3« a;; »»«**~^-'*f **■**■' *■ "* :&■ ■\Zw- .j:;;i~ .rap. y"r^^\ v^ t^tc i&^± / / As regards the cerebral lesions, these have been frequently observed, and of various kinds and degrees. For the most part, the qualities of the bile, cystic and hepatic, are altered in colour and consistency. To use the language of Good, it has « been met with acid, acrid, saltish, insipid, whitish, black, green, eruginous, and versicoloured—as dense and dark as elderlob, as tenacious and limpid as the white of eggs, and as crowded and granular as the spawn of frogs." Every part of the interior of the body in violent and lingering attacks may be tinged of the same hue as the skin. The brain and spinal mar- row, the tissues and substance,—the pericardium—the heart,— the lungs and their membranes,—the abdominal viscera,—the blood-vessels,—the fat,—the cartilages,—the bones,—even the hair, have been observed in this state. Excepting the milk, perhaps all the secreted fluids, as the perspiration, the saliva, the sputa, the semen, the serous exhalations into the cavities, &c, are also found discoloured. These statements are made on the au- thority of Bartholine, Lieutaud, Morgagni, Van Swieten, Storke, Haller, Burserius, Heberden, Powell, and many of the more modern writers. The fact indeed is no longer disputed. Nor is that of the exemption of the milk from contamination. Notwith- standing his extensive experience in the disease, we are told by Frank, that he never met with it, and such is the report of every one who has carefully attended to the subject. The reverse of the allegation of some, that while the meninges are liable to be af- fected, the brain itself escapes, seems now also, sufficiently estab- The pathology of jaundice is imperfectly understood. That it does not depend on the absorption of cystic bile, as maintained by some writers, is shown by cases reported by Richter and Cholmondly, where it occurred in persons, who after death were found destitute of a gall bladder. An instance is also reported bv Sir Everard Home, of a similar kind, without jaundice, or any y 30* 354 ICTERUS, OR JAUNDICE. serious impediment to health, and Blundell, a teacher of mid- wifery in London, gives the cases of two children who lived for several months apparently doing well, in whom after death, the biliary ducts were found to terminate in a cut de sac, completely preventive of the passage of a drop of bile into the intestines. Experiments made by Portal in which he tied the common duct of animals with a view of determining the influence of this impediment to the passage of bile in the production of the disease, were without any such effect. Not disposed, however, to conceal any countervailing fact, I have to state, that some years ago, similar experiments performed by Brodie and subsequently by Tiedemann and Gmelin, though with the different intention of ascertaining the use of the bile, more especially as concerned in the process of chylification, were with somewhat opposite results, or that the eyes and skin became partially discoloured. But these being repeated by Mayo, no such effect, in any one instance was observed, and hence, the point remains undecided, each side being supported by equipol- lent evidence. Even, however, were it absolutely demonstrated that jaundice in its most perfect exhibition, uniformly followed the experiment, it would not warrant the conclusion that it is occasioned by the absorption of bile,—since the injuries done to parts by the inci- sions and ligature might excite the very sort of irritation, which will presently be assigned as the real cause of the disease. Doubts have long been entertained by me, whether bile had any thing to do in the production of jaundice, and above all, in the mode commonly alleged. Not now to insist on the impossi- bility of any article entering the circulation unchanged of such an acrid nature as bile often becomes in a diseased condition of the liver, without producing, at once, the most deleterious con- sequences, it appears to me : 1. That were jaundice owing to this circumstance, the disease might at any time occur, or whenever bile is exposed to the action of the absorbents, as when accumulated in the stomach and in- testines, which we know does not. By Powell, an authoritative writer on the subject, we are informed that " the disease never accompanies those cases of immense secretions of bile, which are called cholera, at least I have never seen it in very violent ones, nor am 1 acquainted with any author who mentions it, even ICTERUS, OR JAUNDICE. 355 as an accidental symptom, and if it had happened it could not have possibly been overlooked." "Bianchi," continues he, " gives a case where this circumstance was more narrowly in- vestigated, for he examined the absorbents of a man who had died of cholera, and found that their contents were not in the least tinged by bile." 2. That though the stools usually indicate a want of bile, this is not so uniformly. In several cases I have seen it abundant, and Professor Stokes asserts, "that we have jaundice co-existing with even a copious flow of it." " This is strong proof," he says, " in favour of the opinion that some cases of the disease have no connection or dependence on the absorption of bile." 3. That in many instances of the disease, no obstruction was found on a post-mortem examination of the ducts of the liver, or any other hepatic lesion to account, for it. The writer just cited remarks, that there are instances in which no mechanical re- tention of the bile existed,—the biliary ducts and gall bladder, were open, the bile escaped into the intestines, and yet the whole body was jaundiced. These two points are indeed no longer dis- puted. 4. That the disease comes on too suddenly, as in the instance mentioned by me, of concussion from an explosion of a bomb, or the many related from violent mental perturbations, to sup- pose it to be occasioned by the gradual absorption of bile. 5. That the peculiar bitter taste of bile is not discoverable in the serum of the blood or other fluids. The contrary I am aware has been asserted, though not with sufficient force to subvert the concurrent testimony opposed to this statement. Many times have I had this matter tested, and never known any individual who detected any bitterness in these fluids. The same was de- clared by the late Professor Physick, and is averred by the cau- tious and philosophical Andral in a recent publication, who fully concurs in my views. 6. That in this disease there is comparatively seldom any genuine bile formed. The fluid discoverable on dissection, has scarcely ever such properties as to taste, colour, or consistency. It is a peculiar one, the result of a morbid secretory action, caused by the condition in which the liver exists. 7. Did apsorption, moreover, take place, as is contended for, the tinge imparted to the skin, and other parts, should then be of 356 ICTERUS, OR JAUNDICE. a colour correspondent to that of the hepatic fluid, and not of the various shades of yellow, which usually happens. But such a process no more goes on in this case, than in retention of urine. The bile must be taken up from the pori biliarii, or hepatic or cystic or common duct or gall-bladder, which is in contradiction to all analogy and fact. Does it ever happen in relation to the urine under such circumstances? Granting that a urinous fluid has been discharged from the stomach, and other remote portions of the body, of which, some instances are reported, they supply no evidence of its absorption. These parts had assumed a vica- rious office, as we have frequent occasion to witness with regard to menstruation. Embarrassed by these and other difficulties, some of the advo- cates of the hypothesis, ascribing jaundice to bile, have so far changed their ground, as to assume the greater probability of its being introduced into the blood either by regurgitation, or lacteal absorption. As to the first of these suppositions, its absurdity is so obvious, that it has received very slender support, and in rela- tion to the second, the facts mentioned, strengthened by common experience, refute it. Great reason, indeed, have we to suppose, or rather it may be said, it has been demonstrated, that chyle only is taken up by the lacteals, every other fluid being rejected by them. Let me repeat that there is no absorption of bile. The secre- tory function of the liver in jaundice, so far as concerns the normal exercise of it, is perverted or suspended, as in ordinary bilious or malignant fever, and the earliest manifestation of recovery is the restoration of its office. No longer tenable, these views are now abandoned by the best pathologists, and a very early notion is revived, which alleges, that the phenomenon is caused by the liver being crippled in its structure or functions, the materials of bile pre-existing in the blood, instead of a separation as ordinarily, by that organ, are so deposited, and constitute the disease. Can there be a looser speculation, or a greater absurdity ? The rudiments of bile, are not bile itself, which is a peculiar fluid, the product of the secre- tory office of the liver, and can never exist till the blood is sub- jected to this process. As well might it be presumed, that in the eunuch, the elements of semen, were in a like manner disposed of, productive of some horrible disease. ICTERUS, OR JAUNDICE. 357 Thirty or more years ago, 1 advanced the suggestion, and which I formerly taught, that the seat of jaundice is in the stomach and upper bowels. This indeed, was merely an exten- sion of my views in relation to hepatitis, and the rest of the graver affections of the liver, all which, I have long endeavoured to in- culcate, as originating in gastric irritations, continued to the duo- denum, and thence, to the liver directly, or through sympathy. In anticipation of me, I am aware, though not at the time when I adopted the hypothesis, nor indeed, till very recently, it had been conjectured both by Hunter and Bichat, that gastro-duo- denitis might probably be the antecedent of the hepatic disturb- ance, leading to jaundice. Broussais, long afterwards, and certainly subsequent to me, more definitely than heretofore had been done by any one, maintained the dependence of the disease on inflammation of these portions of the digestive tube, and now the doctrine is espoused by many of the very best pathologists. Commenting on the subject, Johnson says," that a curious fact has been pretty fairly established, that irritation or inflammation of the mucous membrane of the duodenum will sometimes pro- duce jaundice, when no obstruction can be detected in the biliary ducts:" and more recently, we are told by Professor Stokes, that the disease from this source, is by far the most common. " The pathological expression for it, he remarks, is, that it is inflamma- tion of the upper portion of the digestive tube, or in other words, the result of gastro-duodenitis." But were this true, or such a pathological condition only required for the production of jaun- dice, would it not be, instead of a rare, almost a daily event ? It was this striking fact, that forced me to abandon the doctrine. Discarding then, these several hypotheses, I am exceedingly embarrassed as to the pathology of the disease. The state, pro- ductive of it, is undefined, and I may add, that even its precise location, is not determined. Cases of jaundice occur in connec- tion with every sort of hepatic lesion, and sometimes apparently when there is an entire soundness of the liver. The same holds with regard to the alimentary canal, it being found also deeply affected, or the reverse, perfectly healthy. Mostly, perhaps, the duodenum is concerned, and by inflammation acute or chronic, though the uniform association of this condition with jaundice, cannot be averred. Not unlikely, this mysterious affection is owing to a peculiar irritation of the nervous system, and especially, 358 ICTERUS, OR JAUNDICE. in the first place, of the nerves of organic life, with which the lesions of the other organs mentioned have no necessary alliance, however they may occasionally supply or exasperate the irrita- tion. Considering the vast control which the nerves exercise over the whole of the secretory functions in every way,—increas- ing, diminishing, modifying or suppressing the several products, this view of the origin of jaundice may probably gain some coun- tenance or support. No more surely, is ascribed to the nerves here, than they display in many parallel instances. Concisely stated, the considerations which led me to this sup- position, for I claim for it no higher merit, are the occasional independence of jaundice of all such derangements,—its predispo- sition in hysteria, hypochondriasis and melancholy,—the sudden- ness sometimes, of its attacks,—the frequent origination of it, in causes operating directly on the nervous system, as physical inju- ries of the brain, or moral impressions of various kinds, the early phenomena of cramp, or spasms, and its liability to end in apo- plexy, palsy, or some similar cerebral or nervous disturbance. Looking at the intimacy of the gastro-duodenal relations, as formerly explained, embracing every portion of the system, it becomes very intelligible how such effects should take place. By Andral it is conjectured, in those cases, at least, which proceed from mental emotions, " that the primary impression is refera- ble to the nervous plexus so remarkable for its size, and for its double origin in the nervous centres of animal and organic life which enters into the liver with the vessels, and with them is dis- tributed through the organ." Be this as it may, from a sym- pathy with this primary irritation, the capillaries are disordered, and the serum in these vessels consequently undergoes a change as in yellow fever, and in certain instances of poisoning,—tinting to a greater or lesser extent, the various parts of the body. Much the same colouration which occurs in a part from a bruise, hap- pens in all these instances, and as seems likely, is occasioned by an impaired vitality of the extreme vessels. The capillaries being in this enfeebled state, in whatever manner induced, are disposed to effuse a serous fluid of some shade of yellow, or green, or lurid- ness. Besides the hepatic, and gastro-enteric, to which it is most common, we meet with it in the diseases of the spleen. Two cases of complete jaundice I have seen thus associated, and we learn from Abercrombie, that with a tumid spleen, the ICTERUS, OR JAUNDICE. 359 complexion is usually sallow, and general experience confirms it. As true is it of the pancreas, or much testimony to the same effect in regard to it, might be adduced. More than once I have seen jaundice an attendant on gastro-enteric epilepsy, particularly with the lurid hue, and often in chlorotic affections,—the com- plexion exhibiting all the gradations of the usual colours, as well a waxy whiteness, called icterus albus. Even more commonly is it observable in the cutaneous efflo- rescences, especially when of a weak or typhoid character. Cases of rubeola, scarlatina, and erysipelas, have repeatedly come under my care, followed by this sallowness. But the most striking proof is offered in some of the early eruptions of infancy. These at first florid, on the weakening of the vessels, gradually assume the sallow hue. The act of death is very often productive of the same effect—it being indeed a very common occurrence, however pallid before, for the corpse to become all over yellow. My wish on the whole, is, to convey the impression, that though I maintain the initiatory step in jaundice, to be a peculiar state of the nervous system, and to which the characteristic colouration of the disease is owing, I am prepared to admit, as indeed pre- viously intimated, that the remote cause of it may be in many instances, those lesions of the viscera so often found in connection with it, though I am not less persuaded of its taking place inde- pendent of all such derangements. Called on to pronounce the precise character of the nervous state to which I have ascribed so much, I should candidly confess my inability to do it in any degree satisfactorily. Defective as is our knowledge of the nervous system, every speculation rela- tive to it, cannot fail to be vague and uncertain, as indeed is shown in the prevalent pathology of the whole of its diseases. Contemplating, however, the prominent features of the case before us, I think it may be inferred that the nervous state in question, is the reverse of excitation, or that there is a want of innervation in the capillary circulation, and hence, at least the discolouration of the serous fluids. Disorder in other instances of the secretory and nutritive offices, seem to proceed from this condition, and I know not why the present should not be brought into the same category. Granting that these views may not be very definite, they perhaps, are so far of value, as calculated to awaken attention to an interesting subject, and by showing the 360 ICTERUS, OR JAUNDICE. fallacy of the prevalent notions regarding it, direct curiosity to further investigations, to end, I trust, in happier results. Error may be deemed more pernicious than ignorance, and in getting rid of it, we shall always have a clearer insight into truth and knowledge. From the preceding account of jaundice, it appears that to render the treatment appropriate, our remedies must be varied according to circumstances. It is the remote cause which usually consists of some pre-existing lesion, and not so much the icterose condi- tion itself, to be deemed an effect merely, that we are called upon to remove, and so diversified are these lesions, no uniform or consistent plan of management can be adopted. We have seen that there is scarcely one pathological state of the liver which may not be associated with jaundice,—that it is incident to de- rangements of the spleen, pancreas, and upper portion of the alimentary canal, not to review further the subject. Nor is this the only difficulty to be encountered. Cases in the most opposite conditions of the system, independently of the state of the local affection, and exacting quite a different curative process, may be so obscurely designated as to elude all the powers of discrimina- tion. For these reasons is it that our practice is nearly always tentative, and I fear too often degenerates even into absolute em- piricism. In the mildest, and particularly the forms of the disease where no fever or phlogosis exists, we commence the cure with evacua- tions of the primae viae, and emetics are deemed especially useful. Cathartics are also important, so much so indeed, as to constitute a very essential, and not unfrequently the only means. Begin- ning with purging by calomel alone, or with its ordinary adjuncts, the bowels are subsequently to be kept in a soluble state by magnesia, the neutral salts, or other gentle laxatives. Cremor tartar, as especially adapted to the occasion, has been strongly advised by Stokes, from its cholagogue properties. I have little experience in this application of it. These two classes of remedies operate probably on nearly the same principle, removing causes of gastric or intestinal irritation, and by exciting the liver sympathetically through the impression made on the alimentary canal. In proof of the beneficial tendency of purging in particular it may be repeated, that jaundice is often removed by the spontaneous occurrence of diarrhoea, particularly ICTERUS, OR JAUNDICE. 361 I suspect when proceeding from constipation, either of the upper or lower bowels. Many years ago, I was called into consultation in the case of an eminent lawyer of this city, who had previously suffered very seriously from jaundice, occurring from time to time, and always attended by heavy epigastric oppression, which I speedily re- lieved, and ultimately cured, by the treatment I have recom- mended for duodenal dyspepsia. Two summers since, a lady from the interior of New York, sought my advice for a very inveterate attack of the disease, which she told me was marked more by a bearing down uneasiness, whether of the rectum or uterus, she could not determine, or perhaps both, and by stran- gury than any other affections. Finding her habitually costive, and presuming that the whole of this state of things was owing to lodgment of faeces in the colon or rectum, I purged her actively, and brought away several pounds of such a collection, after which she was much better, and soon got well by the rectifica- tion of the bowels. The disease as I have presented it, is one of the simplest of its forms, and comparatively easy of cure. But it wears a more violent and complicated aspect, and demands a different course of proceeding. Coming on with fever, or a strong full pulse, and topical uneasiness, or this state at any time succeeding, venesec- tion must be practised, and to some extent. Greatly may it be aided by local bleeding, which is too much neglected. The sto- mach, the duodenum, and the liver, are here one or all in irrita- tion, congestion, or phlogosis. By a detraction of six or eight ounces of blood from the epigastric or hypochondriac regions, according to the indication, I have seen signal advantage to accrue, and where the means of such bleeding cannot be had, or has been sufficiently practised, blistering may be substituted or successively adopted. Not less are these measures required in the distrac- tions of the head, which sometimes prevail for days, and relief not being afforded, prove one of the most afflictive and alarming attendants on the case, as denoting apoplexy, or some other horrible catastrophe of a similar kind. These occurring or being distinctly menaced, it need scarcely be remarked, that sanguin- eous depletion, with purging, is to be carried as far as circum- stances will admit. What, however, calls for the most vigorous measures is a relent- 31 362 ICTERUS, OR JAUNDICE. less obstruction of the biliary ducts, from a calculus or spasm of these, or of the stomach or bowels, inducing the intense suffering formerly noticed. The object here is twofold, to induce relaxa- tion, so as to overcome the impediment, and to obviate inflam- mation which would follow, were obstruction or the spasm to continue. To meet these views we resort to copious venesection, sometimes even ad deliquium,—to the warm bath—topical fo- mentations, to bleeding by cups or leeches—and to anodyne ene- mata. Each of these remedies is of great value, and sometimes not the least so is the latter. From the extreme irritability of the stomach, we are often precluded from all administrations by it, and even when otherwise, I think in this mode it is most effica- cious. Give opium itself when spasm is to be resolved, as pre- ferable to all its preparations, excepting, perhaps, the Dover's powder. The dose should be large, and sometimes enormous, which is always well borne, where pain is excessive. I once attended a lady who suffered such agony from the irritation of gall stones, that she gradually in a long attack, came to take of laudanum, a wine-glassful several times in the twenty-four hours. There are cases in which a resort to tobacco enemata would be perfectly justified. Emetics have been used with the same intention. Darwin tells us that in two instances he saw a very large number of cal- culi voided soon after the operation of vomiting, and similar facts are to be met with in other writers. With regard to emetics, however, their use must necessarily be precarious and doubtful, to the expulsion of calculi, for which, they are most commonly directed. Calculi are found of various sizes, from that of a small granule to a hen's-egg, or even larger. The stone being so great as not to pass through the duct, vomit- ing obviously must be mischievous,—and it is utterly impossible to ascertain its dimensions. We can do no more here than to be governed by the symptoms. Much pain, fever, and general ex- citement existing, emetics are to be avoided. But under any circumstances, I would prefer the ipecacuanha, the tartarized antimony, or the tobacco as an injection. When relieved of this urgent affection, the case next calls for the means which are supposed by many to have the power of dissolving or otherwise destroying biliary concretions. But I ICTERUS, OR JAUNDICE. 363 believe they operate on no such principle, and it is not easy to explain their efficacy. Be their modus operandi, however, as it may, experience has taught that some of them are useful. Ether and the spirit of turpentine mixed, had once a high repu- tation, though now little or not at all employed. Ever having done good, I suspect, it was by their carminative or antispas- modic powers, and not from any efficacy as a solvent or deob- struent. Combinations of the alkalies, in the mild as well as the caustic state, have also long claimed, and perhaps justly, much attention. They are variously administered, though a very com- mon shape, is that of castile soap. Equal portions of it, rhubarb and aloes, with or without calomel, I have often known to be effectual. The common potash mixture, prepared agreeably to the annexed formula, is likewise serviceable, in a table-spoonful dose occasionally.* But incomparably the best preparation which I have ever tried is the following popular nostrum.! As long as I have had any connection with the profession, has its reputation been familiar to me, and I could relate many astonish- ing cures by it, even where every thing else had utterly failed. Whence it originated, no one seems to have known, and it was commonly ascribed to some old woman. But I have lately ascertained, that it is the prescription of a regular practitioner of the state of Delaware, communicated to the Medical Repository, a Journal of New York, as early as the year 1798. Many articles which must act in a very different mode from the alkaline remedies are entitled to confidence, among which are the acids, mineral as well as vegetable. Cider or lemonade I have known to be serviceable, though the sulphuric or nitric, or nitro-muriatic acid is more prescribed. As a general rule, how- ever, the treatment consists principally in keeping up a pretty constant impression on the primae viae by purgatives, with which view, the pill or the syrup of the butternut, is well entitled to notice.J * R.—Potassae Carbonas, Gum arab. 5a 3j.; Tinct. theb. gtt. xxx.; 01. menth. gtt. x.;Aq. font. §iv. .. , . + R.—Carbonas potassse gj.; Sapon. Hispan., Gum arab. aa gss.; Alcohol. dilut ib. To be frequently stirred, so that the ingredients may be well mixed and dissolved, which will require several days. The dose is half a wine-glass- ful to be taken for three successive mornings, fasting, and, if not relieved, omit it for one day, and then recur to the same mode. $ The Juglans Cathartica of Michaux. 364 ICTERUS, OR JAUNDICE. Next, when the case does not give way, an alterative course of mercury should be resorted to, which proving inappropriate or useless, the nitro-muriatic acid exhibited internally, as well as applied externally, by frictions or a pediluvium, may succeed. It is at this juncture, that the taraxacum too, is much trusted to, by some practitioners, and colchicum has lately acquired some repute. The reverse, however, in a degree of this plan of management, is recommended, consisting alone in the narcotics, as cicuta, hyoscyamus, belladonna, the prussic acid, &c. To alleviate spas- modic pain, or to quiet irritation, though perhaps, they may be more extensively useful, I give opiates, and for no other purpose resort to narcotics, believing that these are the chief purposes which they are capable of fulfilling at this stage of the disease. It may, however, be proper to mention, that independently of other evidence, several of the New England physicians have be- stowed the strongest commendations on cicuta especially, among whom are the distinguished names of Jackson, Bigelow, Fisher, and Thacher. "When," says the last of these writers, "the dose is gradually increased, until its effects are distinctly felt in the head, the yellowness of the skin and eyes, in most instances, begins to disappear by the second day, and the disease is soon removed." Whatever it may be, surely this is an exaggerated account of its efficacy. Of the icteric cases, dependent on disorganized conditions of the liver, and other structures, I shall here say nothing. These being merely effects of another disease, the cure can only be accom- plished by its removal, to point out the treatment of which, is alien to my present design. Little more, therefore, remains to suggest as to the management of icterus, than that advantage is sometimes derived from the use of those mineral waters, which are found appropriate to the other hepatic or gastro-enteric de- rangements. Even a journey to the springs, and particularly when taken on horseback, is occasionally useful, not probably, as is generally imagined, so much by dislodging calculi, as in- vigorating the primae viae, or the secretory action of the liver. It is on the same principle, that electricity, and galvanism, have been applied to the cure of these cases, with however, no utility. Too much, is usually done in the treatment of this disease. As long as the sallowness of the surface endures, it is thought by ICTERUS, OR JAUNDICE. 365 many practitioners, and always by the patient, that there is occa- sion for the continuance of active remedies. But this colour of the skin, merely an effect, over which, we have little control, often continues long after the cause of it has ceased to operate, and when unconnected with positive disease, may be disregarded, or left to the natural, or recuperative powers to remove. From an opposite course, harassing the system, and especially the primae viae, by such measures, I have certainly seen a very serious detriment to health induced, and in some instances permanent and invincible injury. Convalescence is more effectually pro- moted by a duly regulated regimen, very similar to that in dys- pepsia, and by the moderate use of the vegetable bitters, or mineral tonics, particularly the mildest of the martial prepara- tions, so united with rhubarb as to obviate costiveness. An op- pression in the region of the duodenum, is not unfrequently felt an hour or more after a meal, owing perhaps, to an accumula- tion of food from torpor of that intestine, to relieve which a couple of ounces of the infusion of senna and gentian, in the proportion of two drachms of the former to a drachm of the latter in a pint of boiling water, has been recommended very strongly. But I have found the dinner-pill preferable. As to the more inveterate forms of the disease, the green or black jaundice, it is confessed by Baillie, the highest authority on the subject, and which seems to correspond with common expe- rience, that they are nearly intractable, no permanent salutary effect being made on them by any ascertained means. Mercury has very little influence. " The kind of induration," he tells us, " which attends the disease, is not affected by it in the same manner as those indurations of the liver usually are, which sometimes accompany yellow jaundice. Mercury, however, will sometimes alleviate for a time the uncomfortable feelings of the patient, and induce him to think he is getting better, without in- ducing any substantial benefit. The daily use of neutral salts in small doses, has appeared occasionally to have been of some advantage, but of all the cases of green jaundice, which have fallen under my notice, I recollect two only which recovered. An icterose predisposition being established and which is gene- rally laid by an attack of any severity, a speedy relapse, or more remote recurrences of the disease, are very apt to take place. To guard against these is an important consideration, as the consti- 3V 366 ICTERUS, OR JAUNDICE. tution, thus repeatedly assailed, becomes disordered, and ulti- mately a train of morbid consequences arises of the most fatal import. It will be well studiously to avoid all the exciting causes, and which are chiefly embraced in want of attention to the bowels, inappropriote clothing, indiscretions in diet, including stimulating drinks, exposure to the fluctuations of weather,— inordinate exercise, or the reverse, habits of indolence, the indul- gence of intemperate passions, or the cherishing of anxieties, or carking cares. This is a prophylactic precept, which should always be inculcated, and strictly observed. ON SOME OF THE DISEASES OF THE SPLEEN. SPLENITIS. An acute inflammation of the spleen originating in the viscus itself, as a mere phlegmasia, or independently of fever, is so rare an event, that I am not aware it has ever come under my observa- tion, and the same is said by Abercrombie, whose experience is ample. Cases supposed at first to be of this nature, I have uni- formly found to turn out to be engorgement of the organ, or phlo- gosis of its integuments, or of the left lobe of the liver. Yet 1 do not deny the occasional existence of the affection, as well on ac- count of the probability of its occurrence, as that several authen- ticated cases of it having been lately reported. The inflammation, I have said, may be seated in the mem- branous coverings, or in the substance of the spleen. These con- sist of the peritoneal coat and of a soft fibrous capsule, the former of which is more frequently affected than either of the other varieties.* Neither this, nor phlogosis of the capsule, is the con- dition, however, to which I allude,—splenitis, as usually under- stood, being seated in the parenchymatous portion. Not having witnessed a well ascertained case of it, my remarks on it will be short, and of course, entirely borrowed. * "I have repeatedly seen," says Abercrombie, " the spleen in a thick dense covering of false membrane in connection with peritonitis, without any disease of its substance," &c. 368 SPLENITIS. By the disciples of the school of Stahl, who claimed a peculiar attention to the disease, it is affirmed, that an attack is ushered in with singularly violent rigors, succeeded by intense heat, intolerable thirst, sometimes delirium, or even phrenzy, great dyspnoea, the pulse of the correspondent side sometimes partially suppressed, often intermittent, weak, and not quick or irritated, the whole returning in quartan paroxysms, and ending most com- monly by resolution, affected by epistaxis from the left nostril, or by copious haemorrhage, from the viscus itself. This is partly a fancy sketch, and the case with greater proba- bility is now described, as coming on with the ordinary phe- nomena of pyrexia, chills and flushes, soon followed by anxiety and straitness about the praecordia, some difficulty of respiration, and dry cough,—tension, and pain in the left hypochondrium, of a pungent, pulsatory, or burning character, increased by pressure, sometimes pervading the whole abdomen, shooting through the diaphragm up to the left shoulder,—nausea, or violent vomitings, some cerebral disturbance evinced by giddiness, especially when the head is raised, or distressing aching of it. Continuing thus for a time, fever becomes more clearly evolved, with a full, and irregular pulse, slow, hobbling or even intermittent, in some in- stances attended by haemorrhage from the nasal or haemorrhoidal vessels, or those of the stomach or bowels, or, perhaps, the spleen itself, the blood which is dark, being discharged in the latter in- stances, by puking or purging, or both, and the skin occasionally a lemon or orange or saturnine hue. These symptoms, however, —the abdominal haemorrhages, and change of complexion, are not frequent occurrences in acute splenitis. Of the etiology of the disease, I have only to remark, that it is represented to be the same, or nearly so, as of acute hepatitis. But while originating in miasmatic influence as a common source, either directly, or through the medium of fevers, I am persuaded, that the cold stage of intermittents, and especially of a malignant character, lays the foundation of this, and most other affections of the spleen. From all that I have observed, 1 can scarcely doubt its being nearly always engorged at this period;—and it is not to be conceived, that such an anormal condition could be repeated, as it is in each paroxysm, without leading to some positive derange- ment, of more or less severity. It is hence, that we find splenitic lesions so constantly in connection with fevers of the kind. Further SPLENITIS. 369 particulars in which the etiology of the disease of the two organs vary, will be subsequently indicated. Between acute splenitis, and hepatitis, there must be so close a similitude, as not always to be readily distinguished. The posi- tion of the pain, the sallowness of the skin, which is deeper, and more common in the latter, and the appearance of the stools, are the most characteristic signs of hepatitis, and where these are wanting, the presumption is, that the other viscus is affected. But this is a very imperfect diagnosis, and I scarcely know how to improve it. There is no pathognomic symptom of splenitis. The lesions of many of the viscera simulate it. But by pursu- ing the same course as in hepatitis, we may negatively arrive at a pretty satisfactory conclusion. Collect and compare the symp- toms of the different organs, and see which preponderates. Ceteris paribus, I should presume, an inflamed spleen to be less formidable than an inflamed liver, and the grounds of prognostication essentially the same. Not a little extraordinary is it that its affections should so often prove alarming, seeing its apparently trivial importance in the animal economy. From remote antiquity, to the present day, we have accounts of the spleen having been removed by acci- dent or design, without any very serious inconvenience, or detri- ment to health, even in the human species. Distrustful as we may be of these, the fact in relation to animals, is indisputable. By several of the older writers, are such experiments reported, and lately, we have heard that on a repetition of them, at Paris, out of forty dogs selected for the purpose, one half recovered per- fectly in a short time,—the residue perishing from abdominal in- flammation. During convalescence, they ate and drank, as usual, digested well, nor were any of the functions appreciably disordered. The ultimate result of these cases, or what became of them, I am not informed. It is also curious, though the vessels were not tied, no haemorrhage ensued. Nothing more was done than merely closing the external wound. Examined post-mortem, a very usual appearance is said to be phlogosis of the peritoneal covering, with extravasation of lymph, and false adhesions to the neighbouring parts. The fibrous cap- sule is more rarely affected, and its changes vaguely noticed Generally, the viscus itself is of a darkish gray, or brownish red colour,-seems swollen, and may be enlarged to various dimen- 370 SPLENITIS. sions. Cut into, its texture is found charged with sanies, or black dissolved blood, or in rarer instances, with pus infiltrated, or col- lected in a series of small, or in one or more large abscesses, or its parenchyma, very friable or pultaceous, or quite deliquescent. It is this condition, I suspect, which has sometimes been mistaken for gangrene, though, perhaps, such may really take place. As not without interest, I may add that Smith, a late writer, affirms, that the spleen in fever, particularly low fever, is very constantly to be met with materially altered in its aspect, and deranged in structure, its natural purple colour converted into a deeper and darker tint, and its substance on the slightest touch, breaking down into an almost fluid mass. Louis has made pretty nearly the same report, or that out of forty-six cases of typhoid fever, which he examined, in four only, was the spleen unaffected. Three-eighths of the cases exhibited merely an enlargement of the viscus to thrice its natural size, three-fourths softenings,—a fifth part of which to such a degree, as to be readily reduced to a pulp. The observations of Tweedie, are to a similar effect, and Wardrop, Pearson, Vetch, Dawson, and the other historians of the Walcheren fever, state, that the spleen was usually found in- creased, weighing from three to five pounds, seeming to be a mere sack, filled with a fluid resembling tar. Excepting the single remark, that there is much reason to be- lieve, that inflammation of the serous envelope of the organ may exist independently of splenitis proper, and is frequently mistaken for it, I have nothing further to say of the pathology of the affec- tion. This of course, must be similar to that of the phlegmasia generally, of the viscera, modified only, by peculiarity of structure. For the treatment, I may be content also, with a reference to my observation on acute hepatitis,—the same remedies, regulated by the same principles, having nearly a common applicability to the two cases. The only exception, perhaps, regards the use of mercury, which, from the texture of the spleen, cannot be urged as freely in its affections. Great caution, indeed, is required here in the administration of the article, the object being to attain its alterative influence,—carefully avoiding salivation, which is in- variably mischievous by breaking down as it were, the organiza- tion of the viscus. Being less apt to produce inordinate effects, the blue pill, in small doses, should always be preferred. CHRONIC SPLENITIS. 371 CHRONIC SPLENITIS. Even those who are incredulous of the existence of acute, do not doubt that the spleen is liable to sub-acute or chronic phlo- gosis. The difference in this respect admits of an explanation. Endowed with little sensibility, those circumstances by which inflammation is readily excited in more susceptible parts, here operate slowly, and seldom or never with intensity. This, in the outline, does not vary materially from the acute form of the disease. With a disturbed circulation, rather than well defined fever, we have an uneasy, dull, tensive sensation in the part affected, with a constant drawing downwards in the erect posture, or when lying on the right side, towards that direction. Darting pains are occasionally felt over the abdomen, and there is a pretty constant ache under the left scalpula. The belly is more or less tumid, and renitent, even where no effusion has taken place,—the bowels costive or irregularly open, the stools of an unnatural, dark colour, and consistence, with scanty urine. Digestion is feeble, the appetite bad, and the tongue loaded. Dyspnoea often exists, with dry spasmodic cough. The difficulty of breathing, indeed, is sometimes attended by great anguish, and even a sense of impending suffocation. There are occasionally headache, hebitude of the senses, and emphatically splenetic humours. As gloom and melancholy were ascribed by the ancients to the right, so were petulance and waywardness to the left hypo- chondriac. Though we, perhaps, do not now observe this nicety of distinction, the general fact, of the mind being usually much disordered, with proneness to dejection of spirits, or peevishness, or sullenness of temper in these visceral diseases is universally confessed. Blackmore the poet, who having been also a phy- sician, is of higher authority, declares that: " The spleen with sullen vapours clouds the brain, And binds the spirits in its heavy chain. Howe'er the cause fantastic may appear, The effect is real, and the pain sincere." Gradually the external integuments become soft and inelastic, and the complexion leaden, with a still darker line under the eyes, 372 chronic splenitis. and often the various shades of sallowness exist even to the icte- rose complexion. Debility and listlessness are complained of, and sooner or later, dropsy usually appears, beginning with oedema of the ankles, which progressively spreads,—then ascites, and possi- bly hvdrothorax, or perhaps a copious haemorrhage ensues of dark blood, which either relieves or proves fatal. But though such is its more usual aspect and terminations, it sometimes ex- hibits greater activity of character—ending in suppuration. The symptoms of the latter are, for the most part, very obscure, some- times taking place without any indications whatever,—and rarely characteristic of such an occurrence. An increase of emaciation, with hectic fever, are the common results. This and every other affection of the spleen, the chronic more conspicuously, are found to abound in the same localities, as those of the liver. The chief difference indeed, seems to consist in the former requiring for their development, rather an excess of mois- ture than heat, while the latter are promoted by a high temper- ature alone. Disorders of the spleen of every description are hence endemic to the humid districts of Italy, Spain, France, Holland, the British Isles, India, South America, the United States, and probably, every portion of the world, combining this quality with even a moderate degree of heat. An actual examination will enable us, for the most part, inde- pendently of symptoms, to pronounce the spleen to be affected, even when it is moderately enlarged. I am aware that this has lately been denied by Piorry, of France, who alleges that, on the contrary, it is very often impossible to do it by the touch, though it be of considerable magnitude, owing to its ascending upwards towards the diaphragm, instead of descending below the ribs. But really, it seems to me that this objection is very futile, not at all confirmed by practical experience, and that, perhaps, he was induced to raise it to afford an occasion of recommending per- cussion, to which he is devoted, and especially his pleximeter, an instrument invented by him for the purpose. Granting that the organ may be sometimes in the state he describes it, I should still be very distrustful of the power of such a process to elicit any distinct information of the nature and condition of the case. Be the mass in the cavity of the abdomen whatever it might be, the left lobe of the liver, the kidney, which has been known to rise up, quite out of its normal position, a thickening of the omentum, CHRONIC SPLENITIS. 373 or any adventitious tumour, the sounds in all these instances, must be the same, or so much so, as to prove vague and indis- criminative. Nevertheless, in some instances the spleen is so reduced in its dimensions as not to be felt, and when otherwise, it is difficult and sometimes utterly impracticable, to determine the precise lesion. Being enlarged, all such states are betrayed by nearly the same symptoms. It may, however, be remarked, that when its investing tissues are concerned, the pain is more sharp or lan- cinating, the tenderness greater, the entire sensation more super- ficial, with a quicker and harder pulse than in the derangements of the parenchymatous structure. Let the facts be also remem- bered, that the fibrous capsule especially, as well as the nerves, are liable to a species of rheumatic, arthritic, or neuralgic irritation which may be mistaken for inflammation. Of the other organs, the sufferings of the liver have the closest resemblance to those of the spleen, between which the prominent differences were formerly pointed out. Chronic splenitis is usually less serious than a correspondent affection of the liver. Even when unable to remove the affec- tion entirely, it has on the reduction of the phlogosis, remained without great inconvenience for many years. Generally, how- ever, such cases are curable,—though some of them baffle all our efforts. Disorganizations here, have taken place. From the manner in which an abscess ruptures much may be learned as to the probable result of the case. The matter may find its way out externally, or through the parietes of the abdo- men, over the spleen, or pass out by the umbilicus,* or be dis- charged into the peritoneal cavity, or into the intestines, large or small, or into the stomach, and even into the thorax. Examples of all these modes are to be met with in our medical records. Which of them is the most favourable or the reverse, can readily be determined, after my remarks on the same, or nearly the same events in regard to the liver. Those anatomical phenomena proper to a chronically inflamed state of the organ, are very much diversified, and adding such as appertain to other pathological conditions of it, which from the want of the power of discrimination, is usually done, they become * Abercrombie. 32 374 CHRONIC SPLENITIS. infinitely varied, and multiplied. The appearances that first oc- casionally attract attention, are the changes on the surface of the spleen,—the deposition of lymph, and false adhesions with the adjacent parts,—or its peritoneal coat, thickened or otherwise degenerated. As in acute splenitis, we are without any precise information of the lesions of the fibrous capsules. It has, how- ever, been found affected, though seldom,—softened even to dif- fluence, or on the contrary, hardened, smooth, and polished. Great alterations are incident to the substance of the viscus itself. The spleen may be prodigiously augmented, filling up nearly the whole cavity of the abdomen. Good quotes a case of its weighing ninety-three pounds, which no doubt is an exag- geration. Bonet and Sauvages, each, however, tell us of one, of more than a third of this weight. We are assured by Abercrom- bie, that he has seen it often, of twelve times its natural size. Greatly overgrown,—I have met with it, though not to such an enormous extent. There is in some of these cases, merely hyper- trophy, or without much change of structure. But it may be otherwise. An instance, is mentioned in the Transactions of the Academy of Sciences, of France, which contained thirty pounds of purulent matter, and another in the same work, where eight pounds were drawn off by tapping. The next day on the death of the patient, a sac was found eighteen inches long, and twelve broad, and within it seven pounds more of pus. Besides the states of enlargement, or extensive abscesses, on other occasions, we meet with pus infiltrated through the sub- stance of the spleen, or mixed with blood, in the cells, or accu- mulated in small pouches, or the organ is so soft, as to be diffluent, or like a black pultaceous mass of blood, or as affirmed, may be really gangrenous or melanotic. Conversely, we find it indurated, or scirrhosified, or converted partially into a sort of cartilaginous, or osseous, or stony degeneration. The latter are rare, though certainly sometimes occurring, since Morgagni uses the phrase in relation to this state of the spleen, "ossea lapidum." More frequently we see it tuberculated or infested with hyda- tids, or extremely reduced in size, even so shrivelled away as hardly to be recognized. I have seen it in several instances, not weighing more than three or four ounces, and Littre has given a case of only an ounce and a half. No pathological discussion can be required here, after what was said on the correspondent condition of the liver. CHRONIC SPLENITIS. 375 As it is only in the more simple of these affections, where per- haps, chronic phlogosis alone, or mixed with congestion, exists, without any material structural deviations, that we can hope to be of much service, the treatment maybe very summarily stated. The remedies consist of venesection, repeated as circumstances shall require, the frequent application of cups or leeches, and ultimately a succession of blisters or an issue over the affected part. Evacuations of the bowels by calomel, and its usual com- binations, are next highly useful. Cruveilhier has lately corroborated by his testimony the ex- perience of his predecessors, as to the decided efficacy of active and continued purging under these circumstances. This having been carried sufficiently far, not a little is urged in favour of a union of purgatives and tonics, as an infusion of senna and gen- tian. Yet more is alleged of the " Bengal Spleen powder," or a mixture composed of rhubarb, jalap, scammony, and cream of tartar, with columbo, and the sulphate of iron, taken three times a day, in such doses as to keep up regular, though moderate, evacuations. Cures are declared to be wrought by this treat- ment, in fifteen or twenty days. Combinations of aloes and steel are also strenuously recommended. Of late the importance of inducing haemorrhois is insisted on, and it is, perhaps, to the irritation from the drastic articles on the lower bowels, that their efficacy is to be ascribed. But with the same intention would not repeated applications of leeches around the anus prove far more decisive ? Emetics have by some practitioners been advised in the absence of inflammation, to excite the torpid viscus, and we learn from a respectable source,* that vomiting occasionally induced by a cataplasm of tobacco to the side, has, in some instances, been eminently efficacious. Of this practice I have no experience. Certain deobstruents, as the taraxacum particularly, are entitled to more confidence. But it is to an alterative course of mercury that we are mainly to trust, on the failure of the preceding mea- sures Contrary however to what I had considered an estab- lished practice, the following language is held by Abercrombie on this point: " It is now generally admitted," says he, "that in the treatment of enlarged spleen, mercury is uniformly, and highly * Stedman. 376 ENGORGEMENT OF THE SPLEEN. injurious, producing mortification of the mouth and rapid failure of strength." Twining, as well several other of the late writers, certainly hold the same language. But Cullen, Good, Thomas, Pemberton, &c, maintain the reverse, and assimilate the treat- ment of the splenitic, very much to that in the hepatic affections. Nor does Annesley, one of our most recent and respected author- ities, who practised long and extensively in India, pursue a differ- ent course. Concisely stated, his practice is to give a large dose of calomel three or four times, on alternate nights, to be worked off the next morning, and then the blue pill with aloes and myrrh. Not improbable, I think, where mercury has proved so detrimen- tal as represented by some, certain states of congestion hereafter to be indicated, were mistaken for inflammation, it being very apt to operate in this way, under such circumstances, or that it was abused. Easily may mischief be avoided by a due regula- tion of it, and when appropriately applied, I am persuaded, it will prove as safe, as it is affirmed to be efficacious by the long, ample, and constant experience of the practitioners of this country. Let me however, repeat an admonition which I suggested on a recent occasion, that the blue pill should here also be preferred, as not so apt to affect the constitution severely. Nitro-muriatic acid is favourably spoken of by some, and, perhaps, the preparations of iodine may be deserving of trial,— though they have not much of my confidence. ENGORGEMENT OF TPIE SPLEEN. Considering its structure, which is essentially cellular, and still more the sluggishness of its circulation, we should a priori, be led to conclude, that in a greater degree than any other organ, the spleen might be exposed to oppressive congestions, and such is the fact. An hypothesis was, indeed, advanced by Heister, and after- wards very ingeniously maintained by the late Professor Rush, which alleged, that in the more vehement commotions of the system, the spleen serves as a diverticulum to the general circu- lation, by accumulating within itself a large portion of blood. Confirmatory, perhaps, of this conjecture, it is stated by Andral, that in some of those excruciating experiments on animals, by ENGORGEMENT OF THE SPLEEN. 377 the French physiologists, productive of great disturbances in the circulation, heavy engorgements of the spleen were often ob- served. As to the salutary tendency of the design in the preven- tion of vascular lesions, as supposed by Dr. Rush, whatever view may be entertained of it, I think, on the whole, there can be little doubt of the occurrence itself, under different circumstances. The symptoms of this congestive condition are, in some in- stances, so analogous to those ascribed to splenitis, that I might almost be satisfied with a reference to the preceding account of the latter. That the two cases have often been confounded, I am strongly inclined to suspect, and, perhaps, we should be safe in affirming that in all recent attacks of the spleen itself, different as may be the ultimate issue, engorgement is the primary state, which by continuance, may lead to inflammation, and its diverse degenerations. There is in each condition, with the same sense of tenderness, and painful distension in the left hypochondrium, dull or lancinat- ing pains, in various directions,—precordial uneasiness, difficult respiration, wildness and distraction, and a full, active, or slow and irregular pulse. The distress may, indeed, be so extreme, as to amount to agony, and were not relief promptly afforded, life would be extinguished. As long ago as 1805, my attention was attracted to this affec- tion, by a tremendous attack of it, which came under my care. The case, which will illustrate the severest form of the disease, was that of a young married woman, who becoming fatigued by long standing at the launch of a ship-having previously walked a considerable distance, in extremely hot weather, was suddenly seized with a sense of great fulness, and tension of the left side, as if it were bursting-embarrassed respiration,menacing suffo- cation -livid countenance, distraction of mind, protuberant eyes, cold skin, and a feeble hurried pulse, with altogether the most alarming appearances. An examination of the side, left no doubt as to the nature of the affection, and in the manner presently to be detailed, she was relieved. The spleen being ruptured, which sometimes happens there is an immediate failure in the vital forces,-the pulse sinks, the skin becomes cold, and collapsed, with extreme anxiety, precordial, or epigastric oppression, and retchings or vomitings. Commonly we meet with this aggravated affection, m the cold 32* 378 ENGORGEMENT OF THE SPLEEN. stage of malignant fevers, particularly of intermittents,—and I have repeatedly seen it as the only symptom of the paroxysm. On other occasions it is brought on by a collapse from cold, or the exhaustion of heat. Twice I have witnessed it from an immer- sion in a common cold bath, and in one instance, by that of the Yellow Springs of this vicinity, the water of which, is of an ex- ceedingly low temperature. Not uncommonly does it proceed from the exhaustion of long exposures to our summer heat, and particularly, among our labouring people. Extraordinary exer- tion of any kind, by running, leaping, &c, may induce it, and I once knew it to follow the fatigue of standing in one position for a length of time, the details of which case I have just given. But usually it is brought on more slowly, by the gradual operation of miasmata, and though sometimes, under such circumstances, it attains to a considerable height, it is mostly of less severity. The suddenness of the attack, the peculiarity of the pulse, and the absence of fever, are the chief circumstances which distinguish it from splenitis. For the most part, it is curable, and rarely proves otherwise, except an extravasation of blood takes place in excess, or the spleen itself is ruptured, or where it is an incident to pernicious intermittents, or other malignant diseases, in extremely depressed systems. Even in the worst of these cases, that of rupture, re- coveries may possibly take place, as cicatrices have been detected from lesions of the kind. An autopsic inspection exhibits, sometimes, the highest possi- ble grade of engorgement. Cruveilhier, however, tells us, that he has also remarked large deposits of blood in the substance of the organ, with all the other phenomena of apoplexy of the brain, lungs, or liver. These occurred in intermittents, and in horses from violent efforts. Bailly, the French writer, gives moreover two cases of a like nature, in intermittent fever. When the sub- stance of the viscus is lacerated, the rent may be very trivial, or considerable, and of different figures or shapes. Great effusions of blood are observable, though sometimes slight, clotted, or more fluid. As elucidatory of the whole of this pathological condition, it will suffice to remark, that it essentially consists in congestion, which however may depend on an active or forcible concentra- tion of blood in the viscus, or in an exhaustion of those powers of reaction by which an equipoise in the circulation is restored. CHRONIC CONGESTION OF THE SPLEEN. 379 Nothing can be more simple than the management of this af- fection in a vigorous constitution. The remedies are copious venesection, topical bleeding, by cups in preference to leeches, as more expiditious,—then blistering and active purging with calomel, and those articles which quicken its operation. This is the course to be pursued in such attacks. Coming on however, in certain enfeebled states of the system, the case is to be man- aged more cautiously. Not more shall I now say in regard to this point, than that a practice consisting of a simultaneous em- ployment of sanguineous depletion by cups, with stimulants, tonics, and revellents, proves the most efficient. It is here that the sulphate of quinine has acquired the highest repute. But to be effectual it must be very liberally administered. As usually given it is entirely nugatory. Five or ten grains may be directed at once, to be repeated in an hour, in great emergencies, and I have heard of doses of double, treble, or quadruple, and even to the amount of a drachm. The quinine has hitherto been chiefly, or perhaps exclusively, used in cases dependent on miasmatic influence. But, though better adapted to these, I can discover no reason why it should not be applicable to the other form of the disease, where tonics are proper. I must not omit to mention that opium is a very important adjunct in the man- agement of such congestions, and especially when of the former character. It operates by exciting a reaction, which removes the concentrations of blood. Combined with the quinine, I have found it to be an excellent practice. But I cannot forbear pro- testing against the exorbitant use of either of these articles. Never have I met with an occasion where I thought it warrant- able, and in regard to the quinine, I know of the most fatal con- sequences from it. Cerebral and nervous distress, very alarming, is common,—apoplexy, palsy, and blindness, do happen,—and lately reports have reached us from Paris, of sudden death in several instances from a drachm dose of this medicine. CHRONIC CONGESTION OF THE SPLEEN. Between this and chronic splenitis, much similarity prevails in their external physiognomy. Carefully examined, however, it will be perceived that in the former, there is more sense of weight 380 CHRONIC CONGESTION OF THE SPLEEN. and oppression in the spleen, little or no sensibility on pressure, greater sluggishness of the circulation, and liability to hemorrha- gic and hydropic effusions. Examples of the latter coming within my own knowledge, where gallons of blood were lost by vomiting and purging, were, I suspect, of this nature. Commonly, how- ever, we meet with congestion of this organ in a mitigated degree, denominated splenicula. But as this title is a diminutive of sple- nitis, it has been unhappily selected, or inaptly applied, conveying as it does, an erroneous impression of the pathological condition. The case I have now in view is known by the vulgar appella- tion of ague cake. It is of slow formation, nor in its beginning, progress, or at its height, may it be marked by any decided local or constitutional disturbance. An enlargement of the spleen, is obvious,—some inconvenience will be complained of, from the weight or uneasiness excited by exercise, with short and hurried breathing,—and these are the chief inconveniences experienced —the general health being tolerably well preserved. In other instances, however, it is very much the reverse, or with constant pain in the part, pretty acute or of a graver description, we have sometimes recurrences of paroxysms of intermittents, or more permanent febrile irritation, ordinarily exacerbated at night, ending in colliquative perspiration, attended by change of colour of the skin, pale, or of the various shades of yellow, or of a saturnine hue—impeded respiration, and short convulsive cough—haemor- rhage occasionally, or dropsy, or diarrhea,—emaciation, con- cealed partly by bloatedness, extreme languor, and disinclination to motion,—dejection of spirits, fretfulness of temper, and torpor of mind. Even still more inveterate and alarming states of it, indicative of far greater depravations of the system, are presented, and par- ticularly when occurring among the poor and destitute, ill fed, ill clothed, and ill lodged, with drunken and other bad habits. Not uncommonly have we, under such circumstances, the strong- est evidence of a universal cachexy of the solids and fluids. Nu- trition in all its series of operations, seems defective, or nearly suspended. There is neither digestion, nor assimilation,—the aspect is strikingly anemic, or of a deadly white, the tendency to hemorrhage, or serous effusions, or both, very great and some- times to a fearful extent. The hemorrhagic disposition is, in- deed, so considerable, that copious flows of blood take place from CHRONIC CONGESTION OF THE SPLEEN. 381 the most trivial injuries, as a slight cut, or scratch of a pin, or the bite of a leech, &c. The blood, however it may escape, is uni- formly dark, and very thin, or if a coagulum forms, which is seldom, it is black and soft, denoting an imperfect decarboniza- tion, as might be presumed from the disturbance of respiration incident to these cases. Gangrenous or foul sloughing ulcers, appear in different parts of the body, difficult or impossible to heal,—and I have seen the same description in the mouth, or lips, or gums, which we are told have in some other instances led to an exfoliation of the jaw, and loss of the teeth. No disease, in short, produces a more general distemperature than some of these splenitic affections. In all their diversities, they abound in damp, miasmatic dis- tricts, and occur especially in young persons, who are partially acclimated, without any antecedent disease. But under other circumstances, they are more frequently the result of autumnal fever,—mostly ill cured intermittents, neglected, or improperly managed. From the description I have given of these acute and chronic congestions, I think they need not be confounded with each other, or any of the diseases of the spleen or other organs, and I shall therefore, forbear to waste time by enumerating the signs of discrimination. Nor can it be required of me to note with any particularity, the indications by which our decision of the event of a case is to be governed. Chronic congestion, when excessive, is alarming: whereas, the other or milder cases, are the contrary, and may not excite solicitude, unless by protraction the general dyscrasy noticed, has been induced. Cadaveric examinations, show in the extreme condition, an enormous distension of the spleen, so as sometimes to occupy a considerable portion of the abdominal cavity, very friable, or softened, or even diffluent, resembling black concrete or fluid blood. It has, indeed, been compared to a large clot of blood wrapt in a thin membrane. But in more moderate cases, with various gradations of these states, there is induration of parts of the spleen with several of those other degenerations, or adventi- tious products, incident to chronic splenitis. Nothing more occurs to me to remark concerning the pathology of this form of the disease, than that, while mostly, it is of a purely congestive nature, it sometimes, from duration or otherwise, be- 382 CHRONIC CONGESTION OF THE SPLEEN. comes partially inflammatory, the two conditions, existing in diverse proportions, in different cases. Generally, we commence the cure of these cases in vigorous individuals, by moderate venesection, or preferably, by cupping, and by very active purging, again and again renewed, with those articles which operate on the lower bowels powerfully. Every one of experience seems agreed as to the propriety of the latter practice especially. Twining, who has written well on the sub- ject, having* seen much of the disease in India, strongly recom- mends the following mixture, which is a modification of the celebrated Bengal powder.* Excepting that mercury is less serviceable, and should be more cautiously directed, than in hepaticula, and that the martial pre- parations alone, or in unison with the sulphate of quinine, the latter of late greatly extolled, are of a wider applicability, and of greater utility in the splenitic lesion, I know not of any other peculiarity in the cure of the two affections. But there are some remedies among the native physicians of India, in such high repute, as perhaps, to deserve attention. Twining, especially, commends their efficacy. • They all seem to have garlic as the basis, and are employed after great freedom of purging, with which, the cure of such cases seems always to be commenced.t What is the value of these prescriptions, I know not myself. But independently of the respectable testimony in their behalf, we might presume from the activity of the ingredients, that they are not without efficacy. Garlic especially, is most grateful, and useful to the drunkard, who is so liable to splenitic derange- ments. Essentially the same regimen is proper here, as in the hepatic lesions, under the several diversities. The chief difference in- deed, regards the greater utility of certain modes of exercise in the chronic affections of the spleen, as by walking, riding on * R.—Pulv. jalap, Pulv. rhei, Pulv. columb., Pulv. zingib., Supertart. potass. 5a 3j.; Ferr. sulph.3iss.; Tinct. sennae, giv.; Aq.menth.3x.—M. The dose §jss. j- R.—Allium sativ. bulb. gr. xx.; Aloes, gr. vi.; Ferri sulph. gr. iv. These articles are to be made into pills, and taken every morning. R.—Allium sat. bulb.gviii.; Aloes, §i.; Alcohol dilut. rbij.—To be thoroughly digested, and from three to four drachms in an equal quantity of water, taken twice a day. On some occasions, vinegar is substituted in the place of brandy, and of this preparation, the same amount is directed. CHRONIC CONGESTION OF THE SPLEEN. 383 horseback, swingirg, and sailing, &c. These are very effectual in the dispersal of the torpid congestions of the viscus, and, there- fore, should never be neglected. Beneficial merely from the motion, swinging and sailing are still more so, when nausea, and vomiting are induced. I have known several instances of enor- mous spleens very speedily removed by sea sickness, and also, by that from swinging. As to diet, I have only to observe, that some of the writers of the East Indies declare, that milk is sin- gularly pernicious in the whole of the splenitic disorders, in what way, however, is not stated. This pernicious tendency I have not perceived, and whether it belongs generally to the article, or is confined to that of India, owing to peculiarity of climate, or to the food or management of cows, I will not say. It is satisfac- tory to learn, that though this condition sometimes leads to disas- trous results; it will in other instances endure for a great length of time, then spontaneously subside, and still more frequently yields to a change of residence exempt from miasmatic influence, or to the waters of some of our mineral, springs, the warm or hot springs of Virginia particularly, to which I am inclined to attach the more value, from the efficacy of the common vapour bath under similar circumstances. The latter, indeed, is a most valu- able resource. THE END. CYCLOPEDIA OP PRACTICAL MEDICINE. LEA AND BLANCHARD, PHILADELPHIA, WILL PUBLISH THE CYCLOPEDIA OF PRACTICAL MEDICINE; COMPRISING TREATISES ON THE NATURE AND TREATMENT OF DISEASES, MATERIA MEDICA AND THERAPEUTICS, MEDICAL JURISPRUDENCE, &c. &c. EDITED BY J* JOHN FORBES, M.D.,F.R.S. Physician in Ordinary to her Majesty's Household, &c. ALEXANDER TWEEDIE, M.D.,F.R.S. Physician to the London Fever Hospital, and to the Foundling Hospital, &c. • JOHN CONOLLY, M.D. Late Professor of Medicine in the London University, and Physician to the Hanwell Lunatic Asylum. &c. [ THOROUGHLY REVISED, WITH ADDITIONS, BY ROBLEY DUNGLISON, M.D. ■Professor of the Institutes of Medicine, &c. in the Jefferson Medical College, Philadelphia; Lecturer on Clinical Medicine, and Attending Physician at the Philadelphia Hospital; Secretary of the American Philosophical Society, &c. TERMS OF PUBLICATION. THE WORK WILL BE PRINTED WITH A NEW AND CLEAR TYPE, AND BE COMPRISED IN TWENTY-FOUR PARTS, AT FIFTY CENTS EACH, J± FORMING, WHEN COMPLETE, FOUR LARGE SUPER-ROYAL OCTAVO VOLUMES, EMBRACING OVER THREE THOUSAND UNUSUAL1Y LARGE PAGES, IN DOUBLE COLUMNS. Any person forwanling Twenty Dollars, free of postage, in Current Funds, will be entitled to two copies. The whole work will be completed during the year 1844. PUBLISHERS' NOTICE TO THE CYCLOPAEDIA OF PRACTICAL MEDICINE. This important work consists of a series of Original Essays upon all subjects of Medicine, contri- buted by no less than SIXTY-SEVEN of the most eminent practical Physicians of Great Britain and Ireland, and among them many of the Professors and Teachers in London, Edinburgh, Dublin and Glasgow, whose reputation conveys a high and just authority to their doctrines. Each subject has been treated by a writer of acknowledged eminence, whose particular studies have eminently fitted him for the task ; and all the articles are authenticated with the names of the authors. The Editors are men of elevated attainments, and in the undertaking have spared no personal pains; in the hope, by uniformity of plan, simplicity of arrangement, and the harmony and con- sistency of its several portions, to make the Cyclopaedia represent, fully and fairly, the state of PRACTICAL MEDICINE at the time of its appearance. From innumerable foreign and domestic sources, the scattered knowledge, which has so fast accumulated since the commencement of the present century, has been gathered together and placed at the command of every reader of the English language ; and whilst the great claims of the older cultivators of Medicine have never been forgotten, the labours of the moderns, and more particularly of the French, German, and Italian Pathologists, by which, conjointly with the efforts of British and American Practitioners, the whole face of Practical Medicine has been changed, have attracted the most diligent and thoughtful attention. The Editors affirm, that if the reader will take the trouble to inspect the mere titles of the articles contained in the work, comprising nearly THREE HUNDRED ORIGINAL ESSAYS of known and distinguished authors, and will bear in mind either the leading physiological divisions of disease, or consider them with reference to the Head, the Chest, the Abdomen, the Surface, or the gene- ral condition of the body, as well as the subjects of OBSTETRICAL MEDICINE, MATERIA MEDICA, or MEDICAL JURISPRUDENCE, he will sufficiently appreciate the care bestowed to make the Cyclopaedia satisfactory to all who refer to its pages, and, at the same time, strictly a book of practical reference. No subject, it is believed, immediately practical in its nature or application, has been omitted; although unnecessary disquisition has been, as much as possible, avoided. It entered consistently and properly into the plan of the Editors to admit a far wider range of subjects than appears heretofore to have been considered necessary in works written professedly on the Practice of Medicine, but a range comprising many new subjects of extreme importance to those engaged in practice, or preparing for it. Such are the subjects of ABSTINENCE {CONTAGION ^EXPLORATION OF! PROGNOSIS THE CHEST AND \ PULSE ABDOMEN SOFTENING GALVANISM {MESICAL STATISTICS HEREDITARY TRANS-? STETHOSCOPE MISSION OF DISEASE SUDDEN DEATH INDURATION \ SYMPTOMATOLOGY mRITATION \ TEMPERAMENT INFECTION \ TOXICOLOGY LATENT DISEASES TRANSFORMATION MALARIA AND MIASMA TRANSFUSION PERFORATION TUBERCLE PSEUDO-MORBID AP- VENTILATION PEARANCES \ MINERAL WATERS and those of various general articles on the pathology of organs. It will be found, too, that admirable articles from the best sources have been inserted on the important subjects of DISEASES OF WOMEN AND CHILDREN, AND OF MEDICAL JURISPRUDENCE. In order, however, that the nature and value of the work may be fully understood, a list of the articles, and the names of the contributors, is appended. The excellence of this work on every topic connected with Practical Medicine, has been admitted by all who have had the good fortune of being able to consult it. The hope, indeed, expressed by the Editors, has been amply realized — "That they have prepared a work required by the present wants of medical readers, acceptable to the profession in general, and so capable, by its arrangements, of admitting the progressive improvements of time, as long to continue what the general testimony of their medical brethren, as far as it has hitherto been expressed, has already pronounced it to be, «A STANDARD WORK ON THE PRACTICE OF MEDICINE." ACUPUNCTURE \ CONVALESCENCE AGE \ COUNTER-IRRITATION CHANGE OF AIR > CONGESTION AND DE- ANTIPHLOGISTIQ TERMINATION OF BLOOD DERIVATION DIETETICS DISINFECTION PHYSICAL EDUCATION ELECTRICITY ENDEMIC DISEASES EPIDEMICS EXPECTORATION REGIMEN ASPHYXIA AUSCULTATION BATHING BLOOD-LETTING MORBID STATES OF THE BLOOD CLIMATE COLD Such a work, it is believed, will be most acceptable to the members of the profession throughout the Union, as there exists, at this time, no publication on Practical Medicine, on the extended plan of the one now presented. To adapt it to the Practice of this country, and to thoroughly revise the various articles, the atten- tion of PROFESSOR DUNGLISON will be directed ; whose character and established reputation are a sure guarantee that his portion of the work will be carefully executed. CONTENTS OF, AND CONTRIBUTORS TO, THE CYCLOPEDIA OE PllACTICAL MEDICINE. Abdomen, Exploration of, Dr. Abortion.....Dr. Abscess......Dr. Abstinence.....Dr. Achor......Dr. Acne.......Dr. Acupuncture .... Dr. Age.......Dr. Air, Change of, . . . Dr. Alopecia.....Dr. Alteratives.....Dr. Amaurosis.....Dr. Amenorrhcea .... Dr. Anaemia......Dr. Anasarca.....Dr. Angina Pectoris . . . Dr. Anodynes.....Dr. Anthelmintics .... Dr. Antiphlogistic Regimen Dr. Antispasmodics . . . Dr. Aorta, Aneurism of, . Dr. Aphonia......Dr. Aphthae......Dr. Apoplexy, Cerebral, . Dr. Apoplexy, Pulmonary,. Dr. Arteritis......Dr. Artisans, Diseases of, . Dr. Ascites......Dr. Asphyxia.....Dr. Asthma......Dr. Astringents. . . . . Dr. Atrophy . . . . . . Dr. Auscultation .... Dr. Barbiers......Dr. Bathing......Dr. Beriberi......Dr. Blood, Morbid States of, Dr. Bloodletting .... Dr. Brain, Inflammation of, < pr' Bronchitis.....Dr. Bronchocele .... Dr. Bullce......Dr. Calculus.....Dr. Calculous Diseases . . Dr. Catalepsy.....Dr. Catarrh......Dr. Cathartics.....Dr. Chest, Exploration of, . Dr. Chicken Pox .... Dr. Chlorosis.....Dr. Cholera......Dr. Chorea......Dr. Climate......Dr. Cold.......Dr. Colic ...... JD£ Colica Pictonum . . . Dr. Coma......Dr. Combustion, Spontane- SDr ous Human, . . c Congestion of Blood . Dr. Constipation . . • 3Dr' Contagion.....Dr. Convalescence . • • vr. Convulsions .... Dr. Convulsions, Infantile . Dr. Convulsions, Puerperal Dr. Coryza......Dr. Forbes. Lee. Tweedie. M. Hall. Todd. Todd. Elliotson. ROOET. Clark. Todd. CONOLLT. Jacob. Locock. M. Hall. Darwall. Forbes. Whiting. A. T. Thomson. Barlow. A. T. Thomson. Hope. Robertson. Robertson. Cluttereuck. Townsend. Hope. Darwall. Darwall. Roget. Forbes. A. T. Thomson. Townsend. Forbes. Scott. Forbes. Scott. M. Hall. M. Hall. Quain. Adair Crawford. Williams. And. Crawford. Todd. Thos. Thomson. Cumin. Joy. Williams. A. T. Thomson. Forbes. Gregory. M. Hall. Brown. And. Crawford. Clark. Whiting. Whiting. Tweedie. Whiting. Adair Crawford. Apjohn. Barlow. Hastings. Streeten. Brown. Tweedie. Adair Crawford. Locock. Locock. Williams. Counter Irritation . . Dr. Croup......Dr. Cyanosis.....Dr. Cystitis......Dr. Delirium.....Dr. Delirium Tremens • . Dr. Dentition, Disorders of . Dr. Derivation.....Dr. Determination of Blood Dr. Diabetes.....Dr. Diaphoretics .... Dr. Diarrhoea . . . . ^ j)r' Dietetics.....Dr. Dilatation of the Heart . Dr. Disease......Dr. Disinfection .... Dr. Diuretics.....Dr. Dropsy......Dr. Dysentery.....Dr. Dysmenorrhcea . . . Dr. Dysphagia.....Dr. Dyspnoea.....Dr. Dysuria......Dr. Ecthyma.....Dr. Eczema......Dr. Education, Physical, . Dr. Electricity.....Dr. Elephantiasis Arabum . Dr. Elephantiasis Graecorum Dr. Emetics......Dr. Emmenagogues . . • Dr. Emphysema .... Dr. Emphysema of the Lungs Dr. Empyema ..... Dr. Endemic Diseases . . Dr. Enteritis......Dr. Ephelis......Dr. Epidemics.....Dr. Epilepsy......Dr. Epistaxis . . . • • Dr. Erethismus Mercurialis Dr. Erysipelas.....Dr. Erythema.....Dr. Expectorants .... Dr. Expectoration .... Dr. Favus......Dr. rDr. Feigned Diseases . . K Dr. CDr. Fever,General Doctrine of, Dr. " Continued, and its S J3r Modifications, £ " Typhus ... Dr. " Epidemic Gastric Dr. " Intermittent . . Dr. " Remittent . . . Dr. " Infantile Remittent Dr. " Hectic .... Dr. " Puerperal . . . Dr. " Yellow ... Dr. Fungus Hcematodes . . Dr. Galvanism.....Dr. Gastritis......Dr. Gastrodynia .... Dr. Gastro-Enteritis ... Dr. Glossitis......Dr. Glossis, Spasm of the, . Dr. Gout.......Dr. Hemorrhoids .... Dr. Williams. Cheyne. Crampton. Cumin. Pritchard. Carter. Joy. Stokes. Barlow. Bardsley. A. T. Thomson. Crampton. Forbes. Paris. Hope. CONOLLY. Brown. A. T. Thomson. Darwall. Brown. Locock. Stokes. Williams. Cumin. Todd. Joy. Barlow. Apjohn. Scott, Joy. A. T. Thomson. A. T. Thomson. Townsend. Townsend. ToWNSENn. Hancock. Stokes. Todd. Hancock. Cheyne. Kerr. Burder. Tweedie. Joy. A. T. Thomson. Wilson. A. T. Thomson. Scott. Forbes. Marshall. Tweedie. Tweedie. Tweedie. Cheyne. Brown. Brown. Joy. Brown. Lee. Cillkrest, Kerr. Apjohn. Stokes. Barlow. Stokes. Kerr. Joy. Barlow. Burne. CONTENTS, &c, OF THE CYCLOPEDIA OF PRACTICAL MEDICINE. Headach.....Dr. Burder. Heart, Diseases of the, Dr. Hope. " Displacement of the, Dr. Townsend. Hematemesis .... Dr. Goldie. Hemoptysis .... Dr. Law. Hemorrhage .... Dr. Watson. Hereditary Transmis- £ r> t> sion of Disease . \ Dr. Brown. herpes......Dr. A. T. Thomson. Hiccup......Dr. Ash. Hooping-Cough ... Dr. Johnson. Hydatids . . . . . Dr. Kerr. Hydrocephalus ... Dr. Joy. Hydropericardium . .Dr. Darwall. Hydrophobia .... Dr. Bardsley. Hydrothorax .... Dr. Darwall. Hypertrophy .... Dr. Townsend. Hypertrophy of the Heart Dr. Hope. Hypochondriasis . . . Dr. Pritchard. Hysteria......Dr. Conolly. Icthyosis.....Dr. A. T. Thomson. Identity......Dr. Montgomery. Impetigo.....Dr. A. T. Thomson. Impotence.....Dr. Beatty. Incontinence of Urine . Dr. Cumin. Incubus......Dr. Williams. Indigestion.....Dr. Todd. Induration.....Dr. Carswell. Infanticide.....Dr. Arrowsmith. Infection.....Dr. Brown. Inflammation Dr. A. Crawford, Dr. Tweedie. Influenza.....Dr. Hancock. Insanity.......Dr. Pritchard. Irritation.....Dr. Williams. Ischuria Renalis . . . Dr. Carter, Jaundice.....Dr. Burder. Kidneys, Diseases of, . Dr. Carter. Lactation.....Dr. Locock. Laryngitis.....Dr. Cheyne. Latent Diseases . . . Dr. Christison. Lepra......Dr. Houghton. Leucorrhcea .... Dr. Locock. Lichen......Dr. Houghton. Liver, Inflammation of, Dr. Stokes. " Diseases of, . . Dr. Venables. Malaria and Miasma . Dr. Brown. Malformations of the Heart Dr. Williams. Medicine, Principles and Cn. r„„„T„,, Practice of, . . | Dr. Conolly. Melaena......Dr. Goldie. Melanosis.....Dr. Carswell. Menorrhagia .... Dr. Locock. Menstruation, Pathology of D r. Locock. Miliaria,......Dr. Tweedie. Mortification .... Dr. Carswell. Narcotics.....Dr. A. T. Thomson. Nephralgia and Nephritis Dr. Carter. Neuralgia.....Dr. Elliotson. Noli me tangere, or Lupus Dr. Houghton. Nyctalopia.....Dr. Grant. Obesity......Dr. Williams. CEdema......Dr. Darwall. Ophthalmia .... Dr. Jacob. Otalgia and Otitis . . Dr. Burne. Ovaria, Diseases of the Dr. Lee. Palpitation.....Dr. Hope. Pancreas, Diseases of the, Dr. Carter. Paralysis.....Dr. R. B. Todd. Parotitis......Dr. Kerr. Pellagra......Dr. Kerr. Pemphigus.....Dr. Corrigan. Perforation of the Hoi-Cr, n „„___.. low Viscera . . J Dr. Carswell. Pericarditis and Carditis Dr. Hope. Peritonitis .... Dr. M'Adam, Dr. Stokes. Persons found Dead . Dr. Beatty. Phlegmasia Dolens . . Dr. Lee. Pityriasis.....Dr. Plague......Dr. Plethora.....Dr. Pleurisy, Pleuritis, . . Dr, Plica Polonica.... Dr. Pneumonia.....Dr. Pneumothorax . . . Dr. Porrigo......Dr. Pregnancy, &c, Signs of, Dr. Prognosis.....Dr. Pseudo-morbid Appear-Cp ances . . . . £ Psoriasis.....Dr. Puerperal Diseases . . Dr. Pulse.......Dr. Purigo......Dr. Purpura ...... Dr. Pyrosis......Dr. Rape.......Dr, Refrigerants .... Dr. Rheumatism .... Dr. Rickets......Dr. Roseola......Dr. Rubeola......Dr. Rupia......Dr. Rupture of the Heart . Dr. Scabies......Dr. Scarlatina '.....Dr. Scirrhus......Dr. Scorbutus.....Dr. Scrofula......Dr. Sedatives.....Dr. Sex, Doubtful, ... Dr. Small-Pox.....Dr. Softening of Organs . Dr. Somnambulism and Ani- S jjr mal Magnetism . £ Soundness, &c, of Mind Dr. Spinal Marrow, Dis-£rjr eases of, . . ; (_ Spleen, Diseases of, . Dr. Statistics, Medical, . . Dr. Stethoscope .... Dr. Stimulants.....Dr. Stomach, Organic Dis-5j)r eases of, . . . ? Succession of Inherit- St\t ance-Legitimacy, (_ Suppuration .... Dr. Survivorship .... Dr. Sycosis......Dr. Symtomatology . . . Dr. Syncope......Dr. Tabes Mesenterica . . Dr. Temperament.... Dr. Tetanus......Dr. Throat, Diseases of the, Dr. Tonics......Dr. Toxicology.....Dr. Transformations ... Dr. Transfusion .... Dr. Tubercle.....Dr. Tubercular Phthisis . . Dr. Tympanites.....Dr. Urine, Morbid States of, Dr. Urine, Bloody, . . . Dr. Urticaria.....Dr. Uterus, &.c. Pathology of, Dr. Vaccination .... Dr. Varicella.....Dr. Veins, Diseases of, . . Dr. Ventilation.....Dr. Wakefulness .... Dr. Waters, Mineral, . . Dr. Worms......Dr. Wounds, Death from, . Dr. Yaws......Dr. Cumin. Brown. Barlow. Law. Corrigan. Williams. Houghton. A. T. Thomson. Montgomery. Ash. R. B. Todd. Cumin. Hall. Bostock. A. T. Thomson. Goldie. Kerr. Beatty. A. T. Thomson. Barlow. Cumin. Tweedie. Montgomery. Corrigan. Townshend. Houghton. Tweedie. Carswell. Kerr. Cumin. A. T. Thomson. Beatty. Gregory. Carswell. Pritchard. Pritchard. R. B. Todd. Bigsby. Hawkins. Williams. A. T. Thomson. Houghton. Montgomery. R. B. Todd. Beatty. Cumin. M. Hall. Ash. Joy. Pritchard. Symonds. Tweedie. A. T. Thomson. Apjohn. Duesbury. Kay. Carswell. Clark. Kerr. Bostock. Goldie. Houghton. Lee. Gregory. Gregory. Lee. Brown. Cheyne, T. Thomson. Joy. Beattt. Kerr. NOW READY. DUNGLXSON'S PHYSIOLOGY, A NEW EDITION TO 184 4. LEA & BLANCHARD HAVE JUST PUBLISHED HUMAN PHYSIOLOGY, WITH UPWARDS OF THREE HUNDRED ILLUSTRATIONS, BY ROBLEY DUNGLISON, M.D., PROFESSOR OF THE INSTITUTES OF MEDICINE, &C, IN JEFFERSON MEDICAL COLLEGE, PHILA.; ATTENDING PHYSICIAN AND LECTURER ON CLINICAL MEDICINE AT THE PHILA. MED. HOSPITAL; SECRETARY TO THE AMERICAN PHILOSOPHICAL SOCIETY, &C. &C. FIFTH EDITION, GREATLY MODIFIED AND IMPROVED. IN TWO VOLUMES, OF 1304 LARGE OCTAVO PAGES. In presenting this new and much improved edition of Professor Dunglison's standard work on Physiology, the Publishers beg to state, that "although only a short time has elapsed since the publication of the fourth edition of this work, the labours of Physiologists have been so numerous diversified, and important, as to demand material modifications and additions in the present edition, and that no little time and industry have been bestowed by the author to introduce these, and to digest the various materials contained in the ex professo treatises, as well as the various Journals of this country and of Europe. To this edition nearly ninety wood-cuts have been added to elucidate either topics that had been already treated of in the previous editions, or such as are new in this; most of the old cuts have been retouched, and many replaced by others that are superior. Altogether, the author has endeavoured to make the work a just and impartial record of Physiological science, and to render it worthy a continuance of that favour which has been so liberally extended to it." The size of the volumes has been materially increased, by the addition of over eighty pages, and the illustrations are far superior to those of any former edition. THE PRACTICE OF MEDICINE, OR A TREATISE ON SPECIAL PATHOLOGY AND THERAPEUTICS. BY ROBLEY DUNGLISON, M.D., PROFESSOR OF THF. INSTITUTES OF MEDICINE, ETC. IN THE JEFFERSON MEDICAL COLLEGE, PHILADELPHIA, LECTURER ON CLINICAL MEDICINE, AND ATTENDING PHYSICIAN AT THE PHILADELPHIA HOSPITAL, ETC. CONTAINING THE DISEASES OF THE ALIMENTARY CANAL, THE DISEASES OF THE CIRCULATORY APPARATUS, DISEASES OF THE GLANDULAR ORGANS, DISEASES OF THE ORGANS OF THE SENSES, DISEASES OF THE RESPIRATORY ORGANS, DISEASES OF THE GLANDIFORM GANGLIONS, DISEASES OF THE NERVOUS SYSTEM, DISEASES OF THE ORGANS OF REPRODUCTION, DISEASES INVOLVING VARIOUS ORGANS, &c. &c IN TWO VOMJMES, OCTAVO. This work has been introduced as a text book in many of the Medica] colleges, and the general favour with which it has been received, is a guarantee of its value to the practitioner and student. " In the volumes before us, Dr. Dunglison has proved that his acquaintance with the present facts and doctrines, wheresoever originating, is most extensive and intimate, and the judg- ment, skiJl, and impartiality with which the materials of the work have been collected, weighed, arranged, and exposed, are strikingly manifested in every chapter. Great care is every where taken to indicate the source of information, and under the head of treatment, formula? of the most appropriate remedies are every where introduced. In conclusion, we congratulate the students and junior practitioners of America, on possessing in the present volumes, a work of standard merit, to which they may confidently refer in their doubts and difficulties.''—British and Foreign Medical Review for July, 1842. " We hail the appearance of this work, which has just been issued from the prolific press of Messrs. Lea and Blanchard, of Philadelphia, with no ordinary degree of pleasure. Comprised in two large and closely printed volumes, it exhibits a more full, accurate, and comprehensive digest of the existing state of medicine than any other treatise with which we are acquainted in the English language. It discusses many topics—some of them of great practical import- ance, which are entirely omitted in the writings of Eberle, Dewees, Hosack, Graves, Stokes, Mcintosh, and Gregory; and it cannot fail, therefore, to be of great value, not only to the stu- dent, but to the practitioner, as it affords him ready access to information of which he stands in daily need in the exercise of his profession. It has been the desire of the author, well known as one of the most abundant writers of the age, to render his work strictly practical; and to this end he has been induced, whenever opportunity offered, to ihcorporate the results of his own experience with that of his scientific brethren in America and Europe. To the former, ample justice seems to have been done throughout We believe this constitutes the seventh work which Professor Dunglison has published within the last ten years; and, when we reflect upon the large amount of labour and reflection which must have been necessary in their preparation, it is amazing how he could have accomplished so much in so short a time.' —Louisville Journal. " As a system of Practical Medicine, this work will meet a cordial welcome from all who know the untiring assiduity and laborious habits in the pursuit of knowledge, of the author, who has already presented the public with numerous excellent works, bearing the stamp of originality, as well as of profound research. "The object of Professor Dunglison is to present, in as compact a form as was consistent with accuracy and perspicuity, a history of all the affections which properly come under the care of the physician, with all the improvements and modifications which have taken place latterly in Pathology and Therapeutics, so as to enable the student and practitioner ' to appre- ciate their present condition,' and to avail themselves of knowledge scattered about in various journals and monographs. " This task has been faithfully executed, and the work may be recommended as a good class-book, in which the soundness of the author's views and his freedom from exclusive opinions have enabled him to select from the experience of others those facts and views, which, together with his own experience, were to furnish the proper data for correct descrip- tions and for sound practical deductions.''—Aeie York American. LEA. & BLANCHARD HAVE JUST PUBLISHED DUNGLISON'S THERAPEUTICS & MATERIA MEDICA. GENERAL THERAPEUTICS AND MATERIA MEDICA, ADAPTED FOR A MEDICAL TEXT-BOOK, BY ROBLEY DUNGLISON, M. D., Professor of Institutes of Medicine, &c In 2 vols. 8vo. A second edition of the work on General Therapeutics, being oalled for by the publishers, the author has deemed it advisable to incorporate with it an account of the different articles of the Materia Medica. To this he has been led by the circumstance, that the departments of General Therapeutics and Materia Medica are always associated in the Medical Schools. The author's great object has been to prepare a work which may aid the Medical Student in ac- quiring the main results of modern observation and reflection; and, at the same time, be to the Medical Practitioner a trustworthy book of reference. Throughout, he has adopted the Nomenclature of the last edition of the Pharmacopoeia of the United States, a work which ought to be in the hands of every practitioner as a guide in the preparation of medicines; and he has endeavoured to arrange the articles in each division, as nearly as he could, in the order of their efficacy as Therapeutical agents. ALSO, A FOURTH EDITION, BROUGHT UP TO 1843, OF NEW REMEDIES, Pharmaceutically and Therapeutically considered. By Robley Dunglison, M. D., Professor of the Institutes of Medicine and Materia Medica in Jefferson Medical College of Phila- delphia; Lecturer on Clinical Medicine; and attending Physician to the Philadelphia Hospital, &c.&c. In one vol. octavo.—over 600 pages. Extract from the Preface to the 4th Edition. » Since the publication of the third edition of this work in 1841, the Pharmacopoeia of the United States has appeared, under the revision of Professors Wood and Bache, and the Au- thor This has rendered it necessary to modify somewhat the nomenclature, and, to a certain extent, the arrangement of the < New Remedies.' " The Author has likewise endeavoured to embody all the new information of a therapeuti- cal or pharmaceutical character contained in the different-scientific journals, as well as in the ex professo works on Materia Medica and Pharmacy, that have been published since the appear- f the last edition. Farther and varied opportunities have necessarily occurred for test- n, nor of idle hypothesis but of close, persevering Clinical Observation, ac< •mpanied with much soundness of judgment, and extraordinary clinical tact."—Medico-Chirurgical Review. A TREATISE ON FEVER. By Southwood Smith, M.D., Physician to the Lon- don Fever Hospital, fourth American edition. In one volume octavo. COATES'S POPULAR MEDICINE, OR FAMILY ADVISER, consisting of Outlines of Anatomy, Physiology, and Hygiene, with such Hints on the Practice of Physic, Surgery, and the Diseases of Women and Children, as may prove useful in families when regular Physicians cannot be procured: being a Companion and Guide for intelligent Piincipals of Manufactories, Plantations, and Boarding Schools; Heads of Families, Masters of Vessels, Missionaries, or Travellers; and a useful Sketch lor Young men about commencing the Study of Medicine. By Reynell Coates, M.D. This work is designed to supply the place of Evvells' Medical Companion, which is now entirely out of print. OUTLINES OF A COURSE OF LECTURES ON MEDICAL JURISPRU- DENCE. By Thomas Stewart Traill, M.D., with notes and additions. A small volume. A PRACTICAL TREATISE ON MEDICAL JURISPRUDENCE, with so much of Anatomy, Physiology, Pathology, and the Practice of Medicine and Surgery, as are Essential to be known by Members of the Bar and Private Gentlemen; and all the Laws relating to Medical Practitioners; with Explanatory Plates. By J. Cliitty, Esq., second American edition, with notes and additions adapted to American Works and Judicial Decisions. In One Volume Octavo. ABERCROMBIE ON THE BRAIN. Pathological and practical Researches on Diseases of the Brain and Spinal Cord. New edition, 1 vol. 8vo. A PRACTICAL TREATISE ON THE HUMAN TEETH, showing the causes of their destruction and the means of their preservation, by William Robertson. With plates. First American from the second London Edition. In one volume octavo. ANATOMY, PHYSIOLOGY, AND DISEASES OF THE TEETH. By Thomas Bell, F.R.S., F.L.S., &c. Third American edition. In one volume octavo, with numerous plates. DISSERTATIONS ON NERVOUS DISEASES. By Drs. James Hope, J. C. Prichard, John Hughes Bennett, Robert H. Taylor and Theophilus Thomson. In one volume octavo. DISSERTATIONS ON DISEASES OF THE ORGANS OF RESPIRATION. By Drs. Williams, Theophilus Thomson, W. B. Carpenter, and W. Bruce Joy. In one volume octavo. DISSERTATIONS ON FEVERS, GENERAL PATHOLOGY, INFLAMMA- TION, AND DISEASES OF THE SKIN. By Drs. Symonds, Allison, Christison, &c. &c. In one volume octavo. DISSERTATIONS ON DISEASES OF THE DIGESTIVE, URINARY AND UTERINE ORGANS. By Drs. Joy, Symonds, Thomson, Ferguson, &c. &c. In one volume octavo. DISSERTATIONS ON HAEMORRHAGES, DROPSY, RHEUMATISM, GOUT, SCROFULA, &c. &c. By Drs. Burrows, Watson, Shapter, Joy, &c. &c. In one volume octavo. The above five volumes are from the Library of Practical Medicine, edited by Dr. Tweedie, with notes by Dr. Gerhard. Each volume is complete within itself, and is for sale separately. THE MEDICAL STUDENT; OR AIDS TO THE STUDY OF MEDICINE. Including a Glossary of the Terms of the Science, and of the Mode of Prescribing-; Bibliographical Notices of Medical Works; the Regulations of the different Medical Colleges of the Union, &c. By Robley Dunglison, M.D., &c. &c. In one vol. 8vo. LEA & BLANCHARD'S PUBLICATIONS, DISEASES OF FEMALES, PREGNANCY AND CHILDBED. THE PRINCIPAL DISEASES OF FEMALES, TOGETHER WITH THE DISEASES INCIDENT TO PREGNANCY AND CHILDBED, CHIEFLY FOR THE USE OF STUDENTS, BY FLEETWOOD CHURCHILL, M.D., Lecturer on Midwifery and Diseases of Women and Children, in the Richmond Hospital, School of Medicine,&c. &c, with Notes and Additions by R. M. Huston, M.D., Professor. &c. in the Jefferson Medical College. Second American Edition, in 1 vol. 8vo.—Just ready. A/\AAAAAaA. DUNGLISON'S PHYSIOLOGY-WITH ILLUSTRATIONS. HUMAN PHYSIOLOGY, ILLUSTRATED WITH OVER TWO HUNDRED ENGRAVINGS ON WOOD; BY PROFESSOR ROBLEY DUNGLISON; the fourth edition with numerous additions and modifications, in 2 vols. 8vo. This work is occupied w ith the functions executed by healthy man. It embraces a general exposition of the functions; the new views entertained in regard to the formation of the tissues; hut is especially intended to give an accurate view of the actions of the different organs, as an introduction to the study of pathology, hygiene and therapeutics. It treats moreover, of the anatomy of the organs so far as is necessary for a full understanding of the functions; and is lamely illustrated by appropriate engravings. The last edition contains several additional illustrations to elucidate either topics that have been already touched upon in the work, or such as are new. Every effort has been made to place the work, in all respects, on a level with the existing state of the science. THE DISEASES OF THE EYE. A TREATISE ON THE DISEASES OF THE EYE, BY W. LAWRENCE, Surgeon Extraordinary to the Queen, &c, from the last London Edition, with numerous additions, and sixty-seven Illustrations, many of which are from original drawings. By Isaac Hays, M.D., Surgeon to the Wills Hospital, &c., &c, in 1 vol. 8vo.— Just ready. The character of this work is too well established to require a word of commendation—it is justly considered the best on the subject. The present is a reprint of the last London Edition, which appeared in 1841, completely revised and greatly enlarged by the author—and to it considerable additions have been made by the editor. Several subjects omitted in the original are treated of in this edition, on whioh occasion free use has been made of the work of Mackenzie, to which is added the editor's own experi- ence, derived from many years' attention to the subject. THE URINARY ORGANS, &c. LECTURES ON THE DISEASES OF THE URINARY ORGANS, BY SIR B. C. BRODIE, BART. F.R.S. From the Third London Edition, with alterations and additions, a small 8vo. volume.—Now ready. The work has throughout been entirely revised, some of the author's views have been modified, and a considerable proportion of new matter has been added, among which is a Lecture on the Operation of Lithotomy. .^a/w\,%.v.-wv.>. RICORD ON VENEREAL. A PRACTICAL TREATISE ON VENEREAL DISEASES; OR, CRITICAL AND EXPERIMENTAL RESEARCHES ON INOCULATION, APPLIED TO THE STUDY OF THESE AFFECTIONS; WITH A THERAPEUTICAL SUMMARY AND SPECIAL FORMULARY, BY PH. RICORD, M.D., Surgeon of the Venereal Hospital of Paris, Clinical Professor of Special Pathology, &c. Translated from the French, by Henry Pilkington Drummond, M.D., in one volume. —Sow ready. _____^^, LAWRENCE ON RUPTURES. A TREATISE ON RUPTURES, BY W. LAWRENCE, F.R.S., Author of a Treatise on the Diseases of the Eye, &c. &c, from the Filth London Edition, consi- derably enlarged. In 1 vol. 8vo— JVoio ready The neruliar advantage of the treatise of Mr. Lawrence is, that he explains his views on the anatomy if hernia and the different varieties of the disease, in a manner which renders his hook peculiarly useful , to the -indent. It must be superfluous to express our opinion of its value to the surgical practitioner. As a treatise on hernia, presenting a complete view of tiie literature of the subject, it stands in the first rank.—Edinburgh Medical and Surgical Journal.______________________________________________________ LEA & BLANCHARD'S P U B L I C ATIO N S ._ ESSAYS ON ASTHMA, APHTILE, ASPHYXIA, APOPLEXY, ARSENIC, ATROPA, AIR, ABORTION, ANGINA PECTORIS, and other subjects, embraced in the Articles from A to Azote, prepared for the Cyclopaedia of Practical Medicine by Dr. Chapman and others. Each article is complete within itself, and embraces the practical experience of its author, and as they are only to be had in this collection, will be found of great value to the profession. The two volumes are now offered at a pricp so low, as to place them within the reach of every practitioner and student. OUTLINES OF PHYSIOLOGY; with an Appendix on Phrenology. By P. M. Roget, M.D., Professor of Physiology in the Royal Institute of Great Britain, &c. First American edition revised, with numerous Notes. In one volume octavo. GEOLOGY AND MINERALOGY, considered with reference to Natural Theology. By the Rev. William Buckland, D.D., Canon of Christ Church, and Reader in Geo- logy and Mineralogy in the University of Oxford. With nearly one hundred copper- plates and large coloured maps. A new edition from the late London edition, with. supplementary no'es and additional plates. THE BRIDGEVVATER TREATISES, complete in seven volumes octavo, em- bracing: I. The Adaptation of External Nature to the Moral and Intellectual Constitution of Man. By the Rev. Thomas Chalmers. II. The Adaptation of External Nature to the Physical Condition of Man. By John Kidd, M.D.F.R.S. III. Astronomy and General Physics, considered with reference to Natural Theology. By the Rev. William Whewell. IV TIip Hand ; its Mechanism and vital Endowments as evincing Design. By Sir Charles Bell, K.H., F.R S. With numerous woodcuts. V. Chemistry, Meteorology, and the Function of Digestion. By William Prout, M.D.F.R.S. VI. The History, Habits, and Instiurts of Animals. By the Rev. William Kirny, M.A.F.R.S. Illus- trated by numerous engravings on copper. VII. Animal and Vegetable Physiology, considered with reference to Natural Theology. By Peter M:irk Ro'/et, M.D. Illustrated with nearly five hundred wood-cuts. VIII. Geology and Ylineralosy, considered with reference to Natural Theology. By the Rev. William Buckland, D.D. With numerous engravings on copper, and a large coloured map. The works of Buckland, Kirby and Roget, mav be had separate. A POPULAR TREATISE ON VEGETABLE PHYSIOLOGY, by W. P. Car- penter, Author of Principles of Human Physiology, &c, published under the auspices of the Society for the Promotion of Popular Instruction. With numerous wood-cuts, in one volume 12mo. A POPULAR TREATISE ON AGRICULTURAL CHEMISTRY; intended for the use of the practical farmer, by Charles Squarry, Chemist. In one vol. 12mo. ROGET'S ANIMAL AND VEGETABLE PHYSIOLOGY, with nearly five hundred wood-cuts, in two volumes, second American edition. THE HISTORY, HABITS, AND INSTINCTS OF ANIMALS, by the Rev. William Kirby, M.A.F.R.S. Illustrated by numerous copperplate engravings. The Ninth Bridge water Treatise. A FRAGMENT, by Charles Babbage, Esq. From the second London edition. In one volume octavo. A PRACTICE OF PHYSIC. Comprising most of the diseases not treated of in Diseases of Females and Diseases of Children, second edition. By W. P. Dewees, M.D., formerly Adjunct Professor in the University of Pennsylvania. In one vol. 8vo. ELEMENTS OF HYGIENE; on the Influence of Atmosphere and Locality; Chance of Air and Climate, Seasons, Food, Clothing, Bathing, Sleep, Corporeal and Intellectual Pursuits, &c, on Human Health, constituting Elements of Hygiene. By Robley Dunglison, M.D. In one volume 8vo. ABERCROMBIE ON THE STOMACH. Pathological and Practical Researches on Diseases of the Stomach, the Intestinal Canal, the Liver, and other Viscera of the Abdomen. By John Abercrombie, M.D. Third American, from the second London edition, enlarged. In one volume 8vo. DISEASES OF THE SKIN. A NEW WORK. A PRACTICAL AND THEORETICAL TREATISE ON THE DIAGNOSIS, PATHOLOGY, AND TREATMENT OF DISEASES OF THE SKIN, arranged according to a Natural System of Classification, and preceded by an Outline of the Anatomy and Physiology of the Skin. By Erasmus Wilson, M. D., author of a System of Human Anatomy, &c, in 1 vol. 8vo. TO THE MEDICAL PROFESSION, dtc. LEA & BLANCHARD present a condensed list of books published and preparing for publication by them, and would refer to the other pages in this number of " The News" for a more detailed account. The prices and all other information in relation to them will be given on application free of postage. Being extensively engaged in the publication of Medical and Scientific works, it will be their effort to furnish them at prices lower than formerly, and as low as they can be afforded consistent with correct and well executed editions. The latest editions will always be furnished, and to their present exten- sive list they will add from time to time such other good works as the wants of the profession may call for. Their publications may be found at all the principal Bookstores throughout the Union. Arnott's Elements of Physic, in 1 vol. 8vo., 520, Graham's Chemistry, with cuts, 1 vol 8vo 750 pages. closely printed pases. |Goddard's Dissector's Companion, in preparation, 1 American Medical Journal, published quarterly at! vol 12mo. $5 a year Twelve numbers of the new series are Griffith's Manual of Medical Jurisprudence, in pre- now published. j paration. Abercrombie on the Stomach, 1 vol. 8vo, 320 pages ■Harris on the Maxillary Sinus, 1 vol. small ovo. Abercrombie on the Brain, a new edition, I vol. 8vo, 324 pages Alison's Patholoey, In preparation. Ashwell on the Diseases of Females complete in 1 vol. 8vo., in preparation. Andral on the Blood, 8vo. in preparation. Bache's new work on Chemistry, with cuts, now preparing. Bell on the"Teeth, with plates, 1 vol. 8vo.,351 pages. Bucklaud's Geology and Mineralogy, 2 vols. 8vo, with numerous plates and maps. Berzelius on the Kidneys and Urine, 1 vol. small 8vo, 179 pases Brideewater Treatises, with numerous illustrations, 7 vols 8vo., 3287 pages. Bartlett on Fevers ol the United States, &c, 1 vol 8vo., 393 pages. Billing's Principles of Medicine, 1 vol. 8vo., 304 pages Brodie on Urinary Oreans, 1 vol 8vo., 214 pages. Brodie on the Joints, 1 vol. 8vo., 216 pages. Chapman on Consumption, Dyspepsia, Rheuma lism and Diseases of the Li ver, 1 vol. 8vo., at press Chiuy'6 Medical Jurisprudence, 1 vol. 8vo., 509 large pages Carpenters Human Physiology, 1 vol. 8vo., 618 pages, with cuts. Carpenter's General and Comparative Physiology, U> be published hereafter in 1 vol. 8vo Carpenter's Vegetable Physiology, 1 vol. 12mo , with cuts, 300 pages. Carpenter's cyclopedia of Natural Science, to be published hereafter Cooper, Sir Astl«y, his work on Hernia, imperial 8vo , now in press. Cooper on Dislocations and Fractures, 1 vol. Svo., with cuts Condie on Diseases of Children, 1 vol. 8vo , in press Uostello's Cyclopedia of Practical Surgery, to be published hereafter. Churchill on Females, 1 vol. 8vo , 59o large pages Churchill's Theory and Practice of Midwifery, I vol. Wvo , 519 pages, with cuts. Cyclopedia of Obstetrics and Diseases of Women and children, to be published hereafter. Cyclopedia of Practical Medicine by Forbes, &c Edited by Dunglison: in 4 large super royal vols. at press. Parson's Medical Formulary, in preparation^ Dewees' System of Midwifery, with plates, 10th edi tion, 660 pages. Dewees on Children, 8th edition, 548 pages. Dewees on Females, with plates, 8th edition, 532 DfeweM1 Practice of Physic, 1 vol. 8vo, 819 pages. Dunglison's Physiology, 4th edition, 2 vols. 8vo., 1230 pages, with cuts. Dun°lison's Therapeutics and Materia Medica, a new work, 2 vols. 8vo, 1U04 pages. Dunglison's Medical Dictionary, 3d edition, 1 vol 8vo , 749 very large pages. Dunglison's New Remedies, 5th edition, 1843, 61o DiFnfllson's Practice of Medicine, a new work, 2 vols 8vo., 1322 pages. Druitt's Modern Surgery, 1 vol. 8vo., 534 pageSQ Ellis's Medical Formulary, 7th edition, 1 vol. 8vo , 262 pages Elliotson's Mesmeric Cases, 8vo., 56 pages. FerEUMon'i Practical Surgery, 1 vol. 8vo., 629 pages. 165 pages. Horner's Special Anatomy, 2 vols 8vo., 6th edition, 1114 pages. Horner's Anatomical Atlas, preparing. Hope on the Heart, 1 vol. 8vo., 572 pages. Harrison on the Nervous System, 1 vol. 8vo., at press, Jones and Todd on the Ear, 1 vol. 8vo., at press. Kirby on Animals, many plates, 1 vol 8vo , 519 pages. Lawrence on the Eye,l vol 8vo , 778 pages. Lawrence on Ruptures, 1 vol. Svo , 480 pages. Mitchell on Animal Magnetism, in preparation, 1 vol. 12mo. Maury's Dental Surgery, with plates, a new work, I vol. 8vo ,285 pages Mutter's Surgery, 2 vols. 8vo , now in preparation, with cuts Miiller's Physiology, 1 vol 8vo., 886 pages. Medical News and Library, published monthly. Meigs on Females, in preparation, I vol 8vo. Prout on the Stomach and Renal Diseases, 1 vol. 8vo., with coloured plates. Popular Medicine, by Coates, 1 vol 8vo., 614 pages. Philip on Protracted Indigestion, 1 vol. 8vo. 240 pages PereFra's Materia Medica, 2 vols. 8vo., 1566 very large and closely printed pages. Roget's Animal and Vegetable Physiology, with many cuts, 2 vols. Svo , 871 pages. Roeet's Outlines of Physioloey, 1 vol 8vo.,516pages. Rigby's System of Midwifery, 1 vol 8vo ,491 pages. Ricord on Venereal, 1 vol 8vo., 256 pages Ramsbotham on Parturition, with numerous plates, 1 vol imperial 8vo., 458 pages. Robertson on the Teeth, 1 vol. 8vo , 229 pages. Squarey's Agricultural Chemistry, 1 vol. 12mo., 156 pages. Simon's Medical Chemistry, in preparation. Select Medical Essays by Chapman and others, 2 vols. 8vo , 1149 pages, double columns. Tweedies Library of Practical Medicine, 3 vols. 8vo , 2nd edition, revised. 2ulb large and closely printed pages Tweedie on Fevers, Inflammations and Cu-j Cjjj taneous Diseases, 1 vol 8vo. Tweedie on Diseases of the Nervous System, 1 vol 8vo Tweedie on Diseases of the Organs of Respi ration, 1 vol. 8vo. gS Tweedie on the Digestive, Urinary and Ute- rine Organs, 1 vol 8vo Tweedie on Rheumatism, Gout, Dropsy, Scur _ vy, &c, 1 vol 8vo. _ J ? Traill's Medical Jurisprudence- 1 vol. 8vo., 234 pages. Trimmer's Geology and Mineralogy, with many cuts, 1 vol 8vo.,"527 pages. Todd's Cyclopedia of Anatomy and Physiology, to be published hereafter Walshe's Diagnosis of the Lungs, 1 vol. 12mo., 310 Watson's Principles and Practice of Physic, 1 vol. 8vo Wilson's Human Anatomy, with cuts, 1 vol. 8vo. 576 pages. Wilson's Dissector, or Practical and Surgical Ana- tomy, with cuts, by Goddard, 1 vol. l2mo. Wilson on the Skin, 1 vol 8vo : 370 pages. Youatt on the Horse, by Skinner, with plates, 448 pages, 1 vol. 8vo. O" For a more detailed account see L. & B's. Extended List. CARPENTER'S PHYSIOLOGY, lnth over One Hundred Splendid Wood-Cuts. PRINCIPLES OF ETJMAN PHYSIOLOGY, With their chief applications to Pathology, Hygiene, and Forensic Medicine. Especially designed for the use of Students; with over one hundred Illustrations. BY WILLIAM B. CARPENTER, M. D., Lecturer on Physiology in the Bristol Medical School, &c. FIRST AM. ED., WITH NOTES BY THE AUTHOR, AND NOTES AND ADDITIONS BY MEREDITH CLYMER, M. D., Lecturer on the Institutes of Medicine, Physician to the Philadelphia Hospital, Fellow of the College of Physicians, &c. One Volume Octavo. fXj- This edition of Carpenter's Physiology has been most carefully prepared by Dr Clymer, at the request of Prof. Jackson, for his lectures at the University of Pennsylva- nia. rai fwsws. w memiine. At the request of numerous members of the profession L. & B. will publish early in November in book form, in one volume, 8vo., at the low price of THREE DOLLARS, LECTURES ON THE PRINCIPLES AND PRACTICE OF PHYSIC. BY THOMAS WATSON, M. D., Of King's College, London. This work is now passing through the columns of the Medical News, nnd will be continued in that way to the subscribers through 1844, but in the meantime its a p. pearance complete in a single volume is in consequence of the earnest desire of many persons who wish the work at once. A NEW TEXT-BOOK ON CHEMISTRY. JUST PUBLISHED, THE ELEMENTS OF CHEMISTRY: INCLUDING THE APPLICATION OF THE SCIENCE TO THE ARTS: With numerous Illustrations. By THOMAS GRAHAM, F.R. S., L.&ED., Professor of Chemistry in the University College, London, President ofjhe Chemical Society, #c. eye. WITH NOTES AND ADDITIONS, BY ROBERT BRIDGES, M.D., Professor of General and Pharmaceutic Chemistry in the Philadelphia College of Pharmaey, and one of the Editors of the American Journal of Pharmacy. In one vol. 8vo. The great advancement made recently in Chemistry has called for a new and perfect treatise on the present"slate of the science. Such the present one is presumed to be, while an attempt is made to apply it to the eluciilaiion of the great questions of vegetableand animal physiology. The work fully represents the proeress of the science up to the date of publication. The publishers of this edition have endeavoured to make it worthy of the eminent character of the author, and it will be found to have numerous additional cuts to illustrate the various subjects. It is already introduced as a Text book into several Colleges, and has universal approbation. From among numerous recommendations the annexed are submitted. RECOMMENDATIONS OF GRAHAM'S CHEMISTRY. Messrs. Lea & Blanchard.— Phila. Oct. 3d, 1843. I owe von my acknowledgments for a copy of your American edition of Gra- ham's Elements of Chemistry, edited by Dr. Bridges. It is a work which ought to be in the possession of every student of the science of which it treais, &c. &c. I am, gentlemen, yours truly .KOrj.ri.Kl nAKK. Philada. Sept. 1843. Messrs. Lea & Blanchard:-Let me thank you for the copy of Graham's Chemistry, published by you, under the corrective editorial care of my friend, Dr. Robert Bridges. A work on Chemistry by Professor Graham, carries, because of its author's name, the highest re- commendation. It has, besides its complete learning and lucid arrangement, the merit of extraordi- nary comprehensiveness, within moderate limits, exactness withouttediousness, and brevity without The modest and accomplished editor has enriched the work with sensible remarks and useful addi- Ions He has brought the book up to the science of its day of publication, enlarged and corrected the index, and by amplifying the tables, and rectifying the accidental errors of the English edition, ke has presented to the American public one of the most desirable chemical works of the period. Yours, &c. J- K. Mitchell, M. D. Navy Yard, Washington, Avg Ulh, 1843. Messrs Lea & Blanchard:-I am acquainted with Graham's Chemistry, and have been so since its first appearance in this country. I have found it highly useful as a work of general reference, and as embracing the most recent improvements of the science. In regard to organic chemistry, as well as to other branches of the subject, it appears to me to deserve a rank among the best works to which the English language affords access. Professors and teachers will, I have no doubt, feel duly sensible of the obligation which the editor and publishers of the American edition have conferred on them in offering to the public a reprint of this valuable work. Yours, &c. Walter R Johnson. LEA & BLANCHARD HAVE JUST PUBLISHED CHURCHILL'S MIDWIFERY, With One Hundred and Sixteen Illustrations. ON THE THEORY AND PRACTICE OF MIDWIFERY. BY FLEETWOOD CHURCHILL, M.D., M.R.I. A., Licentiate of the College of Physicians in Ireland; Physician to the Western Lying in Hospital, Lecturer on Midwifery, &c. in the Richmond Hospital School of Medicine. Author of "A Treatise on the Diseases of Females," &c. &c. WITH NOTES AND ADDITIONS, BY ROBERT M. HUSTON, M. D., Professor of Mat. Med. and General Therapeutics, and formerly of Obstetrics and the Diseases of Women and Children, in the Jefferson Medical School of Philadelphia; President of the Phil. .Med. Societv; Physician to the Lying-in Department of the Phil. Hospital. WITH 116 ILLUSTRATIONS FROM DRAWINGS BY BAGG AND OTHERS, ENGRAVED BY GILBERT, Executed in a style corresponding with Wilson's Anatomy, Carpenter's Human Physiology, Fergusson's Surgery, &c. &c. " It is impossible to conceive a more useful or elegant manual: the letterpress contains all that the practical man can desire; the illustrations are very numerous, well chosen, and of the most ele- gant description, and the work has been brought out at a moderate price."—Prov. Med. Journ. "This is inconte=tably one of the very best books, on the important subject on which it treats, that has been issued from the British or American press. The author has had great experience, and is, withal, an able and accomplished writer; well read in his profession, and gifted with a vigorous and condensing mind; while the American editor is known as a skilful practitioner of obstetrics, and well acquainted with every thing that has been said or done in that department. The notes, which he has added, bear ample testimony to his possessing these qualifications. The work does not consist simply of the ipse dixit, of the author. It embraces a brief statement, well expressed, of the views of the best authorities, and is illustrated, as the title sets forth, with numerous wood cuts, which, by the way, are beautifully executed. The book is altogether well 'got up,' and we can conscientiously recommend it most strongly as an excellent accompaniment to the tyro in his studies, and to the practitioner when beset with doubts or difficulties. It forms a fit accompaniment to the volumes of Wilson on Anatomy, and Fergusson on Surgery."—U.S.Oaz. " Dr Churchill, in his preface, states that the object of the present publication,' is to offer to the students of Midwifery a work, embracing the modern discoveries in the physiology of the uterine system, with all the recent improvements in practice, in a condensed form, amply illustrated, and at a moderate price.' The work amply fulfils, we think, all thpse indications. The physiological portion is more complete than that of any precedine treatise, English or French. ''The work is beautifully printed, and illustrated in the best style of Gilbert, with one hundred and sixteen cuts."— Med. Examiner. "This is another of those excellent republications, for which the medical profession is so greatly indebted to the great Philadelphia publishers. As Lecturer on Midwifery, in the Richmond Hos- pital School of Medicine, Dublin, and Physician to the Western Lying-in Hospital, he has tho. rough preparation for the composition of such a work, and the result isa treatise ^extraordinary merit. It embraces the modern discoveries in the physiology of the uterine system, with all the recent improvements in practice. Illustrated by one hundred and sixteen engravings, which can- not be surpassed for fidelity, it contains, perhaps, the most clear and satisfactory account of the " Theory and Practice of Midwifery," which can be put into the hands of students and practition- ers."—Bait. Patriot. "We shall not attempt an analysis of Dr. Churchill's volume, which we would regard as con- sisting of a full, methodical discussion of most of the questions in obstetrics, followed by clear deductions for practical guidance, and the formation of sound opinion. We do not remember to have seen more beautiful woodcuts by Gilbert, after drawings by Bags, than those so lavishly, yet so discriminatingly, spread through the volume."—Bulletin of Med. Science. "Both the publishers and American editor have conferred a special favour in reproducing tbii work in the United States."—Boston Med. and Surg. Journal. LEA & BLANCHARD HAVE LATELY PUBLISHED FERGUSSON'S PRACTICAL SURGERY, WITH OVER TWO HUNDRED AND FIFTY ILLUSTRATIONS. A SYSTEM OF PRACTICAL SURGERY: By Professor William Fergusson, of King's College, London, illustrated by over two hundred and fifty splendid cuts, exe- cuted by Gilbert, from designs by Bagg, with notes and additions by George W. Norris, M. D., one of the Surgeons to the Pennsylvania Hospital, in one volume 8vo The publishers commend this work to the attention of the Profession as one combining cheapness and elegance, with a clear, sound, and practical treatment of every subject in surgical science. No pains or expense have been spared to present it in a style equal, if not superior to the London edition, and to match the editions of "Wilson's Anatomy," "Churchill's System of Midwifery, and " Carpenter's Human Physiology." BRODIE ON THE JOINTS. PATHOLOGICAL AND SURGICAL OBSERVATIONS ON THE DISEASES OF THE JOINTS. By Sir Benjamin C. Brodie, Bart., F. R. S., Serjeant Surgeon to the King, &e. &c. From the Fourth London Edition, with the author's altera- tions and additions. In one volume 8vo., cloth. " To both the practical physician and the student, then, this little volume will be one of much ser- vice, inasmuch as we have here a condensed view of these complicated subjects thoroughly investi- gated by the aid of the light afforded by modern Pathological Surgery."—iv". Y.Journal of Medicine. WALSHE ON THE LUNGS. THE PHYSICAL DIAGNOSIS OF DISEASES OF THE LUNGS. By Walter Hayle Walshe, M. D., Professor of Pathological Anatomy in University College, Lon- don, &c. &c. In one volume 12mo., extra cloth. The British and Foreign Medical Review, edited by Dr. John Forbes, the translator and anno- tator of Lasnnec's immortal work, says, " we do not hesitate to say that there exists in no language any work on the physical diagnosis of diseases of the lungs, suited for students, so clear and precise, and at the same time so comprehensive and practical as this. It is one which no learner in aus- cultation can fail to possess, without losing advantages elsewhere unattainable; and it is onewhil very few even among the most experienced auscultators will consult without adding something to their previous stock of knowledge." WILSON PHILIP ON INDIGESTION. A TREATISE ON PROTRACTED INDIGESTION AND ITS CONSE- QUENCES. Being the application to the practical department of Medicine of the Results of an Inquiry into the Laws of the Vital Functions: Addressed by the Au- thor on his retirement from the Medical Profession, both to the Members of that Pro. fession, and to the well-educated public, particularly parents. By A. P. W. Philip, M. D., F. R. S , London and Edinburgh, &c. &c. From the Eighth London Edition. In one volume 8vo., cloth. PROUT ON STOMACH AND RENAL DISEASES. ON THE NATURE AND TREATMENT OF STOMACH AND RENAL DIS. FASFS- Beinp- an lnouiry into the Connection of DlAbElfc,S>, UALA^UL.U&, ?ND OTHER AFFECTIONS OF THE KIDNEY AND BLADDER WITH INDIGESTION. By William Prout, M. D.v F. R. ,S., Fellow of the Royal College of Physicians. In one vol. 8vo., with plates, from the Fourth London Edition. Extract from the Preface to the Fourth Edition. "Since the third edition was published, Professor Liebig's Treatises on Animal and Vegetable ChemUuvhave. appea^d, and attracted no little notice. Some of the views advanced by this dis- tinluZed chemfst^n his last work, are the same I have long advocated. Others of his views are dirlaly opp^ed to mine"and seem to me to be neither susceptible of proof, nor even probable." Also, WILSON'S DISSECTOR. THE DISSECTOR, OR PRACTICAL AND SURGICAL ANATOMY. By Eras- nius Wilson, author of a System of Human Anatomy, &c, edited and re-arranged by Piul Beck Goddard, M. D., Demonstrator of Anatomy, &c, at the University of Pennsylvania, &c. &c, in one large 12mo. volume, with numerous illustrations. HOMER'S ANATOMY AND HISTOLOGY, SIXTH EDITION. LEA & BLANCHARD HAVE JUST PUBLISHED SPECIAL ANATOMY AND HISTOLOGY, BY \VM. E. HORNER, M. D. PROFESSOR OF ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA, MEMBER OF THE IMPERIAL MEDICO-CHIRURGICAL ACADEMY OF ST. PETERSBURG, OF THE AM. PHIL. SOCIETY, &C. In Two Vols. Svo. This edition has undergone a complete revision by Prof. Horner, and perfected from recent sources of information. The portion on Histology and Histogeny is two-thirds new, and a new chapter on Glandular Structure has been added. The author has deemed it advisable to have prepared an Atlas of Anatomical Plates to illustrate his lectures; and this has been undertaken under his supervision, by Dr. H. H. Smith, which will render the whole work most complete, and form an additional volume. NOW PREPARING, AN ANATOMICAL ATLAS, EMBRACING THE BONES, MUSCLES, LIGAMENTS, NERVES, VISCERA, &c. By HENRY H. SMITH, M. D. &c. &c. UNDER THE DIRECTION OF PROFESSOR HORNER. " The claim of the present series of Plates is that it has been selected from the most accurate of the numerous ones now existing, as well as from the microscopical observations on the Anatomy of the Tissues, and where those existing were not deemed satisfactory, to have been enriched by original drawings from specimens fur- nished by the beautiful Anatomical Museum of the University of Pennsylvania. In the arrangement of the work, it will be seen that reference has been had to the production of a volume suited to general circulation in the country where access cannot be had to subjects, and of such a size as could be conveniently used in the Lecture, Dissecting or Operating Room; with a Terminology sanctioned by general usage, in the United States, and with concomitant references on the same page, thereby saving to the young student much embarrassment and confusion/' This work is most extensive in its design and will consist of about six hundred illustrations in wood, executed by Gilbert in his best manner, forming a most beau- tiful series of Anatomical Plates. It will consist of five parts, any one of which may be had separately if desired; or the whole will be done up and make a most beau- tiful volume in Imperial octavo. A page is annexed which conveys some idea of the design, but not of the beauty of execution. The first part, embracing the Bones and Ligaments, will be ready in November. Price %i 00. PIG. 4. FIG. 5. FIG. 7. FIG. 4. A Longitudinal section op a Femur, SHOWING THE CELLULAR STRUCTURE AT ITS EXTREMITY. FIG. 5. A Longitudinal section op a Tibia, SHOWING 1. The Compact Structure. 2. The Cellular Structure. 3. A Transverse section of the Femur, showing its Compact Substance, its Internal Cellular Structure, and the Medullary Canal. FIG. 6. The Texture of a Bone as shown in a Humerus, after maceration in dilute acid. 1.1. The Compact Matter as usually seen. 2. 2. The same split, so as to show the Longitudinal Fibres composing it. 3. The Internal Cellular Matter. 4. The Bone seen under its Articular Cartilage. FIG. 7. A view op the Concentric Lamella of the Compact Matter op a Bone. SIR ASTLEY COOPER'S WORKS!!! LEA & BLANCHARD HAVE NOW IN PREPARATION, AND WILL SPEEDILY ISSUE, THE ANATOMY AND SURGICAL TREATMENT ABDOMINAL HERNIA; - BY SIR ASTLEY COOPER, Bart. Edited by C. ASTON KEY, Surgeon to Guy's Hospital, &c. This important wrk of Sir Astley, will be printed from the authorized second edition, published in London, in large super royal folio, and edited by his nephew, Professor Key. It will contain all the Plates and all the Letterpress—there will be no omissions, interpolations, or modifications—it will be the complete work in ONE LARGE IMPERIAL 8vo. VOLUME. with over 130 Fieures on Twenty-six plates, and about 300 large pages of letterpress. The correct- ness of the plates will be guaranteed by a revision and close examination under the eye of a distin- guished Surgeon. To be followed by the worksou THE TESTIS, BREAST, &c, by the same author. TO BE READY EARLY IN DECEMBER. A TREATISE ON DISLOCATIONS AND FRACTURES OP THE JOINTS. Edited by BRANSBY COOPER, Esq.., F. R. S. PUBLISHED WITH ADDITIONAL NOTES AND CASES, BY THE AMERICAN EDITOR, In one volume, 8vo. Sir Astley Cooper left very considerable additions in MS. for the express purpose of being introduced into this Edition The whole of the Plates have been redrawn, engraved on Wood, and printed with the Text. No expense has been spared in its typographical execution; and it is pubiished at a price to make it available to every member of the profession. ^NOW'ltEADY. A TREATISE THE DENTAL ART, FOUNDED ON ACTUAL EXPERIENCE. ILLUSTRATED BY TWO HUNDRED AND FORTY-ONE FIGURES IN LITHOGRAPHY, AND FIFTY-FOUR WOOD CUTS. BY F. MAURY, DENTIST OF THE ROYAL POLYTECHNIC SCHOOL. CtanslateU from tfce jFccncl), WITH NOTES AND ADDITIONS, BY J. B. SAVIER, DOCTOR OF DENTAl SURGERY. One vol. 8vo. This work is used as a Textbook in the Baltimore College of Dental Surgery, and commends itself to the Profession from the great reputaton of the author, and as embracins the latest information on the subject. Its steady demand is the best testimony of the general favour with which the profession has received it. It is in fact a cyclopaedia of the science From tfie American Journal of the Medical Sciences. "The work is divided into three pans: the first is devoted to the ' Anatomy and Physiology of the Mouth and its Appendages,' as for example—the tonaua, maxillary bones, muscles, nerves,~arteries, veins and glands; the teeth, together with a description of the manner of their formation, development, structure, and eruption of both the temporary and permanent sets; also a description of the denial pulps and enamel, and the varieiies of ' form,' 'number,' 'position,' 'structure,'and the ' consistency of the teeth.' "In the second part of the work, he treats of 'Dental Hygiene and Therapeutics,' embracing a. de- scription of the means for the preservation of the teeth and all the other parts of the mouth. " The third part of the work is devoted to ' Mechanical Dentistry,' or a description of the various methods for the insertion of artificial teeth; every one of which is illustrated by one or more wood cut engravings and lithographic plates "The information contained in the first and second parts of the work should be possessed not only by every dental, but by every medical practitioner, and more espncially by those residing in the couu- try and small villages where the services of scientific and skilful dentists can rarely be had." .oa^' «S5^kl LIBRARY OF MEDICINE § nlm omiaoaT s ""Us NLM041420895