NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Serrice transactions OF THE MEDICAL SOCIETY or THE COUNTY OF CAYUGA, FOR 1832. LI BR ARY^l APR.-19 1917 .StffrGlOfrGEftfRAl'S OfFICfc PUBLISHED BY THE SOCIETY. is3a. r LIBRARY APR, 19, 1917 ^Swrseon-General's &f fici T R AKS'A'CTlOIf »/"Censors. SYLVESTER WILLARD, Sennett, DANIEL D. WAIT, Victory, ) Resolved, That a Publishing Committee, consisting ot Drs. I. H. Smith, E. Humphreys and J. G- Morgan, be appointed, whose duty it shall he to publish the important transactions of this Society, and eucn. other matter as, to them, shall seem proper; which may 1be tound in the archives of the Society. (A copy.) N. PALMER, Secretary. In pursuance of the last Resolution of the Society, the Committee addressed a communication to the Secretary of the County Society, so- licitinrr answers to interrogatories, having, for their aim in the answers given,Dall the prominent points in the history of the Society, from the time of its organization to the annual meeting in August, l»;w. The following has been received from the Secretary, in answer to our interrogatories, and is herewith published for the benefit of the member* •f the Society. 4 Transactions, Srt. Dear Sir,—In accordance with your request, I have critically exam- ined the " Book of Records'' of our Society, and find the following a9 the result of my investigations in relation to your inquiries :— The Society was organized August 7th, 1806. The first President was Frederick Deluuo, vb.n served until the 6th Nov. 1806, when he with- drew from the Society. t James McClung served in the same capacity from Nov. 6th, lSOb, to Nov. 5th, 1807. J ,oto Barnabas Smith, . from 1807 to Nov. 4th, 1813. Consider King, from 1813 to Nov. oth, 1818. Frederick Delano, from 1818 to Nov. 2d, 1820. Joseph Cole, from 1820 to Nov. 1st, 1821. Frederick Delano, from 1821 to Nov. 4th, 1S24. C-msider King, from 1824 to Aug. 2d, 1S27. Nal:ia-,.i*i A^imvall, from 1S27 to Aug. 7th, 18-8. Phinehas Hurd from 1828 to Aug. 6th, 1829. Campbell Waldo, from 1829 to Aug. 4th, 1831. Ira H. Smith, from 1831 to Aug. 2d, 1S32. Ira Doty, from 1832 to There appears on record no requisition for the President to deliver an address, either inaugural or valedictory ; nor for any member of the So- ciety, previously to May 4th, 1820. But according to the first By-Laws of the Society, it was made obligatory on the part of the candidate stu- dent for membership, thai he previously deliver a dissertation on some medical subject. You will accordingly find that the most of the disser- tations delivered prior to that date (1820,) are from candidates. Oa the 4th of May, 1820, the By-Laws were so amended that the Pres- ident was required to address the Society at the close of his term of of- fice; and there were also to be appointed, at each stated meeting, two members for the purpose of preparing disseitations for the following meetings. The following are the Presidents and members who have complied with the said By-Laws, viz : 1807, Feb. 5, Dr. L. Q. C. Fuller, on Typhus Febre. " May 7, Dr. Consider King, on Irritation Fever. 1813, May 6, Dr. Austin Delano, on Muriatic Acid. " Aug. 5, Dr. Jason Atwater, on 1814, May 5, Dr. Abel Geer, on " Aug. 4, Dr. Andrew Groom, on 1818, Nov. 5, Dr. David G. Perrv, on Calorie. 1819, Aug. 5, Dr. ED. Tuttle, on Calomel in certain diseases " Nov. 4, President's Address, F. Delano 1820, Nov. 2, Do. do. do. 1822, Nov. 7, Dr. Stephen Mosher, on Fever. 1823, Nov. 6, Dr. Jared Foot, on Blistering. 1825, Aug. 4, Dr. Campbell Waldo, on Dropsy. " Nov. 3, President's Address, C. King. 1826, May 4, Dr. Erastus Humphreys, on " Nov. 2, President's Address^ C. King. 1827, Aug. 2, Do. do do. Smith's Address. 5 «< " Dr. J. G. Morgan, on 1829, Aug. 7, Dr. Noyes Palmer, on Subacute, fy Chronic Bronckites. 1829, May 7, Dr. Charles Van Epps, on 1830, May 6, Dr. Hilam Bennett, on Iodine. " Nov. 5, Dr. Samuel Gilmor, on 1831, Aug. 4, President's AtIdress, Dr. Campbell Waldo, on The Treatment of Inflammation ef large joints by cold applications. 1832, Feb. 2, Dr. Erastus Humphreys, on Indian Cholera. " Aug. 2, President's Address, I. H. Smith, on The pains, pleas- ures, 8fc. of the Medical Practitioner. All the papers which are in my possession of any value to you, I here- with send also. Enclosed are such minutes of the late annual meeting a.8 will be of service to you. Very respectfully, yours, N. PALMER. Cayuga, 17th Aug. 1832. Art. I. President's Address, (for 1832,) on the Pains, the Pleasures and the Responsibilities of the Medical Profession, and also its Value and Importance to the Human Family. By I. H. Smith, of Auburn. Gentlemen op the Medical, Society, I need not say that I am diffident of an ability to interest, nor, that my aim and exertion are both in requisition to serve you. Any man must be a stoic, or much inflated with self-complacency, when t called to act on an occasion like the one on which we are now assembled, not to feel most sensibly.—And hers I would suggest the propriety of a succes- sive, annual change of the individual who should be honoured with the distinction, and on whom should devolve the duty of addressing this So- ciety, at its returning anniversary. In this way, talent would be elicited, —the varied display of subjects obtained, and that lively interest excited, which tends to the ultimate growth and elevation of all literary associa- tions. And, moreover, would it not tend, also, to do away the cause of many party jealousies—stimulate to one common absorbing interest, and prompt alike to industry, and that emulation alone, which seeks distinc- tion, at the shrine of merit? Individuals of equal claim, and yet possess- ing that variety of thought, attainment and views which necessarily exist in every community, would, not only have opportunity, but in turn, feel under equally increasing obligation to contribute in aid of the same object. Under these considerations, therefore, you will please to extend your wonted charity, and permit me to offer a few thoughts, (believing as I do that they are not irrelevant to our present purpose,) on the pains, the pleas- ures and the responsibilities of the medical profession : and also, its val- ue or importance to the human family. Nothing more true, or more within the repeated experience of every prac- titioner of medicine, than, that mortifications,repulses and disquietudes of a most bitter character, are among the evils against which he has to con- tend. Who, among the best of the fraternity, and located in as good, as intelligent, and as opulent a community as our country affords. l"»* 0 Smith's Address. has been compelled to brook the insults of some wonder-working, obtru- sive prescribess 1 Who but, after days and nights of laborious attention, watching in almost breathless anxiety for the kind moment that should announce a ray of distant hope ; and even when that moment had arrived : Who the physician, but has been driven to the necessity of yielding his patient into the hands of an empyric, under the distrust and anathemas of deluded friends, tamely to witness the increasing influence of the magic spell-worker, to his own disgrace, and (in humbled pride,) the disgrace of the medical profession ? And this too, accompanied with the mo>t un- hallowed reflections, apprehensions, and reproach ; declaring that the course pursued had been wrong—that every effort had been worse than wrong—had been poison, superadded to the herculean disease, which had so long held the vict'm in his tiger grapple. Who, but after having expenced time, money and the most unceasing mental exertion of which he was capable": Who, but has had the mortification to be charged with unfaithfulness—wanton neglect—rashness—ignorance, or, all together ? And, what is still more painful, who is there, even among the most re- spectable for talent, for prudence, for promptness and a correct administra- tion of medicine; having struggled with fatigue and great responsibility : and when, to his understanding, aided by the lights of science and much experience in the healing art, could perceive that the disease was losing its power, and in prospect soon to be overcome: again returns the inqui- ry ; who is the physician, that has not, at this trying moment, been shock- ed—confounded !—and in shameless abuse, disgraced, by the introduc- tion into the room of the patient, some paragon of idiocy : a mere blight and stench of death, viz : the steam doclor—the Indian doctor—the know- ing doctor—into whose hands the patient is to be committed, frightfully to meet his consequent destiny. Nor is he disappointed. The event ve- rifies the predictions of science, prudence, experience and sound philos- ophy:—they all unite and exclaim—death! inevitable death, as the ne- cessary consequence of distrust and ill-advised temerity. These are among the sources, or certain attendants of a medical prac- titioner's life, that cause him pain; cause him many times, almost to doubt the existence of gratitude, or even that pittance of moral sensibili- ty, which distinguishes man from the lower grade of animal creation.— The physician has not only to encounter the fatigues, the anxieties and responsibilities which are not the ordinary incidents of most other avoca- tions, but he is imperiously doomed to witness the unrelenting march of the meagre king ; bidding defiance alike to kindred sympathy, the pride of nature and the healing art. These are but too often the necessary ac- companiments of the career of the medical man. 1 he bitter cup is thys frequently presented, while all that science, knowledge and the experience of ages can plead in bar ; the tender is maintained : none are permitted to escape the offer : none so fortunate, as never to taste. The votary of medicine has also to forego much of pleasurable relaxation from the pur- suits of business—much of the luxury of domestic retirement, allotted to the man of wealth ; while other callings and othei business admit of mul- tiplied pastime?, with days of rest and social interchange. But the phy- sician has neither days nor nights in quiet fee. He is constantly held in requisition to march to the abode of anguish; there to breast himself to Smith's ^Address. 1 the groans of the sick and the dying ; thereto witness the frailty and end of the creation of God. These, my friends are painful realities ; painful to all states and conditions of men ; the sage philosopher and the 4* whis- tling boy," substituting imaginary for real woes that surely await him. But, my friends, are there not many pleasures; much happiness in store for the medical man? May he not, in common with the better part of society, acknowledge his full share of the pleasures of reflection and conscious bliss? So long as sympathy, the cause of humanity, or " the power to feel an- other's wo'' shall continue to have a place in the breast of man, so long will the physician meet their successive moral admonitions, and thereby become convert to the holy principles of benevolence. I think it true, that no avocation, no condition of life, will sooner touch the heart, expand the soul, or dissipate the charms of the miser's god. And what the effect ? When a passion for gold, shall give place to the touch of misery? When love of fame shall be associated with rags? Nay, more, when virtue shall appear in her appropriate habiliment, what will be the effect on the heart and the understanding? It will be kindness—charity—with an ardent de- sire to contribute in aid of reviving hope, and peace, and joy. At the very outset, the physician is called to mingle in society of every grade of intelligence—the learned circle—the refined and interesting—in mansions where fullness and comfort dwell. Nor is he permitted to pass by the den of filth and disgust, filled with beings, hardly bearing that seem- ly image bestowed on man at his creation. He is also called to visit the hut, where peace, and penury, and virtue reside—where honest industry supplies but a bare subsistence, and the only luxury allotted the abode, the luxury of reciprocal interchange of innocence, the hand of succour, and the overflowings of a grateful heart. These constitute the physician's school—here he may—must learn les- sons that will ever tell on the page of moral history, truths of golden Worth—truths enduring as moral right and the dignity of man. These are pleasures substantial. In them may be found rich funds for intellec- tual enjoyment: they are ever at command, and always indispensable to self-approving moments, and thereby to constitute the life of man. a glow- ing hope—a joyous day :—a rich boon to the heart already expanded with grateful emotion toward the Author of all good. U any be favored with the opportunity to study man in the abstract— of knowing him in the more complicate, and various social relations; is it not the physician? If any man has interest to prompt, or motive to urge to a just estimate of moral principle, and moral influence; is it not the physician ? It is the physician,—because his interest, his duty and his pleasure are but the necessary result of his daily caliing. Then, as the exercise of benevolence is happiness to him who is the author or recipi- ent, so is the physician that happy individual. In addition to the above, must follow in the train of the medical man. the high-wrought satisfaction of having averted the ravages of dire pestilence—of arresting many, and perhaps, many thousands of his fellow beings from the grasp of th« king of terrors. Does not this swell the heart in joyous gratitude ? Is not the Divinity in man richly portrayed in the fact that pain, and sickness, and 8 Smith's Address. death have been stayed, relieved and averted from the couch of suffering humanity ? This the physician's boon—this his meed of pleasure. We come now to reflect a few moments on the responsibilities of the medical profession. And here let me remark, that by responsibility, I do not mean a legal, life insurance, nor a pecuniary remittance in case of damages sustained by an aggrieved party ; but I do mean, that the physician is amenable to the rules of civil society—to the dictates of his own better judgment, and thj character, standing and welfare of the profession at large. Well-regulated public opinion is law,—or .rather, it is most usually in harmonious accordance with correct principle, and consequently in all the various pursuits and business of life, a legitimate rule of action. To op- pose it, is to hazard reputation, and a prospect for usefulness—to live in the midst of dark distrust, subject always to an arraignment of motive, a misconstruction of any act that might seem praiseworthy, or bear the impress of true benevolence. Hence, we aigue that he is not only amenable to, but highly responsi- ble/or public opinion. It is much within his power, as it is his duty, to give it direction and cast; and to determine its effect upon the surroun- ding country, where he may chance to reside. The great and the good physician, is a man of sense—a man of know- ledge ; possessed of much sensibility, and a signal ornament to the king- dom of nature. As the accredited guardian of health—as the welcome friend of those in distress, he may be ever useful—useful to friends, neigh- bours and the family of man. If on the alert, attending to the duties of his profession—making appropriate researches and experiments upon the various causes of disease and death, how much the physician—how main- ly competent is he to point him, who has already felt the sting of poison, to the healing balm— to restoration and hope in the bosom of friends ? What would bethought—what would be said of the physician, possess- ing the ability of arresting the approach of disease—of saving the life of a fellow being, who should neglect or refuse his aid ? On the converse,— what would not be thought and felt and proclaimed in the ardour of devo- tion of him who should, in the disinterestedness of friendship, with care and skill, render the opportune service, and save the life of a much valued member of society ? If this is the condition—this the employment of the medical practition- er, how awfully responsible—how vitally important are the duties and the place, of the medical man ! It is then, a responsibility of great moment—requiring all the sagacity, prudence, energy and wisdom which fall to the lot of mortals. As the number, variety and importance of his duties shall be multiplied__as the sphere of his usefulness shall be extended—so will his responsibilities in- crease in number—grow in magnitude, and swell the amount of accoun- tability to himself—his fellow man, and his Creator. It remains in conclusion, to say something of the importance of the medical profession. In primeval days—days better known as free from luxury and idleness than those in which we live, and of course, less exposed to pain, and sickness and death; little was known of the nature of disease, and but Smii7 3 Address. 9 little required of the man of drugs. As diseases were few and simple in character, so their cure, whether by the efforts of nature, or the inte to many of the superstitions, divinations and other ridicubus fooleries that were practised more or less, during the e;irly days of medi- cine. But, even during this period, the physician justly maintained a prominent place in the knowledge of the day : giving tone and character to tie buddings of science, and such aits as v ere "Known at the time — Indeed, either science or accident had rightly informed, or thrown in their way, some of the most important chemical results; such as the signal art of embalming, for, in th.s way, were some of the ancient patriarchs preserved from the waste of dissolving time. At any rate; ihe claim is well sustained, that at every stage, and all ages of the world, physicians have been pioneers in the science of nature, and liberal in contribution to such sums of knowledge as marked the different periods. Nor have their research and subjefts of investigation, either in theory, or a practical point of view ; been at all limited :—They have at the same time, shone in war, and the healing art; and even Hercules himself, thought it necessry to finish the hero, that he too, should.be instructed in the art of medicine. Butgentlemen — It remained for Hippocrates, who lived (according to accounts heretofore transmitted,) four h'indred years before the Christian era : it remained tor him I say, to redeem the science, or rather, to raise it from the fogs of chimerical superstition, which had been engendered and propagated by the Egyptian priests: combining in the same code, medi- cine, religion and civil policy : and they to have an exclusive supervision, and control of the whole. But, now, meek philosophy asserts her claim: the science of nature gradually unfolds to man his right—his dignity—and breaks the mysiic chain which has so long, and so much, enslaved the human mind. Reason now ascends her empire, and proclaims her intended march :— She boldly throws the mask, and hails the approaching day ; a day com- memorative of good to the human race. From this time, the science of medicine has been studied with avidity; its march has been triumphant—its elevation commanding ; and its re- sults at different periods, the light of nature m de brilliant and useful, to the. health and moral condition of the world of mankind. History proceeds, and awards to Erasistratus, the high praise of detect- ing the indications of the pulse—to Harvey ; the never fading laun.l, of discovering the circulation of the blood : and to the immortal Boerhaave, that of arranging systematically, and founding a theory for practice, in accordance with the most improved science of the day. Following in the train of this splenid galaxy, were Hoffman—Fother- gill, i^t lahl. Sydenham, Davy, Cullen, Brown. Darwin, and many others ; who with some deviations and improvements, did much tu enrich the world, »nd render permanent, the worth and dignity, ot the science of medicine. In later times—times more fami'iar to us all; may be found enrolled on this list of worthies, (and whose fame will be perpetuated till the death of tin.e,) such names as Hush—Bell—Good—Physic—Abercrombie— B 10 Humphreys' Dissertation. Gregory—Mitchell—Dewees—Mc Naughton—Beck,—and numerous others: whose works of professional science, the arts and the whole cir- cle of useful literature ; will ever stand as monumental evidences, of the intrinsic value and importance, of the medical profession. Then Gentlemen —If at all ages of the world, the science of medicine has been thus estimated, and its votaries thus useful to their fellow men, let me repeat—that to the honour of our profession it may justly be recorded; thatth- arts, science and literature,—natural and moral philosophy, the cabinet and the field, the cause of humanity ; have all received the foster- ng care : and an able defence at the physician's hand. Art. II. Dissertation on Indian Cholera, delinered at the Quarterly Meeting of the Society, Feb. 1832. By Dr. E. Humphreys, of Auburn. Mr. President :—In obedience to the call of the Society, and in ac- cordance with my own inclination, I propose to address the Society upon a subject; though it may not be altogether new, its importance is, never- theless, greatly enhanced, in view of it- wide spreading mortality, its rapid extension, and the increasing probability, that the epidemic of which I speak, may yet appear on our own shores.—Perhaps it rnay be thought arro.he last fourteen years, will form a loss of eighteen millions of persons. What must then have been the extent of its murderous effects, when we comprise its destructive course, over so many other regions of insular and continental A&u: ? The kingdom of Siam lost, in 1S20, in the single city of Bunkuk, the capital, 40,000 persons :—and there perished in the island of Java, 102,000 inhabitants, of whom 17.000 belonged to the city of Batavia. At Pekin, the capital of China, the people having exhausted the whole means of sepulchre, the burial of the multitude of dead, was provided for from the imperial treasury. In the Isle of France, the loss u: 1810 was, according to official docu- ments, 7,000, but 20,000, according to information of private individuals. At Lahore, in 1827, of the inhabitants of the valley, 30 000 were carried off by the epidemic. In Western Asia and Arabia, the reports are but imperfect:—yet the accounts of its ravages are fiightful and appalling. It appeared in Muscat in July, 1821, and according to accounts, 10,000 fell in that city. At Bassora on, and near the mouth of the Euphrates ; there perished in eleven days more than 15,000 persons of an entire population of 60,000 ; and the number of the dead had been carried by some accounts to 18.000. In Bagdad, according to accounts from Dr. Merenies, one third of the entire "population fell by the disease within a month, while it raged there. In the provinces of the Russian Empire, the number attacked accor- ding to the latest accounts, is 54,557:—and the number of deaths 31,236. In Caucassus out of 16,000 persons attacked, 10,000 are said to have perished. At Tifflis, three fourths of those attacked fell, and two thirds at Astrachan, and in the province of Caucassus. I might go faither in detailing the histoy of the ravages of this frightful epidemic, but it would necessarily extend to an unreasonable length, an article originally intended to be brief. The mortality of this epidemic has not always been equally great; its prevalence has been less extensive and its mortality lets general in those places that are situated at the greatest altitude. Its aliment is found in the great maritime cities ; upon navigable riv- ers, canals, and the greatest thorough-fares of nations. 14 Humphrcys' Dissertation. Symptoms.—This formidable disease, according to Asiatic writers, does not appear to be attended by any premonitory symptoms that can be regarded as peculiar to it. But, as it has appeared n< Europe, it lias been attended by premonitory symptoms ; a knowledge of winch appears to be all-important to a successful treatment of Cholera:—the most usual of which are, a sensation of uneasiness, either with, or without pain in the pit of the stomach, the want or loss of appetite ; a great heaviness in the lower part of the abdomen, with a disposition to diarrhoea, or a char- rhcea pa-tlv developed, and which may precede the attack for some time; afterwards'some nausea, and sometimes slight vomiting; weakness in the limbs, head-ach, alternate shivering, and slight heat. These symptoms are not always united ; sometimes one, and some'imes others predominate. During its prevalence all are more or less affected: they last several days, disappear, and return ; and often have no other cfjee t. They must be regarded as an imperfect development of the disease, and what constitutes its first stage. The second stage is ushered in by the following symptoms: usually in the night, or towards morning, the patient is sick at stomach, which is succeeded by vomiting its contents ; at the same time the bowels are at once completely evacuated ; the entire intestinal tube seems to be at once emptied of its fecal or solid contents, and an indescribable, but most subdu- ing sense of exhaustion, sinking and emptiness is produced. Fainting su- pervenes, the skin becomes cold, with giddiness, and ringing in the ears. The powers of loco-motion are generally soon arrested ; spasmodic con- tractions, or twitchings of the muscles of the fingers and toes are felt, and these affections are gradually extended along the limbs, to the trunk of the body. The pulse is from the beginning small, weak, and accelerated; and after a certain interval, but especially on the accession of spasm, or vio- lent vomiting, it suddenly sinks, so as to be lost in all the external parts. The skin, which from the commencement of the disease, is below the natural temperature, becomes colder, and colder ; it is rarely dry, gene- rally covered with a profuse cold sweat, or with a clammy moisture. It often assumes a livid hue ; and the whole surface appears collapsed the lips become blue, the nails present a similar tint; and the skin of the]1 feet and hands become much corrugated, and exhibit a sodden appear ance. In this state the skin is insensible, even to chemical agents; yet thai1 patients generally complain of oppressive heat on the surface, and wish1 to throw off the bed-clothes. I The eyes are sunk in the orbits, which are surrounded with a livid1 circle ; the cornea becomes flaccid, the conjunctiva is frequently suffused with blood ; the features of the face collapse, and the whole countenance ] assumes a cadaverous aspect, strikingly characteristic of the disease.—: There is almost always urgent thirst, and a desire for cold drinks although the mouth be not usually parched. The tongue is moist, whitish ar. cold. A distressing sense of pain, and of burning heat at the epif'astrv Humphreys' Dissertation. 15 um are common. Little or no urine, bile, or saliva are secreted. The tvoice becomes feeble, hollow, and unnatural. ) Respiration is oppressed, generally slow, and the breath is generally ^deficient in heat. u During the progress of the symptoms, the alimentary canal is various- ly affected. After the first discharges by vomiting and purging, however ithese symptoms may be, the matter evacuated, is always watery, and :in a great proportion of cases, it is colourless, inodorous, and often homo- igeneous. x In some cases it is turbid, resembling muddy water, or yellowish, or s of a greenish hue. The discharges from th« stomach, and those from the bowels do not appear to differ, except ihat the former are mixed with wthe injerta. Neither the vomiting nor purging are symptoms of long continuance. They are either obviated by art, or the body becomes unuble to perform these violent actions, and they, together with the spasms, generally dis- appear a considerable time before dealh. If blood be drawn, it is always dark, almost black, very thick, ropy, and generally of a slow, or difficult ] effusion. » Towards the close of the attack, jactitation comes on, with evident inter- Er: nal anxiety and distress:—and death takes place, often in ten or twelvo,gen- i erally within eighteen or twenty-lour hours, from the commencement of the ^attack. iijr During all this struggle and commotion in the body, the mind remains ?;clear, and its functions undisturbed, almost to the last moment of exis- c fence. The patient, although sunk and overwhelmed, listless and averse -to speak, and impatient of all disturbance, still retains the power of think- ing, and of expressing his thoughts; as long as his organs are obedient to his will. i-t Such is the most ordinary course of Cholera, when its tendency to 0'r death is not checked by art. And such are the predominating symptoms, ras described by Scott, Ennesly, Johnson, and others. Although the dis- ease presents a great degree of variation, in the local epidemic visitations, 01Tand at different periods;—as when it appeared epidemically in a town or a district, in the lines of a corps, or in the camp of a marching regiment. e'In one visitation, it may be distinguished by the paucity of purging, or , Ahe prevalence of vomiting, or vice versa:—at another time, spasms will be prodominant, and at another little of it will be observable. But ra frequent variety, and the worst of all is, the apparently slight commo- tion in the system, as evinced by vomiting, purging, pain or spasms; e,while on the other hand, a mortal coldness, with arrest of the circulation, I ^comes 0n from the beginning, and the patient dies, without a struggle. This, says Dr. Scott, frequently manifested itself, as the prevailing type, ■ and was almost invariably fatal. lL In the second visitation, says Dr, Orion, vomiting, purging, pain and [ Spasms, were very frequently, in a great measure, if not entirely absent. °a ill the powers "of the system failing at once ; and death commonly ea- lS!!'v line, in thiee or four hours from the attack. He adds that several in- ^ ances were heard of at Hobly, and other places, of natives being struck '! .ith the disease, while walking in the open air; and having fallen down, 16 Humphrey*1 Dissertation. retched a little, complained of vertigo, deafness and blindness, and expned in a few minutes. Dr. Gordon gives many instances of this kind. The re-appearance of iecal matter, especially if tinged with bile, sel- dom, perhaps never takes place, until the disease has been subdued. Of all the symptoms of Cholera, none were so invariably present, as collapse: and none, according to Scott, so truly essential and diag- nostic, as the immediate sinking of the circulation. A burning sensa- tion in the region of the stomach, with thirst, was almost always present, and formed a prominent characteristic of the disease. Indeed, where thirst was present in its highest degree, it appeared to mbdue all other feelings ; and the ignorant soldier, as well as the mecical officer, who firmly believes, that cold water is almost certain death, alike eagerly seek, and swallow it. Dr. Ennersley says of the pathoguornoric symptoms, " a burning sen- sation between the scrobiculus cordis and umbilicus, was the most con- stant ; nay he asserts, that he never saw an instance without it. This sensation was precisely over the spot, where the vermillion blush was in- variably found, on examination after death. This blush was situated in the small intestines, and exactly resembles the colour they assume, when injected to show their villi. The same writer remarks, that strong diag- nostic symptom, was the black thick, and ropy condition of the blood, taken from a vein, or even from an artery. In regard to bile, both the Bombay and Bengal Board of Medical Officers, agree in the non-appearance of bile in the stools,or in the bowels after death. They say, neither in FiUropeans, nor in natives, was any tinge of that secretion discovered in the intestinal canal. Pathology. It will not be denied by the intelligent practitioner, that all our efforts at successful practice, in a disease of so formidable a char- acter as Cholera, must fall infinitely short of what it ought to be, unless it is based upon correct pathological views of the disease. If the post mortem appearances, which are disclosed on dissection, are fully recon- cilable in the mind of the practitioner ; with the more obvious manifesta- tions of disease, as illustrated by the symptoms:—in other words, if the ratio symptornatum, are fully comprehended ; our anticipations of suc- cess in practice, may in a great measure be realized. I think it will fully appear, from illustrations afforded by dissection,— that morbid anatomy does not differ in Cholera, in its general and essen- tial character, from that afforded by dissection in other diseases of a highly congestive grade :—1 herefore, the treatment should be conducted upon the general principles of the science; varying as the symptoms shall vary, from accidental, or occasional causes. In this view of the subject, let rne call the attention of the Society, to what follows on the subject of post mortem appearances, as to my mind, it most fully illustrates the formidable nature, and in a great decree the essential character of the disease. fe ' 1 he stomach contains more or less of a watery, muddy, and some- times, a grumous fluid; the colour varying.—sometimes colourless greenish, or passing to a yellow tint, occasionally brown, or approaching The peritoneal coat seldom presenting any other appearance than Humphreys' Dissertation. 17 The peritoneal coat, seldom presented any other appearance, than a congested state of its vessels. The mucous surface, was covered with a dark-coloured slimy mucus ; which when removed, disclosed congestion of the venous capilleries. The congestion seemed to be seated in the sub-mucous cellular membrane, and was occasionally so extensive, as to give the appearance of ecchymosis of the coat. '1 he internal tunic, was occasionally corrugated, thickened, and doughy to the touch. Sometimes the :-1omach was flabby, and relaxed : in other cases, where some degree of reaction had taken place, the internal surface of the organ, particularly about the pylorus, presented a vermillion col- our, approaching to red, and was apparently thickened, and contracted. The omentum wad corrugated in some instances, & thrown to one side of the abdomen. The small intestines were occasionally contracted in parts, fre- quently distended with flatus,and th >ir veins generally engorged with thick, black blood. Externally, they presented a thickened.doughy appearance ; and their colour varying, from a pale vermillion, thro' all the deeper shades to a dirk, purple hue; the former being chiefly remarkable on the peritoneal surface of the duodenum, and jejunum; the latter on the ilium, about where it terminates with the cecum. In the iarge intestines, congestion of the veins and venous capilleries was generally evident ; the external coat was generally dark coloured, owing to the blackness of the blood in the congested vessels. The liver was darker than natural, and loac'od with dark, thick blood. The gall bladder was always distended, with thick viscid bile, which was generally of a dark green, or black colour, in subjects who had died be- fore the appearance of bile in the excretions; but where some degree of reaction had taken place, the gall bladder was generally found empty, or contained a small quantity of healthy bile. The spleen was generally found enlarged, and engorged with black blood; and its texture frequently soft, and of uniformly darker colour than nat- ural. The blood, says Dr. Er.ncsly, particularly excited my attention, in the first case of dissection that came under my care. In every dissection that he performed, he uniformly found the vena ca- va, the mesenteric veins, the veins in the vicinity of th; heart, the vena portce, the iliac and subclavian veins, and the sinuses of the brain, loaded with a thek viscid black blood. He also mentions, that he has observed this particular state of the blood in almost every case, where be had occa- sion to perform venesection ; whether in cholera, dysentery, fever, hepa- titis, or rheumatism, during the last four or five years. Dr. Davy says that in some cases, the flaccidity of the muscular parts after death, lesembled that produced by electricity, or of animals when hunted to death. . The colour of the venous and arterial blood, was the same, both being of ihc dark hue. The blood drawn, in cholera, never presented the buff Yh.8 same writer remarks, an analysis of the air expired, from the lum's of the sic c, did not contain more than one third of the caiboi.ic acid contained m the breath ot healthy people. It is also stated, that the breath is generally deficient in heat. c 18 Humphreys' Dissertation. The foregoing sketch of the pathological condition of the system, of those who have fallen victims to cholera, is drawn from the waitings of those, who have been familiar with the disease, in all its vano .s foims ; both in Asia and Europe. We cannot therefore, be surprised, at the extraordinary mortality of a disease, that exmb.ts such extraordinary change*, in the condition ot tiie circuiting fluid: both as it respects its change of character, and its unequal distnbu ion. Drs. Barry and Ruse!, in their report to the Ceniral Hoard of Health in England, observe, that ot the two great classes of functions, pet formed by the organs, of which man is composed ; oneouK is attached it- tlu> disease. The oper.i.ions of the sen^c^, and of the intelligence, are either left un- touched, or are alkcted, Lut i;j a secondary manner. Those functions, on the contrary, by which existence, ns a living being, is preserved; tnose complicated powers, by means of which, we are for ever appiupria'irig. aid v.on verting into a part of ourselves, poifions of matter; ; ound us—are all, and at once, deranged, by the attack of this ter- rible malady. Nutrition is annihilated ; respiration becomes difficult, irregular and in"fficient; the involuntary muscles no longer perform their task ; the vo'- untary are drawn into contractions, by . ther powers than the will, the blood ceases to circulate, its physical properties are altered; its serous portion is suddenly thrown out, upon the intestinal mucous surfa.ee of the body, the secretions are all arrested, and animal heat is no longer pro- duced. Under such rapidly destructive, and almost universal derangement of function, the most energetic efforts are to be directed to reproduce, what the disease has rendered nature unable to keep up. viz. fluidity, heat, and motion to the blood ; and the regulation of the actions of the voluntary and involuntary mutcles. An important inquiry naturally suggests itself in this place, viz is the almost universal derangement of function which manifests itself in the epidemic, the consequence of a direct application of a poisonous princi- ple to the sentient extremities of the nerves ;—and thus by its direct ef- fects prostrating at once the powers of the nervous system i or, are its etfects, a though his. manifested upon the nervous system, in such degree Slhl",, ,f^^^ the functions of th« stomach, lungs, heart and bra.n ; an'dde,,^/ieV;Per,,tT8- ^n,d lhu8 P^unng co.,ge«Uon in the large AnVn'l H Y-'SSe> :VUh W*«'«» and, apparent rfebil.ty ? ^ asto"a*correct T" ^ ^u ^ °^T* !o »* "Hope.her nnjortunt; Mupon a correct elision will greatly depend the success of our prac- In regard to the condition of the circulating fluid above described • that it was not cons quent on de,th, although it migl.t he heightened .1 en bv is ev.^nt. from the appearances which this fluid exh.h.ted when aken away row, a patient, even at an early period of the disease Neither does ,t appear certain, that this state of the blood wis the hrst material derangement, consequent on the invasion 5tl,I „ i but, that it was one oC the earliest links, in thechain if <■?■ 7 ? quent to the remote cause of the disease; and that it aflerw^rdV te^Tj," Humphreys' Dissertation. 19 by an evident process to heighten, and perpetuus, the derangement, whence itself sprang. That the nervous system, particularly the gangloinic ; with the great sympathetic nerve, received the first impression of the morbid cause, ap- pears most conclusive; and that the peculiar condition of the circulating fluids,followed as a consequence, and in conjunction with the specific cause of the disease; overwhelming the lungs, the brain, the heart, and large blood vess-els. liciice the sudden irre^t of the circulation, the overwhelming depres- sion of the nervous system, dimness of siDht, ringing in the ears., faultering of speech, and the wh^le assemblage of symptoms, premoni- tory of death. Although the symptoms of cholera in fhe abstract, were varied in the extieme; and as appears by the testimony of different writers, were en- tirely wanting in some entire visitations :'yet the prominent charae'eris- tic features of the epidemic, were alwajs present, in an eminent degree. Is this pestilence a cholera? I answer, no. Because its essential, or pathognomonic symptoms are not the charac- istics of cholera. Collapse is a symptom almost invariably present in a greater or less degree in this epidemic, 'i his has never been represented as a symptom of common cholera. "•A burninj sensation between the scrobieulu* cordis and umbilicus, was the most constant, nay. he asserts, that he nwver saw an instance with- out it." Su< h N th'-; testimony of Dr. Ennesly. Who has described this particular symptom us constituting a feature of cholera ? Dr. S<~"tt says that no symptom was so truly diagnostic and essential as the immediate sinking of the circulation. Who ever dreampt of this symptom, as a diagnostic in cholera? Our patients will sink in common cholera if the disease be not check- ed, and the symp'oms obviated by art:—but the sinking proceeds from a cause thai is most manifest and obvious. A sense of emptiness, sinking and exhaustion, is represented as being constantly present, and constituting one of its prominent features. This symptom 1 have cbserved in som<; of the worst cases of common cholera, and in different degrees ; but it is by no means one of its diag- nostics. A dark, thick and ropy condition of the blood has been found to be invariably present in the epidemic. The same condition of the blood, though varied in degree, may bo found in diff.-rent stages of other diseases :—although it has not been no- ticed by medical writers as diagnostic in any one. Extensive venous congestions were found to pervade both the thoracic and ahdominil viscera, in all cases on dissiction. Venous congestions are found occasionally in other diseases ; but in no one does it uniformly take place, except in congestive typhus—to which the epidemic bears stro ig m irks of relationship. The above symptoms are enumerated as being tiuly essential and pathognomonic of the great eastern epidemic. W hat symptoms has the epidemic in common with cholera, that are al- ways present in both ? I answer, none. 20 Humphreys' Dissertation. Puking and purging arc the characteristics of cholera ; and symptoms that very frequently manifested 'hemselves in the epidemic ;—but they are by no means constant. They are not only absent in individual cases but in en'ire visitations, as hus been before staled. '1 he worst cases, and those the most quickly fatal according to the best authoritif s, were unat- tended by vomiting, purging, pain orgasms. An absence of bile in the ejections from the stcmach. or in the dejections by the bowels is invaria- ble in the epidemic. The bile appears to be accumulated in the gall blad- der, from whence it seldom finds its exit, until the disease is checked. It is represented in all cases, as being thick, dark, and altered in its proper- ties—as acrid, and even corrosive An absence of bile is more or less frequent in common cholera, but it is by no means uniformly so. To what then is tins epidemic likened unto? If we reject all adventi- tious symptoms, and confine our attention to its characteristics, or pa- thognomoncs, uemust conclude that it is no more, or less than typhus congesticaepidemica, and not cholera epidemica. Let any one attentively peruse the description of congestive typhus by the late John Armstrong, and he will be fo.cibly struck with the strongly marked features of each, resembling the other. The vomiting, purging and spasms, should be considered as adventitious symptoms, and therefore not entitled to give character to the epidemic :— they, together with the protean appearance of the dejections by the bow- els, are the effects of vitiated bile, accumulated in the gall bladder, and to extensive venous congestion in the stomach, bowels and liver ; in sub- jects acted upon by a powerful epidemic influence. Etiology.— Whatever I may advance upon this dark, yet impor- tant subject, aside from facts derived from the writings of those who hive been familiar with the disease, must bi^ regarded in a «reat measure as speculation. Notwithstanding it may be so, if they are drawn from facts and circumstances ; and based upon correct pathologi- cal principles, they are not without their use. First, then, it is evident, that all tiie ordinary causes of disease, must be excluded ; although where epidemic cholera prevails, the ordinary causes of disease, may operate as occasional, or exciting causes, and vary its character; as we have found in detailirg the symptoms of the disease, its character has in many particulars varied in'the different lo- calities. Sir Gilbert Blane, and many other distinguished medical men in Eu- rope, are of opinion, that the disease depends upon a specific conta«i i hey attempt to prove it by tracing ihe course ot the disease from li gal to Bombay, following the track of the grand army, in the'eo ion. en- lence- ia ment of the P.ndaree war. Also in the detail of its progress from India through Persia, to Syria, and Astrachan, by the line of the taravan- which they contend conveyed it to those countries in 1821 and '5 'II !' adduce much additional testimony, corroborative of that opinion 1 •• "^ from the experience of a portion of the medical faculty, who- hav 'h W" •familiar with the disease, during its progress in Russia,'and other^WT" of Europe. Although many facts and circumstances, which h-iv h collected by the contagionists, are plausible; and indeed at firsfv'66" Humphreys' Dissertation. 21 appear imposing, they nevertheless fail, in comparison with the over- whelming mass of testimony, adduced by the non-contagionists. The Calcutta Medical Board, who had better opportunities of ascer- taining this point than Sir Gilbert Blane, gave a decided negative to the supposition of the contagious creed. And the inhabitants of Bourbon, acting upon the contagious doctrine, instituted a strict quarantine; but the epidemic laughed to scorn, their little hypothetical barriers, and marched into their city without ceremony. The suddenness of its appearance, and disappearance, appear alto- gether irreconcilable with the laws of contagion, as far as they are at present understood. Dr. Aliardyce, surgeon of His Br. Majesty's 3Hh Reg't. informs us that in this Regiment the disease appeared on the 21st Sept. and commit- ted dreadful ravages before night. On the 25th it abated remarkably, and in three days more it entirely vanished. In like manner, the Bengal and Madras troops at Nagpore, were attacked at the end of May, 1818. On the 10th of lune, the rains appeared with great violence, when the epidemic abated, and immediately afterwards ceased. In Dr. Jameson's Bengal report, it is stated, that two millions of per- sons had assembled to celebrate a religious fesiival, on the hanks of the Ganges ; that the cholera broke out suddenly amongst them, while at ,their°devotions ; and in eight days, destroyed 20.000 persons. The pestilence was stayed, as soon as the multitude was dispersed; it did not extend even to a village eight miles distant. An intelligent writer remarks, that the causes of cholera seem to ope- rate like a "poisonous cloud ; men in perfect health, arrive at a certain spot, and fali down by dozens ; some never to rise again, and others to escape, barely with life, after excessive pain and torture. Cases are also related, of large bodies of men entering into such a strata of poison- ous air, as at Nagpore. And in other instances, the pestilential cloud seems to have been wafted into the midst of a stationary assembly, as at the camp of the Marquis of Hastings, on the banks of the Sindee ; in this instance it is said, the disease rapidly abated, after the removal of the en- campment from the infected district to the high grounds atEnck. It is said that armies in India, hav* fled hum the track of the pesti- lence, and been safe out of the limits of that track. The disease frequently made its attack in close and sultry weather; and vanished after severe thunder storms, and heavy rains. It fought its way in the very teeth of the most powerful monsoons, and left un- touched, various districs that bordered on its course. It appeared, and vanished, in all the changes of the moon ; and in all the states of atmos- pheric electricity—and at sea, as well as on the land. " In Moscow, by far the greater part of the medical men areof opinion that the disease is not contagious, but produced by some peculiar state of the atmosphere, not cognizable, either by the senses or by instruments; that this was proved by almost every person in the city, feeling, during the time, some inconvenience or other, which wanted only the exciting cause to bring on cholera ; that very few of those immediately about the patients were taken ill. That a strict investigation had been made into what were reckoned the 21 Il.iwfi-cys' Divertalion. first four cr^cs that occurred in ..loscow, and that it was proved that they had nciti.cr themselves been in any infected place, nor had communica- tion with any one coming from such a place. Dr. Albci-s says when the cholera first reached .Moscow, all the physi- cians of the city "were persuaded of its contagious natuie; but the e- peri- ence gained, i:i" the course of the epidemic, has produced an entirely op- posite conviction. Thev found that it was impossible, for any length of time, completely to isolate such a city as Moscow, containing 300,000 inhabitants; and having a circumference of nearly seven leagues. During the epidemic, it i- certain that 40.000 inhabitants quitted Mos- cow, of whom a large number never performed quarantine; and noiwifh-, standing this fact, no rase is on record of cholera having been transferred from Moscow to other places. And it is equally certain that in no situa- tion appointed for quarantine, any case of cholera lias occurred. In many houses it happened, that one individual attacked by cholera, was attended indiscriminately, by all the relatives, and yet did the disease not spread to the inmates. It was finally found that not only the nurses continued Cr^.s from the distemper, but also that they promiscuously at- tended ihe sick chamber, and visited their friends, without in the least, communicating the disease. There are cases fully authenticated, that nurses, to quiet timid females laboring under cholera, have shared their beds, during the nights, and that they, notwithstanding, have escaped as physicians have in hospitals. "x hese, mi.'! numerous other examples, which, during the epidemic, be- came known to every inhabitant of Moscow, have confirmed the convic- tion of the non-infectious nature of the disease ; a conviction in which their personal safety was so much interested. Sir Win. Cricbton has endeavored to establish the contagious charac- ter of cholera. And although the evidences adduced by him do favor the probability of the contagious character of the disease ; yet they amount to any thing but demonstration of the fact of its being so. The different governments in Europe, appear to act upon the belief of the contagious principle; and as prudential measures, have adopted municipal regula- tions, to prevent the introduction of the disease into the.r respective coun- tries ; not however, because the contagious character of cholera is fully established; but inasmuch as the question admits of doubt, it is deemed prudent and wise to do so. If the cholera be, a? is maintained, a disease ofastriclly contagious character; can it be doubted, that pI! who are ex- posed to the operation of its contagion should be, affected by it; and in that respect obey the laws of other contagions diseases. The breaking up of such an immense assemblage, as that upon the banks of the Ganges, while clvviera was making such frightlul ravages among them, and their sui sequent dispersion over an immense extern of coun- try, and the fact that the disease was not communicated, even to a village eight miles distant, would of \u elf appear to be almost incontestable evi- dence, of the non-contagions character of the epidemic. Add to tl ". ts sudden appearance, and almost instant havoc of multitudes as it IV- pore, and in the camp of the Marquis of Hastings ; and its equally sad- den disappearance, especially alter thunder storms and heavy rams M' d Humphrey's Dissertation. 23 the numerous instances of an equally striking character, in that reject, and it must need an extraordinary tax upon our creduuty, to believe tnat the great Indian epidemic depends for its caiu,o, and is propagateo by, a specific contagion. It appears not an improbable supposition, that epidemic cholera, and 1 go farther, and say. all other epidemics, strictly speaking, may derive their cause from a common source : viz a change in the constitution of the atmosphere, or a morbid principle floating in it, the existence of which is neither cognizable to the senses, or has not u* yet been detected by in- struments. _ . Although the essential character of that principle may vary, and ,n that, give the varied character which is so strikingly manifest m the different CP '! he Cholera of India, the Sweating Sickness of England, the 'T> mus Petechialis, Typhus Syncopalis, and Pneumonia Typhodes of A- er^a, may all have had a common origin, being different manifestations of the same cause, operating in different portions of country, upon different con- stitutional subjects, under different circumstances. Typhus Petechialis appeared in one of the most salubrious and heal-^ thy districts in i\'ew England, and attacked indiscriminately, persons oA all ages, sexes, and conditions in life. . It marched into a neighborhood like a merciless banditti— it ravaged evPry house—it would burst with appalling fury, upon a neighborhood many miles distant, and whose inhabitants had kept strict quarantine with thi infected district. . It travelled, as did the cholera in India, fror- uost to post, attacking a second district, after having ravaged the first the earliest cases in this epidemic, were attended with vibicis, and petechia, which gave it. a charac- ter and a name; hut in later cases, ihew appearances were ma great measure, if not altogether wanting ; yet the leading characteristic features of the disease were invariably present; nnd the diathesis so completely predominating, as to impart its character to the diseases of the country, for a suc< essjon of years. fyphus Petechialis, after prevailing for a series of years, was succeeded by Pneumonia Typhodes. The Inner affection in this variety of the epidemic, was the prominent, and leading symptom, in addition to the sinking of the circulation. Pneumonn. Typhodes, made its appearance in this part o. the country, a« the cold weather approached, nr.d while the weather was extremely variable, and while the lungs were m a state of predisposition from extra- ordinary atmospheric vicissitudes. It-might, a priori, have been expected th-.t if my T-^■.•>•' Dissertation. hydrogen, ond carbonic acid, gave to srarlef n assrmentum, the purple hue of venous blood. And Brewster says, the chance of colour horn purp'c to scarlet.may be produced in the crassamentum of venous blood.ou' ot ine body, bv exposure !o atmospheric air, or still more by oxygen; wine scarlet blood is rendered purple, by exposure to azote, hydrogen, or car- bonic and. If then, the appearances of the blood in cholera, us cvinc ed by dissection, and as it appears when drawn during the disease, other from a vein or an artery, be compared to scarlet blood.that ha* hf« n icnder- ed purple, out of the body, by being exposed to azote or carbonic acid ; and being found to correspond so nearly in appearance.—And 1! the mor- bid effects of those no.vous agents, pathologically considered, so nearly describe the effects produced in cholera, on the nervous system, and the blood, it does appear that our convictions must be strong, that the atmos- phere in those regions, where cholera has committed its ravages, is contam- inated with a suiplussage. of its irrespirable constituents ; however it u ay have been acquired, and however partial it may have been in its production. ; The probability then, of this epidemic reaching our own country, will not depend upon municipal regulations, quarantines, or sanitary cordons, j Trkatmk.nt.—From what has been advanced, it is evident that the treatment of this epidemic must be conducted upon general principles. In the firs*, stage, our indications are to evacuate ihe offending matters contained in the stomach and bowels; establish the healthy secretions of the liver, and its regular discharge into the bowels ; prevent congestions in the large and deep-seated vessels, and obviate the sinking tendency of the dise-.se. In the forming stage of the disease, where the habit is not plethoric, emetics of* the sulph zinci, with pulv. lpicac, have been given ; and in all cases where bile has been ejected during the operation, the best effects have resulted—reaction has been thereby established, the distuibed state of the bowels calmed, a. good degree of capillery action restored to the surface, and congestions prevented. !l however the habit be full, and ihe constitution unimpaired, bloodletting should not he neglected ; alter which, calomel should be given in full doses, and worked off with infusion of senna, ginger, and sulph magnesia; in other cases, if the patient be of delicate habit, and symptoms of approaching debility are manifest, cal- omel 15 grs. and opium 1 gr. should be given, to be repeated .n four hours —the feet to be immersed in salt and water, made hot r.s the patient can bear it. The feet should afterwards be covered with strong sinapisms. Warm aromatic drinks, with small doses of camphor mixture and aqua ammonia, should be administered, both during and after the opera- tion of emetic or cathartic medicines. This course will generally arrest the disease in its first Mn«»c__in other- ;«ases if calomel and opium are judiciously administered, ihe'calomel will often ina few hours exert its specific effects upon thesystc m. and thus aveit all subsequent danger from the disease. It has been remarked by all wri- ters who have been funiliai with the epidemic, that whenever a regular dis- charge of bile from the gall bladder into the intestines has been produced, such patients have been considered safe. After the di-ease has become fully developed, one great and important object should never be lost sight of; reaction must be produced : that is Humphreys' Dissertation. 27 a full and healthy circulation in the superficial vessels must be produced and kept up, or the patient will be lost. To effect'which, two different and apparently opposite systems of prac- tice have been pu.i: - ; enrh resulting from the different pathological views entertained by those who have practised in the epidemic ; or per- haps the same view of the morbid condition of the system has been en- tertained ; while remedial agents possessing apparently opposite effects, may have been brought into use, to fulfil a similar indication. A system of depletion lias been pursued on the one hand, with the view of relieving the circulating system from'local congestions, and the heart and arterie's from a state of oppression, and apparent debility. Bloodlettino- has been generally recommended in the commencement of the attack, and where the patient is of full habit, and the action of the he irt and areries is not greatly oppressed. Its utility in such cases is too obviou- to escape the notice of the most superficial observer. But bloodletting in thj more aggravated forms of the epide-r-ic, is a remedy so little indicated by the usual symptoms, that its'employment in the cure of this fatal disease, to use the language x>f Scott, has affiirded a signal triumph to the medical art It requires no common effort of reasoning, or reflection, to arrive at the conclusion, that when the powers of life appear depressed to the lowest decree, the pulsation of the heart all but extinct, the natural heat of the bodv"-me, and the functions of the system suspended, and incapable of beim "revived bv the st.ongest stimulants -the attraction ofhlood should yet prove a remedy against a train of symptoms sp desperate. Dr Johnson was probably the first who adopted the practice in this for- midable stage of disease ; and whether it was at first employed as an anti- spasmodic^ to obviate local inflammation,that dissections had oemonstra- ted to exist, it was natural. But the employment of bloodletting, without reference to either of these % states, and as a remedy for collapse in this epidemic, must have been the suit of reasoning and reflection, founded on the general principles of the res science d"° Ennesly says that the blood, on opening a vein is at first thick, black and comes awav in drops; at length it becomes thinner, and flows w 1, more ease, till the color changes to a bright red 'I his » a change w "should be always looked for, and whether it Ukes place afe he attraction of one ounce, or thirty, is of no consequence; that change must take place before the patient can be considered sate. When in such circumstances, a full st.eam of red blood can be p oca- ccd a favourable change will assuredly take place ; the -uri.ee w £ co ne warm the sense of sinking, and the burning sensation at the umbh> cus and icrobiculus cordis wifi gradually subside; and the system be- come susceotible of, and respond to, other remedies If bloodletting has not uniformly been follow 3d by favorable r ,,1 , l J be f^nd to hive failed most frequently when practised by tind h „ds ; where small qu mtities have been taken, such foi inMance, a. we - suppose to be yielded by the remote branches of vessel* ; but it nngln suppose 10 °« >l«l ,. 'vets reach the internal vessels, and the ♦l^ evacuation be carried till its enecis rca< n nie im- " ..„.«:„„ hel'uself} the., th, circulating system will be freed from an oppietston •yf.tation. which in peded its functions, and it becomes equal to the ta^k of prope - ling the ruaj--s of blood. .. so far If ,:.:s view of ihe subject be correct, tho presence ot rn,,i,r^' ". ' 5 from uc^rring us from going on, should be only regarded as an aud.uon al reason for renewing our efforts for getting blood. ; If this operation be performed wilh the moral conviction, nnt u ■ uc- ccssful i;; obtaining blood, the life of the patient will probably be. .aMu , the operator will persevere, and call in every suitable aid. suet, as i.ic- tions, bathing the arms in warm water; re-opening the orifices ot the ves- sels, administering stimulants and external warmth. He will not he in- duced, says Scott, to desist by any intermediate accession of e,e b.uty or collapse ; t.or is he tempted to rest satisfied with any temporary inehora- tior, of pulse; his object goes beyond the present moment, and he leels satisfied, that if he can fullv unload the internal vessels, he will save his patient; imd that if he fails, he will most probacy lose hum The principle is, that collapse in the < , idemic, is not the consequence of the loss of blood, but is a condition winch nothing but its abstraction can be trusted to for relieving it. On opening a vein, one scruple of calomel, and two grains of opium should he given in the form of a pill, and washed down with a camphor draught; and if the calomel be rejected, it should be repeated until it re- mains upon the stomach. Its effects in diffusing excitement are augmented by repeated small doses of aqua ammon, camphor mixture, and external heat to the lower extremities. Leeches applied to the umbilicus and scrobiculus cordis, will do much iii relieving internal heat, and allaying the irritability ot the stomach ; af- ter they Lave done their duty, mustard cataplasms or epistpastics should be applied to the part. If spasms are severe, spirits turpentine embroca- tions should be freely used. Oleum cajipula has been used internally aa an antispasmodic, in doses from 10 to 30 drops, according to the urgency of the symptoms. In case, wieac the bowels are constancy discharging a watery fluid, gmall anodyne enemas with camphor should be given, and calomel repeat- ed until its effects are manifested upon the system. Another class of the profession, and perhaps by far Ihe greatest propor- tion, have k garded this epidemic as a disease ot debility ; all the pheno- mena of the worst stages ot which, are produced by causes independent cf, and existing prior to, congestions in vessels of parts essential to life. Ilence the dread of the lancet, and other depletives ; and a resort to an unnumbered catalogue of stimulants and tonics, to arouse the exhausted excitability of the nervous system; and stimulate to action theheaitand t .Tories, already engorged and oppressed with blood, that has become un- fitted foi the purposes of life, and the presence of which ilt Us oieseiit ft',■■.' , will almost inevitably insure the death of the patient. j o go into a detail of the numberless ; inscriptions or follow the mul- titude of routine prescribers, would be incompatible with the duty I lipve aLsignedmyself on this occasion. Neither do I expect to pout cu' with unerring f. .unity, the road to successful practice in so formidable an ep- idemic. ' * ■ Waldo's Address. 29 But if what I have advanced shall enable us the better to recognize, and distinguish the disease, as well as illustrate its pathological character, I shall feel a degree of gratification in having performed an acceptable service. The practi-e of prescribing to the name of a foi midable disease, is ever frau'dit with imminent danger ; and always rests in a greater or less de- cree upon principles purely empyrical ; and pioves itself a barrier to suc- cessful investigation in diseases. That physician, on the contrary, whose profound knowledge of his p-ofession. will enable him to investigate at the bed side of his patient, the true character of the disease, and form correct opinions of the morbid condition of parts situated beyond Ihe reach of the eve, will hardly fail in anticipating a remedy to fulfil his indication. Such a paysician will hardly need the fonnui >ry of one who has practised three thousand miles distant from him ; and upon subjects, laboring un- der different predispositions, and situated in localities totally dissimilar. If he cnn arrive ai settled principles in regard j0 the disease, his path is plain ; and if he fails of this, ha may be compared to the mariner ai sea, without rudder, chart or compass. SUMMARY. Bloodletting to unload the congested vessels, and relieve the heart from oppression. Emetics, lir the treble purpose of cleansing the stomach, promoting a disch irge of bile, and diffusing excitement. Calomel and opium, to allay gastric irritability, aid in diffusing excite- ment, and remove offending matters Irom the bowels. Ether and tine, opium, black-drop, oleum cajiputa, asafcetida, rubifa- cien's, and the application of dry heat, as antispasmodics. Althongh calomel, when it produces a healthy discharge of bile, will prove the surest remedy against spasms. Camphor mixture, aqua ammonia, inf. cascarilla, aromatic teas, and sometimes wine may be used in emergencies, and for a temporary pur- pose. Alkaline draughts, with small doses of tine, opium, to correct acidity, and assist ui allaying gastric irritability. Calomel, senna, soluble tartar, and jalap, as cathartics. Stimulating cataplasms to the feet, and sometimes epistpastics dating pouiiiccs to the epigastrium. Address on the Use of Cold Applications in local Ifammation, delivered at the Annual Meeting, August, 1^31, By Dr. C. Waldo, of Mcntz. ■ Gentlemen- ok the Society :—By your mandate 1 now appeaftbe- fore you. Permit me to assure you, no feeling but that of a deep sense of duty, in being obedient to the requisitions of this society, could induce me to ad Iress you at this time. I well know that what I am about to say is properly a subject for the analysis of science ; but may 1 not flatter myself that if you should find in it heterogeneous pnncipies, )OX will still with a friendly and indulgent kindness m.tigate the seventy cf criticism, and the moie so as your com- 30 Waldo's Ac'- ess. mands are extended to me at a lime when I am laboring under the effects of the severest domestic affliction. . , Gentlemen—The subject of this address is the practice proper to bo adopted in wounds of large joints ; and the propriety oi applying coin UU- rim' their subsequent inflammations, which I shall endeavor to illustra e. By a wound of large joints, 1 mean an opening through t..e capsulai lament ...to the joint. This may be by pasture, cont^ton, taeeratiun or incision. These wounds are more or less important, not only accord- ing to their extent, but according to the importance ana magnitude of the iomt injured. Wounds of the knee oftener occur than ot any o her large joints, and on that account as well as from the importance of that joint, together with its extreme liability to inflammation, are of the highest im- portance to the patient, as also to the medical attendant. Wounds of die joints divide the common integuments like wounds in other parts, and are on this account, in common with them, liable to in- flammation ; and in common with all medical and surgical business in- volve the practitioner in serious and weighty responsibility. But when we consider the fact, that here are other parts injured, and parts too, subject to an inflammation of an infinitely moie obstinate and destructive character, frequently producing the destruction of joints and limbs, and even of life itself; we are irresistably driven to reflect upon the increased importance of these, over all other wounds, and the fearlul responsibility restin" upon every practitioner to whom such cases are committed. Although some difference of practice is necessary to meet the exigences of the different kinds of wounds, yet the difference is not great, therefore I propose to take one kind—the incised, and of an important joint—say the knee. Here the indication is simply that of uniting the wound by the first in- tention ; or to give nature an opportunity to heal it, by preventing the accession of inflammation. Every thing should be done to promote, and everything strictly forbidden which would have a tendency to thwart this intention. Therefore, all extraneous substances, and even blood itself should bo carefully removed. Large vessels, if cut, should be secured by ligature, but stiches are peifectly inadmissible. The patient should be ordered to bed—the limb placed straight (but if an elbow, it should be placed crooked)—the lips of the wound should be secured accurately and firmly together with strips of adhesive plaster. Superinctunb'jnt to these, should be placed along the line of the won..J armed pledgets of lint. The limb should be made easy—all motion ot the joint strictly forbidden. A long splint should be secured on the limb, simply to prevent flexion of the joint. At all events, it is the business of the surgeon to see in this case, (and it is at the expense of his reputation if he°do not!") that the limb be so secured, as to prevent flexion or motion of the joint • for if that takes place, (after a short time,) there is no cure by the f.rst inteii- tion. Lotions of vinegar and cold water with sacch. sat should be ordered The patient bled, and tne antiphlogistic regimen strictly enjoined. The patieut should be made sensible of the danger, in case the directions are not ob- served—he should be told that it is 'much easier to prevent than to cure infl immation in such cases,'' and further, that if by any imprudence c; misfortune, infl immation should commence, the most favourabh termina- tion which could be looked for, is that of a stiff joint, and that the limb and even his life would be in imminent danger. But suppose you fail to secure punctilious observance of your direc- tions, or that by any other means inflammation should commence; you are called to attend—von find your patient with great swelling, high heat, excessive pain, exquisite soreness; in short you have a case of phlegmo- nic inflammation, superadded to that of the tendons, capsular ligament, cartilage, and synovial membrane. By neglecting to use splints, the leg is flexed to an angle of forty-five degrees, and now immoveable. Add to all these, the appalling fact, that an extensive abscess has already formed and discharges unhealthy pus. You look a-ound you to find some pow- erful means by which you may suddenly subdue so formidable an enemy ; you look in vain—you are finally compelled to meet him, and as- sume the fearful" responsibility of the issue, with no other, than the common means of warfare. You make even more than a doubtful prognosis, but yet you are doomed to risk the event upon ordinary means. You now fully realize that it is easier to prevent, than to cure such an inflammation. But all that you can now do, is to put in requisition the antiphlogistic regimen, among the different remedies of which, none of a local nature, is more powerful in my humble est.mr-tion, than the application of cold, or in other words the application of substances of lower temperature than th" part inflamed ; thereby causing an absorption of heat and consequent lowering the temperature of the inflamed part. Whatever theory of in- flammation, or of the production of heat in inflammation, may be adopted, all will agree? in one fact, viz : that heat is always accumulated in great- er quantity than natural, in ph'egmonic inflammation. The degree of temperature is, I consider, in proportion, to the violence of action, and in proportion to the temperature and action, is the tendency to resolution, suppuration or mortification. The heat of a part in inflammation is allowed to rise to 106 or 7 degrees. Cooper says it is an acknowledged and well known fact, that the action of the arteries, as well as every other operation in the animal economy is promoted and increased by the influence of heat. To which I add, is it not an equally acknowledged fact, that in proportion as you abstract heat you diminish action, even to the destruction of vitality ? Hence the obvious indication arises, viz : to reduce the temperature of the inflamed part by the application of topical cold, and in particular by continually abstracting the heat from the part, by keeping up a constant evaporation from its surface. The application may be cold water, and that by immersion, affusion, or by cloths dipped in water. Cold water is in my opinion cold enough to be beneficial for the highest grade of inflamma- tion :' but still no evil would result from the application of snow or ice to highly heated parts, provided it be not continued too long. It is an invariable rule with me, of twenty years' standing, to grnduate the degree of cold of the application, to the degree of heat of the part to 3'2 WaiJj's Address. which it is applie i; taking cold water for the highest grade. I P1"'*"0 this rule until the application and the inflamed part ror. e together, a little above the healthy standard, or usually about 100 degrees, without any relerence to the termination : whether it he by resolution, suppuration, or mortification. This practice of continuing cold applications until the temperature of the part is reduced, as near to its natural state as the pro- duction of healthy pus will admit, and not •.hinging to warm fomentations whenever it is decided suppuration must take, place, is, 1 am aware, m seeming contradiction with high authority. Let us examine it—the direc- tion to change to warm, implies what we otherwise know to be usmilly the fact, that cold applications had been u,ed. the consequence of which is a reduction of temperature from the high degree usual in active inflam- mation. It is in this reduced state of temperature, which is from 102 to 101 de- grees that we are directed to change from cold to warm fomentations. And how warm are these warm fomentations to be? About blood warm. By this we understand that the surgeon judges of warmth in this case by his own health v feeli.ig or ten perature of'.IS degrees. A fomentation then of 98 degrees is the one directed as a warm one, and this to be applied to a part, the temperature of which is at 103 or I degrees. This supposed warm fomentation then is of several dcgiees lower temperature than that of the part to which it is applied, thus show- ing it to be in reality, a cold application. And further, we can readily understand that it will conlinue to he a cold application under the illusive name of a warm one, until by evapo- ration or other process, the inflameel part shall be reduced to the degrco of the fomentation, or in other words till they meet at 9S degrees. Thus we see the mistake. The warm application is misnamed. It shouid hi called what it really is, a cold one. We shall by a further view of the subject discover another mistake. The fact that cold applications had been always directed, and almost uni- versally used, so as almost uniformly to produce the temperature wherein pus would form, and in which it was proper to use this supposed warm application, and this being the case so generally presented—the rule of practice formed from this general appearance, was. by a little inadvei tance made too general—in fact it was made universal. There are no excep- tions. You must always change the cold for this, to the healthy ieehng, lukewarm (orne.itation, when the formation of pn> is inevitable. But who is there thai will not, upon a little reflection recall to mind cases, wherein such change would bj, not only weak, but dangerous prac- tice. Suppose the following, of which I h;-\e seen numbers. A patient has an inflammation of the ancle joint, extending through the celular mem- brane, tendons, ligament^, synovial membrane, periostinm, and ncrhaps into the bone itself. The swelling great—pain and soreness so exquisite that not the lea*t motion can he allowed—heat so high that blisters have risen, in different places, notwithstanding supuration has already taken '■^place. * In this case who would he willing to rc-t with a warm fomentation or one of 98 degrees, thereby making little or no impression u^on the disease Waldo's Address. 23 Who cannot see, that here the indication is, notwithstanding the suppura- tion, to reduce the temperature of the part as quickly as possible, as the only mean of saving the joint from destruction. And who will discredit his own intellect, by saying, this indication would be answered as readily, and to as great an extent by a fomentation of 98, as by one of 60 degrees. Cases are not unfrequent in which the experienced observer recognizes (he inevitable certainty of suppuration, unless the high excitement exhausts the vitality of the part, producing gangrene and mortification. Js it proper to change to warm applications in this easel It is an established theory, that it is the high inflammatory action which exhausts the sensorial power, producing death or mortification of the part. Does it not follow then, that if you reduce the high action, you lessen the danger of mortification ? It is admitted that caloric is a violent excitant. In proportion then as you abstract caloric, you lessen the action, and inconsequence, the dan- ger of mortification—and render the suppuration less profuse. rl hat ap- plication then, is the best that will absorb the most heat in a given t me. The question then of changing to warm applications, resolves itself into this—Which will abstract the greatest quantity of caloric, a (old or warm application, viz : one of 98 or one of tiO degrees 1 In this form the question cannot be answered wrong. A.i will agree that it is a cold one, or one of 60 degrees ; and therefore it should not be changed for a warm one. And yet we are told by authors, that if pus be about to form, we must use a warm application. We see the error of making a general rule, an universal one, as authors have done on this subject. Since writing the above, I have for the first time found this doctrine in print. I am happy to say that professor Assahni, an eminent surgeon of Italy, advances the same doctrine, and adopts the same practice. Authority of such eminence will surely shield me from the imputation of temerity and give the subject an influence, which it coidd not otherwise command. But I have said, that cold applications properly graduated, are proper in all cases of inflammation, until the part is i educed to about natural heat. But authors say, there are cases in which from some mysterious and unknown cause, cold applications produce pain, and cannot be u&ed, and they advise the use of warm applications, which are said to give ease. Cooper says " there are constitutions and parts which derive most benefit Irom the local employment of warm emollient remedies ; but ad- mits that the generality of cases derive most benefit from cold ones. Again he says '-if we may judge by the feelings of certain patients, there are ' undoubtedly particular constitutions, in which the local use of warm rem- edies produces greater relief, than the application of cold." But on the same page he says, "the absurdity of attempting to leconcile every use- ful practice with a philosophical theory is, in no instance, more strikingly exemplified than in ihe opposite sorts of local applications which are of eervice in inflammation—and adds, "were I to endeavor to define the particular instances, in which warm applicati , The collapsed integuments are a bad conductor of hoat which contin- ues to U accumulated, in the inflamed parts, and if this non-conductor be King's Address. 36 continued any considerable time, the heat accumulates underneath, pre- ducing pain from increased action. The manner in which these pains are removed affords good evidence of the truth of this theory, for the misnamed " warm" fomentations relieve all of them ; or in other words, cold of a less degree, allows the parts to regain their action ; the integuments are thus converted into a good con- ductor. The accumulated heat escapes, and all from an application of lower temperature than the part called by authors, a warm ; but which is in fact a cold one, thereby affording incontestible proof, that it was not merely cold, but too great a degree of it, which rendered it painful and gave rise to the strange and unphilosophic notion, that there are constitu- tions in which active inflamn.ations will not bear to be treated with cold applications. Gentlemen—I have briefly sketched the practice proper in recent inci- sed wounds. I have passed on to consider the inflammation which will sometimes ensue, and have endeavored to illustrate the propriety of fol- lowing the natural indication in such cases, viz: to reduce the tempera- ture—I have passed to consider the exceptions made by authors, to the prosecution of this indication to the final reduction of temperature to about the healthy standard. These exceptions are two: first, when pus is about to form, warm ap- plications are directed. I have endeavored to show a mistake in this ex- ception, and that it has no foundation in philosophy. The second exception arising from the strange vagary that there are constitutions, which, when heated too much, cannot bear to be cooled, I have endeavored to show, exists only in ibe imagination, and depended solely on a fallacy of terms. _ If 1 have succeeded even partial!/, the philosophy of curing inflamma- tion* by graduated cold applications, will claim your candid investigation, and if found defensible, yourapprobation. Gentlemen—If in this &eble effort, 1 have given hints which shall ex- cite the attention to r*(cs of practice, by which the sufferings of one hu- man beimr may be mitigated—if this should be the mean of preventing one stiff joint, ox the amputation of one limb, or of preventing one crooked leg, the satisfaction will be a rich compensation for such an humble effort. v , Sfc. de- Art. IV. Address on the Use of Opium in Bowel Affections lioercd Nov. 2,1826, by Dr. C. King, of Ledyard. Gentlemen— Improvement in the profession of Medicine, advances n a direct ratio with other sciences. Physicians are better educated than they formerly were, and much more instructed in their profession, before they are licensed to practice. The introduction of chemistry, as a neces- sary branch of the student's education, habituates him to a philosophical mode of thinking, and teaches him the maxim of Lavoisier, that "no hilosophy ought to be received as true, till it is demonstrated by actual periment" Instead of reasoning from supposed data, they now draw jnclusions from the result of dissection, and the absolute effects of medi- cine on the living body. 36 King's Address. They are then furnished with a text, from which they can give the pub- lic a true history, and a successful mode of practice in. particular diseases, which hitherto have mocked the best efforts of the healing art. '1 he fruit ofthe.e labors is circulated through the country, in our periodical pubh* cations. With these reflections before me, I have selected, some of the diseases of the bowels for our present entertainment. Cholic, is a disease, so common, and yet so frequently cured by means which are in the possession of every family, that perhaps some may say, it will be time lost, to dissertate, on so familiar a subject. But it exists in every degree, from a slight griping, to intussusception, and that ardent inflammation, which terminates in gangrene. Whether it is called flatu- lent, bilious, or Devonshire; its essential characteristics, are the sime. Cholic may be divided into three stages. 1st, Spasmodic. 2nd. Inflam- mation of the intestines, accompanied with more or less spasm. 3d, Gan- grene. In the progress of this disease, it quickly slides irom one stage to the other. Systematic writers impute the remote cause of cholic, to exposure to cold, raw and acessant food, and constipation. They dwell on costivene-s, the removal of which constitutes the leading feature of their Methodus Medendi. The proximate cause, they denominate spasm. If it is not radically cured in the first stage, it seldom admits of cure at all. Inflammation supervenes, puking becomes obstinate—the abdomen swells—pain in the port affected more constant, with the spasmodic stage lapping on to the inflammatory. The agitation ?nd compression of (he intestines in the act of pukin?, produces the most excrutiating pain in the inflamed nart, with a permanent increase of sensibility. One degree of sensation begetting another, till ttm sensorial power of sensation is ex- hausted, when gangrene ensues, and >\l,e patient only finds relief in the arms of death. We have all seen cases of CJhohc go on in this way, while we were pouring down oil, and other cathartics*, with no other effect, then to increase the difficulty. For when a cathartic has passed the pylorus, and reached the inflamed intestine, it produces so great an excitement on a part already too sensible, that the intestines re-act on that stimulus, invert the vermicular motion above (he inflamed portion, and bung on puking with all the train of evils which agitation and compression of the inflamed intestines, can produce. \ In almost thirty years' practice of medicine, I never saw a case of %holic, in which I could trace constipation of the bowels to be the exciting or proximate cause. With me then, there is no reason why cathartics should cure cholic, on any other principle than that of depletion. The difficulties which accrue from the exhibition of cathartics in this com- plaint, are often insurmountable, and fatal to the patient. These consid- erations, have induced me to abandon the use of caihartics in cholic and to rest on this conclusion-that the 1st stage is the time for physicians to act. Jn this stage the indications of cure are, to remove the spasm and morbid sensibility from the intestines. To answer these indication- the warm bath, semicupium, fomentations of the abdomen, and injections' are useful, and ought not to be omitted. But when the attack is severe ' the spasm vehement, and the sensibility great, relief is only to be obtained on general principles. These are bloodletting and opium. What' (says an King's Address. 37 °hj>etor,) give opium in a case where all our best writers recommend ca- thartics ? Yes, bloodletting and opium, are the greatest antispasmodics we are possessed of. Bleed as copiously as you would in pleurisy, and then give opium in as large doses as you would in epilepsy, and repeat the exhibition once an hour, till the patient becomes entirely free from pain, and falls asleep. If you stop the use of opium at this point, you will never find in the event that you have given too much. For just as much opium as is necessary to overcome the spasm and sensibility of the intestines, in the event, will be no more than an ordinary dose in ordi- nary circumstances. When the patient, by liberal bleeding and large and repeated doses of opium, has become entirely free from pain, the cho- lic is cured. This has been my practice for twelve years, and I have not had occa- sion in that time to make a third visit to any one patient in case of cholic. I observed above, that the first stage in this complaint was the time for physicians to act. It is in this stage, that this mode of practice has been adopted, and with me it has been invariably successful. But when the disease has run into the second stage, accompanied with spasm and all the morbid sensibility of the first, it is questionable, whether we can then be of any essential use to our patients. If so, we cannot be too Ftrnngly impressed with the importance of curing the disease, while it is in the spasmodic stage, an importance no less than the life of the patient. This is our time to work, and in pursuing the above prescribed plan, I think we should seldom, if ever, fail of an absolute cure. In this view of our subject, you will perceive that I am dictated much byth°. morbid sensibility in the part affected,—A circumstance which is overlooked by our systematic writers. I am ready to acknowledge that this morbid sensibility of the intestines in most cases is the effect of a pre- vious diseased action, and depends on that diseased action for its cause as much as Trismus does, on a wounded tendon. But when this mor- bid sensibility has taken place, we can do but very little better in attempt- ing to cure the primary affection, without destroying the morbid sensibili-/' ty. than we should, by endeavoring to cure lock-jaw, by applying an emo- lient poultice to the wounded tendon. Benjamin Bell, tells us, that after depletion with the lancet, Opium in large doses, is a proper remedy in inflammation, not only in giving relief from pain, but by the indirect debil- ity which follows. In cases like tho