is good, it is ad- 
visable to begin with a few brisk purgatives of calomel and scammony, fol- 
lowed by castor oil, to ascertain if the fits do not depend on worms. And 
in young men the state of the urethra should be inquired into, as an irrita- 
ble urethra, attended with involuntary seminal discharges, may be one 
cause of the fits, and unless relieved by the use of the bougie, may render 
any other means abortive. 
The doses may be thus stated: Fresh juice, one ounce, or, Hooper’s 
inspissated juice, half a drachm, twice daily. 
I avail myself of the present opportunity to state that this (May) is the 586 
EPILEPSY. 
best time to collect the plant, as it is shortly about to flower, ami the juices 
are richest. Part xix., p. 294. 
Belladonna.—Belladonna is very useful in cases where the attacks 
occur frequently. The dose of the aqueous extract should be at first about 
a grain and a half, in divided doses; and this may be increased to about 
three grmns daily. Pa,rt xxi., p. 77. 
Epilepsy—Penal.— [The subject of the following case was admitted in 
a state of profound epileptic coma; and from October the 18th to 20th, 
had five convulsive fits accompanied and coma, which con- 
tinued for two days, when he began to recover:] 
Dr. Todd remarks: “The long continuance of a state of profound coma 
is always calculated to excite anxiety in the friends and attendants of the 
patient, and to create fear lest some extensive mischief shall have been 
done to the brain. In this case there were two circumstances among 
others which greatly encouraged me to believe that no serious organic 
lesion existed in that organ. The first of these was, that the coma was 
accompanied with convulsive fits. Now you will not understand me to 
say that I do not apprehend danger from such paroxysms of epilepsy as 
this man has had; but that, when epileptic convulsions and coma occur 
together, and where there is no hemiplegic paralysis, we have a good deal 
of presumptive evidence that there is no apoplectic clot, or other organic 
lesion likely to damage the brain permanently. Thus we were led to 
ascribe both the coma and epilepsy, not to the pressure of a clot upon or 
within the brain, but probably to one and the same cause, which cause was 
suggested by the second circumstance to which I have referred—namely 
that his urine was scanty in quantity, and highly impregnated with albu- 
men. 
“ Thus I viewed the case as one of those in wdfich the cerebral affection 
was due to the presence of some irritating matter in the blood which 
ought to be eliminated by the kidneys. There are very good grounds 
for believing that urea in the blood is capable of affecting the brain so as 
to cause coma and convulsions. Other substances retained in undue quan- 
tity may produce the same effect, for aught we know; and certainly 
coma and convulsions may occur in cases where we have no evidence of 
the presence of urea in the blood; but it is quite as certain that, when 
the kidneys fail in their action to secrete only an ounce or two of urine in 
the day, instead of thirty or forty ounces, coma and convulsions are very 
apt to ensue. 
“ To prove the presence of urea in the blood, take the serum from a 
blister, evaporate to dryness over a water-bath, then add alcohol, which 
dissolves it out. Evaporate this alcoholic extract to dryness, and, after 
mixing with a little water, so as to make a spongy mass, add a few drops 
of nitric acid; if urea is present, characteristic crystals of nitrate of urea 
are formed, recognized either by the eye or the microscope. In those 
cases of epilepsy where there is evidence of irritating matter in the brain, 
use a treatment actively eliminatory. Shave the head and blister the 
scalp, apply mustard cataplasms to the back of the neck, and purge freely. 
Elaterium is one of the best purgatives, as it carries off a great amount of 
serum, which contains urea. Warm baths, or hot air-baths, are very 
valuable where there is not much depression of the system.” 
Part xxv., p. 66. EPILEPSY. 
587 
Epilepsy.—Dr. E. Watson having studied Dr. Marshall Hall’s theory of 
the relation of larnygismus to epileptic convulsions, adopted the following 
treatment. The patient was a young lady, who for several years had been 
afflicted with epilepsy. Dr. Watson applied a solution of nitrate of silver 
(E)j- to §j.) to the glottis, daily for a fortnight, and afterward for some 
weeks with longer intervals between the applications. There can be no 
doubt but that the treatment gave marked relief, both in the frequency 
and intensity of the paroxysms. Part xxvi., p. 42. 
Epileptic Convulsions.—In the case of a child one year and seven 
months old, after all means of relief had been tried without effect, and 
the patient seemed sinking fast, it was determined to try chloroform inter- 
nally. Five-minim doses were given after every fit. After the first dose, 
the child slept almost continuously. The remedy was ordered to be given 
three times a day, the dose being afterward increased to seven minims, 
but the convulsions were never again repeated, and after the first dose of 
chloroform, the child rapidly improved. Part xxviii.,y>. 61. 
Tracheotomy for the Relief of Epilepsy.—In two cases of this disease, 
the operation of tracheotomy was performed with the best results. It 
was found that the operation was best performed thus: The incisions were 
made in a transverse direction above the thyroid body, the muscular 
fibres being divided freely, and the trachea laid bare just below the 
cricoid cartilage. The main incision into the trachea was also made trans- 
versely, but from the middle of the lower edge a short downward incision 
was added. Part xxviii., p. 62. 
Epilepsy.—Let the patient live by rule, and take a proper degree of 
exercise. Act daily on the bowels twice by the following pills: mercurial 
pill, one scruple, compound colocynth pill, two scruples ; make into twelve 
pills, and take one occasionally. Also take of the juice of the cotyledon 
umbellicus (Davenport’s) one teaspoonful daily before breakfast. Avoid 
stimulants, suppers, balls, theatres, etc. Increase the juice by and by to 
two teaspoonfuls. Part xxix., p. 53. 
Epilepsy.—Dr. F. E. Wilkinson corroborates Dr. Marshall Hall’s state- 
ment of the value of strychnia, dissolved in acetic acid, in the treatment 
of epilepsy. 
Epilepsy—Chloroform.—As long as an animal is fully under the influ- 
ence of chloroform, no convulsions can be produced. Chloroform controls 
and modifies the convulsions of epilepsy, and also the delirium of epilepsy, 
as well as those convulsive jerks of the muscles of both upper and lower 
extremities which are so distressing. Chloroform also has a marked 
power over puerperal convulsions; also over the convulsions of infants, 
and laryngismus stridulus. Part xxx., p. 37. 
Epilepsy treated by the Barh of Blade, Elder Tree.—Give an infusion, 
of the bark of black elder (sambucus nigra). It acts as a hydragogue 
and probably eliminates the poison from the blood which causes the epi- 
leptic fit. 
In order to prepare it for administration, the branches of the elder, of 
one or two years,, are taken; the grey bark is removed, and the second 
bark which remains is scraped off. About five ounces of common water, 
hot or cold, are poured upon two ounces of the bark, and the infusion is 588 
EPILEPSY. 
allowed to stand forty-eight hours. The infusion, properly strained, 
should be taken at intervals of a quarter of an hour for a certain number 
of times when the fit is threatening, the patient fasting. It should be re- 
sumed every six or eight days. Part xxx., p. 38. 
Epilepsy and Convulsive Diseases Generally.—Avoid all the usual ex- 
citements ; avoid low postures, deep sleep, and tight collars or cravats. 
Relieve acidity of the stomach with bicarbonate of potass, also scybala in 
the colon by enemata. Sometimes a good emetic, as half a drachm of 
ipecacuanha, will check a convulsion. It is possible that minute doses of 
strychnia may do good in the undue spinal excitability of epilepsy, in the 
same way as a little alcohol does in the undue cerebral excitement of deli- 
rium tremens. Part xxxi., p. 58. 
Epilepsy.—Dr. R. Hunt maintains that an abnormal excess of alkali in 
the blood directly predisposes the nervous system to disease, and not only 
this, but also that it probably causes various chemical changes in the 
blood, which result in the generation or retention of noxious matters in 
the system, which excite a tendency to spasm and convulsions. 
Dr. Prout says that alkalies, when assisted by heat, rapidly convert 
urea into carbonate of ammonia. From this we may infer, that when they 
exist in excess in the blood, they will also prevent its elements combining 
so as to form it, and thus noxious matters will be retained which ought to 
be eliminated, as urea. This, 'we know, will act on the brain and the spinal 
cord, and probably account for many of the symptoms from which epilep- 
tics suffer so much, if not for the epileptic convulsion itself. Such being 
the supposed cause, the greatest benefit has been derived from an acid 
treatment, externally, by means of the nitro-muriatic acid bath, for twenty 
minutes every night, and by giving twenty minims of the dilute nitro-mu- 
riatic acid twice a day, a compound rhubarb pill every night, and allow- 
ing subacid fruits, lemon juice, vinegar, etc. This treatment, by acids, 
has been tried with wonderful success in many cases which had for years 
been considered hopeless, and in which almost everything likely to relieve 
had been tried without success. In the cases where it has been most 
beneficial there has been a deficiency of urea in the urine and a cloud of 
phosphates deposited on boiling. 
From the uniform deficiency of organic principles, as urea, and the ex- 
cess of mineral matters, especially chloride of sodium, in the urine, we may 
infer that they must have some connection with the state of the blood, and 
the disease in question, as cause and effect; this is supported by the results 
of the acid treatment, which, as it corrects the abnormal state of the urine, 
cures the disease. Part xxxiii., p. 53. 
Epilepsy.—The oxide of zinc is very useful as a tonic and anti-spasmo- 
dic in all cases of general nervous debility. It may be given without the 
slightest fear of danger, in doses gradually increased from fifteen to thirty 
grains daily. 
Oxide of zinc and oxide of silver are now very extensively used in 
nervous affections. The most agreeable form of the medicine is the 
sirup of the iodide of zinc. Do not mistake hysteria for epilepsy; in 
the latter the loss of consciousness is extreme, but not in hysteria. 
Part 61. EPISTAXIS. 
589 
Phosphate of Zinc in Epilepsy.—Dr. Barnes has extensively tested the 
restorative and curative powers in phosphate of zinc—a new remedy in- 
troduced by him in the treatment of epilepsy and other nervous affections 
resulting from cerebral exhaustion. This physician was led thus to combine 
phosphorus and zinc by reasoning upon the well known efficacy of zinc in 
epilepsy, and the fact that in exhausting nervous diseases there appears to 
be a waste of phosphorus in the brain matter. 
In convalescence from fevers, which induce great wasting of tissues, and 
notably of brain matter, to the extent, not unfrequently, of leading to in- 
sanity, Dr. Barnes has exhibited the phosphate of zinc with quinine and 
other remedies with the most satisfactory results. In combination with 
conium, it is frequently exhibited with advantage in phthisis in preference 
to the sulphate of zinc. In the menstrual form of epilepsy, when accompa- 
nied by exhaustion and anaemia, the remedy has been of great service. In 
one case of insanity following on exhaustion produced by lactation for 
eight months, the phosphate of zinc, judiciously combined with other 
remedies, completely restored the patient to physical and mental health in 
three months. Dr. Barnes refers to the readiness with which the phos- 
phate of zinc adapts itself to the peculiarities of different cases by the fa- 
cility of combination with various other remedies. He prescribes the 
dilute phosphoric acid as the proper solvent. With this basis he combines 
tincture of valerian, tincture of cinchona, calumba, quinine, or iron, 
according to the indication present. It is less liable to cause vomiting 
than the sulphate. The experience of Dr. Barnes is certainly decisive 
enough to recommend the phosphate of zinc to the attention of the pro- 
fession. Part xxxvii., p. 48. 
Ipecacuanha.—Small doses of ipecacuanha recommended in cases of in- 
ternal hemorrhage. Principle: 
More rapid coagulation of the blood, under the influence of nauseating 
remedies. Parti.,p. 37. 
Oil of Ergot.—Mr. Wright, in the course of his observations on the 
therapeutic action of oil of ergot, says: 
In a severe case of epistaxis, I arrested the hemorrhage, by injecting up 
the nostrils equal parts of very dilute spirit and oil of ergot; and I have 
little doubt that in the severe cases of flooding which succeed delivery, the 
injection of this oil, diffused through water, into the uterus, would be pro- 
ductive of the happiest results. Part ii., p. 42. 
General Bleeding.—“ In severe cases of epistaxis, it is well known, 
there is no more judicious means of arresting the bleeding than by taking 
a quantity of blood from the arm.” Part ii,,p. 73. 
Simple Means of Arresting Epistaxis.—This consists in nothing more 
than closing with the opposite hand the nostril from which the blood flows, 
while the arm of the same side is raised perpendicularly above the head. 
In every instance in which he has had recourse to this means during the 
EPISTAXIS. 590 
EPISTAXIS. 
past three years, M. Negrier has always found that it suspended the 
hemorrhage. Part vi., p. 89. 
Matico Leaves.—Recommended as an astringent and styptic in epistaxis 
and other hemorrhages. 
If employed externally as a styptic, it is better to apply the under side 
of the leaf. Internally the decoction or infusion may be safely given, 
half an ounce to the pint, and the dose three tablespoonfuls, increasing 
the strength to one ounce to the pint gradually ; suspending its use for a 
day, and substituting a gentle purgative ; but if it produces nausea, it 
should be omitted for a few days. Part-V\\\., p. 37. 
Hemorrhage from the Hose.—Especially in old persons, introduce the 
little finger into the nostril, and press upon its floor until the bleeding 
stops ; then take a dossil of lint, and roll it upon powdered alum, and press 
it upon the floor of the nostril with the little finger. Introduce pieces of 
lint, in this way, until the roof of the nostril supplies the pressure of the 
finger. Part xiv.,p. 192. 
Epistaxis treated by Insufflations of Alum.—When hemorrhage from 
the nasal cavities assumes a dangerous aspect, recourse is generally had to 
plugging, a measure both inconvenient and painful. M. Lecluyse has suc- 
cessfully employed means far more simple, and at the same time, according 
to his own account, more certain, namely, the insufflation, by means of a 
quill, of equal parts of powdered gum arabic and alum. In one case this 
succeeded after three repetitions; other means, and plugging among them, 
have entirely failed. Part xv., p. 120. 
Treatment of Epistaxis.—Mr. Vincent prefers to keep the parts Avhich 
are bleeding free from all coagulum, by syringing the nostrils repeatedly 
with warm water, until the bleeding ceases. It will not afterward occur. 
Part xix., p. 142. 
Epistaxis.—Oil of turpentine will be found an excellent astringent, given 
in doses of from twenty to sixty minims every three or four hours. Tinc- 
ture of muriate of iron may be given as an adjunct, or not, according to 
circumstances. Part xxi., p. 116. 
Plugging the Nostrils.—A tube of caoutchouc with a dilatable ex- 
tremity, or balloon, has been invented by M. Gariel, which, by being 
introduced into the nostril and expanded by insufflation, exerts such 
pressure as to arrest the hemorrhage in cases of epistaxis. By being 
carried into the back part of the mouth along the floor of the nares, and 
then expanded, the posterior nares may also be plugged. M. Diday, of 
Lyons, has also made an ingenious use of a similar dilatable tube, by 
introducing it into the uterus, and expanding it, in repressing uterine 
hemorrhage. Part xxii., p. 216, 
Treatment of Epistaxis.—M. Reveille-Parise observes that it is very 
desirable to be in the possession of a simple means of arresting epistaxis 
when severe. Plugging is not the simple operation is has been described ; 
it is very tedious, and often excites vomiting or sneezing, which aggra- 
vates the bleeding. Moreover, we may not have any appropriate instru- 
ment at hand. 
The following plans may be tried: 1. Apply alcohol on dossils of 
charpie. 2. Blow into the nares equal parts of powdered gum and alum, EKGOT. 
591 
or dossils rolled in this mixture may be applied, taking care to moisten them 
with warm water, before removing them. 3. Perhaps the best plan is 
previously to dry the nostrils and then pass into them dossils of pure clean 
cotton wool, until they are filled, not pressing it too tightly, or allowing it 
to be too loose. Part xxvi., p. 109. 
Tincture of Benzoin as a Remedy for Epistaxis.—[The case was that 
of a delicate child with disease of the heart following rheumatism. She 
had had several severe attacks of epistaxis before the one on account of 
which the author—Prof. Barker, of New York—was called. 
The posterior nares had been twice plugged, each time by a distinguished 
surgeon who had been called in consultation. He represented the present 
attack as more severe than any she had had before. 
“For some time past I have been accustomed to arrest the severe he- 
morrhage resulting from malignant ulceration of the cervix uteri, by 
painting over the diseased surface the tinct. benzoin co. It now occurred 
to me that this article might possibly prove equally serviceable in the 
present case. I injected about a drachm, by means of a small syringe, up 
the left nostril, the passage from which all the hemorrhage came. For a 
moment or two she complained bitterly of a severe burning pain in the nose, 
extending back to the ear, but it very soon subsided, and the hemorrhage 
entirely ceased within five minutes after the injection was used. I re- 
mained with my patient about a half hour, and then directed a teaspoonful 
of elix. paregoric to be taken, and this to be repeated in an hour if she did 
not fall asleep. She has had no hemorrhage since, and her general health 
has improved in the most remarkable manner, under the steady use of the 
sirup of the phosphate of iron.” Part xxxvii., p. 58. 
Turpentine as a Styptic—To arrest hemorrhage m epistaxis, and after 
venesection. Vide Art. “Turpentine.” 
Preservation of the Ergot of Rye.—1st, Reduce the recent ergot well 
dried into powder. 2dly, Expose the powder to a temperature of 45 or 
50 degrees (centigrade), in order to dry it thoroughly and quickly. 
3dly, Put it into giass bottles not exceeding a hectogramme in size, and 
seal hermetically. 4thly, Withdraw it from the action of light, by shut- 
ting it up either in a dark place, or by covering the bottles with black 
paper. If the results obtained by this process be really as advantageous 
as the author announces, we cannot too soon direct the attention of phai’- 
maceutists to it; for it too frequently happens, especially at the latter part 
of the season, that the officinal preparations of the ergot are so deterio- 
rated, that it is impossible to calculate with certainty upon their effects. 
Part xi., p. 230. 
Ergot, Substitute for.—Dr. Washington, of America, has discovered 
Ghat dry cupping on the lowest part of the sacrum produces dilatation of 
the os uteri, and higher up contraction of the uterus. We one 
or other of these, according to the nature of the case. But the lower 
ERGOT. 592 
ERYSIPELAS, 
one should always be on when the upper one is applied, so as to insure re- 
laxation of the os when the j)ains come on. Part xxviii.,j9. 273. 
Ergot of JV/ieat.—The medical and obstetrical property of this ergot is 
as incontestable as that of ergot of rye ; its effects are as prompt, as direct, 
and as great. Its hemostatic action appears equally certain. 
Part xxxiv.,p. 254. 
ERYSIPELAS. 
Bark of the Ulmus Campestris {Elm).—Recommended internally and 
externally,in mild cases of erysipelas. Four ounces of the fresh elm bark, 
bruised, boiled in four pints of water, form a thick decoction. 
Part i., p. 61. 
Ambulatory or Erratic Erysipelas usually terminates in the formation 
of abscesses. These abscesses generally form without pain, and often 
without the patient being at all aware of their development. Such an 
occurrence is frequently the counterpart of what is going on in some inter- 
nal part; a slow inflammatory action is set up, and terminates in suppura- 
tion, without either pain, fever, or any outward symptom being manifested. 
Part iii., p. 116. 
Treatment of Erysipelas.'—M. Velpeau declares, that having frequently 
failed with the usual remedies employed against this malady, such as com- 
pression, the flying blister, nitrate of silver drawn across, or around the 
inflamed surface, white precipitate ointment, the various acids, etc., a new 
idea suggested itself to him, from a consideration of the modifications in- 
duced in the blood by the preparations of iron. He was thence led to 
employ as a local application a solution of the sulphate of iron, in the pro- 
portion of one ounce to a pint of water, or an ointment containing two 
drachms to an ounce of lard. The ointment he considers a more conve- 
vient application for the head, neck, and trunk. Great care is, however, 
requisite in thoroughly powdering the salt before mixing it with the lard. 
It should then be rubbed freely over the whole inflamed surface, and even 
a little beyond. The solution is employed by means of compresses, wetted 
every six hours, and maintained on the part by means of a bandage. The 
skin must be kept constantly moist. One of the inconveniences of the sul- 
phate of iron, is that of reddening the linen with which it comes in contact. 
No means of neutralizing this effect has been as yet discovered. M. Velpeau 
states that in twenty-four cases in which he employed this application, the 
most marked and rapid influence was exerted over the progress of the 
eruption. It is suggested also to administer the sulphate of iron inter- 
nally. Part vi., p. 80. 
(Edematous Erysipelas.—Case cited recurring in an old cachectic sub- 
ject, benefited by tincture of iodine locally, together with bandaging and 
constitutional treatment. Part vi., jo. 119. 
3fus0~ls considered very useful in the delirium which sometmes at- 
tends erysipelas and other exanthemeta. Part ix.,p. 77. ERYSIPELAS, 
593 
Treatment of Erysipelas. — Numerous clinical facts prove, that the 
sulphate of iron is one of the most efficacious topical remedies in erysipe- 
las. This substance may be employed in solution, or as an ointment; 
Professor Velpeau prefers the former, and has recourse to the latter only 
when it is impossible to apply compresses soaked in the liquid on the seat 
of the disease. When these topical remedies are had recourse to, the 
erysipelas generally yields in the space of twenty-four hours; the skin 
becomes less tense, and loses its shining aspect; the epidermis is drawn 
into small folds, and cracks ; the tumefaction decreases; the pain and the 
heat disappear. Professor V. insists particularly upon not confounding 
this disease with angioleucitis, diffused phlegmon, cellular phlebitis, and 
erythema, as it is doubtful whether the ferruginous application is useful in 
these disorders. Erysipelas is characterized by a diffused inflammation, 
without any notable . swelling of the sub-cutaneous tissues, extending 
gradually from one part to another, the edges of the inflamed spot being 
as red as its centre, and slightly elevated and festooned; the skin a line 
beyond this edge appears to be normal—whereas, a line within, it is as 
inflamed as in the centre of the affected part. According to Professor V., 
this festooned edge is the pathognomonic sign of erysipelas. Finally, 
should the disorder appear to be produced by some internal cause, we 
must first direct our remedies against this, the sulphate of iron being 
only really efficacious when the inflammation is purely local. 
Part xi., p. 189. 
Treatment of Erysipelas.—[As to the local treatment, hot fomenta- 
tions, says Dr. Basham, are very useful, and are generally (not always 
though) preferred Lv the patient to cold applications. He continues: 
The nitrate of silver has been used freely to the erysipelatous surface 
in these cases, and with the effect of cutting short the inflammation, by 
setting up an action different from, and incompatible with, the specific 
action of erysipelas. That it does cut short the inflammatory condition 
of the skin is proved by the absence of vesication when it is applied in 
time, the cuticle subsequently merely desquamating. That the action of 
the nitrate of silver on the skin is incompatible with erysipelatous inflam- 
mation is also testified by the fact, that the disease will not extend itself 
beyond a line marked out by the lunar caustic. Advantage is taken of 
this fact to prevent the erysipelas extending, by surrounding the inflamed 
parts with a cauterized line of demarcation. 
There are some cases, however, in which it is less advisable to use the 
nitrate, than to depend upon free incisions made with a lancet, scoring the 
skin in parallel lines, and sufficiently to extract blood freely for the relief 
of the fullness and distention. This course is especially necessary when 
the appearance of the skin indicates a more intense degree of inflamma- 
tion, of a more palpable phlegmonous character, and certain, if not by this 
means relieved, to terminate in suppuration and purulent infiltration in 
the subjacent cellular tissue. This practice may appear severe, but it is 
not so; it quickly affords relief, and saves much subsequent pain and trouble. 
[Any little abscesses that form on the face, for instance in idiopathic 
erysipelas, where general purulent infiltration is rare, should be opened by 
a free incision, and the contents being evacuated, pressure should be made 
upon the sides, or the sac will refill. With regard to constitutional treat- 
ment, brisk purgatives—at the beginning olkthe affection, mercurial alte- 594 
ERYSIPELAS. 
ratives, and toward the end, wine or ammonia, if required, are the reme- 
dies to be relied upon; for, as Dr. Basham observes, general blood-letting, 
and depleting treatment, are not admissible in those cases met with in the 
metropolis. He says:] 
The chylopoietic viscera are always irregular in function and secretion, 
and require the agency of mercurial purgatives; these unload the bowels, 
relieve the biliary congestion, and improve the aspect of the dejections. 
Brisk saline purgatives, cooperating with the mercurials, so that 'they be 
not pushed too far, are of great utility. Colchicum, in combination with ? 
neutral salt and magnesia, is in my experience the best form of cathartic. 
The action of the colchicum is developed principally on the duodenum; it 
stimulates the hepatic duets, cleanses this portion of the intestines of 
mucoid accumulations, modifies the accompanying fever, diminishes the 
heat of the skin, relieves the local turgescence, and furnishes other indica- 
tions of amelioration. Two or three good pui'gative actions are generally 
sufficient, for hypercatharsis must be carefully avoided. The form in 
which I usually prescribe colchicum, is the haustus colchici compositus of 
our Hospital Pharmacopoeia. Yin. colchici, dr. ss.; solut. magn. sulph., 
dr. iij.; magnesite carb., gr. xx.; aquae mentha? pip. oz. j. m. fiat haustus. 
The type of the fever in the majority of metropolitan cases is unques- 
tionably of an asthenic order, ammonia and other stimuli becoming neces- 
sary oftentimes in the early stages of the disease. 
Opium exercises a most beneficial influence wherever irritability, 
restlessness, and delirium, are the concomitants of fever. The pulvis 
ipecacuanha? comp, is, in most cases, the best form in which opium can be 
given, from its developing a secondary influence over the skin. 
It has been already observed, that diffusible and vinous stimuli are 
important and essential remedies, so soon as the pulse and tongue indicate 
the approach of a typhoid condition. Ammonia is best given, as the 
sesquicarbonate in the mistura ammonia? acetatis, or effervescing draught, 
formed by twenty grains of the sesquicarbonate with two teaspoonfuls of 
lemon-juice. The tongue becoming moist, the skin cool, and the pulse 
lowering in frequency, express a remission of the adynamic state. Of 
vinous stimuli, it is hardly necessary to specify any particular kind; port 
wine or brandy is most usually employed. 
The convalescent stage of this affection differs in but little from similar 
periods of other fevers. Cinchona-bark tea, with a mineral acid, forms the 
cheapest and most effective tonic, prepared by pouring a pint of boiling 
water on an ounce of the bruised lance-leaved bark, the water being first 
acidulated with three drachms of the dilute sulphuric acid. It differs from 
the infusum cinchona? of the pharmacopoeia only in the maceration with 
acidulated water, the object of which is to render the kinate of cincho?iine 
more readily soluble. You will find this tonic economical, and quite as 
efficacious in the convalescent periods of most acute diseases as the more 
expensive preparation of quinine. Part xv., p. 257. 
Treatment of Erysipelas by Nitrate of Silver.—[If nitrate of silver be 
applied early it will certainly subdue the local inflammation ; but still we 
must use constitutional remedies, especially for the regulation of the 
digestive functions. Of the mode of using the nitrate, Mr. Higginbottom 
thus speaks :] 
Even in idiopathic erysipelas, there is no period of the disease when I ERYSIPELAS. 
595 
would not apply the nitrate of silver. I have never in any case seen meta- 
stasis, or any other had effect, from the use of this important remedy. 
When it is necessary to apply the nitrate of silver over an extensive 
surface, as in erysipelas, I have for some years used the concentrated solu- 
tion, to the inflamed skin, and for two or three inches beyond its margin. 
R Argenti nitratis, 9iv. ; acidi nitrici, gtt. vj.; aquae destillatse, 3iv. 
Before the application, the part should be washed with soap and water, 
and then pure water; and the solution must be again applied in twelve 
hours if the first application is found not to have been uniform. 
In severe cases of inflammation, in which there may be a suspicion of 
deep-seated suppuration, a poultice of bread and water, or a plaster of 
neutral ointment, may be applied after the nitrate of silver, to keep the 
surface soft for a future examination. 
Sometimes, even after the most decided application of the nitrate of 
silver, the inflammation may spread, but it is then generally much less 
severe, and it is eventually checked by the repeated application of this 
remedy. 
The nitrate of silver is not a caustic, in any sense of the word. It sub- 
dues inflammation, and induces resolution and the healing process. It 
pi’eserves and does not destroy, the part to which it is applied. If we 
compare a caustic, as the hydrate of potassa, with the nitrate of silver, we 
find that the hydrate of potassa destroys and induces a slough and the 
ulcerative process ; but if we touch a part with the nitrate of silver, the 
eschar remains for a time, and then falls off, leaving the subsequent parts 
healed. 
If an ulcerated surface secreting pus be touched by the nitrate of silver, 
the succeeding discharge is immediately converted into lymph; it is the 
property of the hydrate of potassa, on the contrary, to induce not only 
ulceration, but suppuration. The nitrate of silver and the hydrate of 
potassa (as indeed all caustics) are as the poles to each other; the first 
preserves, the second destroys; the first induces cicatrization, the second 
ulceration. Part xvi., p. 225. 
Treatment of Erysipelas by Linear Blisters.—Erysipelas is not a 
severe disease when it is confined to a limited part of the body; it is 
generally its extension, either superficially or in depth, that produces the 
danger. 31. Piorry affirms that he has discovered a means of effecting 
the desired limitation of inflammatory action with great certainty, by 
applying at the commencement of the disease, narrow blisters around the 
circumference of the inflamed skin, at a distance of an inch or two from 
its border. He states that the erysipelatous blush soon reaches the inflam- 
mation arising from the blister, but in more than twenty cases has not 
gone beyond it. Part xvi., p. 225. 
Traumatic Erysipelas.—Traumatic erysipelas will not show itself with- 
out constitutional predisposition, arising from epidemic or endemic causes; 
but when this predisposition exists, the slightest injury to the tissues may 
give rise to the disease: hence arises the propriety of postponing opera- 
tions on hospital patients, when erysipelas is present in the ward. This is 
especially applicable to operations on the head and face, regions in which 
erysipelas is very liable to occur ; a liability depending, Mr. Cooper thinks, 
on the fact that in the head and face most of the muscles are inserted into 
the skin. 596 
ERYSIPELAS, 
Blood-letting can very rarely be borne; leeches are inadmissible from 
the irritation which their bites sometimes produce; and cold must never 
be applied in erysipelas of the head or face, for fear of producing fatal me- 
tastasis. The only remaining antiphlogistic plan is to act upon the secre- 
tions. For this purpose give the following medicines: R Hydr. chlorid. 
gr. iss.; pulv. Jacobi ver. gr. iij. M. ft. pil.; and $ Magnes. carb. gr. x.; 
sodse sesquicarb. 9j., vin. ipecac. 3ss.; mist, camphorae §j. M. to be taken 
twice or thrice a day with a spoonful of lemon juice. If the symptoms are 
typhoid, substitute ammonia for the soda. Porter and generous support 
must be alloAved; and, if there is much debility, wine or brandy. If there 
is much tension of the skin, puncture it, but do not make long incisions, 
unless there is extensive cellular sloughing. If the inflammation has great 
tendency to spread, apply lunar caustic or mercurial ointment round its 
borders. Part xvii., p. 196. 
Use of Creasote in Erysipelas.—Dr. Fahnestock, of Pittsburg, uses 
creasote in the treatment of erysipelas, with the best results. 
In every case of local erysipelas he immediately applies the purest crea- 
sote, with a camel’s-hair brush, over the whole of the affected surface, 
extending it some distance beyond the inflamed part, and at the same 
time administering a dose of calomel followed by a sufficient portion of 
jalap to insure free catharsis. This, in the majority of cases, is all that he 
finds necessary. But when the mucous membrane of the mouth and the 
fauces is also affected, he pencils those parts with a solution of the nitras 
argenti, say from half a drachm to a drachm in an ounce of distilled 
water. 
In the phlegmonous form, it will be found necessary to repeat the appli- 
cation more frequently than in the simple, with the addition of a bread and 
water poultice, applied nearly cold, and well sprinkled with water strongly 
impregnated with the creasote, or a cloth, kept constantly wet with the 
solution, especially for the face. 
The creasote when applied, should cause the parts to become white im- 
mediately ; if this does not occur it is not pure. 
The skin does not become in the least marked by the application, no 
matter how often it is applied. Part xviii., p. 227. 
Severe Cold, or Congelation.—Employ cold so as to produce congelation 
of the parts for a few seconds, by applying a piece of ice, made of a suit- 
able form by a hot iron, and dipped into a mixture of salt and nitrate of 
ammonia. Part xviii., p. 342. 
Treatment of Erysipelas by Congelation—Dr. James Arnott recom- 
mends the application of a freezing mixture of pounded ice and salt, on a 
flat sponge or in a bag of silk gauze, to a part of the inflamed surface, and 
keep it applied for about a minute, or until the skin becomes white and 
hard. Then apply it to another part of the surface, and so on until large 
patches of the skin have become frozen. Part xix., p. 198. 
Use of Nit. Silver.—If the inflammation spreads, repeat the application. 
If there are vesicles, break them and apply the solution over the denuded 
part; but do not disturb the vesications caused by the nitrate of silver 
itself. When erysipelas is spreading to the scalp, shave the head as 
early as possible, and apply the solution freely all over the scalp. N itrate 597 
ERYSIPELAS. 
of silver may be applied in any period of the disease; and it never causes 
metastasis. 
Phlegmonous.—Apply a number of leeches to the inflamed part, or 
make small incisions with a lancet; put on a bread and water poultice until 
the bleeding has ceased, and then apply the solution of nitrate of silver 
(9j. to 5j.) freely upon and beyond the inflamed parts. If suppuration is 
expected, cover it with a plaster of neutral ointment (a modification of 
ung. plumbi co.), but if not, expose the parts to the air to form an eschar. 
The constitutional treatment will be ipecacuanha emetics, saline purga- 
tives, and repeated doses of calomel with James’ powder. 
Part xxi., p. 250. 
Treatment of Erysipelas by Collodion.—Apply collodion all over the 
inflamed surface daily. It may be safely applied to the head and face. 
Part xxi., p. 257. 
Treatment of Erysipelas.—Mr. Lawrence recommends the antiphlogistic 
treatment; Dr. Fordyce the stimulating plan; Desault gives a grain of 
tartar emetic in a considerable quantity of fluid in the bilious erysipelas. 
According to Dr. Walsh, there is no form of the disease which should not 
be attacked from the first with tartar emetic, and under all and every cir- 
cumstance we shall find that the disease yields to this remedy. It should 
be administered in small doses (one grain dissolved in any bland fluid being 
taken in the twenty-four hours), which may be repeated three or four 
times, so as to keep up its effect on the disease, on which it appears to act 
as a specific. As a general rule, when the erysipelatous surface is getting 
a yellow tinge, the skin shrivelling a little, and the pulse becoming less 
frequent (as it generally falls under the use of the tartar emetic), the pro- 
per time has arrived to commence with tonics and omit the tartar emetic. 
Of these, the sulphate of quina has been found the most successful. In 
some cases, where there are low typhoid symptoms, with prostration of 
strength, tonics and stimulants may have to be given with the tartar 
emetic, even from the commencement. Pil. rhei co., gr. vj. with pil. hy- 
drarg., gr. ij. may be given as an aperient, to be repeated in six or eight 
hours if necessary. All local applications are unnecessary except in idio- 
pathic erysipelas, in which flour or powdered starch may be used, and in 
the traumatic form, a large linseed-meal cataplasm. There is rarely any 
occasion for leeching, or the making of incisions, if the antimonial treat- 
ment be early adopted. Erysipelas being a constitutional disease, local 
treatment is of little use ; “ inflammation being the method taken to throw 
off the morbid state of the blood, anything that tends to check that erup- 
tion will be the means of preventing the efforts of nature, and probably 
cause a metastasis to some other part of the body.” Part xxii., p. 34 
Muriated Tincture of Iron.—In the common foi’m of erysipelas, give 
fifteen drops of the muriated tincture of iron, every three hours. It may 
be especially given in cases of infantile erysipelas, in doses of two drops, 
as well as in that form of erysipelas dependent upon internal injury. From 
the analogous nature of puerperal fever to erysipelas, many valuable lives 
might be preserved, in the opinion of the author, by its bold and persever- 
ing use. Part xxiv., p. 252. 
Erysipelas Phlegmonodes.— Mr. Guthrie remarks that until the battle 598 
ERYSIPELAS. 
of Salamanca, in 1812, it was the custom of surgeons to stand quietly by 
and watch the progress of this peculiar form of inflammation, until life was 
either destroyed by the extensive mortification which ensued, or by the 
indomitable fever and affection of the brain which accompanied it. 
Accident (Mr. Guthrie observes) led me, after that battle, to perceive 
that the only effective means of relief in severe cases, lay in free incisions 
made into the part at an early period, according to the extent of mischief 
which had supervened ; which mode of practice has been invariably incul- 
cated in my lectures, from the year 1817. Part xxv., p. 263. 
Erysipelas.'—Prof. Bennett says: 
Erysipelas is opposed to scarlatina, in being the least infectious of the 
eruptive fevers, in being the least fatal, and in running a much slower 
course. * In many other respects there is a close analogy between them ob- 
servable in the kind of fever, the sequelae, and critical discharge of coagu- 
lable urine, as lately pointed out by Dr. Alexander Wood and Dr. James 
W. Begbie. The general indications for treatment are tho same. The 
special treatment is directed by means of topical applications to diminish 
the local inflammation. For this purpose numerous remedies have been 
tried—such as dusting the part with flour, lotion of acetate of lead and 
opium, cerates, oil, etc.—any of which serve the purpose of cooling the 
surface, rendering it more soft, and diminishing irritation. 
There can be no doubt that erysipelas is occasionally a fatal disease, from 
the intensity of the fever, and amount of integument involved. It is gene- 
rally supposed that when it attacks the face and scalp, it is more dangerous 
than when a similar amount of surface in any other part is affected. This 
opinion does not appear to be founded on very exact observation. Even 
when the scalp is extensively invaded, death from erysipelas is a rare oc- 
currence. On going round the wards of the Hotel Dieu, in May, 1851, 
with M. Louis, I saw several severe cases of erysipelas of the scalp, which, 
I was told, were under no treatment whatever, because, as M. Louis 
informed me, according to his experience, erysipelas of the scalp was never 
fatal, unless it occurred in individuals of bad constitutions, or was associated 
with some complication. I need not say that, without forming any such 
exclusive opinion as this, it must be very difficult, in a disease that so 
generally tends to recovery, to judge how far this or that remedy is bene- 
ficial. Mr. Hamilton Bell lias lately recommended fifteen to twenty drops 
of tr. ferri muriatis every second hour, as a most beneficial remedy in ery- 
sipelas. Part xxvi.,p. 22. 
Collodion and Castor Oil in Erysipelas.—Apply the following to the 
skin; Collodion 30 parts, castor oil 2 parts; mix. Apply it once a day for 
three successive days to the parts attacked. A cessation of the burning 
pain and the disappearance of the redness take place. 
Part xxvii., p. 156. 
Tinct. Iodine Externally.—In the treatment of this disease by the em- 
ployment locally of the tincture of iodine, Mr. Norris arrives at the follow- 
ing results: That its application over the whole of the affected part ap- 
pears to exert a specific control over the disease; that the earlier it is 
applied the more manifest is the result; and that as often as the skin 
becomes pale from the vaporization of the iodine it should be repeated, not- ERYSIPELAS, 
599 
withstanding the somewhat severe smarting which ofttimes immediately 
ensues. Part xxvii., p. 157. 
Ferruginous Collodion.—Having observed the utility of the salts of iron 
in erysipelas, M. Aran, to facilitate their application, combined them with 
collodion, forming a preparation which united the compressive and astrin- 
gent effects. It consists of equal parts of collodion and Bestuchef’s tincture 
(ethereal tincture of perchloride of iron). Spread on the skin, it forms a 
somewhat thinner pellicle than ordinary collodion, but it is much more 
supple and resisting, so that the limb can be moved in any direction with- 
out the cracking which takes place when collodion alone is used. Its adhe- 
sion is also more prolonged. Part xxviii., p. 321. 
Erysipelas.—Early in the case, when the pulse is hard and full, and 
when there is no intestinal irritation, give an emetic of tartarized antimony 
and ipecacuanha, followed by minute doses of the antimony, till the pulse 
softens. Then give wine and good nutriment, especially if the tongue be 
brown ; give from four to six ounces of wine daily with sago, beef-tea, etc., 
but avoid giving the wine or brandy so long as the fever is high. The above 
quantity ought sometimes to be doubled. As a topical remedy, mercurial 
ointment is as good as any, and perhaps better, but use it cautiously, or 
the patient will be suddenly salivated. Part xxx.,p. 174. 
Treatment of.—M. Velpeau seems to place the greatest faith in iron. 
Apply the protosulphate of iron 3viiss. to gxxxv. of water, or 8 parts to 
30 of lard. Apply either of these three times a day to the part, and to a 
little distance beyond the disease. 
M. Debout recommends the following formulse: Ointment: Sulphate 
of iron 5 to 10 parts, water to 25 parts, oil 12| to 25 parts, lard 70 to 
40 parts. Solution: Sulphate of iron 10 to 20 or 40 parts, water 120 to 
110 or 90 parts, glycerine 70 parts. Tart xxxi., p. 195. 
Treatment of Erysipelas.—According to Dr. R. B. Todd, if you uphold 
the powers of the system from the commencement of the attack, it rarely 
happens that secondary phenomena manifest themselves ; if you do not, the 
cellular tissue becomes involved, extensive abscesses form, which reduce 
the patient exceedingly, or perhaps wear out his life. If the glottis 
becomes affected and cedematous, you must perform tracheotomy, give 
food and stimulants perseveringly at stated intervals, strong beef-tea, and 
half an ounce of brandy every half hour, also ammonia and chloric ether. 
If the force of the poison falls principally on the mucous membrane of the 
pharynx, so that the patient cannot swallow, the only resource left is to 
throw strong beef-tea injections, containing large doses of quinine, into the 
rectum; you may also touch the back of the fauces with the solid nitrate 
silver, or a strong solution of it, and as soon as the patient can swallow a 
little, give large and frequent doses of brandy, ammonia, chloric ether and 
beef-tea. If the plan of feeding by the rectum fails, you must have recourse 
to the stomach tube, though only when all other means of introducing 
food are found unsuccessful. If it attacks the peritoneum, producing 
puerperal fever, or puerperal peritonitis, it must be treated in the same 
way, or the patient will sink. The stimulating and supporting plan is the 
best adapted to save life and prevent the secondary effects of this malady. 600 
ERYSIPELAS. 
The treatment consists in giving food and stimulants early, freely and 
steadily, such as two or three ounces of beef-tea at stated times, and from 
tAvo drachms to half an ounce or an ounce of brandy slightly diluted with 
water; and if drugs are needed, ammonia, chloric ether and bark. Don’t 
give two different forms of alcoholic fluid at the same time, as wine and 
brandy, gin and brandy, etc., and for other nourishment it is desirable to 
observe the same rule. If you begin this treatment early, from the very 
commencement of the attack, you will prevent both delirium and coma, 
but if, notwithstanding the treatment, coma does set in, you may with 
certainty conclude that the blood is poisoned by pus, and death will occur 
from pyaemia. Of all stimulants, the alcoholic are the best, and if you 
have your choice choose brandy; it acts as an antidote to the erysipelatous 
poison. The tincture of sesquichloride of iron is very commonly given in 
this disease, it mainly acts by excluding depressing treatment, and perhaps 
partly as a tonic, but if you do no more than this you do Arery little; you 
must not only prevent depletion and depression, but you must nourish and 
support. Part xxxii., p. 33. 
Erysipelas in Military Life—Treatment.—Dr. Bird says : Such modi- 
fied differences of innervation and vascular action accompany the varied 
forms of this disease, that no uniform plan of treatment can be applic- 
able to all, and the attendant circumstances of each particular case must 
be fully considered, before an exclusive antiphlogistic or tonic mode of 
treatment be resorted to. In most cases a union of both will be found the 
most judicious system to be pursued, and must consist of both consti- 
tutional and local means. In regard to the former, all morbid secretions 
connected with gastric and biliary irritation must be evacuated by means 
of small doses of calomel, James’s powder, and acetous extract of colchi- 
cum, combined with half a grain of opium, followed next morning by 
castor oil or any other eligible purgative. The impaired functions of the 
kidneys and skin are to be at the same time restored by means of either 
the acetate or nitrate of potass, given with the bicarbonate and nitrous 
ether, converted into draughts of effervescing citrate, by means of lemon- 
juice. If there be much red sediment in the urine, an ample allowance 
of beef-tea, to which a few drops of the liquor potass® have been 
added, must be freely administered, with solution of quinine, as soon as the 
febrile symptoms have lessened, and the urinary secretion has been par- 
tially restored. The patient, unless plethoric in habit, must at the same 
time have plenty of nourishing but anti-bilious diet; and when vascular 
action is of the asthenic type, an allowance of wine may be necessary. 
The age, strength and habits of the patient must also be taken into 
account. Occasionally both local and general depletion may be necessary. 
The first can be best effected by means of cupping-glasses, or the scarifica- 
tions may be effected with the point of a lancet, as practised by Sir R. 
D.obson. If the disease be of the plilegmonoid kind, and the extent of 
sero-fibrinous exudation threaten suppuration or the vitality of the part, 
incisions of from two to three inches in length must be practised, to relieve 
the strangulation. Various local applications are made use of by various 
practitioners, such as fomentations of poppy-heads, collodion, solution of sul- 
phate of iron, etc. As a local application, there is nothing better than cam- 
phor mixture, with a proportion of vinegar, and tincture of opium, applied 
warm by means of lint, and then covered Avith oiled silk. Part xxxii.,p. 188. 601 
ERYSIPELAS. 
Erysipelas.—Apply a solution of gutta perclia in naphtha, and over this 
place thin gutta percha tissue; it acts by exclusion of air. This holds 
firmly for from three to five days, and may then be readily taken off, if 
wished, as a simple plaster. You may keep it in a small tin pot, having a 
lid which screws on to prevent evaporation; and when wished to be used, 
it may be warmed and applied with the finger. Part xxxiii., p. 226. 
Tincture of Lobelia— Use of.—Dr. Livezey wishes to recommend to 
notice a strong, saturated tinct. lobelia), applied frequently by saturating 
muslin, or fine linen cloths, and which he believes will prove more satisfac- 
tory than any other application. Part xxxv., p. 169. 
Creasote in Erysipelas.—Dr. Delarue strongly recommends the follow- 
ing application in erysipelas, which he believes exerts even a specific effect 
upon the disease: creasote, eight parts; lard, thirty parts; to be applied 
to the parts every two hours. Part xxxv., p. 169. 
Idiopathic Erysipelas.—Erysipelas, at the present day, requires a tonic 
and stimulating treatment; but, at the same time, the antiphlogistic treat- 
ment formerly employed was then justified. The present type of the dis- 
ease depends on a deteriorated condition of the constitutional powers of 
the inhabitants of populous parts. The oause of this deterioration is capa- 
ble of very important amelioration. Part xxxvii., p. 165. 
Treatment of Erysipelas.—The following plan of treatment is recom- 
mended by Dr. P. H. Bird, author of the Jacksonian Prize Essay on 
Erysipelas: 
Erysipelas must be treated by stimulants, and by the free and steady 
administration of nourishment: frequent and large doses of brandy, beef 
tea, quinine, ammonia, chloric ether, etc., should be given, and attention 
paid more to the state of the pulse than to that of the secretions. In rural 
districts, among a hardy and robust population, a more marked inflamma- 
tory form will be benefited by purgatives, and slight but not too lowering 
antiphlogistics; each case presenting its own peculiarities and indications, 
on which the necessity and the proper time for the administration of stimu- 
lants must depend. 
Opiates must be given with great caution—they are contra-indicated in 
cerebral congestion and coma; in these cases the milder preparation of 
hyoscyamus is to be preferred; but to lessen pain and irritation, tranquil- 
lize the system, and procure sleep, they are of much service in the latter 
stages and more severe forms of the disease. For this, they should be 
given in sufficiently large doses to produce the desired effect, small doses 
only adding to the febrile excitement, and rendering the head more liable 
to become affected. In cases attended with violent delirium, I have seen 
the hydrochlorate and acetate of morphia, in grain doses, produce a most 
beneficial effect. 
In desperate cases, with intense coma and typhoid symptoms, turpentine 
has’produced good results; its purgative action should be decided, other- 
wise it is apt to cause unpleasant head symptoms; it should be given in 
doses of 3ij. to 5iv., with one-half or two-thirds the quantity of castor-oil. 
When diffuse inflammation is spreading dowrn. the larynx and trachea, 
tracheotomy is imperatively called for, combined with the free adminis- 
tration of stimulants. 
The tincture of the sesquichloride of iron is especially indicated in albu- 602 
ETHEK, 
minuria, coincident with, or consequent on, general erysipelas, of which I 
have met with three cases. 
In cases of chronic erysipelas, the functions of the stomach and liver are 
often disordered, and the secretions consequently vitiated; these conditions 
must be rectified by a course of alteratives, aperients and tonics—such 
as iodide of potassium, alkalies and sarsaparilla, preparations of zinc and 
iron. 
With regard to local treatment, I am not aware of any that will cut 
short the disease ; in the uncomplicated variety, collodion, or gutta percha 
dissolved in benzule, forms an elegant remedy; and in uncomplicated ery- 
sipelas of the face, punctures relieve the distention; but the most agreeable 
application will be found to be that of lard and cotton wool, after relaxing 
the skin by warm fomentations. In uncomplicated erysipelas of the ex- 
tremities, a perfect line of nitrate of silver, at least three inches above the 
ine of disease, in nine cases out of eleven proved a sure barrier. Where 
an interstice has been left, I have seen it creep through and spread. 
In the variety complicated with diffuse inflammation of the cellular tissue, 
the early use of small incisions when the skin is hard, tense and resisting, 
and the pain severe and throbbing, is much to be recommended. 
In chronic erysipelas, a solution of the nitrate of silver should be fre- 
quently applied, or small blisters at short intervals at a little distance from 
the affected part; occasionally, w7hen these fail, an issue in the arms effects 
a cure. 
To conclude, then, erysipelas is merely an example on the skin of that 
diffuse inflammation which in other tissues constitutes diffuse inflammation 
of the mucous membrane, diffuse phlebitis, puerperal fever—all of which 
have a common origin, a poison in the blood, are infectious and contagious, 
and may mutually produce each other. 
The term erysipelas should be confined to diffuse inflammation of the 
skin and subcutaneous cellular tissue. Part xxxvii., p. 171. 
Erysipelas.—When in the legs or arms, elevate the parts as much as 
you can conveniently; it facilitates the cure considerably. 
Part xxxix., p. 231. 
Erysipelas—Pigmentum Album.—Paint the part over pretty thickly 
with common white paint, going a little beyond the edge of the inflamma- 
tion. “ I have never yet met with a case of this nature where it has not 
done immense good. The light, shining skin soon becomes wrinkled and 
shrunken, and after repeating the application once or twice, the inflamma- 
tion very rarely extends. This same application may be used with advan- 
tage in other forms of cutaneous affection. Part xl., p. 149. 
ETHER. 
Ether in Midwifery.—Dr. Protheroe Smith has more particularly than 
almost any other writer called our attention to the influence of this agent 
in relaxing the os uteri. 
Dr. Smith’s opinions respecting the relaxation of the os uteri are re- ETHEK. 
603 
markably confirmed by Professor von Siebold, wbo bere makes one striking 
remark, “ that in both the operations, the parts of generation, the vagina 
and os uteri, were rendered so soft and lax by the narcotism, that the 
introduction of the blades of the forceps were effected with the greatest 
ease.” Now, we would suggest the application of this remedy in cases 
where the rigidity of these parts constitutes the greatest possible bore to 
the practitioner, as wrell as a most painful period to the patient. It is very 
probable that we shall be able to save many hours of suffering by simply, 
at an early and convenient period of labor, producing relaxation by ether 
or chloroform, which we consider to be one of the most useful, convenient, 
and delightful modes of relieving the suffering patient, and for which the 
profession is so deeply indebted to Dr. Simpson. Part xvi., p. 340. 
Effects of Electricity in overcoming the Stupor of Etherization.—M. 
Ducros states that the phenomena produced by the vapor of ether on 
chickens and pigeons last from seven to eight minutes; but if* these birds, 
when thus under the influence of ether, are submitted to the action of 
electricity, by placing them on the isolating stool and allowing a current 
of positive electricity to pass into them, they recover from their insensi- 
bility in about thirty seconds. If they are jdaced on the electric conduc- 
tor, they are aroused in ten seconds; and if they are placed at the extre- 
mities of the conductors, and thus made to receive electric shocks, their 
vigor is instantly restored. When submitted to the action of the simple 
apparatus of Clarke, the electro-magnetic current is equally instantaneous 
in effecting their restoration. The influence of negative electricity, instead 
of abridging the insensibility appears to prolong it. Part xvi., p. 342. 
Administration of Ether in Capsules.—M. Clertan, of Dijon, states that 
he has for some time been accustomed to give ether in capsules in nervous 
affections. After several years of observation, by himself and others, he 
concludes that ether, when introduced in a known dose, pure and wuthout 
loss, into the stomach, has an effect which wras totally unknown until the 
preparation of the ether pearls (perles d'ether). According to the old 
plan, the ether became partly volatilized before passing halfway down the 
oesophagus; and what arrived in the stomach was dissolved in water, and 
m a state favorable to rapid and sudden volatilization. M. Clertan has 
several times seen neuralgia, hemicrania, and gastralgia, arrested instant- 
aneously by from one to three of these capsules—each capsule containing 
four or five drops. 
The ether arrives in the stomach without irritating the membrane of the 
mouth or pharynx, or producing cough; and it produces its sedative action 
by its rapid absorption. Part xxviii., p. 320. 604 
EYE. 
EYE. 
Amaurosis—Ocular Myotomy in certain Cases of.—M. Petrequin has 
made a communication on this subject to the Academie des Sciences of 
Paris: 
“ From what I have observed in those who squint, I have been led to 
conclude that certain cases of amaurosis have for their primary cause a 
spasmodic condition of one or more of the muscles surrounding the globe 
of the eye. It is now a scientific fact, that muscular spasm exists in stra- 
bismus ; it is not less true that in most cases, there is also considerable 
weakness of vision in the deviating eye. Myotomy then may become a 
heroic remedy against amaurosis depending on contraction of the 
muscles.” 
The author of the report then gives two cases, one of amaurosis of the 
left eye, in which the light returned immediately and completely after the 
oj>eration. In the other the amelioration, though decided, was not so 
perfect. . Part iv., p. 109. 
Incomplete Amaurosis—Electro-Puncture.—This consists in a union of 
acupuncturation with electricity. The operation consists in employing 
acupuncturation in the usual way, either with a single needle, or with two 
or more, and making a communication between them and the prime con- 
ductor of an electrical machine ; or they may be made to form a part of 
the circuit in the discharge of a Leyden jar. In this way the electrical in- 
fluence may be graduated from the simple aura to a full shock. 
Magendie affirms, that he has treated many cases of incomplete amau- 
rosis with great success by this agency. He employed it, however, in the 
form of what has been more properly termed galvano-puncture—by fixing 
a needle in the frontal nerve, and another in the superior maxillary, and 
making these communicate respectively with the poles of a galvanic pile 
of twelve pairs of plates, each six inches square. Whenever the contact 
was made the patient experienced a painful commotion in the course of the 
nerves, and at the bottom of the orbit; the light became better appreci- 
ated, and the pupil contracted. Part \.,p. 63. 
Amaurosis from Pressure on the Petina.—Amongst the various causes 
of pressure upon the retina, hydrophthalmia is not uncommon; and on this 
subject Dr. llocken has written a good paper, which, amongst other 
things, points out the efficacy of turpentine in its treatment. “ General 
hydrophthalmia is an affection in which the vitreous and aqueous humors 
are both morbidly increased. The pressure from behind is counter- 
balanced by the force exerted anteriorly, and hence the iris retains its nor- 
mal relative situation from the equality of pressure exerted on all sides.” 
In this rare affection there will generally be found great imperfection of 
vision, a tendency to central thinning and a central protrusion of the cor- 
nea, occasioning marked visus obliquus. The ordinary remedies so fre- 
quently fail in this disease, that we are generally obliged to have recourse 
to paracentesis oculi, with a repetition of the operation when the fluid ac- 
cumulates sufficiently. Beer even recommends in some cases, that the 
cornea be divided and the lens extracted, as well as the chief part of the 
vitreous humor. Dr. llocken has seen turpentine of excellent use in some 
of these cases. 
The dose should be small, and continued regularly—half a drachm to a EYE. 
605 
drachm, two or three times a-day, in almond emulsion, containing a small 
quantity of the sesquicarbonate of soda in solution, and some agreeable 
sirup to cover its unpleasant taste. Part v.,p. 133. 
Treatment of Amaurosis.—Dr. Debreyne relies chiefly on the repeated 
application of small blisters in the neighborhood of the affected eye, first 
on the temple and then over the eyebrow. In obstinate cases, the blis- 
tered surface should be sprinkled with a powder composed of starch and 
strychnine—about a fifth of a grain may be used at first, to be gradually 
increased. When this treatment fails, a seton should be tried. Dr. D. 
has used with very decided success a collyrium, containing some extract 
of belladonna, in a good many cases of day blindness or nyctalopia. 
Part x., p. 26. 
Inoculation with Strychnia in Amaurosis.—The subject was a lady, 
twenty-seven years of age, of nervous temperament, affected with incom- 
plete amaurosis of the left eye, and commencement of the same disease in 
the right one. The disease was of three months’ standing, and of rheu- 
matic origin; after two months’ fruitless efforts, Dr. Verlegh tried inocu- 
lation with the sulphate of strychnia in the neighborhood of the orbit. A 
grain of the salt was dissolved in two drops of water; the first day 
twelve inoculations were performed, six above the eye in the course of the 
supra-orbital nerve, six under, and on the side of the nose where the eth- 
moidal filaments and nasal branch terminate, and whence arise the fila- 
ments which go to the iris. There was no effect that day; but next day 
some slight tremors occurred in the neighborhood of the inoculated spots. 
After two days’ rest the inoculations were repeated, and the number of 
punctures increased to eighteen. The patient now became sensible of a 
slight haziness. After five successive inoculations carried to the length of 
thirty punctures, she commenced to distinguish objects; after the eighth, 
vision was completely restored; the contraction of the pupil gradually in- 
creased, and the other symptoms diminished after five grains of the 
sulphate had been used; during the same time inoculations were had 
recourse to in the neighborhood of the right eye; after the lapse of two 
months the patient continued perfectly restored; and this the author con- 
ceived sufficiently long to warrant him in considering the cure as perma- 
nent. Part x., p. 169. 
Amaurosis.—Employ galvanism, either passed across the orbit (Majen- 
die); or influencing the optic nerve by the irritation of the fifth (Grapen- 
geisser); introduce into the nose a silver probe, from the silver end of the 
battery, and touch the region of the frontal nerve, well moistened, with 
the other pole. In more severe cases apply a blister before employing the 
galvanism. Take care not to excoriate the skin. Part xv., p. 79. 
Amaurosis.—In a case of this disease succeeding retinitis, the follow- 
ing pills were prescribed : Strychnia, one grain ; ext. gentian, six grains; 
to be divided into twelve; one to be taken every night. In a week the 
patient was greatly improved, and in two months vision was completely 
restored. Part xxviii., p. 248. 
CATARACT. 
Operation for Secondary Capsular. — Secondary capsular cataract 
is one of the most frequent consequences of the operation for cataract, 606 
EYE. 
either by extraction or depression. The extraction of secondary capsular 
cataract, through the cornea, is always a matter of great difficulty, because 
the surgeon often fails in trying to bring the opaque membrane forward 
by means of the forceps or hook ; it generally escapes backward, and 
many unsuccessful attempts are made before it can be seized with the in- 
strument. Prolapsus of the iris, followed by staphyloma, irregularity, or 
even obliteration of the pupil, may result from such attempts. In order 
to avoid these accidents, M. Sichel proposes to extract the opaque capsule 
through the sclerotic, in a manner somewhat different from that practised 
by Bell, Earle and other ophthalmologists, for the removal of lenticular 
cataract. The usual way of dividing the sclerotic coat has been by a 
vertical incision ; hence, when the external rectus muscle contracts, it con- 
stantly separates the edges of the wound, and diminishes the chances of 
success. M. Sichel, then, applies this method to secondary capsular cata- 
ract ; but instead of a vertical incision, he makes a small transverse one, 
parallel to the fibres of the external rectus muscle, as high up as possible, 
and uses an extremely fine forceps. Part iii., p. 106. 
When a cataract forms in youth, it is almost always in the membrane 
of the lens ; whereas, in old age, it is the substance of the lens itself that 
becomes opaque. Part iii., p. 117. 
Influence of Artificial light in causing Impairment of Vision.—The 
late Dr. James Hunter, of the Edinburgh Eye Dispensary, points out very 
clearly the perniciousness of artificial light on the retina; common day- 
light is composed of red, yellow, and blue rays, in the ratio of five, three, 
and eight; that is, a predominance of blue rays; wffiereas, artificial light, 
as that from gas, candles, etc., has this proportion reversed, that is, there 
is a great excess of the red rays, and the blue rays are most deficient; the 
consequence is, that the retina becomes exceedingly more excited and 
heated by the glare of a gaslight than by common daylight, and the way 
to remedy this is either to cover the gaslight or candle with a blue glass 
or to wear blue spectacles. Part iii., p. 136. 
Modification in the Operation of Depression for Cataract.—There are 
cases of disease of the eye where cataract is present, but in which the 
usual operations for it would be unavailing, such as in those cases where 
the vitreous humor is so softened and melted down that the lens will 
not retain its situation when depressed, neither would it be prudent 
to extract it, as the vitreous humour would follow, neither can the lens be 
broken up. In these cases, Mr. Morgan recommends tapping the globe 
through the sclerotica to diminish the vitreous humor so as to allow the 
lens to fall below the axis of vision. lie does this by passing a large sized 
needle, with cutting sides, through the sclerotica about three lines distant 
from its juncture with the cornea a little below its transverse diameter ; he 
then draws the cutting edge vertically downward, making an incision 
parallel with the corneal line of attachment of the sclerotica, and of about 
a quarter of an inch in length ; if the vitreous humor do not escape, gentle 
pressure may be made on the globe, till sufficient escapes to allow the 
lens to sink below* the axis of vision. Part iv., p. 87. 
Catoptrical Exploration of the lens.—The catoptrical exploration of 
the lens unfolds to us a new mode of examining the eye. “ If a lighted 
candle be placed before a sound eye, three reflected images are seen, situ- EYE. 
607 
ated one behind the other. The anterior and posterior are erect, the 
middle one is inverted. The anterior is the brightest and most distinct, 
the posterior the least so. The middle one is the smallest. If the candle 
be moved the two erect images follow it; but the inverted image moves 
in the opposite direction. The anterior is produced by the cornea, the 
posterior by the anterior surface of the lens; and the middle or inverted 
image is from the posterior surface of the lens.” We thus see how valua- 
ble this may be made in examining the eye in incipient cataract and other 
doubtful cases. If the three images can be seen as above described, we 
may be sure the lens is transparent and the impaired vision must be owing 
to some other affection than cataract; for cataract obliterates the inverted 
image and renders the deep erect one very indistinct. “Glaucoma only 
when very much advanced, obliterates the inverted image, while in all its 
stages it renders the deep erect one more evident than in the healthy eye. 
In incipient cataract the inverted image is indistinct, and at last totally 
vanishes. This examination of the eye will be found of the most essential 
consequence in many obscure and incipient cases of ophthalmic surgery. 
Part iv., p. 94. 
Choice of Seasons for Ophthalmic Practice.—Dr. Robert Hamilton, of 
Edinburgh, directs the attention of ophthalmic surgeons to the care 
which is manifested by the German ophthalmogists in their treatment 
of different affections of the eye. This especially refers to the choice of 
seasonable weather for the different operations for cataract, artificial 
pupil, and staphyloma. 
“ Good and steady weather,” as Dr. Gulz remarks, “ with an agreeable 
temperature, is what we desiderate, and everything that interferes with 
this—the cold and snowy weather of winter, the piercing and chilling 
blasts of spring, or the very hot season, or the very wet one—we try as 
much as possible to avoid. And hence May and July, September and 
October are the months we prefer. Part vii., p. 145. 
Plack Cataract.—M. Magne relates the following case of this rare and 
curious disease. A female, above sixty years of age, had labored under 
some affection of the eye, for which she had consulted a number of 
oculists. She was quite blind ; the eye-balls were prominent; the sclero- 
tica appeared to be thin; the iris well shaped, but perfectly immovable; 
bottom of the pupil dark, as in the healthy state. 
From these and other symptoms, the disease was supposed to be amau- 
rosis ; but a second examination of the patient was made in a darkened 
chamber, and with the aid of a candle, as recommended by M. Sanson. 
The deep-seated images were absent, and the author accordingly declared 
the case to be one of black cataract, with adhesion of the iris. This diag- 
nosis having been confirmed by M. Cruveilhier, the lens on the right side 
was depressed. 
The adhesions of the iris were numerous ; but as soon as the capsule 
was lacerated, the dark color of the lens became evident, and on depress- 
ing it, several black fragments were detached. On the second day after 
the operation the pupil appeared to be less contracted, the base being 
quite dark, but on the following day it was closed with a white substance. 
M. Cruveilhier regarded this as the lens, which had come forward, after 
having lost its dark color in the vitreous humor. The operation was un- 
successful, and was, therefore, repeated in a fortnight; but the first touch 608 
EYE. 
of the needle showed that the body supposed to be the lens, was, in reality, 
the capsule, which was extremely soft and elastic. A few shreds were re- 
moved with much difficulty, and the patient recovered but a very imper- 
fect power of vision. Part viii., p. 160. 
Depression of the Lens in Cataract.—The lens should be disengaged 
from its capsule in depressing it. To accomplish this, introduce the cata- 
ract bistoury through the coats of the eye, about a line and a half from the 
margin of the cornea ; it penetrates the vitreous humor, and forms a breach 
in it, at the proper place for the reception of the lens when depressed ; the 
point of the instrument, directed toward the lens, is to be pushed across the 
eye to its opposite side, then penetrate the posterior part of the capsule, 
and, by drawing it outward, incise it across its middle ; then push the point 
of the needle between the lens and the iris, its flat side placed on the lower 
part of the lens, and press it backward and upward, then shift the point 
of the needle forward upon the lens, and this presses it backward into the 
breach of the vitreous humor, from whence it does not rise. 
Part xiii., p. 314. 
Case of Traumatic Cataract.—[Mr. Close reports a case of traumatic 
cataract, which was treated at the Manchester Eye Hospital, by Mr. 
Walker. A piece of iron flew with much force against the patient’s right 
eye while at work as a mechanic. Mr. Close reports:] 
On looking at the eye it is evident that the cornea has been cut in a 
perpendicular direction directly through its central portion, the edges 
of the wound being slightly uneven and covered with a layer of lymph; 
the iris appears to have escaped uninjured, the pupil being moderately 
regular, but rather contracted; the capsule of the lens is opaque, and a 
portion of opaque lens protrudes through the pupil. The globe is highly 
vascular. 
[He was to have calomel gr. ij., opii gr. ss., at bed-time. Belladonna 
applied at night, and lead lotion through the day ; next day there was 
no amendment. The intolerance of the light was very severe, and 
it was decided to puncture the cornea, and give exit to the broken-up 
lens.] 
The grooved-needle knife was accordingly introduced at the outer 
margin of the cornea, and its point pushed into the pupil. By this opera- 
tion a small portion only of the dissolved lens passed along the groove of 
the instrument, the larger part, in consequence of the pressure, being 
forced through the wound in the centre of the cornea. This was followed 
by the immediate restoration of sight. He was then directed to be re- 
moved to bed and have a belladonna plaster placed over the eye. 
An interesting point connected with the case is the rapid recovery after 
the removal of the foreign body (the broken up lens), notwithstanding 
the severe penetrating wound of the cornea, effected too by an obtuse 
body coming forcibly in contact with the eye. The rapidity of recovery 
is generally in a tolerably exact ratio to the healthy condition of the 
patient. Part xiii., p. 315. 
Congenital Cataract.—The best time for the operation in these cases 
is between the second and fourth month ; it should not be delayed beyond 
the fourth or fifth month, as the eyes speedily acquire that restless seek- 
ing after light, which is characteristic of such cases, and which greatly in- 
terferes with the operation. Sir Charles Bell says that belladonna is of EYE. 
609 
no use, as it may endanger the falling forward of the lens, which might 
produce severe irritation by coming in contact with the iris. Mr. White 
Cooper states, however, that it is of decided use, as it does not endanger 
the iris from this cause, and that if the needle be properly used, there 
need be little fear of this accident, but that if from any unforeseen circum - 
stance it should occur, it is far better that the mass should not be bulged 
against the iris, which is prevented by its dilatation being effected by 
means of the belladonna. Part xxvi., p. 295. 
Division and Removal of False Membrane or Opaque Capsule from 
the Axis of Vision.—Instead of using the cataract needle for the purpose 
of dividing and removing the false membrane, and which commonly 
stretches and injures the neighboring structures, Mr. Bowman has 
effected this object by a very simple method. He introduces two needles 
through different points in the cornea, down to the band of membrane : 
one acts as a fixed point, while with the other the membrane is torn 
across, and the fragments carried to opposite sides of the pupil, thereby 
avoiding the laceration produced by the ordinary operation. 
Fart xxvi., p. 298. 
Cataract—Extraction of—The short broad knife has the disadvantage 
of not retaining the aqueous humor so completely and so readily as a 
long narrow blade, which travels along with great ease without the force 
and difficulty sometimes experienced in cutting with the short-bladed knife. 
Part xxxiii., p. 220. 
Cataract—Extraction of—In performing extraction, in cases of adher- 
ent pupil, the adhesions are to the capsule and not to the lens itself; and 
the former having been well lacerated, the latter is found to be as loose as 
in the healthy eye. A second needle operation, for getting rid of the cap- 
sule after the section has well healed, is of course generally necessary, as 
indeed is very often the case after ordinary extraction. In rare cases, 
when the whole margin of the pupil is firmly united and too rigid to allow 
of the escape of the lens through it, the scissors may be used to liberate 
and enlarge the pupillary margin. Part xxx\.,p. 140. 
Removal of Cataract by Extraction.—It is of great moment to obtain 
early union of the wround, and for this end, the upper section ought to be 
made in the left eye as well as in the right. The even and gentle support 
of the upper lid insures accurate apposition. The weight of the aqueous 
humor is principally sustained by the lower and unmutilated half of the 
anterior chamber; and the aqueous humor, tears and other discharges, are 
carried away from the wound, which is not therefore disturbed by their 
confluence between its edges. Part xxxv., p. 292. 
Linear Extraction of Soft Cataract.—Provided that the lens is soft and 
without a nucleus, it may be removed at once by the method adopted at 
the Moorfields Hospital in such cases, and there called linear, from the cor- 
neal incision being a line more or less in width. With a broad needle, 
make a puncture on the outer side of the cornea, about a line in width, and 
with the same needle lacerate the capsule and break up the lens. A chan- 
nelled curette must noAV be introduced, through which the fluid part of the 
lens may escape. By a little manoeuvring the capsule itself may be passed 610 
EYE. 
into the aperture, and being seized with the forceps, may be bodily re- 
moved. Part xxxvi., p. 207. 
Cataract.—A single cataract of soft consistence occurring in an eye 
otherwise healthy, should be submitted to an operation for its cure. Con- 
fusion of vision seldom results, and when present is susceptible of correc- 
tion by an optician’s lens. Part xxxvi., p. 208. 
Cataract.—The great objection to needle operations is the length of 
time required for cure. Moreover, one operation rarely suffices, and ge- 
nerally two or even three may be necessary. But the ultimate results of 
needle operations are far more favorable than those of extraction. Even 
in hard cataract it is very rare indeed that the lens remains undissolved, so 
that objections on this ground are of no practical moment. 
Part xxxvii., p. 189. 
Glaucoma.—It seems probable, from the morbid anatomy of this disease, 
that the loss of sight does not depend upon disease of the retina, but upon 
the effects of pressure upon this membrane, at the entrance of the optic 
nerve. This pressure being relieved the sight is restored. For this pur- 
pose Dr. A. von Graefe recommends the excision of a portion of the iris, 
in its entire breadth from the edge of the pupil to its ciliary margin. The 
aqueous humor drains away for a day or two after the operation. The 
hardness of the globe is at once lessened; the pain abates; the dullness and 
haziness of the cornea disappear, and improvement commences in the 
deeper parts of the eye. The results are not so striking in chronic as in 
acute glaucoma, as in the former structural changes have occurred in the 
retina, owing to the long-continued pressure to which it has been exposed. 
Part xxxvii.,/). 194. 
Relief to the tension of the globe may be obtained by simply puncturing 
the sclerotic with a fine grooved needle directed backward, and introduced 
about three or four lines behind the margin of the cornea: it may be re- 
peated if necessary. This plan of procedure is quite as effectual and much 
easier to perform than Graefe’s plan of iridectomy, and is attended with 
none of the risks of that operation. Part xxxvii., p. 314. 
Extraction of Cataract—IIow to fix the Eye.—The following is a simple 
and most effectual plan of fixing the eye during this operation. With rather 
firm pressure, a little beneath the inferior margin of the cornea, securely 
clasp a somewhat broad portion of the conjunctiva and subcutaneous fascia, 
by means of a pair of ordinary artery forceps, deliver the instrument to an 
assistant, whose hand, supported upon the patient’s cheek, receives it, and 
holds it as he would a pen. The lower lid requires no further depression 
than that necessarily produced by the attachment of the instrument to the 
ball in this way. The operator must stand at the head of the patient, who 
is in the horizontal position. The eye will be found to be perfectly steady 
and motionless. Part xxxviii., p. 184# 
Cataract—Catoptric Test.—It is usually said that in a healthy eye you 
see two erect images from the cornea and anterior'surface of the lens re- 
spectively, and a small inverted one from the posterior surface of the lens; 
but in a healthy eye the second erect image can scarcely ever be detected, 
and not one observer in twenty can tell whether the third is inverted or 
erect, except by its moving in an opposite direction to the candle ; if this EYE. 
611 
third image he present, we may decide upon the absence of cataract, as the 
transparency of the lens and its capsule is essential to its formation. 
Part xxxviii., p. 185. 
Cataract with Diabetes.—The occurrence of cataract with diabetes has 
been long known, but very cursorily mentioned or passed over by authors. 
The fact is certain, however, that cases occur in which, during the continu- 
ance of diabetes, cataract appears, generally running a very rapid course, 
and being in every instance yet seen symmetrically developed on both 
sides: the lenses increase remarkably in their antero-posterior diameter, 
so as to encroach upon the anterior chamber, and even*to interfere mecha- 
nically with the free play of the iris. The color is generally remarkably 
opalescent. In one case, the very appearance of the cataract led to the 
discovery of the diabetes. Now, in the treatment of this form of cataract, 
strenuously avoid any operative interference so long as a useful degree of 
vision is preserved. But when the period arrives that all useful vision is 
extinguished, unless the powers of life are rapidly failing, we must attempt 
to afford relief. From the uniform degree of softness, depression is inappli- 
cable. Extraction cannot be performed because a wound in the cornea 
will not heal in this state of system. Solution, therefore, only remains, and 
keratonyxis (the anterior operation, the needle being introduced through 
the cornea), is the preferable mode, and in performing it the surgeon should 
be more than usually scrupulous to employ a needle of the greatest deli- 
cacy ; to make sure that the shaft will completely fill the aperture made 
by the point ; to confine his first manipulations to a narrow area in the cen- 
tre of the capsule; carefully withdrawing the needle, so as to avoid the 
crucial wound generally inflicted upon the cornea. Dart xxxix.,/>. 239. 
Cataract, Declination of.—When the lens is of mixed consistence (a 
hard nucleus enveloped in soft lens matter), and in close contact with the 
ciliary body and iris, thus obliterating the posterior chamber, the lens may 
be spitted by the needle. It is an improvement in the reclination of cata- 
ract in these circumstances to use two needles, pressing back “ the outer 
and lower side of the lens from the iris with a fine needle passing through 
the nasal side of the cornea, thus making a free space for another needle 
(the sclerotic needle) to pass to the front of the cataract,” and thus to re- 
cline the lens as desired. Dart xxxix.,j?. 241. 
Soft Cataract.—It is well known that when soft cataract is treated in 
the ordinary way, by being broken up with a view to solution, it is often 
dissolved very slowly, and not without ultimate injury to the visual powers 
of the eye. But by the operation of linear extraction, or, in other words, 
extraction through a small section, the pieces may be successfully removed 
at once. The incision of the cornea is made by means of a triangular- 
shaped knife, sharp at the point, keen on both edges, and about two and a 
half or three lines broad at the base. It should enter the cornea near its 
outer margin, and pass horizontally in front of the iris, until the whole 
length of the cutting edges has entered the anterior chamber ; it is then 
withdrawn. The capsule must then be broken up, and the fragments 
brought into the anterior chamber. Most of these will come out with the 
gush of aqueous humor. Others may, if necessary, be removed by a small 
silver scoop ; but there is no objection to a few small fragments being left; 
they will rapidly be absorbed on the resecretion of the aqueous humor. 
Dart xl,,p. 168. 612 
ETE. 
Treatment of Ulcers on the.—Mr. Walker says, speaking of affections 
of the cornea: 
Where the ulcer is of some size and penetrating, it will be proper to 
apply the pencil of nitrate of silver to its edges. But usually, it is much 
better to apply it to the conjunctival surface of the lower lid, as by 
so doing you are more likely to destroy the morbid action which 
gives rise to the ulceration ; and at the same time a portion of the 
dissolved nitrate i§ carried over and in contact with the ulcer, and pro- 
duces most of the beneficial effects of its direct application to the abraded 
surface. 
The other local means which I have advised for the treatment of 
chronic or indolent ophthalmia are also to be used. If the ulcer be 
situated near the centre of the cornea, and seem likely to penetrate the 
anterior chamber, it will be proper, in addition, to apply the extract 
of belladonna to the eyebrows and lids, with a view of keeping the 
pupil dilated, and the free margin of the iris from falling into the per- 
foration. If, on the contrary, the ulcer be situated at the margin of the 
cornea, then it will evidently be better to omit the application of the 
belladonna. 
When a portion of the iris has passed through the aperture of the 
cornea, and forms a prolapsus of some size, it will be proper to touch 
the protruded part occasionally with the caustic pencil; or if it be 
very large, it may in some instances be necessary to snip it off with 
scissors, so as completely to remove what must otherwise be a source of 
irritation. 
For the internal treatment, you will do well to employ tonics, such as 
the sulphate of quina, and the more so if the patient be of strumous dia- 
thesis. Attention to the state of the alimentary canal should likewise be 
paid. Part ii., p. 107. 
Opacity of the Cornea.—Mr. Walker has also made some most useful 
and practical remarks respecting opacity of the cornea. He says: 
The process by -which an opaque deposit of any kind is removed from 
the texture of the cornea is that of absorption. 
The substances employed for the purpose of promoting the action of the 
absorbents are of the class termed stimulants; and the one most frequently 
used in the solution of the nitrate of silver. Its strength, in the first 
instance, should not exceed two grains of the salt to an ounce of distilled 
water. After a time, the proportion of the nitrate may be increased 
gradually up to ten grains to the ounce of water. This is decidedly the 
most popular of this class of remedies, and by some it appears to be 
regarded almost as a specific. In prescribing it, however, you must not 
forget the caution I formerly gave as to the long-continued use of the solu- 
tion of nitrate of silver, viz., that it is very apt to leave a permanent stain 
of a deep olive-color in the conjunctiva. 
A solution of the oxymuriate of mercury is, perhaps, as good an applica- 
tion as any other. One grain of the salt to an ounce of distilled water is 
sufficiently strong to commence with: after a time, two or three grains to 
the ounce will be borne, but its strength ought to be increased very 
gradually, as it is considerably more irritating than the nitrate of silver 
solution in like proportions. On the whole, it is decidedly preferable to 
CORNEA. EYE. 
613 
the latter remedy, inasmuch as it never leaves any stain on the conjunctiva, 
however long its use may he continued. 
Various stimulants are also employed in conjunction with some unctuous 
substance for the removal of opacities. Of these, probably, the red precipi- 
tate ointment, the citrine or golden ointment, the nitrate of silver ointment, 
and the ointment of hydriodate of potass, are the best; and they also 
should be brought into contact with the conjunctival surface of the inferior 
lid, in the manner before pointed out. 
A very old-fashioned remedy, and by no means the least effective, is 
that of blowing through a reed or quill upon the surface of the eye, some 
finely poAvdered substance, such as the oxide of zinc, white sugar, red pre- 
cipitate and sugar, poAvdered glass and sugar-candy, and calomel and 
sugar. The operation of these substances is precisely similar to that of 
the drops and ointment—they produce a certain amount of irritation in 
the organ, Avhich is presumed to increase the activity of the absorbent 
vessels. Part 108. 
Iodine in Opacity of the Cornea.—The case in which this remedy Avas 
successfully employed, Avas one of opacity of the cornea consequent 
on syphilitic ophthalmia, and so considerable as almost completely to 
destroy vision. The iodine Avas given internally, and from four to six 
drops of the folloAving collyrium Avere let fall into each eye three times 
a day. 
R Iodini, gr. j.; potassii iodidi, gr. ij.; aq. dest. 3vj. M. 
Afterward this was exchanged for an ointment consisting of iodine, gr. 
iss., iodide of potassium, 9j., and lard, §ss., of which a small portion Avas 
once or tAvice a day put betAveen the eyelids. The cure was perfected in 
three months. Part iv., p. 104. 
Action of Hydrocyanic Acid, etc., on the Eye.—Dr. Turnbull says: 
It is a well-known fact, that the eyes of those Avho haAre been destroyed 
by hydrocyanic acid, for a length of time after death, shoAv none of the 
usual symptoms of dimness. On the contrary, the eye is clear, and the 
pupil much dilated. This satisfied me that the acid exerted a specific action 
upon the eye, Avhich might be made available, as a medical agent, for 
relieving many of the diseases to which that organ is so subject. 
My first experiment A\-as undertaken with the diluted acid, by dipping 
a sponge into it, and rubbing it upon the forehead for the space of a feAV 
minutes, which gave the skin a very red appearance; but the patient 
experienced not the least sense of heat, and the pupil Avas slightly dilated. 
I continued to use this Avith very beneficial effects in incipient cataract, 
opacities of the cornea, inflammation, amaurosis, iritis, etc. Of late, I 
have substituted the vapor of the concentrated acid to the eye Avith much 
more decided effect, and without the slightest danger. The plan I gene- 
rally adopt, is to put into an ounce-vial a drachm of the acid, and hold it 
in close contact Avith the eye, the eyelid being open, for the space of about 
half a minute, or until such time as the patient feels a little warmth, or the 
person holding the vial sees the pupil greatly dilated, and the vessels of 
the eye injected Avith blood, which is the invariable effect of the applica- 
tion of the acid. 
The person AArho holds the acid to the eye should be careful not to allow 
the patient to smell it. 
The essential oil of bitter almonds I use for the same diseases. I put 614 
EYE. 
two drachms of water to two drachms of the oil in an ounce vial, and hold 
it in the same Avay to the eye as the acid; hut its effects are not precisely 
alike. The feeling induced by the oil is soothing, and generally relieves 
all sense of pain, even in tic douloureux, without sensibly dilating the 
pupil, or causing much redness of the eye. I find it very useful in 
taking away the heat occasioned by the hydrocyanic acid. 
Part iv., p. 117. 
Division of the Muscles of the Eye in certain cases of Blindness.— 
When the central portion of the cornea has become opaque, and the 
remaining portion continues sound, so as to render it possible for the rays 
of light to be admitted obliquely through the pupil, it has been suggested 
very ingeniously by M. Cunier, that instead of making an artificial pupil, 
we might divide one of the recti muscles, and thereby turn the eye side- 
wise, so as to admit the light much more advantageously through the 
pu]fil. Part v.,p. 143. 
Keratoplasty, or Transplantation of the Cornea.—When the cornea is 
detached from the rest of the globe of the eye in an animal, and immediately 
reapplied by means of sutures, it unites again; and the same union 
takes place, even when the cornea is transplanted from the eye of one 
animal to another, its transparency remaining ininjured. 
Part vi., p. 150. 
Treatment of Leucoma by Incision into the Cornea.—Two cases are 
related in which this treatment was adopted. The case which suggested 
it was that of a girl, twenty-two years of age, who had lost the left eye 
from purulent ophthalmia in infancy, and in whom the right was almost 
blind from leucoma of nearly the whole cornea. Various means had been 
used in vain. Dr. Iiolscher made an artificial pupil by drawing the 
iris through the cornea and excising a portion of it. Severe inflamma- 
tion ensued, which was wfith difficulty managed ; but three months after, 
the patient not only had a good artificial pupil, but the cornea had become 
less leucomatous, and this especially at the part where the incision through 
it had been made. The next bad case of leucoma, therefore, which the 
author met with, he treated as follows: The patient was a lad fourteen 
years old, who had lost his right eye from purulent ophthalmia in infancy, 
and had leucoma of nearly all the left cornea. At four different times, 
with intervals of eight days, a common cataract knife was passed into the 
cornea as deep as possible without penetrating it, and was drawn out with 
a sliding motion. After the first three times no inflammation ensued ; 
therefore, after the fourth, some tinct. opii was dropped into the wound 
three times a day. Severe inflammation set in, but it was moderated by 
local bleeding, and the ti’eatment by opium was continued for two months. 
The leucoma became gradually less, and the patient, who could at first 
only discern light from darkness, became able to guide himself in walking, 
and to perceive the window-frames in his room. The second case was 
that of a man forty years old, who had leucoma of one eye from gonor- 
rhoeal ophthalmia. It had been variously but vainly treated for a year. 
The author made incisions into the cornea twice, with an interval of four- 
teen days. After the second, a tolerably severe inflammation ensued, 
which required active treatment. As soon as it had ceased, sulphate of 
zinc and tincture of opium were again dropped into the eye, and after a 
year and a half, not a trace of leucoma could be seen. Part vi., p. 155. 615 
Pannus—Cure of inveterate Cases by the Inoculation of the Matter of 
Plenorrhcea.—The term pannus has generally been applied to an opaque 
vascular thickening of the layer of the conjunctiva covering the cornea, 
generally produced by the continuance of purulent or strumous ophthal- 
mia, or by chronic inflammation of the cornea. During the course of 
these affections, especially the first, the palpebral lining becomes com- 
pletely altered in structure, giving rise to what is called a granulated stat« 
of the eyelids, which by its mechanical friction on the surface of the cor- 
nea, causes its vessels to be enlarged, loosening and thickening its con- 
junctival layer ; hence haziness, a nebulous state, or great opacity. The 
treatment of this affection has confessedly been one of the most difficult 
and tedious in surgery. Various plans have been adopted; the removal 
of the palpebral conjunctiva by the knife or scissors, occasional small 
bleedings by one or two leeches, or scarifications, alternated with the use 
of astringents of diacetate of lead or sulphate of copper, besides numerous 
other methods, have been tried in vain, and when the disease has gained 
considerable ground, it is too often irremediable. 
In these cases the German ophthalmologists have discovered a remedy 
which holds out better hopes of cure than any we have yet possessed. 
This consists in inoculating the diseased conjunctiva with the matter of 
gonorrhoea, which, however, ought not to be done unless the pannus is 
complete. Other no less important contra-indications would be the exist- 
ence of any bad habit of body, especially struma, gout, rheumatism, 
syphilis, etc. The virus should be selected from a case of mild gonorrhoea, 
or from a child laboring under purulent ophthalmia. The disease will run 
its course more mildly than in a healthy eye, and it has been frequently 
found to leave the cornea perfectly clear in ten or fourteen days, oftener, 
however, requiring six weeks. If one inoculation does not succeed, an- 
other should be performed. In one case it was done five times. One very 
curious circumstance was noticed in some of these cases, which beautifully 
proves the intimate sympathy which exists between the two eyes. When 
both were affected with the disease, it was only necessary to inoculate 
one. As soon as one eye began to improve, the pannus of the other like- 
wise began to disappear, and both eyes were actually cured together. 
And therefore the rule now is, that when both eyes are affected, the 
inoculation of the one suffices for the cure of both. 
Part viii., p. 136. 
EYE. 
Nebula of the Cornea.—Simple nebula of the cornea may he easily re- 
moved by a solution of nitrate of silver, or, in more severe cases, by the 
following drops: 
R Hydrarg. bichloridi, gr. ij.; aquas dest. §j. 
It is a curious fact, that after the application of any of the usual stimu- 
lants employed for this purpose, in a few weeks they appear to. lose their 
effect, the eye, as it were, becoming invincible to them. It is, therefore, 
better to use the nitrate of silver drops for a few days; then a solution of 
the bichloride of mercury, then the vinum opii, which plan secures the un- 
impaired virtues of each. The effects produced by these various stimu- 
lants are different in almost every case, and it will be for the surgeon to 
regulate the precise strength capable of being employed without causing 
inflammation. The worst form of opacity we are called upon to treat is 
leucoma, and Dr. Hall, of Retford, admits that when this arises from ex- 616 
EYE. 
tensive ulceration, which has altogether changed the nature of the corneal 
substance; or when extensive opacity is the result of some powerful escha- 
rotic, which, although it may not destroy the vitality of the part, appears 
to have produced some chemical change in its structure, it is useless to 
attempt the cure of such an affection. Still, although this opacity cannot 
be destroyed by any means at our command, or removed by a surgical 
operation, this admission only applies to the central portion of leucoma. 
In time, its edges, on examination, will be found less opaque, and a halo 
of hope surrounds this dimness of vision; and although the more dense 
central portion does not admit of cure, something may be effected with 
the surrounding edges. Dr. Hall has seen cases where a steady continu- 
ance in the application of remedies has produced very great benefit, and 
the results are doubtless sufficiently favorable to justify their employment 
in all such unfortunate cases. He advises most strongly the nitrate of sil- 
ver ointment, of a strength regulated to the peculiar condition of the af- 
fected eye, and also the continued use of counter-irritation, behind the ears 
or at the nape of the neck. He also thinks that the regular application of 
this ointment ought to be combined with the internal use of mercury, and 
a slight degree of ptyalism kept up for a considerable period. 
$ Pulv. argenti nitratis, gr. x.; liq. plumb, diacetatis, ntxx.; adipis, 3j. 
Ft. ungt. 
This ointment should be used every night or every second night; it al- 
ways creates more or less ophthalmia, and its application must be regulated 
accordingly. 
The preparation of mercury most useful in these cases is the hydrargy- 
rum bichloridum. He has given it for six or eight weeks in the following 
form without severe affection of the gums, irritation of the bowels, or any 
Bymptom which made it necessary to intermit or reduce the doses. 
R Liquoris hydrarg. bichloridi, 3iss.; tr. cinchonae, 5ij.; aquas dest., 
5viiss. M. ft. liaustus ter in die sumendus. 
He adds, that in some cases where neither the drops of the nitrate of 
silver nor the ointment of this substance can be borne, the ointment of the 
iodide of potassium may be substituted; but although useful in some cases, 
it is not nearly so efficacious as the preparations already mentioned. 
Part viii., p. 205. 
Conical Cornea consists of a transparent conical structure, apparently 
differing in no particular from the natural texture of the cornea, which is 
preceded and attended by no pain or inflammation; the cornea is pro- 
longed forward, and presents to the observer a peculiar dazzling, sparkling 
point of brilliancy, a dew-drop or gem-like radiance, as though a piece of 
solid crystal were embedded in its centre. The treatment adopted by difi 
ferent practitioners has been exceedingly various: leeches, calomel, evacua- 
tion of the aqueous humor, constant and well-directed pressure, breaking 
up of the crystalline lens, the use of a strong lens, and other means, have 
in vain been tried to remedy this defect, and it is certain that until the 
external form of the cornea be changed, until this conical projection, be it 
a solid cone or a hollow one, be got rid of, or nearly so, the pencils of light 
incident to the upper portion of its surface must be unduly refracted, pro- 
ducing excessive and irregular convergence, and consequent confusion in 
the direction of the rays of light. Mr. Middlemore hit upon a very in- 
genious contrivance to remedy this defect—he made an artificial pupil in EYE. 
617 
another part of the iris, near its margin, where the least change of struc- 
ture had occurred; and although too frequently attended with only partial 
success, it was occasionally very useful. 
Dr. Pickford points out his own mode of practice in some very interest- 
ing cases. This practice is founded on the suggestion of Mr. Guthrie, in 
the “London Medical and Surgical Journal,” and in his lectures in 1832 ; 
and consists in the long-continued use of emetics and purgatives. A scruple 
of sulphate of zinc, combined with half an ounce of Epsom salts, may be 
given every morning, and continued, if necessary, for twelve months: or a 
single grain of tartarized antimony may be substituted for the sulphate of 
zinc. The zinc, however, is to be preferred. If the disease depends upon 
some disturbance in the functions of the great sympathetic, spinal nerves, 
and par vagum, as Dr. Pickford supposes, producing faulty action of the 
nutrient capillaries and absorbent vessels of the cornea, these remedies will 
probably answer in many cases. Part ix., p. 126. 
Excision of the Superficial Layers of an Opaque Cornea.—In 1833, 
Rosas removed several of the layers of the cornea; and in 1841, Dr. Gulz 
was remarkably successful in a similar operation. The eyelids being fixed, 
the cutting consisted in the continuous and repeated introduction of the 
knife, following the motion of the eye-ball, through the external layers, so 
gradually approximating the internal parts of the cornea. The transparent 
layers of the cornea were at length reached ; it was then, by the use of dif- 
ferent instruments, bared to the extent of a line and a half in diameter, the 
innermost layers being fortunately uninjured throughout, and consequently 
the anterior chamber of the aqueous humor remaining unopened. The pa- 
tient could see the hands of a watch, although the cornea had been previous- 
ly quite opaque; but inflammation took place in four weeks from some 
accidental circumstances, and nearly destroyed the good effects of the 
operation. This, however, was subdued, and the patient continued to see 
very tolerably. Part ix., 130. 
Prussic Acid in Opacity of the Cornea.—Mr. Patersone relates the 
following case: 
T. G., set. 23, weaver, of a strumous diathesis. About eight months ago 
had an attack of inflammation in both eyes, to relieve which went to a 
hospital, and remained under treatment for about six months, without 
being benefited, further than getting rid of the pain and redness. Both 
cornea were occupied with opacities nearly in the centre, almost covering 
the whole expanse of the pupil, xvhich rendered him unable to read or 
follow his usual employment. Had the vapor applied to both eyes daily 
for the space of seven weeks; at the end of which, he could read a good 
type, and was also able to pursue his occupation. 
I may state, also, that I have applied the vapor in two eases of amaurosis, 
along with the ordinary remedies in this disease, with considerable success. 
Part ix., p. 178. 
Cyanide of Zinc in Ulcers and Opacities of the Cornea.—M. Carrier 
believes that preparations of hydrocyanic acid have great efficacy in caus- 
ing cicatrization of ulcers of the cornea and absorption of opacities. The 
compound which he prefers is the cyanide of zinc, made into an ointment, 
in the proportion of 1 to 25 of lai’d. Part ix., p. 178. 
Solutions of Lead in Lnfiammations of the JEye.—These applications 618 
EYE. 
ought never to he recommended, as it too often happens that “ when a 
solution of salt of lead is applied to the surface of the eye, it immediately 
undergoes decomposition, so that an insoluble precipitate of chloride ot 
lead is thrown down, which attaches itself to any excoriated or ulcerated 
spot of the conjunctiva or cornea, adhering thereto tenaciously, and in the 
healing of the spot becoming permanently and indelibly imbedded in the 
cicatrix. Even Goulard water applied to an ulcer of the cornea is very 
liable to produce a chalk-white, opaque cicatrix.” Part x., p. 169. 
Creasote in certain Diseases of the Conjunctiva and Cornea.—Dr. 
Tanesville first used this remedy in diseases of the eyes in 1836, in a case 
of opacity in the cornea, with ulceration resulting from scrofulous ophthal- 
mia, which was from three to four years’ standing. After failing with all 
the known means, he used mercurial ointment, with which he incorpo- 
rated a few drops of creasote, and introduced a small quantity of it 
between the eyelids evening and morning. This treatment was followed 
by rapid amelioration. The ulcers cicatrized gradually, the opacity disap- 
peared, and in the space of two months the patient was cured. Dr. T. 
has since used it with the greatest success in many other cases of acute 
and chronic scrofulous ophthalmia. He says that he has applied it yery 
usefully also as a topical remedy in several external scrofulous affections, 
ulcerations of the skin, etc., whence he concludes that it is an invaluable 
means in all local affections of scrofulous origin. He observes, however, 
that it should be employed conjointly with a suitable constitutional treat- 
ment. Simple cerate may be substituted for the mercurial ointment, or 
fresh lard, and this is indispensable in cases where mercurial ointment 
cannot be borne by the patients. The use of creasote becomes more 
requisite in proportion as the disease is more chronic. One of the most 
important advantages of creasote, used as a caustic in scrofulous ulcera- 
tions of the cornea, is its facility of application. It is sufficient to 
introduce a small portion of the prepared ointment between the eyelids, 
and to rub the latter slightly against the globe of the eye, whereas touch- 
ing the little ulcers themselves with the caustic is a matter of some 
difficulty in children. This ointment is very efficacious also in curing 
inflammation of the Meibomian glands. It is also used with success in 
«h ronic vascular albugo, which is often tjie result of granular inflammation 
of the conjunctiva. Part x., p. 171. 
Staphyloma—Affecting the Cornea alone.—Pass a curved needle armed 
with a fine ligature, from below upward through the cornea, the anterior 
chamber, and again through the cornea above; remove a portion of the 
cornea between the points where it has been pierced in the usual way, and 
bring the edges together by the ligature. 
General Staphyloma.—Tap the cornea with a spear-shaped needle, ana 
when the globe is of the normal size, apply pressure upon the lids; 
repeat the operation every two or three days, for six or eight times. 
Part xv., p. 263. 
Sloughing of the Cornea from Defective Nutrition.—Give wine and 
beef-tea, with bark, quinine, or steel; and attend to the bowels. 
Part xvii., p. 199. 
Treatment of Corneitis.—Generous diet, pure air, and comfortable 
clothing, are generally required. As to local applications, apply none 
whatever in the early stage, except a tepid or slightly sedative lotion, to EYE. 
619 
allay the pain. When the disease has become chronic, such stimulant ap- 
plications as vinum opii, or solution of nitrate of silver, may be used, but 
very cautiously. Dilate the pupil occasionally by belladonna, either by 
applying the extract to the eyelids and brow, or by applying occasionally 
a piece of rag dipped in a solution of a drachm of good extract in eight 
ounces of water. Apply stimulants for the dispersion of the diffused 
opacity of the cornea which remains, but not till all inflammatory action 
has long disappeared. Solutions of nitrate of silver, sulphate of copper, 
or sulphate of zinc, will do; or a solution of iodide of potassium, ten 
grains to the ounce; or a camel-hair pencil dipped in water, and brushed 
two or three times on soap.. Part xvii.,y>. 201. 
Cornea, Opacities of—Nebula.—Apply daily a solution of nitrate of 
silver, made with one to three grains of the nitrate to seven drachms of 
aq. dest., and one drachm of vin. opii, without the aromatic. Or, in severe 
cases, use the following application once or twice a day; bichloride of 
mercury, two grains; distilled water, an ounce. In applying these or 
other lotions, do not drop them into the eye, but touch the opaque spot 
with a camel-hair pencil, dipped into the solution. It is often advanta- 
geous to vary the kind of application every week or two. 
Leucoma.—Even in the worst cases, where the central portion of the 
opacity is quite beyond the power of art to remove, the edges of the spot 
may be much improved by persevering treatment. Let a very small por- 
tion (not larger than a large shot corn) of the following ointment be put 
into the eye every night or every second night: nitrate of silver, three 
to ten grains; solution of diacetate of lead, twenty drops; lard, one 
drachm. Give a drachm of the solution of bichloride of mercury, with a 
drachm of tincture of bark, in distilled water, twice a day ; this should be 
given uninterruptedly for a considerable time. And apply counter- 
irritation behind the ears, or at the back of the neck, by blisters usually, 
or, if blisters are, from any cause, inadmissible, by setons or issues. In 
cases of strumous children, in whom mercury is inadmissible, use appropri- 
ate local treatment, and a course of tonics, cold bathing, etc. 
Part xx., p. 185. 
Corneitis.—In the treatment of diffuse opacity of the cornea from cor- 
neitis, by stimulants, Dr. Jacob says, solutions of nitrate of silver, sulphate 
of copper, sulphate of zinc, or the combination called lapis divinus, will, 
perhaps, answer; but he uses a solution of iodide of potassium, ten grains 
to the ounce of water, or he touches the surface with a camel-hair pencil, 
previously dipped in water, and brushed two or three times on soap. 
Part xxii., p. 357. 
Cornea, Specks and Opacities of.—Under the continued use of gently 
stimulating applications, as the nitrate of silver, many of those depositions 
which apparently seriously compromise distinct vision for life, may be made 
slowly, but ultimately entirely to disappear. The proper laminated tissue 
seems to be capable of enlarging its vascular resources for its support 
under disease, and for the subsequent removal of diseased products to such 
an extent, that, if it has itself escaped disorganization, it is able, under 
favorable circumstances, completely to resume its transparency. 
Part xxiii, p. 214. 
Use of Tannin.—Employ tannin in the form of pommade: in thick 620 
EYE. 
mucilage; in fine powder; and especially in the form of a concentrated 
solution, one part to three of water. The affections in which this applica- 
tion has proved most successful have been acut* and chronic blenorrhoea, 
cedematous swelling of the conjunctiva, vegetating granulations, vascular 
and ulcerative affections of the cornea, and especially pannus. 
Part xxiii., p. 215. 
Iron Spiculce in the Cornea.—The difficulty of extracting spiculse of 
iron or steel imbedded in the cornea or conjunctiva—an accident so 
frequent among engineers—is often so much more embarrassing than one 
expects, that those of the profession who are not aware that the use of the 
knife may always be avoided, will be glad to recollect, that by repeating 
one of the simplest of their experiments in chemistry—the immersing a 
piece of iron in solution of sulphate of copper, the iron is entirely 
removed. The application may be made by holding the eye open for a 
short time in a solution of sulphate of copper, of the strength of one to 
three grains to the ounce. Part xxv.,p. 253. 
Opacity of Cornea.—Carefully pick off the opacity with a miniature 
gouge. The signs of the fitness of the cases are, the opacity being 
raised, and to all appearance being of an earthy nature and superficial. 
So long as the opacity is due to deposit of earthy material, we have every 
reason for operating. Malgaigne operates in these cases thus: he made 
an incision above the upper edge of an opacity which covered the lower 
part of the cornea and divided the external laminae; he then fixed the 
edge of the opaque portion with fine forceps, and in raising it this peeled 
off very easily, and the separation was completed by another incision 
round the lower edge. Part xxix., p. 253. 
Cornea, Vascular Opacity of.—When caused by granular conjunctiva, 
apply various stimulants or astringents, as nitrate of silver, sulphate of 
copper, acetate of lead, alum, or zinc, so as to cure the granular condition 
of the conjunctiva, which causes the opacity. If the granulations be 
small, round, vascular, and sensitive, use a mild stimulant, as ten grains to 
the ounce, of nitrate of silver or sulphate of copper; if large, pale, and 
insensible, the solid nitrate may be applied freely and frequently. The 
sulphate of copper is, perhaps, preferable to nitrate of silver. It may be 
rubbed freely over the surface daily, or every other day. Weak solutions 
of nitrate of silver only irritate. Part xxx.,p. 182. 
Affections of the Cornea.-—Chronic thickening of the epithelium of the 
cornea may depend upon a hypertrophied state of the palpebral conjunc- 
tiva, rubbing against the front of the cornea; for this you must rub freely 
the inside of the lid with a smooth piece of the sulphate of copper, and 
at the same time, apply the ointment of the red oxide of mercury. A 
collyrium, composed of four grains of the sulphate of alum, or zinc, with 
half a drachm of the sedative solution of opium to one ounce of water, is 
also very useful. Ulceration of the cornea readily yields to one or two 
touches of the solid nitrate of silver, and the internal administration of 
one or two purgative doses of rhubarb and carbonate of soda, combined 
with some tonic. When the. ulceration extends deeper, it presents an 
even surface on its bottom, with a sharp, well-defined edge. The best 
remedies for this are tonics, both locally and generally. Apply daily, or 
every second day, the nitrate of silver, by impregnating the fine point of EYE. 
621 
a camel-hair pencil with a saturated solution of the salt, and then gently 
touching the ulcerated surface with it; give Dover’s powder with calomel 
at night, and Peruvian bark with carbonate of soda during the day. The 
preparations of iron are sometimes very valuable. The nitrate of silver 
does not act as an irritant, as many suppose, but as a direct sedative, 
allaying the irritability of the part. If the ulceration pass through the 
anterior elastic lamina, opacity will remain which will be best removed by 
the bichloride of mercury. In ‘purulent and gonorrhoeal inflammations, 
the nitrate is all-powerful in arresting their destructive tendency. In 
inflammation of the conjunctival corneal layer, named “pannus,” local 
and general tonics perseveringly employed, along with small doses of the 
bichoride of mercury, will remove the disease. In very bad cases, destroy 
the enlarged vessels supplying the part by nipping up small portions of 
conjunctiva all round the cornea, and passing a very fine ligature round, 
tying each, and cutting them off very close. If the penetrating ulcer be 
situated near the centre of the cornea, the treatment must be quite diffe- 
rent ; drop a solution of sulphate of atropia (six grains to the ounce of 
water) upon the conjunctiva, and smear extract of belladonna upon the 
eyebrows; after twenty minutes, endeavor with a fine probe to free the 
margin of the iris from the aperture, and then touch the ulcer with a 
fine point of solid nitrate of silver. In inflammation of a strumous cha- 
racter, the cornea quite suddenly becomes milky in hue; this opacity is 
evidently in the lamellated structure, and must be treated by applying 
four or six leeches to the eye every second day, to stop in limine the 
morbific action. Give mercury, so as to gently affect the system, com- 
bined with Dover’s powder, or the tartrate of antimony with quina. 
When the acute stage has passed, give the iodide of potassium, and tonic 
doses of the bichloride of mercury. When all inflammatory action has 
disappeared, apply the ointment of the red oxide of mercury every night, 
and, during the day, drop a solution of iodide of potassium (ten to 
twenty grains to one ounce of water), into the eye for some weeks; it 
will remove the olive-colored stain produced by the long-continued use of 
nitrate of silver. The preparations of iron and iodine are the best tonics 
for internal exhibition. Mercury, in minute doses, is an active and very 
safe tonic; it is certainly very efficacious in removing the opacity of struc- 
ture which remains after the acute stage has passed by. If the postex-ior 
elastic lamina be inflamed, mercury should be given, so as rapidly and 
certainly to affect the system, combined with tartar-emetic and opium, but 
mercury is the essential remedy. Extract of belladonna, applied over the 
eyebrows, is of no small importance in allaying any irritation which exists, 
and in keeping the pupil dilated. Part xxxiv., p. 184. 
Circumcision of the Eye in Cases of Vascular Cornea.—In two or 
three cases of very severe chronic vascularity and thickening of the layer 
of conjunctiva in front of the cornea, Mr. Bowman, at the Moorfields 
Hospital, has performed the operation of circumcising the eye, as recom- 
mended by some continental surgeons. The operation consists in dissect- 
ing up with a small, sharp-pointed knife the conjunctiva at the margin of 
the cornea, reflecting it all around on to the sclerotic, and cutting wholly 
away a circular band of moderate width. If the patient be under chloro- 
form, the dissection, although very delicate, is not one of difficulty. Its 
object is to cut off altogether the supply of blood to the corneal layer of 622 
EYE. 
conjunctiva, in the hopes of making the latter shrivel away, and cease to 
fee an impediment to vision. Part xxxv., p. 138. 
Corneal Fistula.—A case lately occurred to Mr. Dixon at the Moor- 
fields Ophthalmic Hospital, in which a minute corneal fistula occurred in 
the cicatrix, left after extraction of cataract. At first, cauterization with 
a probe coated with nitrate of silver was tried alone, but without success. 
Subsequently a counterpuncture was made at the lower part of the cornea, 
and the cauterization at the same time repeated. Whilst the cornea was 
thus flaccid, the old fistula completely and firmly healed. 
Part xl., p. 159. 
Strumous Corneitis.—In children, what is called strumous corneitis, is in 
most cases the result of a congenital syphilitic taint, and the remedies directed 
against it should be chosen accordingly. Mercurials and iodides should be 
given, at the same time supporting the system by tonics and a liberal diet. 
The mild mercurial ointment should be rubbed in behind the ears every 
night at bedtime. Ptyalism must never be induced. If the intolerance 
of light be great, the occasional employment of blisters behind the ears 
may do good. Part x\.,p. 163. 
ENTROPION. 
Subcutaneous Myotomy in Entropion.—M. Petrequin recommends sub- 
cutaneous myotomy for certain cases of entropion. He says: “I have re- 
cognized the fact, that there are certain cases of entropion produced 
exclusively by a permanent contraction of the orbicularis muscle. 
The blepharospasm, so often accompanying scrofulous ophthalmia, has at 
once served as an indication and a proof of this fact. This, then, is 
truly a muscular entropion.” 
Ho give a case of complete success, in which he performed the opera- 
tion in the following manner. He placed the instrument on a level with 
the floor of the orbit (the lid being held extended), passed it under the 
skin, and the orbicularis, up to the free edge of the eyelid, taking care 
that no fibres escaped division superiorly; the instrument was then 
carefully withdrawn, assisting the division by pressing on the eyelid with 
the finger. Part iv., p. 109. 
Operation for Entropion.—Raising the eyelid from the globe, so as 
to admit the blade of a strong pair of scissors under it, make a perpendi- 
cular incision a quarter of an inch long through the tarsal cartilage and 
lid, upon the temporal side, and a second upon the nasal side, avoiding 
the puncta, and including the entire inverted portion of the lid : evert the 
flap, and with a small scalpel connect the perpendicular incisions by a 
horizontal one through the conjunctiva and tarsal cartilage close to its 
ciliary margin; apply sulphate of copper to diminish the chance of adhe- 
sion in the horizontal incision, and if adhesions take place, break them up. 
The success of the operation depends upon the horizontal incision healing 
by granulation. When the inversion is very complete, and of long stand- 
ing, excision of the edge of the tarsal cartilage with the bulbs of the eye- 
lids must be practised. Part xvi., p. 231. EYE. 
623 
Entropion.—This disease, occurring on the lower eyelids of old persons 
suffering from ophthalmia, and for which an operation has generally been 
performed, has been treated successfully in many instances by the applica- 
tion of collodion, which, by the contraction it causes, overcomes the 
relaxation of the integument, and the eyelid resumes its normal position. 
Part xxiii., p. 215. 
Distichiasis.—The following method of treating single hairs, when 
inverted, is worthy of attention. Place the horn spatula within the lid, 
and make an incision with a small knife down to the root of the inverted 
lash, wait until the hemorrhage has ceased, and then apply a point of 
nitrate of silver down to the bottom of the wound, by means of a porte- 
caustique, and remove the lash. This plan seldom fails, though it fre- 
quently destroys two or three of the neighboring cilia. 
Part xxviii., p. 330. 
Entropion and Trichiasis.—After a deep wound of the scalp, a firm 
and depressed cicatrix remains, and the growth of the hair at this part is 
directed toicard it. In the same manner, by excising deeply a narrow 
slip of skin, muscle, and fibro-cartilage just above the roots of the eye- 
lashes, a firm cicatrix is caused, and the lashes are directed outward or 
toward the cicatrix ; by this means the marginal portion of the orbicularis 
is involved in the cicatrix, whilst the eyelashes are preserved ; the 
removal of merely a portion of skin is very ineffectual, on account of its 
slight connection with the subjacent tissues. Part xxxviii., p. 190. 
Use of Tincture of Iodine.—The continued application of the com- 
pound tincture of iodine to the upper lid, has the effect of causing gradual 
contraction of relaxed tissues; in this way it is of the greatest use in 
cases of ptosis, causing contraction of the relaxed levator muscle, and in 
trichiasis and entropium, eversion of the inverted edge of the lid. 
Part xxxviii., p. 193. 
IRIS. 
Spirits of Turpentine in Iritis. — Mr. Arnott strongly recommends 
the internal administration of the spirit of turpentine in iritis, after the 
more active inflammatory symptoms have been reduced by bleeding and 
tartar emetic. This remedy he has found to succeed in curing the disease 
when mercury and the strictest antiphlogistic regimen had failed. The 
spirit of turpentine was administered, as recommended by Mr. Hugh Car- 
michael, in emulsion in the dose of a drachm three times a day; and the 
only objection to the employment of the remedy was the difficulty or even 
impossibility of some stomachs retaining it beyond a certain length of time. 
This, however, might be obviated by diminishing each dose, but increasing 
their frequency. 
Mr. Foote believes that turpentine acts, in these cases, by inducing irri- 
tation in the mucous membrane of the intestinal and urinary canals. He 
quotes and approves of Mr. Carmichael’s formula for its administration. 
R Olei terebinthinae rectificati, §j. vitellutn uninus ovi; tere simul, et 
adde gradatim emulsionis amygdalarum giv., sirupi corticis aurantii gij., 624 
EYE. 
spiritus lavandulae compositi 3iss., olei cinnamomi guttas tres vel quatuor. 
Misce; sumat cochlearia larga duo ter de die. Parti.,p. 87. 
Syphilitic Iritis.—The administration of mercury recommended, so as 
to excite its full effects upon the system. Part i.,p. 128. 
Changes in the Color of the Iris Produced by Inflammation. 
TABLE OP THE MORE COMMON CHANGES IN THE COLOR OP THE IRIS, OBSERVED DURING OR 
AFTER INFLAMMATION. 
MOKBID COLORS. 
Natural Color of the 
Iris, or of the inflamed 
portion of it. 
First Stage of Inflam- 
mation, before lymph 
is effused. 
Transition Stage—in- 
creased vascularity, 
and commencing ef- 
fusion of lymph. 
Third Stage, when 
lymph is effused, or 
in the Sequelae of the 
Disease. 
Blue. 
Purple of a campanu- 
la, imperial, or plum 
shade. 
Black, hornblende 
black, o r greenish 
black. 
Dingy green, sap 
green, or grass green. 
Bluish grey, with yel- 
low markings. 
Basalt black, or grey- 
ish black. 
Applebark green. 
Yellowish green. 
Basalt black. 
Clove brown. 
Brownish black. 
Reddish black. 
Chestnut. 
Lighter chestnut, or 
hazel. 
"I Hazel, wood brown, 
light olive, or wax 
V yellow, according to 
the depth of the ori- 
J ginal color. 
Hazel. 
Brownish red, or tile 
red. 
Wood brown, or very 
light hazel. 
Tawny orange, or am- 
ber yellow. 
Citron, or more or less 
of a yellow hue. 
Deep orange. 
Lighter orange. 
Light yellow. 
Transparent and near- 
ly colorless—(the an- 
terior serous layer). 
Arterial red. 
Reddish orange. 
Very light, or prim- 
rose yellow. 
In the treatment of iritis, a minute attention to the color of the iris is 
highly useful, (a) In determining when the employment of mercury be- 
comes a sine qua non. Incipient rheumatic iritis may he often cured by 
leeching, colchicum and sudorifics, which frequently require to he used for 
some time before they remove the disease. But, whenever there occurs a 
change in the color of the iris, indicative of the commencing effusion of 
lymph, mercury (unless most especially contra-indicated by some other 
circumstances in the condition of the patient) must be administered, and 
speedily too, or else the mobility of the iris will be permanently impaired, 
or extensive adhesions, and even closure of the pupil, be almost inevitable. 
'(£>) In chronic cases, the progressive restoration of the natural color of the 
iris is a good test of the efficacy of the means employed, whether mercury, 
iodine, or oil of turpentine; and for deciding on the propriety of continu- 
ing their use. (c) Whenever the change of color in the iris indicates the 
recent and extensive effusion of lymph into its interstices, there is great 
danger of a slow and gradual closure of the pupil taking place for some 
weeks and months after all inflammatory action has subsided, and the cure 
apparently complete. In such cases, the daily use of belladonna, or hyo- 
scyamus, to keep the pupil moderately dilated, becomes an essential point 
of treatment, (d) When the pupil is closed, either by lymph, or by en- 
tanglement of the edges of the iris in a penetrating ulcer of the cornea, or 
in the cicatrix, after the extraction of a cataract, or from other causes, and EYE. 
625 
an operation for an artificial pupil is contemplated, any change in color, 
indicating the matting together of the iridal fibres with lymph, should be 
carefully noted. In such cases, the prognosis as to the probable utility of 
any operation, such as “incision” (iridotomia), or “simple ciliary separa- 
tion” (iridodialysis), the success of which depends on the contraction of 
the liberated portion of the iris, should be extremely dubious, and a pre- 
ference given to “ excision ” (iridectomia), or to compound ciliary sepa- 
ration,” the separated portion being either drawn out and cut off (iridec- 
tomedialysis), or left strangulated in the wound of the cornea (iridenclei- 
sis). Part iii., p. 98. 
Treatment of Iritis and Conjunctival Inflammation, by Belladonna 
Injections.—Mr. Bulley relates several cases in which this treatment 
seemed highly beneficial: 
The lotion which he uses is injected into the eye by means of a syringe; 
and in the application of the douche or irrigation, he uses different ingre- 
dients in solution, according to the particular structure involved. Thus, 
in case of incipient iritis and atonic ophthalmia, he used a lotion of bella- 
donna with sulphate of copper ; but in others, left out the copper. If the 
iris be the seat of disease, and the conjunctiva likewise affected, he usgs 
the following lotion : extract of belladonna, 20 grains; sulphate of copper, 
5 grains; water, a pint. To be injected frequently during the day, with a 
clean brass syringe, with an ivory pipe, capable of holding from three to 
four oimces of the fluid; “at first it is necessary to throw the stream upon 
the closed lids, at least for the first few times. By degrees the patient 
becomes inured to the shock,” and can bear it upon the eye itself. 
Part v., p. 143. 
Bheumatic Iritis.—The combination of hydriodate of potass with liquor 
potassre highly recommended. Part viii.,y>. 25. 
Effect of Temperature in causing Reflex Actions.—“Contractions of the 
iris are produced by drawing cold water into the nostrils.” 
Part viii., p. 47. 
Injuries of the Iris—Artificial Pupil.—Mr. Estlin says : 
The liberties that may be taken with the iris is a matter of great impor- 
tance with reference to the operations for artificial pupil. I am inclined to 
believe that many persons with extensive opacities on the cornea, espe- 
cially in cases where suppurative ophthalmia has preexisted, are condemned 
to perpetual blindness, to whom a valuable degree of vision might be given 
by the removal of the iris opposite any clear portion of cornea that may 
be left. In every case of the kind, where there is no useful sight, if any of 
the cornea is clear, and the eye be otherwise healthy, the operation ought 
to be tried; and I have been surprised to find with how small a portion of 
cornea remaining transparent, a person may have a degree of vision to some 
extent useful, and, in a great degree, a source of comfort to him. And in 
such cases I prefer the operation of tearing away a portion of the iris, and 
cutting it off. A small section is made in the cornea near to the clear por- 
tion, the iris drawn out with a hook or forceps, and as much cut off as is 
practicable. Care will be necessary in this operation to avoid injuring the 
crystalline capsule. 
[Mr. Estlin describes a mode of making an artificial pupil, which he has 
practised for many years. It is done with a small knife used originally by 626 
EYE. 
Sir W. Adams, called an iris-knife, and figured in Mackenzie’s work. It 
has generally been used by being introduced behind the iris through the 
sclerotica, and then pushed through the iris into the anterior chamber. 
Mr. Estlin says:] 
I have been accustomed to use this little instrument differently, inserting 
it through the cornea, near the temporal canthus, close to the sclerotica, 
with the flat part of the blade toward the iris. This instrument being 
passed through the anterior chamber to its nasal extremity, the handle of 
the knife is turned a quarter of a circle, so as to bring its cutting edge 
against the iris, and it is then withdrawn by a quick movement, that de- 
presses the point of the instrument upon the iris, so as to make a horizon- 
tal cut across that membrane. 
I have found this mode of making an artificial pupil particularly success- 
ful in cases where the natural pupil has closed after extraction of the cata- 
ract. Part viii., p. 142. 
Palsy of the Iris.—It sometimes happens that a patient is affected with 
blindness from a palsy or excessive dilatation of the iris, which probably 
permits such a quantity of light to be admitted into the eye as to over- 
power the retina. This seems probable from the fact that occasionally, 
Avhen the patient looks through a little hole in a card, his vision is con- 
siderably improved. It is very possible from the dilated and insensible 
pupil, and consequent blindness, that a practitioner might mistake such a 
case for amaurosis ; and as the treatment of the one for the other would 
be highly improper, it is necessary to be aware of the existence of such 
cases. Mr. Ure and Mr. Arnott relate interesting cases of this blindness 
from an insensibility of the iris, and the former especially reminds us of 
the efficacious treatment of Serres, which consists of cauterizing the cir- 
cumference of the cornea by nitrate of silver. 
The solid caustic should be scraped to a point, and gently wiped round 
the circumference of the cornea nearly at its junction with the sclerotica; 
this may be repeated every day or two, according to its effects, taking 
care not to produce too severe inflammation. But although this treat- 
ment may be occasionally very successful in an atonic state of the orbicular 
fibres of the iris, we should be disposed to try milder measures first, such 
as the vapor of ether or electricity. We should also recommend the use 
of turpentine, which has such a remarkable influence over the iris in many 
cases where every other remedy has failed. This may be given in doses 
of half a drachm or a drachm every night and morning, or thrice a day. 
Part viii., p. 156. 
Night Blindness—Oil of Turpentine.—In two cases of this description, 
in which the patients were seized with a total blindness every evening, 
the moment the sun set, although in other respects perfectly well, Mr. 
Ividd tried the whole routine of medicines without effect. The iris alone 
showed symptoms of disease; the rest of the eye was healthy. The iris 
was very interrupted and sluggish in its movements, and evidently very 
insusceptible of its usual stimulus, the pupil contracting very little even on 
the approach of the strong glare of the sun. 
Being aware of the action of turpentine on this part of the eye, Mr. 
Kidd ordered the following mixture with excellent effect: 
K. 01. terebinth.; ol. ricini, aa. §j.; mist, camphor®, §iv.; liquor, potass®, 
3j.; tne. opii, gtt. x. Ft. mistura. EYE. 
627 
Half an ounce to be taken every night and morning. The patients were 
cured in a few days. 
It is often difficult to continue the use of turpentine on account of its 
disagreeable nature. Bouchardat recommends the following formula : 
Take of gum acacia, ten grammes; mix it with ten grammes of water; 
add of white honey, fifty grammes ; oil of turpentine, fifty grammes ; car- 
bonate of magnesia, q. s. Make a soft electuary. 
The dose is from 2 to 10 grammes (36 to 180 grains) a day in unlea- 
vened bread. In some cases a little laudanum may be added. 
Part viii., p. 157. 
Effect of the Anisodus Luridus on the Pupil.—The anisodus luridus, 
a perennial herbaceous plant belonging to the natural family of the 
solanece, was brought from Nepaul to Europe in 1824. In our gardens it 
often does not come out till the middle of June ; it then springs up with 
astonishing rapidity, and soon surpasses the atropa belladonna in height. 
It strikes its roots deep into the ground, and withstands the severest win- 
ters. It is of a pale green color. A tincture prepared with an ounce of 
the dried leaves to eight ounces of alcohol at 20 degrees, when given to 
different patients, produced an extreme dilatation of the pupil, the highest 
dose being twenty drops in the twenty-four hours. Two of them suffered 
from amaurosis for a short time, and their blindness did not go off till the 
medicine was omitted. Part ix., p. 86. 
Treatment of Inflammation of the Eye.—Dr. Jacob remarks that the 
treatment of inflammation of the eyeball ought to be upon the same gene- 
ral principles as that of inflammation in other parts. Bleed and give 
nauseating medicines, purgatives and low diet, and stimulate the liver, 
kidneys, and skin, to rid the fluids of pernicious ingredients. In the 
second stage, to prevent or arrest the consequences of inflammatory 
action, give mercury or iodine, bark, colchicum, turpentine, etc. In the 
third stage, when the inflammatory action has subsided, apply belladonna, 
and give mercury or iodine in smaller doses, and for longer periods, with 
local stimulation and cutaneous irritation. 
When the disease has been treated with mercury, and returns, try de- 
pletion and antimonials, with confinement to bed, and low living, for two 
or three days before you again resort to that remedy. Give tartrate of 
antimony or James’s powder, so as at first to cause nausea, and afterward 
diaphoresis. Mercury is the sheet anchor, given so as just to affect the 
gums : at first, give three grains of blue pill, three grains of compound 
colocynth powder, and one-eighth or one-tenth of a grain of tartrate of anti- 
mony three times a day, for a couple of days ; then five grains of blue 
pill with the same quantity of antimony, for two days more; and finally 
five grains of blue pill three or four times a day. If it affect the bowels, 
add a little opium to it. This produces a mercurial effect upon the sys- 
tem in seven or eight days. Or two grains of calomel and a quarter of a 
grain of opium may be given every four or six hours, if we wish to affect 
the system sooner. The length of time we are to continue the mercury 
must be decided by its effects. 
Iodine, turpentine, colchicum, and bark, are valuable where the inflam- 
mation is modified by specific disease, or constitutional derangement, or 
where mercury has already been given, or cannot with safety be used. 
From the very commencement of an attack of iritis, extract of bella- 628 
EYE. 
donna should he used. Mix it with water until it acquires the consistence 
of cream, and paint the eyelid, brow, and upper part of the cheek with it; 
let it dry, and then apply it again, and cover it with a little damp linen, 
and keep it moist by applying a lotion made with two drachms of the extract 
to eight ounces of water. If its application be not foynd comfortable, it 
need not be applied more than once or twice in twenty-four hours. When 
its application to the skin does not affect the pupil, drop a little of the 
solution upon the conjunctiva, even during the inflammatory attack; its 
effects soon pass off. It is best to apply it in the morning. Part xiii., p. 308. 
Atropia and Belladonna.—Make a solution of one, two, or three grains 
of atropia to 5j. of distilled water ; add a drop of nitric acid to render it 
soluble, and a di*op of spt. vini to make it keep. Introduce a drop of one 
of these solutions between the eyelids, which will keep the pupil dilated 
from four to ten days, according to the strength of the solution used. 
It may be useful in iritis; also capsulitis; also when it is wished to 
break up recent adhesions between the iris and lens; to withdraw a pro- 
truding iris from its position ; in central cataract; or in central opacity of 
the cornea, where the pupillary margin is attached to the back of the 
cornea, etc. Its use is less marked when conjunctivitis is present, than in 
a healthy eye, and its effects are more evanescent. 
In ulcers of the cornea, belladonna is of special service; by it synechia 
anterioi', etc., may be prevented. In cases of rupture from ulceration, with 
hernia of the iris, apply the solution of atropia close to the eyelids, and 
keep them closed with plaster ; smear the eye and brow with the extract 
of belladonna, and, if necessary, use leeches to the temples, just over the 
malar bone ; apply blistering and use such constitutional treatment as is 
calculated to subdue inflammation, and the further spread of the sloughy 
or ulcerating process. 
In neuralgic affections of the eye, intermitting and unattended with 
inflammation, or obvious alteration in the structure, or motion of the organ 
—try belladonna internally, from one-sixteenth to one-sixth of a gr. in 
solution three times a day. In the old and inveterate photophobia or oph- 
thalmia, attended with vascular cornea, of discharged soldiers, the internal 
use of belladonna is marked. Part xiv., p. 258. 
Iritis, Pheumatic.—In the active form, abstract blood, purge, and at- 
tend to the function of the skin. Follow these measures by the adminis- 
tration of tonics, otherwise a tedious subacute stage will follow. On the 
slightest appearance of fibrinous effusion give mercury; and blister for 
opacity of the cornea. ' Part xvii., p. 201. 
Iritis, Chronic.—Great benefit has been derived from the long-con- 
tinued use of small doses of the bichloride of mercury, given in solution. 
Part xx., p. 185. 
Hernia of the Iris; Rapid Retraction by the Use of Atropine on 
both Eyes.—The “ Philadelphia Medical Examiner ” mentions a case of 
wound of the cornea, under the care of Mr. Moorehouse, where the iris 
was herniated. Attempts at reduction were made by touching the pro- 
lapsed iris with a solution of atropine (five grains to the ounce of distilled 
water), but with little result. Mr. Moorehouse then thought of taking 
advantage of the consentaneous action of the two hades, and applied the 
solution to both eyes. This method succeded at once, the iris retreated, 
and the wound of the cornea soon healed up. Part xxiv., p. 251. EYE. 
629 
Treatment of Iritis.—Having reduced the inflammation by ordinary 
measures, give mercury according to the severity of the case and the 
vigor of the patient, one or two grain doses three times a day, until the 
system has become influenced. When the acute stage has passed, a few 
grains of powdered bark assists in reestablishing tone in the vessels, and 
repressing lingering congestion. A corresponding change in diet should 
also now take place. Aconite is sometimes an admirable remedy, but it is 
uncertain, and sometimes dangerous in its action. It may be used in 
those cases which resist ordinary treatment, in doses of ten minims of the 
tincture three times a day. The greatest caution should be observed in 
its use. In the syphilitic disease, if there be racking pain about the 
globe, forehead, and temple, we may give an opiate, when the dilatation 
of the pupil is fully effected by belladonna. We may use simple opium, 
or the pulv. ipecac, co., or a preparation of morphia, or apply the mercury 
and opium ointment or the belladonna liniment to the seat of pain. In 
all cases of iritis, we should apply belladonna round the orbit, keep the 
patient in a darkened room, and abstain from giving opium until dilatation 
of pupil be effected. In syphilitic iritis turpentine is the remedy intro- 
duced by Mr. Carmichael, of Dublin, and may be given with great advan- 
tage. One drachm may be given three times a day, made into an emul- 
sion. Blisters are very valuable, but should be applied behind the ear, or 
to the nape of the neck. Part xxviii., p. 245. 
Photophobia.—A few drops of chloroform evaporated from the palm of 
the patient’s hand, and held near the eye, will generally allow a photo- 
phobic eye to be temporarily opened for the purpose of examination by 
the surgeon. Part xxxviii., p. 259. 
ARTIFICIAL PUPIL. 
Made in the Superior Eyelid. ■— In a case of contraction of the 
orbicular muscle of the eyelid, which had resisted every remedy, even 
the twice-repeated section of the muscular fibres, M. Gerold resorted 
to the following operation, which he has been the first to propose and to 
execute. After introducing a small fiat piece of wood, well oiled, under- 
neath the superior eyelid, exactly opposite the pupil of the eye, he made 
a crucial incision, which completely divided the skin, the muscle, and the 
mucous membrane. The external skin was then dissected off the four 
flaps thus formed, and the mucous surface was turned outward, and 
fastened to the base of the flaps, so that the mucous membrane formed the 
circumference of the artificial opening. No accident supervened, and 
vision was restored; the patient wore spectacles as a precautionary 
measure. Part ix.,p. 182. 
Artificial Pupil.—A very useful instrument is employed by Mr. Bow- 
man in these cases, consisting of a needle-pointed hook, which enables the 
operator to enter the cornea, and drag out the iris with the same instru- 
ment : thus there is less chance of the escape of the aqueous humor, and a 
very small opening is made. There is no difficulty in withdrawing it. A 
little care is necessary lest in using the hook the lens be wounded by the 
needle-point projecting beyond it. It is peculiarly adapted to cases where 
extraction has previously been performed. Part 20'7. 
Formation of Artificial Pupil by Galvano- Cauterization.—An ingenious 630 
EYE. 
suggestion has been made by M. Tavignot in the “Moniteur des Hdpitaux” 
for making an artificial pupil by galvano-cauterization. He passes in the 
platinum end through an aperture in the external circumference of the 
cornea, and applies it to the point he wishes to influence. By this means 
the size, shape, and position of the pupil can be accurately regulated. 
Thus far it is deemed only applicable to subjects who have already under- 
gone the operation for cataract; as, in the case of the lens being present, 
its opacity would be induced. Part xxxvii., p. 188. 
Artificial Pupil—Iriddesis.—Mr. Critchett’s operation. The usual 
way of operating for artificial pupil is often clumsy; the pupil is too large 
and irregular, and often too near the cornea. You cannot regulate the 
size and place by the old method. Try a new way by tying the prolapsed 
iris in the following way: The patient, if at all restless, being placed 
under the influence of chloroform, the wire speculum is inserted, and with 
a pair of forceps, a small fold of the conjunctiva close to the cornea is 
held so as to fix the eye. An opening is then made with a broad needle 
through the margin of the cornea, close to the sclerotic, and just of suf- 
ficient size to admit the caftula forceps; with it a small portion of the iris, 
near, but not close to, its ciliary attachment, is seized and drawn out to 
the extent considered necessary to enlarge the pupil; a piece of fine floss 
silk, previously tied in a small loop round the canula forceps, is slipped 
down and carefully tightened around the portion of iris made to prolapse, 
so as to include and strangulate it. This manoeuvre requires a little 
practice and dexterity, and is best accomplished by holding each end of 
the silk with a pair of small forceps with broad extremities, bringing them 
exactly to the place where the knot is to be tied, and then drawing it 
moderately tight. A single tie is sufficient; the ends are then cut off, and 
the operation is complete. Little or no irritation usually follows. The 
small portion of iris included in the ligature speedily shrinks, leaving the 
little loop of silk, which may be removed from the eye about the second 
day. By this method, the size, form, and direction of the pupil can be 
regulated to a nicety. Part xxxix., p. 242. 
LACHRYMAL AFFECTIONS. 
Fistula Lachry malis.—In casesof fistula lachrymalis, Dr. Parrish, of Phil- 
adelphia, recommends us to place more reliance on dilatation than we are at 
pi'esent accustomed to do. He thinks that as dilatation is so successful in stric- 
ture of the urethra, the same principle ought to he adopted in these cases. In- 
stead of using fine catgut, as recommended by Beer, or other means mention- 
ed by various authors, Dr. Parrish uses a bougie made of waxed linen,-which 
he can have made of any size. It is made by dipping a piece of fine linen into 
white wax, in a melted state, and suddenly withdrawing it. It is then allowed 
to cool, and cut into portions which, when tightly rolled, form a bougie of 
any size which may be required. This kind of bougie may be cut or bent 
with great ease, and be made smaller by unwrapping, without the necessity 
of having a great number of sizes already prepared. After reducing the 
inflammation round the fistulous sore, Dr. Parrish introduces one of these 
fine bougies down to the strictured part, and there secures it by adhesive 
plaster to the external parts. This may be removed in a day or two, and 
again introduced, or a larger one may be used, if possible, so as to dilate 
the fistulous orifice, and to induce a more healthy action in the mucous EYE. 
631 
surface of the sac and duct. By perseverance, the hougie may ultimately 
be made to pass through the whole extent of the canal, and after this, 
bougies of larger size may cautiously be persevered with till the duct be 
sufficiently dilated. * Tart ix., p. 155. 
Fistula Lachrymalis.—Suppose, says Mr. Liston, that you have a 
fistula lachrymalis to deal with, that there has been inflammation and sup- 
puration of the sac at the inner corner of the eye, and that this collection 
has been opened, or has been evacuated by ulceration, and the coverings 
may have so far contracted, but still the fluids from the eye and sac are 
discharged upon the cheek, you must endeavor to restore the nasal duct. 
For this purpose an incision must be made into the sac. It is of no use to 
attempt passing a probe through the fistulous opening. You must intro- 
duce a narrow bistoury through the sac down into the duct, and lodge it 
fairly in the bony canal, or you may employ a sort of sharp-pointed 
grooved director. 
You are told that it is necessary to feel for the tendon of the orbicularis 
palpebrarum, but when there has been inflammation present, and this 
always precedes the formation of matter and fistula, you can feel nothing 
of the kind, you must trust to your eyes and your anatomical knowledge. 
Knowing the direction of the canal, you put your knife behind the margin 
of the bone, behind the nasal process of the superior maxilla, push it down 
at once, and lodge it fairly in the canal. In that way you are in a position 
to make the passages pervious. If you follow the knife with a probe, 
withdrawing the knife while you introduce the blunt instrument, you 
come at once into the nose, and there will possibly be some slight flow of 
blood from the nostril. If, after a few days, you close the nostril and 
make the patient expire forcibly, the blood and matter Avill be thrown up 
into the corner of the eye, and then you are sure that you have properly 
effected your object. You must remember that the bony parietes of the 
nasal duct are, in some respects, very thin. The intentional perforation 
of them was contemplated, proposed and even practised by our forefathers. 
When any difficulty arose in getting the natural canal restored, the os 
unguis was bored through with a large trois quarts, and even the actual 
cautery was by some resorted to, in order to make a more permanent 
opening for the passage of the tears and discharges into the nose. This 
proceeding is now, happily, abandoned, and, I may say, forgotten. But 
unintentionally, and from ignorance, the posterior part of the canal is 
occasionally penetrated by the knife or probe. If the point of the instru- 
ment, instead of being directed downward and slightly backward in the 
course of the canal, is pushed more directly backward, it may be made 
very readily to penetrate the ethmoid bone, and it will then be lodged 
above instead of below the inferior spongy bone—a serious blunder 
enough. But it is necessary to keep the passage pervious, and with this 
view, it has been recommended to introduce into the nasal duct, from 
above, various sorts of tubes—a very unsurgical proceeding it seems to 
me—but one practised by many good surgeons, and by one in particular, 
very eminent in our profession, the late Baron Dupuytren. 
Various forms of tubes have been recommended, some of silver, some 
of gold, but I Avould not advise you to insert any of them, Avhatever their 
composition or shape, because, as foreign bodies must cause inflammation, 
you Avill be under the necessity of removing them, and if this be done, 
the patient, after all his sufferings, will be in the same state as before. 632 
EYE. 
But suppose that a patient comes to you who has had a tube put in by 
some one else—it is productive of great irritation of the parts and suffer- 
ing to the individual; how are you to get it out ? The tube is out of 
sight, the skin has closed over it, there is an abscess about it. You divide 
the skin, and you feel the end with the point of your bistoury or wTith a 
probe, but you cannot insinuate a pair of forceps to seize or extract it. 
The tube is generally lodged deeply and pretty well fixed, and you must 
introduce a probe, made with a Screw, into the metal tube ; by a turn or 
two you fix it firmly, and thus remove it. These probes are often very 
useful in ascertaining whether portions of bone are loose, in removing 
small sequestra. 
I have stated that you are not to employ a tube in the treatment of 
lachrymal fistula; but you may, with great propriety, use what is called 
a style. You introduce a bit of a small wax bougie in the first instance, 
or you had better provide yourself with a silver probe of proper length, 
and use that at once, making it follow the knife or grooved director. If 
there is a large ulcerated opening, you may put a bit of thread to prevent 
its slipping down out of sight, which sometimes takes place. If you have 
not a very large opening, you lodge the style in the duct, and leave the 
nail-head projecting. You must have styles of different sizes and lengths 
to suit different individuals. You, of course, do not expect that a style 
suited for an adult male should lie comforlably in the nasal duct of a young 
female, in whom the bones of the face are much smaller. The style should 
be of such a length that the head merely appears at the corner of the eye, 
whilst the lower end rest on the floor of the nostril, or nearly so. There 
may be a little excitement for a time, consequent on the lodgment of the 
style, with some discharge, but this soon finds its way along the sides of 
the probe and into the nose, gradually diminishing in quantity. The 
actions of the parts soon become quiet, and the patient wears the style 
without inconvenience, and it can be taken out night and morning, wiped 
and replaced without pain. If he chooses he may leave it off after a while 
during the day ; there is a mere pin-hole, which is scarcely observable, and 
through it a small style may be introduced at night and removed in the 
morning. This is a rational and proper mode of proceeding to keep the 
parts pervious. How long the style is to be worn, and at what period it 
can be discontinued without risk, must depend on circumstances 
The practice followed for many years past in Italy, in the treat- 
ment of chronic inflammation of the lachrymal canal, is to introduce a 
minute fragment of the lunar caustic into the fistula, if such be present; 
or by a small puncture made into the sac, if not. An acute inflammatory 
action is immediately set up; but by the following day this is usually much 
diminished, and ceases entirely in three or four days afterward. The en- 
gorged parts then gradually subside, the purplish color changes to a white, 
the tears resume their natural course, and every trace of the disease van- 
ishes. In most cases, a single application of the caustic is sufficient. Pro- 
fessor Lallemand very generally adopts this mode of treatment. 
Part x., p. 137. 
Lachrymal Obstruction.—Examine the condition of the mucous mem- 
brane of the nostril, and if it is found thickened and congested, or ulcerated, 
apply to it, by means of a camel-hair brush, an ointment composed of three 
parts of unguentum liydrargyri ammonio-chloridi, to one part of oil of al- 
monds ; or apply in the same manner a solution of nitrate of silver, four 633 
EYE. 
grains to the ounce. At the same time, attend carefully to the general 
health. Part xix.,p. 209. 
Epiphora.—The term “ Epiphora ” is here restricted to a watery state 
of the eye, produced by some obstruction in the puncta or canaliculi. 
There is scarcely any affection so trivial which the surgeon undertakes 
with less hope of ultimate satisfaction; for all know that some cases resist 
all ordinary measures, and yet present no obvious indication for their 
treatment. 
A frequent cause of this disease is displacement of the inferior punctum, 
so that the tears never reach the orifice at all. The canal must be slit up 
from the punctum, to such an extent as to carry back the orifice to that 
part of the conjunctival surface where the tears are collected. The wound 
should be kept open for a few days, that the canal may be converted into 
a groove. Part xxviii., p. 249. 
Lachrymal Sac—Injection of.—Mr. Obre has brought into notice an 
ingenious invention for injecting the lachrymal sac. A small silver canula 
is attached to a small vulcanized India-rubber bag. The canula being in- 
troduced into the meatus, a slight pressure on the bag propels the fluid. 
Part xxix., p. 255. 
Fistula Lachrymalis.—Instead of passing the knife into and along the 
lachrymal canal, make a simple puncture into the abscess or lachrymal sac, 
and then, introducing the style, guide it to the orifice of the canal, and 
with gentle pressure pass it along the tube. Part xxxi,,p. 198. 
Division of the Tear Punctum and its Canal.—For the performance of 
this little operation, a very fine and sharp pair of scissors are preferable to 
a knife and director, as the operation is accomplished much more rapidly 
and easily; the slit is always perpendicular and never reunites. The 
greatest width of the blades of the scissors should be one-sixth of an inch, 
and their length from rivet to point half an inch. Part xxxvii., p. 185. 
Obstructions of the Lachrymal Passages.—The surgeons of the Edin- 
burgh Infirmary bear strong testimony as to the etficiency of Mr. Bow- 
man’s plan of treating these cases. This consists in slitting up the lower 
canaliculus upon a grooved probe, as far as the caruncle. The real place 
and degree of obstruction can then be readily ascertained, and treated with 
silver probes of various thicknesses. An opening through the skin is thus 
avoided. Part xxxviii., p. 195. 
Patency of the Slit-up Canaliculus.—In all cases it is necessary to pass 
a probe occasionally through the wound made by the knife in Bowman’s 
operation, in order to prevent adhesion of the two opposite surfaces. But 
where the operation is done for everted punctum, from thickened lower 
lid, when a larger opening and one nearer the eye is desirable, or in the 
case of timid nervous people, or children, who require much restraint dur- 
ing the operation, or when from any other cause subsequent interference is 
attended with difficulty, it is better at the time of operation to excise with 
the scissors a small portion of the posterior lip of the wound. This will 
effectually prevent adhesion. Part xxxviii., p. 197. 
OPHTHALMIA. 
Strumous.—Mr. Walker gives the following treatment: 
Strumous ophthalmia, according to my experience, always more readily 634 
EYE. 
yields to the stimulant treatment, when properly employed, than it does to 
the antiphlogistic. I make these observations as definitely applicable and 
true, whether the disease be in the acute or chronic stage; whether it be 
more or less intense; whether it be confined to the conjunctiva, or have 
extended to the cornea, or even to the sclerotica; the principle in all these 
cases is still the same, viz., the necessity to use stimulants. But the stimu- 
lants to be employed must be selected in accordance with the severity of 
the attack. If the attack be slight, then the milder stimulants will be suf- 
ficient ; such, for example, as the sulphate of zinc solution and the zinc 
ointment; if somewhat more severe, the sulphate of copper solution 
and the red precipitate ointment; if very active, the sulphate of cop- 
per in substance ; or the nitrate of silver either in solution, ointment or 
substance. 
In an acute case I should generally prefer the nitrate of silver pencil, 
applied directly, but lightly, to the conjunctival surface ; whereas, in one 
of a less intense character, I should probably use the sulphate of copper in 
substance, as well as some of the other stimulants before mentioned. 
The only local adjuvants I deem necessary are such as have a sedative 
tendency, e. g. warm water, poppy fomentation, saturnine lotion in a tepid 
state, or a solution of the extract of belladonna. The last, more particu- 
larly, is often productive of great relief where the eyes are excessively in- 
tolerant of light. In its effects on the iris, we have indubitable evidence 
that it acts immediately, and in a peculiar manner, on the nervous system 
of the eye. The liquor opii sedativus, in the proportion of a drachm to 
an ounce of water, is also highly extolled by some surgeons as a local 
application. 
Counter-irritation, by means of blisters, setons, or issues, I scarcely ever 
resort to. Blisters, more particularly when applied behind the ears, are 
very apt to be followed by many disagreeable results. 
In the management of more obstinate and protracted cases, I must re- 
mind you of the caution I formerly gave, as to the excessive employment 
of the nitrate of silver; and, therefore, as soon as the symptoms improve, 
you may properly substitute the sulphate of copper for the nitrate of silver. 
The internal treatment should be such as is calculated to increase the 
energies of the system. The various medicinal agents known under the 
appellation of tonics, such as the mineral acids, chalybeate preparations, 
and more particularly quinine, can alone be expected to be productive of 
benefit. 
Iodine is thought by some practitioners to possess properties which 
render it useful in the treatment of struma, and particularly of glandular 
enlargement. In such cases it often produces very decided benefit; but I 
very much doubt if it lias any control over the affections of the eye, al- 
though M. Lugol lias expressed himself very strongly to the contrary. 
The formula recommended by Lugol is the following: 
Ilydriodate of potash, ; iodine, grs. iij.; water, giij. 
The dose is half a teaspoonful three times a day, for children. For the 
enlargement of the glands, the following liniment is recommended: 
Hydriodate of potash, Bj.; lard, ~j. 
M. Dupuytren, who was adverse to the use of antiphlogistic remedies, 
appears to have placed the greatest reliance upon the internal administra- 
tion of belladonna in the treatment of strumous ophthalmia. 
Part i., p 104. EYE. 
635 
LTyclrochlorate of Baryta in Strumous Ophthalmia.—Dr. Payan agrees 
with Mr. Phillips in extolling the efficacy of barium in scrofulous diseases. 
Dr. P. having observed that this remedy was used with excellent effect by 
Lisfranc in scrofulous diseases, he resolved to try it in an obstinate case of 
ophthalmia accompanied by a high degree of photophobia. The patient 
was six years of age. He dissolved two grains of the hydrochlorate in 
three ounces and a half of “ eau sucree,” and this quantity was taken in 
portions during the course of the day. No particular effect being pro- 
duced, on the third day three grains were taken, and the dose was gradu- 
ally raised to ten grains in the course of the day. On the twentieth day 
the medicine was discontinued, the patient being considered nearly well. 
In another case, twelve grains in the course of the day were taken with 
excellent effect, and without any symptoms of gastric irritation being pro- 
duced. During the administration of the remedy, Dr. Payan orders a 
light and sparing diet, considering that harm is frequently done by the 
tonic medicines and stimulating regimen which are generally ordered as a 
matter of course in strumous ophthalmia. Part i.,p. 111. 
Oxymuriate of Mercury in Strumous Ophthalmia.—Dr. Hamilton re- 
fers to the ordinary treatment of this obstinate disease, such as the use of 
some of the various tonics, bark, quinine, columba, rhubarb, the prepara- 
tions of iron, of iodine, and particularly of hydriodate of potass, mercury, 
leeches, blisters, issues, the citrine and other ointments, vinum opii, zinc, 
nitrate of silver, lead, etc., and states that, although the disease is often 
cured by some of these various means, the case is often protracted and 
troublesome in the extreme. 
Dr. H. relates several well marked cases in which he prescribed the 
oxymuriate of mercury, with decoction of bark, three times daily, with 
remarkable success. 
Dilute citrine ointment, between the eyelids at night, was used, and a 
drop of vinum opii, in the eye every morning, with occasional purges of 
jalap and scammony powder. 
To young children the dose has generally been the one-sixteenth or one- 
twelfth of a grain twice a day; to adults, the one-twelfth or one-eighth. 
The vehicles in common use are tinct. cinchonse, rhei, and occasionally 
spirits of wine. The medicine has been directed to be given one hour 
after meals. The only unpleasant effects from its use have been sickness 
of stomach or griping; by stopping the medicine for a day or two in both 
instances, and the administration of a little castor oil in the second, these 
effects have speedily ceased. Part ii., p. 104. 
Solution of Common Salt as an Eye Lotion in Ophthalmia.—Dr. Hays 
strongly recommends a saturated solution of common salt as a lotion in 
ophthalmia. He thinks that in many cases of chronic granular ophthalmia, 
it has contributed more to the cure than any other application. In some 
conditions of chronic granular ophthalmia, as where the eye is irritable, 
with injection of the conjunctiva of the ball, and lachrymation, he knows 
of no remedy which affords such prompt and marked relief. 
Part 109. 
Leaves of the Walnut in Scrofulous Ophthalmia.—Four cases of scro- 
fulous ophthalmia were treated with walnut leaves ; in addition to the in- 
fusion and sirup, the following collyrium was employed: 636 
EYE. 
Decoction of walnut, 8 ounces; extract of belladonna, 1 scruple; lauda- 
num, 1 scruple. 
The four cases were speedily cured. Part iv., p. 60. 
Uses of some of the Combinations of Iodine.—The following mixture 
was found useful in scrofulous ophthalmia: 
R Aquae destillat., eight ounces; liq. hydriodat. arsen. et hydr., eighty 
drops ; tinct. zingiber., half an ounce. M. Dose—One ounce every three 
hours. 
In this affection we may probably also find advantage in the use of the 
sirup of proto-iodide of iron, in the proportion of four grains of the proto- 
iodide to the ounce of sirup; of this about ten drops may be given three 
times a day to a child four years old. Part vi., p. 64. 
Creasote in Diseases of the Cornea and Conjunctiva.—Dr. Hildreth, of 
Ohio, very strongly recommends the use of creasote mixed up with the 
strong mercurial ointment, about fifteen drops of the former to half an 
ounce of the latter, in cases of scrofulous ophthalmia combined with 
opacity of the cornea. He orders a small quantity to be introduced 
morning and evening, under the upper eyelid, and by that means it is 
rubbed over the whole cornea. This treatment was found to clear a 
cornea which was nearly white, much better than nitrate of silver, and to 
be in every respect a better application than this substance, and it is 
especially useful when combined with the usual constitutional treatment. 
It should be applied to the eye, of such a strength that the burning or 
smarting pain from it shall not continue more than five minutes after its in- 
troduction. If too strong, it must be diluted with fresh lard perfectly 
pure, or with simple cerate. In more chronic cases the application may be 
made stronger if necessary. Part vii., p. 151. 
Strumous Ophthalmia—Malambo or Matias Parle.—Mr. lire says : 
In scrofulous ophthalmia, after removing feculent accumulations from 
the bowels, I have known an infusion, made with two drachms of the bark 
to a pint of water, cause a speedy and complete removal of the inflamma- 
tion and morbid sensibility of the eyes. The dose of the infusion just 
mentioned is from one to two ounces, repeated twice or thrice in the 
course of the day. It may, in some instances, be advantageously con- 
joined with salts of iron, or of mercury, with both of which it is compati- 
ble. The addition of a little sirup of orange-peel and compound tincture 
of cardamon forms a draught by no means disagreeable. 
Part viii., p. 80. 
Cod-liver Oil Externally in Scrofulous Ophthalmia.—M. Brefeld 
treats of the employment of cod-liver oil in topical applications, in the 
treatment of some scrofulous diseases; he praises very highly the following 
ointment for the cure of scrofulous ulcers, which follow inflammation and 
suppuration of the lymphatic glands : 
R Cod-liver oil, 16parts; yolk of egg or lard, 12 parts; liquid subace- 
tate of lead, 8 parts ; to be mixed together and made into a homogeneous 
ointment. Pledgets of lint are to be smeared with this, and applied to the 
ulcerations. 
In the case of scrofulous ophthalmia, especially Avhere there is inflannna- 
mation of the eyelid with photophobia, M. Brefeld recommends that the EYE. 
637 
free edges of the eyelids should be anointed with the pure cod-liver oil. 
M. Cunier has frequently had recourse to the external use of cod-liver oil 
in scrofulous ophthalmia, accompanied with great intolerance of light, with 
a profuse discharge of tears, and with swelling of the eyelids ; he combines 
it in this case with the alcoholic extract of belladonna of which he 
prescribes one part to two of the oil. Introduced between the eyelids by 
means of a pencil properly charged with it, the cod-liver oil acts benefi- 
cially in scrofulous ulcerations of the cornea, and hastens in a remarkable 
manner the absorption of opacities of that membrane. In the interciliary 
ulcerations, this oil is also very useful; M. Cunier employs it in such cases, 
in the form of the following ointment: 
R Oxid. hydrarg. rub. gr. iv., ol. jecor. aselli 5j., cerati Edin. (Cerat 
d’Edimbourg) Bij. 
This ointment is very useful in opacities of the cornea, following vascular 
pannus, in cellular pannus, atonic ulcerations, etc. Part 233. 
Strumous Ophthalmia.—In a series of reports of ophthalmic cases occur- 
ring at Guy’s Hospital, Mr. France relates that of a woman with strumous 
ophthalmia, the exciting cause of which had been suppression of the cata- 
menia from exposure to cold. There was opacity of both cornete, and 
intense photophobia, which failed to yield to the usual treatment of 
leeching, counter-irritation, alterative mercurials, purgatives and tonics. 
Belladonna collyrium was used with better effect; and the intolerance of 
light and other symptoms, were finally removed by the free application of 
nitrate of silver to the skin of the upper eyelids. Part xvi., p. 230. 
Etherization in Photophobia.—For the intolerance of light let the pa- 
tient inhale ether vapor. Ether inhalation will not cure, though it relieves, 
the intolerance of light; but may be used in children, to facilitate exami- 
nation of the eye, or the application of nitrate of silver, etc. For very 
young children pour half a drachm of ether into a basin containing a little 
lukewarm water, and hold it under the child’s face for a few seconds, a 
handkerchief or towel being thrown over the head to confine the vapor. 
Part xvi., p. 235. 
Tu'eatment of Scrofulous Ophthalmia.—[Dr. Edwards recommends M. 
Morand’s plan of treatment for scrofulous ophthalmia, which consists in 
the application of a strong solution of nitrate of silver to the nasal mucous 
membrane; there being generally a swollen and inflammatory state of this 
membrane in conjunction with the ophthalmia.] 
The caustic which M. Morand employed was the nitrate of silver, either 
in substance, or in solution, or ointment; it was applied for the first 
week night and morning; after this every day, and latterly every second or 
third day. He particularly advises that, after cauterization, a deep inspi- 
ration should be taken, so that the effects should be as extensive as possi- 
ble. Part xvii., p. 202. 
Ophthalmia— Granular.—Acetate of lead is a much more efficient and 
less painful remedy than nitrate of silver. Apply it uniformly over the 
surface of the eyelids by means of a fine hair-pencil moistened with water 
and then dipped in the impalpable powder of acetate of lead. 
Part xx., p. 183. 
Strumous Ophthalmia.—Use one part of Scheele’s acid with two of dis- 638 
EYE. 
tilled water. It may, in some instances, be used in a more concentrated 
form. A few drops to be applied to the eye night and morning. 
Part xxv., p, ‘252' 
Ophthalmia Tarsi—TTng. Picis.—Dr. Parish believing the obstinate 
disease ophthalmia tarsi to be analogous in its nature to tinea capitis, in 
which ung. picis proves of such great service, has resorted to it in the for- 
mer affection with almost undeviating success. It is carefully rubbed into 
the roots of the tarsi at bed-time, and washed away with castile soap and 
tepid water in the morning. Part xxv., p. 252. 
Ophthalmia, Strumous.—Smear the external surfaces of both eyelids 
over with the solid nitrate of silver, previously moistening the lids. Paint- 
ing the surfaces over with the tincture of iodine has also the same effect, 
and is perhaps more convenient. Part xxvii., p. 164. 
Remittent, or Strumous Ophthalmia.'—The primary cause of this dis- 
ease, Mr. Hancock believes to be in not adapting the food to the digestive 
powers of the child ; and a second to the close, stifling and unwholesome 
condition of the air in places where such patients are generally found. 
Remarking upon the treatment, he says: 
The objects to be desired in the treatment of remittent ophthalmia are, 
the relief of the organs of digestion, and the correction of the secretions, 
as when these two points are attained, the other symptoms will improve, 
and the eyes will share in the general change for the bettex*. To achieve 
these, however, a systematic plan must be adopted, embracing diet, cloth- 
ing, good nursing, as well as medicine, otherwise but little benefit will re- 
sxxlt. Abstract remedies, whether for the eyes alone, or the system gener- 
ally, are of but little use. As far as I have observed, medicine alone will 
scarcely ever effect a cure; diet alone will rarely do so, although I have 
seen children, who from improved air, and comfort, and light diet, have 
lost the intolerance of light without the aid of medicine at all; but these 
are very rare instances. 
Remittent ophthalmia may almost always be traced to a disordered state 
of the digestive organs—a want of digestive power, an incapacity of pro- 
perly assimilating the food. The liver becomes sluggish, irregular in its 
action, and frequently enlarged: the mesenteric glands are enlarged, the 
secretions vitiated, and the blood consequently becoming impure, the whole 
system is deranged. The child is pale, weak, and fractious, a torment to 
itself and every one about it; its appetite is lost, or very capricious, and it 
is said to be strumous, weak, and delicate: but this condition need not be- 
come peiTnanent if the case be judiciously treated; if it be not at the onset 
erroneously supposed to depend upon cachexia or debility, and treated ac- 
cording to that supposition. The debility is, in most cases, more apparent 
than real; it is commonly that of irritation or of oppression, rather than of 
actual weakness. Remove the cause and the debility will usually disap- 
pear pan' passu. 
[Mr. Hancock uses no local application ixi these cases, except where the 
cornea has given way and the iris protrudes—in which case he touches the 
part with caustic and applies the extract of belladonna round the eye.] 
The treatment should commence with an emetic of tartrate of antimony, 
given as advised by Mr. McKenzie—viz., in minute doses, at frequent inter- 
vals, until free vomiting is induced ; and this should be done in all cases, 
however attenuated or however stout the child may appear. It has fre- EYE. 
639 
quently been remarked to me, “ Surely you would not order that poor child 
an emetic, it is so attenuated and starved; its stomach requires filling rather 
than emptying.” My reply has always been, “ It may be true that the 
child has not much in its stomach, but what it has is evidently offensive 
and unwholesome, and consequently the sooner it is ejected the better.” 
What we desire is to relieve the stomach of its offensive contents, and to 
render its secretions more natural; to correct and restore the secretions of 
the kidneys, liver, and other glandular structures, and to influence the ca- 
pillary system generally, so as to improve the condition of the skin and 
mucous membrane, and to allay the morbid excitement of the nervous sys- 
tem. This is best done by the tartrate of antimony. 
I have not found anything like the same amount of good resulting from 
the sulphate of zinc, from the ipecacuanha powder, or even from the tar- 
trate of antimony itself, when the latter is given in a sufficiently large dose 
to cause vomiting at once. The following will be found a very convenient 
form : tartrate of antimony, four grains; sirup, half an ounce ; cinnamon 
water, three ounces; distilled water, eight ounces, as a mixture. Fora 
child under three years of age, two teaspoonfuls of this medicine should be 
given every ten minutes, until free vomiting is induced; above this age, a 
tablespoonful may be given at the same internals. It commonly requires 
four or five doses to produce the full effect—in some instances more, and 
in a few less. The treatment should be repeated daily until the intolerance 
of light begins to subside, which it will mostly do after the first or second 
day, although in some of the more obstinate cases four or even six days 
will elapse before the desired result is obtained. When, however, this takes 
place, the emetics should be discontinued, and a powder of calomel and 
rhubarb or mercury-with-chalk, with compound scammony powder given 
every night, or every alternate night, until the tongue becomes cleaner, 
the abdomen softer and flatter, and the alvine secretions more natural; and 
as this change takes place, improvement of the eyes commonly accompanies 
it, if attention be paid to the diet at the same time. When the attack has 
been complicated with eruption, aperients should be continued until such 
eruption has disappeared. 
When, however, the attack of ophthalmia has been preceded by measles, 
small-pox, scarlet fever, or any other depressing complaint of that nature, 
or if the child has been exposed to excessive want, is much attenuated, arid 
covered with a cold, clammy perspiration, the greatest caution should be 
observed in the administration of calomel, even in small doses, and as an 
aperient; and in no instance should more than one dose of this medicine 
be given without the patient being seen, as, should ptyalism take place, 
such extensive sloughing of the fauces, gums, and even the lips and cheeks 
will sometimes ensue, as to destroy the child in a very few days, if not 
hours. I was sent for, between three and four years ago, to see a child 
three years of age, who had been laboring under this form of ophthalmia, 
succeeding measles. The gentleman in attendance had sent six powders, 
each containing five grains of mercury-with-chalk, directing one to be given 
thrice daily. The child took four, when profuse salivation set in, with 
swelling of the tongue, lips, and cheeks. When I saw it on the following 
morning it was almost in a state of collapse; a gangrenous spot extended 
from the side of the mouth over the cheek; there was scarcely any pulse 
to be felt at the wrist, and the surface of the body was cold and clammy. 
The child died in a very few hours. 640 
EYE. 
In cases accompanied with extreme attenuation and cold clammy state 
of the skin, it is safer to abstain from calomel altogether, and to substitute 
the compound scammony powder with taraxacum and henbane. 
The same degree of caution is necessary in the use of tonic medicines in 
this disease as in remittent fever, and, from what I have observed, I believe 
they never should be given whilst photophobia exists, or in the common 
and ordinary forms of the complaint. It should be borne in mind that las- 
situde and weakness are not the causes of remittent ophthalmia any more 
than they are of remittent fever; they are consequent upon the causes pro- 
ducing the disease, and are just as much effects as the ophthalmia itself. 
If we overlook this fact, if we endeavor to build the patient up by tonics 
and strengthening diet, we defeat our object, we increase the lassitude and 
debility by oppressing the patients by our remedies, since the digestive 
organs have not the power of assimilating medicines of this description: if, 
on the other hand, we try to remove the oppression which is bearing the 
patient down ; if we coniine our attention to the improvement of the diges- 
tive functions and the correction of the secretions, we find that the symp- 
toms of lassitude and weakness gradually disappear, the morbid irritability 
of the nervous system and intolerance of light subside, and the child im- 
proves in health and spirits; after the tongue has become clean, the secre- 
tions more natural, and the intolerance of light has been subdued by eme- 
tics. In those extreme cases where sloughing of the cornea has set in, or 
where the complaint is accompanied with profuse perspiration, and the 
attacks assume the paroxysmal or intermittent character, quinine may be 
employed with advantage, but even under these circumstances its effects 
should be cautiously watched, and it is better to combine it with some 
gentle aperient. 
In those cases in which there appears to be a want of the due proportion 
of red globules in the blood, steel may be given when the urgent symptoms 
of ophthalmia have subsided, but not before. In exhibiting this medicine, 
I am guided principally by the appearance of the tongue, gums, and inside 
of the lips. When the tongue is tremulous, and with the gums and inside 
of the lips paler than natural, I have found steel useful, but not so when 
these parts present the opposite character. I do not consider mere pallor 
of the countenance as any criterion of the utility of this medicine. The 
preparation which I have found to agree best is the tincture of iron pre- 
pared by Mr. Boutell. The remedy upon which I place the greatest reli- 
ance to complete the cure is the hydriodate of potass in doses of from 
half to one or even two grains thrice daily, according to the age of the 
patient, and in combination with the tincture of iodine, as advised by 
Lugol. 
It should not, however, be employed until after the intolerance of light 
has yielded to the emetics and alteratives. Where the child is highly nerv- 
ous and excitable, henbane, in tincture or extract, thrice daily, in doses 
proportionate to the age of the individual, is very useful, but, like the 
hydriodate of potass, should always be preceded by emetics and alterative 
medicines. Like quinine, it requires watching, and Ave should carefully 
provide against torpor of the bowels, Avhich Avill sometimes ensue. 
Other cases occur in which the presence of Avonns in the alimentary 
canal keeps up the symptoms, Avhich will not yield to the usual treatment. 
A dose of turpentine and castor oil ansAvers extremely well under such 
circumstances, and this may be repeated if necessary. EYE. 
641 
Again, attention should be paid to the state of a child’s mouth and 
teeth. Intractable cases will frequently improve after the abstraction of a 
decayed tooth, or the lancing the tense inflamed gum over a tooth pushing 
its way through. In many instances the overcrowding of the teeth is the 
cause of much suffering, the jaw being too contracted to admit of their 
due and regular development. This is often very prejudicial to the 
ophthalmic symptoms, and is only overcome by the abstraction of one or 
more of the teeth, which, affording sufficient space to the remainder, 
removes the cause of irritation. 
[Mr. Hancock has no faith whatever in any form of counter-irritation, 
but strenuously urges the regulation of the diet, which should be of the 
plainest character. He states that severe relapses have returned after a 
hearty, solid meal.] Part xxviii., p. 250. 
Coniin as an Application in Scrofulous Intolerance of Light.— 
Mauthuer employed with great effect the following preparation in the non- 
inflammatory blepharospasm of scrofukms children : Coniin, gr. ss.; olei 
amygd. dulc., 5j. Mix, to form a thick fluid, with which the lids may be 
daily pencilled. In eight, or at most fourteen days, this troublesome con- 
dition ceases. Hard glandular swellings of the neck bear this remedy 
better than salves composed of iodine. Part xxx.,p. 184. 
Purulent Ophthalmia.—Give mercury at the onset just to touch the 
gums; when ulceration has set in it must be given more sparingly; the 
solution of nitrate of silver (eight grains to one ounce) must be applied 
every two, four, or six hours, according to the intensity of the inflamma- 
tion, etc. The weak solution of nitrate of silver is far more useful than a 
strong solution. When the inflammation runs high, leeches may be 
repeatedly applied as long as the preservation of sight is possible; or you 
may adopt Tyrell’s mode of scarification, though Mr. Dixon, of Moor- 
fields Hospital, entirely repudiates these radiating incisions of the 
conjunctiva. Throughout the course the eyes ought to be continually 
sluiced with warm poppy fomentations, containing one or two drachms of 
alum in the pint. Part xxxii., p. 198. 
Granular Conjunctiva.—Dr. Hobt. Hamilton and Mr. Benj. Bell, of 
Edinburgh, recommend very strongly, as a local application to the granu- 
lar surface, the solution of diacetate of lead; it should not contain any 
carbonate of lead, which is apt to be deposited from it on exposure to the 
air. It may be applied not oftener than once in two days by means of a 
camel-hair brush of moderate size. Part xxxiii., p. 214. 
Purulent Ophthalmia and Strumous Ophthalmia.—In what is so well 
known as strumous ophthalmia, quinine and iron given internally (more 
especially the former) are the chief remedies to rely on. In corneitis, 
iron is, perhaps, more valuable; and where the sclerotic is chiefly in- 
volved, cinchona and alkalies, and colchicum. In purulent ophthalmia, the 
plan recommended by Mr. France, with the exception of mercury, has not 
been much improved on; the depletory plan is not so good as the careful 
use of nitrate of silver. The sulphate of alum is an astringent in great 
favor with Mr. Haynes Walton. Mr. France uses it in decoction of 
poppies. Part 215. 
Pundent Ophthalmia.—The following lotion is almost specific in various 
forms of purulent ophthalmia and chronic conjunctivitis: R Cupri sul- 642 
EYE. 
phatis, gr. ij.; vini opii, 3j.; aquae dest., 5vij. Fiat lotio. It is applied 
freely with a soft camel-hair brush, three times a day. Part xxxv., p. 142. 
Ophthalmia—Purulent.—During the acute stage, you may, 1. Deplete 
locally by leeches. 2. Scarify the inner surface of the lids. 3. Divide 
the external canthus, or scarify the ocular conjunctiva in radii, if chemosis 
is high. 4. Apply nitrate of silver drops, the strength varying according 
to the severity of the symptoms. 5. Foment constantly with decoction 
of poppies, containing a little alum. 6. After the bowels have been well 
opened, for which purpose croton oil is the best, as being the most speedy 
purgative, exhibit mercury, which must be used guardedly if ulceration 
threaten the cornea. 7. Give quinine when debility prevails. 8. Mode- 
rately nutritious diet should be given, and progressively improved. In 
the convalescent or chronic stage, tonics with varied and mild local 
astringents and slight counter-irritation must be used to complete the 
cure. The above is the treatment adopted at Guy’s Hospital. 
Part xxxvi., p. 201. 
Inflammations of the Eye.—Except in catarrhal and purulent inflamma- 
tion the surgeons of the Moorfields Hospital strongly disapprove of the 
use of topical stimulants. In catarrhal and purulent inflammations, nitrate 
of silver drops are used of one grain to the ounce, though in purulent in- 
flammation, especially in infants, an alum lotion of eight grains to the 
ounce answers better. To remove lime from the eye a vinegar lotion is 
the most effectual; it should be very freely used. Part xxxvii.,p. 200. 
Strumous Ophthalmia.—When the intolerance of light is great, the 
bowels irritable, and the child very restless, a full opiate at night, with 
bark in the day, is often very quickly effectual. Battley’s liquor cinchona} 
is the best preparation for children. In cases of pustulo-strumous 
ophthalmia in children, chlorate of potash, as an alterative saline, is very 
useful. Part xxxvii., p. 266. 
Purulent Ophthalmia of Children.—The use of nitrate of silver, 
though undoubtedly quite sufficient to cure the disease, is attended with 
the disadvantage of causing great pain—so much so, that the mother, 
from mistaken tenderness, neglects to apply it. The use of chloride of 
zinc dissolved in- glycerine, five grains to half an ounce, and applied about 
three times a day with a camel-hair brush, is not open to this disadvantage. 
It may be dissolved by trituration in a glass mortar. Frequent ablutions 
should be used; and pure glycerine may be applied frequently to dilute 
the purulent discharge. Part xxxviii., p. 188. 
Ophthalmia Tarsi.—Wash the edges of the eyelids, carefully removing 
any adherent matter from the roots of the eyelashes and Meibomian aper- 
tures. Carefully evert the edge of each eyelid, and apply tinct. iodine by 
the aid of a tine camel-hair brush; and in the intervening periods 
frequently apply glycerine in the same way. Quinine and sulphuric acid 
should be administered internally. By this treatment many cases ordina- 
rily deemed incurable may be cured. Part xxxviii., p. 195. 
Chloride of Lime in Diseases attended with Contagious Discharge.— 
Dr. R. Hall uses the solution as follows: 
The eyelids are slowly and gently separated until the cornea can be 
VENEREAL DISEASE OF THE EYE. EYE. 
643 
seen, when that is manageable, and all secretion is wiped away with a fine 
soft sponge. A large bushy camel hair pencil, charged with the strong 
solution, is then insinuated beneath the upper eyelid and swept round the 
front of the eye; the pencil is again charged with the solution and applied 
to the everted lower lid. Unless plenty of fluid be thus applied, the ap- 
plication will be equally painful but less effectual. There is considerable 
pain, of a smarting, burning character, for half an hour or longer, and the 
already swollen eyelids become more tumid and prominent. This tume- 
faction is cedematous in character, the skin losing, in some measure, its 
peculiar redness, and becoming more transparent. In a few hours a 
serous discharge oozes out from between the eyelids, and the swelling par- 
tially subsides. This is followed by secretions of matter, but after two or 
three applications of the chloride, in perceptibly diminished quantity, the 
discharge gradually loses its characteristic yellow color, and is seen in 
flakes on opening the eyelids. After three or more applications, the eye- 
lids no longer swell as they did after the first, and the pain is much less. 
The eyes are kept clean with warm water, matter never being suffered to 
collect beneath the tipper lid; a little spermaceti ointment is smeared on 
the edges of the eyelids, and the strong solution is applied once in every 
twenty-four hours, until the secretion ceases to be in the least degree 
puriform. No other treatment whatever is necessary. Part xi., p. 186. 
Syphilitic Inflammation of the Eye.—In the treatment of syphilitic 
inflammation of the eye, mercury is the grand remedy; it not only acts as 
a specific in eradicating the disease of which the iritis, etc, is only a symp- 
tom, but as in ordinary ophthalmia, it prevents those morbid changes of 
structure which would injure or destroy the function of the organ. 
Ffteen years ago, Mr. Carmichael, of Dublin, called the attention of the 
profession to the use of turpentine in these cases, but, from the well- 
known effects of mercury in syphilitic diseases, and its consequent pecu- 
liar adaptation to cases of this kind, turpentine has scarcely had the trial 
it ought. 
Mr. Carmichael’s formula: R. Olei terebinth, rectificat. §j.; vitelli unius 
ovi simul, et adde gradatim, emulsionis amygd. giv.; sir. cort. aurant. 
§ij.; lav. c. 3hj.; ol. cinnam. gtt. tres vel quatuor. Misce, sumat coch- 
learia“rga duo ter in die. If the inflammation run high, cup or leech the 
temple. This remedy alone is frequently successful, but in obstinate cases, 
mercury is the sheet anchor. Part xiv., p. 261. 
Ophthalmia—Gonorrhoeal.—Apply solution of nitrate of silver, 3j. to 
§j. But if the patient is steady, use the solid nitrate; carry the pencil 
lightly over the lower, and then the upper lid, observing not to touch the 
cornea, and immediately inject water, to remove uncombined caustic. 
Repeat the cauterization, if required, in five or six hours. Excise or 
scarify chemosis after the caustic has been applied. 
Scrofulous.—Give sulphate of quinine, combined with alterative doses 
of calomel. Partxv.,p. 266. 
Treatment of Gonorrhoeal Ophthalmia.—M. Ricord’s treatment is as 
follows : The patient is to be kept quiet; the head should be raised, and 
the eyes completely secured from light; the diet very low. The first 
thing to be done is to rub the nitrate of silver over the affected surfaces, 
so as to produce a white film. After cauterization, the eyes should be 644 
EYE. 
sedulously washed with warm water. The patient should be watched 
after the first use of the nitrate; it will then be perceived that the secre- 
tion is momentarily suspended by it, but when the crust formed by the 
caustic falls oflf, the pus reappears, but is lighter in color, and sero-sangui- 
neous. So long as little white streaks, the result of cauterization, remain 
visible, and so long as the secretion is not again purulent, it maybe judged 
that the influence of the nitrate continues, but if the secretion has become 
again purulent, the cauterization may be repeated; indeed, it can be safely 
used three times a day. The eye must be repeatedly cleansed during the 
day, and poppy-head fomentations be constantly applied; poultices are to 
be eschewed, as they favor cedema. Mercurial frictions are injurious at 
this stage, not so at a later period. 
If there be chemosis, this state should, if possible, be removed, while 
it is merely the result of cedema; when it has become phlegmonous, the 
conjunctiva is so distended as to be with difficulty seized with the forceps. 
The excision should be preceded by cauterization, and is to be made with 
curved scissors and flat forceps. When chemosis has reached the phleg- 
monous state, it cannot be excised, and is to be scarified. If there be 
much febrile action, blood is to be taken from the arm. Leeches may be 
placed in the course of the jugular vein, or behind the ears. Mustard pedilu- 
via are to be avoided, as the essential oil is apt to irritate the eyes. Blisters 
on the nape are advisable on the decline of the disease. Part xvii., p. 198. 
Treatment of Purulent Ophthalmia of Infants by Douches. — M. 
Chassaignac has employed irrigation of the eye for the treatment of 
the ophthalmia of young infants with the greatest success; so that 
while formerly blindness at the Foundling Hospital was constantly 
occurring from this cause, it is now seldom so produced there. The child 
is laid on a table, and water allowed to flow from a small tap through a 
tube over the surface of the eye during from 5 to 15 minutes several times 
a day. M. Chassaignac has discovered that in this disease a pseudo-mem- 
brane is frequently produced, the removal of which much expedites the 
treatment. The mortality of children suffering from disease of the eyes 
during the last ten years, was 1 in 3 ; while this plan has been adopted, it 
has been but 1 in 8. In the course of investigation, this means wajffound 
applicable to several other inflammatory conditions of the eye, and also 
especially for the removal of opacities of the cornea, which resist ordinary 
means. Part xvii., p. 198. 
Gonorrhoeal Ophthalmia.—Make early free radiating incisions of the 
sclerotic portion of the conjunctiva, as when in a state of intense chemosis 
this portion is said to strangulate the vessels passing to the cornea, and 
thereby induce sudden sloughing and mortification. 
Occurring in children, apply a solution of chloride of zinc of the strength 
of one grain to the ounce. Part xxiii., p. 212. 
Purulent Ophthalmia in Infants.—If the inflammation is excessive, 
the conjunctiva may be scarified, and fomentations employed; but these 
are exceptional cases. The bowels may be opened in the first instance 
by the grey powder with rhubarb, and afterward by castor oil. Then the 
eye must be thoroughly cleansed from all purulent secretion by ablution, 
or by means of a syringe (a sponge should not be used for any other pur- 
pose, on account of the contagious character of the disease). The agglu- EYE. 
645 
tination of the palpebrse may be prevented by the application of some 
mild unirritating ointment smeared over the lids, as by the ung. cetacei, 
or ung. zinci. Then a lotion, containing a grain or a grain and a half of 
nitrate of silver to the ounce, may be used, two or three drops being in- 
troduced upon the conjunctiva three times daily, taking care to cleanse 
the eye first. When the complaint is subdued, and lest the eye should 
become discolored, -we may employ a lotion composed of sulphate of zinc 
two grains, wine of opium two drachms, rose water six drachms. If this 
does -not answer, an alum Avash may be substituted. If an ulcer should 
form, and an opening be effected into the interior chamber, a point of 
nitrate of silver should be introduced, and if the iris protrudes, belladonna 
should be applied. 
After all morbid discharge has ceased, the case has become chronic, and 
any ulcer which may have existed has closed, or shows a disposition to do 
so, the black wash, composed of seven grains of calomel to an ounce of 
lime water, is extremely useful, promoting cicatrization, and tending to 
disperse the hazy opacity which always surrounds a cicatrix. Some de- 
gree of opacity may result from the inflammation to which the cornea has 
been subjected, independently of ulceration; and in such cases likewise, in 
their chronic stage, the black wash is beneficial. 
If destruction of the entire cornea has taken place, it can be of no avail 
in restoring vision to apply nitrate of silver to the part, or belladonna to 
the brow; the treatment then becomes merely palliative, and the only re- 
maining object is to relieve the conjunctival inflammation and control the 
deformityrAvhich ensues. Part xxviii., p. 253. 
PTOSIS. 
Operation.—[Mr. Curling communicates the case of a gentleman whose 
eyelids “ hung loose and motionless over both eyes ” from paralysis. 
Finding the patient to have still complete power over the occipito-frontalis 
muscle, it struck him that by uniting the superior palpebra to that muscle, 
the patient might have some power over the lid. lie says:] 
I performed the following operation : The integuments between the 
eyebrow and lid, which were very abundant, wrere raised wTith the thumb 
and forefinger of my left hand, and those of an assistant, to such an extent 
that it was just possible for the patient to close the lids, when, by a single 
stroke of the scissors, the skin included between our fingers was removed, 
leaving an elliptical wound, which extended from a little below the eye- 
brow to about one-third of an inch from the margin of the lid and the 
whole width of the palpebra. Scarcely any bleeding ensued. The edges 
of the wound were approximated and retained by two sutures, and the 
part united by the first intention, and perfectly healed in eight days. Ho 
ectropium or deformity resulted. The patient, afterward, could completely 
close the lids, and, as was anticipated, could raise the superior one, and 
uncover the eye, simply by the action of the occipito-frontalis muscle. 
Part iii., p. 89. 
Hereditary Ptosis.—In the Gazette Medicale we have an extract from 
an Italian medical journal giving an account of a very extraordinary case 
of hereditary ptosis. The patient presented himself to M. Alessi, with 
chronic ophthalmia of the right side, when he observed that the upper 
eyelid of the left side was so relaxed as to cover about a third of the pupil. 646 
EYE. 
On questioning the patient, it was found that this affection was hereditary, 
his father having suffered from it, as well as his son and grandson; and to 
increase the singularity of the case, the deformity changed side with each 
generation. M. Alessi visited and examined the man’s son and grandson, 
and found them affected as had been described. lie attributes it, not to 
atony of the elevator muscle, or paralysis of the '7th pair, etc., but to a 
flattening of the supra ciliary ridge, especially toward the outer angle : so 
that the integuments, not being sujjported on the usual prominence, fall 
over the eye-ball. Part iv., p. 108. 
Ptosis.—After operations for ptosis, unite the edges of the wound toge- 
ther by means of collodion. Part xix., p. 318. 
Use of Tincture of Iodine.—Mr. Carr had directed a young man with 
ptosis of the right eyelid, apparently depending upon an atrophic condition 
of the levator muscle, to come to his house, for the application of nitric 
acid to the lid. When the man came, finding he had no nitric acid at the 
time, he applied some tincture of iodine to the lid simply as a placebo, 
directing him to come again next day. As this single application had 
caused slight contraction of the lid, Mr. Carr determined to continue ap- 
plication, which he did, and with the result of a perfect cure in a month. 
Part xxxviii., p. 193. 
STRABISMUS. 
Cure of Slighter Degrees of without Division of the Muscles.— 
Dr. Dieffenbach states that he has cured the slighter degrees of strabis- 
mus by snipping off a piece of the conjunctiva with the subjacent cel- 
lular tissue, near the insertion of the rectus muscle on the side from 
which the eye diverges. He states that a larger piece of the conjunctiva 
must be removed when the eye is turned outward than when it is turned 
inward, because, when the eye is turned inward, it is generally occasioned 
by the greater power of the internal rectus ; but when the eye is turned 
outward there is generally paralysis, or at least, a weak state of the rectus 
internus. Dart iv., p. 108. 
Cure of Squinting by the Use of Prismatic Spectacles.—This condition 
has been recently cured by the use of prismatic spectacles. Supposing the 
squint to be internal, for example, the prismatic glass is placed to the outer 
side of the eye, so that at length by the constant straining efforts of the 
eye, to obtain an accurate view, the eyeball is gradually drawn more into 
its natural position. As this natural state is more and more perfected, 
prisms should be used of gradually diminishing power. 
Part xxviii.,y>. 255. 
Squinting.—In this operation take care to know, and to tell the patient 
beforehand, whether one or two operations will be necessary. “ If you 
find the vision of both eyes good, but the degree of convergence consider- 
able, in all probability two operations will be necessary.” If with this con- 
vergence you have unequal visual power, one operation will generally be 
sufficient. Part xxxi.? p. 196. 
Strabismus.—This is rather relative than positive, therefore, before you 
operate, you must test the relative power of vision in the two eyes, and 
select that one for operation which is habitually inverted. 
Operation for.—Under the influence of chloroform, the muscle must be EYE. 
647 
divided sub-conjunctivally, in the following manner : Fix the eyelids open 
with a spring speculum, seize the conjunctiva and make a small opening 
through it and the sub-conjunctival fascia with a pair of blunt-pointed 
scissors, at the lower border of the internal rectus, so as clearly to expose 
the sclerotic ; then pass the strabismus blunt hook through the opening 
beneath the muscle, and divide the tendon by a succession of small cuts 
with the scissors between the hook and the insertion of the muscle into the 
sclerotic. If the tendon is broad you may make a counter opening at the 
upper border of the muscle, and divide in the same manner. The advan- 
tages of this plan are great; there is no inflammation, suppuration, or 
granulations ; the caruncle does not shrink into a deep fossa as is so com- 
mon, and eversion never occurs. 
EverHon after the Operation for.—Place the patient under chloroform, 
and expose the globe by means of the wire speculum, and with a pair of 
scissors carefully dissect off the parts covering the sclerotic on the inner 
part of the globe, commencing about two lines from the inner border of 
the cornea, and extending upward and downward, and then inward. You 
must now divide the external rectus, then draw the flap which has been 
raised firmly forward, and pass a very fine silk suture through it near the 
inner cornea; it must then be passed through the conjunctiva left near the 
cornea, by first separating it from the sclerotic toward the cornea, and 
passing the needle twice through it, so that it may not tear loose. Two or 
three sutures may be passed through in this way, but before you draw 
them tightly, cut away the superfluous part of the flap, then tie them. 
The immediate effect of this proceeding is some inversion, but the parts 
unite to the globe in their new position, and the eye becomes situated in 
the centre. Part xxxii., p. 208. 
Strabismus—Sub-conjunctival Operation— This was first practised by 
M. Guerin, in France. In 1843 it was repeated by Mr. Charles Brooke ; 
it afterward was neglected and condemned, until recently it has been 
again brought into notice. The operation may be thus performed: The 
eyelids must be kept apart with the spring speculum; draw the eye from 
its unnatural position, make a small incision with a probe-pointed pair of 
scissors down to the sclerotic, three or four lines internal to the cornea, 
and horizontal with its lower boi'der; through this aperture pass the knife 
beneath the muscle, turn its back to the sclerotic, and, with a gentle saw- 
ing motion, the muscle will be heard to give way. A particular knife will 
be required, with the blade bent at an angle with the handle, to facilitate 
its introduction. 
Which Eye to Operate upon.—In alternating squint, when both eyes 
appear to be affected, the comparative visual power of the two eyes is the 
only test that can be depended upon. We may lay it down as a law, the 
less the difference in the visual power of the two eyes, the greater the ten- 
dency of the squint to alternate, and, conversely, the greater the difference 
the less the tendency to shift. The rule of practice must, therefore, be to 
select that eye for operation, the visual power of w’hich is inferior to the 
other; but when the power of the two eyes is alike, it is immaterial wdiich 
you choose. Part xxxiv., p. 194.. 
Strabismus.—In performing the sub-conjunctival operation for the relief 
of this affection, two very important points are, to make the external 
incision small, and though vertical, completely below the lower margin of 648 
EYE. 
the muscle, and at the conclusion of the operation to apply one or two 
very fine sutures to the edges of the wound to secure accurate adaptation. 
The muscle is dragged to the wound by a blunt hook, and though more or 
less covered by conjunctiva, it can easily be divided by a pair of blunt- 
pointed scissors. Part 186. 
Strabismus— Which is the Affected Eye.—There is often the greatest 
uncertainty which is the eye to be operated on. To decide this question, 
place the patient in front of you, at the distance of two or three yards, and 
direct him to cover one eye, say the left, and look at you with the other, 
keeping the head straight; the right eye will be in the centre of the orbit. 
Then direct the patient to uncover the left. Now if the right, which has 
not been closed, is normal, it will keep its central position, while the left 
is turned inward; but if it be deformed it will turn in, while the left 
will become straight. The experiment should be reversed. 
Part xxxviii., p. 197. 
Divergent Strabismus.—Cases of divergent squint are much more diffi- 
cult to remedy than those of convergence. In obstinate cases of this kind, 
where division of the external rectus fails to effect a cure, Mr. Critchett 
adopts the practice of bringing forward the attachments of the internal 
rectus. The patient being under chloroform, with scissors and forceps, 
the conjunctiva of the inner side of the globe is divided at about a quarter 
of an inch distant from the corneal margin, for the length of three-fourths 
of an inch. Continue the dissection inward, dividing freely the internal 
rectus, and the adjacent fascia and cellular tissue. A considerable flap is 
thus separated, and through its entire thickness, half an inch from its free 
margin, sutures are now placed. Then cut away a curved portion of the 
free mai-gin, a third of an inch wide, and tie the sutures. About three 
sutures will suffice. This operation is not nearly so difficult to perform as 
it might appear. Part xxxviii., p. 198 
Strabismus.—The method of operating now followed in London is as 
follows : Make a horizontal incision in the conjunctiva, at a point corres- 
ponding to the inferior border of the tendon of the muscle to be cut, as 
near the cornea as possible, pass a blunt hook under it; then introduce 
the inferior blade of a blunt-pointed scissors as far as requisite, and divide 
the muscle by a succession of small cuts ; the wound may be closed with 
two silk ligatures. The disadvantage of this operation, though a great 
improvement on the older methods, is, that a large opening is required for 
the play of the scissors; this may be avoided by the use of a grooved blunt 
hook, the limb of which must be short and the curve a right angle ; by this 
the muscle may be drawn down to the opening, and a knife slid along the 
groove divides it. Thus, a very small wound is required, and it heals by 
the first intention. It is worth remembei’ing, that the greater the distor- 
tion the further from the insertion of the tendon should the muscle be di- 
vided and vice versa. Partxxxix., p. 257. 
Eccentric Strabismus.—In cases of recent strabismus, especially in young 
children and delicate women, it is well to bear in mind the influence of 
peripheral causes of irritation. A case recently occurred in the Royal 
London Opthalmic Hospital, in which the squint came on coincidently with 
the necrosis of the terminal phalanx of one finger, and was wholly cured 
by the removal of the dead bone. The most common peripheral source 
of irritation is worms. Part xxxix., p. 261. EYE. 
649 
MISCELLANEOUS. 
Surgical Use of the Magnet.—In the workshops of Fairbairne (in 
Belgium) there has been recently put up an artificial magnet of great 
power, at the level of the eye. Every instant one may see a turner, or 
an adjuster, or some other kind of workman, who has had a particle of 
iron driven into his eye, running to the magnet, which draws it out as soon 
as the eyelids are separated and the eye held near its pole. One may 
conceive from this how a magnet might be made of sufficient power to 
draw a piece of iron even from the flesh or from the bones. 
Part vi., p. 155. 
The Eye Fountain.—This will be found of great use by persons afflicted 
with weak or inflamed eyes; also after a long study. It is in shape like a 
small vase, attached to which is a small air-pump, the use of which is to 
propel, through a very fine jet, a continuous stream of water or lotion 
against the eyes. Part xxiv.,p. 251. 
Weak Eyes—.Use of Gelatine Paper.—Mr. Dobell has called the 
attention of the Royal Society to gelatine paper as a medium for 
coloring light, likely to be useful in many employments, and in cases of 
weak sight. This kind of paper, which was first invented at Rouen, in 
1829, is now produced in great perfection ; it is highly transparent, and 
in sheets measuring sixteen inches by twenty-two, but can be made, if 
required, of the'dimensions of the largest plate glass. These sheets, 
moistened with a solution of gelatine, may be stuck on the panes of a 
window, and thus change the light admitted to any required color. A 
green light, falling on the white silk made up by dressmakers, deprives it 
of all its painful glare ; and in the same way, yellow silk is made to appear 
green by a blue light, as has been proved by actual experiment, and 
it is attended with the happiest results. Jewellers who have tried the green 
paper, say, that when once accustomed to working in a colored light, they 
find it greatly relieves their eyes. In reading, too, a sheet of the green 
paper laid on the page preserves weak eyes from being injured by the 
strong contrast of black and white, and enables many to read with comfort 
who have been hitherto obliged by too susceptible vision to abstain from 
books. Other applications of gelatine paper naturally suggest themselves; 
it may be used as screens and shades for many purposes ; the glasses of 
spectacles may be coated with it; gardeners may use it in their conserva- 
tories ; and the yellow will probably be taken into their service by 
photographers. By the addition of a small quantity of acetate of alumina 
during the process of manufacture, the gelatine paper becomes watei-proof, 
just as linen or woollen cloth is rendered waterproof by the same chemical 
substance. Part xxxi., p. 235. 
Belladonna— Uses of.—In intolerance of light, a lotion made of half a 
drachm of the extract dissolved in eight ounces of water, and applied 
warm, will relieve a large proportion of cases. To dilate the pupil, for the 
purpose of exploring the interior of the eye, a drop of the solution of the 
sulphate of atropia, applied to the conjunctiva, will produce the effect in 
about ten minutes. At the commencement of scrofulous ophthalmia, one 
or two grains of the powdered leaves with two or three of the hydrarg. c. 
creta have generally a good effect. The tincture of belladonna, when 650 
EYE. 
given in ten-drop doses to adults, relieves neuralgic pains about the eye, 
and even the pain attendant on internal ophthalmia, in the most astonish- 
ing manner. Part xxxv.,p. 135. 
Sulphate of Atropna.—This salt is preferable to the pure alkaloid for 
therapeutical purposes, but the absorption of the solution, if strong (such as 
five grammes to the ounce of distilled water), must be guarded against. 
Its application is peculiarly soothing in painful inflammatory states of the 
eye, the intolerance of light and abundant lachrymation being much re- 
lieved. 
Belladonna.—When used to dilate the pupil, the extract gets hard and 
contracts, producing a disagreeable tightness; this may be avoided by 
mixing it with a little glycerine. Part xxxvi.p. 210. 
Atropine Drops.—The formula for the atropine drops in use at the 
Royal Ophthalmic Hospital is two grains of the sulphate of atropine to an 
ounce of distilled water. This solution is mainly employed for dilating 
the pupil, in order to allow of better examination of the state of the eye, 
and also prior to needle operations. At this hospital the pupil is never 
dilated before the performance of extractions. Dilatation of the pupil 
to its utmost possible extent is desirable before inspection with the 
ophthalmoscope. Attention to this hint will prevent disappointment, and 
the loss of much time to novices with the instrument. In the course of 
iritis, when it is deemed desirable to employ belladonna, the extract itself, 
rubbed up with warm water, and used as a fomentation, is preferable to 
atropine. It should be used as warm as can be borne. 
Part xxxvii., p. 188. 
Discoloration of Conjunctiva from Nitrate of Silver.—In those cases 
where the conjunctiva has become discolored from the prolonged use of 
nitrate of silver, try a solution of hyposulphite of soda (gr. x. to §j.) ; or 
solution of iodide of potassium (gr. viij. ad §j.) It should be applied by 
means of an eye-glass, so as to insure a prolonged contact with the con- 
junctiva, and should be continued for many months. 
Part xxxvii., p. 311. 
To Produce Dilatation.—Take atropine, five grains; lard, three drachms; 
otto of roses, one drop. Make into an ointment. A piece the size of a 
pea to be applied three times a day, until dilatation of the pupil is effected. 
Part xv., p. 61. 
To Believe Extreme Dilatation.—{Mydriasis.')—To relieve extreme 
dilatation of the pupil from belladonna, let a pinch or two of powdered 
ergot be taken like snuff. Part xviii., p. 250. 
Shortsightedness.—Induce a contraction of tliq iris by means of the 
extract of ginger, rubbing it over the whole forehead for five or ten 
minutes with the view of acting upon the fifth pair of nerves. The effect 
of this contraction is permanent. Part xxiii., p. 218. 
Ophthalmoscope—Improved.—This instrument enables us to throw a 
large quantity of light into the eye in such a way that the observer, 
without intercepting the rays which enter, may receive directly into his 651 
EYE. 
own eye those reflected from the retina of the explored organ. The in- 
strument is a small round concave miror, about two inches in diameter, 
with a focal distance of four and a half inches; the silvered surface being 
accurately adapted to a plate of blackened copper. The centre is perfo- 
rated by a small hole for the observer to look through. It is obvious that 
the observer, by having a light at the back of his patient (in a darkened 
room), can reflect it from his mirror into the eye, and by means of his 
little peep-hole he can distinctly observe the interior of the organ, the 
pupil being previously dilated by belladonna. This little instrument 
may be held in one hand, but Mr. Dixon adapts it to a spectacle frame 
so as to have both hands at liberty. Part xxx.,p. 179 
Gold as an Anaesthetic in Operations on the Eye.—Recommended by 
means of pounded ice put into a bladder, mixed with salt, and placed ovel 
the eye, temple, cheek, and brow, and kept there for about twenty 
minutes. Part xxx., p. 184. 
Use of Atropia.—A good way of applying this is the following, as it 
saves much time : Make a solution of gutta percha in chloroform. In this 
dissolve the required quantity of atropia, and paint the eyelid over with it 
by means of a brush. In a few minutes the effect will be seen on the pupil. 
Part xxxii., p. 313. 
Extirpation of the Ejye.—Divide the conjunctiva as close as possible 
round the margin of the cornea, then cut through the external rectus 
muscle close to the sclerotic, then the superior and inferior recti, and the 
obliqui; then draw the globe forward and divide the optic nerve, turn 
the globe out of the orbit, and complete the operation by dividing the in- 
ternal rectus. It is readily done, there is no hemorrhage, no local or con- 
stitutional disturbance, and the cure is speedy and complete. It may be 
performed, 1st, where there is extensive staphyloma of the globe, and in 
such cases it is afar milder operation than that of opening the globe. 2d, 
where a foreign body is suspected within the globe. 3d, where there is 
extensive adhesion between the globe and the lids. 4th, where there is 
frequently repeated acute inflammation, preventing the use of the other 
eye. 5th, wdiere there is deep-seated disease of the globe, threatening the 
loss of the other eye. Part xxxiii., p. 217. 
Sympathetic Inflammation of the Eyeball. — When an eye hitherto 
sound has become weak and inflamed through sympathy with the one 
which had been previously impaired, it can be rescued from destruc- 
tion in no other way than by getting rid speedily and conclusively of 
the abiding source of irritation. This can be effected in two ways: by 
cutting off the fore part of the eye, and evacuating the humors or by 
removing the inflamed eyeball completely, after division of all its muscles. 
Part xxxviii., p. 181. 
Excision of the Eyeball.—The following is briefly Mr. Dixon’s method 
of performing this operation: “The wire speculum having been intro- 
duced, the conjunctiva, elevated by dissecting forceps, is divided all around 
at the margin of the cornea with scissors curved on the flat and slightly 
rounded at their points. The tendon of external rectus and the adjacent 
areolar tissue are next seized in the forceps and snipped through. An 
assistant now fixes the globe and draws it forcibly inward by holding in 652 
EYE. 
forceps the insertion of the just divided muscle, and the superior rectus, 
the oblique and the inferior rectus are in order snipped through. The 
globe now starts forward, and the optic nerve having been easily reached 
and cut through, it is turned hind part before, and a few more touches 
suffice to divide the last remaining muscle, and to complete the opera- 
tion.” Part xxxviii., p. 184. 
Chloride of Zinc Collyrium.—At the Royal Ophthalmic Hospital 
(Moorfields) Mr. Critchett has some time been employing a lotion of 
chloride of zinc as an eyewater in cases of vascular and thickened con- 
junctiva. He holds that the disease is a sort of “gleet of the eye,” and 
analogous in nature to gleet of the urethra. The strength used is one 
grain to the ounce. Part xxxiii., p. 224. 
Lime in the Eye.—Apply, drop by drop, under the eyelids, a strong 
solution of sugar. It can always be obtained, and completely prevents 
the caustic action of the lime. Part xxxviii., p. 190. 
Ophthalmoscope.—This instrument has now the following uses. a. It will 
enable the merest tyro to pronounce positively as to the existence or non- 
existence of cataract—a feat which, in certain peculiar cases, used formerly 
to baffle the best-trained observers, b. It makes easily evident the very 
first beginnings of cataract at a period long before the opacity is discover- 
able by the unassisted eye. c. It reveals in cases of true glaucoma the 
existence of a cup-like depression of the optic entrance, a sign of the 
greatest importance as to showing a morbid degree of intraocular pres- 
sure, and indicating the necessity for iridectomy, d. It affords a clear 
demonstration of the physical cause of muse®, and sweeps aside the old 
notions about varicose vessels in the choroid, etc. e. In affording indis- 
putable proof of the dependence of many cases of what used to be classed 
as amaurosis or retinal apoplexy, or punctate extravasations of blood in 
the retina (a sort of purpura of the retina), it saves the surgeon 
from the risk of the serious error of prescribing mercurials and 
antiphlogistics to patients already suffering severely from humoral dys- 
crasia. f. In another class of cases it exhibits to the observer, in the 
clearest manner, the existence of limited effusions of lymph, in the deep 
structures of the eye, such effusions requiring for their removal immediate 
resort to mercurial treatment, g. In yet other cases, in which, with 
amaurotic symptoms of the most serious kind, the surgeon might have 
felt bound to attempt something even without a certain knowledge of 
their pathology, it will show the retina already detached and disor- 
ganized, and demonstrate the uselessness of treatment. 
Part xxxix., p. 237. 
Eight Plindness in Scurvy.—Night blindness in cases of scurvy, on 
board ship or elsewhere, is more frequent than is generally supposed. 
The affection appears simultaneously with scurvy, and disappears suddenly 
whenever a better diet is obtained, as fruit, fresh meat, and vegetables. 
It probably depends on an altered state of the retina, the scorbutic blood 
not nourishing, and blunting the nervous pulp. Part xl., p. 171. 
Weak Vision in the Aged.—In the case of aged persons whose sight is 
becoming enfeebled, and requires the aid of convex glasses, great advan- 
tage is derived, supposing no nervous lesion exists, from painting every EYELIDS, 
653 
evening the eyelids and brow with laudanum, and allowing this to remain 
all night. Part xL, p. 177. 
Erectile Tumors of the Eyelids—Treatment.—A little girl, fourteen 
years of age, had presented, since her birth, on the upper eyelid, an erec- 
tile tumor about the size of a grain of coffee. The tumor was of a livid 
red color, increased daily, and was excessively tense when the child cried. 
M. Carron du Villards inoculated the tumor and its circumference with 
vaccine virus, traversing it with a thread impregnated with the vaccine 
matter. On the fifth day, the symptoms of inoculation manifested them- 
selves. Five pustules appeared around the tumor, which itself became 
inflamed. On the tenth day it was covered by a black crust, which came 
off on the twentieth, leaving a healthy, rosy surface underneath. All 
traces of the erectile tumor had disappeared. 
A child, nine years of age, had borne since its infancy, an erectile tumor 
in the external angle of the eye. The tumor had never increased in size 
until the child was attacked with scarlatina. Its increase from that time 
was so rapid as to alarm the parents, who applied to M. Carron du 
Villards. Three entomological pins were fixed in the tumor, and their 
extremities having been bound together with a little silver wire, were 
exposed to the flame of a wax candle. The tumor became swollen, 
cracked, and then sank. On withdrawing the pins they brought away a 
portion of its parenchyma. Eight days afterward the child was cured. 
A young woman of Versailles had an erectile tumor, of the size of a 
pea, on the superior eyelid. After an attack of scarlatina, it became 
endowed with increased vitality, and appeared ready to burst every time 
she coughed. In six weeks it acquired the size of an olive. M. Carron 
du Villards having been then consulted by her family, determined to ope- 
rate by the coagulating method. The tumor was injected, by means of 
Anel’s syringe, with a stypic solution. It became black, and then faded. 
On the fourth day it was surrounded by an inflammatory circle, and 
covered by small phlyctenje. The fifth day a portion of it separated, and 
the rest dried up. On the eighth day the entire crust fell off, leaving 
underneath a rosy, new skin, similar to that of a cicatrised blister, without 
loss of substance or deformity. Part ix., p. 181. 
EYELIDS. 
Palpebral Tumors.—Do not touch until they are the size of a pea, and 
present a yellow elevation internally; then, everting the eyelid, open 
from the conjunctival side with a small sharp scalpel; press out the 
contents with a small spatula, and touch the sac with a probe coated with 
lunar caustic, and smear with oil afterward, to prevent irritation. If 
there is a fungous growth, remove with curved scissors. 
Part xv., p. 263. 
'Warty Excrescences of the Eyelids. — [Mr. Estlin considers these 
tumors to be diseased sebaceous glands, and regards the disease as infec- 
tious, though the common cuticular warts are not so. These “ soft warts ” 654 
EYELIDS, 
cannot be got rid of by lunar caustic—nor even by potassa fusa, unless it 
is very freely applied. Mr. Estlin says:] 
The most expeditious and least painful method is to slit them quite 
through with a lancet or cataract knife, passed perpendicularly to their 
bases, and then forcibly to squeeze the separated halves, with the thumb- 
nails placed on the sound skin, till the contents are fully turned out of 
their lodgment; the force required to do this will sometimes bruise the 
skin a little, but in two days the part is usually healed. The tumors, 
Avhen thus removed, are found to be lobulated, appearing like miniature 
brains. If they resist considerable pressure, the loosened portion may be 
taken hold of Avith forceps, and thus the Avhole extracted. This practice 
may be employed when the tumors have begun to inflame or suppurate. 
Smaller ones usually disappear without treatment; their chief annoyance 
arises from the inflammation they occasion in the eye and lids. Children 
are the chief subjects of the affection. Part xa'., p. 265. 
Tarsal Tumors.—Use a pair of forceps with one blade ending in a ring, 
and having a sereAV to fasten the blades together. Slip the ring portion 
beneath the lid so as to encircle the tumor, screw the blades together with 
the necessary degree of firmness, and evert the lid. Open the sac freely, 
and turn out the contents with a small silver spatula, or a Davielle’s scoop; 
then apply a fine probe coated with nitrate of silver over the anterior, 
smear the surface Avith a little oil, restore the portion of the lid, and take 
off the forceps. Part xvii., p. 297. 
Ncmus of the Eyelid cured by Platinum IFire heated Red-hot by Gal- 
vanism.—[In this case, a child 5£ months old was admitted an in-patient 
at the Bristol Eye Hospital, with ncevus of the upper eyelid of the right 
side; various remedies had been resorted to, but with no good effect. Mr. 
Bernard describes the operation as folloAvs:] 
Two pieces of thin platinum wire Avere passed at right angles to one 
another through the base of the nsevus, and heated red-hot, for the space 
of rather more than half a minute, by connecting them AArith a galvanic 
battery; the wire Avas then Avithdrawn, and cold-water dressing applied. 
Small superficial sloughs formed at the points Avhere the wire penetrated 
the skin, but healed in about three Aveeks. 
The tumor was much diminished in size, and I consider that, after a little 
time, the remains Avould have been obliterated; hoAve\Ter, as the SAvelling 
had increased on each side of the part of the lid which had been treated 
with the red-hot AA'ire, I proceeded to introduce four platinum Avires at 
right angles, heated as before, with results perfectly satisfactory, as the 
present appearance of the child is as folloAvs: Tumor quite obliterated; 
skin of eyelid rather less movable than the other side, and showing six 
small cicatrices, which, hoAvever, are not Ausible at the distance of tAvo 
yards. Part xxv., p. 252. 
Treatment of Tinea Tarsi.—First carefully remove all the scales and 
crust from the eyelid, then rub the solid nitrate of silver along the edge 
of the lid ; repeat this twice a Aveek. It is absolutely necessary that all 
deposit be cleared away, so as to alloAV the remedy to come in direct con- 
tact with the cuticle, the opening of the hair follicles, orilices of the Mei- 
bomian glands, etc. If the treatment be steadily persevered with, the EYELIDS, 
655 
redness subsides, the thickening of the lid is removed, and the hairs pre- 
viously destroyed grow again. 
The disease appears to be much more frequently secondary to measles 
than to any other affection, and its subjects are generally more or less 
cachectic. It often varies remarkably with the condition of the patient’s 
health. Tonics are, therefore, indicated, together with a liberal diet. 
Mr. Startin’s treatment consists in smearing the edge of the lid every 
night with a mild mercurial ointment (ammonio-chloride, 10 grains to the 
ounce), and administering an arsenical tonic in combination either with 
iodine or mercury. Part xxx., p. 184. 
Tarsal, or Meibomian Tumor.—This is an encysted growth, and, there' 
fore the cyst must be taken out, or injured by laceration, so that adhesive 
inflammation may follow. This has generally been done from the inside 
of the lid. Mr. Walton does it from the outside. He divides the cyst 
outside the lid, squeezes out the contents, and then, if possible, pulls away 
the cyst with a pair of forceps; or if he fail in this, he dissects it out. The 
external incision being made horizontally, there need be no fear of a scar. 
Part xxxi., p. 198. 
Ointment for Tinea Tarsi.—Almost the sole use for ointments in oph- 
thalmic practice is against tinea of the lids. For the treatment of this most 
troublesome disease, several formulae are contained in the Moorfields Phar- 
macopoeia, most of them having some form of mercurial as their active in- 
gredient. The dilute nitrate of mercury ointment is the one which enjoys 
by far the largest amount of confidence. Part xxxvii., p. 186. 
Tinea Ciliaris.—The old incrustations about the roots of the lashes 
should be removed by means of a pair of broad blunt forceps, meeting only 
at their extremities. The scab being seized close to the edge of the lid, 
must be gently detached and drawn a little forward, but not over the 
whole length of the lashes; these latter should be cut off close to their 
roots. Nitrate of silver should then be applied on the outer edge of the 
lids (avoiding the Meibomian orifices). The scabs cannot accumulate again 
when the lashes are kept short; the lashes themselves are preserved ; and 
any applications are more readily made. Part xxxvii.,p. 812. 
Eyelid—Restoration of.—The great secret of success in plastic opera 
tions about the eye, is to take a flap from the adjoining skin nearly twice 
as large as may seem to fit the wound made for its reception. The subse- 
quent contraction will then make a good fit. If hemorrhage comes on 
after the flap has been fitted, and you cannot stop it, lift up the flap again 
and apply the actual cautery to the vessel, then replace the flap and use 
wire sutures. Part 262. 
Cancerous Ulcer near the Inner Canthus.—An irregular, slowly-spread- 
ing cancerous ulcer close to the inner canthus of the eye was successfully 
extirpated by the sulphate of zinc paste, as recommended by Dr. Simpson. 
A few grains of the sulphate having been heated to drive off the water of 
crystallization, wrere powdered and made into a thick tenacious paste, by 
the aid of a little glycerine. A little of this was applied over the ulcer and 
its hard edges, and the whole covered with dry lint. The unhealthy sur- 656 
FEET. 
face and hard edges were destroyed, and the wound cicatrized. In these 
cases it is found by experience that extirpation by the knife does not an- 
swer, the scirrhous hardness and obstinate ulceration returning. 
Ncevus of the Eyelids.—The simplest plan of treating these is by draw- 
ing a little floss silk through them, steeped in perehloride of iron. The 
following inflammation will be slight. If this fails, severer remedies may 
be resorted to. Part xl., p. 161. 
FEET. 
Paralysis affecting the Feet.—[Mr. Braid gives several cases of talipes, 
arising from a paralytic state of certain muscles, instead of the more com- 
mon cause, viz., a too powerful or contracted state. For the cure of these 
cases, he excises a small portion of the particular tendons implicated in the 
disease, and by the consequent union of the divided ends, he produces 
such a degree of contraction in the paralytic limb as to act most favor- 
ably. The following case will more completely illustrate what we mean :] 
Miss , tet. six years, has been deprived of the use of the left leg by 
a paralytic stroke. Her present condition is this: the left leg is perfectly 
powerless, dangling by the side of her crutch, without reaching the ground, 
and is much colder than is natural; the foot assuming the appearance of a 
slight degree of varus, so that it would, if brought to the ground, rest on 
its outer edge, the toes inclined a little inward and the heel slightly ele- 
vated. I made a longitudinal incision along the course of the peroneus 
tertius, which I elevated, and excised a portion of it, to the extent of three- 
sixteenths of an inch. I then closed the wound with plaster, and applied 
splints and bandages, so as to approximate the divided ends and maintain 
them in contact. 
In twenty days she was enabled to walk about in a laced-up boot; and 
in a week more to throw her crutches aside entirely. She has continued 
well and strong ever since. Besides the operation, nothing else was done 
in this case, excepting the use of a stimulating liniment, which she had 
employed before without the least benefit. Part iii., p. 88. 
Fetid Perspiration from the Feet.—This will generally be relieved by 
washing the feet night and morning in salt and water, and afterward ap« 
plying a little olive oil. 
The best effect will be produced by bathing the feet every night in a 
strong solution of subcarbonate of soda. Part xxxiv., p. 341. 
Painful Affections of the Feet—Galvanism.—This most important 
agent is partly overlooked by the profession from an insufficient knowledge 
of its utility. It is very useful in cases of painful affections of the feet, the 
sequel of rheumatic inflammation, with diminished and unequal power of 
the muscles of the leg and foot, also decreased temperature and tume- 
faction of the cellular tissue, a condition not yielding to either general or 
local treatment. The current may be passed along the course of the limb. 
Part xxxvii., p. 207 FEET. 
657 
Flat Foot.—The tendons which require division in severe cases of flat 
foot are those of the peronei and the extensor communis digitorum. “ In 
congenital cases,” observes Mr, Tamplin, “ as far as my observation goes, 
the measure is invariably necessary, although the deformity may be slight, 
and the foot is easily brought into and held in position.” The moment the 
feet are released from the instrument, the deformity returns, even after a 
period of twelve to eighteen months. But subsequent division of the 
peronei and the common extensor of the toes is speedily followed by a cure 
of the deformity, and removal of all tendency to contraction. 
Part xxxviii., p. 145. 
Disease of the Tarsus—Conservative Operations.—According to Mr. 
Ericlison, disease of the tarsus, in the vast majority of cases, commences in 
the bones, and affects the articulations secondarily. If the os calcis is the 
primary seat of disease (and this bone is the most frequently affected of 
all), a T-shaped incision having been made, gouge away the diseased osse- 
ous structures. This may generally be done with success, for however ex- 
tensively the cancellous structure of the bone is involved, provided an ex- 
ternal sound shell exists, the removed bone in most cases will be replaced 
by fibroid tissue, which in time, to a great extent, ossifies. If the whole 
bone is involved, and the astragalus partially, the former must be entirely 
removed, and the latter gouged as far as necessary. Disease commencing 
in the astragalus, rarely long continues confined to it, and it is the result 
of experience that gouging operations, even if performed early, are rarely 
of much benefit; excision ought, as a rule, to be practised in preference. 
If the ankle-joint and calcaneum have become implicated, in addition to 
removal of the astragalus, the diseased parts must be gouged from the 
under surface of the malleolar arch and upper surface of the calcaneum, 
and the two brought together. A strong and even movable foot will 
result. When the scaphoid or cuneiform bones are primarily diseased 
(the middle of the three cuneiform is so most frequently), the great tarsal 
synovial membrane becomes implicated, and Chopart’s operation may be 
required, though sometimes partial removal, and gouging similar in princi- 
ple to the operations already mentioned, may suffice. The cuboid is sel- 
dom primarily diseased. Infants and very young children frequently re- 
cover from caries of the tarsal bones with abscess by proper constitutional 
and local treatment, so that operations on them should not be hastily per- 
formed. Part xl., p. 84. 
FEVER. 
Congestive Fever—Hemostasis.—If the means used by Dr. Buckler to 
arrest the flow of blood be found on further trial to act on the general 
system in the way he affirms, we shall certainly possess an important addi- 
tion to our remedial powers in many of the most dangerous and most 
rapidly fatal affections which we have to encounter. The object to be had 
in view in Dr. Buckler’s means of hemostasis, is to fill any particular limb, 
or even all the limbs, with blood, by arresting its course through the 
great veins and branches, and by this means depriving the trunk and the 
several vital organs of a considerable portion of their blood. This fluid, 
in short, is detained in the extremities by ligatures placed round them, and 658 
FEVER. 
the blood is thus arrested; the limbs become gorged, and the body con- 
tains considerably less blood than usual. This practice, if found suc- 
cessful (and it has been so in Dr. Buckler’s hands), will be valuable to 
prevent hemorrhage, to relieve inflammatory engorgement in parenchy- 
matous organs, or inflammations of membranous tissues, to remove simple 
vascular congestion, and to restore the balance of the circulation. The 
process consists simply in tying a bandage round a limb sufficiently tight 
to arrest the venous circulation, while the arteries are allowed to pulsate. 
The veins thus become swollen, and appear as if they would burst; all the 
blood they contain being thus as effectually withdrawn from the general 
circulation as if it had been drawn into a basin. If this be done on all 
the extremities at once, the skin becomes relaxed, and the pulsations of 
the heart and arteries weakened; and if the patient have previously been 
weakened by loss of blood, or by disease, so that the vessels shall be par- 
tially empty, we shall then find the skin to pour out the most abundant 
perspiration ; the patient complains of feeling light about the head, of 
sickness, and weakness; and we shall find the carotids pulsating feebly, 
and all the symptoms of syncope threatening. There are many cases in 
which it is very difficult to produce syncope, owing in some measure to 
the difficulty of the blood being extracted from the brain, from the cir- 
cumstance of the heart and lungs being so gorged, that the downward 
current from the brain is prevented; this would be obviated by detaining 
a portion of the blood in one or more extremities, until our object is ac- 
complished, when we could at pleasure allow the fluid to return to the 
general circulation. Then, again, there are cases in which syncope takes 
place from the slightest causes, and in which the horizontal position does 
not remedy the evil with sufficient rapidity, but by compressing the veins 
of the neck, and allowing the carotids at the same time to pulsate, we may 
rapidly relieve this state by detaining the blood in the cerebrum : and 
even when the patient remains in the upright position, this method will 
generally succeed without placing him horizontal. But the most import- 
ant object which this means will enable us to accomplish, is to relieve in- 
ternal organs of congestion, and to assist general or local blood-letting in 
the subduction of inflammation. In short, according to Dr. Buckler, 
“ hemostasis accomplishes what no other known remedy is capable of 
doing. It puts syncope under our control, both as to duration and 
degree. It is capable of exerting, under given conditions, a more power- 
ful control over the circulation than the lancet, antimony, or digitalis, and 
controls the heart’s action, without exhausting the vital forces, or giving 
rise to ill consequences, which the protracted use of most of the sedative 
agents is likely to do. And, finally, hemostasis in the hands of judicious 
practitioners, must prove a means of saving an incalculable amount of 
human blood.” Fart vii., p. 67. 
Treatment of Fever.—Dr. Cowan has taken pains to collect the expe- 
rience of others, as follows: 
A .surgeon in extensive practice has found the following powder very- 
advantageous in 140 cases of simple fever, continuing its use until the 
gums were slightly affected : 
R Nitrate of potash, four grains; tartrate of potash, a quarter of a 
grain; mercury with chalk, five grains. Mix. Repeated every four 
hours. FEVEB. 
659 
And in all fevers of a low type he was convinced of the benefit of the 
saline treatment. His formula was: 
R Chloride of soda, three drachms; carbonate of soda, two drachms; 
hydrochloric acid, half a drachm; camphor mixture, six ounces. Mix. 
Half an ounce every hour. 
He founded his experience upon notes of 120 cases. 
In reference to the use of mercury, Dr. Macartney says, “ In no single 
instance have I known mercury fail in arresting the progress of fever, 
provided it be not combined with visceral affections or characterized from 
the beginning with great prostration of strength.” 
Mr. R. Stevens asserts the value of mercury in all contagious diseases, 
and he has met with more than ordinary success since employing it in the 
treatment of fever. 
Dr. Elliotson, and many other writers, speak favorably of the mild use 
of mercury in this disease; and when the type was inflammatory it might, 
perhaps, be always judiciously prescribed. 
Mr. George Ross, of Enfield, strongly recommends the employment of 
ipecacaunha emetics, followed by fifteen to thirty grains of calomel, and an 
equal quantity of jalap, four hours afterward. This is repeated on the 
recurrence of exacerbation of the symptoms, which assume in almost 
every case a quartan type, two or three times, and neither excites exces- 
sive purging or any inconvenient constitutional disturbance. The quanti- 
ty of calomel necessary seldom exceeds a drachm; the effect is quickly 
beneficial, the convalescence rapid, and the duration of the complaint cur- 
tailed. He objects to repeated small doses of mercury, as more distress- 
ing to the patient, more likely to excite intestinal irritation, and much less 
successful in the result. He thinks well, though less favorably, of the 
saline treatment, and in intractable cases would administer the nitrate of 
potass in doses of ten to twenty grains three times a day. 
In the “Lancet ” for December 14, 1839, some interesting results on the 
use of salines are given by Dr. Jordan Lynch. He practised in the worst 
districts of London, and states that his successes, after employing the fol- 
lowing treatment, exceeded his most sanguine expectations. After 
premising an emetic, and a brisk purge of calomel and rhubarb, or jalap, 
he gave a solution of three drachms of common salt to the pint of water 
in the twenty-four hours, the patient drinking largely of cold spring 
water, adding to the mixture a drachm of muriatic acid as the symptoms 
improved, with effervescing soda powders till convalescence was complete, 
supporting the strength with beef tea and porter. The acid effectually 
checked the diarrhoea. Out of 97 cases not one died, and recovery, he 
says, took place in as many days as it required weeks on the ordinary plan. 
Dr. Copland, in his elaborate article, “Fever,” par. 596, says, “ The 
chloride of soda is a valuable medicine in all the typhoid forms of fever 
when judiciously prescribed ;” and Chomel, who gave it an extensive trial, 
states that it has proved more successful in low fevers than any other 
means, when pe/severingly employed. Drs. Graves and Stokes also think 
highly of it in petecchial fever. 
Dr. Wilson, of the Middlesex Hospital, adopted Dr. Stevens’ saline 
treatment, with great advantage, during the prevalence of petechial fever 
in 1837. The patients were all put into a warm bath and washed with 
soap, the head shaved, and cold applied if necessary. The following pow- 
der was given in water every four hours: 660 
FEVER 
R Carbonate of soda, half a drachm; chloride of sodium, one scruple; 
chlorate of potass, six grains. Mix. 
If this were refused, a drachm of the chlorate of potash in a quart of 
water was given for drink in the twenty-four hours. In some severe 
typhoid cases, where active treatment was inadmissible, in addition to 
wine and beef-tea, Dr. Graves gave carbonate of soda, one scruple; nitrate 
of potash, ten grains; every three hours, with great success.» 
Dr. Furnival, in his work on consumption and scrofula, says, “ In the 
middle or even later periods of typhus, I must bear testimony to the 
great efficacy of large doses of the sesquicarbonate of soda alone, every 
four hours, either in water or some tonic infusion. It is surprising how 
soon the tongue will clean and the collapse give way.” 
Dr. Bright speaks favorably of a similar plan, and the common efferves- 
cing draughts, prescribed as simple refrigerants, may be more actively 
useful than the prescriber suspects. 
Among the German writers there is extensive evidence in favor of the 
hydrochlorate of ammonia in putrid adynamic fevers, and a very general 
preference has been attached by writers of all classes to combinations in 
which chlorine plays a part. Indeed, the compound recommended by Dr. 
Stevens is probably resolved in the stomach into the muriates of soda and 
potash. The nitrate and chlorate of potass are also particularly deserving 
of trial. 
Dr. Paris states that in Westminster Hospital a drachm of the muriatic 
acid combined as a drink has been giVen for many years in typhus fever 
with evident advantage; and in the “Lancet” of 23d January, 1841, a 
very strong statement is made by Mr. Alqhuen, of the value of the oxy- 
muriatic acid, when freely administered under similar circumstances. 
Huxham, Fordyce, Frank, Hufeland, and many others, unite in the recom- 
mendation but both theory and practice preponderate as a general rule 
in favor of the preceding class. 
Dr. Buzorini thinks that ipecacuanha possesses a specific power of 
exciting the nervous system. It increases all the excretions, moderates 
the alvine discharges, diminishes restlessness and delirium. Dr. B. founds 
his opinion upon ten years’ experience, and advises its being given in 
infusion in the proportion of one or two scruples of the root to five or seven 
ounces of water. Dose, half an ounce every two, three, or four hours. In 
influenza, and fevers with bronchial complication, especially in children, it 
might prove a very useful and cheap practice. 
Frank’s celebrated fever powders consisted of tartar emetic, six grains, 
and bitartrate of potash, half an ounce, divided into six powders, and one 
given every hour. 
A provincial physician in extensive practice, and with keen observing 
powers, attributes great benefit to the following formula in all cases of 
severe febrile disturbances, eruptive or otherwise: 
$ Liquor of the acetate of ammonia, five ounces ; potassio-tartrate of 
antimony, six grains; sirup of poppies, or of ginger, one ounce ; tincture 
of opium, one drachm ; spiVit of nitric ether, six drachms. Mix. Half an 
ounce every one or'two hours. 
It excites vomiting, and then purges and sweats. 
Against headache in congestive fever, the formula of Raspail has been 
much vaunted: 
R Liquor ammonire, one ounce ; distilled water, nine ounces; chloride FEVEK. 
661 
of soda, five scruples; camphor, ten grains. Adding any agreeable 
scent. 
A piece of linen to be steeped and applied over the part, carefully pro- 
tecting the eyes by a thick bandage above the brows. The action is often 
rapid, the pain ceasing in fifteen to thirty minutes. It ought to be reap- 
plied at the commencement of the paroxysm, and is also very valuable in 
other local congestive conditions. M. R. thinks there is a peculiar 
chemical change excited in external applications depending on the nature 
of the local action. Before concluding, we would just allude to the use 
of belladonna for the relief of head symptoms with contracted pupil, as 
recommended by Dr. Graves, and to the good effects of emetic tartar and 
opium in cases of cerebral congestion, as stated by the same observer. 
Dr. Stokes’ excellent observations on the indications for the use of 
wine in fever, being founded on an examination of the heart rather than 
the pulse, are also of a truly valuable and practical character. 
Part viii., p. 20. 
Lobelia Inflata.—Dr. Livezey, speaking of the uses of lobelia, says: 
This brings me to the consideration of the lobelia inflata in febrile disor- 
ders, incident to every section of country, more or less, in summer and 
autumn. When it is desirable (as in fact it is always so) to lessen vascular 
action, and as a febrifuge, the “ nitrous powders ” sink into utter insignifi- 
cance in comparison with this plant, which is not liable to the same objec- 
tion as the tartarized antimony used in combination with calomel and the 
nitrate of potassa by many of the older practitioners, which too frequently 
increases that tenderness and erethism already existing in the mucous 
membrane of the stomach and intestines. 
In high vascular action, also, with cerebral disturbance, when the appli- 
cation of cups to the nape of the neck, etc., fails in restoring rationality to 
the sensorium, the most admirable results follow the administration of an 
enema, lai-gely composed of the lobelia; or when accompanied with ener- 
vation and subsultus tendinum, the efficacy of the enema will be much 
enhanced by the addition of a portion of pulv. valer. and tinct. capsicum 
or camphor, which, when thus combined, produces a powerfully revellent 
action, changes the scene of excitement, and leaves the cerebral functions 
free. Part xvi., p. 134. 
Transfusion of Blood.—In many cases of collapse occurring in fever, 
transfusion of blood might properly be used ; as in the exhaustion which 
occurs in a variety of Irish fever, the crisis of which is marked by 
excessive perspiration ; and also in a more advanced stage of the conva- 
lescence, when death is imminent from simple weakness. 
Part xx., p. 12V. 
Rheumatic Fever treated by Lemon-Juice.—In a case of rheumatic 
fever in Charing-Cross Hospital, half an ounce of lemon-juice, given three 
times a day, was found very successful in removing the pains in the joints, 
after various other remedies had been tried. Part xxii., p. 3 V. 
The Pulse in Fever.—A good mode of estimating the strength of the 
pulse in fever and other asthenic states, is to cause the patient to sit up in 
bed, and compare the condition of the pulse in this semi-erect posture with 
its state in the horizontal position. Part xxv., p. 26. 
Fever.—Fever in one sense is incurable, but, by proper management, it 662 
FEVER. 
cures itself. “We cure the patient by him from dying” 
during a certain j)eriod, and then the disease dies out; we keep him up 
by food, stimulants, and tonics. One of the most important doctrines of 
the day, is, that fever may produce local symptoms very like inflammation, 
but not really so; and if these local affections be treated on the antiphlo- 
gistic plan in cases of fever, it is probable that the results will be fatal. 
Therefore, in fever, although the patient be attacked apparently by inflam- 
mation of the brain, causing delirium, etc., don’t deplete, but steadily 
support the patient by food and small and repeated doses of brandy or 
wine, say a teaspoonful or tablespoonful every hour or two. The same 
principle must be remembered in affections of the lungs, heart, and 
digestive organs. All or some one of them may be attacked by apparent 
inflammation, but don’t deplete if you see typhus present. On the other 
hand, boldly give food and stimulants, till you see the brown tongue 
assuming a healthier aspect, notwithstanding the apparent inflammatory 
symptoms, as it is the rarest thing possible for real inflammation to co-exist 
with fever. Part xxix., p>- 17. 
Surgical Fever—Veratrum Viride.—The veratrum viride has been 
very extensively used in America, and its effects are thus described: 
The administration of a concentrated tincture reduces the pulse and keeps 
it reduced with a certainty, and to a degree, which can be effected by no 
other drug. Dr. Barker and others have published cases where they have 
thus brought down the febrile pulse in a few hours, from 140 beats to 80, 
60, or less in the minute, and kept it at will at this lower standard. It 
thus is a powerful arterial sedative ; but it has this further important action, 
that it is a powerful depurant, stimulating the action of the skin, kid- 
neys, and secretory functions generally. It thus may be substituted 
for colchicum in the treatment of acute gout and rheumatism; most 
probably it depends for its therapeutical effects upon the common prin- 
ciple of the genus veratrin, if so, we may fulfill the same therapeutic 
indications with the species which is in all our European pharmacopoeias, 
the veratrum album. Part xl., p. 98. 
Sleeplessness Puring Fever—Use of Tobacco.—The most important 
medicinal property of tobacco is the application of the moistened leaves to 
the bare scalp in severe cases of fever attended by pervigilium, and deli- 
rium. If it succeed in inducing sleep under these circumstances, it will 
be an invaluable remedy, for we know of no more deplorable condition, or 
one more fraught with danger, being the forerunner of collapse and death. 
We have been told of a curious and efficacious use of tobacco in America: 
the fact was not stated by a professional person, though by one of un- 
doubted veracity. A leaf of tobacco is often applied over the radial 
artery, or the pulse at the wrist. It seldom fails to produce free vomiting. 
Its powerful effects when applied to the whole surface of the scalp may be 
easily conceived. Part xii., p. 31. 
Fever.—Dr. W. Stokes says : 
A certain change has occurred in our opinions as to the origin of the 
so-called typhoid inflammation of the lung. We at one time held that it 
was the co-existence of gastritis or enteritis which gave to the pneumonia 
the typhoid character. This view was held by us before we had, by that 
imperceptible power of conviction which arises from experience, admitted 
the two following principles in their entirety: FEVER. 
663 
1st. That symptoms which are diagnostic of local disease, where the 
patient has not an essential fever, are either altogether valueless or much 
lessened in value when such a condition exists; and 
2nd. That the gastric or gastro-enteric lesion is rare even as a secondary 
disease in fever ; so that when irritation of the structures of the intestinal 
tubes occur it is a remote, tertiary, and accidental phenomenon. 
Our present opinion on this matter is in general the following: that in 
cases in which there are, in connection with the signs of typhoid lesion of 
the lung, evidences of gastro-intestinal disease, both the pulmonary and 
abdominal lesions spring from the one parent condition, and that so far 
from the specialties of the pulmonary being derived from the accidental 
complication with the abdominal disease, both have a common character 
originating in the same source. I am quite sure that a large proportion 
of these cases described as asthenic pneumonia depending on gastro-intes- 
tinal complication, have been examples of essential fever, with the two 
affections coexisting as secondary lesions. 
Recollect that the ordinary rules .of diagnosis lose much of their value 
in typhus fever. You may have all the signs of inflammation of any of 
the vital organs, without the slightest organic change. Even the physical 
signs of a pneumonia, when occurring in a case of typhus, are not to 
be taken as proof that a local inflammation has occurred. 
Part xxxii., p. 28. 
Low Fever.—The blood of low fever more nearly resembles that of 
scurvy and purpura than that of any other disease. There is the same 
excess of black blood discs, the same deficiency of neutral salts and 
organizable lymph. As in scurvy, so in low fever, great benefit will be 
derived from the use of acids—muriatic acid, being the least foreign to the 
system, should be preferred. Give this acid, diluted with water, freely to 
the patient, promoting the action of the skin by tepid sponging. We 
must not expect this or any other treatment to cut short the disease, only 
to promote and hasten a favorable termination. Part 17. 
ENTERIC, OR COMMON CONTINUED FEVER. 
In a commm uni cation on fever by Dr. Mettauer, we have the following: 
Another modification of the ipecacuanha pill employed by us, was the 
combination of two or three grains of the inspissated bile of the swine, 
with one grain of ipecac, and two of the carbonate of potass. It seemed 
to act with decided effect, as a supporting and secerning remedy, upon the 
mucous membrane of the stomach and intestines, and as a diaphoretic at 
the same time. It was especially valuable in those cases attended with 
a denuded and raw tongue; this organ always becoming more healthy 
after its administration. 
We were induced to' resort to it first in the low, depressing state of 
continued fever, with the design of acting especially on the gastrointesti- 
nal mucous membrane, which we believed became disorganized in such 
cases in a great measure from the want of the biliary influences; and in, 
these cases it always acted with decided benefit. It went to substitute the 
action of the bile." Simply heating the bile over a sand-bath until it be- 
comes dry and pulverizable, was our mode of preparing it. It is a valuable 664 
FEVER. 
agent in dyspepsia, and in many chronic affections attended with defective 
biliary secretion. In chlorosis, amenorrhoea, some forms of dysmenor- 
rhoea, and constipation, we have also employed it with decided advantage. 
Part viii., p. 71. 
Typhus and Enteric Fever.—Dr. Ritchie sums up his method of treat- 
ment as follows: 
The chief indication is to destroy the inflammatory action in the follicles 
of the intestines, and in the lungs, when it exists there, consistently with a 
due regard to the irritation of the cerebro-spinal axis, and the loss of 
fibrin and of red globules by the blood, which distinguish this disease 
from simple inflammation. This is to be done, 1st, by restoring the circu- 
lation and secretion of the skin by the warm bath, and a flannel under 
dress ; 2d, by detraction of blood by cupping or leeches from the abdomen 
or loins; 3d, by blisters, and afterward constant warm fomentations to the 
abdomen ; 4th, by the steady use of opium, united with ipecacuanha, borax, 
and chalk, with or without catechu, and in doses proportioned to the seve- 
rity of the diarrhoea, or, where this symptom resists these means, and the 
bronchitis is not acute, by the addition to the opium of acetate of lead ; 
5th, by a strictly farinaceous or milk diet; 6th, besides these modes of ful- 
filling the indication mentioned, it is necessary to support the strength, in 
advanced stages, to the extent that the bronchitis does not prevent, by 
the use of small quantities of wine. Pneumonia is to be met by mercurial 
friction externally, and by the hydrargyrum c. creta internally; and 
hemorrhage from the bowels, by super-acetate of lead, and renewed blis- 
ters to the abdomen ; or when the fever of pneumonia forbids the employ- 
ment of the acetate of lead, by the use of turpentine. Part xiv., p. 38. 
Cerebral Complication in Continued Fever.—When the cerebral affec- 
tion in the course of continued fever is attended by a quick and feeble 
pulse, great restlessness, total want of sleep, subsultus, and much disturb- 
ance of the nervous system generally, Dr. Graves’ plan of treatment is 
highly valuable. It consists in giving tartar emetic with opium, the for- 
mula being, tartar emetic, four grains; tincture of opium, half a drachm 
to a drachm; camphor mixture, eight ounces; half an ounce or an ounce 
to be given every two hours. Part xviii., p. 28. 
Simple Continued Fever of Children.—The simple continued fever of 
childhood Avas for a long time overlooked, and was then described as re- 
mittent fever, worm fever, or hectic fever, and was supposed to be de- 
pendent upon gastric or intestinal irritation. Dr. West considers that 
the affection so described is really identical with the continued fever of 
the adult. 
The heat of skin and the craving thirst are the two most urgent symp- 
toms in the early stages of the affection. The first of these is generally 
relieved by the tepid bath at 90° or 92° every morning, and by sponging 
the surface of the body several times a day with' luke-warm water. The 
desire for cold drink is often very urgent, and no beverage is half so grate- 
ful as cold water to the child. Of this it would, if permitted, take abun- 
dant draughts, but it should be explained to the attendants that the thirst 
is not more effectually relieved by them than by small quantities of fluid, 
while pain in the abdomen is very likely to be caused by the over-disten- 
tion of the stomach. The cup given to the child should therefore only FEVEE. 
665 
contain a dessert or teaspoonful of water in it, for it irritates the little 
patient to remove the vessel from its lips unemptied. 
During the first week the treatment is chiefly expectant, consisting in 
the use of light aliment; simple salines, such as the citrate of potash, with 
a little ipecacuanha wine if there is troublesome cough ; and a little castor 
oil if the bowels are confined. If there is a disposition to diarrhoea, give 
equal parts of Dover’s powder and hydrarg. c. creta once or twice a day. 
Ascertain every day whether there is abdominal pain and tenderness ; if 
it exists, and is not relieved by the application of linseed meal or bran 
poultices, the application of a few leeches may be needed. Local deple- 
tion may also be needed, for symptoms of cerebral disturbance, if there is 
great heat and flushing, and noisy delirium; as also if there is much moan- 
ing, restlessness, and headache. But if the delirium occurs only at night, 
and is of a tranquil kind, it will suffice to apply cold to the head, and to 
keep the apartment cool and quiet. 
In mild cases of the disease, that expectant treatment usually appropri- 
ate during its early stages may be continued throughout its course ; great 
caution being exercised as the child begins to improve, to prevent its 
committing any error in diet. When severe, however, the second week 
often brings with it a train of symptoms that require many modifications 
in the plan of treatment. The vital powers need to be supported, and the 
nervous system requires to be tranquillized ; and this is to be attempted 
by means similar to those which we should employ in the management of 
fever in the adult. The mere diluents which were given during the pre- 
vious course of the fever must now be exchanged for beef or veal tea or 
chicken broth, unless the existence of severe diarrhoea contra-indicate their 
administration. In that case, which, however, does not very often occur, 
we must substitute arrow-root, milk, and isinglass, for animal broths. In 
a large proportion of cases, nutritious food is all that will be required, but 
wine is sometimes as essential as in the fevers of the adult; and the indi- 
cations for giving it are much the same in patients of all ages. Even 
though wine be not necessary, I generally give some form of stimulant 
during the second and third weeks of the affection. The prescription 
which I usually follow is one much praised under such circumstances by 
Dr. Stieglitz, of St. Petersburg. For a child of five years old, it is four 
minims of dilute hydrochloric acid, eight of the compound spirit of sul- 
phuric ether, and three drachms of camphor mixture every six hours. It 
seldom disorders the bowels if they be not much disturbed at the time of 
commencing its administration ; while a small dose of Dover’s powder, as 
a grain or a grain and a half at bed-time, is doubly useful, both in check- 
ing tendency to diarrhoea and in procuring sleep for the child, who, with- 
out it, would probably be watchful and delirious all night long. So long 
as any severe abdominal symptoms are present, I abstain from the use of 
the acid mixture, but give the mercury and chalk, with Dover’s powder, 
every four or six hours, to which I occasionally add an opiate enema 
at bed-time; and support the strength by food and wine, as may be 
necessary. 
The only complication that is apt to be troublesome is the bronchitis. 
Usually, however, the cough to which this gives rise is rather an annoying 
than a dangerous symptom; and it is in general more harassing at the 
commencement of the affection, and again when convalescence is begin- 
ning, than during that time when the graver symptoms are present. A 666 
FEVER. 
little ipecacuanha wine, nitrous ether, and paregoric, will usually relieve 
it, to which it may occasionally be expedient to add the application of a 
mustard poultice to the chest. 
[In the treatment of the weakness which is left by the disease, Dr. West 
thinks that tonic medicines are unadvisable ; change of air, and especially 
removal to the sea-side, are not only safer, but are almost always success- 
ful.] Part xviii., p. 32. 
Treatment of the Diarrhoea and Dysentery of Fever.—In the diarrhoea 
and dysentery of fever, give oil of turpentine in doses of eight minims, in 
the form of emulsion, and if the case is tedious, change the form of exhi- 
bition, by giving Ohio turpentine in pills. In seme cases the administra- 
tion of mucilage and sedati\res, together with the application of leeches 
and blisters over the caecum, is useful, and so also is the application of 
mercurial ointment in the same region; but mercury, given internally, and 
the mineral astringents given either by the mouth or by enema, are inef- 
ficacious. Part xx., p. 23. 
Spotted Fever.—In the bloody diarrhoea of spotted fever, give two or 
three grain doses of gallic acid. Part xxii., p. 33G. 
INFANTILE GASTPJC FEVER. 
The origin of gastric fever occurring among children is usually to be 
ascribed either to unhealthy ingesta or depraved secretions. The pulv. 
sodse comp.* of Guy’s Pharmacopoeia, in doses of three to eight grains at 
night, and a full dose of the pulv. rhei salin.f every morning for a week or 
so, will in most cases be found very successful treatment. To the latter 
compound, so well known to the profession for its almost specific power 
in these affections, Dr. Fordyce accorded this elaborate praise: “ llad I 
been more ambitious of dying a rich man, than of living a useful mem- 
ber of society, the powers of our anti-hectic powder in curing, as if by 
miracle, the hectic fever and the swelled bellies of children in this town 
would have remained a secret while I lived.” Part Gl. 
Nitro-Muriatic Acid in the Gastric Fever of Children.—A remedy 
which is a favorite one Avith Dr. Arthur Farre, in his out-patients’ room at 
King’s College Hospital, in the treatment of gastric fever in young chil- 
dren, is the nitro-muriatic acid. To a child of a year and a half to four 
years old, a mixture containing a drachm of each of the diluted nitric and 
hydrochloric acids, to six ounces of water, is ordered, in doses of half an 
ounce, three times daily. At the same time, a dose of grey powder (four 
grains) is given every night at bed-time. If the disease be passing off, and 
tonics needed, the grey powder may be omitted, and the acids given in an 
infusion of quassia, or with bark. The peculiar tongue of infantile gastric 
fever is well known, resembling closely that of scarlet fever in the promi- 
nence of its papillae, but differing from it in having a white, instead of a red 
ground. Thus the papillae present in the midst of a whitish fur, but in 
some cases the centre of the tongue is red and beef-like, the sides only 
being furred. Part xxxvi,,p. 27. 
* Sodas carbonatis exsiccat®, 3 v.; hydrargvri chloridi, 3 i.; pulv. cretae composit, 
3 x. M. 
f Rhei radicis pulv., 3 i.; potass® sulphatis, 3 ij. M. FEVER. 
667 
NERVOUS FEVER. 
Use of Tartrate of Antimony xeith Opium in the Advanced Stages. 
—The use of tartar emetic in cases of fever, whenever there is un- 
doubted evidence of the determination of blood to the head, produc- 
ing head-ache, loss of sleep, and delirium, is too well known to require any 
notice in this place ; but its use, combined with opium, in the advanced 
stages of nervous fevers, is a much more modern practice, and we believe 
the credit of its tirst introduction into practice with this particular purpose 
is due to Dr. Graves, of Dublin, who, in his work on clinical medicine, 
gives a very interesting case, among others, in elucidation of his particular 
practice. It was that of Mr. Cookson, a medical pupil, who was attacked 
with fever, which seemed to be going on well for seven or eight days, 
when symptoms of a hysteric character showed themselves: and, it must 
be remembered, that in most cases of fever when such is the case, nervous 
symptoms of the most formidable character will generally come on. On 
the 14th day his tongue was black and parched, his belly tympanitic, and 
he had been raving for the last four days, not having slept an hour for four 
or five days and nights. Dr. Stokes saw the case. Besides other means, 
the cautious use of opium was resorted to, Dover’s powder, and opiate 
enemata; which, failing in procuring sleep, a full dose of black drop was 
given, with the conviction that if this tailed in procuring sleep, he would 
have no chance of life : next morning this was found to have failed; he had 
universal tremors, and subsultus tendinum, his eye was suffused and rest- 
less ; he had been lying for some days entirely on his back, his tongue was 
dry and black, his belly tympanitic, pulse 140, quick, and thready; his deli- 
rium was chieliy shown in short broken sentences, and in a subdued tone 
of voice ; and it was now eight days and nights since he had slept. Under 
these circumstances, Dr. Graves suggested a similar medicine to that which 
he found so successful in delirium tremens, viz., a combination of tartar 
emetic and laudanum, in the following form : R Ant. tartar, gr. iv.; tinct. 
opii, 5j.; mist, camphorse, gviij. A tablespoonful to be given every second 
hour. The success of this was magical, and the patient recovered rapidly. 
Of course, it would be well, in these cases, to proportion the antimony and 
laudanum to the degree of congestion and nervous symptoms. A certain 
amount of congestion might not contra-indicate the remedy, provided we 
increased the tartar emetic and diminished the laudanum; and where the 
nervous symptoms preponderated, we might reverse this, give more lauda- 
num and diminish the tartar emetic. Part vii., p. 10. 
Irritative Fever—Treatment of Constitutional Irritation, arising from 
Injury or External Diseases.— [It is quite correct, Mr. Cooper observes, 
to use topical depletion, sedation, and counter-irritation, at the same time 
as we give opium, bark, or stimuli. He remarks further:] 
Purgatives and sudorifics are other antiphlogistic means employed to 
allay constitutional excitement, and, I think, are generally best employed 
together, the object being to restore all the secretions which the irritative 
fever has had a tendency to suppress, and not to act merely on one parti- 
cular secretion ; for as the skin is dry, the bowels costive, the bile deficient, 
and the urine less abundant than natural, each of these organs requires the 
appropriate remedy to increase its natural action, and I know of no better 
medicine than that which Sir Astley Cooper for years prescribed under 
these circumstances: 668 
FEVER. 
R Ilydr. chloridi, gr. iij.; pulv. opii, gr. ss. m. ft. pil. statim sumenda. 
R Magnes. sulphatis, §j.; liq. ammon. acetat. 3j*; hq* antim. tart. 5j.; 
trae. hyoscyami, 5j.; aquae menthae virid. gvij.; M.capt. cochl.larg. ij. quaque 
4ta hora, donee alvus bene respondent. 
This remedy you will rarely find fail in restoring secretions and allaying 
constitutional irritation. Effervescing draughts will also be frequently 
found highly beneficial, particularly when there is any tendency to sick- 
ness, and antimony in that case should not be employed. Great attention 
should be paid to dietetic observances, and abstinence from animal food 
should be strictly enjoined, or, at any rate, nothing beyond weak beef-tea, 
or broth, should be permitted at the commencement of the excitement, and 
only under certain circumstances should it ever be allowed. Large quan- 
tities of diluents are also useful in maintaining the secretions. When in- 
flammation is attended with symptoms of a typhoid character, general anti- 
phlogistic means are inadmissible, as the patient is liable to become exces- 
sively reduced by any copious evacuation; yet at the same time, it is not 
to be considered that such patients, however depressed, will bear animal 
food; for while the skin is hot, the pulse quick, and the secretions sup- 
pressed, the bowels must still be gently acted on, and small doses of opium 
will be found beneficial after they have been sufficiently relieved ; but not 
until the pulse and temperature of the skin have been lowered, can animal 
food be safely permitted. Part xvi.,p. 307. 
INTERMITTENT FEVER. 
Hydrocyanoferrate of Quinina.—It is well known that the sulphate of 
quinina, as well as most other remedies, often fails in the treatment of 
intermittent fever. When this is the case it is well to remember that 
there is another remedy not hitherto much employed in this country, 
but especially used and recommended by Signor Bertozzi, of Cremona, and 
Dr. Zacarelli, who found it to succeed in those cases especially where 
the sulphate had failed. 
The hydrocyanoferrate of quinina, when in small fragments, is of a pea- 
green color ; its taste is intensely bitter; it dissolves in cold, but better in 
hot alcohol, and is precipitated almost entirely from the solution by water. 
In prescription, it would be an error to promote its solution in water by 
means of dilute sulphuric acid, as is done in the case of sulphate of quinina; 
the salt would be decomposed by this acid, and the solution would become 
blue. It ought not to be prescribed with tincture of cinchona, and con- 
sequently not with infusion or decoction. The dose, given by Doctor 
Zacarelli, was equal to three grains and a half troy, repeated according to 
necessity. 
Although this febrifuge is precipitated by water from its alcoholic solu- 
tions, it separates in the state of so fine a powder, and remains so long sus- 
pended, that it will answer for exhibition very well in this state. The fol- 
lowing formula will be found convenient: 
R Hydrocyanoferratis quininae grana quatuor, spiritus rectificati drach- 
mam, Solve. Adde Aquae, vel, 
Misturae Camphoratae drachmas septem. Misce, fiat haustus, ut res nata 
sit, phiala prius agitata, sumendus. 
In pills. FEVER, 
669 
P Hydrocyanoferratis quinime grana viginti-quatuor; mucilaginis gum- 
mi Arabici, q. s. fiat massa quam divide in pilulas duodecim. 
These pills will be of a proper size, and two of them will constitute a 
dose ; to be repeated according to the discretion of the prescriber. 
M. Donovan believes that the liquid form is preferable to the pilular, 
unless under peculiar circumstances. Part ii., p. 48. 
Piperine in Intermittent Fevers.—Dr. Iiartle recommends the use of 
pipeline in those cases of intermittent fever which have resisted the use of 
quinine. Dr. Hartle says: 
I began, as soon as the sweating stage was established, by giving three 
grains of pipeline every hour, until eighteen grains had been taken; and 
on the following day, when the intermission was complete, I gave the same 
quantity every three hours. It has in every case succeeded in checking 
the paroxysm, and as soon as that was accomplished, I gave for some days 
the following pills: 
R Pilulae hydrarg. gr. j.; piperinse, gr. ij.; sulph. quinae, gr. ij.; sirup, 
com. q. s. Fiat pil. No. 1. omni mane, meridie, et vespere capienda. 
Part 37. 
Large Doses of Quinia in Intermitting Fever.—Recommended by Dr. 
Flint. 
The general excitant effects of the quinia are said to be usually almost 
imperceptible. There are cases, however, in which it would be inadmis- 
sible, on account of the inflammatory state of the gastric mucous membrane, 
in which it would be well to administer the drug as an enema, as recom- 
mended by Dr. Elliotson. Part v., p. 65. 
Intermittent Fever—Pliloridrine.—Phloridrine is a medicine very highly 
spoken of by French practitioners as a useful adjunct to our cinchona pre- 
parations. It has been used for some years in Germany, Poland and 
France. It is extracted from the bark of the roots of the apple-tree and the 
wild cherry-tree, and is thus prepared: the bark of recent roots is boiled 
with water sufficient to cover them, for half an hour. This is poured off, 
and the same quantity is again used; these two fluids are mixed together, 
and at the end of six hours deposit the phloridrine in the form of a deep- 
red velvety-looking matter. 
M. Lebaudy, the editor of the “Journal des Connaissances Medico-Chi- 
rurgicales,” says, “ its efficacy is so decided that we cannot hesitate to 
class it with the most powerful febrifuges ; and it has this advantage over 
quinine, that it never induces gastralgia.” Part v., p. 87. 
Sulphate of Bebeerine.—The bebeeru bark of British Guiana has been 
brought into notice as a substitute for quinine, by Dr. Maclagan and Dr. 
Rodie, who consider it to possess antiperiodic powers of considerable value. 
They have given it with success in ague, and the more serious cases of in- 
termittent : 
The bark and seeds of the plant yield two alkaline bodies, to which Dr. 
Maclagan has applied the terms bebeerine and sisseerine, from the Indian 
and Dutch names of the tree. Dr. Rodie has found the sulphate of bebee- 
rine equally as successful as quinine itself, and, moreover, it is not attended 
with any irritation of the stomach, nor that alarming symptom of deafness 
and determination to the head, which so frequently follow large doses of 
quinine. The sulphate of bebeerine may be given in doses of ten or twelve 670 
FEYEK. 
grains during each intermission, and it will be found that from a scruple to 
half a drachm or a drachm will generally be sufficient for a common inter- 
mittent. Part viii., p. 04. 
Yellow Baric.—Mr. Battley lias for many years prepared a concentrated 
cold infusion of yellow bark, which he terms liquor cinchonce cordifolia, 
and which, from personal experience, we can recommend as an excellent 
medicine. There are probably few individuals more experienced in these 
matters than Mr. Battley, and his opinion is in a great measure correct 
when he says “ that the value of yellow bark has been too generally and 
too exclusively attributed to the quinine it contains ”—and he goes on to 
state, “ it lias ever been an object with me to preserve unbroken that natu- 
ral union by which several active principles are often combined in the 
same plantand from long experience he is convinced that no method of 
extracting the virtues of plants is equal to maceration in cold distilled water, 
which takes up from plants, with few exceptions, all their medicinal pro- 
perties. 
By this process he obtains, from twenty-eight pounds of good yellow 
bark, from five to six pounds of concentrated liquor, containing about ten 
ounces of quinine. It is only necessary to sub-pulverize bark and macerate 
it from four to six hours in twice its weight of cold distilled water, repeat- 
ing the process twice, or at most, thrice, and to concentrate the infusions 
over a water bath to sp. gr. 1200, and allow the liquor to deposit the 
gummy matter and so much of the tannin as it cannot retain in solution. 
Part viii., p. 44. 
Intermittent Fever.—If, says Dr. Williams, you see much of intermittent 
fever in malarious districts, you will find that there are a great many cases 
that are neither quotidian, tertian, nor quartan, nor do they belong to any 
type at all. There are irregular paroxysms occurring every now and then, 
in one case without any cause; in another, arising from an obvious cause. 
The malarious poison alone is often not enough to produce the fit; but 
some additional cause, such as exposure to cold, error in diet, or something 
else, disturbs the system, and brings about the fit. Thus ague will be- 
come developed as the result of an accident. A person falls down and 
sprains a joint, breaks a limb, or becomes bruised, and the seeds of ague 
which were in the system before, now manifest themselves. Those who see 
most of ague are more fully aware of this, than you would be if you took 
your account of intermittent fever only from what you read in books. 
Malarious influence certainly operates on the body by greatly disturbing 
the circulation. IIow it produces that effect it might be difficult to ex- 
plain, and we have not time to stop and investigate it ; but this is a fact, 
that it causes great internal congestion, and a corresponding amount of 
intro-pulsion of blood from the surface. The surface becomes pallid, 
exsanguineous, while the blood accumulates in the internal organs. This 
seems to be the immediate, the essential effect of malarious poison, and it 
occurs whether there be a fit of ague or not. A fit of ague is a reaction 
against this irregularity of circulation. 
The paroxysm of intermittent fever is a sort of struggle between the 
protective power of the system and the poison; and hence we can easily 
perceive why, ’when the paroxysm of ague is imperfect, the effects of the 
disease on the system are more severe, and why the body actually suffers FEVEE 
671 
more under these circumstances, than it does where the fit is complete and 
vigorous. 
The same observation is applicable to the case in which the cold fit is 
long, and the hot and sweating stages are short and imperfect. In these 
cases, although there is reaction, it does not overcome the disturbance of 
the system, which the malarious poison has produced, and therefore leaves 
it accumulating in it. 
The ascertained effect of malarious poison on the system is, to cause a 
great amount of congestion of the internal organs. Blood accumulates in 
them, and so long as it accumulates it does not circulate; it does not 
undergo these changes which we know to be necessary for its reparation, 
and its very existence in a state, of integrity. Blood, whether accumulated 
in a part, or circulating, is perpetually prone to chemical change. In the 
worst forms of intermittent fever, the effect is aggravated by the great 
intensity of malarious poison, which rapidly overcomes the vital powers of 
the system. What do we find in hot climates ? Intermittent fevers 
assume a malignant form ; they become typhoid nearly in their commence- 
ment—that is, accompanied by an enormous amount of congestion in the 
internal organs, and by a palpable change in the condition of the blood in 
them. The spleen, in the case of the Walcheren fever, was represented 
by writers as resembling a bag of tar, the blood being as black as pitch. 
A similar account is given of pernicious intermittents of Italy, in which the 
spleen is so gorged with blood that it sometimes becomes ruptured, and 
gives exit to a mass of corruption. The blood not only stagnates, but 
accumulates in an altered state, prone to decomposition. In this country, 
we have no causes operating in such intensity; the effects, therefore, fall 
short of this ; but even here the blood so accumulated must necessarily be 
disordered. Many facts seem to prove that wherever there is an accumu- 
lation of blood in an organ, that blood does not undergo the usual process of 
circulation and purification; there noxious matter is engendered ; the blood 
is, as it were, destroyed for the purpose of the economy; and if, under 
a change of circumstance, it is restored to the circulation, instead of being 
available for the circulation, it has to be removed as excrementitious mat- 
ter unfit for the body. This suggests to us that in the treatment of 
diseases arising from a malarious influence, we have not only to cure the 
paroxysms by anti-periodic medicines, as they are called—by tonics, which 
seem to operate by preventing or removing the internal congestions—but 
we have likewise, as a leading indication—an indication which prevails 
the more the longer the disease has lasted, and the more visceral 
disturbance it has produced—to promote the elimination of the injured 
blood from the system. A great deal of the blood is bad, and never can 
circulate again comfortably in the vessels of the system ; and to rid them 
of this effete matter, you must keep the drains free ; you must increase 
the excretions at the same time that you are giving anti-periodic 
medicines. Lastly, you are to attempt to fulfill a third indication—that 
is, to restore what has been lost, by promoting the formation of good 
blood, which is to be effected by general tonics, particularly iron and good 
living—nourishing diet—as much as the digestive organs can bear. 
Part xii31. 
Observations on Ague.—A sailor, 18 years of age, came under Dr, 
Chambers’ care at the Essex and Colchester Hospital, in November last, 672 
FEVER. 
affected with ague. The attack was of fifteen months’ standing, was a 
tertian, but now had become quartan ; he had been subjected to a variety 
of treatment, and said he could not bear quinine. Countenance anaemic ; 
pulse 60; bowels costive ; urine scanty; tongue furred; feet and ankles 
swell toward night; action of heart regular but labored ; a congested state 
of all the viscera. These were the leading symptoms when he applied at 
the hospital. He was ordered to be bled immediately, and ten grains of 
quinine in a draught. Calomel, ext. of colocynth, and ext. of hyoscyamus 
were given every other night—and small doses of quinine three times 
daily. This treatment was continued for three weeks, and he has never 
had an attack of ague since. Dr. Chambers makes the following observa- 
tions : 
There was congestion, and consequent inactivity, of all the excretory 
and secretory organs; the blood was increased in quantity, but deterior- 
ated in quality; there existed that state which Dr. Turnbull, in his 
lectures in the “Lancet,” alludes to as anaemic jfiethora. There was 
mental and physical depression, in consequence of the long duration of the 
disease and its resistance to treatment. It was evident, then, that relief 
to the congestion was of primary importance ; yet his feeble pulse, and 
his weak and pallid appearance, almost forbade having recourse to 
depletion ; however, all doubt as to its propriety was quickly removed on 
referring to the heart, from the labored action of which it was evident 
that the feebleness of the pulse was merely the feebleness of oppression. 
Accordingly he was bled to ten ounces, and took ten grains of quinine 
before he left the hospital, and in addition I directed him to take a glass 
of gin and water, as he had a long journey to go, and the day was cold. 
The quinine was continued for three weeks, and during the whole period 
it did not produce the least unpleasant effect. It is, then, I think, apparent 
from the result, that the obstinacy of the disease, and the disagreement of 
the quinine, arose from non-attention to the coexistent visceral congestion. 
Part xiii., p. 26. 
Quinine in Periodical Diseases.—It is the sedative influences of quinine 
which cures an intermittent—therefore give a single decided dose, grs. xv. 
-xx., eighteen hours before its operation is desired; this will probably 
suffice for a pure intermittent. In a more congestive form of fever give 
30 to 50 grs. When periodicity exists in a disease, give quinine, regardless 
of any existing inflammation. 
Dr. Holmes, army surgeon, speaking of the efficacy of this remedy in the 
management of the malarious diseases of Florida, says : 
I had an attack of congestive fever in December, 1841, a month after I 
came to the territory, with which I lingered for three weeks on the verge 
of the grave, at a distant post, and with no better medical assistance and 
advice than I could give myself. A stranger to the powers of quinine, I 
took it in grain doses, for a fever which I am in the habit of checking now 
in a day’s time, by drachms, instead of grains, of this great agent. The 
congestion was on the brain, the pain so intolerable that the slightest 
motion could scarcely be borne; the intolerance of light and sound 
perfectly tormenting to the senses ; the muscular system weak and lan- 
guid ; the eyes and cheeks cadaverous, and after a few days deeply sunken 
in. How often, subsequently, with all these symptoms at their height, have 
I given forty to fifty grains of quinine—have seen its effects on the brain, FEVEK, 
673 
aggravating for the time every symptom, or occasionally but slightly 
affecting the disease for some hours; and then, as the sedative effects 
came on, have beheld the patient drop into a composed sleep, his skin be- 
come moist and natural (no better diaphoretic than this agent, in many 
states of the system), and awake in six or eight hours, a man really free 
from disease ; this may appear all exaggerated to those who have never 
seen congestion, or its treatment in this manner, but to any one who has, 
I appeal whether this description is not unvarnished truth. 
Part xv., p. 30. 
Quinine in Miasmatic Fevers—Intermittent.—Give 15 or 20 grains of 
quinine at once. It may be given in any stage of the disease, and requires 
no previous treatment, except a brisk purgative of compound jalap powder 
when there is great torpor of the bowels. If there is diarrhoea and irritable 
stomach, combine with the quinine a little sulphate of morphia; if the skin 
is very dry, and the thirst urgent, add a little sp. seth. nit. 
Part 43. 
Treatment of Intermittent Fever by Tartar Fmetie.—Begin by purging 
freely with calomel and jalap, followed by senna and salts. Then, after 
the first paroxysm of the fever has clearly declared itself, give tartarized 
antimony in such doses as to prostrate the patient’s strength, and keep up 
its effects for some time during all stages of the fever, without producing 
any violent effects on the stomach or bowels. The dose required for this 
purpose, in an adult male, will usually be one-tenth of a grain repeated 
every hour; but the quantity must be changed, and the interval length- 
ened or shortened according to circumstances. In cases complicated with 
congestion or inflammation of the internal viscera, local and general bleed- 
ing must be employed to aid the effects of the antimony. And in pro- 
tracted cases, where the system appears to become habituated td the 
remedy, the tartar emetic should be discontinued, and twelve or fifteen 
ounces of blood quickly abstracted by cupping from the epigastric and 
hypochondriac regions; five grains each of calomel, and James’s or anti- 
monial powder should be given at bedtime, and compound jalap powder 
in the morning; and after the operation of the purgative, if a fresh par- 
oxysm of the fever distinctly declares itself, the tartar emetic should be 
resumed. Part xx., p. 21. 
Ague treated by Terebinthinate Liniment along the Spine.—M. Aran 
mentions that he has succeeded in staying ague fits by the use of the 
following liniment: essential oil of turpentine, three ounces and a half; 
chloroform, about one drachm. The patient wras a young man with 
whom quinine had failed, and the above liniment was used about two 
hours before the fit. The latter appeared at the usual hour, but was 
somewhat shorter than the preceding; the second was kept off for four 
hours; the third failed to appear altogether, and the patient was soon 
quite well, experiencing only for a few days a certain amount of discom- 
fort at the accustomed hour of the fits. Part xxvi., p. 26. 
Ague.—In cases of the quotidian type, small doses of strychnia, one- 
twenty-fifth to one-fiftieth of a grain, have proved very valuable in seve- 
ral cases of laborers who were much exposed at night; and this without 
the use of any other medicine, excepting a dose of calomel and opium, 
followed by a purge of compound jalap powder tc commence the treat- 
ment of the case. Part xxix., p. 54. 674 
FEVER. 
Intermittent Fever.—Give two ounces of the infusion of olive leaves 
three times a day ; made by macerating two ounces of the fresh leaves in 
a pint of water. Part xxxii., p. 31. 
Creasote in Intermittent Fever.—Zwetkoff was induced to make a trial 
of creasote in intermittent fever, (1) on account of its specific influence 
over the abdominal ganglia of nerves, especially the solar plexus, and (2) 
on account of its good effects in periodical vomiting. lie gave it in doses 
of from nine to fifteen drops, three times per day, in mucilage. 
Part xxxii., p. 33. 
Intermittents. — Vide Selections from Favorite Prescriptions, Art. 
“ Medicines.” 
Treatment of Ague by Iodide of Potassium.—In cases of long stand- 
ing, which resist the usual method of treatment, the following has been 
remarkably successful: $ Potass, iodid. 5iss.; aquas menth. pip. gxij. 
M. sum. §j. 4ta hora. Part xxxiii., p. 34. 
Intermittent Fevers—Febrifuge Properties of Apiol.—In the treatment 
of these diseases apiol possesses all the advantages of the arsenical com- 
pounds without their inconveniences. Though infei’ior to quinine when 
the object is to cut short a dangerous paroxysm, yet it may be adminis- 
tered with the same advantage in all cases where it is not of much impor- 
tance to put a stop to the paroxysms a day earlier or a day later, and is 
perfectly safe in administration. Part xxxv.,p. 22. 
Ague.—The injection of disulphate of quinine diminishes the quantity 
of uric acid in the urine. In ague there is a considerable increase of uric 
acid in the urine. It is possible that further observation on this point 
maf throw much light on the nature of this disease. 
Part xxxvi., p. 272. 
Ague.—In old inveterate cases of ague, which have resisted quinine, 
M. Barbaste recommends the trial of iodine. Give about ten drops of the 
tincture to a dose, three times a day, in a bitter infusion; in many cases 
the promptness of its results have been surprising. Dr. Manfredonia, of 
Naples, recommends it to be used as the iodide of quinine in doses of from 
one to two drachms per diem. Part xxxviii., p. 21. 
Ague.—Quinine not only acts specifically in curing ague when present, 
but prevents the disease attacking the healthy man when in malarious dis- 
tricts. For this effect, give four grains of quinine, either alone or in one 
ounce of wine, twice a day, while the patient is exposed to malarious 
poisons, and continue the medicine for fourteen days after he has left the 
district. This is necessary, as the poison sometimes lingers in the system, 
and does not show itself for that period. Part xxxix., p. 36. 
TYPHOID FEVER. 
Boudin, physician to the Military Hospital at Marseilles, treated 
fifty cases of typhoid fever (dothinenteritis), in most of which severe 
diarrhoea was the prominent feature, with the nitrate of silver, thus: 
When the lower portion of the intestinal tract was presumed to be the 
seat of ulceration, enemata, containing from one to three grains, dis- 
solved in distilled water, were administered. In most cases one enema FEVEK, 
675 
sufficed, the symptoms undergoing speedy amelioration. In other cases, 
the remedy was given by the mouth in half-grain doses every half-hour, 
formed into pills with gum tragacanth, or starch, until from two to four 
grains were thus taken. In some instances these two modes of treatment 
were combined; the results were, that only two of the fifty cases suc- 
cumbed. Part xvi., p. 156. 
To Distinguish Typhoid Rash from Flea-Rites.—In addition to the 
“ central punctum,” which has been described by Dr. Lalor as a useful 
diagnostic in determining whether the maculae were those of flea-bites or 
of fever, I have found that if the shirts of the patients presented the ap- 
pearance of blood dots, it was conclusive that the “ maculae ” were caused 
by fleas. The reason of this is obvious, and a knowledge of the fact has 
often determined the nature of the eruption where the puncta could not 
be found. Part xx., p. 24. 
Typhoid.—The great secret of success in administering support to pa- 
tients in this disease is to give a small quantity very frequently, and also 
not to give a variety of food. Give your stimulants early. The best are 
brandy or port wine, but give them separately; the stomach does not 
easily digest two kinds of stimulants. Give them also in small quantities 
and often. Chloric ether is a good medicinal stimulant. If the pulse 
strikes the finger in a “vacillating” manner, it is a good sign for stimu- 
lants. The strength of the heart’s action is also a good sign—the second 
sound especially is a good indication. If diarrhoea be present, we must 
check it by the use of such astringents as contain tannin, as the infusion or 
tincture of rhatany, catechu, matico, logwood, or enemata containing small 
quantities of laudanum. Counter-irritation is also useful. If there is 
hemorrhage, give five minims of turpentine, and repeat it every three 
or four hours. Apply it also externally to the abdomen. 
Part xxv., p. 30. 
Typhoid Fever.—Typhoid is known by its comparatively non-contagious 
nature, by the less development of cerebral symptoms, by the less depres- 
sion, by the scattered rose-colored rash not persistent, constantly renewed, 
disappearing temporarily on pressure, and by the existence of disease of 
Peyer’s glands, with diarrhoea. 
In typhoid fever the symptoms are by no means always so well-marked 
as in typhus, and indeed the early stages of this disease are recognized 
with difficulty, and the malady steals on in a most insidious manner. In 
other cases, however, the symptoms of fever are sufficiently evident: there 
are the hot head, the greater or less delirium, the thirst, the full and rapid 
pulse. In this fever there is less tendency to delirium than in typhus, the 
progress of the disease is not so rapid, the danger from collapse not so im- 
minent, the abdominal symptoms much more evident. In the early days 
of this disease, the same treatment may be adopted as is recommended in 
typhus; the constipation, which is often a marked symptom, is to be over- 
come by small doses of castor-oil, and a mixture may be given containing 
solution of acetate of ammonia and camphor mixture. It must be particularly 
remembered that, in this disease, there are inflammation and ulceration of 
Peyer’s glands, and that the external indications of this affection are to bo 
found in the rose-colored spots scattered over the chest and abdomen. Our 
attention must, therefore, be especially directed to the detection and re- 
pression of abdominal disease. The abdomen is often hot and painful on 676 
FEVEK. 
pressure, and there is sometimes obstinate constipation, and frequently 
diarrhoea; the latter symptom being often severe and generally very alarm- 
ing. In combating these abdominal symptoms, a cautious employment of 
depletion and the use of alteratives will generally be found of great service. 
Notwithstanding the danger of blood-letting, it will often be advantageous 
to apply some leeches over the abdomen, "when there are great heat and 
pain over that region; but it must be especially noted, that this measure 
is far better borne in private practice, or in establishments for the general 
treatment of disease, than in fever hospitals, where depletion is attended 
with danger. Besides the application of leeches, great comfort is afforded 
to the patient by placing a large warm poultice over the whole abdomen, 
and various forms of counter-irritation are often attended with beneficial 
effects, the principal of them being the use of blisters, or the acetum can- 
tharidis, and epithems of warm turpentine. The internal remedies to be 
employed, for the purpose of controlling the abdominal disease, are small 
and repeated doses of mercury; again adverting to the fact, that this 
mineral must be used with great caution, and is less available in hospital 
than in private practice. The administration of two or three grains of 
hydrargyrum c. creta, with as many of the pulvis ipecacuanhas compositus, 
every six hours, is a useful remedy for checking the inflammation of the 
intestinal glands and regulating the secretions. But it often happens that 
diarrhoea, which is a concomitant of this disease, sets in wdth great severity, 
and by its drain upon the system, threatens to carry away the patient. 
Under these circumstances, the chalk mixture will often be found effica- 
cious, and tincture of catechu or of kino, with a few drops of tincture of 
opium, may be added, or the pulvis kino compositus, or the pulvis cretaa 
compositus c. opio, may be given. But perhaps the most efficient remedy 
in this state of the disease is the acetate of lead, and it may either be given 
internally in grain doses, or (what is a very valuable mode of administra- 
tion) may be injected into the rectum as an enema, with solution of starch 
and some tincture of opium. By this proceeding, which is very frequently 
adopted at the Fever Hospital, the most serious cases of diarrhoea are 
often relieved, and the fives of the patients are saved. 
Part xxxiii., p. 20. 
Quinine in Bilious Typhoid.—Quinine is most useful in the bilious 
form of typhoid, when it displays a remittent character, or a tendency to 
relapse. It is also very valuable where the fever, although not very in- 
tense, is extremely prolonged, without any material change; it may then 
be given, in doses of three to five grains, three times a day. When given 
in large doses, it may produce cinchonism. In two cases, by Dr. Robert- 
son, it produced coma; in other cases it has been found to cause violent 
headache and increase the tendency to coma, and hence it calms the watch- 
fulness and delirium of fever. Part xxxiii., p. 22. 
Typhoid Fever.—In these cases, perhaps one of the most successful plans 
of treatment is the administration of wine and quinine. At first the qui- 
nine should be given in large doses of ten grains every two hours. This, 
in a case treated at St. George’s Hospital, caused a very striking change— 
the pulse came down, the skin became cool and moist, and the diarrhoea 
ceased. Should this effect ensue, the quinine should be given in smaller 
doses, as of two grains three times a day. Part xxxvii., p. 19. FEVER. 
677 
TYPHUS. 
Hydrioclate of Potass. — Dr. Morrison says: I think all parties 
will agree that derangement of the secreting and excreting functions 
takes place, as well as an alteration in the vital properties of the blood, in 
the course of every ordinary case of typhus fever. The dry, glazed, 
brown, or black tongue—the dark sordes about the lips and teeth—the 
foetid and dark-colored evacuations from the bowels and kidneys—the dry- 
ness of the surface of the body—together with the dark color, and 
deficient coagulating power of the blood, and the great liability to livid 
petecchise and vibices, etc., will, I think, fully prove that position. In fact, 
I want to make it appear, that at a certain period of every regular case 
of typhus, the body is laboring under a condition, which is probably best 
expressed by the word cachectic. Now, if this be conceded, it will, I 
have no doubt, greatly assist me in procuring for the hydriodate of potass 
a favorable introduction. 
Its effects are now very well known to be almost miraculous in many 
cachectic diseases; and I believe I might almost hazard the appellation of 
acute cachexy to low, idiopathic typhus. 
All the secretions seem greatly improved by it—the tongue is greatly 
and speedily improved by it—the whole frame seems to recover vigor 
from its use. Whether its primary action is on the blood, I will not ven- 
ture to say; but I cannot suppose that the benefit which is derived from 
its exhibition arises solely from its supplying saline particles to that 
fluid. 
The dose which I have been in the habit of administering is three 
grains every four or five hours, dissolved in a little water. Of course it 
may be given with wTine, camphor, etc. 
Dr. Stevens says that the blood is deficient in its saline ingredients, after 
a certain period has arrived, in cases of typhus fever; and that small and 
repeated doses of neutral salts are admirably calculated to remedy this 
deficiency, and by this means to cure the disease. 
[Dr. Stevens’ saline powder, composed of eight grains of chlorate of 
potass, twenty grains of muriate of soda, and thirty grains of bicarbonate 
of soda, will be found to produce somewhat similar effects to those' 
described by Dr. Morrison as resulting from hydriodate of potass. In 
those cases described as “ marked by a dry, parched, brown or black 
tongue—by dark sordes on the teeth and gums, etc.,” we have lately 
found the effects of Dr. Stevens’ saline treatment to be very surprising. 
In almost every case we have found the dark appearances in the mouth tc 
be altered in an incredibly short time. We have given the above dose to 
adults every two or three hours, in the middle and last stages of the dis- 
ease for some time ; and almost in every case the tongue, lips, etc., 
became moist and florid, and recovery rapidly followed; except where 
some other disease existed.] Part ii., p. 65. 
Diacetate of Lead.—A young gentleman laboring under typhus fever 
was attacked with diarrhoea and discharge of blood from the bowels, the 
diacetate in the full dose was administered, and both hemorrhage and 
diarrhoea were restrained after two doses. He recovered. Part v.,£>. 75. 
Typhus— Calomel and Cold Affusion.—Typhus is the typification of 678 
FEVER, 
disease of membranous tissues, beginning with the pituitous membranes; 
the serous and mucous linings of the large cavities; the mucous linings of 
the alimentary, gastric, and intestinal canals; the epithelium; and, above 
all, the skin—the extensive covering of the surface of the body: all being 
more or less implicated, directly or indirectly, in the progress of typhus. 
The great extent of membranous tissues, beyond all others, in the animal 
organization, their important and almost universal function, and their sin- 
gular sympathy in health, disorder, and disease, sufficiently explain the in- 
veteracy of the character of typhus. If it be assumed that the great 
mucous surfaces, intercluding the skin, so universally expanded over the 
external and internal parts of the animal structure, in and through which 
transpiration, exhalation, absorption, secretion, and sensation are so won- 
derfully performed, are the seats of disease in typhus, the remedial 
agency of calomel and cold affusion is not difficult of solution. 
When the disease advances, the vital powers become nearly subdued, 
and neither mild nor temporizing remedies will rouse the slumbering 
functions; an impulse must be speedily obtained, directly, through the 
vascular system, and indirectly, over the ganglionic and cerebral func- 
tions ; this is the best obtained by large doses of calomel, aided and suc- 
ceeded by cold affusion. 
Calomel, in large doses, acts proximately as a sedative, without losing 
any of its well-known valuable qualities as an alterative, upon the absor- 
bent and glandular structures. The first good it produces, is sound, calm, 
undisturbed sleep, to which the patient has been long a stranger, during 
which the ganglionic, absorbent, and glandular systems are silently 
invaded by its alterative agency; the intestines become filled with 
secretions, ready to be removed by any mild cathartic (e. g. small doses 
of neutral salts), exhibited periodically and regularly, to make them 
patent: the dose of calomel should be renewed every night (without any 
other medicine, only the neutral salts in solution, with infusion of senna 
and the mindererus’ spirit), and repeated till the functions approach their 
normal state. The cold affusions over the naked surface of the body are 
to be practised daily, by throwing over it, while in a sitting posture, a 
bucketful of cold water, during the acme of the febrile paroxysm. 
The breathing becomes more free, and the stertor, so frequently present, 
gradually subsides; the pulse, from having been oppressed and feeble, yet 
quick and wiry, becomes compressible, free, and bounding, increased in 
volume, and diminished in frequency; the. peculiar expression of counte- 
nance now collapsed, anxious, and cadaverous, with a cold, lead-like, lack- 
lustre expression, the eye injected, and the sardonic grin and incoherent 
mutter quivering on the lip, also subside; the subsultus tendinum and 
picking of the sheets also cease, and a profuse sweat pervades the surface, 
the skin becoming relaxed, soft, and elastic, and its temperature gradually 
restored to a uniform, healthful, and natural condition. Part xi., p. 91. 
Typhus—Treatment of.—Dr. Davidson gives the following summary : 
1. That as typhus is a disease which cannot be checked in limine, and 
is often tedious in its progress, causing great emaciation and exhaustion, 
we ought not, without very strong and special reasons, to employ any 
measures which may vitally lessen the powers of life, such as bleeding, 
vomiting, and excessive sweating or purging. 
2. The ordinary measures may be the following: Place the patient iu a FEVER. 
679 
large, well-ventilated apartment, on a mattress with few bed-clothes, let 
the head be shaved, and kej>t cool with an evaporating lotion, give a gen- 
tle purgative every second or third day, let the skin be bathed once or 
twice a day with tepid water, and this may be accompanied with small 
doses of tartrate of antimony, antimonial powder, or ipecacuanha. His 
drink should be light, cooling, and slightly diuretic, and his diet nutritivq, 
but light, and little liable to acescency. When there is a tendency to 
congestion in any organ, a little calomel or hydrargyrum c. creta may be 
combined with the purgative, or calomel, with a small portion of opium, 
may be given every six or eight hours. The application of two or three 
leeches to the temples or nostrils is often useful in congestion of the brain, 
and also when there is intense headache, which is often the forerunner of 
delirium. Blisters are also often advantageous in such cases. Derange- 
ments of particular functions, or symptoms arising from idiosyncrasy of 
constitution, sometimes occur, and must be treated accordingly. 
3. Mercury in small doses is frequently used in promoting several of the 
secretions, and in relieving the congestions of internal organs. 
4. Opium is injurious in a large proportion of cases, from its ten- 
dency to cause congestion of the head ; but when diarrhoea is a symp- 
tom, it ought to be administered with a view to check the exhausting 
evacuations. 
5. Wines and other alcoholic liquors, as they contain both stimulant and 
alimentary elements, are the most to be relied on for supporting the 
strength, and are the least injurious. The pulse, taken along with the 
general symptoms of exhaustion, ought to be the rule for its exhibition, 
both as to time and quantity. 
6. Ammonia, camphor, quinine, and other similar tonics, are not to be 
depended on in bad cases; and, when exhibited along with wine, frequently 
cause the patient to refuse both. 
7. When the disease is complicated with local affections in the head, 
chest, or abdomen, these must be treated on the same general principles 
as the idiopathic disease, which they represent; with this important modi- 
fication, that evacuations of all kinds must be employed more sparingly, 
and with much caution; and that even in these cases, if there be much 
prostration of strength and a very weak pulse, wine must be adminis- 
tered, although more moderately than in the simple disease. 
Fart xi., p. 93. 
Typhus Fever.—Let us, says Dr. Corrigan, as we stand at the bed-side 
of a patient in typhus fever, recollect that in looking at the extent of the 
maculae, or for the presence of petecchise, or in examining the distended 
vessels of the conjunctivae, we are looking not at a mere local derange- 
ment, but that we are studying in these external indications the state gen- 
erally of the circulatory system as a whole. In this view we can under- 
stand why we attach importance to the color of the maculae, why we look 
upon rose-colored maculae as a good sign, and dark-colored maculae as indi- 
cations of danger. 
The dark-colored maculae are indications of danger, because their color 
is owing, we know, to an enfeebled circulation. The feebler it is, the: 
darker will be the color of the maculae; while the more energetic is the- 
capillary circulation, the more vivid will be the color of the blood passing 
through it. In this view we can also find an explanation of the fact, that 680 
FEVER. 
a patient may have an intellect not disturbed, may have a cool skin, a 
clean tongue, a soft abdomen, a pulse not above VO or 80, with volition 
and sensibility perfect—and yet die of typhus fever in seven or eight 
days. Of what does the patient die in such a case ? He dies of this 
lesion of the function of circulation. In most cases this lesion is not the 
only one present, although often the most prominent; but I wish to fix 
attention on it, as it leads to a practical rule for the administration of one 
of our most important agents in the treatment of fever, viz., wine. You 
are too often bewildered in the directions as to its employment. You are 
told to beware of delirium in its administration, and yet, again, you read 
that delirium subsides under its use. You read instructions either to re- 
frain from its use when the tongue is dry, or to judge of the propriety of 
continuing its exhibition by its effects on the tongue. Instead of attempt- 
ing to reconcile all the contradictory statements, ask yourself what is it 
that, as you consider a patient’s state, would lead you to think of its em- 
ployment ? Is it not the state of the function of circulation, taken as a 
whole, indexed to you by the pulse, on the one hand, and by the state of 
the capillary system of circulation in the skin, on the other ? 
It is for this you give it. It is the specific remedy directed to remedy 
the general lesion of the function of circulation, and hence in its adminis- 
tration you may give it, and you must give it, whether there is or there 
is not delirium; for delirium may be present or absent in a case requiring 
its exhibition for the function of circulation. You should give it indiffer- 
ently, whether the tongue is moist or dry. You may give it with a soft 
abdomen, or with an abdomen tympanitic. You are giving wine, recol- 
lect, as the specific remedy for the lesion of the function of circulation 
(remember always comprising under this the capillary and cardiac circula- 
tion) ; and by the change in the circulation, and by this alone, are you to 
judge of the necessity of continuing, decreasing, or augmenting its dose. 
Under its exhibition, you will see the vessels of the conjunctiva contract, 
the maculae become rose-colored, and the patches of skin in the face, and 
on dependent portions of the body, lose their dark livid hue. 
In some cases, four to six ounces are enough for a few days, in continu- 
ance, to restore the circulation to sufficient tone; in other cases, it requires 
as much as one ounce of wine every hour, or 24 ounces in 24 hours; and 
even in addition to this, as much as eight ounces of brandy; and all this 
barely sufficient to preserve the circulation from sinking. 
We must never abandon a case of fever as long as there is life. We 
must remember that the patient one day, in a state seemingly moribund, 
may on the next day, or within twenty-four hours, be out of danger. It 
will not unfrequently happen, that even the power of swallowing is lost for 
several hours; but even then we can stimulate the circulating system by 
injections; and in some cases the preservation of life has been owing to 
ether, given in the form of injection every two hours, in quantities of two 
drachms, until, under its stimulating effect, the circulation gained some 
vigor, and the power of swallowing returned. 
With the same object of stimulating the capillary circulation, blisters 
are applied in succession over the surface. The nurse is supplied with four 
or six small blisters; one after another is applied, with intervals of six 
hours between them, over chest, abdomen, thighs, and legs. They are 
thus applied, not as counter-irritants, not to act as derivatives on internal 
structural disease, but as stimulants to excite the capillary system. An 681 
FEVEE. 
action produced in any part of it will be conveyed through the whole, 
and thus their action on the skin coincides with and assists the action 
of the internal stimulus of wine, ammonia, and brandy. 
Part xiii., p. 30. 
Nitrogen in Typhus Fever.—Mr. Grantham places great reliance on 
what he calls diluting the system of fever patients with nitrogenized mat- 
ters ; he has witnessed its beneficial effects. 
He proposes to dilute the system with nitrogenized matters, from the 
fact of ammonia or nitrogen being deficient in the system in typhus. 
After giving a full dose of castor oil, give 10 grains of carbonate of ammo- 
nia every six hours till the return of cerebral action, and then give aperi- 
ents and quinine. Good beef-tea, well seasoned with spices and salt. 
Plenty of water and diluents. Port wine when the pulse will bear it. 
Part xiii., p. 30. 
Typhus.—According to Dr. Richter, the great indication of treatment 
is to produce fibrin, i. e., to separate the nucleus (the true representative 
of fibrin) from the envelope of each blood corpuscle. By giving chlo- 
rine (muriatic acid) and ammonia, alternately, this is accomplished. The 
envelope is decomposed, the nucleus remains undissolved. 
Part xiii,,p. 32. 
Treatment of Typhus Fever.—[Dr. Corrigan proceeds to the analysis 
of this disease in reference to its several functional lesions, and commences 
with those of the cerebro-spinal system, or that system which connects 
man with surrounding objects. We find first the absence of sleep, which 
is essentially not a mere symptom, but a part of the disease; for if the 
patient do not obtain sleep, he must die; as in delirium tremens, in which 
death may occur solely for want of his natural rest, there being no organic 
disease to account for his death. If watchfulness continue for a few sue, 
cessive nights, delirium and subsequent coma are the invariable conse- 
quences, and these supervening, constitute a very serious aggravation of 
the disease.] 
Remember, as I have so often said, that insomnia is not a symptom but 
a part of the disease; and that if sleep be not procured, delirium, and 
then coma, and most probably death, in the end, must ensue. If we now 
pass from the consideration of light, air, etc., to the question of medical 
treatment, the first thing to be done will be to have the head shaved; 
and this of itself is generally sufficient; the application of intense cold is 
often a serious error; it very often obviates the object you have in view— 
that of procuring sleep. After this, if you ascertain that the patient has 
still had no sleep, you will not be doing wrong, I am sure, if you apply 
four or six leeches to the temples. This is a remedy upon which, for my 
own part, I place more reliance than almost any other. 
A state of general debility, requiring the exhibition of wine, need by 
no means prevent your employing this remedy; for while you give wine 
with a view to the tone of the heart, larger vessels and capillaries, you 
are perfectly justified in relieving the distended capillaries of the head by 
the local abstraction of a small quantity of blood; just as in some forms 
of ophthalmia, it is often the best practice to employ local bleeding to 
relieve the distended capillaries, and tonics to give them and the general 682 
FEVEK. 
circulation tone. You need have no fear of taking this small quantity of 
"blood from the capillaries, for they very soon .accommodate themselves to 
the trifling loss sustained : there is not the risk that might attend even so 
small an abstraction of blood, taken from a vein. 
The application of cold to the head is another useful means of obtaining 
the same object, but it is one which is too often carried to excess. A 
bladder containing pounded ice is placed on the head, but air is quickly 
disengaged, the ice lies heavily upon the top or back part of the head, 
and sometimes causes even sloughing of the integuments. Instead of ice, 
take a single fold of linen dipped in cold lotion; lay it on the head, and it 
will generally answer all purposes. 
All these matters may seem at first trifles, upon which I may appear to 
dwell unnecessarily; but if we recollect that this want of sleep is not a 
symptom, but part of fever, too much attention can hardly be paid to 
minute details. 
The question might suggest itself to you here, why, as opium is given 
in delirium tremens, and in such like diseases, why should it not also be 
administered here, where obtaining sleep is a matter of such paramount 
importance ? Why not give it for the lesion of the cerebro-spinal function 
which we are now considering ? Because, if opium be given in fever, and 
if it do not procure sleep, it does mischief of another kind. It will act 
injuriously upon the nutritive function, including that of secretion and 
excretion. In analyzing the disease before us, we may derive great assist- 
ance from comparing some of its lesions in function with symptoms in 
other diseases. For instance, in delirium tremens, while the tongue and 
gums secrete their natural quantity of mucus, and the secretion of urine 
is abundant, you may continue to give opium for the purpose of procuring 
sleep ; but suppose, in the course of the treatment, the tongue became 
dry and brown in the centre, the urine high-colored and scant}, and a 
slight wound or cut, if there happened to be one on any part of the body, 
become dry and everts its edges—in other words, as the nutritive function 
is passing into a deranged state, then the opium is acting as a poison 
upon the system, and the continuance of its administration would be fatal. 
The same considerations are to guide you in the exhibition of opium in 
fever. Iiyoscyamus, as it does not interfere with these functions, will be 
more advisable. 
At the approach of coma, you must not, unless there be strong vascular 
action about the head, persist in bleeding, but have recourse to blistering, 
as a means of rousing the patient from his state of torpor. I have been 
in the habit of having the blister cut into strips of an inch in width, laid 
across the head in a direction from ear to ear, so that no part is left 
uncovered, and that the strips lie close to the skin. Counter-irritation 
may also be produced in a few hours by means of croton oil and ung. 
liydr. mixed. There is a state of the breathing preceding the approach 
of coma, which you might confound with that of bronchitis, but in which 
the danger is very different; it becomes exceedingly rapid and labored, 
amounting to forty or fifty respirations in a minute, but the respiratory 
murmur is audible in the tubes; there is no mechanical obstruction in 
them; this is what is called cerebral respiration; while in that of the 
bronchitis or catarrh the tubes are filled with mucus, and a mechanical 
obstruction is thus offered to respiration, from which very few cases reco- 
ver. You observe, besides, the characteristic lividity of the countenance, FEVER. 
683 
while in the cerebral breathing the countenance is pale, natural, or high- 
colored. The cerebral breathing is a breathing of debility, very similar 
to that you hear in a person after very violent exercise. In the case of 
P- , the breathing was very rapid and laborious, but still the face was 
very pale. Here the debility was very great, requiring enormous 
quantities of wine, so much as thirty ounces of which were given in the 
day. 
There is one point upon which I cannot speak too strongly; I allude to 
the condition of the bladder. You should look with the strictest atten- 
tion to the state of this organ. The nurse may tell you the patient passes 
water freely—in tact, that it flows from him in the bed; but you are 
aware, from what occurs in the surgical wards in injuries of the head, that 
this is not to be trusted to ; at all events, make it a rule to examine 
closely, and there is no harm in the introduction of a catheter. In the 
female the bladder will distend to a volume capable of containing at least 
three quarts, while all the time the urine is dribbling away in the sheets. 
In speaking of leeching and other remedies, you observe that I have said 
nothing of what is to be done on this day or that of fever. Get the idea 
of days out of your head; fever is not like a case of peritonitis or pneu- 
monia, in which the stage of congestion and the stage of deposition of 
lymph, etc., are to be gone through in order. 
Mark well the crisis, as shown by the secretion of urate of ammonia, or 
urea, or by long sleep and perspiration; where the latter is too 
about the sixteenth or seventeenth day, there is much risk. In common 
inflammatory fever, it is advantageous about the second or third day, but 
in typhus it depresses the system to extreme exhaustion. 
It is very hard to say why it is so, but you must by all means avoid 
anything that would encourage perspiration. Part xiv., p. 25. 
Harrhoea Succeeding Typhus.—After the fever has abated, the diar- 
rhoea sometimes continues, and the patient gets no strength. Now, in 
such cases, small doses of sulphate of quinine, with the sixth of a grain of 
sulphate of copper, dissolved in any suitable vehicle, to which a few 
minims of dilute sulphuric acid has been added, plain water—aqua fontis 
is the best—may be given with advantage. If the stomach will bear the 
remedy, it will act well. Acetate of lead, combined with opium or ace- 
tate of morphia, in pills made up with breadcrumb, is also a useful sedative 
in these cases of chronic diarrhoea; these remedies may also be used in 
the form of an enema. Part xiv., p. 32. 
Use of Preparations of Iron in Fever.—Iron in fever may be given in 
form of mist, ferri c., made with the sesquicarbonate of ammonia instead 
of carbonate of potash, in cases of urgent debility, as soon as gastric dis- 
turbance will admit, and where an adynamic condition of constitution and 
sinking of the vital power is threatened, which is evinced by a dull or 
dusky color of the eruption, and a cool state of skin. The iron may also 
be combined with valerian. If coma supervene, turpentine internally, 
or by enema, as recommended by Dr. Copland, is valuable. Symptoms 
of inflammatory fever contra-indicate the use of iron. Part xiv., p. 40. 
Warm Hydropathic Treatment.—We have tried this method lately 
with considerable satisfaction in cases where the skin was hot and dry, and 684 
FEVEE. 
perspiration was required; particularly in children. The following has 
been our simple apparatus: the flannel petticoat of the mother dipped in 
warm water, and, after being squeezed pretty well, put over the whole 
surface of the child, and tied gently under the chin ; over this moist warm 
flannel wrap two, three, or four blankets, so as to prevent evaporation, or 
envelope the patient in oil silk; in about half an hour or an hour, the skin 
will be in a profuse perspiration, and the moist flannel may then be taken 
off and the surface kept warm with the dry blankets. We merely throw 
out this hint respecting the warm hydropathic treatment for the considera- 
tion of our readers, and have no doubt that it will be improved. It is in 
reality enveloping the body in a poultice made more completely than by 
the ordinary cold water system, and is much more grateful to the feelings 
of the patient. Part xv., p. 34. 
Senna with Matico, in Hemorrhage from the Bowels.—Dr. Watmough 
has used matico in cases of hemorrhage, but was much pleased about three 
months ago, with the benefit obtained from combining it with senna, in a 
case of typhus fever, where hemorrhage from the bowels took place. 
Having previously attended to the state of the liver, etc., he immediately 
ordered matico and foliorum sennas, utrq. dr. ij., to be infused in a pint of 
boiling water, and a wineglassful to be taken frequently. Scybala mingled 
with blood soon passed the intestines, after which less blood flowed, and 
by continuing the above mixture in similar doses at various intervals for 
three or four days, during which time the alvine evacuations gradually 
improved, the patient soon got rid of this troublesome symptom. 
Part xv., p. 120. 
Typhus Fever—Complications.—Where a person who has asthma or 
chronic bronchitis gets typhus fever, the symptoms become extremely ur- 
gent, the countenance assumes a livid hue, the pulse becomes very quick, 
small and compressible, the patient appears in danger of being suffocated. 
The blood not being properly oxygenized in the lungs, the carbon exercises 
a poisonous influence on the whole system. In addition to the general 
treatment recommended, blister after blister must be applied to the chest, 
until the crisis is over. It is here, also, punch must be freely permitted, 
and that camphor and ammonia, combined with anodynes, will be given 
with good effect. The patient should, if possible, be mercurialized. When 
diarrhoea sets in toward the thirteenth or fifteenth day, it should not be 
interfered with ; but when it is a complication in the commencement, the 
application of hot poultices to the abdomen, or in some instances the appli- 
cation of a blister will be found to answer, together with a liberal allow- 
ance of port wine, negus, and a small anodyne draught at night. When 
the liver is engaged, and the patient is jaundiced, blue pill will be required 
to be administered, and afterward the application of a blister to the hepatic 
region, which should be dressed with mercurial ointment until the gums 
are touched. A disagreeable and troublesome sequel often occurs after 
this complication; the patient will complain of want of sleep and acute 
pains in the joints. Dover’s powder, given at night, and colchicum 
draughts during the day, will soon remove the evil. It is not uncommon, 
after a severe attack of fever, for the patient to get oedema of the lower 
extremities; this is to be removed by putting the patient on a generous 
diet and administering diuretics, 'when it will soon disappear on the patient 
getting into condition. 685 
FEVEE. 
With respect to the prognosis, cceteris paribus, persons of a bilious tem- 
perament are better able to get through the disease, next those of a san- 
guineous, whilst those of a nervous or scrofulous diathesis experience some 
difficulty in recovering. It will be found more males die of typhus fever 
than females. Part xvi., p. 34. 
Typhus— Use of Stimulants. — [Dr. Wright, of Birmingham, well 
observes, that when stimulants are indicated in fever, we must not be 
deterred from their use by the existence of thirst, flushed cheeks, depraved 
secretions, etc. He says:] 
You have seen, in my practice of last year, how a persevering use of due 
stimulation in typhoid fever will lessen the frequency, and at the same time 
increase the force of the pulse; dissipate the flush from the cheeks; moisten 
the mouth, and clean the tongue; dispose to sleep, and, by giving tone and 
energy to the system, improve those secretions that had become depraved 
from weakness. Even the suggestions of organic chemistry, valuable as 
they often are in the practical business of the bedside, are sometimes to be 
disregarded in the necessity that may exist for prosecuting any single and 
well-indicated plan of treatment. It might be argued, that when the urine 
is ammoniacal, the perspiration alkaline and foul like the breath, and there 
is a general tendency to putrescence, ammonia would be an unsuitable re- 
medy. Yet you have several times seen all these morbid conditions cor- 
rected by this very medicine. I have no doubt that any other diffusible 
stimulant which, like ammonia, has often a prolonged action, and little 
affects the sensorial functions, would have answered as well; but I know 
of none that in all these particulars is equal to ammonia, and, therefore, 
give it the preference. 
One of the best cases illustrative of the value of stimulant treatment 
which I saw during the prevalence of the typhoid fever of 1846, was in the 
person of a little boy, aged eleven years. He had been ill some days when 
I first saw him, and presented all the ordinary features of the fever. Mr. 
Elkington was treating him with bark, ammonia and nitric ether, which 
seemed to me to be so judicious a plan as to deserve a continuance. 
On the following day the boy was in much the same state as before, 
and we agreed to give his medicine a little more frequently, and also 
to allow him more wine. In spite of this, his vital powers continued to 
fail, and on the occasion of our next visit, the subsequent day, the nurse 
told us it was not necessary to go upstairs, as the little fellow was “ all 
but dead.” For several hours he had lain in the condition in which we 
found him, and the nurse had declined administering either wine or medi- 
cine, from his inability to swallow. He was cold all over; pupils dilated, 
and quite insensible; eyes open and covered with films; action of heart 
inappreciable over its site; pulse not sufficiently distinguishable at the 
wi'ist to say what kind of pulse it was; breathing hardly perceptible. 
There was no consciousness whatever of passing events, and nothing that 
we could say or do roused the poor creature: to sum his case up in a few 
words, he had every appearance of being close upon the point of death. 
Still, he was not dead/ and, acting upon the belief that “ whilst there is 
life there is hope ” (in such cases as these a very advisable belief), we de- 
termined to not lose even the last chance, and therefore proceeded to give 
him wine. The first teaspoonful put into his mouth remained some seconds 
there, and then passed with a feeble gurgle down his throat. W e followed 686 
FEVEK. 
that dose by a similar one, and then another, and another, until half a 
glassful had been swallowed. We then let him rest for about a minute, at 
the end of which time his pulse had become perceptible at the wrist. This 
was the only sign of reaction, and trifling though it was, it was encouraging, 
inasmuch that it showed us that there was vitality enough left to respond 
to stimulation. We, therefore, ordered that he should have a large wine- 
glass (holding about an ounce and a half) of port given to him every other 
hour, and in the intervening hour a similar glass of strong beef-tea, con- 
taining two drachms of compound spirit of ammonia. One hour he had the 
wine, and the next hour the beef-tea and ammonia. The remedies were 
strong for so young a subject, but the case was desperate, and we did not 
choose to abandon him whilst there was even a “ forlorn hope ” left. 
We visited our patient the next morning, about fourteen hours having- 
elapsed, and we found him on the night-chair, sufficiently comfortable and 
conscious to greet us with a smile. In this short space of time his tongue 
had become moist, and had nearly lost its dark brown color; the sordes 
had completely disappeared from his teeth; in fact, without enumerating 
the items in proof, I may say he had become a living, intelligent creature ! 
From this period there was only one uninterrupted and rapid progress to 
recovery. Part xvi., p. 37. 
Typhus—Antiphlogistic Treatment of.—[Dr. Kennedy gives the case 
of a young man laboring under an attack of typhus, which impressed on his 
mind the necessity of more active treatment in many of those cases which 
assume at first an inflammatory character, followed by the usual exhaus- 
tion, such cases as are more frequently found among the wealthy and mid- 
dle classes. He relates his case as follows :] 
The symptoms of the disease ran high ; the skin was hot; the pulse 120, 
jerking; the tongue densely coated with a cream-colored fur; and the 
patient complained much of pains through his body, and more particularly 
of racking pain in the head. His eyes were suffused, and a good deal in- 
jected ; and his manner altered from his usual state. It was thought 
advisable to bleed him from the arm, and gxij. were taken. The coagulum 
was of a fair consistence, and presented on its surface a sizy buff. The 
symptoms were moderated by the bleeding, but as pain of the head still 
continued, some leeches were applied to the temples, and with marked 
relief. In this way matters went on till the seventh day, when petecchiaj 
appeared; few in number, well defined, and of a reddish color. At this 
period the symptoms began to put on a much more serious aspect. The 
tongue got dry and brown ; the pulse rose to 130 ; the eyes became more 
injected; and the slight delirium which had previously existed, now 
showed itself in fits of great violence; the patient being at times hard to 
manage, and keep in his bed. A modified antiphlogistic treatment, includ- 
ing tartar emetic, etc., had been used during all this time. In spite of it, 
however, the patient was going on from bad to worse, and on the morning 
of the tenth day his state appeared nearly hopeless. It so happened that 
during one of the fits of violence which took place this day, the bandage 
got loose on the arm ; the vein burst, and before the bleeding was com- 
manded a considerable quantity of blood was lost; probably gxij. The 
effect was magical. The patient was at once brought to his senses/ so 
much so, as to be aware of the danger of what was going on. I found him 
with a pale, anxious face, and his pulse excessively rapid. Otherwise he FEVER# 
687 
•was quiet, and perfectly collected. By means of stimulants, anodynes and 
heat, he rallied from this state; and he subsequently made a slow, but 
steady recovery. 
The case just given was one of common typhus. The petecchhe, dry 
tongue, and wandering delirium, afford proof of this. It could scarcely be 
referred to any of the varieties of the disease into which authors have 
divided it. If any, it might possibly be placed under the head of inflam- 
matory typhus. 
Dr. K. concludes that the head symptoms are usually the most serious; 
therefore anticipate these, as Dr. Graves advises, by free leeching and 
blistering. Better still, bleed from the arm to eight or twelve ounces: 
this treatment will moderate all the symptoms, will prevent the occurrence 
of secondary inflammations and congestions, and will cause the patient to 
derive more benefit from the administration of wine at the proper stage, 
than he otherwise would do. The treatment should be anticipatory, and 
should be active and antiphlogistic, as distinguished from expectant. 
Part xvi., p. 38. 
Chloroform in Typhus Fever.—When the system is worn out for want 
of sleep, and when there is much delirium, lot chloroform be inhaled to 
induce sleep. Commence with 10 minims on a little sponge or pocket- 
handkerchief, and, if necessary, repeat it in a few hours, increasing the 
dose according to circumstances, being guided by the state of the pulse. 
In the case cited, the only other means used being the sponging of the 
body with tepid water, and applying cold pads to the head. The system 
was supported by beef-tea, porter, wine, etc., and to allay thirst, toast and 
water. The patient is now recovering ; the pulse is reduced from 130 to 
between VO and 80; the tongue is clean and moist; the skin cool; diarrhoea 
has ceased ; the appetite is returned, and the countenance is regaining its 
natural aspect. Part xvii., p. 20. 
Feast in Typhus.—When the petecchise are very dark, or threatening 
to run into putridity, or in cases of dysentery attended with great fetor 
of the dejecta, give yeast in the following manner: R Cerevis. fermenti, 
gx.; camphorte, 5ss.; acth. nitric. 5iv. M. An ounce every one, two, or 
three hours. Part xx., p. 23. 
Pelirium in Typhus.—“ The approach of delirium should be the signal 
to the practitioner to look to the support of his patient.” 
Part xxi., p. 364. 
Arrest of Typhus Fever by Quinine — Dr. Dundas says: 
I would here observe, that large doses of quinine are not only safe, but 
advantageous in every stage, and in every form of typhus fever, and that 
the action assigned to it by Dr. Pereira and others is altogether erroneous. 
The presence of intense headache, quick and strong pulse, dry and burn- 
ing skin, dry, chapped and black tongue, intense thirst, hurried respira- 
tion, abdominal tenderness, and diarrhoea, do not contra-indicate its use. 
On the contrary, under large and repeated doses, the headache will 
subside, the pulse calm down, the breathing become less frequent, perspi- 
ration will return, the tongue will become moist, and the diarrhoea will be 
checked. 
After the first decided impression has been made on the disease by the 688 
FEVER. 
quinine, it is invariably necessary to support the patient’s strength by good 
beef-tea, and a moderate allowance of wine. Purgatives, without some 
decided necessity, should be avoided. When the head continues much 
involved, a strong capsicum enema—a drachm of the powder to ten 
ounces of water—will often afford relief. The minor adjuvants in fever 
may also occasionally be resorted to with comfort and advantage. 
Part xxv., p. 17. 
Typhus Fever treated by the Free Exhibition of Brandy.—Out of the 
eighteen cases under the care of Dr. Todd, treated by the administration 
of brandy, one only was fatal; in all the rest the plan pursued was 
remarkably successful. 
The type of the disease was of the well-marked typhus character— 
presenting the following symptoms previous to the commencement of the 
treatment: 
A copious eruption of scattered measle-like spots (mulberry or typhus 
rash); bowels either confined or but slightly relaxed; great prostration 
of strength ; delirium (in six cases coma was present); a small and very 
rapid pulse. It may be well to premise, that they were treated as is done 
in almost all general hospitals in the open wards, their beds being pur- 
posely arranged so as to occur at some distance from each other, in order 
to prevent the accumulation of contagious emanations. The treatment 
pursued consisted in administering, either every hour or every half-hour, 
day and night, from half an ounce to an ounce of brandy, with a draught 
every second hour, containing sp. Eeth. chlorici, mx., ammonke carbonatis 
gr. v., aq. pur. §j. The patients were induced to drink as much strong 
beef-tea as possible ; the head was always shaved; and, in most, a blister 
was applied to the scalp. Part xxviii., p. 20. 
Turpentine in Typhus Fever.—Dr. Laird, of Edinburgh, used this 
remedy with marked benefit in a severe case of typhus according to the 
following formula: Spirit of turpentine, spirit of nitric ether, of each 
three drachms; compound tincture of lavender, two drachms; camphor 
mixture, four drachms. Of this mixture (well shaken up), a teaspoonful 
was given in a wine-glassful of water every four hours. 
Part xxviii., p. 29. 
Food and Stimulants in Typhus.—[In Dr. Stokes’s lectures, the reader 
will find an ample store of valuable practical remarks, but none more so 
than his directions to feed a fever. The following opinions about the 
actions of the heart, and their guide in the administration of stimulants, 
are most valuable. He says]: 
What we have established as to the state of the heart in connection with 
the effect of stimulants, is simply this: we have ascertained that the 
efficacy of stimulants is often directly as the debility of the heart. It has 
been also ascertained that the power of bearing stimulants, their effect 
upon the nervous system, their good effects on the general condition, are 
directly as the weakness of the heart. We may lay down as a rule, that 
there are three conditions of the heart to be looked at by the practical 
man in the treatment of fever. In one, we have an excited heart—a 
violently-excited heart all through the case; and this heart may be 
excited and violent, although the symptoms be those of extreme adynamia, FEVEE. 
689 
although the surface be cold, the breath cold, and the pulse so feeble that 
it cannot be discovered. Nay, the heart may act with great force for 
several days, and yet there be no pulse at the wrist. This is one case. In 
the next case, we find exactly an opposite condition, in which the systolic 
force of the heart is diminished. This is shown by loss of impulse of the 
heart, by diminution of the first sound, and, in certain cases, by extinction 
of the first sound of the heart, while the second remains. This is a case 
which calls for wine, and in which you should give it: it is a case in which, 
in the vast majority of instances, wine will agree with the patient. There 
is a third set of cases in which the heart does not seem to be implicated at 
all in the course of the disease, in which, notwithstanding the existence of 
the most extraordinary group of symptoms affecting various organs, the 
heart, in the middle of the storm, seems to be in a state of calm and quiet. 
If we compare these three sets of cases with a view to prognosis, vre may 
arrange them in this way. The case of excited heart all through, with 
feeble pulse and with adynamia, is unquestionably the worst case. There 
is no worse symptom in fever than an excited heart. It is especially a 
bad symptom when, with that excitement, wTe find a feeble pulse. The 
next will be the case of sinking of the heart; and the most favorable case 
i3 that in which, as I said before, the heart seems to escape disease. But 
you are not to suppose, that because you have an excited heart, you are 
not to give wine if the symptoms of the patient require it: and you are 
not to suppose that, because the heart is not affected at all, you are to 
withhold wine if the general symptoms of the patient require it. You afre 
not to found your exhibition of wine or stimulants upon any one thing; 
you are to take the general state of the patient into consideration. What 
we have done is to discove. an intelligible practical rule which will guide 
you in the use of wine in certain, I think in many cases; but you are not 
to suppose that because this man has a clear first sound at his heart, there- 
fore you are not to give wine. You are not to suppose that because the 
heart is safe, you can do without wine. Now, in the case of H., recollect 
that although his heart seemed to escape, or was at most only feeble 
through the course of the disease, what frightful adynamia existed ; how 
for day after day the patient’s face was hippocratic, or almost so; how 
the general character of the disease was that of the most terrible putres- 
cent fever; yet his heart escaped. And here is the result. We have 
given that man upward of twenty bottles of wine and twenty-four ounces 
of brandy, and now, on the twenty-eighth or thirtieth day of the disease, 
we have the satisfaction of feeling that his case may be set dowTn as among 
the triumphs of medicine. I wish also strongly to impress on you the 
great importance of the use of other forms of nourishment in this 
disease; for we must not only keep up the nervous energy of the system 
by wine, but we must support nature by food. There is no mistake 
more fatal in fever than the withholding of food. I wras early taught 
the importance of the use of careful nourishment in fever by my colleague, 
Dr. Graves. 
In a large number of cases of typhus fever, the stomach has an excel- 
lent power of digestion; and, I believe, if we were bold enough, we should 
find that many articles of food usually forbidden to fever patients might be 
given with safety. 
In the treatment of fever, you are never to despair so long as the patient 
can swallow. So long as he is able to take nourishment, so long as he is 690 
FEVER. 
able to swallow wine, no matter how dreadful or apparently hopeless the 
symptoms may be, you are not to desert him, but—to use the phrase of 
our glorious sailors—you are to fight the ship whilst she swims. In a dis- 
ease under the mysterious law of periodicity, every hour of compelled life 
is a clear gain. And over and over again, you will find that your efforts 
will be crowned with success. You will see a patient lying with his back 
icy cold; you will see him pulseless—his lungs filled up with secretion—his 
belly tympanitic—with dreadful diarrhoea—the lower extremities gangre- 
nous—himself in a state of insensibility—and yet, even under these cir- 
cumstances, a recovery is possible. But that recovery can only be effected 
by the steadfast determination of the physician not to desert his post until 
the vital spark has actually fled, and if you commit an error in holding 
on—in hoping against hope—at all events it is an error on the right side. 
Part xxx., p. 20. 
Use of Chloroform in Fever.—The fever poison sometimes acts on the 
brain in a remarkable manner, producing symptoms of disease both in the 
chest and abdomen, although those two cavities may be, in reality, free 
from disease. One of the most frequent characteristics of lesion of the 
brain is insomnia, causing, or followed by delirium, subsultus, etc., and 
accompanied, probably, b}r congestion of the substance of the brain. 
There are two axioms laid down in Dr. Corrigan’s late work on Fever, 
which should always be remenbered: 1st, “ the loss of sleep, if it continue, 
is of itself sufficient to kill;” and 2ndly, “ if even the shortest sleep be 
procured, some advantage is gained.” 
To procure this sleep, then, by means which will not do injury to the 
circulating or digestive powers, would appear to be the most rational 
mode of treating this complication, and the rapidity with which the symp- 
toms of great nervous exhaustion subsides, when one sleep has been pro- 
cured, proves the soundness of this mode of treatment. 
To attain this object, Dr. Gordon recommends the internal administra- 
tion of chloroform. 
When the tongue is dry and brown, head not very hot, respiration 
short, frequent, and irregular; and when added to those there is delirium, 
more or less violent, give twenty-five minims of chloroform in a draught, 
to be repeated in an hour. This may be repeated in a few hours if neces- 
sary, and if the pulse be watched, may be continued every second hour 
for some time. The inhalation of' chloroform is useless in these cases, 
and may be followed by convulsive movements. Part xxx., p. 27. 
Typhus Fever.—Typhus is known by being very contagious, by the 
greater prevalence of cerebral symptoms, by the greater depression, by 
the dark mulberry rash, very much resembling measles, persistent, not re- 
newed, and not fading on pressure, and by the absence of disease of 
Peyer’s glands. 
Typhus fever is recognized in its early stage, without much difficulty; 
there is a rapid and rather full pulse at first, a brown tongue, great thirst, 
and more or less delirium; the bowels are generally confined; there is a 
characteristic mulberry rash. The bowels should be opened with a 
drachm or two of castor-oil; the thirst should be allayed by toast-and- 
water; a mixture should be prescribed containing spirits of nitric ether, 
solution of acetate of ammonia, and camphor mixture. If there should be 
great delirium, much relief will be obtained by shaving the head, and a FEVER. 
691 
blister should be applied to the nape of the neck. As the disease ad- 
vances, the pulse, retaining its rapidity, most probably loses its fullness, 
and as soon as this is observed, beef-tea and wine should be administered 
in small quantities often repeated, and a mixture containing the cai'bonate 
of ammonia, should be substituted for, or added to, the mixture just des- 
cribed. If the symptoms of sinking should increase, which is very often 
the case, and is indicated by a feeble, fluttering, and irregular pulse, 
trembling of the limbs, and muttering delirium, then brandy should be 
administered pretty freely in addition to the wine, and strong beef-tea 
should be frequently given. In addition to the carbonate of ammonia, the 
stronger diffusible stimulants should be prescribed, as the spiritus ammo- 
nite aromaticus, the spiritus setheris compositus, and a modification of the 
mistura spiritus vini Gallici. It is only by a vigorous adoption of these 
measures that life can sometimes be saved; and, indeed, it is perfectly ex- 
traordinary how, under circumstances apparently desperate, the patient 
has been restored by an unsparing use of those and similar stimulants. 
The use of opium in typhus fever, must not be passed over without a 
remark upon its great value in certain stages of this disease. In the early 
period, this drug would be injurious; in the latter it is \iseless. But 
where there is great restlessness and irritability, together with great 
weakness, the use of opium is invaluable; it quiets the patient, procures 
him sleep, and raises the pulse. The usual form of administration of this 
medicine at the London Fever Hospital, is the tincture, given in doses of ten 
minims, and repeated if restlessness is not relieved. Part xxxiii., p. 20. 
REMITTENT FEVER. 
The connection between malaria and the evolution of sulphureted hy- 
drogen from different localities, is strikingly pointed out in an interesting 
paper by Professor Daniell. He seems clearly to prove that the unhealth- 
iness of particular places, as the western shores of Africa, and particularly 
where large rivers empty themselves into the ocean, is owing to the evo- 
lution of sulphureted hydrogen, produced by “ the decomposition of 
sulphates in the waters by the carbonaceous matter of vegetables.” So 
small a mixture as a fifteen hundredth part of the sulphureted hydrogen 
in the atmosphere, acts as a direct poison upon small animals, and pro- 
duces very uneasy sensations on the human body. When in larger propor- 
tions its effects are still more remarkable, producing sudden weakness and 
all the signs of asphyxia. The fatal effects of a communication of the sea 
water with inland marshes, was observed by Signor Giorgini in 1741. 
Dr. Robert Hamilton of Lyme Regis, noticed the same fact in 1793. 
Dr. James Allen, in his paper “ on some of the predominant diseases of the 
African islands,” arrives at the same conclusions, without, however, giving 
the same explanations that Professor Daniell does. It seems evident that 
wherever such decomposition goes on as to produce the evolution of sul- 
phureted hydrogen, the dreadful effects of miasma will follow to the 
animal system. And it is highly satisfactory that Professor Daniell hav- 
ing so clearly traced the cause of this pestilential influence, has also 
directed us to the remedy, namely, chlorine. Chlorine and sulphureted 
hydrogen cannot coexist together. “Plentiful fumigations of chlorine 
would, therefore, infallibly prevent the deleterious effects.” This ought 
to be particularly known in Africa and the islands adjoining its eastern 692 
FEVEK. 
coast, Madagascar, etc., and also in the unhealthy climates of the east and 
west, where there is frequently every facility afforded for the intermixture 
t)f the waters of the ocean with the immense quantities of vegetable mat- 
ter washed down by the rivers and torrents from the luxuriant soil. 
Part iv., p. 137. 
Pathology of Fever.—Dr. Willis advances opinions respecting the cause 
of fever, which, if correct, seem to overturn all our preconceived notions 
of it—especially with reference to its origin in those localities where we 
suppose marsh miasma and malaria to exist. He reminds us of the obser- 
vation of Fourcault, that an animal, healthy and uninjured, very soon dies 
if its body be covered with an impervious glaze. “ Becquerel and Bres- 
chet repeating the experiment of M. Fourcault, discovered that the ex- 
tinction of life under the circumstances indicated was accompanied by a 
signal fall of temperature; the animal, whose body was indued with an 
impervious glaze, began to lose heat on the instant, and the loss never 
ceased until life had fled, when the temperature of the internal as well as 
external parts of the body was found to be within 30° cent, of that of the 
external atmosphere, which, on the day of the experiment, indicated 
17° c.” None of these gentlemen have offered any other explanation of 
this phenomenon than the old one, that the office of the cutaneous exhala- 
tion, as a means of refrigerating the body, was gone. 
Dr. Willis thinks that when the secreting function of the skin is sup- 
pressed or greatly disordered by a chill, it may produce the same effects 
as when the surface is covered by an impervious varnish. In this process 
there may be included more or less of inflammatory action. In common 
with many others, he denies that the specific poisons called miasm or 
malaria, are the cause of those deadly fevers which are so common in tro- 
pical regions. In short, he asserts that these poisons are nothing more than 
“ moist warm air—air excessively moist, considered in connection with its 
own temperature, and the temperature of the human body.” It is well 
known that an individual will bear a very high temperature better when 
the surrounding air is dry, than when it is moist. In the former case the 
capillary arteries exude, and the veins imbibe with increased activity; 
but if the excitement continue too long the temperature of the body in- 
creases too rapidly, and death would result. But this is not the true ex- 
planation, when the surrounding air is moist. In this case the animal dies 
from the same cause as when the body is covered with an Impervious 
Glaze—from the want of oxygen being properly conveyed into the 
system. 
“Now it is highly interesting to observe that the air of unhealthy inter- 
tropical climates differs little from that of a vapor-bath at between 80° and 
90° Fahr. The dew-point of the atmosphere in these countries appears, in 
general, to be not more than four or five degrees, and frequently not more 
than a single degree, Fahrenheit, below the temperature of the ambient air. 
Were the temperature between 90° and 100° Fahr., and the dew-point in 
the same proportion high, man could not by his nature continue to exist for 
more than a very few hours. In a country having a high mean tempera- 
ture, say of about 80° Fahr., and an atmosphere that is close upon the point 
of saturation with humidity, which is precisely what obtains on the western 
coast of Africa, to quote a single instance, man is evidently on the verge of 
circumstances that are even incompatible with his existence. He has but 693 
FEVER. 
to be exposed to fatigue and the burning rays of the sun to be actually 
brought into such circumstances. The surrounding atmosphere cannot 
take up the watery vapor, which is then presented to it in large quantity 
by the sudoriparous glands, with sufficient rapidity to meet the wants of 
the system, in its state of excitement, and requiring the freest access of 
the most thoroughly oxygenated plasma to keep up movement and life in 
its several constituent atoms. Great general derangement—Fever— 
ensues, and life is almost of necessity the forfeit.” 
Whether or not this be a true explanation of the cause of many fevers, 
we know that to restore a healthy action of the skin is of the first conse- 
quence, and when we find its functions restored, we seldom feel serious 
alarm. Dr. Willis recommends for this purpose, beside the usual exhibi- 
tion of antimonials, etc., that the patient be covered with a sheet and have 
a sponge dipped in tepid water passed over every part of his body, by the 
hour together, until the thermometer, both in the axilla and mouth, has 
been brought down from 106° or 108° Fahr. to 90° or 100°. This was the 
object of the cold affusion in the practice of Dr. Currie. Part x.,p. 13. 
Remittent Fever—African Remittent.—To preserve in health the crew 
of a ship on the malarious coasts, they should land as seldom and for as 
short a time as possible, and not after nightfall; should not sleep on shore 
if it can be avoided, and on no account without having a complete screen 
between the body and the sky; should be prohibited from access to in- 
toxicating liquors; and should take daily a dose of quinine or bark, both 
when exposed to the malaria and for a fortnight after returning on board. 
The ship must be kept clean, well ventilated, and free from damp. If in 
spite of all precautions malignant fever break out, the ship must leave the 
coast. Part xvi., p. 44. 
Remittent Fever.—The treatment in these cases, says Dr. G. Bird, is 
exceedingly simple. First, remove the hair, wash the body daily all over, 
and put the patient on low diet; and after clearing the bowels with hyd. 
c. cret., or ol. ricini, give sodae sesquicarb. until the state of the secretions 
is corrected; quinine then given acts almost like magic, curing the patient 
generally in a week. Part xi., 
Treatment of West India Remittents and Intermittents by Quinine.— 
In using quinine as a remedy for the West India intermittent or remittent 
fever, it should be given till its specific effect on the system, termed by the 
author “ cinchonism,” and marked by the supervention of more or less 
deafness and ringing in the ears, is produced. The best way to saturate 
the system with the remedy, against the paroxysms of intermittent, is to 
give hourly doses of three grains, till twelve doses have been taken; or if 
the disease is a quotidian with short intermission, six grains hourly, until 
six doses have been taken. One of the most valuable applications of qui- 
nine is against relapses of intermittent fever. For this purpose, two days 
before the anticipated relapse, give three grains of quinine thrice daily for 
four days; repeat the treatment at the time of the next anticipated relapse, 
and so on for three or four times successively; when, by thus baffling the 
relapse, the disease will be entirely eradicated. Part xviii., p. 26. 
Tropical Fever and Dysentery.—When the remissions are imperfect, 
and there is acute congestion of some important abdominal or other organ, 
give quinine (in 9j. doses) from 5j. to 5ij. daily. The more acute the 
symptoms and the less the remissions, the larger and earlier should be tli 694 
FEVEE. 
doses. These doses should be continued until complete cinchonism is pro- 
duced, namely, singing in the ears and deafness. In robust cases, before 
the accession of the fever, one blood-letting often gives great temporary 
relief. Part xxix., p. 32. 
Malignant Fever.—Dr. Cummins believes that all malignant fevers re- 
quire powerful stimulants of every kind ; and of all therapeutical agents, 
quina, in large doses, is the most valuable. In purely nervous cases, we 
should expect it cutting short the disease; in those where the blood is 
primarily diseased, it will neutralize the tendency in the diseased bloody to 
produce disordered functions of the sympathetic nerve, and will thus keep 
the patient alive until the diseased blood has been thrown out of the sys- 
tem by crisis. Part xxxiv., p. 17. 
Remittent Fever.—In the treatment of this form of fever, especially as it 
occurs on the coast of Africa, quinine is undoubtedly the most powerful, 
and most generally applicable antiperiodic remedy which we possess. A 
form lately introduced called “ Herring’s unbleached sulphate,” is quite 
equal to the bleached in its action, and is considerably cheaper. Its value 
in fevers is especially as an antiperiodic, its pure tonic effect being only 
secondary. 
Dr. Baikie believes: 
1. That remittent and intermittent fever are essentially the same com- 
plaint, differing only in degree and intensity. 
2. That the endemic fevers of Africa, and of other tropical regions, are 
of this class. 
3. That these may, to a great extent, be guarded against by the use of 
quinine as a prophylactic. 
4. That the main therapeutic agents for the treatment of this class of 
diseases are antiperiodics. 
4. That an almost invariable sequela is an affection of the spleen, so much 
so as almost to be regarded as a stage of the disease. Part xxxv., p. 17. 
YELLOW FEVER. 
Use of Quinine. — The “Lafayette Gazette” mentions the salutary 
effect, in cases of yellow fever, derived from the exhibition of the 
sulphate of quinine, in very large doses. The common practice of phy- 
sicians has been to give it in small doses during the periods of remission. 
The new practice is based on a different theory, and varies essentially from 
the old. When quinine is taken in large quantities, medical men have 
observed that it produces but a slight and inconsiderable stimulating effect, 
which is succeeded within a few hours by a powerful sedative impression, 
that is generally durable. With this view, the medicine is exhibited in 
one very large dose, of from twenty to sixty or eighty grains, in the very 
incipiency of the fever, while the morbid action appears to be in process 
of formation—that is, within six or eight hours immediately after the ap- 
pearance of the earliest symptoms. The quinine is administered in a single 
dose; the object of the physician is to bring about the sedative influence 
of the remedy before any of the organs, as the head, stomach, etc., become 
specially affected by the disease. If it should fail to produce the antici- 
pated effect, the case is too far advanced for a second trial, and it must be 
treated on general pathological principles. Let it, however, be remern- FEVER. 
695 
bered that in thirty or forty cases which have been subjected to this novel 
curative method, not one has terminated fatally. The action of the quinine 
has been uniformly most salutary, operating like a charm, and dissipating 
the symptoms of the malady ere they become concentrated on different 
organs. Part in, p. 34. 
Nature of the Black Vomit.—Dr. Nott gives it as his opinion that the 
black vomit is blood, exhaled in its natural state from the capillaries of the 
stomach, and changed black by the secretions with which it comes in con- 
tact ; this chemical change, his facts go to show, is produced by one or 
more acids. He tested the black vomit in a number of cases, and in every 
instance found it to be acid. When ejected from the stomach during life, 
it invariably turns litmus paper red, and the aqueous portions thus filtered 
differed in color; in some it was perfectly limpid, like water; in one, of a 
light green color, like dilute bile with an acid added; in others, it was of 
a deep brandy or rum color, which appearance was no doubt given by a 
small admixture of blood. 
The secretions of the stomach in yellow fever are often excessively irri- 
tating ; and this property is probably attributable to the presence of acid. 
The patient often complains, in the black vomit stage, of a burning or 
scalding sensation in the stomach, -which is immediately relieved by 
throwing off its contents. The patient, too, often complains of the 
black vomit scalding the oesophagus, which, after death, is usually found 
more or less denuded of its epithelium. The acridity of this secretion may 
possibly account for many of the morbid changes in the stomach and oeso- 
phagus. A morbid secretion of tears will scald the cheek; mucus from the 
nose inflame the lip; morbid secretions from the bowels excoriate the anus; 
morbid bile irritates the stomach and bowels, etc.; and we know that the 
gastric juice will often corrode the stomach in a short time after the ex- 
tinction of life. The next step was to ascertain whether acids would, with 
blood, produce a compound with the characters of black vomit. Dr. 1ST. 
accordingly took a few drachms of blood from the heart of a patient dead 
of yellow fever, and added to it four or five drops of muriatic acid diluted 
-with a drachm or two of water, and shook them well together; the black 
color was produced instantly. The same experiment was tried repeatedly 
on the blood of yellow fever patients, and on that drawn from a patient 
with pleurisy by cups, and the effect was invariably the same. 
Part xv., p. 108. 
Yellow Fever—Abortive treatment by Quinine.—In New Orleans, as 
well as in the surrounding country, the fevers are intermittent, remittent, 
and continued, “ alternating in type, and running into each other.” In 
summer and autumn, they have a decided tendency to crisis by hemor- 
rhage: “this,” says Dr. Fenner, “makes yellow fever: it forms the true 
characteristic difference between the high degrees of summer and autum- 
nal fever in the city and country, and must depend on locality and attend- 
ant circumstances. During the healthiest years it predominates over all 
other types; but during the sicklier years, in the country, it runs into re- 
mittent, bilious and congestive; "whilst in the city it runs into yellow fever., 
Dr. Harrison testifies that he had often observed malignant intermittents 
immediately to precede the outbreaks of yellow fever epidemics.” 
Dr. Fenner’s observations being drawn from a vast public and private 
experience, and in particular from observations made in, and from the sta- 696 
FEVER. 
tistics of, the New Orleans Charity Hospital, which is probably the most 
extensive fever hospital in the world, the following statement is of peculiar 
force: “ Physicians may say what they please about being able to distin- 
guish a case of yellow fever, as soon as they examine it; we do not be- 
lieve it possible, according to their ideas, liarely does a summer pass in 
which we do not hear of some intelligent and experienced practitioner 
being perfectly astonished at seeing what he had pronounced a case of in- 
termittent or remittent bilious fever terminate in black vomit, or other 
hemorrhage.” 
Dr. Fenner is a very warm advocate in favor of the administration of 
large doses of quinine, for the purpose of cutting short yellow fever. In 
fact, he urges the excellence of the abortive treatment of yellow fever, 
with the slime confidence that Dr. Dundas recommends the same treat- 
ment in the continued fevers of this country. The experience of Dr. 
Fenner certainly gives additional strength to the important practical doc- 
trine which Dr. Dundas has brought before the profession. 
Part xxv., p. 23. 
Yellow Fever.—[Dr. Cummins observes that the small doses of quinine, 
recommended in our Pharmacopoeias, have no effect in yellow fever, and 
that many cases are lost from the dread of pushing the remedy to the ne- 
cessary extent.] 
Most persons believe that when deafness is produced there is no further 
indication for its use ; but this is a fatal error, as in most cases it is neces- 
sary to push it for a much longer period. It is difficult to lay down any 
fixed rules as to the quantity that should be given in any individual case; 
but if a well-founded and long-established rule of medicine is borne in 
mind, that in certain diseases ten times or more of the ordinary dose of a 
medicine is required to produce its effect, and that yellow fever is one of 
those diseases, it will be found that the best guide for the administration 
of quinine is the amount of nervous depression present. 
Quinine is a stimulant, and as depression would succeed the use of the 
quinine, the remedy should be continued through the case. Sometimes, 
by this remedy, we may cut short the disease at once, if the case is seen 
very early. To do this we may give 5ss. of quinine, and 9j. of calomel, 
directly, and a similar dose with five grains of James’s powder an hour 
afterward, followed in two hours by an ounce and a half of castor oil. 
This treatment will very often cure the disease at once. If it does not, 
and the disease progresses, twenty grains of quinine may be given for four 
doses. If deafness has commenced, wre should wrait until it has subsided. 
Then ten grains may be given every second hour, and continued according 
to the degree of headache, pain in the back, congestion, and muscular 
prostration. During convalescence, three grains may be given three 
times a day in wine. If the larger doses of quinine be vomited, a large 
mustard plaster should be applied to the epigastrium, and another dose 
given; and if vomiting again occurs, the process should be repeated. 
Occasionally, however, 5j. of sulphuric ether, and eight or ten drops of 
creasote may be given, to allay any spasm, and we may then wait an hour 
before again trying the quinine. Part xxviii., p. 25. 
Yellow Fever—Treatment with Spirits of Turpentine.—First clear out 
the bowels by a dose of calomel or blue pill, with a solution of Epsom 
salts. Then give turpentine in doses of twenty minims, three times a day; FINGER. 
697 
a little sweet nitre may be mixed with this remedy. If the dejections are 
bloody or vitiated, give along with the turpentine small doses of opium 
and castor oil. The auxiliaries are sinapisms and blisters to the epigas- 
trium, emollient enemata, and during the stage of debility, wine negus, 
beef-tea, etc., and cinchona injections. The turpentine was tried in a very 
severe case of typhus with excellent effect, in the following form: Spirit 
of turpentine and spirit of nitric ether, of each three drachms; camphor 
mixture, four drachms; compound tincture of lavender, two drachms. A 
teaspoonful to be given in a wineglassful of water every four hours. 
Part 28. 
Yelloio Fever—Quinine.—Give quinine in the early stage of depression, 
promptly, boldly, and in large doses. The first stage is one of diminished 
vital energy, which quinine raises. Give ten to twenty grains every 
second or third hour. Four or six hours should never elapse between one 
dose and another during the stage of depression; and, when necessary, 
give it up gradually. Part xxx.,p. 25. 
Yelloio Fever.—Give fifteen minims of spirit of turpentine every three 
or four hours, combined with a little nitric ether and camphor mixture. 
As soon as a remission takes place, give quinine, and a more nutritious 
diet. Part xxxi., p. 40. 
FINGER. 
Reunion of a Completely Separated Portion of Finger.—Mr. A. 
Graham relates the following case: A joiner, of middle age, and appa- 
rently healthy constitution, while splitting wood with an axe, cut through 
the index finger of his left hand, between the first and second phalanges. 
He lifted the separated part from among the shavings, and immediately 
walked a few yards to a place where I happened to be. Being asked for 
the amputated portion, he took it from his waistcoat pocket, and laid it on 
the table. I fixed it on by two sutures, and adhesive strap, and on the 
fourth or fifth day a pair of scissors being applied to the point of the fin- 
ger, he distinctly felt them. Complete union took place, with restoration 
of the powers of the part which had been separated. Part iii., p. 92. 
Reunion of Completely Separated Portions of Finger.—A girl, four- 
teen years old, was engaged with another person in some domestic occu- 
pation, when the latter accidentally let fall a knife, which cut off two of 
her fingers below the first phalanx. The writer being soon after sum- 
moned, found the two pieces in some meal on which the patient’s hand was 
resting at the time of the accident; but he discovered, to his great sur- 
prise, that each of them was divided into two portions. However, he de- 
termined to try to unite them, and having put the bits together, he kept 
them all in their places with sutures and strips of plaster. In a few days 
the adhesion was completed, and the patient ultimately recovered the 
entire use of her fingers. Part vi., p. 154. 
Reunion of Fingers after Complete Separation.—A laboring man, 
whilst cutting grass with a sickle, had, by a clean incision, cut out of the 
thumb a triangular-shaped piece, the incision extending from the end 698 
FIRE. 
down the centre of the nail, nearly to the root, then outward toward the 
forefinger. The piece thus disunited consisted of the portion of nail 
described, integument, muscle, and a minute portion of bone. From the 
finger he had nearly sliced off a piece of muscle and integument on the 
side next to the thumb. I sent him back to the distance of two miles, to 
search amongst the grass for the dismembered portions, which he suc- 
ceeded in finding, and which, upon his return, I carefully Avashed with 
warm water, and adjusted in exact apposition to the surfaces from whence 
they were cut. I freely applied collodion, so as effectually to exclude the 
atmosphere, and prevent any further hemorrhage, and with narrow 
pieces of strapping held them firmly in the position in which I had placed 
them. The result has been the perfect reunion of both pieces, leaving lit- 
tle or no cicatrix. 
I should mention that the period that elapsed from the occurrence of 
the accident to the replacing of the parts was four hours; also that the 
pain, which was very acute, from the exposure of the cut surfaces to the 
atmosphere, ceased immediately that the parts were replaced; and the 
man experienced little or no pain afterward. Part xx.,p. 115. 
Finger—To Remove a Gold Ring from.—First, polish the outer surface 
of the ring by means of a strip of linen and prepared chalk, then apply 
quicksilver to the whole surface of the ring; in the course of a few min- 
utes, by means of gentle pressure made upon the ring, it will break in 
pieces. The mercury amalgamates with the gold, crystallizing it, and ren- 
dering it brittle as glass. * * * * 
Wind closely and tightly round the finger, as far as the ring, a piece of 
well-soaped twine; then, with the end of a needle 01* probe, force the end 
of the twine beneath the ring, and gradually unwind. The ring will come 
off with the twine. Part xxviii., p. 321. 
Means of Preserving Combustible Substances from.—[In seeking for a 
substance capable of preserving combustible articles from the action of 
fire, it appeared to Dr. Smith that:] 
Sulphuric acid seemed to present the most promising characteristics of 
a substance incapable of burning, and of acting so strongly on vegetable 
substances as to make them incapable of burning. Sulphuric acid itself is 
a body perfectly burned, or we may say over-burnt, having an atom of 
oxygen given to it by artificial means, so to speak, which atom is difficult 
to separate, and therefore not resembling the oxygen of many highly 
oxydized bodies. It requires a high degree of heat to raise it to vapor; 
and the vapor formed is sluggish and heavy, remaining long where 
formed, and quenching flame wherever it is. It destroys the texture of 
wood also and other vegetable substances, causing them to give out after 
a time gases which do not burn, mixed with some which do burn; but 
if there be enough of acid, forming a mixture which does not burn. 
The wood also cannot be again induced to become combustible until it 
be heated to redness, so as to remove all the sulphuric acid, leaving only 
charcoal. 
FIRE. FIRE, 
699 
If sulphuric acid could be introduced into the wood just at the time 
the fire was going to take place, the fire would cease to take place ; 
and this we can do easily by saturating the wood with sulphate of 
ammonia. When there is no fire present, there is no sulphuric acid 
present, as such ; but as soon as the heat rises, ammonia goes off1, and 
sulphuric acid is instantly presented to the wood. The ammonia does 
not come olf quite pure, it is mixed with nitrogen and sulphurous acid; 
and this disengagement of gases is of advantage in extinguishing fire ; 
Avhen the heat rises to 536° the sulphuric acid is then left to act on the 
wood in part, and to volatilize in part, and that which I have mentioned 
takes place. 
I have no doubt that a house built of wood prepared in this manner 
might have a fire lighted on the wooden floor without danger, burning 
only on the spot to which the fire was limited. A ship also would be safe, 
even if the cinders did fall from the grate in stormy weather. 
I know that muriate of ammonia has been used, and that it acts very 
well; but I think the sulphuric acid is superior, the ammonia being only 
to keep it innocent; any other volatile base might do. I am sorry, 
however, that this is not perfect; it3 solubility in water is a great 
disadvantage, as it cannot be applied to clothes to be frequently Avashed. 
True, it is so cheap that it might be applied every washing where 
there are peculiar dangers; but if a person Avere standing very near 
the fire, the ammonia Avould in part be evaporated, and the acid remaining 
A\Tould be enough to injure the fabric. There are, hoAvever, cases, such as 
curtains, to Avhich this could not apply, and where it Avould be valuable. 
Sir William Burnet’s liquid is chloride of zinc; he uses it for preserving 
Avood and canvas, and also for preventing fire. I am certainly surprised 
that more use has not been made of it, being, as far as I have seen it, so 
efficient. I belieAre the manner in which the chloride of zinc acts is very 
similar to that of sulphuric acid, destroying the organic matter on the 
approach of heat, and rendering it incombustible. It can be introduced 
into Avood at a specific gravity of 2000, I believe; sulphate of ammonia 
cannot easily be used above 1200. By heating the solution more may be 
attained. Sulphate of ammonia is cheap and easily procured and used, 
not hurting anything Avith Avhich it may come in contact, and therefore 
more easily managed in households. 
The chloride of zinc is said to unite Avith the fibre. This cannot be said 
for the sulphate of ammonia. It Avould not, hoAvever, come from the 
centre of a beam of Avood, even if immersed in Avater, as the Avater enters 
Avith great difficulty into Avood; and the solution itself cannot be intro- 
duced Avithout forming a vacuum in the saturating vessel, and so removing 
all the air from the Avood. 
[At the Worcester meeting of the Provincial Association, Mr. Crompton, 
of Manchester, exhibited the action of the sulphate of ammonia, in pre- 
serving paper, etc., from the action of fire.] 
He exposed a piece of neAvspaper, Avhich had been soaked in sulphate of 
ammonia to the flame of a candle—though the texture of the neAvspaper 
was destroyed, it did not take fire. The heat caused the ammonia to fly 
off, and the sulphuric acid being set free, charred the paper. As the sul- 
phate of ammonia did not the slightest injury to the texture of the fabric, 
itAvas most desirable as a non-combustible application for children’s dresses, 
bed curtains, etc. Fart xx.,p. 175 700 
FIRING. 
FIRING. 
“Firing ” as a Counter-irritant.—Sciatica, lumbago, chronic rheuma- 
tism, paralysis, neuralgia, and hysterial pains, are the diseases in which this 
form of counter-irritation has been serviceable. Dr. Corrigan says : 
The iron used is very portable, consisting of a thick iron wire shank, of 
about two inches long, inserted in a small wooden handle, having on its 
extremity, which is slightly curved, a disc or button of iron, a quarter of 
an inch thick, and half an inch in diameter, the whole instrument being 
only six inches in length. The face of the disc for application is quite 
flat. This, trifling as it may seem, must be attended to. In the French 
cauterizing irons, as they are sold by the cutlers, the buttons for the 
cauterizing are spherical, and the consequence is, that they must be either 
pressed long and deeply into the skin, to bring them in contact with an 
extent of surface equal to their diameter, or they can be made only to 
touch at a single point. Another objection to the French iron, is the great 
length of its iron handle. This is necessary in the French instrument, as 
the iron is intended for being heated in the fire, but it terrifies the 
patient ; whereas this little instrument will hardly attract attention. The 
only other portion of apparatus required, is a small brass spirit-lamp, so 
small that it can be carried in the waistcoat pocket. 
To use the instrument, it is only necessary to light the lamp, and hold 
the button of the instrument over the flame, keeping the forefinger of the 
hand holding the instrument at a distance of half an inch from the button. 
As soon as the finger feels uncomfortably hot the instrument is ready for 
use, and the time required for heating it to this degree is only about a 
quarter of a minute. It is applied as quickly as possible, the skin being 
tipped successively at intervals of half an inch over the whole affected part, 
as lightly and rapidly as possible, always - taking care to bring the flat 
surface of the disc fairly in contact with the skin. In this way the process 
of firing a whole limb, or the loins making about 100 applications, does not 
occupy a minute, and the one heating by the lamp suffices. You can 
ascertain at once whether the heat be sufficient. If you look sidewise at 
the spots as you touch them, you will observe that each spot the iron has 
touched, immediately becomes of a glistening white, much whiter than the 
surrounding skin. In the coarse of a quarter of an hour, or sometimes of 
a very few minutes, the whole skin becomes of a bright red, and the 
patient feels a gloAV of heat over the part. The iron, I need hardly 
observe, is never rendered red hot. It is, indeed, very little hotter than 
boiling water, and I never made an eschar with it, and very rarely indeed 
raise a blister. There are merely seen upon the skin next day, a number 
of circular red marks, the cuticle not even being raised, and the surface 
being ready, if required, to receive a fresh application. 
The thickness of the disc or button of the instrument is not a matter of 
indifference. If it be thinner than the measure I have given, it will cool 
too rapidly; if it be thicker, it will take too long a time in heating. Of 
the little pain produced by its application, you can form an estimate when 
I tell you that some of our resident clinical clerks here have preferred it 
in their own cases, when suffering under local muscular rheumatism, to 
any other method of counter-irritation, as being the least troublesome, 
the most rapid, the least painful, and the most effectual. I can certainly FISTULiE. 
701 
recommend its application in the way here directed, as one of the most 
useful of our counter-irritants; it can be applied so rapidly, so extensively, 
and, as I have already said, without even the patient knowing very often what 
has been done. Its superiority over blisters may also be owing to the 
suddenness of impression produced. The effect is often as instantaneous 
as the application. My friend, Dr. Mitchell, master of the Victoria 
Lying-in Hospital, consulted me some months since for a severe attack of 
lumbago. I applied the firing, and he was in one minute quite free from 
pain. He has since used it himself extensively in practice. 
A gentleman, in leaping from a railway carriage, strained the muscles 
of his loins. He used for two or three days, liniments, and took a warm 
bath. He continued to suffer so much that he at length called on me. 
He could not sit down on a chair without much inconvenience, but to rise 
was a labor of great torture. While conversing with him, and drawing 
off his attention, I heated the iron and fired him over the loins. He was 
instantly well. 
In another case a gentleman from riding a hard pulling horse, began a 
year since to feel numbness in the little and ring finger of the left hand. 
This gradually crept up along the ulna, to the elbow, and at length there 
was such loss of muscular power, and so much numbness whenever the 
bridle passed upon the fingers of the left hand, that he became very 
nervous about riding. I fired him along the forearm inside and outside 
from the elbow to the hand. He has felt no inconvenience since, and a 
period of a month has elapsed. In sciatica I consider this mode of firing a 
most valuable aid in our treatment. It may, however, require several 
applications before permanent relief is obtained. I have also used it with 
the greatest advantage in cases of neuralgia of the fifth pair of nerves, and 
in paralysis of the portio-dura of the seventh. Even delicate females will 
not object to its frequent repetition when required. Part 55. 
FISTULA. 
FISTULA IN ANO. 
On the subject of fistula in ano, Sir B. Brodie makes some remarks 
which throw rather a new light on the cause of the difficulty in healing 
the abscesses in the neighborhood of the anus. It has generally been 
supposed, till lately, that the healing process was prevented chiefly by the 
irregular action of the sphincter and levator ani muscles : this opinion, 
however, is now found to be incorrect. The true reason seems to be some 
ulceration in the mucous membrane of the bowel, within a short distance 
of the anus. We know that an ulcer may simply perforate the mucous 
membrane without penetrating through either the muscular or peritoneal 
coats, or it may perforate through the mucous and muscular only, or 
through all three. Sir B. Brodie thinks that fistula in ano arises originally 
from ulceration of the mucous membrane, extending through the muscular 
tunic into the cellular membrane external to the intestine. This is of the 
greatest importance to know, not only in a pathological but in a practical 
point of view; because if in all, or in most cases, there be an ulcer of this 702 
FISTULA. 
nature, it is evident that an operation will be of little use, unless the small 
ulcer situated more or less up the bowel be discovered and included in the 
operation. Sir Benjamin says he is persuaded “ that the inner opening 
always exists; and he never fails to find it when he feels for it in the right 
place, which is generally, if not always, situated immediately above the 
sphincter muscle, just the part where the fieces are liable to be stopped, 
and where an ulcer is most likely to extend through both the tunics.” The 
most common cause of abscess of this kind is the lodgment of hard 
fieces in the boxvel; by the straining which is necessary to expel them the 
mucous membrane is torn or abraded, and then the passage of the fieces 
causes ulceration. Although the internal ulcer is generally just above the 
sphincter, the abscess will often extend much higher, a probe may pass for 
one, two, or even four inches up the side of the bowel. 
There may also appear to be more abscesses than one, there being seve- 
ral openings externally, but it is important to know that the whole cause 
of the mischief is the one ulcer just above the sphincter, which is perpetu- 
ally allowing bits of fieces to escape through it, and thus keeps up the 
mischief. Cases are recorded in which the internal orifice has evidently 
healed up as the fistula) have healed. This has occasionally been accom- 
plished by the long-continued use of Ward’s paste, the confectio pipr. nigr., 
which acts as a stimulus to the part, and may eventually cause the ulcer to 
heal. But the great art of curing fistula seems to consist in finding the 
small ulcer which has given rise to the disease. This opening is too often 
looked for in the upper part of the sinus, which,-if high up, is never the 
proper place to find it. It must be sought for immediately above the 
sphincter muscle. To find this opening it is better also to use a probe 
with a flat handle, so that we may know in which direction we are pushing 
it when bent; it is better also to have probes of different sizes. In feeling 
for the internal orifice we should pass the finger into the rectum, and just 
above the sphincter we shall often find a little irregularity, which is the 
place where the orifice is probably placed. The probe, which ought to be 
grooved, is then to be introduced into the external wound, and by a little 
manipulation, tjie opening into the rectum will be found. The probe may 
now be passed into the bowel, and by means of the finger its point may be 
brought out at the anus, taking care to have the groove of the probe down- 
ward, or in such a direction that the scissors or knife may be easily guided 
along it. Sir Benjamin Brodie generally makes use of a pair of curved 
knife-edged scissors to divide the parts. It has long been supposed neces- 
sary, when the abscess extends to some distance up the side of the bowel, 
to lay open the whole sinus into the rectum ; but this may be a frightful 
operation ; it is not known what vessels may be divided, and it is altoge- 
ther an unnecessary operation, as the case will generally be cured by sim- 
ply finding the internal ulcer, and dividing all the parts between that and 
the skin, in the way just recommended. Part ix., p. 102. 
Fistula in Ano treated by Ligature.—Mr. Lomas, of Manchester, gives 
us his method of using the ligature in fistula in ano, as follows : 
I employ a fine metallic wire of silver or platinum. Having passed a 
probe director (one of Sir Benjamin Brodie’s) along the fistula and through 
its internal orifice, its point, being very flexible, is readily directed down- 
ward and out at the anus, by the finger previously introduced within the 
rectum ; the structures to be divided are now upon the instrument, and, as FISTULA. 
703 
it were, everted. The wire is then passed along the groove of the director, 
and the ends are crushed together until a very moderate compression is 
exerted upon the inclosed parts. It promotes the personal comfort of the 
patient to leave the twisted ends rather long, and to fix them on the sacrum 
with a cross slip of adhesive plaster. This trifling arrangement allows the 
buttocks to lie perfectly apposed, and he (the patient) is free from the dis- 
agreeable sensation of an interposed body or rough point, and visits the 
closet more comfortably. All that remains to be done is to twist up the 
ligature as it becomes slack, and in a week or a little more, it is free. I 
do not confine the patient altogether: it is, however, advisable to keep him 
on the sofa for the first twenty-four hours, as erysipelas might arise in a 
bad subject, and also to limit his movements considerably during the entire 
treatment. 
[He remarks, that he has found no strong reason to prefer it to the 
knife, and thinks that the plan of presenting the parts for division upon 
Sir B. Brodie’s probe director, and dividing them with a sharp bistoury, 
is an operation so short, simple, and effectual, as to leave nothing to be de- 
sired. The opinion of Mr. Luke, of the London Hospital, is, that the liga- 
ture consumes decidedly less time in establishing a cure than the knife.] 
Part xi., p. 154. 
Fistula in Ano.—Fistula in ano (blind external) can often be cured 
without cutting, by injecting alcohol the whole length of the sinus, three 
or four times a day, until it brings on inflammation; when that takes place, 
the cure is generally completed in a short time. In full habits, bleeding 
by the arm should be practised, if required, and the bowels opened pretty 
freely, before the alcohol is injected. Should the inflammation become too 
severe, it should be regulated by poultice or cold-water dressings, and low 
diet should strictly be attended to. Part xi., p. 156 
Fistula in Ano.—Abscesses in the ischia-coccygeal space very frequently 
lead to fistula in ano, if they are not its constant cause. Transfix them with 
a bistoury as soon as ever they are detected. Part xvii., p. 173. 
Remarks on Fistula in Ano.—Bransby B. Cooper says: In nearly 
every instance does the disease begin in the rectum and proceed downward, 
arising from some disordered state of the viscus, or perhaps of the viscera 
above ; and when an abscess has once formed in connection with the rec- 
tum, the parts around are kept in a constant state of irritation from the 
escape of gas or fseces. I repeat, it is an extremely rare circumstance for 
an abscess to rise externally to the bowel, and ulcerate through it, although 
I do not deny that this may, and does sometimes happen. Surgeons usu- 
ally in these cases of fistula in ano, search about with a probe, and endea- 
vor to find the communication with the rectum, or to ascertain the extent 
of the fissure. To me, however, this is a matter of very little importance 
and consideration ; for, whether the fistula does or does not communicate 
with the gut, or whatever its extent, the treatment or course to be adopted 
is the same, namely, to divide the fibres of the sphincter ani muscle, and 
thus allow the parts, which were previously under the constant influence 
of muscular action, to remain as much at rest as possible. 
The operation itself is a very simple one, and only requires the exercise 
of a little moderate care and attention. I usually place the patient on his 
hands and knees in bed, or else kneeling across the back of a chair, so as 
to obtain a full view and exposure of the affected part; then passing a 704 
FISTULA. 
director through the fistula as far as the bowel, and along this a probe- 
pointed bistoui-y, I withdraw the director, and take hold of the bistoury 
with either the right or the left hand, according to the side of the anus on 
which I am operating ; next introducing the index finger of the other hand 
into the rectum, and feeling for the point of the bistoury, I press the two 
togethei*, and in that position withdraw them, cutting through rectum, 
sphincter, and all the intermediate parts. It is not requisite or necessary 
to pass the bistoury to the extreme extent of the fistula; on the contrary, 
the division of the sphincter fibres is sufficient to promote the healing of 
the whole fistula. And again, whatever number of fistulae there may be, 
the operation on one will effect the cure of all. I have just one or two 
more remarks to make, in completing this subject, which are of much im- 
poi’tance, in insuring a successful result fi*om the operation. The division 
of the sphincter should be in a direction straight across it, and not too much 
toward the coccygis, or some of the fibres will remain undivided and the 
operation incomplete. And in the female, the division must not be directed 
toward the vagina, or the opposed sux-faces of the wound will be constantly 
subjected to the action of the muscular apparatus of this organ, and will not 
unite or heal. Should you ever meet with a fistula between the vagina and 
the rectum, I, by all means, recommend you to leave it alone ; foi*, if you 
operate on it, the wound you occasion will never heal, and your patient for 
ever afterward be unable to retain her faeces. If you like, however, to 
make an incision, and divide the sphincter ani away from the fistula, I think 
you may, in some cases, be successful in effecting a cure, by removing the 
exciting influence of this muscle. At all events it is worth a trial. 
Part xxiii., p. 167. 
Fistula in Ano treated by the Platinum Wire made red hot by a Gal- 
vanic Battery.—The peculiarity of the method rests principally upon the 
faculty of the red hot platinum wire to divide the textures as surely as a 
bistoury, and to do this without causing any, or but a very trifling hemor- 
rhage. In fistula in ano, for instance, it is found that the charred surfaces 
throw off the eschar in a few days; that the healing process, without the 
aid of lint, commences at the fundus of the wounds, and that the whole 
tract soon closes up. 
The patient brought into the theatre was a man about thirty, who had 
been suffering for some time from fistula in ano. Various means had been 
resorted to in order to promote the healing of the tract, but to no purpose. 
Mr. Marshall therefore determined to lay open the intestine and fistula in 
the following manner: A battery of six strong cast-iron cells, with zinc 
plates and copper connections, was disposed close to the operating table ; 
and the conductors (somewhat thick copper rods, to avoid the loss of gal- 
vanic force), were rendered flexible for about five or six inches, by an elas- 
tic tube filled with mercury. The pole held by the operator’s right hand 
was in immediate connection with the battery, but on the left side the cui*- 
rent could be completed or interrupted by the intervention of a capsule 
filled writh mercury. The extremities of the poles, slightly covered with 
mercury, were then connected with short holders, to which a platinum 
wire could easily be fixed, and when the assistant dipped the left pole into 
the mercury, the wire was seen almost immediately to become red hot. 
Now the great advantage of using the galvanic force in this manner is, 
that the wire may be disposed upon the aflected parts whilst cold; it is FISTULA. 
705 
easily adapted by being flexible, and when it is so placed as to answer the 
operator’s purpose, the circuit is completed, and the effect produced in the 
direction which the surgeon gives to the wire. 
The patient having been put under the influence of chloroform, Mr. Mar- 
shall introduced one end of the platinum wire into the fistulous tract, and 
made it reappear at the anus ; the two ends were then connected with the 
poles, the circuit completed, the wire became red hot, and was gently 
brought downward, dividing all the interposed tissues, and cauterizing 
them at the same time so effectually as to prevent any amount of hemorr- 
hage. The only dressing used was a piece of lint dipped in cold water, 
applied externally. 
Mr. Marshall has found from previous cases, both in private and hos- 
pital practice, that the whole tract heals very rapidly from the bottom 
after the casting off of the eschar, which separation generally takes place 
in a few days. 
Mr. Marshall thought that the method just described would eventually 
be peculiarly applicable to fibrous tumors of the uterus, and stated that he 
is having a battery constructed, where the cells would be managed in such 
a manner as to be quite ready for use by being dipped into the diluted 
acid; that the apparatus might then be put entirely out of the patient’s 
sight by being placed under a seat or sofa, and that nothing but the con- 
ductors need be seen. 
Mr. Marshall first used the galvanic force in the manner above described, 
in a very obstinate case of fistulous opening in the cheek of a young man, 
which had refused to cicatrize under every imaginable kind of treatment. 
As the tract was about one inch and three quarters long, and somewhat 
sinuous, a wire heated in the usual manner must get almost cold before it 
reached the whole extent of the tract; this objection was, however, en- 
tirely removed by the use of a wire introduced cold, and then heated by 
the galvanic battery. The success obtained in this latter case, which had 
almost been despaired of, was the first step in the series of cases which 
Mr. Marshall has since treated with very favorable results. 
Part xxiii., p. 315. 
Fistulce— Use of Nitric Acid.—[The frequently unfortunate and unsa- 
tisfactory results of the operation for the cure of fistula in ano, suggested 
the following plan to Mr. Evans :] 
A blunt-pointed silver probe, five inches in length (the sinus itself in this 
case being four inches in depth), was inserted into the wound, having pre- 
viously been dipped in dilute nitric acid (one part of acid to one part of 
water), and suffered to remain there a minute. That this had a strong 
cauterizing effect, I knew from the pain it occasioned. Thus far the result 
was desirable; but in consequence of the destruction of the silver probes 
by the acid, and the impossibility of using them more than three or four 
times; I had some copper ones made, and using them in the same manner, 
only thus substituting a nitrate of copper for a nitrate of silver, and I think 
with a better effect. Under this treatment I was pleased to see the depth 
of the sinus daily decrease by the gradual filling of it with healthy 
granulations ji'om the bottom. This was continued nearly every day for 
two months. The patient is at the present time perfectly sound. 
Part xxiv., p. 211. 
Fistula in Ano.—Mr. Curling remarks that when the fistulous opening 706 
FISTULA, 
in the rectum is more than an inch and a half above the external sphincter, 
the division cannot be made without risk of dangerous hemorrhage, and in 
such cases recommends the employment of ligature in preference to divi- 
sion by the knife. Part xxiv., p. 212. 
Fistula in Ano.—Make a paste of chloride of zinc, with flour and water, 
and this being entangled in a grooved probe, pass it up to the opening in 
the rectum. The point of a second probe or instrument is then to be placed 
in the groove and passed just sufficiently high, that by being retained in 
that position while the armed probe is withdrawn, the groove may be 
cleansed of the paste. This may be repeated every second a: third day. 
Part xxvi., p. 194. 
Fistula in Ano.—After the incision of fistula, to prevent the edges of 
the wound from uniting, touch them with the nitrate of silver. By this 
plan there is no necessity for interposing tents, lint, or other material. The 
application may be made at first every, and then every other morning. 
Part xxvii.,y>. 143. 
Fistula in Ano.—Wherever a fistula has existed six weeks or two 
months, you must suppose that an internal opening exists. The tract that 
leads to it may be tortuous, but you must search for it again and again. 
You may introduce a bent probe up the fistula, and bring it out at the 
anus, and then cut out the probe, if you like, with the bistoury. The in- 
tervening parts are generally very superficial. 
A piece of lint is placed in the wound at the time of the operation, and 
the only other dressing required is washing the part occasionally with 
soap and water for a few days. Part xxxi., p. 156. 
Fistula in Ano.—After the division of the sphincter, there is often a 
relaxed condition of the part, so as to allow the rectum to protrude for 
several inches. The best treatment for this is the application of nitric 
acid; but the prolaption may be entirely prevented taking place, by apply- 
ing the nitric acid around the margins of the sphincter on the fourth day 
after the operation, and before the relaxation takes place. 
Part xxxii., p. 151. 
Fistula in Ano.—The best injection for this consists of half a drachm 
of the nitric oxide of mercury, and half an ounce each of mucilage and 
distilled water. 
To avoid the danger of wounding the finger, when penetrating the 
bowel with the bistoury, introduce a glass-plated speculum, having an 
incisura half an inch wide, and extending two and a half inches from the 
orifices of the instrument and the bowel. Cut down upon this along a 
director, with a sharp-pointed bistoury. Part xxxiv.,p. 163. 
Fistula in Ano.—By the ordinary means used in the cure of this funda- 
mental nuisance, confinement to the house, if not to bed, is generally ne- 
cessary. The ligature may be used with the greatest advantage when it is 
desirable that business should not be interrupted. The instruments required 
are two very fine silver probes seven inches long; one probe blunt, the 
other sharp-pointed atone end, and both perforated at the other. Having 
previously prepared your patient by administering an aperient, introduce 
the blunt-pointed probe, armed with silk, into the external opening of the 
fistula, pass the index finger into the rectum, search for the opening, seize FISTULA, 
707 
the extremity of the probe (wuich is easily bent), draw it through the 
anus, and, tying the ligature, you complete the operation. Three cases 
are related; in the first, the ligature came away in fourteen, in the second, 
in twenty-one days. In one case it is mentioned that the patient, a 
professional man, during the process of cure, continued to discharge the 
greater part of his duties without intermission. Part xxxix., p. 183. 
Use of the Ecraseur.—-The ecraseur is peculiarly useful in the treatment 
of anal fistula, especially when we have to do with the severer forms of the 
disease occurring in broken-down or debilitated constitutions, in whom we 
find, along with the local disease, a strong tendency to, if not the actual 
existence of organic lesion. The form of instrument made by M. Char- 
riere is preferable to that originally introduced; one end of the chain is 
fixed and the other is tightened by a nut, working on a fine screw, each 
turn of which brings in one tenth of a link; thus the process of crushing is 
smooth, and perfectly free from jerking or laceration. The only difficulty 
experienced is in the introduction of the chain, but this may be readily 
accomplished by first passing a piece of silk cord, by means of an eyed 
probe, bent to a proper curve. By means of the cord so passed, the chain 
may be readily introduced. Part xxxix., p. 184. 
Double Fistula in Ano.—Avoid multiple divisions through the sphinc- 
ter ani, as there is no doubt but that if there are two or more divisions of 
the sphincter muscle, subsequent union does not admit of such an amount 
of control over its functions as when only one is made. In some cases, the 
skin between the two fistula; may be divided, and then this common cavity 
connected with the gut by a single division of the sphincter. Part xl .,p. 113. 
Fistula and Sinus.—Many or most cases of fistula in ano and sinus 
from other causes may be cured by injection with a small quantity of a 
very strong solution of iodine, and this mode of treatment, though not 
superseding the use of the knife, should be tried before having recourse to 
the latter. The solutions used may be 5ss., 3j-, or 3ij- to the ounce of 
spirit of wine, with a little sulphuric ether as a quick solvent of the iodine, 
or if it is not wished to keep so large a quantity ready prepared, from gr. 
iiiss. to gr. xv. may be dissolved in 3j. of sulphuric ether, just when a case 
requires the treatment. A very fiile gold nozzle may be fitted to Dr. 
Alex. Wood’s hypodermic injection syringe, and you have everything com- 
plete. Supposing it to be a case of fistula in ano, you would proceed as 
follows: First clear out the fistula by injecting with a little plain tepid 
water, then, having dilated the rectum with Weiss’s female dilator, and 
inserted a little cotton-wool into the rectum to absorb any superfluous in- 
jection, and so preserve the rectal mucous membrane, insert the nozzle of 
the syringe, previously charged with the stronger injection, into the fistula 
a little way, and inject about 30 minims into the part. A suppository con- 
taining half a grain of morphia may then be introduced, and the operation 
is complete. Dr. Skinner describes it as an operation which in his hands 
has rarely failed. Part xl., p. 114. 
After pointing out the necessity for freely dilating the natural pas- 
sage, before the fistula can have a chance of closing, Sir Benjamin 
Brodie adds his latest experience. “ I formerly,” says he, “ have 
advised the patient never to void his urine without the aid of the 
FISTULA IFF PERINEO. 708 
FISTTJLJS. 
catheter ; but I am now inclined to believe that the irritation thus kept 
up tends, on the whole, to delay rather than to expedite the cure. At 
other times I have kept the patient in bed for some weeks, with an elastic 
gum catheter constantly in the urethra and bladder; but I cannot say 
that, with my present experience, I have much more faith in this mode of 
treatment than in that which I mentioned before. After a few days the 
urine generally begins to flow by the side of the catheter, which does not 
therefore answer the purpose for which it was introduced, of preventing 
its escape by the sinus. Then, in many cases, the catheter causes an 
abundant suppuration of the urethra; and the purulent discharge, finding 
its way into the sinus, prevents it from closing as much as it would be 
prevented by the contact of the urine 
Blind Fistula in Perineo.—Sir Benjamin Brodie advises the following 
method of treatment: Watch for the opportunity when matter is collected 
in it, and then establish an external opening by dividing the integuments 
over it with a lancet, so as to convert it into a fistula of the ordinary 
kind. There are some of these cases, however, the treatment of which 
requires a more particular explanation. A patient may apply to you who, 
perhaps, has had gonorrhoea formerly, followed by a slight obstruction 
of the urethra, complaining at the same time of a discharge from 
the urethra, which he calls an obstinate gleet. You examine the 
perineum, and you find in it a small tumor, not larger than a horse-bean or 
filbert. It is at some distance from the surface, and the patient says that 
it has been coexistent with the gleet, and that it is sometimes inflamed 
and tender. Now this little tumor indicates the existence of a blind 
fistula. There is a small orifice in the urethra, and a narrow channel 
leading from it into the centre of the tumor; and every time that the 
urine flows, a very small quantity finds its way into the channel, escaping 
from it immediately afterwards by regurgitation into the urethra. In 
consequence of the smallness of the cavity, and the quantity of solid 
matter deposited on its outside, the fluctuation of fluid in it is not per- 
ceptible. I have known this state of things to continue, producing more 
or less occasional inconvenience for many years. The first thing necessary 
to the cure, is to make an opening in the perineum leading into the cavity 
iu the centre of the tumor. But this’may not be very easily accomplished, 
on account of the smallness of the cavity. You should introduce the 
lancet somewhat obliquely, so as to divide the tumor as nearly as possible 
through its centre. Then introduce some lint, so as to prevent the wound 
uniting by the first intention. After three or four days you may remove 
the lint, and then you will ascertain whether you have done what was 
required, by observing whether, when the patient voids his urine, any 
portion of it flows through the opening which you have made. If this be 
the case, nothing further is required than that the stricture should be 
dilated in the usual way. If, however, no urine flows through the open- 
ing, you may proceed thus : introduce a piece of caustic potash through 
the wound into the centre of the tumor, so as to make a considerable 
slough. A portion of the tumor being thus destroyed, the probability is 
that, when the slough has separated, it will be found that the central 
cavity is exposed, and that you have accomplished the object which you 
had in view. Part vi., p. 100. 
Perineal Fistula.—If the application of caustic or the actual cautery 
fail to keep the orifice raw, so that the granulations cannot close it, a talia- 709 
FISTUL2E. 
cotian operation should be tried, as modified by Dieffenbach, which con- 
sists in not turning the flap round or bring the edges together, but of 
separating two little lateral flaps from the penis, at the sides of the fistu- 
lous opening. 
If calculi are passing through the urethra, and lodge in front of the 
scrotum, endeavor to draw them forward to the orifice, which, by a little 
enlargement, will alloAV them to come out. If not able to be brought 
forward, try to pass them back, so as to cut on them in the perineum 
behind the scrotum. Part xiv., p. 219. 
Perineal Fistulce.—These are sometimes very troublesome to heal. If 
the actual cauteiy fail, the injection of acetum lyttJB twice a week will 
often procure perfect closure. Part xxxiii., p. 209. 
Perineal Fistula.—If it does not depend upon stricture, touch the edges 
of the opening with a solid stick of nitrate of silver every second day; in the 
course of a few weeks, if the patient be otherwise in good health, it will 
gradually heal without any other means whatever. Part xxxv.,p. 134. 
RECTO-URETHRAL FISTULA. 
Curious Case.—[A man, fifty-nine years of age, had been for some time 
subject to difficulty in voiding fasces, and found that flatus and feculent 
matter passed by the urethra. On examination a stricture was found 
about three inches up the rectum, and it was supposed that there was 
a fistulous communication between the rectum and the membranous por- 
tion of the urethra. By Sir B. Brodie’s advice no treatment was adopted 
except the daily passage of a rectum bougie. Mr. Giraud says:] 
An improvement slowly took place in the state of the rectum, and of 
late the calibre of the gut has become almost restored to its natural size, 
fistulous communication between the rectum and the urethra remains the 
same, and a few weeks ago an unusual irritation was felt in the urethra, 
and very soon something alive made its appearance at the orifice; the 
patient removed it with his finger. On placing it in a wineglass half filled 
with warm water, the movements it exhibited showed great activity, and 
by the alternate contraction and dilatation of its rings, and the protrusion 
of a vaginated proboscis, it soon arrived at the edge of the glass. It 
appears to be a species of echinorhyncus. Questions may arise, whether 
a similar creature to this might have occasioned the fistulous opening 
Detween the rectum and the urethra, and whether the stricture in the gut, 
Avhich is now nearly at an end, might not have originated from the local 
irritation. Part xvii., p. 172. 
RECTO-VAGIXAL FISTULA. 
[Speaking of cases of fistulous opening between the rectum and vagina, 
Mr. Cooper says:] 
I am acquainted with a case in which a lady was the subject of this 
lesion; and, after every attempt had been made to sew up the fistulous 
openings of rectum and vagina, and other plastic operations had been 
ineffectually resorted to, Mr. Copland restored the patient to health by 
the mere division of the sphincter ani, which not only prevented the 
retention of the fieces within the rectum, but, at the same time, precluded 
the necessity for the action of the levator ani muscle. The contents of 
the rectum, no longer meeting, therefore, with any obstruction to their. 710 
FISTULA. 
passage from the anus, had no tendency to pass into the vagina, the fissure 
in which immediately healed. 
A lady was lately under my care, who was the subject of a fistulous open- 
ing from the rectum into the vulva, through which the fleeces in part escaped. 
The mode I adopted was, to divide the fibres of the sphincter ani mus- 
cle, and pass a probe covered with potassa fusa through the sinus, so as 
perfectly to destroy the mucous surface of the fistula. As the granula- 
tions thus produced did not seem to fill up the opening, I brought the 
surfaces of the fistula in contact by means of a ligature, which came away 
in a few days, and the opening into the vulva was much diminished, but 
still the communication between the two organs was not obliterated. I 
then daily applied the tincture of lytta to the granulating surfaces, and 
the lady left London, although it could not be said perfectly cured, with 
the prospect of the granulations becoming ultimately converted into per- 
manent tissue. 
These cases, as well as those of lesions between the bladder and vagina, 
are most difficult to cure; and I believe that, unless the division of the 
sphincter ani itself promotes their obliteration, although other means may 
be somewhat accessory, they are never sufficient to produce cure. My 
colleague, Dr. Lever, has had several cases of recto-vaginal and vesico- 
vaginal fistulae, which he has attempted to obliterate by plastic operations, 
and by sutures, caustic, and actual cautery: the result of liis experience 
is, however, that very few persons are ever permanently cured, although, 
by means of actual cautery, he has frequently reduced the abnormal 
openings to the size of a pin’s head, but I believe that only in one or two 
cases has he succeeded in producing a permanent cure. Part xviii., p. 198. 
v Fistulous Communications between the Pectum and the Vagina.—The 
extremity of the septum between the vagina and rectum occasionally 
becomes lacerated in labor, the patient being afterward unable to retain 
her faeces. The cure of this distressing infirmity may be effected by 
paring the edges of the gap, and, after division of the external sphincter 
on each side, bringing them together with sutures, which should be tied 
in the vagina. An opiate afterward will keep the bowels at rest for two 
or three days, and the sutures may be taken out on the third day. The 
operation does not always succeed, but the double division of the sphinc- 
ter much lessens the chances of failure. Part xxiv., p. 212. 
URETHRAL FISTULA. 
At a meeting of the Academie de Medecine, M. Ricord presented 
a patient whom he had cured of a urethral fistula, situated at the 
inferior part of the penis, by means of an opening made into the 
membranous portion of the urethra, through which he introduced a 
catheter into the bladder. This catheter he allowed to remain-: and when 
the urine had ceased to flow through the primary fistula (which was not 
till after two months had elapsed), M. Ricord revivified its edges, and 
then united them with sutures. When the union was completed, the 
urine again took its normal course, and the opening made in the perineum 
soon after cicatrized. Part iv.,p. 106. 
Fistula— Urinary.—Distinguish that arising from a local cause, from 
that depending on constitutional states. In the first form, cure the stric- 
ture, which is usually the cause of the disease, by introducing a catheter FISTULA 
711 
every two or three days; if this fail, lei it be worn constantly ; then try 
what effect its removal has; lastly, resort to operation, either by passing 
a staff down to the stricture, cutting down on the staff, and then dividing 
the stricture, or by dilating the fistula till we can pass a small gum cathe- 
ter into the bladder, and then proceeding with the further steps of the 
operation; or by careful incision into the urethra behind the stricture, 
followed by the division of the latter. In the second, or constitutional 
form, restore the general health, and as local treatment, direct the patient 
to make pressure upon the fistula when he makes water; or introduce the 
catheter cautiously and at long intervals. Part xvi.,y>. 196. 
TJrinary Fistula.—In a great number of cases, nothing else is required 
than to dilate fully the urethra, and the fistula; will heal of themselves; 
there need be no meddling with them—the less they are touched the bet- 
ter. But in weak constitutions, or when the fistula passes through much 
indurated tissue, we must improve the general health by good diet, tonics, 
and cod-liver oil; and, locally, we must stimulate the walls of the fistula, 
so as to bring about adhesion of opposing surfaces, by applying a strong 
tincture of cantharides, by means of a camel-hair pencil, or by touching 
with a probe coated with nitrate of silver. If these fail, lay them open, 
so that they may heal up soundly from the bottom. Part xxxiii., p. 196. 
Urinary Fistulce.—If the opening be small, and situated in front of the 
scrotum, you will often succeed in closing it by the application of strong 
nitric acid to the edge of the fistulous orifice and upon the skin around it, 
even when the hare-lip operation has failed. It may be applied several 
times in the course of several months. Nitrate of silver, or strong tinc- 
ture of cantharides, has been successfully employed in the same manner. 
The tincture of cantharides may be applied three or four times in twenty.r 
four hours: the loose cuticle should then be scraped out and the tincture 
again applied ; this must be occasionally repeated, until the granulations 
appear healthy, and bid fair to close the aperture. 
Dieffenbach’s method of treating these fistulous openings, when small, 
was to pass a large catheter into the bladder, to revive the edges of the 
opening, to detach the skin from the subjacent structures for half an inch 
in every direction, and to bring the free borders together in the median 
line by means of the twisted suture. This done, two incisions were made, 
one on each side, to relieve tension. This plan he afterward modified by 
dissecting beneath the skin from the outlying lines of incision toward the 
fistulous opening, so as to convert the part into a bridge, which might 
avoid contact with the urine which escaped along the course of the cathe- 
ter. Success cannot be expected if the fistulous opening be more than 
one-third of an inch in any direction. M. Nelaton prefers to make the 
outlying incisions about an inch above and below the opening, which is 
supposed to afford a better chance for the urine to escape. Again, he has 
proposed not to close the openings by sutures at all, but to allow it to 
contract by itself. Part xxxiv., p. 177. 
URETHRO-VAGINAL FISTULA. 
In cases of this kind, when the usual modes of treatment fail,, 
the galvanic cautery may be very useful; it possesses many advan- 
tages over the ordinary red-hot irons, and can be very readily applied.. 
An ordinary battery is placed on a chair by the side of the bed; the 
two wires are then arranged, and when the circle is completed, the 712 
FISTULA. 
coil or bead of platinum at the end of the wire will be of a white heat. 
The speculum being introduced, the edges of the fistula must be touched 
with the little pea of fire. It will not produce the least pain, which is the 
advantage of employing a white heat. Part xxxii., jt>. 240. 
Urethro-Vaginal Fistula.—[In the case which was the subject of the 
present operation, the last confinement, twelve weeks before admission to 
the Samaritan Hospital, under the care of Mr. Spencer Wells, had been 
severe and tedious.] 
Since the labor the woman had been quite incapable of retaining any 
urine; and her labia, perineum, and thighs were much excoriated by the 
constant dribbling. On examination, a fistulous opening, hardly admitting 
a uterine sound, and just admitting a No. 3 catheter, was found, an inch 
or rather more from the meatus, establishing a communication between 
the vagina and bladder, or rather with the urethra just at its junction 
with the neck of the bladder. The opening was situated at the bottom 
of a deep fold of the vaginal mucous membrane. The edges were formed 
of flabby reddish granulations. These Mr. Wells removed, in order to 
make the surface to be brought into apposition even and smooth, and 
then passed a silver wire suture by means of an ordinary curved needle 
through the vaginal mucous membrane, carrying it down to the mucous 
membrane lining the urethra, but without perforating this membrane. 
The wire was bent until the edges of the opening were closely approxi- 
mated, fastened by a split shot, and the ends were cut off. Mr. Wells 
thought that the presence of a catheter in the urethra quite as likely to 
do harm as good, and preferred trying at first what the effect of simple 
suture would be. The woman was not confined to bed. A vaginal 
douche of cold water was ordered night and morning. 
The effect of the little operation was immediate. The woman at once 
recovered the power of retaining her urine, although only for a short 
time, for the first day or two. On the fourth day she said she could re- 
tain it for three or four hours. Mr. Wells removed the suture on the 
sixth day, and found the fistula perfectly closed. The cicatrix, though 
delicate, was quite perfect; and the patient said her power of retaining 
and passing the urine was as complete as it ever had been. 
This is the second case Mr Wells has met with in which a single suture 
sufficed for the cure of a very small fistula near the meatus. In the first 
case a silk suture was used, which was left to cut itself out—a catheter 
being kept in the bladder for several days. 
The application found most generally useful at the Samaritan Hospital 
in relieving the excoriation which is so distressing in these cases, is a mix- 
ture of equal parts of zinc ointment and glycerine. Part xxxviii., p. 162. 
UTERO-VESICAL FISTULA. 
Mr. Harrinson has met with a case of a disease mentioned in 
books, but not described, as utero-vesical fistula. The patient was forty- 
one years of age, and had been delivered of her last child, the seventh, 
five years before. The labor was severe and protracted, and instru- 
mental aid required to complete it. Retention of urine followed, for 
which the catheter was required for thirteen days. She then felt some- 
thing give way—and the urine flowed away, and continued to do so for 
upward of five years. The horrors of her condition during this period are FISTULJS. 
713 
indescribable. Day and night the urine dribbled away; not a drop passed 
through its natural outlet; while the quantity of secretion was augmented 
by the constant irritation. Sleep was almost denied her; three or four 
times a night had her dripping garments to be changed. On repeated 
examination by various surgeons, no fistulous opening could be discovered, 
and incontinence from weakness was, therefore, supposed to be the cause. 
Mr. Harrinson suspecting the cause, examined her with the greatest care, 
but without success. But one day, exploring with a catheter in the bladder, 
concavity downward, and a finger in the os uteri, the two came into contact. 
A communication between the fundus of the bladder and the uterus was 
thus discovered, large enough to admit with ease a No. 0 male catheter. 
It occurred to me to inquire what would be the eflect of a skein of silk 
passed through the opening, allowed to remain there a certain time, tem- 
porarily to stop, and produce a degree of inflammation sufficient perma- 
nently to close its orifice. And, also, whether this desirable termination 
would not be most materially facilitated, when that irritation had been 
produced, by withdrawing the threads one by one, with a few days’ inter- 
val, that the orifice might gradually contract around the threads. That 
they should be reduced in size also, as well as number; so that at last 
there might be nothing left to contract around, and the orifice be entirely 
obliterated. The more solid tissue of the uterus, rather than the lax tex- 
ture of the vesico-vaginal septum, perhaps favored the attempt; while the 
facility of imbuing the threads with any triable sanative application in- 
creased the possibility of success. With this end in view, I jnoceeded to 
operate in the following manner: A Brodie’s catheter, armed with a long 
piece of twine, was introduced into the bladder, concavity downward, and 
being guided by a finger within the os uteri, I readily found the rupture, 
passed the instrument through into the vagina, seized the thread, and then 
withdrew the catheter; thus leaving one end of the twine hanging from 
the urethra, and the other from the vagina. To the urethral extremity I 
tied a skein of six threads of glover’s silk, oiled them, and drawing at the 
vaginal extremity, dragged the silk through the fistula, and then tied the 
urethral and vaginal ends together. 
[During the three subsequent months, the size of the thread was changed 
three times, until it was reduced as small as was compatible with strength 
and durability. Mr. II. now endeavored to close the orifice entirely. He 
therefore withdrew the last thread, just after the irritation of the menstrual 
period had ceased, when it seemed probable that ultimate union would 
take place, if ever it did. The experiment was unsuccessful; in twenty- 
five days the dribbling was as bad as ever, and he was compelled to intro- 
duce four large threads, which were soon reduced to one, which she still 
wears. No inconvenience is produced by it; it merely requires to be drawn 
down once a day to cleanse it, and for the last three years, by the use of 
this simple remedy, not a drop of urine has escaped.] Part xii., p. 223. 
VESICO-VAGINAL FISTULA. 
Dr. Keith, of Aberdeen, has had a very singular case, which may 
be the means of suggesting some practical improvement in those 
cases in which all the ordinary methods have failed. His patient had 
such a large fistula of this kind, that for seven years she plugged 
it up with a pint bottle cork, and was thus enabled to pass her time 
with comparative comfort. The cork, however, at last slipped into 714 
FI8TULJS, 
the bladder, and the urine again passed through the orifice. After a time, 
however, she began to suffer from symptoms of stone, and this body seemed 
to act like a bullet valve to the fistula, for the urine again began to pass by 
the urethra, and the fistula in about nine months became considerably con- 
tracted in diameter. She suffered so severely from the stone, however, 
that it was necessary to crush and evacuate it. The urine again passed 
through the fistulous orifice, which, however, had become sufficiently small 
to allow of a button-headed cautery, at a white heat, to be applied so as to 
cause a slough, including the edge of the false opening all round. This 
checked the passage of urine, and in six days the cautery was reapplied, 
, and again in sixteen days. In three weeks there was an oozing of urine, 
and the cautery was again applied as before. This cured the case com- 
pletely. From observing the peculiarities of this case, Dr. Keith suggests 
that in those large fistulous orifices, which are too wide to expect success 
from cauterization, we should employ some artificial bullet-valve of a 
smooth and unirritating nature, and of sufficient weight to keep the orifice 
blocked up from the bladder, so as to favor the contraction of the edges 
of the wound, and for this purpose he recommends a small thin bulb or 
bag of India-rubber, filled with mercury. Should incrustation happen in 
the progress of the cure, a squeeze with a screw litliotrite, or percussor, or 
a long oesophagus forceps, would throw it off, and at last when the opening 
had contracted to such a size as to admit of its ready cure by the cautery, 
the thin bag could be easily burst or punctured, and then withdrawn by 
the urethra. 
In a former article we referred to Mr. Liston’s practice of allowing a 
long interval to elapse between each cauterization, in order to give the 
parts after each operation a fair chance of contracting as much as possible: 
and we know, from examples of burns, to what a long period contraction 
may be continued if left alone. This, however, will be chiefly required 
when the orifice of the fistula is large, as in the above case of Dr. Keith’s; 
and we think that if his suggestion could be carried out, a great deal of 
time and misery might occasionally be saved ; as it will be seen that in his 
case a fistula contracted in less than nine months from the size of a pint 
bottle cork to that of a No. 16 bougie. Part ix., p. 119. 
Autoplastic Operation for Vesico-Vaginal Fistula.—M. Jobert has 
proposed and executed successfully a new plan for the cure of this distress- 
ing malady. The occlusion of such fistulax by means of autoplastic opera- 
tions is necessarily attended with great difficulty, and in the hands of most 
surgeons would probably fail in the great majority of instances. The 
method now proposed by M. Jobert is termed “ autoplastic par glisse- 
ment.’>’> It consists in loosening the connections of the posterior wall of the 
bladder by means of an incision made through the mucous membrane 
across the anterior part of the cervix uteri. In the words of M. Jobert— 
“ This operation consists in making a semicircular incision across the ante- 
rior part of the cervix uteri, at the point where the latter is joined by the 
vagina. The dissection is made from below upward, and the edge of the 
bistoury is kept directed toward the cervix, so as to protect the bladder 
from danger. Immediately after this incision and the dissection, which 
easily isolates the base of the bladder, retraction of the anterior portion of 
the vagina takes place, and displacement forward of the posterior region 
of the bladder. The apposition and re-union of the edges of the fistula 
then become easy; and thus the reparation of a very lai’ge breach may be 715 
FISTULA, 
accomplished.” The edges of the fistula, which are then found to approxi- 
mate each other much more easily, are pared and united by suture. A 
catheter is to be retained permanently in the urethra for the first two or 
three days, and is afterward to be very frequently introduced to prevent 
any accumulation of urine in the cavity of the bladder. Part xv., p. 233. 
Treatment of Vesico- Vaginal Fistula by Creasote.—A vesico-vaginal 
fistula, subsequent to artificial labor, having been treated with lapis infer- 
nalis seventeen times without any success, Emert proceeded to remove the 
gangrenous scab produced by the last cauterization, after which he touched 
the fistular opening to a great extent by means of a pencil-brush immersed 
in creasote. The success was most surprising. The new scab was so firm 
as to enable the patient to retain her urine the whole day, and to micturate 
without becoming moist. The detachment also occurred much later than 
after the application of other caustics, and when efiected, the urine flowed 
in far less quantity from the somewhat diminished fistula. A second appli- 
cation of creasote, six days afterward, induced a perfect cure of tlxe fistula, 
and no urine has passed from it during two months which have since 
elapsed. A fortnight after the last cauterization, Emmert found the fistula 
perfectly cicatrized, its previous existence being marked only by a bluish 
red streak, two lines in length. He therefore declares creasote to be the 
best application in such cases, the nitrate of silver being too feeble, and the 
concentrated acids too energetic in their action. Part xvi., p. 201. 
Vesico- Vaginal Fistulce—Galvanic Cautery.—Having exposed the open- 
ing by a proper speculum, Mr. Marshall applied the galvanic cautery, at a 
white heat, over the whole of the exposed edge. The operation was re- 
peated seven times, at intervals varying from three to eight weeks. The 
opening would originally have admitted three fingers, but after every 
operation the size gradually diminished, until at length the patient could 
fulfill her duties comfortably. Part xxviii., p. 273. 
Vesico-Vaginal Fistula.—Place the patient under chloroform, and in 
the position for lithotomy. The legs being held by assistants, and the 
sides and back of the vagina being held back by retractors, bring the fistu- 
lous opening into view. This will be aided by seizing the bladder just at 
the junction of its neck with the body, and holding it firmly upward and 
forward. The margin of the opening, for about the eighth of an inch in 
depth, must now be divided completely round with a sharp knife. Three 
or more silver wires, about eighteen inches long, are now to be passed by 
means of the porte-aiguille, and brought together by the instrument, thus 
leaving the parts in apposition. A silver button must then be carefully 
passed over the end of each double suture, and a perforated shot passed 
over each Avire and pressed down upon the button, and then firmly pressed 
by a pair of long strong forceps. The wires must then be cut off close to 
the shot. Place the patient in bed, on a water cushion, on her side, 
with a catheter inserted into the bladder and allowed to remain there. 
Opium, with generous diet and wine, will be required. Part xxxv.,p. 226. 
Vesico-Vaginal Fistula.—Support the patient as if on her hands and 
knees. Expose the vagina by Dr. Sims’s retractor, make a curved cut 
through the mucous membrane of the vagina one-third of an inch behind 
the posterior border of the opening into the bladder; the mucous mem- 
brane behind this cut must be raised, so as to form a flap half an inch 
deep; the ends of this cut are connected by another similar one, about 716 
FISTULJ3. 
one-third of an inch in front of the opening into the bladder, and a similar 
narrow flap raised by dissecting the mucous membrane forward. The 
mucous membrane circumscribed by these two cuts should then be 
removed, by which the opening into the bladder will be enlarged, and 
surrounded by the reflected flaps of the mucous membrane of the vagina. 
The apparatus for union is that recommended by Dr. Marion Sims, which 
consists of two bars, with shot clamped on the wires. When the flaps are 
brought together, they form an upraised ridge, which extends quite 
across the front wall of the vagina. A curved self-retaining catheter is 
then adapted on Dr. Sims’s plan, which does not irritate. The patient 
should lie on her side. Part xxxv., p. 228. 
Vesico- Vaginal Fistula.—The best time at which to perform any ope- 
ration for its cure is within three months, for after this time the edges 
take on an unhealthy action and become indurated, so that they do not 
readily adhere; the bladder also loses its capacity for dilatation if not early 
remedied. To obtain a raw surface, Mr. Baker Brown pares away the 
mucous membrane from the margin of the fistula, and also from the sur- 
face of the vagina. Dr. Pancoast’s plan is to split the posterior border of 
the fistula to the extent of half an inch, and to pare the anterior into a 
wedge-shaped tongue, which is inserted into the groove made by splitting 
the posterior border. A modification of these, which we recommend, is to 
split the entire margin of the fistula all round to the extent of three or 
four lines, to open the flaps out, and bring them together by the quilled 
suture. The needle, armed with a double ligature, is first passed deep 
through the anterior flap, then through the posterior flap, and withdrawn, 
leaving the ligature to which the quill or bougie must be attached. The 
points to be noticed in this operation are, 1. To split the flaps into healthy 
areolar tissue. 2. To pass the ligatures sufficiently deep. 3. Not to tie 
the ligatures too tight. 4. To get rid of the urine so soon as secreted, 
by keeping Sims’s S-shaped catheter always in the bladder. 
Part xxxv., p. 229. 
Vesico- Vaginal Fistula.—When ligatures are used in operations for 
this disease, penetration by them of the vesical mucous membrane must be 
carefully avoided. Part xxxvi., p. 239. 
Artificial Cuticle.—A mixture of collodion and castor oil may be used 
with great success when the skin is abraded by irritating fluids, as urine, 
in cases of vesico-vaginal fistula. In these cases it may be spread over the 
excoriated skin of the perineum and thighs; it forms a smooth elastic coat- 
ing or varnish which resists the action of the urine for many hours. 
Part xxxvii., p. 182. 
Vesico-Vaginal Fistula.—The greatest improvement in these, as in 
other cases requiring sutures, consists in using wire sutures instead of silk 
or thread. Wire does not cause inflammation beyond the adhesive ; silk 
and thread cause suppuration ; thus pus is absorbed by the thread, and 
increases the mischief. A bullet or wire may remain for months without 
causing suppuration. Some surgeons use silver wire, but the common blue 
iron-wire of the shop>s is the best. It is the annealed iron wire known as 
No. 32. It does not rust. It should be of a very fine kind for surgical 
purposes. Part xxxix., p. 296. 
Vesico-Vaginal Fistula.—In performing the operation for the cure of 
this affection, Dr. Simpson recommends the patient to be placed on her FISTULA 
717 
elbows and knees, or simply on her left side, and the use of a duck-bill 
speculum, by which a flood of light is thrown upon the exposed fistula. 
For paring the edges of the opening, he uses a straight spear-shaped knife 
alone, and in using it gives the advice that the edges be levelled off to a 
considerable distance from the vesical margin, so as to leave as large a 
surface for adhesion as possible—doing this very slowly and carefully, 
seeing that the least bit of mucous membrane would prevent the much- 
desired union by the first intention. For passing the iron-wire thread 
sutures, the needle used is hollow, and the wire, after the passage of the 
needle through the lips of the fistula, is pushed through the tube, and 
seized by forceps; the tubular needle is then withdrawn. The needle 
should be entered from below, and made to emerge above, nearly half an 
inch on either side of the opening, in order that the edges may be held 
strongly and steadily. The vesical mucous membrane must never be per- 
forated by the sutures. To consolidate the lips of the fistula and surround- 
ing parts, and keep them perfectly at rest, use an iron-wire splint made by 
twisting together ten or fifteen strands of the iron-thread into a cord, the 
ends of which are then doubled over each other, and plaited round into an 
ovoid or circular form. A number of openings are made among the 
threads by a boring instrument, through which the ends of the sutures are 
passed and the splint passed up to the opening and there firmly applied, 
the sutures being twisted together and cut off short. Dr. S. considers 
this preferable to Bozeman’s button suture, as it precludes both longitu- 
dinal and transverse movement in the wound, whilst Bozeman’s allows of 
slight transverse motion. This splint is removed about the ninth or tenth 
day. In the after-treatment much stress is laid upon the administration, 
for some time, of such doses of opium or morphia as shall suffice to keep 
the patient fully under the influence of the drug. Part xxxix., p. 298. 
FISTULOUS OPENINGS. 
Cheek, Fistulous Opening in.—In a case of this kind, a platinum wire, 
heated by electricity, was passed through the fistulous opening so as to 
produce a slough. This caused little pain, and ultimately produced a cure 
of the disease. Part xxiv., p. 204. 
Fistulous Openings about the Jaws and Feck.—In sores and fistula} in 
this situation, always carefully look out for old carious teeth; sometimes 
an old stump, with or without a sharp fang, will be causing all the mis- 
chief, and by extracting this, the sore will heal rapidly 
These are frequently connected with carious teeth, and are never 
cured until the irritating body is removed; but they may also be from 
the irritation produced by wisdom teeth, when there is scarcely room for 
them ; in these cases, the remedy is, to remove the second molar, and the 
opening soon heals up. Fart xxxv., p. 95. 
Fistulous Opening in the Testicle.—W. H , aged 30, applied with 
strumous disease of the testicle. Iodine and iron were given, which 
arrested the progress of the disease, and produced a corresponding im- 
provement in his health. The outward form of the testicle was retained, 
but with an open sinus of an inch and a half in length in an oblique direc- 
tion from the apex, and discharging a thin, white, glairy fluid, peculiar to 
fistulae. A probe previously dipped into nitric acid, was inserted into the 
fistula, and effected a cure. Vide “ Fistula in Ano.” Part xxiv., p. 211. 718 
FLATULENCE, 
FLATULENCE. 
Flatulence.—Flatulence is often owing to an inefficient action of the 
liver, and a deficiency of bile in the intestines. Whatever promotes the 
hepatic secretion tends to remove flatulence of this origin; hence a few 
drops of colchicum wine are often effectual. Still more sure are minute 
doses of mercury. An anti-dinner and an evening pill, consisting of a grain 
of the blue pill and three of the extract of rhubarb, acts with a wonderful 
good effect in many cases of this kind, in which, along with flatulence, there 
are slight constipation, yellow-furred tongue, ill-tasted mouth, etc. As in 
gastro-duodenitis, there is often, from the vascular tumescence of the duo- 
denal mucous membrane, a constriction, and sometimes complete tempo- 
rary occlusion of the mouth of the ductus communis clioledochus, with, 
of course, interruption to the discharge of bile; hence, in part, the flatu- 
lent eructations, etc., which accompany gastro-duodenitis. It is far from 
unlikely that the pancreatic duct and secretion are often affected in a 
similar way. Dr. Dick proceeds to the— 
Treatment.—When the tongue is pale, when there is no tenderness on 
pressure at the epigastrium, or in the right hypochondrium, when there is 
no thirst, no dry heat of skin, and no quickness of pulse, flatulence requires 
carminatives, bitters, and even stimulants. Thus the patient may be directed 
to use freely any of the following waters : cinnamon, fennel, cassia, pimento, 
peppermint, pennyroyal, mint, Cologne, lavender, caraway, aniseed, dill, 
balm ; to these, some of the respective tinctures may be added. With the 
carminative waters just named, one or more of the following bitters may 
be given—chamomile, quassia, columba, absinthium, rhubarb, to which may 
be added valerian, castoreum, and camphor. As an expellent of flatus ex- 
isting in the bowels, assafeetida, or oil of turpentine, the former given by 
the mouth or in injection, the latter in injection, are superior to all things 
else, excepting, perhaps the infusion and spirit of armoracia. 
Secondly. If flatulence is accompanied with a dry and preternaturally 
red tongue and fauces, with thirst, heat of the skin, tenderness of epigas- 
trium, scanty and high colored urine, heartburn, etc.—in short, with symp- 
toms of inflammatory irritation of the gastro-duodenal mucous membrane, 
then alteratives are clearly indicated, or rather such substances as promote 
the secretions of the mucous membrane ; these are ipecacuan, sulphur, 
potassio-tartrate of antimony, the various preparations of mercury, mag- 
nesia, iodine, nitrate of silver. These we would be disposed to give a trial 
to successively, almost in the order in which we have named them. But 
a great variety of other means may be tried, and among these the follow- 
ing, in those cases in which flatulence is accompanied with obvious torpor 
and fullness of the liver, as well as with gastric irritation. The wine of 
colchicum, for example, may be given with a few grains of the sulphate of 
potass, or if there are acid eructations and heartburn, with carbonate of 
magnesia; the infusion or tincture of arnica maybe given in the same 
combinations, and so may the powder and extract of cusparia. In short, 
instead of perplexing our minds with the confused subdivisions of authors, 
whose classifications betray they had no clear and scientific notions of the 
proper treatment of flatulence, the simple point to be ascertained and 
kept in view is, whether flatulence (always a mere symptom) is or is not 
accompanied with inflammatory irritation, is or is not attended with 719 
FOOD, 
stomachic debility—and according as we decide these queries, we adopt 
the former or latter modes of treatment above mentioned. 
Part xvii., p. 113. 
Use of Acetate of Lead in Flatulent Distention of the Intestines.—[A 
patient having taken active purgatives for the relief of an attack of colic, 
and the bowels having been freely acted upon, was seized with distressing 
pain and cramps, and distention of the belly from flatus. Vomiting came 
on, and hiccough, and continued together with the pain and distention in 
spite of opiates, turpentine injections, calomel and opium, castor-oil, etc.; 
and the case appeared desperate. Under these circumstances, Dr. Bad- 
deley says,] 
Feeling convinced in my own mind that, under the absence of inflamma- 
tion, this distention proceeded from leant of tone in the muscular fibres 
of the intestinal canal, and their consequent failure of power to contract 
and expel the increased generation of air, I ordered large doses of alum, 
persisting at the same time, in the daily injection of turpentine, which 
appeared to give more relief than any other remedy which was applied. 
Again disappointed, however, in the result, and remembering the strong 
advocacy by Dr. Graves, of Dublin, of the acetate of lead in tympanites, I 
determined to give it a fair trial, though not without considerable appre- 
hension of its constipating effects. 
I prescribed three grains of the superacetate of lead, with the sixth of 
a grain of acetate of morphia, in a pill every four hours, and a continu- 
ance of the turpentine enema every evening. The excellent effects of this 
combination soon began to manifest themselves by the comparative sup- 
pleness of the abdomen, the expulsion of a large quantity of air, the sub- 
sidence of the cramps, spasms, and pain, and even by copious dejections. 
The hiccough gradually declined, the appetite began to return, and con- 
valescence was at once established. Part xvii., p. 114r 
FOOD. 
For Children.—Gumpredit advises an ounce of finely-scraped full-grown 
carrot to be mixed writh two cupfuls of cold soft water, and allowed to 
stand for twelve hours, being frequently stirred during this period. The 
fluid portion is then to be strained off, what remains being pressed to yield 
some more. This fluid is then to be mixed with the proper quantity of 
biscuit powder, or bruised crust of bread, or arrowroot, etc., and the pap 
placed over a slow fire, until it begins to bubble. Care must be taken that 
the heating be not pushed so far as to cause boiling, or the albumen will 
coagulate. After its removal from the fire, it is to be sweetened with a 
due amount of white sugar. Dr. Gumprecht states that by mixing the 
carrot juioe with biscuit, crust of bread, or arrowroot and sugar, we obtain 
all the farinaceous and nutritious elements required, viz., albumen, gluten, 
starch, sugar, fat, and the phosphates of lime and magnesia. The food is 
more particularly adapted for children who have been suckled and are 
being weaned; for those who are being brought up by hand the following 
preparation is deemed more advisable : an ounce of very finely scraped 720 
FRACTURES, 
yellow carrot, and two drachms of biscuit-powder are to be mixed with 
two cupfuls of cold soft water. This must stand in a covered vessel, in a 
cool place, for twelve hours, and be frequently stirred during this time, 
it is then to be drawn off, or strained through a linen cloth. Some sugar- 
candy and a pinch of salt are to be added to the fluid, which may then be 
administered by means of the sucking-bottle; care being taken that the 
food is at the proper temperature. 
[The above preparations of the carrot as diet are contra-indicated when 
there is any tendency to diarrhoea.] Part xxii., p. 168. 
Forcible Feeding.—Dr. Szigmondy describes a simple and effectual 
means of administering fluid nourishment to persons who are unconscious, 
suffer from trismus, or obstinately refuse food. The patient is laid hori- 
zontally on a bed, with the head somewhat raised, and the food is poured 
by teaspoonfuls through the nostril. Reaching the pharynx, the move- 
ment of deglutition is provoked ; and as soon as this is perceived, another 
small portion is poured in. In this way, too, physic can be given to 
children who resist. He relates a case of severe alcoholic coma, with 
spasmodic closure of the jaws, which was speedily relieved by the intro- 
duction of a solution of tartar emetic. This means is far easier to practise, 
and causes less irritation, than the introduction of the stomach-pump. 
Dr. Beer stated that by the magnetico electrical induction apparatus, the 
mouth can be sufficiently opened to admit of portions of solid food being 
introduced. Part xxxii., p. 293. 
FRACTURES. 
The Advantages of Delay {Expectation) in the treatment of Commi- 
nuted Fractures.—By this term we wish to express a prudent and well- 
considered delay for several days after the receipt of a severe accident, 
and during which time a skillful management of all the symptoms 
constitutional as well as local, is perseveringly pursued—so that on the 
one hand a fair chance is given to nature to repair the damage, and on 
the other hand, that the health of the patient is not unwisely risked too 
far before any mutilating operation is resorted to. 
The judicious employment of local and general bleeding, of refrigerant 
drinks, of low diet, etc., in robust and phlethoric constitutions, and of 
opiates and other anodynes, along with these means, in such as are feeble, 
lymphatic and nervous, will often serve to prevent, or at least to mitigate, 
the severe symptoms which follow, as a matter of course, every serious 
injury or wound. At the same time the free incison {debridement) of such 
parts as may be tense and confined, the extraction of splinters which are 
always a cause of much pain and irritation, the resection of any protruded 
bones, the adjustment of opposite surfaces by means of stitches or 
bandages, the continued effusion or irrigation of cold water on the seat of 
the injury, the employment of emollient or resolving remedies according to 
existing indications, the use of the starched bandage {bandage amidonne) 
as soon as the first or inflammatory accidents have passed away, and the 
administration of internal or external revulsives when any complication 
supervenes—these means, if judiciously practised, will in very many cases FRACTURES, 
721 
enable the surgeon to conduct bis patient through numerous dangers and 
difficulties, and restore him to health without having undergone any loss 
or mutilation. The salutary effects of one or two large blood-lettings in 
cases of severe injuries of the limbs, are well known to most practical 
surgeons; many an unpleasant accident might be avoided by the prompt 
and decided use of the lancet. 
In reference to the application of leeches in such cases, it may be useful 
to state that they should be applied not to the immediate vicinity of the 
injury, but at some distance from, and above its seat, and if possible near to 
the point where the smaller veins terminate in the larger trunks. 
Openings must be cut in the bandage over the seat of any wound, so 
that this may be regularly dressed. We regard the employment of the 
continued irrigation of the injured part and of the subsequent application 
of the starched bandage as two of the most valuable acquisitions which 
the art of surgeiy has obtained in modern times, and as destined to intro- 
duce in the treatment of comminuted and complicated fractures and such 
like injuries, a most beneficial revolution. Part i., p. 90. 
Aphorisms of Practical Surgery.—When the tibia and fibula are 
fractured at the same time, the seat of the fracture of the two bones is 
never at the saxne point. 
The fracture of the upper part of the fibula is always a direct fracture, 
and is never produced by a contre-coup as Pouteau has assei'ted. The pa- 
tient may be able to walk about immediately after the accident. It differs 
from fracture of the lower part of the bone, both in its producing cause, in 
the absence of displacement of the fragments, and lastly, in its mode of 
treatment, as nothing is required for the cure but rest. 
Fracture of the lower end of the radius is often mistaken for luxation 
of the carpus backward, and the true nature of the accident is not dis- 
covered during the fonnation of the callus. It is then found that the 
carpus projects backward, and the ends of the radius forward ; that the 
extremity of the ulna projects toward the inner side of the fore-arm; 
that there is a sinking in of the radius, as if it had been cleft with a 
hatchet; and that the interosseous space, so necessary to the movements 
of rotation, is effaced. 
Surgeons are very apt to commit mistakes in their diagnosis of the 
different fractures to which the fore-arm is liable; and yet it is most 
necessary for the judicious treatment of each, to have formed an accurate 
opinion of what accident has taken place. The most frequent fracture of 
the fore-arm is that of the radius alone; next that of the two bones 
together; and lastly, that of the ulna alone. In the treatment of frac- 
tures of the fore-arm, it is always proper to place two graduated compresses, 
one on the palmar and the other on the dorsal surface of the limb, and 
also two splints, and a roller to be passed circularly round; this bandage 
has the advantage of keeping the two bones apart and of maintaining the 
interosseous space. 
A fracture of the patella is never united by a perfectly formed callus 
within eighty days or so. The provisional callus, which exists at the end 
of about thirty days in other fractures, is not sufficient here. 
What renders the consolidation of fractures of the patella difficult, 
is that the fibrous tissue, which is necessary to the formation of the 
definitive callus, exists on the anterior surface only, and not on the postei’ior 722 
FEACTUBES, 
surface of this bone. The neck of the thigh-bone is nearly in the same 
condition. 
Whenever, after forty or fifty days of the treatment of a fracture, the 
callus becomes painful, we have reason to fear that it either has given way, 
or is about to give way, and that the limb will become deformed. 
Hemorrhage from the ear, accompanied with coma, almost invariably 
indicates a fracture of the base of the skull. 
Various accidents may arise from the falling with force upon the feet; 
as, for example, fracture of the heads of several of the metatarsal bones, 
fracture of the os calcis, rupture of the vault of the foot in consequence 
of the ligaments being lacerated, luxation of the astragalus, and commi- 
nuted fracture of the tarsal extremities of the tibia and fibula. 
Part iii., p. 114. 
Anchylosis—Is liable to result from the long continued use of any appa- 
ratus which renders completely immobile the articulations of a fractured 
limb. Part iv., p. 110. 
India\ Pubber Bandages.—The object of this memoir, which was read 
at the Royal Academy of Medicine in November, 1840, is to point out 
the advantage obtained by the use of strips of India rubber in the place 
of common ligatures and bandages, made elastic by means of the same ma- 
terial, in place of the common roller. The author has used them for the 
last two years, and speaks very highly of their power of maintaining parts 
in apposition during the most varied movements of those parts. lie par- 
ticularly instances hare-lip, and the operations for the restitution of lost 
parts. The elastic bandages are also said to be very useful in maintaining 
oblique fractures of the lower extremities in perfect apposition, opposing a 
force in constant operation to the irregular action of the displacing muscles. 
In this way also they may assist in the replacement of parts after tenotomy. 
Part iv., p. 113. 
Excision of the Callus in Badly United Fractures.—A man, 32 years 
of age, fell from a cart and fractured his tibia and fibula nearly in their 
middle. Inflammation, followed by purulent infiltration, attacked the 
limb, and as the patient Avas very restless, after the cure Avas effected it 
was found that the fragments of the bone had united in an irregular angu- 
lar manner. Professor Portal first tried to break the callus across, in 
order to reset the limb, but not succeeding in this, he cut down on the 
irregular angular projection by a vertical incision, and uncovering the 
bones, passed a chain saw round them and removed about an inch of the 
bone. The Avound united by the first intention ; the limb Avas kept care- 
fully extended, and in forty-eight days the patient Avas dismissed cured. 
The limb was shortened a very little. Part v., p. 128. 
Ununited Fracture treated with Iodine.—[In a case of fracture of the 
tibia and fibula, where ligamentous structure only had united the bones 
for about tAvo years, Mr. Scott made use of the folloAving treatment Avith 
success. The heel had been drawn up by the muscles about an inch, 
which made the great toe point downward. Permanent extension was 
first tried, but this failing, the tendo Achillis Avas divided, and a Aveight 
suspended by a bandage passed round the leg, immediately above the seat 
of fracture.] 
Tincture of iodine (iodin. 5j.; sp. rect. §j.) Avas locally applied daily for FRACTURES. 
723 
the course of a month, at the end of which time an extensive callus had 
formed, of considerable firmness. The frequency of its application was 
now diminished to two or three times during the week, but persisted in 
for three months longer, when he was taken down from the apparatus and 
placed in the horizontal posture. The foot had assumed its natural 
position, the only deformity being a slight bow inward at the place of union. 
Part viii., p. 163. 
Pest Position in Fractures of the Forearm. — Mr. T. O’Connor 
remarks on this subject as follows: 
Of seven cases of fracture of radius treated by me within the last year, 
two were treated on the semi-supine, and five on the supine plan; in every 
instance the fracture was immediately above the styloid process, com- 
monly called Colles’ fracture. In the two treated on the semi-supine 
plan, rotary motion was in a slight degree impaired, and that notwith- 
standing the full employment of the means usually recommended to pre- 
serve the interosseous space. The instruments which I used to press the 
soft parts into the space, were two circular pieces of wood, each about an 
inch in circumference, enveloped in common wadding, and extending 
anteriorly and posteriorly from elbow to wrist, kept in situ by a mode- 
rately tight bandage—the fracture, of course, previously reduced—the 
same instruments were employed in the five cases treated on the supine 
plan, and with a result so highly satisfactory, that I am fully resolved to 
treat fracture of the forearm on no other plan whatever. Part ix., p. 173. 
Diagnosis of Fractures of the Loicer End of the Radius.—[Mr. 
Lonsdale thinks there are one or two points connected with fractures of 
the lower end of the radius, which deserve more attention than has 
hitherto been paid to them, as diagnostic symptoms of this particular 
kind of injury. He refers to the prominent ulna, and peculiar displace- 
ment of the hand. He says:] 
When the radius is fractured within its lower inch, or inch and a half, 
by fall on the hand, it will be found that, in the majority of cases, the 
following deformity exists : the whole hand appears to be displaced late- 
rally outward, or in a state of abduction; that is to say, the ulnar edge 
of it, instead of being in a line with the ulna itself, occupies a position 
more external, or toward the radius, which causes the end of the ulna to 
project, and to be apparently dislocated. There is also generally found 
to be a depression on the opposite side, in the radius itself, in the situa- 
tion of the fracture ; and there is not unfrequently a prominence poste- 
riorly above the carpus, when the displacement has taken place in this 
direction as well. The crepitus is not often present in these cases, for the 
fractured surfaces are so tightly locked together, that motion between 
them is seldom obtained. 
I believe that in every case of injury about the wrist, from a fall upon 
the hand (whether in old or young people, though more frequently in the 
formei1), where there are found to be this peculiar prominence of the ulna, 
and lateral displacement of the hand, it may safely be said, that the lower 
end of the radius has been fractured, without the necessity of taking any* 
other symptoms to help the diagnosis, even if no deformity is to be 
felt about the radius itself, or other part of the joint. Part ix., p. 182. 
Acupuncture for the Consolidation of Fracture.—A young man, aged 
twenty-six, of a strong constitution, fractured the two bones of the fore- 724 
FKACTUKES- 
arm ; the fracture was simple. The surgeon who attended him, perceiv- 
ing that, at the end of five weeks after the accident, reunion had not 
taken place, applied afresh the apparatus, and ordered absolute repose for 
the limb for four weeks longer. This time having elapsed, M. Wiesel 
observed that the fragments of bone still preserved their mobility, and li6 
then determined to have recourse to acupuncture, which he performed in 
the following manner: he introduced between the two movable fragments 
of the xilna, two needles, sufficiently long to traverse the false articulation 
from side to side, and kept the needles in that position for the six follow- 
ing days, after which he withdrew them, because they had excited, by 
their presence, a considerable swelling of the part, and severe pain. M. 
Wiesel, fifteen days afterward, traversed in the same manner the false 
articulation of the radius, with two Other needles, which, at the end of a 
few days, caused sharp pain, and a slight suppuration. lie then applied a 
simple bandage to the limb, and in the space of six weeks a complete con- 
solidation took place. This case is no less interesting for its success than 
for the simplicity of the means adopted. It proves that, in cases of false 
articulation, the surgeon, before employing the seton or removing the 
ends of the bone, has a method to try, very simple and innocent, and 
which, in some cases at least, has been attended with most advantageous 
results. Part ix., p. 186. 
Treatment of Fractures.—Immediately after the fracture of any bone, 
when there is a tendency to great tumefaction, it is wrong to apply either 
splints or bandage, for any restriction of swelling is liable to produce 
gangrene; under these circumstances, the limb should be placed on a 
pillow in a semi-flexed position, so that the muscles may be perfectly 
relaxed, and the bones placed as nearly as possible in their natural posi- 
tion ; which circumstances may be ascertained, whatever may be the 
swelling, by the immediate comparative ease of the patient. An evapo- 
rating lotion is then to be used; or should there be any tendency to invo- 
luntary contraction of the muscles, strips of soap plaster may be gently 
applied around the limb, which, by causing a secretion beneath it, dimi- 
nishes the irritability of the muscles, as well as the urgency of the inflam- 
mation. If it can be avoided, purgative medicines should not be given, 
as they would produce a necessity for frequent change of position. As soon 
as the tumefaction and inflammation have subsided, which, under the 
treatment recommended, generally happens in three or four days, well- 
padded splints should be applied, and retained in their situations by broad 
pieces of tape resting firmly on the splints, but which should not be any- 
where in contact with the limb. 
It has been stated, that a bandage should never be applied immediately 
after the occurrence of fracture; however, it may be considered as an 
exception to this rule, that when a portion of fractured bone has wounded 
and irritated a muscle, a bandage is the best means of removing its spas- 
modic action. When fracture of a bone happens in the neighborhood of, 
or passes into a joint, local bleeding, by means of leeches, is always neces- 
sary, and may require to be frequently repeated : even the necessity for 
general bleeding may sometimes be indicated, when there is much consti- 
tutional irritation; in which case, calomel and opium will also be found of 
the greatest service. In fractures into joints, when inflammation becomes 
so violent that the surgeon sees that anchylosis must necessarily occur, the 725 
FKACTUKES, 
joint should be placed in such a position as to render the limb as useful 
as possible. Under these circumstances, for instances, if the elbow joint 
be the one affected, the forearm should be semi-flexed; by which position 
the patient will afterward be able to feed himself. In the knee-joint, 
the leg should be very slightly flexed upon the thigh ; by which method 
he is better able to direct the foot, and the limb is rendered more 
manageable in the sitting posture. In the ankle-joint, we should 
endeavor to procure a union with the foot perfectly flat; whereby the 
patient will afterward enjoy considerable use of his limb. Part xi., p. 167. 
Fractures of the Pibs—jRemarks on.—The manner in which the acci- 
dent occurs is of importance in cases of fractured ribs ; for if the chest 
has been jammed, the salient angle will be outward, and the accident less 
dangerous, than where the fracture has been produced by a direct blow or 
fall upon the ribs; for then the salient angle will be inward, and the 
prognosis will be more unfavorable, from the chance of the lungs being 
wounded. For this reason, and from the urgent dyspnoea, the prognosis 
will be at first unfavorable, but the symptoms may be relieved by bleed- 
ing, bandaging, etc. The bleeding diminishes the action of the heart, 
and the tendency to inflammation; and after its employment the potassio- 
tarti*ate of antimony is a very excellent medicine for maintaining the in- 
fluence produced by the loss of blood. Calomel also, just to affect the 
mouth, acts as a preventive of inflammation of the serous membranes. 
The use of the bandage is evidently to diminish the action of the lungs, 
and keep them as quiet as possible ; it does not act as splints to the long 
bones, which are for the purpose of keeping the fractured extremities in 
apposition; or, if there be any analogy, it is where a splint is put behind 
a joint to prevent motion, for the bandage around the chest performs the 
same office. In diseases of the respiratory organs, the great difficulty in 
the treatment is to keep the parts quiet; and hence the great danger of 
diseases of the larynx, for which, in my opinion, openings in the trachea 
are not sufficiently often made for the purpose of maintaining a perfect 
state of rest of the diseased cartilages of the larynx. During sleep these 
organs are in a comparative state of rest, and, therefore, opiates, or 
rather sedatives, are indicated; the objection to the first being, that they 
check the natural secretions. Hence, bandaging, antimony, opium, calo- 
mel, aperients, and complete rest, are the means to be employed in cases 
of fractured ribs under common circumstances. Part xii.,p. 149 
Fracture of the Spine—Diagnosis of—[Mr. Cooper, in a lecture on 
fracture of the spine, makes the following remarks on the diagnosis of 
the exact vertebra broken :] 
With regard to finding out the exact vertebra broken, you are not 
always able to tell by examining the spine. The method which I always 
adopt is this: place each hand widely spread out over each side of the 
chest; you will feel the ribs above the paralyzed part move naturally by 
the intercostal muscles, those below only move according as they are 
acted on by the descent of the abdominal viscera. I confess, I think it is 
dangerous practice to make extension to attempt to replace the broken 
vertebra, for you are liable to tear through the spinal cord, and add to 
the mischief; besides it does not necessarily occur in fracture that the 
paralysis depends on pressure from bone; it may be from blood, or, per- 
haps, serum. 726 
FRACTURES, 
Patients very rarely recover where there is complete paralysis, distended 
abdomen, suffused countenance, and partial priapism. The danger 
depends, as to dissolution, and its period, on the proximity of the injury 
to the brain; you all know that if it is above the fourth or fifth cervical 
vertebra, that is, above the origin of the phrenic nerve, immediate death 
is the consequence. I have known a patient having fractured the sixth or 
seventh cervical vertebra, live six or ten days, breathing solely by the 
diaphragm. How, the first object in the treatment of disease is to 
prevent symptoms; and secondly to relieve them by the attention to 
diet, by pharmaceutical means, and what I wish to draw your attention 
to, by mechanical means—by surgery. Here, we are sustaining the 
powers of life by wine and nourishment, and relieving the patient by 
mechanical means, viz.: drawing off the urine and washing out his blad- 
der. The catheter, in these cases, should always be introduced with the 
utmost delicacy, for as the patient cannot feel so as to tell you when you 
are going wrong, you may do much mischief. The principal cause of 
death, in these cases, is owing to the decomposition of the urine (for the 
vital functions are not much interfered with); the urine decomposes, 
causing inflammation of the bladder, which secretes a large quantity of 
unhealthy mucus, and that also decomposes, increasing the irritation. I 
do not, however, think we are right in saying that the vital functions are 
not much interfered with, for look what a large secreting surface—the 
skin—is deprived of its function ; and the effect this has upon the consti- 
tution is well known. In the case of burns, if more than one-fifth of the 
body is deprived of cuticle, the result is fatal; and we do not know Avhat 
effect the stoppage of secretion from so large a sui-face may produce on 
that of the lungs and kidneys, and thus hasten the fatal termination. 
* Part xii., p. 150. 
Dieffenbach'18 Operation for Pseudarthrosis from Ununited Fracture.— 
[The first- case related, in which the operation was performed, was that of 
a woman who had broken her thigh fifteen months before. It was quite 
ununited, and such an incumbrance that she desired the amputation of the 
limb. Dr. Bushman proceeds:] 
There was some soft callus between the fractured bones in which they 
moved as in a capsule, but no bony deposit. Dieffenbach caused the ab- 
sorption of this grisly matter by rubbing the ends of the bones together, 
and thus setting up inflammatory action; and, this object effected, he at- 
tempted to produce bony union; not, indeed, by the usual and very 
uncertain routine of very close and accurate contact—removing the ends 
of the bones by excision, escharotics, or setons. His experience of 
gun-shot wounds had taught him that when foreign bodies, as bullets, are 
lodged in bones, a great quantity of healthy and hard callus is always 
poured over them; and the experiments of Duhamel and Flourens has 
established the fact, which it remained for the genius of Dieffenbach to 
turn to account. So having pierced the leg with a small scalpel down to 
the fractured bones, with a common gimlet he drilled holes through each 
end of the bone, and about half an inch from each fractured extremity. 
Into each of these holes he introduced a small ivory peg, the same size of 
the gimlet, and strongly wedged them with a few strokes of a hammer. 
The limb was then extended, placed in splints, and carefully bandaged. 
In ten days it was apparent, from the less degree of mobility between the FKACTUKES. 
727 
ends of the fractured bone, that healthy callus had been thrown out; and 
so the ivory pegs were removed, and the wounds allowed to heal. In 
three months from the date of operation the patient walked without 
crutches, and was dismissed cured. Part xv., p. 151. 
Treatment of Ununited Fracture by Subcutaneous Puncture.—Employ 
ubcutaneous incisions of the parts, by passing a strong needle obliquely 
lown, and moving its edge freely about in all directions, so as to cut up 
the ligamentous bond of union, and the dense investment of the ends of 
the bones; withdraw the needle and cover the puncture with- isinglass 
plaster. The parts will probably be reduced to a state very similar to 
what attends on ordinary fracture at the first. A pouch of blood will 
form; the blood will be absorbed ; fibrin will take its place; the plasma 
will become organized, and probably form an excellent imitation of the 
ordinary provisional callus; while at the same time secretion and orga- 
nization may advance from the ends of the bone ; and consolidation, as by 
definitive callus, be completed. 
The connecting materials of the “ false joint ” are disrupted and excited, 
not destroyed. They are valuable toward the formation of bone, when 
brought into and maintained in a state of moderate vascular excitement. 
“A state of active hypenemia generally precedes the osseous transforma- 
tion of the fibrous, cartilaginous, and fibro-cartilaginous tissues. M. llayer 
observed, that when he excited an artificial irritation in the fibro-cartilage 
of a rabbit’s ear, the part was at first softened; a yellow matter was 
next deposited in its texture ; and, finally, a calcareous deposit was formed, 
and a true ossification produced. M. Cruveilhier likewise observed 
different portions of periosteum, ligaments, and cartilages, pass into the 
osseous or ossiform state, under the influence of different stimulating appli- 
cations.” 
Of course, in no case is local treatment exclusively to occupy our atten- 
tion. Constitutional management must never be overlooked; and often it 
proves of the highest importance. Further, the foregoing observations are 
not intended to apply to those cases where non-union is obviously depen- 
dent on the impaction of a slip of muscle between the fractured ends, or 
to the presence of a piece of bone, or to the lodgment of a foreign body 
from without. In such cases, immunity from motion, with attention to the 
system, after removal of the cause, is usually sufficient. 
Part xviii.,jt>. 144. 
Treatment of Fracture of the Thigh in Inf ants.—[It is well known how 
difficult it is to get a fracture of the thigh in infants united without shorten- 
ing and curving forward of the femur. Mr. Lonsdale, however, suggests 
a plan by which this difficulty may be obviated. He says:] 
I employ two strips of sheet-iron, an inch wide, and thin enough to 
allow of being easily bent at any angle required, though sufficiently 
thick to bear the weight of the limb without yielding. They are 
applied as follows: The child is placed on its back, and an assistant holds 
the limb in a position so as to flex the hip and knee joints, the angle of 
flexion being similar to that employed when the inclined plane is used for 
adults. The two thin iron splints are then bent at angles corresponding to 
the hip, knee, and ankle joints, to adapt themselves to the limb, in the 
position in which it is being held by the assistant. An important point to 
attend to is the proper length of the splint. The upper one should be long 728 
FKACTUKES. 
enough to pass up in front of the hip joint, to lie flat on the lower part of 
the abdomen, and to extend down over the instep to the toes. The back 
one should extend up behind the buttock, being curved to fit its shape, as 
high as the posterior margin of the crest of the ilium, and long enough to 
extend down behind the heel to the sole of the foot. If the two splints 
are bent at proper angles, to correspond with the shape and position of 
the hip, knee, and ankle joints, they will, when firmly bound to the limb, 
keep it in the position required, which is one that most favors the correct 
apposition of the ends of the bone, by relaxing all the muscles. The limb 
must of course be evenly rolled before applying the splints, and the splints 
themselves be padded. The upper ends of the splints are to be firmly 
fixed to the pelvis, by passing the bandage many times around them, and 
occasionally reversing the direction of the bandage round the ends of the 
splints themselves, to prevent them being displaced laterally. 
Part xviii., p. 147. 
Collodion in Compound Fracture.—The value of solution of gun-cotton 
was tested in a case in St. Vincent’s Hospital—a compound dislocation of 
the ankle, with the usual fracture of the fibula. The tibia protruded 
through a long transverse wound at the inner ankle. The bone Avas easily 
reduced; but retraction of the divided integument kept the edges of the 
wound about an inch apart. After careful and gentle manipulation, aided 
by suitable position, Hr. O’Ferrall succeeded in bringing the posterior 
commissure of the Avound together, and sealed it with the solution. 
Another point Avas then made to touch, and was sealed like the former. 
Eventually the entire wound Avas thus sealed up, although synovia mixed 
Avith blood had been freely oozing before. It is iioav the sixth day—there 
is no inflammatory symptom, and the patient rests very Avell. 
Part xix., p. 135. 
Symptoms of Fracture of the Pase of the Skull.—[In reply to the 
question “ What are the pathognomonic signs of fractures of the base of 
the skull?” Mr. Adams observes :] 
Hemorrhage from the ear is generally ranked as a symptom of fractured 
base: this may arise from a Arariety of sources—thus, it may depend on 
rupture of the membrana tympani; it may depend on rupture of the late- 
ral sinus, or of the carotid artery, as when an extensive fracture traverses 
the canal lodging this vessel; in either of the tAvo latter instances the 
hemorrhage would be so profuse as to leave no doubt as to the nature of 
the injury. But hemorrhage from the ear is, in my opinion, not pathogno- 
monic of this accident: it is so commonly found in slight cases of injury 
to the head, and in cases AAdiich occur without any untoward symptoms, 
and many such cases are brought to this hospital, that I feel justified in 
discarding it as a sign wholly to be relied on. Noav, if in a case of in- 
jured head, hemorrhage from the ear has taken place, and the injury has 
been accompanied or succeeded by paralysis of the portio dura, then I 
should be disposed to regard these signs collectively as indicative of a 
fractured base; but separately and singly, although it has an important 
indication, I do not rely upon it as conclusive of the existence of such an 
accident. 
Although hemorrhage from the ear and paralysis of nerves passing out 
of the base of the skull are presumptive signs of fractured base, yet they 
are not positive signs of this accident; and, indeed, I know only of one FRACTURES, 
729 
symptom which is strictly pathognomonic of the injury, and that is a free 
discharge of serum from the ear after a severe injury of the skull. This 
symptom, however, comes on, not immediately, but on the second or 
third day after the accident. I remember a case some years ago, of a 
man in w hom a serous fluid escaped from the ear in such quantities as 
to soak through the pillow', and to require repeated changes of linen. 
A similar case is recorded in the tenth volume of the “ Medical Gazette,” 
w'here the patient lost between four and five ounces of a similar fluid in 
one night; both these cases did well. In the Memoires de la Societe de 
Chirurgie de Paris, there is an article on this subject by M. Robert, 
who, from numerous dissections, has distinctly traced this phenomenon 
to a fracture extending across the petrous portion of the temporal bone, 
and a direct opening from this into the arachnoid cavity. 
Part xx., p. 102. 
Method of Treating Fractured Fibs.—[Mr. Hancock does not employ 
either the bandage or venesection, believing these means to be unneces- 
sary, or even injurious. We are told that] 
He relies chiefly on opium. By the use of this drug he subdues irrita- 
tion, moderates inflammation, procures to the patient a very desirable 
amount of rest, and wards off all the thoracic complications which some- 
times render these cases extremely serious. Part xxi., p. 191. 
Practice of Tenotomy in some cases of Fracture.—W. S., aged forty, 
was admitted into the Middlesex Hospital, having fallen downstairs in a 
state of intoxication. Both bones of the leg wrere broken, and the fracture 
of the tibia extended through both malleoli, the foot being twisted out- 
ward. Violent spasms of the muscles frustrated all attempts to keep the 
fractured extremities of the bones in apposition ; the slightest movement 
brought on this spasmodic contraction, which extended to all the muscles 
of the limb, so as to cause great distortion of the foot, and render the skin 
over the base of the tibia extremely tense. All the symptoms continuing 
unabated on the following day, and the suffering of the patient being con- 
siderable, Mr. Shaw determined on dividing, in the usual way, the tendo 
Achillis, which was very tense. After this, all the difficulties entirely 
ceased, and no further trouble was experienced in the treatment of the 
case. Part xxi., p. 191. 
Fracture of the Nech of the Thigh Pone.—[Mr. Lizars, believing “ the 
diagnosis of the fracture of the neck of the thigh bone is little understood, 
even by surgeons holding important situations,” mentions the following 
reasons for his belief. 
In the majority of cases the diagnosis is simple : The shortening of the 
limb, the eversion of the toes, the flattening of the nates and the pain at the 
joint, especially wdien the thigh bone is rotated, at once indicate the nature 
of the accident, which generally occurs after fifty years of age. But in a 
very considerable number of individuals, there is no shortening of the limb, 
for one or more days, nay w'eeks, or even months, after the occurrence of 
the accident; and in such cases, when the fracture has been overlooked 
or neglected, the shortening becomes so great, that inversion, instead of 
eversion of the foot and toes, takes place, and the ignorant and inexpe- 
rienced surgeon pronounces the case to be dislocation of the head of the 
thigh bone on the dorsum of the os ilium, and the unfortunate sufferer is 
tortured writh lacs and pulleys. 730 
FRACTURES. 
I am of opinion, that in all cases of injury of the hip-joint, if there is flat- 
tening of the nates, and especially if the individual be upward of forty years 
of age, we ought to look for fracture of the neck of the thigh bone, and 
apply Desault’s long wooden splint, and retain it for six or eight weeks, 
if the skin over the sacrum remains sound, and the health of the patient 
will bear it. Part xxii., p. 202. 
Fractures of the Pibs.—Pass large strips of adhesive plaster round the 
top of the chest, down over the site of the injury to about midway between 
the last rib and crest of the ilium; enjoin absolute quiet (not a word to be 
spoken). 
This circumstance, Mr. Hilton dwells on as essentially necessary in these 
cases: indeed, with absolute quiet, the strapping carefully managed, and 
the tartrate of antimony sedulously attended to—especially if perspiration 
break out—the rapidity with which these cases do well is quite wonderful. 
Part xxii., jo. 205. 
Fracture of the Ribs.—Mr. Hilton remarks, that a fracture of the first 
and second ribs is more hazardous than that of the lower; and, again, that 
a fracture of the lower is more perilous than one of the middle. 
The two points of mechanical treatment in fracture of the ribs are, first, 
rest; and second, bandaging the chest, by fixing straps of adhesive plaster 
circularly from the spine to a little beyond the sternum, on the injured side 
only, leaving the other free, as well as the abdomen on both sides. 
Part xxv., p. 177. 
Treatment of Gun-shot Fractures.—[On this subject, Mr. Guthrie lays 
down briefly the following precepts :] 
1. An upper extremity should not be amputated for almost any accident 
or accidents which can reasonably happen to it from musket-shot. 
2. If the head or articulating extremity of the bone entering into the 
composition of the shoulder-joint should be broken to pieces, that portion 
of the bone should be sawn off, but the arm must remain. 
3. If the elbow-joint is shot through, it is to be cut out, and the forearm 
brought into the bent position. The sufferer will have a very good and 
useful arm, etc. I have, however, added that if the surgeon does not 
kuow how to do these operations he had better cut off the arm. 
Part xxv., p. 179. 
Compound Fractures—Military Surgery.—A fracture of a bone, says 
Mr. G. J. Guthrie, however simple it may be in its nature, is said to be com- 
pound when accompanied by an external opening in, or a wound of, the soft 
parts, communicating with the broken bone—a complication which usually 
gives rise to ulcerative inflammation and suppuration throughout the whole 
extent of the injury, preventing thereby those milder processes being effected 
which, under the more favorable circumstances of the skin being unbroken, 
lead to a speedy union of the broken parts; whence the desire manifested 
by the surgeon, in ordinary cases of compound fracture, to close the ex- 
ternal wound, if possible, but which, from the nature of a gun-shot wound, 
it is useless to attempt. A fracture is said to be comminuted when the 
bone is crushed, as by a heavy wheel passing over it. It may still, how- 
ever, be a simple fracture, or without an external wound; and is, in that 
state, much less dangerous than a similar injury accompanied by an exter- 
nal opening, however small, the edges of which cannot be immediately and 
permanently reunited. FRACTURES, 
An arm or a leg, as a general rule, is not to be amputated in tbe first 
instance, for a compound or gun-shot fracture. An effort should always 
be made to save it; and, under reasonable circumstances with regard 
to the extent of injury, the comfort, climate and ordinary good health of 
the sufferer, the object will usually be obtained, under good surgical treat- 
ment. 
It is not so with the thigh. After the battle of Toulouse, forty-three of 
the best of the fractures of the thigh were attempted to be saved under 
my direction, and even selection. Of this number, thirteen died; twelve 
were amputated at the secondary period, of whom seven died ; and 
eighteen retained their limbs. Of these eighteen, the state three months 
after the battle was: five only can be considered well, or as using their 
limbs: two more think their limbs more valuable, although not very ser- 
viceable, than a wooden leg; and the remaining eleven wish they had suf- 
fered amputation at first. Of the officers with fracture of the femur, one, 
having been taken prisoner during the action, died under the care of 
the French surgeons, by whom he was skillfully treated; the other has 
preserved a limb, which he rather wishes had been exchanged for a 
wooden leg. 
Nearly all the wounded, after this battle, had every possible assistance 
and comfort, from the second day after the action. The medicines and 
and materials for their treatment were in profusion. The sick and wounded 
(1359 in number, including 117 officers) were in charge of two deputy in- 
spectors-general, ten staff-surgeons, six apothecaries and fifty-one assistant 
surgeons: and the whole worked from morning until evening with the 
greatest assiduity. The surgery of the British army was at the highest 
point of perfection it attained during the war ; and this enumeration is 
given to show the number of medical men required under the most favor- 
able circumstances for 1500 wounded men, if they are to have all the aid 
surgery can give them. 
E\‘ery broken thigh or leg was in the straight position, and the success 
was greater than on any previous occasion. Nevertheless, with all these 
advantages, there can be little doubt that if amputation had been performed, 
in the first instance, on the thirty-six out of forty-three who died or only 
partially recovered, some twenty would have survived, able, for the most 
part, to support themselves with a moderate pension, instead of there 
being perhaps five, or at most ten, nearly unable to do anything for them- 
selves. The Baron Larrey, with the elite of the military sm-geons of 
France, as well as those of Germany, has maintained this opinion ; and in 
the present state of our knowledge, it is perhaps the safest practice, parti- 
cularly under doubtful circumstances, in which it cannot be ascertained 
whether rest, the best surgical care and comfort may not bo wanting, 
without all which a favorable result cannot be expected. 
The peculiar difficulty in treating a gun-shot fracture takes place when 
the bone is splintered for some distance, as well as broken. In these cases, 
inflammation occurs internally in the membranous covering of the cancel- 
lated structure of the bone, which ends in the death of the parts affected; 
whilst the periosteum takes on that peculiar action externally, which ends 
in the deposition of ossific matter around the splinters which have lost 
their life, and are enveloped by it. The bony matter, at first small in 
quantity, is gradually augmented, and deposited for some distance in the 
surrounding parts, so that it has been known to include the neighboring 732 
FKACTUEES. 
vessels and nerves in less than twenty days; and at the end of a few 
weeks the quantity of ossific deposit is often very remarkable. Each 
splinter of bone becomes the sequestrum of a necrosis, in a similar manner 
as it is known to occur in the bones of young persons spontaneously 
affected by this disease, with this essential difference, that in the idiopathic 
disease there is only one, as if worm-eaten, sequestrum, perhaps the length 
of the shaft of the bone, and easily removable by one operation, while 
there may be in the traumatic disease several dead centres of dead deposit, 
each of which requires to be removed by an operation to effect a cure. 
This new bony deposit will often be half an inch and more in thickness, 
and at a late period is as hard as the old bone. The repetition of opera- 
tions required in such cases is very distressing, particularly in the thigh, in 
which the disease often continues for months, and even years. 
A musket-ball will often lodge in the less dense parts of bones, such as 
the great trochanter and condyles of the femur, without fracturing the 
bone; it will sometimes even pass through the femur above and between 
the condyles, merely splitting, but without separating the bone in parts or 
pieces. Balls sometimes lodge in the shaft of the femur, without breaking 
it, and frequently do so in the tibia, the humerus, the bones of the cranium, 
and even in others of less size. Balls thus lodged will sometimes remain 
for years, nay, during a long life, without causing much inconvenience. It 
is, however, generally the reverse, and they are often the cause of so much 
irritation and distress, that the sufferers are willing to have them, and even 
their limbs, removed at last, at any risk. 
Whenever, then, a ball can be felt sticking in a bone, although it cannot 
be brought into sight, it should, if possible, be dislodged and removed by 
the trephine, by small chisels, by small, strong-pointed curved elevators, 
or by any of the screws invented for the purpose, which have sometimes 
been found efficient. 
When a ball merely grazes a bone without breaking it, and passes 
through the limb, and no splinters can be felt by the finger, dilatation is 
unnecessary in the first instance ; although some small splinters may be 
cast off subsequently, or a layer of bone may exfoliate, requiring assistance 
for their removal. 
The bone may be fractured in a case of this kind transversely, and will 
require only the simplest treatment in an almost similar manner. 
If the ball should enter and be flattened against the bone without break- 
ing it, and lodge against it or in the soft parts, it should be sought for 
and removed. When the ball is flattened and the bone broken, it may lie 
between the broken extremities, and even lodge in one of them, render- 
ing the case more complicated, and the necessity for close investigation 
more urgent. 
When a ball strikes the shaft of a bone, such as the femur, directly and 
with force, it shatters it often in large, long, and pointed pieces, retaining 
their attachment to the muscles inserted into them. A fracture of this 
nature in the middle of the thigh will often extend downward into the 
condyles, and as high as, although rarely into, the trochanters. These are 
cases for immediate amputation. 
Gun-shot fractures of the head and neck of the femur have been hitherto 
Altai injuries, unless the whole extremity has been removed. It is hoped 
death may be prevented without this most formidable operation, by the 
removal of the head and neck of the bone. If the upper third of the femur, 733 
FRACTURES, 
Ijelow the trochanter, is badly fractured, and an attempt is made to save 
the limb, death generally occurs after several weeks of intense suffering. 
Few escape with a useful limb, which had been badly fractured in the 
middle part, their strength and health being destroyed by the pain, sup 
puration and constitutional irritation which ensue. 
The least dangerous and the most likely to be saved, are fractures of 
the lower third, or at most the lower half of the thigh, and when they do 
not communicate with the knee-joint, an attempt ought always to be made 
to save them. 
The preservation of a fractured femur from a musket-ball, when splin- 
tered to any extent, ought only to be attempted if the principal splinters 
can be removed. When the splinters of the femur are long and large, it 
has been supposed that if they retain their attachments to the soft parts, 
they may be placed in apposition and preserved. It ought, however, only 
to be attempted under the most favorable circumstances, and will not even 
then succeed. In the humerus it is different. An examination by the 
finger, iti the first instance, is necessary to ascertain the extent of the 
injury to the bone, and to enable the surgeon to remove the broken por- 
tions, as well as the ball or any extraneous substances which may be in the 
wound. The incisions necessarily required for this purpose in the thigh 
are sometimes neglected, or the surgeon refrains from making them from 
the great thickness of the muscular parts, and from the wound having 
taken place on the inside, near the great vessels, so as to render incisions 
of sufficient size or extent in some degree dangerous. The thickness of the 
muscular parts is not a sufficient reason for avoiding an incision, neither is 
the vicinity of the great vessels and nerves, although they may not be 
divided ; and if the situation of the bone on the outside of the thigh be 
attended to, the broken portions may sometimes be got at, at that part, if 
not on the inside. If this cannot be done, amputation had better be had 
recourse to. The object of the examination of such a wound being to 
ascertain the state of the fracture, and to remove the splinters and any 
extraneous substances, the extent and number of the incisions must depend 
on them; the true principle of what has been called dilatation in wounds. 
If the ball should have merely struck and grazed the bone, and passed 
out, causing a transverse fracture only, there is no necessity for making 
incisions at the moment, although one or more may be subsequently 
required to aid in the discharge of an exfoliated piece of bone, or of a 
splinter which may have been overlooked. If the ball lodge deeply in the 
soft parts, after breaking the bone, it should be removed, if practicable, 
by a second or counter opening, and a free vent should always be made 
for the dischai’ge. It may be, however, laid down as a general rule, that 
whatever is likely to be required during the first few days, had better be 
done on the first than on the second or third; for after inflammation has 
commenced, any handling or examination of the limb, however gently made, 
gives great pain. 
After the first incisions have been made, and the larger splinters, which 
can be felt, have been removed, a secondary danger occurs from those 
which are smaller, and may have been overlooked, or have not been dis- 
covered. This arises from the enveloping of these splinters in the new 
ossific matter described as being formed by the inflamed periosteum. 
This evil must be prevented by a careful examination of the wound when 
suppuration has been fully established. 734 
FRACTURES, 
The earlier this is done the softer the ossific matter will he, and which 
at an early period will cut like Parmesan cheese intermixed with lime. 
If deferred until the bony matter is quite hard, it must be cut through 
with the chisel, or bone scissors or forceps, the application of which some- 
times requires great force. ‘ 
The position of the patient in a gun-shot fracture of the thigh or leg is 
of the utmost importance. He should lie on his back, and the limb should 
be straight. It is almost impossible to keep a man’s thigh in the bent 
position, or on its side, without his turning on his back, and the union of 
the bone, if it takes place at all, must be then at an angle. The bent 
position forward, or on an inclined plane, is defective, inasmuch as the 
matter, which must necessarily be secreted in great quantity, will gravi- 
tate backward in spite of every care to prevent it. When a proper bed- 
stead is used, a slightly inclined plane will sometimes be advantageous at 
a later period, when the body may also be raised, even to the erect 
position, the principal object being to take off the action of the two 
muscles inserted into the smaller trochanter, which, with the rotators 
behind, raise and evert the upper end of the broken bone. This direc- 
tion outward, should be met by a similar direction of the lower part 
of the bone, and by the application, from time to time, of a proper splint, 
compress, and bandage, on the elevated bone, if they can be borne with 
perfect ease. 
Splints are of various kinds, and made of different substances. The dis- 
covery of gutta percha has enabled some to, be made of that substance, 
which, when molded into sheets, of from one to two-eighths of an inch in 
thickness, can be rendered soft and pliable by the application of hot water, 
regaining its firmness as it dries. Splints can thus be made of any size or 
length, and of any form, with apertures, if necessary, for the passage of the 
discharge from the wounds. 
One wooden splint of more than the length of the limb, and somewhat 
similar to that called Desault’s, is absolutely necessary for the thigh, if it 
can be borne, as a means of extension, or rather of preserving length. 
A shorter one on the inside, and one behind, will sometimes be required 
to complete the set. A short one may be wanting for occasional use 
in front. 
The bones of the leg being more exposed, admit of greater liberties 
being taken with them, and of larger portions, or even parts, being taken 
away successfully, than ought to be attempted in the thigh. A leg should 
therefore be rarely amputated for a fracture from a musket-ball. The 
splinters should be removed to almost any extent and number, and irre- 
gular portions sawn off, even if both ends should be thus implicated. If 
one bone of the leg remains uninjured, the case becomes comparatively 
simple. The position should be straight on the heel, as a general rule, 
admitting a few exceptions. 
The best apparatus for a compound fracture of the leg in either civil or 
military surgery, and particularly in the latter, is that contrived by 
Mr. Luke, at the London Hospital. 
The arm, when fractured by musket-shot, admits even of more strenuous 
efforts being made to save it; and from its smaller size, and the more 
ready exposure of the bone or bones when badly broken, the danger is 
less. If an artery should yield by ulceration, it should be laid bare by 
operation, and a ligature placed on each bleeding end. An additional or FRACTURES, 
735 
second wound in the forearm only complicates the case, and the loss of a 
finger or two does not augment the danger. In fact, amputation should 
rarely take place in the first instance ; and only in the second when mor- 
tification has commenced, or the strength and health of the patient will no 
longer bear the drain upon them. 
In making incisions for the removal of splinters of bone, both at an 
early and at a late period, and particularly in the latter, when the soft 
parts are all impacted together, and nothing is gained beyond what is cut, 
the course of the trunks of nerves, as well as of the great arteries, should 
be carefully attended to, and these parts avoided ; for a successful cure of 
the fracture will be much deteriorated in value, if accompanied by a loss 
of motion and sensation in the hand or fingers. 
Splints for the arm should be made of solid materials, although light. 
The pads or lining for the splints should be made of cleaned or carded 
wool, rather than of tow or old linen, protected by some one or other of 
the modern modifications of caoutchouc. JPart xxvi., p. 131. 
Division of the Tendo Achillis in Certain Cases of Fracture of the 
Leg.—In a case of this accident, where constant displacement of the bones 
was produced by the extreme spasmodic action of the muscles of the calf, 
after all means to remedy this state of things had been tried in vain, the 
tendo Achillis was divided with the most complete success. 
Part xxvii., p. 110. 
Galvanism in Ununited Fracture.—Introduce a needle from each side of 
the limb into the interspace between the bones, and pass a continuous cur- 
rent of galvanic electricity through. In an obstinate case mentioned by 
Mr. IIoll, of the York County Hospital, the application was continued 
daily for a fortnight, and a cure was the result. 
The fracture was of the leg, very movable, and had existed more than 
a year. Part xxix., p. 156. 
Treatment of Fractures of the Base of the Cranium.—If the patient be 
collapsed from the immediate elfects of the accident, cover him up with 
blankets next his skin, add artificial heat by placing bottles of hot water 
in his bed, but not in contact with the skin ; give brandy or ammonia to 
aid reaction, and as soon as vascular and nervous reaction are sufficiently 
reestablished after the accident, as evidenced by the gradual recovery of 
the natural temperature of the body, and by the improved state of the 
pulse, purgatives should be employed to clear the bowels efficiently. If 
the patient has been accustomed to take large quantities of stimulants, the 
same kind of drinks must be had recourse to, especially if the pulse flag, 
or the temperature of the surface be disposed to decline. After the purge 
has acted satisfactorily, give the patient mercury and chalk and Dover’s 
powder: if an adult, five grains of each twice or three times daily during 
a few days, or until he becomes slightly mercurialized. The patient to be 
kept as quiet as possible reclining in bed, and not allowed to sit up or 
attempt to walk. If the pulse become hard, and incompressible, cup the 
back of the neck or apply leeches to the head, or bleed from the arm, but 
do it with care and discretion. Should the patient be very irritable, the 
head a little hot, the pulse a little accelerated, thirst slightly increased, 
the skin hotter than natural, and dry, and the tongue furred and white, 
apply a blister to the nape of the neck, and give diaphoretics in the form 
of the solution of the acetate of ammonia. Farinaceous food and iced 736 
FRACTURES. 
water to be the first diet; if no fever or untoward symptoms arise within 
three days, then beef-tea and milk may be taken, and subsequently solid 
animal food. 
Of course the directions for diet or medicinal treatment must be modified 
in relation to age, constitution, actual condition, and previous habits of the 
patient; here you must fall back upon the general principles of practice. 
Part xxix., p. 163. 
Ununited Fracture.—"When fractured bones will not unite, the seton, 
as first used by Dr. Mott, will cause such a degree inflammation at the 
ends of the bones as to cause their union when not too far asunder ; but 
when too movable, or too far asunder, or when from other causes they 
will not unite, use the xoire-ligature. Bore canals in the cylindrical parts 
of the bone, about three-eighths of an inch long, then pass a copper Avire 
(No. 16) through these canals, and twist it tightly till the ends of the 
bones come firmly in contact. This practice has generally been applied 
only in old ununited fractures, but it is a question whether or not it may 
also be used in more recent cases, when the bones are very movable. In 
military surgery it may be useful. Any kind of Avire will do. 
Part xxx., p. 123. 
Compound Fractures.—Where the bone protrudes, making a small 
punctured wound, the case frequently takes a much more unfavorable 
course than where the skin has been extensively wounded; gangrene, 
fascial inflammation, and abscesses, are far more apt to occur. 
It is the result of Mr. Cusack’s \xast experience, that Avhere the fibula, 
in particular, protrudes, making a small punctured Avound, the case is most 
prone to run an unfavorable course. You see, then, that so far from mea- 
suring, as you would bo apt to do, the evil consequences likely to result 
from a compound fracture by the degree of injury done to the soft parts, 
on the contrary, Avithin certain limits, a small punctured wound Avill gene- 
rally lead to Avorse results than Avhere the skin is extensively lacerated. 
The first step you have to take, when called in a case of compound frac- 
ture, is, of course to endeavor to reduce the bones. When the upper 
fragment projects, the skin affords the first impediment to the reduction ; 
the more you pull the more you draAV in the skin betAveen the bones. 
There is but one means of overcoming this obstacle. Pass a probe-pointed 
bistoury beneath the loAver lip of the Avound in the skin, and divide it; this 
Avill at once liberate the bone, and alloAV it to slip back, and if perfect coap- 
tation cannot be othenvise procured, a portion of the bone may afterward 
be clipped off Avith a forceps. The bones being properly adjusted, the limb is 
to be placed on its side or back, according to the situation and the direction 
of the fracture ; and now comes the question as to the advisability of apply- 
ing bandages. There is some difference of opinion upon this point. Noav, 
bandaging may be advantageous or injurious, just according to the parti- 
cular period at which it may be done. If you see the case before SAvel- 
ling takes place, ahvays apply bandages; they will not only keep doAvn 
swelling, but will help to maintain the bones in situ, and Avill control the 
spasms of the muscles, Avhicli are so frequent an accompaniment both of 
simple and compound fractures. If much swelling, however, have taken 
place, bandaging must not be attempted; it will surely increase the 
tumefaction, excite vesication of the skin, cause pain and fever, and if done 
Avith any degree of tightness, may lead to gangrene. As to the treatment 737 
FRACTURES 
to be pursued in compound fracture, all you can do is to watch the symp- 
toms as they arise, marking their character, and meeting them accord- 
ingly. During the early period of the case, you will have to deal with 
symptomatic inflammatory fever, which sometimes runs very high ; then 
the type alters, and in cases attended with much suppuration, hectic fever 
becomes gradually established. One of the most troublesome symptoms, 
at this stage, is often diarrhoea, which sometimes proves quite uncontrol- 
lable by the most powerful astringents. The chief point, however, to 
attend to, in the course of compound fracture, is the formation of abscesses. 
The patient is going on satisfactorily; his pulse is tranquil, his skin cool; 
he sleeps Avell, neither does he experience any pain—when, suddenly, he is 
seized with a rigor, high fever is lit up, and he complains of severe pain. 
This change implies the formation of matter in some part of the limb; 
examine it carefully, and if you detect an abcess, open it at once. Some- 
times the suppuration presents itself in the form of a succession of small 
abscesses; but, occasionally, a large collection of matter forms beneath 
the fascia, and unless this be let out by an early and free opening, it may 
burrow until it destroys the cellular tissue between the muscles to a seri- 
ous extent. 
Now, with respect to the performance of amputation in compound frac- 
ture, it may be had recourse to at three different periods ; within twenty- 
four hours from the receipt of the injury—primary amputation ; and after 
this period,..principally for gangrene; and at a still more remote period, 
for hectic fever—secondary amputation. 
As regards primary amputation, we should be very slow in having re- 
course to it. It is wonderful what powers of repair nature occasionally ex- 
hibits, particularly in young persons; so that unless the amount of injury be 
obviously irreparable, it is our duty to endeavor to preserve the limb. In 
those cases, however, in which primary amputation is unavoidable, we must 
take care to hit on one particular moment for its performance—when reac- 
tion is fairly established, but before it passes into fever. In cases of severe 
compound fractures of the limbs, particularly those inflicted by sudden and 
powerful violence, the individual remains in a state of collapse for several 
hours afterward, and if amputation be performed under such circumstances, 
a fatal result may accrue. You must wait until reaction sets in; still, if 
you wait until it has glided into fever, you operate under a great disadvan- 
tage ; your case will be very apt to have an unfavorable issue. 
One of the greatest questions, however, in practical surgery, is the period 
at which amputation should be performed in compound fracture, when 
gangrene supervenes. Military surgeons, as Larrey and Guthrie, say you 
may amputate when the gangrene is spreading. Most surgeons say, delay 
till the gangrene has ceased to spread, and the line of demarcation has 
been fairly established. Perhaps the best practice is a middle course, viz.,, 
if within a certain period no disposition to an arrest of the gangrene ap- 
pear, we ought to operate while the patient is strong enough to bear it... 
Should, however, the gangrene spread quickly, accompanied by great pros- 
tration of strength, delirium and rapid pulse, the operation is inadmissible.. 
Part xxx., p. 126. 
Treatment of Fractured Patella.—[In cases of transverse fracture off 
the patella, it is sometimes very difficult to secure coaptation of the frag? 
ments. Mr. Clark employed lately a novel expedient.] 738 
It consisted of a cap of gutta perclia molded to the front aspect and 
sides of the joint, and with a hole cut in its centre large enough to receive 
the patella. The two halves of the broken bone having been by manipula- 
tion brought into apposition, the splint, lightly padded with lint, was placed 
over them and confined by means of bandage. Its influence was thus, by 
pressure from above and belowT, to keep the fragments in exact position. 
The case in which the plan was adopted did remarkably well, and after the 
first reduction no trouble with subsequent displacements occurred. It is 
of course advisable to adopt the ordinary measure of flexing the thigh as 
much as possible on the pelvis during the treatment, and with this view, in 
the present instance, the leg was swung by a broad suspensory bandage 
passed beneath the calf and fixed to the curtain-pole of the bedstead. 
Part xxx., p. 129. 
Diagnosis of Fracture.—[Most surgeons dislike fractures of the long 
bones in children, especially when near the joints. The ends of these bones 
are more vascular and more disposed to ulceration than the middle parts. 
Mr. Stanley makes the following practical remarks on this subject:] 
Pott’s fracture is a rather insignificant accident, fracture of the lower 
third of the fibula, with dislocation of the tibia and eversion of the foot; it 
is rather a dislocation of a bad and troublesome kind, first explained very 
admirably by Mr. Pott, than an injury of such startling and very moment- 
ous importance as generally believed. A man jumps from a height, the 
foot twists outwardly, the foot is drawn out by the peronei, and you have 
an injury easily recognized; but take care, when you are called to Avhat 
may or may not be fracture of the upper end of the same bone and tibia, 
near the knee, with hemorrhage into the cancellous structure of the bone, 
or fracture without crepitus of the lower end of the femur, or what is nearly 
the same, swelling of the elbow, and a fracture not to be made out in the 
humerus—in all these cases, I would advise you to act with great caution, 
and as if there were fracture really present. You will have, in fact, hemor- 
rhage of the bone, and effusion into the joint, which, I wmuld repeat again, 
is one of the most untoward complications of these injuries, leading, possi- 
bly, very often to false joints or ununited fractures, and reflecting no very 
conspicuous credit on whoever has the fortune to meet with such cases. 
Part xxxi., p. 123. 
Starched Apparatus in Fractures.—Mr. Royston uses it as follows: 
All kinds of fractures of the leg, excepting compound, may be treated 
with the starched apparatus. Apply a dry bandage next the skin, then 
two pasteboard (side) splints made perfectly soft by soaking in hot water, 
and molded carefully to the shape of the limb, and lastly a bandage which 
has been tightly rolled in a thick solution of starch. This becomes quite 
hard and dry in about twelve hours, and the following day the patient 
may walk about on crutches, with his leg suspended in a sling from his 
neck. 
The only cases in which we have any fear of employing it are young 
children of a strumous habit of body, whose skin is tender and irritable. 
In such cases we should immediately remove it, if the little patient com- 
plained much of pain. 
We often employ it in fracture of the shaft of the humerus, occasionally 
when the elbow-joint is implicated, and in one case of fractured olecranon, 
it was used with very good result. It has been used here in fractures of 
FKACTUKES. FKACTUKES, 
739 
the lower end of the radius, when there has been no great displacement, 
with success. 
In fracture of the femur, the long splint is always kept on for a month 
prior to applying the starched apparatus, and the long splint (without the 
pad) for a day or two afterward, until the apparatus has become thorough- 
ly dry and firm. 
Stiffness of the knee joint often happens after fracture of the femur, if 
the joint has been included in the starched apparatus; we only carry the 
pasteboard splints as low as the condyles of the femur, and do not include 
the joint. 
In oblique fractures of the leg, we sometimes use M‘Intyre’s splint for 
ten days or a fortnight, and then put the case up in starch. 
The starched apparatus has been found to answer very well in fracture 
of the leg immediately above the ankle joint. 
I treated one case of Pott’s fracture of the leg with it last year. The 
patient (a female) went out at her own request at the expiration of a fort- 
night, and ten days after the starch apparatus had been applied. She at- 
tended at the hospital at the end of the month, when the apparatus was 
removed. The bones of the leg were firmly united, and there was con- 
siderable freedom in the use of the ankle joint. Part xxxi., p. 125. 
American Splint.—A modification of Desault’s long splint for fractures 
of the femur, is made by fitting the upper extremity exactly like a crutch 
under the axilla. It should extend to five or six inches below the external 
malleolus. A shorter splint may be fitted on the inner side, to extend 
from the perineum to a similar distance below the ankle as the outer splint. 
The advantages of this are, that extension is made from the entire leg, 
instead of the instep, and the axilla becoming a second fulcrum, relieves 
the perineum very much. Part xxxv., p. 74. 
XInunited Fracture.—Prof. Syme directs that, after removing the ends of 
the bones, the most perfect rest must be maintained, and this can only be 
effected by placing the ichole limb under restraint. A hard firm case may 
be formed by covering the limb with pasteboard and starched bandages, 
by which means the slightest movement will effectually be prevented. 
Part xxxv., p. 313. 
Plaster of Paris Bandage.—In cases where the ordinary starch bandage 
is used at present, the plaster of Paris bandage may be advantageously 
substituted, as it is fighter and dries quicker, and hence is less liable to be 
spoiled by the patient’s movements during the time of drying. It is made 
by rubbing dry plaster of Paris well into an ordinary bandage. The 
patient’s limb is first enveloped in a roller, and over this the plaster of 
Paris bandage, slightly wetted, is applied. As each turn is laid on it is 
more thoroughly moistened, and then lies quite evenly and comfortably. 
Additional strips may be laid on, and supported by turns of the principal 
bandage at any parts where more pressure is required. 
Part xxxvi., p. 287. 740 
FROZEN PERSONS—GALACTAGOGUE. 
FROZEN PERSONS. 
Treatment of Frozen Persons.—It may be well to notice the practice 
which has been found most successful in the Convent of the Great St. 
Bernard. 
No sooner have the maroniers, accompanied by their sagacious dogs, 
conveyed the body of an unfortunate to the convent, than it is immersed 
by the monks in cold water containing a large quantity of ice. This is 
almost the only treatment employed, for it is generally successful. Should 
it fail, there is little hope ; for experience has taught these charitable men 
that no subsequent treatment is likely to prove efficacious. 
Part xxxiv., p. 269. 
GALACTAGOGUE. 
Galactagogue and Emmenagogue Effects of Warm and Stimulating 
Applications to the Mammae.—Dr. M‘William noted the value of fomen- 
tations with the leaves of the ricinus communis and jatroplia curcas, as 
used in the Cape de Verd Islands, for producing a secretion of milk. Dr. 
Tyler Smith, by a similar method produced a similar effect, even in the 
colder climate of London. Dr. Cormack believes that the warm fomenta- 
tions were the chief cause of the excitement produced in the mammary 
gland, and that stimulating embrocations and cataplasms possess this 
power in a still higher degree. lie says: 
My object is to establish the following propositions: 
1st. Warmth and stimulants applied to the mammae often act powerfully 
as galactagogues. 
2d. Warmth and stimulants applied to the mammae often act powerfully 
as emmenagogues. 
3d. The leaves of the bofareira (or the ricinus communis) and jatropha 
curcas act as galactagogues and emmenagogues; but not from their pos- 
sessing any peculiar or specific power. 
Warmth and Stimulants applied to the Mammae often act powerfully 
as Galactagogues— Case—Milk restored to the Mammae by Ilot Fomen- 
tations.—A lady, when nursing her infant, about seven months old, was 
attacked with acute bronchitis of moderate severity, which was success- 
fully treated by low diet, and tartar emetic in small doses. At the end 
of four days the bronchitis was cured; but the milk, which had previously 
been failing, almost entirely left the breasts. On the fifth day, from expo- 
sure to cold, she experienced a relapse of the bronchial affection. As she 
had been considerably weakened by the previous attack, and as the symp- 
toms of the relapse were not sufficiently severe to justify recourse a 
second time to antimony, I ordered her to take a draught containing 
ammonia and chloroform, as an anodyne, expectorant, and diaphoretic, 
every eight hours; and to carry out similar intentions, I also directed a 
succession of pillow-cases, filled with heated moist bran, to be applied to 
the chest. When I saw her on the following day, after this treatment had 
been employed, she told me that she had profusely perspired for some 
hours; she was (after copious expectoration) free from cough and pain in 
the chest; and, what was equally a source of pleasure and surprise to her, GALACTAGOGTJE. 
741 
her breasts had become distended ivith milk. This lady was able to resume 
nursing, and to continue it with the assistance of a suitable diet. 
Case—Hot Poultices keeping up theSecretion of Milk when this was 
not Desired.—A lady suffered, after her confinement, from a succession of 
abscesses and abortive abscesses in the breast. The surgeon who 
attended her treated her by antiphlogistic medicines, under which disci- 
pline she passed some wretched months, from mental and bodily depres- 
sion, aggravated by hysterical attacks. The local affection did not seem, 
to make any satisfactory progress; and the great obstacle to a cure was 
stated to be the impossibility of getting rid of the milk, in spite of saline 
purges being freely administered. The mammae during the whole of the 
period to which I refer, had been ceaselessly treated, night and day, with 
hot poultices and medicated fomentations. These applications were aban- 
doned, and a generous diet prescribed. In a few days there was not a drop 
of milk in the breasts / and the abscesses, actual and threatening, had 
ceased to give any pain, and had, in fact, almost disappeared. 
Warmth and Stimulants applied to the Mammae, often act powerfully 
as Emmenagogues.—Warm clothing of the abdomen and limbs, hot 
hip-baths, and medicines which stimulate the bladder and rectum (such as 
ergot, cantharides, and aloes), have undoubted emmenagogue powers in 
properly selected cases of retarded or suppressed catamenia. It is 
equally true, though not so familiarly understood, that measures which 
act directly and primarily upon the breasts, such as warm clothing to the 
bust, and the application of stimulants, not only cause them to swell and 
throb, but likewise stimulate the ovaries, and cause the menses to flow. 
The practice adopted by some practitioners, of applying leeches to the 
mammae in amenorrhoea, owes its efficacy to fomentations used, and the 
irritation of the bites. C P , aged 19, complained of headache, 
languor, loss of appetite, and inability to attend to her usual business, 
that of a servant. She stated, that about five months ago, the menstrual 
discharge being then present, she incautiously exposed herself to cold in 
washing clothes in the river. The catemenia then suddenly ceased, and 
had not since returned; and from that period she had been constantly 
subject to ill health. She had consulted different medical gentlemen, and 
taken a great variety of medicine, with little advantage. I directed that 
the clavicular half of the right mamma should be covered with a sinap- 
ism. It was allowed to remain on for thirty minutes; and on visiting her 
in six or seven hours after its removal, I found the whole right breast con- 
siderably swollen, hot, and painful. The next morning the enlargement 
of the mamma was very much increased, the tumefaction having 
extended to the clavicle and axilla of the irritated side. There was no* 
hard circumscribed or prominent tumor, but a painful, diffuse, elastic dis- 
tention of the mammary gland, and surrounding cellular substance. On 
the evening of the day next succeeding the application of the sinapism, 
the catemenia appeared. The flux having continued for two or three 
days in moderate quantity, she found her health restored. 
Injurious effects may so readily be produced by excessive irritation of 
the mammae upon themselves, upon the ovaries and uterus, and (as a con- 
sequence of the undue excitement of any of these organs) upon the 
whole system, that, in following the practice recommended in this paper, 
it is necessary to proceed with caution. 
A poultice made of two or three parts of bread to one of mustard, 742 
GALLIC ACID GANGLION. 
separated from the skin by a fold of soft linen, may be applied for half 
an hour, in the intervals maintaining great local warmth by means of 
abundance of cotton wadding. 
In endeavoring to excite menstruation, we must take care that we do 
not excite inflammation of the ovaries, or of the womb. When we find 
the patient comjdaining of severe pain in the loins, and suffering from 
general fever, we ought at once to discontinue mammary irritation, and 
prescribe rest in bed, abdominal fomentations, and the frequent use of the 
hip-bath. In cases of this description, as in ordinary attacks of dysmenor- 
rhoea, we may often not only relieve pain, but accelerate a resolution of 
the inflammation, by administering opiate enemata. 
Part xxviii., p. 270. 
GALLIC ACID. 
Various Uses of—Dr. Hughes speaks highly of gallic acid, as a local 
application in aphthous ulceration of the mouth and tongue; it is also a 
valuable injection in the gleety stage of gonorrhoea. As an internal 
remedy, gallic acid has been used with great success by Dr. Simpson and 
others, in certain forms of uterine hemorrhage, and with this advantage 
over most anti-hemorrhagic medicines, that it had no constipating effect on 
the bowels; but as gallic acid passes directly to the kidneys, acting 
thereby as a direct astringent, the urine becoming impregnated writh it 
very soon after its exhibition, it, consequently, is an astringent peculiarly 
suited to hemorrhages from the urinary organs, and as such has been 
strongly recommended by Drs. Stevenson, Gold, Bird, and others. 
Tart xv., p. 144. 
Tannic and Gallic Acids.—Tannic acid has the fault of sometimes act- 
ing too astringently, while its effects are in general limited to the points 
where it is applied; whether in the stomach, or at the surface of a wound, 
it immediately forms with the mucus, protein, etc., an insoluble compound, 
and does not gain access to the circulation. Part of it is, however, 
changed into gallic acid, which, after the continuous use of tannic acid, is 
found in the urine. 
Gallic acid more resembles, in its pharmaceutical peculiarities, catechu 
than tannic acid. It has an acid rather than an astringent taste. It does 
not coagulate protein or mucus. It is readily reabsorbed from the 
stomach, enters the circulation, and is found in the urine. Ilomburger, of 
Carlsruhe, employs it in doses of two or three grains in hematuria, in the 
bloody diarrhoea of spotted fever, and in tubercular hemoptysis, with excel- 
lent effect. Part xxii., p. 336. 
GANGLION. 
Treatment of Ganglion.—Mr. Brown, in the course of his remarks on 
bursal disease, says: 
I find that setons are available in cases of ganglions also, although it GANGRENE, 
743 
appears that in some other cases they cannot be borne long enough to be 
successful. Thus, for example, more than twelve months ago, a lad, about 
fifteen, was brought with a very large ganglion on the back of the left 
hand. It was long in shape, and irregular, being narrowed, or partly 
divided at one part. On the hand being flexed or clasped, the ganglion 
would become fixed, and be made very tense. It materially weakened 
the hand and forearm, and caused, on the hand being at all strongly used, 
much aching pain. Not having a better instrument at hand, I introduced 
a very narrow bistoury under the skin at some little distance anterior to 
the ganglion, and passed it on through this, but unfortunately not far 
enough to pass through the other end of the tumor. I say “ unfortu- 
nately,” because the case illustrates what I think to be the general error 
in the treatment of ganglions by “ puncture,” as it is called. Thus, if you 
burst a ganglion by the old practice of striking it with the back of a book, 
the contents escape, not externally, but in the surrounding cellular tissue, 
where the thick glairy fluid which constitutes it, acts as a foreign sub- 
stance, causing an increased action, by which not only the fluid itself is 
absorbed, but the sac so reacted upon is more likely to become oblite- 
rated. The operation, therefore, should be commenced on the subcuta- 
neous principle, and the instrument carried through the distal wall of the 
sac, the fluid being pressed out through that aperture into the surround- 
ing cellular tissue, instead of being squeezed out at a mere puncture in the 
surface. This practice has been, I believe, found uniformly successful by 
Mr. Liston, and it is that which he inculcates. To return to the case that 
I was describing. After squeezing out the contents of the ganglion, I 
applied a compress: the opening closed up, but there was still a sac and 
fluid left. After a little time, I passed a small seton through the tumor. 
On seeing the case on the third day, I found the inflammation to be con- 
siderable, and there was febrile disturbance. The seton was withdrawn, 
and bathing and poultices ordered. An aperient, and saline diaphoretic 
medicines were given, after which the case very speedily, and without any 
further trouble, did well. Vide “Bursal Affections.” Part xv.,p. 173 
GANGRENE. 
Treatment of Gangrenous Inflammation.—Dr. Davidson brings for- 
ward two cases of gangrenous inflammation, in one of which there ap- 
peared, about ten weeks previously, a sore upon the inner surface of the 
prepuce, three days after sexual intercourse: the integuments around the 
gland gradually became much swollen, until at last two gangrenous spots 
appeared, “ one in the situation of the primary sore, the other near the 
frenurn, which rapidly extended over the body of the penis, involving and 
destroying the corpora cavernosa and spongiosa for about two inches. 
The urethra appeared to be opened to a considerable extent, the whole 
presenting a deep, foul, and irregular ulcer, the edges of which were indu- 
rated and shelving, discharging a bloody fetid sanies. Nitrous acid satu- 
rated with nitrate of silver, was ordered to be applied to the ulcer daily,, 
with an emollient poultice.” In a very short time, the phagedsenic ulce- 
ration was checked. The other case was somewha.t similar. 
Dr. Davidson remarks: 744 
GANGRENE, 
Strong nitrous acid does not dissolve so much nitrate of silver as might 
be expected, and the weaker it is, it dissolves the more of this salt. I find 
by experiment that one ounce of nitrous acid, of sp. gr. 1414, dissolves 
nearly 14 grains of nitrate of silver, and that 7 drachms of this acid, united 
to one drachm of water, dissolve 20 grains. In preparing this acid solu- 
tion of nitrate of silver, a little excess of the latter was always added, in 
order that complete saturation might be insured. Some attention should 
also be given to the quality of the nitrous acid, for if it contain muriatic 
acid, chloride of silver will be formed at the expense of the nitrate of 
silver. Fart v., p. 115. 
Gangrene of the Face.—Mr. Obre says: 
If the patient do not sink from previous disease, it advances rapidly 
until it destroys the external integument. In this state there is a remedy 
which has produced the most decided benefit. I allude to the application 
of the actual cautery. It has been used in this disease by Baron Isnard, 
and was named to me by Dr. Hennis Green, at whose recommendation I 
have repeatedly used it with marked benefit. The application of a red 
hot iron to the face appears a formidable measure; but it may be done 
without producing pain. When I have used it, the patients did not 
appear conscious of its application. A fiat piece of steel being introduced 
along the side of the tongue to defend it, the heated iron is to be well 
applied over the entire gangrenous parts. When any spot has been left 
untouched, the gangrene, when arrested in other parts, will at this point 
advance. After the cautery has been used, a yeast poultice may be applied. 
In a day or two the slough is thrown off, when granulation and contraction 
of the wound soon take place. 
Case.—The subject was a boy, nine years of age, living in an unhealthy 
situation, who suffered an attack of typhus, and was treated with bark 
and wine. When sufficiently recovered to sit up in bed, an ulceration of 
an ash-color was perceived on the external and back part of the gum of 
the upper maxilla. It had increased to such an extent, before being dis- 
covered, that the first two molar teeth were loosened, and soon fell out. 
Nitric acid was applied, the ulceration soon passed to the mucous mem- 
brane of the cheek, which was hard, swollen, and of a glazed appearance. 
In a day or two the ulceration passed through the cheek to the size of a 
halfcrown piece. It presented a gangrenous appearance, and was very 
offensive. The hands required to be restrained to prevent his destroying 
a poultice of yeast which was applied. Although in this state, he sat up 
in bed and ate animal food. The strides of the disease were now alarm- 
ing, advancing to the commissure of the mouth in front, and passing back 
to within an inch of the tragus. The parents having consented, the 
actual cautery was applied to the external diseased parts with little or no 
uneasiness to the child. For a week its progress was perfectly arrested, 
when it began to increase under the integuments. 
The edges of the sore were irregular and everted, the internal parts of 
the mouth quite exposed (from the wound), with the superior maxilla, 
high as the zygoma. Being fearful that the lower eyelid would be 
destroyed, as the disease was extending in that direction, the cautery was 
repeated with the same success as previously, the slough soon came away, 
and granulation superseded; at times the double teeth on that side fell 
out. From this time the wound gradually improved, contracting by GANGEENE, 
745 
cicatrization, and the boy eventually but slowly, perfectly recovered, as will 
be seen by the cast which I made two years after his recovery. He is, 
however, unable to open the mouth to a greater extent than the quarter 
of an inch, in consequence of adhesion of the cheek to the gum on the 
diseased side, which inconvenience I am desirous of removing by the 
knife. Part ix., p. 183. 
Spontaneous Gangrene.—M. D., aged twenty-seven, was admitted for 
gangrene of the left leg. The left foot was black and shrivelled, and the 
leg, to a definite line a little below the knee, mottled red and violet. On 
the discolored portion were several vesieations. No pulsation in the left 
femoral artery; much pain on pressure in its course. She was in a very 
exhausted state, quite beyond all remedial means, and died in about a 
fortnight after admission. On dissection of the vessels in and connected 
With the affected limb, the left common iliac and external iliac arteries 
were in their natural condition. At the commencement of the femoral 
was an annular contraction, as if produced by ligature, and the cavity at 
this point was completely obliterated. Fibrinous coagula, adherent to the 
inner coats of the artery, filled the vessel for a few inches below the con- 
tracted portion. The following is taken from the remarks made by Mr. 
Teale on the case: 
The form of gangrene which you have witnessed in this case, has been 
variously named senile, dry, sympathetic, and spontaneous gangrene. 
It was formerly supposed to depend upon a state of debility, more espe- 
cially as regarded the circulation, and was therefore treated with tonics 
and stimulants ; but the result of this mode of treatment was anything 
but satisfactory. The first great advance toward a more correct pathology, 
as well as to a more successful treatment of the affection, was made by M. 
Dupuytren, who advocated the opinion that the gangrene was dependent 
upon inflammation and consequent obstruction of the arteries. 
The morbid condition of the arteries, observed by Dupuytren, un- 
doubtedly performed an important part in the production of the gangrene ; 
but I imagine that this distinguished surgeon has taken only a partial view 
of the subject, and has overlooked the importance due to a similar ob- 
struction of the venous trunks in the production of gangrene. We know 
well that if we obliterate an arterial trunk by ligature, the circulation is 
continued by the collateral vessels, and the vitality of the limb is pre- 
served, provided the veins remain pervious. We also know, that Avhen 
the large venous trunks are obstructed with fibrin, an cedematous condi- 
tion, usually named phlegmasia dolens, is produced, but gangrene does not 
occur if the arteries are able to perform their functions. When, however, 
from any cause, the arterial and the venous trunks are simultaneously 
obstructed, gangrene results. 
So frequently have I observed this coincidence, that I have been in- 
duced to regard the simultaneous obstruction, both of the arterial and of 
the venous trunks, as the essential cause of this form of gangrene. The 
case which has given rise to these remarks is an additional illustration of 
the fact. 
The value of this treatment recommended by M. Dupuytren, namely, 
the substitution for the tonic and stimulant treatment, formerly in vogue, 
of a moderate antiphlogistic system, combined with soothing and emollient 
applications, I have had repeated opportunities of verifying. 746 
Frequently have I witnessed, even in aged subjects, most evident and 
immediate relief of pain from the abstraction of a few ounces of blood, when 
opiates, stimulants, and tonics had proved unavailing; and by the same 
treatment I have not unfrequently seen threatened gangrene averted, and 
existing gangrene arrested in its progress. But I need scarcely tell you 
that in adopting this moderate antiphlogistic treatment, regard must be 
had to the condition of the patient. If the skin be of somewhat higher 
temperature than natural, the cheeks flushed, the pulse not deficient in 
force, although the patient be advanced in years, and apparently much 
shattered by the disease, the repeated abstraction of small quantities of 
blood may be employed with safety and advantage; but if the powers of 
life be flagging, as in the case you have lately witnessed, we have no 
alternative but to endeavor, by the use of stimulants and cordials, to pro- 
long life for a brief period. 
The pathological principle which I have now been explaining, has an 
important bearing upon the operation for popliteal aneurism. Fe w operations 
are more simple and easy of execution than the application of a ligature on 
the femoral artery at the part where it is about to pass behind the sartorius; 
but if you consult the records of surgery, you will be surprised to find, 
when the free anastomoses of the arteries of the lower extremity are con- 
sidered, how frequently this operation has failed from the occurrence of 
gangrene. This is undoubtedly owing to the close proximity of the 
femoral artery and vein, from which circumstance the coats of the vein 
are liable to suffer violence during the operation, or they may subse- 
quently become implicated in the inflammation excited in the vicinity of 
the ligature. From these causes the vein may become obstructed with 
fibrin, while the cavity of the artery is obliterated by ligature, and when 
both the arterial and venous trunks are obstructed, we have already seen 
that gangrene is produced. The knowledge of this fact strongly 
inculcates the importance of our using the utmost care to avoid doing 
violence to the vein while we are applying a ligature to the artery; and 
should the parts implicated in the operation hereafter become painful or 
tense, it is equally important that we should guard against purulent 
matter being pent up within the wound, by allowing it the opportunity of 
escaping freely in the course of the ligature. I have also known gangrene 
follow the operation for popliteal aneurism from a cause which, 1 believe, 
is altogether beyond our control. A few years ago I tied the femoral 
artery for a popliteal aneurism of unusually large size. The tumor pul- 
sated strongly in every part; its contents were almost entirely fluid, as 
there had been but little deposition of fibrin. The ligature was applied 
without the slightest delay or difficulty, and with the least possible dis- 
turbance to the surrounding parts. On the following day the tumor was 
very little reduced in size, but the pulsation had entirely ceased, and the 
tumor was perfectly consolidated. The patient complained of severe 
pain in the leg. On the next day the foot was discolored, and gangrene 
was evidently commencing. After a few days the foot and half the leg 
were gangrenous, and I amputated the limb above the knee. On dissecting 
the amputated part, the principal veins of the leg, as high as the tumor, 
were all filled with coagulum; above the tumor the femoral vein was per- 
vious and healthy. A section of the tumor showed it to be perfectly con- 
solidated by the deposition of concentric layers of fibrin. In this case it 
was evident that the sudden conversion of this large, soft, yielding tumor, 
GANGRENE, 747 
into a firm unyielding mass, had caused such a degree of compression of the 
popliteal vein as to arrest the flow of blood through it, and venous obstruc- 
tion in addition to the arterial being produced, gangrene resulted. 
Part xii., p. 176. 
Hospital Gangrene.—The liquor arsenicalis, diluted with an equal quan- 
tity of water, is a very valuable remedy. Blackader tried it with very 
considerable success. lie used to wash the parts with sesquicarbonate of 
potash, and, after removing as much of the pulpy substance as he could, he 
dipped lint into the solution and put it on the part, changing the lint every 
half hour. You might, perhaps, suppose that by applying arsenic to the 
wound there would be a danger of poisoning the part, but it is found that 
gangrene produces in the flesh an insusceptibility of injury from poison 
applied in ting manner. The best application is strong nitric acid, which 
must be applied till the slough becomes of an ash color, dry, and insensi- 
ble ; if the sloughs are thick, incise them before the acid is used. Give 
opium when the escharotic is applied. 
After the sloughs are removed, granulation begins over the part, which 
is sometimes attacked again, when you must repeat the treatment with 
nitric acid. Under the frequent return of these attacks patients will, how- 
ever, often sink. Part xvi., p. 304. 
Senile Gangrene.—Dupuytren saved three-fourths of his patients by 
bleeding; but in this country the practice has not been so successful. Bark 
is inefficient; ammonia and musk are useful; so is opium. Give half 
grain doses of muriate of morphia every four hours; and give brandy or 
wine. Envelop the limb in carded ■wool, and apply fomentations, or 
poultices, and use chloride of lime to remove the fetid smell. 
Part xvi., p. 304. 
Treatment of Hospital Gangrene.—[In the general treatment, good 
diet, opium, and stimulants are required. Let the diet be nourishing, but 
not solid if the tongue be coated. Give opium in such doses as to relieve 
the pain; the quantity required is very variable, even up to two grains 
every hour or two; if there is much heat of skin, give it as Dover’s 
powder. 
Give ammonia freely; if the skin is hot and there is much inflammation 
round the sore, give it as a saline draught, with five grains of sesquicarbon- 
ate in excess. As to the administration of wine, be guided by the 
pulse; it is seldom required at the commencement of the disease, and 
sometimes may be dispensed with even in the later stages. Regulate the 
bowels with a rhubarb draught or a colocynth pill. As to local treatment 
Mr. Hawkins says:] 
With regard to local remedies—if the ulceration be purely phagedenic, 
or if it be attended with but little sloughing and is painful, soothing appli- 
cations are the best. A drachm of the extract of conium to a pint of Gou- 
lard’s lotion is a very good form of lotion, and was used in both of my 
patients; and if the pain be very severe, you may add mxvi. of Scheele’s 
prussic acid. The solution of opium is uncertain in its efiects, and often 
aggravates instead of allaying the pain of an ulcer. Sometimes you will 
find plain water answer better than medicated applications; it may be ap- 
plied cold if there be much redness around the sore ; it had better be used 
tepid, with oiled silk over it, if the ulcer be weak, and the redness not 
vivid. If the ulcer have rather more of a sloughy character, stimulants 
GANGEENE. 748 
GANGRENE, 
will often rouse the vessels to a healthier action, and so do good; in the 
same manner as they are serviceable in cases of severe burn. The Peru- 
vian balsam may be used, or the tinctura benzoini c.; and they must be 
thoroughly applied, so as to come in contact with every part of the ulcer- 
ated surface; or the green dressing—unguentum elemi compositum, mixed 
with balsam of copaiba, may be employed. Great advantage is sometimes 
obtained from the chlorine lotion, a drachm of strong solution to fifteen 
of water. This, applied over the surface, often stops the disposition 
to slough, and has the additional advantage of correcting the great fetor 
by which the disease is sometimes accompanied. It is when the sore is 
but moderately sloughy that the charcoal poultice, or one of port wine, 
may be useful; they are but seldom used now, though often applied for- 
merly. 
In the third form, not phagedsenic, nor sloughing phagedasnic (the mixed 
form; that is), but gangrenous, the gangrene sometimes spreads so rapidly 
that unless it be stopped at once it may be attended with the greatest 
danger to the patient. Various applications have been used to destroy the 
whole surface next to the gangrenous textures and consolidate the parts 
underneath the sloughs while they are separating, so that a healthy surface 
may be exposed when the dead portions come away. 
The strong mineral acids are the best; the nitric or muriatic, for instance. 
The former is most used, and may be applied by means of a piece of wood, 
taking care to touch every part of the sore, so that the whole of the living 
part beneath may be affected by it; "watch when the slough separates, lest 
there be any part left with a disposition to slough remaining; if there be, 
apply the acid again. None of our patients, I believe, have been bad 
enough to require this plan of treatment, which is a painful one ; nor do I 
ever use it in sloughing phagedoenic sores, but it is invaluable in the gan- 
grenous form of disease. 
When the disease has ceased, the ulcers may be treated in the common 
way by various applications; diluted nitric acid was used for each of our 
two patients, and agreed well, so will sometimes solution of caustic, or red 
wash, or black wash, or whatever else seems appropriate to the condition 
of the ulcer. Part xvi., p. 305. 
Hospital Gangrene.—Hospital gangrene had not been witnessed, as an 
epidemic disease, in St. Bartholomew’sHospital within the memory of any 
of the present medical officers; and diffused inflammation of the cellular 
membrane, in so severe a form as here described, is of the very rarest oc- 
currence. These two singular affections broke out simultaneously, and 
were confined, almost without exception, to a few of the men’s wards ap- 
propriated to the reception of patients who have either undergone severe 
operations, or sustained serious injuries from accident. The former disease 
attacked, in most instances, recently incised wounds, of inconsiderable ex- 
tent. There was little or no preceding constitutional disturbance; some 
patients complained of occasional darting pains about the brow, and of in- 
ability to sleep, but the skin was cool; the tongue clean and moist; and 
the appetite remained unimpaired. The first symptoms were the suppres- 
sion of the ordinary healthy puriform discharge, and the appearance of a 
dusky-red inflammatory blush in the neighborhood of the wound. This 
was accompanied by immediate and rapid sinking of the pulse, which be- 
came accelerated, beating with regular strokes, between 90 and 100 in the GANGRENE. 
749 
minute. In some cases a stinging, burning sensation was felt in the wound. 
Within four-and-twenty hours, the edges, which had become undermined, 
everted and eroded, separated, and there was exposed a glazed surface, 
covered by a tenacious grey or fawn-colored secretion, which in thirty-six 
hours became a circular, bulF-colored slough. The sore, surrounded by a 
dusky red zone, extended both in breadth and depth, by a mixed process 
of sloughing and of phagedsenic ulceration, and rapidly disorganized the'* 
soft parts down to the subjacent bones. A thin and extremely offensive 
discharge was secreted ; and in many instances the pain became so severe, 
that patients compared it to the “ burning of a hot coal.” The spontane- 
ous subsidence of the disease was marked by the disappearance of the 
dusky-red discoloration of the skin, and by the rising of the pulse. The 
secretion lost its fetid odor and became more puriform; the slough, which, 
if large, was dry and black, separated, and left a granulating and extremely 
sensitive surface, which cicatrized very slowly. 
The only local treatment of any avail in arresting the progress of the 
disease, was the free application of the undiluted nitric acid to the surface 
and to the edges of the sore. It sometimes happened that the eschar thus 
formed separated in a few days, and left a perfectly healthy surface, which 
healed without an unfavorable symptom; but in other instances the remedy 
failed; the sloughing process recommenced, and local applications became 
of secondary importance. The common bread-and-water poultice, or the 
charcoal poultice (of which the latter is extremely useful in correcting the 
horrible fetor proceeding from the sore), was the most comfortable to the 
feelings of the patient. Opium was given in large doses, to relieve pain, 
and to procure rest. Quinine and ammonia were administered with advan- 
tage, as the stomach would bear them. The patients, who almost without 
exception retained the appetite, were allowed meat, with a moderate quan- 
tity of beer, wine or spirits; they were separated as much as possible one 
from another. 
In attempting to investigate the causes which gave rise to these mala- 
dies, care must be taken not to confound hospital gangrene with sloughing 
phagedtena, as witnessed in patients suffering from syphilis, or broken down 
by intemperance and irregular habits. In both classes of cases the sore is 
characterized by a foul surface, rapidly spreading by a mixed process of 
ulceration and of sloughing; but the latter disease occurs in isolated cases, 
and is confined almost exclusively to the lowest order of prostitutes. Hos- 
pital gangrene spares neither the young nor the old, the temperate nor the 
intemperate; attacking wounds of inconsiderable extent, it produces a 
frightful sore, which frequently spreads in spite of all efforts to restrain it. 
Part xvii., p. 294. 
Senile, Gangrene.—Prof. Syme considers the best plan of treatment is to 
lower the tendency of excitement throughout the system, by enforcing a 
strictly vegetable diet, abstinence from every kind of stimulant, and the 
maintenance of perfect quiet in the horizontal posture. Apply linseed 
poultices, and so long as nocturnal pains continue give muriate of morphia 
freely. Part xvii.,y>. 296. 
Traumatic Gangrene.—Mr. Vincent would not amputate for traum atie 
gangrene. He would give food when the stomach can bear it, and stimuli 
if required. 
The cases which M. Larrey represents to have been saved by amputa- 750 
GANGRENE. 
tion were actually rescued from death by the administration of brandy. 
This liquor, in fact, he regards as the great resource for sustaining the 
action of the heart in these circumstances, and beyond all comparison the 
best means. Some years ago, he states that he tried the comparative 
efficacy of brandy and ammonia; and the superiority of the former was 
marked and distinct. Ammonia, he thinks, impairs the action of the 
% stomach more than any other agent. This impairment is the very thing 
to be avoided. 
Ammonia also impairs the secretions, and in so doing causes great evil. 
To maintain them in such circumstances, Mr. Vincent recommends the use 
of mild preparations of mercury with antimony. At all times where the 
secretions are bad, it is necessary to keep up regular evacuations, which 
he maintains not to be weakening, according to the recent doctrines of 
some speculative innovators, but which he knows to be necessary for pre- 
serving health. Part xix., p. 206. 
Hospital Gangrene.—Remove the patient from the source of conta- 
gion ; let him be kept, cleanly, and have a good supply of fresh air. 
Destroy the diseased part with the actual cautery, or by the application 
of the pure mineral acids, or a solution of arsenic or of chloride of zinc, 
or other caustic which shall penetrate the sloughing parts and destroy a 
thin layer of the unaffected parts beneath them. On the separation of* 
the sloughs, treat the sores upon general principles. Be guided as to 
the constitutional treatment, by the kind of fever which the symptoms 
represent; Rising emetics, purgatives, and the early abstraction of blood, 
if the type is purely inflammatory, and less vigorous means, if it is of a 
different character. Part xix., p. 20V. 
Observations on Gangrene.—[After mentioning the terms ordinarily 
used to express varieties of gangrene, as dry, humid, and traumatic, Mr. 
Guthrie says:] 
These words or terms do not convey to the mind of the surgeon any 
real practical distinctions, yet practical distinctions are the points required; 
and to. effect this object, I have made one which is on many points of the 
greatest importance, because it leads to an essential difference of practice, 
viz., into constitutional and local. Surgeons have, I am aware, spoken 
and written of chronic and idiopathic mortification, or certain states 
depending on internal causes, which have occupied a considerable time 
before they gave rise to any great development of evil; whereas, the 
difference between local and constitutional mortification may depend on a 
few hours—a time so short, and yet so precious, that it becomes a matter 
of life and death in many instances. 
Constitutional gangrene may be humid or dry, whether it arises, as it 
were, idiopathically, following a spontaneous inflammation, or in old age, 
in which it appears almost as .a first symptom. Local mortification may 
be either humid or dry, although, when it is humid, it arises chiefly from 
the warmth of the applications by which it is surrounded, causing it 
to be also the commencement of the process of putrefaction, whilst, if 
left to itself, or nearly exposed to the air, it would become shrivelled and 
dry. 
Examples of humid, or the common kind of mortification, following 
erysipelas, are seen sufficiently often in all hospitals to render a description 
of it here unnecessary, and I shall confine my observations to local morti- 751 
GANGRENE. 
fication only. The purest example of local mortification is when it occurs 
from the supply of blood being cut off from the foot by the division of 
the great vessels in the thigh. 
The surgery of London was not as far advanced in 1823 as the surgery 
of Toulouse in 1814. In the first place, these gentlemen did not know 
that the lower end of the femoral artery, when wounded, always bleeds 
black blood, not scarlet, like its upper end, so that you may have, and 
will have, two kinds of blood from the two ends of the same artery. 
This was a fact well known on the banks of the Guadiana, the Tormes, 
and the Garonne, but not on those of the Thames. So it was with the 
equally important fact, that arresting the flow of blood in the upper 
part of an artery would not prevent its bleeding, if wounded, at its 
lower part. 
The third point, or that of the first appearance of mortification, is not so 
fully acknowledged, and that because it is not understood. The accident 
is not seen as often in all England in seven years as it was in a day in the 
plains of Estremadura and Castile. The existence of mortification is not 
acknowledged, because the part is neither red nor blade, which it is pre- 
sumed all mortifications ought to be. It is, in reality, the reverse, or quite 
white. 
In all cases like those I have referred to—and I have reported many in 
my record on wounded arteries—the foot first suffers, and the failure of 
the circulation is usually remarked in the great toe, or in the ends of the 
other toes. It may so remain for days, and then extend as far as the instep, 
or ankle, when it frequently stops for a short time, and then proceeds as 
high as the calf, after which life is soon destroyed. In many cases the ex- 
tension of the mortification is more rapid at the beginning, and soon pro- 
ceeds as high as the calf of the leg, at which part nature seems often to 
make a great effort to resist its further progress. The fact I state; the 
cause, I presume, must depend on the circulation around the knee. It is 
on account of the fact that I have selected this part as the one at which 
amputation should be performed. 
Amputation at or above the middle of the thigh is a very dangerous 
operation at all times, and a very unsuccessful one in all cases of wound of 
its artery, accompanied by mortification of the foot and leg. The person 
does not die under the operation, but the stump does not take on the ac- 
tion necessary for his recovery. The mortification had become constitu- 
tional instead of being local before the operation was done. The stump 
swells, opens out, looks white and discharges usually but little, and never 
healthy matter. The system generally suffers in proportion, and the pa- 
tient rarely survives beyond three or four days, if he live so long. To 
prevent this result, amputation is to be performed as soon as mortification is 
so established as to be no longer doubtful. Under the most favorable cir- 
cumstances, the person must lose his toes, or his foot at the ankle, and an 
amputation a little higher, leaving room for an artificial leg, does not make 
the matter worse, more particularly as the cases of recovery, with the loss 
of the toes or the foot at the ankle, are not forthcoming, to prove the 
propriety of doing nothing, or for waiting for what is called a line of sepa- 
ration. 
The patient is not aware of anything being abnormal in his foot, the sen- 
sibility and capability of motion being nearly as natural as usual. The 
temperature of the part, under the ordinary circumstances of being in bed, 752 
GANGRENE, 
is scarcely diminished—often not perceptibly so to the touch of the 
observer; and when it is less, it is not beyond a degree or two of the ther- 
mometer. It is the change of color which marks the commencement of 
the mischief to the initiated. The flesh-color has changed to the white of 
a bad tallow candle ; and as the mischief advances on the instep to the leg, 
this white becomes spotted like the best mottled soap. It does not turn a 
red or purple black, like that of a humid mortification, unless the part pu- 
trefies under the application of hot poultices, etc., but gradually shrinks 
and dies. The long tendon of the great toe seems to stand out along its 
back, and the skin becomes brown over it, and shrivelled. The person, 
nevertheless, can bend and extend the toe, and feel and describe his sen- 
sations when it is touched. There is no redness at first, marking the spot 
beyond which the commencing mortification does not extend ; there is 
merely the difference between the natural and the altered color of the 
parts. This is followed by some little swelling and slight redness, the pre- 
cursors, in general, of the further progress the mortification is about to 
make. As time passes away, the course of all the tendons in the foot is 
marked by the discoloration of the skin over them, and the whole skin 
gradually becomes browner, dark colored and dry, unless artificial heat 
changes the chemical action going on in the part, dead as to circulation, 
but yet alive as to motion and sensibility, although both are at this period 
impaired. 
This mortification is local, in the first instance; how long it may remain 
so depends, in a great degree, on the excitability of the constitution of the 
patient, and is of longer or of shorter duration. There is always, however, 
I shall say, as a general rule, sufficient time for its continuance as a local 
disease, to allow of the commencing mortification being clearly perceived, 
and its probable extent ascertained, at an early period. 
What, under these circumstances, is the precept to be followed ? Is it 
the old Hunterian one, of waiting for the cessation of the mortification un- 
der the means employed, and the formation of a line of demarcation, or is 
it the precept I have laid down for you, of amputating immediately, and 
below the knee ? My decision is for the latter, and I hope it will always 
be yours. 
I must impress upon you, however, that although mortification too fre- 
quently follows an injury of the main artery, when suddenly committed, 
and without any previous disease in the limb, it does not always do so; 
and that attention to the direction I have elsewhere given, of keeping up 
a gentle but continual friction, by the hands of assistants, on the lower 
part of the extremity in danger, may tend to prevent it. It is a proceed- 
ing which should never be omitted in any case where a doubt exists as to 
the probable occurrence of the mischief which may be expected. 
Part xxi., p. 330. 
Attaching the Extremities of the Young.—In the young, the pathology 
seems to he obliteration of the arterial trunks. In the old it is from ossifi- 
cation of the vessels. 
How is the obliteration brought about in the young ? Mostly, if we do 
not mistake, as a consequence of arteritis, the vessel becoming plugged up 
with the fibrinous exudation excited by the inflammation of its coats. And 
here some analogy is seen to exist between gangrene of the feet, and soft- 
ing of the brain ; for in both cases does the disorganization of the whole GANGRENE. 
753 
or a portion of the part affected, depend upon a diminished or totally 
arrested supply of arterial blood. 
Dr. Kirkes thinks that by actual cases, post-mortem examinations, 
reasoning, and analogy, he has established that—“ 1st. Fibrinous concre- 
tions on the valves of the heart admit of being readily detached during 
life. 2d. That if detached and transmitted in large masses, they may sud- 
denly block up a large artery, and thus cut off the supply of blood to an 
important part 3rd. That the effects produced and the 
organs affected would be in a great measure determined by the side of the 
heart from which the fibrinous material had been detached; if from the 
right side, the lungs would bear the brunt of the secondary mischief; but 
if, as was most commonly the case, the left valves Avere the source, the 
mischief would be more widely spread, and might fall on any part, but 
especially on those organs which were largely and directly supplied Avith 
blood from the left side of the heart, as the brain, spleen, and kidneys.” 
In the treatment of spontaneous gangrene in the loAver extremity, it is 
proper to Avait until a line of demarcation is formed, so as not to run the 
risk of having a stump with diseased arteries. But Ave have seen, in some 
instances, the sphacelated parts ulcerate aAvay completely, and the stump 
formed Avithout the intervention of the surgeon’s knife. There is, Avefear, 
a certain amount of risk in adopting this course, for the long process of 
separation betAveen living and dead portions of the limb lays the patient 
open to that fearful complication knoAvn under the name of purulent 
absorption. ISTor is this all, for the noxious gases resulting from the de- 
composition may be \*ery baneful, both to the patient himself and to his fel- 
loAV-sufferers in the same ward, and thus do incalculable mischief. The 
surgeon has therefore to use his powers of discrimination—and seize upon 
the moment Avhen the line is sufficiently marked to leave no doubt upon 
the soundness of the vessels above, and amputate a little beyond the ulcer- 
ated points. Part xxvi., p. 166. 
Gangrena Senilis.—Lessen the tendency to overaction by soothing 
means ; confine the patient to bed; debar him from animal food in every 
form, Avith the exception of milk. Supply him Avith doses of morphia in 
proportion to his pain and restlessness. Avoid giving him stimulants, and 
cover the affected part Avith a linseed poultice. Under this plan the dis- 
tressing symptoms gradually disappear, the slough ceases to extend, and 
the sore cicatrizes soundly. Part xxvii., p. 351. 
Gangrene—Spontaneous.—As all these cases are deficient in power, a. 
stimulating rather than depleting plan must be pursued. Large dosfls of 
opium Avill be avell borne, and are very beneficial. The best local stimula- 
tion is Avarmth by cotton wool. According to Mr. Stanley— 
Spontaneous gangrene does not always take place in parts at a distance* 
from the heart; cases have occurred where the nose, for example, hasbeem 
the part so affected. The pathology and the therapeutics in these cases 
are exceedingly interesting, and it is important to knoAV what is the 
line of treatment to be pursued in such cases. The surgeon generally 
Avaits until the line of demarcation has formed before he uses the knife, 
except in traumatic gangrene, Avhere the measures must be prompt and 
effectual. ■ Part xxix., p. 208. 
Gangrenous Sores—Disinfecting Powder.—Mix and rub together 100 
parts of plaster of Paris, and from 1 to 5 parts of coal-tar; they form a grey 754 
GASTRALGIA—GASTRODYNIA. 
powder with a bituminous odor. This powder may either be used as it is 
or made to cohere into a sort of ointment by olive oil, when it may be 
spread on lint and used as a dressing. It is found that this powder absorbs 
the pus and other morbid products engendered on the surface of sores, 
and moreover destroys all offensive odor. Part xl., p. 151. 
GASTRALGIA. 
Ioduret of Silver.—The following formula is recommended in gastral- 
gia : R Ioduret of silver, nitrate of potash, each 10 grains. Pulverize 
together thoroughly. Add liquorice powder, half a drachm ; white sugar, 
20 grains; mucilage gum arabic, q. s. Make into 40 pills. Let the 
patient take one thrice daily. Part vi., p. 13. 
Powdered Hemlock.—M. Lisfranc has a high opinion of this remedy as 
an anti-nervine in the gastralgia of women suffering from uterine affections 
—beginning with a grain every morning, gradually increased to four. 
Part vii., p. 163. 
Gastralgia.—In many forms of gastralgia the administration of a tea- 
spoonful or two of powdered charcoal (poplar wood the best) before meals, 
two or three times a day, is very useful. It may be given in the forms of 
pills or lozenges, or made into a paste with water, or spread upon bread. 
Part xxi., p>. 148. 
Gastralgia—Treatment by the Subnitrate of Bismuth, united with 
Belladonna.—According to Professor Caizergues, of Montpellier, the sub- 
nitrate of bismuth is more efficacious when united with belladonna. He 
orders this mixture in painful affections of the stomach, properly so called, 
and which are isolated from all inflammatory complication, and against 
affections of the stomach which are connected with a positive disease, or a 
general morbid state, like chlorosis, for instance. The professor generally 
employs the following formula : R Subnitrate of bismuth, ten grammes ; 
extract of belladonna, one gramme; make forty j>ills, two to be taken 
night and morning. Part xxiv., p. 109. 
Gastrodynia and Gastralgia.—The first of these terms should he ap- 
plied to such pains in the stomach as are of a rheumatic, and the second to 
such as are of a purely neuralgic nature. The pain in both is almost al- 
ways much more severe than in genuine chronic gastritis; and yet it is 
usually not increased, but is often relieved, by pressure on the epigastrium. 
Moreover, there is no feeling of heat, nor is there much thirst, and the 
pulse is not quickened. Generally there is but little derangement of the 
digestion ; and almost all kinds of food may be taken without any decided 
effects either as to increasing or mitigating the pain. In genuine gastro- 
dynia we can usually discover that there has been the retrocession or tran- 
sport of a previous rheumatic affection of some of the joints, etc. lienee a 
certain degree of phlogistic action may be coexistent with the pain ; not 
so, however, with gastralgia. 
GASTRODYNIA. GA8TKODYNIA. 
755 
As to the treatment, opiates are, on the whole, the most efficacious reme- 
dies. In many cases they require to be administered in large doses. Some 
of the diffusible antispasmodics, such as ether, camphor, the liquor Iloff- 
manni, etc., are often useful. The subnitrate of bismuth is an admirable 
preparation in numerous cases. Sometimes, more especially where the dis- 
ease is of a rheumatic character, the use of blisters, applied either to the 
epigastrium or to one of the lower limbs, is necessary. There is no remedy 
so generally beneficial, nay, even necessary, as opium in such affections; 
as, for example, in cramps, colicky pains, dysentery, as well as in gastral- 
gia. In some cases it must be associated with blood-letting; in others, 
with laxatives and emetics; and in a third set, with bitters and tonics. 
Medical men have been, especially during the last thirty years, far too 
timid in the employment of this admirable remedy in the treatment of dis- 
ease. They forget that often, very often, nature only requires to be freed 
from present pain to enable her to restore a disordered function to a 
healthy condition, and a suffering organ to the regular performance of its 
duties without distress or inconvenience. 
[In Dr. Debreyne’s treatment of gastrodynia and gastralgia of the sto- 
mach with opium, he might have referred more particularly to the prussic 
acid, which, when properly prepared and preserved, we have found so effi- 
cacious in this country, and especially when combined with small doses of 
the acetate of morphia, as the eighth or the sixteenth of a grain, three 
or four times a day. We have seldom or never had occasion to give large 
doses of opium in these cases, as we almost invariably succeed with these 
minute doses of morphia, when properly persevered in, and assisted by 
proper regimen. And when we fail with these remedies, wre have recourse 
to Dr. James Johnson’s favorite remedy of nitrate of silver, given in small 
doses, which will be found a most valuable, and we might almost say cer- 
tain, remedy in such cases.] Part i., p. 23. 
Belladonna, Hydrocyanic Acid, etc.—Dr. Waller stated, during a dis- 
cussion in the Medical Society of London, that he had seen the belladonna, 
in conjunction -with hydrocyanic acid, in the proportion of one quarter to 
half a grain of the extract to three minims of Sheele’s preparation, four or 
five times a day, of great benefit in cases of severe gastrodynia. 
Dr. Garrard, also, had found belladonna and quinine of service in gastro- 
dynia. Part ix., p. 75. 
Gastrodynia.—[Dr. Dick observes that the term gastrodynia, as also the 
terms gastralgia and cardialgia, are sometimes used to imply uneasiness in 
the epicardiac region, when the stomach, if affected at all, h so only in a 
secondary or subordinate manner. He says:] 
If there is heartburn, with sour eructations, we try at first a simple ant- 
acid, as ten or fifteen grains of carbonate of potass, in, if you will, two or 
three ounces of some aromatic water. If this is not sufficient, and an 
alterative alkali is indicated, the carbonate of magnesia may be tried. If 
the tongue is furred, and its edges red; the breath heavy, hot, and fetid; 
the bowels irregular; the urine turbid and high-colored; and the stomachic 
uneasiness rather dull than acute, but constant—it is presumed that the 
gastric mucous surface, probably also the duodenal and jejunal mucous 
membrane, is in the same condition as that of the tongue—sub-inflamma- 
torily congested. In this case, if the patient is young and plethoric, the 
treatment is simple. The compound infusion of senna, with the sulphates 756 
GLANDERS, 
of magnesia or potash, until the tongue cleans and the stomach-pain van- 
ishes, are all that is necessary. 
The same symptoms may, however, occur in arthritic and rheumatic 
subjects, and persons considerably past middle life. Here a more cautious 
treatment is required. The neutral salts are to be avoided. Extract of 
rhubarb, and blue pill must gently correct the secretions and promote ex- 
cretion, and the infusion of senna must be combined with that of rhubarb 
and with the tincture of cardamoms, or the compound spirit of horse-radish. 
To the extract of rhubarb and blue pill, I have often seen advantage from 
the addition of extract of colchicum, in such proportions as two or three 
grains of rhubarb plus a grain and a half of blue pill and extract of colchi- 
cum respectively. 
If the cardialgia arises from the ingurgitation of bile, as evinced by ex- 
treme nausea, bitterness of taste in the mouth and bilious retchings, we 
ought to commence with the induction of vomiting, and thereafter give 
draughts, composed of decoction or infusion of taraxacum, with sulphate of 
magnesia. This last measure is, however, only to be resorted to if the 
stools are pale and inefficient, and the hepatic region full and tender; for 
in this case we must presume that the hepatic veins are congested, and 
require to be stimulated to evacuate their contents. But if, along with 
bilious vomiting, there are bilious stools, the treatment, after the emetic, 
should consist of little else than diluents. If the bile be freely and spon- 
taneously discharging itself, there is no use in exasperating the obviously 
already excited liver by purgatives. 
If the cardialgia is flatulent, draughts of a mixture composed Of four or 
six drachms of the compound tincture of ammonia, and of the tincture of 
assafoetida, respectively, with six or eight ounces of the compound infusion 
of senna, will dispel the cause. 
The cardialgia of pregnancy has no cure but parturition. That which is 
owing to interrupted menses or suppressed hemorrhoids, long established, 
must be treated by leeches applied to the anus or groins, by hot pediluvia, 
and by sufficient and prudent purging. The cardialgia of old subjects, if 
plainly traceable to suppressed hemorrhoids, must be treated promptly. 
Aloes must be given in the purgative, and stimulant suppositories inserted. 
Perhaps the two last kinds of cardialgia ought more properly to be con- 
sidered as cases of gastrodynia or gastralgia. Part xviii., p. 114. 
GLANDERS. 
Case of Acute Glanders—Recovery.—It is generally admitted that 
glanders may be communicated from the horse to man. The following 
case is an example in proof: W , a liorsekeeper, aged 58, was admit- 
ted into the Paddington Infirmary. His face generally was swollen and 
suffused; especially in the submaxillary region. A large quantity of 
saliva was pouring from his mouth, his breath was extremely fetid and 
sickening, his gums were swollen, his teeth were loose, and his nostrils 
were filled with a thick glutinous secretion, which was with difficulty 
removed. From destitution he had been accustomed to sleep in stables, 
or wherever he could get a shelter, and from this circumstance he had 
undertaken the charge of some glandered horses. He got progressively GLANDULAR AFFECTIONS. 
757 
worse, the swelling increasing under the jaw to an enormous tumor. He 
broke out into profuse cold sweats, but he had no rheumatic pains, nor any 
local affection of the face, nose, or salivary glands. “Now this seems to 
be a case of acute glanders, and yet it so differs from other reported 
cases, as neither ecchymoses, gangrene, nor pustules Avere observable on 
the mucous membrane, neither was there any specific affection of the 
lymphatics or cellular tissue. The enfeebled state of his constitutional 
poAvers from previous destitution, seems to have been the chief predispos- 
ing cause. 
“Treatment.—I had no reasonable expectation,” says Dr. Mackenzie, 
“ of the patient recovering, nor had he, or any one avIio Avas present at the 
time Avhen I first saw him ; and yet in twenty-four hours he Avas compara- 
tively out of danger. Now this change cannot be ascribed to any 
improvement in his sanitary condition consequent upon coming into the 
hospital. For, in spite of Avine and other assistance, he was Avorse then 
than Avhen he Avas admitted. Hence I think that the improvement which 
took place must be mainly attributable to the treatment Avhich may be 
thus recapitulated in the order of sequence. 1st. An incision in each of 
the Whartonian ducts. 2dly. An emetic of ipecacuanha. 3dly. Sesqui- 
carbonate of ammonia in water hourly, as concentrated as it could be 
SAvallowed. 4thly. An opiate at bedtime, Avith Avine and nourishment, in 
such quantities as the patient could be prevailed upon to take. 
“The incision Avas made in the Whartonian ducts on account of their 
being much distended, and from an impression that their orifices were 
closed from the swollen state of their parietes. It gave immediate relief 
to the patient, by alloAving a free escape of a large quantity of pent-up 
saliva, and the swelling and tension of the parts were at once lessened by 
it. The emetic Avas considered to be indicated by the existence of gastric 
derangement throughout the progress of the case, Avhich was manifested 
by a constant disposition to sickness, and the inability of the patient to 
retain anything upon his stomach. It was also given for the purpose of 
producing reaction, and rousing the constitutional powers by its operation 
upon the ganglionic nervous centres. 
“But the principal reliance was placed upon the frequent administration 
of the sesquicarbonate of ammonia in a concentrated form. This remedy, 
and this mode of exhibiting it, were suggested by the good effects which 
I had seen it produce Avhen so given in the severe affections of the throat, 
which are met Avith in malignant scarlet fever. Tavo drachms of the car- 
bonate of ammonia are dissolved in five ounces of Avater; the patient to 
take two teaspoonfuls every two, three, or four hours, according to the 
urgency of the symptoms. It may be administered in erysipelas, rubeola, 
scarlatina, urticaria, roseola, and erythema, Avith all their varieties.” 
Part xxiv., p. 44. 
GLANDULAR AFFECTIONS. 
Inflammation of the Glands in the Groin.—Sir B. Brodie discourses 
as follows: 
Caustics may often be used very advantageously for the purpose of 
destroying diseased lymphatic glands. A man has chronic inflammation 
anrl enlargement of the glands in the groin, forming a considerable tunic1' 758 
GLANDULAR AFFECTIONS. 
The skin over them ulcerates, forming at last a large ill-conditioned ulcer, 
which will not heal. What is the reason of this ? Because no ulcer will 
heal unless it has a healthy basis, and here the basis is a mass of diseased 
glands. These diseased glands may take a long time to recover them- 
selves—not merely months, but one or two years—and as there are 
plenty of glands to spare, there is no harm in destroying them. You 
may effect this by the caustic potass, but not very well; you want some 
kind of caustic which will lie in the substance of the diseased glands, and 
destroy their inner structure as well as their outer surface. The form of 
caustic I am going to mention was used by the late Mr. Pearson, from 
whom I had the prescription. It consists of one ounce of crumb of bread, 
two drachms of oxymuriate of mercury, one drachm of red oxide of lead. 
These are to be mixed together, kneaded with the fingers, and formed into 
a sort of paste. The paste should be rolled into little conical troches, and 
these, if left to dry, become hard like bread seals. These troches may be 
stuck into the enlarged glands like pins into a pincushion. They produce 
no effect at first, but in the course of a little time they begin to act, and 
the patient knows this by the pain produced. This lasts for some hours, 
and if a sufficient number of the troches be employed, the whole of the 
gland is at once destroyed. If any portion remains not destroyed it is 
easy to effect it by repeating the process. I do not know whether the 
red-lead answers any useful purpose; I suppose not, but I found it in the 
original prescription, and on all occasions, where I find a particular pre- 
scription to do just what is wanted, I am unwilling to alter it. 
Part iii., p. 73 
Glandular Enlargements in the Groin and Axilla of Young Persons 
—Treatment by Caustic Potass.—Dr. Darley mentions a form of consti- 
tutional or sympathetic enlargement of the glands of the groin, frequently 
met with in young men, and not the consequence of venereal virus, but 
rather the effect of a weakened and cachectic constitution. This tumor is 
very indolent in its nature; a long time elapsing before suppuration is 
established, and resolution is not a common termination. Dr. Darley 
treats these tumors by making a tolerably sized eschar with caustic potash 
in the early stage, and covering it with a small poultice. The tumor will 
be found to have disappeared when the eschar separates. 
Allied to this is a tumor often met with in the axilla of young persons. 
A young man applies for advice, with the arm either in a sling or sup- 
ported by the other hand, and the shoulder depressed and pushed forward, 
and there is much anxiety and suffering in his countenance. If this be 
treated in the common way, we have to wait long before it suppurates; 
and if it be opened, only a small quantity of thick pus escapes. The 
opening will soon close, and the absces£ point in another direction, leaving 
sinuses, which are tedious in healing. Dr. Darley treats such tumors by 
making a small eschar with caustic potash in the very beginning, when 
they are hard and indolent. They must not be mistaken for the acute 
abscess frequently met with in this situation, and easily treated by incision. 
Part 297. 
Glandular Enlargements.— Vide Selections from Favorite Prescrip- 
tions, Art. “ Medicines.” 
Obstruction of the Ducts of Salivary Glands.—[Diseases of the 
salivary glands are little noticed by medical writers, but, in fact, with the GLANDULAR AFFECTIONS. 
759 
exception of that form of inflammation of the parotids called mumps, 
and after the administration of mercury, we seldom see them affected. 
Suppuration is very rare, as are also tumors, which, moreover, generally 
affect these glands only secondarily. Cretaceous deposits and obstruc- 
tions of their ducts, from these or inspissated secretions, are sometimes 
found. Ranula is now supposed to be an encysted tumor, having no rela- 
tion to the submaxillary gland, other than that of propinquity. A second 
form of this may occur in the mylo-hyoid space, not projecting so much 
into the mouth as externally.] Dr. Hakes says: 
A consideration of two or three well-known facts cannot fail to make xis 
regard the frequent occurrence of this sudden accumulation, as by no 
means improbable, and also lead us to anticipate the time at which they 
might be expected to take place. 
The existence of salivary concretions is one of these facts ; it must not, 
therefore, surprise us if at times they occupy and block up the small ducts 
which carry off the saliva from the glands. Again, the secretion of saliva 
is acknowledged to be pretty copious. Authorities vary as to the quantity 
secreted in twenty-four hours, some stating the amount as low as twelve 
ounces, others as high as eighteen. Though the secretion proceeds con- 
stantly, many things are known to increase the amount and rapidity of 
production, and especially the presence of food in the mouth, and the pro- 
cess of mastication during a meal. We have then but to suppose obstruc- 
tion of the duct to take place about the time of taking food, and we have 
all the circumstances present necessary for establishing such an attack, if 
only the ducts are capable of sudden and rapid dilatation; this can be 
proved by experience alone, and however much we might feel inclined to 
say with Mr. Erichsen, when speaking of ranula, “ It is not easy to under- 
stand how so small a duct can be dilated to so large a size as is occasion- 
ally attained by these tumors,” I think the perusal of the following case 
will leave no room to doubt the fact. 
A youth was eating his dinner, and in the midst of it began to complain 
of stiffness of the mouth and difficulty of deglutition; his mother very soon 
noticed a distinct swelling under the jaw. As some of the inmates of the 
house were at the time suffering from mumps, this was supposed to be a 
sudden attack; but on account of the suffering it caused, and its rapid 
growth, I was sent for. On examining the orifice of the submaxillary 
duct, a small white concretion, not larger than a pin’s head, was discovered 
obstructing its orifice; this was easily removed, a quantity of saliva escaped 
into the mouth, and the patient was immediately relieved. A year or two 
afterward, while he was at tea, the same thing recurred, but on this 
occasion the calculus was larger, and rather irregular in shape. After 
endeavoring for some time to remove the calculus, but failing, partly on 
account of the nervous restlessness of the lad, I fixed it by means of a 
pair of bull-dog forceps, and then cutting through the duct beyond the 
calculus, removed it, together with the orifice and enveloping poi’tion of 
the duct. He has had no return since, but his mother informs me that he 
sometimes feels a little uneasiness in the situation of the gland, and gets 
rid of it by pressing underneath the margin of the jaw, which seems to 
displace something. Part xxxvii., p. 140. 
Enlarged Lymphatic Glands.—If you have an enlargement of cervical 
glands in a patient of middle or older age, evidently neither inflammatory 760 
GLEET. 
nor sympathetic, at once suspect cancer, especially if up under the upper 
or middle part of the mastoid muscle. The suspicion is increased if the 
patient has lost weight and strength, and the swelling is hard and not 
very movable. Take care and do not confound scrofulous sloughing of 
the inguinal glands with that of a syphilitic origin. In the former there 
is not that great external swelling or inflammation seen in the latter; 
and though the former is often excited by an attack of gonorrhoea, yet 
there will not be any syphilitic sores on the genital organs. 
Part xxxvii., p. 172. 
Scrofulous Disease of Neele.—In cases of gland disease of the neck 
with extensive ulceration of the adjacent skin, or in cases of what is called 
“ cutaneous struma,” the internal use of calomel and opium in minute 
doses, with cod-liver oil, is almost invariably ordered at the Hospital for 
skin diseases. This practice is contrary to the generally-received opinions 
on the use of mercury, yet not only does no injury occur, but exceedingly 
favorable results as regards the local disease. Part xxxviii., p. 173. 
GLEET. 
Treatment of Gleet.—[Mr. Jones relates the two following cases in 
which he successfully treated this troublesome affection by the injection 
of the tincture of sesquichloride of iron.] 
J. T., aged 24, had gonorrhoea eighteen months ago, and gleet continued 
since; has been under treatment of a surgeon, who ordered cubebs, 
copaiba, etc., but as he was careless of consequences, did not apply 
regularly: he had a discharge of thin white pus when he applied to me. 
Ordered nitrate of silver and sulphate of zinc injections, alternately to be 
used, but without effect. I then made use of tincture of iron, gts. xxv. 
three times a day, and gradually increased to gts. xl.; in a fortnight he 
was perfectly well; and has had no return since. 
W. S., aged 21, had gleet twelve months; ordered the tincture of iron, 
dose, gts. xx. two or three times a day; to be increased to dose, xxxv. 
After seven or eight days the discharge had nearly ceased; in fifteen days 
he was cured. Part vi., p. 149. 
Creasote.—In obstinate cases of gleet, occurring in flabby leucophleg- 
matic males, Dr. Allnatt has great confidence in the efficacy of the follow- 
ing formula: 
R Creasote, 20 minims ; solution of potash, 2 drachms ; white sugar, 
2 drachms. Rub together in a mortar; afterward, add by degrees, 
8 ounces of water. Make an injection, to be used three times a day. 
Part vii.,y>. 86. 
Treatment of Gleet.—In cases of gleet, Mr. Bennett Lucas prefers an 
injection composed of alum and water, from two to five grains to the 
ounce, or of acetate of zinc, two or three grains to the ounce. He has 
relinquished the nitrate of silver in this stage of the disease. The injection 
of port wine and tannin recommended by Ricord, and also by Mr. Lang- 
ston Parker, he also thinks very useful. It is composed of 18 grains of 
tannin, in six ounces of port wine. 
Mr. Childs adopts a mode of treatment at the very commencement of GLYCERINE. 
761 
the disease still more energetic than that of Ricord, and most other 
writers on the subject. He applies the solid nitrate of silver to the 
part, by wiping it over the mucous membrane, by means of an armed 
bougie, a modification of Lallemand’s caustic-holder. Part viii., p. 189. 
Treatment of Gleet.—The evils resulting from the use of injections in 
the treatment of gleet, arise from their being too strong; hence, not only 
failing to act as astringents on the mucous follicles, they cause irritation, 
inflammation, and even stricture of the canal; this applies more particu- 
larly to the nitrate of silver injections. 
Dr. L. D’Etiolles recommends the following ointment, which answers 
much better than the nitrate of silver: kino, ten parts ; sulphate of zinc, 
one part; lard, twenty parts. Part xiii., p. 290. 
In cases of gleet of an obstinate character, apply a solution of nitrate 
of silver, one or two scruples to the ounce, to the prostatic portion of 
the urethra. ' Part xxv., p. 242. 
CMa Turpentine—In Gleet.—As this frequently depends on an in- 
creased and altered secretion of the follicles of the prostate gland, it 
cannot be got rid of by astringent injections, as it is often impossible to 
reach the true seat of the disease : whereas the exhibition of cliia turpen- 
tine, in doses of five grains, often puts a stop to the discharge instantly. 
Part xxv., p. 214. 
Tannate of Alumina—In Gleet.—Use an injection, before going to 
bed, of tannate of alumina, five grains to the ounce of distilled water. 
Part xxv., p. 339. 
Gleet and Obstinate Gonorrhoea.—If there be no stricture, use nitrate 
of silver injections, raising the strength from one grain to ten grains to 
the §j. of water. The pipe of the syringe should, at least, be two inches 
long, because on the lower surface of the urethra there are certain sensi- 
tive spots, and so long as these exist, the discharge will not give way. If 
the injections fail, the urethra should be sounded, and if a stricture is 
found, the bougie must be used. There is an intermediate state of stric- 
ture, one in which it is formings and in which the urethra feels granular. 
In this state the remedy is the bougie, perseveringly used. If, however, 
the injections fail, and no stricture is found, then a blister should be 
applied. 
This is the quickest, safest, and most efficacious remedy which has yet 
been proposed. After the blister, the patient should be kept quiet for 
three or four days, and when the blister begins to heal up, a few mild 
injections should be given. Zinc, sulph. gr. x. ad 9j.; sp. camp, mxx.; 
aquas destil. §j. A teaspoonful to be injected three times a day. 
Part xxviii., p. 221. 
GLYCERINE 
Nature and Uses of.—[The nature and uses of glycerine, the sweet 
principle of oils, which may now be had of any first-rate druggists, are 
thus stated by Mr. Startin :] 
When perfectly pure and anhydrous, glycerine is a nearly colorless 
liquid, of a sweet taste and sirupy consistence ; it has a faint, but not clis- 762 
GLYCERINE, 
agreeable odor, and possesses a great affinity for water, with which it 
readily combines; it also easily unites with oils, and dissolves many gums 
and resinous substances; it will neither crystallize nor ferment like 
sugar, nor will it evaporate beyond a certain point, but is destroyed by 
ebullition. 
The antiseptic and uncloying properties of glycerine first led me to 
attempt its use for medical purposes, as I believed, by the means of such 
properties, lotions, poultices, baths, etc., might be rendered peculiarly 
emollient and soothing. When preternatural dryness, roughness, or harsh- 
ness of the skin was present, and particularly in those cases where the hair 
or scalp was involved, as in instances of dandriff or pityriasis of these 
parts, my expectations were more than realized by reducing my conjec- 
tures to practice ; and I found that by the addition of one-fourth to one- 
eighth, or even one-sixteenth of glycerine to any lotion, poultice, or 
external application, all the indications I have mentioned were fulfilled, and 
that such application never became perfectly hard and dry, whilst it soothed 
and tranquillized the diseased part, by attracting moisture from the air, 
and thus keeping up a constant evaporation from the surface; its anti- 
septic properties also, in a great degree, prevented the unpleasant odor 
of vitiated secretions or discharges, whilst its undrying nature did not 
permit the formation of hard scabs or incrustations, which it is known 
very often interfere with the healing process, and occasion much pain on 
their removal. 
Pills made with the addition of a few drops of glycerine never become 
dry, and sirups and extracts by its means are kept from evaporation 
to dryness, as also from fermentation, and the formation of cryptogamous 
vegetation, or moldiness, and many other uses for this agent will not fail 
to suggest themselves ; I shall briefly enumerate some diseases of the skin 
in which I hare employed glycerine with most benefit and success; these 
are pityriasis, or dandriff (particularly that form of the disease which I 
have termed P. congenita), lepra, psoriasis, lichen (in its dry advanced 
stage), impetigo inveterata, and prurigo. I have found glycerine also a 
useful addition to lotions in the incrusted forms of lupus, or herpes exe- 
dens, and to various syphilitic or strumous eruptions, which have a ten- 
dency to produce fetid discharges and hard crusts, for which reason it has 
proved of service in the scabbing stage of small-pox. As a wash for 
the hair and for chapped hands, face, or nipples, combined with a little 
rose-water and a few grains of borax (the glycerine being in the propor- 
tion of one-sixteenth), this remedy furnishes, perhaps, one of the most 
elegant and efficacious preparations which has been introduced. It may 
also be combined with soaps, which it renders peculiarly softening and 
efficient, particularly to individuals who have a dry or hard skin. 
Part xvi., p. 226. 
Glycerine and Tannin.—Pure glycerine dissolves nearly its own weight 
of tannin, affording a very powerful local astringent application. 
The solution of tannin in pure glycerine appears to me to supply a 
desideratum long felt, and capable of a great variety of useful applica- 
tions. 
The solvent property of glycerine over tannin allows us to form a 
lotion of any desirable strength, as the solution is readily miscible with 
water. GLYCERINE. 
763 
The solution of tannin in glycerine, in one or other of its strengths, is 
peculiarly applicable to many disorders of the mucous membrane, readily 
combining with mucous, and forming a non-evaporizable coating over di*y 
membranes; hence it may with benefit be ajjplied to the mucous mem- 
branes of the eye and ear in many of its diseased conditions. It forms a 
most convenient application to the vaginal, uterine, urethral, or rectal 
membranes, where a strong and non-irritant astringent lotion is desired. 
In local hemorrhages, where the bleeding surface can easily be reached, 
it will prove very convenient, and may be applied either with a sponge or 
small brush. 
The solution must be kept in the dark, and should not be prepared for 
any great length of time before used, or decomposition will occur. 
It is singular that glycerine does not possess the same property toward 
gallic acid. Part xxxii., p. 300. 
Glycerine.—Glycerine possesses remarkable nutrient and alterative pro- 
perties. Dr. Lindsay believes it to be the active principle of cod-liver oil. 
He has carefully observed its effects in eight patients, who were all more 
or less anaemic, emaciated, and feeble: at the end of a month, they were 
all greatly improved in their general condition—they seemed plumper and 
stronger, and in some the countenance was even ruddy, and in most there 
was a marked increase in weight. It is most palatable when mixed with 
coffee, which may be sweetened by it instead of sugar. It may be added 
to tea, and it sweetens milk and cream very pleasantly ; but its mixture 
with water is very palatable, and is the readiest and cheapest mode of 
administration. Its sweetness would, probably render it a favorite with 
children. Part xxxv., p. 290. 
Endermic Application of Iodide of Glycerine.—In cases in which 
previously the alcoholic solution of iodine was employed, a solution of 
iodine in glycerine, in the proportion of one part to five, will be found 
more advantageous. It does not affect the skin like the alcoholic tinc- 
ture, and may be applied for a long time to the parts about the neck and 
female breast without much inconvenience. If excoriations are caused, 
discontinue the application, and apply cold fomentations. The paintings 
should be performed once a day, and covered with gutta perclia paper. 
They may be continued for a month without producing iodisni. 
Part xxxv., p 291. 
Solvent Property of Glycerine.—The especial property which glyce- 
rine possesses of dissolving the disulphate of quinine would alone be 
sufficient to render it an object of interest, but it is equally powerful with 
many other substances. It readily dissolves the disulphate of quinine in 
the proportion of two grains to the fluid drachm, forming at first an 
opaque fluid, which, in the course of a few hours becomes a clear bright 
solution, possessing the peculiar pale-blue superficial tint peculiar to the 
solutions of that substance, and this without the aid of heat or any 
acid. This solution is miscible with waters and tinctures in various 
proportions, and it appears a gi'eat advantage to possess a clear, bright, 
elegant, and by no means disagreeable solution of the disulphate of 
quinine, without the addition of acid. Gallic acid, which requires one 
hundred parts of cold water for its solution, is soluble in rather less than 
twelve parts of glycerine, making a clear, straw-colored liquid, of a 
pleasant, sweetish, sub-acid taste, in this state offering a desirable mode 764 
GONORRHOEA. 
of administering the gallic acid where pills might be objectionable, and a 
large quantity of fluid impracticable. 
Tannic acid is also freely soluble in this substance, and as an external 
astringent application might prove preferable in many instances to an 
oily or greasy compound. In the treatment of hemorrhoidal affections, 
it may possibly offer, as an application combined with opium or the salts 
of morphia, some advantage over the reigning preparation—unguentum 
gallxe compositum, it being more tenacious, and at the same time lubri- 
cating, and when combined with the salts of morphia, in place of opium, 
it possesses the decided advantage of not staining the linen. 
The hydrochlorate and acetate of morphia are readily soluble in glyce- 
rine, making a clear, limpid solution of a slightly yellow tinge, forming, 
as it were, a kind of sirup, which might possibly prove in many ways 
useful in the hands of the profession. 
Glycerine also dissolves the ferri et quinse citras, in the proportion of 
five grains to the drachm, forming an olive-yellow colored liquid pecu-« 
liar to the solutions of that salt. Part xxxvi., p. 253. 
GONORRHOEA. 
Ireatment of Gonorrhoea by Frequent and Weak Injections of 
Sulphate of Zinc.—It consists simply in the very frequent injection of a 
very weak astringent solution into the urethra, the only necessary condi- 
tion being, that the operation should be performed at very short intervals, 
and the solution so weak as to occasion little or no pain. The solution 
found to answer best, is that of sulphate of zinc, in the proportion of one 
grain to the ounce of water, to be still further diluted if the patient feels 
the injection painful. Before each injection a jet of urine should be dis- 
charged, in order to clear out any morbid contents that may be accumu- 
lated in the canal. The instrument used should be a small syringe, sur- 
rounded at the point with a little lint, or other soft material, which serves 
to protect the tender orifice of the urethra from the contact of the harder 
substance. The operation can be very easily performed by the patient 
himself, and scarcely needs description.. Part i., p. 105. 
Treatment of Gonorrhoea.—[Finding that copaiba so frequently dis- 
agreed with the stomach, M. Velpeau introduces his doses of 3j. of the 
balsam, mixed with four ounces of viscid fluid and a little opium, up the 
rectum in the form of enema. Although the patient can seldom retain 
this long enough, yet in some cases the effects are precisely the same as 
when the balsam is taken into the stomach; it soon cures the disease. 
But M. Velpeau’s favorite remedy is a mixture of copaiba and cubebs, as 
follows:] 
Take of balsam of copaiba, two drachms; powdered cubebs, six drachms; 
powdered opium, two grains. Mix, and add sufficient carbonate of mag- 
nesia to form a paste, which is to be divided into six parts, one to be taken 
three times a day, and generally speaking, three doses will effect a cure. 
But we should not discontinue the administration of it for a few days 
after, as, if we do, the discharge is very likely to return, and what is 
woi'se, in increased quantity. You must, however, always pay particular 
attention to the state of the stomach and bowels during its use. GONOKRHCEA, 
765 
Mr. Carmichael is in favor of injections of nitrate of silver in this com- 
plaint, but in very small quantities. He uses only one quai’ter of a grain 
to the ounce, and seldom increases it to a grain. 
M. Ricord speaks in high terms of a solution of the iodide, or proto- 
ioduret of iron, as an injection. He has used from one to eighteen grains 
of this preparation to an ounce of distilled water, but care is requisite in 
going beyond his minimum proportion. It is a powerfully astringent sub- 
stance. Part i., p. 109. 
Extract of Cubebs.—Recommended at the very first issue of discharge 
in gonorrhoea, and while the discharge is thin. If taken after the inflam- 
mation in the urethra has become sufficiently great to induce the forma- 
tion of puriform fluid—it only serves to aggravate the disease in its second 
stage. 
Dose : About fifteen grains of the extract three times a day. It is 
highly beneficial often in the third stage, when the discharge is great in 
quantity, but thin and transparent. Part i., p. 118. 
Ointment of Oxide of Silver.—Has been used with decided benefit in 
the chronic stage of gonorrhoea, as an auxiliary to the usual medicinal 
treatment, and with but little inconvenience beyond the mere mechanical 
irritation of the bougie. Part ii., p. 36. 
Injections.—A favorite injection with M. Ricord, is a solution of the 
ioduret of iron, 3 grains to 6 ounces of distilled water. 
Another consists of a solution of pure tannin in port wine, in the pro- 
portions of eighteen grains of the former to six ounces of the latter. 
Part ii., p. 85. 
Chloride of Zinc in Acute and Chronic Gonorrhoea.—M. Gaudroit con- 
cludes that the chloride of zinc, properly diluted, has a remarkable power 
in curing simple gonorrhoea of the urethra and vagina, also in dilating the 
urethra, and thereby ameliorating strictures. He believes that it is always 
by an inflammation sui generis that the discharge is cured, and that injec- 
tions of the chloride of zinc determine a series of phenomena not produced 
by other caustics. It is only necessary to use a few drops of injection, as 
the extremity of the urethra is the only part to which it should be applied. 
To combat vaginal gonorrhoea in women, M. Gaudroit proposes a new pro- 
ceeding, which consists in the use of solid vaginal suppositories, composed 
of a paste made to melt easily, and containing a certain quantity of liquid 
chloride of zinc and sulphate of morphine. 
In men the author employs the following formula: 
R Liquid chloride of zinc, 24 to 36 drops; distilled water, 4 ounces. 
Agitate and filter through paper. 
A small quantity of this solution should be injected about an inch along 
the urethra, two or three times a day. 
The vaginal suppository which he employs is formed of 
R Liquid chloride of zinc, 5 drops; sulphate of morphine, half a grain. 
Mix with three drachms of the following paste: Mucilage of gum traga- 
canth, 6 parts; powdered sugar, 3 parts; starch powder, 9 parts. 
To cure radically a gonorrhoea in man, it will ordinarily suffice to apply 
two injections a day for two or three days. The first injections are almost 
always followed by more or less swelling of the glans penis, but this does 
not prevent their continuance. 766 
GONOKKIKEA. 
In women four or six suppositories, one being introduced every day, or 
every second day, suffice to obtain a cure. The first introduction fre- 
quently occasions a swelling with more or less heat of the vulva, but these 
phenomena are soon completely dissipated. Emollient baths have in most 
of the cases been employed for this purpose. Part iii., p. 107. 
Treatment of Gonorrhoea with Cubebs and Alum.—A correspondent in 
the Journal des Connaissances Medicales recommends very highly a com- 
bination of powdered cubebs and alum in the treatment of gonorrhoea, 
and adduces several cases in illustration of its efficacy. The formula 
which he uses is the following: Two ounces of cubebs, and half an ounce 
of powdered alum are to be mixed well together and divided into nine 
doses, of which one is to be taken three times in the course of twenty-four 
hours. 
A cure is said to be usually effected in from six to eight days. 
Remarks.—It is more than probable that alum has not been used in cases 
of gonorrhoea so much as it deserves to be. That the salt is rapidly ab- 
sorbed into the system, and is eliminated, in a great measure, by the urine, 
appears from numerous experiments. Part iii., p. 114. 
Use of Injections in Gonorrhoea.—[Under the head of “ Abortive Treat* 
ment,” in Mr. Acton’s valuable work on syphilis, he makes the following 
remarks on injections in gonorrhoea:] 
At the commencement of a discharge from the urethra, and previous to 
any redness around the orifice, or pain felt in making water, the surgeon 
will frequently be able, at once, to cut short the affection, and cure his 
patient; under other circumstances, this plan will not avail. 
It consists in employing, during the succeeding forty-eight hours, twelve 
injections of nitrate of silver at regular intervals: the strength of the solu- 
tion of the salt should be, two grains to the gviij. of distilled water. Let 
the injections be then left off, and cubebs or copaiba be given. If the cases 
be recent, and the disease not too far advanced, this treatment will succeed, 
fifty times in a hundred cases, in checking the disease; and there is no fear 
of occasioning stricture, or swelled testicle at this period of the complaint. 
Under this treatment the running will at once cease; but to complete the 
cure, it will be necessary to continue the cubebs, diminishing gradually 
the dose. No further recourse should be had to injections, as a con- 
tinuance in their use would only tend to keep up irritation; at the end 
of fifteen days the surgeon may allow his patient to resume his usual 
habits. 
Soon after the injections have been employed, there will appear a red- 
dish-looking discharge; this should not prevent the patient from continu- 
ing the twelve injections at intervals of four hours, notwithstanding any 
slight pain which may occur; a slightly purulent, rosy discharge is a very 
favorable sign, as it shows that the disease will rapidly yield. 
Part iv., p. 95. 
Treatment of Gonorrhoea.—Ricord lays it down as a rule that, in all 
cases where the disease is not complicated” with phlegmonous inflammation 
of the structures surrounding the urethra, the abortive treatment ought to 
be in the first place attempted. lie shows that stricture and most other 
evil consequences of gonorrhoea are owing rather to the persistency of in- 
flammation than to the means of cure, llis treatment is applicable to all 
periods of the disease when acute inflammation does not attend them; GONORRH(EA 
767 
even a sub-acute degree of inflammation does not contra-indicate the treat- 
ment. We need not remind the reader that injections of nitrate of silver 
form his chief remedy. He uses one injection a day, composed of 10 
grains to the ounce of distilled water, which need not be limited in its 
course to the first inch or two of the urethra, but may be allowed to pass 
throughout its extent, as the inflammation often extends beyond the bulb, 
and where no inflammation exists, the injection will do no harm, not even 
if it enter the bladder (which is not very likely), as it would be decomposed 
by the urine. This treatment gives rise to another kind of inflammation 
which would subside by desisting from the injections of nitrate of silver, 
but may more rapidly be dispelled by injecting three times a day, a solu- 
tion composed of 8 oz. of rose water, sulphate of zinc, and sub-acetate of 
lead, of each 17 grains. Part viii., p. 188. 
Chloride of Lime in Diseases attended with Contagious Discharge— 
Gonorrhoea.—In the first stage, before the discharge has become com- 
pletely puriform, or the scalding great, a single injection of about two fluid 
drachms of the strong solution will always put a stop to the disease, either 
in a first or subsequent clap. In the second stage, when there is a consi- 
derable discharge of pus, and more pain, several injections are required. In 
gleet, provided the discharge be not kept up by some strictural change in 
the urethra, the strong injection is likewise useful, but not to so striking an 
extent. The effects of injecting the strong solution are, sharp pain, and 
often erection for the moment, slight puftiness and eversion of the orifice of 
the urethra, and tenderness on pressure, and a feeling of unusual firmness 
for two or three inches down the corpus spongiosum, where these did not 
already exist. In a short time the pain subsides, and in a half an 
hour a serous discharge issues from the mouth of the urethra. Part xi ,,p. 186. 
Combination of Copaiba with Purgatives in Gonorrhoea.—From an 
account given by M. Jacquetant of the hospital practice of M. Diday, it 
would seem that the balsam of copaiba acts much more energetically in the 
removal of gonorrhoea if combined with purgatives. The formula which 
M. Diday found most successful was three drachms of the balsam of co- 
paiba, four drachms and a half of the powder of cubebs, and forty-five 
grains of the powder of jalap, made into an electuary, of which one half is 
taken in the morning and the remainder in the evening. The treatment 
rarely lasted more than five days, by which time a permanent cure was in 
general effected. Part 188. 
Caustic Pougie in Gonorrhoea.—Mr. McDonald has tried the following 
remedy with great success : 
The remedy I refer to is that of smearing a bougie with ointment of the 
nitrate of silver, introducing it into the urethra for about three inches, and 
letting it remain there a minute or two. I have found from two to three 
applications complete the cure, and if in the very acute stage of the disease, 
one application is generally sufficient. This mode of treatment is equally 
applicable in all stages of gonorrhoea. 
I believe injections of the solution of nitrate of silver (5ss. to §j.), have 
been used with great success in gonorrhoea, but I infinitely prefer the oint- 
ment introduced on a bougie, as I think it is the better means of getting 
the nitrate of silver more thoroughly in contact with the lacuna magna, 
which is generally considered to be the principal seat of the disease. 
Part's.ii., p. 216. 768 
GONORRHOEA. 
Treatment of Gonorrhoea in the Female.—Let the patient first remove 
as much of the secretion as possible from the vagina, and then inject in an 
efficient manner a preparation of copaiba (about a drachm of the soluble 
balsam to a pint of water), and retain it for five minutes; and then insert 
a piece of lint six inches square, folded into four, saturated with the copai- 
bal solution. This process is to be repeated four times a day. In those in- 
tractable cases in which the neck and cavity of the uterus are involved in 
the disease, apply an ointment with six or eight grains of nitrate of silver 
to the ounce of lard, to the internal surface of the uterus, by means of an 
elastic bougie. Part xviii.,jp. 210. 
Treatment of Gonorrhoea by Vinum Colchici.—Dr. Ficinus, of Dres- 
den, confirms the opinion formed by Eisenmann, of the value of vinum col- 
chici in gonorrhoea. He gives from twenty-five to thirty drops three times 
a day, combined with tinct. opii, enjoining at the same time a low diet, 
warm bath, etc. These means he has found attended with unprecedented 
success in the treatment of gonorrhoea and other inflammatory discharges 
from the urethra in males, and from the vagina and uterus in females. 
Part xix., p. 186. 
Treatment of Urethral Pains following Gonorrhoea.—When severe 
pains remain in the course of the urethra, after all traces of the discharge 
have ceased, treat them by applying compression to the penis, as firmly as 
possible, without interfering with micturition. Apply this compression 
either by one strip of adhesive, two fifths of an inch broad, rolled circu- 
larly round the penis, like a bandage, beginning at the glans ; or by a num- 
ber of srfcall strips, the two extremities of each strip crossing upon the 
urethra. Part xix., p. 187. 
Treatment of Gonorrhoea.—Begin by giving purgatives, and nauseating 
doses of tartarized antimony, and when the inflammatory symptoms are 
relieved, give the following mixture: R Bals. copaib. gss.; pulv. cubebae, 
gss. ; iiq* potassaj, 3iss.; mucilag. acaciae, gss.; aq. destil. gviss.; M. Two 
tablespoonsfuls to be taken twice a day, as at eleven and three o’clock, but 
not upon an empty stomach. When the inflammation is severe, employ 
emollient injections into the urethra; also sedative injections, such as liq. 
plumbi diacet. mxx. in 3iss. of water. In mild cases, and in constitutions 
that are not irritable, stimulating injections may be used, such as hyd. bi- 
chlor. gr. j. in gviij. of water. Part xxi., p. 270. 
Acetate of Potash in Gonorrhoea.—Give acetate of potash in half drachm 
doses, every four hours. Even where the disease does not yield by the use 
of acetate of potash, Mr. Hilton has repeatedly found that, after its ad- 
ministration, a few doses of copaiba completed the cure and prevented 
relapse. Part xxii., p. 264. 
Intractable Gonorrhoea.—The severe forms of gonorrhoea which are so 
exceedingly obstinate, are owing to the inflammation spreading along the 
entire canal, extending over the mucous membrane of the bladder itselfj 
nay, even in some cases to the ureters and kidneys; and pus diffused 
through the urine is an indication of it. There is no specific remedy for 
this form, but when pus has once appeared in the urine, the antiphlogistic 
treatment must be more strictly enforced; and when the inflammatory GONOKEHCEA. 
769 
symptoms have subsided, then, and not until, specific remedies, as bal- 
sams and cubebs, may be resorted to. Part xxii., p. 265. 
Injections.—Ricord frequently prescribes the following as an injection 
to be used two or three times daily; and it is obviously applicable as a 
lotion to other cases. Take of tannin and sulphate of zinc, each one 
gramme; rose water, two hundred grammes. If the sulphate of zinc be 
perfectly pure, the solution will be colorless; but if (as is generally the 
case) it contain some oxide of iron, it will be of a deep red hue, from the 
formation of a tannate of the oxide of iron, which, being a good astringent, 
does not injure the lotion. 
Use an injection of the solution of diacetate of lead, 5ij- to six ounces of 
distilled water. Another is a solution of alum, four grains to the ounce. 
Another an infusion of green tea, a drachm to half a pint. By ringing the 
changes on these, perhaps, all the good effects of injections may be ob- 
tained. Part xxiv., p. 260. 
'Balanitis, or Gonorrhoea Preputialis.—In the uncomplicated disease 
wash the parts dry, then carefully, and by means of dry lint accurately 
placed between the glans and prepuce, separate the two surfaces. If the 
parts are slightly inflamed, whiten the parts by simply passing a stick of 
caustic over them. The parts should then be washed daily with a lotion 
of zinc and tannin, one grain of each to the ounce, then dried and lint ap- 
plied as before. If phimosis be present and be irremediable, the operation 
of circumcision must be performed. Part xxiv., p. 269. 
Chronic, or Gleet.—Examine the passage by a wax bougie, JSTo. 6 or 8. 
If an irritable surface is detected, use the strong caustic injection, and give 
copaiba or cubebs; following up by injections of zinc and tannic acid. If 
incipient stricture be detected, the nitrate of silver is not advisable; but 
bougies should be passed every other day, astringent injections being used 
in the intervals. Part xxiv., p. 269. 
Use of Blisters.—A blister applied to the penis will often cure the most 
prolonged gleet. Two blisters and mild injections have cured a clap which 
had resisted the most energetic treatment. If uncomplicated, it should be 
applied from the root to within half an inch of the mouth of the urethra; 
in milder cases, one inch and a half. If there are any vesicated spots, they 
must be covered with pieces of linen spread with zinc ointment. Brown’s 
blistering tissue is preferable to the common blistering plaster. In severe 
cases, a longer application is necessary. To protect the penis from friction, 
a T bandage must be applied, with a bag to receive the penis, and thus to 
keep it up against the abdomen if necessary. In common cases, a soda and 
jalap powder maybe taken twice a day, and a zinc injection used 3j. to Oj. 
Part xxiv.,/). 272. 
Gonorrhoea.—Give a saline purge during the first day, consisting of a 
scidlitz powder, with half an ounce of sulphate of magnesia; the recum- 
bent position being enjoined, weak linseed tea with a little nitrate or bi- 
tartrate of potash, used as a common drink; and pure cold water used as 
an injection twice every half hour. During the second day the same quiet 
and rest observed, and drink used; a solution of two grains of sulphate of 
zinc in one ounce of water is to be used as an injection twice every half 
hour. On the third day the rest may not be so strictly enforced, but the 770 
GONOEEHCEA, 
injection and drink must be used as before,, The disease may be thus al- 
most always cured in three days, but the success mainly depends on the 
persevering use of the injections. Part xxv., p. 270. 
Tannate of Alumina.—Use an injection of tannate of alumina, live 
grains to the oz. of distilled water, before going to bed. Part xxv., p. 339. 
Gonorrhoea treated by M. Jozeait's Copahine-mege.—The peculiarity of 
M. Jozeau’s saccharated capsules was stated to be that they were easy and 
agreeable to take, that they produced no nausea, sickness, or unpleasant 
purging, and that, when continued, they cured gonorrhoea in a short 
time. 
The copahine-mege was prepared by M. J. by surcharging the copaiba 
with oxygen, by means of nitric acid, the latter being added in proportions 
which varied according to the kind of copaiba acted upon. The nitric acid 
yields some of its oxygen to the essential oil, and the nitrogen is given olf 
in the form of hyponitrous acid, by combining with the oxygen of the 
atmosphere. The copaiba thus treated is then well washed with water, 
until it no longer reddens litmus paper, and to it are added one-tenth part 
of cubebs in line powder, the same proportion of carbonate of soda, and 
one-sixteenth part of calcined magnesia. The mixture is allowed to stand 
until it is quite solidified, and in that state it is made into small masses. 
The latter are then carefully covered with sugar, to which a jfieasant pink 
color (coccus cacti) is given, and they then look like very pretty sugar- 
plums. For lymphatic patients and delicate females, a second mass was 
prepared, into which, beside the above-mentioned ingredients, some steel 
was made to enter. This is then a sort of martial preparation of copaiba. 
The doses are stated as follows: 
When there is neither pain nor inflammation, five saccharated capsules 
are taken three times per diem. One capsule more is then given with 
each dose every subsequent day, the doses being thus increased until 
purging is produced. Where there is pain or inflammation, these should 
first be treated by the surgeon in the manner he thinks the most advisable, 
and the copahine is to be commenced when acute symptoms have abated. 
It has been noticed that the martial capsules have effected a cure when the 
simple preparation has failed. Part xxvi., p. 282. 
Bougies—Alumnized.—In stricture, combined with chronic inflamma- 
tion, these bougies are of great value in procuring degorgement of the 
mucous membrane. This is effected generally in from seven to twelve 
days, when the dilatation of the stricture is then proceeded with. They 
are prepared by warming the end of Avax bougies, and then incorporating 
with them some powdered alum, so as to form a kind of magma of the Avax 
and alum. Part xxvi., p. 284. 
Use of Tannin.—Inject a solution of tannin, 5ss. to 9ij.to §ij. of Avater. 
The injection is to be used three or four times a day. Ten cases were 
thus cured in from six to nine days. No pain followed its use. 
Part xxvii., p. 162. 
Gonorrhoea.—M. Alquie speaks in the highest terms of the great utility 
of the tannate of zinc (1 part to 100 of Avater) injection employed, night 
and morning:, in gonorrhoea, after the acute symptoms have subsided. 
Part xxviii., p. 221, GONORRHOEA. 
771 
Gonorrhea—Painful Erections in.—Give lupulin; begin with one 
scruple and increase the dose if necessary. Zambaco gives this dose 
and increases it to sixteen scruples, but we should hesitate how we com- 
menced with stronger doses than five or ten grains. Part xxxi., jp. 241. 
Gonorrhoea.—M. Ricord employs large doses of cubebs in powder, or 
copaiba capsules, together with his favorite injection, consisting of 10 
grains of the subnitrate of bismuth to 6 ounces of water. In London, the 
capsules, with lead injections, rarely fail to cure when given after the in- 
flammatory stage has passed. If the disease should continue in a subacute 
form, examine the urine, it will most likely contain mucus, and if it do, 
there will be some irritation of the bladder or prostate : you must then 
lay aside both the capsules and the injection for a time, and give the ex- 
tract of the spruce fir as follows: R Ext. abietis nigr. inspiss. 5\j.; magnes. 
carb. q. s. M. fit. pil. xxx.; cap. j. vel ij., bis vel ter in die. If you find it 
necessary to give opium by the rectum, it will be most convenient in the 
form of a suppository, and this will be far better to introduce if made of 
the butter of the cacao-nut, than if made with Spanish soap. R Pulv. opii 
gr. j., buty. cacaonis gr. x. M. Ft. supposit.; hac nocte utend. 
Part xxxiii., p. 242. 
Gonorrhoea—The injection of the balsam of copaiba is much more effica- 
cious than when given in the usual way. The following formula may be 
adopted: Copaiba, five drachms; one yolk of egg; extract of opium, one 
grain ; water, seven ounces 
The infusion of buchu is quite as efficacious in gonorrhoea as balsam of 
copaiba, and is not so objectionable on account of its smell or disagreeable 
taste. Part xxxiv., p. 223. 
Gonorrhoeal Epididymitis.—Cold applied to the sex-otum by compresses 
dipped in water is a powerful remedy, assuaging pain, preventing further 
effusion, and expediting absorption; if it induces an uneasy sensation the 
temperature must be raised from cold to cool, and continued until the 
cure is complete. Conjointly with this the patient should take a saline 
purgative at intervals. Part xxxiv., p. 223. 
New Remedy in Gonorrhoea.—Professor Sigmund, of Vienna, recom- 
mends, in place of the expensive and frequently adulterated or too old 
balsam of copabia and cubebs, rectified turpentine and the seeds of hera- 
cleum sphondylium, an indigenous and active, though little employed 
drug. Part xxxv., p. 186. 
Gonorrhoea of the Nose.—Dr. Edwards, of Edinburgh, records the fol- 
lowing case: 
A respectable widow, aged sixty-one, applied for relief at the New Town 
Dispensary, under the following circumstances: Her whole face was 
swollen, esjtecially the eyelids, nose, and upper lip. There was slight 
conjunctival congestion, and a small abscess pointed close to the left angle 
of the mouth. Her nose was extremely tender on pressure, the skin over 
it red, tense, and shining, with a few inflamed papillae scattered over it. 
The upper lip was much enlarged, and its cutaneous surface excoriated, 
evidently from the irritating effect of a purulent fluid which flowed 
copiously from both nostrils. So tender were the parts that she scarcely 
ventured to wipe off this discharge, and kept her head hanging forward so 
as to allow the matter to drip upon the floor. She described herself as 772 
GONORRHOEA. 
much reduced in strength since the occurrence of the malady, which she 
accounted for by the fetid odor of the discharge, making her loathe all 
food. She came into the room supported on the arm of another woman. 
The patient’s extreme emaciation and general appearance led me at first 
to suspect malignant disease, and, from the treatment prescribed, her for- 
mer medical advisers seem to have been of that opinion also; but by dint 
of cross-examination, I ascertained that about six months previous to my 
seeing her she had been paid a visit by her son; he was at that time suffer- 
ing from gonorrhoea, and he used a pocket-handkerchief to suspend his 
testicles. He left this handkerchief lying about his room, and she picked 
it up, and used it for her nose for two or three days. On the fifth day her 
left nostril felt hot, dry, and itchy, and soon began to discharge yellow 
matter ; soon after the right nostril became similarly affected, and her 
eyes slightly inflamed. These symptoms were accompanied by headache, 
pains in the limbs, and shivering. She imagined at first she was suffering 
from a severe influenza; but finding the nose getting daily into a more 
disgusting condition, she consulted medical men, who prescribed various 
remedies. 
This history being ascertained, the indications for treatment were clear. 
I opened the small abscesses, and ordered glycerine for the sore, upper 
lip, and edges of the nostrils, which were to be syringed frequently with 
warm water; citrate of iron and quinine, in pills of two grains, thrice a 
day. Under this simple treatment the symptoms at once yielded, and a 
little myrrh lotion injected into the nostrils when the inflammation was 
abated stopped the discharge. Part xxxv., p. 187. 
Gonorrhoea.—According to Mr. Skey, there is no such thing as gonor- 
hceal rheumatism, though there may be rheumatic gonorrhoea. He says : 
One thing has struck me very much in gonorrhoea—it is seldom found 
after twenty-five years of age ; and as we go on to forty, in the myriads 
of out-patients seen in the wards and out-patients’ department every year, 
we find the gonorrhoeal tendency becomes more what I call “ eccentric 
it diverges more from the centre of the genito-urinary surfaces. As we 
approach the age of forty in patients, gonorrhoea becomes longer or 
shorter in duration, more inclined to attack other parts, whether it be the 
testis, the cutaneous surface, the iris, conjunctiva, etc. I believe gonorrhoea, 
in fact, is a congestive or dropsical state of the urethra, a constitutional af- 
fection, a “ tertium quid” of something in the system of the man more 
than arising from infection from the woman ; but in a great many instances 
gonorrhoea is merely the result of mistaken treatment. You will ask me 
the question, however—Is gonorrhoea dependent always on inoculation of 
gonorrhoeal matter? or, perhaps, in other words—Can patients acquire 
gonorrhoea without inoculation, as taught in books ? I believe they can 
mo3t clearly. I don’t believe at all in inoculation of gonorrhoeal matter ; 
the question is one of great practical, every-day seriousness, as on it, may 
often depend the peace of a family. I say the large majority of gonorrhoea 
patients in private practice—where one can more easily trace out the 
history of the attack—the large majority occur in men who have had in- 
tercourse with women without any disease whatever of a gonorrhoeal 
character. I am quite satisfied of this in my own mind; perfectly satis- 
fied. I prefer, however, for your instruction, to direct your attention to 
the books of half a dozen military surgeons. Any kind of irritation, even 773 
GOUT. 
the employment of bougies, will cause a discharge from the urethra, and 
every experienced surgeon knows Avhen children are violated, a discharge 
generally folloAVS from the mere injury to the parts. 
Evans, Rose, and Guthrie, during the Peninsular Avar, in a situation 
peculiarly adapted for observation, came to a knoAvledge of this fact—that 
the catamenial discharge in the one sex Avill produce gonorrhoea in the 
other. Mr. Evans was sure also that the ordinary secretions of the female 
will produce even venereal disease. Part xxxvi., p. 191. 
Gleet and Gonorrhoea.—Mr. Skey recommends an injection of half a 
grain of sulphate of zinc to an ounce of rose-Avater, about five time a day. 
Keep up his system Avith tonics, alloAving his usual diet, unless egregiously 
faulty, and banish purgatives, antimony, etc. Administer internally the 
tincture ferri or ferrocitrate of quinine, and the balsam copaiba in small 
doses only. Part xxxvi., p. 195. 
Gonorrhoea and Leucorrhoea.—In weak and lymphatic subjects injec- 
tions of the perchloride of iron have been tried Avith success, the propor- 
tion of the perchloride being twenty drops to three ounces and a half of 
Avater. Part xxxix., p. 344. 
Injections—Of glycerine, mur. morphia, and water. Tinct. ergot inter- 
nally. 
GOUT. 
Acetate of Morphia in Arthritis and Nervous Affections.—The follow- 
ing is Dr. Cristin’s method of administering the acetate of morphia in 
these affections. Dissolve one grain of acetate of morphia in four ounces 
of distilled water, and add one ounce of sirup of gum arabic. A spoonful 
of the mixture to be taken every hour. When the pains are relieved, or 
sleep is about to commence, it should be given every two hours only, or 
suspended altogether; depending upon the narcotic effects produced. 
During its administration the patient should avoid fluids. 
A woman aged sixty, Avas afflicted Avith arthritis in the extremities; 
there were acute pain upon motion, hard pulse, burning heat of skin, 
etc. The acetate of morphia relieved the pain, procured sleep, removed 
the fever, caused profuse perspiration and diarrhoea, Avith abundant secre- 
tion of urine. Opium excites perspiration, but diminishes the other secre- 
tions. Acetate of morphia is therefore the preferable agent. 
Nervous pains, such as frontal neuralgia, sciatica, cephalalgia, and syphi- 
litic pains, have all yielded to this remedy. 
[Dr. Cristin gives only the tenth of a grain of the acetate every hour, 
but Ave generally have found it necessary to give much larger doses 
Avithout any other bad effect than severe sickness, which, however, is 
easily abated by creasote, or stimulants, as the spt. ammon. com., etc. 
We give one-fourth or one-sixth of a grain every hour or two, in severe 
cases, till the system is completely under its influence, and then keep up 
its effects by smaller doses, and less frequently repeated.] 
Part i., p. 28. 
Treatment of Gouty Concretions with Penzoic Acid.—Mr. lire’s inten- 
tion, in the feAV remarks contained in this paper, is to introduce to the 
profession a remedy which he believes to be likely to prevent the forma- 774 
GOUT. 
tion of tophous concretions in gouty subjects. The remedy is benzoic 
acid, administered in doses of a scruple, an hour after a meal. “ In the 
course of a couple of hours (as the author has found by frequent experi- 
ments, made upon himself and others) the urine voided, amounting to 
five or six ounces, will be found on adding a small quantity of muriatic 
acid, to yield a copious precipitate of beautiful rose pink acicular crystals, 
-which weigh, after being allowed to settle for a day, fifteen grains.” The 
body thus produced by the agency of vital chemistry is liippuric acid, and 
is found to have taken the place of uric acid in the urine, none of the 
latter being discoverable. 
By thus substituting hippurate of soda, a salt of easy solubility, for the 
very sparingly soluble urate of that alkali, the author conceives that the 
formation of the tophous concretions may be altogether prevented. 
Part iii., p. 56. 
Dietetic and Medical Treatment of Gout and Rheumatism.—Three 
objects demand especial attention in the treatment of the gouty diathesis. 
First, to invigorate the digestive organs, and prevent the undue formation 
of free acid (lactic acid), in the stomach. Secondly, to promote the elimi- 
nation of the gouty matter, through the various excretions. Thirdly, to 
obviate the tendency to the formation of lithic acid. 
It ought to be remembered that food is not the only source of lithic 
acid; this may arise from a disintegration of the tissues. Liebig considers 
that the lithic acid is generally derived from this source, while Prout and 
Wilson Philip think that it arises chiefly from the chyle. There seems to 
be little doubt that it may and does arise from both these sources—that 
it can be derived both from the albuminous tisues and from an excess of 
the matter of the chyle, taken in the blood beyond what is required for 
the nutrition of the tissues. “ The truth appears to be,” as Dr. B. Todd 
says, “ that the development of this substance may take place from the 
imperfect assimilation of the food, quite irrespective of the ulterior 
changes in the system, or it may occur from certain changes in the 
system, whatever may be the nature of the food.” The first of 
these opinions is proved by the great quantity of lithic acid which 
will sometimes be deposited after an improper or indigestible meal, and 
the second, by the same deposit occurring during the course of some 
deep-seated disease, as of the liver, quite independent of, and notwith- 
standing every care respecting the kind of food taken. With respect to 
food it is evident that such as will most discourage the formation of lactic 
acid in the stomach and duodenum will be the best, such as regulated 
quantities of animal food with a small quantity of vegetables, and espe- 
cially the avoidance of those saccharine and other vegetable products 
which may be prone to the. acetous fermentation. It is proved that bread 
and the ordinary vegetables contain the same azotized nutrient principles 
as animal food, but we must take a much larger quantity to obtain the 
same amount of nutrient material. In the treatment of the gouty dia- 
thesis, these principles are of the first consideration. In an attack of this 
disease we ought to remember that it is one means of eliminating gouty 
matter from the system, and therefore its management requires great 
caution. It is too common to begin immediately with colchicum. This 
ought, however, not to be administered at the onset of the disease, till the 
bowels have been properly cleaned out, nor ought it to be given in the 775 
asthenic form of disease, and when it is given it ought to be commenced 
in small doses, gradually increased, except indeed some cases of rheumatic 
gout, in which much larger and earlier doses have been attended with 
great benefit; when the joints continue in a state of chronic inflammation, 
Dr. Todd recommends a succession of small blisters or the iodine paint, 
composed of one drachm of iodine, half a drachm of iodide of potassium, 
dissolved in an ounce of spirits of wine. This may be painted over the 
parts occasionally, and will be found very useful where any efi'usion has 
taken place into the synovial membrane or sheaths. In the treatment of 
rheumatic fever we must bear in mind that the three channels which are 
the most favorable to the elimination of rheumatic matter, are the bowels, 
the skin and kidneys. It is probably owing to the efiect on the kidneys 
that the value of nitrate of potass is owing, as well as to its remarkable 
sedative power. 
In the French hospitals this medicine seems to be given in excessive 
doses, eight or twelve drachms daily, and would, no doubt, produce great 
irritation, were it not dissolved in a large quantity of liquid. Its sedative 
powers might probably be increased by combining with it tartarized anti- 
mony in minute doses. Dr. Todd recommends five or six grains of nitrate 
of potash with one-eighth of a grain of tartarized antimony with a little 
laudanum if necessary, every four or six hours. He, moreover, in com- 
mon with most practitioners, places great confidence in opium, which 
ought to be given at least every night, and in the day if necessary, unless 
some other symptom contra-indicate its exhibition. Part ix., p. 42. 
Iodide of Potassium.—Dr. Oke says: When a paroxysm of gout has 
either subsided or been subdued by colchieum, it not unfrequently hap- 
pens that it loiters in the system, sometimes plaguing one joint and some- 
times another, not in sufficient force to fever the system, but just enough 
to confine the gentleman to his arm-chair, or to keep the man of business 
from his counting-house. Under such circumstances I have found the 
iodide of the greatest service in clearing the system of the disease for a 
considerable time. I gave it in the following combination : 
Iodide of potassium, 5 grains; sesquicarbonate of soda, 10 grains; cam- 
phor julep, 1| fluid ounce. This dose to be taken thrice daily for a month 
or six weeks. Part ix., p. 62. 
Benzoin Water—Is prepared as follows : Purified benzoate of potash, 
biborate of soda, of each 15 grains, bicarbonate of potash, half a drachm, 
distilled water, 16 fluid ounces—which solution was prepared under a press- 
ure of 2* atmospheres of carbonic acid gas. The water will be found to 
retain a large proportion of its gas long after exposure to the air. 
This “ benzoin water ” will be found to unite the properties of an antacid, 
of a diuretic, and of a tonic. It will be found useful in an irritable state of 
the mucous membranes,whether manifesting itself in dyspepsia, or in chronic 
bronchitis; in all cases where there is a disposition to the formation of 
earthy deposits, in whatever part of the human frame—and particularly 
where such formations are the result of an excessive generation of lithic 
acid in the system. Part ix., p. 93.. 
Terchloride of Gold as an Outward Application in Ilheurnatic- Gouty 
Affections, made into a Salve with Lard.—It is said to relieve the pain, 
often in a truly wonderful manner. The purple stains are speedily re- 
GOUT. 776 
GOUT. 
moved by washing the part with a little urine; a fact that was discovered 
by accident. Part xi., p. 88. 
Remarks on Gout.—When an individual lives too well, and takes too 
little exercise, there frequently takes place a morbid plethora in the sys- 
tem. “ The blood is loaded with nitrogenized principles and calcareous 
salts, and if the skin and kidneys fail in removing these from the system, 
they are sooner or later deposited upon the synovial membranes and the 
tendons, or within the arterial walls, in the former as urate of soda, in the 
latter as phosphate of lime.” Now it appears that gouty people have fre- 
quently, if not always, an abundance of uric acid in their urine, except 
previous to an attack of the disease, when the kidney no longer excretes 
it; and it therefore is supposed to be circulating in the blood in the form 
of urate of soda. This is shown by Mr. Ure to be the case by various ex- 
periments. He further states the remarkable relief which is afforded by a 
copious secretion of bile, and for this purpose recommends the sulphate of 
manganese. A drachm of this is to be dissolved in about half a pint of 
water, and swallowed before breakfast. In a short time it is found to act 
beautifully on the liver, and to produce copious bilious stools, without 
causing the unpleasant effects which sometimes follow the use of mercury. 
It is probable that colchicum is often given too frequently and for too 
long a time, to patients who are subject to repeated attacks of gout. Sir 
B. Brodie thinks that its continued use suppresses the biliary secretion, and 
must therefore be given for shorter periods and more sparingly than is too 
often the case. Mr. Ure recommends as topical applications in these cases 
acetic ether and rectified coal naphtha. About half an ounce of acetic 
ether may be gently rubbed over the part affected every twelve hours, 
care being taken that the patient is kept warm afterward, or the coal 
naphtha may be pencilled over the part with a camel’s-hair brush. 
Part x.,p. 95. 
Rheumatic Gout—Use of Phosphate of Ammonia, recommended by Dr. 
Ruckler.—Mix phosphate of ammonia, say §ss., in §vj. of distilled water; 
and give half an ounce of this either combined with small doses of musk or 
not. It decomposes the insoluble lithate of soda supposed to exist in the 
blood, and forms two new soluble compounds, phosphate of soda and 
lithate of ammonia. Give it for a considerable time where thickening of 
the white tissues exists; it deprives the blood of the lithic acid and soda, 
and creates a demand for them, which leads to absorption of these elements 
from the tissues where they have been deposited. This remedy is not in- 
tended to supersede the use of the lancet, and other remedies in acute 
rheumatism. Part xiii., p. 154. 
Gout.—In gouty inflammation apply leeches, and keep up a gentle oozing 
from the bites by warm fomentations; then keep the part covered and 
apply a lotion made of one part of spirit, three of camphor mixture, and a 
little vinegar. Give colchicum to stimulate and increase the secretion of 
the mucous membrane of the bowels and to eliminate lithic acid and other 
nitrogenized the system. Part xiii.,j». 160. 
Nitrate of Strychnia Externally in Gout.—M. "Wendt recommends the 
nitrate of strychnia, in the form of ointment, in irregular gouty affections; 
for example, in gouty affections of the vertebral column, which, through 
the filaments of the great sympathetic, attack the chest, and give rise to 777 
GOUT, 
symptoms imitating angina pectoris. The formula recommended is as fol- 
lows: nitrate of strychnia, 10 parts; axunge, 8 parts: to he made into a 
perfectly homogeneous ointment, and applied by friction on the sides of the 
spine two or three times a day. Part xv., p. 43. 
Pyro-Acetic Spirit in Gout and Pheumatism.—Dr. Hastings recom- 
mends naphtha. He says: For upward of twelve months I have em- 
ployed pyro-acetie spirit in these affections, and my treatment has been at- 
tended with a success quite extraordinary, far exceeding the results usually 
obtained by colehicum, etc. I have not yet seen a case of gout or acute 
rheumatism which has not rapidly disappeared under its use, at the same 
time that it brings about a very improved condition of the general health. 
Chronic rheumatism requires a more lengthened treatment for its removal; 
indeed it has less power over this affection than the two preceding. 
Part xv., p. 43. 
Use of Benzoate of Ammonia, or Potash, in Gout.—Dr. Seymour says 
he has used this medicine repeatedly in practice, in cases in which the 
small joints were red, swelled, and painful, or where fluid matter was de- 
posited in the joint of the great toe soon after the paroxysm commenced, 
and also in cases where the lithate of soda existed in the joints of the 
fingers and superficially immediately under the cuticle on the surface of 
the lower extremities; and his impression certainly is, that it is decidedly 
useful. It is a decided diuretic, acting in some cases of dropsy fully and 
freely, and is especially adapted to those cases where constant nausea and 
occasional vomiting render the use of many medicines in the class of diu- 
retics impracticable, and also, where diarrhoea exists, forbid the employment 
of saline diuretics. 
He has repeatedly seen, by experiment at the hospital, that in dropsy 
with albuminous urine, the albumen is greatly diminished under the use of 
the benzoate of ammonia. What is a recommendation also to its use in 
many of the cases mentioned above is, that it is not disagreeable to the taste. 
Part xvi., p. 68. 
Phosphate of Ammonia.—After cleansing out the bowels with proper 
aperients, give ten grains of phosphate of ammonia every eight hours, 
either in simple water, or in infusion of serpentaria with spirit of nitre. 
Order perfect rest and simple diet; cover the parts with fleecy liosiei'y and 
oiled silk; and give an aperient pil. liydrarg. with pil. rhei comp, every 
other night. Part xvii., p. 26. 
Nature and Treatment of Gout.—According to Dr. White, an attack 
of gout is invariably dependent upon impaired function of the liver, and 
is certain to be relieved by a copious evacuation of bile. The best way 
to secure this end, is to give one of the following pills every four hours: 
R Hydr. chlorid., ext. colch. acet., ext. aloes purifl, aa. gr. j.; pulv. ipecac, 
gr. ij. M. fit pil. After two or three of these pills have been taken, 
assist their action by giving a dose or two of the compound decoction of 
aloes. By this time the paroxysm will have been relieved ; and the pills 
may then be given at longer intervals for a little time longer. 
Part xviii., p. 44. 
Treatment of Gout—Metastatic.—Metastatic gout must be treated by 
the application of sinapisms, blisters, hot pediluvia, and stimulant frictions, 
to recall the disease to the extremities. While the feet are plunged into 778 
GOUT. 
hot water with mustard in it, if the stomach is attacked, we must give 
cold or iced drinks with opium; if the head is the seat of metastasis, we 
must apply cold lotions to it; while if the heart is affected, we should 
apply no means hut the counter-irritation, and above all take care not give 
hydrocyanic acid. Part xviii., p. 47. 
Treatment of Gout.—Small bleedings to the extent of from three to 
six ounces, are useful. When purgatives are used, they should be warm 
cordial ones, which may be advantageously given in the form of tincture, 
and associated with aromatics and bitters. Colchicum should not be given 
to the extent of producing vomiting or purging, as it will act quite as 
well without any such manifestation. To change the uric acid condition 
of the urine, give alkaline phosphates, tartrates, or citrates, rather than 
carbonates, or pure alkalies. 
Give lemon-juice, in doses of from half an ounce to an ounce three times 
a day. 
The best aperient in cases of gout, consists of ten grains of pure sul- 
phur, and ten grains of sulphate of potash, with occasionally five grains 
of rhubarb. Part xx., p. 39. 
Piagnosis and Treatment.—The distinguishing points between rheu- 
matism and gout, are, in the latter, the age of the patient; his diathesis ; 
his habitual use of malt liquor; the rapid or sudden way in which the 
attacks come on; and the fact, that the parts first affected were the small 
joints, especially the metatarso-phalangeal joint of the great toe and the 
tarsal joints. In rheumatism, there is always a great tendency to sweat, 
and the ankles and knees are generally first attacked. As to the heart 
affections in rheumatism, there is a proneness to fibrinous concretions on 
the pericardium or endocardium. In gout, the nutrition of the muscular 
structure suffers, and inorganic deposits (lithate of soda, phosphate, and 
carbonate of lime) take place in the chorda? tendinea?, and other parts of 
the fibrous tissue of the heart, ultimately impairing the efficiency of the 
valvular apparatus. An active antiphlogistic treatment creates asthenia, 
and this gives a shifting character to both diseases, perilous to both, but 
especially so to gout. By moderate purgation, the use of diaphoretics, 
by keeping the joints warm, and if the urine be very acid, by the adminis- 
tration of alkalies, we may to some extent expedite convalescence, and 
undoubtedly relieve pain. Counter-irritation, by means of a small blister, 
is of decided utility in many cases, both in relieving pain and removing 
the effusions or thickenings which remain in gouty joints. Colchicum 
holds a curious relation to gout, sometimes for good, sometimes for evil; 
in the majority of cases perhaps the latter. In sthenic cases, in young 
subjects, it relieves pain, but though it shortens the duration of the attack, 
it likewise shortens the interval between the attacks; and, as the system 
is very tolerant of the remedy, there is great danger of immense doses 
being ultimately required to produce a decided effect. 
The chief remedies in some cases, under Dr. Todd, were the use of 
opium, free counter-irritation over the epigastric region by mustard and 
turpentine, and the exhibition of the sesquicarbonate of ammonia, allow- 
ing three or four grains in excess. The opium may be given in the form 
of morphia, at bed-time, in a draught. It has been tried with the combi- 
nation of the acetic exti’act of colchicum, but this seems to depress. 
When the erysipelatous state is at its height, fifteen minims of the chloric 779 
GOUT. 
ether may be added to the dose of the sesquicarbonate of ammonia as a 
grateful stimulant. Lemon-juice is a valuable remedy, increasing the 
quantity of urine often in a very marked way. Part xxiv., 
Gout—Acute.—Apply pure spirits of wine to the part by means of a 
piece of lint, and cover it with oil-silk. 
Chronic Gout and Rheumatism.—Mix 5j. of carbonate of soda with a 
bread poultice and apply this hot every night. Part xxix., p. 45. 
Treatment of Gout.—A man, aged fifty-eight, was admitted under the 
care of Dr. Hughes, into Guy’s Hospital, suffering from chronic rheumatic 
gout, which affected all the joints of his hands. The attack had lasted 
for six weeks, and was increasing in severity. He had frequently before 
suffered from the same disease. Dr. Hughes prescribed the following: 
R Extract, acet. colch. gr. j.; pulv. Doveri, gr. ij. Ft. pil. ter die 
sumend. Pulv. Doveri, gr. v., omni nocte sumend., et pulv. rhei cum 
magnesia Bij. omni mane. 
In a few days the pain had quite disappeared, and the man could sleep 
well, which he had not done for many weeks. Subsequently the decoc- 
tion of bark was ordered as a tonic, and in about ten days he was well in 
every respect. 
Dr. Hughes remarked that the treatment adopted was one which he 
almost never found fail to afford a very speedy relief in all forms of gout. 
He believed the acetic extract of colchicum to be quite a specific for the 
disease, and was inclined to attribute the failures which some met with to 
impurities or adulterations of the drug. Part xxx., p. 29. 
Use of Iodide of Potassium.—Iodide of potassium dissolves lithate of 
soda very readily, but not lithic acid. Therefore give this medicine in 
cases of gout, except during the acute attack. Give five to eight grains 
two or three times a day for a short time; or one grain every day in one 
or two doses for some weeks or even months. Part xxx., p. 30. 
Gout and Rheumatism.—Attend to all the excretions, and not to those 
of one organ exclusively. Unless fever be present, give bark and hydro- 
chlorate of ammonia, which stimulate all the excretory glands. Try to 
improve the general health by change of air and exercise, steel, cod-liver 
oil, and a variety of other means, before giving colchicum, guaiacum, and 
other medicines of this kind. 
Be careful, especially in puerperal cases, to remember that a joint may 
be affected by a gonorrhoeal taint, and may closely resemble pure gout or 
rheumatism. Ask if the child has had mild or severe purulent ophthal- 
mia ; if this has been the case, it is very probable that the joint affection 
of the mother is gonorrhoeal. Part xxxi., p. 42. 
Gout Treated with Piper Methysticum.—[Dr. Pritchard’s patient had 
tried the usual remedies for a severe attack of gout, but found no relief.] 
Seeing it was a well-marked case of podagra regularis, and that my 
patient, though corpulent, showed signs of much debility from previous 
treatment, and moreover wTas exceedingly irritable, I ordered the limbs to 
be enveloped in piline, saturated With the tincture of piper methysticum, 
enjoined perfect tranquillity and freedom from business matters, and to 
take the tincture of piper methysticum every four hours in the following 
form : 780 
GRAVEL, 
R Tinct. pip. meth. §ss.; aquae purae §vj. Capiat quart, part, quaque 
hora. 
ToArink lemonade, and to have for his dinner manna croup puddings; 
for his'tea cocoa-nibs, boiled in milk, one-half pint. 
Constipation troubled him a good deal. I ordered the following pill: 
R Pil. rhei comp. gr. iv., cap. j., nocteque mane, and that he w'as not to 
mind his bowels acting at present, for the action of the piper is more 
marked wflien retained in the system. This was merely to calm him ; for, 
as a principle, I do not give aperients in gout. 
He expressed himself another man, and from this time he wrent on 
improving, and continued under treatment about a fortnight; recovery was 
complete. Part xxxi., p. 45. 
GRAVEL. 
Treatment of Gravel.—The general treatment of gravel has been 
briefly pointed out by Dr. Watson, in his lectures. 
The subject of gravel, simple as it seems to be, is not sufficiently studied 
by the generality of practitioners, who frequently rest satisfied with 
observing a red deposit, and endeavoring to counteract it by giving 
alkaline medicines, without particularly discriminating between the 
different deposits which are liable to occur in the urine. It is, perhaps, 
generally known that healthy urine exhibits acid properties, turning 
litmus paper red ; not that it contains a free acid, but that certain of the 
alkaline and earthy bases are not exactly neutralized, but exist in the state 
of supersalts. The pure lithic acid is nearly insoluble, but the lithate of 
ammonia is very readily soluble, and it is this which reddens the vegetable 
blues ; and whether out of the body or within it, the lithate of ammonia 
will of course be decomposed if any acid be present in the urine, for 
which ammonia has a stronger affinity than it has for lithic acid, and the 
lithic acid will be thrown down in the form of red sand, very much like 
particles of cayenne pepper. If, therefore, we find the urine thick and 
muddy, with a reddish sediment, we may suspect that it is owing to the 
lithate of ammonia; the pure lithic acid at ether times showing itself in 
form of the fine sand above mentioned, or in larger crystals. The urine, 
in these cases, is more acid than usual, and gives to litmus paper a deeper 
shade of red; it is generally accompanied, too, by a tendency to feverish 
and inflammatory complaints. Alkaline remedies are in these cases called 
for—the bicarbonates of soda and potash. Now, it is important to know, 
that the potash is a preferable remedy to the soda; inasmuch, as soda 
will sometimes combine with the lithic acid and form an insoluble salt; 
whereas, writh potash, there is not this danger, the resulting salt being 
perfectly soluble, and passing away dissolved in the urine. Another kind 
of gravel or sand which is found in urine, is rather white / and denotes an 
alkaline or neutral state of the excretion, and is chiefly owing to the triple 
phosphate of ammonia and magnesia. It is of the greatest importance, in 
a practical point of view, to know that tiffs ichite gravel generally accom- 
panies a debilitated condition of the system. It is found in persons who 
have been weakened by toil and mental anxiety, or by insufficient nourish- 
ment ; in persons who are cachectic, sallow, languid and spiritless. u As GKAVEL. 
781 
the urine cools, the white sand is thrown down, and in many cases a sort 
of film is formed on the surface of the water. If we skim the pellicle off, by 
placing a bit of paper under it, and then suffer the paper to dry, we may 
easily see the little crystals.” The urine soon grows putrid, and even 
ammoniacal, in smell. Although the urine, even these cases, is often very 
slightly acid, yet it is sometimes so alkaline as to turn turmeric paper 
brown ; and we must be careful how we depress the vital powers. We 
must abstain from giving alkaline or saline draughts, colchicum and 
mercury, from active purgatives and bleeding; and we must counteract 
the phosphatic diathesis by generous diet, tonic medicines, bark and wine; 
the muriatic and nitric acids are given with vast advantage, and opium has 
a wonderful effect in assisting these medicines to restore the acid proper- 
ties of the urine. We should be particularly aware of the effect of these 
remedies, as it is generally admitted that it is a much easier thing to 
render acid urine alkaline than to render alkaline urine acid. The oxalic 
diathesis is another common form of this affection, in which there is a 
tendency to the formation of the oxalate of lime, or mulberry calculus. In 
the treatment of all these kinds of gravel we should never forget the 
necessity of well regulated exercise, which has at all times a wonderful 
effect on the kidneys, especially when the lithic acid diathesis prevails; 
diet, also, is equally important. Part vi., p. 21. 
Treatment of Gravel, Calculus and Gout.—In the treatment and pre- 
vention of gravel, calculus, and gout, we find many excellent directions 
from the pen of Mr. Jones, chiefly founded on the views of Liebig. These 
affections are so frequently the result of an excess of uric acid in the sys- 
tem, that to remedy this diathesis is often sufficient to prevent the former. 
One important indication of treatment throughout these cases, is to pro- 
mote the action of oxygen on the system, by which the excessive formation 
of uric acid is counteracted; the oxygen changing it into urea and car- 
bonic acid. This may be accomplished in various ways, and first, by 
exercise, which, if taken in moderation, assists materially in the absorption 
of oxygen into the system, but if carried to excess may depress the vital 
powers, and thereby encourage the formation of an excess of uric acid, the 
very substance which we wish to diminish. Other means will materially 
assist in the formation of oxygen : the avoidance of too much sleep, and 
hot rooms—the exhibition of the different preparations of iron, by which 
the amount of red particles is increased. Another very important means 
of accomplishing the same object is food. This may even rank above 
exercise in many respects. The great principle to be had in view is to 
diminish the non-nitrogenous principles of the blood. Liebig has shown 
“ that the substances which contain no nitrogen, by combining with the 
oxygen which has been inspired, hinder its action on uric acidand hence 
the diet in these cases ought to be such as will not to any considerable ex- 
tent interfere with the action of oxygen, as nitrogenous articles of diet— 
a moderate quantity of meat, with a much smaller quantity of bread, the 
meat of course to be proportioned to the degree of exercise—in short, all 
articles which contain much sugar or starch, are to be avoided in these 
cases, or given in moderation; as bread, potatoes, rice, apples, pears, and 
all kinds of fruit, fat, butter, etc. The non-nitrogenous bodies in the 
blood may also be diminished by certain medicines, which act on the 
liver, as calomel, aloes, colchicum, colcynth, etc.; and the uric acid may be 782 
GUARANA, 
kept in the ultimate textures in a state of solution by the alkalies. Mr. 
Jones considers that whenever the uric acid diathesis exists for any length 
of time, it must necessarily produce a disposition to gout: and however 
unintentional it may have been, we can see that most of the measures 
which have been recommended for the cure of gout by different physi- 
cians, have been such as would promote the action of oxygen in the 
system. Sleep lessens the quantity of oxygen taken into the system by 
diminishing the number and extent of the respirations, and sedentaiy 
habits act in the same way; excessive eating loads the blood with those 
substances which must have oxygen to carry them off; by taking acids, 
the uric acid is rendered less soluble; wines are injurious, from the alcohol 
they contain, and acid wines are doubly injurious, by both acid and alcohol 
adding to the excess of non-nitrogenous substances, for which the oxygen 
has a greater affinity than it has for the nitrogenous substances. We find 
that abstinence assists materially in restoring the proper proportions of 
oxygen and nitrogen, by adding no fresh fuel, and thus giving the oxygen 
and opportunity of consuming those non-nitrogenous (carbonaceous) sub- 
stances, which had been previously so heaped up as to threaten to put an 
end to all action. Exertion increases the respiration, and thus causes 
more oxygen to be absorbed, and more action to take place. Purgatives 
remove the bile, which contains an excess of carbonaceous matter, on 
which the oxygen would otherwise act to the hindrance of its action on 
the nitrogenous substances, whilst alkalies and water hold the uric acid 
dissolved, and promote the changes in the tissues. By these views, the 
relation of gout to acidity, to uric acid, and oxalate of lime calculi, is 
plain. They all arise from the same cause, the want of action of oxygen. 
Part vii., p. 60. 
Treatment of Uric Acid Gravel by Phosphate of Soda.—In the treat- 
ment of uric acid gravel, Dr. Golding Bird suggests that the phosphate of 
soda, in doses of 9j. to 3ss., given three times a day, may be even pre- 
ferable to the pure alkalies and their carbonates, as these so frequently 
disorder the digestive organs when given and continued for any length of 
tune. Part x., p. 82. 
GUAR AN A. 
Properties and Uses of Guarana.—This substance was presented to 
Mr. Ritchie by a Brazilian, and from a statement of its virtues he was 
induced to employ it in several troublesome and obstinate diseases. 
It is held to be stomachic, antifebrile, and aphrodisiac; is used in dysen- 
tery, diarrhoea, retention of urine, and various other affections. It stimu- 
lates, and at the same time soothes, the gastric system of nerves. It 
reduces the excited sensibility of the coeliac plexus, thereby diminishing 
febrile action, and strengthening the stomach and intestines, particularly 
restraining excessive mucous discharges, increasing the action of the heart 
and arteries, and promoting diaphoresis. It is therefore indicated as a 
valuable remedy in fevers, or reduced vital power resulting from cold or 
prolonged wetness, grief, too great muscular exertion, depression of spirits, 
long watching, and also in colic, flatulence, anorexia, nervous hemicrania, 
or in a dry condition of the skin. It is contra-indicated in a plethoric or GUMS. 
783 
loaded condition of the abdominal viscera, and when there exists determi- 
nation of blood to the head. It is said to increase the venereal appetite, 
but to diminish the fecundating power. 
In cases where irritation of the urethra or urinary bladder succeed 
venereal or attend organic disease, it exerts a most salutary effect in 
soothing the irritability of the mucous membrane, relieving the nervous 
prostration which accompanies these affections, and exalting vital power. 
Unlike the disagreeable remedies which are generally, and often without 
success, employed in these affections, it is taken with pleasure, and 
with an amount of success which, as far as my experience extends, is 
universal. 
If we examine guarana according to its chemical characters, it must be 
regarded as a most valuable substance, from its possessing in so great a 
proportion that important nitrogenous principle guaranine. This, if not 
identical with caffeine, is at least analogous to it, and to theine and theo- 
bromine—all important elements of food and grateful stimulants. From 
its chemical constitution, then, we may predict with great certainty its 
physiological action as being powerfully tonic ; but, in the combination in 
which it is found, experience indicates that it possesses conjoined more 
valuable properties than belong to the simple tonics. Its power of cor- 
recting generally the discharges, and restoring the normal vitality of the 
mucous membranes, must be viewed as one of these. 
Guarana, in the state of powder, is exhibited in doses of 5j- three or four 
times daily, mixed with water and sugar, or with sirup and mucilage, con- 
joined with an aromatic, as cinnamon, vanilla, or chocolate. A convenient 
form is that of extract, obtained by treating the guarana with alcohol, and 
evaporating to the consistence of pills. This may be exhibited in the form 
of solution or pills. The Brazilians, however, use the powder with sugar 
and water alone, and consider this draught grateful and refreshing. 
Part xxv., p. 325. 
GUMS. 
Epidemic, Ulceration of the Gums in Children.—Dr. Duncan gives an 
account of a very severe and fatal ulceration of the mouth and gums of 
infants, with high fever and apparently of an epidemic origin, which 
occurred in the North Dublin Union Workhouse, where there are as many 
as sixty or eighty children under two years of age. 
It first occurred in the winter of 1843-44; was usually preceded by 
diarrhoea, without, at first, any signs of enteritis. After a few days, the 
state of the mouth attracted notice; on examination, the gums were found 
ulcerated, the fangs of the teeth exposed and covered with sordes. If the 
disease were not checked at this stage, it advanced rapidly to a fatal ter- 
mination. The ulceration of the gums was very similar to that pro- 
duced by mercury: which, as in these cases it was of an undoubted 
constitutional origin, should induce great circumspection in pronouncing 
such to be the cause, when a case may be met with in private practice. 
The spongy state of the gums, with their tendency to bleed, point out 
an analogy with purpura hemorrhagica, another disease of impaired blood, 
which is borne out by the discharge in each case of blood in the stools. 
The great importance of establishing a diagnosis between this disease and 784 
GUMS. 
common mercurial ulceration of the mouth is self-evident. The opinion of 
Dr. Duncan is that it is only a form of cancrum oris, and that of neither is 
mercury to he considered the exciting cause. If this can be proved, then 
shall we be able to banish our apprehensions, and avail ourselves of the 
valuable therapeutic properties of this mineral in its treatment. The 
importance of establishing this point is further illustrated by the frequency 
of prosecutions for malpraxis, when the real cause of death was cancrum 
oris. The differences between cancrum oris and mercurial sore mouth, are 
first, in the salivation, which in the former, though decided, is slight; 
there is likewise a perceptible difference in the fetor of the breath, but 
tflie most distinguishing characteristic is the ulceration of the gums, which 
in the disease in question is usually confined to one side of the mouth, 
whilst in the mercurial affection, the whole is equally affected. Dr. Mar- 
shall Hall also particularly notices this, having found it in a case which he 
examined. Other arguments in support of the opinion that it is not 
dependent on mercurial action, are, that it occurs almost exclusively 
amongst children, who are scarcely susceptible of that action. Again, it 
is well known that the action of mercury cannot be produced during the 
existence of fever, yet this is an invariable accompaniment of the disease 
under consideration. But the most conclusive of all is, that mercury may 
be beneficially employed in its treatment. How cancrum oris is admitted 
to resemble very closely the gangrena pudendi of young females, and 
during the epidemic which Dr. Duncan considers, one case of the latter 
actually occurred, thus satisfactorily proving their common origin. 
Mr. Kinder Wood first pointed out the unhealthy condition of the 
digestive organs in the cases of gangrena pudendi which had come under 
his notice, that will be found to occur in cancrum oris. The pathology 
of the disease appears to be essentially an inflammation of the intestinal 
mucous membrane, the mouth affection being merely a part of a more 
general morbid state. The diarrhoea, and in the fatal cases, ulceration of 
the intestinal mucous membrane, point to this origin, which is confirmed by 
the peculiar gastric form of diseases prevalent at the time. 
So far as my observation Avent, I remarked that little benefit resulted 
from local treatment; I tried various astringent and other gargles and 
applications, borax and honey, muriatic acid and sulphate of copper, but 
found them to exert no appreciable influence upon the disease, while con- 
stitutional remedies certainly did. The ordinary astringents, such as chalk 
mixture, catechu, and acetate of lead, often failed to check the diarrhoea; 
and even opium, given in as large doses as I thought safe to patients so 
young, did not appear more effectual. The best internal medicine for 
this purpose was an acidulated decoction of bark, or an infusion of oolumba 
and nitric acid (e.g. R Acid. nitric, dil. gtt. xij.; infusi columbre, givss.; 
tiuct. cinchon. c., 5iv.; sirupi aurantii, §j.) This controlled, in a remark- 
able degree, the diarrhoea which had resisted other remedies, was readily 
taken by the children, and did not appear to produce any unpleasant 
effects. I have already mentioned the fact of my having used mercurial 
preparations, in the form of hyd. c. creta, combined with Dover’s powder, 
with considerable encouragement. I was induced to resort to this class of 
medicines, from observing the unhealthy condition of the alvine discharges. 
Of course I did not think of using this combination at the same time that 
the patient was taking any acidulated medicine. 
But the most valuable agent I met with in the management of these 785 
GUM RESINS, 
cases was a speedy and decided counter-irritation of the abdominal surface. 
The excitement of the capillaries here relieved, in a remarkable manner, 
the congestion that existed within. 
The best mode of producing a light, and at the same time a sufficiently 
enduring irritation of the surface, I found to be the laying a mustard 
poultice on the abdomen, till the skin was reddened, and the immediate 
application of a blister on the part for a single hour. Its action was 
speedy, safe, and effectual. 
It controlled almost immediately the distressing and wasting diarrhoea, 
lowered the fever, and improved the condition of the mouth. Throughout 
the progress of the disease it was necessary to support the jDatient’s strength, 
and for this purpose wine was given very freely. In all cases its first ad- 
ministration was carefully watched, and where it seemed to disagree it was 
instantly laid aside. But in the majority of cases it harmonized admirably 
with our intentions, quenching the patient’s thirst, supporting his strength 
and diminishing the diarrhoea. Billard, the able French writer on the dis- 
eases of infancy, gives a correct view of the pathology of these affections 
of the mouth, both in his text and his illustrative cases; but he falls into 
the mistake so common to his countrymen, of supposing that the presence 
of intestinal inflammation must be an insuperable barrier to the adminis- 
tration of stimulants, forgetting the important truth in practical medicine, 
that inflammation may be of opposite characters, and require either a 
stimulating or an antiphlogistic mode of cure. 
Firmly believing, as I do, in the intestinal origin of this disease, I am 
equally persuaded of the safety and necessity of administering stimulants 
with due discretion, but with sufficient boldness, even at an early period, 
in the progress of the case. Part xii., p. 84. 
Discoloration of the Gums from Nitrate of Silver.—Dr. Branson, of 
Sheffield, observes that when nitrate of silver has been given for some time 
it produces a blue discoloration of the gums, similar to the effects of lead; 
and he regards the first faint appearance of the blue line as a valuable 
proof of the action of the medicine, and the depth of color of the line as 
affording a very useful warning that the limit is reached beyond which it 
is unsafe to proceed. Part x., p. 187. 
Gums—Chronic Inflammation of.—Extract loosened teeth, scarify the 
gums frequently with a sharp lancet, and rub a little powdered tannin over 
the gum, twice or thrice a day; or apply compound spirit of horse-radish,, 
or spirit of scurvy grass, with a piece of soft sponge. 
Ulcers on the Gums.—Apply diluted nitric acid (equal parts) with a 
camel-hair pencil. Part xvi., p. 185.. 
Action of Carbonate of Potash on Gum Desins.—The attention ©f Mr. 
Hulse having been drawn to the action of carbonnate of potash on myrrh, 
he was induced to try its effect in reducing other gum resins, and the 
result was perfectly satisfactory. 
Mr. Hulse says: 
GUM RESINS. 786 
GUM KESINS. 
The intrinsic value and utility of this alkaline carbonate as an agent, 
when used according to the formulae hereafter referred to, will become 
manifest to the practitioner and the pharmaceutist, especially in the pre- 
paration of the compound mixture of iron, the compound pills of iron, the 
compound galbanum pills, and, indeed, every other mixture and pill which 
contains a gummo-resinous ingredient in its composition. 
With regard to myrrh, if one part of carbonate of potash be added to 
two parts of myrrh in the lump, and rubbed together, the alkali produces 
complete saponification; and if to this be added medicated or distilled 
water, we obtain an elegant emulsion of myrrh, and nearly the whole of 
the gum resin is retained in suspension, which would not be the case 
without the aid of the carbonate of potash, then with the usual pro- 
portion of sugar, using the raw instead of refined, adding first the rose 
water, then the sulphate of iron, powdered, and, lastly, the spirit of nut- 
meg, it will not be an unsightly mixture, and the precipitate will be very 
trifling. 
Again, in the compound pill of iron, if carbonate of potash is used instead 
of carbonate of soda, and raw or Muscovado sugar in lieu of the refined, a 
pill mass can be compounded with less trouble than by following the col- 
lege formulae, and which will retain a convenient pilular consistency for 
any reasonable period. 
It Myrrh in lump, two drachms, reduce it to powder in an iron mortar 
with carbonate of potash, one drachm, then add sulphate of iron, pow- 
dered, one drachm ; raw sugar, one drachm. 
Mix, and beat all into a mass, without any liquid. Attention to this last 
remark is necessary, for the addition of any liquid renders the mass 
too soft, the raw sugar being sufficient to bring it to a proper consis- 
tence. 
The solubility of this pill is such, that after having been made six months, 
I put two pills, of five grains each, into a glass of water, about the tempe- 
rature of the stomach, and they were completely disintegrated in two hours. 
If water will thus serve to dissolve these iron bullets, as they are some- 
times termed, we may expect the fluid of the stomach will have a much 
quicker action upon them. 
I will now refer to that hitherto troublesome preparation, the compound 
galbanum pill. This pill, which to most gentlemen has ever been an an- 
noyance, can be as easily and as readily prepared as the preceding one, 
and becomes as tractable and as convenient for making into pills as any 
other mass. Without presuming to deviate materially from the instruc- 
tions given in the pharmacopoeia, I proceed as follows: 
R Myrrh in lump, and sagapenum, of each one drachm and a half; gal- 
banum, one drachm; assafoetida, half a drachm. 
Triturate these with two drachms of carbonate of potash, in an iron mor- 
tar, until the whole are sufficiently reduced ; add raw sugar, two drachms, 
and beat all together into a mass, without any liquid, which mass will re- 
tain its consistency for any reasonable period. 
The pill of aloes with myrrh, compound squill pill, compound rhubarb 
pill and other similar preparations, will be considerably improved if made 
with the assistance of carbonate of potash and raw sugar; but with every 
other than the compound galbanum pill and compound pill of iron, a small 
portion of water must be used. 
The raw sugar (saccharum non-purificatum), as an ingredient in com- GUTTA PEECHA. 
787 
pound pill of iron, is decidedly preferable to the refined, which alone will 
hot form a mass. 
In all pill masses and mixtures containing gum resins, the pharmacopo- 
list will find it preferable to use ingredients that have been powdered in 
his own premises. 
In examining the solubility of gum resins in water with the aid of car- 
bonate of potash, I find them to vary considerably. Myrrh is the most 
soluble, ammoniacum is next, sagapenum third, while galbanum and assa- 
foetida do not appear to be much, if at all, assisted by it. In galbanum 
there is a second stratum of precipitate, very flocculent, lying upon one 
more dense, but that is not the case with any other; and I question if it 
would be found so invariably in every sample of the gum, for the analysis 
of gum resins is differently stated by chemists, evidently owing to the dif- 
ferences in their qualities and composition. 
This subject leads me to notice the practice of some of our brethren 
who keep, ready prepared, an emulsion of myrrh, for the purpose of dis- 
pensing Griffith’s mixture more quickly. This is very objectionable, inas- 
much as the emulsion by keeping becomes thin, and on mixing the other 
substances, a rapid precipitation takes place, leaving the bottle more than 
half filled with a nearly transparent fluid. Part vi., p. 16. 
GUTTA PERCHA. 
Nature and Uses of.—Gutta percha is tlie native name of the exuded 
juice of a tree so called, indigenous to Singapore and its vicinity, and col- 
lected like caoutchouc, which, in appearance, it somewhat resembles. It 
is brought for sale in lumps, and at ordinary temperatures feels quite hard; 
when a piece of it, however, is plunged in boiling water, it softens, becomes 
pliant, may be rolled out, or molded into any form the operator chooses, 
and, after cooling, perfectly retains the form so given. When softened by 
the heat of water at or near the boiling point, it can be rolled out into 
laminse of suitable thickness for splints, and while still pliant placed on a 
fractured limb, and adapted to its contour throughout. It hardens ere it 
falls to the temperature of the body, and retains its form unchangeably. 
By applying flannel wrung out of hot water to the outside of the splints, 
the gutta can be again softened and turned up in any part or entirely re- 
moved and readapted. 
Dr. Little showed its application as supporting splints in knee disease 
and in ordinary fracture; the patients expressed feelings of comfort under 
the gutta, which had replaced the uneasy pasteboard splints in previous 
use. This material can, of course, in ingenious hands, be turned to various 
purposes. Part 150. 
Application of Gutta Percha in the Treatment of Diseases of the Skin. 
—When any abrasion of the surface of the body takes place, nature imme- 
diately sets to work to provide some impermeable covering for the protec- 
tion of the delicate tissues from the action of external influences. This was 
the idea which led Dr. Graves to introduce a solution of gutta percha in 
chloroform for the same purpose in various diseases of the skin. The ad- 
vantage of this preparation over collodion is, that it is not liable to crack 788 
HEMATEMESIS, 
and peel off; but being more tough and extensible, it more nearly resem- 
bles the natural covering. The effect, he says, has been most favorable in 
the cases in which it has been tried, diminishing inflammation and aiding 
the restoration of the healthy structure of the skin. 
The t ransparency of this artificial membrane enables us to watch the pro- 
gress of the subjacent diseased skin, and its colorless nature prevents it 
from disfiguring the face when the eruption occupies that part. Its perfect 
cleanliness, too, is no small advantage, and affords a very agreeable con- 
trast when compared with the usual ointments, etc. 
The saturated solution of gutta percha in chloroform is more especially 
suited to dry, scaly, tubercular and chronic diseases of the skin, but has 
also been used with advantage in erysipelas, impetigo, psoriasis, and in 
preventing ulceration from the pustules of small pox. 
It is of great importance, and essential to the success of this treatment, 
to observe that the gutta percha solution should not be applied to the face 
until the pustules are fully maturated, or even begin to exhibit the first ap- 
pearance of collapse, as indicated by the well known central depression on 
the apex; applied then, the solution is of the greatest service; ap>plied 
before maturation, it is mischievous. 
The camel’s-hair brush should be plunged, the moment it has been used, 
into hot water, to prevent it from being consolidated by the coagulated 
gutta percha. Part xxvi., p. 287. 
Caustic Gutta Percha.—By mixing two parts of chloride of zinc with 
one of powdered gutta percha, in a tube over a spirit-lamp, a very useful 
and flexible caustic will be formed. Part xxxiv., p. 277. 
HEMATEMESIS. 
Acetate of Lead.—In five-grain doses or more, repeated, pro re natd, 
advised in liematemesis. Part vi., p. 87. 
Treatment of Hematemesis.—[When the patient vomits blood, he is to 
be treated according to his constitution and the quantity discharged. 
When this occurs in plethoric subjects, or when there is much fever, it 
will not be desirable at first to check the hemorrhage ; but when it arises 
from the intestinal canal, it is highly necessary to increase the natural se- 
cretions of the abdominal viscera, and especially that of the liver. This 
will be done most effectually by calomel or blue pill, with saline aperients, 
followed next morning by sulphuric acid and sulphate of magnesia.] 
When the hemorrhage is more considerable, and the patient appears to 
be much weakened by it, we must adopt immediate measures to arrest it; 
and this may be done pretty surely—if no organic disease is connected 
with it—by sugar of lead combined with opium ; and, likewise, oil of tur- 
pentine, in small doses, seems to act very effectually here : from 15 to 30 
minims for a dose, repeated four or five times a day. In persons already 
considerably blanched, and in whom the hemorrhage appears to be quite 
of a passive character, unaccompanied by any increased action, the muri- 
ated tincture of iron is useful. In the scorb.itic forms of the disease, tonics 
and astringents are commonly employed; oil of turpentine and creasote, 
with other measures to support the strength of the patient. Even here it HEMATEMESIS, 
789 
is necessary to see that the secretions are free, and to promote this muriatic 
acid is sometimes useful. Meloena is merely a modification of this affection, 
and the treatment is the same. There may be a discharge with the faeces 
of blood, or matter of pitchy blackness; and sometimes there is accom- 
panying it pain in the iliac and hypochondriac regions, and great agitation 
and pulsation. It is necessary to purge freely; castor oil and a few drops 
of turpentine are very useful, and acid mixtures, in most cases, are service- 
able in promoting the natural secretion and tending to arrest the bloody 
flux. Part x., p. 63. 
Hematemesis.—The treatment of hematemesis is in some degree modi- 
fied by the causes of it. When the hemorrhage is due to suppressed or 
inefficient catamenia, or to suppressed hemorrhoids, and occurs in plethoric 
subjects, it may be proper not only to use the local means presently to be 
enumerated, and to place the lower extremities in hot water, but even to 
phlebotomize the arm or foot. In addition to the above means, we must, 
in the case of a woman with torpid uterus, foment the pudenda and ad- 
minister emmenagogues. With a man used to hemorrhoids and hemor- 
rhoidal discharges, but in whom they are suppressed or scanty, a hot semi- 
cupium and stimulant suppositories or injections should be had recourse to. 
Internal styptics should simultaneously be administered, such as simple 
cold or iced water, or ice itself (if procurable); or an alum whey, consist- 
ing of a pound of that fluid, in which two drachms of alum are dissolved, 
and of which a small teacupful may be taken. Rose water may be substi- 
tuted for the whey or oxymel. A favorite astringent pill in France is one 
composed of three or four grains of alum, two or three of sang-dragon 
(calamus draco and conserve of roses), of which from one to six or eight 
may be taken in twelve or sixteen hours. Some recommend, also, the ap- 
plication of bladders containing ice or cold water, externally, to the epi- 
gastrium. Such means will usually speedily succeed in hematemesis of 
this indirect and simple kind. The recurrence of it must of course be pre- 
vented by anticipating its causes—namely, by reestablishing the catamenia 
and the hemorrhoidal discharge, or else by reducing systematic plethora, 
obviating the necessity for either hemorrhoids or hematemesis. 
Part xix.,p. 95. 
Oil of Turpentine.—Give oil of turpentine in doses of from twenty to 
sixty minims every three or four hours. It may be given in simple water, 
agreeably flavored, or it maybe used in combination with compound infusion 
of roses, iced water, or solutions of tannic or gallic acid. Part xxip. 116. 
Treatment of Hematemesis.—The natural method by which the bleed- 
ing is checked is the contraction of the stomach. Endeavor, therefore, to 
produce this contraction; and in accordance with the principle adopted, 
give the remedies as little diluted as possible, so as not to distend the 
stomach. Oil of turpentine, which will excite contraction of the stomach, 
and small doses of gallic acid in the solid form, are most to be relied upon. 
Let the diet be liquid, concentrated, quite cold, and given in very small 
quantities at once. Ice is objectionable, as distending the stomach; and 
blood-letting is only applicable in a few cases. Part xxi., p. 362. 
Hematemesis.—When acetate of lead and opium, turpentine, gallic acid, 
tannin, etc., fail, we may try ergot of rye; give a drachm and a half of the 
powder divided into eight doses—each dose every four hours. 
Part xxx., p. 03, 790 
ELEMATURIA 
HEMATURIA. 
Tinct. Ferri Sesquichlor. (Tinctura Ferri Mur.) in Discharges of 
Blood from the Urethra, etc.—[Mr. Clay attributes the collection of 
blood in the bladder, which we occasionally meet with, not so often to dis- 
ease of the bladder itself, as to disease of one or both kidneys. The 
small quantity of urine which is excreted in most of these cases is strong 
presumptive evidence that the kidneys themselves are in fault. The injec- 
tion of warm water into the bladder merely removes the coagula without 
curing the disease. The same observation applies to the injecting of 
saline solutions, such as salt, which, however ingenious in preventing the 
coagulation of the blood which collects, does not act on the kidneys; and, 
perhaps, only stimulates those organs unnecessarily. Mr. Clay proceeds 
as follows:] 
In all cases where great discharges of blood have taken place by the 
urethra, it is generally remarked that the quantity of urine is small; and 
this is a strong presumptive proof that the disease is seated in the secret- 
ing organs, and not in the bladder : under such circumstances we can hope 
for no advantage by local applications to the inner surface of the bladder; 
it must be evident our only advantage is by constitutional treatment, as- 
sisted by local applications over the region of the kidneys. I have just 
discharged a case cured, illustrative of this subject. I found Mr. W , 
aged sixty, unable to pass any urine—a teaspoonful, or, at most, two, of 
blood coming away at every attempt; the bladder was distended, and the 
abdominal surface very tender. I passed the catheter; about six ounces 
of blood came away, considerable relief was given; the blood discharged 
was nearly pure, and destitute of urinal smell. As the quantity of blood 
discharged was but trifling, I proposed passing the cathethev again next 
morning; in the meantime I ordered a warm fomentation to the abdomen, 
and gave the following : 
R Tincture of muriate of iron, §j.; tincture of opium, 5j-; infusion of 
Iceland moss; infusion of gentian, of each §iv. Let an ounce be taken 
every four hours. 
After continuing the use of the tinct. fer. mur. for about ten days, he 
gave it up, being quite free from any unpleasant symptoms. This case was 
remarkable, as being one that had existed for some years, and all hope of 
permanent relief was lost; it only forms one of many that I have relieved, 
or entirely cured, by the same means; occasionally I have obtained relief 
from blisters and tartar emetic plaster over the region of the kidneys; but 
except in cases, and of no great extent, I have not found them of perma- 
nent benefit; on the contrary, few cases have withstood the tinct. fer. mur. 
Part iii., p. 30. 
Sulphate of Alumina and Potass in Hemorrhage.—Dr. X. Grattan, 
some time ago, recommended alum in fifteen grain doses, combined with 
dilute sulphuric acid, as a remedy in profuse menorrhagia and in the 
hemorrhage of abortion. Dr. Lynch relates a case of hematuria in which 
the following draught quickly restored the patient to a healthy state : 
R Sulphatis alumince et potasste, gr. xv.; acidi sulphurici diluti, gtt. 
xxx.; sulphatis magnesite, 5j. ; infus. roste, §j. Fiat haustus, ter quotidie 
eumendus. Part iv., p. 23. 791 
HJ5MATURIA, 
Bleeding from the Urinary Organs.—Dr. Prout states that “when 
blood is derived from the kidney, it is in general equally diffused through- 
out the whole urine : on the contrary, when derived from the bladder, the 
blood for the most part comes away in greater or less quantity at the ter- 
mination of the discharge, the urine having previously flowed off nearly 
pure.” When the blood proceeds from the urethra, it will generally 
come away gattatim, or in a stream unmixed with urine, and neither 
preceded nor accompanied by any desire to make Avater. But there are 
many cases Avhere it is almost impossible, from the absence of pain, etc., to 
fix upon the part Avhence the blood arises, and in these doubtful cases it 
Avill probably be found that the kidneys are the organs giving rise to it, 
from the existence of earthy concretions, which Ave knoAV may form in the 
kidneys in great numbers, and to a considerable size, without furnishing 
any signal except that of hematuria, Avhich may lead to suspect any mis- 
chief. 
The treatment of hematuria must be exceedingly various. When the 
bladder is so distended that complete retention of urine takes place, 
recourse must be had to a large eye catheter and an exhausting syringe, 
by the aid of AAdiich, and the occasional injection of cold Avater, the 
coagula may be broken doAvn and removed. If the hemorrhage returns, 
injecting cold Avater into the rectum or bladdex-, and, if necessary, from 
twenty to forty grains of alum in each pint of Avater may be used. Dr. 
Prout says this seldom fails, even Avhen the cause is malignant disease. 
Among internal remedies, Buspini’s styptic, recommended by Sir Benja- 
min Brodie, in his published lectures, is no doubt a valuable medicine. 
Dr. A. T. Thompson says this consists in a solution of gallic acid in alco- 
hol diluted Avitli rose Avater. The French are very fond of the extract of 
rhatany root, the Tcrameria of our pharmacopoeia. Dr. Watson gave this 
to a female in scruple doses three times a day, and the hematuria ceased 
after the first dose, although the affection had resisted treatment for some 
Aveeks. Gallic acid enters into the composition of this vegetable extract, 
and it is Avorthy of notice, that gallic acid is one of those substances 
Avhich, AAThen introduced through the digestive organs into the blood, 
passes through the round of the circulation unchanged, and reappears in 
the urine; it is, therefore, proved to be a most useful astringent in more 
cases of hemorrhage than those Avhich arise from the urinary organs. The 
styptic virtues of the uva ursi, bistort, tormentil, pomegranate, kino, 
catechu, and the several preparations of gall-nuts may likeAvise depend on 
the same principle, or rather, probably, on the tannin, as this exists in 
much greater proportions than gallic acid in most of these substances, 
although the medicinal effects are alike. In one hundred parts of 
rhatany root Gmelin found thirty-eight parts of tannin, and Peschier 
forty-tAvo parts. Hence xve find its value, not only in internal hemorrhage, 
but also in profuse mucous discharges, passive hemorrhages, as metorrha- 
gia, and in relaxation and debility of the solids. But in those mucous 
discharges Avhich proceed from chronic affections of the urinary organs, 
Ave shall find that uva ursi and pareira brava are the tAVO most valuable of 
our medicines. When combined Avith hyoscyamus, and persevered in for 
a considerable time, Dr. Prout says the uva ursi is of the greatest use :: 
on the other hand, Sir Benjamin Brodie places much more confidence in? 
pareira brava, AArhich he uses Avith the greatest benefit in cases of 
charges from the urino-genital mucous membranes ; in chronic inflamma- 792 
HJ2MA.TURIA, 
tion of the bladder especially, Sir B. Brodie thinks it has the greatest 
influence, “lessening very materially the secretion of the ropy mucus, 
and diminishing the inflammation and irritability of the bladder also.” 
He gives it in the form of a concentrated decoction with tinct. hyoscyam., 
and where there is a deposit of the triple phosphates, he accompanies it 
with the muriatic or diluted nitric acid. His formula is, half an ounce of 
the root in three pints of water, boiled down by gentle simmering to 
one pint; of this eight or twelve ounces may be taken daily. 
Part vi., p. 49. 
M. Tissicr, of Lyons, has been administering a new astringent prepara- 
tion in hematuria, etc. It is prepared by digesting rhatany in sulphuric 
ether, by which he obtains a brown extract, soluble in water, and possess- 
ing an astringent taste when placed on the tongue. It is said to be par- 
ticularly serviceable in cases of non-contraction of the uterus after 
prolonged labors and miscarriages; and in leucorrhcea, menorrhagia, etc., 
depending on a want of power and contraction in the tissues of the womb 
and vagina. Part viii., jo. 65. 
Treatment of Hematuria.—[As there are various causes giving rise to 
hematuria, so must its treatment be varied correspondingly. No general 
plan can be adopted, and in this, as in all other cases, the general condi- 
tion must be particularly attended to. Dr. Fife observes :] 
General blood-letting, according to my experience, is seldom requisite, 
as in those cases where the circulation was most active, other means, fol- 
lowed by less permanent reduction of the powers of the system, invariably 
sufficed to subdue the excitement; where, however, the patient is young, 
vigorous, and plethoric, much time and suffering will, doubtless, be saved 
by recourse to it. The topical abstraction of blood, by cupping over the 
loins, where the kidneys are affected, is most beneficial; and where the 
bladder is similarly engaged, leeches to the groins, or perineum, were 
equally useful. In renal cases, dependent on, or connected with, sub-acute 
inflammation, counter-irritation, by means of the antimonial ointment, 
proved of great service. Blisters are to be avoided. Where the pain 
seemed connected with calculi of the kidney, friction with morphia, in 
the form of ointment, or the belladonna in that of plaster, applied over 
the loins, materially relieved it. In cases where the circulation was 
increased, and where sickness was not urgent, the tartrate of antimony 
was given with advantage, and where, by the reason of the presence of 
sickness and vomiting, it appeared contra-indicated, the digitalis was 
advantageously substituted for it. 
As a means of arresting the hemorrhage, the acetate of lead and 
sulphate of alum both claim confidence, although neither of these medi- 
cines is free from very decided objections, which may, however, be much 
diminished by their combination with other medicines; the acetate of 
lead, for example, should be combined with opium, and the sulphate of 
alum with hyoscyamus. When so combined, the constipating or para- 
lyzing effect of the one is in a great measure counteracted, and the constipat- 
ing and irritating tendency of the other, as certainly lessened. As a 
means of relieving pain, hyoscyamus and conium are decidedly preferable 
to the preparations of opium, and when given in sufficient doses, and at 
proper intervals, hardly less to be relied on. Where the pain is connected 
with the bladder, and that viscus is in a highly irritable state, supposito- HJSMATHRIA, 
793 
lies are most efficacious, and free from the objection which attaches to the 
liberal employment of anodynes by the mouth. The remedy against the 
discharge of blood in which I have most confidence, and which has in no 
case produced any unpleasant effect, is the secale cornutum. I have gene- 
rally given it in doses of from ten to fifteen grains, in combination with 
the carbonate of soda, or potass, and at intervals of from four to six hours, 
according to the urgency of the case. Where it at all disorders the 
stomach, as it rarely does, this tendency may be diminished by the addi- 
tion of a few grains of ginger, or compound cinnamon powder. Of the 
alkalies, the liquor potassaj is the most convenient, being readily combined 
with the tincture of digitalis, where vascular excitement calls for it. 
Of the acids, the sulphuric, hydrochloric, and nitric, may all be given 
with benefit, as all of them seem to have the effect of diminishing the 
hemorrhage, the selection of any particular acid being regulated by the 
circumstances attendant on individual cases. The vegetable acids I have 
not used medicinally, although I have allowed the use of lemonade, where 
patients desired it, and where no contra-indication existed. In decidedly 
chronic cases, both turpentine and copaiba have proved useful, appearing 
not only to diminish the tendency to hemorrhage, but also to act most 
beneficially on the mucous membrane, especially by lessening the 
discharge of mucus, which is necessarily attended with considerable 
waste of the powers of the system. The pareira brava and uva ursi have 
also been used with more or less advantage. The preparations of iron in 
combination with quinine and iodide of potassium, are useful in improving 
the general health and tone of the system; the hydrochlorate of iron has 
been supposed to restrain the hemorrhage, but how far it really possesses 
this power, I do not feel competent to pronounce any opinion. Cold, in 
the form of enemata, and also externally applied, has been highly recom- 
mended. Part xiv., p. 88. 
Case of Hematuria treated with Gallic Acid.—A man received a vio- 
lent blow on the left lumbar region, from the handle of a crane. Three 
of the lower ribs were broken close to the vertebrae; there was excessive 
ecchymosis, and acute pain on pressure over the kidney, and the man w’as 
conveyed to the hospital in a state of great collapse. He passed blood 
and bloody urine. After bleeding, etc., Mr. Hughes administered gallic 
acid, as recommended to him by Dr. Neligan, in doses of two grains and 
a half, made into a pill with extract of gentian, every three hours. After 
the third pill, the gallic acid was detected in the urine (by tinct. ferri. 
mur.) and the quantity of blood in the urine immediately began to dimi- 
nish. In a few days he was quite well. Part x.v.,p. 143. 
Treatment of.—When it arises from irritation of the kidneys by morbid 
matter, as lithic acid, endeavor to relieve these organs, by acting on the 
skin and bowels by purgatives and diaphoretics; apply counter-irritation 
by means of mustard—not turpentine or cantharides; and if the patient is 
plethoric, even take a small quantity of blood by cupping. 
In that form arising from inflammatory renal dropsy, endeavor to 
restore the action of the skin by the use of the hot air bath, the debilitat- 
ing effect of which may be counteracted, and its efficacy increased, by dash- 
ing cold water on the patient as soon as he comes out of the bath; further 
promote the elimination of water from the system by giving hydragogue 
purgatives, such as compound powder of jalap, or elaterium ; and relieve 794 
HEMATURIA. 
the renal congestion by cupping or leeching, which are more efficacious 
when the congestion has assumed a more passive character than at the 
commencement of the attack. Afterward give nutritious diet, with bitar- 
trate of potash in diuretic doses. 
When the bleeding is the result of general hemorrhagic tendency, give 
astringents, as lead, tannin, or gallic acid. The latter is of the greatest 
value, and may be given in doses of as much as five grains two or three 
times a day, either suspended in mucilage, or made into a pill. 
lJart xix., p. 99. 
Treatment of Hematuria.—Give oil of turpentine in doses of twenty to 
sixty minims every three or four hours. It may either be given in water, 
agreeably flavored, or added to a decoction of uva ursi, chimaphila, pyrola; 
or with tincture of muriate of iron. Part xxi., p. 116. 
Hematuria.—Dr. Rees mentions two forms of hematuria; the one pro- 
duced by calculus in the kidney, and the other by malignant disease. 
The diagnosis between these two conditions must depend on the obser- 
vation of the following points: 
1st. In malignant disease the blood is generally passed in larger quan- 
tity than in calculus of the kidney. 
2ndly. There is more frequent tendency to nausea on slight occasion 
than in calculous disease. 
3rdly. Microscopic examination of the urine will frequently show pus 
or mucus in excess, if there be talculus ; whereas, in malignant disease, this 
sign does not so frequently exist. 
4thly. The appearance of those suffering from malignant disease of the 
kidney, is nearly always indicative of a state of anaemia more or less ad- 
vanced. 
5thly. In calculus, hematuria generally follows upon some unwonted ex- 
ertion. 
6thly. Careful examination of the abdomen will frequently lead to the 
detection of tumor if there be malignant disease of the kidney. 
Treatment.—The same remarks made with regard to alkaline urine from 
irritation of the mucous membranes, may be applied to the presence of a 
calculus in the kidney. 
It matters not how the calculus may be composed—be it uric acid, oxa- 
late of lime, or phosphatic—be it soluble in acids or alkalies—we can- 
not treat it chemically tvhile in the kidney. Our object must be to render 
the urine as unirritating to the mucous membrane as possible, and enable 
that membrane thus to bear the presence of the calculus with as little incon- 
venience as possible. There is another indication, however, which we 
answer by this alkaline and demulcent plan, and a most important one. It 
consists in the relaxation of the spasm of the canal. By effecting this, a 
small calculus may be often brought away, which otherwise might remain 
to increase, and perhaps destroy the patient. It is with this view that we 
should combine our demulcent and alkaline remedies with such sedatives 
as the patient can bear without disturbance of stomach. Our most favor- 
able result, of course, will be the expulsion of the calculus. Xext to this 
we must hope that it will become encysted, and, by being so fixed in the 
kidney, cease to cause irritation; while we have to fear, as the worst result, 
the setting up of inflammatory action in the body of the kidney. This 
may terminate in the effusion of lymph in the tissue of the organ, and in a 795 
HAEMORRHAGIC DIATHESIS. 
subsequent contraction of the inflamed part; and sometimes the patient 
may be so fortunate under these circumstances as to have the calculus 
which has caused the acute nephritis, should it be a small one, impacted 
in the kidney, so as to create no further irritation. In a great many of 
these cases, however, the acute nephritis terminates in suppurative disease; 
and if there be any constitutional imperfection dependent on strumous or 
syphilitic taint, this is the way in which we may generally expect the case 
to end. All we can do under these circumstances is to support our pa- 
tient, exhibit opiates, and render the renal secretion as unirritating as pos- 
sible. It is absolutely necessary that such persons should avoid exercise 
in any way beyond that necessary to walking gently, or exercise in any 
easy carriage. Neglect of this doubles the danger to the patient, while 
the difficulty of enforcing the injunction is often very great. 
With respect to the treatment of cases in which the hematuria depends 
on malignant disease of the kidney, of course we cannot proceed with any 
hope of cure. The ansemia so often noticed in these cases, which causes 
dyspnoea on slight exertion, and restless nights (from the facility with 
which any error in diet produces palpitation and throbbing of the carotids) 
may be to a great extent combated by the exhibition of iron in some pala- 
table form. Perhaps the best preparation for the purpose is the tinctura 
ferri sesquichloridi, taken in doses of from rax. to ntxx. three times a day, 
the bowels being watched the while, and kept regular by the exhibition 
of mild and aromatic laxative medicines. 
It may be objected to the use of iron that it frequently tends to produce 
hemorrhage. It is quite true that care is necessary on this point. Watch 
the effects of the remedy, however, and you will constantly find you can 
exhibit it with advantage ; that it will not induce hematuria, and especially 
if it be exhibited in the form of the sesquichloride of iron tincture. With 
regard to the use of styptics, they frequently appear useful in cases where 
the disease is not much advanced. 
The best styptic is perhaps tannic acid; it should be given in the form 
of pill, at intervals between the doses of iron, in doses of from four to eight 
grains three times a day. It should not be given in solution, on account 
of its being rapidly converted in the stomach into gallic acid. 
Part xxiv., p. 132, 
H2EMORRHAGIC DIATHESIS. 
Treatment of the Hemorrhagic Diathesis.—The great object of treat- 
ment is to increase the quantity of fibrin in the system. This may be done 
in scrofula—in which disease fibrin is also absent, and is substituted by 
albumen—by a nutritious diet; but in the hemorrhagic diathesis we have 
not the necessary time. It has been discovered that fibrin invariably in- 
creases in quantity very rapidly during local inflammation; and Mr. Miller 
therefore suggests, that by rapidly causing a superficial inflammation at a 
point distant from the bleeding part, we shall accomplish our purpose; 
acetate of lead with opium may also be given in large doses. Dr. Christi- 
son says, thepil. plumb, opiat., (Ph. Ed.), is the best astringent he knows. 
Each pill contains three grains of the acetate of lead, and half a grain of 
opium; two to six may be given daily; and as we have already noticed, 796 
HEMORRHAGIC DIATHESIS. 
this dose may be considerably increased if the ui-gency of the case requires 
it. To diminish the quantity of serum in the blood, if the state of the 
patient will admit of it, is another indication of treatment; and this will be 
best accomplished by sulphate of soda, given in such doses as to purge 
freely. This salt has been found not only to diminish the quantity of 
serum, and thereby jxroduce a better relative proportion between the con- 
stituents of the blood, but also to preserve the blood globules in their nor- 
mal state. Pressure is another important step to be adopted; and in the 
case of bleeding after extraction of a tooth, plaster of Paris has been re- 
commended for the purpose. Styptics of various kinds—transfusion, and 
a variety of other means of treatment have also been tried. 
Part vi., p. 107. 
Arrest of Bleeding in the Hemorrhagic Diathesis by Matico.—The 
subject was a lad about 4 years of age, who was first brought to Mr. 
Hamilton for bleeding from the tongue, which had been bitten in a fall. 
The use of caustic and pressure for two days had failed in arresting he- 
mon-hage, and the mother was gx*eatly alarmed, as.he had before nearly 
bled to death from a slight wound about the mouth, and she had lost 
another boy by a similar oozing from a slight wound of the nose. 
I first tried the actual cautery, the prong of a large steel fork applied to 
the bleeding point, quite red hot. This only caused a momentary stop- 
page. I then passed a small sewing-needle with a double ligature behind 
the spot, and tied on each side of it. This was successful for a time; but 
in an hour or two the child was brought back, bleeding as fast as ever. I 
recommended the mother to make the child keep a piece of alum in his 
mouth, continually sucking it. Fortunately he did not object to this, and 
after an hour or two it effectually arrested the hemoi’rhage. The child 
was a long time regaining its strength, or any approach to a natural color. 
[About a year and a half after this, lie again bit his tongue, and this time 
sucking alum failed in arresting the oozing. He was, as before, blanched, 
and the blood thin and wateiy.] 
I tided pressure with my fingers, with a small piece of fuzzy lint; but 
the blood soon soaked through the lint. I then took a very small piece of 
the matico leaf, which I happened to have by me, and applied the lower 
surface over tlie bleeding point, and kept it there as loixg as the child 
would keep the tongue quiet, which was not half a minute. I kept the 
little boy in my study some time; but the hemorrhage did not return, nor 
did the leaf come off. As I knew, however, this would sooner or later take 
place, I desired the nurse to re-apply a piece of the same size and in the 
same manner as she had seen me do. The next day she brought him to 
me well. The first piece of matico had fallen off in less than half an hour; 
but there was then scarcely any appearance of bleeding. She applied a 
a second piece, and the hemorrhage was completely arrested. 
Mx\ Young confirms the valuable properties of this substance in arresting 
hemorrhage from leech-bites in children, etc. He has also found great be- 
nefit from it in leucorrhcea, in the form of an injection, made by boiling an 
ounce of the leaves in a pint of water for ten minutes. And as an external 
application to hemorrhoids, in the form of an ointment, he has found it 
unsurpassed. Part xii., p. 179. 
Hemorrhagic Diathesis—Ten Days’ Hemorrhage after the Extraction 
of a Molar Tooth.—[This patient, a boy 14 years of age, was found by HAEMORRHAGIC DIATHESIS 
797 
I3r. Clay, laboring under profuse hemorrhage in consequence of the 
extraction of the third molar tooth of the upper jaw; the gums and cheek 
were very much lacerated; various styptics had been applied without 
stopping it. Dr. Clay used matico, secale, Ruspini’s styptic, and even the 
actual cautery, without the slightest benefit. Constitutional treatment 
alone remained, and, in consultation, it was decided he should take the 
following mixture :] 
R Plumbi superacet., 3ss.; acid. acet. dil., §ss.; sir. rhei., §ss.; mist, 
camph., §v.; M. ft. mist., §vi. Sumat xeger coch. magn. duo onmi tertia 
hora. 
Thus, five grains of the acetate of lead were given every three hours, or 
nearly so, in addition to which, pads, saturated with the liq. plumbi 
diacet. were applied to the bleeding surfaces, with as coi’rect a pressure as 
possible. Twenty-four hours passed under this treatment without 
improvement. 
At a second consultation, it was agreed to persevere with the acetate 
of lead mixture until the day following, continuing also the pads of lint 
saturated with the liq. plumbi diacet., covering the pads also with finely 
pulverized matico. On the following morning, much to the satisfaction of 
all parties, the bleeding was checked; this was the tenth day, and up to 
this time he had taken nearly a drachm of the acetate of lead. The boy 
began to complain of pain in the stomach and head; it was therefore 
evident we could not proceed further with the acetate ; and as the bowels 
had not been moved since its exhibition, it was determined to substitute 
the sulphate of soda, which the American physicians speak so highly of. 
A saturated solution was ordered to the extent of a wineglassful, 
every four hours, and in a very short time the bowels were acted 
upon. The bleeding was perfectly arrested from the tenth day, great 
care being taken for some time in removing the pads, and which were 
for several days moistened with the liq. plumbi diacet. I have omitted 
to mention that the head was shaved when the constitutional treatment 
commenced, and that evaporating lotions were kept constantly upon it. 
From the tenth day, the boy very gradually recovered, though extremely 
reduced. 
The case is an instructive one, as it serves to show how very little 
dependence can be placed on styptics, or, indeed, on any local application; 
in cases of hemorrhagic diathesis, constitutional treatment alone is the best, 
indeed, the only, mode by which we can hope for peraianent advantage. 
Part 234 
Oil of Turpentine in Hemorrhagic Diseases.—[This remedy, not a new 
one, for it has been noticed by several writers, has been used by Dr. Percy 
with the best results. We are told that:] 
The cases in which its use is indicated are those of passive hemorrhage. 
It must not be employed in cases where there is an active determination 
of blood, and where the pulse is full. When the discharge of blood is the 
consequence of organic disease, as of disease of the uterus, or of tubercular 
disease of the lungs, the action of the remedy is not so efficacious; but the 
author has seen a case of scirrhus of the womb, in which the hemorrhage 
was for some time stopped by this remedy. The author has found the 
action of turpentine oil very rapid, an effect being manifest in a few hours, 
often after one small dose. In order better to ascertain its power, he used 798 
it alone, 'without having recourse to local astringents or cold applications, 
where he could do so without fear of endangering the life of the patient. 
He had used it most frequently in cases of menorrhagia and epistaxis; but 
he mentions, that it appears to him to be particularly applicable in the 
cases of hemorrhage attending typhus. He noticed the fact that turpen- 
tine exerts different actions on the body according as it is taken in large 
or small doses, being more readily absorbed in the latter case ; and he 
remarks, that as its beneficial action in cases of hemorrhage must depend 
on its being absorbed, the inference would be drawn that the doses in 
which it is given in such cases ought to be small. Ilis experience confirms 
this conclusion. He has always found a dose of from eight to thirty drops 
sufficient. The best vehicle for it is almond emulsion, with a little gum 
arabic. When there is pain in the abdomen, a few drops of laudanum may 
be added. Part xviii., p. 16S. 
Hemorrhagic Diathesis.—[J. R., aged 6| years, whilst looking out of 
the window and drawing in his head suddenly, bit his tongue, which bled 
profusely. This continued until three o’clock next day, and remained 
uncontrolled in spite of the repeated application of the nitrate of silver.] 
Several astringents were tried, as also nitric acid, which failed ; the 
under surface of a matico leaf was then applied to the wound, and an 
infusion of matico given internally. This did not succeed ; and about 
eleven o’clock, p.m., Mr. Poland applied the actual cautery, which stopped 
the hemorrhage. On the following day the child’s body and extremities 
were found to be covered with large patches of purpura, looking like 
bruises after injury. He was ordered meat and vegetables, lemon-juice to 
drink, and ten grains of chlorate of potash in water three times a day. 
Under this treatment, persevered in for three weeks, the boy perfectly 
recovered. Part xxiv., p. 199. 
HEMOPTYSIS. 
HAEMOPTYSIS. 
Ipecacuan.—In moderate doses, recommended in cases of internal 
hemorrhage. Theory—more rapid coagulation of the hlood, under the 
influence nauseating remedies. Part i., p. 37. 
Treatment of Hemoptysis with Tartrate of Antimony.—The following 
formula recommended: 
R Tartrate of antimony, two grains ; sirup of poppies, half an ounce ; 
water, eight ounces. M. Dose, two tablespoonfuls every hour or two. 
• Part iv., p. 35. 
Acetate of Lead in large doses.—In a case of hemoptysis, supervening 
upon phthisis, Dr. Lane having resorted to other remedies without relief, 
administered the acetate of lead, in doses of five grains every four hours. 
Three doses sufficed to arrest the hemorrhage. Part vi., p. 87. 
Hemoptysis—Pulmonary Apoplexy.—Dr. Graves has explained the dif- 
ference in hemoptysis, when the blood conies from the bronchial or from 
the pulmonary arteries. The blood going to the lungs along the bronchial 
arteries being red, while that in the pulmonary is dark venous, it will be 
evident by the kind of blood which is expectorated from wdience it 
originates. Dr. Graves has shown that when it arises from the branches 799 
HAEMOPTYSIS. 
of the pulmonary artery, it is in consequence of the direct, effusion of blood 
from those branches Avhich ramify on the air-cells, and that the blood 
expectorated has nothing to do with the bronchial mucous membrane or 
bronchial arteries; and that the blood may escape into the inter-vesicular 
pulmonary tissue, where, having no exit like the portion which is thrown 
out into the air-cells, it may remain. This constitutes pulmonary apoplexy. 
He does not allow that when blood expectorated is dark venous, it 
necessarily comes from the stomach, but correctly shows that it may be 
equally dark and venous when arising from these pulmonary branches: 
and that, when the stethoscope is applied, the signs of disease of the lungs 
will often be evident enough; at the same time, even blood from these 
vessels may be rather red, owing to its partial aeration. From these cir- 
cumstances, when we find that in pneumonia the expectoration is tinged 
with dark venous instead of arterial blood, we may conclude that it is of a 
more dangerous nature than when the bronchial vessels only are impli- 
cated. When these last-mentioned arteries give rise to the hemorrhage, 
it is generally of a less dangerous nature and more scanty; although it 
occasionally happens that even when from this source it becomes alarm- 
ing. One very important indication of treatment in cases of hemoptysis, 
is to relieve the congestion and arrest the further effusion of blood, by 
copious depletion; and the extent and promptitude of this measure will 
depend upon the fact whether the hemorx-hage is arising from the pulmo- 
nary or from the bronchial vessels. If from the former, it will be more 
dangerous and extensive, owing to the blood plugging up and obliterating 
the ultimate divisions of the air tubes, perhaps to a great extent of 
surface ; but if from the bronchial vessels only, this effusion will seldom 
be very extensive, and not nearly so dangerous as in the former instance, 
arising in phthisical cases perhaps rather from the congested state of the 
bronchial membrane than from ulcerative action implicating the vascular 
tissue. When free depletion has been adopted, according to the case, 
Dr. Graves relies chiefly on ipecacuanha given in doses of two grains every 
quarter of an hour, until there is some improvement, and then every half 
hour or hour until the bleeding stops. This remedy is to be preceded by 
a purgative enema and a saline cathartic. The ipecacuanha is recom- 
mended not only in these cases, but also in hemorrhage from the bowels, 
and even in hematemesis, in preference to the acetate of lead, which 
Dr. Graves employs only in those cases of passive hemorrhage in which 
opium is indicated, and then in combination with the last remedy. 
jPart viii., p. 54. 
Hemoptysis.—Give oil of turpentine, in doses of from twenty to sixty 
minims every three or four hours, either simply in water or combined with 
infusion of matico. Part xxi., p. 116. 
Hemoptysis—Tubercular.—An excellent remedy is gallic acid, in doses 
of tAVO or three grains. Part xxii., p. 336. 
Hemoptysis.—In hemorrhage from the lungs or uterus, give small doses 
of ipecacuanha combined AAritli acetate of lead and opium. 
Part xxiii., p. 299. 
Hemoptysis.—There are tAvo circumstances in reference to the circula- 
tion in phthisical lungs unfavorable to the occurrence of profuse hemor- 
rhage. In inflamed lung, the blood-vessels, though tortuous, are free, 800 
ILBMOPTYSIS. 
but in tubercular lungs the blood coagulates in the extremity of the vessels. 
But there is an additional point well worthy of your attention. When 
you look at this large vomica you observe a considerable band passing 
across it. Of what does this band consist ? It contains no bronchial tube. 
Bronchial tubes readily ulcerate ; and by that process expectoration from 
cavities is promoted. The band consists mainly of blood-vessels and cellu- 
lar substance. Blood-vessels are inapt to ulcerate. The walls of the pul- 
monary arteries, when surrounded by tubercular ulcerations, instead of 
sharing the disorganization, usually thicken; by the deposition of fresh 
material, their calibre gradually lessens; after a time they cease to be 
pervious, they are tilled with a thin, reddish, fibrinous plug, and trans- 
formed into solid cords. Dr. T. Thompson continues: 
It is probably only in those rare instances in which such a vessel is sud- 
denly torn before the calibre is perfectly closed that fatal hemorrhage is at 
all likely to occur. The popular idea that all bleeding from the lungs is 
produced by ruptured blood-vessels is a serious error. The ordinary cause 
of hemoptysis is doubtless compression or obliteration of the pulmonary 
veins by the tubercular deposit; in consequence of which, blood, inter- 
rupted in its natural channels, overflows or exudes into the neighboring 
bronchi. If this explanation be correct, hemoptysis moderate in amount 
must be regarded rather as beneficial than alarming. By preventing the 
stagnation of unhealthy blood, it must tend to oppose the extension of 
tubercular disease; and, as far as a conclusion may be drawn from the 
cases under my care, the tendency of hemoptysis of considerable amount 
would seem to have been rather favorable than otherwise. 
In arresting hemorrhage from the lungs, undue haste should be depre- 
cated. As a general rule, it is better to produce determination to other 
organs, than to employ direct astringents. Give a dose of calomel, or mer- 
curial pill with henbane, followed by the use of half-drachm doses of sul- 
phate of magnesia with diluted sulphuric acid administered twice a day, 
or antimony, with nitrate of potash. If the hemoptysis is passive, alum is 
the best of the astringents to be used, as the following : It P. gum. arabic., 
p. saccli. alb. aa. 5iij.; p. tragacanth, 5iss.; alum, 3ij.; g. catechu, 3iij.; 
aquae rosoe, q. s., to form a mass to make sixty lozenges. Gallic acid is not 
so prompt and effectual as the acetate of lead, but suits some cases re- 
markably well. 
The most powerful of direct astringents in the treatment of urgent cases 
is acetate of lead. You may give two grains for a dose in a mixture, with 
half a drachm of distilled vinegar; or if you give it in pill, take care to 
give acetic acid immediately afterward, in order to counteract the tendency 
of the carbonate of lead to produce colic. Turpentine is probably one of 
the most certain and suitable remedies in a majority of instances. Two 
drachms of spirits of turpentine, two ounces of mixture of gum arabic, and 
four ounces of infusion of matico or of cinnamon water, with thirty minims 
of tincture of capsicum, form an appropriate mixture, of which an ounce 
may be given at intervals. In slight cases, the infusion of matico alone h 
often sufficient. 
When the hemoptysis is associated with suppressed catamenia and hys- 
terical symptoms, lytta is of great value; but let me repeat the opinion, 
that in a majority of instances of phthisis moderate expectoration of blood 
is useful, and that whilst you allay the apprehensions of the patient, you 
may leave the symptom to its own course. Part xxiv., p. 76. HAEMOPTYSIS. 
801 
Gallic Acid in Hemoptysis.—Of a case under his care, in which severe 
hemoptysis occurred, Dr. Bayes says: 
He was becoming faint and livid-looking when I arrived, and I really 
was afraid lest he should have been suffocated. The air passing through 
the blood already in his throat produced a gurgling sound, which alarmed 
his wife, to whom it sounded like the “ death rattle.” 
I took a drachm of gallic acid, put it in a six-ounce bottle, dissolved it in 
hot water, and added rather more than a tablespoonful of brandy. I cooled 
this mixture in some ice which was in the room, and gave Mr. li. a dessert- 
spoonful of it every three minutes. The pulse, which could not be felt at 
the wrist, recovered slightly after the third dose. At the end of half an 
hour, the face became less livid, and he seemed much revived; I, however, 
continued the gallic acid every five minutes until the end of the first hour, 
and afterward every ten minutes until nearly two hours had elapsed, when, 
to my great joy, the expectoration became perfectly inky. Alter the first 
inky expectoration the breathing became greatly relieved, and the patient 
fell into a quiet doze. He had taken the first drachm of gallic acid in one 
hour and fifty minutes. I then mixed a second drachm, in the same man- 
ner as the first, and gave him a tablespoonful of the mixture at half-past 
one o’clock, after which he fell asleep soundly; I then left him, with orders 
that the gallic acid should be given him, in five-grain doses, every hour, 
for six hours, while he was awake, or to be repeated every ten minutes, if 
the hemoptysis were to recur. On calling next morning, I found he had 
expectorated but twice, and the sputa were perfectly inky. I kept him 
under the influence of the gallic acid for three days, gradually diminishing 
the frequency of the dose. At the end of this time, as he had neither 
cough nor expectoration, I changed his medicine to the infusion of roses 
and sulphate of magnesia, and ordered him also to take five-drop doses of 
creasote, three times a day upon sugar ; he now went on steadily getting 
well. 
Perhaps one of the most satisfactory results of the large doses of gallic 
acid was the entire disappearance of the attendant diabetes, and the simul- 
taneous reappearance of bile and sufficient stools. 
The dyspnoea was almost completely relieved as soon as the system was 
well saturated with the gallic acid. The difficulty of breathing was, no 
doubt, caused by the gorged state of the vessels of the lungs, which was 
relieved by the powerful astringent acting upon them from within. 
Part xxvi., p. 51. 
Hemoptysis.—Dr. T. Thompson “ doubts if hemoptysis ever precedes 
the deposit of tubercle in the lung, and thinks that, in many cases, the local 
loss of blood may be advantageous to the patient by relieving congestion.” 
He deprecates “ undue haste” in arresting the hemoptysis, and adds, “ as 
a general rule, it is better to moderate this symptom by producing deter- 
mination to other organs than to employ direct astringents.” 
Should the hemorrhage be passive, and direct astringents be required in 
consequence of the loss of blood being excessive, alum is, according to our 
author, one of the best that can be employed ; this remedy acts, he says, 
“ more efficiently when allowed to dissolve in the mouth, than when 
taken in mixture.” The following is the prescription Dr. Thompson re- 
commends : 
Take of powdered gum arabic and of white sugar, each three drachms; 802 
HEMORRHAGE. 
powdered tragacanth, a drachm and a half; alum, two drachms ; catechu, 
three drachms; rose water, as much as sufficient for a mass to be formed 
into sixty lozenges. 
Acetate of lead is preferred to gallic acid, while turpentine is said to be 
one of the most certain and suitable remedies, in a majority of Instances. 
Part xxix., p. 92. 
Hemoptysis.—The only remedies to be trusted, in severe cases, are tur- 
pentine, gallic acid, chloride of sodium, or nitre with digitalis; acetate of 
lead, or alum, is not sufficient to meet the danger. You may give ten to 
thirty drops of turpentine every hour, and especially in weak cachectic in- 
dividuals ; it is less suitable for the young and plethoric. Gallic acid is 
preferable to other astringents, because it does not exert the same desic- 
cating and constipating effects as tannin, etc. If you give chloride of 
sodium, one to two and a half drachms will be the dose. 
Part xxxiii., p. 78. 
HEMORRHAGE. 
Oil of Ergot of Rye.—Mr. Wright states as follows : 
I have found th s oil a valuable external application in cases of local 
rheumatism. I have tried it in three instances, and in all of them it has 
proved curative. The affected part should be well rubbed with it for a 
quarter of an hour, night and morning, until relief be obtained. It is one 
of the best remdies with which I am acquainted for the cure of toothache. 
I have repeatedly known it subdue the pain when creasote has failed. 
But, perhaps its greatest value, as an external application, is in the arrest- 
ing of hemorrhage. I have often wounded small arteries in dogs and 
rabbits, and subdued the bleeding completely with a drop of this oil. 
Hemorrhage from the jugular and femoral veins has been similarly 
arrested. The troublesome bleeding which sometimes follows the extrac- 
tion of a tooth, and leech-bites, it is equally efficient in stopping. 
In a severe case of epistaxis, I arrested the hemorrhage by injecting up 
the nostrils equal parts of very dilute spirit and oil of ergot; and I have 
little doubt that in the severe cases of flooding which succeed delivery, 
the injection of this oil diffused through water into the uterus, would be 
productive of the happiest results. Part ii., p. 42. 
General Bleeding—Advised in certain severe and intractable forms of 
local hemorrhage. Part ii., p. 73. 
Extract of Monesia—Suggested in cases of passive hemorrhage, in 
doses of from 12 to 36 grains, during the day, in the form of pills. 
Part ii., p. 77. 
Treatment of Hemorrhage.—Dr. Watson, in his lecture, says : 
Next to blood-letting, astringents constitute the great resource against 
actually existing hemorrhage; and among these, cold is one of the chief. 
It may be placed in direct contact with the bleeding surface: as when ice 
is swallowed to restrain hematemesis: or cold water injected into the 
rectum in excessive and exhausting hemorrhoids ; or into the vagina, in 
flooding from the uterus. Or it may be applied to the surface of the body, HjEMOKKHAGE. 
803 
as near as possible to the seat of the hemorrhage; as to the nose and fore- 
head in epistaxis; to the chest in hemoptysis; to the epigastrium in 
hemorrhage from the stomach; to the lower part of the abdomen or to 
the perineum in hemorrhage from the intestines, uterus, or urinary organs. 
But the influence of cold in constringing the smaller vessels is not confined 
to the part with which it is in contact; it will stop hemorrhage by the 
sympathetic shrinking which it produces in distant parts. Epistaxis, for 
example, has often been arrested by the sudden apposition of cold water 
to the neck, back, or genital organs. Part iii., p. 48. 
Nitrate of Silver, in Stopping Hemorrhage after Extraction of Teeth.— 
Mr. Ray, after an ineffectual trial of other means, as pressure, astringents, 
etc., took a stick of nitrate of silver, rounded at the extremity, and firmly 
forcing it to the bottom of the cavity, allowed it to remain a few seconds 
in this situation ; very little pain was experienced, and, upon its withdrawal, 
he was gratified in finding a complete cessation of the hemorrhage. The 
mouth was kept open with a cork, for about half an hour, to admit air 
freely, and insure the preservation of the clot, which might have been 
destroyed or removed by suction ; she then took forty minims of opium 
and a teaspoonful of compound spirit of ammonia, and afterward rested 
five or six hours. Part iii., p. 96. 
Hemorrhage after Lithotomy Stopped by Creasote.—In a case of litho- 
tomy it was found impossible to arrest the hemorrhage by any of the 
usual means, and no particular vessel could be discovered from which the 
blood might flow. The patient was at last reduced to the lowest ebb 
from the continued loss, and had already lost consciousness, when a 
sponge dipped in pure creasote was introduced into the wound, and 
pressed against the bleeding parts for an instant. The hemorrhage 
was immediately arrested. No particular pain was experienced, no un- 
pleasant symptoms followed: thin eschars were thrown off, and the patient 
recovered. Part iv., p. 117. 
Creasote.—In arresting hemorrhage from small vessels, o" the oozing of 
blood from abraded or cut surfaces, bleeding ulcers, and leech bites, a 
creasote ointment or lotion is often very effective. It acts by coagulating 
albumen, and thus forming a crust. Pure creasote may be tried when 
the bleeding is more profuse. In the hospital at Cadiz, Dr. Cormack saw 
it used with complete success, in the oozing of blood from the wound of a 
compound fracture. He never had the opportunity of seeing its power 
over pretty active hemorrhage, in the human subject, except in this case. 
Part vi., p. 72. 
Suppression of Hemorrhage.—Mr. Vincent does not agree in the com- 
mon opinion, that it is best not to disturb clots, in cases of bleeding. He 
says: 
The most important step in managing all cases of bleeding is, that the 
surgeon should be most careful to keep the bleeding vessels free from all 
coagulum. The smallest arteries will go on bleeding if they are covered 
with a clot, and many considerable hemorrhages will stop if the bleeding 
points are clear from all blood; even rather large arteries will some- 
times permanently cease to bleed, if kept uncovered and exposed to 
the air. 
I have every reason to feel assured, from what I have tried in these 804 
HAEMORRHAGE, 
cases, that the bleeding may be stopped in epistaxis upon these principles, 
by winch the patient may be saved from the annoyance of what is called 
plugging. The plan of the proceeding that I have adopted is to keep the 
parts which are bleeding freed from all coagulum, and this should be done 
iu this case by syringing the nostrils so as to wash the blood out. Now 
if a styptic be used, such as the sulphate of zinc, it coagulates the blood 
as it issues from the vessels, and so iar stops the bleeding ; but there is a 
process going on, by which this clot is loosened from its adhesion, and 
perhaps on the second day the bleeding is renewed. This will happen 
repeatedly ; so that these cases have ended by being plugged. But what 
1 contend for is, that if the syringing be carried on until the bleeding 
ceases, it will not only stop, but not recur. It is generally considered of 
importance, that the water used in cases of bleeding should be cold : but 
from what I have observed, arteries will contract under the use of warm 
water, which has a better etfect in clearing away the clots, and keeping 
the parts clean from the blood. I have already alluded to the inlluence 
of a coagulum in keeping up bleeding, when speaking of the necessity 
of squeezing out the coagulum in a pile when it is opened. 
Part xix., p. 143. 
Hemorrhage—Transf usion of Blood.—In all cases of collapse induced 
by hemorrhage, whether primary or secondary, transfusion of blood should 
be employed. Part xx.,p. 127. 
Exposure of Bleeding Surfaces to the Air, a means of arresting 
Hemorrhage.—Mr. Skey believes that no agent is at all comparable in 
its power to arrest bleeding from small vessels like rest and exposure to 
air. The surgeon who has least fear of hemorrhage loses the least blood. 
“ A small wound may be tortured by styptics, by compression, and by 
other unprofitable agents, till it becomes the fruitful source of hemor- 
rhage.” Instances are recorded of the most alarming cases of hemor- 
rhage being at once arrested by the wound being freely exposed to the 
air. Part xxiii., p. 150. 
Tincture of Mastic as a Hemostatic.—It is stated, in a recent number 
of “Schmidt’s Jahrbucher,” that Dr. Frankl has found the tincture of 
mastic an excellent hemostatic. He employs it in epistaxis, and in 
troublesome bleeding from kech-bites. It is applied to the points whence 
the blood issues, by means of a camel’s hair pencil. Terzer, a dentist of 
Vienna, is also reported to have used it successfully in hemorrhage follow- 
ing the extraction of teeth. Part xxvii., p. 132. 
PagliarPs Hemostatic.—M. Pagliari, a pharmacien at Rome, professes 
to have discovered a styptic liquor of great power; and several of the 
officers of the French army have testified to its efficacy. 
The composition is as follows: Eight ounces of tincture of benzoin, one 
pound of alum, and ten pounds of water are boiled together tor six hours 
iu a glazed earthen vessel, the vaporized water being constantly replaced 
by hot water, so as not to interrupt the ebullition, and the resinous mass 
kept stirred round. The fluid is then filtered, and kept in stoppered bot- 
tles. It is limpid,- slighily styptic in taste, aromatic in odor, and the color 
of champagne. M. Hepp, of Strasbourg, has substituted the white resin 
for the benzoin. Every drop of this fluid poured into a glass containing 
•urnan blood produces an instantaneous magma; and by increasing the 805 
HAEMORRHOIDS. 
proportion of the styptic to the quantity of the blood, a dense, homogene- 
ous, blackish mass results. 
Many are the circumstances in which the surgeon may not be able to 
have recourse to the ligature, as in the case of friable arteries, secondary 
hemorrhage from deep-seated, painful, or inflamed wounds, the impossi- 
bility of seizing the artery, or where the hemorrhage results from numer- 
ous arterioles, which are too small or retracted, or from veins and capillary 
vessels. In all cases, in fact, where compression is now usually employed, 
without much benefit being expected to result from it, and often, indeed, 
proving useless or dangerous, this fluid seems indicated. 
Part xxvii., p. 343. 
Hemorrhage.—A new hemostatic agent is benzoic acid, dissolved in 
alum. If you cannot arrest hemorrhage by compression, and where it is 
not necessary to ligature the artery, soak a little lint in Monsel’s prepara- 
don of benzoic acid and hlum, and place it upon the bleeding surface. 
Professor Hannon’s preparation is “ Benzoic acid one part, alum three 
parts, ergotin three parts, water twenty-five parts—the whole to be boiled 
thirty minutes, with constant stirring, and renewal of water. Then it 
must be evaporated to the consistence of an extract. A layer spread over 
the bleeding surface produces instant coagulation. Compression is not 
necessary.” Part xxxi., p. 151. 
Internal Hemorrhage.—The following styptic, recommended by Dr. 
Warren of New York, will be found scarcely ever to fail in cases of 
hemoptysis or uterine hemorrhages. Sulphuric acid 3v., spt. turpentine, 
alcohol, aa. 3ij- Mix the turpentine slowly with the acid, add the alcohol, 
and keep in a stoppered vial. The dose is 40 drops, and it may be given 
rubbed up with sugar. Part xl., p. 107. 
HEMORRHOIDS. 
Internal Piles.—In the advanced stages of internal piles, an operation 
is required for their cure; but as the parts are frequently irritable and 
inflamed, thereby disabling the surgeon from reaching them, it becomes 
necessary to soothe and palliate for a time by leeches, enemata, the re- 
cumbent posture, and mild laxatives, such as confection of senna and sul 
phur. 
Mr. B. Cooper says: The object, then, in these internal piles, covered 
with mucous membrane, is to surround them with a ligature tightly 
applied, to cut off the ends of the ligature and return the pile and rectum 
into the pelvis. The ligature should be tied very tight, but still you must 
be cautious: for if the base of the tumor be narrow, and the ligature a 
small one, you would cut off the pile as certainly as with the knife, and I 
have known several patients killed by cutting off internal piles with the 
knife or scissors. The piles hang by peduncles much smaller than the 
base of the excrescence ; now the object is not to tie the neck or peduncle, 
but to surround the mucous membrane and submucous cellular tissue 
where it forms a flat surface on the gut, taking care not to include any 
muscular fibres ; for if you do so the muscle is irritated, it contracts, and 
tenesmus is set up, which tells "you what you have done, and then you had 
better at once remove the ligature and apply another more carefully. If 806 
HAEMORRHOIDS. 
yon do not tie the muscle, but only the mucous membrane and submucous 
cellular tissue, there is little or no pain produced, and the cure is almost 
infallible and unattended by risk. I always tie the ligature once, and then 
lay open the tumor with the lancet, and turn out the blood or coagula it 
contains. By this the ligature is a little loosened : so I tighten it, and 
then make the second knot, cut off the ends, and return all together into 
the pelvis. The opening the pile is a great advantage; for if the tense 
tumor be returned, even if you have no difficulty in getting it back, it acts 
as an extraneous body and causes great irritation, whereas there is nothing 
of the sort if it be opened ; it is easily returned and causes no irritation. 
You may tie two, three, or four piles in this manner at one sitting: main- 
tain the recumbent posture, and if there is any uneasiness about the parts, 
use fomentations. The bowels having been freely opened before the ope- 
ration, keep them costive for a day or two to obviate the mechanical in- 
jury caused by the passage of a motion; and to compensate for this, you 
may excite the other secretions a little. Induce a little perspiration and 
a freer flow of urine. With regard to the after treatment, the habit of 
passing the stools at night is the most effectual means of preventing any 
return. Part iii., p. 86. 
Reduction of Hemorrhoidal Tumors.—Much difficulty is sometimes 
experienced in returning protruded hemorrhoids. Pressure alone, is 
applied in vain. But if the patient be directed, Dr. Marshall Hall says, to 
make forcible expulsive efforts, and pressure be simultaneously made, the 
tumor frequently recedes immediately, the sphincter is positively relaxed, 
the ligature which it formed round the tumor is removed, and the reduc- 
tion is easy. 
Dr. Hall inquires whether a similar measure would aid the accoucheur in 
returning prolapsus uteri ? Part iv., p. 106. 
Nitrate of Silver.—An ointment made from galls is a favorite remedy 
for hemorrhoids, but like camphorated spirit of wine in the cure of chil- 
blains, it often fails. An ointment composed of from 5 to 10 grains of 
nitrate of silver, very finely pulverized, and an ounce of lard, succeeds, in 
many cases where the hemorrhoids are recent. When hemorrhage arises 
from internal piles, or from congestion of the lining membrane of the anus, 
the solution, in the proportion of from 10 to 30 grains to an ounce of 
water, injected with a syringe, is a preferable method. It ought, how- 
ever, to be remembered that when the solution is strong, not more than a 
drachm of it should be thrown into the rectum. In prolapsus ani the effi- 
cacy of this solution is not so certain, although we have on several occa- 
sions succeeded in curing the patient with it. Part v., p. 44. 
Hemorrhoids Vesicce.—Dr. Watson, in his lecture, says; Hematuria 
may occasionally be vicarious of some other hemorrhage, and especially 
of bleeding from the hemorrhoidal vessels. So that it is always right, in 
obscure cases, to inquire, whether the patient has been habitually subject 
to hemorrhage from the rectum: and if so, whether that hemorrhage is 
suspended. Part vi., p. 50. 
Palliative Treatment.—Mr. Stafford observes : 
The treatment of piles varies according to the state in which we find 
them, and also whether they are internal or external. In simple piles, 
when they are external, and when there is no inflammation, laxatives in- 
ternally, and astringents externally, are the best remedies. At first, per- HAEMORRHOIDS. 
807 
haps, give a dose of castor oil, or an aperient of senna and manna, and 
sulphate of magnesia combined, or any other aperient, except aloes and 
scammony, which will answer the effect of relieving the bowels. After 
this order laxatives, such as the confectio sennse alone, or combined with 
potass, supertart, or sulph. sublim., and desire the patient to foment with 
the decot. papaver alb., or sit over a bidet of warm water. Apply a solu- 
tion of liq. plumb, acet. dil. Use a cooling ointment, such as cerat. plumbi 
acet., or if the hemorrhoid requires being constringed, employ the ung. 
galli, the ung oxyd. zinci, etc.; also, should they be in a relaxed state, 
desire the patient to use an injection of the decoction of the elm or oak 
bark, with the addition of alum in proper proportions. 
In some cases it has been recommended by Sir Astley Cooper to punc- 
ture the pile with the point of a lancet, and squeeze out its contents. This 
should be done cautiously, for fear of hemorrhage. In chronic piles, the con- 
fectio piperis has been of great service continued for some time. It appears 
to stimulate and give a new action to the parts. If the piles are inflamed, 
then apply leeches, upon them, or to the verge of the anus, using an eva- 
porating lotion, a poultice, an opium injection, or an opium ointment, as 
the case may require, repeating all these remedies as often as they may be 
necessary. The diet is of great importance ; it should be bland, and meat 
should be avoided. Gruel, arrow-root, puddings, macaroni, etc., is the best 
food. Part vii., p. 130. 
Use of Nitric Acid as an Eschar otic in certain forms of Hemorrhoidal 
Affections.—[The safety and efficacy of the following mode of practice 
adopted by Dr. Houston in hemorrhoidal cases, is confirmed by the testi- 
mony of Dr. Cusack. Before explaining his use of nitric acid, Dr. Hous- 
ton enters briefly on the pathology of hemorrhoids. The form in which 
they commonly exist, is that of a simple varicose state of the veins, and it 
would be well if the terms “ varices” or “ varicose tumors of the rectum” 
were applied to such cases instead of the term “ hemorrhoids.”] 
Dr. Houston condemns the use of both knife and ligature in certain 
forms of hemorrhoids, and recommends that the diseased parts should be 
destroyed by nitric acid, which possesses some peculiar advantages. The 
kind of disease to which this escharotic is more particularly applicable, is 
that which is called “ the vascular tumor” called by different names, as 
hemorrhoidal excrescence, erectile tumor, spongy hemorrhoid, varicose 
tumor, internal hemorrhoid, etc. It is an affection of the mucous mem- 
brane and sub-mucous tissue, and has generally for its basis a knuckle or 
bunch of varicose veins, but may also be a distinct and independent 
growth, the result of some other irritation in this region. Every surgeon 
has his fears, when he uses either the knife or the ligature in such cases, 
and if both the means could be supplanted by something more safe and 
efficacious, it would be more frequently resorted to. Dr. Houston points 
out the properties of pure nitric acid as an escharotic on which we may 
place much dependence, both for its safety and efficacy in those cases 
where a superficial destruction of the part to be removed is all that is 
required. “This acid at the density of 1500 destroys on the instant the 
vitality of the part to which it is applied, by the production of a che- 
mical decomposition of its solid and fluid elements. The depth of the 
slough which is to follow, may be regulated in some degree by the quan- 
tity of acid laid on the part; and its extent, laterally, may be confined 808 
HAEMORRHOIDS. 
with sufficient exactitude to the limit of its first application, by instantly 
smearing the whole over with olive oil, which neutralizes its further corro- 
sive powers, by combining and forming with it a new but no longer 
corrosive compound.” By this application, therefore, the surgeon may 
remove the tender, tumid, and bleeding tumor, with little pain and danger, 
and in the cicatrization which rapidly follows, a radical cure is effected. 
The way the acid is to be applied is as follows: Let the patient strain as 
at stool, so as to cause the tumor or tumors to come into view ; then let a 
piece of wood cut into the shape of a dressing-case spatula, be dipped in 
the acid and rubbed on the tumor to the extent desired. If a superficial 
slough only be required, one application will be sufficient; if a more deep 
one, then two or three applications may be made in quick succession, 
which being finished, let the part be well smeared over with olive oil. 
Part vii., p. 132. 
To Restrain Bleeding from Piles.—Dr. Allnatt accidentally discovered 
the value of the following: B Creasote, liquor potassa?, each a drachm; 
water, six ounces. M. Use as an injection. Part viii., p. 163. 
Nitric Acid and the Actual Cautery in heun rrhoidal Affection*.— To 
prevent disappointment in the application of the acid, it is necessary to 
have Dr. Houston’s precept always in view. He says: 
“The only case which the nitric acid will serve is the internal bleeding 
pile—that soft, red, strawberry-like elevation of the mucous membrane, 
for which I have used the term vascular tumor, and which the acid re- 
moves by the production of a slough of its surface. The surface to be 
thus acted upon must be soft, and free from any coating of cuticle, such as 
is apt to form on it by persistent prolapse ; for, if the acid be used in 
a case so circumstanced, nothing more than a removal of the cuticle may 
be expected from the application; and further, to insure to the caustic its 
full effect, the part to be touched by it should, beforehand, be dried and 
cleared qf all mucous or other adherent fluid. There is no danger, that I 
know of, to be apprehended from the application of the acid; I have never 
seen any consequence from it beyond what I have stated in my reports. 
But, to be successful, the remedy must, of course, be used with decision. 
The acid must be laid on in quantity, and rubbed in with force enough to 
be pressed into the pores of the surface. At the best, it produces only a 
very superficial slough ; and, on this account, it will be necessary in some 
cases, as where the tumors are old and firm iu texture, to make a second, 
and even a third application. Of this the patient should, of course, be 
informed beforehand, that he may not be taken by surprise, in case any 
such necessity should arise.” 
There are, perhaps, few cases of the kind in which some other caustics, 
but especially in which the actual cautery would not be equally and even 
more efficacious; but the value of nitric acid in cases which do not require 
a deep slough, consists in its ready application and in its unobjectionable 
character. A patient will readily submit to have such a mode of practice 
adopted, when he would be afraid of the actual cautery, although this 
might not be any more painful than the other; or, as Dr. Houston ex- 
presses himself, “ if the surgeon can thus, by the substitution of an acid 
for the knife, the noose, or the red-hot iron, succeed in stripping his 
services of their terrors, he will, by gaining upon his patients, steal a 
march upon the disease, and thereby find an opportunity of applying to it 809 
HAEMORRHOIDS. 
an easy, because an early remedy.” It is seldom that the application of 
the acid is painful. If the patient be very irritable, it may be well to give 
an opiate. These cases are very common. A patient, perhaps, is in the 
habit of parting with blood at stool, with more or less prolapse of the 
bowel, on the surface of which will be seen one or more of these vascular, 
strawberry-like tumors, from which the hemorrhage evidently arises. The 
nitric acid may be rubbed in with a piece of stick dipped in it, and the 
part may be immediately smeared with a little oil. The sloughs will come 
away about the sixth or seventh day. It will occasionally happen, 
however, either that the surface of the tumor is not soft enough for the 
acid to take effect to a sufficient depth, or that it is too large and exten- 
sive for such a superficial slough as that usually caused by nitric acid to 
be of much use; in this case we must have recourse to the actual cautery, 
which Dr. Houston applies in the following way: He introduces a 
speculum with a slit or hole in its side, so that the tumor, with a portion 
of the mucous membrane, if requisite, will squeeze through and appear 
within the speculum. The red-hot iron is then applied to the spot, and if 
there be much prolapse of the bowel, a small portion of the mucous mem- 
brane may also be touched with it. A slough of sufficient depth will thus 
be made, and after the healing of the mucous membrane, it is probable 
that the prolapsion of the bowel will be cured. There is no doubt that 
the actual cautery would be the best and most certain means of causing a 
slough in all cases of this description: either a superficial or a deep slough 
may be caused at pleasure ; but in all cases where a deep slough is not 
necessary, the nitric acid will be found equally efficacious, and much less 
repulsive to the feelings of the patient. Part x., p. 130. 
Ulcerated Pile treated with Chromic Acid.—Mr. Ure gives the follow- 
ing case: 
J. L.r aged 31, tailor, had at the verge of the anus a dark hemorrhoidal 
tumor, the size of half a walnut, of which the surface was ulcerated and 
extremely painful. The tumor had been extruded several days, and vari- 
ous attempts at reduction proved of no avail. The patient seemed in a 
most deplorable state, haggard and worn out by suffering, from which he 
could only obtain a brief respite by observing a half-bent posture. He has 
been subject to piles for some years. The bowels were open. I applied 
the chromic acid freely over the Avhole of the diseased surface. 
[The application occasioned much uneasiness for some hours. A con- 
siderable slough came away, and the excrescence shrunk to a small size 
and became quite insensible. The bowels at first were torpid, and his ap- 
petite bad, but these soon yielded to epsom salts with infus. gentian, and 
in about a fortnight he was perfectly cured.] 
Chromic acid is, as every chemist knows, a most powerful oxidizing 
agent, yielding half its oxygen readily to organic substances, and being 
reduced to sesqui-oxide. On this principle, I was led to employ it as an 
escharotic. It is exceedingly convenient for application, inasmuch as it 
consists of a thick crystalline pap, which, when rightly managed, does not 
spread beyond the prescribed limits; and so soon as its erosive operation 
is finished, passes into the state of inert pulverulent sesqui-oxide above 
mentioned. Part xi., jo. 183. 
Treatment of Internal Hemorrhoids.—[The bad effects which occasion- 
ally follow the excision of piles, render it very desirable to adopt some 810 
H-iEMOEKHOIDS. 
other mode, if any can be found equally efficacious. These are avoided to 
a great extent by the use of the ligature, as practised by M. Amussat for 
many years, but certain nervous symptoms are sometimes thus produced 
of a troublesome character; on the discovery, therefore, of the solidified 
Vienna paste, he immediately adopted it.] 
A great number of patients have already been operated on with this 
caustic, which consists of a cylinder composed of solidified potass and lime, 
and the effects were far less serious than when the ligature was had re- 
course to. At first, Dr. Amussat seized the hemorrhoidal tumor with a 
pair of dissecting forceps, so as to enable him to cauterize it more easily; 
but, his son, M. Alphonse Amussat, thought that the circular cauter- 
ization of the pedicle, by means of forceps, might replace advantageously 
the cauterization of the whole of the tumor, and consequently re- 
quested M. Ciiarri&re to make several forceps porte-caustique. That to 
which Dr. Amussat gives the preference is similar to the forceps used in 
dressing wounds, whose rounded blades form two little cylinders of about 
an inch and a half in length, and from one to two lines in diameter, which 
increase in width as they become deeper, and are made to receive solidi- 
fied caustic, or a paste made with the powdered caustic and a little alcohol. 
One of the extremities, longer than the other, is bent like a hook, so as to 
prevent the hemorrhoid from slipping when seized, and at the same time, 
as the furrow exists on it internal surface, to cauterize the tumor. This 
instrument may easily be made with an ordinary dissecting forceps, by 
cutting off the extremity of one blade, bending the other at right angles, 
and making a furrow on its inner surface. Part xii., p. 202. 
Matico.—[Dr. O’Ferral has found matico of great service in certain 
hemorrhoidal affections. He writes:] 
There is a form of disease engaging the verge of the anus, and a portion 
of the mucous membrane above it, in which I have found this vegetable 
astringent to produce unequivocal and rapid amendment. The condition 
to which I allude presents some characters in common with the “ vascular 
tumor of the rectum,” in which the nitric acid recommended by the late 
Dr. Houston is so often useful. But it does not, like the vascular tumor, 
require the nitric acid—it is not, like the inflamed varix, much influenced 
by leeching—and the operation for fissure is unnecessary for its cure. It 
appears to be the simple result of chronic inflammation of the integument, 
at the verge of the anus, and of a portion of the mucous membrane above 
it, the latter assuming the appearance of that hypertrophy which is usually 
termed the villous state. When examined externally, the verge of the 
anus presents a considerable swelling of a purple color, and divided into 
separate tumors or prominences by fissures or folds of the skin. When 
these tumors are separated (which gives exquisite pain if hastily done), the 
bottom of the clefts is exposed, and the cuticle is there found to be abraded 
and the surface covered with a sero-purulent discharge. These fissures 
are sometimes deep, and penetrate through the cutis to the cellular tissue 
beneath. The consistence of the swellings is firmer than that of the true 
hemorrhoid in the recent state, but wearing its purple tint. They cannot 
be emptied by pressure. They are, on the other hand, less firm than the 
hemorrhoid in the state of chronic consolidation. The cellular tissue of 
the part appears to be in a state of oedema, and covered by a thickened 
skin. Where the parts are forced or drawn out, the mucous membrane is HAEMORRHOIDS. 
811 
found to be tumid, vascular, and apparently deprived of its epithelium; it 
is easily made to bleed. 
This condition of the mucous membrane does not extend very far up- 
ward, and its prominence is little, compared with that of the vascular 
tumor of the rectum. It is not protruded at stool, and therefore, perhaps, 
yields but little blood, compared with what oozes from the former when 
occasionally strangulated by the sphincter. These are the anatomical cha- 
racters of the condition in which the matico will be found to succeed. It 
appears to consist of chronic inflammation of the inner and external integu- 
ment and cellular tissue, the prominence of the skin throwing it into folds, 
the clefts of which are apt to ulcerate, and when stretched during defeca- 
tion, may occasion pain, which resembles in some respects that of fissure. 
I have not seen any trace of true varix, internally or externally, in this 
affection. The purple tint appeared to depend on congestion of the ex- 
treme venous radicles only. This complaint begins gradually, and is 
chronic in its formation, but at length becomes so painful, that the erect or 
sitting posture can scarcely be borne. There is pain in defecation, which 
persists for a short time only afterward. There is occasional, but not con- 
stant, bleeding, and only in trifling quantities, but there is constant painful 
uneasiness, with sense of weight, increased by walking, and at length ren- 
dering the erect position almost intolerable. 
I have seen this state in several persons, at or beyond the middle periods 
of life. Both sexes are liable to it. It is called “ piles;” but leeching and 
cold applications produce only temporary benefit, and warm applications 
have been found to increase the morbid sensibility of the parts. The mode 
of employing the matico in this affection is in the form of ointment or 
lotion. Dr. Young, of Winslow, recommends the ointment in “ external 
hemorrhoids.” In the affection here described, the decoction appeared 
to me to succeed best. A dossil of lint, soaked in a decoction, made by 
boiling two drachms of the leaves in six ounces of water, is to be intro- 
duced within the anus three times daily; another piece of lint, in form of 
a compress, similarly charged, is laid outside, and covered by oiled silk; 
the whole is supported by a T bandage. If the resemblance to vascular 
tumor should induce the application of nitric acid in this affection, it will 
be found to have done too much. The tumor of the mucous membrane is 
too slight to bear the escharotic, and the patient will be worse than before. 
Part, xii., p. 203. 
Treatment of Internal Bleeding Hemorrhoids.—Dr. Watson states 
that for the bleeding internal piles, he has found injections of acetate of 
lead the most valuable remedy. He recommends to employ this remedy 
of the strength of one drachm of acetate to eight ounces of rain or distilled 
water, and to repeat the injection after every alvine dejection, a3 it is then 
chiefly that the hemorrhage occurs. Two ounces of the solution he re- 
gards as sufficient for one injection. An occasional blue pill he finds use- 
ful, followed by a dose of castor oil, with extract of taraxacum. For 
obviating the obstinately costive habit which usually attends hemorrhoids, 
Dr. Watson recommends as the best, two or three drachms of the follow- 
ing confection at bed-time: common rosin, well pulverized, one ounce, 
clarified honey, five ounces. Half an ounce of balsam of copaiva renders 
this confection still more efficacious, but it is then apt to disagree with 
delicate stomachs. This medicine produces, early next morning, a soft 812 
HAEMORRHOIDS. 
consistent motion without griping, tenesmus, or any other disagreeable 
sensation. Part xiii., p. 257. 
Internal Piles, with Prolapsus and Hemorrhage.—In many cases of 
internal piles, when the patient goes to stool, a number of small tumors 
protrude through the anus. They are usually of a deep purple or violet 
color, resembling purple grapes or damsons, but sometimes much larger, 
equalling a chestnut or small egg in size. At first, when small, they 
either go up of themselves or are easily reduced: but they soon become 
larger; for when they get through the anus, the contraction of the sphinc- 
ter strangulates them and causes them to be much distended with blood; 
by degrees, also, they drag down more of the mucous membrane of the 
rectum. As they increase in bulk they are harder to reduce; and as they 
continue long out, the contraction of the sphincter becomes exhausted, 
the muscle relaxes, and offers less resistance to the protrusion, so that a 
portion of the bowel with the internal piles comes down, not only during 
the efforts at stool, but when the patient walks or rides, particularly in 
hot weather. The complaint then becomes truly distressing. One or 
more of the piles become inflamed, the blood coagulates in them and is 
absorbed, and lymph poured out, which becoming highly organized and 
full of vessels, forms what has been called the vascular tumor. At length 
the projecting tumors in the rectum are irritated and abraded by the pass- 
age of hard fieces, and ulceration of their summits takes place, with free 
hemorrhage from their highly vascular structure. This is particularly apt 
to occur during the efforts in passing a motion, when the open pile, stran- 
gulated by the pressure of the sphincter, and distended to the utmost, 
sometimes actually spits out blood, and in those cases you will see the 
sides of the night-chair dashed with blood of a florid color, which also 
trickles down the patient’s thighs and legs. Even after the piles and pro- 
lapsed bowel are returned, the hemorrhage at times goes on within the 
gut. I recollect the case of a shoemaker who had very free bleeding dur- 
ing each motion, but the first part of the motion was a large clot of black 
blood, the result of the hemorrhage into the rectum after the previous 
motion. Besides the irritation, the pain, the serous discharge which 
always takes place when the prolapsus is large, the loss of time in the re- 
duction, these constant daily bleedings, often to the extent of six or eight 
ounces of blood, finally exert a most injurious effect on the constitution. 
The patient’s complexion is of a pale, watery-looking, yellow color; the 
sclerotic of a pearly white. He loses all energy ; he suffers from the vas- 
cular reaction attending large losses of blood, viz., palpitation of the heart, 
violent headache, with noise in the ears; and, at last, from the deterio- 
rated state of the blood, deprived of its more solid particles, anasarca 
supervenes. 
. [Mr, Hamilton considers internal piles of long standing to be of three 
kinds:] 
1st. The most numerous are true varicose enlargements of the hemor- 
rhoidal veins, the soft purple piles covered by smooth mucous membrane. 
2d. A varicose vein covered by mucous membrane, altered by inflamma- 
tion, thickened and highly vascular, so as to bleed readily from the whole 
surface, which is red and rough. 3d. A firm red pile of rather a pale 
color, composed of highly organized coagulated lymph, permeated by 
numerous vessels, sometimes of large size, and which, when the mucou 813 
HAEMORRHOIDS. 
membrane is abraded, and they are opened, bleed very freely. This 
is the vascular tumor, and is often the seat of the chief hemorrhage. 
Now, with regard to the treatment. When the case is recent, the pro- 
lapsed piles not large, the bleeding small, and the constitution not affected, 
you are not called on to operate, as you can generally do a great deal by 
other means. Regulate the bowels by mild purgatives—a few grains of 
blue pill, and rhubarb at night, and a little of the infusion of roses and 
Epsom salts in the morning for a few days, after which, give the ordinary 
electuary of confection of senna, sulphur, cream of tartar, and mel rosa3, 
or, what is better, treacle, as the mel rosse gripes some people. If, be- 
sides the pile coming down, there is bleeding, let the patient, after break- 
fast, throw up a pint of cold water with a drachm of nitre dissolved in it; 
this you will lind very useful. Enjoin steady exercise, and moderation in 
diet. In thin, delicate subjects, in whom the disease is sufficiently com- 
mon, tonics, particularly the mistura ferri aromatica, are of service. 
Should there be any serious organic disease, particularly of the chest, you 
should interfere as little as possible with the piles. 
When the pain and irritation from the pile, as well as the hemorrhage, 
are beginning to weaken the patient, effectual means must be adopted. 
Mr. Hamilton on this subject remarks : 
Of these, the chief are the actual cautery, which is now seldom resorted 
to; the nitric acid, cutting off the hemorrhoidal tumors, or tying them. 
In a very bad constitution, where you would not like to try either the 
knife or ligature, you may occasionally resort to the application of the 
actual cautery to the bleeding pile. It is much less painful than you 
would think. 
With respect to the nitric acid, I have no confidence in it in cases 
where the prolapsus is large, as I have seen it applied in such cases with 
scarcely a brief temporary effect. Where there is a single bleeding vas- 
cular tumor, it will be found a safe and often efficacious remedy. As to 
cutting off internal piles either with the knife or ligature, there ap- 
pears to be a common consent among the best surgeons in this country 
against it. Sir Astley Cooper mentions four fatal cases—three from 
hemorrhage. 
The operation which I should recommend, and wffiich you saw me 
perform in the two cases just discharged, is tying one or more of the 
piles. 
Previous to the operation, as in those cases, you will give a purge the 
day before, because it is well to let the rectum rest for a couple of days 
after the operation. It would be wrong not to inform you that this ope- 
ration, simple as it appears, has caused death. In one case tetanus fol- 
lowed ; in another, gangrene of the rectum wras the cause of the fatal 
result. Such consequences are, however, rare indeed; and out of a very 
large number of cases which I have experienced, I never saw any serious 
symptoms ensue. Pain sometimes follows the operation. 
In true prolapsus, all the coats of the rectum come down; it is a protru- 
sion of the upper part of the bowel through the lowyer, and out through 
the sphincter—a sort of invagination by the dependent position of the 
prolapsed bowel, which may be from one to several inches long. From 
the pressure of the sphincter it becomes very much swollen, and the re- 
duction proportionally difficult. Inflammation finally commences, and if 
the part has been down beyond a certain time, ulceration begins round 814 
HJLMORRHOID8. 
its base, or gangrene of a portion of it ensues. What you must do will 
be best shown by the following case: 
About a month ago I was asked to go and see an old man, whom I was 
told had been given up by his medical attendant. I found the old man 
very ill, in great torture, with a feeble intermittent fever, and dry brown 
tongue, a large, hard prolapsus, which had been down several days, and 
which was extensively ulcerated; he also had retention of urine. Attempts 
had been made to reduce the prolapsus, but they had failed ; no sooner 
was it put up than it protruded again immediately. I first drew off the 
water. I then touched the ulcerated portions of the prolapsed rectum 
with solid nitrate of silver. This gave pain, but I knew it would be 
likely to prevent after mischief. I then, after having oiled my fingers, 
reduced the prolapsus as I have described to you, beyond the internal 
sphincter; but directly I withdrew my fingers, the prolapsus was pro- 
truded—this happened a second time. I therefore got a moderate-sized 
tallow candle, cut it in half, rounded the end, and after having reduced 
the prolapsus, before it came down I introduced the candle, and de- 
sired the man to keep it in for a couple of hours. It effectually pre- 
vented the bowel coming down, and he recovered. A conical instru- 
ment, such as this small glass speculum recti, would answer for the 
same purpose. 
It is clear that, after having reduced a prolapsus, you have merely tem- 
porarily relieved the complaint. In young children, I suppose from the 
long continued straining at stool, with a relaxed mucous membrane and 
a weak sphincter, the disease is common enough, and very obstinate. It 
generally gets well, and only demands any treatment necessary to re- 
move the existing causes of constipated bowels or diarrhoea, ascarides in 
the rectum, etc. In adults, the disease is a very serious inconvenience. 
You are, therefore, called upon to afford, if possible, permanent relief. 
This may be attained either by Iley’s operation of cutting off a fold of 
skin at the margin of the anus, so as to include in the piece removed a 
small portion of the mucous membrane ; or by Dupuytren’s, which is 
merely a modification of Key’s, being the same in principle, viz., to re- 
move with a sharp scissors some of the folds which radiate round the anus, 
taking care that the incision should extend a short way within the anus. 
The same operation I have already advised for internal piles with prolaj)- 
sus, may also be used in the true prolapsus of all the coats of the bowel, 
namely, tying a few small folds of the membrane just within the anus. 
But in old men, in whom the true prolapsus most frequently occurs, and 
in broken-down constitutions, where there is organic mischief elsewhere, 
all you can do is to palliate. Should the gut come down when the patient 
walks, you can use an anal truss, the ivory knob of which goes a short 
distance up the anus, and prevents the protrusion; or a pyriform pessary 
of boxwood may be passed up the anus, and kept up by proper T bandage. 
Part xiii., p. 258. 
Mode of Arresting Bleeding after the Excision of Internal Hemorr- 
hoids.—Surgeons have, for the most part, been deterred, on account of 
the bleeding that has often followed, from cutting them off. But it must 
be remembered, that if there be any coagulum left in the tumor after the 
incision, it will go on bleeding. Excise the piles, not including any part 
of the membrane round them, even if there is a prolapsus, and inject 815 
HAEMORRHOIDS, 
/jinall quantities of a solution of sulphate of iron, a grain to the ounce, 
which will completely restrain the bleeding. Part xvii., p. lYO. 
There are cases in which the inconvenience experienced does not, in the 
first instance, arise from the existence of hemorrhoidal tumors, nor from 
any inflammatory affection of the parts, but from portions of the relaxed 
mucous membrane becoming inverted and griped by the muscular fibres 
situated at the lower part of the rectum. The following case is men- 
tioned by Mr. Abernethy: 
A medical man having dined out was seized with some disturbance in 
his bowels, which caused him to get up during the night. He returned 
to bed, but could not rest. lie experienced great pain and irritation about 
the pelvis, and was unable to attend to his practice the next day. When 
Mr. Abernethy saw him he had no less than thirty or forty scarifications 
upon his nates, from cupping-glasses which had been applied in the hope 
of procuring some relief Mr. Abernethy, suspecting that a small plait of 
bowel had descended, and was griped by the sphincter muscle of the 
bowel; examined the parts, and found a small protrusion: this he 
returned to its natural position, and immediately relieved the patient. 
The insensibility of the mucous membrane in this complaint frequently 
causes the symptoms to be referred to the neighboring parts, and, there- 
fore, it is, I believe, that this disease often exists without being recognized. 
A patient will often complain of a dull pain over the sacrum, or a heaving, 
aching pain in the perineum, which neither he nor his surgeon can satis- 
factorily account for. In the course of time some other symptom presents 
itself, which draws attention to the rectum, and the usual remedies for 
piles are administered: laxatives, mercury in different forms, and some- 
times local depletion, are had recourse to, without, of course, any ultimate 
benefit as long as the disease depends upon a mechanical cause. 
Permanent relief in such cases can only be sought by means of such 
remedies as tend to brace the mucous membrane of the bowel. The sim- 
plest as well as the most efficacious method of accomplishing this is to re- 
move one or two small longitudinal folds of the mucous membrane; when 
any portion of the lining of the bowel can be forced down this may be 
easily accomplished, in the same way as recommended for the removal of 
hemorrhoidal tumors. It is not necessary to remove the precise portion 
of membrane which has become inverted; the destruction of any portion 
will, after the wound is healed, have the effect of bracing the remainder. 
In this, as in the operation for hemorrhoidal tumors, it is the process of 
cicatrization which cures the disease. 
When an operation cannot be had recourse to, other means may be 
tried, in order to give tone to the bowel; among the first of these may be 
mentioned frequent ablution with cold water. Different kinds of ointment 
may also be used for the same purpose. The following has been used 
with considerable benefit: R Pulv. hydr. nitr. oxyd., 5hj.; pulv. capsici, 
gr. v.; ung. cetacei, §j. M. Part xviii., p. 188. 
Hemorrhoids.—These painful tumors, says Mr. Cooper, must be looked 
upon as resulting from a varicose condition of the veins of the rectum ; a 
state generally produced by some obstruction in the portal system. 
The superior hemorrhoidal vein returns its blood to the vena portae, 
which, if it become obstructed from disease of the liver, would necessarily 
tend to congestion of the veins of the rectum; and this anatomical fact 816 
H^EMOEKHOIDS. 
teaches us, that in piles, the remedies may often be advantageously 
directed to the relief of the loaded liver. High living, want of exercise, 
or constipated bowels, frequently, therefore, induce congestion of the 
veins of the rectum, and their consequent varicose condition. If this con- 
gestion become permanent, the blood within the veins coagulates, and, 
acting as extraneous matter, excites inflammation in the surrounding sub- 
mucous cellular tissue: adhesive matter is then thrown out, and unites the 
congeries of varicose veins into a solid mass, which constitutes a pile. It 
sometimes happens that some of the veins included in the adherent mass 
still contain fluid blood, and, therefore, slight hemorrhage occasionally 
occurs. From these bleedings the patient frequently derives so much re- 
lief as to be led to believe that the attack of piles has subsided; such 
relief is, however, generally but of short duration, as the vessels soon fill 
again, and produce a return of all the symptoms. Sometimes the piles 
become so much elongated by frequent protrusion as to be rendered per- 
manently external; when, from exposure to constant friction and other 
sources of irritation, their mucous membrane soon becomes converted into 
true skin. It would be supposed that in this condition the hemorrhoids 
would produce much less irritation, but such is not the case; for, as they 
still remain connected with the interior of the rectum, they continue to 
excite considerable disturbance, and sometimes becoming themselves in- 
flamed, require leeches and strict dietetic observance for their relief, it 
being also necessary that the patient should be kept in the recumbent 
position. External piles do not, however, always appear as the mere 
result of the protrusion of internal piles, but are sometimes entirely inde- 
pendent of them, and arise from inflammation and thickening of the sub- 
cutaneous cellular tissue around the anus; these piles are ajq>arently 
unconnected with a dilated condition of the veins, although originally the 
congestion of the latter may have produced the inflammation. 
External piles, even when unattended by internal, frequently produce 
prolapsus ani, extreme pain in the course of the sciatic nerve, pain in the 
perineum, and in some instances even difficulty in passing the urine; nor 
are these phenomena inexplicable to the anatomist and pathologist, when 
it is remembered that these parts are supplied by filaments of nerves de- 
rived from the same source. The excision of piles forms, however, an 
almost infallible means of removing all these symptoms. A short time 
since I was consulted by a patient in the Edgeware Road, who was the 
subject of both internal and external piles ; his medical attendant had tied 
several of the internal ones without affording any permanent relief; but 
when I removed the external hemorrhoids the patient was rapidly cured. 
Whether the piles be internal or external, they necessarily cause great 
inconvenience in the act of defecation, and the faeces are generally passed 
in small portions, and are often attended by a flow of blood; these symp- 
toms are not, however, referable to piles alone, as they may equally pro- 
ceed from stricture of the rectum. It may, however, easily be ascertained 
by an examination per anum, whether the symptoms are produced by 
piles or stricture. The first treatment of piles should always bear refer- 
ence to the state of the patient’s general health; for, as they usually de- 
pend upon some disturbance to the function of the liver and bowels, or 
both, until the healthy action of these organs be reestablished, there can 
be but little hope of removing the local disease. Small doses of mercury 
to act on the liver, and mild purgatives to excite a healthy action of the HAEMORRHOIDS. 
817 
bowels, constitute the means to be employed: but the purgatives should 
be of the least drastic nature, and not likely to act especially upon the 
lower bowels. The nostrum termed “Ward’s Paste,” or the confec. 
piper, nigr., of the London Pharmacopoeia, will be found useful; but if 
they should produce nausea, as they frequently do, I have found the fol- 
lowing prescription of very great benefit in restoring the natural action 
of the bowels: R Aloes decoc. co., 3iss.; sarsse ext., 3ss.; sarsse decoc. 
co., §iss. M. Ft. haustus ter quotidie sumendus; giving also an altera- 
tive pill two hours before dinner to induce evacuation of the bowels at 
bedtime. If the irritation still remains so as to create an uncontrollable 
action of the bowels, considerable benefit will be derived from the use of 
the following pill: R Morph, acet., gr. one-sixth; hyos. ext., gr. iss.; 
camphorse, gr. ij.; colocynth. ext. co., gr. ij. M. Ft. pil. bis terve quo- 
tidie sumenda. Part xviii., p. 194. 
Treatment of Piles.—Internal piles Mr. Vincent cuts off by the knife; 
then he directs the injection of a solution of sulphate of iron in water, 
one grain to one ounce, which arrests all inconvenient bleeding. Of liga- 
tures he disapproves, as painful and not always safe. We have known it 
cause fatal inflammation of the rectal veins. 
In prolapse of the rectum, he recommends, as very useful and effectual, 
the injection of a solution of sulphate of iron; and under the employ- 
ment of this remedy for one week, two Aveeks, or at most one month, he 
has seen the disease so often cured, that he is disposed to regard operation 
as unnecessary. Part xix., p. 170. 
Palliative.—Always advise people who have piles to defecate just 
before going to bed, and that they may do this, give a dinner pill, con- 
taining about a grain each of aloes, soap, extract of liquorice, and gum 
mastic. Part xx., p. 146. 
Collodion.—The application of collodion is suggested, with a view of 
exerting compression upon the tumor by the contractile powers of that 
agent. Part xxi., p. 197. 
Tannin.—When there is no inflammatory action present, apply tannic 
acid made into an ointment with lard. Part xxi., p. 326. 
Linseed Oil in Hemorrhoids.—Administer two ounces of fresh linseed 
oil, morning and evening. The amendment is generally so rapid that the 
remedy is seldom continued longer than a week. The only precaution 
the while being the abstinence from alcoholic drinks and stimulating diet. 
Part xxii., p. 220 
Treatment of Hemorrhoids by Operation.—Pass a thin copper or iron 
wire, in the form of a loop, made through a double canula, around the 
root of the growth, and strangulate it by drawing the wire tight. The 
canula may then be retained in its situation for any length of time, from 
half an hour to an hour or more, and the pile may then be removed with 
a knife or a pair of scissors. Should bleeding occur, immediate pressure 
may be made by the finger, or by pads of lint. Serious hemorrhage, 
however, it is stated, is of rare occurrence. Part xxiii., p. 186. 
Hemorrhoids treated by the Platinum Wire made red hot by a Gal- 
vanic Battery.—The patient was affected with external hemorrhoids, con- 
nected both with the verge of the anus and Avith the lower portion of the 818 
HAEMORRHOIDS. 
mucous membrane of the rectum, the protruding mass being as large as a 
pigeon’s egg. Chloroform having been administered, the hemorrhoidal 
tumors were drawn out by a peculiar kind of forceps, and the heated wire 
slowly drawn across the pedicle of the mass. This was repeated for dif- 
ferent portions of the growths, and where a little oozing of blood took 
place, the wire was made to cauterize the part slightly, which measure at 
once stopped the flow of blood. Mr. Marshall stated that it was important 
that the wire should act rather slowly, as a rapid section was likely to 
allow of a little hemorrhage. The time taken to sever a tumor did not, 
however, as far as we could judge, exceed forty seconds. 
The forceps to which we just alluded were constructed according to 
Mr. Marshall’s directions; they differ from the usual instrument in having 
a ring about an inch in diameter at the end of each branch; when the for- 
ceps are closed, the rings are superposed, and gain a very firm hold of the 
part to be secured. Mr. Marshall prefers these forceps to the vulsellum. 
Part xxiii., p. 315. 
Hemorrhoids.—[This kind of bleeding very frequently occurs as a sort 
of safety-valve in obstruction of the liver ; acting immediately in relieving 
the portal system. In such cases, it should not be interfered with, if it 
keeps within due limits. But in some cases these are exceeded, and great 
debility and general anaemic symptoms induced.] 
The remedy, which will be found most efficacious in restraining such 
hemorrhage, is the purified oil of turpentine, with the tincture of kino, as 
described in the following formula: 
R Olei terebinthinae pur., 5ss.; tincturae kino, sirupi zingiberis, aa. 5j.J 
aquae cinnarnomi, aquae mollis, aa. 3iij.; mistune acaciae q. s. ad bene 
miscendum; fiat haustus bis terve die sumendus. 
It is important that the oil should be first carefully rubbed down with 
the mucilage, and the other ingredients gradually added, in order that the 
draught may be well mixed; otherwise it may be rejected. 
Turpentine, in the above formula, has seldom failed to insure the pur- 
pose of a styptic in this kind of hemorrhage. 
As a styptic for internal passive hemorrhage, it stands unrivalled. 
The bowels are to be regulated by such aperients as will gently act upon 
the liver, without irritating the rectum. 
R Pil. hydrarg., extracti jalap® (vel extr. rhei), extract! copaibae, 
sing., 9j. Misce; divide in pilulas, xij.; e quibus capiat duas bora somni 
pro re nata. 
Should the bleeding recur from a hemorrhagic idiosyncrasy, an injec- 
tion of cold water should be employed every morning; which will not 
only evacuate the bowels, but give tone to the veins of the rectum. 
Part xxviii., p. 201. 
Hemorrhoids.—In using nitric acid, the strongest possible should be 
procured, not that which is usually kept by chemists. The best way of 
applying the acid, is by using some instrument which will encircle the base 
of the tumors, hold them in their situation, and sufficiently press upon 
them so as to prevent hemorrhage. If necessary, any portions of the 
tumors may be removed, the parts wiped dry, and the acid at once 
applied to the surface. There are two classes of these tumors, one which 
is soft and vascular, and very liable to bleed, and another which is firmer 
and which does not bleed. For the first, the best treatment is the nitric HAEMORRHOIDS. 
819 
acid application, but for tne second, the nitric acid is not sufficiently 
strong. For these, Mr. Lee has invented a pair of broad forceps, by 
which he grasps the tumor, and a portion of it near the operator is 
removed with the curved knife. The cut surface is then touched with the 
acid or with the actual cautery, and the parts returned into their natural 
position. If the portion cannot be protruded, then Mr. Lee has operated 
in another way. A rectum speculum is introduced having a slide ; the 
opening is applied against the tumor, and when the tumor has bulged into 
the speculum, the slide is placed in the groove and the tumor firmly held 
between it and the rest of the instrument. A long narrow knife is intro- 
duced within the speculum, a portion of the tumor cut off and the nitric 
acid or the actual cautery applied. Part xxix., p. 217. 
Employment of the Hemorrhoidal Capsule—Vienna Caustic.—In 
many cases the Vienna caustic may be used. Before using this, or nitric 
acid, or any other caustic, it may be an advantage to ligature or encircle 
the tumor with M. Jobert’s hemorrhoidal instrument. When this is 
applied, it will effectually prevent the caustic acting on the contiguous 
parts, and by its strangulation, may prevent much of the pain which would 
otherwise be caused. Part xxx., p. 151. 
Hemorrhoids treated by the Galvanic Cautery.—Two methods may be 
used for internal piles: one, that of absolute removal by the heated plati- 
num wire ; the other, that of destroying the substance of the tumor from 
the surface by the application of a disc-shaped coil of incandescent wire. 
Small isolated and prominent internal piles may easily be removed across 
their base ; but when the mass is larger, it is best to cauterize it deeply, 
from the mucous surface. Part xxx., p. 152. 
Hemorrhoids.—In ligaturing piles, use twine rather than silk. In all 
operations on or about the rectum and anus, remember Mr. Copeland’s 
golden rule, “ cut skin and tie mucous membrane.” 
Part xxx., p. 218. 
Treatment of Piles.—The following is the formula of an ointment often 
found very useful as an application to piles, when not of very large size. 
It is copied from the Pharmacopoeia of Guy’s Hospital: 
R Gallarum contrit., 3ij.; opii (emolliti aquae cum 3j.) 3ss.; liq. plumbi 
diacet., 3ij-; adipis, §j. Misce. Ft. ung. 
We have here combined the astringent properties of lead and of galls 
with the sedative and anodyne ones of opium. 
If the piles be large, ulcerated, and very painful, the free application of 
nitric acid will be the best; if in a more chronic condition, the above oint- 
ment may be ordered, or lunar caustic may be freely smeared over the 
parts. A good formula for an astringent ointment is valuable, even 
if the other means be in a general way preferred, since, in private 
practice, cases are not unfrequently met with in which the surgeon must 
prescribe without being permitted to inspect the part. 
Part xxxi., p. 159. 
Hemorrhage from Piles.—A woman, aged 38, pale, anaemic, and very 
weak from loss of blood from the rectum, entered M. Trousseau’s wards. 
On examination, the hemorrhage was found to depend upon piles. She 
was ordered injections of nitras argenti, of various degrees of strength— 
from 20 to 40 centigrammes of the salt, without any benefit. Enemata of 820 
HAEMORRHOIDS. 
rhatany were next tried, but also unsuccessfully. M. Trousseau therefore 
ordered an injection of 50 centigrammes of sulph. cupri, dissolved in a 
glassful of water, to be administered daily. The hemorrhage gradually 
became less, and in eight days had quite disappeared. The patient was 
ordered clialybeates internally. Part xxxi., p. 159. 
Treatment of Piles.—Mr. Wormald ordered for a middle-aged man, of 
spare habit and yellow complexion, long the subject of piles, the following 
medicines: A pill consisting of two grains and a half of blue pill every 
night, a scruple of extract of taraxacum, dissolved in water, three times 
daily, and an injection of two grains of sulphate of iron to the ounce of 
water, to be used every morning. For the relief of the irritation caused 
by the tumors, and by the tendency to prolapse of the rectum which 
attended them, the man was directed to place just within the bowel 
after every motion a small plug of cotton wool, well oiled. 
Part xxxi., p. 311. 
Use of Tormentilla.—Tormentilla is a very valuable vegetable astrin- 
gent in cases of piles, passive hemorrhages, diarrhoea, etc. One or two 
ounces of the decoction may be given every three hours. 
Part xxxii., p. 99. 
Piles.—When you have piles associated with protrusion of the rectum, 
the application of nitric acid is much safer, and quite as effectual a remedy 
as the ligature and the knife, and there will not be the danger from phle- 
bitis which sometimes follows these operations. Part xxxiii., p. 122. 
Hemorrhoids—Internal.—When they are florid, granular, and do not 
project much above the surrounding mucous membrane, the application 
of nitric acid is the best mode of treating them; but if they are large, 
pendulous, or indurated, the ligature ought to be used; it is entirely free 
from danger if properly done. 
Ligature of.—You must first empty the bowels by an enema, then seize 
the tumors with a forceps and draw them down ; pass a double ligature 
through the base of the tumor, tie thoroughly tight in two portions, and 
return them within the rectum. You may give half a drachm of laudanum 
immediately afterward. Some surgeons include them in a single ligature ; 
but this should not be done excepting they have a very narrow peduncle ; 
the ligature is much more likely to slip, and you cannot draw it so tight. 
The treatment of internal hemorrhoids should be, 1st, to remove the 
whole of the enlargements within the sphincter by ligatures; 2d, each 
tumor should be transfixed by a double ligature ; 3d, the ligatures should 
be tied as tight as possible ; 4th, Enlargements exterior to the sphincter 
should be removed with the scissors. Part xxxiv., pp. 157-165. 
Use of the Ecraseur.—As a general rule we may say that there is no 
danger from hemorrhage when piles are removed by the ecraseur, but this 
is not universal, for in a case where it was used for the removal of internal 
piles, the patient passed four ounces of blood an hour and a half after the 
operation ; some time after this, twenty ounces of dark clot were passed. 
Opium and chloric ether were given, but the hemorrhage continued, and 
the patient died. Part xxxv., p. 86. 
Distinction between External and Internal Piles.—It is a very com- 
lon mistake with students to confound external with extruded piles, and HJEMOKEHOIDS. 
821 
to call those internal which are out of sight, and those external which are 
visible. We need not say that this is an utterly false nomenclature. Ex- 
ternal piles are those which form without (external to) the circumferen- 
tial margin of the sphincter, and are consequently always covered with 
skin ; internal ones are those which are within the sphincter (not above 
it), and are covered by mucous membrane. External piles, consequently, 
are always dry and cuticular, internal ones moist and slimy. The external 
have a light uniform bluish tinge, varying according to the density of the 
skin over them; internal ones are bright and florid, or from all the shades 
of florid to those of livid and purple, according to the intensity of their 
congestion. External piles almost never bleed; internal ones almost 
always do so. External piles are dilated hemorrhoidal veins ; internal ones 
are of a very different nature. External piles may be cut away with im- 
punity, while to tie them would risk phlebitis and purulent absorption. 
Internal piles may be tied with safety, while to excise them is to risk fear- 
ful, and it may be, fatal hemorrhage. It is most important to understand 
clearly that the difference is one of kind and not of mere position. 
v "V -r* t* t* t 'i* *r- 
Internal piles are not dilated or varicose veins of the anus, for if cut 
across the hemorrhage is arterial, not venous; and if tied there is no risk 
of phlebitis. External piles may be snipped off, and there is no danger of 
bleeding after the vein has once emptied itself; internal ones, if cut away, 
bleed continuously and profusely, and their hemorrhage, as just stated, is 
arterial, not venous. Part xxxv., p. 107. 
Internal Hemorrhoids ought never to be Excised.—There are few prin- 
ciples more unquestionably established in British surgery than that on 
account of the risk of uncontrollable hemorrhage internal piles ought 
never to be excised. In this rule Sir Astley Cooper, Sir B. Brodie, 
Mr. Salmon, Mr. Curling, Mr. Quain, Mr. Ashton, Mr. Syme, and 
Dr. Brooke, all emphatically concur. Part xxxv.,/). 108. 
Method of Applying the Ligature to Internal Piles.—The usual pre- 
liminaries of the operation having been observed, Mr. Salmon, of St. Mark’s 
Hospital, passes a toothed tenaculum into the gut, with its teeth looking 
outward, and seizes the pile which it is intended to tie; this is drawn 
downward and held away from the margin of the sphincter, while the ope- 
rator with the scissors makes a deep gash just at the margin of the junc- 
ture of skin and mucous membrane. The pile may be still further isolated 
by incisions at each side. A strong waxed silk ligature is now applied in 
the track of the deep wound ; the ligatures are left long, and the piles not 
returned. The first dressing may be a compress of cotton wool; on the 
following morning a bread poultice may be substituted. As the pile is 
generally supplied by a single large artery at the upper part, there is no 
danger of hemorrhrge from the first free incision. Part xxxv.,/). 109. 
Perchloride of Iron in Hemorrhoids.—When large, first blister them, 
then apply the perchloride of iron to the denuded surface ; by this means 
they shrink and soon disappear. Part xxxv., p. 114. 
Hemorrhoidal Tumors—Method of Using the Ecraseur for.—The 
bowels having previously been well opened, place the patient under the 
influence of chloroform, and on his left side, the right leg and thigh 
being Hexed. Draw out the hemorrhoidal mass, and include the whole 822 
HAIR. 
within a firm twine ligature, along the track of which the chain of the 
6craseur must be placed, and shortened till it constricts the tumor. The 
tumor must be very gradually removed, the chain being slightly tightened 
about every fifteen seconds. An almost bloodless surface will be left, on 
which the track of the wound will be scarcely discernible. Graduated 
pressure must be now maintained against the anal opening, by means of 
the usual perineal bandage, and the bowels locked up for seventy-two 
hours after. It will be necessary to pass up daily an oiled elastic bougie, 
gradually increased in size, to prevent adhesion, and so stricture of the 
rectum. Part xxxvi., p. 289. 
Tincture of Benzoin in Hemorrhoids.—Prof. Barker, of New York, 
mentions the following case of a gentleman who had for several years 
been suffering from internal piles, which had greatly impaired his general 
health from frequent bleedings. 
One very hot morning in June, 1856,1 was called to see him on account 
of severe hemorrhage. I learned that for several days he had lost a good 
deal of blood after his morning dejection, but this morning it was so ex- 
cessive as to induce complete syncope. When I saw him he was still very 
faint, and there was a constant oozing of blood from the rectum, which 
was so sensitive that I could arrive at no satisfactory result from physical 
exploration. With a small syringe I injected into the rectum a half ounce 
of tinct. benzoin co. as soon as it could be obtained. Its effects were 
quite striking. He was at once aroused from his syncopic condition, and 
since that time has never suffered from the hemorrhage. 
Part xxxvii., p. 58. 
Piles and Prolapsus Ani.—Nitric acid will only prove speedily and 
effectually serviceable in those cases of internal piles where the diseased 
texture is only of moderate extent, has a broad base, and presents a very 
vascular appearance, as though the excrescence was composed chiefly of 
minute arterial branches. When, however, the hemorrhoidal excrescences 
are very large, and of a blue appearance, mainly consisting of venous 
ramifications, nitric acid should not be applied, neither should it when a 
patient is suffering from what is called an acute attack of piles. 
In cases of prolapsus ani of considerable size, when there is not a com- 
plication of large or several piles, and when the mucous membrane is 
simply thickened and relaxed, this remedy will be eminently serviceable. 
Part xxxvii., p. 150. 
Bleeding Piles.—One of the simplest and surest means for temporarily 
checking this kind of hemorrhage, is the application of perchloride of 
iron dissolved in glycerine, and applied on a piece of lint. 
Part xl., p. 315. 
Trichopathy and the Chemical Pathology of the Human Hair.—[The 
varieties in the color of the hair, Dr. Cattell considers, depends on the 
presence of sulphur, and not on colored fatty matter. The variety of color, 
however, he says, depends upon the relative quantity actually existing in 
the hair, in combination with oxide of iron. Dr. Cattell observes :] 
HAIR. HAIR. 
823 
Tricho-crosology is a compound Greek term, which I have devised appo- 
sitely to express the chemical processes employed in reducing some of the 
unseemly varieties of color, to which the hair is subject, to a supposed stan- 
dard or standards of natural or ideal beauty. These embrace the forma- 
tion of paste, pomade and liquid. 
I. Phumaform Hair Dye.—1. Oxide of lead, three ounces; carbonate of 
lime, two ounces—mix into a proper consistence with hot water, and apply 
it to the hair, enveloped in oil-skin. 2. Carbonate of lead in the place of 
the oxide of lead, and proceed as in the other case. The efficacy of this 
stain depends on the formation of a plumbite of lime. 
II. Steariform Hair Dye.—Nitrate of silver, a drachm; nitric acid, two 
drachms; iron filings, two drachms—mix. After the lapse of a few hours, 
pour the supernatant liquor on two drachms of oatmeal. Lastly, well mix 
with three ounces of lard. 
III. Chulosiform Hair Dyes.—1. Silver, two drachms; iron filings, half 
an ounce ; nitric acid, one ounce; water, eight ounces—mix. When the 
metallic substances are dissolved, pour off the supernatant liquor, which 
constitutes the dye. 2. Nitrate of silver, eleven drachms; nitric acid, a 
drachm ; distilled Avater, twenty ounces ; soap (sap. viridis), three drachms; 
gum arabic, a drachm—well mixed. 3. Nitric acid, a drachm; nitrate of 
silver, ten drachms; soap (sap. viridis), nine drachms; mucilage, five 
drachms; water, thirty-seven ounces and a half—mix. This differs from 
the foregoing only in proportions. 4. Lead filings, two ounces; hartshorn 
shavings, one ounce; oxide of lead, two drachms; camphor, a drachm, 
Avater, a pint. Boil for half an houx-, and when fine, pour oft' the superna 
tant liquor on diacetate of lead and rosemary leaAres, of each one drachm. 
Again boil, and Avhen sufficiently fine, pour off the supernatant liquor, 
Avhieh constitutes the dye. 
Of these preparations, as stains for the hair, none claims so decided a 
preference as the last. It can produce injuiy to neither the hair, skin, nor 
brain, and possesses the advantage of communicating a beautiful color and 
curling property to the hair. Whatever objection there may be to the use 
of dyes containing the nitrate of silver, from their liability to darken the 
skin, still I regard them preferable to the employment of caustic earths, 
OAving to the depilatory action of the latter. Before the application of any 
liquid stain, it is necessary that the hair be freed from all greasy matter. 
A close brush and a comb are all the requisites in staining the hair. Con- 
nected with the general pathology of the hail*, the only two points to xvhieh 
I shall now refer, are allopeeia and calvities—baldness and fall of the hair. 
Allopecia may arise from any cause destroying the \ritality of the bulb of 
the hair—as various fevers, the wearing silk hats, the existence of Avhat, in 
common parlance, is called a worm at the root, neglect in cleansing the 
head, etc. 
Calvities follows precisely analogous causes, and merely differs from allo- 
pecia in degree. To remedy these affections, it would appear, by our daily 
advertisements, that every advertiser had discovered some secret process— 
had, in fact, ransacked the Avhole arcana of science. But leaving these, 
and the victims that use them, I will mention a general remedy or two 
which will be found much more efficacious and infinitely more satisfactory 
in their results than bear’s grease, Macassar oil, or any other advertised 
preventive or curative. 
1. Rosemary, maiden-haii', southern-wood, myrtle berries, hazel bark—• 824 
HAND. 
of each two ounces. Incinerate, and with the incinerated substance make 
a strong ley, with which to wash the hair at the roots every day. Keep 
the hair cut short. 2. Carbonate of potash (pearlash), two drachms ; W'a- 
ter, a pint; use as the preceding.. The efficacy of both these remedial ap- 
plications depends upon their alkalescent character. 
But where a greasy substance is required for the hair, I -would suggest 
the substitution of the elaine of olive oil; though expensive, it will in many 
cases well repay the use, as it never thickens, engenders scurf, or in any 
way produces detriment to the hair, like common oil or pomade. The 
only other greasy matters which I would suggest as substitutes for the 
elaine, are ox marrow, well agitated in a mortar, and castor oil, freed of its 
adhesive matter. Part xiv., p. 256. 
Glycerine.—A wash for the hair. Vide, Art. “ Glycerine.” 
Rules for making Incisions in the.— Vide, Art. “ Whitlow.” 
Conservative Operations on the Hand.—As a small but not unimportant 
matter of “minor surgery,” we have recently seen some five or six ampu- 
tations of fingers for scrofulous and other diseases at various hospitals, in- 
volving a practical point, on which surgeons do not seem well agreed— 
namely, whether in removing the index, middle, or ring fingers, for in- 
stance, it is better to save as much as possible of the phalanx next the 
palm, or remove the phalanx and the head, and a small part of the meta- 
carpal bone, in order to render the hand less unsightly. Mr. Erichsen, as 
a rule, removes as much as possible of the bony parts with the diseased 
finger, and believes he thus leaves a more shapely hand and one more use- 
ful. If we take the ring finger, for instance, on which he operated, and 
leave the first phalanx untouched, it is only in the way subsequently, and 
always getting injured, ulcerated and cut; but if, on the contrary, the 
surgeon, when called on to remove the finger, makes a V incision at the 
back of the hand, he can easily take away the entire finger and head, or 
part of the entire metacarpal bone, when the little or middle fingers come 
into apposition, and in a large hand especially, the result of the operation 
can scarcely be noticed, while the entire hand has lost none of its efficiency. 
Where the index finger is the one diseased, some surgeons even slice off 
the metacarpal bone, whether affected or not, by a peculiar slanting or 
oblique movement of the small saw, a single line of cicatrix marking the 
original wound; a few stitches to hold the parts in contact and common 
water-dressing being all that is necessary afterward to complete the cure. 
If the metacarpal bone be involved in the disease, there can, of course, be 
no question as to its removal, and instances are given of excision of the 
index finger, together with the entire metacarpal bone, with most un- 
expected and admirable results as to the appearance and usefulness of the 
hand subsequently. 
Mr. Fergusson pointed out these various operations to his class, and 
one even still more strange in the practice of Mr. Butcher, where the os 
magnum, the cuneiform, trapezoid, and unciform, were entirely removed, 
the inferior edge of the lunar pared, two-thirds of the fourth and fifth meta~ 
HAND. 825 
HAND, 
carpal bones also excised, four arteries ligatured, yet leaving a useful hand! 
All our surgeons seem agreed, however, that the same rule does not hold 
good with respect to the tarsus as the carpus. Mr. Erichsen says the rule 
is the opposite; and in the amputation of toes, the big toe especially, we 
cannot leave too much bone, as a surface on which the perpendicular axis 
of the body is to rest, while in amputation of fingers we cannot, on the 
other hand, cut too much away. Part xxxiii., p. 146. 
Gunshot Injuries of the Hands.—On this subject Mr. Wyatt remarks 
as follows: 
It has been said, as an aphorism, that amputation should be the last re- 
source and even opprobrium of surgery, as death is of the practice of medi- 
cine; still, impossibilities cannot be performed, or a limb saved which 
sound experience says can no longer be preserved. In former days, wounds 
of the hands and fingers were much dreaded, cn account of the liability to 
tetanus; as the nature and treatment of gunshot wounds have become bet- 
ter understood, we place more confidence in the resources of Nature, and 
have become less desirous for the doubtful eclat of operations. It has been 
admitted that the type of diseases has undergone an extraordinary and 
almost radical change during the past five years, and that the cause for the 
severe treatment then employed has, consequently, long since passed away; 
may we not, as practical surgeons, incline toward a similar opinion, with 
reference especially to gunshot wounds ? for I conceive that the spoliative 
and' expectant systems of treatment, are but the analogues of operative and 
conservative surgery, the status of which we shall improve, in proportion 
as we prove it to be less of an art than a science. I believe that it would 
be most desirable to follow the consecutive symptoms of a given disease, 
uncontrolled, to its termination; by that means alone shall we be able to 
estimate the value and force of our particular remedies. 
Certain cases must have come under the cognizance of the attendant 
surgeons during the Crimean war, where, after much deliberation with 
reference to the practice to be pursued in a very severe injury, the issue 
has been considered sufficiently doubtful to give the patient the chance of 
preserving his mutilated limb ; and, almost contrary to all expectation, the 
result has proved successful. Such a case occurred to me. A man was 
wounded in the trenches by a fragment of shell, which carried away 
the 'whole of the sural vessels of one leg, fracturing at the same time 
the fibula in two places. He had apparently a good constitution, and, 
after a most anxious reflection, I decided to give the man the chance of 
having even a distorted limb; although it was by several surgeons con- 
sidered almost too great a risk. The man was himself much opposed to 
any operation. After great care and attention he was in eleven weeks con- 
sidered sufficiently recovered to undertake the voyage to England, with 
rather an awkward leg, it is true ; but still it was one which he would have 
been very loth to exchange for the best substitute in cork or wood that 
could ever be produced. Monsieur Bandeux, the distinguished inspector- 
general of the French army, who has lately made a tour of inspection 
through the allied camps, informed me that it is extraordinary what an 
amount of preservation of limbs is now attempted, by resections, at their 
military hospitals, after injuries which formerly would not have.been con- 
sidered amenable to such treatment, and with more than great success; 
for it appears that out of twenty-nine cases of resection performed by him- 826 
HAND. 
self, only tln-ee were fatal, which is a result, I think, sufficiently satisfactory; 
but they weie performed in large military hospitals in France, and not in 
field hospitals, in position even, much less in bivouac after an action. 
The more remote the seat of injury from the larger articulations, with 
the greater freedom, I conceive, may conservation be attempted ; but, when 
preservation of iimbs after injuries near the larger joints is attempted, the 
most mature deliberation is necessary; indeed, I cannot conceive a more 
important duty to devolve upon the military surgeon, or one requiring 
more experience of nature’s resources, as regards future prognosis; neither 
can I conceive anything so distressing as to be obliged to remove a limb 
which has proved useless after a so-called cure of conservative surgery; 
and this contingency must be always remembered in military practice. I 
very much doubt if we are not always justified in attempting to preserve a 
portion of the hand, even after the most severe injuries. I think that, es- 
pecially where the tendons are intact, notwithstanding that the metacarpal 
bones may be much comminuted, we should endeavor to preserve the 
phalanges, provided the patient’s constitution is good. I must, however, 
confess, that I believe unless the state of the wounded after an engagement 
can be such as to render them free from the discomforts and dangers at- 
tending frequent locomotion, that excisions of the joints of the lower ex- 
tremity should rarely be performed ; and this opinion I have arrived at 
from very practical experience during this Avar. What, for instance, but 
an untoward result could be anticipated from those wounded soldiers Avho, 
after the battle of Alma and Inkermanrr, were removed to Scutari, there to 
be placed in a crowded hospital, after a tedious voyage of several days? 
If it be admitted that after treatment of excision of joints requires especial 
care and attention, then it is manifest, that where such cannot be obtained, 
it will not be desirable to \renture too much in that direction. Hemor- 
rhage after gunshot injuries in the hand is often most difficult to control; 
indeed, I know of one case wdiere amputation Avas advised, after deligation 
of the artery had first been attempted Avith no success: in this case, pres- 
sure at the seat of injury was impossible, on account of the inflammation 
and sloughing Avhich had folloAved ; every kind of styptic was also tried in 
vain: and the lad had lost a large quantity of blood : pressure Avas then 
carefully applied over the course of the radial and ulnar arteries, and, as 
ice could not be obtained, a syphon Avas constructed, by which cold Avater 
was allowed to drop perpetually on to the wound : this was continued for 
twelve hours, Avhen all hemorrhage ceased,and subsequently a good reco- 
very was made. It is also worthy of note, that during this war hardly any 
cases of tetanus folloAving Avounds have been reported ; and as such a com- 
plication Avas at one time supposed to be peculiarly liable to follow injuries 
of the hand in military practice, hoAV can we account for the immunity 
during this campaign, except from the improved system of treatment em- 
ployed? Of all gunshot injuries in the neighborhood of the hand, I think 
the greatest danger to the subsequent recovery of the member arises from 
those cases in Avhich a ball has penetrated the carpal bones alone, on 
account of the extensive irritation which ensues. Part xxxiv., p. 132. 
Wounds of the Hand.—-It is a practice often productive of inflammation 
and thecal abscess (especially in the working classes) to encircle every little 
wound of the fingers with strips of adhesive plaster. Instead of this, hav- 
ing first cleansed the hand by soaking in warm water, apply merely strips 827 
HANGING. 
of lint or linen wetted in tepid water. If it be a severe lacerated wound 
at the back of the hand or palm, pass a finger through an aperture in the 
linen, which is thus enabled to support the parts very firmly ; raise and sup- 
port the arm on a pillow, and keep the linen constantly wet with cold water 
dropping on to the part. Part xxxvii., p. 121. 
Wounds of the Palmar Arch.—In hemorrhage from wounds of the pal- 
mar arch, correctly adjusted pressure should supersede that more painful 
and hazardous procedure, hitherto deemed requisite, viz., indirect arterial 
deligation. The graduated compress affords the most effectual mode for 
its employment. 
Dr. Arnott gives the following directions: First, bandage the fingers 
separately, and continue this upward to the wound, and apply partial com- 
pression to radial and ulnar, or brachial arteries, according to convenience. 
It is of primary importance that the compress should be placed in a dry 
bed ; for this purpose lightly pencil over the wound with nitrate of silver, 
by which means the divided vessels are constringed to some extent, and 
an adherent film or pellicle is instantaneously formed upon the surface, 
highly advantageous in allowing the deeper portions of the compress to be 
accurately and duly applied. Now apply the compress piece by piece, the 
smallest first, accurately in contact with the bleeding point; over this 
others, gradually increasing in size. The whole conical mass is now 
covered by the bandage continued upward, keeping all correctly adjusted. 
Part xxxix., p. 157. 
Injuries of the Hand, Fingers, etc.—Don’t be in a hurry to amputate a 
finger or hand, however severe the injury. It is surprising how nature 
will cure injuries of small bones and joints, when the parts are connected 
only by shreds of lacerated skin or flesh. In the hand particularly preserve 
the thumb and a finger or two- Part xxxix., p. 146. 
Wounds of the Palmar Arch.—Compress the vessel in the wound by 
a firm roller, lay the fingers over this in a flexed position, and maintain 
them there, flex the hand on the forearm and the forearm on the upper 
arm, and render movement of the entire extremity impossible by the ap- 
plication of a roller from wrist to shoulder. The happiest results will fol- 
low this mode of treatment. Part xl., p. 104. 
HANGING. 
Case of Hanging Successfully Treated by the Affusion of Cold Water. 
—This case is reported by Mr. Noyce: 
It appears that the patient had been suspended at least two minutes, and 
respiration had ceased six minutes, before attempts at resuscitation could 
be made. The heart’s action continued, but was very weak; pulse 80, 
countenance pale, conjunctiva red. Mr. N. attempted to perform artificial 
respiration, but the pair of bellows were so much out of order, that he 
could not effect his object. He then determined on the application of cold 
water, and describes its effects as follows: 
On the first affusion I perceived a gurgling in the throat, and renewed 
the operation ; a slight inspiration directly succeeded. The affusion was 828 
HANGING. 
frequently repeated, and was followed each time by an inspiration, each 
more perfect than the last, until the lungs were fully inflated; respiration 
then continued regularly, accompanied by frequent yawning and sighing. 
I bled him to 16 ounces, which restored him to consciousness, and lie has 
had no bad symptoms since, excepting a severe pain at the back of the 
neck, which shortly passed off, and he remains quite well. 
Part xiii., p. 238. 
Modes of Death by Hanging.—The modes of death by hanging may be 
thus summed up, not in the order of their frequency, but of their fatality : 
First, Luxation of the odontoid process of the second cervical vertebra, or 
fracture of the spine, and consequent injury to the medulla spinalis ; 
second, suffocation from pressure on the windpipe, producing complete 
obstruction to respiration; third, congestion of the brain, or apoplexy from 
the arrest of the return of blood from the head to the heart, the result of 
compression of the great bloodvessels of the neck; fourth, injury inflicted 
by violent and prolonged pressure on the important nerves of the 
neck. 
Much of the success of the treatment of a case of attempted suicide by 
hanging will depend on the nature of the injuries inflicted, the period at 
which assistance is procured, and a proper discrimination in the selection 
of remedial measures. Thus, if the surgeon be summoned to a person 
within a few minutes after he has suspended himself, although the breath- 
ing may have completely stopped, yet, provided there is neither disloca- 
tion nor fracture of the vertebrae, and consequent injury of the me- 
dulla spinalis, animation may, in many cases, be restored by an immediate 
recourse to artificial respiration. Electricity or electro-galvanism, if within 
reach, ought at the same time to be applied to the cardiac and spinal re- 
gions ; if, on the ether hand, the patient is cut down before respiration 
has ceased, and symptoms of congestion of the brain or apoplexy should 
present themselves, bloodletting ought at once to be resorted to. Although, 
as already stated, there is reason to believe that the apoplexy which results 
from compression of the great bloodvessels of the neck is frequently 
congestive form, yet, as we possess no infallible rule by which we can posi- 
tively pronounce in these cases, whether cerebral hemorrhage has taken 
place or not, we should in every such case exercise as much caution in the 
abstraction of blood as we would in apoplexy from other causers ; here, as 
elsewhere, we should, whilst endeavoring to remove congestion, or arrest 
hemorrhage, ever bear in mind that the brain has suffered from a violent 
shock, for the repair of which the system will require its best resources. 
Much difference of opinion has existed both as to the quantity of blood 
to be taken away in cases of apoplexy, in which bleeding is indicated, and 
as to the precise situation from which the blood should be abstracted. The 
condition of the pulse, and the effects of the withdrawal of blood on it, will 
be the safest guides as to the former; with regard to the latter, we gener- 
ally select the temporal arteries, agreeing, as we do, with Abercrombie, 
who, whilst treating on the subject, says: “ Much importance has been at- 
tached to bleeding from the jugular vein, as more likely to give imme- 
diate relief to the head ; but we must remember that the only jugular vein 
that can be opened is the external jugular, which has little communication 
with the brain, and, consequently, bleeding from it is much inferior to 
bleeding from the temporal artery.” Part xxxi., p. 248. HARELIP. 
829 
HARELIP. 
Operation.—This ; ase, upon which Dr. Houston operated, was a very 
troublesome one ; the patient, a child two years and a half old, having a 
double harelip, with double fissure of the hard palate anteriorly, but only 
one in the soft palate. The incisor teeth were distorted. The first step 
was, detaching the edges of the labial fissure from the bones by an inci- 
sion with a scalpel through the mucous membrane, after which the outer 
layer of the projecting tubercle of bone was removed by nippers, and the 
distorted teeth, together with the pulps of the secondary ones, were also 
taken away, thus making a fiat surface and support for the new lip. The 
edges of the harelip were then pared with strong, sharp scissors ; there 
was but little hemorrhage. The needles employed to bring the wounds 
together, were two long, fine, woollen or darning needles, tempered and 
filed at the points to the shape of glover’s needles. The lower was that 
introduced first; the point was made to penetrate the skin on the left 
side, about a line above the free edge, and two lines and a half to the out- 
side of the vertical incision. Thence it was pushed slightly upward and 
backward, so as to appear on the cut surface a little higher than the level 
of its entrance. It was then pushed through on the opposite side in a 
similar, but reversed order, and brought out there at a point of the skin 
exactly opposite to the point of entrance. The two flaps glided readily 
toward each other on the long, smooth needle, and when made to touch, 
were found to fit with every exactitude, giving to the red border a 
straight edge below, and forming the lip into a level surface in front. The 
manoeuvre of raising the point of the needle during its entrance insured a 
firmer hold of the flesh, and, by pulling down the mucous membrane a 
little, added to the fullness of the lip at that part. The second needle 
was then introduced in a direction parallel to the first. It entered the 
skin close under the left nostril, passed through about half the thickness 
of the flesh of the lip, then traversed the central triangular piece, and 
came out again under the right nostril. This needle was introduced in a 
directly transverse course, and not in an arched direction, as practised 
with the preceding one; and it was not allowed to pass altogether so 
deeply into the substance of the lip, as by such a disposition a better seat 
was given-to the central tubercle. A high position was selected for this 
needle, with the view of closing the fissure into the right nostril as far as 
possible. Both needles being thus laid in, a thread of silk was twisted 
several times, first round the upper one and then another round the lower, 
as in the figure of 8, and both were made subsequently to cross in the 
centre between the needles, so as to keep the apex of the tubercle in its 
place, care being taken, however, not to pull them in any degree calcu- 
lated to approximate the needles to each other. It was found that, by 
tying the superior needle first, a better adaptation of all the parts of the 
complicated wound, and a neater arrangement of the red borders was 
accomplished, than could be by the more usual mode. 
The peculiar length of the needles, by lessening their readiness to fall 
out of the wounds, facilitated greatly the subsequent manipulations of the 
dressings, and rendered unnecessary the application of a ligature in either 
of them until the fitting place and direction for both had been determined 
upon. As final steps, the projecting ends of the needles were nipped off, 830 
HARELIP, 
little rolls of sticking-plaster were applied to their stunqis, and the cheeks 
were drawn and held forward by adhesive straps, so as to take off all 
stress from the needles. No further dressings were applied. In seventy- 
two hours the dressings and needles were removed, when the union 
between the wounded surfaces was found to be complete in every part. 
The palatine fissures were left untouched. 
Dr. Houston afterward examines the question as to what period of life 
is the best fitted for the performance of an operation for the cure of hare- 
lip, and he decides in favor of the third month after birth, urging as Ins 
reasons that the parts recover themselves better than when the operation 
is done later in life; that the lip in due time acquires fullness and pliancy; 
the nose is prevented from assuming a spread-out, ugly appearance ; the 
fissure in the p>alate, if there be any, closes greatly with the growth, if 
supported by a firm and perfect lip ; bad habits of speaking, such as 
nasal or guttural utterance, which, if once established, become irremedi- 
able, are avoided; and by removing such disfiguration before the child is 
conscious of its existence, it is spared the feelings of humiliation which 
the consciousness of such infirmity necessarily imp>arts, and which invari- 
ably gives a tone to the character of the individual. He states that he 
has operated on several infants of three months old, with equal success in 
all cases, and has never failed. Dupuytren also recommends the third 
month, Velpeau the first six, but if they had already passed, he then 
deferred operating until the tenth or fifteenth year. Sir A. Cooper 
advised waiting until the patient had completed the second year of exist- 
ence. Part vi., p. 158. 
Operation for Harelip.—I advise you, says Mr. Liston, to defer the 
operation till the first set of teeth have come in, and I have seen good 
reason for adhering to this rule. When the operation is undertaken at 
an early period, there is often great difficulty; sometimes union does not 
take place, the parts turn out again, and the patient is rendered more 
deformed than in the first instance. When the features are enlarged 
somewhat you have more ground to work upon, you can put the parts 
then neatly together, and you can almost answer positively for the union 
taking place. I operated on a child the other day, in whom the operation 
had been performed twelve months ago. The parents were anxious to have 
it performed, but I then refused; it was done, however, but the moment the 
pins were removed, the lip turned out as before. You continually see 
patients sent back at the hospital till the proper period has arrived. 
Supposing that the fissure is simple, and everything is right and proper 
as it regards health, the operation may be performed by a very easy 
process. The instruments employed are, or ought to be, exceedingly 
simple. Here are all sorts of complicated instruments made for holding 
the lip, but, depend upon it, the fingers are the best forceps. 
If you have a simple fissure on which to operate, you wrap the patient 
well round with a table-cloth, or jack-towel, so that he cannot move. You 
have him held on the nurse’s knee, place yourself in a good light, and lix 
the child’s head betwixt your own knees, with his head toward you. 
Then, laying hold of the edge of the lip with the fingers, you enter the 
knife above the angle of the fissure, and carrying it downward, free from 
the continuation of the prolabium, you take care to remove all that por- 
tion of the lip. You pare off a considerable thickness of the parts, so as HAKELIP. 
831 
„o get a broad surface to oppose to the opposite side. You enter the 
knife again, carry it down on the other side, and bring it out where I have 
done. The operation is now so far completed. You have some little 
bleeding, which you can arrest by the fingers, but you do not care for its 
instant cessation. You immediately put in the needles for the twisted 
3uture ; make two points of suture ; secure them by a thick twisted 
thread, and cut off the ends of the pins. 
If there is a double harelip, the operation must be regulated altogether 
by the size of the intermediate flap. In many old books, those of lieister, 
Benjamin Bell, etc., and even in Mr. Cooper’s “First Lines,” it is recom- 
mended that the operation should be performed on one side, and that one 
fissure being united, and the cure consolidated, many weeks or months 
afterward the other should be operated upon. But there is no occasion 
for anything of the kind ; if there are two fissures, you complete the 
operation at once. Sometimes it is necessary to take away a portion 
of bone which projects forward, and pushes the flap out of its place. 
Before you can get the soft parts together you must detach the flap, and 
with a pair of cutting pliers clip away the bone, perhaps with a couple of 
the incisors. There are many specimens in the museum of portions so 
removed. In cases of bad double harelip, however, there is generally a 
deficiency of the bones, and that you cannot very well remedy. There is 
no mode of filling up the space. Sometimes the fissure of the palate runs 
quite forward to the fissure of the lip, and there is a great void into which 
you can pass the little finger between the bones of the palate. With the 
palate, however, I have nothing to do at present. Your object is to put 
the external parts neatly together. The great object is to have the pro- 
labium straight, and all the incisions are made with that view. Both the 
incisions must be made of the same length to prevent puckering. You 
must take away the rounded portions, for if you do not, you leave an 
awkward-looking notch. Many patients have been operated upon for 
hare-lip in early life that had better have been left alone. I operated two 
or three times every year, sometimes much oftener, where the operation 
has been performed before. In these cases you must cut through the lip, 
remove the cicatrix, and put the parts handsomely together, guarding 
against any notch being left at the free edge of the iip. I had a young 
lady under my care, in the neighborhood of the hospital, two or three 
years ago, who had a split palate, and who had been operate upon for 
fiarelip very soon after birth. I advised her strongly to have the cicatrix 
cut out, and the parts again put together. She consented, and such was 
the change produced in her appearance, that, in some days after the 
operation, on stirring the fire, and rising suddenly before a mirror, she 
started back, not knowing herself. I advise you, when you put in your 
first pin, to twist your ligature upon it; do not take away the ends, but 
give them to an assistant to hold, and then put in the other pin. Vide 
ses of “ Collodion.” lJart x., p. 142. 
Harelip.—When there is a cleft maxilla, and one of the edges of the 
divided alveolus projects, detach the soft parts from the bones more ex- 
tensively than is usually done, and then cut through the protruding alveo- 
lus with the bone forceps, at the spot about corresponding to tiie space 
betwetn the first and second incisors, and bend back the partially 
detached portion to the desired level; it will often quite fill up the gap; 832 
HAY ASTHMA, 
then finish the operation in the usual manner. This operation should be 
performed before dentition, and may be safely done as soon as the child 
»s a month old. Part xviii., p. 1(59. 
Proper Period of Life for Operating on Harelip.—“For my own 
part,” says Mr. B. Cooper, “ I agree entirely with Sir Astley Cooper in 
regarding it as unsafe to operate on infants before weaning: firstly, be- 
cause, from their excessive irritability, they are totally unable to sustain 
any loss of blood; and, secondly, because, after the operation they are 
rendered incapable of sucking; and, indeed, Sir Astley has pointed out in 
his lectures the frequency of the failures he met with in his own practice 
in operating upon infants shortly after birth. I consider the best time, 
under ordinary circumstances, to be soon alter the child is weaned, as it is 
then capable of receiving nourishment independently of its mother, and 
has overcome the distress incidental to the separation from her. 
The twisted suture is, I think, preferable to the interrupted ; but, from 
what I have seen of the practice of my colleague, Mr. Cock, I 
am led to consider the uninterrupted suture better than either.” 
Part xviii., p. 171. 
Harelip—Direction given to the Knife in the Paring of the Edges.—The 
operation was performed in the usual manner, with the exception of the 
direction given to the knife whilst the margins of the fissures were being 
pared. As the scalpel run straight from above downward, Mr. Fergusson 
made it cut slightly inward on botli sides, when he reached the red por- 
tion of the lip, so as to save a little more of that portion than of the part 
covered by skin. This precaution is likely to remedy a defect which is 
generally left after the union of parts in harelip. Every surgeon has 
noticed the peculiar notch which the red part of the lip presents after the 
linear ’wound above it has completely united. Part xxii., p. 322. 
Harelip.—In a complicated case of this kind, after the operation, Mr. 
Quain derived the most essential assistance from the supporting spring, 
which has lately come into use. This encircles the head from behind, 
and the two ends, furnished each with a pad, rest upon the cheeks, 
which are theieby supported in the position given them. All drag- 
ging or pressure upon the sutures is thus prevented. Part xxvi., p. 171. 
New Operation for Harelip.—Having pared the edges, not in the 
usual way, but by an oblique incision from before backward, slightly con- 
cave from above to below, take two or more sutures, each armed with 
two needles, one at either end; introduce the needles immediately under 
the skin, carry them completely through the remaining thickness of the 
lip, and tie them firmly internally, bringing the ends of the sutures out at 
the angle of the mouth, to facilitate removal afterward. A few strips of 
adhesive plaster may be applied externally. All blemishes arising from 
the use of pins are thus avoided. Part xxxvii., p. 140. 
HAY ASTHMA 
Hay Fever or Ilay Asthma—Treatment of by Nux Vomica.—Let ten 
drops of the tincture of the nux vomica of the Dublin Pharmacopoeia, be HEADACHE, 
833 
taken for a dose, in water, and increased gradually to twenty drops, three 
times a day. It is an agreeable light bitter, increases the appetite, and 
influences the Schneiderian membrane, no doubt through the nerves. An 
ointment may also be applied as high up in the nostrils as possible, com- 
posed of 3iss. of Goulard’s extract, spermaceti cerate, §ij. and a few drops 
of oil of roses, or of bergamot. Part xxii., p. 21. 
Diuresis.—Copious diuresis recommended as a revulsive, particularly in 
head affections of children. Part i., p. 24. 
Nervous Headache.—Induced by anxiety, affliction, mental fatigue, etc. 
Half grain doses of the fresh extract of aconite, every two or three 
hours, recommended; the bowels having been previously opened by a 
mild dose of aloes and myrrh pills; Part i.,p. 71. 
Headache of Congestive Fever.—R Liquor ammoniae, §j.; distilled 
water, §ix.; chloride of soda, 9v.; camphor, gr. x. M. Adding any 
agreeable scent. A piece of linen to be steeped, and applied over the 
part, carefully protecting the eyes by a thick bandage above the brows. 
Vide Art. “Fever.” Part viii.,y>. 22. 
Rheumatic Headache.—Against rheumatic headache Dr. Johnson has 
found no treatment so successful as the following: Eight grains of Dover’s 
powder and two of calomel, at bedtime, on alternate nights, for two or 
three times, followed by a third part of the following mixture the next 
morning, to be repeated in two hours, if necessary: 
Infusion of rhubarb, three ounces; tartrate of soda, three drachms ; 
powder of rhubarb, half a drachm; tincture of senna, half an ounce: 
wine of colchicum, a drachm and a half. Mix. Part .viii., p. 27. 
Nervous Headache.—The strong aqua or liquor ammoniae, taken inter- 
nally, will be found to be a most valuable remedy in many cases of neu- 
ralgic suffering about the face and head, odontalgia, severe nervous head- 
ache, etc. The best mode of administering it is to mix from 20 to 40 
drops in a cupful of very thick gruel, and to take this at bedtime, or 
whenever the paroxysm of pain is present. The ammonia must be well 
blended with the gruel, else it will irritate very painfully the inside of the 
mouth and throat. It should produce a profuse salivation and lachryma- 
tion. In very severe or obstinate cases, it may be applied outwardly at 
the same time. Part ix., p. 34. 
Intermittent Headache—Sulphate of Bebeerine.—Dr. Gairdner stated 
that he had recently been very successful in treating a case of intermittent 
headache with the sulphate of bebeerine. The subject was a young and 
recently married lady. There were some reasons to suspect that she 
might be pregnant. The fits of pain were of daily recurrence, and came 
on nearly at the same time. The pain when at its greatest height was 
excruciating. The paroxysm was succeeded by an interval of total 
exemption from pain. He ordered pills containing three grains of sulphate 
of bebeerine in each. Of these, she took three, sometimes four, each day, 
in the intervals between the paroxysms, with the effect of immediately 
HEADACHE. 834 
HEADACHE. 
diminishing the pain, and putting an end to the disease in about three or 
four days. Fart xii., p. 43. 
Certain forms of Headache in Females.—[There is a form of headache 
frequently met with in females, during the menstrual periods, and attack- 
ing mostly the left side of the head :] 
The pain, says Dr. Murphy, is intermittent, shooting, and lancinating ; 
may he fixed for days, and is most severe at the temple (when it is termed 
clavus hystericus), and next at the parietal protuberance and occiput: it 
proceeds from the sub-occipital nerve, and, if the exit of the nerve is 
pressed upon, pain more or less severe is complained of, extending along 
the whole course or at certain sites only of the nerve—as at the temple, 
nape of the neck, parietal protuberance,*etc.: it is usually increased during 
the menstrual period, and is generally a complaint of unmarried females 
between the 33d and 35th years of life, and is indubitably a form of hys- 
teria. The menses are usually profuse or difficult, the bladder irritable, 
and there are ill-defined painful sensations about the pelvis ; other forms 
of neuralgia often co-exist. The irritation of the sub-occipital nerve may 
be traced to the ovaries, being only present where these exist, and while 
capable of fulfilling the function of menstruation; and our treatment must 
be primarily directed to remove any congestion or irritation of these 
peculiar organs, and secondarily to lessen the pain of the nerves. The 
author advises the daily use of hip-baths or sea-bathing, where possible; 
attention to prevent accumulations in the rectum; abstinence from 
stimulants; mental employment; inf. valerian c. digitalis, with pills of 
assafoetida; occasionally general or only local bleeding; and when these 
fail, a gentle mercurial action, the cold bath being, during the time, 
omitted. As local means, he recommends belladonna plasters, veratrine 
ointment, sinapisms, or blistering. Where, however, the patient is 
exhausted by leucorrhoea or profuse menstruation, with symptoms of 
chronic inflammation of the womb or ovaries, the treatment becomes more 
doubtful; but the author prefers the trial of a tonic treatment, and advises 
the exhibition of the valerianate of zinc and quinine, as especially effica- 
cious, and the sulphate of iron in infusion of valerian when there are evi- 
dences of confirmed chlorosis. 
This headache may be termed the nervous headache: it also assumes 
another form, which may be termed the cutaneous headache, and is the 
hemicrania of our forefathers: it seems to be located in the integuments 
of one-half—usually the left side—of the head, which is so exquisitely sen- 
sible as scarcely to bear the least touch of the finger, and the pain never 
passes the mesial line. 
Another form of headache is that arising from deficiency of blood within 
the cranium, and coming on after hemorrhages, exhausting discharges, or 
any other debilitating causes ; the best examples occur in chlorosis. It is 
increased by the erect, diminished by the recumbent posture ; is not a 
very painful form, but is often attended with impaired vision : its cause 
may be traced to diminished muscular power of the heart, which palpitates 
on slight exertion: there is also dyspnoea, pale face, and other symptoms 
of a feeble circulation, with a sinking pain at the epigastrium, and craving 
appetite. If the true cause of this headache is mistaken, and depletion 
used, paralysis has been known to supervene, but if the debility be 
removed, the muscular power of the heart is easily increased ; and the HEADACHE. 
835 
most useful remedies are, steel by itself or combined with quina, full diet, 
and the recumbent posture. 
Another form of headache alluded to by the author, arises from excess 
of blood, and may exist as a passive or congestive, or as an active or 
inflammatory state. The former, arising from the various known causes 
of congestion, is diagnosed by the constant heavy pain at the anterior part 
of the head, increased by the recumbent posture, sense of chilliness, slow 
feeble pulse, tendency to vomiting, and pain in the lumbar region, caused 
by congestion of the spinal cord. It is a dangerous form of headache, 
and has in the depressing diseases proved in a few hours fatal, but in 
other cases, has lasted weeks without much mischief. The treatment 
should be to induce reaction as soon as possible by the warm-bath or an 
emetic. The author deprecated the usual attempts to arrest vomiting 
during the invasion of fevers. If the headache persists, with hot skin, 
leeches to the inner naves will be found of value; applied to the temple, 
they debilitate without relieving this pain of the head, and they are 
altogether inadmissible when this coexists with typhus or scarlatina. 
Blisters may also be applied, and diaphoresis produced by the usual means; 
cokl applications to the head the author considered useless, and even likely 
to increase congestion. Care was also requisite that mere congestion 
should not by the use of stimuli be forced into inflammation, which is 
the next stage if resolution or fatal termination does not take place. 
The author regarded idiopathic phrenitis as a most rare disease, and 
hydrocephalus acutus as congestion, not inflammation. Phrenitis was well 
marked by the tensive pain increased on stooping, by the bright eye, hot 
skin, nausea, and vomiting, tendency to delirium, and occasional twitching 
of the muscles of the face ; the most active antiphlogistic measures should 
be used. 
There were other forms of headache easy of diagnosis, but of these the 
author would only mention the constant pain of head in children, with 
emaciation and want of sleep, and which diagnosed tubercles of the brain. 
The headache of pregnant females referred to the centre of the head, 
and attended with a remarkably slow pulse, and in which, if bleeding is 
neglected, convulsions, abortions, and too often death, are apt to super- 
vene ; and lastly, the pain of the head occurring after a night’3 debauch, 
the cause of which, whether in the stomach or alfected organ, the author 
considered not to have been sufficiently investigated. 
Part xvii., p. 2'79. 
Headache—Intermittent.—In intermittent headaches, brow ague, 
cephalalgia, and other affections in which the mucous membrane of the 
frontal sinuses appears to be the seat of pain, arsenic has proved efficacious. 
Part xxiv., p. 30. 
Headache.—Give doses of half a grain to one grain, three times a day, 
of the sulphate of nickel. This remedy seems to have been a very valu- 
able one in the hands of Dr. Simpson, of Edinburgh. It seem to be of use 
in those cases in which iron has been employed, especially in chlorosis and 
amenorrhcea. Part xxvi., p. 338. 
Periodical Headache.—Use sulphate of nickel as above. 
Part xxvii., p. 340. 
Congestive Headache.—Simple congestive headache and other painful 
affections of the head may be relieved by what is called “traction,” or dry 836 
HEMATOCELE, 
cupping. The spine, and if necessary, the whole back, is smeared with 
spermaceti ointment. The cupping glass is then exhausted and fixed on 
any given spot; it moves with facility over the anointed surface, acting 
powerfully as it goes along. This is very useful in hysterical headache. 
Neuralgic and Hysterical Headache generally depends on subacute 
ovaritis, and attacks the left side of the scalp, shooting from the neck to 
forehead and not vice versa, as in odontalgia. Use the following remedies 
according to circumstances: open the bowels well and regularly; use the 
cold hip-bath or sea bathing; a sinapism or blister to the back of the 
neck; belladonna plaster with a little opium in it. Tonics, as quinine in an 
infusion of valerian; valerianate of zinc, half a grain three times a day with 
one drop of ereasote ; sulphate of iron combined with valerian and ammo- 
nia, or the ammoniated tincture of valerian; morphine in doses of one-sixth 
or one-quarter of a grain to relieve the pain, if other remedies fail. 
Part xxix., p. 314. 
Cephalalgia.—This often comes on from any exposure of the head to 
cold air, and is then generally removed by a cup of strong coffee, or a dose 
of the hydrochlorate of morphia. If these fail when given separately, they 
will frequently effect an immediate cessation of the pain when given in 
combination. Part xxxiv., p. 30. 
Nervous Headache.—To relieve the immediate distressing pain, ano- 
dynes are required. If opium or its alkaloid cannot be resorted to, there 
are other efficient anodynes which may be appealed to. Of these, aconite 
is most to be relied on, from one to two minims of Fleming’s tincture may 
be given and repeated every two or three hours if necessary. In some 
cases, the effect is marvellous. The action of chloroform in this particular 
is too transitory to be of any avail. There are also other agents which 
might be called nervines, as valerian, and amongst dietetic means, tea and 
coffee, which are particularly applicable when the headache is the result 
of fatigue, mental or bodily. Of tonics, to exalt the nervous tone of the 
system, quinine and arsenic are by far the best; iron being also added 
when there is an obvious deficiency in the red corpuscles of the blood. It 
is in that form of headache which comes on in distinct paroxysms at regular 
intervals that arsenic is of most value ; it should be given in small doses and 
for a lengthened period. Perhaps next in value to quinine and arsenic, 
comes zinc, of which the valerianate is the most eligible preparation, but 
it is usually given in doses far too small; six grains are often productive 
of much relief, and cause no ill effects. Part 276. 
HEMATOCELE. 
Hematocele of the Thyroid Gland—Treatment by Tree Incision— 
Cure.—[Mr. Bickersteth was consulted on the 27th Sept., by Mrs. M., 
regarding a tumor resembling a large bronchocle, extending from the top 
of the sternum to the top of the larynx. It was smooth and fluctuating, 
and the integuments very thin over the most prominent portion. It had 
existed three years; but latterly the breathing had become much 
ppressed. The fluid, of a thin dark appearance, was drawn off by x 837 
HEMATOCELE. 
trocar and canula, to the great relief of the patient. On the 4th of Octo- 
ber, however, she returned, with the symptoms more aggravated, and the 
tumor larger ; the fluctuation being quite as distinct as before. Mr. Bick- 
ersteth proceeds :] 
From the consideration of the circumstance that the tumor was com- 
posed of a single cyst, and that its contents were entirely fluid, as appa- 
rently proved by the former tapping, admitting consequently, of complete 
evacuation, I thought that injection with tincture of iodine, after the 
sac had been completely emptied, would afford a reasonable prospect of 
inducing its obliteration; and I was further encouraged to attempt this 
treatment by the recollection, that even if it should fail, no obstacle 
would be presented to the more severe measure of laying the cavity freely 
open. 
Three drachms of the pure tincture of iodine were placed in a glass 
syringe, and I prepared to inject, having first emptied the cyst as far as 
possible. About four ounces of dark fluid blood, much thicker and more 
tarry than upon the last occasion, passed freely through the canula, and 
the swell.ng was removed as effectually as before. But now florid blood 
began to ooze very rapidly, and continued to do so in spite of the means 
used to check it. On this account the injection was discarded, for I feared 
the free hemorrhage would prevent the tincture from coming into contact 
with the walls of the cyst, and thus Tail in producing the requisite degree 
of inflammation; moreover, I did not like the consequences of mixing 
tincture of iodine with fresh blood in the interior of a cyst occupying 
this situation. The canula was therefore withdrawn, and perhaps it was 
as well, for within five minutes the tumor was almost as large as ever. 
Still the relief to her immediate distress was considerable, and by her 
request a short delay was granted, before proceeding to more radical 
treatment. 
October 8th.—She is now earnestly desirous that something should be 
done immediately to relieve her. The breathing is more laborious than 
ever. The inspiration prolonged, and performed with considerable effort. 
Each attempt is accompanied by a peculiar crowing sound. The tumor 
is very firm and tense ; and the skin is ecchymosed over the whole of the 
neck and chest. The patient being seated upon a chair, with the head 
thrown back, and supported by an assistant, I introduced a sharp-pointed 
bistoury into the most prominent part of the tumor, a little to right of the 
mesial line, and having opened the cyst, I enlarged the wound downward 
to the extent of about two inches, by means of a curved probe-pointed 
bistoury. I now ascertained that the cyst was of much greater size than 
I had previously imagined. It passed downward and backward deeply 
into the root of the neck, behind the sternum and in front of the trachea, 
farther than my finger would reach; and from this part I was able to turn 
out large clots of dark solid blood. Hitherto there had been very little 
hemorrhage; bnt in order to treat the case effectually, it appeared neces- 
sary to make the external opening still larger, for as yet, not more than 
one-third of the known extent of the cavity had been opened. But at the 
lower part its depth from the surface greatly increased, and a considerable 
portion of the substance of the thyroid was evidently placed before it, so 
that by cutting in this direction, the danger of wounding important ves- 
sels was great in proportion. Using my knife in the same manner, I again 
extended the incision to within half an inch of the top of the sternum, and 838 
HEMICRANIA. 
thus laid open the'cyst as freely as it was possible. Even then I could not 
find the bottom of the cavity. The hemorrhage from this last incision was 
very profuse ; the blood spouted in every direction as from a sponge, and 
proceeded manifestly from the divided walls of the thyroid. After the 
loss of a few seconds spent in a vain endeavor to secure the vessels by 
ligature, the cavity was stuffed with lint till the cut surfaces were widely dis- 
tended, and then, by drawing a few straps of adhesive plaster from side to 
side, a uniform and steady pressure was secured, which immediately and 
effectually checked all further bleeding. 
The future progress of the case has in all respects been most satisfac- 
tory. Not a single unfavorable symptom occurred. On the third day 
discharge from the wound commenced, and part of the lint came away; 
and at each succeeding dressing a portion separated, until on the eighth 
day the whole had been discharged. Then the cavity began to contract, 
and the swelling and discharge to decrease. At the same time the mar- 
gins of the wound approximated, and showed so great a tendency to unite, 
that it was necessary every second or third day to introduce my finger, 
in order to keep the opening patent until the obliteration of the cyst was 
complete, etc. To hasten the process, I directed a blister to be applied, 
and with most beneficial results. The discharge became thin, and of small 
amount. The edges of the incision puckered in, and have now (five 
weeks after the operation) all but closed, forming a deep furrow, with the 
divided lobes of the thyroid on either side. The breathing has continued 
perfectly free, and the voice also is slowly recovering its natural tone and 
force. 
The perfect relief afforded by this treatment to the most urgent and 
distressing symptoms was most gratifying, and the simplicity of the ope- 
ration, together with the absence of any unfavorable occurrence, is highly 
encouraging for future guidance. 
The real, as compared with the apparent size of the cyst—its extension 
downward so much further than was indicated by external examination— 
its partially solid contents, when fluid alone was discovered with the 
trocar, and every reason existed for supposing that none other was pre- 
sent—are facts not to be forgotten, and must always more or less influence 
our diagnosis, until an actual exploration with the finger has been effected. 
It may be remembered also with advantage how utterly useless in the 
wounded thyroid the ordinary method of securing the vessels by ligature 
proved, and how easily profuse arterial hemorrhage was stopped by con- 
tinued pressure. Part xxvii., p. 256. 
Treatment of Hemicrania and Tic Douloureux by Cauterizing the 
Palate.—In the most intense hemicrania, and in the most obstinate tic 
douloureux, whether fronto-facial or temporo-facial, the pain disappears 
instantaneously on the application of ammonia at 25 degrees, to the pala- 
tine arch, by means of a (camel’s hair) brush; the brush being allowed to 
remain on the part till a copious flow of tears has been excited. 
M. Ducros has tried this in a great number of cases, and the pain has 
always ceased. If the pain returns, a fresh application again produces a 
cessation of the neuralgia. Part viii. p. 159. 
HEMICRANIA. 839 
HEART, 
Citrate of Caffeine in Hemicrania.—Dr. Hannon advocates very 
strenuously the use of the above salt in hemicrania. It is to be given in 
doses varying from five grains to one drachm. Part xxii., p. 86. 
New Pemedy in Hemicrania.—Dr. Jung stated at the Berlin Society 
of Medicine, that in the neuralgic pains known by the term migraine, or 
hemicrania, and especially when the infra-orbital nerve is affected, he has 
found the aspiration of the following mixture an almost infallible remedy. 
Dissolve four grains of acetate of morphia in a few drops of acetic acid, 
and add 3iss. of laurel water and 10 drops of prussic acid. Of this mix- 
ture 10 drops (or in very excitable persons five) are to be mixed with an 
equal quantity of water, and strongly aspired by the nostril corresponding 
to the side of the pain, keeping the other closed. The relief is immediate; 
but the existence of coryza is a contra-indication to the employment of 
the remedy. Part xxxvii., 259. 
Chloroform in Hemicrania.— Vide Art. “ Chloroform.” 
Use of Ether in Capsules.—Recommended in hemicrania. Vide Art. 
“ Ether.” 
Hypertrophy of the Heart.—The cautious administration of small 
doses of extract of conium suggested. Part i., p. 59. 
Use of Sulphur in some Spasmodic Affections, particularly in Angina 
Pectoris.—[Dr. Munk was first led to notice the effects of this remedy in 
a gentleman whom he was attending for a different disease, and who was 
attacked with angina pectoris toward the termination of the attendance. 
Dr. Munk, on taking leave, advised the sulphur to be taken regularly as a 
laxative, without any view of curing him of his accustomed attacks of 
angina pectoris, to which he was very liable.] 
Some months after this [says Dr. M.], when in attendance upon a mem- 
ber of his family, I inquired concerning the attacks, and was informed that 
there had been no return of them. lie had also remained free from 
hemorrhoids, and had kept the bowels gently relaxed by sulphur, a drachm 
of which in milk he swallowed every night on going to rest. 
In consequence of the disagreeable odor of the perspiration, arising 
from its continued use, the confection of cassia was substituted for it. Six 
weeks after this he had a severe attack of angina, another in about a 
month, and again, for a third time, after an interval of seven weeks. At- 
tributing the relapse to the electuary, he of himself again had recourse to 
sulphur. The bowels were kept by it rather more open than by the cas- 
sia ; and, for a considerable period, he continued free from the paroxysms. 
In the autumn of 1838, owing to the heat of the weather, and the conse- 
quent increase of his perspiration and its disagreeable concomitant, the 
sulphureous odor, he once more discontinued its employment, taking now, 
in its stead, small quantities of castor oil, or of the compound rhubarb 
powder of the Edinburgh Pharmacopoeia. Again did the paroxysms re- 
turn, and for a third time did they cease with a recurrence to the employ- 
ment of sulphur. This medicine he continued during the whole of the 
winter, without any return of the complaint. 
HEART. 840 
HEART. 
Dr. Munk was still unable to account for the modus operands of the 
drug until he met Avith Dr. Chapman’s “ Elements of Therapeutics,” in 
which work it Avas asserted that sulphur, e<en when applied topically in 
the form of powder to any part alfected with spasm, cramps in the mus- 
cles, stomach, etc., had a decidedly good effect. Dr. Munk found this 
to be the case, in a case of the latter disease. Part ii., p. 15. 
Functional Derangement of the Heart in Growing Persons.—In refer- 
ence to the diagnosis of such cases, Dr. Corrigan says: 
It is, I believe, as a general rule in such cases, safer and better to judge 
of the strength of the heart by the force of the blood impelled by it than 
by any indication of its state supposed to be furnished by auscultation of 
its action. It is, I believe, also more rational to judge of the power Avith 
which the organ acts (except in obstructions of its orifices), by feeling the 
force of the fluid sent out by it along the main trunks, than by drawing 
an opinion from degrees of intensity of sounds and impulse, on which, 
perhaps, no two observers will agree. It is more reasonable to judge of 
the strength of the action by the momentum of the propulsion than by 
the recoil of the organ, or the noise of its action. 
There is in some of those cases a curious circumstance observable ; the 
boy Avho cannot run or Avalk a hundred yards without palpitation, Avill 
SAvim for a very long time without being in the least incommoded by the 
action of the heart, probably from the spinal muscles not being disturbed 
Avith the weight of the trunk in the latter exercise; but whatever the 
cause, the occurrence is useful as an aid to our diagnosis. 
The treatment consists in diminishing the nervous irritability of the 
patient, and in restoring the tone to the constitution, by sea air, sea bath- 
ing, and full diet, with the different preparations of iron. 
In one case the patient Avas given three drops of hydrocyanic acid every 
night in §j. mist, camph. and half a grain of sulph. quin, ter in die. The 
palpitations Avere rapidly relieved, but not removed. He Avas put upon 
full diet and Avine, and in the course of the summer he recovered ; the pal- 
pitations gradually Avearing out. Part iii., p. 58. 
Sounds of the Heart.—M.- Cruveilhier publishes his OAvn observations on 
an infant born Avith its heart completely exposed and protruding through 
an aperture in the thorax; it lived twenty-four hours after its birth. He 
found only tAvo conditions of the heart, viz., contraction and dilatation ; 
that of repose generally mentioned by authors was completely Avanting. 
During their systole, the parietes of the ventricles became pale, their sur- 
face rugged and in folds, and the fleshy colors more marked. “ The tAvo 
sounds of the heart have their seat at the origin of the pulmonary and 
aortic arteries, and their cause is the flapping (claquement) of the sigmoid 
valves. The first sound which coincides Avith the ventricular systole, and 
Avith the dilatation of the arteries, is the result of replacing (redressement) 
of the sigmoid valves, previously loAvered. That the second sound, Avhich 
coincides Avith the ventricular systole and with the contraction of the 
arteries, is the result of the lowering of the sigmoid Aralves, pushed dow?n 
by the reflux of the retrograde blood.” Part iv., p. 150. 
Sounds of the Heart.—Dr. Watson says: 
The sounds Avhich we hear are tAvo. One of them coincides, in poini 
of time, with the impulse ; and barely precedes the beat of the radial HEART. 
841 
artery. It happens, therefore, when the ventricles contract; during the 
systole. It is accordingly called the first sound of the heart, or the sys- 
tolic sound. The other of the two sounds coincides with the diastole, and 
is spoken of as the diastolic or second sound. It takes place at the in- 
stant when the heart reverts to that place and condition in which it had 
been prior to the systolic movement. These two sounds occur in quick 
and regular succession, and then follows an interval of silence, after which 
the two sounds are repeated; and so on. 
The two sounds are not, however, exactly alike. They differ, somewhat, 
both in quality and duration. The first is a dull, prolonged noise; the 
second a shorter and smarter sound, having more of a clacking or flapping 
character. 
The natural sounds which I have been describing are liable to be 
changed or modified by disease. Either sound, or both, may be accom- 
panied by a noise, which, in its commonest type, very closely resembles 
that produced by the blowing of a pair of bellows. Four persons out of 
five, I should think, if asked what this sound resembled, when they heard 
it accompanying each systolic movement of the heart, would say that it 
was exactly like the repeated blowing of bellows in an adjoining room. 
It is called accordingly, by the French, the “ bruit de soujfietand in 
homely English, a' bellows sound. These sounds are often denominated 
murmurs. 
The blowing sound may be occasioned by any change which altei's the 
due proportion between the chambers of the heart and their orifices of 
communication with each other, and with the blood-vessels that respec- 
tively enter or leave them ; it may also be occasioned by a preternatural 
velocity in the passage of the blood through a healthy and well-adjusted 
heart. If one of its orifices—say the aortic orifice—be narrowed, by dis- 
ease of the valves, or in any other way, the blood will not, as before, glide 
through it smoothly and without noise, but will yield that sound which 
we call a bellows sound. So, also, if the orifice retain its natural dimen- 
sions, but the capacity of the cavity from which the blood is driven be 
augmented. Nay, the same blowing sound may be produced though the 
cavities and orifices be all healthy, and duly proportioned to each other, 
if the velocity of the circulating blood be increased beyond a certain 
measure. If you bear this explanation in mind, it will be found appli- 
cable, I think, to almost every case in which there is a blowing sound ac- 
companying the systole of the organ. If, at the same time, the valves 
over which the blood must pass be rigid, or rough, or even loose and vib- 
rating, these circumstances may modify the blowing sound, and render it 
louder, or hoarser frhan it would otherwise be, and justify the applications 
of bruit de scie, and bruit de rape. 
But this explanation applies to a systolic blowing sound only. What 
are wre to say when there is a similar sound attending the diastolic move- 
ment of the heart? Why a diastolic bclloAVS sound will mostly, if not 
always, be found to accompany and denote some organic disease affecting 
the valves of the heart. Thus, if the mitral valve be converted, as it often 
is, from a loose flapping valve into a bony and rigid unvarying chink, the 
blood which passes through it from the auricle to the ventricle, during the 
diastole, may cause a rushing or blowing sound. On the other hand, the 
reflux of blood through the unshut mitral orifice, during the ventricular 
contraction, may also be attended (though it seldom is) with an audible 842 
HEART. 
noise; and thus we have another source of a systolic murmur. Again, if 
the aortic valves are imperfect, as they often are, and do not effectually 
close that vessel, blood will regurgitate, through them during the diastole, 
and produce a bellows sound. That this is the true explanation of the 
diastolic murmurs, I am convinced both by the observation of disease, 
and by the results of experiments on animals. In some of Dr. Hope’s 
experiments, which he was good enough to allow me to witness, the short 
clack of the diastole was at first distinctly audible; then hooks were in- 
troduced, so as to prevent the perfect closure of the sigmoid valves dur- 
ing the diastole, and then the short smart clack was converted into 
a prolonged bellows murmur: and upon letting them go again, the short 
smart clack recurred. And I have repeatedly predicted, and found such 
disease of the sigmoid valves as prevented their proper function—that of 
shutting out the blood in the aorta from reentering the ventricle—I have 
repeatedly predicted that morbid condition when I met with a certain 
kind of diastolic bellows sound during life, and have found it, and justified 
the prediction after death. 
[In another lecture Dr. Watson makes some valuable observations on 
valvular disease. It being ascertained by the bellows sound that valvular 
disease exists somewhere, can we fix on the particular valve implicated ? 
This may often be done.] 
When a bellows sound accompanies the systole, it must be caused by 
a current passing out of a ventricle. But serious disease of the valves, 
sufficient to occasion a murmur, on the right side of the heart, is very 
rare. In nineteen cases out of twenty, valvular murmurs belong to the 
leftside; so that practically the distinction lies, almost always between 
two orifices, the mitral and aortic, the inlet and the outlet of the left ven- 
tricle. The natural inlet has become an outlet also; or the natural outlet 
obstructed. Now, if the sound be heard at the base of the heart, and 
along the track of the thoracic aorta, up toward the right clavicle, and 
even in the carotids; and if it be less audible toward the apex, and if the 
pulse be steady and regular, the mischief is seated in the semilunar valves 
of the aorta / there is some obstacle which produces a ripple in the 
onward stream of the blood. 
On the other hand, if the pulse be irregular, and if the sound is heard 
better toward the apex of the organ, on the left, it is owing to the regur- 
gitation through a diseased mitral valve. Such regurgitation is often at- 
tended with a purring thrill. 
When, what scarcely ever happens, the sound does result from injury 
of the semilunar valves of the pulmonary artery, it is heard plainest in the 
track of that vessel, up toward the left clavicle. So, also, a murmur pro- 
duced by change in the tricuspid valve Avould be loudest toward the 
apex, on the right. The arterial pulse, for obvious reasons, is but little 
influenced by disease affecting the orifices of the right heart. 
Again, if the morbid sound be diastolic, it accompanies the entrance of 
blood into a ventricle ; and for similar reasons as before, the fault is most 
probably in the left ventricle. It may be owing to the direct, but 
impeded passage of the blood from the left auricle through a narrow 
mitral orifice : yet this very seldom occasions any audible noise. Or the 
diastolic murmur may proceed from regurgitation through the defective 
aortic valves; the natural outlet having become an inlet also ; and this is 
exceedingly common. We attend, as before, to the situation and the 843 
track in which the sound is the loudest. We listen also for the smart 
clack of the natural second sound; and if it is not to be heard, or is very 
indistinct, we have, in that circumstance, corroborative evidence of an 
imperfect aortic floodgate. Moreover, we are again assisted by the pulse. 
The pulse of aortic regurgitation is very striking and peculiar; sudden, 
like the blow of a hammer, -without any prolonged swell of the artery. 
It always reminds me of the well-known chemical toy, formed by includ- 
ing a small quantity of liquid in a glass tube, exhausted of air, and her- 
metically sealed. On reversing the tube, the liquid falls from one end of 
it to the other with a hard, short knock, as if it were a mass of lead. 
The sensation given to the finger by the pulse, when there is much regur- 
gitation through the aortic valves, is very similar to this. It is as if 
successive balls of blood were suddenly shot along under the finger. Dr. 
Hope calls this pulse a jerking pulse ; the pulse of unfilled arteries. And 
this abrupt pulse makes itself visible in the arteries; the wave of blood 
lifts, and moves, and sometimes contorts the vessel. When this kind of 
pulse occurs with a diastolic bellows-sound, heard in the track of the 
aorta, and the short clack of the second sound is absent or diminished, 
you may be quite sure that the aortic orifice is patulous during the 
diastole. The reflux of the blood, when the patency is great, is 
strong enough sometimes to produce a palpable shock or jog, called 
the diastolic impulse. And this refilling of the ventricle from the 
artery may even provoke it to a supernumerary contraction. 
Fart y.,p. 13. 
HEART. 
Rheumatic Heart Affection.—Dr. Todd remarks: Any change in the 
character of the pulse, the occurrence of intermissions in it, a sudden 
diminution or increase in its frequency or force, an irregularity in its 
rhythm, ought at once to awaken the suspicions of the physician as 
regards inflammation, either within, or on the surface of the heart. Above 
all, he should be most careful in his endeavors to detect the first indica- 
tions of a change of structure on the outer or inner surface of the heart, 
as denoted by the presence of a friction-sound, or a bellows-sound. The 
occurrence of any of these signs is, in my judgment, a sufficient warrant 
to justify his having immediate recourse to local bleeding over the cardiac 
region. A large number of leeches should be at once applied ; or a good 
quantity of blood should be taken by cupping. I have no doubt that by 
prompt practice of this kind, inflammation of the heart may be checked 
at its commencement. 
My experience leads me to value very lightly the efficacy of general 
bleeding in inflammation of the heart. I have never seen an instance in 
which it unequivocally did good. 
Immediately after local bleeding, a large blister should be applied, not 
exactly over the cardiac region, but a little to the right of it, in order to 
allow space for the application of more leeches if necessary. The blis- 
tered part should be afterward dressed with mercurial ointment, the 
cuticle having been previously freely removed, so as to expose a large 
surface, from which an abundant secretion may be provoked. If there be 
much irritability, opium should be freely administered; and, if a friction 
sound or a bellows sound be present to indicate that the products of 
inflammation have already begun to be formed, then mercury, combined 
with opium, should be given in doses sufficient to get the system under 844 
HEART. 
its influence as quickly as may be done without depressing the patient too 
much. There is a twofold object in administering mercury under these 
circumstances; first, to check the effusion of lymph; and, secondly, to 
promote the absorption of that which has been already poured out. 
When these constitutional effects of mercury can be quickly induced, 
these important objects will generally be attained. 
It appears to me that there are two states in which, although inflamma- 
tion exists, mercury is slow to produce its constitutional effects. The first 
of these is when the fever is of a highly irritative character, the nervous 
system being in a state of excitement or “alarm;” this occasionally hap- 
pens in pericarditis, and may be brought on by the too frequent use of 
the lancet. Mercury is almost inadmissible in such cases, for it increases 
the general irritability; if administered, it should be given sparingly and 
conjoined with opium in large doses. The second is, when a very extensive 
inflammation exists; under these circumstances mercury appears to me to 
act as opium does in certain diseases; in tetanus, for instance, what enor- 
mous doses of this drug will be borne with little or no apparent narcotic 
effect! What large doses of opium may be given in rheumatic fever 
itself! Such quantities could not at all be borne by the system in health. 
In pneumonia we give tartar emetic freely; it acts favorably upon the pul- 
monary disease, without perceptible effect beyond the resolution of the 
pneumonic inflammation ; yet if we gave as much to a person in health, 
nausea and vomiting would immediately ensue. Tonics likewise may at 
times be given to an enormous extent without any exciting effect on the 
system; and so also with stimulants, a man in typhus fever may take with 
impunity in a short time, as much wine and brandy as would intoxicate 
him in a state of health. I believe the same principle holds with respect 
to mercury; and that in some cases it acts wholly on the diseased organ, 
and produces none of its usual constitutional effects. We are not to infer 
that in such cases mercury does no good, and is inadmissible ; on the con- 
trary, if no untoward effect is produced, we should persevere with the use 
of it, even after the more acute symptoms have subsided. The rate of 
action of the mercury may even assist us in forming an opinion as to the 
extent of the inflammation, a tardy action indicating that it occupies a 
considerable surface; and it may also aid our prognosis, for the appear- 
ance of the affection of the mouth within a moderate time (two or three 
days) augurs well, whilst a difficulty in producing ptyalism must be consi- 
dered inauspicious. Part ix., p. 47. 
Digitalis in Certain Diseases of the Heart.—Agreeing fully in the 
power which digitalis possesses of diminishing the frequency of the heart’s 
action, and the salutary influence which it consequently exerts over many 
of its diseases, the author wishes to show that in all those diseases this 
influence is not the same; in some instances the use of this agent being 
injurious rather than beneficial. Thus, for example, as had been pre- 
viously pointed out by Dr. Corrigan, in cases of patency of the aortic 
valves. 
The operation of this influence is thus explained by Dr. Henderson : 
Patency of the aortic opening, at that period when the ventricles are being 
filled, necessarily admits of regurgitation from the aorta, the eflects of 
which are an overloading of the left ventricle, and gradually an enlarge- 
ment of it. Such being the tendency and issue of the overloaded condition 845 
HEART. 
of the organ which results from this regurgitation, it will he granted that 
whatever increases the amount of the regurgitation must accelerate the 
progress of the enlargement. That the less frequently the heart beats the 
greater will be the opportunity for this regurgitation, is sufficiently obvi- 
ous ; and hence it is that the prolonged employment of digitalis cannot but 
be injurious Avhen the aortic valves are not competent for their office. On 
the other hand, the most favorable results are found to follow the use of 
this drug in disease affecting the mitral valves. Disease of these valves 
gives rise to one of two effects, or to both at the same time, viz., obstruc- 
tion to the flow of blood from the left auricle to its corresponding ventricle, 
or to regurgitation of the same fluid from the ventricle to the auricle. 
When either of these occurrences amounts to a considerable degree, and is 
of long continuance, hypertrophy of the right ventricle supervenes, and 
then it is that the sufferings from dyspnoea are developed, and that dropsi- 
cal effusions take place. Part ix., p. 92. 
Enlargement of the Heart, connected with Incompetency of the Aortic 
Valves.—There is one disease of the heart in which Dr. Ilendei’son has 
shown that digitalis must be highly prejudicial, viz., a patency of the aortic 
opening. When this disease exists, the blood will necessarily be regurgi- 
tated into the left ventricle, and ultimately produce enlargement of its 
cavity; so that under the influence of digitalis the ventricle will act less 
powerfully to empty itself of its contents, regurgitation will be more com- 
plete, and the cavity will consequently be habitually distended and eventu- 
ally permanently enlarged. These are the views of Dr. Corrigan, as well 
as of Dr. Henderson. It is well, therefore, whenever we suspect incom- 
petency of the aortic valves, to avoid giving digitalis, or doing anything 
which may diminish the capability of the ventricle to empty itself regularly 
of its contents. Digitalis, according to Dr. Corrigan, will be found to ag- 
gravate the sufferings of the patient; “his oppression will become greater, 
the action of the heart more labored, the pulse intermittent, general con- 
gestion and dropsy will be increased, and in some instances bronchitis from 
congestion, have been induced; and the respiration becomes more labori- 
ous.” This opinion, however, is not always correct, if we may judge from 
facts, although it is a view which ought always to be remembered in the 
treatment of this disease, as we are persuaded that the too common and 
indiscriminate use of repeated blood-letting, spare diet and digitalis for 
heart disease is a very improper practice, some of these cases requiring a 
treatment exactly opposite. 
“ One case may be mentioned, out of many that occurred, showing the 
bad effects of debilitating treatment on the disease before us, and exempli- 
fying the evil of acting as if one principle were sufficient for guiding us in 
the treatment of all heart diseases. The treatment ordered was in accord- 
ance with that generally recommended, consisting of repeated small bleed- 
ings, blistering, the exhibition of digitalis, and the most rigid regulation 
of diet, a total abstinence from animal food, and even a spare allowance of 
vegetables and milk. At the time the patient, a young man, was put 
under this treatment, he was not in an alarming state; but the disease being 
recognized as heart disease, he had the fortitude to submit to a course 
which he was led to expect held out a prospect of cure. Bleeding after 
bleeding, and blister after blister, were repeated, starvation enforced, and 
digitalis exhibited, until the patient was reduced to such weakness that he 846 
HEART. 
had scarcely strength to raise himself in bed. The local disease was all 
this time, however, growing worse; for the palpitation, cough, etc., were 
from the slightest cause increased to a greater violence than previous to 
the commencement of the treatment. The plan was, nevertheless, perse- 
vered in, until the patient’s death being supposed at hand, this debilitating 
treatment was discontinued. From that hour the patient got better; and 
as his muscular strength returned, the embarrassment of breathing, palpita- 
tion, cough, etc., became less and less urgent. The patient is still alive; 
the disease is still present; but with full living and good air, he is able 
not only to take considerable exercise, but even to undergo the fatigue of 
a business that constantly requires very laborious exertion.” Part x., p. 53. 
Effect of Alkalies in preventing Heart Disease in Rheumatism.—In 
connection with diseases of the heart, we may allude to some recent opi- 
nions on gout, which is so often the cause of some of these affections. IVe 
are indebted to Mr. Ure for many useful observations on this subject. His 
remarks on the utility of the benzoic preparations in controlling phosphatic 
deposition have been alluded to. In another paper he shows that, from 
the experiments of Frommherz and Gugert, for some time before a tit of 
gout the urine contains no uric acid; whereas at other times it is well 
known that there is a superabundance. The uric acid, therefore, is pent 
up, and circulates with the blood, forming urate of soda through the me- 
dium of the serum of the blood; and the salt, by thus intermixing with 
the blood, is supposed to cause many of the phenomena of this disease. 
Dr. Furnivall, in a paper which he has written on the effect of alkalies in 
this affection, asserts that he has long been in the habit of averting the 
effects of gout on the heart by these remedies, but offers no further ex- 
planation of their action than that they correct the acidity of the blood 
which is often found to exist in these cases. The blood in health is found 
to be slightly alkaline. Any acidity, therefore, will be stimulating to the 
heart and blood vessels; and. when this is connected with another fact, viz., 
the increase of fibrin, which Andral proves to exist in the blood during an 
attack of rheumatism, we have two circumstances which must strongly 
tend to excite inflammatory action in the serous membranes of the cardiac 
ventricles, and of the left ventricle in particular. With these views Dr. 
Furnivall has used alkalies extensively in these cases since 1830. lie pre- 
fers the liquor or carbonas potassae, and continues the use of this medicine 
till all acid diathesis ceases to exist. 
Mr. Ure suggests another mode of treatment which maybe combined 
with the use of alkalies. It has often been noticed that when the uric acid 
increases, the secretion of bile decreases, and vice versd. For this reason 
all those remedies which cause an increased secretion of the bile are bene- 
ficial in diminishing more or less the uric acid diathesis. This he asserts 
to be the particular effect of sulphate of manganese, which M. Gtnelin has 
shown, by injection into the blood vessels, to augment the biliary secretion 
so much as to produce a deep yellow staining of the coats of the intestines, 
and of the great vessels in the vicinity. Mr. Ure recommends that a 
drachm of this sulphate be dissolved in about half a pint of water and 
swallowed before breakfast. It will be followed by one or more liquid 
stools of a biliary description, and does not occasion those lowering and 
distressing effects which occasionally follow the exhibition of calomel and 
antimony. jPart x., p. 61. 847 
Characters of the Pulse in Diseases of the Heart.—In contraction of the 
aortic orifice, the pulse is regular and preserves its natural strength and 
fullness, unless the obstruction be extreme, when it becomes small, weak, 
and, in some rare cases, intermittent. In the regurgitant lesion of the 
aortic orifice, the pulse is almost pathognomonic of the disease : it is regu- 
lar, but jerking and receding, and the pulsation of the arteries is visible. 
This depends upon these vessels being incompletely filled, owing to a por- 
tion of the blood transmitted by the systole of the left ventricle returning 
into the ventricle during its diastole. In addition, in this valvular lesion, 
the radial pulse follows the ventricular contraction at a somewhat longer 
interval than in the healthy heart. These characters of the pulse will be 
better marked when the left ventricle is, in addition, hypertrophied and 
dilated. Part x., p. 63. 
HEAKT, 
Prognosis of Valvular Heart Disease.—Dr. Bellingham says: The 
prognosis in valvular disease depends upon a variety of circumstances—as, 
for instance, the particular valve engaged, the nature and amount of the 
lesion, the age of the patient, and the condition of his health, the length of 
time which the disease has lasted, its rapid or slow progress, the altera- 
tions of other parts of the heart, or of other organs with which it is com- 
plicated, and the profession, occupation, and habits of the patient. Val- 
vular disease, if not extensive, and if uncomplicated with hypertrophy or 
dilatation of the ventricles, or congestion of the lungs or other organs, does 
not, by itself, necessarily shorten or' destroy life. Many individuals Avhose 
circumstances removed them from the necessity of active occupation have 
lived long, and have died of other affections. If, however, the disease ha? 
advanced so far as to be complicated with dropsy, and if the patient is in 
temperate, or is obliged to labor for his maintenance, the prognosis is un- 
favorable, and the disease will have a fatal termination, sooner in some 
cases, and later in others. 
The most formidable varieties of valvular disease are, a state of consider- 
able contraction of the mitral orifice, and a state of the aortic valves per- 
mitting free regurgitation. A contracted state of the aortic orifice is a less 
dangerous lesion than a contracted state of the mitral orifice ; and a state 
of the left aurieulo-ventricular orifice permitting regurgitation, is a less 
dangerous lesion than a state of the semilunar valves permitting regurgita- 
tion; because the impediment or obstruction to the circulation is always 
greater in the latter than in the former cases. When disease engages two 
valves at the same time, the prognosis is always, as may be supposed, more 
unfavorable than where a single valve is engaged. For instance, regurgi- 
tant disease of the mitral valve may exist, as I have said, for a considerable 
time, without occasioning much embarrassment to the circulation, or much 
inconvenience to the patient; but if it comes to be complicated with con- 
traction of the aortic orifice, the danger becomes considerable, because, as 
the ventricle contracts, there is not only the direct impediment to the pass- 
age of the blood into the arterial system, but much of it is likewise im- 
pelled backward into the auricle. When mitral regurgitation is combined 
with regurgitation through the aortic orifice, the circulation is liable 
also to become greatly embarrassed, and still more so if these valvular le- 
sions are further complicated with hypertrophy or dilatation of the left 
ventricle. Considerable contraction of the mitral orifice is, as has been said, 
one of the worst forms of valvular disease; but if this condition of the 848 
HEART. 
mitral orifice is combined with regurgitation through the aortic orifice, the 
prognosis will be still more unfavorable, because the impediment to the 
circulation will be greater, and its effects will sooner become evident upon 
the system. In some cases of this description the patient expires suddenly; 
in the others he lingers for a longer or shorter time, and dies, worn out 
with pain and suffering. The age of the patient exerts some influence upon 
the rapid or slow progress of the valvular disease; in young persons it 
usually pursues a more rapid course than in old age—hence the prognosis 
is more unfavorable here (because tlie parts have not time to accommo- 
date themselves to their altered condition) than in the cases of old people, 
in whom valvular disease not unfrequently arises so gradually and slowly, 
that the patient is unconscious himself of anything being wrong; and un- 
less some acute attack, or some other disease comes to complicate it, it 
may be unsuspected up to the time of his death. In many instances we 
know that ossific disease to a considerable extent is found in and about the 
valves of the aorta in persons advanced in life, where nothing of the kind 
had been suspected previously. In addition to the different points already 
mentioned, the condition of the patient’s general health, and the amount 
of congestion of the lungs, liver, or other organs present, must influence 
our prognosis in valvular disease. If the general health is broken down, 
or the system in an anaemic state, the prognosis is more unfavorable than 
under opposite circumstances. If there is much obstruction to the pulmo- 
nary circulation, and the lungs have been long in a state of congestion, 
they are very liable to attacks of inflammation, which will increase the 
dyspnoea, and aggravate the patient’s sufferings. The diseased valves them- 
selves sometimes become the seat of fresh attacks of inflammation, and if 
the system is in an anaemic or cachectic condition, the patient will be un- 
able to bear the necessary treatment, and the disease will prove more 
quickly fatal. If the liver has been long in a congested state, and the por- 
tal circulation been long obstructed, congestion of the kidneys and spleen 
next occurs; eventually, congestion passes into structural alteration, the 
functions of these organs come to be imperfectly performed, the urinary 
secretion becomes more scanty, and fluid is effused into the cavity of the 
peritoneum. In such cases the prognosis must be always exceedingly un- 
favorable. Part xii., p. 49. 
Treatment of Hypertrophy of the Heart.—[In considering the treatment 
of hypertrophy of the heart, we must remember that it has been slow of 
growth, and cannot therefore be quickly removed, and also that we possess 
no specifics for the disease, and cannot place much reliance on drugs alone 
for its cure.] 
The treatment of hypertrophy, says Dr. Bellingham, must vary some- 
what according as the disease is simple or complicated with dilatation of 
the ventricles, or with valvular or other diseases of the heart, according to 
the age of the patient, the presence or the absence of dropsy, etc. It must 
also vary with the cause which has produced the hypertrophy ; indeed, the 
majority of the cases which we see are the result of an impediment to the 
passage of the blood out of or through the cavities of the heart, and the 
increased thickening of the walls of this viscus, is the result of nature’s 
effort to overcome the obstacle. The treatment must also vary according 
to the stage at which the disease has arrived. Few cases, comparatively 
speaking, are met with in hospital practice, where the hypertrophy is sim- HEART, 
849 
pie or uncomplicated; patients belonging to this class seldom present 
themselves or seek for relief, until dropsy or other symptoms supervene, 
which compel them to discontinue work. Simple hypertrophy of the ven- 
tricles is more amenable to treatment than hypertrophy with dilatation 
of the ventricles; but it is a form of the disease which we are rarely called 
upon to treat. Hypertrophy, with dilatation, if advanced, is seldom cured; 
and if it is still further complicated with valvular disease or adhesion of 
the pericardium, it is perfectly incurable ; because the lesion to which it is 
consecutive is irremediable. In such cases we can do little more than pal- 
liate the symptoms which occasion most distress, and endeavor to avert as 
much as possible a termination which is inevitable. The objects to be held 
in view, or the indications of treatment, may be stated in general terms to 
be as follows: 1st. To remove the cause which has occasioned the hyper- 
trophy. 2d. To diminish the action of the heart, and to lessen irritability 
of this organ. 3d. To diminish the amount of circulating fluid without en- 
feebling the heart’s action, or producing general debility. By the two first, 
repose of the organ is insured, and it is placed in a favorable position for 
the hypertrophy to be diminished. By the latter, the cavities of the heart 
not being constantly distended, dilatation is less likely to follow. Hyper- 
trophy of the ventricles is stated to have been successfully treated by fol- 
lowing up Valsalva’s plan of treating aneurism; both Corvisart and Laen- 
nec were advocates of it. This method consists in repeated venesection, 
first in large, afterward in a smaller amount, in limiting the food and drink 
to a very small quantity, and in keeping the patient constantly in the 
supine posture. The objects in view were to reduce the inordinate action 
of the heart, and to diminish the amount of fluid in the circulation to a de- 
gree compatible merely with the continuance of life. Of late years a mo- 
dification of this plan (if it can be so called) has been adopted with advan- 
tage, which is particularly applicable to cases in which the patient is young 
and robust, and where the disease is not very much advanced. It consists 
in moderate local or general bleeding at considerable intervals; a rather 
spare regimen—not, however, limited to vegetables—with a small amount 
of drink ; in other words, the diet should be, what is called dry—by which 
the amount of blood in the system will be diminished, but its quality will not 
be deteriorated; at the same time, perfect quietude of mind and body is 
to be insisted on, and everything likely to hurry the circulation, or to oc 
casion mental emotion, is to be strictly avoided. By these means morbid 
irritability of the heart will be reduced, and the repose of the organ in- 
sured. In following out this plan of treating hypertrophy, however, care 
should be taken, if we avoid one extreme, not to fall into the other. 
Cases in which dilatation predominates over the hypertrophy, or in 
which the patient’s physical powers are low, bear venesection badly. 
Here the loss of a small amount of blood will be followed by even more 
injurious results than the loss of a large quantity when the patient is 
plethoric and robust; exhaustion will more quickly follow, the feeble 
action of the ventricles will become still more enfeebled, they will be 
unable to empty themselves, congestion will ensue, followed by increase of 
the dilatation, and the general debility which results will soon be attended 
by dropsy. Among internal remedies few have been more highly lauded 
by some practitioners than digitalis. M. Bouillaud terms it the true opium 
of the heart, and regards it as the most direct and effectual sedative of 
this organ. He states that he has derived the greatest benefit from the 850 
HEART. 
endermic employment of digitalis; a blister being first applied to the 
praecordial region, the raw surface is sprinkled with the powder, in the 
proportion of* from six to fifteen grains, and repeated daily. By this pro- 
ceeding (according to M. Bouillaud) we diminish, as if by magic, the 
number and the strength of the beats of the heart. On the other hand, 
Laennec (a most accurate observer) in speaking of digitalis, says : This 
medicine, of late, has been much employed in the treatment of diseases 
of the heart, under the idea that, in addition to its diuretic, it exerts a 
sedative action upon the heart. I must confess that this action has never 
to me appeared very evident or very constant, even when the dose has 
been carried so far as to produce vomiting and vertigo. 
For my own act, I cannot say that I have ever derived much benefit in 
cases of hypertrophy, or of hypertrophy with dilatation of the ventricles, 
from digitalis, either endermically employed or given internally; the 
former, in the trials which I made of it, occasioned so much pain as to do 
away with any sedative action. 
As an occasional medicine, and when attacks of palpitation are frequent 
and severe, the digitalis may be employed with temporary advantage in 
case of hypertrophy; and the tincture is to be preferred to either the 
powder or the infusion. Under such circumstances, it may be combined 
with sedatives, as the tincture of hyoscyamus, or the aqua lauro-cerasi, or 
with diffusible stimulants, as ether, subcarbonate of ammonia, camphor, 
etc. When congestion of the lungs or liver has followed the hypertrophy, 
or even in cases where there is no evidence of either, purgatives, occa- 
sionally' administered, are highly serviceable; and the patient is often 
himself sensible of the relief which they afford. They prove of use by 
unloading the portal circulation, and by diminishing the amount of circu- 
lating fluid, without debilitating the patient. The best, under such cir- 
cumstances, is a mercurial purgative at night, followed by a saline cathar- 
tic in the morning, with which colchicum may be combined if advisable, 
and a bitter infusion constitutes a good menstruum. For the same reason 
that cathartics are of service in hypertrophy when the disease is advanced, 
or when it is complicated with dilatation, diuretics will prove still more so 
by removing the watery parts of the blood, without occasioning even as 
much debility as cathartics; and when congestion of the venous system 
has followed, they' will assist in postponing the occurrence of anasarca. 
When dropsy sets in, they are, of course, our principal resource. Re- 
cently the aconite in small doses has been recommended, owing to its 
exerting a sedative action on the circulation, and diminishing the strength 
and frequency of the action of the heart; but as it likewise diminishes the 
frequency of the respiration, it obviously does not admit of being em- 
ployed in advanced cases of hypertrophy where more or less impediment 
to the pulmonary circulation is always present. 
The foregoing, indeed any mode of treatment of hypertrophy, will be 
unavailing, unless (as Dr. Hope observes) steadily pursued; and it must 
be persevered in for one, two, or three years, according to circumstances. 
“ The great majority of recoveries take place between one and two years, 
but a year or two of subsequent precaution is most desirable to prevent a 
relapse.” Two of the greatest impediments to success (he adds) are.— 
1st, that the patient is often so much relieved at the end of two or three 
months as to believe himself well; and, 2dly, that other practitioners, 
finding the heart calm and the respiration free, persuade him that he has HEAKT. 
851 
not, and never has had, organic disease of the oi'gan. The latter observa- 
tion of Dr. Hope is unfortunately too time. Part xii., p. 52. 
Treatment of Dilatation of the Heart.—Dr. Bellingham continues his 
remarks on diseases of the heart as follows: 
As a general rule, the treatment of dilatation is directly the reverse of 
that of hypertrophy. In the one case, we have evidence of increased nutri- 
tion of the heart; in' the othei*, of feeble or diminished nutrition. In the 
one case, we lind a strong heart impelling the blood with increased force 
through the general arterial system ; in the othei*, we have a feeble heart, 
unable to propel its contents to any distance, and probably incapable of 
emptying its cavities. 
The objects to be held in view in the treatment of dilatation are : lstly. 
To remove the cause which occasioned the dilatation, if that be prac- 
ticable. 2dly. To tranquillize the circulation, and relieve the heart of the 
blood which overloads or oppresses it. 3dly. To strengthen the parietes 
of the heart, by Avhich it will be enabled to expel its contents, and the 
further progress of the dilatation be opposed. 4thly. To diminish or 
remove the congestion of the lungs, liver, etc., and the other effects of 
impeded circulation, without debilitating the patient. If the dilatation is 
the result of valvular disease, or if it has followed adhesion of the peri- 
cardium, the effeot of pericarditis, we can do but little more than palliate 
symptoms; both these pathological conditions being irremediable. On 
the other hand, if the dilatation is the result of any cause Avhich can be 
removed; if, for instance, it has followed prolonged muscular exertion, or 
violent mental emotion—if it has succeeded to frequent attacks of bron- 
chitis, or occurs in patients debilitated by loss of blood from any cause— 
if it arises in subjects weakened by previous illness, or comes on in chlo- 
rotic and anaemic individuals, much benefit may often be derived from 
treatment, provided the patient is young, the disease not in an advanced 
stage, and not complicated with attenuation or softening of the parietes 
of the organ. In order to tranquillize the circulation and to relieve the 
heart of the blood which overloads or oppresses it, this organ must be 
maintained in as complete a state of repose as possible, which is to 
be accomplished by rest, by avoiding everything likely to excite or 
agitate the mind, by regulated diet, and obviating dyspeptic symptoms, 
which are vei*y common attendants upon this condition of the heart. The 
food should be nourishing, and but little fluid is to be permitted; at the 
same time, the secretions are to be maintained in a healthy condition ; by 
these means the amount of blood will be diminished, while its quality will 
not be deteriorated. Functional derangement of the stomach is common 
in cases of dilatation, and nothing under such circumstances is more likely 
to bring on palpitation and add to the distress of the patient, than a full 
meal or flatulent food: hence, the food should be such as is easily 
digested, and should be taken in small quantity at a time; and anything 
which occasions distention of the stomach or flatulence, should be care- 
fully avoided. The medicines calculated to relieve the dyspeptic symp- 
toms, will vary, of course, according to circumstances ; sometimes 
antacids, at others acids are indicated ; carminatives are occasionally ser- 
viceable, and the hydrocyanic acid in minute doses is sometimes given 
with advantage. 
In order to strengthen the parietes of the heart, and to enable it to 852 
HEABT. 
expel its contents, tonics variously combined are indicated; by improving 
the general health we give tone to the heart, and thus assist in diminish- 
ing or retarding the increase of the dilatation. Everything calculated to 
debilitate the system is to be avoided; hence, bleeding, digitalis, and anti- 
phlogistic measures of every description are contra-indicated as a general 
rule. If digitalis is a dangerous remedy in some of the diseases of the 
heart which we have been considering, it is still more so in dilatation when 
at all advanced ; or if the parietes of the ventricles are attenuated. Here 
the palpitation is an effort of nature to assist in relieving the heart of the 
blood which distends its cavity; if we diminish the increased action by 
administering digitalis, we take away the only safeguard left; the organ 
can no longer accommodate itself to the amount of blood which it receives, 
and the death of the patient may be the result. 
In order to diminish or remove congestion of the lungs, liver, etc., we 
must be very guarded in the use of measures likely to debilitate the pa- 
tient, and we must trust rather to diuretics, diaphoretics, and expecto- 
rants, than to hydragogue cathartics, or local abstraction of blood, which 
prove so useful in other forms of heart disease. As the exti’emities are 
habitually cold, means should be employed to equalize the temperature, 
and to determine to the surface, by which congestion of internal organs 
will be likewise relieved. 
In conclusion, it must be borne in mind, that dilatation is a chronic 
affection, which, in its early stage, and when moderate, produces little 
inconvenience, and hardly requires treatment, but which, when advanced, 
is little under the influence of internal remedies ; any improvement, con- 
sequently, must be slow and gradual, and in many cases we can do but 
little more than palliate symptoms; consequently, the success of our 
treatment will depend in a great measure upon the patient observing 
carefully the rules laid down for him ; if he lives intemperately, or is 
obliged to labor for his bread, the disease will run a more rapid course. 
Part xii., p. 55. 
Heart—(Functional Diseases).—Palpitation maybe owing: 1st. To 
a distended stomach; and thus interfering with the descent of the dia- 
phragm, and confining the heart’s motions. 2d. A distended colon press- 
ing on the aorta, causing fullness of blood on the left side of the heart. 
3rd. A distended stomach and colon pressing on the ascending cava, and 
causing a deficiency of blood on the right side of the heart. 4th. Hepa- 
tic disease. Each of these states will require its particular treatment. 
Part xiii., p. 77. 
Simulated Hypertrophy.—Impulse of the heart, taken alone, however 
great, and however extensive it may be, is not a sure physical sign of hy- 
pertrophy. Hypertrophy, indeed, cannot exist without excess of impulse, 
but excess of impulse can exist without hypertrophy. When the impulse 
of the heart is excessive, and at the same time its sounds are obtuse, 
muffled, and indistinct, and the praecordial region presents a larger space 
than natural which is dull to percussion, then the signs of hypertrophy are 
complete. But when the impulse of the heart is in excess, and at the 
same time its sounds are as loud and clear as ever, or louder and clearer 
still, and the whole praecordial region is quite resonant to percussion save 
the small space which is naturally dull, then the signs of hypertrophy are 
a complete. HEART. 
853 
When this occurs in plethoric and sedentary young persons, employ de- 
pletion, abstinence, and active habits. In other cases the patient is thin, 
pale, dyspeptic, and nervous: here stomach, nerves, and blood being all at 
fault, long and varied treatment is required. Again it occurs in young 
persons where there is neither ansemia nor hypenemia to indicate the 
source of disease. In these cases no particular treatment can be recom- 
mended, or is likely to do good ; but the disease not unfrequently suddenly 
disappears. Part xv., p. 90. 
Pulmonary Congestion Simulating Angina Pectoris.—Dr. Latham 
frequently meets with cases similar to the following: 
A man has hypertrophy of the heart in a moderate degree, with 
some small amount of valvular injury, or with none at all. Hitherto he 
has been tolerably free from painful palpitation and dyspnoea, except 
under excitement on extraordinary exertion. But suddenly he is found 
gasping and struggling for breath, and expecting instant dissolution. 
What is this; and what is to be done ? Truly one might be excused for 
thinking of angina pectoris, or some spasm of the heart, and flying to 
ammonia and ether and opium for relief. But, putting my ear upon the 
chest, I have found a small crepitation diffused through the half of one 
lung, or in the half of one lung I have been unable to catch any audible 
murmur whatever, either natural or morbid. A single cupping upon the 
chest, just opposite the portion of lung that labors, has swept away the 
crepitation, or has removed the dullness, and brought back the respiratory 
murmur; and the patient has been restored in a day or two to his ordi- 
nary state of comfort. Here in one instance there has been sudden and 
extensive effusion into the extreme bronchial ramifications or vesicular 
structure of the lung, and in another there has been sudden and extensive 
congestion. Part xv.,p. 104. 
Polypiform Concretions in the Cavities of the Heart.—Dr. Hope and 
M. Bouillaud classified the so-called polypi of the heart into three kinds, 
viz., unorganized, slightly organized, and more completely organized. 
Dr. Bellingham proposes a different arrangement of them under the fol- 
lowing heads, viz.: 
1. Concretions consisting of a coagulum coated with fibrin. 2. Con- 
cretions consisting exclusively of fibrin. 3. Concretions consisting ex- 
clusively of lymph.' 4. Concretions consisting of lymph coated with fibrin. 
The treatment of these cases can be little more than palliative, since 
they soon terminate fatally. Various means have been recommended 
with a view of dissolving the concretions, but the absurdity of such prac- 
tice is obvious. Dr. Bellingham gives the following conclusions : 
1. That concretions occasionally form in the cavities of the heart, during 
life, of such a size as to impede the action of the valves, to obstruct the 
passage of blood through this organ, and to occasion the death of the 
patient. 
2. That these concretions, although tenped polypi, have no analogy 
whatsoever with polypi, either in appearance, composition, or mode of 
development. 
3. That certain diseases of the lungs or heart, as bronchitis, pneu- 
monia, endocarditis, valvular disease, etc., sometimes owe their fatal 
termination to the formation of these concretions in the cavities of the 
heart. 854 
HEAET. 
4. That the concretions which form during life in the cavities of the 
heart may consist either of fibrin or of lymph, or of lymph coated with 
fibrin. 
5. That the concretions composed of fibrin are most frequent upon the 
right side of the heart, but may occur on both sides; and that the concre- 
tions which consist of lymph, or of lymph coated with fibrin, are usually 
found only on the left side of this organ. 
6. That fibrinous concretions, whether they occur in amorphous masses, 
or in stratified layers, are deposited from the blood which circulates 
through the heart. That concretions composed of lymph, whether this 
forms the substance of the mass, or merely its nucleus, are deposited by 
the vessels which supply the heart itself with blood. 
1. That fibrin, whether it constitutes the substance of these concre- 
tions, or whether it is deposited in concentric layers in the sac of an 
aneurism, is perfectly unorganized, and perfectly incapable of becoming 
organized. That lymph, on the contrary, is an organizable substance, and 
quite distinct from fibrin, with which it is still confounded by some phy- 
siologists. 
8. That where pus has been found in fibrinous concretions contained in 
the heart, its presence is to be regarded as the result of phlebitis, not as a 
product of inflammation in a substance which is quite unorganized, and 
consequently incapable of undergoing such changes. 
9. That increased extent of dullness in the prascordial region, confused 
or irregular action of the heart, intermission or irregularity of the pulse, 
or an abnormal murmur accompanying the heart’s sounds, are not neces- 
sarily symptoms of the development of a polypous concretion in the cavi- 
ties of the heart. 
10. That no means are known by which polypous concretions in the 
heart, once formed, can be dissolved ; consequently, the administration 
of substances which render the blood more fluid, or which are supposed 
to be capable of dissolving them, can have no useful effect. 
Part xix., p. 68. 
Position of the Orifices of the Heart, and the Great Vessels—Relative 
Position of the Orifices of the Heart to the Parieles of the Chest.— The 
right auriculo-ventricular orifice lies behind the centre of the sternum, on 
a line with the lower margin of the articulation of the' cartilages of the 
fourth ribs with the sternum. 
The left auriculo-ventricular orifice lies behind the cartilage of the 
fourth left rib, near the sternum. 
The pulmonary voices are on a line with the space between the carti- 
lages of the second and third ribs, to the left of the sternum, and very 
close to this bone. In some instances they lie a little lower down, viz., on 
a line with the junction of the cartilage of the third left rib with the ster- 
num, and immediately under it. 
The aortic valves lie behind the sternum, on a line with the junction of 
the cartilages of the third ribs with the sternum, and toward the left edge 
of this bone. When the valves of the pulmonary artery are situated lower 
down, the semilunar valves of the aorta will be lower also, and on a line 
with the interval between the insertion of the cartilages of the third and 
fourth ribs. 
The free edge of the semilunar valves of the aorta corresponds accu- HEART, 
855 
rately, M. Gendrin observes, to the base of the pulmonary valves. A line 
drawn across the inferior margin of the third ribs corresponds to the base 
of the valves of the pulmonary artery, and to the free border of the aortic 
valves. 
Relative Position of the Orifices of the Heart to one another.—The right 
ventricle ascends higher than the left, and the left ventricle descends lower 
than the right. Hence, the origin of the pulmonary artei*y is on a plane 
above that of the aorta. 
The pulmonary orifice is the highest up, as well as the most anterior, 
of all the orifices of the heart. The aortic orifice lies behind it, and on a 
plane lower down. The left auriculo-ventricular orifice is immediately 
behind the aortic orifice, but on a plane lower down. The right auriculo-ven- 
tricular orifice is nearly on the same plane as the left, but more anterior. 
Helative Position of the Large Vessels to the Parietes—Aorta.—The 
ascending portion of the arch of the aorta comes to the right of the ster- 
num, between the cartilages of the second and third ribs. In this part of 
its course it is within the pericardial sac, and in the dead subject lies at 
the depth of one inch and a half from the surface, the margin of the right 
lung and the pericardium being between it and the parietes of the chest. 
The transverse portion of the arch of the aorta crosses the trachea at the 
centre of the first bone of the sternum, on a line with the lower margin of 
the articulation of the cartilages of the first ribs with the sternum, and at 
a still greater depth from the surface. The arch of the aorta approaches 
most closely to the parietes at the point at which the arteria innominata 
comes off; that is, on a line with the junction of the cartilage of the second 
right rib with the sternum. 
Pulmonary Artery.—The origin of the pulmonary artery is on a line 
with the junction of the cartilages of the third ribs with the sternum; the 
tip of the left auricle resting against its left side; it ascends about two 
inches before it divides; and a portion of the margin of the vessel here 
comes to the left of the sternum, between the cartilages of the second and 
third ribs. The division of the artery is on a line with the upper edge of 
the cartilage of the second ribs, where they join the sternum, the apex of 
the pericardial sac being on a line with the junction of the cartilages of the 
second ribs with the sternum, though it is sometimes higher up, and on a 
line with the cartilage of the first ribs. Part xxi., p. 99. 
Rapidity of the Circulation of the Blood.—The rapidity with which 
the blood passes through the system can be estimated if the amount which 
is transmitted into the aorta at each systole of the left ventricle is known, 
and if the entire quantity of blood contained in the vessels is determined— 
the number of pulsations of the heart being given. Thus it has been esti- 
mated that the whole amount of blood contained in the vessel is about 
twenty-eight pounds ; and that an ounce and a half is expelled at each sys- 
tole of the left ventricle. If, then, the heart of the adult beats seventy-five 
times in a minute, 112^-ounces, or a little more than seven pounds of blood, 
would pass through the ventricle in a minute; in four minutes the entire 
twenty-eight pounds would pass through the heart; and in every hour it- 
would pass through it fifteen times; Part xxi., p. 106. 
Fatty Diseases of the Heart.—[The most prominent effects of fatty de- 
generation on the functions of the heart are those which exhibit the defi- 
cient powers of the organ. Dr. Quain first considers] 856 
HEART, 
Coma.—Several writers have described coma, preceded or not by giddi- 
ness in connection with enfeebled powers of the circulation. Mr. Adams 
observed as many as twenty attacks of coma in one of his cases. Mr. R. 
W. Smith and Dr. Stokes have made similar observations. The explana- 
tion of these attacks is this, that the power of the heart is reduced, and 
thus it is rendered incapable of readily sending on the blood which it 
receives; hence arises obstruction to the circulation and unequal pressure 
on the brain. The explanation is no doubt correct. 
Syncope.—Cardiac syncope is a term properly and more frequently used 
by the older writers than by ourselves, notwithstanding the arguments of 
Bichat on the subject. Dr. Burrows, in his interesting work on the cere- 
bral circulation, has clearly established the fact, that syncope is due to a 
deficiency of that pressure within the skull which is essential to the per- 
formance of the functions of the brain. On this principle we can explain 
the frequency with which this symptom is found to occur in fatty disease 
of the heart. 
The case of an old man who fell under the notice of Dr. Williams and 
myself is very remarkable. I was one day suddenty called to him, and 
found him, as I myself and others believed, dead. He had been in his 
usual state, and taking his dinner a few moments previously. Though 
neither pulse nor respiration could be perceived, nor in a hurried examina- 
tion could the sounds of the heart be heard, I felt from something about 
his appearance that he was not dead. An electro-magnetic apparatus was 
set to work from the spine to the region of the heart; other stimuli were 
made use ofj and after several minutes he slowly recovered. These fits, in 
a slighter form, recurred almost daily for two years, when he died in one 
exactly like the first. The heart exhibited fatty degeneration. In some 
cases this feeling amounts to nothing more than a sense of faintness, a feel- 
ing that the person must fall if he does not lay hold of something; and in 
some instances, as in a case at present under my care, this slight faintness 
is accompanied by an impression that he is about to die. Such persons do 
die. This mode of death is in many cases instantaneous; in other cases, 
death, though sudden, is not so rapid in its occurrence ; the fatal faintness 
is progressive, and death may not occur for several minutes after its onset. 
Facts within my knowledge lead me to think that many distinguished men 
have thus died, and that in this condition has lain the hidden and frequent 
cause of many sudden deaths. The paleness of the features, the unaltered 
state of the pupils, the absence of stertor, and the feeble action of the 
heart, enable us to distinguish these cases from apoplectic seizures when 
we see them before death. The age also at which apoj3lexy occurs most 
frequently, is not that at which we most frequently find tatty degeneration 
of the heart. For example, of forty-nine cases of apoplexy, forty-two oc- 
curred in persons under sixty, and seven only in those over sixty; whereas, 
in seventy-nine cases of fatty degeneration of the heart, forty-one were 
above sixty years of age. 
Shortness of breathing is recorded as having been present in about one 
half the cases. In some eases it appears as a sense of choking or suffoca- 
tion—the person feels as if breathing through a sponge. In some instances 
the difficulty of breathing is so slight, that it is scarcely regarded ; in others 
so severe, that the slightest effort, particularly in mounting ascents, is most 
distressing. A peculiarity was observed in two subjects, one of which still HEART. 
857 
lives, viz., that reading aloud caused no inconvenience, whilst it was dis- 
tressing to ascend a gentle height. 
[Another of the recorded phenomena connected with fatty degeneration 
of the heart is pain. In some cases it is confined to the region of the 
heart; in others, it extends over the chest and down the arm, as in angina 
pectoris ; but—] 
There is some evidence to show that rupture of a few fibres may occa- 
sionally occur without being fatal and cause pain ; but in the majority of 
cases the pain appears to be due to over-distention of the cavities with 
blood on the one hand, or to the spasmodic contraction just alluded to on 
the other—it being remembered, that though the heart in health does not 
possess common sensibility, it may in diseased conditions acquire this pro- 
perty. These latter phenomena, that is to say, syncope, breathlessness, 
and pain, may occur separately, or two or all of them may be present at 
the same time; their combination gives us the characters of the disease 
known as syncope anginosa, or angina pectoris. 
As we cannot restore muscular fibres that have been destroyed, we can 
only hope to arrest or suspend for a time the progress of the disease by 
improving the quality of the blood, and thus supporting the vigor of those 
portions of the heart still uninjured. We must pay attention, in the first 
'place, to the digestive organs; give bitter tonics and alkalies, and subse- 
quently iron in different forms, and carefully regulate the habits of life. 
For the pain and the distressing attacks of angina pectoris, the greatest 
relief followed the repeated application of three or four leeches, succeeded 
by a blister, and after these the internal use of iron. Be careful in recom- 
mending exercise. Narcotics are given with great risk, but it is almost 
needless to indicate the usefulness of antispasmodic remedies during the 
paroxysmal attacks. Dart xxii., p. 95. 
Disease of the Heart, and Dropsy following it.—In warding off the 
symptoms or feelings too often concomitant with disease of the heart—next 
to quietness of mind and body, equable temperature, and moderate or 
rather low living—there is nothing equals the use of small doses of colchi- 
cum wine, weak saline purges, and inserting a seton over the region of the 
heart. In a sudden paroxysm of violent dyspnoea, with feelings of imme- 
diate suffocation, no means are equal to abstracting from two to four 
ounces of blood from the arm. In the treatment of cardiac dropsy, the 
following diuretic, which will pump the patient out, so to speak, sometimes 
in a few hours, is recommended, and it is often of equal value in repeated 
attacks of the anasarca. R Infusi digitalis, §iv.; potassse acetat., 5ij-5 sp. 
geth. nitrosi, 5ij.; aquee cassioe, §iss. Capiat cochleare magnum quarta 
quaque hora. If these remedies (diuretics) fail, we must fall back upon 
purgatives, elaterium chiefly. R Elaterii, gr. j.; extracti coloc. comp. 
9iiss.; extracti hyoscyami, gr. xij. M. Divide in pilulas xij. Capiat unam 
nocte maneque. The combination of tartrate of potass, or the tartrate of 
potass and soda, with the infusion of senna, is highly efficient. Puncturing 
the extremities, and thereby draining off the fluid, should not be had re- 
course to until all internal remedies have failed; though, whether as a pal- 
liative or as a hope of cure, it deserves more notice than it commonly gets. 
Although fomentations are more generally advised, yet the evapoi’ating 
lotion has been found very successful in keeping down any disposition in 
the part to erysipelas. Dart xxii., p. 98. 858 
HEART, 
Conclusions respecting the Seat and Nature of Angina Pectoris.—Dr. 
Kneeland draws the following conclusions from his researches into the 
nature and causes of angina pectoris: 
1. From the symptoms and morbid appearances, angina pectoris is not a 
disease of the lungs, heart audits vessels, or stomach, but an affection of the 
nerves supplying these organs. 
2. Anatomy, physiology, and pathology would lead us to place the seat 
of angina pectoris in the par vagum, and not in the sympathetic system 
of nerves. 
3. Like other nerves, the par vagum may be affected with neuralgia 
and rheumatism with inflammation ; it may be compressed by morbid 
growths; its spinal origin may be compromised by hemorrhage, accidental 
wounds, and various irritations—all of which may cause the symptoms of 
angina pectoris. 
4. Angina pectoris and asthma are intimately related; the former being an 
affection more especially of the sensitive filaments of the par vagum; and 
the latter an affection of its motor filaments. Both are generally more or 
less combined in the same case. 
5. Angina pectoris is a disease not necessarily fatal, especially in young 
persons, if accurately diagnosticated and properly treatea. 
6. In addition to the remedies of the books, special attention should be 
given to the inhalation of oxygen, and to the use of electricity. 
7. In cases of angina pectoris, attention should be directed to the exami- 
nation of the par vagum, from its origin to its terminations, which, doubt- 
less, on careful examination, will exhibit lesions sufficient to account for a 
fatal result. Part xxii., p. 123. 
Rheumatic Heart Disease—Endocardial Deposits.—Are the deposits 
of fibrinous matter so frequently found upon the valves of the heart pro- 
duced from inflammation of the lining membrane? or are they precipita- 
tions of fibrin, owing to the blood containing more than its normal pro- 
portion? Opinions upon this subject seem divided. Nitrate of potash, 
however, has been strongly recommended in rheumatic fever in which the 
fibrin is in excess, and apparently with justice, on account of its well- 
known property of dissolving fibrin, preventing fibrinous concretions on 
the valves, by increasing the solubility of this material, and diminishing its 
liability to precipitation. Part xxiii., p. 102. 
Angina Pectoris—Definition.—Neuralgia of the branches of the par 
vagum, going to the heart and lungs; embarrassing the functions of these 
organs, and spreading by nervous connection to other parts. 
Causes—Predisposing • the middle age, the male sex, an indolent, luxu- 
rious, studious, or sedentary life ; gout, rheumatism, or neuralgia; or 
worse than these, the long-continued anxiety of mind and fatigue of body. 
Causes—Excitingy running, walking, especially up hill or up stairs, great 
bodily exertion or mental excitement, and rapid changes of temperature: 
thus we most frequently see a severe attack after great exertion, a fit of 
passion, or on the evening of a cold wet day. As the disease increases in 
severity it will be found that slighter causes are sufficient to produce an 
attack ; and that any one of them will occasion a seizure much more cer- 
tainly after a meal. Finally, when the disease has become chronic, it may 
even attack the patient in his sleep. 
Symptoms.—In the acute form of the disease the patient is suddenly HEART. 
859 
seized with a sharp, darting, lancinating, or stabbing pain under the left 
breast, frequently spreading to the throat, arm, back, and leg of the same 
side; this pain frequently amounts to the most excruciating agony, and has 
been compared by Laennec to the piercing with nails or the laceration of 
the claws of animals; and is accompanied by a sense of suffocation, great 
difficulty of breathing, tendency to syncope, and flatulent distention of the 
stomach followed by eructations; together with the fear and the feeling of 
immediate death. 
The pulse varies in different individuals. 
After lasting for a longer or shorter time, proportioned to the severity 
and duration of the disease, the attack generally passes off spontaneously, 
or yields to the remedies employed. 
A feeling of weakness and numbness sometimes remains for a little time 
in the parts previously affected with pain. In addition to the anginous 
paroxysms the patient generally suffers from some other allied disorder of 
the nervous, digestive, or circulatory system, which may have been either 
a cause or a consequence of his malady; tic, dyspepsia, constipation, diar- 
rhoea (leucorrhoea, if the patient is a female), oedema, dropsy, or organic 
disease of the heart, may also be present to increase his suffering and di- 
minish his hopes of recovery. 
Diagnosis.—The only disease which bears any resemblance to angina 
is asthma; but the sharp pain in the breast and arm, and the sense of suf- 
focation characteristic of angina, can hardly be mistaken for the dyspnoea, 
cough, and expectoration of asthma. 
Prognosis.—Angina is a disease not necessarily fatal when occurring in 
young subjects with no organic disease of the heart ; but when it occurs in 
elderly people with organic disease of the heart or great vessels, it is always 
mortal. 
Pathology.—It is the opinion of Jurine, Desportes, Laennec, Chapman, 
and Copland, that it is a species of neuralgia of the pulmonary and cardiac 
nerves, affecting the functions of the heart and respiratory organs, and ex- 
tending by nervous connection to other parts; the organic lesions found in 
fatal cases being either coincidences or effects of the disease. 
Treatment in the Attack.—If the pulse is full and strong, and the pa- 
tient stout and plethoric, bleeding from the arm should be practised ; but 
if the patient is weak and debilitated, and the pulse feeble and slow, it 
should be altogether avoided. And instead of bleeding, a flannel wrung 
out of hot water and sprinkled with turpentine should be placed over the 
region of the heart; the feet put in hot water containing mustard, and 
sixty drops of laudanum given immediately in a glass of any strong spirit; 
if relief is not speedily obtained, this dose may be repeated with perfect 
safety, and sometimes acts like a charm in relieving the pain. This should 
be followed by the exhibition of some antispasinodic and carminative, such 
as ether, aromatic spirit of ammonia, or ammoniated tincture of valerian 
in cinnamon or mint water, in order to assist the stomach to expel the gas 
which distends it; these should also be given after bleeding in those cases 
in which it is practised, for when greatly distended, as it commonly is in 
this disease, the stomach pushes up the left side of the diaphragm ; this 
diminishes the capacity of the chest, and so impedes the movements of the 
heart. 
Treatment in the Interval.—Attention should be paid to the patient’s 
habits and manner of living; the state of the stomach, bowels, liver (and 860 
HEABT. 
uterus if a female); the condition of plethora or anaemia, and the predis- 
position to gout, rheumatism, or neuralgia; in short, every appreciable dis- 
order of the system is to be met by the appropriate remedies, and corrected 
as far as possible. If the stethoscope should enable us to discover any 
abnormal condition of the heart, the treatment must have a special re- 
ference to that condition : of course, where there is serious organic disease 
of the heart, a cure is not to be looked for; here the utmost we can do is 
to palliate the urgent symptoms. The remedies which have been found 
most useful are leeching, or cupping and counter-irritation over the region 
of the heart by means of croton-oil liniment, tartar emetic ointment, re- 
peated blisters or issues with low diet in the cases of stout plethoric indi- 
viduals. With weakly debilitated subjects an opposite plan of treatment 
ought to be followed; tonics, such as bark and steel, should be exhibited 
with nourishment and cordials. Various other medicines have been recom- 
mended in angina; the preparations of iron, sulphate of zinc, nitrate of 
silver, arsenical solution, sulphate of quinine, mercurials, and colchicum, 
may all be prescribed with advantage according to the various indications 
afforded by the history of each individual case. 
In addition to the. above, we may mention that Laennec recommended 
magnetism, and Kneeland electricity; and that Heberden gave an opiate 
at bed-time, when the attacks occurred during the night. 
Part xxiv., p. 96. 
Cardiac Inflammation.—If exceedingly sudden and formidable, as from 
rheumatism, bleed from the arm boldly, and follow up with opium and 
mercury, as well as colchicum. If the attack has been foreseen, smaller 
amounts of blood, locally abstracted, may serve the same purpose. If ne- 
cessary, this may be followed by a blister and belladonna plaster, while 
mercury and antimony are exhibited with a small amount of opium. Then 
give colchicum cautiously to convert the uric acid into urea: to accomplish 
this, it need produce none of its usual physiological effects. Nitrate of 
potassa and phosphate of soda may also be given, and if acidity is suspected 
in the lower bowels, magnesia may be given. Irritability or pain is to be 
subdued by hyoscyamus, digitalis, aconite, or conium. Part xxiv.,/). 337. 
Rheumatic Pericarditis—Dr. Todd's Treatment of.— Vide Art. “ Rheu- 
matism.” 
Endocarditis.—No matter what may be our opinion of the extent of 
endocarditis, we must meet the depression with stimulants and opium, and 
particularly with a full anodyne at night; and next, if we can obtain a rally, 
we must as soon as possible superadd local bleeding, blistering, and the use 
of mercury, to check the effusion of lymph, and to proceed to the absorp- 
tion of what has been poured out. In the subacute stages, rest and absti- 
nence from stimulants form one of the most important points in the treat- 
ment ; the patient should rest for weeks on a sofa or bed. In convalescence 
from pericarditis or endocarditis, you may give an anodyne every night. 
Part xxxvii., p. 54. 
Heart Disease.—Most cases of disease of the organs of circulation ad- 
mit of division into two great classes, with different symptoms and causes, 
and requiring different treatment; the whole depends on whether the dis- 
ease is at one or the other side of that great barrier, the mitral valve. To 
the one class belong diseases of the aortic valves; to the other, mitral 861 
HEMIPLEGIA. 
lesions and obstructive diseases of the lungs, especially old-standing bron- 
chitis, with wheezing respiration. Now, when death occurs immediately in 
the former class, it is by syncope; in the latter, by apncea; in the latter 
there is congestion of all parts behind the mitral valve ; the lungs, the liver 
and kidneys are congested, respiration is difficult, there is an icteroid line 
of the skin, the urine is scanty, and the engorged venous capillaries unload 
themselves, causing cedema of the cellular tissue of the lower part of the 
body. In the case of diseased aortic valves, however, this result is for a 
long time successfully opposed by the perfect closure of the mitral valve; 
after a time it may yield, and then the cases are practically the same ; still 
it follow's, that, barring the risk of sudden syncope, the danger is much 
more remote in clisease of the aortic than in that of the mitral valves. As 
regards the principle of treatment, it will be found that in disease of the 
aortic valves, a tonic, and often stimulating plan of treatment, is required 
in order to counteract the tendency to yielding of the ventricular wall. 
The sulphate of zinc, among medicinal agents (which, however, must only 
constitute a small part of our tonic plan of treatment), is very useful; but 
reliance may especially be placed on senega in these cases; it may be given 
along with liyoscyamus and nitric ether, and though an empirical remedy, 
the benefit derived from this medicine in palpitation from diseased aortic 
valves is “ invariably great.” On the other hand, in the mitral class of 
cases, we must direct our efforts to unload the congested vessels. The 
portal system must be relieved by free cathartics, after which a free secre- 
tion of urine may often be established. Free secretion from the bronchial 
mucous membrane is also of much advantage. Digitalis, squill, and calo- 
mel, a grain of each in a pill, is a formula in very frequent use by Dr. Ad- 
dison. Bart xl., p. 47. 
Treatment of Hemiplegia from Softening of the Brain.—Prof. Bennett 
says: 
“ I believe that the most important encl for the practitioner to aim at, 
in the early treatment of these cases, is to keep down the frequency and 
force of the heart’s action. For this purpose the strict maintenance 
of the horizontal posture is of the highest moment; and when the patient 
is conscious, it is most desirable that the mind should be tranquillized by 
every means. It will, of course, likewise be necessary to remove all local 
impediments to the easy flow of the circulating fluid ; and it is as well 
that the head should be slightly raised, sufficient to prevent gravitation 
favoring the escape of blood from the ruptured vessels, but not so as to 
create any impediment to the flow which might embarrass the action of 
the heart. 
To remove any source of nervous irritation which may be operating 
injuriously on the brain, the bowels should be cleared ; and in order that 
there may be as little effort as possible on the part of the patient in the 
expulsion of the contents of the bowels, it is expedient that this should be 
done by enema: but if this fail, and the vital power of the patient do not 
forbid it, you may give croton oil, a drop or two of which, placed on the 
tongue, will operate freely; or calomel, in powder, to the extent of five 
HEMIPLEGIA. 862 
HEMIPLEGIA, 
or ten grains, which inay be similarly administered. I would advise you 
to limit the further administration of drugs to giving some slight correc- 
tive, as an alkali—ammonia being, on the whole, the most appropriate— 
unless, indeed, you find the patient in an extremely prostrate condition, 
when it will be necessary to combine with it the cautious exhibition of 
other stimulants and restoratives, as chloric ether, brandy, etc. 
The question of bleeding will arise ; and under the popular notion, that 
all head attacks are accompanied and caused by the rush of blood to the 
head, you will be pressed to have recourse to this expedient. There are 
three objects to be attained by bleeding; first, to diminish an undue 
amount of blood in the head; secondly, to check hemorrhage, or to pre- 
vent it; and lastly, to quiet the heart’s action. 
If the patient be cold and collapsed, it is clear you should not take 
blood ; nor should you have recourse to this practice if the heart’s action 
be very feeble or intermittent; nor if there be an anaemic state; nor if the 
patient be of very advanced age; nor if the evidence of extensive disease 
of the arterial system, or of the heart, leave no doubt on the subject; nor 
would it be desirable to bleed if it were clear that already a large amount 
of hemorrhage had taken place into the brain. Should none of these 
objections exist, then you will have to consider whether any or all of the 
indications above named need be fulfilled, and whether bleeding (local or 
general) promises to fulfill them. As to the first indication, namely, the 
diminution of an undue amount of blood in the brain, I think modern inves- 
tigation of the actual state of that organ clearly points out, that the brain 
is not in a hyperaemic state, in the cases in which the form of hemiplegia 
under discussion is likely to occur. Will taking blood check or prevent 
hemorrhage ? The sudden or rapid abstraction of a moderate quantity of 
blood, either from the arm or temple, or by skillful cupping from the nape 
of the neck, may, I can conceive, check hemorrhage; and with this object 
it is, sometimes, a very justifiable practice, but the quantity taken should 
not be large. Now and then bleeding helps to diminish the frequency 
and force of the heart’s action ; but here, again, the quantity of blood 
withdrawn should be moderate, for the removal of much blood is apt to 
quicken the heart’s action and render the blood poor. I would have you 
look upon this question, to bleed or not to bleed, as almost the most impor- 
tant one you will have to decide; and, judging from my own experience 
on this point, as well as from the results of the practice in a large number 
of cases collected from various sources, I have come to the conclusion 
that, in cases of white softening, with or without hemorrhage, you are less 
likely to err by omitting rather than by adopting the practice. 
You will often be consulted as to “some expedient for jjromoting the 
restoration of the paralyzed limbs to their normal condition.” To this 
question, after having given a fair trial to the various means which have 
been proposed, I must reply, that I know nothing which more decidedly 
benefits the paralyzed limbs than a regulated system of exercise; active, 
when the patient is capable of it; passive, if otherwise. As to the use of 
electricity, which is now much in vogue, or the employment of strychnia, 
which has been strongly recommended, I feel satisfied, as the result of a 
large experience, that the former requires to be used with much caution, 
and that the latter is very apt to do mischief, and never does good. I 
have seen cases in which, alter the employment of electricity for some 
time, that agent has apparently brought on pain in the head, and has ex- HEPATIC AFFECTIONS. 
863 
cited something like an inflammitary process in the brain. And so 
strychnia also will induce an analogous condition of brain, and will in- 
crease the rigidity of the paralyzed muscles. Part xxxi., p. 62. 
Nitro-muriatic Acid Mixture—Recommended in chronic derangements 
of the liver with constipation. Part i., p. 80. 
Debility succeeding Hepatitis.—Mr. Tyson submits the following 
formula: 
HEPATIC AFFECTIONS. 
LIQUOR OXYSULPIIATIS FERRI. 
$ Ferri sulphat., 3ij. (or 3iij.) ; acidi nitrici, 3iij., aquae dest., §iss. 
Tere diligenter per horse quadrantem acidura nitricum ferro yitriolato, 
dein sensim addendo aquam, per chartem cola, et fiant guttae, e quibus 
capiat seger gtt. v-xij. bis in die ex infuso quassiae yel aqua. 
This form I believe, was invented by Sylvester, about forty years ago, 
and has ever since that time been in constant use among the practitioners 
of Derbyshire. I wonder it has not been inserted into the Pharmacopoeia, 
as it is by far the best and most powerful of all the preparations of iron. 
The oxygen of the nitric acid uniting with the sulphate of iron, forms a 
persulphate ; at the same time the iron is converted into red oxide. As 
a medicine it far surpasses the tine, ferri mur., and it never precipitates 
the oxide of iron. It is one of the most valuable restoratives in the debi- 
lity and torpor of the liver, which remains after the successful treatment 
of hepatitis. Patients do not well bear above ten or twelve drops to a 
dose ; and when given with small doses of sulphas magnesia?, etc., it 
equals the purgative mineral waters. I think it will be found to be an 
antidote to prussic acid, as it instantly combines with it. Part v., p. 68. 
Cream of Taraxacum.—Dr. Collier gives his own method of using 
dandelion in hepatic and dropsical diseases—prepared as follows: 
Cut the fresh roots of dandelion, freed from any adherent earthy matter 
(previously washed and slightly scraped) into transverse slices. Sprinkle 
any quantity of these, while moist, slightly with spirit of juniper, and ex- 
press them in a tincture-press. The cream thus expressed will keep any 
reasonable time for the purposes of the practitioner in the hottest 
weather. The dose, a tablespoonful, or more, twice or thrice a day, will 
probably produce two or more diurnal biliary evacuations. It may be 
diluted, and put up in the form of draughts, with any of the diuretic 
waters or infusions, or with a solution of cream of tartar. 
Part viii.,p. 71. 
German Treatment of Engorgement of the Liver. and Spleen.—Dr. 
Schwabe, of Gross-Rudestadt, makes known to us the following recipe, 
which he has employed successfully against the above affections: 
R Belladonna root, powdei'ed, a grain and a half; muriate of quinine, 
four grains; powdered rhubarb, fifteen grains. Mix for ten powders; one 
to be taken morning, noon, and night, in any convenient vehicle. 
Part viii., p. 78. 864 
HEPATIC AFFECTIONS. 
Chronic Hepatic Affections.—In various chronic hepatic affections and 
visceral obstructions, the following formula has been found by Dr. Debreyne 
to answer exceedingly well: 
R Pul. aloes, 5ij.; sapon. hispanic.; pulv. rhei; ferri subcarbonat. aa. 
5iv.; potassii iodureti, 5ij.; in pil. 120 divide. Dose, from two to six pills 
in the course of the day. 
If these pills do not prove to be sufficiently purgative, the patient should 
be instructed to drink some aperient mineral water to aid their action. 
Part x., p. 28. 
Hepatalgia.—Andral has introduced the following observations in his 
“ Clinique Medicale“ We sometimes,” he says, “ observe in the region 
of the liver severe pain, which cannot be accounted for, after death, by 
any lesion of the viscus or its excretory ducts. These are cases of hepa- 
talgia, or hepatic colic. The circumstances just mentioned, and, moreover, 
the nature of the pains, their intermission, and the state of good health 
which often exists in the intervals, all lead us to believe that the pains 
have their site in the numerous nervous filaments which are distributed to 
the livei', and which are derived either from the pneumogastric or the 
great sympathetic.” 
It will be observed that it is essentially a nervous disorder, and it differs, 
of course, in all important points from inflammation. 
Although the pains accompanying hepatalgia may be as intense as those 
of hepatitis, and, in many instances, perhaps more urgent, they are not 
constant, but are at the outset, and frequently also during the whole pro- 
gress of the disorder, paroxysmal, affording in the interval a complete 
immunity from pain. The pathognomonic signs indicative of inflam- 
matory action of the liver, are pyrexia, tumefaction, great tenderness 
in the hypochondrium, frequent and strong pulse, thirst, furred tongue, 
and vomiting, sometimes of a bilious, and, at other times, of a dark- 
colored secretion, as the substance of the liver more or less partakes of 
the invading disease. The bowels are irregular in their action, the evacu- 
ations presenting a great variety of appearances, according as the biliary 
secretion is more or less affected ; and the urine is scanty and high 
colored. In hepatalgia, on the contrary, these signs are invariably want- 
ing ; there may exist, indeed, constant pain and tenderness over the 
region of the liver, increased to a certain degree by pressure, but manifest 
exacerbations, even in the wrorst cases, occur, which are sufficiently indica- 
tive of its paroxysmal character. The functions of the organ may proceed 
uninterruptedly as in its healthy condition. The tongue may be quite 
clean, or sometimes, in the centre, there may be a gentle creamy fur, and 
the urine is generally increased in quantity, and is of a lighter color than 
ordinary: this I have found a characteristic symptom of many nervous 
disorders. 
We have been contemplating the leading features of hepatalgia in its 
pure uncomplicated state, but it is comparatively rare that we meet with 
this condition, as it is generally associated with other decided manifesta- 
tions of the neuralgic diathesis. 
The treatment of hepatic colic, whether in its isolated or complicated 
form, is very simple, and merely requires the combinations which are found 
to be effectual in other cases of neuralgia. Mercury, as in tic douloureux, 
heightens the affection, increases the general irritability, and renders the 865 
HEPATIC AFFECTIONS. 
system universally more obnoxious to the incursions of the morbid nervous 
sensibility. Carbonate of iron is, if possible, evgn more destructively per- 
nicious. Yet, it has been administered with reckless daring in all the 
phases and all the complications of neuralgia. Gentle purgatives, com- 
bined with colchicum, ipecacuanha, and hyoscyamus, will seldom fail to 
work a speedy cure : and if the constitution have suffered from protracted 
unmitigated pain, alkaline vegetable tonics will effect that which we might in 
vain expect from the rough insoluble mineral preparations. Part xi., p. 66. 
Acute Hepatitis.—On the treatment of this affection, Sir G. Ballingall 
says: 
With a view to obviate suppuration, and to promote the resolution of 
inflammation, blood-letting, both general and topical, is our chief resource; 
but, in addition to this, mercury has been long held to possess something 
like a specific influence in resolving inflammatory affections of the liver, 
and to its efficacy in such cases, I can bear personal testimony. I am at 
the same time persuaded, that, from the high repute which this medicine 
enjoys, it has in some instances, particularly of the acute disease, been 
too exclusively trusted to. Practitioners seem now, however to be gene- 
rally aware, that, in patients of robust constitutions and sanguineous habits, 
full mercurial action is not easily induced until the tone of the system 
is lowered by bleeding and other evacuations. It therefore behoves us 
to remember, that, while bleeding in acute hepatitis cannot be too 
promptly resorted to, the exhibition of mercury may perhaps be deferred, 
without any ultimate disadvantage. It was common, in my time, in India, 
to look upon blood-letting as an evacuation which it was upon all occasions 
desirable to avoid, but this was a sentiment in which I never permitted 
myself to indulge. 
In hepatitis, 1 have frequently observed, that when doubt or hesitation 
existed on the part of the practitioner, when half measures were adopted, 
and the early stage of the disease thereby neglected, it became extremely 
difficult of cure, apt to degenerate into a chronic form, and to become a 
troublesome companion for life. Under the apprehension of such a result, I 
have employed blood-letting to a larger extent than what the state of the 
pulse, the height of the symptoms, or the habit of the patient would seem 
to demand, and of such practice I have never had occasion to repent. 
I do not, however, mean to allege, that bleeding will altogether super- 
sede the necessity of mercury, but that in the acute form these should at 
least go hand in hand, and that the latter should be pushed to the extent 
of producing ptyalism with the least possible delay. In the chronic 
form of the disease, it is to mercury we must chiefly trust for the 
reestablishment of a healthy action in the liver, and the restoration of 
healthy secretions. The relief experienced, in many cases of chronic 
hepatitis, so soon as the mercury affects the mouth, is truly surprising ; 
the removal of all uneasy feelings from the side, the comparative clearness 
of the patient’s skin and visage, the return of natural evacuations, and the 
removal of every complaint but debility, abundantly evince the powers of 
his remedy. 
In either form of hepatitis, smart and habitual purging will materially 
promote the objects we have in view; and, in this instance, the preference 
so generally given to calomel in India, is, I believe, well founded. 
Part xi., p. 67. 866 
HEPATIC AFFECTIONS. 
Some of the Diseases of the Liver.—Dr. Budd makes some pathological 
and therapeutical observations, and among cholagogue medicines he 
especially mentions mercury, iodine, muriate of ammonia, and taraxacum. 
Dr. Forbes, however, has never observed peculiar cholagogue properties 
in muriate of ammonia, nor yet in rhubarb, which Dr. Budd subsequently 
instances, and is surprised that colchicum and colocynth should have been 
omitted, particularly the former, since in this respect it stands, perhaps, 
next to mercury. Nitric acid, also omitted by Dr. F., in some cases 
notably promotes the action of the liver. 
Congestion.—The common and usual form of congestion of the liver, is, 
that of the hepatic vein and its capillaries ; and that form may be caused 
by any disease in the heart or lungs tending to obstruct the return 
of blood by the hepatic veins. If, while the hepatic veins and their 
capillaries are thus congested, the portal vein and the capillaries imme- 
diately branching from it are empty, the appearance called mottled liver 
is presented, caused by thiWentral vessels of the lobules being full of 
blood, while those on their margins are void of it. And just in proportion 
as the vessels continue to be distended in a direction distal from the heart, 
and as the portal capillaries which form the margin of the lobules become 
filled gradually, will the mottled appearance merge into a homogeneous 
redness. And now, in addition to sanguineous, will biliary congestion 
begin to take place ; and this plainly in consequence, in the majority of 
cases at least, of the pressure of the distended blood-vessels on the minute 
branches of the biliary ducts, whereby the discharge of bile along these 
ducts is impeded. The general result of this state of things is hyperaemia; 
and a state of distention of the biliary vessels analogous to hypermia, but 
for which we have no exact name. The liver, of course, becomes enlarged, 
and its color, when an incision is made, is a deep reddish-brown or 
black. The diagnostic indications of this state are, the dropping of the 
liver several inches (more or less, according to the degree of enlarge- 
ment), below the ribs, and a fullness felt by the patient and perceived by 
the physician in the right hypochondrium. There is not “ in general ” 
pain ; never, we should say, in this simple form of congestion, until its pro- 
longation begins to give rise to inflammatory action. And even then, pain 
is hardly or not at all experienced, until the peritoneal investments begin 
to suffer, and the affection becomes what Bonnet calls hepato-peritoneal. 
In congestion depending upon obstructed circulation through the heart, 
he advises bleeding, purgatives, diuretics, rest, and those measures, in 
short, which peculiarly relieve cardiac disease. The reviewer here remarks, 
that purpura hemorrhagica, scorbutic disease, and any affections tending 
to diminish the fibrin of the blood, require the mineral acids and the bitter 
extracts, lie says, he has witnessed great advantage from the compound 
infusion and spirit of horse-radish, taken twice or thrice a day, with ten 
drops of nitric or chloric acid added to each dose. Dr. Budd divides 
inflammatory affections of the liver into suppurative, gangrenous, and 
adhesive, and his object is to show, that by far the majority of cases of 
abscess of this viscus are owing to suppurative inflammation of some vein, 
and consequent contamination of the blood by pus. 
When abs( jess has formed in the liver, Dr. Budd would never recom- 
mend it to be opened unless assured by circumscribed oedema, or a slight 
blush 011 the skin, that union had taken place between the integument and 
abscess. -EPATIC AFFECTIONS. 
867 
In diminished secretion, with pale or white stools, give mercury. In 
excessive secretion: increase the amount of oxygen inspired, and thus, 
during respiration there will be consumed materials that would otherwise 
be left for the liver to excrete ; for while the carbon of the lungs is united 
to oxygen, and excreted in a non-combustible state, the carbon of the liver 
is non-oxygenized, is still combustible, and is intended, not for excretion, 
but absorption. Limit the supply of food which contributes to form bile, as 
spirituous liquors, butter, cream, fat, sugar, etc. The patient ought 
not to sleep immediately after a full meal, nor take suppers. 
Part xiii., p. 105. 
Bromine in Hepatic Affections.—There can be no doubt that in some 
cases of hepatic derangement iodine affords relief; and the action of 
bromine considerably resembles that of iodine. A congestion both of the 
biliary and of the blood-vessels of the liver occasionally occurs without 
any obvious cause: the bile is scantily discharged; the volume of the liver 
is enlarged; and the whole abdomen, probably from a remora in the por- 
tal circulation, becomes tumid, as in incipient ascites. In these circum- 
stances, an effect seemingly magical follows the use of iodine or bromine. 
The liver acts and subsides, and the belly rapidly resumes its ordinary 
size. Magendie’s formulas for the use of bromine are still as good as any, 
only the doses may be considerably larger than ordered by him. Bro- 
mide of potassium, ten grains; orange or cinnamon water, four to six 
ounces; dose, a dessertspoouful twice or thrice a day. Or, bromide of 
iron, thirty-six grains; confection of roses, q. s. for fifty pills; two to be 
taken night and morning. 
In dyspeptics with strumous habits, the above formulae, the latter 
of them more particularly, will be found very useful. Part xv., p. 121. 
Liver, Torpor of.—The greatest possible difficulty meets us in the 
treatment of this state, occurring in those who return from tropical to 
temperate climates. What little bile is secreted being vitiated, our indi- 
cations of treatment should be directed to the production of a more abun- 
dant and healthy action, and to the attenuation and elimination of the 
fluid secreted. Use the fluid extract of taraxacum, with the carbonates 
of soda and potash, or with the bitartrate of potash, which affects the 
excretion from the kidneys, increasing it in quantity, and modifying it in 
quality, while they exert a solvent power on viscid bile, on fatty and 
other animal substances, and correct the acidity of chyme. If the 
diuretic effect is wished to be increased, add the acetate of potash, or the 
benzoate of ammonia. If alkalies prove cold or ungrateful, substitute the 
dilute nitric and hydrochloric acids, especially where tropical dysentery 
or diarrhoea has previously existed* or where an irritable state of the 
mucous membrane is present. Aloes seems to be more valuable with the 
above combination than any other purgative. If anaemia is present, 
restore the nutritive functions, if possible, and improve the state of the 
blood, by the alteratives already mentioned, bitter tonics, chalybeates, 
with mild aperients, and great attention to the diet and habits of life. If 
there is reason to believe that organic changes have taken place in the 
liver, or that it is accompanied with induration and enlargement of the 
spleen, use the nitro-muriatic acid bath, as it acts powerfully in promoting 
the functions of the liver, kidneys, bowels, and skin. The nitro-muriatic 
acid, diluted, is made by mixing three parts of hydrochloric acid, two of 868 
HEPATIC AFFECTIONS. 
nitric acid, and five of water; and of this dilute acid, three ounces to 
each gallon of water form a bath; two gallons will form a foot-bath; 
while the outside of the legs and thighs, the right side over the liver, and 
the inside of both arms are sponged alternately. Let a dose of Epsom 
salts be taken in some bitter infusion every other morning, while the 
patient is in the bath. If there is dryness or harshness of the skin, use 
a vapor bath twice a week. If the bath is used for the whole body, excite 
gentle perspiration previously, by covering the patient with hot blankets. 
If it excites irritation of the skin, let the quantity of the acid be dimi- 
nished. If irritation of the gums, with general malaise, is produced, 
relinquish it for a time. This bath may be used for two months, or longer 
iu severe cases. The neglect of this invaluable remedy is very much to 
be regretted. It seems to be equally valuable in the secondary and ter- 
tiary forms of syphilis; and another valuable quality is, that the use of 
opium is not contra-indicated during its exhibition. We obtain from 
the use of these mineral acids all the remedial effects in chronic, which 
we do from mercury in acute diseases, without its injurious effects. 
jPart xxii.,p. 367. 
Portal Obstruction.—When urine contains purpurine, or presents other 
appearances of portal obstruction, the diuretics, or other remedies employed, 
should be preceded or accompanied by the administration of mild mercu- 
rials, taraxacum, hydrochlorate of ammonia, or other cholitic remedies. 
Part xxiv., p. 155. 
Cirrhosis of the Liver.—This morbid change in the liver consists of 
hypertrophy of the fibrous element between the lobules of the organ and 
its subsequent contraction, whereby its volume is diminished, and the 
secreting cells compressed and atrophied. As a further result the large 
venous trunks are also compressed, and their commencing ramifications so 
congested that effusion into, or dropsy of, the peritoneal cavity is induced. 
The nutmeg liver is an incipient condition of cirrhosis, in which the por- 
tal system of vessels in the organ is congested. In both conditions, the 
hepatic cells are more or less fatty and atrophied. The fatty degeneration 
in nutmeg liver may be seen to commence at the circumference of the 
lobules, whereas in the advanced stage of cirrhosis, all the cells are more 
or less diseased, some loaded with fat, and others with yellow pigment. 
Notwithstanding the great organic changes which are frequently 
observed in this disease, danger is not so much to be apprehended from 
interruptions in the functions of the liver, as from the ascites induced by 
the constriction of the large abdominal \ eins, which, by distending the 
abdomen and compressing the lungs and liver, so interferes with those 
important organs, that death is occasioned. 
The treatment in cirrhosis must be purely palliative, and directed to 
diminishing the ascites, by means of diuretics and diaphoretics. The 
question of drawing off the fluid by paracentesis is one which may 
arise, in case the swelling is very great, and the embarrassment to 
the pulmonary and renal organs extreme. Even then, although tem- 
porary relief may be obtained by the operation, there is every reason to 
believe that, in the majority of cases, life is in no way prolonged. 
Part xxvi.,p. 94. 
Liver Pisease.—The observations of Dr. Jones lead him to believe that 
„he effect of mercury is undoubtedly to produce very great congestion of HERNIA. 
the liver; hence, in all inflammatory affections of this viscus, it would ap- 
pear to be a most improper remedy. Part xxviii133. 
Cirrhosis.—Dr. C. II. Jones says: As far as my experience goes, hema- 
temesis generally is one of the earlier secondary results of cirrhosis, 
ascites replacing it, if it has existed, at a later period. In my work on 
Morbid Conditions of the Stomach, page 59, a case is mentioned in which 
death occurred from vomiting of blood, without any history of previous 
illness extending further back than a week. The treatment of cirrhosis, 
and, of course, of its secondary effects, is, at the present day, a sad op- 
probrium to medicine. The bar which is set to the free course of blood 
through the portal vein, impedes, to a great degree, the absorption of any 
medicines given by the mouth. Diuretics produce no effect, because they 
never get into the blood, and so never reach the kidneys. Dr. Christison’s 
recommendation of applying fomentations of digitalis infusion to the ab- 
domen, and thus directly arriving at the general circulation, is certainly a 
promising one; but in one case in which I tried it, it produced no good 
effect. 1 cannot but think that the employment of baths of Kreuznach 
water, now known to be often efficacious in causing the disappearance of 
fibroid tumors of the uterus, might be tried in cases of cirrhosis, with 
some reasonable hope of benefit. These might be conjoined with frictions 
of cod-liver oil over the general surface. Surely it would be better to try 
perseveringly some plan of this kind, rather than the routine treatment 
of diuretics and purgatives, whose result in most cases is so unsatisfactory, 
and which at the most aims merely at the removal of a symptom. 
Part xxxii., p. 99. 
HERNIA. 
Strangulated Hernia—Employment of the Rectal Tube.—Dr. J. 
O’Beirne, of Dublin, recommends the introduction of a tube to a consi- 
derable distance up the rectum in cases of strangulated hernia, for the 
purpose of giving vent to the flatus contained in the intestine, as this pro- 
cess may occasionally prevent the necessity of an operation. He states 
that “no medical man can henceforth be considered justified in proceeding 
to an operation for strangulated intestinal hernia, without having pre- 
viously given a full and fair trial to the mode of treatment in question.” 
Mr. W. H. Maunder, relates an interesting case in a letter to Dr. Beirne, 
in which the inti*oduction of the tube of the stomach-pump, to the distance 
of twenty-six inches, so relieved, and an operation was prevented. 
Part i., p. 93. 
Preeminence of Tobacco in Strangulated Ilernia.—Dr. Jackson says: 
The use of tobacco in hernia, and of tobacco or tartar emetic in dislo- 
cations, I have long preferred to those copious effusions of blood formerly, 
and perhaps still too much in use. To lose blood sufficient to induce 
fainting, and to preserve the system in this state till a bone, or a hernia 
may be reduced, is an expenditure of the vital fluid, a waste of strength, 
which very many who are not prone to faint, will not regain for months 
or years. 
The warm bath, and warm fomentations may be tried, but they will 
hardly succeed in bad cases without the aid of blood-letting. It is true 870 
HERNIA. 
that if the patient is greatly relaxed by the general warm bath, and blood 
be let while he is yet in the water, a very small loss may suffice; but this 
may be in most situations a troublesome remedy, occasioning too much 
delay. Time, said Franklin, is money; but in the treatment of hernia, 
time is not only money to the physician, but life to the patient, as well as 
honor to the profession of medicine. Tobacco will do all that bleeding 
can do, however great the inflammation, all that ice, or cups, or bella- 
donna, or any other means can do that have ever been invented. 
We have very frequently used cataplasms of tobacco with great advan- 
tage for spasms of the bowels, particularly those of saturnine colic. 
Deglutition of tobacco-smoke we have used with decided advantage. 
A few years ago, I was called to a patient in the night, who had been 
suddenly taken with strangulation of an old hernia : the taxis was gently 
tried, but the tumor was too sensible to bear much manipulation. There 
was no syringe, nor means of administering an enema; nor was there any 
fire in the house, by which a tobacco cataplasm could be quickly made ; 
hence, it instantly came into my mind that he might swallow tobacco- 
smoke as a substitute. He was furnished with a cigar, and desired to 
make vehement efforts to pass the smoke into his stomach, lie soon 
became sick and puked, his whole frame relaxed, and covered with a cold 
sweat. The bowel Avas now very easily reduced, and the free use of 
volatile spirits, both internally and externally, soon restored him. 
Part i., p. 121. 
jReduction of Strangulated Inguinal Hernia—The Method of Dr. 
Hesselbach.—“ A strong man should place himself at the end of the bed 
on which the patient is lying, and placing the legs of the patient over his 
shoulders, so that each knee of the patient shall rest upon one of his 
shoulders, his feet hanging downward, shall then raise up the patient. 
The thighs of the patient are thus drawn upward, his head and body rest- 
ing upon the bed. In this position the taxis is to be repeated.” 
In a case cited, by placing the patient in the position above described, 
and reemploying the taxis, the hernia Avas reduced. Part ii., p. 133. 
Strangulated Hernia.—Dr. Warneke recommends the folloAving means, 
when those usually employed for the reduction of strangulated herniae 
have failed. The patient is to take the following: Opium, two grains; poAV- 
dered belladonna root, four grains ; sugar, four scruples. To be divided 
into eight poAvders, of which one is to be taken every half or quarter of 
an hour. The hernia is to be coArered with a warm poultice, containing 
powdered belladonna, and bandages are to be placed pretty firmly round 
the upper part of the patient’s thighs, close to the abdomen, to retard the 
return of the venous blood from the lower extremities, and render bleed- 
ing unnecessary. The author declares that by these means all the symp- 
toms of strangulation are speedily removed, the patient falls into a quiet 
sleep, and a profuse stveat, after which the hernia will be found soft and 
easily reducible. Part ii., p. 134. 
Aphorisms of Practical Surgery.—Congenital ruptures present this 
peculiarity, that the seat of their strangulation is most frequently in the 
neck of the herniary sac, and not at the ring. Wilmer has made this 
remark; and Alanson also has observed, that almost all the cases, in Avhich 
the stricture is situated in the neck of the sac, are cases of congenital hernia. 
The strangulation at the orifice of the herniary sac is very common, HERNIA. 
871 
whereas it rarely takes place at the orifice of the ring ; this opinion is not 
shared by all authors on the subject. (Indeed the very opposite doctrine 
is maintained, we believe, by many surgeons. Were Dupuytren right, the 
operation of dividing the ring without opening the sac would be almost 
invariably fruitless.—Rev.) 
Whenever vomiting ceases during the inflammation occurring in cases 
of hernia, we may be almost assured that the intestine has become gan- 
grenous. Part iii., p. 115. 
Radical Cure of Hernia.—For several years past the attention of sur- 
geons has been directed to discover a safe and effectual method of obtain- 
ing a radical cure of reducible hernia. 
A distinguished surgeon of Paris, M. Belmas, devised a plan to oblite- 
rate the herniary sac without leaving any wound in the integuments. He 
proposed to introduce, by means of a canula in form of a trocar, a small 
portion of gold-beater’s skin into the serous tunic of the hernia, which 
was to be left there so as to excite an exudation of plastic lymph, and thus 
cause the trajet of the hernia to be firmly plugged up. Although a few 
cures have been effected by this mode of procedure, M. Belmas has more 
recently substituted for the gold-beater’s skin, which he used in his first 
experiments, minute filaments of animal matter, wdiich he inserts and 
deposits in the root of the herniary sac by means of a small larding-pin 
(lardoire). 
Mr. Jameson, an American surgeon, has reported a case in which he 
effected a cure in the following manner. The herniary envelopes being 
divided as in the operation for strangulated bowel, he cut a portion of the 
integuments in the form of the blade of a lancet, and folded it back upon 
itself securing it in the ring so as to plug up its trajet. We are not aware 
that this plan has ever been tried in France ; it may indeed succeed, but 
it cannot be altogether free from danger. 
M. Gerdy has proposed another method, which is certainly more safe, 
but is unfortunately much more uncertain. It consists in pushing up along 
the inguinal canal a fold of the integuments of the scrotum, in the form 
of the finger of a glove, and then securing this fold in its new situation by 
transfixing it with a strong thread by means of a needle contrived for the 
purpose. This operation has now been performed a good many times ; ,b#t 
not only has it failed in several instances, but it has even been followed by 
fatal consequences in more than one case. 
As to the proposal of M. Bonnet, of Lyons, to transfix the sac with 
several needles to be left in for some days, and that of M. Mayor, to sub- 
stitute strong threads, like a seton, in place of the needles, M. Velpeau is 
of opinion, that in neither of these ways can we hope to effect more than a 
partial closure of the sac, and, therefore, that we cannot count upon a 
radical cure of the hernia. 
In 1836, M. Velpeau tried the effect of iodine injections into the sac of 
a reducible hernia, and repeated the experiment on two other patients; 
but the difficulty of reaching the sac with certainty, and the unsatisfactory 
results obtained in these three cases, are serious objections to the prac- 
tice ; and M. Velpeau himself, in the last edition (1839) of his work, 
alludes to it without approbation. 
During the course of last year, he tried another method in two cases. 
This consisted of three acts or elements: a subcutaneous incision on the 872 
HEKNIA. 
principles so ably insisted upon by M. Guerin in the surgical treatment of 
so many diseases, scarification of the interior of the sac and especially 
of its internal aperture, and lastly, compression of the entire length of 
the inguinal canal. The left fore-finger being first pushed into the external 
inguinal aperture to the depth of half an inch or so, a bistoury is slided 
along the nail and inserted through the integuments in a direction back- 
ward and outward; the finger is then withdrawn, and the cutting edge 
of the instrument turned against the iliac parietes of the abdomen, and in 
such a manner as to make numerous scarifications, in various directions, 
without endangering the epigastric artery : the bistoury is then with- 
drawn by the small entrance-wound, and the operation is completed. 
jPart iii., p. 117. 
Use of Morphia in Strangulated Hernia.—In the treatment of stran- 
gulated hernia various remedies have been used to produce that complete 
prostration of energy which is often so necessary to accomplish its reduc- 
tion : but the preparations of opium have generally been omitted; bleed- 
ing, the warm bath, tobacco, tartarized antimony, etc., have generally 
been preferred. Dr. Bell and Dr. Davis have, however, brought some 
interesting cases before us which show the value of opium, either in the 
form of morphia or laudanum, in accomplishing the wis’ned-for prostration. 
Dr. Bell gave half a grain of morphia, and repeated it in half an hour, 
with the desired effect. Dr. Davis gave a teaspoonful of laudanum, and 
repeated it in two hours; this second dose was followed by complete pros- 
tration of the muscular system, dilatation of the pupil, and the easy reduc- 
tion of the hernia. Part iv., p. 96. 
Pseudo-Strangulations of Her nice.—M. Malgaigne attacks earnestly the 
proposition laid down by Pott, “ that the operation for hernia is not dan- 
gerous in itself,” and which has exercised such a pernicious influence over 
modern principles. 
As to the cause of hernia, “ authors state that V engouement from ac- 
cumulated fecal matter produces it. Is it true, then, that excrements 
do habitually accumulate in hernia) of some standing? There is not, 
there cannot be hard substances, nor even fecal matter, except in the 
large intestines ; and hernia) of the large intestines do not constitute 
a* twentieth part of intestinal hernia). Thus, then, this engouement 
described in books cannot possibly exist in ninety-five cases out of one 
hundred. 
“I have, like all other surgeons, paid a fatal tribute to this fatal doc- 
trine : I operated in a case of pretended engouement—there was neither 
engouement, nor strangulation, and the patient died. You will find mis- 
takes of the same kind committed by Percival, Pott, Dupuytren, and 
Astley Coopw. As to the engouement of authors, it is a creation of pure 
imagination, it is really a hernial peritonitis disguised, which is the acci- 
dent most commonly supervening in cases of hernia.” 
As to the means of discriminating between this inflammatory action, 
and real strangulation, he brings forward the following propositions : 
1st. In all old intestinal hernia, which have never been restrained by a 
truss, or in which the truss has been disused for a long time, there is no 
veal strangulation ; the ring or rings being much larger than is required 
by the size of the pedicle of the hernia. This general fact results from all HERNIA. 
873 
the observations which I have made either on the living or the dead. I 
have found no exception. 
2d. In the pure epiploceles of whatever size, it is most frequently either an 
adhesive or suppurative inflammation, which is mistaken for strangulation. 
3d. Consequently in these two cases, when well marked, the operation 
is always irrational; and, besides taxis at the beginning or end of the inflam- 
mation, the treatment should be entirely antiphlogistic. Part iv.,p. 111. 
Treatment of Strangulated Hernia by Copious Injections.—In a for- 
mer article we mentioned a case of Mr. Maunder’s in which that gentle- 
man relieved a case of strangulated hernia by inti*oducing the tube of the 
stomach pump to a considerable distance up the bowel, so as to give vent 
to flatus, which was soon followed by a reduction of the strangulation. 
Mr. A. S. Lawrence, of Clifton, relates a case of strangulated hernia, in 
which he effected the reduction, not by the tube of the stomach pump, 
but by injecting four pints of tepid water gruel, followed in an hour by 
another pint, which had to be injected with some force owing to some 
resistance: on applying the taxis afterward, the tumor was easily reduced. 
We agree with Mr. Lawrence, that to introduce the tube of a stomach- 
pump twenty-six inches up the rectum and colon, is a rather dangerous 
operation, as the rectum itself is only about eight or ten inches in length. 
The distention of the bowels by tepid water is a much safer and easier 
operation. Part v., p. 132. 
Strangulated Hernia Treated by Exhaustion through the Elastic 
Tube.—Mr. Webber, of Orford, relates a case where he succeeded in the 
way recommended by Mr. Maunder; that he endeavored to produce a 
vacuum below the stricture by the exhausting power of the syringe. The 
tumor, which occupied the scrotum, was of the size of a goose’s egg, 
remarkably tense and unyielding, with all the symptoms of strangulation. 
The taxis was diligently and carefully applied for about twenty minutes 
without success ; the patient was then bled to syncope, and the taxis again 
had recourse to, followed by the application of cold to the tumor, and 
such other remedies as circumstances permitted. 
A common enema having been previously administered, the oesophagus 
tube of Weiss’ stomach-pump was now passed gradually up until its whole 
length, about twenty-five inches, had been introduced, the brass extremity 
alone remaining without. 
After waiting a quarter of an hour, between two and three pints of 
water were thrown up and retained in the bowel for a short period ; the 
cylinder of the pump having been unscrewed from the elastic tube, and 
the mouth of the latter closed by the thumb, on withdrawing which the 
fluid repassed in a jet of considerable force. The cylinder was now read- 
justed to the tube, and the action of the machine being reversed, the 
piston was worked rapidly with the view of producing a degree of ex- 
haustion or partial vacuum in the intestine ; gentle taxis was at the same 
time resumed, and after the expiration of four or five minutes (during 
the latter part of which the patient complained of a sensation of bearing 
down referred to the whole abdominal region), I had the satisfaction to 
feel the contents of the tumor recede from beneath my fingers, and slip 
into the abdomen with the usual gurgling which accompanies the return 
of intestine. 
The man recovered without any untoward system. Part vi., p. 129, 874 
HEItNIA. 
Injection of Belladonna in Strangulated Ilernia.—A woman, aged 68, 
experienced a swelling in the right groin, during the occurrence of a 
severe cough: this was followed by pain and tenderness in the part, 
vomiting, sleeplessness, and pain in the abdomen. Examination showed a 
strangulated hernia, which could not be reduced. 
Dr. Fischer directed injections of belladonna (one scruple of the leaves 
in each) to be administered, After three clysters the taxis was again 
employed, and the hernia returned without difficulty. Part vi., p. 151. 
Decoction of Oak-baric.—Compresses, impregnated with a strong de- 
coction of oak-bark, kept in situ by a truss or bandage, suggested to pro- 
mote contraction of the ring after the reduction of recent inguinal hernia. 
Part viii., p. 16. 
Treatment of Strangulated Ilernia—Dr. Arnott's Plan.—In addition 
to the usual treatment, by the taxis, by blood-letting, by the warm bath, 
cold applications, injections of tobacco, purgatives, and purgative enemata, 
the exhausting syringe of the stomach-pump, antispasmodics, opium, bel- 
ladonna, and lastly, by means of dividing the stricture, Dr. Arnott offers 
for consideration, as among the best and simplest methods of reduction of 
strangulated hernia, the employment of long-continued pressure of the 
hernial tumor and the application of cold to it. But neither of these 
modes have hitherto been perfectly applied singly, or conjointly. If they 
are so often successful when applied separately in the way which is usu- 
ally adopted, we think that they may be still more so when applied con- 
jointly in the way recommended by Dr. Arnott. The continued applica- 
tion of cold and pressure will reduce the volume of the gas in the intestine, 
and materially aid in keeping down inflammatory action. It may be 
accomplished by placing a bladder of water upon the hernial tumor, and 
keeping up pressure by the hands or some other contrivance ; and at the 
same time by causing a current or constant change of water in the blad- 
der by means of two tubes, one conveying the water to the bladder from 
a reservoir above, and the other conveying it away to a receiving vessel. 
The bladder should be confined to the hernial tumor by a metallic or 
wooden case, in the form of a basin, or by a small flower-pot, of consider- 
ably smaller diameter than its own, and having an opening in the centre 
for the passage of the current tubes. By this means the hernial tumor 
will be completely surrounded by, and imbedded in the bladder, which 
may be kept at the required pressure by a bandage or truss 
In intus-susception, Dr. Arnott has found that rapid mercurialization 
has frequently been a means of relieving the patient. Part viii., p. 127. 
Reduction of Femoral Ilernia on Dr. O'Beirne's Plan.—We have re- 
peatedly referred to this plan of reducing a strangulated hernia, but as 
every fresh fact in corroboration of it is satisfactory, we subjoin the follow- 
ing case by Mr. Collambell, of Lambeth. It was that of a woman, aet. 51, 
ruptured twenty-four years ago. All the symptoms of strangulation being 
present, the taxis being used for a considerable time, and various other 
measures resorted to without avail, Dr. O’Beirne’s plan was tried as fol- 
lows : The elastic tube of a stomach pump was introduced into the rectum 
and passed to the distance of twelve inches. The syringe was then at- 
tached, and two quarts of warm water slowly injected. In a short time 
the syringe was detached, and the water was allowed to run off by the 875 
tube. The syringe being reapplied, and its action reversed, Mr. C. con- 
tinued exhausting the air, when, after a few minutes, the hernia gradually 
subsided, and by keeping up gentle pressure the contents were returned 
into the abdomen. Part viii., p. 154. 
Knife for Dividing Strictures.—A small convex, double-edged, move- 
able knife, concealed within a canula, recommended by Dr. Stewart for 
dividing the stricture in cases of strangulated hernia. Part viii., p. 162. 
Opium in Hernia.—[The following case, by Mr. J. M. Walker, shows 
the good effect of opium in hernia :] 
I was sent for at 10 p.m., to visit 11. PI., aged 45, a stout, muscular man, 
suffering under strangulated scrotal hernia in the right side. He had been 
trying for an hour to reduce it, having done so frequently before, but now 
he informed me it was a great deal larger. He was vomiting, and com- 
plained on the least pressure. In consequence of the extreme tenderness, 
I did not persevere in the taxis, but decided on putting him under the in- 
fluence of opium. I gave him two grains every fifteen minutes, until he 
had taken six grains, and to use hot fomentations. Shortly after the first 
pill the vomiting ceased ; and when I visited him again, at half-past 12 p.m., 
I found him, as he said, exceedingly comfortable; it was quite evident he 
was enjoying all the luxury of an opium-eater. Upon inquiry, he told me 
he had not touched the swelling, but that it had gone away of its own 
accord. Part ix., p. 185. 
Treatment of Gangrenous Intestine in Hernia.—In a case of hernia 
published by Dr. Paul, of Elgin, in which the operation was deferred too 
long, by the refusal of the patient to submit to it, the different tissues were 
so thickened from inflammatory action, that it was with much difficulty 
that the bowel was exposed, and it was then found to be completely gan- 
grenous. The peritoneum wa% so adherent to the bowel, that on separat- 
ing them by the most careful dissection, the bowel burst. The opening in 
the intestine was made sufficiently large, and a warm poultice was then 
applied to the wound. So soon as the patient rallied from the immediate 
effects of the operation, epsoni salts in small doses were given from time 
to time, and in the course of the day the bowels were freely opened via the 
wound. The stomach was now retentive, and, except the formation of an 
abscess in the scrotum, everything went on as favorably as could be wished. 
The swelling subsided rapidly, and the wound appeared to contract. Little 
further treatment was required, beyond keeping the parts clean and regu- 
lating the bowels when necessary. Some exuberant granulations required 
to be kept down by caustic. Ten days after, he felt some desire to have a 
stool by the rectum, and upon making the attempt, he had a copious eva- 
cuation. This desire was encouraged by small doses of the sulphate of 
magnesia, and he continued to have two or three stools per anum dadv. 
The wound now closed up very fast, and very little feculent matter escaped 
from it, so that before the end of the thirteenth week the patient began to 
walk about, wearing a truss. In two weeks more the wound was entirely 
closed, and the man resumed his work as a groom. Part ix.,y>. 187. 
Strangulated Hernia reduced “ en masse.'>'’—[Mr. Luke, in a paper read 
before the Medico-Chirurgical Society, directs attention to the fact, that in 
cases of strangulated hernia the mass is sometimes reduced either by the 
patient or surgeon, and, nevertheless, the symptoms of strangulation still 
continue.] 
HERNIA. 876 
HEENIA. 
It may occasionally happen that a patient has a tumor in the groin, which 
he pushes back into the abdomen, not knowing the nature of the affection; 
or, a surgeon knowing it to be a hernia, uses too much force in the reduc- 
tion. The consequence may be that the hernia is indeed reduced, but the 
stricture, being the investing sac, is reduced likewise, without the bowel 
itself being released. This is called reducing a hernia en masse. What is 
to be done in such a case ? The cases, indeed, are not very common, but, 
nevertheless, it is necessary for the surgeon to be prepared for all contin- 
gencies. The tumor, perhaps, may be pushed into the abdominal cavity 
by the patient himself, but the symptoms of strangulation may continue to 
increase in sevei’ity. In the cases related by Mr. Luke, they were all ob- 
lique inguinal hern'iEe; were reduced by the patients themselves, and were 
each strictured by the neck of the sac in which they were inclosed. It is 
probable that there will be nothing to guide the surgeon but the history 
of the case and the present symptoms of strangulation ; or perhaps a tumor 
may be indistinctly felt at the internal ring, which will be slightly painful. 
It is possible that by coughing and straining the tumor may again be 
brought into the inguinal canal; if this be not accomplished, it will be 
necessary, when all other means have failed, and the patient’s life is in 
danger, to perform an operation of exploration, which consists in cautiously 
dissecting down to the internal ring: the finger may then be introduced 
into the abdominal cavity, to ascertain if any tumor of a suspicious charac- 
ter there exists. In one very interesting case, described by Mr. Luke, 
this was the fact, and the tumor was brought out of the abdominal cavity, 
and found to be a hernia covered and strictured by its sac. This was 
opened, the stricture divided, and the patient did well. Part xi.,p. 124. 
jReduction of Strangulated Hernia en masse.—Since Mr. Luke’s com- 
munication, a case has been noticed by Mr. Wade, of Westminster. The 
patient, a man seventy-five years of age, had had double inguinal hernia 
tor thirty years. Symptoms of strangulation appeared, but no hernia 
could be detected externally. Mr. Wade, from slight darting pain having 
been felt in the right inguinal region, and from the hernia descending on 
the left side on coughing, was led to suspect that the man had himself re- 
duced the hernia “ en masse.” He accordingly laid the canal freely open 
on the right side, and found a membranous band as far as the finger could 
reach, which, on division, allowed of the reduction of the hernia. 
Part xii., p. 197. 
Irrigatioyi with Cold Water in Strangulated Hernia.—M. Moreau Bou- 
tard mentions several cases in which irrigation with cold water enabled 
him to reduce the hernial tumors, after the taxis alone had totally failed. 
The first case is that of a woman four-and-twenty years of age, laboring 
under crural hernia, the result of an effort. The hernia had existed for 
ten hours, and all the symptoms of the strangulation were present. The 
taxis not succeeding, a small stream of cold water was made to fall from a 
height of three feet on the tumor. The contact of the cold water produced 
a general chill, and the muscles of the abdomen contracted ; the nausea 
ceased, the respiration was momentarily suspended, and in less than five 
minutes from the time the irrigation wras commenced, the hernia escaped 
from the hands of the operator and returned into the abdomen. 
The second case was a man of thirty-five, of robust constitution, who had HERNIA, 
877 
labored under inguinal hernia for some years. During defecation, the her- 
nia, which was not restrained by a bandage, escaped and became strangu- 
lated. Dr. Boutard was called in eleven hours afterward. The intestine 
had descended into the scrotum, and formed a considerable tumor. The 
taxis was repeatedly tried, the patient was twice bled from the arm, and 
was placed in a warm bath, but all without success. He was then taken 
from the bath and placed naked on an inclined plane, without being 
rubbed dry. Whilst shivering from the effect of the cold produced by 
the evaporation of the water with which he was covered, a stream of cold 
water was directed on the hernia as before, the taxis being at the same 
time resorted to. In the course of five minutes, the tumor became softer, 
its pedicle moved, and it escaped into the abdomen. Part xii., p. 198. 
Treatment of Strangulated Hernia after Operation.—[Mr. Arnott 
makes the following useful remarks on the treatment of strangulated 
hernia, in a clinical lecture upon two cases in which the operation had 
been successfully performed. Nothing of an aperient nature, unless we 
call hydrarg. cum creta such, was given, yet motions followed in due 
course.] 
The old doctrine was, that after the operation for strangulated hernia 
you could not have too many motions, and, therefore, purgatives were to 
be administered of active character immediately after the operation, and 
repeated till their effect was obtained. No doubt it is satisfactory to find 
evacuations per anum following no long time after the operation, but it is 
a different question whether we should always take active measures, i. e., 
give irritating remedies, to obtain these. If your finger was swollen, tur- 
gid with blood, inflamed from a ligature having been tied around it, and 
left there for some hours, you probably would not think, after loosening 
or cutting this, that the best mode of accelerating the recovery of the 
part was to give the hand some active occupation, and thereby irritate 
and excite it. But, on the contrary, you would be more like to keep it 
quiet, in an easy position and to give nature fair play, to do the best for 
its recovery. The case is the same with a portion of bowel that has been 
strangulated, and is in an analogous condition from an analogous cause. 
Thickened, full of blood, in a state of inflammation, or on the verge of it, 
a piece of intestine in such a state is not likely to be benefited by rough 
treatment, i. e., active aperients, irritants. Beturned into its natural situa- 
tion after the stricture has been divided it is best to leave it quiet—to let 
it alone for some time, to allow the swelling to subside, to- allow it to 
recover. In some cases you must trust to nature alone for the 
cure; in others it is advisable to endeavor to assist her, by resorting 
to the means we usually employ for arresting inflammation. 
Part xii., p. 198. 
Radical Cure of Hernia.—The radical cure of hernia is effected either 
by causing the closure or destruction of the sac, or by indirectly promot- 
ing the closure of the hernial aperture; but Mr. Teale observes, that 
unless both these effects are produced, little advance toward permanent 
cure is made. The substitution of a layer of peritoneum across the her- 
nial aperture, affords a resistance so slight, as scarcely to possess any 
power in preventing a future hernial descent. The use of well adapted 
trusses promotes the radical cure of hernia, by effecting contraction, or 
diminution of the aperture in the aponeurotic or muscular structure. The 878 
cicatrix left after the operation of Desault, may, for a time, mechanically 
prevent protrusion, or allow the aperture to contract; and the operation 
of M. Gerdy, in which the opening was filled with an organized plug, ap- 
pears to have succeeded in the same manner. 
The means employed for effecting the radical cure of hernia, by pro- 
moting closure or contraction of the hernial sac, are, excision of the 
testicle; incision of the sac; excision, suture, and cauterization of the sac; 
ligature of the sac after incision of the integuments; acupuncturation; 
and insertion of gold beater’s skin in the sac. These operations have suc- 
ceeded in destroying or closing the hernial sac, but they do not prevent a 
fresh hernial descent. 
The best means for promoting contraction or closure of the hernial 
aperture, are trusses; ligature of the sac and its envelopes; and the 
cutaneous plug. Trusses should not press too powerfully on the abdomi- 
nal parietes, or they may produce inflammation or irritation of the parts, 
or the walls of the abdomen may become atrophied; or if the pad be very 
small and convex, it may produce elongation of the aponeurosis and mus- 
cle, and thus weaken the parts. The operation by ligature is attended 
with considerable pain, and even loss of life. There are two ways of in- 
troducing the cutaneous plug—the first, to detach a piece of integument 
from the neighborhood of the ring, and introduce it into the aperture; 
the second is effected by drawing the loose scrotal integument into the in- 
guinal canal, and to cause adhesive inflammation between the invaginated 
integument and the walls of the canal. M. Gerdy retains the invaginated 
integuments in situ by one or more sutures. Mr. B. Cooper, in perform- 
ing M. Gerdy’s operation, stitched the invaginated skin to the tendon of 
the external oblique muscle, and brought out the needle an inch and 
a half above Poupart’s ligament; the needle was again passed into 
the canal, and brought out through the abdominal parietes as before, 
about four lines distant, and the skin between the two ends of the 
ligature was thus included and tied over a piece of bougie. 
Part xiii., p. 247. 
Treatment of Strangulated Ilernia—Examination and Treatment of 
the Protruded Intestine.—Mr. Teale goes on to speak of the treatment of 
the protruded intestine, when hyperhematic, and says: “There are no de- 
grees of discoloration of the intestine, short of its vitality being extinct, 
which forbid the replacement of the part within the abdomen.” In in- 
flammation, the intestine exhibits various shades of red color, more or less 
florid, and the vessels are seen to have an arborescent arrangement. 
When congested, the small vessels may easily be seen of a dark color, or 
they may be concealed by infiltration of blood beneath the perito- 
neum. The surgeon has to determine whether the intestine be still living 
or not. 
In order to determine whether the intestine be still living or not, wait 
a few moments after dividing the stricture, and see whether the discolora- 
tion becomes less intense; or press the blood out of the distended veins 
and see if they become rapidly refilled. If no evidence of circulation 
exist, cover the intestine with integuments, or with a moist sponge, and 
wait a little while; the surface of the intestine may then be carefully and 
slightly scarified with the point of a lancet, and, perhaps, a slight oozing 
of blood will take place; if so, however discolored it may be, the intes- 
HERNIA. HERNIA 
879 
tines may be returned into the abdomen. Carefully press out the con- 
tents of the intestine and then replace it in successive portions; then pass 
the finger within the abdomen, to determine that no portion of the intes- 
tine is engaged within the sac, and also to determine that the protruded 
knuckle ot the intestine is not invaginated within a neighboring portion 
of the intestinal canal. When gangrene has taken place, and is general, 
make an incision through the whole length of the gangrenous portion, 
and leave it to slough away. This opening allows the contents of the 
upper part of the canal to pass away; but if this does not take place 
without dividing the stricture, this must be done with as little disturbance 
as possible. The wound must be left open, to facilitate the free discharge 
of matters, and simply dressed with wet linen, frequently renewed. Mr. 
Travers does not recommend division but dilatation of the stricture. Sir 
A. Cooper divided the stricture generally. Mr. Key also advises it. 
Brasdor’s practice of excising the gangrenous parts and uniiing the 
divided extremities by suture, is universally abandoned. Recent adhe- 
sions, if there be no gangrene, are to be destroyed by the finger or han- 
dle of a scalpel—adhesions of two coils of intestine is also to be treated 
in this way. 
It is recommended by some practitioners, as Mr. Key, to return 
the bowel without cutting into the sac, as there is less danger of peritoneal 
inflammation afterward. The objection to this practice is the possible 
gangrenous condition of the bowel, many of the symptoms of which are 
equivocal, so that it is the best practice, after all, to open the sac. 
The great mortality attending these operations has been increased by 
improper after-treatment, as the early exhibition of purgatives. 
Part xiii., p. 249. 
Enterotomy of the Small Intestine.—M. Maisonneuve has adopted a 
mode of practice which is calculated to save the lives of many subjects of 
strangulated hernia, who would otherwise perish. It frequently happens 
after the operation for hernia, that the strangulated portion of intestine, 
when released from stricture and replaced within the abdomen, is incapa- 
ble of resuming its functions; symptoms of obstruction continue, and the 
intestine above the part strangulated remains in a state of tympanitic dis- 
tention. M. Maisonneuve, having operated upon a patient for strangula- 
tion of the small intestine, found, five or six hours after the operation, 
that the obstruction was unrelieved. He separated the agglutinated edges 
of the incision, and, passing his finger into the abdomen, felt a distended 
coil of small intestine, adherent by false membrane to the surrounding 
parts. Without materially disturbing the adhesions, he seized the dis- 
tended coil of intestine with the forceps, and by means of probe-pointed 
scissors established an opening in it, through which the intestinal contents 
were freely discharged. The urgent symptoms were relieved, and the 
patient recovered. Part 254. 
Hernia—Strangulated.—Lay the patient upon a hard mattress with no 
covering but his shirt; keep the room quite cool, and employ cold appli- 
cations to the tumor. Give tartar emetic in such doses as to produce 
great nausea or vomiting, and then use the taxis gently for a few minutes 
and repeat it at intervals. If this treatment does not succeed in four or 
five hours, operation should at once be resorted to. The great danger 
consists, not in the operation itself, but in postponing it too long. 880 
HERNIA. 
Distinguish between true strangulation and inflammation, or pseudo- 
strangulation. If the taxis is not successful, place in a bath, give a tobacco 
injection, and put a cataplasm on the tumor; apply leeches if necessary. 
When inflammation declines, again have recourse to the taxis. 
Part xv., p. 213. 
Some obscure Forms of Hernia.—There are several cases in which 
strangulation exists as the result of a hernial protrusion, but which is not 
remediable by the ordinary operation. The first is that of “ reduction en 
masse where the strictured sac and its contents have been returned to- 
gether through the internal ring. Here the internal ring is to be exposed 
and dilated until the sack is seen, lying between the fascia transversalis 
and the peritoneum; the sac is then to be drawn down into the canal, and 
the ordinary operation performed. The two other forms are more ob- 
scure, and less amenable to treatment. In one, there is a reducible in- 
guinal hernia, but the sac is prolonged into the abdominal cavity, where it 
forms a pouch, or as it were a second sac contained between the facia 
transversalis and peritoneum. The inguinal canal is unusually long, the in- 
ternal ring is found quite free and of large size, and the finger is passed 
through it into the abdominal cavity. These symptoms may lead to sus- 
picion of the state of the case, for which, of course, no further operative 
measures can be adopted. The third form depends upon the existence of 
old irreducible epiplocele: the omentum, as it approaches the internal ring, 
becomes contracted into a firm unyielding cord, and when a fresh intes- 
tinal protrusion takes place, a portion of intestine may become incarcerated 
by this cord within the abdomen. Part xvi.,p. 186. 
New Treatment for Strangulated Hernia.—Place the patient on the 
back, with the thighs well flexed; desire him to empty the lungs as much 
as possible, and then, while an assistant holds the nose and mouth to pre- 
vent inspiration, make gentle pressure over the tumor. 
Part xvi., p. 189, 
Hernia—Strangulated.—Whenever there is any suspicion that the 
bowel or omentum is in a state of gangrene, the sac must certainly be 
opened, otherwise the division of the stricture external to the sac (Petit’s 
operation) should be practised. 
•H- ***** * 
In operating for hernia, after determining the seat of stricture, instead 
of cutting down on the tumor, make the incision directly over the part 
where the stricture will have to be divided. Thus not only will the sac 
not be opened, but the tumor not interfered with. The method is appli- 
cable to hernia of all species. But whenever organic disease exists, open 
the sac and leave a free jiassage for discharges. Part xvii., p. 163. 
Observations on Femoral Hernia.—[Mr. Cooper makes the following 
remarks with reference to some of the difficulties met in cases of femoral 
hernia. He says:] 
In the first place, be most cautious in your diagnosis, and however cer- 
tain you may feel as to the true nature of the tumor, always commence 
the operation rather with the deliberation of one about to enter upon an 
exploration, than with the confidence only admissible under circumstances 
of indisputable certainty. 
Although it is easier to distinguish a femoral than it is an inguinal hernia, HERNIA. 
881 
yet there are abnormal conditions relating to the seat of femoral hernia, 
which complicate its diagnostic marks. An enlarged gland in the upper 
part of the thigh concomitant with sickness and obstruction in the bowels, 
may offer great difficulty as to the mode of proceeding. If, under these 
circumstances, the symptoms be of recent occurrence, internal reme- 
dies may be first had recourse to, and the taxis employed ; but should 
the obstruction have existed for a considerable length of time, and the 
patient be consequently in danger, an exploring operation should be no 
further delayed. Supposing an enlarged gland be exposed, it should be 
removed, and the investigation continued; for it is very probable that, 
under the described circumstances, a hernial tumor may yet be disco- 
vered behind the enlarged gland. Sir Astley Cooper mentions a case, 
in his published lectures, of a patient being admitted into Guy’s Hos- 
pital, with a strangulated femoral hernia, to which he had a poultice 
applied for three days, under the supposition that is was a bubo. 
When the operation was performed, the intestine was found in a state 
of gangrene, and the patient died. Another case is mentioned, in which 
a surgeon not only poulticed, but also opened a femoral hernia, believ- 
ing it to be abscess, and the patient died two days after. I witnessed 
the same mistake in Norwich, several years ago, but in that case the 
patient survived, and the artificial anus proved only a temporary incon. 
venience. 
Psoas abscess and femoral hernia may coexist, and should exploration 
be necessary from the continuation of hernial symptoms after proper 
remedies have been ineffectually administered, the surgeon is not only 
justified, but bound to investigate the nature of the swelling by surgical 
exploration. Varicose veins, or tumors of any kind in this region of the 
thigh, may lead to the necessity for similar treatment as in the cases 
alluded to. I must again also caution you, not to confound inguinal with 
femoral hernia; for, if in either case the one be mistaken for the other, 
neither the force employed in the manipulation by the taxis, nor the sur- 
gical operation for the division of the stricture, will be applicable to either 
indiscriminately. 
In makiug the first incision, without due caution you might easily wound 
the saphena major vein ; you should therefore always previously ascertain 
the precise position of that vessel. Immediately under the skin you may 
meet with some difficulty, in consequence of the presence of enlarged ab- 
sorbent glands, which may require to be removed to enable you to prose- 
cute the further steps of the operation. The fascia superficialis you will 
also sometimes find much thickened, at others much attenuated, and you 
should be prepared for this variation, or you may in some cases hardly 
recognize the structure when exposed to view, and may go on dividing 
the fascia into several layers, so as to complicate the operation, and pre- 
clude the possibility of knowing how far you have proceeded. The laying 
open the sheath of the femoral vessels is in all cases a difficult part of the 
operation, as that tissue is not very easily distinguished, either from the 
superficial fascia, or from the hernial sac. Usually, howevex-, a lai-ge vein 
will be found between the sheath and the superficial fascia, and some fat 
between the sheath and the sac (the peritoneum), but where neither the 
one nor the other be present, great caution is required. The division of 
the stricture is very embarrassing to a young operator, from the great 
depth*of the constriction, and in passing the director under it, it must be 882 
HERNIA.. 
pushed deeply backward in the thigh, before it is directed upward under 
Poupart’s ligament. In femoral hernia I have found the division of the 
stricture external to the sac more frequently effective than in inguinal, but 
it requires some caution in pushing the contents of the sac into the abdo- 
men, that the sac and contents do not all go up together (“ en block ”), 
and thus at once convert an external into an internal hernia—a result 
which would most probably terminate fatally. I once had this misfortune 
occur to me, and the post-mortem examination proved the fact—even in 
the common application of the taxis only, it has been knoAvn to result. If 
compelled to open the sac, you will generally find that a considerable 
quantity of fluid escapes, sometimes before, but more frequently after the 
stricture has been divided. I have seen so much flow out as to give rise 
to some apprehension that the intestine had been wounded—an accident 
more likely to occur in femoral than in any other species of hernia. 
Part xviii., p. 181. 
Operation for Hernia according to Mr. Gay's Method.—[This was a 
case of femoral hernia in a female. After the strangulation had existed 
somewhat less than twenty-four hours, the use of the taxis, aided by the 
application of ice to the tumor, and a purgative enema, having been ineffec- 
tual, Dr. Catherwood operated. He says :] 
I began the operation, after chloroform had been exhibited, by making 
an incision, about an inch in length, between the tumor and the spine of 
the pubis, obliquely, from above downward, and from without inward, 
the highest point of the incision being over the inner part of the femoral 
ring. After completely dividing the superficial fascia, the tip of the 
finger was readily passed to the angle between Gimbernat’s ligament, and 
the neck of the hernial tumor, and a section of the edge of the ligament 
made with a concealed bistoury. A few fibres were now found to hold 
the tumor, which were divided by bringing the edge of the bistoury 
directly forward. By making a very gentle pressure on the sound skin, 
the rupture immediately returned. The whole operation occupied but a 
very short space of time. Within ten minutes the bowels were moved, 
and their action continued at short intervals during the night. 
Observations.—This mode of operating possesses such great advantages 
over the commonly adopted method, that it only requires to be tho- 
roughly known and understood, to receive the sanction of the profession. 
Part xviii., p. 185. 
Obstructed Hernia.—The affection under consideration is of a very 
insidious nature, and its symptoms are not very well marked. In common 
with other forms of hernia, we have obstructed bowels, a tympanitic 
abdomen, and more or less vomiting ; flaccidity of the tumor, and 
absence of pain are more characteristic symptoms. Mr. Gay thus gives 
the diagnosis: 
Briefly, then, obstinate constipation, low vital powers, an old and irre- 
ducible hernia in an unusually flaccid and painless state, are the positive 
indications of an “obstructed hernia.” What is to be done? No delay 
should be suffered when these symptoms coexist. The hernial tumor 
should be cut down upon, the incarcerated bowel relieved, if necessary, 
by the breaking up of the adhesions, and the patient’s strength revived 
by the administration of stimuli. Part xix., p. 106. HERNIA. 
883 
Management of Hernia—Strangulated.—Choose the operation by 
opening the sac. This practice does not increase the danger, as the peri- 
toneum may be wounded with impunity, and peritonitis is a compara- 
tively rare cause of death after hernia operations ; whilst there are 
important advantages to be derived from exposing the intestine. 
Always open the sac freely ; and, after the operation, pass the finger 
into the abdomen, and examine it for some little space w’ithin the stricture, 
to be sure that the intestine is free. 
Always open the sac. Section of the peritoneum is not dangerous, but 
on the contrary, beneficial; and if the sac is not opened, strangulation 
will sometimes not be removed by the operation, the sac being returned 
as well as its contents. (Mr. Hancock, Charinsr Cross Hospital.! 
Always divide the stricture outside the sac in the first instance; the 
latter can afterward be opened if found necessary. Do not make lamellar 
separations of the fascia, and do not wound more tissues or go deeper with 
the incision than is absolutely necessary; and especially avoid interference 
with the hernial tumor and its envelopes, if possible. Make a small inci- 
sion, large enough to admit the finger, through the skin and superficial 
fascia on the inner side of the tumor; and through this reach the seat of 
stricture and divide it, touching the sac only at the constricted point. 
Never open the sac, except when compelled to it; for the object of the 
operation may be effected, nine times out of ten, by dividing the stricture 
external to the sac; the process is less severe and the result more suc- 
cessful than by the old method, and, with moderate care, there is no dan- 
ger of pushing back the sac together with its contents. The objection 
that gangrenous intestine or omentum may thus be returned into the 
abdomen will hardly hold good; for when the contents of the sac are in 
this state, it is scarcely possible to return them without the exercise of such 
force as we know to be unjustifiable. And if a portion of intestine is in 
a doubtful state, i. e., not actually perforated, but likely to become so, 
the safest place for it is in the abdomen. After an operation for hernia, 
keep the bowels quiet for some days by means of opium ; to which calo- 
mel may be added, as it maintains the healthy functions of the skin, liver, 
and kidneys, and renders it easy to unload the bowels by mild means. 
Irreducible Omental.—Adopt every means to get it reduced ; and if the 
patient cannot spare the time, or will not undergo the discipline necessary 
for starving out a portion of protruded omentum, and rendering it capable 
of being returned into the abdomen, recommend an operation. The ease 
and safety which attend Petit’s opera tion, will justify us in doing this. 
Part xx., p. 134. 
Ascending or Intermuscular Hernia.—A hernia, Mr. Luke observes, is 
liable at its exit from the abdomen, to be pushed aside, or have its course 
altered, by any opposing obstacle; for its tendency is always to pass in 
that direction in which it meets with least impediment to its course. Such 
impediments do occasionally arise, and more particularly in the female; a 
circumstance attributable to the lesser anatomical development of the 884 
HERNIA. 
canal and external ring in that sex, from which probably proceeds the 
more frequent occurrence of this form of hernia. In the male sex the 
canal and rings are sufficiently large to allow of a hernial descent, so that 
we continually observe that the direction of an inguinal hernia in the male 
is downward, unless it be turned aside, or its direction altered by artificial 
means, and especially by the pressure of a truss. In the female, however, 
natural obstacles occur in the downward direction; it therefore sometimes 
happens that the lesser impediments to the progress of a hernia lie in an 
upward or outward direction, in which case the tumor, after passing from 
the internal ring, turns toward the ilium, and becomes interposed between 
the layers of abdominal muscles above and on the outside of the ring. 
Such herniae are covered anteriorly by the internal oblique muscle, and 
bear nearly the same relation to the tegumentary surface as an ordinary 
hernia confined to the inguinal canal, but differ materially from it in its 
relation to the internal ring. The tumor lies nearer to the ilium in this 
form of hernia, in a position which, being not usually occupied by hernia, 
may give rise to some difficulty in diagnosis, and may, through inadvert- 
ence, be mistaken for some other disease, either of the caecum on the 
right, or colon on the left side. It also lies somewhat buried, when small, 
under a covering of muscular structure, and occasionally under an accu- 
mulation of adipose tissue, and may on that account be passed over alto- 
gether without notice. In its position it constitutes the kind of hernia 
named above. Part xxi., p. 212. 
Hernia.—The following conclusions of a practical nature from atten- 
tively investigating the varieties of arterial distribution in relation to 
hernia, have been arrived at by Dr. Redfern. In inguinal hernia, divide 
the stricture upward. The risk of hemorrhage is greater in operating 
for femoral than for inguinal hernia. Divide the stricture of a femoral 
hernia inward, or upward and inward. Divide as few fibres as possible; 
avoid a sawing motion ; and press the edge of the knife rather less on 
the anterior surface than directly on the edge of the fibres constituting 
the stricture. If the structure of the neck of the sac is divided upward, 
the spermatic artery may be wounded, and the testicle lost. 
Part xxii., p. 213. 
Hernia—Strangulated.—The following plan was resorted to before 
operation in a case under Dr. Wise : The patient was placed upon the 
table and a long sheet folded several times on itself carried round the 
lower part of the abdomen of the patient, was twisted on itself in front 
and again on the sides, so as to enable an assistant standing on each side 
of the patient to hold the extremities of the sheet and to pull the bowels 
gently upward or toward the patient’s head, while a third assistant held 
the feet steady and the surgeon used the taxis. The plan succeeded per- 
fectly, and may be safely resorted to in an early period of the hernia. 
Part xxv., p. 205. 
Strangulated Hernia.—In a case of strangulated femoral hernia in a 
female, Sir. Ferguson did not make the Y-shaped incision as is usual over 
the tumor, but he made a straight cut, about one and a half inches long, 
over the inner side of the hernial tumor, almost directly over Gimbernat’s 
ligament, which he wished to touch. He did not care whether he saw the 
jac or not, but sought for the ligament, and having divided it, with a little HERNIA. 
pressure the contents of the sac receded. For this simple plan, the pro- 
fession is indebted to Mr. Gray, of the Royal Free Hospital. There is 
often more danger incurred by the taxis than by the operation, because 
we do not know what pressure the parts will bear without serious injury. 
Part xxvi., p. 176. 
Hernia.—The rule of practice should be that in cases of strangled hernia 
the parts should be freed with the least possible delay. The taxis should 
not be resorted to where constitutional symptoms have manifested them- 
selves, or in those cases where the local pain or tension show the encroach- 
ment of lesions, which, if unchecked, must prove fatal; or, lastly, where 
strangulation has been protracted beyond a few hours. 
Part xxvii., p. 139. 
Permanent Cure of Reducible Hernia.—The contents of the hernial sac 
being returned into the abdomen, and the ring explox-ed to ascertain that 
no portion of the intestine protrudes, the pad of a well-fitting truss is 
slipped down so as to make pressure on the inguinal canal, and prevent 
any escape of the hernia. With the forefinger of the left hand the sper- 
matic cord, as it passes out from the external inguinal opening, is pressed 
upward on the pelvic bone, so as to prevent it from being injured. A 
delicate trocar and canula, the latter having fitted to it a small Anel’s 
syringe, is now carefully but firmly forced through the integuments with a 
rotatory motion to facilitate its progress, and pushed forward till it enters 
the external inguinal ring or neck of the sac. The trocar being now with- 
drawn, the canula is kept firmly in place, and twenty or thirty drops of the 
tincture of iodine, tincture of cantharides, or sulphuric ether, thrown in 
and lodged in the neck of the sac, when this is practicable, or else in the 
vicinity of the external abdominal ring. Subsequently to the operation, a 
small compress is applied over the minute wound made by the trocar, the 
pad of the truss slipped down over it, and the patient directed, for a week 
or two, to maintain the recumbent position. 
In addition to the injection, in some of the operations, a tenotomy knife 
was previously introduced, and the internal surface of the neck of the sac 
scarified. The wound made by the knife in these cases much facilitated 
the subsequent introduction of the trocar, which is with some difficulty 
Worked through the integuments. 
In no instance did any bad result follow the operation—the pain and 
inconvenience hardly amounting to that presented in a case of hydrocele 
treated by injection, or in any simple operation. Part xxviii., p. 181 
Chloroform and Taxis in Hernia.—Mr. Savory, tutor at St. Bar- 
tholomew’s Hospital, records four cases, in which, though the taxis at 
first failed to reduce the hernia, yet, under the influence of chloroform, 
the taxis being again applied, the reduction was easily made. 
Part xxviii., p. 184. 
Scrotal Hernia.—In describing an obstinate case of this kind, Mr. Hil- 
ton remarked that the main obstacle to reduction was the loaded condition 
of the blood-vessels of the protruded part. This was to be obviated by, 
first, decreasing the quantity of the circulating medium generally, by 
purgation, diuresis, and abstinence from fluids; and, secondly, by local 
means to constringe and unload the congested vessels of the incarcerated 
omentum, as by the recumbent position and the application of pressure and 886 
HKRNIA, 
of cold. It may be remarked that cold, by producing contraction of the 
dai’tos, affords the best and most uniform pressure which can be exerted. 
Part xxviii., p. 189. 
Hernia—Inguinal.—The evidences of a hernia having been reduced 
en masse, are: 1st. The signs of strangulation continuing after the 
apparent reduction ; 2d. The loss of the hernial sac : 3d. A feeling of 
fullness at the internal ring, and of an ill-defined firm swelling in the 
abdomen behind or below the ring; 4th. A disproportionate amount 
of pain in this part to that which exists in the other part of the abdomen ; 
5 th. The usual drawing up of the testicle. Part xxix., p. 210. 
Opium and Emetic Tartar.—In strangulated hernia, if you use opium, 
do it promptly and decidedly; give the following pill at once: Morphias 
muriatis, antim. potass, tart., of each one grain ; and give a quarter 
of this dose every fifteen minutes for four doses. Then, if necessary, put 
the patient into a warm bath and attempt the reduction. 
Part xxx., p. 139. 
Laceration of the External Abdominal Ping in the Reduction of 
Hernia.—A new method of reducing inguinal hernia has been invented 
by M. Seutin, of Brussels. He proposes that the external abdominal 
ring should be enlarged by being lacerated under the skin by the index- 
finger. 
In ten cases in which the taxis had failed, M. Seutin ruptured the exter- 
nal pillar of the ring, and immediately the reduction of the protruding 
intestine was effected. Part xxx., p. 140. 
'Value of Cough-Impulse as a Symptom of Hernia.—The cough im- 
pulse may be a valuable diagnostic sign. If there be no effect on the her- 
nia by coughing, you may expect that the stricture is tight. If impulse be 
felt in the upper part of the neck of the tumor, and not in other parts, the 
seat of the stricture may be accurately determined, being just below the 
spot where the impulse is felt. Part xxxi.,j». 155. 
Femoral Hernia.—When you have been obliged to open the sac, you 
may form the best prognosis by an examination of the bowel immediately 
above the constriction. If it be of a pale reddish-grey color, and feel thick 
and fleshy, the chances are in favor of a successful result; on the other hand, 
if it be of a bright pink color, appearing thin as if distended with air, and 
if there be a large escape of red or dark-colored serous fluid on opening the 
sac, the prognosis is most unfavorable. In all cases when the sac is opened, 
it is a good plan to draw down an inch or two of the bowel, especially when 
the strangulation has been of long duration, for in such cases perforation 
not unfrequently occurs from half an inch to an inch above the constriction. 
Part xxxii., p. 149. 
Strangulated Hernia.—When operating in these cases, let it be your 
rule to endeavor to relieve the stricture without opening the sac; you gain 
nothing by opening it, but you may lose a great deal by doing so without 
necessity for it; in some cases, however, there may be reasons to deviate 
from it, as when the strictui’eis internal to the sac, etc. 
Part xxxiii.,jtf. 180. 
Mode of Performing Taxis.—Draw the body of the tumor gently down 
with one hand, and with the thumb and two or three fingers of the other 
steadily compress the neck of the hernia, with the view of causing the con- HICCOUGH 
887 
tained fluid to pass into the intestine above the swelling. When gurgling 
is heard, or when, from the sensible diminution in the size and tension of 
the hernia, there is reason to infer that the passage of fluid has commenced, 
then, at the same time, keep up gentle pressure on the body of the tumor 
without pressing it upward, and the possibility is that the contents of, and 
then the hernia itself will be reduced. If the body of the tumor is not 
drawn somewhat downward and kept so, the part of the gut (and the neck 
around it) just below the lower orifice of protrusion, will be forced up, and 
doubled a little on itself against the borders of the opening, and injury to 
the intestine and failure in reduction be the probable consequence. If this 
plan be found not to succeed after one carefully-conducted trial, it will 
rarely be found to answer after many, and an indication is then given for 
the performance of an operation, as delay will but complicate the case, and 
further endanger the life of the patient. It may seem absurd to assert or 
insist on so obvious a truism, but the gloomy part of the records of sur- 
gery bears much painful testimony to the neglect of this precept, that the 
propriety of operating early, without persisting in the taxis, cannot be too 
strongly enforced and too clearly illustrated. Part xxxiii.,p. 185. 
Hiccough treated by Quinine.—Among the many anomalous and not un- 
frequently very obscure, results of miasmatic influence, are various affec- 
tions of the digestive organs. Of these, hiccough is a most troublesome and 
occasionally a very intractable one. In some cases, this gastric disorder 
has been observed to exhibit a distinctly intermittent character, and to be 
associated with the existence of other phenomena which are usually attri- 
buted to the operation of the same morbific cause. M. Mendiere has pub- 
lished, in the pages of the “ Revue Medicale,” several cases of this sort, in 
which the distressing symptom of hiccough was promptly and decisively 
cured by the free use of quinine, after it had resisted every other mode of 
treatment. He has used the same remedy with good results in many cases 
of severe cardialgia. 
[The addition of a few drops of tinct. opii to the quinine will greatly en- 
hance its efficiency in such cases. 
We have usually found the liquor opii sedativus the best form in which 
to exhibit it: this may be given in a bitter infusion, to which ammonia 
may generally be added with advantage at the same time.] 
Part x., p. 73. 
Use of Chloroform in Hiccough.—In the case of a gentleman, forty-six 
years of age, of weak constitution, and highly nervous temperament, M. 
Latour employed chloroform during a very severe attack, which had lasted 
during three hours, the convulsions of the diaphragm occuringat intervals 
of six or eight seconds. A bottle containing chloroform was applied to 
the nostrils, and removed after a few inspirations. At the first removal, a 
temporary cessation was produced, and three applications of the chloroform 
bottle entirely put a stop to the paroxysm. Part xix., p. 68. 
Hiccough.—Preparations of dilute sulphuric acid will *be found to act 
beneficially with great promptitude, in the most obstinate cases. 
Part xxi., p. 361. 
HICCOUGH. 888 
HOAKSENESS, 
HOARSENESS. 
Inhalation of Ammonia Gas.—[The inhalation of gases is, perhaps, too 
much neglected in particular diseases. At present we know but little re- 
specting the properties of gases upon the animal economy, but when we 
remember the rapidly deleterious effects of the vapor of hydrocyanic acid, 
of bromine, of sulphureted hydrogen, wre may suppose that there may be 
other gases which might act medicinally and beneficially. Mr. Smee brings 
forward the following paper respecting the use of ammonia gas for stimu- 
lating the mucous membrane of the mouth, fauces, trachea, and bronchi.] 
If a bottle, containing a solution of the gas, as the common liquor ammo- 
nia or hartshorn, be opened, part of the gas escapes. If this comes in con- 
tact with the conjunctiva, it stimulates it, and causes much fluid to be 
poured from its secreting surface, and its influence on the delicate lining 
membrane of the nasal cavities is not less powerful. In fact, this vapor ap- 
pears immediately to cause a secretion of fluid from the parts with which 
it comes in contact. 
When this gas is absorbed by the mouth in far larger quantities, it ap- 
pears to cause in a similar manner an increase of the watery part of the 
secretion, usually passing from all the several parts with which it there can 
come in contact. A priori it might be expected the glottis would resist 
the intrusion of the gas, but this is by no means found to be the case when 
in a diluted state, as it apparently readily passes into the innermost recesses 
of the lungs, and instead of producing disagreeable effects, causes sensa- 
tions which are extremely grateful and agreeable. 
The immediate effect of the inhalation of this gas is to cause the fauces 
and pharynx, before dry, and perhaps covered with inspissated adherent 
mucous, to force out a watery fluid to lubricate and relieve the membrane ; 
the phlegm will then separate and come away, and a more or less instan- 
taneous relief is frequently felt. 
The most convenient mode of administering the ammoniacal gas is to use 
the vapor that spontaneously exhales from solutions of ammonia. Of thyese 
it is preferable not to employ a solution stronger than the liquor ammonim 
of the shops, or weaker than the same diluted to twenty or thirty times its 
quantity of water. 
The liquor ammoniae, diluted according to the discretion of the medical 
attendant, may be placed in a common vial, and as much should be in- 
serted as to occupy about the two lower inches of the bottle. The patient 
has only to’apply his lips to the mouth of this homely contrivance, and 
draw in his breath, when he will inhale a certain quantity of the ammonia. 
The number of inspirations to be taken at one time may be determined 
by the strength of the water and the effect of the remedy. Two, three, or 
four inspirations will, in general, be sufficient at one time, but this must be 
repeated three or four times during the day. 
The value of the local application of this gas is seen in cases of what is 
called dryness of the throat. 
Ammonia gas is also beneficial in chronic hoarseness, especially in that 
which is often left as a sequel of influenza. This gas affords great relief 
and comfort to the relaxed, swollen, and apparently semi-oedematous state 
of the mucous membrane, which supervenes from remaining in crowded, 
overheated, and ill-ventilated rooms, where every person not only inhales HOOPING-COUGH. 
889 
his own breath over and over again, but is under the infliction of breath- 
ing his neighbor’s also. In cases of incipient cynanche tonsillaris, it ap- 
pears to be of much value if used at the very commencement of the attack. 
There are occasionally cases of syphilitic ulceration of the throat wit- 
nessed, where the patient suffers from such debility that the practitioner 
is afraid of applying any remedy capable of depressing the system, where 
the inhalation of the gas might probably be of great service. 
In old standing cases of asthma, in which the extremities are cold, the 
pulse feeble, and the general vital powers depressed, the local application 
of ammonia is particularly grateful, the patients feeling, as they describe it, 
a glow after its exhibition, and the warmth first imparted to the lungs ex- 
tending by degrees over their whole system. 
In cases where the patient feels a peculiar sense of contraction upon pass- 
ing into cold atmosphere, as though the lungs resisted the intrusion of so 
unpleasant an agent, the inhalation of ammonia seems to quiet the spasmo- 
dic action. 
As a stimulating agent it must obey the laws of stimulants generally. It 
should not, therefore, be employed when the part with which it comes in 
contact is inflamed, nor when a dry parched tongue, a full pulse, and a dry 
skin, denote a feverish system. In all chronic cases, or even occasionally 
in acute cases, with a feeble circulation ; in fact, whenever the system is de- 
pressed, and stimulants are advisable, the inhalation of ammonia may be 
used with the greatest advantage and comfort to the patient. 
Part vii.,£>. 64. 
HOOPING COUGH. 
Diuresis—Recommended as a revulsive in diseases of infants. 
Port i., p. 24. 
Asscifoetida in Hooping Cough.—It is indicated only after the febrile 
period has passed, and its-influeuce is diminished in the third stage, when 
tonics should be combined with it. As assafcetida is a medicine which it 
would be very difficult to induce children to take by the mouth, Dr. 
Rieken prescribes it in enemas—he orders three grains of the gum resin 
to be rubbed up with a sufficient quantity of yolk of egg, and mixed with 
125 to 250 scruples of water. This mixture will suffice for ten or twelve 
lavements for children under a year old ; for from four to six for children 
three years old ; and for two or three only for those that are older. For 
the first five or six days, two enemata are given daily, sometimes more ; 
after that, one at night will be sufficient. If diarrhoea should come on, it 
may be stopped by increasing the quantity of the yolk, and by adding 
starch or gum arabic; olive oil should be added if tenesmus should super- 
vene. The use of the assafcetida is very well borne by children of a strong 
constitution, and still better by those that are nervous or lymphatic. 
Part vi., p. 8G. 
Ioduret of Silver.—Recommended in hooping cough in the form of pills, 
containing from one-eighth of a grain to one-fourth of a grain, three times 
a day. ° Part x\i., p. S\. 
Various Remedies for Hooping Cough.—The following is Dr. Cowan’s 
epitome of the experience of the best writers on hooping cough. 890 
HOOPING COUGH. 
The popular and professional catalogue of remedies for hooping cough 
is both lengthened and varied, proving.the usually obstinate nature of the 
disease. 
Dr. Thompson considers prussic acid his sheet anchor, gradually in- 
creasing the dose, and combining carefully regulated temperature with a 
milk and vegetable diet. He says the disease seldom resists more than 
four to live weeks. 
When the acute symptoms have subsided, the following extensively used 
formula of Dr. Beatty, of Dublin, recommended by Dr. Graves, has proved 
very useful: 
R Compound tincture of bark, five ounces; tincture of lytta, tincture 
of camphor, of each half an ounce. Mix. A teaspoonful three times a 
day in linseed or barley tea. 
Above five or six years of age the dose may be increased one-third 
daily until half an ounce is taken. 
The liquor arsenicalis, in decoction of bark, is favorably mentioned ; and 
in the second volume of the “Provincial Transactions,” p. 412, a combi- 
nation of the tincture of lytta with the tincture of lobelia, is stated to have 
proved successful. 
Belladonna, by liniment, plasters, and internally, is undoubtedly a valu- 
able agent. 
Dr. Lombard, of Geneva, mentions as a sure symptom of the decline of 
the disease, the greater frequency of accesses during the day than night, 
and vice versa, lie speaks highly of the sesqui-oxide of iron in diminish- 
ing the number and violence of the fits, giving twenty-four to thirty-six 
grains a day in divided doses. 
Dr. Crossley Hull’s great remedy, in all cases, was powdered alurn, 
which he prescribed in a little water eight times a day, beginning with 
ten grains, to be increased two grains each dose till twenty are reached, 
which Avas then continued till the cough had ceased, which he states was 
the case generally in a week or less. The above doses are for young per- 
sons, about fourteen ; adults may increase the dose to twenty-six grains. 
Infants are to begin with four or five grains, increasing two grains a dose 
to fifteen. Ho other medicine was given; milk to be avoided. 
Dr. Reese strongly advises a warm irritating plaster to the chest, and 
the following medicine: 
R Tincture of assafoetida, one drachm ; tincture of opium, ten minims ; 
poAvder of ipecacuanha, ten grains; Avater, two ounces. Mix. A tea- 
spoonful every three hours to a child two years old, increasing the dose 
ten minims for every year. 
When this fails, the tAvo following formula are (too) highly praised: 
R PoAvdered leaves of conium, one scruple; mint Avater, tAvo ounces ; 
sirup, tAvo drachms. Mix. A teaspoonful three times a day to a child 
of any age, adding ten minims to the dose, till nausea and giddiness are felt. 
R Di-acetate of lead, four grains; sirup of poppies, tAvo drachms; fen- 
nel water, tAvo ounces. Two tcaspoonfuls to a child from tAAro to ten 
years every five hours ; half an ounce for an adult. 
It is said to cure generally in three days. 
Mr. C. H. Chavasse speaks highly of the following formula: 
R Sulphate of copper, half a grain; sirup of poppies, half an ounce; 
anise Avater, an ounce and a half. Mix. A teaspoonful to be taken every 
second or fourth hour, according to the age. HOOPING COUGH. 
891 
Sir William Watson’s celebrated prescription was: 
R Tartar emetic, one grain ; tincture of opium, twenty minims; dis- 
tilled water, one ounce. Mix. A teaspoonful every, or every other 
night. 
Mr. Pearson, after premising an emetic, relied much upon— 
R Tincture of opium, one minim ; ipecacuanha wine, five drops ; carbo- 
nate of soda, two grains ; water, half an ounce. Make a draught, to be 
taken every four hours. 
Di. C. Waehtl, of Vienna, has found cochineal very useful in rapidly 
checking the paroxysms. 
R Cochineal, ten grains; bitartrate of potash, one scruple ; sugar, one 
ounce ; water, six ounces. A teaspoonful every four or six hours. 
It is an old and popular remedy. 
The following is Iioche’s far-famed embrocation : 
R Olive oil, one ounce ; oil of cloves, half an ounce ; succinum oil, half 
an ounce. Mix. Part viii., p. 22. 
Cochineal in Hooping Cough.—[The following is recommended by 
Dr. Alnatt. He has employed the same remedy for 20 years in hooping 
cough with success. He says:] 
A peculiar acid is generated in the system by the disorder, which may 
be detected in the excretions from the stomach, and which, in my opinion, 
is the exciting cause of the spasmodic action of the glottis, producing the 
“ whoop.” It is obviously desirable, therefore, to neutralize this acrid 
condition of the first passages, in order to obtain the full advantage of 
the antispasmodic and anodyne properties of the cochineal; and for this 
purpose the alkaline solution is invaluable. It is of a deep purple or 
violet hue, will keep a long time without change, and the active powers 
of the cochineal are not impaired by the combination. The following is 
the form: 
Take of carbonate of potassa, a drachm ; cochineal, a scruple; boiling 
water, eight ounces. The dose is a teaspoonful three times a day. 
Part ix.,p. 68. 
Pelladonna and Ipecacuan.—Recommended in hooping cough, in the 
form of pill, containing one-fourth of a grain of extract of belladonna, 
and half a grain of ipecac, in each—every two or three hours. 
Part ix., p. 15. 
Hooping Cough— Opinions respecting.—The views of different medical 
men on the nature and treatment of hooping cough seem to be exceedingly 
variable. Many different opinions have been published on this subject. 
Most practitioners seem to agree that in the early stages of the affection 
we have inflammation of the lining membrane of the air tubes, which may 
extend more or less throughout the whole lungs ; and hence, whether we 
regard it as of a specific character or not, the treatment, in the first place, 
ought to be more or less antiphlogistic, as in the early stage of bronchitis 
or pneumonia. The par vagum seems to be implicated in the affection, 
and the irritation of this nerve may account for some of the most trouble- 
some symptoms. 
W ith reference to the irritation of the par vagum in hooping cough, Dr. 
T. Thompson relates a case in which this nerve had become exposed, from 
the formation of an abscess, or other cause; and it was remarkable, that 892 
HOOPING COUGH. 
when the nerve was in contact with air, a spasmodic action resembling 
hooping cough was produced; when the nerve was covered over by a 
cicatrix, the hooping cough ceased. 
When the acute symptoms have subsided, the great object of practice is 
to subdue irritation and improve the general health ; and it is in this stage 
that such a variety of remedies have been proposed. Dr. Walker gives 
the twelfth of a grain of extract of belladonna three times a day to a child 
four years old. We suspect that this will prove an uncertain remedy, and 
not free from danger in very young children. Opium ought never to be 
given, even as a palliative, as its remarkable effects in causing congestion 
of the mucous membrane of the lungs will inevitably prolong the disease, 
however pleasing the first effects in allaying the cough may be. It is pos- 
sible, however, that the counteracting or neutralizing properties of strong 
doses of tartar emetic or ipecacuanha, may render this a more warrantable 
remedy in extreme cases. The irritating cough may frequently be relieved 
by conium, hemlock, or hydrocyanic acid; and we ought never to forget 
the remarkable property of the alkaline medicines, as potash, of relieving 
the irritability of mucous surfaces. When a great quantity of mucus is 
secreted, Dr. Golding Bird recommends alum to be given. This should 
only be ued, however, in the second or nervous stage, characterized by 
nervous cough with bronchial flux, unaccompanied by febrile action; or 
we may probably find that the acetate of lead, as recommended by Dr. 
Henderson (Vide Art. “Bronchitis”), may here be useful, where the se- 
cretion is excessive. Dr. Golding Bird, however, finds alum the most effi- 
cacious ; he gives it in doses of from two to six grains to children from one 
to ten years old, repeated every four or six hours. 
For a child of two or three years, the following formula has generally 
been employed: 
Aluminis, gr. xxv.; extracti conii, gr. xij.; sirupi rhaedos, 5ij.; aquae 
anethi, §iij. M. Capiat coch. j. med. 6ta quaque hora. 
Tannin is recommended with a somewhat similar motive. It may be 
given, after the acute stage is passed, in doses of a quarter or half a grain 
every two hours, with a dose of conium. Sir G. Lefevre recommends musk, 
as having some specific influence in the spasmodic attacks of this disease. 
He gives it in doses of a grain three or four times a day; and states that 
in a few days it will often arrest the most convulsive species of coughing. 
Part xi., p. 53. 
Tar Vapor in Hooping Cough.—[Mr. Waddington recommends in the 
treatment of hooping cough, a remedy which is, to say the least, cheap 
and easily applied. He says:] 
There are three stages of hooping cough. In the first stage, the patient 
should be taken into the open air, as usual, if the weather will permit, live 
sparingly, and take every now and then a gentle emetic. In the second 
stage, confine the patient to a bed-room and sitting-room upon the same 
floor, communicating with each other. In these rooms Swedish tar should 
be kept boiling, night and day, over a small lamp; thus the vapor of tar 
will pervade both rooms. When the symptoms run high, the remedy is 
almost miraculous. Part x\\., p. 77. 
Hooping Cough.—Dr. McGregor advises, in the first stage, mild anti- 
phlogistics, daily emetics, and strict confinement to the house, except in 
summer months. In the latter stages, give the following: Tincture of 893 
HOOTOtG COUGH. 
catharides, tinct. of opium, comp. aa. gss.; tinct. cinch, co. gvss. A tea- 
spoonful to be taken three times a day in a little boiling water; the dose 
to be increased if no stranguary is produced. Part xiy., p. 73. 
Ether in Hooping Cough, Spasmodic Cough and Asthma.—[Dr. 
Willis, in referring to the use of ether as a remedial agent in the treat- 
ment of spasmodic diseases generally, of the respiratory organs, states 
his belief that it will scarcely be found less important than in surgical 
operations.] 
Ether, given by the mouth, has long been familiarly employed in the 
treatment of asthma. I have for many years been aware of the fact, that 
it is vastly more efficacious administered directly in vapor by the breath. 
So effectually have I seen its immediate application, that I have even found 
it necessaiy to suffer the patient to have an occasional tit of coughing to 
its natural termination, with a view of clearing the chest from accumulated 
mucus. 
Hooping cough often, perhaps most frequently, proves fatal, in the ab- 
sence of all inflammatory or organic disease, through the simple violence 
and continuance of the spasmodic cough. The patient goes on coughing, 
till the lungs fail in their function ; he becomes livid in the face, and black 
blood is circulated to the brain; convulsions then ensue, and animal sensi- 
bility fails or is lost. The spasm may now have ended, but the sufferer is 
no longer aware of the necessity of breathing / the respiratory muscles are 
paralyzed, a minute passes, and life is gone. If respiration be restored at 
this critical moment, life may be saved; and this I have myself done— 
using my own mouth to the child’s, to free the air-passages from the frothy 
mucus that filled them, and blowing the chest up gently, circulation re- 
turned, automatic movements followed, and consciousness was restored. 
Part xv., p. 103. 
Treatment of.—Professor Trousseau recommends the following solution 
of nitrate of silver in cases of hooping cough: $ Aq. destil., §j.; sirup, 
simplicis, gss.; argenti nitratis, gr. one-fifth : to be taken daily. 
Part xvi., p. 133. 
Use of Coffee in Hooping Cough.—Give strong coffee, well sweetened. 
The dose for a child of two years old is a teaspoonful four times a day, 
or oftener; for a child of four years, a dessertspoonful; and for an older 
patient, a tablespoonful. Let the diet consist principally of fried and roast 
meat; the quantity of milk used being diminished, and farinaceous food, 
confectionery, and fruit, being entirely prohibited. ' Part xx., p. 83. 
Hooping Cough.—Give Fowler’s arsenical solution. Previous to and 
during its use, bleeding, blisters and emetics, may be employed according 
to the indications. Children of a year old may take it safely. In catarrh 
or influenza, it may also be given, in the following form: R Liq. pot. arseni- 
tis, 3j.; vini ant. tart., vini ipecac., liq. potas. aa. 3iiss.; aquae destil., gxij. 
Fiat mistura cujus sumatur gj. ter die. Part xxiv.,p. 29. 
Hooping Cotigh.—Apply a solution of nitrate of silver, 20 grains to the 
§j. of water, to the larynx by means of a probang and sponge. Out of 125 
cases of this disease so treated, 78 were speedily cured, 39 were greatly 
relieved and shortened, and 8 resisted the treatment altogether. 
Part xxvi., p. 67. 
Tannin in Hooping Cough.—Dr. V. Brewning employs the following: 894 
HOOPING COUGH. 
ft Tannin, gr. }; acid, benzoic., ext. belladon., utrq., gr. r\; pulv. rhei, 
gr. iij.; p. gumra. acac., gr. xij. M. fiat pulv. The powder may be given 
three or four times a day. For a very young child half the dose twice 
daily will be sufficient. Part xxvi., p. 71. 
Chloroform in H oping Cough.—In the case of a girl, sixteen years old, 
afflicted with hooping cough, the inhalation of a little chloroform during 
the paroxysm, in two days removed the hooping sound. The best way to 
use it in cases of children, is to drop about thirty drops in the palm of the 
hand, and hold it near enough to allow a due mixture of atmospheric air 
with the vapor. The best time is before the irritation in the chest has in- 
creased to a cough. It should be repeated oil each return of the irritation. 
Part xxviii., p. 93. 
Topical Treatment of Hooping Cough.—That the solution of nitrate of 
silver removes the excited state of the extremities of the branches of the 
par vagum, is proved by the fact that, after all inflammation has passed 
by and the hoop only remains, the topical treatment is by far the most ef- 
fectual. The most convenient apparatus for the application of the solu- 
tion, is,by the sponge and whalebone. The strength of the remedy should 
be regulated by the stage of the disease; the greater the degree of 
inflammation the weaker should be the solution, and its strength should 
be increased as the disease decreases. Perhaps, we may say at first fifteen 
grains to the ounce; in other cases two scruples to the ounce may be 
used with advantage. The application should be renewed at least every 
second day. If the hoops are very violent, however, or the remedy 
has not been applied until the disease has reached its height, the 
applications should be more frequent. It may be noted that in all 
cases where it is necessary to introduce the sponge into the larynx, 
the finger should be introduced into the patient’s mouth, so as to 
touch the tip of the epiglottis, along the surface of which the instru- 
ment may be glided down with certainty to reach the rima glottidis. 
Part xxviii., p. 94. 
Treatment of.—According to Dr. Todd, hooping cough is a disease 
which runs a certain course, can be communicated from one person to an- 
other, and is probably due to the influence of a poison which gets into the 
system, and produces its local manifestations on the vagus nerve. It is 
not an inflammatory affection of any part, being simply dependent on a 
morbid state of the blood, caused by the introduction into it of some poi- 
son from without; and whatever inflammations may occur in the course 
of it must be regarded in the light of complications of the disease. 
As hooping cough seems to be the elimination of some poison in the 
blood, we must endeavor to find an antidote to it, As we know of no 
antidote, we are obliged to let the patient cough the disease away, guard- 
ing him against the bad consequences, and protecting him from the com- 
plications. The disease is not an inflammatory condition of any part, 
therefore, any antiphlogistic treatment does harm by weakening the 
patient and impoverishing the blood. The first thing is to guard against 
bronchitis and pneumonia, by affording a well-regulated temperature. 
Then we must uphold the strength by keeping the patient well 
nourished. The chest may be also sponged with water once or twice 
a day; of remedies, the sedative, anti-spasmodic class, is the best for 
allaying the irritability of the parts, as the preparations of opium, HOOPING • COUGH. 
895 
henbane, conium, belladonna, and hydrocyanic acid. Depressing drugs 
should be avoided, as tartar emetic and ipecacuan. The careful inhalation 
of chloroform deserves a trial, but only in small quantities. Splashing 
the chest with cold water is also valuable, taking care not to wet the 
head, and that the temperature of the room be warm when it is done. 
Part xxix., p. 82. 
Hooping Cough.—Nitric acid arrests the paroxysms and removes the 
hoop. It is a tonic, and supplies the blood with nitrogen, which removes 
or neutralizes the excess of tibrin existing in that fluid at the time, and 
which is a great source of danger. Give dilute nitric acid. Twelve 
drachms of the dilute acid in a four-ounce bottle with sirup—a dessert, 
spoonful to be taken every few hours by a child under two years old. 
For an infant give about a teaspoouful. Part xxx., p. 51t 
Hooping Cough.— Vide Selections from Favorite Prescriptions, Art. 
“ Medicines.” 
Use of Tannin.—The following mixture is very useful in the third 
stage of pertussis: R Tannin, gr. vj.; ext. belladon., gr. j.; ext. cicutce, 
gr. iv.; inf. sennae, gij.; aq. foenicul., sir. altheae, aa., §j. One teaspoonful 
every two hours. Part xxxii., p. 287. 
Hooping Cough.—This is essentially a nervous disease, and our treat- 
ment must be directed to the removal of the spasm. The secretion which 
is present is chiefly due to the violence of the cough, and consequently 
should not be increased by expectorants. You must remove all sources 
of irritation, give nutritious food, remove to a pure air, and give morphia 
to relieve the spasm. The dose to begin with must be very small 
(say the sixty-fourth of a grain to an infant four months old), and 
rapidly increase the quantity until a slight drowsiness is perceptible, 
and then regard that as the measure of the dose; this effect must 
be maintained, and in the course of a few days the spasm will cease, 
the cough be relieved, and the child will soon be well. 
Part xxxiii., p. 101. 
Use of Cantharides.—It was thus given to an infant: Tincture of bark, 
half an ounce ; tincture of cantharides, three drachms; compound tinc- 
ture of opium, half an ounce. A teaspoonful to be taken three times a 
day in a tablespoonful of linseed tea. This remedy, or a modification of 
it, Dr. Hynes has been in the habit of employing in cases of pure uncom- 
plicated pertussis, and invariably with the effect of cutting short the dis- 
ease after a few days’ persistence in the treatment; the strangury which 
it induces must be kept up in a mitigated form for some days. Dr. 
Hynes, at first, orders for his patient a gentle emetic of ipecacuan pow*- 
der, then an active aperient, places the patient on a non-stimulating diet, 
and commences the use of the foregoing remedy. Part xxxiv.,jo. 45. 
Hooping Cough.—The nitric acid mixture of Dr. Gibb, which has 
proved so serviceable in hooping cough, is composed of acid. nit. dil., 3xij ; 
tine. card, co., 5iij.; sirup, simpl., giiiss.; aquae, §j. M. For a child under 
two years, one teaspoonful of this may be given every two hours. Chil- 
dren from two to five, and so on, may take increased quantities. It is of 
some importance to bear in mind the necessity for a soda gargle im- 
mediately after taking the medicine. Part xxxv.,p. 38. 896 
HYDATIDS. 
Of the Lower Lip.— Vide Art. “ Lip.” 
Ilydatids of the Uterus—Case of—Dr. Hyslop’s patient was 26 years 
of age, and the mother of several healthy children. Dr. II. says: 
For several months prior to this date, September, 1847, she has been 
losing flesh, and much annoyed with a profuse leueorrhoeal discharge, which 
tonics and astringent injections have failed to arrest—has menstruated regu- 
larly, but profusely, till four months ago, when suppression of the function 
took place, and in its stead, frequent discharges of clotted blood or bloody 
serum have occurred at irregular intervals, and occasionally in rather pro- 
fuse and exhausting quantities. She complains of frequent paroxysms of 
sickness, faintness, and feeling of exhaustion—straitness and sense of weight 
across the chest, together Avith palpitation of the heart, loss of appetite 
and borborygmi—dragging pains in the back and loins, and feebleness of 
the lower extremity. 
Above the pubis there can be readily felt, and accurately defined, a cir- 
cumscribed swelling of the size of a well-developed uterus immediately after 
delivery; solid but not painful to the touch ; of a regular and globular 
shape and rather mobile. This tumor has only recently attracted the no- 
tice of the patient, and she fancies it varies in size from time to time. On 
examination per vaginam the uterine oi'ifice appeared quite closed, and no 
effort to introduce the finger was successful. The tumor in utero could be 
readily felt through the vaginal Avails. 
Patient assures me it is impossible she can be pregnant. 
Failing, after the lapse of several weeks, to obtain any relief of the symp- 
toms, and especially of the severe sanguineous discharge, from the use of 
mineral acid, the recumbent posture, gallic acid, iodine injections, plug- 
ging the vagina, and even ergot of rye, I resolved to take advantage of 
one of the capricious intervals of a cessation of the hemorrhage, to artifi- 
cially dilate the os uteri, and make a manual examination of the uterine 
cavity, remove the cause of irritation, and endeavor to bring about a 
healthy state of the uterowaginal mucous membrane. 
With this design, I prepared a series of sponge-tents, and accomplished 
the complete dilatation of the os uteri, bringing into view, through the spe- 
culum, a bulky bloody-tinged body, hanging pendulous from some part of 
the superior surface of the uterine cavity. 
Having previously, at intervals, administered tAvo cupfuls of a pretty 
strong infusion of ergot, I introduced my hand into the uterus on the 11th 
of October, atid, guided by the morbid mass itself, sought its most elevated 
attachment, and cautiously detached it from the mucous surface of the 
uterus. This I repeated until I conceived I had removed the entire bidk 
from the uterus, Avhich thereafter slowly, though sparingly, contracted on 
my hand, and on the folloAving day could scarcely be felt. 
A considerable hemorrhage took place both during and subsequent to 
the operation, which, from the debilitated and exhausted state of the pa- 
tient, it was exceedingly desirable to obviate. I directed cold-Avater cloths 
and warm flannel alternately to be applied locally. Repeated doses of the 
infus. secal. cornut. during the day and subsequent night, and five-grain 
doses of gallic acid administered thrice a day, Avere continued for upAvard 
of a fortnight, Avhen the colored discharge had nearly ceased. Under this 
treatment, and a generous diet, she recovered sloAvly. 
HYDATIDS. 897 
HYDATIDS. 
The masses removed in this case were stringy bodies, like the fibrinous 
portions of a clot of blood, covered internally and externally with hosts of 
large and small hydatids. Part xxi., p. 299. 
' Hydatids.—For the expulsion of hydatid growths from the uterus, 
apply galvanism. Partxxix.,p. 266. 
Treatment of Hydatid Tumors in the Abdomen— Operative Measures. 
—It has been attempted to show that operative interference Should be re- 
served for cases in which urgent symptoms impend. A hydatid tumor 
in the abdomen may cause urgent symptoms, first, by acquiring a very 
large size, and distending the cavity; secondly, by interfering with the 
function of the viscera adjoining it, as the liver, kidney, etc.; thirdly, by 
occluding, by pressure on the intestines, uterus, etc., the passage of the 
excretions; fourthly, by exciting surrounding inflammation, and threaten- 
ing to rupture. In any one of these conditions, surgical assistance may 
come to be demanded, but the measure required will differ considerably in 
each. Thus, when the cyst is so large as to have distended the abdomen, 
it will generally have acquired adhesions, so that its puncture will be com- 
paratively without risk. The same will be probable if it have excited sur- 
rounding inflammation, under which condition also it may become neces- 
sary to make a permanent opening for the escape of pus, when otherwise a 
trocar puncture would have sufficed. The cases, however, in which 
urgency is caused by interference with the viscera, are by no means secure 
from the risk that the tumor may be quite unconnected with the parietes ; 
and in the treatment of these the greatest judgment will be called for. If 
the tumor be in the lower half of the belly, examination per rectum and 
per vayinam, if the patient be a woman, should never be omitted, as it 
might chance that a puncture would be best made into one or other of 
these canals. -A case has been already mentioned, in which a rectal exa- 
mination would, probably, have saved the life of the patient. Supposing, 
however, that it seems necessary to make an external opening, and that 
there is reason to believe that the cyst has no adhesions to the parietes, 
the surgeon has then the choice of two methods—the use of a very fine 
trocar, or the application of an escharotic. The latter means was employed 
successfully by Mr. Le Gros Clarke, in a case under his care, and the 
former may be confidently stated to be very safe. The selection will, 
therefore, depend chiefly upon whether it be wished to make a permanent 
opening or not. And this brings us to the consideration of the important 
question already mooted, as to whether it is absolutely necessary to obtain 
the evacuation of the contents of the cyst, or whether to kill it, and then 
trust to their absorption, will suffice. Hitherto the plan of simply destroy- 
ing the life of the cyst has, we believe, not been tried. In Mr. Le Gros 
Clarke’s case, however, it probably occurred, and the cure resulted with- 
out the removal of the smaller cysts, as had been intended. This acci- 
dental result is very instructive. Might it not be worth while, in future 
cases, to take means to secure the death of the parasite, such, for instance, 
as the injection into it of a solution of salt, or of iodide of potassium.?. 
The evacuation plan necessarily involves long-continued and profuse sup- 
puration, which, supposing the cyst large, may become very dangerous 
At any rate, whichever plan be selected, there can be no doubt as to the 
propriety of conducting the first steps of the treatment on the plan exem- 
plified in the case which did so well under the care of Mr. Cock, namely, 898 
HYDROCELE. 
of reducing the size of the tumor by repeated punctures with a very small 
trocar. Ilydatid cysts re-secrete very slowly, and by such means great 
diminution in size may be effected, almost without risk. The trocar should 
be an exploring one, and of very small bore. 
We must not leave this part of the subject without venturing one fur- 
ther remark, to the effect that a patient, suffering from urgent symptoms, 
however produced, in consequence of a hydatid tumor in the abdomen, 
should never be allowed to die without an attempt to relieve by operation 
being made. The recorded cases have been quite sufficiently successful to 
indicate the propriety of making such attempt, even under very unhopeful 
circumstances. Part xxxi., p. 219. 
HYDROCELE. 
Treatment of Hydrocele—Iodine Injection.—For the last few years, 
Mr. Bransby Cooper has used this exclusively—two drachms of tincture 
of iodine and six drachms of water; two drachms of which mixture may 
be injected and left. 
Always place your Patient in a Chair.—Always place your patient on 
a sofa, or lean him back in a chair, because any one is liable to faint, how- 
ever bold he may appear. 
Never let a Patient walk Home after Injection.—Even after simple 
tapping, I have several times known inflammation thus set up sufficient to 
bring about a radical cure; and I know of several cases where the patient 
has walked after injection, where great sloughing, and in one case death, 
ensued. I have notes of a case here where acute inflammation was thus 
set up, which terminated in gangrene and death in thirty-six hours, though 
the sac was not injected. 
Sir Astley Cooper also mentions cases where dangerous symptoms came 
on after the patient had been allowed to walk; and one above others, of a 
gentleman who Avent down to Birmingham in the mail soon after injection, 
and sloughing of the whole of the scrotum followed. He also gives two 
cases, where he thought suppuration was thus produced. 
Part iii., p. 93. 
Radical Cure of Hydrocele.—M. Yelpeau expresses his surprise that 
the surgeons of London, Berlin, and America should still perform danger- 
ous, long, and bloody operations, instead of the one he is in the habit of 
using. But he himself recommends incision of the sac, in cases where the 
contained fluid is thick, or where the coats of the tunica vaginalis are so 
hard, thick, and solid that injection of the sac will fail to cure the disease ; 
and in cases where the sac has degenerated into a stony or osteo-calca- 
reous shell, or into lardaceous matter, he recommends excision. 
In the radical cure of hydrocele, Velpeau prefers the tincture of iodine 
as an injection, to all others. It has the following advantages : “ a small 
quantity only is required, half an ounce to an ounce ; it produces no ill 
consequences even if allowed to remain in the sac; it does not cause any 
serious injury if injected into the cellular tissues ; and lastly, it is almost 
uniformly successful.” The strength of the liquid is two or tliree drachms 
of the tincture to an ounce of water, and he has even used the pure tinc- 
ture without injury. Part iv.,p 99. 899 
HYDROCELE. 
Improved Treatment of HydroceleIt need scarcely be recalled to 
mind that in the operation for hydrocele, after the serum has been dis- 
charged through the canula of the trocar, it is usual to inject an irritating 
fluid in order to induce an adhesive inflammation in the parietes of the 
tunica vaginalis. The inflammation somewhat subsides after about the 
fifth day, but a month commonly elapses before the whole quantity of 
the injected fluid is absorbed and a cure effected. On this somewhat 
tedious course of pi’actice M. Lisfranc, has made the following improve- 
ment : On the sixth day, after the use of a vinous injection, he makes a 
second puncture, for the purpose of emptying the tunica vaginalis of all 
the accumulated liquid, thus sparing nature the task of its absorption; 
and by these means he alleges that a cure can be completed in less than 
half the time occupied by the usual method. Party ii., p. 116. 
-Radical Cure of Hydrocele.—The injection of different liquids, such as 
the solution of different salts, wine, brandy, and iodine, may certainly 
cause mischief occasionally, by finding their way into the cellular tissue: 
but, nevertheless, this mode of treatment is found to be generally very 
successful and simple. Dr. Porter of Dublin, however, prefers the following 
method: Having first tapped the sac to ascertain the nature of the dis- 
ease, and allowed the fluid to reaccumulate, he makes an incision of an 
inch or an inch and a half in length, down to the tunica vaginalis, ascer- 
taining if any considerable blood-vessel is wounded and then passes a bis- 
toury into the cavity at one extremity of the incision, and brings the point 
out at the other extremity, dividing the intervening portion by rapidly 
withdrawing the knife. A tent of rolled lint, moistened with oil, and 
secured with a ligature, is then introduced. Next day the patient is bled 
from the arm; particularly if the scrotum show signs of inflammation. 
The tent is left to become loose, and drop out of itself’ which usually takes 
place on the third or fourth day, and need not be replaced. Mr. Adams 
relates a case in which he cured the affection simply by withdrawing the 
liquid, and then pushing through the canula a camel’s hair brush dipped 
in a strong solution of iodine, so as to smear it over the internal surface of 
the sac, and thereby promote the usual course of inflammatory action. 
Part x., p. 140. 
Rare Form of Hydrocele.—[J. D., aged 24, admitted into the hospital 
for enlargement of both testicles, hydrocele, and ulcerated scrotum, attri- 
buted by the surgeon who sent him in from the country, to improper ex- 
citement of the generative organs. The difference between the sides of 
the scrotum was slight; the left side was solid from the testicle, which 
was swelled to the size of a small fist, whilst about half the right was fluid.] 
On examining the hydrocele more particularly, says Prof. Sytne, I felt 
that it could be diminished by pressure, and therefore made the patient 
take the horizontal posture, when it became very evident, that the swel- 
ling extended into the abdomen, so as to form a well-defined oval tumor, 
obvious to sight and touch, ascending nearly to the umbilicus. A slight 
degree of pressure emptied the scrotal part of the bag, rendering that 
within the abdomen more tense; and when the latter was compressed, or 
the patient stood erect, though the abdominal tumor did not disappear, it 
became less distinct, while the external one became more fully distended. 
When the two parts of the swelling were compressed alternately, a dis- 
tinct fluctuation was perceived between them. 900 
HYDROCELE. 
[The natural state of the testicles was soon pretty much restored by 
potassse hydriod. and the use of a bougie, but the hydrocele remained in 
statu quo. This was then punctured, and 28 ounces of fluid drawn off, but 
so rapidly did it accumulate again, that in ten days the operation had to 
be repeated. Iodine injection was then thrown up, and the fluid did not 
form again.] 
This case derives interest not only from the extreme rarity of the form 
in which the disease presented itself, but also from the light which it 
throws upon another morbid condition of more frequent occurrence. It is 
plain that the hydrocele occupied the cord, and not the tunica vaginalis— 
since, in the latter situation, the fluid would have surrounded, instead of 
lying, as it did, entirely above the testicle; and if it had had access to the 
cavity of the peritoneum, would not have been circumscribed within the 
limits of a distinct tumor. 
The abdominal part of the swelling must have been seated in the cellular 
texture enveloping the spermatic vessels, and externally, to the perito- 
neum. Now, hydrocele of the cord is frequently met with during infancy 
and early childhood, when it is very apt to be mistaken for rupture in con- 
sequence of the testicle being felt lying quite free at the bottom of the 
tumor; and the risk of this error is generally increased, when, as occa- 
sionally happens, the tumor diminishes or disappears upon being subjected 
to pressure, or when the patient is in the horizontal posture. But it is 
especially to guard against the erroneous diagnosis which thus results, 
that the present case seems to deserve attention ; as it shows that in 
hydrocele of the cord, accommodation for the fluid may be afforded within 
the abdomen, and renders it probable that what was thus ascertained to 
take place on a large scale, may be of less unfrequent occurrence to the 
smaller degree requisite for explaining the temporary disappearance of the 
swelling caused by hydrocele of the cord, through the influence of press- 
ure or the horizontal posture. Part xii., p. 212. 
Treatment of Hydrocele by Alcoholic Fomentations.—Dr. Pleindoux of 
Nismes, relates the following case : A wine-merchant, of Nismes, had 
been affected for a length of time with a considerable hydrocele on the 
left side of the scrotum, and for private reasons requested palliative treat- 
ment. A puncture was made on the 11th October, 1844, and more than 
a pint (demi-litre) of water drawn off Nine months after, a second 
puncture, simply to evacuate the fluid, was made. It then occurred to 
the patient to envelop the scrotum with a large compress, doubled four 
times, and steeped in alcohol of 30 degrees. This application, kept in its 
place by a suspensory bandage, was renewed every evening. The first 
effect was to produce great contraction of the scrotum. A slight sensa- 
tion of cold only was experienced, which remained some minutes. These 
fomentations were continued forty days, and the patient Avas completely 
freed from his hydrocele, which has not returned during eighteen months. 
Having observed this fact, M. Pleindoux repeated the application on the 
first occasion which presented itself, and has uoav done so four times suc- 
cessfully. Part xiv., p. 234. 
Cure of Hydrocele.—Dr. Harvey, of Bristol, has for thirty years suc- 
cessfully employed the folloAving treatment in hydrocele, obtaining a 
radical cure without injection. His mode of treatment is as follows: 
First, discharge the fluid with a trocar, or pocket lancet, and then apply a HYDROCELE. 
warm vinegar poultice all over the scrotum, in order to bring on inflam- 
mation, which generally takes place in a few hours, and becomes painful. 
When sufficient inflammation has been excited, remove the vinegar poul- 
tice, and apply a bread and milk poultice; in a short time the pain and 
inflammation generally subside, and the cure is completed. Give a few 
smart doses of purgative medicine. Part xiv., p. 235. 
Treatment of Hydrocele.—In young children, the cure of simple hydro- 
cele, if not spontaneously produced, may generally he effected by local 
applications; and I have frequently produced absorption of the fluid by 
the use of the following lotion : 
R Amra. hydrochlor. 3j.; liq. am. acet. sq. vini rect. aa. gij.; aqme 
destil. giv. M. Ft. lotio ssepe applicand. 
Should this treatment not succeed, acupuncturation is almost infallible 
in children. In later periods of life, hydrocele sometimes undergoes a 
spontaneous cure, from a blow, or any cause which induces inflammation, 
or from a rupture of the tunic attended by diffusion of the fluid. 
[Speaking of the various operations which have been recommended for 
the radical .cure of hydrocele in the adult, Mr. Cooper observes:] 
Incision was the operation employed by John Hunter; it was performed 
in the following manner: He made an incision into the tunica vaginalis, 
allowing the fluid to escape, and then, sprinkling flour on the surface of 
the tunic to excite inflammation, the membranous sac filled up by granu- 
lation. This operation, however, so frequently led to sloughing, that Mr. 
Pott repudiated it, and substituted that of injection, which is now almost 
always employed. In those cases, however, in which there is a great dif- 
culty in forming a diagnosis, incision is a most safe mode of proceeding, 
provided no further means be employed to produce inflammation of the 
tunica vaginalis. In June, 1839, I admitted a patient, aged sixty-four, 
into Stephens’ Ward, Guy’s Hospital, who was the subject of a large 
scrotal tumor, which had formed so rapidly, that I doubted whether it 
was hydrocele or hematocele; this doubt was strengthened by the perfect 
opacity of the tumor, and I proceeded therefore to open the tunic by way 
of exploration: a pint of brownish serum was evacuated, and I found the 
tunica vaginalis extremely thickened, in some parts cartilaginous, and at its 
upper portion ossified ; the patient was, however, perfectly cured by this 
simple operation. My colleague, Mr. Cock, also treated a similar case by 
incision, but in that instance the whole cartilaginous tunic was thrown off 
by a sloughing process; but the patient also recovered. I have myself 
had several cases in which I have adopted simple incision as the mode of 
treatment. 
[Mr. Cooper does not, however, approve of this operation, except in 
such cases as offer a difficulty in ascertaining the precise nature of the 
disease. The operations by excision, caustic, and seton, he decidedly 
condemns. 
Mr. Cooper now always uses the iodine injection in the radical cure of 
hydrocele, as he finds that its use is invariably successful, and is free from 
all the ill effects which frequently followed the employment of the solution 
of zinc, or wine and water.] 
In performing the operation, take care to push the canula quite into the 
cavity of the tunica vaginalis, by a quick, semi-rotatory, jerking motion, 
having placed the fore-finger on the canula so as to limit the extent of its 902 
HYDEOCELE. 
introduction. If from want of this precaution, the fluid injected has 
become extravasated into the cellular tissue of the scrotum, make several 
incisions into it, which will generally prevent bad consequences. In cases 
where there is difficulty in forming the diagnosis of hydrocele, the opera- 
tion of incision may be resorted to. 
Congenital hydrocele differs from the common species in having a com- 
munication with the peritoneal cavity, into which the fluid may be returned 
by pressure. In this form of hydrocele, of course, injection is not to be 
thought of; a truss should be worn with the view of obliterating the com- 
munication between the cavities. 
Acupuncturation may be safely adopted in cases of congenital hydrocele 
that are not cured by the pressure of a truss. 
The mode of proceeding is to insinuate the needle into the tunica vagi- 
nalis by several punctures, which permit of the exudation of the fluid into 
the cellular membrane, where it becomes absorbed. 
Encysted hydrocele is so termed when the fluid, instead of being con- 
tained within the tunica vaginalis, is secreted in an adventitious sac. 
Puncture with a needle, and squeeze out the fluid into the surrounding 
cellular membrane. Then give purgative medicines, and let the patient 
wear a suspensory bandage, and evaporating lotion. 
Hydrocele of the cord is much more difficult to diagnose than hydrocele 
of the tunica vaginalis, having a great resemblance to bubonocele. As to 
its pathology, Mr. Cooper observes : 
Mr. Curling seems to have adopted Mr. Pott’s opinion, that this disease 
is an cedematous condition of the cellular membrane of the cord—an 
anasarcous effusion ; but, from two or three cases I have seen, I am 
inclined to believe that the collection of fluid is within the serous mem- 
brane itself, although there can be no doubt that an anasarcous condition 
of the cord does occur, as in other parts of the body, and which may be 
cured by the same local and constitutional means employed for anasarca 
generally. 
I should consider the best treatment for true hydrocele of the cord, whe- 
ther seated in the inguinal canal, or below the external ring, to open the 
tunic, evaporate the fluid, and apply a truss. I should hesitate before I 
employed an injection, from the dread of the ill effects which might result 
from the close proximity of the peritoneum; but this mode of practice is 
sometimes recommended. 
Encysted hydrocele of the spermatic cord I should consider as similar in 
every respect to encysted hydrocele of the testicle, excepting in situation; 
that they are always in both cases exterior to the cavity of the tunica 
vaginalis, and contain a limpid, uncoagulated fluid. 
The means to be adopted for the obliteration of these cysts, if they do 
not spontaneously disappear, are either acupuncturation or seton, the for- 
mer of which should always be first attempted before having recourse to 
the more dangerous mode of the introduction of a silk into the cyst. 
Hematocele is a collection of blood instead of serum in the tunica vagi- 
nalis ; and the diagnostic marks between hematocele and hydrocele are, 
that in hematocele, the effusion of blood results at once from the lesion 
of a blood-vessel, and therefore rapidly forms upon the application of the 
exciting cause; while the fluid of a hydrocele results from an inflamma- 
tory action, and only gradually accumulates. In hematocele the tumor is 
always opaque, and much heavier than in hydrocele; consequently greater HYDEOCELE. 
903 
inconvenience is experienced. If called to a recent case of hematocele, 
you will generally find the scrotum more or less ecchymosed and dis- 
tended by a fluctuating tumor, and probably the history of the case 
will prove that a blow, or some other external force, has been the cause of 
these appearances, and is sufficient to constitute the diagnosis of the malady. 
Hematocele not unfrequently results from the operation of tapping a 
hydrocele, in consequence of the trocar wounding some abnormally dis- 
tended vessel, either of the skin or tunica vaginalis. In such a case, a few 
hours after the serum has been drawn off, the swelling is as large as ever, 
from the accumulation of blood. The largest hematocele I ever saw was 
produced in this manner. 
[The treatment of hematocele is to lay open the cavity, and turn out 
the eoagulum.] Part xix., p. 175. 
Treatment of Hydrocele by Seton.—When the iodine injection fails, 
employ a seton, consisting of one or two threads of dentist’s silk. Intro- 
duce it by means of a nsevus needle, allowing the fluid to drain away 
through the punctures thus made: or else tap the hydrocele, pass a needle 
six inches long, armed with the seton, up the canula, draw it through the 
upper part of the scrotum, remove the canula and knot the thread. When 
a sufficient amount of inflammation appears to be set up, remove the 
seton, and treat the case by rest and antiphlogistic regimen. 
Part xxi., p. 240. 
Padical Cure of Hydrocele.—After emptying the sac, introduce through 
the canula some finely-levigated powder of nitric oxide of mercury 
(quantity not stated). This plan is quite safe and certain, and is much 
more convenient and speedy than that of injection. Part xxi., p. 242. 
Treatment of Hydrocele.—Many instances are recorded of patients hav- 
ing experienced a spontaneous cure of hydrocele, even without any appa- 
rent cause for the absorption of the fluid—in young children this is not by 
any means uncommon. 
In children, says B. B. Cooper, I never recommend tapping, but try 
first the effect of general treatment, applying merely a lotion to the part; 
the bowels should be opened freely, and the following lotion applied con- 
stantly to the scrotum: 
R Amnion, rauriat., 5j.; sp. vini rectif., liq. ammon. acet., aa. §ij.; aquse, 
§iv. M. Ft. lotio. 
Should such treatment not prove successful, I try acupuncturation, 
making two or three small punctures into the tunica vaginalis; and 
squeezing the fluid into the cellular tissue, so as to produce a kind of 
eedematous condition of the scrotum. I have seldom known this plan of 
treatment fail in children, but in adults it is only palliative. In the 
adult, first simply tap and draw off the fluid, and do not employ an 
injection. If the disease returns, then inject two drachms of one part of 
tincture of iodine to §j. of water. This is generally successful. 
Part xxv., p. 247. 
Hydrocele.—The color of the fluid may be easily diagnosed in common 
daylight by looking through a tube, one end of which is firmly placed 
against the tumor. Mr. Lloyd uses the ointment of the nitrico-oxide 
of mercury, passing a tube smeared with it through the canula, and 
moving it about in the inside of the sac. Mr. Wormald prefers the 904 
palliative treatment, making twelve or twenty punctures with a full-sized 
needle, and repeating the operation when the sac refills. 
Part xxviii., p. 218. 
Hydrocele—Radical Cure of.—After the withdrawal of the fluid, intro- 
duce a few grains of red precipitate into the sac through the canula, by 
means of a director. This is quite safe, is uniformly successful, and will 
answer when iodide injection fails. Part xxxiii., p. 213. 
Hydrocele.—Pass about a grain of the red oxide of mercury into the sac, 
by means of a probe, through the canula which has drawn ofi'the fluid. It 
will produce inflammation, and effect a cure in every instance. 
Part xxxv., p. 135. 
Hydrocele.—Puncture the swelling with a common darning-needle, which 
rotate about for a few minutes, and the fluid will thus be allowed to escape 
into the cellular tissue of the scrotum, whence it will be speedily absorbed. 
This is perfectly simple and almost painless, and in a tolerably large num- 
ber of cases, a permanent cure will follow. (Mr. Stanley.) 
HYDROCEPHALUS. 
Hydrocele-Pliotoscope.—When the translucency of the swelling is made 
a means of diagnosis, much trouble may be avoided by using a tube of tin 
about 7 inches long, in diameter at its larger end, and tapering to f at 
the other, where it is furnished with a wooden eye-piece. It must be 
blackened inside. In sunlight a candle can be thus dispensed with. 
Part xxxvip. 183. 
Hydrocele.—Mr. Pollard, at St. George’s Hospital, adopts with success 
the treatment of hydrocele recommended by Dr. Simpson, viz., the intro- 
duction of metallic wires through the sac, leaving them there for a few 
days; they completely drain it of fluid, and excite sufficient inflammation 
of an adhesive character to insure the obliteration of the sac. 
Part xl., p. 148. 
HYDROCEPHALUS. 
Peculiar Mode of giving Mercury in Chronic Hydrocephalus.—Dr. 
Watson, in his lecture, relates the following: 
An apothecary of considerable experience once took the pains to write 
out and send me the particulars of two cases in which he had seen a peculiar 
mode of administering mercury successfully. 
He had a lad, fourteen years old, under his care, with chronic hydroce- 
phalus. He had been ill two or three years. He was nearly blind, had 
very little use of his lower extremities, and could not walk across the room 
without support. He suffered violent pains in his head, and was unable to 
bear the least pressure on his scalp. His bowels were constipated, and his 
pulse “ oppressed.” Cupping and blistering, and the blue pill, and drastic 
purgatives, and ordinary diuretics, tried in combination and succession, 
gave him temporary relief; but no permanent benefit was obtained. Dr. 
Gower then suggested a plan which he had himself found successful in such 
cases, and which had first been used by Dr. Carmichael Smyth, who had 
recorded ten cases of recovery under its adoption. Dr. Gow7er’s plan was 
to rub down ten grains of crude mercury Avith about a scruple of manna, 
and five grains offresh squills; this was to be one dose ; and it was to be 
repeated every eight hours. HYDROCEPHALUS. 
905 
My informant rubbed the quicksilver down with conserve of roses, and 
then added the fresh squills, making the whole into the consistence proper 
for pills, with liquorice-powder. The patient took this dose three times 
a day, for nearly three weeks, without any ptyalism being produced. Its 
effects were great prostration of strength, and loss of flesh, with gradual 
relief of all the boy’s sufferings. It operated profusely by the kidneys. 
The medicine was continued twice a day, and at length once, for another 
fortnight; when all the symptoms of the disease had disappeared. The 
boy Avas greatly emaciated ; he was then ordered an ounce and a half of 
Griffiths’ mixture thrice daily; and soon regained his health and strength, 
and got quite well, and he remained well eight years afterward. 
Part iii.,p. 62. 
The IIydrocephaloid Disease.—Dr. Marshall Hall observes as follows : 
The exhaustion on which it principally depends, has its origin, in early 
infancy, chiefly in diarrhoea, or catharsis; in the later periods of infancy, 
in the loss of blood, with or Avithout the relaxed or evacuated condition 
of the bowels. It has very frequently succeeded to Aveaning, or to other 
changes in the diet, or to constipation. 
The exhaustion from loss of blood generally folloAvs the inappropriate 
or undue application of leeches, or the use of the lancet. Dr. Hall, indeed, 
gives a useful caution. Of the Avhole number, he says, of fatal cases of 
disease in infancy, a great proportion occur from this inappropriate or un- 
due application of exhausting remedies. This observation may have a 
salutary effect in checking the ardor of many young practitioners, who are 
apt to think that if they have only bled, and purged, and given calomel 
enough, they have done their duty; when, in fact, in subduing a former, 
they have excited a new disease, Avhich they have not understood, and 
which has led to the fatal result. 
Dr. Ilall divides the affection into tAvo stages—the first that of irritabil- 
ity, the second that of torpor. 
In the first stage, ho goes on to observe, the infant becomes irritable, 
restless, feverish; the face flushed, the surface hot, and the pulse frequent; 
there is an undue sensitiveness of the nerves of feeling, and the little pa- 
tient starts on being touched, or from any sudden noise ; there are sighing 
and moaning during sleep, and screaming: the bowels are flatulent and 
loose, and the evacuations are mucous and disordered. 
If' through an erroneous notion as to the nature of this affection, nour- 
ishment and cordials be not given, or if the diarrhoea continue, either 
spontaneously, or from the administration of medicine, the exhaustion 
which ensues is apt to lead to a very different train of symptoms. The 
countenance becomes pale, and the cheeks cool or cold ; the eyelids are 
half closed, the eyes are unfixed, and unattracted by any object placed 
before them ; the pupils unmoved on the approach of light; the breathing, 
from being quick, becomes irregular and affected by sighs; the voice be- 
comes husky, and there is sometimes a husky, teasing cough ; and eventu- 
ally, if the strength of the little patient continue to decline, there is a 
crepitus or rattling in the breathing ; the evacuations are usually green ; 
the feet are apt to be cold. 
A similar train of symptoms occurs in other cases, in which the 
strength of the little patient has been subdued and the vascular system 
exhausted by the abstraction of blood. Stimuli, if efficacious, reduce the 906 
frequency of the pulse, and restore the wonted warmth, color, expression, 
and smiles to the countenance. 
Dr. Hall particularly insists on a close observation on the condition of 
the cheeks, in regard to color and warmth. That condition, he observes, 
may be considered as the pulse of very young infants indicating the de- 
gree of remaining power, or of exhaustion. In the present case, espe- 
cially, there is no symptom so important, so distinctive. It is from the 
condition of the cheeks, in conjunction with a due consideration of the 
history, that the diagnosis of this morbid state, and the indication of the 
appropriate remedies, are chiefly to be deduced. The general surface, 
and especially the hands and feet, also afford important sources of infor- 
mation as to the condition of the nervous or vital powers. Next to these, 
the degree of frequency of the pulse, and the character of the breathing, 
are points of the greatest importance ; during the stage of irritability, the 
breathing is quick ; during that of torpor, it is slower, irregular suspirious, 
and, finally, crepitous; the pulse changes in its beat, from being full be- 
coming smaller, but retaining, perhaps, its former frequency. 
We should be.especially upon our guard, not to mistake the stupor, or 
coma, into which the state of irritability is apt to subside, for the natural 
sleep, and for an indication of returning health. The pallor and coldness 
of the cheeks, the half-closed eye-lid, and the irregular breathing, will suf- 
ficiently distinguish the two cases. 
The following is Dr. Hall’s methodus medendi. The remedies, he says, 
for the morbid affection are such as will cheek the diarrhoea, and afterward 
regulate the bowels, and restore and sustain the strength of the little 
patient. With the first object, it may be necessary to give the tinctura 
opii, and chalk, and afterward, the pilula hydrargyri, rhubarb, and mag- 
nesia ; with the second, sal volatile, but especially brandy ; and proper 
nourishment, are to to be given according to circumstances. But in this, 
as in many cases of infantile disorders, the milk of a young and healthy 
nurse is the remedy of most importance; in the absence of which, ass’s milk 
may be tried, but certainly not with the same confident hope of benefit. 
Five or ten drops of the sal volatile may be given every three or four 
hours; and twice or thrice in the interval, five or ten drops of brandy may 
be given in arrow-root done in 'water. As the diarrhoea and appearances 
of exhaustion subside, these remedies are to be subtracted, the bowels are 
to be watched and regulated, and the strength is to be continually sus- 
tained by the nurse’s or ass’s milk. The brandy has sometimes appeared 
to induce pain; sal volatile is then to be substituted for it; a dose of mag- 
nesia has also appeared to do good. 
For the state of irritability, the warm bath is a remedy of great 
efficacy. For the coma, a small blister, or sinapism, should be applied 
to the nape of the neck. A state of exhaustion of the general system, 
as I have observed elsewhere, by no means precludes the possibility of real 
congestion of the brain. It rather implies it. In extreme cases, there 
are not only the symptoms of cerebral congestion during life, but effusion 
of serum into the ventricles of the brain is found on examination after death. 
In every case the extremities are to be kept warm by flannel, and the 
circulation should be promoted in them by assiduous frictions. It is of the 
utmost importance carefully to avoid putting the little patient into the 
erect posture. A free current of air is also a restorative of the greatest 
efficacy. Part iv., p. 50. 
HYDKOCEPHALCJS. HYDROCEPHALUS. 
907 
Large Doses of Iodide of Potassium in the Last Stage of Acute Hy- 
drocephalus.—Dr. Roeser gives us a case where he employed large doses 
of the iodide of potassium. The child lay quite insensible, pupils fixed 
and dilated, complete paralysis of one side, face flushed, body bathed in 
perspiration, and all the other symptoms denoting the last stage of the 
disease. One drachm of the iodide of potassium was dissolved in half 
an ounce of water, thirty drops of this solution were given every hour 
in a little water ; one drachm of the iodide was at last given in twenty-four 
hours, and then the good effects appeared : in short, the child rapidly reco- 
vered without any other bad effects than a crop of boils. Part iv., p. 54. 
The Employment of Cold Affusion in Acute Hydrocephalus.—Dr. 
Munchmeyer observes that the medical world is greatly divided in opinion 
as to the value of this remedy. Cold affusion must be looked upon as a 
directly antiphlogistic remedy, nor is its employment indicated during 
the early inflammatory stages of hydrocephalus, but rather when effusion, 
the consequence of inflammatory action, has taken place, and a tend- 
ency to paralysis exists. After the subsidence of the violent symptoms 
of the disease, and when the patient has sunk into a comatose state, with 
a pale countenance, occasionally suffused with a flush, dilated pupils, strabis- 
mus, and slow pulse, this remedy will frequently prove of excellent service. 
In order, however, for benefit to be derived from it, it must be em- 
ployed in an efficient manner. Dr. Munchmeyer directs that the patient 
should be taken out of bed, stripped of his clothes, and wrapped up in some 
simple covering (if waterproof the better), which leaves only his head 
exposed. He should then be placed in a sitting posture in a bath or tub, 
and the person who administers the affusion should mount on a chair and 
pour cold water upon his head, in a moderate stream from the height of 
five or six feet. This may be continued for a minute or two, and repeated 
twice or thrice. The patient should then be wrapped up in a warm sheet 
and placed in bed, where he should remain till it is thought proper again 
to have recourse to the remedy. At first, it will probably be requisite to 
repeat the affusion, in the course of an hour and a half or two hours; but 
as the patient improves, the interval may be longer, so that at last it will 
not be necessary to employ it above two or three times daily. 
The immediate effect of cold affusion is, that the patients awake from 
their comatose condition and begin to cry violently, which they continue 
to do so long as the water is poured upon them. They afterward appear 
exhausted and pale, the skin is cool, the pulse small and very frequent. 
When placed in bed they usually fall into a doze, the pulse becomes more 
regular, and the warmth of the skin returns. By degrees, as with the 
repetition of the remedy the patients improve, they begin to have sound 
sleep, from which they awake in the possession of all their senses, recog- 
nize those by whom they are surrounded, and cease to squint. At the 
same time, too, a sweat, frequently of a critical nature, breaks out upon 
the whole body, and during its continuance the employment of cold affu- 
sion is very hazardous. The patient’s sleep becomes more refreshing, and 
the comatose condition recurs at longer intervals; he begins to notice 
what goes on around him, the head regains its natural temperature, and 
the febrile symptoms disappear. The employment of affusion must, how- 
ever still be continued for some days, since relapses very frequently occur. 
Part iv., p. 65. 908 
Ht DROCEPHALUS. 
— [In Dr. Ilannay’s Dispensary cases is the following one of chronic hydro- 
cephalus, which is said to be congenital:] 
The infant was in its eighth month, and the head had acquired a size 
much beyond natural. It presented an unnatural expression, looked lan- 
guid and inactive; squinting, vomiting, and costive bowels. It had been 
several times attacked with convulsions, after which it lay comatose tor 
several hours. The fontanels were large and full. I directed diuretics 
(nit. pot. and pulv. ipecac.), as I have a notion that to increase the urinary 
discharge is on many accounts very advantageous in this disease. 
Decided benefit in this case was derived from a liniment of powdered 
ipecacuanha root. 
The formula I adopt is as follows : $ Ipecac, pulv.; olei olem Europ. aa. 
5ij.; adipis suill. §ss.; M. opt. fiat liniinentuin fricando admovendum. 
The part we wish to irritate is to be rubbed freely with this liniment for 
fifteen or twenty minutes three or four times daily, and enveloped in flannels. 
This produces, in about thirty-six hours, or sometimes sooner, very numer- 
ous small papulae and vesicles, seated on a deep-red base of irregular extent. 
The eruption endures very vividly for a few (three) days, during which the 
pustules become covered with a scab-like scale, and fall off, leaving no mark. 
They never ulcerate, as do the pustules from the tartrate of antimony. 
In feeble, young, and very irritable persons, it will, I feel assured, prove 
a very suitable counter-irritant. I specially beg attention to the use of it 
in the head diseases of a chronic kind in infants and young children. 
Many of these cases follow the suppression of eruptions and scabbed dis- 
eases of the scalp. Now, the ipecacuanha liniment produces a scabbed 
state of the scalp, as nearly resembling the affections in question as can be 
imagined, and maintaining a counter-irritation on the surface which I have 
proved, I think, to be a very valuable agent of this nature. Part viii., p. 70. 
Compression in Chronic Hydrocephalus.—M. Hirsch has published ex- 
amples of the efficacy of compression in cases of chronic hydrocephalus. A 
child, eleven months old, labored under this affliction ; the head was large, 
fontanelles open, and all the sutures widely separated. The lower extre- 
mities were paralyzed. On the 11th May, a mixture, containing infusion 
of bark, digitalis, and sweet spirits of nitre, was administered, and mercu- 
rial frictions were made on the head. The paralysis gradually disappeared 
under the influence of this treatment. On the 28th the head was enveloped 
with strips of sticking-plaster, which compressed it on all sides; the plaster 
was renewed on the 28th of June and 4th of September, and in February 
it was found that the fontanelles and sutures were completely ossified. 
The child had begun to walk and speak. Part viii., p. 74. 
Strabismus in Hydrocephalus.—Dr. II. Kennedy says: When strabismus 
in hydrocephalus of adult life exists only to a slight degree, it is, I think, no- 
ticed better at a distance from, than close to the patient. Part viii., p. 78. 
Chronic Hydrocephalus—Tapping the Membranes of the Brain.— 
[Sir John Fife publishes a case of chronic hydrocephalus in a child, 
17 months old, in which he tapped the membranes of the brain. The child’s 
countenance was pale and clear, but otherwise healthy.] 
The head is immensely large, twenty-six inches in circumference, ten 
from ear to ear over the occiput, thirteen from ear to ear over the vertex, 
fifteen from ear to ear over the forehead ; the skull appears to be dilated 
pretty equally; the eyes slightly project; the upper part of the face at the 
orbits is broadened; at the base of the nose it is completely blue from the 909 
HYDROCEPHALUS. 
collections of veins which are placed there, and issue out over the fore- 
head; the other parts of the skull are also traversed by numerous tortuous 
and enlarged veins. The child seems as intelligent as others at the same age. 
Operation.—Sir John Fife placed the child on the knee of a nurse, its 
head in a line with the spine, which was half recumbent; he then with a 
small trocar penetrated the membrane in the coronal suture on the left 
side, half-way between the longitudinal suture and the temporal bone. 
After passing the trocar somewhat less than two inches, the stilette was 
withdrawn, followed by fourteen ounces of fluid, the first twelve of which 
were perfectly limpid, the last two bloody. Compression by the hands of 
assistants was carefully made on the head, and maintained afterward by 
adhesive straps and a long bandage, a little dry lint being applied to the 
wound. In an hour after the operation the child looked rather pale, but 
otherwise appeared the same, and was sucking vigorously its mother’s breast. 
[A week after the operation, the child seemed-rather stupid, but with 
this exception the case went on well, merely requiring castor oil to keep 
the bowels in a free state. On the ninth day a bandage was applied round 
the head.] Part xi., p. 177. 
Hydrocephalus—Acute.—The only available treatment is the prophy- 
lactic, which should be the same as for phthisis. Let the child be suckled 
by a healthy wet nurse, and not be weaned till it has cut four molar teeth; 
and let milk subsequently form a large part of the diet. Let it reside in 
the country; wear warm clothing, and have flannel next the skin; avoid 
over-exercise of body and mind, and be shielded as much as possible from 
exposure to the contagion of the exanthemata. When the disease has ap- 
peared, employ moderate depletion, remembering that the disease is a 
scrofulous inflammation ; give purgatives so as to maintain a free action 
of the bowels for several days; and obtain mercurial action by giving calo 
mel with the purgatives. Part xvi.,p. 68. 
Chronic.—Cut the hair close, and rub in two drachms of mild mercurial 
ointment, daily, into the scalp, and keep the head covered with a flannel 
cap. Give a quarter or a half a grain of calomel twice a day, unless diar- 
rhoea comes on. After thirty or forty days, if the patient is improving, 
gradually diminish the medicines; but if not, add a mild diuretic and in- 
sert a couple of issues in the occiput, or apply blisters to the nape. Leech- 
ing may be occasionally required. In order to prevent the bones of thv 
head yielding to any accumulation of fluid in cases of external hydrocepha- 
lus, apply compression by bandaging the head with strips of diachylon 
plaster about one third of an inch broad: or use Dr. Arnott’s air press. 
Tapping the head is occasionally proper ; use a fine trocar and canula—mace 
the puncture in the coronal suture an inch or an inch and a half from the an- 
terior fontanelle ; withdraw only a few ounces of fluid at a time, and keep up 
pressure both during the escape of the fluid and afterward. Part xvi.,p. 7's. 
Treatment of.—Dr. Willshire says that it is only by a decisive effort ap- 
plied at the commencement, that the progress of this fatal disease can be 
arrested. The treatment has varied according to the opinions held respect- 
ing the nature of the disease: purely antiphlogistic treatment having been 
adopted by those who believed meningeal and cerebral congestion to be 
the cause of death ; while those who regarded ventricular effusion as the 
most important pathological character of the disease, have employed means 
both to prevent such effusion, and to lead to its absorption. 910 
HYDROPHOBIA. 
Remember that there are two elements of the disease to deal with, the 
scrofulous and the inflammatory. If called to the case early, it may be 
necessary to apply leeches behind the ears, and keep the child in a cool 
room, Avith cold to the head ; if the symptoms are chiefly those of pressure 
and there is great tendency to sleep or stupor, leeches are not required, 
but the other parts of the treatment are the same as in the first case, viz., 
to dry cup the nape, or apply sinapisms; to purge freely by the adminis- 
tration by the mouth of aloes and sulphate of potash, and by the exhibi- 
tion of enemata of castor oil and turpentine. Then rub iodine ointment 
freely over the scalp, and give iodine internally. A grain of iodide of 
potassium with one-tenth of a grain of iodine every three hours, may safely 
be given to the youngest child. Part xvi., p. 73. 
Ilydrocephaloid Disease.—Ilydrocephaloid disease, occurring in the pro- 
gress of infantile diarrhoea. Give (a child 18 months old) a tablespoonful of 
equal parts of milk and barley-water every quarter of an hour, with 15 drops 
of brandy every hour, and a little veal broth every two hours. Administer a 
draught containing ten grains of aromatic confection, half a drachm of 
compound tincture of bark, and six drops of sal volatile every three hours, 
and a grain of Dover’s powder at bedtime. Gradually withdraw the sti- 
mulants Avhen the symptoms are relieved. Hydrocephaloid symptoms may 
also come on in pneumonia, or after real congestion of the brain has been 
somewhat over-treated. Part xvi., p. 76. 
Chronic Hydrocephalus.—As a last resource you may tap with a com- 
mon trochar, and inject tAvo or three ounces of a solution of tincture of 
iodine (fourteen minims to tAvo ounces), previously heated to the temper- 
ature of the body. It is not attended with the danger which at first sight 
might be supposed, and it will have a very perceptible effect in controlling 
the secretions. Part xxxiii., p. 68. 
Hydrocephalus.—When once the soft union of the cranial bones yields 
to the expanding influence of the fluid within the brain, the progress of the 
effusion is mainly attributable to an atonic condition of the vessels. This 
gradual increase of fluid maybe prevented by the application of permanent 
equable pressure by means of an elastic cap, closely fitting the head. In 
a case treated by the author, the effusion of fluid Avas considerably reduced, 
approximation and union of the previously widely separated cranial bones 
being induced. Part xxxvii., p. 237. 
Hydrocephalus.—In some cases great amelioration of the symptoms will 
follow the free use of croton oil as a counter-irritant. The liniment (croton 
oil, half a drachm; turpentine liniment, half an ounce) must be rubbed, 
about every four hours, over the entire head, until a plentiful crop of pus- 
tules make their appearance. This plan of treatment Avas first suggested 
to the author by a case in which the cephalic symptoms supervened on the 
cure of eczema of the scalp, with profuse discharge. Part xl., p. 42. 
Indian Ilemp.—The resinous extract of Indian hemp, in the form of pill, 
to the extent of from 5 to 10 grains, and repeated according to effect, re- 
commended in hydrophobia. Part ii., p. 31 
HYDROPHOBIA. 911 
Bite from a Mad Bog.— Vide Art. “ Practical Remarks on Caustics.” 
Opium Smoking.—Suggested as a remedial agent in hydrophobia, teta- 
nus, tic douloureux, etc. Bart v., p. 56. 
Aconite in Hydrophobia.—The analogy which exists between tetanus 
and hydrophobia, says Mr. Page, naturally leads to the inference that, if 
aconite be efficacious in tetanus, it may also be employed with advantage 
in the latter disease; and should a case occur in my own practice, I should 
certainly employ this remedy in preference to any other, carrying its effects 
to the furthest allowable extent. In fact, from my previous knowledge of 
the physiological effects of this drug, I had determined to administer it in 
the event of hydrophobia manifesting itself in any of six children who were 
bitten by a dog in an undoubtedly rabid state. In five of the children the 
bitten parts were excised; and, happily, I have not been called upon to 
test the therapeutic proj)erties of aconite in any one of them. I may here 
mention that the results of Dr. Garrod’s important experiments on the 
property which animal charcoal possesses of destroying the power of vege- 
table poisons, whether in or out of the body, together with his suggestion 
that it may exert a like influence over animal poisons, induced me to re- 
commend the application of poultices of animal charcoal to the wounded 
parts, which was continued until they were perfectly healed. 
jPart xiii., p. 60. 
Hydrophobia—To Prevent.—First apply caustic, especially in solution, 
and then excise all that can with safety be removed. If there is no reason 
to suspect the dog of being rabid, it is better not to operate, since the 
operation itself produces much irritation, as well as alarms the patient. 
Part xvi., p. 110. 
Chloride of Zinc in a Beliquescent or Liquid State.—Dr. Cattell, in 
treating of the precautions to be observed in dissecting, says: 
From my experience in caustic applications, I am not aware that I could 
point to one that exerts a more penetrating influence than this does. 
Should a case of hydrophobia fall under my care, immediately after the 
wound had been inflicted by the animal, the first application should be the 
deliquescent solution of chloride of zinc. Part xvi., p. 300. 
Tracheotomy Suggested.—According to Dr. M. Hall, in cases of hydro- 
phobia, the patient dies from repeated excitation of reflex action, wearing 
out, as it were, the power of the spinal centres; and from asphyxia, in- 
duced by repeated paroxysmal closure of the larynx. Tracheotomy is, 
therefore, to be performed, in order to prevent asphyxia; and the patient 
is then to be placed on a spring bed, and surrounded by ranges of curtains 
of lace or net, and every current of air, every shake of the bed or the floor, 
in a word, every excitation, or cause of reflex action or emotion, absolutely 
avoided. Part xviii., p. 98. 
Use of Chloroform in Hydrophobic Mania.—Mr. Ackerley recommends 
that repose be procured by inhalation of chloroform, once or twice a day; 
and apply counter-irritation to the head and spine, and give active purga. 
tives. Part xviii., p. 99. 
Hydrophobia.—In a case of this terrible affection, chloroform was ad- 
ministered with great relief to the restlessness, vomiting, and violence of 
the convulsions, though it had no effect in preventing the fatality of the 
case. Part xxvi., p. 29. 
HYDROPHOBIA. 912 
HYPOCHONDRIASIS. 
HYPOCHONDRIASIS. 
Hypochondriasis.—Most cases of this disease arise in invalids from inter- 
tropical climates, from their giving up an accustomed stimulus, this stimu- 
lant being heat. To supply the place of this, the use of the A’apor bath is 
a highly important agent. Part xxiv., p. 335. 
Solar Plexus—Exhaustion of Nervous Power of the.—[Believing the 
depressing feelings belonging to hypochondriasis to depend on a depraved 
sensibility of the stomach or colon, or both, Dr. Osborne determined to try 
the effects of chloroform taken internally.] 
The patient Avas a farmer, twenty-eight years of age. In him the poet’s 
exclamation, Peati agricolce ! appeared to be completely reversed. The 
angles of his mouth Avere drawn down, his brow generally contracted, and 
he appeared sometimes as if contemplating suicide; yet he stated that he 
Avas in comfortable circumstances, married, and with a family. He com- 
plained of an inward sinking and sense of depression, so constant and over- 
powering, that for some months he could not command himself to make 
any exertion, and had become unable any longer to attend to his business. 
His boAvels Avere usually torpid, but although he had repeatedly taken pur- 
gative medicines with effect, yet he had obtained no further benefit. A 
careful examination having been made without detecting any disease, he 
was ordered to take ten drops of chloroform thrice daily, and tAvo assa- 
foetida pills every alternate night. At the end of about four days of 
gradual improvement, his countenance had become placid. He confessed 
that he felt much better / and in a feAV days aftenvard, feeling a strong 
desire, and also a capability of resuming his ordinary A'ocations, he went 
home. 
There are several other uses to Avhich chloroform may be applied in affec- 
tions of the stomach and intestinal tube, but this appears to be one of the 
greatest value, inasmuch as no other medicine can be named which in this 
respect seems to come into competition with it. 
The menstruum which Dr. Osborne used in the above and other cases 
Avas the decoction of Irish moss (Carrageen). With this, chloroform forms 
a uniform mixture, and in the proportion of ten drops to the ounce they 
remain for an indefinite time Avithout separation taking place. The taste 
of the mixture is SAveet, like that of a heavy sirup, to relieve which it may 
be Avell to add a feAV drops of some aromatic or bitter tincture. 
Another mode of avoiding the pungency of chloroform is by giving it in 
combination with tinctures, as it is soluble in alcohol, and remains dissolved 
even in proof spirit. The following is a specimen of this kind of formula, 
and is peculiarly grateful to the taste, and susceptible of various additions 
and alterations, according to the requirements of mdividual cases: Chloro- 
form and tincture of ginger, of each half an ounce; aromatic spirit of am- 
monia, tAvo drachms. Mix. Twenty-five drops to be taken thrice daily in. 
a Avineglassful of milk. Part xxix., p. 70, 
Hypochondriasis.—Sleeplessness of, etc. Vide Selections from Favor- 
ite Prescriptions, Art. “ Medicines.” 
END OF VOL. I.