A EEYIEW 
OF THE 
TRANSACTIONS 
OF THE 
MEDICAL ASSOCIATION OF THE STATE OF ALABAMA, 
BY 
J. B. GASTON, M. D., MONTGOMERY, ALA 
BARRETT & PRINTERS. A REVIEW: 
BY J. B. GASTON, M. D., MONTGOMEKY, ALA. 
Transactions of the Medical Association of the State of 
Alabama, Twenty-Seventh Session, 1874; vol. i., 8vo., 427 
pages. Barrett & Brown, publishers, Montgomery, Ala.* 
Although the epidemics of the past year—yellow fever, 
cholera aud dengue—occupied much of the time of the Asso- 
ciation, the variety of subjects discussed was quite sufficient 
to give spice and interest to the occasion. 
The President's Address, by George A. Ketchum, M. D., on 
“ The Sanitary Needs of the People of the State and the Re- 
lated Obligations of the Medical Profession,” teaches, in strong 
and sometimes eloquent language, that the obligation of the 
State to preserve the health of her citizens is quite as imper- 
ative as that to protect their lives and their property; that, 
in fact, the former duty is but a corollary of the latter. 
This subject is of great national interest and statistics of 
death-rates largely diminished—fifty per cent, in some cases 
—by attention to the laws of hygiene, must impress upon 
thoughtful physicians the conclusion that more can be done 
in diminishing the ratio of mortality from disease by hygienic 
than by therapeutic agencies. The address is a valuable 
State paper, and we are pleased to see that the Association 
has printed one thousand extra copies as “ a means of calling 
the attention of the people of the State and the attention of 
the General Assembly to the subject.” State and municipal 
* Extracted from Richmond and Louisville Medical Journal of December, 
1864. 2 
authorities should be taught that they, quite as much as the 
Medical Profession, hold the health and the lives of the peo- 
ple in their hands. 
YELLOW FEVER. 
The Transactions contain two papers on yellow fever—one 
by it. F. Michel, M. D., and the other by Jerome Cochran, 
M. D. Dr. Michel tells us—- 
(1) That the fever was brought from Pensacola to Mont-* 
gomery by tivo persons, and refers to his “History” of the ep- 
idemic, published in the Charleston Journal and Review, Jan- 
uary, 1874, where he gives an account of the introduction of 
the disease and its propagation from person to person and 
from house to house, until it became epidemic. 
(2) That there were five hundred cases of the fever in Mont- 
gomery, with one hundred and eight deaths. 
(3) That a remarkable number of colored persons was at- 
tacked, but that few died. 
(4) That malarial and other fevers were rarely visible after 
the appearance of yellow fever, and cites authorities to prove 
that this has been usually the case in epidemics of this dis- 
ease. 
(5) That there was no dengue in Montgomery in 1873 ; that 
the differences between dengue and yellow fever are “ well 
marked and characteristic,” and that dengue is an exanthem, 
and “ not haemorrhagic in character.” 
(6) That “the characteristic features” of black vomit were 
“first insisted upon by Dr. Middleton Michel in the Charleston 
Medical Journal, May, 1873;” and occupies four pages of the 
Transactions with an abstract of his paper. 
Most of these points are very creditably sustained, but there 
are some exceptional features, and to these we will briefly 
allude. At the outset, Dr. Michel arrays himself under the 
banner of the non-contagionists, but in the same sentence, 
with conspicuous impartiality, tells us that he “ believes as much 
in the local origin as in its being an exotic.” It is well that 
he thus early enrols himself as a “ non-contagionist,” for in 
the absence of such declaration, his “ History” might, with 3 
great justice, be pleaded in bar of any such claim in the future. 
The “History” gives, we venture to say, as striking an illus- 
tration of the portability, the importation by persons, the 
propagation from person to person,—the contagiousness—of 
yellow fever as ever has been published. 
Most physicians, we presume, wrould be very ready to admit 
that dengue is “not haemorrhagic in character”; yet we are 
sure all would not concur in some of the reasoning by which 
our essayist endeavors to establish this conclusion. “ Patho- 
logically considered, dengue,” says he, “ is one of the exan- 
themata, and being such, I do not believe it haemorrhagic in 
character.” And again, in the conclusion of his argument on 
this subject, “ I must therefore repeat that, pathologically con- 
sidered, dengue is one of the exanthemata, and can not be 
regarded as haemorrhagic in character.” Now, if the major 
proposition—no exanthem is haemorrhagic—could be estab- 
lished, the conclusion (if we admit Dr. Michel’s view of the 
exanthematic nature of dengue) would follow necessarily. 
But since the Doctor mentions one haemorrhagic exanthem— 
“ variola haemorrliagica ”—and since others will occur to every 
intelligent physician, the untenable character of his major 
premise need not be further insisted upon. But not only is 
his major proposition false, but his minor—“dengue is an ex- 
anthem ”—seems not to have the sanction of universal assent. 
Dr. Anderson says, “ in some epidemics of the disease in Mo- 
bile the eruption has been the exception, not the rule.” The 
usual course of argumentation is to proceed from the known 
or the admitted to a comprehension of the unknown or the 
doubtful. In the argument under consideration the rule seems 
to have been reversed. The premises, probably, more than 
the conclusion, need to be established. 
A claim of priority of publication (which I construe the lan- 
guage of our author—already quoted—with reference to Dr. 
Middleton Michel’s paper on black vomit to be) should, in 
justice to the medical public and to the party for whom the 
claim is made, be based so far as practicable upon the exact 
language of said party. This Dr. Michel has not given, or if 
he has (and the style and form of expression at times seem to 4 
indicate that the investigator himself is speaking) he has used 
no marks to indicate where said language begins or where it 
ceases. 
That this paper constituted at the time of its publication a 
valuable contribution to the literature of the subject can not 
be doubted by one who has observed the frequent and favor- 
able allusion made to it by Dr. La Roche. That it contained 
a more detailed and systematic account of the characteristic 
features of black vomit than any previous publication I am 
inclined to believe. But the assertion of Dr. R. F. Michel, 
that “ the characteristic features” of black vomit were 11 first 
insisted upon by Dr. Middleton Michel in the Charleston Med- 
ical Journal, May, 1853,” requires, to say the least of it, a 
very thorough revision. 
Dr. Henry Warren, 1740, insisted that black vomit was 
“ mortified blood.” Louis, 1828, insisted that “ the black 
vomit is nothing but fluid blood, altered according as it has 
remained a longer or shorter time in contact with the mucous 
membrane of the stomach.” La Roche, American Journal, 
1854, while commenting on Dr. Middleton Michel’s paper, 
and after stating that the microscope was first applied to the 
examination of black vomit in 1845, by John Davy, “with re- 
sults similar to those obtained more recently,” says that 
proofs of the sanguineous nature of black vomit “ had long 
been regarded * * * by numerous and competent au- 
thorities as perfectly conclusive.” Dr. J. C. Nott, American 
Journal, April, 1845, says that “ black vomit is blood exhaled 
in its natural state from the capillaries of the stomach, intes- 
tines, and even the bladder, and changed black by the secre- 
tions with which it comes in contact; this chemical change, 
my facts go to show, is produced by one or more acids.” “It 
invariably turned litmus paper red,” and the filtered aqueous 
portion (which he describes in some cases as “ limpid like 
water,” in one as “ light green,” and in others as “ deep 
brandy or rum color,”) “in several cases effervesced strongly 
with carbonates.” He attributes the “ burning or scalding 
sensation in the stomach ” to the “ presence of acid,” and 
“the varieties of black vomit” to “blood, acids, mucous and 
aqueous liquid, mixed in various proportions. Give me,” 5 
says he, “ blood, muriatic acid (or, I presume, any other acid) 
and gum-water, and I will make it to suit the notions of the 
most fastidious pathologists ; perfectly black, brown, reddish, 
etc.” In all these characteristics Dr. M. Michel follows Dr. 
Nott pretty closely. 
Dr. J. L. Riddell, New Orleans .Journal, ix., 1852, says : 
“ The black color is due beyond question,—[he insists upon 
it,]—to blood which, in all cases examined by me, bore the 
appearance of havirg been materially modified by acid. 
Most of the blood corpuscles seemed to have been disinte- 
grated, broken down into small granules and irregular 
masses. Clots [microscopic] generally abounded, containing 
whole corpuscles, generally spherical, and smaller than the 
normal size ; from .00020 inch in diameter to .00030; the 
usual measurement being .00025.” In one specimen “ most 
of the corpuscles presented nearly their usual appearance, 
measuring from .00025 to .00033.” Dr. R. made artificial 
black vomit by the addition of hydrochloric and other acids, 
and found “ that the corpuscles resembled closely those 
usually found in black vomit.” He discovered an abundance 
of epitheliel cells, and gives their forms and the measure- 
ments of cells nuclei and granules. Other “ vital organiza- 
tions ” are described, which Dr. R. thinks have no “ special 
agency in producing or maintaining yellow fever.” 
Prom the foregoing extracts it appears that the description 
of black vomit published by Dr. Middleton Michel, May, 
1853, had been anticipated, as regards every essentially dis- 
tinctive quality of that liquid, by other writers, and that Dr. R. 
F. Michel is not sustained by the facts in asserting that “ the 
characteristic features ” of black vomit were “ first insisted 
upon by Dr. Middleton Michel in the Charleston Medical 
Journal, May, 1853.” 
Although we have excepted to several propositions of Dr. 
R. F. Michel’s paper, there is much in it that merits com- 
mendation. It has its excellencies, and to these, did space 
permit, it would give us pleasure to invite special and favor- 
able consideration. 
The Yellow Fever Epidemic of 1873, by Jerome Cochran, M. 
D.—Part first gives brief historical sketches of the epidemic 6 
in New Orleans, Memphis, Shreveport, Pensacola, Montgom- 
ery, Calvert, Greenwood, and Mobile. 
The number of cases and deaths which occurred in these 
places is given as follows : 
Cases. 
Deaths. 
New Orleans. . 
2,000 
226 
Memphis 
10,000 
2,000 
Shreveport .... 
3,000 
7 59 
Pensacola 
GOO 
61 
Montgomery .. . 
500 
102 
Calvert 
450 
125 
Mobile 
210 
35 
Total . . . 
/ 
16,700 
3,308 
A review of the above-mentioned sketches teaches that the 
fever was brought to some of these places bj vessels, to 
others by persons, and in two places—New Orleans and 
Shreveport—the origin is still involved in some obscurity. 
It was brought to Pensacola by the Golden Dream, from 
Havana, which reached the harbor on the lOtli of June, after 
having lost, at sea, eight of her crew by yellow fever. This 
vessel “ was placed in quarantine, cleansed, fumigated and 
white-washed and detained twenty-four days before she was 
allowed to approach the city.” On the 2d of August, just 
forty-three days after the arrival of the Golden Dream—a 
period marked by no sickness on said vessel so far as we are 
informed—a sailor, eight days on board, was attacked with 
yellow fever, and “died with black vomit on the 5th.” “ The 
first three cases that occurred in the city,” had no direct com- 
munication with the Golden Dream. They were, however, 
inmates of Mr. Orthong’s residence—just two squares from 
the water’s edge—and he had visited the vessel repeatedly. 
It was, therefore, not infected persons, but an infected vessel 
that brought the fever to the harbor of Pensacola. It was 
not in infected persons, but either in Mr. Orthong’s healthy 
person, in his clothing, or “ as the more probable opinion 
seems to be, in the wings of the invisible swift winds that the 
seeds of the pestilence found agents of transportation ” into 
the city, 7 
The steam tow-boat Bee “ reached Memphis on the 10th 
of August, and remained there several hours.” Two deck 
passengers, sick with yellow fever, were put ashore in Happy 
Hollow and died the next day—one in Riley’s shanty, Happy 
Hollow, and the other at the Adams-street station-house. 
From the latter place the disease did not spread. “ The first 
victim claimed from the population of the city was a young 
man who had rendered some humane assistance to the poor 
stranger who died at Riley’s. Riley himself was then stricken, 
and soon died.” The disease was confined to Happy Hol- 
low for “ some weeks,” and thence it spread throughout the 
city. From this account it seems probable that the fever was 
propagated in Memphis not from the tow-boat Bee, but from 
the anonymous stranger who died in Riley’s shanty. 
In Mobile, Montgomery, Calyert and Greenwood, the fever 
was introduced and propagated by persons who had come 
from localities where the disease was prevailing. 
In connection with the progress of the fever in these sev- 
eral localities, the following circumstances seem to be espe- 
cially noteworthy: 
In Mobile the jail escaped altogether, and in Memphis “the 
jail, which was in the heart of the district that suffered so se- 
verely, escaped invasion until the 8th or 10th of October.” 
These prisons are surrounded by high walls, and had little 
communication with the environs. In Memphis heavy rains 
had no perceptible effect on the fever. In Shreveport the fe- 
ver became epidemic in eighteen days (?) after the appearance of 
the first case. The blacks were attacked almost as generally 
as the whites, but the mortality amongst them was very much 
less. On this point, Dr. E. D. Fenner, History of Yellow Fe- 
ver in New Orleans, 1853, says: “ During an epidemic he 
(the negro) will take the fever almost, if not fully, as readily 
as the white; but it will be altogether milder and less dan- 
gerous in its tendency.” 
Death from failure of the heart’s action was observed in 
several instances; but there was no confirmation by post- 
mortem examinations of the views of Dr. Joseph Jones in re- 
ference to the fatty degeneration of that organ in such cases. 
Here let us observe that Dr. Nott, American Journal, 1845, 8 
says, “ the heart in some cases was found soft and tiabby.” 
Dr. Faget’s views with regard to the relation between tem- 
peratuie and heart-beat seem to have found some confirma- 
tion during this epidemic. 
Part II. contains an admirable discussion of the lessons of 
the epidemic. In this part Dr. Cochran traces very clearly the 
revolutions and modifications of medical opinion during the 
last twenty years with regard to the propagation of yellow 
fever and its relation to our endemic paludal fevers. “Within 
the last twenty years,” says he, “ and very noticeably within 
the last ten years, the tendency of opinion on all these points 
has undergone considerable change. The doctrine of the 
affiliation between malarial fever and yellow fever has been 
completely7 overthrown, never any more to be revived. The 
doctrine of the transmission of yellow fever from continent to 
continent and from city to city by telluric or atmospheric 
waves, has been pushed into the back ground of speculation. 
And the doctrine of direct importation has been so thoroughly 
established by the occurrence of multitudes of facts as to ad- 
mit no longer of controversy.” 
The doctrine that yellow fever is sometimes propagated 
from “germs that have remained over from some previous 
epidemic, germs that have been able to maintain their vital- 
ity from one season to another because of mild winters and 
other circumstances favorable to their preservation and de- 
velopment,” “if true at all,” says Dr. C., “is true only of 
one or two of our Gulf cities, and only occasionally even of 
them.” 
With regard to morbid poisons he cites the microscopic 
observations of Beale on the contagion of vaccinia ; of Beale 
and Burden-Saunderson on the contagion of cattle plague ; 
of Chaveau, of Lyons* on the contagia of small-pox, sheep- 
pox, cow-pox and farcy ; of Coze and Feltz as to the nature 
of the several contagia of measles, scarlet fever, typhoid fe- 
ver and septicaemia; of Klebs on pyaemia and septicaemia ; 
all of which, with similar investigations by other observers, 
go to show a general agreement amongst authorities, that the 
septic agents of zymotic diseases are albuminous, colloidal, 9 
solid and particulate. Some, with Klebs, believe that these 
particles are the spores of a special fungus. Others, with 
Beale, hold “ that they are particles of living protoplasm of 
the diseased organisms; particles which have undergone or- 
ganic degradation and functional perversion, according to the 
character of the pathological movement which seems to invest 
them with specific poisonous properties.” Dr. C. admits that 
no one has seen the germs of yellow fever, yet affirms, upon 
analogical grounds, that such germs do exist and asserts that 
“ there is no other theory capable of explaining the phenom- 
ena of the disease.” 
Both of the essayists on yellow fever, although advocates 
of the importation of this disease by persons and of its prop- 
agation from person to person, speak of it as infectious, and 
of its cause as an infection. One of them declares himself a 
“ non-contagionist,” and the other rejects the term, contagion, 
altogether in the discussion of this and kindred subjects. 
In view of the controversy with regard to the mode of com- 
munication of yellow fever, carried on so bitterly a few years 
ago between the contagionists and non-contagionists or in- 
fectionists, we must consider this a somewhat questionable 
use of terms. The signification which the highest authorities 
on a subject attach to the terms used in their discussion of it 
ought to be conclusive as to the proper use and meaning of 
said terms. Etymology throws little light upon the differentia 
of such terms. As in pronunciation so in definition, the cus- 
tom of the best writers and speakers determines the rule. 
From such sources, speaking at a time when the origin of 
yellow fever in particular localities was very prominently be- 
fore the Medical Profession, we learn that contagion was ap- 
plied to a poison produced by disease in living beings and 
possessing the power of inducing like morbid action in other 
healthy living beings, either by contact, near approach, or 
through the medium of external bodies, such as fomites or 
Note.—When these pages were written we had not seen Liebermeister’s clas- 
sification, in which “ contagious“ miasmatic,” and “ miasmatic contagious dis- 
eases” are minor divisions of that class of diseases whose poisons “can repro- 
duce themselves, and to an unlimited extent,” which are termed “infectious.” 10 
the atmosphere impregnated with the poison; and that infec- 
tion was applied to a poison not portable by the sick or con- 
valescent, not communicable from person to person, and not 
produced as above mentioned, but originating in a concur- 
rence of material and dynamic agencies external to human 
bodies. "VYe do not hold that, at any time, there was a uni- 
versal agreement in these distinctions, but we do claim that, 
at the time above mentioned, they were generally adopted by 
writers on yellow fever in this country. Nor does there seem 
to have been any change in the use and signification of the 
term contagion, for Niemeyer, October, 1870, says that “the 
word contagion is universally used in the sense that diseases 
which are transferred from sick to healthy persons are conta- 
gious.” The distinction with reference to infection was never 
so generally recognized. It, however, has been recognized 
and adopted by some of the highest authorities of the last 
fifty years. 
The impossibility of absolute quarantine, difficulties of 
local administration, and difficulties growing out of the imper- 
fections of our scientific knowledge are admitted. Neverthe- 
less, in view of the exotic origin and portability of the germs 
of yellow fever, the utility of quarantine is insisted upon. 
And since the general government regulates foreign commer- 
cial intercourse, its intervention is invoked to make and en- 
force such regulations as may be necessary to protect our 
coasts. 
DISINFECTION. 
The discussion of this subject is conducted with earnest- 
ness and ability ; and a trenchant pen is directed against the 
protective virtues of carbolic acid disinfection as it has been 
practised in some of our Southern cities, especially New Or- 
leans and Mobile. The utility of a certain restricted use of 
disinfection as a prophylaxis of yellow fever is admitted, but 
it is claimed that “ all attempts to destroy the multitudinous 
germs of pestilence which, in epidemic seasons, are scattered 
broadcast through the illimitable kingdoms of the air must 
be abandoned as altogether hopeless.” You can disinfect a 11 
ship, but you cannot disinfect a city. You can disinfect the 
rooms of a house, but “ to disinfect all out-of-doors is a prob- 
lem of more embarrassment and difficulty than seems to be 
generally appreciated.” The ineffectual disinfection of the 
Golden Dream, herein before-mentioned, illustrates not only 
the vital tenacity of the germs of yellow fever, but also the 
importance, nay, the absolute necessity of thoroughness in all 
attempts at disinfection in even the most circumscribed local- 
ities. “ In view of the appalling mortality which has, on sev- 
eral occasions, occurred in connection with the use of carbolic 
acid” we are advised to be careful while attempting to sup- 
press yellow fever with carbolic acid, that “ we are not con- 
tributing something to the suppression of the lives of our fel- 
low-citizens.” An atmosphere so saturated with disinfect- 
ants as to assure the destruction of disease-germs, would, it 
is held, also prove fatal to human beings and domestic ani- 
mals. 
This paper, of sixty-two pages, concludes with a brief dis- 
cussion of the nature of dengue and the characteristic differ- 
ences between it and yellow fever, to which we will allude in 
another place. 
Report on Dengue, by JV. H. Anderson, M. D.—The facts and 
opinions of this paper are entitled to great respect, by reason 
of the large experience, the temperate and unbiassed judg- 
ment and the habitual accuracy of the author. 
Attention is called to the “many different phases * * * 
mentioned by intelligent authors who have described dengue 
in their particular localities,” and our author says that the ac- 
counts of Dickson, Arnold, Campbell, and Fenner, “ would 
not enable us in Mobile to recognize our dengue as the same 
disease which fell under their observation.” Little impor- 
tance is attached, as diagnostic symptoms, to the arthritis, the 
swelling of the joints, the decline of fever with a sweating 
stage on the third day, and its reappearance with insomnia, 
restlessness and vomiting, followed by an eruption, with relief 
of the above-mentioned distressing symptoms on the fifth or 
sixth day. These symptoms Dr. A. has “ not witnessed; cer- 
tainly not in the succession mentioned. In some epidemics 12 
of the disease in Mobile, the eruption has been the exception, 
not the rule.” 
In the symptomatology of the disease the fact is mentioned 
that “there is little desire for cold drinks.” 
In the diagnosis, both Dr. Anderson and Dr. Cochran (the 
latter citing Dr. Ross as his authority) call attention to the 
desire for cold drinks in yellow fever as distinguishing that 
disease from dengue. In my limited experience with dengue, 
the selection of drinks has been very capricious. In one case 
nothing gave satisfaction until Congress water was tried. It 
was highly relished, and that, too, by a person not at all fond 
of it while in l^ealth. 
The opiniomexpressed in the Transactions by different es- 
sayists with regard to the pathology of dengue, afford a signal 
illustration of the adage that doctors icill differ. Dr. Michel, 
following Dickson, regards dengue as an exanthem. Dr. 
Cochran, with Faget, considers it a mucus fever, but differs 
with Dr. F. as to its paludal origin. Dr. Anderson holds that 
“the nervous system bears the brunt of the attack;” believes 
it to be “ an affection of the ultimate filaments of the cerebro- 
spinal nerves after they enter the muscles.” Attention is 
called to the fact that the extreme motor filaments may be 
paralyzed by a poison, while the trunk will not be affected by 
exposure to the same agent. The effects of woorara, when 
applied to the trunk and when applied to the ultimate fila- 
ments of a motor nerve, are mentioned in illustration of this 
proposition. So, it is held, the dengue-poison may produce 
morbid impressions upon the ultimate filaments, and be innoc- 
uous as regards the trunk of a nerve. The discussion of this 
branch of the subject and the interpretation of the various 
symptoms of dengue in accordance with this hypothesis are 
both interesting and ingenious. And although the Profession 
may not endorse Dr. Anderson’s views with regard to the 
particular part involved, it will, we think, accept the general 
proposition that “ the nervous system bears the brunt of the 
attack.” 
“As to its being allied in any way to yellow fever,” Dr. A- 
“can see no shadow of evidence.” 13 
No novelties of treatment are proposed for the acute attack. 
Electricity, however, which is valueless during this stage, is 
recommended as an excellent remedy during convalescence. 
“ No tonic, however, is as bracing as cold weather.” 
Cholera in Birmingham, 1873, by M. H. Jordan, M. D.—Mr. 
Stellar, the first sufferer and victim of cholera in Birmingham, 
received his “bed and bed-clothes” from Huntsville a few 
days before his attack, on the 2d of June, and “ as cholera was 
prevailing at Huntsville at the time,” (?) Dr. J. concludes that 
the infection was brought in this bedding to Birmingham. 
But when we are told by Dr. Dement of Huntsville, in the 
next paper, that the first case of cholera in thqft city occurred 
on the third of June—the very day of Mr. Stellar’s death— 
the anomaly of an offspring older than its parent is at once 
presented and affords a sufficient excuse for our questioning 
the accuracy of the above-mentioned conclusion. 
Dr. Jordan seems to be a careful and accurate observer of 
disease and his experience with cholera has developed the 
following interesting facts and observations: 
“On the 5th day of July, Mrs. Hale had slight symptoms 
of diarrhoea, and concluded to go to her father-in-law’s, at the 
top of Shades Mountain, about eight miles in the country. 
The next day she was attacked with cholera and died in twenty- 
four hours. Her mother-in-law, who waited upon her atten- 
tively and was constantly in the room with her until her death, 
took the disease in two days thereafter, and died in twelve 
hours.” The use of cistern-water afforded no protection what- 
ever against the disease. Dr. J. favors the moderate use of ice 
and ice-water by the sick, but condemns their free use as in- 
jurious and dangerous, the opinion of Reynolds, Aitken, and 
Yandell to the contrary notwithstanding. In the treatment 
of the cramps of cholera special attention is directed to the 
application of large dry cups along the spine from the occiput 
to the sacrum as never having failed to give relief. 
Cholera in Huntsville, 1873, by J. J. Dement, M. D.—This 
paper gives a brief account of an epidemic in Huntsville, 
which, in a few weeks, carried off fifty-one of its inhabitants ; 
seventeen white and thirty-four colored. The period of incu- 14 
bation in cholera, usually short, placed by Niemeyer at from 
thirty-six hours to three days and by others at from eight to 
twelve days, seems to have been extended in one case to four- 
teen and in another to twenty-three days. The only person 
attacked at Johnson’s Wells, nine miles from Huntsville, was 
a gentleman who had left Huntsville two weeks previously. 
One person was attacked on Monte Sano, four miles from 
town, who had been absent from Huntsville twenty-three 
days. 
The White Blood-Corpuscle in Health and disease; by Jerome 
Cochran, M. I)., Mobile, Ala. 
The doctrine of the genesis and structure of cells has, within 
the last twenty years, undergone great change and he who 
now speaks and writes of the nucleated cell, with its cell-wall 
and cell-contents, as the primary part in histology, must, in 
the light of current biological investigation, be regarded as a 
fossil of the Schleiden and Schwann period. It is to be re- 
gretted, we think, that the term, cell, has been so extended in 
signification as to embrace the homogeneous amoeboid particle 
of living matter which is now regarded as the unit of organi- 
zation. Authority, however, has so decreed it; and although 
its derivative meaning and common use suggest ideas and ge- 
ometric forms which find no illustration in the white blood- 
corpuscle, we are taught that this corpuscle—without a cell- 
wall, non-nucleated, and non-difterentiated—is a simple cell. 
A brief captional analysis is all that space would permit in 
the- way of a synopsis of this paper, and we will, therefore, 
simply notice some of its most salient points. 
As a history and coinpend—comprehensive, yet compact— 
of current biological doctrines this paper is exceedingly val- 
uable to the Profession and highly creditable to its author. 
The cell-doctrine is briefly but lucidly discussed. Scattered 
facts are arranged into a convenient system, so that they be- 
come endowed with an amount of physiological and patholog- 
ical significance and importance which before has scarcely 
been suspected. 
The most sweeping generalizations of biologists, however, 
are embraced and followed unhesitatingly and with unswerv- 15 
in" fidelity to their logical extremes. Not only is the some- 
what startling proposition, “ that living matter is always and 
everywhere of the same identical nature; the same in its chem- 
ical constitution; the same in its physical properties; the same 
in its vital endowments,” accepted as a “scientific demonstra- 
tion”; but the identification of the white blood-corpuscle and 
the amoeba—a legitimate deduction from the foregoing propo- 
sition, we believe—is adopted, and unqualifiedly affirmed. 
“ Yea, verily, it is an amoeba,” says the Doctor. 
Now, is it legitimate to conclude because, with the various 
analytical appliances at our command, including the micro- 
scope, we can discover no difference in the living matter of 
plants and animals, that, therefore, they are absolutely iden- 
tical ; because, forsooth, they seem to be the same, that their 
identity is a scientific demonstration, to question which would 
be an evident absurdity? We think not. Do not the differ- 
entiations which follow close on this state of primal uniformity 
afford some ground to suspect that there may have been un- 
observed, transcendental differentiations in the living matter 
itself? Are there not good reasons for believing that the germs 
of a conferva and of an oak, of a zoophyte and of a man—all 
microscopically identical—are, after all, somehow or other, not 
exactly the same thing? Let us, hypothetically, transpose 
these factors of organization. Would the germ of an oak, 
resting upon the membrana decidua, so develop and so differ- 
entiate under the influence of the new circumstances and in- 
cident forces as to form a man ? Would the fertilized human 
ovum placed in the embryo-sac of the plant, develop and grow, 
and spread its branches, a shade and resting place for the dis- 
placed and wandering plant-germ now developed into a man? 
Who can tell? That either of these results would happen is 
certainly not a scientific demonstration. That either of them 
would not happen is, we believe, the verdict alike of common 
sense and rational philosophy. 
It may be claimed that the identity of living matter, always 
and everywhere, is a fact of observation which should not and 
can not be ignored until some heterogeneity is discovered. 
But it should also be remembered that the subsequent differ- 16 
entiations of said matter are also facts of observation which 
can not be ignored. And in the explanation of these, it seems 
quite as philosophical to invoke the aid of transcendental dif- 
ferences in the primal, living matter itself, as to throw the 
whole responsibility on the incident forces. 
Symmetrical diseases of the skin show that every part of 
the skin is different from every other part, except its symmet- 
rical part, and there is no proof that even symmetrical parts 
are identical in structure. Symmetrical diseases of the bones 
illustrate the same fact with regard to the osseous system. 
And, although inappreciable to us by the most delicate chemi- 
cal and microscopic analyses, there may be heterogeneity in 
the living matter of plants and animals. We can scarcely 
conceive of living matter more free from the disturbing influ- 
ences of varying circumstances and forces than the segmenta- 
tion-spheres of the ovum. Nevertheless, in them the most 
striking differentiations are inaugurated. “ They march like 
soldiers to their appropriate places” in forming the blastoder- 
mic layers of the embryo ; and this is but the beginning of a 
series of unparalleled differentiations observed during the de- 
velopment of the embryo and foetus. 
Not only are we taught the universal identity of living mat- 
ter, the identification of the white blood-corpuscle and the 
amoeba, the invariable community of character of the white 
blood-corpuscle with the lymph and pus-corpuscles, but the 
rigorous identification of the white blood-corpuscle with 
the germinal vesicle and the segmentation-spheres of the 
developing ovum is a speculation upon which Dr. Cochran es- 
pecially insists. In view of these conclusions, he may well 
exclaim: “The stone so long rejected of the builders has be- 
come, indeed, the head of the corner; the foundation stone 
upon which must be constructed the whole edifice of the phys- 
iology of the future.” 
The division of one bioplast into two bioplasts—one cell 
into two cells—solves, it is held, the whole mystery of repro- 
duction. Sex is not a primary and indispensable factor in re- 
production ; but the new creature, in the first stages of its de- 
velopment, is a bud springing from the body of the mother, 17 
while the office of the male element is to supplement the de- 
velopment of the female factor, so as to raise the creature, so 
begun, to a higher development than it would otherwise be 
able to reach. 
While the division of one bioplast into two bioplasts is the 
essential feature of reproduction, the fusion of two bioplasts 
into one bioplast is the essential feature of sexual conjugation. 
This latter act restores to the new creature the waning power 
of growth and development, “breaks up, in the most thorough 
manner, the paralysis of equilibrium which is stealing over 
them both, and in the complex mass, which results from this 
union, sets all the wheels of life into active motion.” 
It must not be supposed that wejiave attempted a synopsis 
of this paper. This, in the beginning, was specifically dis- 
claimed. Many of its subdivisions have not been mentioned. 
Indeed, we have mentioned only those speculations which 
seemed to be impressed, to some extent, with the character 
of the author’s own thought; and we take leave of the sub- 
ject, regretting that the readers of these pages can not expe- 
rience the pleasure which we have received in reading and 
studying the original paper. 
Hternorrhagic Malarial Fever. By E. I). McDaniel, A. M., 
M. [)., Camden, Ala. 
To name ii disease is one thing; to define a disease is 
quite another thing. A definition should embrace the essence 
of the thing, or such an idea of it that, being admitted, all the 
phenomena follow by implication. Some names—just as 
good as any too—are entirely arbitrary. Others are, to a 
greater or less extent, definitive or descriptive. To this lat- 
ter class belong most of the names which have been applied 
to the disease under consideration. Of these Dr. McDaniel 
mentions nearly a score, and as the result of their somewhat 
rigid analysis, proposes “icterode ltannatnric malarial fever," 
which he claims is not only “ a significant and appropriate 
name,” but “ a perspicuous, precise and differential defini- 
tion,” As a name it certainly does comprehend more of the 
characteristic features of the disease than any which has been 18 
proposed, but on account of its length, is, we think, some- 
what objectionable. As a definition, it is, on the contrary, 
very compact, and presents both the genus and differentia 
specijica of the disease, so far as established by the literature 
of the subject and is, therefore, unexceptionable. 
We consider this a good paper, and especially valuable 
on account of its discussion of the therapeutic value of 
quinine in this disease. In view of the malarial origin, fre- 
quently remittent or paroxysmal type of the disease, and the 
well known properties of quinine, no physician, we presume, 
would in his first experience with its treatment withhold this 
most efficient anti-malarial and anti-periodic agent. At one 
time all relied on it, and Jt still holds the unwavering confi- 
dence of many of the first physicians of this State. Some 
use it very heroically—use it “ internally, externally and eter- 
nally.” But what has been the result of the quinine-treat- 
ment? A fearful mortality, averaging probably twenty per 
centum. Such results coupled, in some instances of distinctly 
intermittent or remit ent type, with the signal failure of qui- 
nine to arrest the paroxysms and an aggravation of the liaem- 
aturia under its use, have caused some physicians, including 
Dr. McDaniel, to regard quinine with great suspicion, and 
others to abandon it altogether; and the results have sus- 
tained them in their course. Of this latter class, some ad- 
minister tinct. fer. chlo. very freely—from a half teaspoonful 
to a teaspoonful every two or four hours—until the lisema- 
turia and paroxysms are arrested. Others claim a good suc- 
cess, wdio do not use this remedy, or, if they use it consider 
it of secondary importance in the management of the disease. 
“In conversation on this subject with physicians and others,” 
says Dr. McDaniel, “ I have had my attention called to cases 
in which luematuria followed quinine apparently as effect 
does cause. And over and over, and over again, have I in 
my own practice observed the hsematuria re-established or 
aggravated after quinine ; and, on the other hand, have seen 
the disease, with a very formidable array of symptoms, go 
handsomely on without one grain of quinine to a happy con- 
valescence.” 19 
The experience of Dr. East, Galveston Medical Journal, is 
quoted as entirely consistent with and confirmatory of these 
views. “ As often as he got his patients into a satisfactory 
condition, and then commenced giving quinine, just so often 
he plunged them back into hcematuria, with its unnumbered 
woes and dangers.” 
Dr. A. T. Pearsall, of this city, the originator, so far as I 
am informed, of the heroic iron-treatment, writes me that lie 
has treated fifteen cases of haemorrhagic malarial fever since 
he adopted the treatment by tincture of iron, and that all of 
the cases so treated have recovered. Dr. McR., of Lowndes 
county, equally fortunate in the management of the disease, 
uses tincture of iron, but not so heroically, and with less faith 
in its curative powers. He attributes his success quite as 
much and more, indeed, to the abandonment of quinine and 
to other agencies to which he, in common with most other 
physicians, usually resorts, than to the use of iron. 
From the facts and opinions found in Dr. McDaniel’s pa- 
per, from the results of our own very limited experience and 
the comparatively large experience of other physicians— 
brought to our attention by letter and otherwise—in the 
treatment of this disease both with and without quinine, we 
are led to the conclusion that this agent is in very many, 
probably in most, instances not necessary, and in some posi- 
tively injurious in the management of this form of malarial 
fever. 
Pnerfteral Eclampsia. By E. M. Peterson, M. 1)., Greensboro, 
Ala. 
This is a well written and, in the main, an excellent discus- 
sion of the subject. Albuminuria is in itself a condition of 
little importance, but as a sign of “ a pathological condition 
which prevents the excretion of the poisonous principles 
which result from tissi e-metamorphosis,” it becomes invested 
with peculiar significance and importance. That albuminuria 
is not, however, an invariable attendant upon uraemic intoxi- 
cation, is illustrated by the case of eclampsia reported by Dr. 
Peterson. The immediate cause of this affection of thenerv- 20 
ous system—this neurosis of motility, as Braun calls it, is, as 
is well known, a toxaemia. The intoxication is uramric, and 
results from a diseased condition of the kidney. The iden- 
tity of this condition with Brightian degeneration, which has 
been affirmed by high authorities, is, upon plausible and ap- 
parently sufficient grounds, denied by our author. 
Without restricting the intoxication to any one of the con- 
stituents of urine, our author points out possible transforma- 
tions of urea and uric acid into several isomeric poisonous 
compounds, any one of which, in the blood, would be de- 
structive of health. Frerich’s doctrine, that carbonate of am- 
monia resulting from transformation of urea under the influ- 
ence of a ferment, is the toxic agent in uraemia, is very sum- 
marily disposed of by the assertion that “the conversion of 
urea into carbonate of ammonia is the most favorable chem- 
ical change which it can undergo, as in this form it can be 
more readily excreted, and is less harmful in the organism.” 
Dr. Peterson certainly has not seen an account of Dr. W. 
A. Hammond’s experiments, published some fifteen years 
ago ; for no one at all familiar with the results of said experi- 
ments could, fora moment,maintain the innocuousness of any 
considerable quantity of carbonate of ammonia in the blood. 
The presence of a ferment in the blood being admitted, the 
transformation of urea into carbonate of ammonia might oc- 
cur ; and having occurred, the explosive violence of puerp ral 
eclampsia would not be an improbable result. But the pres- 
ence of a ferment is a mere hypothesis, and the occurrence of 
any such transformation has been rendered extremely im- 
probable, if not absolutely disproved, by the experiments 
above referred to, published in A. Med. Chir. Review, March, 
1858. An analysis of these experiments shows : 
1. That while both urea and carbonate of ammonia injected 
into the blood vessels of sound animals produce decided 
symptoms of poisoning, neither causes death, the animals 
being relieved by the excretory action of the kidneys. 
2. That both urea and carbonate of ammonia cause death 
when injected into the blood vessels of animals whose kid- 
neys have been extirpated. 21 
3. That in neither condition does urea undergo transform- 
ation into carbonate of ammonia. 
“ I desire to express the opinion,” says Dr. Peterson, 
“ that the retention in the blood of an ex- 
cess of the poisonous principles of the urine from any cause 
constitutes the dominant factor in the etiology of eclampsia 
gravidarium, parturientium et puerperarium.” 
In another place the Doctor says: “ A large majority of 
the cases of eclampsia puerperalis * * * are 
due to retention in the blood of the products of dissimilation, 
and their poisonous effects on the nervous system.” 
While these views are orthodox the fact seems to be that 
none of the exclusive theories of intoxication in eclampsia 
have been established. Whether the intoxication is due to 
urea, uric acid, or to some other constituents of the urine, or 
to their isomeric poisonous derivatives; or whether it is due 
to none of these, but to some of those primary products of 
tissue-metamorphosis—creatine, creatinine, and other ex- 
tractives—which are finally converted into urea and uric acid, 
has not been demonstrably determined. 
The whole question with reference to the specific factor of 
intoxication in puerperal eclampsia must, therefore, be re- 
garded as still sub judice. 
Unavoidable circumstances prevent a notice of the remain- 
ing papers. This is regretted, for some of the essays omitted 
in this review are amongst the most meritorious contribu- 
tions to this highly creditable volume of Transactions of the 
Medical Association of the State of Alabama.