AN EPITOME 
• , 
OF 
BPiAITIIWAITE’S RETROSPECT 
OF 
PRACTICAL MEDICINE AND SURGERY; 
CONTAINING 
A CONDENSED SUMMARY OF THE MOST IMPORTANT CASES ; THEIR TREATMENT, AND AH 
THE REMEDIES AND OTHER USEFUL MATTERS EMBRACED IN THE FORTY VOLUMES THE 
"WHOLE BEING ALPHABETICALLY CLASSIFIED, AND SUPPLIED "WITH AN ADDENDA, 
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STANDARD A LIST OF INCOMPATIBLES EXPLANATION OF THE PRINCIPAL 
ABBREVIATIONS OCCURRING IN PIIARMACEUTICAI FORMULAS A VOCA- 
BULARY OF LATIN WORDS MOST FREQUENTLY USED IN PRESCRIP- 
TIONS, AND A COPIOUS INDEX. 
13Y WALTER S. WELLS, M.D. 
VOL- IT. 
NEW YOKE: 
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New York. 
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OP 
BRAITH WAITE'S RETROSPECT. 
HYSTERIA. 
Essential Oil of Valerian a Remedy in Nervous and Hysterical Affec- 
tions.—[Mr. Gore relates the case of a lady, and accompanies his remarks 
with the following practical observations :] 
I viewed her case as one arising from a lesion of innervation of an ady- 
namic character, out of which the other morbid phenomena arose—the 
diminution in the animal temperature, the absence of the pulse, and the 
general tremor, as the results of the circulation forsaking the periphery, 
for an impeded action in internal organs; and the result of the treatment 
entirely coniirmed this view. 
A jar of warm water was applied to her feet, warm flannel to the sur- 
face, and a teaspoonful of the following mixture in a wineglass of water 
every hour, until relief followed: 
Mist, camphor®; spt. ammon. aromat, aa. §ij.; ol. ess. valer., gtt., 
xxv. M. 
She got a little warm wine whey occasionally. A restless feeling of 
languor continuing, she got: 
Some warm leaf tea, and at nine o’clock a pill containing the eighth of 
a grain of morphine, one drop of oil of valerian, with some extract of 
hyoscyamus. 
She slept well, and when I called in the morning, I found her quite en- 
livened at the idea of being so much sooner well of this attack than of 
former ones, though she considered it more severe. 
[Speaking of another case, he says:] 
Soon after this time, I was called to the country to see a lady of wealth 
and importance, who labored under many distressing nervous symptoms— 
disturbed rest, irregular bowels, impaired digestion, headaches, a partial 
palsy of the left arm, with nervous twitchings in the left side of the face, 
colicky pains across the abdomen, with much inflation of the bowels. 
Throughout the continuance of her illness the catamenia continued 
undisturbed. She was of a spare habit of body, and every indication of 
plethora absent. The dyspeptic symptoms were those which first called 
for attention, out of which I conceived, the nervous disturbance arose; 
but long after her bowels became regular, the evacuations healthy, and 
the appetite good, her nervous symptoms remaining unaltered, she was 4 
HYSTERIA. 
subjected to the influence of electricity, and of the following mixture she 
took a small teaspoonful in half a tumbler of porter twice a day: 
Rhubarb root, sliced, 3hj-; chirayeta, 3ij-; coriander seeds, bruised, 
5iiss.; Bradishes’ alkaline solution, §viij. 
This was allowed to stand for ten days, and on being filtered, sixteen 
drops of oil of valerian were added, which made a very good antacid, 
anti-spasmodic, tonic, aperient mixture, and from the use of which she 
derived much signal benefit. 
[It will be observed that in this case Mr. Gore used the chirayeta, and 
as this lemedy is not generally known, we would just remind the profes- 
sion that in many cases of indigestion, and especially when accompanied 
with an unpleasant giddiness after eating, this will be found a valuable 
remedy. The following is a good way of preparing and taking the 
infusion of chirayeta: Add half an ounce of chirayeta to one pint of 
boiling water; let it stand closely covered for twelve hours, and then 
strain it through a fine sieve, and pour it into a wine bottle in which has 
been put half an ounce of the subcarbonate of soda; this to be well 
shaken together. A wineglassful of the infusion to be taken three times 
a day, one hour before each meal. A larger quantity of the above, not 
to be made at once, as it does not keep good for many days. Mr. Goi’e 
ends his observations as follows:] 
In the abdominal pains, and in that pain of the side peculiar to many 
young females, a combination of aloes, assafoetida, and oil of valerian, 
proves exceedingly advantageous. 
I had one case of chorea, which, after a little attention to the bowels, 
derived inestimable benefit from a single drop of the oil, in a lump of 
sugar, three times a day. After about three weeks this young woman 
was quite restored. It occurs to me that this would be a very suitable 
remedy to drop into a carious tooth accompanied with pain, where inflam- 
mation of the fang was absent, but having no opportunities to test thi6 
since the idea occurred to me, I can only give it as a suggestion. 
Part ii., p. 54. 
'Efficacy of Opium Injections in Cases of Nervous Excitement.—It 
seems that both tobacco and opium, when administered in the form of 
an injection, take even a more powerful effect than when taken into 
the stomach. Dupuytren explains this fact with respect to opium, by 
supposing that in the stomach its effects become modified by the process 
of digestion, whereas, when administered by the rectum it becomes 
absorbed, unaltered, into the system. This is well illustrated in a 
case of nervous excitement, published by Dr. Maddock, in which 
the opium injection was used with remarkably good effects; and 
no doubt, in many cases of nervous excitement, produced either by 
disease or by operations, this remedy would be found valuable. 
Part iv., p. 44. 
Tobacco in Hysteria.—In a case of hysteria, related by Dr. J. II. 
Thomson, where all the usual remedies seemed comparatively useless, 
tobacco leaves, soaked a few moments in hot water, and then spread over 
the epigastric region of the patient, succeeded in arresting three consecu- 
tive attacks. Part vi., p. 82. 
Ioduret of Silver—Suggested in various painful hysterical affections, 5 
in doses of from one-eighth of a grain to one or two grains, two or three 
times a day, in the form of a pill. Part vii., p. 82. 
Ergot of Eye.—Mr. Xardo has found the internal administration of 
ergot of rye, followed by the rapid removal of the disease, depending on 
atony of the nervous and genital systems. 
His practice consisted in administering about a scruple of the ergot, 
with sugar, in divided doses, each day, intermitting the dose every third 
or fourth day. Part vii., p. 90. 
Local Hysteria.—Dr. R. B. Todd, after alluding to the power of the 
mind to create pain, or to perpetuate it after it had been excited by some 
physical cause, observes: I do not profess to give an account of all the 
forms that local hysteria may assume, so many and so various are they. I 
shall, however, briefly refer to the principal varieties that are likely to be 
met with in practice. 
Pain in the Side.—Among the most common forms of local hysteria 
are those pains in the right or left side; of these I believe the most fre- 
quent is that on the left side; the pain is referred to a spot immediately 
beneath the left mamma, corresponding very nearly to the situation of the 
apex of the heart. In most cases the pain is increased on pressure ; some- 
times, however, firm and steady pressure gives ease, and I have sometimes 
observed patients to make pressure themselves, in order to obtain some 
relief. It is quite extraordinary what a common symptom this pain is, or 
that on the right side. It is very frequently (that on the left side espe- 
cially) accompanied with lcucorrhoea or some form of uterine derange- 
ment, so much so, that now, after I have learned that a young woman of 
hysterical appearance complains of this pain, my next question invariably 
refers to the existence of leucorrhoea. In some instances this pain is 
always increased on inspiration, and is attended with a short but fre- 
quent cough, without expectoration. If there be any emaciation, or if 
there has been phthisis in the family, the fears of the patient’s friends be- 
come excited, lest this cough and pain should be the forerunners of con- 
sumption. And it is not always easy to assure oneself that the irritation 
of nascent tubercles may not have some share in the production of the 
phenomena. 
Irritable Spine.—The irritable spine is another form of local hysteria, 
w'hich, if treated on erroneous principles, or if its real nature be not de- 
tected, may lead to very serious consequences. This affection has been 
deemed of sufficient importance by some practitioners, to merit its being 
designated by the special name of spinal irritation. But this term is 
highly objectionable. Many who have written upon this subject have 
striven, on very insufficient evidence, to show that the spinal cord itself is 
at fault. The truth, however, is that the spinal irritation is but a symp- 
tom of a general state, a local malady, depending on a constitutional 
cause. These cases are often mistaken for actual disease of the vertebrae, 
and patients have been confined to the recumbent posture for its cure, a 
mode of treatment admirably calculated to perpetuate the real complaint. 
It often happens that the patient has difficulty in walking, and this is re- 
garded as the consequence of the spinal affection. She at first finds her- 
self easily fatigued; the pain in her back is increased by walking or 
standing; she gradually becomes disinclined to move, and gets 
accustomed to the horizontal position, and, therefore, readily yields to 
HYSTERIA. 6 
HYSTEKIA. 
any suggestions in favor of quiet, or reluctantly obeys the advice which 
recommends an opposite plan. The most acute pain is felt over a particu- 
lar spot on the back. Slight pressure will produce it, when the patient’s 
attention is alive to it; and firm pressure will often fail to create it when 
her attention has been diverted from it. But there is always a good deal 
of tenderness in the whole course of the spine and in other parts also. 
You will derive great assistance in your attempts to distinguish the real 
nature of this affection, by attending to the nature of the pain ; it is 
always of that exaggerated kind which is characteristic of hysterical pain. 
It is much more acute than the pain which attends diseased vertebrae; 
it is more superficial, so as often to appear, as I believe it is, seated in the 
skin that covers the spinous processes. 
Local Pulsation.—We had lately a case in which this form of local 
hysteria was very well marked; and it was accompanied with another 
symptom not uncommon in hysterical persons. This was a strong 
pulsation of the aorta in the epigastric region, simulating aneurism. 
For some time the pulsation appeared so strong, and was so circum- 
scribed, that had I not knowm the decidedly hysterical character of 
the patient’s constitution, I should have felt considerable apprehen- 
sion on her account. However, as her strength improved, and her 
catamenia became regular, these symptoms disappeared. 
Hgsterical Affection of Joints.—The profession is much indebted 
to *Sir Benjamin Brodie for having directed attention to the frequency 
with which local hysteria manifests itself, especially among the higher 
classes, in the form of affections of the large joints, simulating those 
diseases with so much accuracy that practitioners have frequently 
been misled by it. Sir Benjamin states the remarkable fact, which 
no one is so well able to ascertain as a surgeon of his great expe- 
rience, that four-fifths of the supposed cases of joint-disease which 
occur among the higher classes are hysterical. This statement ought 
to impress us strongly with the importance of being well acquainted 
with the peculiar features of these hysterical affections of the joints. 
You will, of course, expect to find in these cases indications of 
the hysterical constitution; globus; perhaps, occasional hysterical 
paroxysms; general irritability; enfeebled nutrition; pain easily ex- 
cited on pressure at various parts of the body ; irregular catamenia, 
or some uterine disturbance. The joints which are most frequently 
affected are the hip and knee. The patient keeps the painful joint 
quite at rest, being fearful of the least disturbance. When the joint is 
moved, she will call out with much more expression of pain than if there 
were actual ulceration of the cartilages. “ There is always exceeding 
tenderness,” Sir Benjamin Brodie remarks, “ connected with which, how- 
ever, we may observe the remarkable circumstance, that gently touching 
or pinching the integuments in such a way as that the pressure cannot 
affect the deep-seated parts, will often be productive of much more pain 
than the handling of the limb in a more rude and careless way.” As, 
however, in most hysterical affections, if you can succeed in engaging 
your patient’s attention about some other object, and thus directing her 
thoughts from her own sufferings, you will find that the joint can be 
moved with comparatively little or with no pain. 
Irritable Breast.—Another very serious form of painful hysterical alfec- HYSTERIA. 
7 
tion is the irritable breast. It is not generally attended with swelling or 
enlargement. The irritability is excessive, and the patient shrinks quite 
as much from superficial as from deep-seated pressure, and even before she 
has been actually touched at all. These characters, along with the evi- 
dence of hysterical constitution, are sufficient to enable the attentive prac- 
titioner to distinguish the real nature of the affection. 
Paralysis of the Bladder.—Hysterical paralysis of the bladder is also 
common, and much mischief may arise from neglect of constitutional treat- 
ment, and too close attention to the local affection. Sir Benjamin Brodie 
lays down the rule, that in these cases the catheter should not be had 
recourse to; and the only exceptions to it are in those extreme cases in 
which actual paralysis has taken place, and the bladder is likely to become 
diseased, if not artificially relieved. A similar want of power over the 
rectum may occur in hysterical women. I have known women complain 
that they were unable to expel the contents of the rectum, although they 
were conscious of tieces having passed into it. With respect to many of 
these cases of hysterical paralysis, there is much truth in Sir B. Brodie’s 
remark, “that it is not that the muscles are incapable of obeying the act 
of volition, but that the function of volition is suspended.” 
Spasmodic Affections.—Among the various forms of local hysteria, we 
may class some singular spasmodic affections, which often prove exceed- 
ingly troublesome ; for example : 
Laryngeal Affection.—In the woman Collier, whose case I have 
had occasion to refer to as an instance of paraplegia, we had an example 
of a spasmodic affection of the muscles of the larynx, very much 
resembling the spasmodic croup, or laryngismus stridulus, which occurs in 
children. This attack was always preceded by depression of spirits and 
hysterical crying; the breathing became difficult, and both inspiration and 
expiration were attended with a stridulous noise ; there was also a loud 
barking cough, which could be heard at a considerable distance. The 
attack passed off as the temporary excitement disappeared. 
Hysterical Sobbing.—One of the most singular cases I ever saw was 
that of a girl named Howe, aged 19, who was admitted in consequence of 
a peculiar spasmodic affection of the diaphragm, of a most severe kind, and 
which, while it lasted, was most troublesome and painful. 
At her admission, she stated that for the last three months she had been 
very subject to leucorrhoea. In other respects, she was in good health. 
Her face has the aspect of hysteria; the full upper lip is very well marked. 
Four days before her admission, in taking down a bedstead, she fell and 
struck the right side of her abdomen. In half an hour she was seized with 
a catching of her breath, and with pain in the right side of the abdomen. 
This continued for two or three hours, so as to interrupt her work, and 
then went off. Her bowels were open at the time, but she is of costive 
habit. In the evening, the catching of her breath and the pain returned; 
it now continued some time, so that she scarcely lay down during the 
night. Next morning there was great epigastric tenderness, and she was 
unable to bear the pressure of her stays. 
At our first visit, we found her affected with this catching of the breath, 
It exactly resembled a violent fit of sobbing, unattended with flow of tears. 
There is a jerking movement of the neck from side to side with each sob, 
but the limbs are motionless. Any excitement increases the sobbing. It 
was much increased by our visit, anil subsided after we left. The upper 8 
HYSTERIA, 
extremities are now thrown into jerking movements, resembling those of 
chorea, shortly after the sobbing begins. 
Her treatment consisted in free purging for the first few days, lest there 
should be any lodgment in the intestinal canal, and subsequently tonics. 
Her attacks ceased, and as she remained quite free up to the 5th of April, 
and her health was much improved, she was discharged. She was, how- 
ever, readmitted on the 10th, with a recurrence of the paroxysms, without 
any apparent cause. They are accompanied with jerking movements of 
the upper limbs and tremblings of the lower ones, which give her an 
unsteady gait in walking. Pressure excites or increases the sobbing, par- 
ticularly when applied on the right side; and if the pressure be continued, 
the sobbing becomes excessively violent, and the whole body is thrown into 
convulsive movements. 
She had followed a tonic treatment for a considerable time without any 
benefit to these paroxysms. I determined now to try a succession of 
blisters to the epigastrium. The first excited a very severe paroxysm; 
however, by perseverance in the use of them, she has not only become able 
to bear them, but the paroxysms have considerably diminished in frequency 
and severity, so that now she can bear a good deal of pressure without 
inducing the sobbing. 
Sir B. Brodie has recorded a case very similar to this. 
Hysterical Sneezing.—Women are sometimes attacked with violent fit? 
of sneezing, coming on at particular periods and lasting for a considerable 
time. Of my own knowledge, I am aware of but one instance of this, in a 
newly married lady, in whom the fits of sneezing used to come on early in 
the morning. There was, I had reason to believe in this case, great disap- 
pointment that the signs of pregnancy did not appear about the usual 
time; and it was curious that these attacks should have come on chiefly 
when the morning sickness would have shown itself in the early stage of 
pregnancy. Part viii., p. 59. 
Treatment.—The following formula is very highly lauded by Dr. 
Debreyne: 
R P. camphor®, gss.; P. assafoetida, §ss.; extr. belladonnas, 9iv.; extr. 
aquos. opii, 9j. 
Mix and divide into 120 pills; commence with two at first per diem, and 
gradually increase the dose to six in the 24 hours; they should always be 
taken before food. Occasionally a wineglassful of the infusion of valerian 
<«■ orange leaves may be given with much advantage along with each dose 
of the pills. 
Dr. D. is in the habit of administering them also for the cure of general 
or partial nervous trembling, and of chorea. Sometimes he exhibits, 
in the latter disease, the belladonna by itself; and, he says, very generally 
with success. When it fails, he has recourse to cold bathing. 
Part x., p. 25. 
Hysteria treated by the application of Cold to the Region of the 
Uterus.—M. Butignot mentions the case of a young woman, eighteen 
years of age, attacked for the first time with hysteria, which lasted seven 
days. She was quite blind during this period, but remained perfectly 
sensible. There was permanent contraction of the muscles of the trunk 
and extremities, with occasional convulsive movements. She could only 
swallow a few drops of liquid at a time, and speak a few words in a low HY8TERIA. 
9 
voice. Treatment was of no avail, soothing and antispasmodic remedies 
did no good, but M. B. remarked on the fifth day that the paroxysm became 
aggravated about noon; he immediately gave quinine, under which treat- 
ment the symptoms gradually subsided. The following year she was again 
attacked as before, and from pain in the hypogastric region, with sup- 
pressed catamenia, he was led to infer the existence of over-excitement in 
the uterus. He ceased all treatment, and applied cold compresses to the 
lower part of the abdomen and upper part of the thighs. In half an hour 
the patient was relieved, and had no return of her symptoms. 
Part xiii., p. 68. 
Hysteria.—M. Gendrin gives opium, in large doses, commencing with 
gr. v. daily, and increasing to gr. x. or gr. xij.: The appearance of an 
hypnotic effect is a sign that the disease, and the tolerance of opium induced 
by it, are on the decline, and the dose must then be lessened. 
Part xv., p. 12. 
Treatment of Hysteria.—Occurring in a patient of plethoric habit, and 
accompanied by cerebral symptoms : leech the head, or cup between the 
shoulders ; if this is ineffectual, give two grains of digitalis twice a day, 
and put a blister on the nape; for the convulsions of the voluntary 
muscles, give half a grain of extract of belladonna, every eight or twelve 
hours. 
Produced by Accumulation in the Colon.—Clear out the bowels by the 
repeated exhibition of pills composed of extract of jalap, compound extract 
of colocynth, and compound rhubarb pill. 
Combined with Pyrosis.—Give trisnitrate of bismuth, with a bitter 
infusion. 
From Anaemia.—Give chalybeates. 
Hysterical spasms may be subdued by the inhalation of ether vapor, or 
chloroform. Part xvi., p. 90. 
Observations on Hysteria.—Referring to cases in which females have 
become outrageously excited, Mr. Corfe says: 
Now, all attempts to pacify such persons by ordinary means, as by argu- 
ment, by medicine, or by reasoning, are fruitless; they are like eels for 
wriggling, and like bulls for fierceness and strength; our only alternative 
is to fix them on the stretcher, and strap them there, mount a chair placed 
on each side of the head, and keep up a constant stream of cold water on 
the face; and the more they scream the more cold water they are obliged 
to gulp down their throat, until the globus is conquered, the head cooled, 
the passions subdued, and, when they really find that we give them more 
in proportion to the screaming, they become calm and sue for pity. 
Part xvii., p. 58. 
Belladonna in Hysteria.—Marked benefit is derived from belladonna, 
given as follows: Take of camphor, 12 grammes (about 3iij. and gr. v.) ; 
assafcetida, 12 grammes; extract of belladonna, 4 grammes.(about 3j.); 
aqueous extract of opium, 1 gramme (about gr. xvss.) ; sirup of gum, 
enough to make 120 pills. Give one pill the first day, two on the second, 
and gradually increase the dose to six pills daily. Part xxi., p. 11. 
Treatment of Cerebral Hysteria.—Employ as a prophylactic and cura- 
tive agent in this affection, the persevering and systematic application.of 
electro-galvanism to the abdominal and pelvic regions, in combination 10 
INDIAN IIEMP, 
with other means. Amongst the adjuvants that should be administered 
concurrently with its use, Dr. Laycock mentions tar in small doses, the 
introduction of which we owe to Professor Simpson, and which is in itself 
an excellent remedy for habitual constipation, without the aid of electro- 
galvanism. Part xxii., p. 82. 
Colchicum in Hysteria and Chorea.—Thirty drops of the tincture of 
colohicum, taken every eight hours, was followed by complete relief. In 
chorea, also, the same remedy has proved valuable. Part xxv., p. 300. 
Hysteric Hemiplegia.—This may be known from hemiplegia depending 
on disease of the thalamus opticus and corpus striatum by its occurring 
generally in young subjects, by the muscles of the face not being 
affected, and by loss of sensation preponderating over loss of motion. The 
best treatment is steel and valerian. (Prof. Gull.) Part xxxiv., p. 28. 
INDIAN HEMP. 
Indian Hemp.—There are few medicines which have excited more 
interest than Indian Hemp, and few medicines of known medicinal powers 
have so often and so signally tailed to fulfill the hopes respecting it. The 
reason of this seems to be that the preparations which have been used by 
different experimenters have not been alike. One man has used the sim- 
ple tincture of the seed, another the tincture of the resin, and another 
the resin itself. Again, one preparation may be very useful in India, but 
the same, when brought to this country, may be so deteriorated as to be 
useless. Dr. O’Shaughnessy may have found the resin of the plant pow- 
erful in India, while it is necessary, when used in this country, to make a 
tincture of the resin, prepared in India from hemp, collected at the proper 
season. Mr. Donovan, from numerous experiments on his own person, 
and on others, especially recommends the tincture of the resin as superior 
to all the other preparations of this drug. The resin itself seems to be 
totally insoluble in watery liquids, and it should therefore be made into a 
tincture. The pilular form will often pass undissolved through the ali- 
mentary canal. This is corroborated by the fact that Mr. R. O’Shaugh- 
nessy found that one drachm of the tincture, which contains three grains 
of the resin, had a much more powerful effect than five grains of the 
latter. Mr. Donovan prepares his tincture of the resin by mixing two 
grains of the resin with one drachm of rectified spirit; and of this he 
gives at first from eight to fifteen minims in a very small quantity of proof- 
spirit. If the draught be mixed with water, the resin will be rapidly pre- 
cipitated and adhere to the vessel, and will thus escape being swallowed. 
Part xi., p. 1G. 
Indian Ilemp as an Oxytocic.—This seems to be a valuable oxytocic 
remedy. Several cases are given by Dr. Christison illustrative of its 
powerful effects. The extract may be given in the form of pill, but in 
this form the hemp is rather uncertain. Another form recommended is the 
emulsion, made by rubbing a scruple of the extract in a warm moitar in a 
drachm of olive oil, to which may be added half an ounce of mucilage, 
and seven and a half ounces of distilled water. The tincture is perhaps 
the best form, of the strength of three grains of the extract to a drachm INFANTS. 
11 
of rectified spirit. The dose of the extract is from one to six grains, of 
the tincture ten to thirty drops. To promote uterine contraction, loss 
than thirty drops is of little service. In tetanus one or two drachms must 
be given. Part xxiv., p. 320. 
INFANTS. 
Nursery Treatment of.—No other kind of milk to be given to an 
infant in addition to the milk of the mother or wet-nurse. The less rock- 
ing the better. When asleep, to be laid upon its right side. The best 
food is “Lemann’s biscuit-powder,” soaked for twelve hours in cold spring 
water, then boiled for half an hour, not simmered, or it will turn sour. 
Very little sugar to be added to the food, and then only at the time when 
given. 
Sweets, of every kind, are most injurious, producing acidity, flatulency, 
and indigestion, sores in the mouth, and disordered secretions. An infant 
will take medicine the more readily if made lukewarm in a cup placed in 
hot water, adding a very little sugar when given. The warm bath (at 
ninety-four degrees of heat, not less, for ten minutes, every other night) 
is a valuable remedy in many cases of habitual sickness or constipation. 
“ Soothing-sirup,” sedatives, and anodynes, of every kind, are most 
prejudicial. They stop the secretions. A very small dose of laudanum 
given to an infant may produce coma and death. When an infant is 
weaned, which is generally advisable at the age of nine months, it is of 
the utmost importance that it be fed with the milk of one cow, and one 
only (a milch cow), mixed with “Lemann’s biscuit-powder” (prepared as 
before directed), and very little sugar. 
Solid meat is not generally required until an infant is fifteen months of 
age, and then to be given sparingly, and cut very fine. Roasted mutton, 
or broiled mutton-chop (without fat), is the best meat; next to that, 
tender lean beef or lamb ; then fowl, which is better than chicken ; no 
pork or veal; no pastry; no cheese; the less butter the better. An infant 
should not be put upon its feet soon, especially while teething, or indis- 
posed. Avoid over-feeding at all times, more particularly during teeth- 
ing. It is very likely to produce indigestion and disordered secretions, 
the usual prbnary causes of convulsions, various eruptive complaints, and 
inflammatory affections of the head, throat, and chest. Part vii., p. 90. 
Hint on the Feeding of Children.—Nurses in general, who have the 
charge of young infants brought up by the hand, have an invincible objec- 
tion to thin food, as the object is to make the child look as fat and hearty 
as possible, and we have to struggle against this prejudice sometimes in 
cases even of imminent danger. 
In most of these cases we find the alvine dejections to consist of a thick, 
pasty mass, without a proper admixture of bile, constipation being a fre- 
quent accompaniment; and it is not till the secretions become less con- 
sistent, and of a better color, that we observe decided signs of ameliora- 
tion as to the spasmodic attacks. The generality of authors who have 
written on this subject allude to this state of bowels. Dr. Underwood 
mentions, that he has known some of the largest and finest infants he had 
ever seen, die suddenly within the month, immediately after the nurse had 12 
INFANTS. 
boasted of their having taken “ three boatfuls of victuals.” There are 
numerous cases, also, of general convulsions occurring soon after being 
fed with thick food. In a family in which twelve children were succes- 
sively subject to this disease, they were all fed by hand, principally owing 
to the mother having sore nipples. Part xvi., p. 293. 
Piet of Infants.—We have had a considerable experience in directing 
and observing minutely the rearing of infants upon a substitute for 
mother’s milk. We never allow a healthy infant, for the first two months, 
to have any other food as a substitute for its mother’s milk than cow’s 
milk diluted with two-thirds of water, and well sweetened with fine sugar. 
Of this fare we sanction an unlimited supply, at intervals of from one 
and a half to two hours during the day, and three or four hours at night, 
provided it be sucked from a teat. Upon this simple fare, we have seen 
children grow up in the plenitude of health and strength. If the food be 
as thin as we have described, no evil can arise from' over-feeding; and by 
allowing an interval to elapse between the times of feeding, digestion 
goes on better, and fretfulness is averted. To weak or scrofulous infants, 
the addition of a little mutton suet is good, or the same benefit may be 
obtained by giving two teaspoonfuls of cod-liver oil daily. Oatmeal, and 
all farinaceous foods, are unsuitable and unnatural for the first two months, 
and are certain to induce fits of feverishness and griping pains. After the 
second month, rusk, melted down in the sweetened milk and water, is 
useful; but the food must still be thin, and sucked from a teat by the 
infant. The exertion of sucking is, for many reasons, very salutary. 
Part xxviii., p. 291. 
Prolonged Retention of Life by Infants who have not Breathed.— 
The long period during which life may, under certain circumstances, be 
retained by the infant who has never breathed, is a fact full of interest to 
the physiologist, the medical jurist, and the accoucheur. The experiments 
of Legallois show that, in the mammalia, the foetus which has not breathed 
can resist death from submersion much longer than the foetus in which 
respiration has been carried on. Puppies and kittens, immediately after 
birth, may be kept under water for twenty-eight minutes with impunity; 
when five days old, they perish after sixteen minutes’ submersion ; and, 
when fifteen days old, they die as rapidly as other warm-blooded animals 
of any age, from deprivation of air. The human still-born foetus can pro- 
bably live longer without respiration than any other mammalian foetus. 
The following cases are collected in the “GazetteHebdomadaire” for De- 
cember 1st, 1824, from different sources. They are very striking, and 
very suggestive to the practical accoucheur. 
A woman aged 25, who had tried to conceal her pregnancy, was 
delivered when seated on a tub. The infant, born without any signs of 
life, was buried in a sand-pit, and, after remaining there for half an hour, 
was removed, and lived. This case is described by Dr. Weese in 1845, in 
“ Badisch. Ann. f. Staatsarz,” x. 2. 
In 1850, a young woman was tried by the tribunals of Berlin, who had 
buried her new-born male infant, believing it to be dead. After an hour, 
the infant was disinterred, and recalled to life. 
T. P., a servant, aged 23, was delivered in a stable, when leaning 
against the wall, alone, and in a state of unconsciousness, about half-past 
four, a. m. When she came to herself, she found the infant on the ground, INFLAMMATION. 
13 
having a spade lying upon it, with its cutting edge turned to the body. 
She took the infant, which was perfectly cold, believing it to be dead, and, 
with the placenta attached, wrapped it up in her apron, and buried it m 
the garden. Suspicions arose that she had been contined : she confessed ; 
and at half past nine the infant was dug up from a depth of thirty centi- 
metres. It was found lying on its face, with the placenta under the abdo- 
men. Though cold, apparently dead, and pulseless, the cord was tied. 
For two hours, P., a surgeon, used means to reanimate it, when at last it 
began to breathe feebly, gradual signs of life became more evident, and it 
cried. Some slight wounds were observed on its body: wounds in the 
neck, which did not bleed at first, bled when the infant was restored. It 
took the breast greedily. On the 17th and 18th, the wounds suppu- 
rated ; and on the 19th, it died of convulsions. The physicians intrusted 
with the judicial autopsy, reported that it had been inhumed before it 
breathed; and that it had not breathed till after it was exhumed; and 
that the statement of the mother was possibly true. She was therefore 
acquitted of the charge of infanticide, but was found guilty of concealment 
ofi jregnancy. Part xxxi., p. 213. 
Defective Assimilation in Infants.—This disease, which is the most 
frequent and fatal of all infantile disorders, is almost always the result 
of want of breast-milk, and the use of injudicious food. Fatty acids, 
and already artificially digested animal and occasionally vegetable sub- 
stances, and especially breast-milk, must be supplied. It is a very good 
plan to mix human and cow’s milk. Simple juice of meat is very useful. 
The remedies of use are phosphate of soda, producing an emulsion with 
fats, thus allowing of their assimilation ; chloride of potassium to dissolve 
carbonate of lime; phosphate of lime, to enable the blood to take up more 
carbonic acid, and thus hold in solution more carbonate of lime (these 
substances severally strengthening muscular and bony tissue). Nitrate of 
silver and sulphate of copper are the best remedies for the diarrhoea. 
Wine is also required even in large quantities.Dr. Routh.Partf xl., p. 57. 
Hints on the Treatment of Inflammation.—Dr. Watson enters into 
the treatment of inflammation, and places his chief reliance on blood-let- 
ting, copiously used at the commencement of the disease. Respecting 
venesection from the external jugular vein, he says: 
There is a distinct and peculiar danger attending the incision of this 
vein, that, namely, of admitting air into it. You perhaps are aware that 
if air enters a large vein near the heart, and passes on to that organ, it 
kills outright. 
[When on the subject of mercury in the treatment of inflammatoiy dis- 
eases, he offers the following valuable hints:] 
Patients who are kept under the influence of mercury grow pale as well 
as thin: and Dr. Farre, who has paid great attention to the effects of this 
drug, remedial and injurious, holds that it rapidly destroys red blood : as 
effectually as it may be destroyed by venesection. 
But the great remedial property of mercury is that of stopping, con- 
INFLAMMATION. 14 
INFLAMMATION, 
trolling, or altogether preventing the effusion of coagulable lymph ; of 
bridling adhesive inflammation. 
In common adhesive inflammation, whether of serous or the cellular 
tissues; whenever, in fact, you have reason to suppose that coagulable 
lymph is effused, or about to be effused, and mischief is likely to result 
from its presence, then you may expect much benefit from the proper ad* 
ministration of mercury; as an auxiliary, however, to blood-letting, not 
as a substitute for it. 
[Speaking of antimony, Dr. Watson says:] 
Antimony, as far as my own observation goes, is admirably suited to 
cases of active inflammation, in which mercury would either be not so 
useful, or could not be brought to bear. It is in inflammation of the 
mucous membrane of the air passages that antimony is so signally beneficial. 
On the other hand, antimony does not appear to be nearly so valuable a 
remedy as mercury, when serous membranes are inflamed. 
As to the form in which the antimony should be exhibited, I apprehend 
that we shall all come at last to freshly dissolved tartar emetic. 
Part iii., p. 32. 
Blood-letting in Inflammation.—In commenting on the practice of 
bleeding in the erect posture in inflammation, and then giving a large dose 
of opium to prevent reaction, Dr. Craigie believes it will often be found to 
give rise to a great fallacy; the faintness thus produced being often merely 
mental, and always too temporary and too trifling to facilitate the re- 
moval of the congested blood from the vessels of an important organ or 
membrane in a state of intense inflammation ; except, perhaps, when the 
disease is in the head, eyes, or upper parts of the body, in which case, the 
erect position must certainly be the most proper, and during venesection, 
must cause the greatest drain of blood from the parts. Part iii., p. 39. 
Use of Poultices in Inflammations of the Great Cavities.—Nothing 
is more remarkable in the practice of physic in France, than the constant 
use of cataplasms in the treatment of inflammations of the great cavities. 
The moment inflammation is supposed to exist in the chest or abdomen, 
the first order given is to apply cataplasms. 
In the bronchial irritation attendant upon the exanthematous fevers, 
poultices to the chest are universally employed ; and where any want of 
energy appears to exist in the system, preventing the coming out of 
eruption, cataplasms, consisting of the usual linseed meal, with the addi- 
tion of a very small quantity, say a twelfth or fifteenth part of mustard 
meal (not flour), are applied to the feet, and maintained for days to- 
gether ; thus keeping up both the temperature of the extremities, and 
gently stimulating the skin. The same mixture is also, when necessary, 
applied to the cal ves of the legs and thighs. 
Pleurodynia, diaphragmitis, and many other affections of a painful 
nature, are likewise treated by poultices; and it is certain, that their 
effects are often, in such cases, very satisfactory. Part iii., p. 42. 
Opium in Acute Internal Inflammations.—Recommended by Dr. R. 
Christison, particularly in inflammations of the mucous membranes. 
Part iii., p. 45. 
Hemostasis.—A substitute for blood-letting in cases of inflammation. 
Vide Art. “Congestive Fever.” 15 
INFLUENZA. 
Nitrate of Potash.—In large doses, suggested in inflammatory affections. 
Part ix., p. 19. 
Treatment of Chronic Inflammation.—[Chronic inflammation generally 
indicates a scrofulous diathesis, and we must direct our treatment to the 
constitution, and employ alteratives if any medicines are used; but im- 
proved diet, change of air, and removal to the sea-side, will often be suffi- 
cient. Mr. Cooper observes:] 
In chronic inflammation of the joints, glands, and in the formation of 
indolent tumors, and even those of a specific character, as fungus and scir- 
rhus—which go on increasing insidiously and almost without pain—too 
active means prove highly injurious, and small doses of bichloride of mer- 
cury, with sarsaparilla, or Plummer’s pill with hyoscyamus at night, seem 
to be the best remedies, assisted by generous diet and free air. Our Lon- 
don hospitals are the worst possible places for such patients to be sent to. 
Mercury in these cases is not given with the same view as in syphilis, to 
act specifically, but merely to act gently upon the chylopoietic viscera, and 
is given in very small doses; and so soon, therefore, as the secretions are 
restored, the mercury should be withheld and iodine prescribed. The 
formula which I usually order it in is as follows: 
R Iodini, gr. ss.; potass, iodidi, 5ss.; sirup, papav., §ss.; infus. gent, co., 
§viij. M. Capt. cochl. larga ij. bis quotidie, with tepid applications to the 
chronic swellings, either warm water dressings or the following lotions, if 
the warmth does not prove agreeable to the patient’s feelings : R Ammon, 
hydrochlor., 5j.; sp. vini rect., liq. aminon. acetat. aa. §ij.; aquae destillat., 
§iv. M. ft. lotio. 
Friction, steaming and bandaging, will, each of them, in certain cases, 
prove advantageous, as well as a variety of stimulating applications; as, 
for instance, equal parts of camphor and soap liniments, with a small 
quantity of tincture of opium, often prove of great service. 
Part xvi., p. 307. 
INFLUENZA. 
Opium.—Dr. Christison finds opium of the most use in inflammations of 
the mucous membranes, especially coryza, catarrh, influenza and dysentery. 
He would cure coryza at once by causing the patient to avoid all meals 
after dinner, to use liquid sparingly, and by giving a full dose of muriate 
of morphia or Battley’s solution at bedtime ; and breakfast before getting 
up the next morning. It seems necessary, however, that the remedy should 
be administered early in the attack. “Febrile catarrh too may be checked 
abruptly in the same way, if patient and physician are lucky enough to 
meet during the first or second day at farthest.” 
Dr. Christison has repeatedly seen epidemic influenza thus checked at 
the outset—the local inflammation vanishing, while the strange lassitude, 
listlessness and ennui, so characteristic of this disorder, went on as usual 
for some days during convalescence. Part iii., p. 45. 
Ipecacuan—Suggested in influenza. Proportion, one or two scruples 
of ipecacuan to five or seven ounces of water. Dose—Half an ounce everf 
two or three hours. Part viii., p. 22. 16 
INSANITY, 
Eupatorium Perfoliatum in Influenza—Manner of Administration.—- 
In the severest cases, where it wras determined to treat the disease with 
the herb alone, the patient, after being covered in bed, was induced to 
swallow a wineglassful of the infusion, prepared by infusing an ounce of 
the dried leaves in a pint of boiling water, warm, every half hour. After 
the fourth or fifth dose, considerable nausea, sometimes vomiting, with free 
diaphoresis, ensued, and there was an immediate amelioration of all the 
symptoms. Along with the nausea, free expectoration commenced; and 
after the former symptom had subsided, the patient was freed from every 
annoyance, and remained in every respect comfortable. Sufficient to keep 
up the impression on the system, the infusion was now given only every 
third or fourth hour in the same dose. The bowels were generally opened 
in about six hours after the commencement of the treatment, and afterward 
continued in a lax condition. Toward the evening of the second day, and 
particularly if the patient had been guilty of imprudent exposure, the 
symptoms frequently returned, and it was necessary to repeat the course 
adopted at first. But generally the medicine, continued as directed, kept 
the symptoms completely in check, and the patient was out on the fourth 
day. In cases where the treatment was commenced with calomel, etc., the 
infusion, to secure its diaphoretic and expectorant effects, was introduced 
on the second day in wineglassful doses every second hour. To correct the 
debilitating effects of the disease, frequently remaining after all its acute 
and more violent symptoms had subsided, a wineglassful of the cold infu- 
sion was directed three times a day. 
The treatment of the disease in old persons, or in other cases where there 
was a marked tendency to prostration, was commenced in the same man- 
ner. As soon as the effects already mentioned as occurring were induced, 
the cold substituted for the warm infusion was directed in the same dose 
every second hour, to be continued, gradually lessening the period through- 
out the disease, unless the violent symptoms returned, when it was to be 
discontinued until the same course was repeated with the warm infusion, 
and then resumed. (Dr. Peebles.) Part x., p. 33. 
INSANITY. 
Seclusion, as employed at IlanweU, in the Treatment of the Insane.—In 
the management of the insane, seclusion of the patient is advised during 
the period of the paroxysm, or fit of passion. To acquire the confidence of 
the patient, by kind and soothing treatment, is considered indispensable, 
and nothing will so much oppose its acquisition as brutal, or even im- 
patient usage during the paroxysm. Part iii., p. 63. 
Non-restraint System in the Management of the Insane.—The appear- 
ance and general state of the patients in the wards of Hanwell, the order, 
activity and cheerfulness, which pervade the asylum, and the rapid subsi- 
dence of the wildness of new patients, are all alleged by Dr. Conolly as 
proofs of the superiority of the gentle plan of treatment. It occasionally 
happens that patients are brought into the asylum in severe restraints. 
They are immediately set free; nor is the restraint ever put on again; yet 
the patient remains quiet. Part vii., p. 87. INSANITY. 
17 
Injurious Influence of Tobacco in Insanity.— Vide Art. “ Tobacco.” 
Insanity produced by the use of Chloroform during Labor.—[At a 
meeting of the Westminster Medical Society, a few months ago,] 
Dr. Webster related the following case, communicated to him by a pro- 
fessional triend, in consequence of perusing in “ The Lancet ” a report of 
the three similar instances he had mentioned at a previous meeting of the 
Society. Only one drachm of chloroform, sprinkled upon a handkerchief, 
was used ; but the effect it produced was so sudden and violent, that the 
patient, after inhaling, remained quite insensible, which greatly alarmed 
the attendants; with the insensibility there vTas likewise deadly paleness 
of the countenance; however, she slowly rallied, but had a painful and 
protracted labor. During several days subsequently, the lady continued 
in a very nervous condition, although not then actually incoherent; but 
she soon became so furiously maniacal as to require coercion by a strait- 
waistcoat. After being insane during many months, the patient gradually 
recovered her reason, and ultimately got convalescent. 
Part xxi., p. 361. 
Medical Jurisprudence of Insanity.—A careful distinction, says Dr. 
Jameson, must be made between diseases having mental symptoms, and 
diseases of the mind; betwixt madness and such affections as hypochon- 
driasis and hysteria. Hypochondriasis consists of illusions and hallucina- 
tions regarding one’s bodily sensations, and is, therefore, not insanity until 
these become deep-seated and permanent delusions, compelling to irrational 
conduct. Hysteria, hypochondriasis, and various other affections, which 
often precede, cause, and accompany insanity, are not diseases of the mind, 
but, more strictly speaking, diseases having mental symptoms, until by 
generating delusions they pass into insanity, and afterward continue as 
complications of the disorder which they have created. Thus, we have 
hysterical mania, which is not hysteria merely, but hysteria and mania 
combined; so also there is hypochondriacal monomania, which is not hypo- 
chondriasis alone, but hypochondriasis and insanity together. 
Simple defect of intellectual power, intellectual dullness, must not be 
confounded -with the imbecility which constitutes a variety of insanity, 
which is not merely a feeble intensity of mind, but a positive deficiency of 
faculties. Wherever there is a feeble exercise of attention, or defective 
memory, there will be imperfect comparison and resulting inaccuracy ot 
judgment; but not from these, or similar causes, any necessary tendency 
to be governed by delusions. In all cases of imbecility included in the 
term unsoundness of mind, there are both emotional and intellectual defi- 
ciency, a loss of control over conduct, and from the antecedence of judg- 
ment being in some part defective or diseased, a liability to confound the 
actual with the unreal. Delusion is not a prominent characteristic, how- 
ever, for in such cases feebleness is the type of all the mental manifesta- 
tions, whether healthy or disordered. 
Eccentricity has also to be distinguished from insanity. All the insane 
are eccentric in their ideas, their language, or their conduct; but the 
merely eccentric have but a voluntary resemblance to the insane. Eccen- 
tricities differ from lunacies, in not arising from a loss, but from an undue 
exercise oij the faculty of judgment; very often from a vanity or self- 
respect in the individual, that leads him to prefer his own judgment to all 
other judgment, experience and authority. They offend against custom 
vor,. ii.—2 18 
INSANITY. 
and experience more than against reason. The eccentric, if he cannot give 
a satisfactory reason for his' outre conduct, can at least assign an intelli- 
gible motive: the lunatic lias no explanation to afford that does not involve 
an absurdity. A certain individual behaves in all respects like other men, 
unless that he constantly walks about without a hat, or any other artificial 
covering for his head. When questioned upon this point of disagreement 
with the custom of his neighbors, he says that nature did not intend the 
head to have any other protection than what she herself had afforded, that 
a bare head is more becoming, that he feels himself in every way more 
comfortable as he is, and that he is certain that he will live longer in con- 
sequence of acting in this rational way. In two instances in which lunatics 
adopted the same habit, the causes assigned by them wrere of a very dif- 
ferent description. One did not have his head covered, because it had 
grown so large that he could not get a cap to fit it; and the other was so 
annoyed by certain mischievous tormentors of an invisible kind drumming 
upon the crown of his hat, that in general he preferred to carry it in his 
hand. The eccentric man had a rule of conduct, the result of his own 
narrow judgment; the two lunatics were impelled by fancies upon which 
their judgment was entirely inoperative. Lord Monboddo, insisting that 
the human family were originally adorned with tails, showed himself an 
eccentric theorist; had he asserted that they actually retained them, he 
would have had an insane delusion, instead of a philosophic crotchet. He 
would have had a false perception on which his judgment was inoperative, 
whereas he was guided by his judgment to a strange conclusion. 
Eccentricities no more constitute insanity, than idiosyncrasies constitute 
disease ; and as these are competent with a sound state of body, so are 
those with even a vigorous judgment. For example: There was an old 
man well known in London in the last century, who was of an ungainly 
appearance, and subject to occasional attacks of hereditary melancholy. 
So inconsistent was he in his habits, that sometimes he practised great ab- 
stemiousness, and at other times devoured huge meals, with brutish 
slovenliness and voracity : sometimes he would persist in drinking nothing 
stronger than water, but occasionally he drank wine by tumblerfuls. His 
income was far from large, and not of a certain amount, yet he kept a set 
of old men and women about his house, whose bickerings and disagree- 
ments now and then drove him out of doors. He was in general very 
loquacious, but had been known to sit in company and drink a dozen cups 
of tea without speaking a syllable. When not engaged discoursing, it was 
his custom to keep muttering to himself. In walking he performed 
strange gesticulations with his limbs, and would not go in at a door, un- 
less he could effect his entry in a certain preconceived number of steps, 
and so as to introduce himself on a particular foot, turning back, and re- 
commencing, until he succeeded as he desired. There was a row of posts 
near his house, which he would not pass without touching singly, and if 
he found that lie had omitted one in the series, he retraced his steps to 
remedy the neglect. lie hoarded up orange skins for some mysterious 
purpose which he would never divulge. He suffered remorse of conscience 
for once having taken milk with his coffee on Good Friday, lie believed 
in ghosts, and went ghost-hunting in Cock-lane; and he maintained 
that he had heard his mother calling upon him by name from the other 
world. Yet Dr. Johnson was so far from insane, that his judgment com- 
manded respect and admiration everywhere, and by the common consent INSANITY. 
19 
of eminent contemporaries he was the most vigorous thinker and the 
greatest sage of his time. 
There are, however, instances of eccentric conduct resulting from abuse 
of the imagination, which verge closely upon madness, and occasionally 
pass into it. The distinction is, that the individual’s voluntary power over 
his thoughts is capable of bringing the comparing faculty into efficient 
operation, when he chooses duly to exert his will. Thomas Hood speaks 
of one who, in consequence of exciting his fancy by German tales of 
diablerie, used to fly upstairs at his utmost speed from the street door to 
the attics, because a sort of wager with the devil came into his head, that 
he would gain the top before counting a certain number, or forfeit eternal 
happiness. Every one possibly experiences moods which differ in no re- 
spect from insanity, than that they are neither permanent nor independent 
of the will. These may be common in imaginative minds, but instead of 
being indulged, they should be guarded against and restrained, for, 
though they exist at first by sufferance of the will, they sometimes gain a 
strength that defies control, and triumphs over the reason. Hoffman, a 
master in fantastic fiction, suffered so much from intemperate abuse of the 
imaginative faculty, that solitude became terrible to him. He was never 
quit of a mysterious sense of danger; things the most cheerful became 
incongruously associated with thoughts the most dreadful, while monsters 
and spectres, which he himself had created, tyrannized over his reason. 
To appease his terrors, he had frequently to summon his wife from bed to 
sit by him as he studied at night. He was constantly on the verge of in- 
sanity, and died of spinal disease, his mind being tortured by his fancy to 
the last hour of his existence. 
Often it is not an easy matter to draw a distinction between insanity 
and moral depravity. In every case of mental alienation there is disorder 
of moral as well as of intellectual manifestations. The moral disturbance 
is usually the earliest developed feature of the malady, frequently it is the 
most prominent, and occasionally no other is distinguished; so that the 
bad have been liable to pass as mad, and the mad for bad, according to 
the philosophy and fashion of the time. There is no problem in law, medi- 
cine, and ethics, of greater social importance, or of more difficult solution, 
than the discrimination of insanity and vice. A wicked deed may be the 
result of an undeveloped moral sense, as for example in a child or an 
idiot; it may be the consequence of such extremity of passion as impels to 
instinctive, instead of deliberative action; and it may be the indication of 
a conscience enfeebled by voluntary neglect, and the habitual gratification 
of evil desires. Any of these states may be simulated by disease; but it 
is with the last two only that the jurist will have difficulty; for in all cases 
of insanity in which the moral sense is non-existent, the powers of the 
understanding are also either undeveloped or destroyed. Ho hideousness 
of depravity can amount to proof of insanity, unsupported by evidence of 
a judgment incapacitated, or a will fettered, by disease. In those Cases 
of mental disorder in which the emotions are perverted, and where there 
is no clear proof of deranged intellect, cases which do from time to time 
occur, the presumption of insanity, in regard to a criminal action, has to 
be upheld by evidence of suspension of the will. The actions of an indi- 
vidual in such a state ought to be impulsive, involuntary, and irreconcil- 
able with the idea of a healthy state of the emotional faculties. 
Part xxii., p. 358. 20 
INSANITY. 
Medical Treatment of Insanity.—[The following is a brief outline of 
Dr. Winslow’s views on the pathology and medical treatment of in- 
sanity :] 
It is necessary that we should, before being able to appreciate the effect 
of medical treatment, entertain just and enlightened views as to the cura- 
bility of insanity. I now speak from a somewhat enlarged experience, 
from much consideration of the matter, and I have no hesitation in affirm- 
ing that, if brought within the sphere of medical treatment in the earlier 
stages, or even within a few months of the attack, insanity, unless the re- 
sult of severe physical injury to the head, or connected with a peculiar 
conformation of chest and cranium, and a hereditary diathesis, is as 
easily curable as any other form of bodily disease for the treatment of 
which we apply the resources of our art. It is a lamentable error to sup- 
pose, and a dangerous, a filse, and unhappy doctrine to promulgate, that 
the disordered affections of the mind are not amenable to the recognized 
principles of medical science. The vast amount of incurable cases of 
insanity which crowd the wards of our national and private asylums, 
is pregnant with important truths. In the history of these un- 
happy persons—those lost and ruined minds—we read recorded, the sad, 
melancholy, and lamentable results of either a total neglect of all efficient 
curative treatment at a period when it might have arrested the onward 
advance of the cerebral mischief, and maintained reason upon her seat; or 
of the use of injudicious and unjustifiable measures under the mistaken 
notions of the nature and pathology of the disease. In no class of affec- 
tions is it so imperatively necessary to inculcate the importance of early 
and prompt treatment, as in the disorders of the brain affecting the mani 
festations of the mind. I do not maintain that our curative agents are of 
no avail when the disease has passed beyond what is designated the “ cur- 
able stage.” My experience irresistibly leads to the conclusion that we 
have often in our power the means of curing insanity, even after it has 
been of some years’ duration, if we obtain a thorough appreciation of the 
physical and mental aspects of the case, and perseveringly and continually 
apply remedial measures for its removal; but I cannot dwell too strongly 
upon the vital necessity of the early and prompt exhibition of curative 
means in the incipient stage of mental derangement. 
I believe insanity (I am now referring to persistent insanity, not to those 
transient and evanescent forms of disturbed mind occasionally witnessed) 
to be the result of a specific morbid action of the hemispherical ganglia, 
ranging from irritation, passive and active congestion, up to positive and 
unmistakable inflammatory action. This state of the brain may be con- 
fined to one or two of the six layers composing the hemispherical ganglia ; 
but all the layers are generally more or less implicated, in conjunction 
with the tubular fibres passing from the hemispheres through the vesicular 
neurine. This specific inflammation, from its incipient to the more ad- 
vanced stage, is often associated with great vital and nervous depression. 
It is, like analogous inflammation of other structures, not often accompa- 
nied by much constitutional or febrile disturbance, unless it loses its 
specific features, and approximates in its character to the inflammation of 
active cerebritis or meningitis. This state of the hemispherical ganglia is 
frequently conjoined with active sanguineous circulation and congestion, 
both of the substance of the brain and its investing membranes. The 
morbid cerebral pathological phenomena—viz., the opacity of the arachi- INSANITY, 
21 
noid, the thickening of the dura mater, its adhesions to the cranium, the 
depositions so often observed upon the convoluted surface of the hemi- 
spheres, and on the meninges, the hypertrophy, scirrhus, the cancerous 
affections, the induration, the depositions of bony matter in the cerebral 
vessels and on the dura mater, the serous fluids in and the ulcerations 
upon the surface of the ventricles, the alterations in the size, consistence, 
color, and chemical composition of the vesicular neurine and fibrous por- 
tion of the brain—are all, in my opinion, the results, the sequelte, more or 
less, of that specific inflammatory condition of the hemispherical ganglia 
to which I have referred. It does not necessarily follow that the fons et 
origo mali of insanity is invariably to be traced to the brain. The pre- 
liminary morbid action and irritation are ofted situated in the heart, the 
stomach, the liver, the bowels, the lungs, or the kidneys, the brain being 
secondarily affected; nevertheless, in all cases inducing actual insanity, the 
hemispherical ganglia are involved in the morbid action. The most re- 
cent pathological doctrine propounded to explain the phenomena of insa- 
nity—I refer to the views of a recent writer—that derangement of mind 
is the effect of “ loss of nervous tone,” and that this loss of nervous tone is 
“ caused by a premature and abnormal exhaustibility of the vital powers 
of the sensorium ”—conveys to my mind no clear, definite, or precise 
pathological idea. It is true that we often have, in these affections of the 
brain and disorders of the mind, “ loss of nervous tone,” and “ exhaustion 
of vital power;” but, to my conception, these are but the effects of a prior 
morbid condition of the encephalon, the sequela} of specific inflammation 
of the hemispherical ganglia. To argue that insanity is invariably and 
exclusively the result of “ loss of nervous tone,” is to confound cause and 
effect, the post hoc with the propter hoc ; and would, as regards therapeu- 
tical measures, act as an ignis fatuus, alluring us as pathologists from the 
right and legitimate path. I feel anxious that my views upon this im- 
portant subject should be clearly enunciated, and not open to misconcep- 
tion. I think much mischief has arisen from a belief in the existence of 
active ordinary cerebral inflammation in cases of insanity, for it has led to 
the adoption of treatment most destructive to life, and has seriously inter- 
fered with the permanent restoration of the reasoning powers. Never- 
theless, insanity is occasionally complicated with acute cerebral symptoms 
sufficient to justify us in the cautious use of somewhat active measures for 
its removal. We must avoid the fatal error of a too rapid process of gene- 
ralization, and be careful of not looking to symptoms instead of to the 
disease itself, and of permitting ingenious and well constructed d priori 
theories of the nature of insanity to dazzle our imaginations and abstract 
the mind from the steady and patient investigation of pathological science 
and individual cases of disease. If we allow our judgment to be warped 
by the inflammatory theory on the one side (I am now speaking of ordi- 
nary, not of specific inflammation), and conclude that the excitement of 
mania is to be subdued by copious depletion or the administration of anti- 
phlogistic measures—or if, on the other hand, we adopt the speculative 
opinions of those who believe that, in every case of insanity, irrespectively 
of its origin, its progress, or its character, there exists “ mere loss of ner- 
vous tone,” caused by “ a premature abnormal exhaustibility of the vital 
powers of the sensorium ”—how lamentably shall we be misled as to the 
real character of insanity, and in the application of our therapeutic agents i 
These circumscribed and partial views of the pathology of insanity often 22 
INSANITY* 
lead to serious solecisms in practice. In ninety per cent, of the cases ol 
acute mania there is found in the brain and its meninges a state of sangui 
neous congestion, particularly of the hemispherical ganglia, combined 
with alterations in the grey nervous matter. In forming an opinion of the 
actual pathological condition of the cerebral substance, we should remem- 
ber that, particularly in public asylums, it is a rare occurrence for recent 
cases to be admitted; that the acute and sub-acute active cerebral condi- 
tions have subsided, and the disease has assumed a chronic form, before 
the patient is examined and placed under treatment; consequently many 
deductions recorded by pathologists have been based upon the study of 
chronic, and not of acute mania. A large percentage of the cases, before 
admission into our national asylums, have passed through the primary and 
acute stages, and have probably been subjected to medical treatment. 
This fact must never be lost sight of in forming our opinion, not only of 
the nature of the disease itself, but of the medical treatment necessary for 
its cure. In private practice the acute forms of insanity are often met 
with ; but even with the advantages which the physician can command, of 
investigating the earlier stages of deranged mind, he often discovers that 
the mental affection has been allowed to exist and slowly progress for a 
considerable period, no treatment, either medical or moral, having been 
adopted for its removal. In the incipient form of insanity, particularly 
when it manifests itself in plethoric constitutions, has been sudden in its 
development, is the result of physical causes, and is connected with the 
retrocession of gout, or is rheumatic in its character, there can be no doubt 
the nature of the changes induced in the brain is more allied to that of 
inflammation than that of nervous exhaustion. The attacks from the slow 
and insidious operation of moral causes are less likely to be accompanied 
by active symptoms. In many instances the maniacal excitement is 
asthenic or atonic in its character, resembling the delirium of the last 
stages of typhus fever. 
The most simple classification of insanity, the one best adapted for useful 
and practical purposes, is its division into the acute and chronic forms ; the 
insanity ushered in by excitement or by depression into mania and melan- 
cholia—amentia and deme?itia. The minute divisions and subdivisions, 
the complicated and confused classification to be found in books, may serve 
the ostentatious purposes of those desirous of making pompous display of 
scientific lore, but 1 think they have tended to bewilder and obscure the 
understanding of the student, and lead the man in search of practical truth 
from the investigation of the disease itself to the mere study of its symp- 
toms, and to the consideration of unessential points and shades of differ- 
ence. Adhering to this division of the subject, each form should be viewed 
in relation to its complications, as well as to its associated diseases. Among 
the former are epilepsy, suicide, homicide, paraplegia, hemiplegia, and 
general paralysis. The associated disease implicate the lungs, heart, liver, 
stomach, bowels, kidney, bladder, and skin. 
Before speaking of the preliminary examination of the patient supposed 
1.0 be insane, and the prognosis in cases of insanity, I would premise that 
those inexperienced in the examination of this class of cases would often 
arrive at false and inaccurate conclusions, if they were not cognizant of the 
fact, that the insane often describe sensations which they have never ex- 
perienced, and call attention to important symptoms which have no exis- 
tence except in their own morbid imaginations. A patient will tell you INSANITY. 
23 
that he has a racking headache, or great pain and tenderness, m the epi- 
gastric region, both symptoms being the fanciful creations of his diseased 
mind. This is particularly the case in the hysterical forms of insanity, in 
which there always exists a disposition to pervert the truth, and exagge- 
rate the symptoms. Again, serious bodily disease may be present, the patient 
not being sufficiently conscious to comprehend the nature of the questions 
asked, or able to give intelligible replies to the anxious interrogatories of 
the physician. Insanity often masks, effectually obscures, other organic 
affections, the greater malady overpowering the lesser disease. When 
Lear, Kent, and the Fool are standing alone upon the wild heath, exposed 
to the merciless pelting of the tempest, Kent feelingly implores the king to 
seek shelter from the “tyranny of the open night” in an adjoining hovel; 
it is then that Lear gives expression to the psychological truth just referred 
to: 
“ Thou think’st ’tis much that this contentious storm 
Invades us to the skin ; so ’tis to thee; 
Eut where the greater malady is fixed, 
The lesser is scarce felt; 
. . . . The tempest in my mind 
Doth from my senses take all feeling else 
Save what beats there." 
Disease of the brain may destroy all apparent consciousness of pain, and 
keep in abeyance the outward and appreciable manifestations of other im- 
portant indications of organic mischief. Extensive diseases of the stomach, 
lungs, kidneys, bowels, uterus and heart have been known to have pro- 
gressed to a fearful extent without any obvious recognizable indication of 
the existence of such affections. Insanity appears occasionally to modify 
the physiognomy and symptomatology of ordinary diseases, and to give 
them peculiar and specific characteristic features. 
Again, it is necessary for the physician to watch the operation of medi- 
cine in masking important diseases. The different forms of narcotics, if 
given in heroic doses, often mislead us in our estimate of the nature of 
bodily diseases not directly connected with the mental affection. The most 
essential preliminary matters of inquiry have relation to the age, tempera- 
ment, and previous occupation, and condition in life of the patient. It 
will be necessary to ascertain the character and duration of the attack; to 
ascertain whether it has resulted from moral or physical causes ; if of sud- 
den, insidious, or of slow growth; whether it has a hereditary origin, or 
is the effect of a mental shock, or of mechanical injury; whether it is the 
first attack; and if not, in what features it differs from previous paroxysms. 
It will also be our duty to inquire whether it is complicated with epilepsy, 
paraplegia, or hemiplegia, suicidal or homicidal impulses. If any prior 
treatment has been adopted, we must ascertain its nature; whether the 
patient has suffered from gout, heart disease, rheumatism, cutaneous affec- 
tion, or syphilis. It is important in cases of females to obtain accurat e in- 
formation in relation to the condition of the uterine functions, and to ascer- 
tain the state of the moral affections. We should also inquire whether the 
patient has been suspected of habits of self-abuse. Having obtained accu- 
rate information upon these essential points, our own personal observation 
will aid us in ascertaining the character of the mental disturbance; the 
configuration of the head, chest, and abdomen ; the gait of the patient, the 24 
INSANITY. 
degree of sensibility and volitional power manifested; the state of the re- 
tina, the pulse, the urine, and temperature of the scalp and body gener- 
ally ; the condition of the skin and ehylopoietic viscera; the action of the 
heart, lungs, and nature of any existing disease of the uterus. If a patient 
complains of any local mischief, however imaginary it may appear to be at 
the time, it is essentially necessary that we should clearly satisfy our minds 
upon the point before dismissing it as not entitled to serious investiga- 
tion. A patient once bitterly complained of retention of urine; upon ex- 
amination the bladder was found to be distended, and the man had passed 
no urine for twenty-four hours. I was about to introduce a catheter, when 
the patient burst into a fit of laughter, and immediately emptied his blad- 
der. Esquirol relates a case of a merchant, who, whilst suffering from 
melancholia, declared that some foreign body was sticking in his throat. 
No notice was taken of this supposed fanciful idea. The patient died, and 
an ulcer was discovered at the upper third of the oesophagus. A patient 
complained of devils being in his stomach and bowels, and declared that 
they were acted upon by electric or magnetic agencies. After death he was 
found to have scirrhus of the stomach, and chronic inflammation of the 
bowels. A patient refused to eat; he said he could not swallow his food 
without great pain. As he had exhibited other symptoms of a disposition 
to suicide, it was thought by myself and others, that his obstinate refusal 
of food was associated with ideas of sell-destruct ion, lie died, and at the 
post-mortem examination a stricture in the pylorus was discovered. These 
illustrations, and they could easily be extended, will prove the impor- 
tance of paying minute attention to particular delusions, with the view 
of ascertaining whether they have not a particular and actual physical 
origin. 
The prognosis in cases of insanity will mainly depend upon the duration 
of the attack, its character and origin, and the diathesis of the patient. 
The prognosis is generally unfavorable if the disease is hereditary—if the 
symptoms are similar in character to those exhibited by other members of 
the family when insane. Insanity, accompanied by acute excitement, is, 
cceteris paribus, more easy of cure than when it has been of slow and gra- 
dual growth, and is marked by great mental depression. The prognosis is 
favorable in cases of puerperal mania; it is unfavorable when there exists 
a want of symmetry between the two sides of the head, with small ante- 
rior, and large posterior cerebral development. Any great inequality in 
the cranial conformation would be a suspicious indication. The existence 
of any malformation in the development of the chest is also an unfavora- 
ble sign, and would induce us to give a guarded prognosis. Dr. Darwin 
says, when a person becomes insane, who has a small family of children to 
absorb his attention, his prospect of recovery is but small, as it establishes 
that the maniacal hallucination is more powerful than those ideas which 
usually interest us most. The prognosis is unfavorable when patients are 
under the morbid delusion that they are poisoned, and are constantly suf- 
fering internally from peculiar sensations. Religious delusions are more 
difficult to eradicate than other morbid impressions. The age of the pa- 
tient will materially guide us in forming a correct prognosis. Hippocra- 
tes says the insane are not curable after the fortieth year; Esquirol main- 
tains the greater portion recover between the ages of twenty and thirty ; 
llaslam, between the ages of ten and twenty. As a principle, we may INSANITY. 
25 
conclude that the probability of recovery in any given case is in propor- 
tion to the early age, physical condition, and duration of the attack. 
When a patient has youth and a good constitution to aid him, and is ad- 
vantageously placed, having at command remedial measures, and is 
excluded from all irritating circumstances, the prognosis may be favorable. 
I have seen patients after the advanced age of sixty and seventy recover; 
and cases of cure are upon record where insanity has existed for ten, 
fifteen, and twenty years. In forming our prognosis, it is important to 
ascertain the educational training of the patient. lias he been in the 
habit of exercising great self-control? lias his mind been well disci- 
plined? lias he kept in abeyance the passions, or have the motions and 
impulses of his nature obtained the mastery over him? He who has been 
taught to practise self-denial and self-control in early life, is, cceterispari- 
bus, in a more favorable position for recovery than he who has permitted 
himself to be the willing and obedient slave of every passion and caprice. 
Insanity, accompanied with criminal propensities, is said to be incurable; 
because, as Ideler urges, such patients “ cannot bear the torments of their 
consciences, and relapse into the stupefaction of insanity to flee from the 
consciousness of their guilt.” The prognosis is unfavorable when the in- 
sanity is complicated with organic disease of the heart and lungs, with 
deafness, and paralysis in any of its forms. Lesions of the motor power 
are very unfavorable indications. Great impairment of mind, accompa- 
nied with delusions of an exalted character, and associated with paralysis, 
is generally incurable. Esquirol says, epilepsy, if associated with insanity, 
places the patient beyond all prospect of cure. I should be loth to adopt 
this sweeping condemnation. I have seen cases of epilepsy, combined 
with mental derangement, recover; although, I admit, they constitute a 
difficult class of cases to manage. 
[As it would be impossible to describe in detail the particular class of 
remedial agents adapted to each class of deranged minds, in the succeed- 
ing lecture the subject has been generalized, the most prominent 
kinds of insanity, and the difficulties of their management, only being dis- 
cussed.] 
In regard to the treatment of acute mania, the important and much- 
litigated question at issue among practitioners of all countries, is that re- 
lating to the propriety of depletion. Whilst some practitioners of great 
repute and enlarged experience fearlessly recommend copious general de- 
pletion for the treatment of insanity, and refer to cases in which this 
practice has been attended with the happiest results, others, equally emi- 
nent, and as much entitled to our respect, denounce the lancet as a most 
fatally dangerous weapon, and shudder at the suggestion of abstracting, 
even locally, the smallest quantity of blood. In avoiding Scylla, we must 
be cautious of being impelled into Charybdis. The error consists in a 
vain effort to discover a uniform rule of treatment, and attempting to 
propound some specific mode of procedure adapted to all cases. He who 
maintains that blood-letting is never to be adopted in the treatment of 
mania, without reference to its character, its origin, the peculiar constitu- 
tion of the patient, and the existence of local physical morbid conditions, 
which may be materially modifying the disease, and giving active develop- 
ment to delusive impressions, is not a safe practitioner. Neither would I 
confide in the judgment of the physician who would, in every case of 26 
INSANITY. 
violent maniacal excitement, attempt to tranquillize the patient by either 
general or local depletion. 
In attacks of insanity, when the symptoms are acute, the patient, young 
and plethoric, the habitual secretions suppressed, the head hot and painful, 
the eyes intolerant of light, the conjunctiva} injected, the pupils con- 
tracted, the pulse rapid and hard, and the paroxysm sudden in its develop- 
ment, one general bleeding will often arrest the progress of the cerebral 
mischief, greatly facilitate the application of other remedies, and ulti- 
mately promote recovery. In proportion as the symptoms of ordinary 
insanity approach those of phrenitis, shall we be justified in the use of 
general depletion. Although it is only occasionally, in instances present- 
ing peculiar characteristic features—cases occurring in the higher ranks of 
life, where the patient has been in the habit of living above par, and is of 
a sanguineous temperament—that we are justified in having recourse to 
the lancet, there is a large class of recent cases presenting themselves in 
the asylums for the insane, both public and private, in the treatment of 
which we should be guilty of culpable and cruel negligence, if we were 
to omit to relieve the cerebral symptoms by means of the local abstrac- 
tion of blood. It is the fashion and caprice of the day to recklessly decry 
the application of cupping-glasses or of leeches in the treatment of in- 
sanity, in consequence, I think, of the slavish deference shown to the 
opinion of a few French pathologists of eminence, who have, by their in- 
discriminate denunciation of all depletion, frightened us into submission, 
and compelled us to do violence to our own judgment. The local ab- 
straction of blood is, in the hands of the discreet and judicious practi- 
tioner, a powerful curative agent; and yet it is the practice of some men, 
and men, too, of position, to discard altogether the remedy. 
I will briefly refer to the kind of case in which the local abstraction of 
blood will be found most beneficial, if proper regard be had to the tem- 
perament, constitutional condition, and the local circumstances modifying 
the character of the attack. In insanity, when the exacerbations occur 
at the menstrual period, cceteris paribus, leeches to the vulva and 
thighs, with the use of foot-bath, and the exhibition of aloetic purgatives, 
will be attended by the most favorable results. In irregular and 
obstructed menstruation, the local abstraction of blood will be very ser- 
viceable. In suppressed hemorrhoids, leeches to the neighborhood of the 
sphincter ani will greatly benefit in unloading the hemorrhoidal vessels, 
and relieve the brain of undue excitement. In cases of nymphomania, 
leeches to the vulva are indicated, and have been known to greatly bene- 
fit. In cases of intermittent insanity, the paroxysm may often be cut 
short by relieving the overloaded state of the vessels of the head by 
means of cupping or the application of leeches. In some instances I have 
tried Dr. Wigan’s plan, and have applied leeches to the Schneiderian 
membrane, particularly for the treatment of insanity of early life, and 
connected with conduct evidently the effect of cerebral irritation. I have 
seen this mode of procedure of essential benefit in persons of plethoric 
constitution and of sanguineous temperament. Occasionally the insanity 
is found to be associated with active visceral disease, or with hypertrophy 
and other affections of the heart. Under these circumstances, when 
there exists great tenderness over the region of any of the visceral organs, 
and we are satisfied, by a careful stethoscopic examination, that hypertro- 
phy of the heart is present, leeches applied over the seat of the local mis- INSANITY. 
27 
chief, conjoined with other appropriate treatment, will materially aid us in 
subduing the maniacal affection. In cases of illusions of hearing, or of 
vision, it will often be necessary to apply leeches behind the ears, or over 
the superciliary ridges. I have known this practice entirely remove the 
morbid illusions which had been embittering the person’s life. 
But apart entirely from the local affections to which I have referred,* 
for the treatment of idiopathic insanity, apparently without any complica- 
tions, or modified by any of the associated diseases, the careful and tem- 
perate local abstraction of blood, when general depletion is inadmissible, 
will often materially shorten the duration of an attack of insanity, and re- 
store the mind to a healthy condition. I am anxious to record my favor- 
able opinion of this mode of treatment, because I have witnessed so many 
sad results from an opposite timid and reprehensible neglect of the means 
placed within our power for the treatment of the varied forms and degrees 
of mental derangement. Sad consequences have undoubtedly followed 
the indiscriminate use of depletory measures; the presence of violent 
mental excitement has occasionally led the practitioner to the conclusion 
that the disease was of an active character; and in the attempt to allay 
the undue cerebral excitement by means of antiphlogistic measures, the 
patient has sunk into incurable and hopeless dementia. But recognizing 
an anaemic class of cases, where great excitement is often associated with 
loss of nervous and vital power, we must be cautious in permitting serious 
disease to be creeping stealthily on in the brain, no effort being made to 
relieve the congested cerebral vessels or inflamed tissue, until serious 
disorganization has taken place in the delicate structure of the vesicular 
matter, and the patient is forever lost. In the treatment of acute mania, 
the remedy next in importance to cautious depletion is that of prolonged 
hot baths. To Dr. Brierre de Boismont, of Paris, at whose excellent in- 
stitution I first witnessed the application of this remedial agent, the 
profession is indebted for reviving a practice which had long fallen into 
disrepute. In treatment of acute mania, the prolonged hot baths will be 
found of the most essential service. Dr. Brierre de Boismont has 
recorded the history of sixty-one of seventy-two cases that were subjected 
to this mode of treatment. Three-fourths of this number were cured in a 
week, and the remainder in a fortnight. The patients remain from eight 
to ten and fifteen hours in warm baths, whilst a current of cold water is 
continually poured over the head; the temperature of these baths is from 
82° to 86° Fahr.; the affusions 60° Fahr. Among the therapeutic effects 
of these baths, Dr. B. de Boismont reckons a diminution of the circula- 
tion and respiration, relaxation of the skin, alleviation of thirst, the intro- 
duction of a considerable quantity of water into the economy, an abun- 
dant discharge of limpid urine, a tendency to sleep, a state of repose. 
This mode of treatment is said to be ineffectual in cases of periodic inter- 
mittent mania, in mania beginning with great mental impairment, or asso- 
ciated with epilepsy or general paralysis. The result of my own 
experience of this plan of treatment has produced a very favorable 
impression upon my mind, and I think it is entitled to a fair trial in all our 
public asylums where they admit acute and recent cases. 
In some forms of acute mania it is desirable, as a substitute for deple- 
tion, to diminish the activity of the circulation by the exhibition of nau- 
seating doses of the tartrate of antimony; it may be serviceably combined 
with the tinctures of digitalis and hyoscyamus. This remedy, however, 28 
requires careful watching, as it often has been known to suddenly reduce 
the vital powers to a low ebb, and extinguish life. It will be found bene- 
ficial in proportion to the recent character of the case, and the positive 
activity of the cerebral circulation. The tincture of digitalis was formerly 
in great repute as an anti-maniacal remedy; the experience of late years 
has not encouraged us in administering it in the doses prescribed by some 
of the old writers; nevertheless, it is a useful agent, and occasionally proves 
a valuable auxiliary in the hand of the practitioner who carefully watches 
its operation. 
For the cure of the acute forms of insanity, the douche bath has been 
much lauded; but this remedy is now rarely used in British asylums. I 
have occasionally seen benefit derived from its exhibition, but it requires 
great caution in its use. A patient has been subjected, whilst in a parox- 
ysm of acute delirium, to the douche bath, and has sunk almost immediately 
into incurable idiocy ! The physical shock has occasionally been known to 
produce a good moral impression. For illustration: a patient imagined 
himself emperor of the world, and would not allow any one to address him 
by any other title. The immediate application of the douche bath 
destroyed his idea of royal dignity, and he was willing to admit that he 
had never been, nor was at any time a regal personage. A few hours sub- 
sequently, the delusive impression returned in all its original force ; the 
douche bath was again had recourse to, and a second time the morbid im- 
pression vanished; by a series of baths lie was restored to sanity, and after 
his complete recovery, when the particulars of his case were placed before 
him, he observed, “ Why did you not whip me, and beat this nonsense 
out of my head ? I wonder how you could have borne with my folly, or I 
have been guilty of such contemptible arrogance and obstinacy.” As a 
substitute for the douche, the shower-bath is often used with great benefit, 
particularly in certain forms of melancholia, associated with nervous de- 
pression and general debility. In cases of melancholia, or other kinds of 
chronic insanity connected with a congested state of the liver, the nitro- 
muriatie bath will occasionally do much good. In a few instances I have 
noticed marked benefit from Bertolini’s sedative bath, composed of hen- 
bane, two pounds, and equal parts of hemlock, and cherry laurel leaves, 
well infused in a sufficient quantity of hot water. But the simple hot-bath 
in certain conditions' of the nervous system, particularly in some forms of 
suicidal mania, is of the utmost benefit. A warm bath a short period 
before retiring to rest, bathing the head at the same time with cold water, 
particularly if the scalp be unnaturally hot, will often insure a quiet and 
composed night when no description of sedative, however potent its charac- 
ter and dose, would influence the system. 
In the early stages of insanity, and throughout its whole course, the 
bowels are often in an obstinately constipated condition. The concentra- 
tion of nervous energy in the brain appears to interfere with that supply 
which should proceed to other structures; consequently there appears to 
be a want of healthy sensibility in the mucous membrane of the bowels, 
and an interruption to the peristaltic action of the intestinal canal. There 
is no class of agents which act so certainly and effectually in relieving the 
mind when under the influence of depressing emotion, as cathartics. The 
ancients considered hellebore as a specific in certain forms of melancholia. 
In the hands of modern practitioners, it has not been found to merit the 
high encomiums which have been passed upon it. It is important in every 
INSANITY. INSANITY. 
29 
case of insanity, but particularly in the acute stages of mental derange- 
ment, to act powerfully upon the bowels by means of a succession of brisk 
cathartics. The bowels are often found gorged with fecal matter, and 
immediate relief often follows the administration of two or three doses of 
calomel and colocynth, or of croton-oil. It will often be necessary to assist 
the operation of the cathartics by means of enemata. In hysterical and 
some other forms of insanity, there is always a disposition on the part of 
the patient resolutely to resist the calls of nature, and, knowing this 
peculairity, we must carefully watch the condition of the bowels, otherwise 
serious mechanical obstructions may ensue, followed by intractable diseases 
of the rectum. Insanity is often associated with gastric and intestinal dis- 
ease, with an irritable condition of the mucous membrane of the alimentary 
canal; and, in such cases, although it is important to relieve the bowels 
and prevent them from being constipated, we must bear in mind that the 
injudicious exhibition of irritating drastic cathartics may aggravate the 
mental disease, by increasing the gastric and intestinal irritation, and 
thus do permanent and irremediable mischief. Much injury may arise 
from the indiscriminate and injudicious administration of cathartics. In 
insanity associated with menstrual obstructions, it will be necessary to 
exhibit the class of purgatives known to act specifically upon the lower 
bowel; consequently aloetic cathartics, such as the compound decoction 
of aloes, are found of most service in these cases. In plethoric habits, when 
there is a marked determination of blood to the head, no medicine will 
relieve so speedily as active doses of the compound powder of jalap. 
In the treatment of insanity, the class of medicines termed sedative play 
an important part. If exhibited with judgment, the most gratifying 
results often follow their continuous and persevering administration. The 
sedative treatment of insanity is a subject of itself, and I quite despair of 
touching even upon the confines of many interesting and important points 
involved in the consideration of this division of my lecture. Iu insanity 
unassociated with active cerebral circulation, congestion, or paralysis, or 
after the head symptoms have been relieved by the local abstraction of 
blood and the administration of appropriate medicine, the exhibition of 
sedatives will be followed by the most beneficial results. In recent cases 
they are generally inadmissible, excej)t in delirium tremens and puerperal 
insanity, and other forms of derangement analogous iu their pathological 
character and symptoms to these affections. In chronic insanity, in melan- 
cholia unconnected with abdominal repletion, or visceral disease, the per- 
severing use of sedatives in various combinations will often reestablish 
sanity, when no other coui’se of treatment is likely to be successful in dis- 
pelling the illusive impressions, or raising the drooping and desponding 
spirits. Battley’s solution, the tincture of opium, the meconite, acetate, 
and hydrochlorate of morphia, the preparations of hyoseyamus, eonium, 
stramonium, camphor, hops, aconite, ether, chloroform, hydrocyanic acid, 
Indian hemp, are all of great and essential service if administered with 
judgment and sagacity. In suicidal insanity, when local cerebral conges- 
tion is absent, and the general health and secretions are in good condition, 
the meconite and hydrochlorate of morphia often ac-t like a charm, 
uninterruptedly andperseveringly given until the nervous system is com- 
pletely under its infiuence. I have witnessed the most distressing attacks 
of suicidal mania yield to this treatment, when every other system has 
failed. I could cite the particulars of numerous cases ol this form of 30 
INSANITY, 
insanity radically cured by the occasional local abstraction of blood from 
the head, the administration of alteratives, the warm bath, and sedatives. 
In the use of this powerful curative agent, our success will often depend 
upon a ready adaptation of the hind of sedative to the description of case 
in which it may be deemed admissible, and a judicious combination of 
various hinds of sedatives. I do net think we pay sufficient attention to 
such combinations. I have often seen an apparently incurable and un 
manageable case yield to several kinds of sedatives combined, when it 
resisted the operation of any one or two. The extract of coniuni is often 
of service in cases of insanity combined with epilepsy; conjoined with 
mineral tonics, conium is occasionally of benefit, particularly in melancholia 
connected with chronic diseases of the digestive organs and with neuralgia. 
In cases of uterine irritation, I have seen great good result from the com 
bination of hops, camphor, and hyoscyamus. In illusions of vision, bella- 
donna, commencing with quarter-grain doses, will be found a useful remedy. 
In insanity complicated with dysmenorrhoea, the combination of camphor 
with hyoscyamus, opium, or conium, may be given with great advantage. 
The hydrochlorate of morphia, in union with dilute hydrochloric acid, is 
said to bo useful in cases where the sedative treatment is desirable. I am 
often in the habit of exhibiting sedatives and tonics in a state of combina- 
tion, particularly conium with iron, opium with quinine, or with the infu- 
sion or compound decoction of cinchona. In debility, with irritability of 
the nervous system, accompanied by restlessness, Battley’s solution, with 
the preparations of cinchona, will often prove of great benefit. The tinc- 
ture of sumbul I have occasionally administered, and I think with advan- 
tage, in paroxysmal or convulsive forms of insanity. I have given to the 
extent of one or two drachms for a dose. In hysterical derangement, the 
tincture of Indian hemp will occasionally allay the excitement, and produce 
sleep more rapidly than any other form of sedative. The valerianate of 
zinc has not answered the expectations of those who have spoken so highly 
of its medicinal virtues. Tincture of opium with camphor, and the tartrate 
of antimony, is an excellent combination in cases of doubtful cerebral con- 
gestion. Tincture of hops in doses of from one to four drachms, it will be 
necessary to give when no other formulae are admissible. As a mild form 
of sedative, compound ipecacuanha powder is occasionally recommended ; 
but a good substitute for Dover’s powder is a pill composed of opium, 
ipecacuanha, and soap. 
In treating the more chronic forms of insanity, particularly melancholia, 
it will be essential to bear in mind that they are difficult of cure, because, 
owing to the slow, obscure, and insidious character of the disease, the 
mental affection has been of some duration before the attention of the 
practitioner has been directed to its existence. As this form of derange- 
ment generally exhibits itself in trifling perversions of the affections and 
propensities leading to little acts of extravagance and irregularity of 
conduct, associated with great depression, we often find the attack has 
existed some years before a necessity is felt for any medical advice or 
treatment—perhaps a suicidal propensity has manifested itself, this being 
the first apparent overt act of the insanity. 
It is necessary, before suggesting any course of treatment in melan- 
cholia, to ascertain whether any latent visceral disease be present. Occa- 
sionally the local irritation will be found either in the liver, or the 
stomach and bowels, and in women the uterine functions are frequently INSANITY, 
31 
disordered. In the religious and other forms of melancholia in females, 
the delusive ideas are often associated with uterine irritation; and under 
such circumstances, if actual physical derangement of an active character 
exists in this organ, the best treatment will be, the application of leeches 
to the neighborhood of uterus, combined with warm hip-baths, sedatives, 
and mineral tonics. In cases of melancholia, the digestive functions are 
often much vitiated, the circulation languid, the skin cold and flaccid; and 
these symptoms being conjoined with a general loss of physical tone, such 
patients require generous diet, good air, gentle exercise, and occasional 
stimuli. When dyspeptic symptoms are combined with an inactive state 
of the bowels, I have often administered the compound tincture of guaia- 
cum with great benefit. It is important to watch the particular features 
in these cases, and to improve the general health by the exhibition of mild 
alteratives and vegetable tonics, with alkalies. I have occasionally admi- 
nistered, with success, in this form of -insanity, apparently associated with 
an abnormal condition of the nutrition of the brain, cod-liver oil, with 
preparations of iron. 
My time will not admit of my submitting for your approval the treat- 
ment best adapted for those forms of mental disease associated with an 
atrophied or softened condition of the nervous matter. I think more is to 
be done for the cure of these cases than the writings of medical men 
would lead the student to suppose, particularly if the disease be seen and 
subjected to treatment in the early stages. I have recorded the details 
of several instances of cerebral disease, exhibiting all the legitimate fea- 
tures of ramollissement, and yielding to the persevering administration of 
the preparations of iron, phosphorus, zinc, and strychnia, combined with 
generous living, and the occasional application of a leech behind the ear, 
should indications of cerebral congestion be present. I have also derived 
benefit in these cases from the use of the milder forms of mercury, asso- 
ciated with cinchona. In cases of impairment of the mind, loss of memory, 
defective power of attention, occasional paroxysm of mental paralysis, 
unconnected with lesions of the motor power, I have found a solution of 
the acetate of strychnine, and a solution of the phosphate of strychnine, 
of great advantage. 
lfi some chronic forms of insanity, in dementia, and persistent monoma- 
nia, connected, as it was supposed, with morbid thickening of the dura 
mater, and with interstitial infiltration of the membranes, as well as with 
exudations upon its surface, I have occasionally had the head shaved, and 
have perseveringly rubbed over the scalp a strong ointment of the iodide 
of potassium combined with strychnine. In other instances I have kept 
the head painted with the mixture of iodine. I have seen marked benefit 
from this mode of treatment. In several cases where the mental symp- 
toms were supposed to be associated with effusions of serum, I have 
ordered the iodine to be applied externally, at the same time exhibiting 
minute doses of calomel, or mercury with chalk, to slightly affect the sys- 
tem : this, conjoined with occasional tonics, diuretics, and stimuli to sup- 
port the vital powers and enable the patient to undergo this treatment, is 
occasionally productive of considerable benefit, in cases apparently placed 
iquite beyond the reach of improvement in cure. 
\ I have only briefly spoken of two distressing, and often unmanageable 
Ibrms of insanity—viz., of suicidal mania, and of those cases where the 
patient obstinately refuses to take either food or medicine. In insanity 32 
INSANITY. 
associated with suicidal tendencies, it will he important to ascertain whe- 
ther any cerebral congestion exist, as such is often the case. A few 
leeches applied to the head, followed by an active cathartic, will relieve 
the local irritation, and often dissipate the idea of self-destruction. In the 
absence of any positive active cerebral symptoms, the prolonged hot bath, 
and the persevering exhibition of some form of sedative, is the best treat- 
ment to be adopted. I have seen the suicidal impulse ren 3ved after the 
administration of a few doses of belladonna; but the meco ute and hydro- 
chlorate of morphia, if given for a sufticient length of tii le, will, in the 
great majority of cases, distinct from actual incurable visceral or cerebral 
disease, effect a cure. Occasionally the shower-bath, and counter-irritation 
in the vicinity of the head, will aid us in reestablishing health. Cases 
sometimes present themselves where the patient determinedly refuses to 
take either food or medicine. This character of case gives those who 
have the care of the insane much anxiety. The refusal of food may be 
connected with determination to destroy life, or it may be associated with 
delusive impressions. I am inclined to believe that in the majority of 
these cases the symptom is the result of some local mischief remote from 
the brain, and sympathetically affecting the organ of thought. Upon 
examination Ave often find, in these cases, great gastric derangement, 
obstinate constipation, considerable tenderness upon pressure in the epi- 
gastric region, hepatic disease, the tongue foul, breath offensive, and other 
symptoms of derangement of the chylopoietic viscera. The determination 
to resist nourishment arises, under such circumstances, from a positive 
loathing of food—a want of all indination for it. I have seen cases of 
this description, where it has been deemed necessary, in order to prolong 
life, to introduce food forcibly into the stomach, speedily cured by the 
adoption of means for improving the state of the general health and 
digestive organs. Mild alteratives, vegetable tonics, blisters over the 
region of the stomach, if the patient complain of pain in that region upon 
pressure, the warm and shoAver-bath—is the most successful treatment to 
adopt in cases connected with obvious visceral derangement. Instances 
sometimes occur, A\There the refusal of food is clearly traceable to a delu- 
sive impression—a hallucination of taste, which makes everything appear 
to the patient bitter, disgusting, and poisonous. The unhappy patient 
imagines that he is commanded, either by good or evil spirits, not to eat. 
These unhappy persons must be treated upon general principles, and the 
remedies be adapted to the peculiar character of each individual case. 
Under such hallucinations of taste, patients often SAvalloAV the most ex- 
traordinary articles. The case of a lunatic is recorded, Avho imagined 
that his stomach required to be strengthened with iron. He Avas seized 
Avith inflammation of the oesophagus, of which he nearly died. He then 
confessed that he had swallowed the blade of a knife. After his death, 
there Avere found in his stomach seven oxidated lath nails, each tAVO inches 
and a half long; thirty-three nails, two inches long; forty-nine smaller 
iron nails and rivets; three pieces of Avound-up iron Avire; an iron screw, 
an inch long ; a brass image of a saint; part of the blade of a knife; and 
other articles ; amounting in number to 100, and Aveighing about twenty 
ounces. It will be necessary, in cases like those to Avhich I haATe been 
referring, to ascertain whether the determination not to eat is the effect 
of such perversions or hallucinations of taste. 
The time aa ill only admit of my alluding generally to the importance, INTESTINAL AFFECTIONS. 
33 
as a principle of treatment, of the administration of tonic remedies, active 
exercise in the open air, and to good and generous living. It is rarely 
necessary, in the treatment of insanity, to deprive the patient of animal 
food. Individual cases occasionally come under our notice, in which it is 
necessary, for a time, to enforce a farinaceous diet; but such is not often 
our duty. Among paupers, insanity is frequently cured by the free use of 
good animalhood, and a generous supply of porter. Even when we are 
satisfied of the necessity of local depletion, it will often be necessary to 
give wine, afid allow the patient a generous diet. Bart xxvii., pj. 313. 
Treatment of Injured Intestine from a Blow upon a Hernial Sae.— 
Accidents of this kind usually occur either by a direct blow, or by the 
person being forced against some hard body. Mr. Key says: 
The extent of injury which the intestine sustains will vary according to 
the violence of the blow. The contusion may be insufficient to burst the 
bowel, or to occasion such a lesion of tissue as shall end in gangrene, its 
effects being only inflammation of the coats of the intestine: or the vio- 
lence may be such as at once to rupture the intestine: or, flailing to rup- 
ture the bowel, the contusion may be so severe as to be followed by 
sloughing and escape of faeces. These three states require distinct con- 
sideration, as the treatment required for each necessarily varies. 
The mildest form of injury which a blow inflicts on a hernia is analogous 
to the contusion of other soft parts. Such contusions, it is probable, are 
not followed by any serious consequences. 
Collapse, vomiting, and abdominal tension, are wanting to give a char- 
ter of severity to the injury. 
The two first indications that immediately force themselves on the sur- 
geon’s attention, are, the necessity of returning the contents of the her- 
nial sac, and obtaining free evacuations from the bowels. To the former 
of these proceedings there can be no objection, as the vitality of the bowel 
is scarcely endangered: and if it were left in the sac, adhesion might form 
between the injured bowel and peritoneum, that would afterward inter- 
fere with its return into the abdomen. The administration of purgatives 
ought to be wholly abstained from, notwithstanding the confined state of 
bowels usually consequent upon an accident of this nature. A bruised 
bowel is placed by nature in a state of rest: the exhaustion of the nervous 
epergy of the part diminishes in the muscular tissue the disposition to 
contract. Such inactivity of the bowel should be encouraged, and not 
thwarted by irritating purgatives. The safety of the bowels depends on 
the non-occurrence of inflammation ; but if, by undue interference, the 
bruised structure is hurried into a state of inflammation, sloughing or 
ulceration will probably be the result. Beyond an occasional enema, to 
unload the larger intestines, nothing need be done. Opium may be re- 
quired, if pain come on, indicating peritonitis; and if joined with calomel, 
care should be taken that the action of the former should preponderate, 
in order to prevent the probability of stimulating the bowel. Food should 
also be given in the smallest quantity, and in a fluid form, that little or no 
INTESTINAL AFFECTIONS. 
VOL. II. 3 34 
INTESTINAL AFFECTIONS. 
feculent residue may remain to oppress the part. In this respect nature is 
our guide : vomiting which usually ensues immediately after the accident, 
empties the upper part of the canal; and the little desire that the patient 
feels for food, prevents, if nature be allowed her own way, any chance of 
repletion. Thus the part is placed in a state of repose; and the circula- 
tion soon regaining its healthy condition, the functions of the intestines are 
restored. 
The necessity for repose in an injured state of bowel it would be well 
to bear in mind, after the operation of strangulated hernia. The bowel is 
gorged by the strangulation, bruised by the taxis as it is too often prac- 
tised, or inflamed by long incarceration in the sac. An intestine in such a 
condition cannot but be injured by an early administration of purgatives, 
which irritate and inflame the bowel, or exhaust what little remains of 
vital energy. 
If the contusion be so severe as to destroy the vitality of the bowel 
without rupturing it, the condition of the patient, both immediately after 
the accident and for several days subsequently, sufficiently attests the 
severity of the lesion which the part has sustained. The hernial sac is 
usually found filled with the injured bowel; but the absence of distention 
serves to distinguish it from a state of strangulation. The integuments 
appear to be bruised, though sometimes but slightly. The part is very 
tender when handled, but feels soft and pliant; and very moderate pressure 
is sufficient to reduce the contents of the sac. 
The shock which the nervous system receives, is followed by a feeble- 
ness of the circulation, a corresponding pallor of the whole surface, and a 
sense of syncope. This condition is, however, only transient: re-action 
almost immediately ensues: the patient passing from the state of collapse, 
and gradually rising into a state of inflammatory excitement, as the injured 
bowel becomes the seat of more or less inflammation. 
The speedy recovery of the patient from a state of collapse, quickly dis- 
sipates the suspicion of a rupture of the intestine ; and the surgeon usually 
endeavors to replace the contents of the hernial sac as soon as reaction 
takes place. To this proceeding there is no objection, if it be done with 
gentleness. The danger of abdominal extravasation will not be increased 
by replacing the injured bowel at the neck of the sac; for should slough- 
ing of its coats ensue, the slough may be walled in by adhesion of the sur- 
rounding peritoneum, and fecal extravasation be prevented; or, should 
this salutary process of adhesion fail to insulate the slough, the sac will 
receive the fecal matter, and quickly give intelligence of the impending 
mischief, by the tumefaction that will ensue within the scrotum. 
The symptoms that arise in this state of things, in some points resemble 
those of a strangulated bowel. 
It does not appear that persons are always aware of being the subjects 
of hernial protrusion. Their ignorance of the fact is not to be taken as 
evidence of a rupture not having existed previously to the blow ; and it is 
of no little importance to establish the existence of a hernia, as without it, 
a rupture of a bowel is in the highest degree improbable, by a blow re- 
ceived upon the pelvis, or scrotum, or even upon the inguinal canal. 
When the blow or injury has been so severe as to cause the rupture of 
the bowel, or the violence of the symptoms are such as to apprehend 
iloughing of the injured intestine, and the escape of the fleces into the peri- 
toneal cavity, the most judicious practice, according to Mr. Key, is to open INTESTINAL AFFECTIONS. 
35 
the sac, and if feces are present to liberate them; and if not, to wait, in 
order to see if the bowel should slough. In either case, the opening of 
the sac will allow a free exit to any feces which are, or which may be 
present. In one case, the patient experienced no relief for three days from 
the opening of the sac, when a copious discharge of feces took place and 
completely relieved him. In another case, the blow was so severe, and 
followed by such severe symptoms, that the bowel was supposed to be rup- 
tured. On opening the sac, however, no feces escaped for four days; at 
the end of which time, the feces appeared and escaped freely. On the 7th 
day, the feces escaped by the rectum, although they continued to pass 
through the wound for five or six weeks, when ultimately the part healed. 
These facts will recall to the minds of most practical men cases of such 
contusion, which have been left to themselves and have proved fatal by 
extravasation of the feces into the cavity of the peritoneum, when an open- 
ing into the sac would have prevented such an occurrence; for although 
such an opening ought not to be undertaken except from the strongest 
suspicions that rupture or sloughing has been caused, yet, when we remem- 
ber how often the sac is opened in cases of supposed strangulated hernia, 
without any danger resulting, we need not risk the life of a patient by an 
unnecessary delay in such a procedure. Part v., p. 104. 
Wounds of the Intestines.—M. Boutard recommends a method of ob- 
taining direct union in wounds of the intestines; in longitudinal wounds, 
by approximating the edges of the wound by means of suture; in trans- 
verse wounds, either by the same method or by invagination. To effect 
this, the author excises the projecting lip or ring of mucous membrane at 
the level to which the mucous and serous coats have retracted ; the everted 
mucous membrane, with its epithelium, which prevents all union, being 
thus removed, on bringing the lips of the wound together, serous mem- 
brane is in contact with serous membrane, muscle with muscle, and bleed- 
ing mucous membrane with the same structure. If invagination is to be 
practised, the mucous membrane is scarified and excised to the extent of 
four or five millimetres in the portion of the intestine which is to be the 
recipient; and thus the serous surface of the invaginated intestine is placed 
in contact with a mucous surface reduced to a condition favorable to union. 
Part ix., p. 189. 
Chronic Intestinal Eruption—Therapeutic Action of the Salts of 
Cerium.—The salts of few metals were at present in our pharmacopoeia, 
and Prof. Simpson saw no reason why many more might not be added to 
their number. He had recently drawn the attention of the profession to 
the salts of nickel, which, as far as his observation went, presented much 
similarity in action to those of iron and quinine, and seemed to be of use 
in cases of sick headache. He now proposed to read to the society some 
very imperfect observations on the therapeutic action of some other metals: 
and first, as to cerium, which, given in the form of nitrate, and in one-grain 
doses twice or thrice a day, appeared to act as a sedative tonic of considex- 
able value, strongly resembling bismuth, and the salts of silver. He had 
employed it, in the first instance, in cases of genei'al chronic intestinal erup- 
tion—a peculiar and inti-actable form of disease, for which arsenic and 
nitrate of silver were genei*ally presci’ibed; and where these remedies had 
failed, cerium had been tried with marked advantage. In irritable dys- 
pepsia, with gastrodynia and pyrosis, and in chronic vomiting, its exhibi- 36 
miJSTINAL OBSTRUCTION. 
tion Avas attended with satisfactory results; and in the vomiting which 
occurs during pregnancy prompt relief was afforded. It was a good tonic, 
and a useful substitute for the salts of silver, bismuth and hydrocyanic acid. 
Dr. S. had not employed it much in convulsive diseases, as chorea and 
epilepsy, in Avhich nitrate of silver was used, but the exhibition of the salts 
of cerium Avas certainly attended with this advantage, that it could be 
persevered in Avithout any fear of discoloration of the skin. As far as his 
experiments with cadmium went, it bore much resemblance to the prepara- 
tions of antimony, and excited diaphoresis and vomiting. Tellurium, be- 
sides its expense, was precluded from being used in practice by its dis- 
agreeable effects. Dr. S. mentioned a case Avhere a dose had been inad- 
vertently given to a student of divinity, and had been followed by the 
evolution of such a persistent odor, that for the remainder of the session 
the patient had to sit apart from his fellow-students. Part xxxi., p. 222. 
INTESTINAL OBSTRUCTION. 
Intestinal Obstruction from Stricture of the Sigmoid Flexure of the 
Colon.—The operation of M. Callisen, of Copenhagen, to produce an arti- 
ficial anus in the lumbar region, over that portion of the intestine, not 
covered by the peritoneum, has been revived by M. Amussat Avith great 
success. In all the old operations for this purpose in the iliac region, by 
MM. Littre and Pillore, the peritoneum Avas A\rounded, Avhich seems to 
have been the chief cause of death in numerous cases. In his operation in 
tiie lumbar region, Callisen “ proposed to make a vertical incision extend- 
ing from the edge of the false ribs parallel to the anterior border of the 
quadratus lumborum muscle. He thus hoped to reach the colon between 
the layers of its short and imperfect mesentery.” This operation, Iioav- 
ever, Avas attended Avith some difficulties, till modified by Amussat, Avho 
“ has shown that the failure of the operation on the dead subject was 
owing to the intestine being empty, and that in such cases as require the 
formation of an artificial anus, the colon is greatly distended; in which 
condition the layers of the peritoneum, forming its imperfect mesentery, 
are so far separated as to alloAV the intestine being reached without open- 
ing the peritoneum.” Amussat has, moreover, adopted the transverse 
instead of the vertical incision. This important operation has not only 
been performed on the adult, but also in an infant of forty-eight hours old. 
' Fart v., p. 107. 
Treatment of Volvulus.—Mr. Pilcher has recorded a case of volvulus 
occurring in a child, in Avhich all the remedies commonly employed for the 
removal of the disease had been unavailingly employed, when he was in- 
duced by the recollection of a former case to order thin gruel to be 
injected by the rectum until the loAArer intestines had become completely 
distended, regurgitation being prevented by pressure around the anus. 
The effect Avas almost immediate, the obstruction giving Avay and the pa- 
tient completely recovering. Part viii., p. 73. 
Internal Strangulation of the Intestines.—[Mr. Mackenzie remarks 
that, considering the great fatality of this disease, if left to itself, it is 
strange that operative interference is not more frequently resorted to. INTESTINAL OBSTRUCTION. 
37 
An operation cannot make matters worse than, in the majority of cases, 
they are; while it is not unlikely to be successful if a correct diagnosis can 
be made. There is one class of cases which Mr. Mackenzie thinks can be 
diagnosed with almost certainty—cases of “ dislocation of the sigmoid 
flexure of the colony Mr. M. says:] 
I use the term dislocation, as being more applicable, inasmuch as it im- 
plies the operation of some active force, considering that condition neces- 
sary before a sudden displacement can take place. That the intestine is 
torn from its attachment by a sudden force, I am fully convinced, from 
having discovered the mesocolon lying in loose shreds amongst the intes- 
tines, saturated with extravasated blood: a circumstance which could not 
in any other manner be accounted for. 
What renders this sigmoid flexure so peculiarly liable to dislocation, I 
am at a loss to determine. In those cases which have come under my 
observation, the imprudent use of raw indigestible substances, as cranber- 
ries, turnips, cabbage, etc., was suspected as the cause of the disease. 
Possibly violent distention of the tortuous gut, by flatus, may force it, on 
physical principles, to assume a straight position, and thereby a strain be- 
ing necessarily made on its attachments, contribute to its separation. In 
whatever manner the displacement is effected, the result is remarkably 
uniform: the intestine is thrown from its natural situation toward the cen- 
tre of the abdomen, and receives a twist at its termination in the rectum, 
which causes complete obstruction of the passage ; the small intestines get 
coiled round it in such a manner as to strangulate the gut by the free 
margin of the mesentery. In these cases, while all the symptoms of stran- 
gulation and obstruction of the bowels are present, there is one symptom 
never absent, which, respect being had to the history of the case, leads to 
a correct diagnosis, namely, that it is impossible to throw up injection per 
rectum in any quantity, for as soon as the gut is filled as far as the twist 
or volvulus, which is always low down, the water or fluid injected flows 
out as fast as it is thrown up, independent of any action of the rectum 
itself. Besides, the introduction of the long tube is impracticable, being 
always arrested at the obstruction. 
It is evident that no method of treatment, save by operation, can pos- 
sibly do any good in this class of cases. The administration of purgatives 
in these as well as in every other case where there is mechanical obstruc- 
tion, cannot be too severely reprobated, inasmuch as they invariably ac- 
celerate the fatal result, and add to the sufferings of the patient. 
Part xvii., p. 162. 
Ileus, or Volvulus.—The abdominal cavity should certainly be only 
opened as a last resource. When an exploration is determined on, it 
should be performed in the linea alba, except the obstruction is in the large 
intestine, when an artificial anus must be formed in the lumbar region. 
Part xviii., p. 185. 
Ileus.—In cases of intestinal obstruction, when the constipation is com- 
plete, and there is fecal vomiting, and these symptoms are not relieved by 
the use of ordinary means, for three or four days, it is justifiable to resort 
to operation. If there are satisfactory indications of the seat of the ob- 
struction, make the incision at or near that point, but if there is much 
doubt, make it in the median line. If the cause of the obstruction cannot 38 
INTESTINAL OBSTRUCTION. 
be removed, or it is deemed imprudent to make an extended search for it, 
make an artificial anus as near as may be to the seat of obstruction. 
Part xix., p. 169. 
Treatment of Obstruction of the Bowels.—[Let us suppose an instance 
of this kind. We are called to a patient who has had no proper evacua- 
tion from the bowels for the last seven or eight days, though he has taken 
repeated doses of powerful aperient medicines, none of which have ope- 
rated effectually. On examination you find some degree of distention 
about the umbilicus, with a varying degree of tenderness on pressure. In 
severe cases you may find permanent sickness, mucus or bile being re- 
jected from the stpmach. The tenderness on pressure is not so great as 
we might expect. Flatus is felt to rumble in the intestines, and proceeds, 
as it were, downward to a certain point, and then stops. With all this 
the tongue is moist and often clean; the pulse is not perhaps accelerated, 
generally weak ; the urine, provided the obstruction is not high up in the 
bowels, is not necessarily affected, though generally high colored.] 
Under these circumstances, and especially in the milder cases, the first 
thing that perhaps you do is to order a large enema to be thrown up. It 
is found to traverse the large intestine easily ; the patient assures you that 
he feels it go as far as the ilio-caecal valve, and after a short time it re- 
turns without any tinge of fecal matter. The obstruction is not in any 
part of the colon, but somewhere in the small intestine. 
We must not forget that the most simple case of obstruction is liable 
to run on into a fatal form, if, with the view of obtaining an action of 
the bowels, we are incautious in the prolonged use of irritating medi- 
cines. Concerning treatment, Dr. E. Wells continues: 
Endeavor, in the first place, to compose and soothe the mind of the pa- 
tient. A slight faintness, produced by blood-letting, has often acted 
beneficially in this state. After these measures, the safest plan is to give 
repeated doses of calomel and opium, the latter in half to one grain doses 
every four hours. Wait now until the bowels begin to act, which they 
generally will do, and when they do, then a small dose of castor oil will 
do good. Gruel may be taken now, as it prevents the sense of sinking, 
and probably acts mechanically in propelling the contents of the intestinal 
tube. 
In those severer cases, where there is frequent sickness, with pain in 
the bowels, and a rumbling of flatus, abstain from giving any food by the 
mouth for some days. The support should be entirely trusted to beef-ter. 
injections, these not exceeding a quarter of a pint, and administered every 
four hours. If there is difficulty of retention, add to them a few drops of 
laudanum. 
It is proved that these are sufficient to maintain the strength for some 
time—at any rate, for a period sufficient to allay the irritating symptoms, 
which forbid the exhibition of food by the mouth. This part of the treat- 
ment I am inclined to consider as of the highest importance : for as long 
as food continues to be administered by the mouth, and is rejected by 
vomiting, there will be little chance of arresting the inversion of the peri- 
staltic action of the intestinal tube. Part 119. INTESTINES. 
39 
INTESTINES. 
Intussusception—Recovery from, by Sloughing of the Intestines.— 
[At a meeting of the Royal Medical and Chirurgical Society, Mr. Jeaf- 
freson read an account of a case of intus-susception of the bowel, which he 
had attended, and recovery by sloughing of a portion had occurred. The 
patient was a young man, 17 years of age. He was laboring under gene- 
ral febrile symptoms ; the countenance was anxious, the abdomen becom- 
ing tympanitic : nothing would stay on the stomach : the matters vomited 
had a grass-green color. Calomel and opium, and purgatives, were given 
for three days, and clysters used, when decided symptoms of inflammation 
of the peritoneum and bowels appeared.] 
Leeches, fomentations, etc., were used in addition to the other means, 
but no evacuations took place till the 31st, when there were very copious 
and offensive discharges from the bowels, and the vomiting ceased. From 
this date the patient gradually recovered. Copious evacuations took 
place, charged with gelatinous-looking mucus, and on one occasion a small 
quantity of blood. On the 8th of June, there was discharged from the 
bowels what the author supposed to be either a portion of the small intes- 
tine, or a cast of it (of coagulable lymph): it was about 2| or 3 inches in 
length, and of a tubular form ; smelt horribly putrid, and one or two 
minute points presented the appearance of sphacelus. After this, with 
some slight interruption, the patient recovered. The substance voided 
was examined under the microscope by Mr. Toynbee, who stated that he 
found cellular tissue, traces of blood-vessels and nerves, and epithelium. 
[Dr. Williams could not agree that such cases were remarkably uncom- 
mon, though they might rarely be met with by any one individual.] 
In tropical climates it was by no means uncommon for even a foot or 
more of intestine to come away in severe cases of dysentery. It would 
seem almost as if this were the mode established by nature to effect a 
cure. 
[Mr. Fitzmaurice had practised many years in Ceylon, where severe 
sloughing dysentery was very common among the natives.] 
It was no uncommon occurrence for six, eight, or even eighteen inches 
of intestine to slough away, and yet recovery take place. In the Museum 
at Woolwich are many preparations illustrative of this fact. 
Part xii., p. 199. 
Wounds of the Intestines.—[When after a wound of the abdomen, we 
find symptoms of wounded intestine, without there being protrusion, we 
must keep the patient perfectly quiet, administer stimuli if needed, but 
insist upon total abstinence from food for some time.] B. Cooper says: 
When the wounded intestine protrudes, its contents may be perceived 
issuing from the wound, although the opening itself appears to be closed 
by the protrusion of the internal mucous membrane. The size of this 
opening and its direction, as to whether it be longitudinal, or transverse, 
must now regulate the treatment to be adopted. If the wound be very 
small, its edges may be pinched up by a pair of forceps, and a thin silk 
tied round so as to include the whole of the wound; the intestine is then 
to be returned into the cavity of the abdomen, but must be kept as close 
as possible to the external wound. The ligature produces a sloughing of 
all the included tissues, and adhesive inflammation of the peritoneum 40 
INTESTINES. 
being set up, an external wall of plastic matter is formed around the dead 
part, which ulcerates off into the intestines, and is carried away with the 
keces. Sir Astley Cooper successfully employed this method of treatment 
in one or two cases in which the intestine had been inadvertently wounded 
in the operation for strangulated hernia. 
When the opening in the bowel is large, different kinds of stitches are 
used to keep the edges of the wound in apposition. The uninterrupted 
suture, however, or glover’s stitch, is, I believe, the best, but the linest 
procurable needle and silk must be employed ; and after the bowel has 
been returned into its natural cavity, the same precaution as I have already 
mentioned to keep it in proximity to the external wound, should be 
adopted. When the intestine has been completely divided by a trans- 
verse wound, various plans have been recommended for reestablishing its 
continuity. For this purpose, some animal substance of a cylindrical form, 
such as the trachea of a sheep, has been introduced. This serves as a sort 
of mold and enables the surgeon to keep the edges of the severed bowel 
in juxtaposition during the application of the suture, the foreign substance 
easily passing away afterward with the stools. Some have recommended 
that the upper extremity of the intestine should be passed into the lower, 
and that a ligature be then applied around the whole. This produces 
contact of the peritoneal coat of the intestine, above and below the liga- 
ture, and, as adhesive inflammation is set up, an effusion of plastic matter 
soon covers the ligature, and reestablishes the continuity of the external 
part of the canal, the ligature itself, and the constricted portion, ulti- 
mately sloughing off internally, and being conveyed away with the excre- 
tions. 
It has been objected to this operation, that, in bringing the severed 
ends of the intestines together, a serous is presented to a mucous surface, 
and that these two structures are ill fitted for union ; but it is not in- 
tended in this operation that they shall unite; the union is caused by the 
effusion of the plastic matter from the external surface above and below 
the ligature, and from serous to serous membrane, the whole of the intes- 
tine included in the ligature being destroyed and sloughing away. 
M. Jobert has proposed, as an improvement in the above operation, to 
invert the inferior extremity before the superior is introduced. In that 
case, two serous membranes are brought in contact, and the union may 
take place at once between them ; but, under these circumstances, the in- 
vaginated portion would not be included in a ligature, but retained in 
position by suture. 
After all, however, from the result of the experiments, it remains 
questionable whether, in complete division of an intestine by a transverse 
wound, it is not better to establish an artificial anus and leave nature to 
her own efforts for the ultimate restoration of the patient; and this does 
not indeed appear to be so difficult a process as may be supposed, particu- 
larly if nature be judiciously assisted by the art of the surgeon. 
Almost immediately after the divided intestine has been replaced in the 
cavity of the abdomen, an adhesive inflammation shuts out the open ex- 
tremities of the intestine from the peritoneal cavity, so that after a few 
hours have elapsed the stitch employed to secure the wounded intestine 
near the external wound in the abdomen may be removed, and as soon as 
the feculent matter passes partly through the latter the patient may be 
considered safe, as far as refers to the danger of extravasation of the INTESTINES, 
41 
teces into the abdomen. But as the formation of an artificial anus renders 
the patient loathsome to himself, and unfitted for a social state, subse- 
quent means must be adopted to reestablish the integrity of the intestinal 
:anal. 
With this view, one of the first steps is to diminish as much as possible 
a tendency which the upper portion of the bowel has to prolapsus or ever- 
sion of its mucous membrane; and this object maybe attained by keeping 
the faeces in a semi-fluid state, and by maintaining slight pressure upon 
the extremity of the protruded part. The lower portion of the intestine 
is liable to contract at its extremity, so that the ready passage of the 
contents of the upper portion is prevented from passing into the lower; 
this may be in some measure obviated by the use of enemata, which 
stimulate the natural action of the bowel and prevent it from falling into 
the abnormal condition always produced by disuse. The strictest atten- 
tion to cleanliness of the external wound should constantly be observed, 
otherwise the presence of the feculent matter will interfere very mate- 
rially with the progress of the healing process. As the wound goes on 
uniting it gradually contracts into a narrow fistula: this contraction is 
still further promoted by gentle pressure ; and after a while, as the faeces 
meet with some resistance in the direction of the wound, they acquire a 
tendency to pass on through the natural passage—a change which is first 
indicated by the escape of flatus and mucus per anum; upon which ene- 
mata, should be freely employed to reestablish the natural function of the 
rectum and anus. 
By such treatment, a recent artificial anus may very generally be cured, 
but if neglected, the lower part becomes so much retracted, and at the 
same time contracted, as to render the cure almost impossible. 
In gun-shot wounds where the ball has penetrated the parietes of the 
abdomen and wounded a viscus, nature has sometimes effected the repara- 
tion of the part—the ball passing away with the faeces. A musket ball 
has also been known to penetrate and lodge in the urinary bladder, from 
which it has afterward been removed incrusted with calcareous matter, 
the patient ultimately recovering. Part xviii., p. 175. 
Peculiar Affection of the Intestinal Mucous Membrane.— Treatment 
by Electro-Galvanism.—[Dr. Gumming gives a detailed account of a dis- 
ease, which, he says, is not described in systematic works, but which is, 
nevertheless, very common, and is productive of serious discomfort to the 
patient. Dr. C. says:] 
We are often consulted by patients who, at the first glance, convey the 
impression that they are imperfectly nourished: they have an emaciated 
appearance. In detailing their symptoms, they lay great stress on a feel- 
ing of emptiness, or rather faintness, at the epigastrium: they complain of 
exhaustion there. They generally next direct our attention to a more or 
less fixed pain either in the left hypochondriac or iliac region, sometimes 
both, more frequently the latter—a pain from which they are rarely ex- 
empt, and which is sometimes very severe and acute, though oftener an- 
noying and irritating. If they have ever been induced to apply a mustard 
blister to the seat of pain, they dwell on the relief, great, though tempo- 
rary, they have experienced from it. The stomach, in most of the cases I 
have seen, has not been irritable; it commonly retains and digests the 
food; but pain is frequently felt in the course of the colon, in a period 42 
INTESTINES 
varying from an hour to two hours thereafter. The bowels are at one 
time constipated, at another lax, in the same person. Some are uniformly 
costive, others more frequently loose ; but in all (and this is the charac- 
teristic mark of the disease), a peculiar membranous, fibrinous matter is 
discharged. In some cases it is stringy, in others tape-like in its form ; in 
others again, in small masses, resembling fat; while in the milder cases it is 
more diffluent and gelatinous. That the disease has, from want of proper 
examination of the intestinal evacuations, frequently eluded observation, I 
know too well from my own experience, and that it has consequently been 
maltreated does not admit of doubt. 
To take the report of the appearances from the patient is, in too many 
instances, the surest way to deceive both you and himself. Jn addition to 
this, there is not unfrequently a considerable discharge of blood from the 
bowels, and that, too, where no hemorrhoids can be detected. A. most 
uniformly there is great pain during evacuation, and always a feeling of 
exhaustion for some time after. In most of the patients there is a peculiar 
expression of countenance. It is an expression of anxiety, quite different, 
however, from that which usually marks organic disease. You do not 
conclude, as is too often the case with the latter, that your patient is 
laboring under an incurable malady. 
Scarcely less characteristic of the disease than any of the preceding 
symptoms is the state of the mind. In all there is more or less nervous- 
ness, greatly increased toward night, inducing sleeplessness: and when, 
toward morning, sleep does come on, nightmare is frequent—dreams 
(generally of an unpleasant natufe) invariable. 
When the affection has been of long duration (and too frequently this is 
the case before we are consulted) the mental irritability is very great. 
It is vastly more common in the female than in the male sex, though 
by no means uncommon in the latter; and in the former it is very often 
accompanied by dysmenorrhoea, and occasionally by the membranous form 
of that affection. 
In the treatment, the primary, and, I believe, indispensable point is total, 
or almost total, abstinence from aperient medicine; and secondly, external 
counter-irritation. 
Circumstances, which I need not at present detail, led me to surmise 
that electro-galvanism would accomplish both these indications of treat- 
ment. The results of its use in a considerable number of cases of this dis- 
ease, warrant me, I think, in affirming that it is competent of itself to the 
cure of almost every case, and that, aided by the internal exhibition of tar, 
it will cure both certainly and speedily. In the first place, it acts as an 
aperient—seemingly by its action on the muscular coat, as well as the 
mucous membrane of the bowels. In every case in which I have used it 
this has been the effect; and if it had no other consequence than this, the 
advantage would be prodigious; for, as in a multitude of instances, the 
disease has been traced to the use or abuse of laxative medicines as a cause, 
and as during the treatment even the mildest aperients irritate the mem- 
brane, and so far aggravate (temporarily) the disease, the evacuation of 
the bowels, by any means that do not irritate, is obviously of great conse- 
quence. It supersedes counter-irritation. The pain in the side, for the 
removal of which the counter-irritant was employed, is relieved by an ap- 
plication of the galvanism for at least twenty-four hours; in many cases fo 
a much longer period; but as the agent is applied once a day, where n« INTESTINES. 
43 
contra-indicating cause exists, till the disease is iemoved, the pain may be 
said to he abolished. 
Galvanism, therefore, might of itself effect a cure; but I have generally 
combined it with the administration of tar, suggested first, I believe, by 
Dr. Simpson, and ha\ e found it of all internal means by far the most effec- 
tual. It relieves the feeling of exhaustion at the epigastrium, imparts an 
agreeable warmth, and promotes appetite and digestion. The plan I have 
hitherto adopted has been, to give the tar, in the form of pill or capsule, 
thrice a day; the electro-galvanism (Kemp’s, of Edinburgh, machine is the 
one I have used), is applied for a quarter of an hour daily, the intensity 
being increased from time to time. Steady perseverance is requisite. 
With this, the case must be obdurate indeed that will resist a cure. 
One remarkable fact connected with the treatment by galvanism is, that 
it determines the portions of the bowels where the greatest amount of irri- 
tation exists—a knowledge which manual pressure fails to convey ; for it 
is a singular truth, that when the instrument is in action, extreme tender- 
ness is complained of in more than one well-defined spot or tract, of which 
the patients were not previously aware. And it is extremely interesting to 
observe how this tenderness, after a time and the continued use of galvan- 
ism, diminishes till a mere point is fixed on as its seat, and how this also is 
removed. Part xxi., p. 150. 
Intestines—Stricture of.—If the stricture is low in the colon, the vomit- 
ing does not come on until some time afterward ; if it is in the small intes- 
tines, the vomiting comes on early. If the vomiting is not stercoraceous, 
it is not likely to be an obstruction of the small intestines. When it is in 
the larger intestines, it takes a longer time to produce stercoraceous vomit- 
ing than when it is in the small. When the seat of obstruction is below 
that point, Amussat’s operation of an artificial opening is the most prefer- 
able in the left colon. When this, from the circumstances of the case, can- 
not be effected, then the opening should be made in the right colon. 
Part xxv., p. 204. 
* Wounds of the Intestines.—Mr. Guthrie gives the following: When an 
incised wound in the intestine is not supposed to exceed a third of an inch 
in length, no interference should take place ; for the nature and extent of 
the injury cannot always be ascertained without the committal of a greater 
mischief than the injury itself. When the wound in the external parts has 
been made by an instrument not larger than one-third, or from that to half 
an inch in width, no attempt to probe or to meddle with the wound, for 
the purpose of examining the intestine, should be permitted. When the 
external wound has been made by a somewhat broader and longer instru- 
ment, it does not necessarily follow that the intestine should be wounded 
to an equal extent; unless it protrude, or the contents of the bowel be dis- 
charged through the wound, the surgeon will not be warranted in enlarg- 
ing the wound, in the first instance, to see what mischief has been done. 
It may be argued that a wound four inches long has been proved to be 
oftentimes as little dangerous as a wound one inch in length; yet most 
people would prefer having the smaller wound, unless it could be believed 
that the intestine was injured to a considerable extent. Few surgeons 
even then would like to enlarge the wound to ascertain the fact, unless 
some considerable bleeding, or a discharge of fecal matter, pointed out the 
necessity for such an operation. 44 
INTESTINE8, 
If the first two or three hours have passed away, and the pain, and firm 
but not tympanitic swelling in the belly, as well as the discharge from the 
wound, indicate the commencement of effusion from the bowel, or an ex- 
travasation of blood, an enlargement of the opening alone can save the life 
of the patient. The external wound should be enlarged, the effused mat- 
ter sponged up with a soft, moist sponge, and the bowel or artery secured 
by suture. When a penetrating wound, which may have injured the intes- 
tine, has been closed by suture and does not do well, increasing symptoms 
of the inflammation of the abdominal cavity being accompanied by general 
tenderness of that part, with a decided swelling underneath the wound, 
indicating effusion beneath, the best chance for life will be given by re- 
opening the wound. It is a point in surgery which a surgeon should con- 
template in all its bearings. The proceeding is simple, little dangerous, 
and under such circumstances can do no harm. 
When the wounded bowel protrudes, or the external opening is suffi- 
ciently large to enable the surgeon to see or feel the injury by the intro- 
duction of his finger, there should be no difficulty as to the mode of pro- 
ceeding. A puncture or cut, which is filled up by the mucous coat so as 
to be apparently impervious to air, does not demand a ligature. 
An opening which does not appear to be so well filled up as to prevent 
air and fluids from passing through it, as such wound cannot usually be 
less than two lines in length, should be treated by suture. When the open- 
ing is small, a tenaculum may be pushed through both the cut edges, and 
a small silk ligature passed around, below the tenaculum, so as to include 
the opening in a circle, a mode of proceeding I have adopted with success 
in wounds of the internal jugular vein, without impairing its continuity; 
or the opening may be closed by one, two, or more continuous stitches, 
made with a very fine needle and silk thread, cut off in both methods close 
to the bowel, the removal of which from the immediate vicinity of the ex- 
ternal wound is little to be apprehended under favorable circumstancos. 
The threads or suture will be carried into the cavity of the bowel, as has 
been already stated, if the person survive; and the external part of the 
wounded bowel will either adhere to the abdominal peritoneum, or to one* 
or other of the neighboring parts. 
When the intestine is more largely injured, in a longitudinal or trans- 
verse direction, or is completely divided as far as, or beyond the mesentery, 
the continuous suture is absolutely necessary. 
When the abdomen is penetrated and considerable bleeding takes place, 
it is necessary to look for the wounded vessel. When the hemorrhage 
comes from one of the mesenteric arteries, or from the epigastric, the 
wound is to be enlarged until the bleeding artery is exposed, when liga- 
tures are to be placed on its divided ends, if they both bleed. I have seen 
the epigastric artery tied several times with success. 
A Portuguese cajador, on picquet, was wounded at the second siege of 
Badajos, in a sally made by some French cavalry. He had three or four 
trifling cuts on the head and shoulders, and one across the lower part of 
the belly, on the right side. He bled profusely, and when brought to me 
had lost a considerable quantity of blood, which came through a small 
wound made by the point of a sabre. This wound I enlarged until the 
wounded but undivided artery became visible; upon this two ligatures 
were placed, and the external Avound was sewed up. The peritoneum 
was opened to a small extent, but the bowel did not protrude, and the 45 
patient (not being an Englishman, and not, therefore, so liable to inflam- 
mation), recovered. 
The recollection of other nearly similar cases, causes me to say, that 
when hemorrhage takes place from within the abdomen, the wound should 
be enlarged; and that if an artery in the mesentery, or in any other place 
which can be got at, should be found bleeding, a very fine silk ligature 
should be placed, if possible, on each side of its divided extremities, and 
cut off close to the knot, the external wound being afterward accurately 
closed. This is a point of practice to which future attention is directed. 
When a musket-ball penetrates the cavity of the belly, it may pass 
across in any direction without injuring the intestines or solid viscera. It 
usually does injure one or the other, and it has been known to lodge with- 
out doing much mischief. The symptoms are generally indicated by the 
parts injured, although in all, the general depression and anxiety are re- 
markable ; their continuance marks the extent, if not the nature, of the 
mischief. Part xxviii., p. 190. 
Intestinal Catarrh.—In those cases of intestinal catarrh in children in 
wdiich the mucous membrane becomes ulcerated around the anus, give an 
enema containing about a drachm of borax. Part xxxvi.,p. 300. 
INTOXICATION. 
Results of Drinking.—Of all diseases of the internal organs produced 
by drinking, the granular liver seems to have attracted most attention; 
perhaps justly; but there is no doubt, that of all organic diseases, the two 
most to be feared in intemperate persons with recent surgical injuries, are 
the granular kidney, and slight but general emphysema, with a dilated, 
but not always much diseased heart; and in persons past the middle of 
life, dying rapidly in hospitals after operations and surgical injuries, com- 
bined with much loss of blood, these two affections of the urinary and res- 
piratory organs are very far from uncommon. The three chief affections 
destroying patients after operations and injuries — namely, the general 
habit produced by drinking; secondly, organic disease of the lungs and 
kidneys, especially emphysema in the former, and granular disease in the 
latter ; and, thirdly, tubercle—act very differently and at different periqds. 
During the early period, and often for weeks after operations, patients la- 
boring under tubercular disease do well; and it is often only at the 
absolute return to health, rather than during the recovery of the patient 
from the operation itself, that the effects of tubercle begin to show them- 
selves. Organic disease produced by drunkenness, and habitual drunken- 
ness, act differently; the organic disease presses heavily at every period, 
and may destroy life early or late; but the mere habits of the drunkard 
show themselves chiefly at a very early period. The patient who nearly 
sinks from his unsound organs within the first few days, often lags on for 
weeks and months in danger; but the man who has simple delirium tre- 
mens is taken ill directly, and often dies ; but if he recovers from his de- 
lirium, he general!/ gets well from the operation, and sometimes quickly. 
Dart xiv., p. 324. 
INTOXICATION. 46 
INTOXICATION. 
Intoxication.—It is sometimes puzzling to distinguish intoxication from 
cerebral disease. 
Mr. Corfe says: A patient is brought into the hospital, perhaps on a 
policeman’s stretcher, or he is carried in by friends, who state that lie was 
picked up in the streets, senseless. His pupils are dilated, immovable; 
his breathing is deep, and low, and heavy, the expiration being short and 
abrupt, whilst the inspiration is a prolonged deep sigh, with more or less 
stertor; pulse is full and strong. The suspicion arises that the man has 
sanguineous elfusion into one or both ventricles of the brain. But it must 
be again acknowledged that, of all the perplexing, deceitful, and varying 
symptoms which diseases occasionally put on, those of cerebral lesions or 
mere cerebral disturbance are, of all others, the most difficult to decide 
upon. We have admitted cases into the hospital in the dead of the night, 
brought here by policemen, who have found the patient senseless, or he 
has been seen to fall senseless on the pavement; we have bled, blistered, 
leeched, and purged; shaved the head, and given turpentine enemas, but 
all to no purpose; insensibility has remained ; when, to our surprise, in 
twelve hours afterward we have gone to visit our patient, we have found 
him perfectly sensible and tolerably well, not more surprised at the loss of 
a head of hair than we have been at the sudden revival of our supposed 
case of apoplexy. Whilst, on the other hand, I have admitted a case as 
one of ‘‘dead drunk,” perfectly inanimate, and have, for the sake of pre- 
caution, sent him into the ward to bed, and yet have found it to prove an 
instance of apoplexy. I have, however, learned a valuable lesson by even 
these difficulties: for in every instance of late years when a case of com- 
plete insensibility is admitted, I have requested the house surgeon to 
empty, and then wash out, the stomach by means of the pump ; and if it 
lias been from drunkenness, the “sot” has shfown his character up before 
we have finished this operation ; and if it has oeen one of apoplexy, it has 
done no harm, and it has proved that it was more than intoxication, as no 
alcoholic fetor has been detected in the contents of the stomach. 
In all cases of intoxication the mental faculties become roused before the 
operation of thoroughly washing out the stomach by the pump is con- 
cluded ; whilst, on the other hand, it may be said, the reverse is ordina- 
rily the case in cerebral lesions, or in mere concussions of the brain. Be- 
fore we allow the tube to be withdrawn from the stomach, in cases of ine- 
briety, we usually inject three ounces of the diluted acetate of ammonia 
draught, which has an extraordinary effect—sometimes in “ sobering ” the 
head, and calming the stomach too. 
I am aware that it is much easier to recommend the employment of the 
stomach-pump than to administer it to persons who are sometimes in the 
highest state of excitement bordering on maniacal fury. I am anxious, 
therefore, to describe the mode in which we employ this remedial agent in 
such cases: 
The patient is seated in a strong wooden chair, another chair is placed 
behind him, and an attendant is ordered to sit in it, and taking the arms 
of the patient, he pinions them by holding the wrists firmly against the 
back of the chair. This method serves to fasten the trunk securely in the 
chair ; the legs are then swung in a round towel, which is passed round the 
ankles by a noose, and, a second chair being placed, so that the back of it 
shall be toward the legs of the patient, another attendant is placed in it; 
he carries the towel over the back of the chair, and sits upon it, and thus 47 
the legs are at right angles with the trunk, and consequently they are al- 
most powerless. If, however, the man offers to flex the knees, the ankles 
are instantly raised higher, and the power of the flexors of the thigh is 
thereby overcome in an instant. By this position, it will be observed, that 
the patient is deprived of all muscular power, and the only fixed point on 
which his body rests is the ischiatic tubera. Iam satisfied that the stomach- 
tube may not only be inti'oduced with comparative ease, but that the ope- 
ration of the pump is perfectly harmless, when judiciously administered, 
upon a refractory patient thus immovably fixed. Part xvii., p. 49. 
Action of Alcohol.—From an elaborate series of experiments, the follow- 
ing conclusions are arrived at by Dr. Duchek: 1. Alcohol in the organism 
is subservient to an increased combustion, the intermediate products of 
which are found in the blood. 2. Intoxication is dependent upon the ex- 
istence of aldehyde in the blood at the time. 3. The effect of aldehyde 
upon the blood is that of rapid consumption of oxygen ; and, finally, 4. 
Hereby the combustion of other substances is interrupted, or rather di- 
minished. 
[In these short remarks the reader will at once perceive the most power- 
ful inducements to abstain from alcohol. It runs away with that oxygen 
which he is always inspiring for the oxidation which is required in almost 
every process of the animal economy. We live, as it were, to oxidize. Al- 
most all the changes in the body are the results of oxidation, and yet the 
spirit drinker continually checks this process of nature.] Part xxx.,p. 298. 
Chronic Alcoholic Poisoning.—From the long-continued use of alco- 
holic drinks, even long after their discontinuance, various nervous symptoms 
sometimes arises, as hallucination and loss of sleep. Oxide of zinc in two 
grain doses, twice a day, an 1 our after each meal, is the best medicinal treat- 
ment that can be adopted, this dose may be gradually increased till the 
patient takes six or eight grains twice a day. Of course it is necessary for 
the patient to cease drinking. By the use of the above remedy, sleep was 
induced, and the trembling of the body and limbs along with other nerv- 
ous symptoms, rapidly disappeared. Part xxxix., p. 56. 
IODIC PREPARATIONS. 
Hints for the Administration of Iodine.—Dr. Mojsisovitz, of Vienna, 
has contributed an elaborate paper to the Medicinische Jahrbucher, on the 
administration of iodine and its various preparations, in which he has 
pointed out certain precautions which are probably not generally known, 
and the ignorance of which may account for the unsatisfactory results so 
often derived from their use. 
As the feculent matters decompose the preparations of iodine, we find 
this substance in the state of ioduret of starch, in the stools of those who 
eat bread, potatoes, rice, gruel, and vegetables, while taking the medicine. 
It is therefore necessary to interdict the use of every sort of food contain- 
ing fecula to patients to whom iodine is given. It is probably owing to a 
decomposition of this kind having taken place, that we are to explain the 
inert effects of those enormous doses of the medicine which have been 
IODIC PREPARATIONS. 48 
IODIC) PREPARATIONS. 
exhibited by some physicians, as Dr. Elliotson, Dr. Buchanan of Glasgow, 
and Professor Forget of Strasbourg. 
According to the experience of our author, the use of saline baths 
greatly promotes the action of iodine on the system. He has also 
reason to believe that the activity of its operation is a good deal influ- 
enced by the condition of the weather at the time. When the air is clear 
and dry, it seemed to have most effect, and more especially when there 
was a tendency to inflammatory complaints : whereas, on the other hand, 
its action seemed to be almost null during the endemic prevalence of small- 
pox, puerperal fever, and diarrhoea. 
The crises, which iodine has a tendency to provoke, are salivation, and a 
cutaneous eruption like scarlatina or miliaria; the secretion of the urine is 
usually the more abundant in proportion as the diet of the patient is kept 
low and restricted. 
Dr. M. prefers the hydriodate of potash, and the proto and deuto- 
iodurets of mercury, to either pure iodine or to any other of its prepara- 
tions. He regards the tincture of iodine as one of the very worst 
formulae that can be used ; it is more likely, he says, to cause a wasting 
of the testicles or mammae, hemoptysis, palpitations of the heart, etc., than 
any of its salts. 
The dose of the hydriodate which he recommends for adults is about 
fifteen grains dissolved in distilled water, in the course of the day. 
If there be any open ulcers, they should be kept wetted with a solution 
of the hydriodate; but if the local affection be a tumor, then he recom- 
mends that it should be well rubbed with the ointment composed of two 
parts of the proto-ioduret of mercury and twenty-four of lard. 
The disease in which Dr. M. has used iodine with advantage are, cezena, 
ulceration of the tongue, palate, etc., various forms of obstinate cutaneous 
disease, and of secondary syphilis, white swelling, and other maladies of 
the joints, periostitis, tumefaction of the lymphatic glands, scrofulous 
induration of the subcutaneous cellular tissue, and many of the other 
kinds of strumous disease. Part iv., p. 58. 
Iodide of Potassium—Therapeutical Action of.—Dr. Lisfranc obtains 
great success from the administration of this substance, in white swellings, 
necrosis, ulcers of the legs, engorgement of the breasts and testicles, 
chronic syphilis, and some diseases of the skin. When a patient is about 
to be submitted to this mode of treatment, certain precautions are neces- 
sary, since some persons may take 5j., without experiencing any inconve- 
nience, whereas others cannot take gr. iv., and even grs. ij., without 
offering untoward accidents. Formerly Dr. L. added from 9ss. to 9j. of 
iodine to the iodide, but, having remarked that it gave rise to intestinal 
irritations, he omitted it, and now employs the following formula: R Aq. 
destill, tilias Europ. §v., sirup. aurant. §j., iodid. potas. 9j. M. Ft. mist, 
cuj. cochl mag. mane nocteque sumend. ex aqua, decoct sapon oflic. vel 
infus humul lup. This quantity is usually taken in the space of a week, 
and, on renewing the draught, the dose of iodide is raised to 9iss., and an 
equal quantity is added to each succeeding one, until the patient takes 
5iiss., 3iij., gss., and even 5v., which last Dr. L. very seldom surpasses. 
The advantages resulting from the administration of this substance are : 
amelioration of the general health, especially in lymphatic patients affected 
with necrosis, and abundant suppuration, or marasmus, caused by an old IODIC PREPARATIONS. 
49 
white swelling. The inconveniences are: an astringent, metallic taste in 
the mouth, with some patients very disagreeable, every morning on wak- 
ing ; this may be remedied by the use of the tooth-brush, or gargles, with 
water alone, or Avater to which, for every half tumbler, a tablespoonful of 
the spirit, cochlear, is added ; a cutaneous eruption, similar to urticaria, 
and when the remedy is continued, resembling eczema, or prurigo ; when 
the face is the seat, the subcutaneous cellular tissue is swollen, and forms 
small tumors, like tubercles. These accidents ought not to prevent the 
administration of the remedy, AA'hen the disease is very serious; but when 
it is slight, the medication must be ceased for a time, and then recom- 
menced. As to the iodic salivation, observed by Mr. Wallace, Dr. Lis- 
franc, in upward of one hundred patients, never witnessed it once; The 
disease in which Dr. L. has advantageously had recourse to it, are: ter- 
tiary syphilis, and that in spite of irregularities in regimen and excess of 
drink ; this Avas especially manifested in one of the lesions produced by 
the affection, which is seated in the rectum, and resembles cancer; so 
much so, that he always commences by administering the iodide, and it is 
only Avhen that substance, aided by compression, etc., has failed, that he 
decides upon operating. In necrosis of the bones of the extremities, and 
for which amputation seemed to be the only means of obtaining a cure ; 
the parts thus affected, were the femur, the tibia, the phalanges, after 
whitlow. White swellings; ulcers of the legs ; for instance, in those of 
atonic nature, or in Avounds which, on individuals of a lymphatic tempera- 
ment, from want of attention and cleanliness, or from friction, have 
become covered Avith vegetations, bleeding with the greatest facility, and, 
in every respect, analogous to a cancerous ulcer. The cicatrix thus 
obtained, is, from its very formation, white, firm, resistant, and allows the 
patient to move about at a very early period. Cancer of the uterus, 
and of the breast; in the pain caused by these affections, opium is admi- 
nistered in some cases ; at first it soothes, but \Tery soon becomes ineffica- 
cious ; nor does it ever prevent the disease progressing; their cure may 
then be attained with the iodide of potassium. In engorgements of 
various organs, chronic orchitis, tumors of the breast, etc. 
It sometimes happens that, Avhen this substance has been given a few 
days, the accidents above described appear ; in such cases we must cease 
to administer it for eight or ten days, and then recommence it, to be 
ceased again should the accidents reappear; and it is very rare that, after 
having prescribed it thus, it is not tolerated on the third or fourth trial. 
Again, in diseases Avhich require it to be taken for a very long time, cer- 
tain peculiarities may be observed ; for instance, when the iodide is admi- 
nistered to a patient affected Avith white SAvelling, at first a notable 
amelioration manifests itself, but very soon after the disease becomes 
stationary, and anorexia and insomnia declare themselves. Such a state is 
Avhat Dr. L. calls iodic saturation; here, the continuation of the remedy is 
not only useless, but even hurtful; it must therefore be discontinued for a 
time, the patient be ordered to amuse himself, to take a nourishing diet, 
some tonics, etc., and to go into the country, if possible. Finally, when 
the system has thrown oft’ the iodide, it may be prescribed aneAv, and with 
the same success as at first. Part xi., p. 103. 
Iodide of Potassium.—The iodide of potassium Avas shown by the late 
Dr. Robert Williams to be of great certainty in rupia and hard periosteal 
VOL. II.—4 50 
IODIC PREPARATIONS. 
node; that its power is much less in roseola, purpura, and ecthyma, but 
still it is better than mercury; while, in lichen, lepra, psoriasis, and iritis, 
mercury is more beneficial than the iodide. If suppuration has com- 
menced in the node, then sarsaparilla is the remedy, the iodide being use- 
less. In soft node and prurigo, he showed the true power of sarsaparilla; 
and in syphilitic angina and rupia, the invariable good effects of combining 
local mercurial applications with the internal administration of the iodide 
of potassium. Part xxiv., p. 268. 
Iodine rendered Soluble by Sirup of Orange-peel and Tannin.—M. 
Debauque has found means of keeping iodine in a state of solution, when 
added to mixtures in the form of tincture. The author uses, for that pur- 
pose, sirup of orange-peel, which answers the purpose perfectly. It was 
suspected that tannin was mainly instrumental in this result; and this was 
rendered evident by putting a few grains of tannin into a quantity of water 
to which tincture of iodine had been added, and in which the iodine had 
of course been precipitated. The addition of the tannin caused the 
iodine to be immediately re-dissolved. Thus will the sirup of orange- 
peel be advantageously added to mixtures containing tincture of iodine, 
and tannin to injections composed of water and the same tincture. 
Part xxv., p. 306. 
Topical Application of.—The topical application of this remedy is very 
general. The following is the formula: 14 Iodini, 3j.; sp. vini reet., §j.; 
ft. solutio. It is better to keep this some time before using. It should be 
applied in glandular affections beyond and around the enlarged parts, so 
that the absorbed fluid may be carried through the gland by the lym- 
phatic vessels. It is used topically, 1st, iw pleuritic and neuralgic stitches/ 
2d, to the throat in cases of aphonia or hoarseness; 3d, to the mucous 
lining of the throat itself in cases of congestion and of enlargement of the 
tonsils ; 4th, around the external parts of the eye, in cases of strumous 
inflammation ’ 5ih, in all forms of periostitis, whether syphilitic or stru- 
mous ; 6th, in glandular affections as above mentioned ; 7th, as injections 
into cysts and cavities of abscesses, provoking adhesive, but not suppura- 
tive inflammation, as in hydrocele. Part xxix., p. 326. 
Iodide of Potassium with Ammonia.—It is said that this medicine is 
more valuable when combined with ammonia, gently stimulating the 
stomach, diffusing the blood, and with it the medicine through the system, 
and, by chemical decomposition, liberating the free iodine, and thus send- 
ing it on its salutary message. 
The proportions usually prescribed are, two to three grains of the iodide 
with four to five of the ammonia. Part xxx., p. 300. 
Iodine Adhesive Paint.—The following is the formula for an iodine 
paint, made adhesive by the addition of mastic, which is used at the Moor- 
fields Ophthalmic Hospital: 
14 Spirit, vin. rect., 3ij.; sp. seth. nitr., 3iv.; mastic., 3ss.; iodini, ad 
saturat. 
This is very useful where iodine is required about the eyes, as it does 
not run on the skin. Part xxxiii., p. 292. 
Effects of the Tincture of Iodine applied locally on the Mucous and 
Serous Membranes, in relation to Pain.—Dr. Boinet remarks that the 
contact of tincture of iodine with the mucous membranes is not at all pain- 51 
IPECACUANHA. 
ful; and that it is possible to paint, almost without the consciousness of 
the patient, the pharyngeal and buccal mucous membranes, the tonsils, the 
neck of the uterus, the vagina, etc., without causing any pain ; on con- 
dition, however, of not allowing the tincture to touch the orifices of the 
mucous cavities—namely, the points where the mucous membrane termi- 
nates and the skin commences; for the pain is very severe, and is pro- 
longed for a considerable time, whether the tincture is applied to the lips, 
the anal orifice, or the female external parts of generation. In these cases 
the patients experience a pain as intense as when the tincture of iodine is 
applied to the skin denuded of its epithelium, or to a recent wound. 
There is the same pain when the ocular or palpebral conjunctiva is touched 
for the treatment of certain inflammations of the eye, the removal of gra- 
nulations, etc. If several successive paintings take place, the same 
change ensues on the mucous membrane as on the skin—namely, that des- 
quamation having taken place, the pain becomes then very severe after the 
subsequent application. As to the serous membranes, the tincture of 
iodine always produces in them very severe and cutting pains, and in an 
instantaneous manner. But this pain is much less severe upon the articular 
membranes than on the peritoneum. The acute pain produced by the 
contact of the tincture of iodine with the peritoneum is, in fact, a certain 
sign which indicates that an ascites has been mistaken for an ovarian 
dropsy; inasmuch as, in the latter affection, the iodine injection is never 
painful. This pain is also a proof, when it arises with less intensity in 
injecting an ovarian cyst, that a certain quantity has penetrated into the 
peritoneum. Part xxxv.,p. 281. 
Iodide of Lime.—This preparation, made with one part of iodine and 
seven of lime, is recommended by Dr. Pidduck as superior to the iodide 
of potassium—in the comparative smallness of its dose ; in its ready com- 
bination with the blood and tissues, manifested by its alterative effects; 
in not passing so quickly through the kidneys; in not producing gastro- 
enteric and vesical irritation : and in being nearly tasteless. Dr. Pidduck 
uses a solution of one drachm (containing eight and a half grains of iodine) 
in a pint of boiling water, which, when cold and filtered, is colorless and 
transparent. The iodine is found to exist in the solution in the form of 
iodide of calcium and iodate of lime. Part xxxvii., p. 251. 
Practical PemarJcs upon Ipecacuanha.—The value and efficacy of 
ipecacuanha, as an emetic or expectorant in many affections of the respira- 
tory organs, more particularly of children, are too generally conceded and 
acted upon to require an extended notice. 
In dysentery, ipecacuanha has been, and continues to be, much used. 
By Mosely, who held it in high repute, ipecacuanha was given in doses of 
half a drachm to two scruples; and by the late Professor B. S. Barton, it 
was regarded as almost a specific, particularly in cases of a typhoid charac- 
ter. In chronic diarrhoea, small doses of the powder, repeated several 
times a day, either alone, or preferably in conjunction wfith opium or 
Dover’s powder, will be found of great value, and frequently, with strict 
IPECACUANHA. 52 
attention to a proper regimen, will succeed in curing many most unpromis- 
ing cases. In these last cases, when dependent upon, or connected with, 
derangement of the biliary secretion, additional power will be given to the 
above doses, by uniting with them two or three grains of blue mass, to be 
repeated every night as long as requisite. 
In hemorrhage from the lungs or uterus, small doses of ipecacuanha, 
combined with sugar of lead and opium, are used with decided benefit. In 
hemorrhage from the stomach, large doses of ipecacuanha have been 
strongly recommended, particularly by Dr. Condie. 
In the early stages of the bowel affections of children, no less than in 
adults, an emetic of ipecacuanha will often succeed in arresting the progress 
of the disease, and rarely fail to prove beneficial. 
By combining from one-fourth to half a grain of ipecacuanha with a 
minute portion of opium, and two or three grains of blue mass, the altera- 
tive properties of this last are materially enhanced. This method will be 
found of great benefit in most mild cases of biliary and bowel derange- 
ment. 
Formula for the Sirup.—Finding the process for the sirup, recom- 
mended in the United States Dispensatory, attended with unnecessary 
trouble, and uncertain as to uniformity, I adopted, after many trials, the 
following formula: R Ipecacuan. rad. contus., giv.; aquseOij.; sp. vin. 
rect., gx.; sacch. alb. lbs., iiij. Macerate the bruised ipecacuanha in one 
pint of boiling water for twelve hours, then add the remainder of the 
water and alcohol, and continue the maceration for five or six days. 
Place the whole in a small displacement apparatus, returning the fluid 
that passes until it becomes perfectly clear, and then continue to pour a 
small quantity of water occasionally upon the surface, until two pints and 
ten ounces by measure shall have passed. Now add the sugar, and with 
a gentle heat, evaporate until the syrup shall be of a proper consistence, 
readily ascertained by occasionally taking out a small portion and allowing 
it to cool. When of a proper consistence, pass it through a small quantity 
of fine tow placed in the tube of a funnel, to render the sirup clear and 
transparent. Three pints and ten ounces of sirup is the quantity obtained. 
It is, in strength, nearly double of that prepared by the usual formula ; 
and this I consider an additional recommendation. Part xxiii., p. 299. 
Saccharized Alcoholic Extract of Ipecacuanha.—Mr. A. G. Dunn 
recommends the employment of a saccharated extract of ipecacuanha in 
preference to the usual prepai-ation of the drug, such as the wine and 
sirup, which he considers liable to vary in strength; and the powder is, he 
thinks, objectionable, from its insolubility. The following is the formula 
for preparing the extract: 
Rad. ipecac., giv.; bruise to a coai-se powder, and macerate for thirty 
days in f. gxvj. of diluted alcohol, shaking it occasionally, then filter and 
express. Evapoi'ate the tincture thus foi’med to gij. with which mix 
powdered white sugar, gviij., and tritui'ate them in a mortar until they 
become dry. 
The extract thus prepared has the peculiar odor and taste of ipecacuan ; 
it is of a brownish-yellow color, and soluble in water, ether, alcohol, 
mucilage of acacia, and, in fact, in all the solutions with which this remedy 
is usually combined. The dose required to be exhibited is the same 
(twice as much) as the genuine powdei’ed root. From its agreeable 
IPECACUANHA. 53 
IRON. 
taste and perfect solubility in fluids, it is much preferred to the other 
preparations of the drug, by those who have employed it; more especially 
in prescribing for children, for whom its sweet taste renders it an excellent 
form for combining with other remedies. Part xxx., p. 300. 
Bisulphate of Iron and Alumina.—When ten parts of well washed 
alumina, three of soft iron filings, and five of carbonate of soda or potass, 
are compressed by fixed air for a considerable time in distilled water, a 
clear carbonated solution is obtained. But when the pressure is removed 
and the consolidation of the carbonic acid ceases, the solution no longer 
remains clear or permanent. When the fluid, however, is treated with 
sulphuric acid in excess, a bi-sulphate results in the crystals of which the 
iron is permanently safe from rusting or peroxidating in the air, or even 
when dissolved, as is the case with other salts, or preparations of that 
metal. When used as an internal tonic or astringent, the iron of this salt 
does not irritate ; when applied as a lotion, it does not rust or stain the 
linen. Sir James Murray continues: 
Great care must be taken not to confound this new saline remedy with 
a salt called by writers “ iron alum.” 
This new salt is also entirely different from a “ sulphate of alumina and 
irony mentioned in some chemical works. 
The new salt is very soluble in any cordial or aromatic water. I give 
it in doses of five or ten grains every two or three hours, till its effects 
succeed. In order to stay the bowels, in wasting looseness during cholera, 
it might be repeated much oftener. The iron is not a stimulant in this 
salt, but rather calms whilst it sustains. The aluminous quality abates 
tormina and soothes the mucous membranes. Even alum itself dimi- 
nishes pain, and does not increase or induce paralysis of the intestines, as 
salts of lead are sure to do when long continued. Part xix., p. 312. 
Preparations of Iron: Ammonio-Acetas Ferri.-—Dissolve one drachm 
of iron wire in half an ounce of hydrochloric acid, mixed with an equal 
quantity of water (by measure); then add half a gallon of water, and 
precipitate with an ounce of liquor potassse; set aside for twenty-four 
hours; draw off the supernatant liquor with a syphon; fill again with 
water, and repeat the process a third time. Lastly, collect the precipitate 
on a linen filter; dissolve the oxide thus prepared in two ounces of strong 
acetic acid, and make up the measure to ten ounces with distilled water; 
set aside for twenty-four hours, and filter. To every twenty ounces of the 
filtered liquor add half a drachm of strong liquor ammoniae. Dose ten 
minims to half a drachm. 
Sirupus Ferri Acetatis.—Dissolve two pounds of sugar in ten ounces 
of water, in a water bath; to the sirup, whilst hot, add eleven ounces of 
the acetate of iron prepared as above (without the ammonia); when 
cold, filter through paper. Dose, twenty minims to one drachm. 
Part xxiii,,p. 301. 
Phosphate of.—Two specimens, one solid the other fluid, have been in- 
troduced, of phosphate of iron dissolved in the metabasic acid in a boiling 
IRON. 54 
IRRIGATION. 
state, and allowed to cool. If exposed to the air for a day it hardens, but 
can be made at once into pills, by means of liquorice powder or flour. It 
is stated to be superior to the other preparations of iron. Dose, one to 
two grains, three times a day. Part xxiii., p. 303. 
Administration of Iron in food.—M. Martens read an essay before the 
Belgian Academy of Medicine, on Ferruginous Medicines. Among his 
conclusions, we find the following : 
“ Wheaten bread may be rendered much more nutritive ” for chlorotic 
patients, “ by adding a small quantity of sulphate of iron. In this way, 
alone, it can be capable of forming a substitute for meat.” 
In the discussion, it was suggested that the same method of medication 
would be beneficial to patients recovering from acute diseases, especially 
when the system was not yet able to bear animal diet. This idea is good ; 
and would be easy of application. Part xxiii., p. 304. 
Pyrophosphate of Iron.—There is no tonic which acts so promptly and 
favorably as the pyrophosphate of iron and soda, prepared in a liquid form ; 
it is easy to administer, rapidly absorbed, and does not produce fatigue to 
the digestive organs. Part xxxvi., p. 254. 
Sirup of Protocarbonate of Iron.—The facility with which protocar- 
bonate of iron dissolves in organic acids, and its perfect harmlessness in 
irritable subjects, render it one of the most valuable agents in therapeu- 
tics; accordingly, all the new preparations into which sugar has been in- 
troduced, for the purpose of giving stability to this saline compound, have 
been adopted in practice. 
M. Dannecy, a distinguished pharmacien in Bordeaux, having ascer- 
tained that the precipitate of protocarbonate of iron obtained by mix- 
ing sweetened and boiled solutions of carbonate of soda and of protosul- 
phate of iron possesses the singular property of dissolving in simple sirup 
without becoming colored, conceived the idea of thus preparing a new fer- 
ruginous sirup. 
This preparation being permanent, will be employed in cases in which 
the form of sirup is preferable to that of pills; for example, in the treat- 
ment of children. Part xxxvii., p. 250. 
Improved Method of Continuous Irrigation.—The instrument consists 
of a zinc reservoir, with a vulcanized India-rubber tube opening from it at 
its side, close to the bottom. The entrance of water into the tube is regu- 
lated by a stop-cock ; at the other end of the tube is affixed a broad zinc 
head, resembling a compressed or flattened rose of a watering-pot, a linear 
series of perforations being cut through its lower or convex edge. Equi- 
distant from each other, and about half an inch apart, threads of worsted 
were passed through these holes from within, and made to project about 
three-quarters of an inch below the metal. This end was suspended over 
the part to be irrigated ; the reservoir charged with water placed upon the 
usual little shelf situated at the head of the bed, and the stop-cock being 
turned, allowed the water to escape into the tube. The extent and rapid- 
ity of the irrigation were, by the aid of the stop-cock, perfectly regulated. 
IRRIGATION IS8UE8. 
55 
A small sheet of oil-skin was placed under the arm and separated from the 
bed, the oil-skin being so arranged as to conduct the water which had 
passed over the limb into a basin or upon the floor of the ward. It is 
obvious that water of any temperature, or medicated in a prescribed man- 
ner, may be made, by this simple and cheap apparatus, to distribute itself 
over any part, however small or extensive it may be. 
By enlarging or diminishing, by elongating or shortening, the head, or 
varying its form, the drops may be carried simultaneously over a larger 
or smaller, or any irregularly-formed surface. Part xxvii., p. 257. 
ISSUES. 
Mode of Inserting.—Dr. Geoghegan recommends the application of 
kali to the surface of the true skin, denuded of its cuticle by the applica- 
tion of a blister. The blister should be of precisely the same size as the 
issue to be inserted, and having been applied for the usual time, the cuticle 
should be gently but completely removed, and the superfluous moisture 
absorbed by a piece of lint (the surface of the skin not being rendered 
altogether dry). The stick of potass should be then passed once lightly 
over the entire surface, no friction whatever being necessary. The opera- 
tion is now complete, save the removal of superfluous potass by the press- 
ure of a piece of lint applied after the lapse of about half a minute—a pro- 
cedure which is, however, unnecessary, where due care has been observed 
in its application. 
The caustic at once extends its influence into the substance throughout 
its entire depth, and the pain, which is of an active burning kind for some 
moments, rapidly subsides, and, in a great measure, disappears in from 15 
to 30 minutes, in the generality of cases. By the mode of procedure just 
described, the more prolonged pain and apprehension attendant on rub- 
bing in the caustic, is avoided ; and from the simplicity and facility of the 
operation, the latter may be administered in the guise of a stimulant ap- 
plication to the blistered surface without inflicting on the sufferer the for- 
malities of an issue, or the horrors of expectation. The destruction of the 
skin to an unlooked-for and undesirable extent, wThich is so frequent by 
the ordinary methods, is entirely avoided by the proposed modification. 
Part xii.,y>. 251. 
Issues—May be made by applying to the part, slightly excoriated or 
denuded of cuticle, a smooth zinc plate of proper size, having a silver 
wire soldered to its back; to the other end of the wire is soldered a 
smooth silver plate of the same diameter as the zinc, and this is closely 
applied to an abraded surface, lower down in the body than the zinc plate. 
In a few days an eschar will form beneath the zinc plate. 
Part xviii., p. 340. 
Issues—May be thus conveniently made by means of galvanism. Get 
a piece of perforated zinc fastened or riveted to a sixpence, shilling, or 
half-crown. Place this on the spot where the issue is to be made, with 
the zinc surface next to the skin, and cover it with a piece of spongio- 
piline moistened with salt and water. Moisten the spongio-piline with 
salt and water every twTelve hours. An eschar will be thus formed in 56 
JAUNDICE. 
about twelve days, or, if the cuticle is removed before applying the little 
battery, the slough will be formed in from four to six days, but more 
irritation is created than by the former method. Part xx., p. 272. 
Issue-making.—Cut a hole the size of the issue required in a piece of 
leather plaster, and apply it to the part, then introduce into this hole 
powdered potassa cum calce, just sufficient to cover the skin, drop upon 
this two or three drops of spirits of wine, and cover the whole over with 
a large piece of plaster. In twenty-four hours the plasters may be removed. 
Part xxxv., p. 308. 
JAUNDICE. 
Inspissated Ox-gall in Jaundice.—Dr. Johnson states that he has, in 
some very bad cases of jaundice, administered inspissated ox-gall in doses 
of live grains, gradually increased to ten grains, three times a day, with 
the best effect. Part iii., p. 31. 
Treatment of Jaundice.—[Dr. Budd recommends the following treat- 
ment in cases of jaundice arising from suppressed secretion:] 
From 3ss. to 3j. of sulphate of magnesia, in conjunction with gr. xv. of 
carb. of magnesia, and 3ss. of aromatic spirits of ammonia three times a 
day—the sulphate of magnesia to keep up free action of the bowels; the 
carbonate of magnesia to neutralize any excess of acid in the stomach or 
bowels; and the aromatic spirits of ammonia to support the nervous sys- 
tem, and to keep up the action of the skin. Part xxvi., p. 95. 
Use of Turpentine in Jaundice, etc.—Turpentine has long been used in 
purpura hemorrhagica, and cases where the blood seems to become more 
diffluent than natural. Its efficacy in yellow fever has latterly been well 
shown by Dr. Laird, who considers the pathology of yellow fever as pri- 
marily connected with a morbid alteration of the blood, and that the tur- 
pentine, besides its general properties as a sedative, styptic, and antiseptic, 
possesses also peculiar power of action. on the skin and kidneys. I can 
bear ample testimony to its success in another form of jaundice, which we 
meet with much more frequently in fever, and arising from a totally dis- 
tinct cause; I allude to jaundice from excessive secretion of bile. In the 
year 1845, Dr. Corrigan treated, with turpentine, a case of this kind 
(“ considerable discharges of blood, mixed with bile, from the intestines ”) 
which occurred in the Hardwicke Hospital, and which recovered, even 
after the brain began to be affected. I have had in my wards several 
cases of this kind within the last three months, all of which recovered 
under the use of turpentine. The usual dose ordered is a drachm every 
two or three hours. It is frequently given with nitrous spirit of ether, to 
promote perspiration and avoid strangury. Dr. L. continues : 
There is a form of jaundice occasionally met with in fever, and which is 
of great practical importance to be acquainted with. A patient in con- 
tinued fever, without any appearance of jaundice or hepatic symptoms on 
the previous day, suddenly becomes quite yellow about the fourteenth or 
fifteenth day of fever, and all the tissues become impregnated with bile ; 
besides giving the usual tint to the skin and conjunctiva, the bile passes 
off by the bosvels most copiously, and the urine is loaded with it. In one JAUNDICE. 
57 
case I observed that the posterior part of the dorsum of the tongue, the 
soft palate, and fauces, had assumed the yellow hue, and that not merely 
the saliva, but the expectoration, was deeply tinged with it. 
These cases are purely critical, and differ from other forms of crisis only 
in the organ in which the critical action takes place. Instead of occur- 
ring in any of the usual modes, such as perspiration or diarrhoea, etc., it 
occurs by a profuse secretion of bile, which endeavors to pass rapidly 
away through all the outlets of the body. Such cases require but little 
treatment ; the rapidity with which all the icteric symptoms pass off is 
most surprising. There are two facts, however, to be noticed regarding 
it; one is, that the premonitory symptoms of this form of crisis are more 
severe than I have ever seen in any other; the other important feature in 
this mode of crisis, is the excessive debility which follows it. 
I have also very frequently seen jaundice arise in the course of fever, as 
a symptom of pneumonia. Part xxx.,p. 68. 
Properties of Carbazotie Acid.—It is formed by the action of nitric 
acid on indigo, aloes, silk, and other organic substances. It forms yellow 
shining scales, soluble in water, to which it gives an intense yellow color 
and bitter taste. The process recommended by Liebig for preparing it 
consists in boiling ten parts of diluted nitric acid in one of indigo, and 
adding to the liquid, when cold, a quantity of potassa. The potassa com- 
bines with the carbazotie acid, and forms carbazotate of potass; which, in 
its turn, is decomposed by the addition of another acid, by which the car- 
bazotic is set at liberty, and is deposited in brilliant yellow crystals. It is 
soluble in alcohol and ether. Dr. T. Moffat says: 
I have prescribed carbazotie acid and the carbazotates of potass, ammo- 
nia, iron, and zinc, in eight cases, and in four of these the skin and con- 
junctiva became yellow during the administration of the remedies. They 
were completely jaundiced; and I believe that the yellowness was owing 
to the coloring matter of the remedies having tinged the serum of the 
blood. The coloration may have been owing to some change produced 
in the biliary system by the remedies; but I am inclined to the former 
opinion. The tinge of the skin and conjunctiva so perfectly resembles 
jaundice, that the keenest observer would be deceived. 
Part xxxii., p. 41. 
Jaundice.—The first principle to be borne steadily in mind in all cases, 
whatever their cause, is to promote in every way the functions of those 
organs compensatory by which elimination of bile is effected, using warm 
and vapor baths, saline purgatives, and the various kinds of diuretics. In 
employing blisters, cantharides is inapplicable, from its action on the 
kidneys. 
In jaundice from acute congestion of the liver, leeches, cupping fomen- 
tations, etc., over the region of the liver, and saline purgatives to unload 
the engorged portal system, are the curative measures most likely to be 
followed by relief. When the congestion is primary, due to spirit-drink- 
ing, and such as may go on to inflammation of the adhesive character, 
mercury pushed to slight specific action is indicated; but in cases of clos- 
ure of the ducts, mercury can do no good, here we can only carry out the 
principle of elimination by other .channels. Part xl., p. 67. 58 
JOINTS. 
JOINTS. 
The Excision of Diseased Joints.—The removal of diseased articulating 
surfaces may certainly be ranked amongst the greatest triumphs of modern 
surgery. Instead of leaving the disease to wear out the constitution of 
the patient, or amputating the limb, and thereby crippling him for life, 
the joint is boldly laid open, the diseased portions excised, and the wound 
allowed to heal by granulation; taking care to place the limb in the most 
suitable position for its after use, after anchylosis has taken place. 
Mr. Cooper says: Now, as to the rationale of the operation, I cannot 
help believing that those who have recommended the excision of joints, 
have dwelt too strenuously upon its advantages, as to the quantity of dis- 
eased structures which, by mechanical means, they remove. In my opinion, 
the great benefit which is derived is from exposing and perfectly laying 
open all the affected tissues, so that nature is not herself obliged to pro- 
duce sinuses and ulcerations through the soft parts. It is not the quantity 
of bone you cut away, but, by exposing a large surface, you allow the dis- 
eased tissues to readily come away, instead of burrowing through the soft 
parts. No more should be removed than is evidently already destroyed 
by disease, and we find that this is generally confined to the articulating 
surfaces alone of the bones implicated. If you remove beyond this, you 
do no good, but, on the contrary, detach muscles which would otherwise 
have been of the greatest service to the new joint, and thereby render it 
far less capable of natural and useful motion.- Part ii., p. 122. 
Removal of Foreign Bodies in Joints by means of Subcutaneous Inci- 
sions.—The proceeding recommended by the author, Dr. Goyraud, of Aix, 
consists in pushing the loose body (if in the knee joint) into the synovial 
pouch above and to the outer side of the patella, beneath the vastu3 ex- 
ternus muscle, and while an assistant holds it fixed there, passing a narrow 
knife through the skin at some distance above the joint, and through all 
the intermediate tissue down to the foreign body. Without enlarging the 
opening in the skin, the synovial membrane and adjacent tissues over the 
loose substance are now to be freely divided, till, by the pressure on the 
latter, it slips out of the joint through the wound and lodges itself in the 
subcutaneous cellular tissue, or in some of the other tissues betweeu the 
skin and the joint. After this the patient must remain at rest for several 
days (the small external aperture being merely covered by sticking-plaster), 
till all chance of inflammation occurring has passed away. The foreign 
body dislodged from the interior of the joint will form a cyst for itself, 
and remain in its new position without producing any annoyance; but if 
it should be deemed necessary, it may easily be removed by a single inci- 
sion through the skin over it, which will no longer be likely to excite any 
inflammation of the joint itself. Part 95. 
Treatment of Cartilaginous Bodies in Joints.—Mr. Liston, in his lec- 
tures on the “Diseases of the Joints,” says he has, in several cases, pur- 
sued the plan recommended by Dr. Goyraud, of Aix, with excellent suc- 
cess. Part ix., p. 185. 
Use of Issues in Diseases of the Joints.—Dr. Brownless condemns the 
indiscriminate employment of issues in chronic diseases of the joints, be- 
lieving that the continual and profuse discharge sometimes kept up by JOINTS. 
59 
them is«very injurious, by weakening the powers of life in diseases where 
so much depends upon the state of the general health. 
If issues are used, make one of moderate size, and when it is nearly 
healed, make another at a different part of the joint; and do this again 
and again. If an issue is kept open (which is not advisable), it must not 
be with peas, but by occasionally retouching with caustic. 
Part xv., p. 169. 
Joints—Scrofulous Disease of.—Secure rest of the joint by plasters, 
leather or gutta percha splints, and bandages; but confine the patient to 
the house no more than is absolutely necessary, or the health will be in- 
jured, and the local disease thereby aggravated. Apply tincture or oint- 
ment of iodine, night and morning, so as just slightly to irritate the skin; 
and alternate its use with other stimulating liniments, blisters, or, in slight 
cases, the cold douche. When abscesses form, allow them to burst spon- 
taneously. Part xxi., p. 25. 
Chronic Disease of.—In chronic diseases of the joints, connected with 
gout and rheumatic gout, much may be done to prevent its progress at its 
very commencement. Place the patient on a careful system of diet, par- 
taking very moderately of animal food, avoiding fruit, acids, etc., and tak- 
ing little or no fermented or spirituous liquors. Perspiration should be 
induced by exercise or by the hot-air bath, once in a week or fortnight. 
Acetic extract of colchicum, in alterative doses, combined with mercurial 
pill, and occasional purgatives, should be given from time to time. Moder- 
ate doses of potash and magnesia (always avoiding soda) may be given 
three or four hours after the principal meals, to neutralize any super- 
abundant acid in the stomach. If the patient is depressed by the colchi- 
cum, give Dr. Gregory’s powder. Little is to be done locally. If pain is 
severe in the part, leeches may be applied, and, if need be, a bandage for 
the purpose of limiting motion. When the disease is fully established, 
these remedies may be still used to mitigate the symptoms, but we must 
then give the iodide of potash in two or three grain doses twice daily, and 
oontinue it for weeks, if it agrees with the patient. No general rule can 
be laid down. In one case, great benefit was found from the use of cod- 
liver oil locally, and from its administration internally. Part xxii., p. 192. 
Iodine Injections in Hydrarthrosis.—M. Velpeau says, in his opinion, 
there is not more danger in injecting a joint than in injecting the tunica 
vaginalis, and that he has done it with complete success, the smallest pos- 
sible trocar being employed. Neither does the question of injecting the 
abdomen in ascites with iodine seem to him one of mere hypothesis. Many 
French surgeons have related numerous cases followed by complete suc- 
cess, where the practice has been employed, while others consider the con- 
clusions drawn to be somewhat hasty. Part xxii., p. 198. 
Inflammation of the Synovial Membranes of Joints.— [As to the consti- 
tutional origin of these affections, Sir Benj. Brodie remarks:] 
Inflammation of a synovial membrane may arise as a local affection, the 
consequence of a sprain, a contusion, or other mechanical injury. In other 
cases, various joints being affected, either simultaneously or in succession, 
it is manifestly the effect of a disordered state of the general system. 
I must confess that, in proportion as I have acquired a more extended 
experience in my profession, I have found more and more reason to believe 60 
JOINTS 
that local diseases, in the strict sense of the term, are comparatively rare. 
Local causes may operate so as to render one organ more liable to disease 
than another; but everything tends to prove that, in the great majority 
of cases, there is a morbid condition, either of the circulating fluid or of 
the nervous system, antecedent to the manifestation of disease in any par- 
ticular structure. 
[Sir Benjamin insists in the treatment “ on the necessity of regarding 
them as constitutional and not local affections.” When the joint is greatly 
and distressingly distended with serum, it is recommended to make a few 
minute punctures, and apply an exhausted cupping-glass ; and as soon as 
pus is known to have been secreted, to make a free incision into the joint. 
He then says:] 
“ If it be a question whether the collection of fluid in a joint be purulent 
or otherwise, it is prudent, in the first instance, to make a puncture with a 
grooved needle. If it prove to be purulent, a free opening should then at 
once be made with a lancet, in a depending situation. It is important that 
this operation should not be long delayed, lest the matter should make its 
way out of the joint in other directions, and form irregular and circuitous 
sinuses among the neighboring tendons and muscles. It is equally import- 
ant that the opening should be sufficiently large to allow the matter to 
flow spontaneously, without it being necessary to have recourse to pressure 
on the joint. If afterward there be reason to believe that there is still a 
lodgment of matter in any part of the joint or among the neighboring soft 
parts, the original opening should be dilated, or the surgeon should avail 
himself of the first opportunity which occurs of making another opening 
in a convenient situation; and it will often happen that several such open- 
ings will be required before the cure is completed.” Part xxiii., p. 271. 
Joints—Diseased.—That as the separation of diseased cartilages from 
the extremity of the bone is commonly by a process of “shedding;” that 
as the portions so exfoliated tend to keep up a constant irritation within 
the joint; that as the natural outlets for these portions, the sinuses, are 
inadequate for that purpose; that as for their removal they have to be dis- 
solved in the discharges of the joint, which is necessarily a very slow pro- 
cess ; but as, whenever they are removed, an immediate process of repara- 
tion commences, Mr. Gay recommends that free and deep incisions should 
be made along the side of the joint, so as to lay open its cavity freely, and 
to allow of no discharges being retained by any possibility within it. The 
incisions should be made in the long axis of the limb. They should extend 
into the abscesses of the soft parts so as to lay them open, and the incisions 
should pass through sinuses, unless out of the way of the incision. If 
either of the bones be carious or necrosed, the incision should be made 
deep into them, to allow the free escape of diseased portions. Important 
vessels should be avoided. The wounds should be kept open by pledgets 
of lint, and free suppuration encouraged. Part xxv.,p. 179. 
Scrofulous and Rheumatic Inflammation of Joints.—Mr. Stanley re- 
marks upon the difference in the frequency with which certain joints are 
attacked by disease, and how exempt others seem to be from the like 
affections. An example of the former fact may be taken in the hip and 
knee joints, and of the latter in the lower jaw, the sterno-clavicular articu- 
lation, or the heads of the ribs with the vertebrae. Some explain this by 
their greater or less exposure to external influences; but this cannot bo JOINTS. 
61 
the case, else why should the hip be more frequently attacked than the 
ankle joint? Others say that joints are more susceptible from the 
activity of their functions; but few joints are more exercised tflan the 
lower jaw, and yet few are more free from disease. 
I now come to the consideration of strumous inflammation of joints, 
and before proceeding to investigate its phenomena, the following ques- 
tions demand attention: 1st. What are the circumstances which would 
lead us to regard the disease as strumous, when brought to the bedside of 
a patient? 2d. In what condition should we expect to find the struc- 
tures, viz.: the bones, cartilages, and synovial membranes of a joint, pro- 
vided the disease be strumous ? With reference to the first question, I 
am unacquainted with any local symptom, any precise condition in the af- 
fected joint itself, which would enable us at once to decide on its stru- 
mous nature. We must look elsewhere. The age and aspect of the 
patient, the past or present existence of scrofulous disease in other parts, 
such as enlargement and suppuration of the cervical absorbent glands, 
strumous ophthalmia, tubercle in the lungs and other organs—any of these, 
especially if actually coexistent, would justify us in regarding the disease 
as scrofulous. Often, indeed, these cases are obscure, and sometimes we 
are led to a wrong conclusion. The aspect of the patient is delusive, and 
should not be too much relied upon. Many instances occur in which the 
patient’s appearance seems indicative of the existence of scrofula, whose 
subsequent progress and favorable recovery prove that such evidence is 
fallacious. 
We have now to answer the second question. What is the state of a 
joint invaded by strumous disease ? The morbid specimen I how exhibit 
shows the condition of the articular extremity of a bone in an extreme 
attack of this nature. The end of the bone is softened from absorption 
of its earthy matter, and its cancelli are filled with tuberculous deposit. 
It is, however, according to my experience, rare to meet with so com- 
plete an example of strumous disease as this specimen furnishes. In the 
majority of cases, I believe that no tubercular matter is found deposited, 
and when found, it is only in the last stages of the affection. Such a con- 
dition of bone, when it does exist, is, in my opinion, irreparable; and, 
when the surgeon is summoned to a case exemplifying the disease in this 
its latest stage, he can do nothing to restore the bone to its natural state, 
nothing to accomplish a cure. There is, however, an earlier stage in 
these affections, which you will often have to treat in private, although it 
is seldom seen in hospital practice—a stage amenable to treatment, a stage 
in which, generally speaking, the morbid impairment of the bone may be 
arrested, and its integrity restored. It is characterized by increased heat, 
and enlargement of the bone, immediately above the joint. There is, 
indeed, increased vascularity, and low inflammation of the bone, which is 
quickly followed by expansion of the cancellous texture, and absorption of 
earthy matter. Ultimately in bone thus degenerated, tubercle is some- 
times deposited. Such, then, is the state of the bone in a joint affected 
with struma. The other structures—the cartilages, synovial membrane, 
etc., are in a state of low inflammation, inflammation which has com- 
menced either in the bone or the synovial membrane itself, and which, if 
suffered to advance, is followed by its usual consequences—exudation, 
thickening of tissues, and sometimes suppuration. Now, the appropriate 
treatment for an attack of this sort is, perfect rest for the limb, and re- 62 
JOINTS. 
moval of all weight and pressure from the inflamed joint, so as to insure, 
as far as possible, its complete tranquillity. If inflammation exists in any 
activity, the judicious application of leeches will be beneficial; but it 
should be borne in mind that leeches must not be lavishly employed, as 
strumous patients cannot stand depletion. The remainder of the treat- 
ment is constitutional, and should be directed to the restoration of the 
general health, if that has failed; to its maintenance if it has not. To this 
end country air, or, where it is practicable, a resort to the sea-side should 
he recommended; alight, nutritious diet enjoined, and the state of the 
stomach and bowels be carefully attended to. 
Not unfrequently disease in the soft tissues around a joint, inflamma- 
tion, and abscess, are mistaken for disease inside the joint; and, in some 
instances, eminent surgeons have amputated limbs under the impression 
that an irremediable articular affection existed, while in reality, the exte- 
rior tissues alone were involved, the joint itself being sound. 
Joints are liable to another form of inflammation, differing from that 
wTe have just reviewed—“rheumatic inflammation.” The diagnosis of 
articular rheumatism is not usually difficult. When rheumatic fever is 
present, it is, of course, obvious; but, when it is not, the implication of 
other joints, the cause and symptoms of the attack, and the history of 
prior rheumatism, will generally guide us to a right decision ; the implica- 
tion of other joints, because it is extremely rare to find rheumatism affect- 
ing one joint only; it attacks two or three simultaneously, or flies about 
from one to another: the cause and symptoms of the attack—because we 
shall almost invariably find that the patient has been exposed to cold or 
dampness, and because muscular pains are generally precursory to the 
articular inflammation. Rheumatic disease thus induced, is commonly 
marked by pain in one particular. spot; the patient does not complain of 
general pain in the joint, but points to one especial locality, and describes 
it as the seat of all his sufferings. 
Articular rheumatism is, moreover, intractable, leaving one joint and 
assailing another, or departing and recurring in the same joint. Joints 
are attacked by rheumatic inflammation in two ways; either their fibrous 
structures, their ligaments, suffer, or their synovial membranes. Now, 
the consequences of rheumatic inflammation of the ligaments may be 
serious, such, indeed, as may terminate in dislocation of the bones of a 
joint. For, under its influence, the ligaments become soft and elongated, 
so as to permit the bone to slip out of the cavity in which it is naturally 
fixed. In this way the head of the femur may be displaced upward on 
the dorsum ilii without rupture or ulceration of either the capsula or the 
ligamentum teres. 
Rheumatic synovitis commonly ends in effusion. Ulceration of the 
articular cartilages may, however, supervene; and I have witnessed a 
case in which this condition was set up within nine weeks from the com- 
mencement of the attack, so that it was found necessary to amputate the 
limb. More usually, however, rheumatic synovitis gives rise to anchy- 
losis, such anchylosis as may result from the adhesion of opposite synovial 
surfaces by effusion of fibrin, and which is called spurious, in contradis- 
tinction to true or osseous anchylosis. 
Gonorrhoeal rheumatism is a form of the disease occurring in conjunc- 
tion with gonorrhoea, brought on by exposure to the vicissitudes of 
weather, and to the development of which, a certain unhealthy coustitu- JOINTS. 
63 
tional state appears necessary. Unlike ordinary rheumatism, it confines 
itself to one or two joints, and, unshifting, clings to them with remarka- 
ble tenacity. It is, in truth, an affection that has long baffled the powers 
of medical surgery. In many instances the patients appear to recover, 
but the complaint returns on the slightest exposure, and no permanent 
cure is effected. There is now under my care a Pole suffering from 
gonorrhoeal rheumatism of the wrist-joint. In him the disease lias 
yielded for the present to three grain doses of the iodide of potassium, 
given three times daily; and I am informed that the gonorrhoeal discharge, 
which had become scanty, has reappeared since the mitigation of the arti- 
cular disease. The best possible termination in these cases, a termination 
which has ensued in the instance I have mentioned, is serous effusion into 
the joint; for when the fluid is absorbed, it is not unlikely a useful joint 
may remain. Some time back, a young man, aged twenty-one, was my 
patient in the hospital, in consequence of a most acute attack of rheuma- 
tism in the shoulder-joint, following gonorrhoea. Though he was in a 
reduced state, 1 ordered him to be bled from the arm; mercury was 
administered; in fact, very active treatment was adopted. Serous effu- 
sion in the joint resulted, and within five weeks I had the gratification of 
seeing him leave the hospital with the functions of the joint in a great 
measure restored. 
We occasionally meet with examples of rheumatic synovitis occurring 
after parturition, which may originate anchylosis. The affection differs in 
no shape from ordinary rheumatic synovitis; but it requires gentle treat- 
ment, as the patients attacked by it are generally much debilitated, 
and frequently suffering from some uterine complication. 
Part xxvi., p. 118. 
Points, Diseased.—M. Tessier, of Lyons, has shown that prolonged 
rest alone, even where little or no disease previously existed—a rest for 
five or six months—is sufficient to cause absorption or ulceration of the 
cartilages of joints. This prolonged rest also aggravates existing disease. 
In the early stage of inflammation of joints, apply plenty of leeches, 
except in scrofulous subjects. To relieve pain, use the following : moisten 
a bit of lint with twenty or forty drops of chlorinated hydrochloric ether, 
and apply it to the joint. After bleeding bring the patient rapidly under 
the influence of calomel, or give tartar emetic. The limb should have 
absolute rest in the most favorable position, for five or six weeks, but not 
longer, for fear of stiffness, etc. The joint may be splintered with lea- 
ther in the following way: Get some thick leather, soften it in warm 
water, and mold it, when pliable, to the joint, and when hard, remove it 
and line it with wash leather. This forms an admirable splint. One may 
be made for each side of the joint. Evacuate any pus that may be 
formed, in good time. Promote the absorption of such materials as the 
inflammation may have deposited, by counter-irritation, by means of 
blisters, croton oil, discutient plasters, composed of equal parts of galba- 
num and mercurial plaster, pressure, friction, the cold douche. 
Ulceration of Articular Cartilages of.—Acute inflammation is marked 
by rapid effusion within the joint, and uniform swelling; in disease of 
cartilage, the swelling is slower, and outside the joint, not coming on till 
some time after the first sensations or uneasiness. In chronic degenera- 
tion of synovial membrane, the swelling, although indolent, is more rapid 64 
JOINTS, 
than when the cartilage is diseased. The swelling is sloughy, elastic, and 
superficial. Scrofulous disease of the heads of the bones is most likely to 
be confounded with disease of cartilage; but ulceration of cartilage 
chiefly belongs to the middle and after periods of life, and to dyspeptics. 
In scrofulous disease, the pain generally comes on after the formation of 
pus. In ulceration of cartilage, the pain comes on earlier, and may con- 
tinue a long time without pus forming at all. Perfect repose, accom- 
plished by splinting the joint, either by Mr. Scott’s method, or by leather 
or gutta percha splints molded to the joint. Give mercury early, when 
not contra-indicated, eolchicum, with alkaline aperients. By and by apply 
counter-irritation. 
Scrofulous Disease of.—In the early stage of the disease, Sir B. 
Brodie says, “All kinds of counter-irritation, such as blisters, issues, setons, 
and tartarized antimonial ointment, are not only not useful, but actually 
mischievous.” The only exception is in cases of hip-joint disease 
painful character. These counter-irritants certainly excite absorption of 
fluid which may exist in the joint, but do not act on the diseased struc 
ture. Perfect repose of the parts in the horizontal position, with leather 
or gutta percha, or other kinds of splints lightly applied, is, no doubt, tin 
best local treatment; at the same time, allowing the patient as much out 
door amusement as possible. Part xxx., p. 93. 
Veratrine Ointment as a Local Application in Scrof ulous Affections 
of the Joints.—To promote absorption in these cases, use the following 
ointment: veratrine, grains five to ten, dissolved in spirits of wine, and 
add to one ounce of axunge. This is not to be used in acute affections, 
but in chronic. Rub about the size of a small bean upon the joint for a 
quarter of an hour daily. If violent itching be produced, use a little 
glycerine and water. Part xxx., p. 123. 
Articular Disease illustrating the Advantages of the Actual Cautery• 
—[The following case commenced after cold and fatigue, about four 
months before admission into the Edinburgh Royal Infirmary. The pain 
in the shoulder was at first intense.] 
On admission she complained of constant gnawing pain in the left shoul- 
der, and extending down the limb as far as the elbow, and sometimes to 
the fingers; when in the sitting posture she held the affected limb with 
the other hand, to ease the pain: the arm was also affected with a feeling 
of numbness and weakness; and although the shoulder was not very ten- 
der on pressure, and very gentle passive motion of the arm could be per- 
formed through a considerable angle without pain, yet any attempts on 
her own part to move it produced great aggravation of her sufferings. 
As a result, no doubt, of habitual disease, the muscles about the shoulder 
were much atrophied, and this caused a remarkable apparent prominence 
of the bony points, viz., the spine of the scapula, the acromion, the ante- 
rior border of the outer part of the clavicle, and the head of the humerus. 
The shoulder had an appearance that suggested at first sight the idea of 
dislocation. 
The patient being under the influence of chloroform, Mr. Syme cauter- 
ized thoroughly the skin over the anterior and posterior aspects of the 
joint, rubbing a red hot cautery iron freely backward and forward four 
or five times over each part. It had the effect of raising and rubbing off 
the cuticle, but did not char the skin. An hour afterward the patient joints. 
65 
was suffering but little pain. Said she slept well that night, the first time 
for four months, and feels now no pain save that of the burns. 
A poultice was applied yesterday; the pain of the burn is now gone, 
and she feels no pain at all. Says that she has not only lost all pain, but 
also that the feeling of numbness is gone from the limb, and that she seems 
to have more power in it. The burned parts present a white sloughy ap- 
pearance. 
The poultice was continued till the sloughs separated, when simple cer- 
ate was substituted for it with a view of retarding, rather than promoting 
cicatrization. 
In time, this case fully recovered. Other cases are given showing in an 
equally striking manner the beneficial effects of the actual cautery in certain 
forms of articular disease. It will be observed that it is by no means so 
painful a remedy as is generally supposed, and also that its good effects 
are more than can be attributed to the mere discharge of pus from the 
sore which it produces, seeing that a great improvement commonly occurs 
within a few hours of its application, and long before suppuration is estab- 
lished. Part xxx., p. 120. 
Incisions into Joints.—According to Mr. Gay, these may be made with 
advantage: 1st. In cases of chronic inflammation, with effusion and pain, 
if these have resisted ordinary remedies and health is declining ; 2nd. In 
cases of acute or subacute synovitis, when the symptoms are unusually 
severe, and the external coverings show a tendency to ulceration, or when 
there is reason to believe that there is pus within the joint; 3rd. When 
the joint is occuped by bony or cartilaginous debris, which cannot find 
exit; and 4th. In cases of carious disease of the bones. 
Mr. Hancock thinks that these can only be beneficial when, from the 
long duration of the disease, the actual structure of the joints have become 
so changed as to diminish the danger of opening into their cavity. When 
the disease is recent and progressing, opening the joint is attended with 
an aggravation of the symptoms. Part xxxv., p. 71. 
Affections of the Joints following Operations on the Genito- TJrinary 
Organs.—Mr. Coulson, Surgeon to St. Mary’s Hospital, in his lecture, re- 
marked as follows: 
It is known that certain affections of the genito-urinary organs are occa- 
sionally followed by severe disease of the joints. 
The injuries and diseases of the genito-urinary organs with Avhich they 
may be connected are various. They may follow lithotomy and operations 
on the urethra. They may follow lithotrity ; the introduction of instru- 
ments into the bladder; irritation of the urethra from the passage of 
foreign bodies, and gonorrhoeal abcess, with ulceration of the urethra. In 
fact, any injury or disease which gives rise to primary suppuration in or 
about the genito-urinary organs of the male, may be followed by secondary 
articular disease. Besides these, there are joint affections, which appear 
to be excited by mere irritation of the same parts without suppuration. 
The articular affections are sometimes purulent, sometimes non-purulent; 
and this distinction is well marked, the two varieties being seldom mixed 
in the same case. The attack of the joint sets in very soon after the ap- 
pearance of constitutional symptoms. Thus it frequently happens that 
the joints begin to swell on the first or second day after the rigors and 
fever. The secondary deposits are often confined to the joints and mus- 
VOL. II.—o 66 
JOINTS. 
cles, and do not extend to the principal viscera. Notwithstanding the ap- 
parent limitation of the general disease, death ensues rapidly after the 
first appearance of the constitutional symptoms—on the fourth, sixth, 
tenth, and twelfth days. 
On the other hand, many of these cases, though extremely severe, ter- 
minate by recovery of the patient ; yet the joints have been extensively 
injured, as is shown by the anchylosis which ensues. 
The purulent affection of the joints generally sets in under the following 
circumstances; a slight injury has been inflicted on the genito-urinary 
organs, or the patient may have irritated the urethra by attempting to pass 
a catheter himself. Severe rigors, followed by fever of a nervous kind, 
ensue; and in one or two days the joints are attacked by pain and swell- 
ing. The tumefaction may increase to a considerable size in a few hours 
the joint becoming red and hot. The knee, shoulder, ankles, and elbow 
are the joints most commonly affected. Some of these cases terminate 
fatally in a fortnight; others again are chronic; even in these the joint dis- 
ease may commence as early as the second day. 
The morbid changes in these cases are various. They are usually inflam- 
matory. The synovial membrane is injected, and sometimes lined with 
false membrane, and the joint contains pus; but ulceration of the cartilages 
is not common. In other cases the lesions are confined to the periarticular 
tissues, which are infiltrated with pus; or the purulent inflammation may 
occupy the interior as well as the exterior of the joint, although the cap- 
sular ligament has nowhere given way. In a few cases the joint has been 
the seat of simple inflammation, and does not contain any pus; and matter 
may be discoved in joints which did not seem during life to be attacked. 
It is very rare to find pus in a joint which appeared healthy up to the time 
of death ; but this has occurred in one case. 
In chronic cases the periarticular swelling often contains pus, and the 
cartilages are softened or eroded. Indeed, we may infer that Che cartilages 
and even ligaments have been extensively diseased from the anchylosis 
which ensues. 
In the milder form of the disease, the joints become painful and swollen; 
but these symptoms are not severe, and the skin is not red. In a few 
days the affection may subside, and pass to another joint; hence thi 
form is often mistaken for rheumatism. The effused fluid is sometime 
purulent; in the majority of cases, we may infer that the effusion is serou 
from the manner in which it disappears. I should observe that many ol 
the acute and some of the chronic cases are accompanied by iutermuscula 
abcesses in the limbs. 
The nature of the articular affections just described is not well under* 
stood. M. Velpeau attributes them to poisoning by urine. M. Civiale 
confesses that he is unable to explain how they are produced. For my 
own part I am inclined to attribute the severe cases accompanied by con- 
stitutional symptoms, and followed by purulent deposits, to the influence 
of pus poisoning. 
I have found small abcesses along the urethra, produced by the frequent 
passage of instruments for stricture. I have also found inflammation of 
the prostatic veins. In other cases, small primary abcesses have been 
found in the prostate or wall of the bladder, or suppurative inflammation 
in the cellular tissue of the scrotum. All these are sufficient causes. 
Part xxxvii., p. 120. 67 
JOINTS, 
Hysterical Joint Affections—Mr. F. C. Skey says, that in three-fourths 
of diseases of the knee joint occurring in young women from fifteen to 
twenty-five, you will find more or less palpably the traces of hysteria; for 
even the presence of real disease of the joint is no guaranty or safeguard 
against the existence of some symptoms really attributable to hysteria. 
Part xxxix., p. 133. 
ANKLE JOINT. 
Amputation at the.—One reason, Mr. Fergusson says, why surgeons 
refuse to perform amputation at the ankle joint, is, that the integuments 
are often swollen and ulcerated. But this is no objection to the proceed- 
ing, the disease being produced entirely by, and kept up by, the irritation 
of the carious bone, a principle of the greatest importance to be remem- 
bered. Sloughing of the lower flap has been often observed, and in order 
to obviate this, Mr. Syme has recommended a shorter flap to be made; 
and Mr. Fergusson states that he has even made a shorter one than that 
recommended by that gentleman. It is desirable to make the flap no 
longer than is absolutely necessary. Part xxiv., p. 185. 
Caries of the Ankle Joint.—Amputation of the leg, below the knee, 
used to be the common operation for caries of the ankle joint and bones 
of the tarsus ; but when the disease does not extend above the articulat- 
ing extremities of the tibia and fibula, the foot may be removed, and the 
thick integuments about the heel preserved to form a cushion for support- 
ing the weight of the body. Besides this, there is much less fatality 
about this operation than in that of amputation of the leg. 
Part xxvii., p. 352. 
Amputation at the Ankle Joint.—Take care to make as much use as you 
can of the sole of the foot for the flap. It will have to bear all the pressure 
afterward, and is skin ready formed for such purpose. Preserve not only 
the skin but the whole of the fibrous and fatty granular structure of the sole. 
Keep the knife free from the posterior tibial artery, which is best done by 
cutting quite behind the flexor tendons, close to, or even shaving the 
periosteum. Instead of using adhesive strips and bandages afterward, 
make use of sufficient sutures, and then apply straps of linen about a foot 
long and an inch wide, soaked in warm water, to the stump between the 
sutures. Keep the parts warm generally, with warm water on lint 
covered with oil-silk, and keep up gentle pressure on the flap. 
Part xxix., p. 184. 
Astragalus—Non-Excision of.—This is a modification of Syme’s ope- 
ration ; but Mr. Simon believes the stump to be better than Syme’s, 
because of its greater breath, its mobility in the joint, and the saved inch 
and a half of leg. The operation is performed similar to that of amputa- 
tion at the ankle joint, the knife running between the astragalus and os 
calcis. The flap is taken in the same manner as in amputation at the 
ankle joint. Part xxix., p. 186. 
Ankle Joint—Exarticulation of.—Peregoff, of St. Petersburg, modifies 
Mr. Syme’s operation at this joint. He preserves the posterior portion 
of the os calcis, which is thus left to fill up the heel flap. The operation 
is conducted in the same way as Mr. Syme’s, except that, after the. exarti- 
culation of the astragalus, the os calcis is divided by the saw behind the 68 
JOINTS. 
posterior extremity of the astragalus, and the heel is thus preserved, instead 
of being peeled out. The saw is then applied to separate the malleoli, 
and a thin slice of the articular surface of the tibia. The cut surface of the 
tibia is then brought into apposition with the cut surface of the os calcis, 
and the skin flaps accurately united by sutures. Part xxix., p. 322. 
Lines of Incision Suitable for Operations at the Ankle Joint.—In 
operations at the ankle joint, arrange your incisions so that you can gain 
access to the tarsal bones, and if the disease be more extensive than anti- 
cipated, that you can even remove the entire foot at the joint, if you wish. 
Make “a transverse incision across the sole of the foot, commencing about 
three-quarters of an inch in front of one malleolus, and ending at a similar 
point in front of the other malleolus: a second incision is then made in the 
median line, beginning over the tendo-Achillis on a level with the ankle 
joint, and joining the former at right angles in the sole of the foot. The 
two lateral flaps thus marked out being next dissected upward, close to 
the bones, the calcaneum and astragalus are freely exposed. By division 
of their ligamentous and tendinous connections, one or both of these 
bones may be easily removedand other parts may be easily reached by 
extending the median incision a little forward. If, from the great extent 
of disease, it is found necessary to remove the entire foot, it may be done 
by uniting the two extremities of the transverse incision by a curved 
incision across the dorsum of the foot. Part xxx., p. 117. 
Tarsus—Excision of the.—When the calcaneum and astragalus are not 
diseased, Chopart’s operation is the best; if these two bones are very 
much diseased, then Syme’s.; if the calcaneum be sound, then Peregoff’s; 
or the calcaneum, astragalus, scaphoid, and cuboid, may any or all of them 
be removed, if the disease is confined to the tarsus, and the foot saved, 
by Mr. Teale’s operation. In Peregoff’s operation, the calcaneum has to 
be cut through with a saw. The chain-saw has been generally used, but 
Mr. Simon thinks the “Dublin saw ” much preferable, and does away with 
the objections usually urged against the chain-saw. In Peregoff’s opera- 
tion, as performed by Mr. Simon, first make the usual transverse incision 
across the sole of the foot, from the external malleolus to the opposite 
point on the inner malleolus; next cut rapidly across the instep meeting 
the ends of the former incision; then disarticulate the astragalus, and cut 
through the end of the calcaneum. Part xxxii., p. 111. 
Ankle Joint—Excision of the Os Calcis.—[William S., aged thirty- 
four years, states that three years ago he had a fall and injured his ankle ; 
in a few months an abcess formed on the dorsum of the foot, which, after 
some time, healed, but broke out and healed again repeatedly, lie has 
not been able to move excepting with crutches since the accident, and has 
repeatedly been advised by different medical men to have the foot re- 
moved. On examination, the soft tissues about the heel were found very 
much swollen. There were the openings of two sinuses, one under the 
the outer ankle, and the other near the tendo-Achillis, which both led to 
dead bone in the os calcis. The ankle joint was free from any serious 
lesion. Removal of the calcaneum was recommended, and was submitted 
to on August 22d, 1854. On September 17th he was discharged cured ; 
in twelve weeks he could walk with only the aid of an ordinary walking- 
stick; and in -eighteen months after the operation, he could walk ten miles 
a day without any inconvenience.] Dr. R. W. Coe observes: JOINTS, 
69 
The first incision must be begun where the calcaneum, astralagus, 
scaphoid, and cuboid bones meet, and carried in the direction of the 
ealcaneo-cuboid articulation outward across the dorsum of the foot, a 
finger’s breadth behind the projection of the fifth metatarsal bone, and 
directly inward across the sole of the foot, as far as a line drawn from the 
fourth toe. A second incision must be commenced where the first termi- 
nated, nearly at right angles to it, and carried backward - so as to termi- 
nate on the inner side of the tendo-Achillis, an inch above its insertion. 
This flap must be turned back, keeping the knife close to the bone, except- 
ing where crossed by the peroneal tendons. The tendo-Achillis must now 
be divided, and the knife carried through the articulation of the calca- 
neum with the astragalus, then the calcaneo-cuboid joint must be laid 
open, and the bone will be found pretty movable, but it must not be torn 
away, neither must other parts be used as a fulcrum to pry it out; the 
connections must be cut. The greatest difficulty is in separating its deep 
connections, which cannot be seen, and scarcely felt, the bone being in the 
way. You must take care to keep the knife close to the bone, so as to 
avoid wounding the posterior tibial artery and nerve. 
Part xxxiv., p. 128. 
Amputation at the Ankle Joint—Per eg off's Operation.—The essential 
point in this operation for removal of the foot is to leave the posterior 
part of the os calcis so as to fill up the heel flap; by this means the limb 
is lengthened by an inch and a half or two inches more than by other 
operations, and the posterior flap has not the bag shape of Syme’s, and so 
does not form a receptacle for a collection of pus. The os calcis is sawn 
through immediately behind the disarticulated astragalus, the remnant of 
the os calcis uniting by its divided surface with the inferior extremities of 
the tibia and fibula. The tendo-Achillis is not divided. 
Part xxxvii., p. 116. 
Excision of the Os Calcis by a New Method.—In the removal of this 
bone, the incisions, one transverse and one longitudinal, are usually made 
across the sole of the foot, but here there is a great disadvantage, namely, 
that cicatrices are left along the line of most pressure. A better plan is 
to carry a horse-shoe incision from a little in front of the calcaneo-cuboid 
articulation round and behind the heel to a corresponding point on the 
opposite side of the foot; dissect up the semi-circular flap thus formed by 
carrying the bistoury close to the os calcis, the under-surface of which is 
exposed. Then make a perpendicular incision about two inches in length, 
over the middle of the tendo-Achillis, falling into the horizontal one. 
Detach the tendon and dissect the flaps up close to the bone, carry the 
blade over the upper and posterior part of the os calcis, open the articula- 
tion with the astragalus, divide the ligaments, and turn the bone out. 
Thus there is no cicatrix over the parts most exposed to pressure. 
Part 119. 
Resection of the Ankle Joint.—Syme’s and Peregoff’s operations or 
modifications of them, are frequently performed in diseases of the ankle- 
joint, when, by resection of the joint the otherwise healthy foot might 
be saved. These former operations should never be performed unless 
there is so large an amount of disease as to preclude all hope of preserv- 
ing a good and useful foot. Mr. Hancock, at the Charing Cross Hospital, 
has now performed this operation four times, three times successfully, and 70 
JOINTS, 
once unsuccessfully, owing to pulmonary affection. The sucoess of the 
operation depends upon leaving the anterior and posterior tibial arteries 
intact, and not opening the sheaths of the tendons ; the only parts cut 
through are, the external and internal lateral ligaments, and the bones. 
Neither the extensor nor flexor tendons, the anterior nor posterior tibial 
arteries are injured, consequently, there are no vessels to tie; when suc- 
cessful, the patients are able to walk and run about with scarcely any 
perceptible limp. Part xl., p. 81. 
ELBOW JOINT. 
Excision of.—M. Robert presented a woman, aged 26 years, on whom 
he had practised the operation of excision of the elbow joint. The disease 
rendering the operation necessary was caries of the humero-cubital articu- 
lation, following a fall on the elbow. There were several fistulous open- 
ings about the olecranon. In the fold of the arm were two deep sinuses 
penetrating into the joint. The soft, parts around were moderately 
engorged. The operation was effected by dividing and reflecting the 
integuments over the olecranon. The humerus was sawn through imme- 
diately above the condyles, the ulna below the coronary process, and the 
radius just below its articular extremity. The limb was placed in the 
apparatus of M. Guizot. But little reaction ensued, and the fever and 
sleeplessness which had previously harassed the patient ceased immedi- 
ately. The patient recovered sufficient use of her arm to resume her 
occupation as sempstress. Part vi., p. 148. 
Operation for the Removal of Loose Cartilages in the Elbow Joint.— 
[Mr. Solly’s patient was left, after a severe attack of rheumatism, with 
pafn and swelling of the elbow joint. This was treated by rest, counter- 
irritation, iodine, and mercurials; and on the subsidence of the general 
swelling, there was found a small circumscribed swellingj which appeared 
to be a sac containing several hard and movable bodies, situated above 
and behind the inner condyle. It was determined to remove these bodies 
by operation. Mr. Solly says :] 
I made an incision about one inch in length over the swelling above the 
inner condyle, dividing the skin, fascia, and synovial membrane, till I ex- 
posed the loose cartilages, for such they proved to be. They were easily 
pressed out of the opening. I introduced my little finger into the sac, and 
felt the articulating surfaces or the humerus and radius, and I thought I 
felt an irregular surface on the ridge between the radius and ulna, like an 
attached portion of a false cartilage, but there were no more loose bodies in 
the joint. Those removed were eight in number. I brought the edges of 
the wound into close apposition, put one suture in through the skin, and 
the isinglass plaster over it. I placed a pasteboard splint on the back of 
the joint, fixing it to the upper and fore-ann, so as to prevent the slightest 
motion in the joint. The wound was quite healed in forty-eight hours, but 
I kept the joint at rest for a week: after this he was able to move it with- 
out the slightest pain—he did not suffer in any way after the operation, 
except for the confinement occasioned by the splint. I have seen him 
repeatedly since he left the hospital, and he has remained quite well and 
resumed his occupation on the river. Part xix., p. 130. 
Disease of the Elbow Joint.—Amputation of the whole limb, excision 
of the articulating surfaces, and the bringing about of anchylosis are the JOINTS. 
71 
three inodes which have been hitherto resorted to, not to cure diseased 
joints, but to prevent the constitution from sinking under the drain of a 
disease but too often found incurable, and to render the portion saved in 
some degree useful to the individual. 
It is almost needless to say, that in a vast many instances all ordinary 
means of curing these diseases fail. Rest, splints, bandages, tonics, change 
of air and diet, mercurials, iodine, all fail to stay the progress of the disease, 
until it no longer becomes a question as to whether we shall have recourse 
to the knife or not, but how soon, and in what way it is most advisable. 
Mr. Gay has for some time past been in the habit of treating cases of 
diseased joints by a plan which has so far been found to be at one and the 
same time simple, rapid, and effectual. It is nothing more or less than to 
make one or more incisions right down to the diseased joint, with a view 
of letting out the debris of the diseased articulation, the remnants of the 
cartilages, etc., which seem to him one of the principal obstacles to the 
procuring of anchylosis; a healthy inflammation is by these means set up 
in the cavity, which speedily results in firm and complete anchylosis. The 
constant success which has attended this plan seems calculated to bring 
about a complete revolution in the treatment of these complaints. 
J. T., a laborer, entered the Royal Free Hospital, under Mr. Gay, with 
disease of the elbow joint. Of its origin and cause he knew nothing, and 
only remembers that it began about seven years ago, and since then it has 
run its course unchecked by any means. On admission, the state of the 
limb was as follows : The arm was straightened and the elbow joint almost 
immovable, even the slightest attempt to procure motion being followed by 
excessive pain. The joint itself was very much enlarged, but the remain- 
ing part of the limb was wasted to a considerable extent. There were six 
sinuses leading to the joint, two on either side, one in front, and another 
on the inner side of the olecranon. Around their orifices the skin was 
livid and unhealthy-looking, and they all conducted direct to the joint, so 
that the probe passed immediately into it. A quantity of thin, ichorous 
fluid was consequently poured out from them. The man’s health was 
much impaired. 
Although the state of the joint seemed to hold out scarcely the remotest 
hope of success, Mr. Gay made an incision on either side, carrying it along 
the course of the lateral sinuses, and fairly down to the joint. These inci- 
sions were each four inches long, and left behind great gaping wounds, 
laying open to view the interior of the joint. The ends of the bones were 
found completely bereft of cartilage, and so soft that portions were as readily 
torn away by means of a steel director as if they had been so much cork. 
But little bleeding followed the operation, which was concluded by filling 
up the cavities with lint, and confining the joint with a bandage. The first 
thing that ensued was a most profuse discharge, which continued unabated 
until about nine days after, when it gradually began to lessen, owing to 
the evident healing of the wounds, which now appeared strongly disposed 
to close. The patient was seized with simple fever, but eventually reco- 
vered, with complete anchylosis. Part xxiv., p. 171. 
Excision of the Elbow Joint.—Always remember that in caries of the 
joint, little more than the articular surface is engaged in the disease. It is 
the ignorance or neglect of this point which has made many cases unsuc- 
cessful. The incisions originally practised by Moreau are the best, viz., a 72 
JOINTS. 
transverse one across the back of the articulation, immediately above the 
olecranon, from the ulnar nerve to the external condyle, and two longitu- 
dinal through the extremities of the transverse, so that the incision alto- 
gether has the form of the letter II. When the flaps have been raised, free 
access is gained to the articulation ; and when the operation is completed 
the edges of the transverse incision, if brought accurately together, gene- 
rally adhere by first intention. Having dissected up the flaps, do not at- 
tempt to remove all the articulation at once, as otherwise there will be a 
risk of cutting the ulnar nerve ; but having exposed the olecranon, cut it 
off in the first instance, so as to get free access to the joint; then divide the 
external lateral ligament, and having pushed the ulnar nerve over the inner 
condyle, free the end of the humerus and saw it off on a line with the tuber- 
osities ; and lastly, remove, in succession the ends of the radius and ulna 
on a line with the base of the coronoid process. More than the extent thus 
defined would be unnecessary and injurious, while less would hardly re- 
move the disease, and even if it did, would incur the risk of anchylosis. 
Part xxxi., p. 106. 
Excision of the Elbow Joint.—When this joint has been anchylosed in 
a wrong position, so as to be useless, a certain degree of motion may be 
secured by the following operation : cut out a large portion of the end of 
the ulna, radius, and humerus, making, in fact, a resection of the anchylosed 
joint. Part xxxi., p. 108. 
Wounds of.—To excise the elbow'joint, because a compound fracture of 
the olecranon had been sustained, would, of course not be warrantable, as 
it may heal and unite without the occurrence of inflammation ; but if arti- 
cular inflammation do take place, the question does admit of serious con- 
sideration whether it would not be best to excise the ends of the bones 
with the hopes of saving the patient’s constitution, and of gaining a mobile 
joint. Part xxxiv., p. 122. 
Elbow Joint—Severe Inf tries of.—Primary amputation ought never to 
be thought of in compound fracture of the elbow, excepting the artery be 
torn through, or the soft parts both before and behind hopelessly damaged. 
The ill consequences to be feared are in inverse proportion to the amount 
of external laceration inflicted. In cases sufficiently severe to warrant it, 
it is far better surgery to freely enlarge the wound behind the joint, and 
excise the projecting ends of the bones, than to be content with a simple 
reduction. 
Much less of suppuration and of constitutional disturbance appears to 
follow cases so treated, and the chance of good motion being obtained after 
an excision is infinitely greater than it is when the ends of the injured bones 
remain. It may be worth a question whether, even in certain cases not 
usually deemed sufficiently severe to warrant it, for the reasons above men- 
tioned, it might not be well to enlarge the wround and excise the joint. 
Crushed elbows with but small external wound, undoubtedly, as a rule, do 
badly. The excision of joints during the acute or commencing stages of 
inflammation, would seem hitherto to have been regarded with suspicion, 
though probably with no very definite reason. In cases of slight injuries, 
in which at the time it had been thought best to do nothing, but which 
have subsequently gone wrong, it might, perhaps, be good practice to do 
secondary excision, say within the first week or two. The immediate re- 
lief aflorded by free incisions under such circumstances is well known, and JOINTS, 
73 
it would probably be increased by the removal of the bones and their ul- 
cerating cartilages. 
In treating these cases poultices and warm fomentations should be utterly 
eschewed. 
When it has been decided to preserve the arm, it is the surgeon’s duty 
(excepting, perhaps, in a case of sloughing), to persevere, in spite of dis- 
couraging circumstances, afterward. Part xxxiv.,p. I'z7. 
Elbow-Joint—Resection of.—The last improvement in this operation is 
that of Langenbeck, who makes only one long incision on the inner edge 
of the ulna. The ends of the bones may be readily turned into the wound 
and sawn away with a key-hole saw, cutting from before backward. In 
certain cases, where there is great swelling and the ligaments are sound, 
this plan will be more difficult, and a cross incision will be necessary. 
Part xxxv., p. 69. 
Excision of the Elbow Joint.—There are two objects to be attained by 
this operation, viz.: First, to remove all the diseased bone, and second, to 
do this in such a way that a useful and movable joint may result. It is 
always far better to remove the whole of the articular surfaces of the joint 
than to remove the diseased portion only, for the disease often extends 
afterward to the other bones; and there is often more suffering and fever 
than when the whole is removed. Part xxxvi., p. 3 48. 
Excision of the Elbow—Heath'1 s Splint.—The great object in this ope- 
ration is to obtain a movable joint; to this end always remove not a mere 
slice from the edge of the bones, but a full inch or so ; there is then less ten- 
dency to anchylosis. Employ a splint invented by Mr. Heath, late house- 
surgeon to King’s College Hospital, consisting of four iron plates, well 
padded, concave on their front surface, to fit the limb, convex behind; 
these are intended to be placed opposite to one another, one pair above and 
the other below the joint, projecting portions perforated with a female 
screw spring from the convex back of each plate. Two iron rods with 
hinges in their centres, and a small screAV at either end, cut in opposite di- 
rections, to fit in the female screws of the iron plates, connect the plates 
above the joint with those below. The plates are now attached firmly by 
means of straps and buckles, and, if necessary, additional strips of plaster. 
By turning round the rods the extremities of the bones are separated to 
the required distance, while by means of the hinges in the centres of the 
rods motion can be made with the greatest facility. Part xxxvii.,j». 108. 
HIP JOINT. 
Treatment of Disease of.—Dr. Evans believes that mercury may be 
regarded as a specific remedy in hip disease. 
That we may apply it with equal certainty and benefit in scrofulous and 
non-scrofulous subjects. 
That it is better to bring the system at once and fully under its action 
than to give a Long and lingering alterative course of mercury. 
That in the majority of cases, mercury alone, when pushed to salivation, 
will effect a cure. That the application of leeches are occasionally, though 
not always required, and when any little pain remains at the groin, a small 
blister will then be of benefit. 74 
JOINTS, 
That rest, the horizontal posture, and attention to regimen, etc., must 
be strictly enjoined. 
That hip-joint disease, if not in all, certainly in nearly all cases, is caused 
not by primary ulceration of the cartilages, but by scrofulous inflamma- 
tion of the synovial membrane—this morbid state being the first link in the 
chain of pathological actions. 
Lastly. That the diseased limb is really elongated during the second 
stage of coxalgia, and that this appears to be in a great measure effected 
not by curvature of the spine, etc., but by the pushing out of the head of 
the femur; this is caused by the inflammation within the joint, aided by 
the organic relaxation of the surroundiug muscles. Part vi., p. 152. 
Ilip-joint Disease.—[Affections of the hip joint are too seldom seen at 
the commencement, when properly applied remedies might restore the 
joint. In the second stage, we have no longer a simple case of erythema 
of the synovial membrane, but an active form of inflammation extending 
to the more dense parts of the capsule and cartilage, attended with severe 
pain in rotation and abduction of the limb.] 
Often in the earliest part of the second stage, the limb will not admit 
of perfect extension, and by careful examination of the joint it may be 
discovered that the thigh is permanently flexed on the pelvis. It is this 
state of the limb to which Mr. Key directs attention, as fraught with the 
worst consequences to the patient. This state of flexion of the femur on 
the pelvis usually takes place slowly and imperceptibly, but sometimes it 
is rapidly induced by a sudden attack of inflammation in a joint that has 
previously exhibited signs of disease in its mildest form. This is the 
worst form of the disease, so far as the deformity of the joint is con- 
cerned ; for the intense pain which the patient experiences on the slight- 
est movement of the limb induces her to seek for ease in positions that 
add greatly to the distortion of the limb by the obliquity given to the 
pelvis. The patient is seen lying usually on her sound side, with the 
affected limb drawn up to nearly a right angle with the pelvis. As the 
patient lies on her side the affected limb appears to be three or four inches 
shorter than the other. When she is placed on her back, which position 
she assumes with difficulty, and the bearings of the two patellae, and the 
spinous processes of the ilia noticed, the former are seen to differ as much 
as from two to three inches, while only a difference of an inch is percepti- 
ble in the level of the iliac spinous processes. This would seem to show 
that the limb was actually shortened ; such, however, is not the case, and 
by examination of the pelvis it will be seen that the twist of the pelvis on 
the lumbar vertebrae, by carrying the affected joint backward, is the 
cause of the great shortening of the limb. 
During the stage of inflammation it is impossible to use any means of 
counteracting this distorted position of the pelvis, and by the time that 
the patient is able to bear extension so as to restore the pelvis to its na- 
tural bearing, and to diminish the angle which the femur makes with the 
pelvis, the parts have become so fixed in their new position as to render 
it difficult to alter their position, and impossible in the majority of cases 
to restore them to their natural bearings. The consequence is, that when 
the patient is convalescent with a somewhat stiffened joint, the foot can- 
not be brought down to the ground, and a shoe with a sole of two inches 
is required to enable her to walk with the foot flat on the ground. How JOINTS, 
75 
is this state of things to be prevented ? The only remedy for the evil is 
in every ease of disease of the hip joint to maintain the straight position, 
as soon as the nature of the affection is ascertained. It is a position appli- 
cable in all stages of the disease. 
In the early stage characterized only by a slight limping in the gait, or 
by an occasional s.ight pain in the knee or thigh, it possesses the advan- 
tage of maintaining the joint in a state of complete repose. The articula- 
tion being at rest, the muscles do not act, but remain in a passive state. 
On the contrary, when the limb is kept bent with a pillow placed under 
the knee, a position usually resorted to in the early stage, the pelvis and 
thigh in a child are continually in motion; little or no pain is felt by the 
little patient, and injunctions to preserve rest are made in vain. In the 
bent position, therefore, rest, one of the most important elements in treat- 
ing a diseased joint, is not maintained, and the disease, therefore, fails 
often to be arrested. By a long splint applied along the outer side of the 
limb, and made to extend from the toe to the axilla, entire rest is given 
to the joint, and absolute inaction of the muscles preserved. 
The arrest of the disease is greatly expedited by the entire tranquillity 
obtained by the straight position in conjunction with the mercurial treat- 
ment. The principal advantage of preserving the limb in a straight posi- 
tion is seen in the second stage of the disease, when under the united 
effects of inflammation and ulceration of the cartilage of the joint, the ten- 
dency of the flexor muscles to contract, induces such a degree of deform- 
ity in the lumbar vertebrae, pelvis, and hip-joint, as when once allowed to 
take place, can never afterward be wholly remedied. 
The course which abscess takes when suppuration takes place in the 
joint seems to be in some degree modified by the straight position. 
When the limb is allowed to bend upon the pelvis, matter is usually 
formed at the back part of the joint under the glutsei muscles, or at the 
side of the joint on the anterior margin of the glutaeus medius. But when 
the straight position is observed, the suppurative action is inclined to the 
fore part of the joint, and the collection of fluid is formed on the outer 
edge of the iliacus muscle, by the side of the tensor vaginae femoris. This 
course of the matter may be accidental; but in two cases now in the hos- 
pital, suppuration has taken this course, one having burst and discharged 
itself; and in the other case the abscess is making its way toward the 
surface in the same direction. 
But there is an advantage gained in the advanced stage of the disease 
too important to be passed over; namely, the prevention of dislocation of 
the head of the bone on the dorsum ilii—an occurrence, though by no 
means frequent, yet found sometimes to take place, and greatly adding to 
the deformity and shortening of the limb. It can only occur in the 
flexed position of the limb, which thrusts the head of the bone backward 
against the capsular ligament and posterior part of the acetabulum ; and 
these structures, together with the head of the bone, being partly de- 
stroyed by the ulcerative process, the femur gradually escapes from the 
cotyloid cavity, and becomes lodged upon the dorsum of the ilium. 
The state of anchylosis in which this disease usually leaves the joint 
requires a concluding observation in reply to any objection that might be 
raised to the utility of a limb anchylosed in a straight line with the body. 
The only inconvenience arising from it occurs in the sitting position, in 
which the patient being unable to flex the limb sufficiently to sit on a chair 76 
JOINTS. 
in the usual manner, is compelled to drop the affected limb in a nearly 
perpendicular posture, and to sit with the pelvis resting on the side of the 
chair. This is the only evil attending the straight position, and is more 
than counterbalanced by the uniform length of the two limbs, and the 
absence of almost all lameness in the act of progression. Care, however, 
should be taken to prevent the patient bearing too early upon the unsound 
.imb during convalescence, when the straight position has been observed 
in the treatment of the case; for a sense of weakness, as in the first stage 
of the disease, induces him to raise the pelvis on that side in order to pre- 
vent much weight being thrown upon the weak limb. The effect of this 
elevation of the ilium is to curve the lumbar vertebrae in a lateral direc- 
tion; and this distortion becomes permanent. Part xii., p. 241. 
Formation of an Artificial Joint.—This method, for which we are 
indebted to the ingenuity of Dr. John Rhea Barton, has been applied 
as yet but to the anchylosis of a single articulation—that of the hip joint. 
It has, however, been suggested by this surgeon, that it might likewise be 
found applicable to similar affections of the lower jaw, knee, elbow, fin- 
gers, and toes, when the muscles of these respective articulations remain 
uninjured. The method consists in the uncovering of the bone at or near 
the diseased point, dividing it across with the saw, and subsequently mov- 
ing the lower portion from time to time upon the upper, to prevent a solid 
reunion of the divided parts. By this mode of proceeding, there is the 
same disposition on the parts for the formation of a false joint, as we often 
find producing that result in fractures where the bones are not kept suffi- 
ciently at rest. Under such circumstances, the two opposing surfaces of 
bone may be expected to unite by flexible ligamentous matter, or become 
smooth and polished by the friction ; the lower fragment, in the latter 
case, rounding itself into the form of a head; and the other hollowing 
itself more or less into the shape of a cup, in which the former plays ; the 
periosteum and surrounding cellular tissue becoming condensed and 
thickened, so as to perform the office of a fibrous capsule, and the 
muscles modified' to a certain extent, to accommodate themselves to the 
new articulation. Part xii., p. 243. 
Inflammation of tlic Ilip Joint.—[The test proposed by Dr. O’Ferrall, 
as a means of diagnosing between hip-joint disease and other affections 
resembling it, we made use of, and it was found that when adduction and 
abduction of the affected limb was made, the entire pelvis moved, forming 
an angular lever, whose fulcrum was the acetabulum of the opposite side. 
On disease in this locality, Dr. O’Ferrall remarks:] 
When a hip joint case is brought under our notice, it is of great practi- 
cal importance to determine its probable duration, before the period at 
which we are consulted; for the success of the mercurial treatment will 
depend much on this question. In T.’s case, the nates of the affected side 
drooped, as in cases of some standing; but when he was laid on his face 
and the muscles of both nates were equally at rest, there was no remark- 
able loss of bulk in the muscles themselves. The measurement of fho 
thigh of the affected side, showed also a circumference equal to that of 
the sound one. There could be no doubt, then, that the case was compa- 
ratively recent, for the characteristic wasting which belongs to disuse, had 
not yet been established. It might be thought that the history of the case 
would be sufficient to determine this point. N othing could be more fallacious. JOINTS. 
77 
[In another case, a young gentleman, whilst hunting, in crossing a 
hedge, his left foot was caught in a bramble, and forcibly everted; he ex- 
perienced great pain in the hip, groin, and knee, and there was percepti- 
ble shortening of the limb of one inch.] 
The diagnosis arrived at was—recent- sprain of the hip joint, previously 
in the state of morbus coxae. This diagnosis, most startling and unpalata- 
ble to himself and friends, was grounded, 1st, on the constitution of an 
angular level by the pelvis and thigh bone, when the latter was moved; 
2ndly, on the obliquity of the pelvis, which was certainly not of sudden 
occurrence; and 3dly, the fact of a remarkable wasting of the muscles of 
the entire limb. 
In the one, the absence of wasting, marked the case as one of recent 
occurrence, and promising a recovery from antiphlogistic treatment. In 
the other the presence of wasting, with obliquity of the pelvis enabled him 
to distinguish an actual case of morbus coxae, when presented to him as an 
instance of recent accident only. The value of the mercurial treatment 
introduced by Dr. O’Beirne, is lessened by employing it in unsuitable 
cases. The diagnosis of stages, in joint diseases, is, therefore, of the 
utmost importance in practice. Part xiii., p. 194. 
Hip Disease.—[After alluding to the severe measures formerly adopted 
in the treatment of hip disease, Mr. Syme says:] 
The great object now held in view is to prevent motion of the joint, and 
this is effected by means of mechanical support, in addition to the horizon- 
tal posture. The splint employed should not be limited to the neighbor- 
hood of the hip, but be made to extend over the whole length of the limb 
and a portion of the trunk ; or, in more precise terms, from the sole of the 
foot to the false ribs, since it is only by preventing motion of the knee, 
and ankle also, that the hip joint can be maintained in a state of perfect 
rest. Together with this local treatment, due attention is of course requi- 
site in regard to the diet and state of the digestive organs. Cod-liver oil, 
which so remarkably corrects the condition of system that predisposes to 
derangement of the scrofulous kind, should, at the same time, be freely 
administered. 
Under this simple and gentle mode of treatment, steadily pursued, a 
large proportion of cases terminate favorably, without any alteration of the 
limb in regard to form, mobility, or strength. On some comparatively 
rare occasions, the pain continues without abatement, or increases in 
severity, and then counter-irritation becomes requisite. For this purpose 
the actual cautery affords by far the most efficient means, and if employed 
during the influence of chloroform, is divested of the only objection that 
can be alleged against its use. The sore established should not exceed 
three inches in length and one in breadth. 
In the event of suppuration taking place, the abscess should not be 
opened until it has nearly approached the surface, when an aperture of 
adequate size, and so situated as to afford a free drain from the discharge- 
bflcomes proper. Water-dressing is preferable to ointments and the long 
splint; or if the limb has been allowed to get into a position which pre- 
vents the employment of this, a piece of leather, fashioned to the shape of 
the hip and thigh, should be still carefully applied, to prevent the irritation 
attending movement of the joint, great attention being at the same time 
paid to the maintenance of the patient’s general health and strength. The 78 
JOINTS, 
result depends chiefly upon the state of the bones composing the joint. If 
they are carious, he must die; if they are not, he may recover. The risk 
of caries being induced, is proportioned inversely to the age of the patient; 
so that the prognosis becomes less and less favorable from childhood to 
maturity. 
Some operations have been lately performed in London, with the view 
of remedying caries of the hip joint, by cutting out the head of the thigh 
bone; but this proceeding must have originated and been conducted in 
forgetfulness of the well-established pathological fact, that when caries at- 
tacks the surface of a joint, it is never limited to one of the bones which 
compose the articulation. If the articulating surface of the head of the 
thigh bone be carious, it follows, as a matter of absolute certainty, that 
the acetabulum must be in a similar condition. But as the acetabulum 
does not admit of removal in the living body, with any prospect of safety 
or advantage, no benefit can be derived from taking away a part of the 
articulation, and, therefore, excision of the head of the thigh bone for 
caries of the joint should be regarded as no less erroneous in theory than 
objectionable in practice. 
In an old volume of “ The Lancet,” it is stated that Mr. Svme cut out 
the head of the-humerus for disease of the shoulder joint, leaving the gle- 
noid cavity to “ shift for itself”—the fact really being that the patient 
labored under necrosis of the upper end of the bone, so that the head was 
expanded into a thin shell containing an exfoliation, which was removed 
with the effect of preventing amputation at the shoulder joint, previously 
deemed requisite, and enabling the subject of the case, then a boy, to 
grow up into a strong healthy man. This statement, like others, having 
no foundation except in the depraved imagination of their authors, was 
treated with the silence that it deserved, and would not be noticed now 
unless there seemed a risk of its being stumbled on by some one in search 
of authorities for bad practice. It is true that Mr. Syme did once cut out 
the head of the humerus for caries, but in-that case the disease, instead of 
affecting the surface of the bone, which was perfectly sound, had hollowed 
out the interior substance into a cavity, so that the circumstance of the 
patient recovering the use of her arm, and enjoying good health for ten 
years after the operation, in no wise invalidates the rule, that caries of an 
articulating surface is never limited to one of the bones which comjmse 
the joint. 
In the London operations the hip joints must have been either carious 
or not; and the proceeding, therefore, either useless or unnecessary. That 
it is possible for patients laboring under disease of the hip joint to recover, 
after excision of the head of the thigh bone, could hardly be doubted by 
any who has remarked the shrunk and distorted limbs which result from 
morbus coxarius, terminating in anchylosis, or examined the preparations 
illustrative of this condition obtained after death. The scars of old sinuses, 
and the histories of persons who have regained good health after suffering 
from hip disease in their youth, frequently afford evidence that the joint 
must have suppurated; that the articular structure must have been seriously 
deranged; that the respective surfaces of the bones must have been more 
or less extensively denuded of their cartilaginous covering; and that there 
must have been great displacement before consolidation was accomplished 
by anchylosis. It is very probable that in some of these persons the head 
of the thigh bone might have been cut out during the suppurative stage, JOINTS, 
79 
without preventing recovery, especially if the most careful attention had 
been subsequently bestowed upon the maintenance of the patient’s strength. 
But in what respect they would have derived benefit from the operation it 
is not so easy to see. Part xix., p. 119. 
Scrofulous Disease of the Hip Joint.—An opening having been made 
freely with an abscess lancet, the limb may be wrapped up in a flannel, 
wrung out of hot water, and this may be continued until the first How of 
matter has ceased, a poultice or water-dressing being applied afterward. 
The opening should be free, so that the abscess should heal from the bot- 
tom ; and also that no pressure need be used to cause it to escape. All 
rough manipulation is to be carefully avoided. The treatment of a sinus 
which is left after the opening of an abscess may be comprised in a few 
words. If the orifice be disposed to heal prematurely, it may be prevented 
by the occasional application of the caustic potash, care being taken that 
the caustic does not enter the sinus itself; otherwise, some simple ointment 
or water-dressing is all that is required. The old practice of probing a 
sinus yields us no accurate information, nor is it useful; and the same re- 
mark applies, but with greater force, to the use of stimulating injections. 
The determination of the question of amputation in instances of this 
species of articular disease, Sir Benjamin Brodie makes to depend upon the 
point, whether or not there be indications of other tubercular disease in 
any of the internal organs. It too frequently happens, that when one dis- 
eased joint is removed by amputation, another becomes the seat of the 
same malady, or tubercular deposits in the lungs, the bronchial glands, or 
in the mesentery, finally destroy the patient. When there is any reason to 
apprehend such results, amputation, of course, is worse than useless. 
Part xxii., p. 189. 
Hip Joint Disease treated by Cod-liver Oil.—Several cases of this dis- 
ease have been successfully treated, at St. Thomas’s Hospital by the use of 
cod-liver oil. It changes the abnormal molecular condition of the blood, 
so well known to exist in these cases, and so often connected with scrofula 
and other constitutional disorders. Part xxii., p. 195. 
Hip Joint—Hysterical Affections of.—[Mr. Coulson wras consulted in 
the case of a young lady, nineteen years of age, highly nervous and ex- 
citable in temperament, with an affection of the hip joint. Leeches had 
been applied, the recumbent position enforced, and counter-irritation in 
every available form employed—but all of no avail. The pain was diffused 
and complained of as insupportable. The joint under examination seemed 
natural, and her general health had not suffered in proportion to the dura- 
tion of the disease; indeed, there seemed as much pain excited if the in- 
teguments alone were examined. No persuasion could prevail upon her 
to make use of the limb. Steel and quinine were prescribed, but with no 
success. At length, by the death of her father, the means of living became 
much reduced, and the different members of the family were obliged to 
exert themselves to meet the calamity.] 
This young lady, upon being made acquainted with the particulars—for 
misfortune it was none to her—one day suddenly rose from her couch and 
walked. She exerted herself much, both mentally and bodily, for the good 
of those around her, seemed to forget her long illness, and has ever since, 
remained well. 
It has been calculated, that at least four-fifths of the females among the 80 
JOINTS. 
higher classes of society supposed to be suffering from diseases of joints, 
are, in truth, affected with hysteria, and with nothing else. 
In hysterical affections of the hip joint, the patient from the first com- 
plains of pain in the part, and not in the knee, as is frequently the case 
when organic changes are commencing in the joint itself. The pain which 
the patient describes as m«st severe is not limited to one spot, but extends 
over the buttock to the lumbar region, and down the thigh. It is this 
general diffusion of pain which constitutes one of our most useful distinc- 
tions between this affection and disease of the hip joint. From the com- 
mencement, the patient complains of such aggravation of pain by pressure 
and motion, that she confines herself to one position of the limb ; and yet 
upon occasions, when the mind is otherwise occupied, or during sleep, she 
will move it without complaint. The sensibility of the limb to the touch 
is frequently so great that the slightest pressure on any part of the hip or 
thigh will cause the patient to scream; she shrinks involuntarily from the 
mere approach of the hand; but, nevertheless, upon a careful examination, 
these morbid conditions will be found to exist more in the skin than in the 
deep-seated parts. As Sir Benjamin Brodie, who first directed attention tc 
these important affections, observes: “ If you pinch the skin, lifting it a 
the same time off the subjacent parts, the patient complains more than 
when you forcibly squeeze the head of the thigh bone into the socket of the 
acetabulum.” The more the patient’s attention is directed to the part, the 
more the pain is increased; but if her attention be directed otherwise, she 
will hardly complain, and the pain does not interfere with her rest. In 
disease involving the structures of the joint, there is nothing of which the 
patient complains so much as the inability to sleep at night—a sudden 
start, or pain, or cramp, banishes sleep, and the patient dreads again to 
close her eyes. In hysterical affections, on the contrary, the sleep is calm 
and refreshing ; and this, perhaps, is a great reason why the general health 
so slightly suffers, even in long-protracted cases. 
Treatment.—The vegetable tonics seem to be more efficacious than the 
metallic. But when the appetite is tolerably good, the tongue clean, the 
bowels regular, then the metallic tonics may be employed with good effect. 
In most neuralgic affections the preparations of iron are valuable, none 
more so than the carbonate. To relieve pain, no remedy is preferable to 
valerian. Dr. Copland says the remedy he has found most useful is the 
spirit of turpentine, prescribed in various modes, internally and externally, 
and administered in enemata; the preparations of iodine alone, or with 
narcotics and camphor. By being compelled to move the limb and enter 
into society, patients have been known to recover, after the complaint had 
resisted every other kind of treatment. Part xxiv.,/>. 167. 
Treatment of llip Joint Disease.—The mode of treatment pursued by 
Professor Carnoclian in morbus coxarius has been very successful. He 
relies principally on constitutional treatment, abandons the use and motion 
of the affected side, and allows the abscess to open spontaneously. The 
number of cases now in progress of convalescence, the general improve- 
ment in the physical appearance oT the patients, and the absence of the 
distressing hectic, indicate the soundness of the principle upon which he 
proceeds The number of victims of Pott’s disease, of all ages, 
is by no means the least interesting feature of practice to be seen here. 
With these also the principal attention is given to constitutional treatment, JOINTS. 
81 
rest and counter-irritation of a mild character being the adjuvant means 
employed. Part xxix., p. 168. 
Sinuses of the Hip depending upon Exfoliations from the Pelvis.— 
Mr. Syme remarks as follows : 
It is necessary that you should recollect the distinction between necrosis 
and caries. In the former disease a portion of bone dies, and separates 
from the living substance, so that no obstacle to recovery exists after the 
exfoliation or detached piece escapes from the position where it is situated; 
but in the latter the bone retains its vitality, and obstinately remains in a 
diseased condition, without any natural limit of duration, except the life of 
the patient or conversion of the caries into necrosis. It must further be 
recollected that the dense osseous substance which composes the shafts of 
bones is chiefly liable to necrosis, and that the spongy or cancellated tex- 
ture is almost exclusively the seat of caries. Now, sinuses about the pelvis 
are unhappily met with very frequently as the attendants or consequences 
of disease in the hip joint, vertebrae, or sacrum, where the disease, being 
of an incurable kind, and the part concerned not admitting of removal, any 
sort of treatment can produce no better effect than a very imperfect 
degree of palliation, and it has hence been usual to regard such cases as of 
a very hopeless character. But nearly thirty years ago there happened to 
fall under my notice a case which showed that such a judgment should 
not be passed as a matter of course, or without more caution and discrimi- 
nation than had been supposed requisite. The patient was a young man, 
aged 28, who for the preceding seven years had suffered from sinuses 
about the hip and upper part of the thigh, which being regarded as pro- 
ceeding from fistula in ano, had been treated by the late Mr. George Bell 
and other surgeons, without obtaining the relief desired. lie had then 
applied to quacks with no better success, and finally abandoning all hope 
of recovery, had allowed the disease to pursue its course. It was a con- 
siderable time after this resolution that my assistance was asked. I found 
him extremely emaciated, and so weak that he could hardly leave his bed, 
Avith a large abscess of the thigh, and seA'eral sinuses about the hip, dis- 
charging matter profusely. Having opened the abscess, I examined the 
sinuses, and found that one, which opened in the fold between the but- 
tock and thigh, led to the tuberosity of the ischium, in A\Thich there 
Avas a cavity containing an exfoliation of bone. I therefore dilated this 
sinus by incision, introduced my finger, and having found an opening 
between the origins of the extensor muscles, -enlarged it by the bistoury, 
so as to obtain access to the interior, whence I removed a small bit of 
dead bone. The patient then quickly recovered, and eArer aftenvard 
enjoyed good health. 
I am inclined to think that violent muscular contraction may have 
been the exciting cause of inflammation and death of the bone. The sub- 
ject is curious, and Avorthy of investigation, but of little importance when 
compared Avith the practical benefit Avliich may result from a knoAvledge 
of the fact that sinuses of the pelvis sometimes depend upon loose exfolia- 
tions, Avhich will not find their Avay out unassisted, but which may be 
readily removed artificially, Avith the effect of a speedy and permanent 
recovery. Part xxxi.,ju. 117 
Hysterical Affection of the Hip Joint.—The pain is more severe than 
in chronic inflammation. Pressure produces greater pain when slight than 
VOL. II.—b 82 
JOINTS. 
when firm, and is more general than when there is inflammation. It is 
most relieved by a belladonna plaster round the joint, and general tonics, 
such as quinine, iron combined with hyoscyainus, or valerian and camphor. 
Part xxxii., p. 121. 
IHp Joint—Excision of.—Great advantage will be obtained by the use 
of Mr. Butcher’s saw: the blade is pressed behind the bone, and then being 
turned in a horizontal direction by a screw, the head and trochanters are 
readily removed. Part xxxv., p. 70. 
Excision of the Ilip Joint.—After the performance of this operation, a 
swing should be used, sufficiently strong to suspend the entire body. The 
wound should be left uncovered, except by the dressings, in order to 
secure a depending escape for the discharge. By this means there is no 
necessity to disturb the patient to allow of the evacuation of the bowels, 
and the accumulation of the discharge from the wound is prevented. 
Part xxxvi.,p. 137. 
KNEE JOINT. 
White Swelling of the Joints.—[Lisfranc distinguishes white swellings 
into those in which a sub-inflammation exists, and those in which no trace 
of this is present. He thinks that:] 
It is not always an easy matter to distinguish the engorgement of the 
soft parts from an enlarged condition of the bone itself, but that in time 
the induration often becomes movable upon the bony parts, these last 
remaining nearly or quite healthy; in this case the disease spreads from 
without inward. 
In cases of white swelling, it is very important to be assured of the con- 
dition of the thoracic and abdominal viscera; for, where diseases of any 
of these exist, they have sometimes been found to make progress in pro- 
portion as the affection of the joint becomes amended—even requiring that 
irritation should be reproduced in the latter. When the visceral affection 
is incurable, but stationary, Ave do not treat the white-SAvelling actively, 
unless it becomes dangerous. 
Unfortunately the thoracic and abdominal affections are often latent, and 
resist our means of investigation—so that death may speedily follow the 
cure of the disease of the joint, in consequence of some unsuspected organic 
affection. 
Abscesses, formed around the white-swelling, should be opened as 
promptly as possible, Avhile, when formed within the substance of the 
engorgement, exit must be given to the pus as late as possible—providing 
the inflammation be not acute, and there be no danger of the pus pene- 
trating the joint. It is very easy to be deceived as to the existence of 
pus—while the sojourn of this fluid in contact with the indurations proves 
to be one of their most powerful solvents. The most experienced surgeons 
often have great difficulty in deciding whether a collection of fluid or pus 
be situated within, or external to the joint. The alternative of amputation 
decides the surgeon in determining to open the collection, and, if symp- 
toms follow Avhich denote that the cavity of the joint is exposed also, he 
proceeds at once to amputate. 
M. Lisfranc considers that, in general, much too little importance is 
attached to regimen, in chronic surgical disease. The ordinary, and 
sometimes an excessive diet is permitted, and tiie great aid in dissipating JOINTS. 
83 
engorgements, derived from allowing patients, in some degree, to what he 
calls “ live upon their own substance” (i. e. a starvation regimen), is lost 
sight of. He has repeatedly known these tumors, which have resisted 
every other means, to become dispersed after diminishing the diet one- 
third or a half. Exceptions will occur to this, when the patient is 
excessively feeble or scrofulous, and when the digestive organs sutfer from 
the change. 
If the patient be strong, and any acute inflammation exist about the 
joint, one or more bleedings from the arm, and afterward leeches, will be 
required. But the periods of employing these must not succeed each 
other too rapidly—for chronic diseases, by their duration, frequently induce 
great debility. 
Local emollient and anodyne baths, continued for two hours at a time, 
are useful. Although, by appropriate means, the inflammatory element 
may disappear in a month, it may persist in other cases for three, six, or 
nine months, and, to such cases, which may also have resisted mercury and 
barytes, we must oppose time, and the continued application of small relays 
of leeches. Eventually the moxa maybe employed. It is rare, indeed, 
to And one of these swellings dissipated by antiphlogistics alone. A 
slight diminution of volume only results from the subsidence of inflam- 
matory action. After the employment of antiphlogistics, an interval must- 
be allowed prior to commencing the use of stimulants—but the presence 
of occasional pain, or pain which has resisted depletion, must not deter us. 
Leeches may be applied for other than the ordinary reasons. From three 
to six, or eight, placed around the base of the tumefaction, will cause a 
degree of heat and excitement in the swelling, when torpid, and favor 
absorption. 
[The leeches may be repeated in this way several times, taking care 
that the bites do not bleed for more than a quarter of an hour, for fear 
of the debilitating effects. Cupping may be substituted, and acts as 
an antiphlogistic or stimulant, according to the quantity of blood drawn.] 
Compression is useful by preventing the too free access of blood to the 
tumor, and causing a slight degree of excitement at its surface. It is most 
advantageously applied so that it may extend an inch beyond the circum- 
ference of the tumor. If employed in improper cases, it may occasion 
inflammation or gangrene, and, in all, requires regulation in its various 
degrees, according to the stages and peculiarities of each. Thus the mere 
application of diachylon, the use of bandages and agaric, and the appli- 
cation of leaden plates to the part, excite different degrees of compres- 
sion. The compression may be readjusted every twenty-four hours, and 
its employment does not exclude the use of iodine ointments, and the va- 
rious internal remedies. Even after the tumor has disappeared, especially 
when of a scirrhus consistence, compression must be continued for several* 
weeks longer. 
It is to be rejected—1. When considerable inflammation exists. 
2. When the tumor, though small, is very hard, unequal, knotted, ad- 
herent to the skin, and especially if this latter be red or discolored. 
When, however, the scirrhous mass has been removed, we may employ 
pressure. 3. When the tumor is in some parts indurated, and in others 
pultaceous. 
The author believes Dr. O’Beirne’s conclusions concerning the utility of 
salivation in these cases, are too general, and too premature. 84 
JOINTS, 
Mercurial inunction, carried to salivation, is equally useful as tlie calo- 
mel. When no inflammation of the part exists, the mercurial ointment, 
applied by topical friction, is an excellent solvent, but, when inflammation 
does exist, it must be applied in thick layers, to remain in contact with the 
part, as recommended by M. Serres, when it acts as an antiphlogistic, and 
not, as in the case of friction, as a stimulant to absorption. 
Lisfranc recommends applying the ioduret of lead, if properly watched 
that no injurious excitement be produced; and he finds that in scrofulous 
subjects, the internal use of iodine, and especially the iodide of potassium, 
is very useful. The iodide of lead is certainly a valuable agent in many 
cases, and especially when the cervical or axillary, and perhaps also 
when the mesenteric glands are enlarged; but it ought to be given in- 
ternally as well as applied externally. The usual dose internally is from 
four to ten grains. 
Blistering must not be employed when even sub-inflammation is present, 
being, as it is, essentially stimulant. 
When the blister occasions an injurious degree of inflammation, we must 
meet this with leeches, etc. We must judge of the ultimate effects they 
are likely to produce by the degree of irritation that results. 
The application of the moxa follows the same rules as the use of blister- 
ing. When a repetition is likely to be required, th* moxa must be of only 
a small size, somewhat less than a shilling. 
The seton is the most exciting of all exutories, and must not be em- 
ployed until the inflammatory action has subsided. It should not be 
passed through the substance of the engorgement, but on one side of it. 
It is only to be employed when all other excitants have failed. 
There are cases of white swelling, which, after proceeding well on to- 
ward a cure, remain, at length, quite stationary, treat them how we will. 
In these we must abandon all active measures, contenting ourselves with 
hygienic precautions, and sometimes in a few Aveeks we may find the swell- 
ing much dissipated, and, even if still persistent, the various therapeutical 
agents will usually be resumed with much greater advantage after such an 
interval. 
M. Lisfranc states that, under his hands, the muriate of barytes, given 
in large doses, has been found very successful, the patient being also 
during its use confined to a vegetable diet and water drink, upon which, 
however, he often gains both flesh and strength. He begins with six 
grains, and reaches, in some cases, as high as forty-eight grains per diem, 
while, at Marseilles, and in Italy, two drachms have been given in the 
same period. 
When the white swelling dates from a rheumatic -origin, it has been re- 
commended to place an irritant, such as a blister, upon the joint itself. 
This practice is attended with the danger of fixing the locality of the in- 
flammatory action; and M. Lisfranc prefers, in the case of the knee joint, 
e. g., placing the blister at the upper and outer*part of the thigh ; and in 
following this practice he has met with great success. In some of these 
cases the pain, which is so distressing, has disappeared under salivation as 
if by enchantment. 
After a cure, the joint is not at once enabled to resume its functions. 
The patient has remained at rest during a long space of time, and pain 
attends his first movements. 
Relapses were formerly very frequent, but M. Lisfranc has found them JOINTS. 
85 
to be rare, since he has given his patients a padded knee-cap to wear. 
This limits the movements of the joint, and supports it during their per- 
formance, prevents any stagnation of the fluids, and aids the resorption of 
any effusion that may occur. Atrophy of the joint sometimes follows, 
which may be persistent, or may disappear, as the general health improves. 
Part vii., p. 158. 
Various Diseases of the Knee Joint—Inflammation of Synovial Mem- 
brane.—When the disease has been of long duration, says Sir B. Brodie, a 
change takes place in the condition of the synovial membrane, quite dif- 
ferent from what is ever observed in the serous membranes. It becomes 
thickened, of a soft pulpy consistence; the inner surface is no longer 
smooth and uniform, but processes of soft vascular substance project from 
it, in the manner of fringes, into the cavity of the joint. In the com- 
mencement of this disease the morbid changes are, of course, confined to 
the synovial membrane ; in a more advanced stage these changes extend 
to the other textures. That portion of the membrane which covers the 
cartilages, though it resists the disease in the first instance, becomes 
aifected afterward. The cartilages themselves adhere less closely to the 
bone than under ordinary circumstances, and by and by they begin to 
ulcerate; generally on*the patella in the first instance, on the femur and 
tibia afterward. 
The fluid found in the cavity of the joint, when the synovial membrane 
is inflamed, is serous. In cases of a slight degree of inflammation, it is 
slightly turbid ; in severer cases it is very turbid, with flakes of coagulated 
lymph floating in it. Under certain circumstances the synovial membrane 
will secrete, not mere serum, but actual pus. In like manner, serous 
membranes occasionally secrete pus, though under ordinary circumstances 
they merely secrete serum. The cavity of the knee joint is then converted 
into one large abscess; the abscess being bounded in some parts by in- 
flamed synovial membrane, and in others by the bones of the joint. I say 
by the bones of the joint; for the cartilages whenever they come in con- 
tact with the purulent secretion, become absorbed. Now let us suppose 
that there has been inflammation of the synovial membrane, and that it 
has subsided. In what condition is the joint afterward? Sometimes the 
membrane is left thickened, of a gristly texture, and that may happen 
even where the cartilages and bones have altogether escaped the invasion 
of the disease. In other cases, the cartilages being absorbed, the cavity 
of the joint is completely filled up by the thickened synovial membrane, 
and the coagulated lymph effused from its surface. The parts all adhere 
the one to the other, and anchylosis by soft substance, in the first instance, 
and by bony substance ultimately, is the consequence. However, com- 
plete anchylosis does not occur except the cartilages have been completely 
absorbed. Where the cartilages have been only partially absorbed, a 
healing process is established. A kind of membrane is formed upon the 
surface of the bone in the place of the cartilage, and the joint retains its 
complete mobility. 
With regard to treatment in all cases of inflammation, and, I may add, 
of other diseases of a joint, the first and most important thing is to keep 
the joint in a state of quietude. 
The best contrivance for keeping the joint quiet is splints, made of thick 
and stiff leather, macerated in warm water, and allowed to dry on the 86 
JOINTS. 
part. They should be pretty broad splints, one being applied to each side 
of the joint, nicely adjusted to it, and kept on by a bandage. These splints, 
when dry, become as hard as a board, but they are easy to be worn, be- 
cause they exactly fit. When the cure is nearly completed, the patient 
should wear an elastic bandage, so as to allow of a little motion, within 
Certain limits, and the heel of his shoe should be raised a little, to keep the 
knee slightly bent. 
In cases of acute inflammation, general antiphlogistic measures may be 
,required as well as the local abstraction of blood. 
After giving a brisk purgative, then give twelve minims of vin. colchici 
jn a saline draught three times a day ; in two or three days stop its exhi- 
bition, and after an interval of a day or two give it again ; it is most useful 
when there is a gouty diathesis, with lithates in the urine; an occasional 
purgative is necessary during the administration of the colchicum, and also 
small doses of blue pill to keep up the secretion of bile which colchicum 
diminishes. Give mercury so as to affect the system; this may be done 
not only in the gouty diathesis, but also where there is rheumatic inflam- 
mation, and combine it with opium, as in iritis. 
In chronic inflammation the same measures as in the acute, only not quite 
so active : leeches ; blisters ; apply them in succession, or keep one open 
with savine cerate ; give colchicum as an alterative, two grains of the ex- 
tract* with as much blue pill, every night, and an aperient every third or 
fourth morning : or give the acetous extract, with calomel and comp. ext. 
of coloc. every second or third night. Give, also, iodide of potassium in 
small doses, combined with alkaline remedies. In slight cases, use lini 
rnents to the joints, lin. vol. eamph., and sp. terebinth.; or olei olivse Sjiss.; 
acid, sulph., 3j., and sp. terebinth. §ss.; or paint the knee with a solution of 
iodine. 
I said that mercury was useful in another and more advanced stage of 
the disease, when the altered character of the pain, attended with starting 
of the limb at night, indicates that ulceration is going on in the carti- 
lages. Here the only remedy is mercury, and the effect of it is remark- 
able. Make the gums sore, and the patient who was suffering tortures, 
will, in a few days, be quite relieved. If it be administered at a suffi- 
ciently early period, it will save the limb, but will not prevent anchylosis. 
Mercury should be given here in the same manner as in cases of iritis, or 
chronic inflammation of the testicle. Calomel and opium may be adminis- 
tered two or three times a day till the gums are sore, mere alterative doses 
being insufficient. 
Treatment of Abscess of the Knee Joint.—[In these cases the suppura- 
tion often involves the whole joint, which is one large abscess. The treat- 
ment is comparatively simple.] 
Make an opening as soon as you can, and let out the matter. But what 
kind of opening ? Not a small or valvular one. 
All large abscesses, and those of joints especially, should be opened by 
a very free incision, so that the pus may flow out without squeezing, or 
any kind of rough manipulation. 
There should not be the pressure even of a finger on the abscess, with a 
view to force out its contents. Make a free opening, let the matter flow 
of its own accord, at the same time keeping the joint in a state of absolute 
and complete repose by means of leathern splints, or by supporting it with 
pillows and cusions, and it will scarely ever happen that any mischief fol- JOINTS. 
87 
lows. If the first opening be made in a depending part, it may be all that 
is wanted. It may be, however, that one or two openings will be required 
in other situations afterward. In these cases the disease has its origin in 
the soft parts. The bones are in the first instance in a healthy state, and 
the progress of the disease is so rapid, that, although deprived of their car- 
tilages, there is not time for the bones to become materially diseased after- 
ward. 
The articular cartilages will have become absorbed, and recovery by 
anchylosis is the result: the joint during recovery must be supported with 
leathern splints: or if the leg be bent on the thigh, use the screw instru- 
ment, with splints at the posterior part of the leg and thigh. In using the 
screw, however, you should observe that it is better to leave the leg a very 
little bent on the thigh rather than quite straight. The former position 
of the leg is more convenient for walking than the latter, especially if the 
patient has the heel of his foot or shoe a little raised. 
Gouty Inflammation of the Synovial Membrane of the Knee-Joint.— 
This disease is met with in those who lead an indolent life, and indulge too 
freely in wine and animal food; some of the smaller joints are generally 
affected first, and it has this peculiarity that there is seldom much effusion 
within the joint; the synovial membrane becomes thickened, and then ab- 
sorbed, and the cartilages are not unfrequently removed by a continuation 
of the disease of their structure. 
In the course of time, that is, after the lapse of some years, the cartila- 
ges, and even the bones, become absorbed; the fingers being actually 
shortened and twisted in a variety of ways. Not unfrequently, in cases of 
long standing, the bones of the knee, examined in dissection, present a sin- 
gular appearance, as if they had actually been worn away by friction. 
In some instances there is a deposit of lithate of soda, or chalk-stone, in 
the joint itself, and in its neighborhood. This, like the last, is a very 
troublesome form of the disease, and is very little under the dominion of 
remedies. 
Give a grain of acet. ext. of colchicum, a grain of blue pill, and three 
grains of ext. of hop, every night, with a gentle aperient every third or 
fourth morning ; after giving these pills for a fortnight, stop them for two 
months, and then give them a fortnight again, and so on : give also a grain 
and a half or two grains of iodide of potassium, with ten or twelve grains 
of bicarbonate of potash twice a day, for six or eight weeks at a time. This 
system must be continued, with occasional intermissions, for one or two 
years, or even longer. This chronic gouty affection is not in itself danger- 
ous, but it shows a bad constitution, and the person thus affected is liable 
to other diseases. 
Scrofulous Disease of the Knee Joint.—Never abstract blood, nor make 
use of counter-irritation. Here, as in all diseases of joints, a state of per- 
fect repose is necessary ; use the leathern splints. As soon as the digestive 
organs are brought into a proper state, give tonics, particularly chalybeate 
tonics. To children give the vinum ferri of the old Pharmacopoeia, for 
three weeks, and then omit it for ten days, and so on for several years, so 
as to improve the weak constitution. If fever be produced, decrease the 
dose, or omit it altogether for a while; or give the tinct. ferri mur.; or the 
sirup of iodide of iron ; or the latter and the vin. ferri alternately. When 
you have a patient with whom no form of iron will agree, then give qui- 
nine, bark, or alkaline solution of sarsaparilla ; the latter is very useful to 88 
JOINTS, 
delicate children. Change of air is highly beneficial, the sea-side ; when 
the joint has become stiff, do not use force to straighten it; it should be 
done gradually by means of a screw apparatus ; if an abscess forms in the 
joint, continue the use of the splints, but have them lined with oil-silk. If 
the disease have been neglected, or it has been found impossible to save 
the joint, amputate as soon as possible. If, by examination with a probe 
it is found that there be a piece of dead bone within the joint, so that it 
cannot exfoliate, the sooner the limb is amputated the better. Bony an- 
chylosis takes years for its completion, so that if the limb be bent there 
will be plenty of time to get it into its proper place. 
Primary Ulceration of the Cartilages of the Knee. — [This disease 
apparently may originate either in the cartilage itself, or in the orifice of 
the adjacent bone ; but in what Sir Benjamin considers primary ulceration, 
it invariably begins in the surface next to the articular cavity. lie says:] 
On examining the joint in an early stage of the disease, the cartilage is 
found to be absorbed at one point, and the surface of the bone exposed and 
carious. Probably there is no effusion of any kind in the joint, neither 
serum nor pus; but the exposed surface of bone is more vascular than 
under ordinary circumstances. As the disease advances, the ulceration of 
the cartilage becomes more extensive, and when it has attained a certain 
point, pus is formed in the joint. As in some cases there is suppuration 
without ulceration, so in these there is ulceration without suppuration. As 
I have observed in a former lecture, the two processes are generally com- 
bined, but there is no necessary connection between them. The cartilages 
at last become destroyed throughout the knee—on the femur, the patella, 
and the tibia. Sometimes when abscess forms, it is limited by adhesion to 
one part of the joint, and then perhaps suppuration takes place in another 
part of it. In other cases the abscess is not so limited ; the whole joint is 
distended with matter, so as to form one large abscess; and in this stage 
of the disease, the bones in the neighborhood of the joint become inflamed 
and dark-colored; the matter lodging in the cancelli becomes putrid, pro- 
bably a portion of the bone loses its vitality and exfoliates into the articu- 
lar cavity, while the abscess finds its way out in various directions, making 
numerous sinuses under the fascia, and among the tendons, before it pre- 
sents itself externally. 
While these changes take place in the affected joint, they are indicated 
by the following symptoms. Generally there are rheumatic pains in other 
joints in the first instance; by and by the pains are, as it were, concen- 
trated in the knee. The pain is very severe, and yet the joint is scarcely 
at all swollen, or rather I should say there is no swelling in the first in- 
stance. After a time there is a slight general enlargement of the joint, 
the consequence of a deposit of lymph, or serum, outside of the synovial 
membrane. The swelling assumes the shape of the articulating ends of 
bones, and appears greater than it really is; because the muscles of the 
thigh are wasted above, as those of the leg are below. The pain is aggra- 
vated by motion, and there is a painful starting of the limb at night. The 
pain is especially aggravated by pressure on the patella, and whenever, in 
this or any other case of disease of the knee, this symptom exists, you may 
suspect that the cartilages of the joint are beginning to ulcerate. The dis- 
ease may go on not only for weeks but for many months, the patient’s health 
suffering all the time, from disturbed rest at night and constant pain in the 
day, aud yet without suppuration taking place. By and by matter forms, JOINTS. 
89 
and then there is an aggravation of all the symptoms. The matter, as in 
all other cases of abscesses connected with the knee joint, burrows in va- 
rious directions among the muscles and tendons, making numerous and 
circuitous sinuses. 
Keep the joint perfectly at rest, and use setons, issues, blisters, and coun- 
ter-irritants. The great remedy is mercury ; two grains of calomel and 
one-third of a grain of opium, three times a day, until the gums are 
affected. Where mercury cannot be borne, give sarsaparilla and iodide 
of potassium ; sarsaparilla should also be given after the course of mercury. 
Ung. hydrarg. may be rubbed into the thighs where it cannot be borne 
internally. A caustic issue inserted on each side the patella will very often 
stop the pain and the starting of the limb at night, w7hen other means 
have failed. 
Morbid Alteration of Structure of the Synovial Membrane.—There is 
a curious condition of the synovial membrane in which it seems to have 
undergone a peculiar morbid alteration of structure. It is thickened in 
various degrees, sometimes to the extent of an inch and a half, having 
assumed a sort of pulpy structure intersected by white membranous 
bands. In some instances there is a preternatural vascularity, and vessels 
injected with blood are seen ramifying in it to a considerable extent. In 
other cases no increased vascularity is perceptible. There is little doubt 
that in some cases this is the result of long-continued chronic inflamma- 
tion ; but in others I am glad to believe that it takes place independently 
of the inflammatory action. 
[The disease may progress for some time, even years, without any other 
symptoms.] 
As it has advanced to the layer of the synovial membrane, which is 
reflected over the cartilage, the latter has begun to ulcerate, the ulceration 
being marked as on other occasions, by aggravation of pain and startings 
of the limb at night. At this stage of the disease small abscesses form in 
the substance of the diseased synovial membrane. These gradually make 
their way to the surface, one coming in one place, and another in another, 
discharging a very small quantity of matter. 
When the cartilages are thus ulcerated, the matter is formed in the 
joint, and perhaps in the substance of the synovial membrane also, the 
patient’s health begins to be affected, as in other cases of articular ab- 
scesses, and at this period nothing can be done for him but to amputate the 
limb. Can any remedial means be employed with success in the early stage 
of the disease ? 
Apply pressure by means of several alternate layers of diachylon plaster 
and bandage ; and afterward by leathern splints, and a firm bandage ; at- 
tend also to the general health. 
Sir B. Brodie considers the affection to be of rare occurrence : he then 
speaks of 
Loose Cartilages in the Knee.—Remove them by operation; get the 
cartilage fixed over the outer or inner condyle, and while it is retained in 
that situation, divide slowly, the skin, cellular membrane, fascia, ligaments, 
and synovial membrane : hold the knife with a loose hand, or the cartilage 
will be pressed into the joint; lay hold of it with a tenaculum, but should 
it recede within the joint, never grope for it, but bring the edges of the 
wound together, and perform the operation at some other time. A valvu- 
lar operation has been proposed. Part xiii., p. 1S5. 90 
JOINTS. 
Case of Scrofulous Disease of the Knee, treated by Sulphur and 
Electro-Galvanism.—This was a case of scrofulous enlargement of the 
knee joint, occurring in a young woman, the swelling being of three 
months’ duration. The general treatment consisted in the administration 
of small quantities of the purest sulphur, combined with carbonate of iron, 
nutritious diet, and such open-air exercise as the case would admit of. 
And the local applications were first hot poultices to relieve the pain, next 
compression by means of strips of iodine plaster and a bandage, and then 
the hot water douche. When she had been about sixteen weeks under 
treatment, Mr. Bulley began to use electro-galvanism. He says:] 
After the electro-galvanism had been applied every other day for a fort- 
night or three weeks, I could observe a very perceptible alteration in the 
shape of the affected joint, the more than natural quantity of synovial fluid 
which remained in its cavity up to the time she left the hospital having 
become absorbed; and I could plainly perceive that the rounded appear- 
ance occasioned by the more solid deposit in the ligamentous tissues was 
gradually becoming less and less apparent, until at the end of about five 
weeks from her leaving the hospital, it had almost completely disappeared, 
and she could walk about upon the limb without any particular pain or 
stiffness in the joint, which, by admeasurement, did not exceed to any 
appreciable extent the size of the other knee; it was, in fact, evident that 
the morbid deposit which I could have no doubt was of the same solid 
character as usually accompanies the more advanced forms of scrofulous 
exudation, had been absorbed and taken away by the j>rocesses employed. 
Part xviii., p. 152. 
Joints Diseased—Issues.—The best kind of counter-irritation is that 
exerted by the issue made with caustic potash. In synovial disease of the 
knee the issue is particularly useful. Part xix., p. 122. 
Removal of Loose Cartilages from Joints.—In his description of the 
subcutaneous or valvular mode of removing loose cartilages, Professor 
Miller remarks:] 
“ In the first place, the patient is to be prepared for the operation. For 
a day or two, the limb is to be disused, so that previous excitement may 
have thoroughly subsided. Low diet is enjoined, the primes vise are 
gently yet efficiently cleared, and general secretion is seen to be in a satis- 
factory state, so that there may be no predisposition to inflammation. 
Then the foreign body, having been made superficial, is gently pushed to 
the extreme verge of the synovial pouch; either on the inside or on the 
outside of the patella, as may be most convenient. The internal position 
is usually the most preferable; and there it is retained fixedly, by the 
fingers of an attentive and steady assistant. A tenotomy needle, or thin 
and narrow bistoury, of fine edge, is passed in an oblique direction ; and 
an incision a little larger than the outline of the cartilage, is made through 
the tense synovial membrane. The instrument is then withdrawn slowly 
and cautiously, the finger gently yet firmly following and consolidating its 
track. A few drops of blood escape, but not a particle of synovia ; and no 
air has obtained admission, even to the areolar tissue. The integumental 
wound is immediately and carefully occluded, by plaster or collodion. 
“The foreign body is then gently pressed through the aperture in the 
synovial capsule, which aperture, as has just been stated, is made suffi- 
ciently free to admit of this being accomplished without force or difficulty. JOINTS 
91 
When exterior to the capsule it is coaxed through the areolar tissue—suf- 
ficiently lax readily to admit of this—by gentle pressure of the fingers ; 
not in the track of the puncture, but in a different direction, probably at 
nearly a light angle to it. When about an inch and a half, or two inches, 
from the synovial wound, it is there permitted to remain. Not perma- 
nently, however, as has been proposed. Otherwise, acting still more as a 
foreign body in its recent and raw site, inflammatory action is excited, 
suppuration is all but inevitable, and extension to the synovial membrane 
becomes extremely probable; the very result to the avoidance of which 
all our pains had been directed. For two days, or three at the utmost, it 
is suffered to remain in its new locality, undisturbed ; the most careful 
prophylactic treatment being meanwhile employed, both generally and 
locally, so as to avert undue excitement. By that time the synovial 
wound will have closed by adhesion ; and both tracks—that of puncture 
as well as that of extrusion—will have been consolidated. Then, the sub- 
stance having been fixed as before, a direct incision is made upon it; not 
more than is sufficient for its ready removal. After it has been lifted out, 
the superficial and slight wound is brought together by strap : and, in all 
probability, it unites by adhesion.” Part xxiii., p. 273. 
Knee Joint—Kxcision of.—The following description of the operation 
of excision of the knee joint as performed by Mr. Jones, of Jersey, in a 
case under his care, will show the formidable nature of the operation. 
The case was one of extensive ulceration of the cartilages. It is grati- 
fying to know that the result was completely successful. It was per- 
formed as follows: A longitudinal incision was made on each side of the 
knee joint, midway between the vasti and flexors of the leg, full five inches 
in extent; rather more than half the length was over the femur, and 
rather less than half over the tibia. These two cuts were down to the 
bones; they were connected by a transverse one just over the prominence 
of the tubercle of the tibia, care being taken to avoid cutting the ligamcn- 
tum patellae by this incision; the flap thus defined was reflected upward, 
the patella, its ligament, and the joint thereby exposed. The synovial 
capsule was cut through as far as it could be seen; the patella and its liga- 
ment were now drawn over the internal condyle, while the joint was kept 
extended. It was next forcibly flexed, the crucial ligaments, almost 
breaking in the act, only required a slight touch of the knife to divide 
them completely; the articular surfaces of both bones were thus com- 
pletely brought to view, and nearly two inches of the femur and half an 
inch of the tibia were sawn off, the soft parts being drawn aside by assist- 
ants. The external condyle of the femur was found hollowed out by a 
large abscess, and it was necessary to saw off a portion of the carious 
bone, and to gouge the remainder, untM healthy cancellous tissue was 
reached. The entire synovial membrane was in a state of pulpy degenera- 
tion, and was carefully dissected off. The hemorrhage had been rather 
great, but had now almost ceased, and no vessel required deligation. The 
blood was sponged out of the wound, the patella (after the diseased por- 
tion had been gouged out) and its ligament were replaced as nearly as 
possible, in their natural state, the bones brought in apposition, the flap 
brought down and held by sutures, the limb bandaged on a slight under- 
splint and laid in a box, the wound covered with moist lint, and the boy 
put to bed yet asleep. The operation occupied full twenty minutes, and 92 
J0INT8. 
was performed while the patient was under the influence of chloro- 
form. 
Preserving the patella, and not dividing its ligament, makes the opera- 
tion more tedious and difficult; but this is a very secondary consideration, 
where it results in obtaining a more favorable issue. That it proved so in 
this instance is abundantly established by the fact that, in less than seven 
weeks after the operation, this patient is able to raise his foot without any 
assistance; while a young man who occupies the next bed, and in whose 
case everything has gone on favorably, was only able to do so in as many 
months. Part xxviii., p. 155. 
KnocJc-Jcnees.—An operation is described by Dr. Mayer, of Wurzburg, 
whereby this deformity was remedied. The front and inner side of the 
head of the tibia having been deprived of integument and periosteum, a 
wedge wras cut from this portion nearly of the thickness of the bone. By 
straightening the limb the bony surfaces were brought in contact, and the 
limb acquired its natural shape. In a month the parts were completely 
healed and the weight could be borne upon the leg. Soon afterward the 
other leg was operated upon with the like success. Part xxviiii., p. 164. 
Excision of Joints.—There is one important view always to be ob- 
served with respect to this operation on the knee and the elbow. In the 
knee joint endeavor to promote firm anchylosis. In the elbow joint 
endeavor to insure mobility. Part xxix., p. 183. 
Incision into the Knee Joint.—[The following case by Dr. Jordison, 
shows the extent to which injury of this large joint may be carried, with 
ultimate safety, and even without anchylosis.]—G. G., aged 20 years, an 
agricultural laborer, of strumous habit, whilst in the act of mowing, came 
in contact with the scythe of his fellow-laborer producing an incised 
wound of about five inches in length, extending transversely across the 
anterior part of the thigh immediately above the superior edge of the 
patella. The hemorrhage, which had been considerable, had in a great 
measure subsided. On introducing my finger into the wound to ascertain 
its course, I could readily pass it into the cavity of the joint, the aperture 
into which was to the extent of about an inch. I lost no time in closing 
the wound, which I did by a number of sutures, covering the entire 
wound with numerous strips of adhesive plaster, and incasing the whole 
in oil-skin, so as to exclude the air as much as possible. I then placed the 
leg and thigh upon a long, straight splint, and had him conveyed home. 
In the course of two hours reaction commenced, and for about six hours 
he suffered excruciating pain, which I successfully combated with large 
doses of opium, combined with small doses of calomel. I allowed the 
dressings to remain undisturbed for several days, and for a fortnight there 
w\as not the least constitutional (Tisturbance, but at the expiration of that 
time (he being still under the most rigid antiphlogistic discipline), the 
pulse suddenly rose to 135, the tongue became loaded, and the counte- 
nance anxious ; the knee was very much enlarged, exquisitely tender, and 
discharged large quantities of synovia. I ordered two dozen leeches to be 
applied, hot fomentations, and to take calomel and opium every four 
hours. In the course of a few days the constitutional disturbance gradu- 
ally subsided, but the size of the knee remained unaltered ; the integu- 
ments now sloughed to a considerable extent, and the discharge of syn- 
ovia still continued very profuse. JOINTS. 
93 
It was upward of two months, before the wound commenced for the 
first time to wear a more healthy aspect, and the tenderness to subside. 
In fifteen weeks from the infliction of the injury it was cicatrized. The 
motion of the joint was at first very limited, but as time wore on it 
obtained greater mobility, and I have now the satisfaction of seeing him 
industriously employed in his wonted avocation, with his once afflicted 
knee as strong, as flexible, and of as much service to him as it was prior 
to the accident. Part xxix., p. 183. 
Knee Joint—Amputation at the.—First make a small anterior flap, 
drawing the knife across the front of the joint, and then inserting the 
point of the blade behind the femur, thrust it through to the other side, 
close to the condyles; then carrying it downward cut the posterior flap 
from the calf of the leg. The saw is then applied a little above the con- 
dyles, and the flaps brought together as in an ordinary amputation. Mr. 
Potter, of Newcastle, saws through the bone before making the posterior 
flap. Take the full length of the calf for the posterior flap, as the soft 
parts at the back of the thigh contract very much in the course of time. 
Part xxx., p 110. 
Knee Joint.—In operations for diseases of the knee joint, save the par 
tella, if possible, with its ligament. Part xxxi., p. 105. 
Excision of the Knee Joint.—Take care to clear away from the face of 
the flap the whole of the synovial membrane. Be careful of the direction 
of the saw as you saw through the femur and tibia—take care that you 
cut through these bones parallel to each other, else their surfaces will 
not meet properly. The line of section in the femur should be close to the 
edge of the articulating cartilage of the inner condyle, which will remove 
all the articular surface likely to be implicated in disease, and still leave a 
breadth of bony surface about equal to the cut surface of the tibia. The 
patella must be left. It is indispensable. Part xxxi., p. 108. 
Excision of the Knee Joint.—Having turned back the flap containing 
the patella, apply the saw carefully, and divide the required amount from 
the femur and tibia, without disturbing the soft parts by the needless in- 
troduction of a spatula; remove both ends together, first raising the 
separated extremity of the femur, and dissecting from above downward. 
By thus keeping the articular extremities in connection, their dissection 
from the popliteal vessels is rendered safe and easier, time is saved, and 
the operator can have the upper soft parts depressed by an assistant when 
the continuity of the vessels is unimportant, whilst he is enabled himself 
to raise the back part of the joint from the more perilous vicinity of the 
vessels inferiorly. Part xxxii., p. 109. 
Knee Joint—Diseases of.—In obstinate cases, which defy the usual forms 
of treatment, local depletion by means of leeches or cupping is injurious. 
You will find the most benefit from the inunction of mercurial ointment, 
with one-third its quantity of fluid extract of opium, followed by perfect 
rest in the recumbent position, and firm application of a flannel roller. 
Part xxxiii., p. 137. 
Contractions of the Knee.—When from nervous irritation, as a symptom 
of general hysteria, there will be no evidence of disease within the joint; 
in these cases put the patient under the influence of chloroform, and the 94 
JOINT'S, 
limb will almost of its own accord fall into a straight position, in which it 
must be retained by means of a long splint. When depending on spas- 
modic contraction of the ham-strings from irritation of the nerves at some 
distance, as by the pressure of faeces, etc., give powerful cathartics to clear 
out the bowels. When from subacute inflammation within the joint, it 
will generally yield without the necessity of extending force, by the appli- 
cation of leeches, blisters, and other remedies to reduce the inflammatory 
action, as small doses of mercury and morphia, etc. When from consoli- 
dation of ligamentous structures in and around the joint, you will gene- 
rally succeed by gradual and forcible extension. Never mind the snaps 
and cracks which may be heard ; there is no fear, if you only take care 
that there is no inflammatory action going on in the joint at the time. 
Part xxxiii., p. 13 7-1 CO. 
Anc.hylosed Knee Joint.—During the acute inflammatory stage, keep up 
counter-irritation by a repetition of caustic issues made with potassa fusa ; 
this method is preferable to keeping an issue open by peas, as there is 
greater advantage to be gained by the primary burning than the subse- 
quent suppuration. If the joint be obliterated, and the disease entirely 
subdued, you may strengthen the limb by forcibly breaking through the 
anchylosing bands ; this may be accompanied by a loud crack, but there 
is no danger ; they generally do very well. Part xxxiii., p. 144. 
Excision of the Knee Joint.—The following two suggestions may be 
worthy the attention of practical surgeons in the management of these 
cases. The first is the division of the hamstring tendons, so as to prevent 
the displacement of the bones, which is so troublesome in the after-treat- 
ment. The second is the making of an opening into the popliteal space, 
for the direct escape of pus, to prevent it bagging and burrowing. 
Part xxxiii., p. 145. 
Excision of the ICnee Joint.—Dr. Vitalis suggests that after the ope- 
ration the limb be put up in one of Ester’s swinging fracture apparatus, 
having an opening at the posterior part through which pus may escape, 
and the wound be dressed without disturbing the limb. 
Part xxxiii., p. 307. 
Excision of the ICnee Joint.—An error in diagnosis as to the suitable- 
ness of a case for excision by no means debars the patient from the likeli- 
hood of cure by amputation. If the patient be under the influence of 
chloroform the shock is not greater, and if the bones are found extensively 
diseased, amputation should be performed at once. Part xxxv., p. 67. 
Resection of the Knee Joint.—There is a great practical distinction 
between strumous diseases of the knee joint, commencing within the cavity 
of the articulation, and those originating in the cancellous structure of the 
heads of the bones entering into the formation of the joint; for every dis- 
eased joint, with the exception of that form of diffuse strumous infiltration 
of the head of the two bones, is, in general, well suited for the adoption of 
resection in preference to amputation. The surgeon should not always 
decide which operation he will perform, till he has obtained a clear view 
of the state of the joint. Part xxxvi., p. 140. 
Dropsy of the Knee Joint.—Provided that the case be one of simple 
uncomplicated chronic dropsy, Dr. Macdonnell’s plan of injection with 
iodine will probably prove successful. The puncture should ’b« made at JOINTS. 
95 
the part most remote from the joint. If the sac is very large the injection 
should not be used directly after the first tapping, but time should be 
allowed for the sac to collapse somewhat. When the injection is going to 
be used, apply a wet bandage from below the knee upward to a level with 
the upper edge of the patella, so as to push the remainder of the fluid above 
the joint into the pouch of synovial membrane. When the fluid is drawn 
off, inject about two drachms of the strongest tincture of iodine, with an 
equal quantity of lukewarm water. Allow this to remain, moving the joint 
a little, that the fluid may be diffused. The wet bandage must now be 
carried further up the limb, the aperture being first closed with adhesive 
plaster. A long padded splint should be afterward applied. 
Part xxxvi., p. 143. 
Removal of the Patella from an Excised Knee Joint.—Mr. Fergusson 
is an advocate for the removal of the patella even when healthy, unless it 
is bound to the condyles of the femur by osseous material. It is liable to 
give subsequent annoyance. 
After-Management of Excisions of the Knee Joint.—It is not only 
“ meddlesome midwifery ” which is bad, but meddlesome surgery. There 
is no one cause so productive of ill effects after the above operation as 
changing the splints too soon, and constantly examining to see if consoli- 
dation has commenced. After the operation the limb should be placed on 
a straight back splint very carefully padded, that there may not be any 
unequal pressure, especially about the heel and the malleoli, where it is 
especially liable to take place. The two side splints should be movable, 
that the wound may be readily dressed. The pads should be secured from 
soiling by being covered with oil silk. Part xxxvii., p. 115. 
Anchylosis of the Knee.—In the treatment of this affection there has 
not hitherto been shown, generally speaking, sufficient patience on the part 
of the surgeon. In infants of six years of age the joints have been excised, 
that is, just at that period of life when successful treatment by extension is 
most to be hoped for. Even where from strumous disease, the tibia is 
dislocated backward, by gradual efforts the bones may be restored to their 
places, and the disease subdued. (Cases related.) As the result of rheu- 
matic disease, bony anchylosis is not uncommon, and requires much more 
energetic, or rather forcible treatment than strumous disease. In the 
straightening of contracted joints extension is wanted, not forcible rupture 
of contracted tendons and uniting bands, though subcutaneous tenotomy 
may be practised if necessary. If the slightest amount of motion be 
attainable on manipulating the joint, a favorable prognosis should be 
given. Part xxxviii., p. 130. 
Suppuration of the Knee Joint-—Free Incision.—When suppuration 
has taken place in the knee joint, it is absolutely necessary that an incision 
should be made. You will commit a fatal error to leave a patient unre- 
lieved of abcess in the interior of the joint, under the impression that you 
are likely to add to the mischief already existing by opening so large a 
joint as that of the knee. The incision must be free, and the cyst allowed 
by its inherent faculty of contraction to force out its own contents. It is 
desirable to leave the opening patent, and not to bring the edges of the 
wound together by strapping and bandaging, although this practice may 
sometimes succeed. Part xl., p. 92. 96 
JOINTS, 
SHOULDER JOINT. 
Arthropathia of the.—A peculiar form of chronic arthritis sometimes 
affects this joint, leading to atrophy both of the soft parts and the bones. 
The treatment of these cases will vary according to the stage of the dis- 
ease. During the early and inflammatory period, use repeated leechings 
and small cuppings, mercurial and belladonna ointment, and emollient and 
resolvent poultices. During the second stage, that of muscular atrophy, 
apply large blisters, moxas, or the cautery before and behind the joints, 
and use baths, with local stimulants and tonic douches, of plain, sulphu- 
reous or aromatic waters. Lastly, when the bones become affected, lay 
aside antiphlogistic and derivative treatment, and employ friction, espe- 
cially with oil of turpentine; use also passive motion, taking care, how- 
ever, not to excite fresh inflammation by doing this too soon, and 
not to run the risk of anchylosis, by delaying it too long. 
Part xx., p. 107. 
Peculiar Affection of the Shoulder Joint.—[Sir Benj. Brodie describes a 
most tedious and annoying affection of this joint, seeming to depend ir. 
many instances on a chronic inflammation of the substance of the deltoid 
muscle, or of the bursa under the deltoid and to be greatly benefited by 
the employment of counter-irritation and the iodide of potassium.] 
“ The cases here referred to occur more frequently in private than in 
hospital practice: and (whether it be accidentally or not I do not know) 
it certainly has happened that I have met with it more frequently in the 
female than in the male sex. The patient complains of pain, which, how- 
ever, is referred not so much to the joint itself as to the arm a little below 
it, near the insertion of the deltoid muscle. At first the pain is trifling, 
but it soon becomes severe and constant. The patient describes it as a 
wearing pain, of which she is constantly reminded. It is aggravated by 
every motion of the limb, and by pressing the articulating surfaces against 
each other. Not only is there no perceptible enlargement of the shoul- 
der, but after some time, in consequence of the want of use and wasting 
of the deltoid muscle, it seems to be actually reduced in size. It is not 
long before the mobility of the joint is impaired, becoming gradually 
more and more limited. When the patient attempts to raise the elbow 
from her side, it is observed that the scapula is elevated at the same time 
with the humerus. She is unable to raise her hand to her face, nor can she 
rotate the limb so as to place it behind her. When the progress of the 
disease is stopped at an early period, the mobility of the joint may be 
restored; but otherwise, although the pain and all other symptoms of the 
disease have subsided, the joint remains stiff, and to all appearance com- 
pletely anchylosed. Whatever motion the arm is capable of, under these 
circumstances, depends not on the humerus, but on the scapula. 
“ It certainly is seldom that this disease terminates in abscess of the 
joint, when proper attention has been paid to the treatment of it. 
“Whether it be from this, or from any other disease, that the joint of 
the shoulder is brought to such an extreme state of disorganization, one 
result is, that it is liable to dislocation, or, more properly, to sub-luxation 
in the direction forward. In one case in which I had the opportunity of 
examining the parts after death, I found the anterior margin of the 
glenoid cavity of the scapula destroyed by ulceration, the head of the JOINTS. 
97 
humerus permanently resting on the ulcerated surface. In another case, 
in the living person, I found the dislocation to be only occasional, the 
head of the bone slipping forward so as to make a visible projection in 
certain motions of the arm, and in certain other motions returning to its 
natural situation. 
“ I may take this opportunity of noticing another circumstance, which, 
though not of much interest in pathology, is of some importance in prac- 
tice. An abscess originating in the shoulder joint sometimes presents a 
peculiar appearance, when it is making its way to the surface. A dissec- 
tion, which I once had the opportunity of making, will explain at once the 
nature and the cause of this peculiarity. The abscess, taking the course 
of the tendon of the long head of the biceps flexor cubiti muscle, had sud- 
denly emerged from the joint at the lower end of the bicipital groove of 
the humerus: then, having taken a direction forward, on the anterior 
edge of the deltoid muscle, had presented itself under the integuments, 
having a spherical form, so that it might have been mistaken for an en- 
cysted tumor. I met with one case, in which this mistake respecting an 
abscess of this kind, was actually made by a surgeon of considerable ex- 
perience, who proposed the removal of the tumor by the knife. 
Part xxiii.,jo. 272. 
Shoulder Joint, Disease of.—In a case which required excision of the 
head of the humerus, Mr. Syme enlarged an opening existing on the inner 
side of the shoulder; he then, by means of a probe-pointed bistoury, 
guided on his finger, detached the connections of the spinati muscles, and 
pushing the arm upward, protruded the head of the bone, which was then 
removed. We may remark that ball and socket joints are most liable to 
chronic inflammation, suppuration, and caries; while the hinge joints are 
more subject to ulceration of the cartilages, and gelatinous degeneration 
of the synovial membranes. But the shoulder joint is apt to suffer from 
disease entirely peculiar to itself; one is, removal of the osseous substance 
by absorption, so that a cavity is left in place of the round extremity, 
from inflammation affecting the head of the humerus, independently of the 
scapula. Again, excessive action of the biceps will produce an injurious 
effect upon its osseous attachments, leading to exfoliation of the coracoid 
process, and disease of the humerus, along which the long head of the 
muscle passes. Part 134. 
Shoulder Joint—Resection of.—Resections of the shoulder, unlike those 
of the knee, generally necessitate the removal of but one of the articular 
extremities entering into the joint; it is very seldom that more than the 
head of the humerus need be removed, either from disease or injury, and 
this, from the vei-y nature of the affections of the joint, which, while they 
seriously damage or even destroy the head of the humerus, rarely attack 
the glenoid cavity of the scapula. Again, the exposed position of the hu- 
merus, which renders this bone so peculiarly liable to injury from gun-shot 
wounds, forms a protection for the scapula. Fortunately, the full benefit 
of resection may be secured by the removal of one articular extremity, as 
it is not our object to obtain bony anchylosis. 
This operation is applicable to compound dislocations, to cases where a 
bullet may have lodged in the head of the bone, and to all wounds of the 
shoulder joint complicated with crushing or fracture of one or both bones 
entering into the articulation, unless, of course, the severity of the injury, 
VOL. II. 7 98 
JOINTS 
by division of the great vessels, or by extensive laceration of the soft 
parts, necessitates ex-articulation of the limb. Nor need the extension of 
the injury to the shaft of the humerus deter the surgeon from attempting 
the operation. 
In disease, either one or both articular extremities of the joint may be 
removed for caries, or, indeed, for any other incurable affection of the ar- 
ticulation, which renders it not merely useless as a joint, but by its 
presence either destroys the utility of the whole extremity, or seriously 
affects the general health of the patient. Lastly, this operation may be 
substituted for ex-articulation, in cases where tumors affecting the head 
of the humerus do not by their extension to the shaft necessitate the re- 
moval of the entire limb. We apprehend that resection of the joint is 
by no means justifiable for mere anchylosis, provided that this is the only 
inconvenience the patient suffers from. 
The operation is contra-indicated where, together with compound frac- 
ture, there is any excessive destruction of the soft parts, or injury to the 
great vessels or nerves. Neither should cases of necrosis or caries be sub- 
mitted to operation, unless the disease be confined to the articular ex- 
tremity of the or at any rate be within reach of removal. 
It appears, from the history of former operations on this articulation, 
that, previous to its performance by Professor Langenbeck, the long ten- 
don of the biceps had always been divided. He it was who first prac- 
tised an operation which had for its object the preservation of this 
tendon. Langenbeck’s method consists in an incision commencing at the 
acromion, and extending downward on the anterior aspect of the joint for 
three or four inches; this should fall just over the bicipital groove, which 
is then opened, and the tendon drawn inward; the muscles inserted into 
the tuberosities are now divided, and the head of the bone thrust out of 
the wound and removed by an ordinary saw. The operation is sufficiently 
easy of execution when the head of the bone retains its connection with 
the shaft, and the soft parts are not tense or swollen. On the other 
hand, it is difficult by this incision to remove the disconnected head of the 
humerus, and especially when the integuments are swollen and oedema- 
tons. To remedy this, and to provide a more dependent aperture for the 
escape of the secretions from the wound, Stromeyer made use of a semi- 
circular incision, commencing at the posterior edge of the acromion, and 
extending downward and outward for three inches, having its concavitv 
forward ; the joint is thus freely opened from above and behind, the ten 
don of the biceps can be preserved, and a free and dependent aperture ii 
left for pus. Stromeyer states that patients recover from this operation 
much more quickly than from Langenbeck’s, owing to the much greater 
facility it affords for cleansing the wound. That perfect recovery may 
take place after division of the tendon of the biceps is well known, and, 
indeed, Esmarch relates three cases of resection in which it had been torn 
across by a ball, and yet in each case the patients recovered, with good 
use of their arms. It may also be gathered from similar evidence that 
transverse division of the fibres of the deltoid but little affect the ultimate 
success of the case. Whatever mode of incision be adopted, the deltoid, 
with few exceptions, becomes much atrophied after the operation ; perhaps, 
this is caused by the division of its nerve, which, with the posterior eir- 
cumilex artery, are the only nerve and vessel of importance that are liable 
to injury. 99 
JOINTS, 
The after-treatment of these cases is far more simple and more easy of 
execution than that of excision of some other joints. Absolute rest, clean- 
liness, and appropriate constitutional support constitute the principal 
measures to be adopted; but we will refer to the plan pursued during the 
Schleswig-Holstein war. Absolute quiet was maintained by bandaging 
the arm to the side. Ice was freely applied to the parts, and maintained 
there until suppuration was fully established. Bleeding, both constitu- 
tionally and locally, was unsparingly employed during the stage of reaction, 
and upon this Stromeyer strongly insists. The wound was never, if pos- 
sible, disturbed, all cleansing was effected by allowing water to flow over 
the wound. Matter, if it formed, was let out by incisions, and not 
squeezed out. Cicatrization was promoted by dressings of nitrate of sil- 
ver lotions; flannel bandaging was employed to consolidate the parts; 
passive motion was commenced as soon as the cicatrix had formed, and 
was continued at the discretion of the surgeon, and as the patient could 
bear it, until considerable voluntary motion of the extremity had been 
regained. Part xxxvi., p. 129. 
WRIST JOINT. 
Endermic use of Morphia in Articular Contractions.—[Dr. Haygarth 
published an account of an arthritic affection, which he termed “ Nodo- 
sity of the Joints.” He described it as almost peculiar to women, as 
occurring at the period of cessation of the menses, principally affecting the 
fingers, and considered it an affection of the whole of the tissues com- 
posing the wrist, and near akin to gout. The joints were painful at night, 
often tender to the touch, swollen, and, in old cases sometimes actually 
dislocated. Dr. Thompson has met with an affection much resembling 
this, which he has successfully treated by the endermic application of some 
of the salts of morphia. Cases of real nodosity he has also found much 
benefited by the same treatment.] 
The disease which is the subject of this communication does not display 
itself at any particular period of life, nor is it confined to either sex. 
Dr. T. has never seen it in persons under the age of puberty. It ap- 
pears, in every instance, to be the sequel of repeated severe attacks of 
acute rheumatism; and has great affinity to inflammation of the synovial 
membranes, as described by Sir Benjamin Brodie. 
[A number of cases are given, from which the following conclusions 
may be drawn.] 
1. That in painful, swollen, and contracted joints, depending on rheum- 
atism, or other causes the topical application of hydrochlorate, or acetate 
of morphia, to a blistered surface, on the affected joint, is capable of 
reducing the swelling, abating pain, and restoring the motion to the 
joints. 2. That these salts seem to produce these beneficial effects, by 
reducing the sensibility of the nerves of the joint, and favoring absorption 
by their counter-irritant influence. 3. That they do not act as general 
narcotics, until the joints are relieved. 4. That they frequently excite a 
pustular eruption over the body; but this disappears spontaneously, soon 
after the use of the topical application is discontinued. Part xii., p. 252. 
Wrist Joint, Excision of.—Mr. Erichsen and Mr. Fergusson have 
removed the bones of the wrist by lateral incisions. Mr. Simon has 
removed them by making two long incisions in the anterior and posterior 100 
SIDNEY AFFECTIONS. 
aspects of the joint, reaching from about two inches above the wrist, 
back and front, to the centre of the palm and dorsum of the hand, the 
incision being so managed as to run between the tendons coursing down to 
their destination on the metacarpal bones and fingers. 
Dart xxix., p. 195. 
Carpal Bones, Excision of-—In cases of partial disease of the wrrist 
joint, in place of amputation of the forearm, excision of the diseased 
bones is sometimes preferable, as by this means the disease is equally re- 
moved, and a very useful hand preserved. It should be conjoined with 
the use of cod-liver oil and tonics, etc., especially in strumous cases. 
Part xxxiii., 145. 
KIDNEY AFFECTIONS. 
Treatment of Renal Disease.—Dr. Bright gives the following outline of 
his treatment of renal disease: 
In the first steps, and the more acute forms of disease, bleeding may be 
considered the most important remedy ; but this is, of itself, wholly inade- 
quate to cure unless we purge freely, and at the same time call upon the 
skin to do its duty. Of all the measures for effecting this latter purpose, 
the strictest confinement to bed is the most effectual; and without that, 
I do not believe that in this climate we have a chance of cure. That pre- 
liminary, however, being adopted, antimonials are probably the best dia- 
phoretics ; but the liquor ammonias acetatis is likewise very useful; and a 
simple saline draught of citrate of potash or soda is, I believe, when dili- 
gently persisted in, of much avail, and the warm bath, in its various forms, 
may in many cases be brought to act most beneficially. 
Amongst the purgatives, I shall only mention that elaterium and jalap, 
with the bitartrate of potash, appear to be the most effectual. When the 
disease has made further progress, and has become chronic, perhaps 
organic, I should still recommend the greatest attention to the full effects 
of purgation, and to the state of the skin, and to protection from atmos- 
pheric changes. A voyage to the West Indies, and a residence in one of 
the more healthy islands, often produce a great change in the constitution, 
acting chiefly upon the pores of the skin. We have, at least, the negative 
experience that confirmed cases rarely recover in this country, whatever 
treatment be adopted. 
There are certain remedies whose actions in this disease are less obvious 
than those to which I have referred ; but many of them probably act by af- 
fording a degree of stimulant or astringent action to the kidney ; of these 
1 may mention the mineral acids as applicable in the declining stages of 
more acute attacks; the uva ursi, in its different preparations, in the 
chronic disease; the pyrola umbellata, and the diosma crenata where great 
irritability of the urinary organs exists—a remedy which I have been led 
to adopt, in many cases, from the very favorable reports of Sir Benjamin 
Brodie; nor have I been disappointed of some good effect, though I 
should perhaps employ with greater confidence a long-continued course of 
soda, coniuin, and uva ursi. 
Dr. Barlow one of the editors of “ Guy’s Hospital Reports,” strongly re- KIDNEY AFFECTIONS, 
101 
commends tartarized antimony in this formidable disease : with respect to 
which he says: 
“ I have never found it necessary to give more than half a grain at a 
dose to an adult; neither have I attempted to push it to the greatest ex- 
tent possible; the object not being to give heroic doses of the remedy, but, 
if possible, to cure the patient.” Part i., p. 55. 
Ischuria Penalis.—Dr. Theophilus Thompson has recorded an unusual 
example of complete interruption of the renal secretion, unattended with 
the urgent symptoms which protracted anuria usually induces. Death 
will generally ensue within three days of such an event: Dr. Prout thinks 
that five days will often elapse before coma takes place. In this case of 
Dr. Thompson’s, no urine was secreted for about 120 hours, and during 
the next 48 hours, only half an ounce was passed, and the natural quan- 
tity was not restored for a month, and yet no urgent cerebral symptoms at 
any time occurred. Dr. T. attaches some importance in the treatment of 
the case to the application of nitrate of silver. The final result of the case 
does not seem to invalidate the value of this opinion. The case was that 
of a lady aged 45, who had for five years suffered in the region of the 
colon from frequent and severe attacks of pain. January 28th, the secre- 
tion of urine was suddenly suspended, so that only half a drachm was 
obtained on introducing the catheter. Nine ounces of blood were removed 
from the loins by cupping, and small doses of tincture of cantharides were 
administered. In the evening, two drachms of turbid urine were passed. 
The loins were cupped again, and blistered: prussic acid, creasote, etc., 
were given, but still, on the 3d February, i. e., seven days after the first 
suppression, little or no urine had been voided. The nitrate of silver was 
now freely applied to an old issue on the loins which had lately been dried 
up, with the view of restoring it: irf the evening, a drachm of urine was 
discharged, and during the night 3|- ounces. The secretion became gradu- 
ally restored. Part ix., p. 67. 
Injuries of the Kidneys.—The kidney may be injured in a variety of 
ways, giving rise to very different symptoms. 1. It may be lacerated and 
cause death by hemorrhage into the cavity of the peritoneum, with the 
addition likewise of urine escaping into the same cavity. 2. It may be 
lacerated, with its capsule, and both blood and urine may escape into the 
cellular tissue around it, without the serous membrane being torn; and 
the fatter the person is, the more distant the peritoneum will of course 
be from the gland. In these cases it has happened that death has 
ensued from secondary hemorrhage into the parts around the kidney, 
behind the peritoneum, many days (in one case as late as the 10th day) 
after the accident, and when the patient appeared to be doing well. 
3. There may be no laceration of the capsule of the kidney, but an injury 
may extend into the infundibula and pelvis of the gland, so that the 
effused blood escapes into the interior, and hence there is hematuria. A 
great quantity of blood may be lost in this way; as much as three pints 
at once. 4. Another consequence of injury of the kidney is suppuration 
within the organ. 5. And another effect is illustrated by two examples 
published by Mr. Stanley, in which, besides suppuration, there were 
formed fluctuating tumors or cysts, containing a clear, yellow fluid, resem- 
bling urine. With respect to the treatment of some of these cases, Mr. 
Hawkins says: 102 
KIDNEY AFFECTION8. 
“ In the first place, with regard to the hematuria, it is seldom that its 
amount causes any alarm; but if the blood comes away in great quantities, 
you have the same resources as in other internal bleedings, to which alone 
you can look for checking hemorrhage from the kidney which does not 
pass down with the urine. Y»u can cause syncope by bleeding, and you 
can give styptics, which I have seen do much good in some cases of hema- 
turia. Of these, the best is lead ; so that you can give three grains of the 
acetate with a quarter of a grain of opium every three or four hours for a 
time. In some cases, in which the lead failed, or alternately with it, I have 
seen the powdered galls stop the bleeding. 
“ This medicine is, however, rather nauseous, and sometimes irritating 
to the stomach. You can also give a dessertspoonful of lluspini’s 
styptic every three or four hours. You might reasonably expect that, if 
these medicines have power in any case of hemorrhage, they would be of 
especial service in hemorrhage from the kidney, to which organ so large a 
quantity of blood is constantly passing. Another styptic—turpentine— 
which is useful in passive bleeding from the kidney, does not seem to be 
applicable to cases of injury in which inflammation is present. The pre- 
sence of blood in the bladder does not usually occasion much trouble ; it 
did so in the patient from whom this blood passed, and I was obliged to 
wash out the bladder to free it from coagula and enable the urine to 
escape, not after an accident, indeed, but for fungus hematodes of the 
kidney. With a double catheter and warm water, there is no difficulty in 
doing this, if you are obliged; at all events, there can be no occasion to 
perform the high operation, as for lithotomy, which was done in one case 
by Mr. Copland Hutchinson, where blood lodged in the bladder. In most 
cases, however, you may disregard the amount of hemorrhage, and treat 
the case as you would another in which there was no bleeding, and you 
will find it cease gradually in two or three days. I need not say that rest 
is necessary, and with this you must employ antiphlogistic remedies. 
You see that our patient now in the house has been cupped once, and has 
had leeches also once, and fomentations to the painful side; and such means 
are usually enough. In the case, however, which I read to you, of recent 
suppuration, I was obliged to bleed as often as five times; cupping, how- 
ever, is generally sufficient. Then you saw that I gave calomel and 
saline purgatives ; and if you have occasion for purgatives in these cases, 
and particularly when the lithates abound, as they did here, the salts you 
select should be the vegetable ones, the potassio-tartrate of soda, or the 
tartrate of potash, so that the alkalies may at once pass to the kidney and 
neutralize the excess of acid. Then, again, you may give saline draughts, 
and add to this sometimes some colchicum if the inflammation does not 
easily yield. 
“After the first symptoms have subsided, you must next look carefully 
for remaining pain and weakness in the loins, and use counter-irritants ; 
apply blisters, taking the precaution of using some muslin or tissue-paper 
under them, in order that the cantharides may not be absorbed and pass 
to the injured or inflamed kidney; and finally, if such pain and weakness 
continue long, you should insert a seton or an issue over the affected part, 
which you will do with the view of preventing the formation of abscess or 
other chronic disease of the kidney, and also to obviate another future 
mischief, which has been pointed out by Mr. Earle, in a paper in the 
‘ Medieo-Chirurgical Transactions,’ namely, the formation of calculi in the 103 
KIDNEY AFFECTIONS. 
kidney; though it does not seem very probable that these bodies would 
be deposited unless the patient’s urinary secretion was otherwise dis- 
ordered.” Dart x.,p. 135. 
Granular Disease of the Kidney—Bright's Disease, or Albuminuria— 
Treatment.—Enjoin a general tonic regimen; avoid as articles of food, fat 
and other highly carbonized materials; attend to the functions of the skin 
and bowels ; relieve congestion of the gland, and, if necessary, use small 
bleedings. (Dr. Johnson.) Make use of cautious small blood-lettings 
in the early stages, particularly if acute; give hydragogue cathartics, 
and improve the general health: do not deplete where the disease is 
chronic. (Dr. Williams.) In the very early stages change the mode of 
life and habits of the patient, enjoin pure air and careful attention to diet 
and exercise ; in this stage, application for relief is seldom made. In 
the second and third stages, relieve congestion; promote the flow of 
urine and the action of the skin, and prevent the deposition of fatty mat- 
ters by a diet which contains neither fat, nor butter, nor any of those non- 
azotized substances nearly allied to it, as starch, sugar, potatoes, etc. (Dr. 
Todd.) 
In the acute form, remove congestion of the kidneys by blood-letting, 
regulated according to the intensity of the disease and the patient’s 
strength ; restore the function of the skin, by keeping the patient in a 
warm atmosphere, giving mild diaphoretics, and the use of the warm or 
vapor bath. Dr. Barlow gives tartar emetic. Next, remove the dropsy, 
by diuretics and purgatives, nitrate of potash, in doses of two scruples 
or more, with digitalis and cream of tartar; the nitrate should be largely 
diluted. 
In the chronic form, first attend to the function of the skin by warm 
clothing, diaphoretics, and the warm bath. Give tincture of eantharides 
in doses of from four to twelve drops, in some emulsion (Dr. Bright); Dr. 
Wells and M. Monneret advise thirty to sixty drops in twenty-four hours; 
or give ioduret of iron (M. Gutbrod); or hydriodate of potash, and use 
iodine ointment (M. Aiken); or give chalybeate tonics, saline purgatives, 
and nutritious diet (Dr. Rees); or equal parts of tinct. of eantharides and 
tinct. of sesquichloride of iron (Dr. Copland). 
Treat the dropsy with cream of tartar and digitalis (Dr. Christison), 
give from a drachm to a drachm and a half of the former three times a 
day, and at the same time a pill containing one or two grains of powdered 
digitalis, or twenty drops of the tincture in cinnamon water: give a blue 
pill (grs. 5) every night for four or five nights. Diuresis may often be 
established by an emetic of ipecac., and tartar emetic, or by a hydragogue 
cathartic; should these fail, give squills, broom, spirit of nitric ether, or 
Hollands and water, or carbonate, nitrate, or acetate of potash; or decoc- 
tion of horse radish (Rayer). Diuretics do not cure the disease; they 
can only relieve the dropsy. 
Try seidlitz or Pullna water; cream of tartar in half ounce doses 
(Rayer) ; give five, seven, or nine grains of gamboge, once every two 
days, triturated with bitartrate of potash, to prevent griping. Combat 
the concomitant affections of the digestive organs with creasote (Dr. 
Christison) ; give it as a pill, one drop of creasote, two grains of rhubarb, 
and one grain of extract of gentian, for the mass; or with the sedative 
solution of opium; or with extract of opium and nitrate of silver, half a 104 
KIDNEY AFFECTIONS. 
grain of each in a pill. Apply sinapisms, turpentine epithems, or a can- 
tharides blister, externally ; sprinkle the blistered surface with muriate of 
morphia; check diarrhoea by chalk, astringents, and opiates; or give 
acetate of lead with opium, or strychnine with opium (Dr. Wood). 
Part xiii., p. 108. 
Case of Excessive Secretion of Earthy Phosphates by the Kidneys, 
with long-continued Irritability of the Stomach.—[This case, recorded 
by Dr. Bird, is an excellent illustration of the relation existing between 
the function of the stomach and kidneys. The patient, in 1841, was 
attacked with vomiting, after dinner, with severe pain at the pit of the 
stomach. This vomiting occurred after every meal for six months, being 
always preceded by intense pain, which was relieved as soon as the 
stomach was emptied. The next eight months the vomiting became less 
frequent, only recurring after dinner. He was admitted into Guy’s Hos- 
pital on the 9th of April, 1845. The following was his condition at 
the time:] 
On admission into Guy’s Hospital, the lad’s complexion was pale and 
bloodless, with a slightly icteric tint; he was emaciated to an extreme 
degree, his bones being barely covered ; and his face bore no small resem- 
blance to a fleshless skull, over which a skin of parchment had been 
tightly drawn. Iiis general appearance was that of a person worn out by 
malignant disease, lie chiefly complained of a burning, gnawing pain, at 
the scrobiculus cordis, and of a heavy pain across the loins. Tongue 
clean and red; pulse quick and sharp; skin dry and imperspirable. He 
vomits shortly after each meal, bringing up his food slightly changed, and 
according to his own account, has never passed a single day, during four 
years, without vomiting once, and more frequently several times. He 
complains of great thirst. The bowels act daily. Flatulent eructations 
frequent, and possessing the odor of stale fish. Urine copious, pale, loaded 
with crystals of the triple phosphate, not albuminous, alkaline ; specific 
gravity 1.020, and evolving a disgusting fishy odor. The abdomen is dis- 
tended with flatus ; there is some tenderness at the scrobiculus cordis, 
where no tumor is perceptible. He had, shortly after his admission, 
vomited nearly four pints of thin, acid, yeast-like matter. 
Misturai magneske, §j. ter in die. Milk diet. 
April 11th.—Has vomited daily after dinner, the vomited matter pre- 
senting the same yeast-like appearance. Urine has an ammoniacal odor, 
and deposited crystals of phosphates. 
R Strychnias, gr. j.; acidi nitrici dil. 5j.; aquas, §xij ; solve et sumat 
aeger, ft. |j ter in die. 
He was strictly confined to milk diet, consisting of eighteen ounces of 
bread, an ounce of butter, and two pints of milk daily, and ordered to 
take the medicine fifteen minutes before each meal. 
[On the 16th, a liniment of croton oil was applied to the scrob. cord., 
after which he ceased to vomit; the pain also ceased, the urine became 
neutral, and contained but few phosphatic crystals. On the 22d, the urine 
was free from deposit, and the skin acted freely. Dr Bird adds :] 
From the date of this report the same treatment was continued, and 
the patient steadily improved; the vomiting ceased, the urine became 
acid, he recovered his flesh—indeed became decidedly fat; it was scarcely 
possible to recognize in him the wretched skeleton admitted but a month KIDNEY AFFECTIONS. 
105 
before. On May 19th, he suffered a slight relapse both of pain and vomit- 
ing, following a severe paroxysm of pains in the region of the left kidney, 
and relieved by a copious discharge of urine loaded with triple phosphate, 
and rapidly becoming alkaline and fetid. He appeared to recover from 
this in a few hours, and left the hospital strong enough to attend to his 
work, and apparently well; having continued the strychnia during six 
weeks, and taken altogether about eleven grains of that alkaloid. 
I am not aware of attention having been previously directed to the connec- 
tion of this condition of urine, and attending diuresis, with intense irrita- 
bility of stomach, or, at all events, of their standing to each other in the 
relation of cause and effect. I may venture to express my own convic- 
tion of the etiology of the case in a few words. A lad of delicate frame 
is engaged in laborious occupations, often far beyond his strength for 
years, during that part of life which is most susceptible to marked influ- 
ences ; functional derangement of the spinal marrow ensues, marked by 
the pain across the loins, and altered state of the urine. The stomach 
thus rendered irritable scarcely retains food, emaciation results, the patient 
is unable to obtain a sufficient supply through the medium of the sto- 
mach for the sustenance and reparation, much less for the increase of tissue. 
The necessary result is, his stunted growth, extreme emaciation, and the 
excretion of an unhealthy fluid from the kidneys, the necessary result of 
the impaired condition of the vital chemistry of these organs, itself an 
almost constant, although often transitory, result of the slightest mechani- 
cal injury to the spine. 
The strychnia was administered in consequence of its well-known influ- 
ence upon the functions of the spinal marrow, and believing that where 
alkaline urine is really secreted as such by the kidneys, independently, of 
course, of the character of the ingesta, there is always some lesions of 
that important structure. Its effects were certainly most satisfactory; for, 
after years of almost incessant vomiting, the patient soon acquired the 
power of retaining his food, the urine slowly losing its alkaline character. 
1 would, indeed, venture to press this important remedy upon the notice 
of surgeons, lo whose province cases of alkaline urine following injury to 
the spme more immediately belong. Nor can I avoid here taking the 
opportunity of alluding to the value of the drug in the distressing vomit- 
ing so frequent in uterine affections, especially in the irritable stomach of 
hysteiia, in which it is almost always successful as an important palliative. 
Part xiv., p. 98. 
Bright's Disease.—The diet must be free from fat, and from those non- 
azotized substances which are easily converted into fat; as starch and 
sugar. Enjoin a removal to pure air, regular exercise, attention to clean- 
liness, and temperature of the skin; and give tonics and other chalybeates. 
The congestion of the kidney will be relieved by attention to skin and 
bowels, but local bleeding may sometimes be cautiously employed. 
Part xv., p. 126. 
Depuration of the Blood.—It is found that the kidneys can depurate 
the blood, not only of matters generally regarded as proper to their func- 
tion, but of substances usually separated by other emunctories; in tact, 
they remove all soluble noxious matter. When, therefore, disease is 
excited or aggravated by noxious or lethal effete matter in the blood, we 
should endeavor to procure the decomposition and elimination of this 106 
KIDNEY AFFECTIONS, 
matter, by stimulating the depurating functions of the kidneys. And this 
may be accomplished by the exhibition of the alkalies, and their carbon- 
ates, citrates, acetates, and tartrates, which not only stimulate the 
kidneys, as do the vegetable diuretics, but also increase the metamor- 
phosis of tissue going on in the capillary system. (Bird.) Pt. xviii., p. 57. 
Case of Injury to the Kidneys.—In consequence of death in general so 
speedily following the suspension of the excretion of urea by the kidneys, 
owing to its consequent quick absorption into the blood, and poisonous 
influence on the brain and nervous system, it rarely happens that time is 
given for a practitioner to determine decidedly, both chemically and 
pathologically, that the comatose symptoms depend altogether on the 
non-elimination of urea by the kidneys. The following case, by Dr. Shear- 
man, from the attending circumstances, elucidates this point fully: 
Edward C , aged eight years, in perfect health, while at play was 
run over across the loins by a heavy truck. In two hours after the acci- 
dent I saw him. He was then in a state of collapse, and my impression was, 
that some internal hemorrhage was then going on, for he was blanched, 
cold, and pulseless. He complained of acute pain in the left lumbar region, 
which was very tender to the touch, spreading to both the inguinal and 
the pubic region. I gave him stimulants, and kept him warm, by which 
means, in the course of thirty-six hours, he gradually improved; and he 
then passed a large quantity of blood with his urine, not having previously 
voided any urine since the accident. This was repeated several times 
during the next twenty-four hours. 
I examined this urine and blood most carefully, but failed to detect the 
least particle of urea or urates in it. My little patient became restless; 
fever set in, with a pulse at 130; and the pain in the region of the kidneys 
increased, notwithstanding the application of leeches, etc. But these 
symptoms, in the course of two days, were succeeded by coma; he could 
not be kept awake. 
I now bled him in the arm, and reapplied leeches to the tender part. 
On examining this blood, urea was most distinctly detected in it, and in 
considerable quantity. The urine, at the same time, contained not a par- 
ticle of urea, urates, uric acid, or albumen, and its specific gravity was 
only 1.005. 
1 got him under the influence of mercury as quickly as possible ; as soon 
as its specific effect was apparent, urea gradually reappeared in the urine, 
and its specific gravity increased. By degrees the comatose symptoms 
subsided, and in the course of five weeks the usual health was reestab- 
lished. lie continues quite well. 
The mode of detecting urea in the blood, which I adopted, was the one 
recommeded by Dr. G. O. Rees (“On the Analyses of Blood and Urine, 
in Health and Disease,” second edition, page 40). Part xviii., p. 135. 
Diagnosis of Penal Disease.—An observation of great importance in 
the diagnosis of renal disease has been recently made by Dr. Johnson, viz., 
that disease of the kidney, of a recent acute nature, is indicated chiefly by 
the presence of fibrinous matter entangling “ entire epithelial cells ” with 
albumen, and very commonly blood; while, on the other hand, “granular 
particles of disintegrated epithelium” indicate a disease of a chronic cha- 
racter. Part xxiii., p. 136. 
BrighVs Disease.—Ascertain whether the coagulability of the urine KIDNEY AFFECTION8. 
107 
present depends on albumen, by the aid of heat first, and then by the ad- 
dition of nitric acid. All intercurrent diseases are more unmanageable, 
and more apt to prove fatal, in consequence of the renal disorder. The 
most mortal of all signs are, a very scanty urine of very low density, an 
extremely impoverished condition of the blood corpuscles, and stupor 
gradually verging toward coma. The treatment of Bright’s disease is 
two-fold; to remove the fundamental disease, and to cure the secondary 
di seases. The main remedies for the former object are general and topical 
depletion, local counter-irritation, diaphoretics, diuretics, and astringents. 
The best diuretics are digitalis, squill, and bitartrate of potash, but when 
all these have tailed, diuresis has been established by Hollands. The 
cathartic plan should not be adopted for the dropsy; it is apt to excite a 
permanent diarrhoea, and mercury should be shunned as inducing in this 
disease excessive action. The best remedy for the diarrhoea is the Edin- 
burgh lead and opium pill, in a dose of five or ten grains, twice or three 
times a day, to which may be added, in severe cases, a fatty suppository 
of morphia. Vomiting may be removed sometimes by bismuth, more 
frequently by morphia, hydrocyanic acid, creasote, chloroform, or little 
fragments of ice ; when these fail, by a blister applied over the epigastrium. 
Part xxiv., p. 142. 
Bright's Disease.—Dr. Jones looks upon the fibrinous cylinders which 
are found in the urine in this disease to be produced by congestion, caus- 
ing effusion of liquor sanguinis, and thus fibrin and albumen being effused 
together, the fibrin coagulating in the ducts producing the cylinders, and 
the granular matter within them. When these appear in the urine, Dr. 
Jones always suspects the presence of granular disease of the kidney. Dr. 
George Johnson was the first who attempted the solution of the problem 
between this deposit and granular degeneration. Dr. Johnson subse- 
quently extended his views, and distinguished four conditions of the kid- 
ney : 1. Acute desquamative nephritis. 2. Chi’onic desquamative nephri- 
tis. 3. Simple fatty degeneration. 4. Fatty degeneration with desqua- 
mative nephritis. He imagined that the microscope would enable us to 
distinguish the sediments peculiar to each of these several diseases, but 
the sediment unfortunately in the same case varies exceedingly at different 
periods. Sometimes even microscopic examination tails altogether when 
the chemical evidence has been decided enough. 
[With regard to the treatment.] 
The intense action of mercury in Bright’s disease has so frequently and 
so forcibly been presented to my notice, that I have formed a general rule 
never to give mercury in cases of albuminous urine. I have seen the most 
violent salivation from single doses even of grey powder, and on this ac- 
count, even in serous inflammation consequent on Bright’s disease, I 
advise you not to give mercury. Why mercury should act so energeti- 
cally in this disease is probably explained by the altered state of the kid- 
ney. In health, most probably, mercury no sooner passes into the system 
than it begins to pass out again by the kidney, like hydriodate of potash 
or the salts of iron. For example, if a single grain of hydriodate of potash 
is taken in an ounce of distilled water, in twelve minutes it can be detected 
passing off in the urine ; but if the kidney is diseased, then most probably 
this rapid excretion does not so easily take place, and the intensity of the 
action of this and other medicines may thus be greatly increased. 108 
KIDNEY AFFECTIONS, 
In the treatment of urinary poisoning, I know no single remedy which 
has produced an effect at all equal to that of a blister on the back of the 
neck. This appears to me to indicate that there is some local congestion 
of the brain, as well as some poison in the blood. I have as yet had no 
good opportunity for trying what the free administration of vegetable 
and mineral acids can do when head symptoms are present; in one case, 
large quantities of lemon-juice appeared to have a beneficial effect. The 
theory of Dr. Frerichs indicates the acid treatment, and it is worthy of a 
fair trial. 
Dr. Watson is, without doubt, right in saying that these head symp- 
toms may arise from insufficient supply of blood. Just, as in children, 
symptoms resembling hydrocephalus may arise from anaemia, when, in- 
stead of depletion, counter-irritation and stimulants are required. On 
this theory, no poison is considered to be present in the blood. The truth 
probably is, that too little blood, too much blood, and poisoned blood— 
each of these states, in different cases, is the cause of the head symptoms 
in Bright’s disease. 
As 1 cannot make any separation of Bright’s disease into different dis- 
eases, so I am unable, from observation, to find that different kinds of 
treatment are desirable. The indications are, first, to relieve the con- 
gested kidney; and, secondly, to improve the general health. Gentle but 
decided action on the skin and bowels appear to me best to fulfill the first 
indication ; cupping, vapor-bath, and elaterium, are the three most ener- 
getic remedies; cream of tartar, compound jalap powder, and abstinence 
from stimulants, are the milder agents. To improve the health, proper 
air, exercise, food, and small doses of iron, are essential. 
Specific treatment by gallic and nitric acid has not benefited my pa- 
tients in St. George’s Hospital. In so-called chylous urine, I know well 
the use of gallic acid, in doses of two drachms daily; but, in Bright’s dis- 
ease, when ten-grain doses were given, I have more than once known bad 
symptoms to occur. In one case, violent convulsions made their appear- 
ance soon after the gallic acid was taken. In no case have I found 
that it stopped the albumen from passing away. I may here mention, 
that tannic acid appears to affect the stomach much more than gallic acid 
does. 
With regard to the treatment by nitric acid, which has been extensively 
tried in Germany, I have not found any good result,, even when dilute 
nitric acid has been taken daily for many weeks. 
As to the result of treatment, omitting the cases which follow scarlet 
fever, which constantly recover perfectly, temporary relief is generally all 
that is obtained. Life may be prolonged for years. Even with ascites, I 
have known a patient in and out of St. George’s Hospital for ten years. 
Usually, although every complication may be removed, the albumen con- 
tinues in the urine. The patient resumes his work, and considers that he 
is recovered; but heat and nitric acid show that this is not the case; and 
it is only by great care that the tendency to a return of the former symp- 
toms, or to gout, can be prevented. Part xxv., p. 126. 
Bright's Disease.—Urea in this disease accumulating in the blood, is 
best eliminated by the administration of colchicum. Part xxv.,p. 142. 
Penal Disease—Acute.—Dr. Johnson correctly remarks, how very 
frequently acute renal diseases, with dropsy and albuminous urine, are 109 
KIDNEY AFFECTIONS. 
preceded by chills upon the surface, produced often by working or stand- 
ing in wet clothes. The same in cases occurring after scarlatina: hence it 
is, that the chief means of preventing consequences ensuing after scarlet 
fever, are protection from cold until the period of desquamation has passed 
by. The circumstances under which these attacks of acute renal disease 
occur, and. of the appearances observable in the urine and in the kidneys, 
warrants the inference, that the renal changes are the result of an effort to 
eliminate some abnormal products, which have been conveyed to the kid- 
neys by the blood. In cases of scarlatina, for instance, it is probable that 
exposure to cold has the effect of checking the process by which the fever- 
poison, or ferment, or the product of fermentation, is eliminated from the 
skin, and that the morbid materials are then transferred to the kidney, in 
accordance with the well-known tendency to vicarious action of the skin 
and kidneys. An instructive illustration of this principle is afforded by 
the fact of several medicines, such as, for instance, the acetate or citrate 
of ammonia, acting either as diaphoretics or diuretics, according as the 
tendency is imparted to them by the skin being kept warm, or the con- 
trary. These facts may assist our comprehension of what probably hap- 
pens when a patient is exposed to cold too early after the onset of scarla- 
tina. The work of elimination is then transferred from the skin to the 
kidney; and, as a result of this, there is, in some instances, a free desqua- 
mation of the renal epithelium, analogous, as it appears, to the cutaneous 
desquamation which follows the eruption of scarlatina. 
Where we have albuminous urine and dropsy, the greatest possible 
care should be taken to guard against cold, because it is the chief cause 
in the production of renal disease, and therefore must tend to perpetuate 
it, if it already exist. In cold weather the patient must be absolutely 
compelled to keep in bed, both on account of insuring the horizontal po- 
sition, and also the equable warmth of the skin. The diet should be scanty, 
and, unless specially indicated, alcoholic stimulants should not be given. 
The next thing is to obtain free action of the skin and bowels ; the first by 
the hot-air bath and diaphoretic medicines, the latter by saline aperients, 
and the pulv. jalapse comp. 
The free action of these great excretory surfaces is a very efficient means 
by which to lessen the injurious over-work of the kidneys. It scarcely 
need be said, that however scanty may be the urine, no stimulant diuretic 
is to be given ; indeed, the more scanty the secretion, the more injurious 
would be the effect of any irritating drug. 
During the convalescence, the urine is usually twice as abundant as in 
health, in consequence, probably, of the naturally diuretic influence of the 
urea and other urinary products which, having accumulated in the blood 
during the acute stage of the disease, find a free outlet when that stage is 
passed. A practitioner who has been perseveringly giving diuretics, and 
who is ignorant of this pathological fact, will be likely to attribute to the 
influence of his drugs this abundant flow of urine, which is, in fact, only a 
natural and a spontaneous diuresis. 
It will be understood that, in deprecating the use of diuretics, it is only 
with reference to cases of acute renal disease. When the disease has be- 
come chronic, and when an excessive dropsical accumulation constitutes 
the most distressing and dangerous symptom, we must endeavor to re- 
move the dropsical accumulation by means of diuretics, whether these 
accelerate the progress of the disease in the kidney or not. 110 
KIDNEY AFFECTIONS, 
After the acute stage of nephritis has passed, Dr. Johnson recommends 
that the patient, especially in winter, be kept in-doors, until no albumen 
can be detected in the urine. If he rebels, he will very probably bring on 
a relapse, of which he should be warned. If, after every precaution has 
been taken, and the period of confinement prolonged, still the urine con- 
tains albumen, though natural in other respects, gallic acid may be given; 
and if after this the quantity of albumen continues, Dr. Johnson advises 
that he should be removed to the sea-side, and allowed to take a daily 
airing. If the malady still persists, and assumes a chronic form, the pa- 
tient must be urged to take a sea voyage as early as possible. As to the 
treatment of cerebral symptoms, consequent on acute inflammation of the 
kidneys, as after scarlatina, or exposure to cold, we must relieve the con- 
gested state by cupping over the region of the kidneys, and abstracting a 
moderate quantity of blood, and by exciting free action in the mucous 
membrane of the bowels, by means of elaterium or pulv. jalap, co., with a 
few grains of calomel sometimes added. 
If we can excite copious discharges from the mucous membrane of the 
bowels, we shall by that means eliminate some of the excreta which are 
poisoning the blood, for urea has been detected in the watery stools pro- 
duced by elaterium. 
It' the patient’s appearance be not decidedly anaemic, we may venture to 
abstract a small quantity of blood; but we shall do this with much caution, 
if we bear in mind Dr. Watson’s suggestion—sanctioned, too, by the high 
authority of Dr. Todd—that an impoverished condition of the blood may 
favor the tendency to coma and the poisonous action of urea. Cold lotions 
may be applied to the head when the scalp is hot, and blisters when the 
skin is cool. Since, in any case, it is a more hopeful task to prevent drowsi- 
ness from passing into coma, than to bring a patient out of a comatose 
condition when once he has fallen into it, it is important to keep a watchful 
eye upon the premonitory symptoms. In sbme cases, it appears that the 
most successful mode of keeping them in check is to give a nutritious but 
unstimulating diet, with moderate doses of steel, and, at the same time, to 
keep up a free action of the bowels. 
Can the kidney perfectly recover from an acute inflammatory attack ? 
Dr. Johnson answers, yes, if the case has come early under treatment, and 
yielded to it in moderate time. No harm will result, except the spoiling 
of a few of the tubes and wasting of the parts, unless the disease has been 
so long prolonged as to destroy the epithelial lining of the tubes and ren- 
der them liable to be converted into cysts. Part xxviii., p. 134. 
Passive Hemorrhage from the Kidneys.—[It is not always easy, when 
we are quite certain that the urine contains blood, to be able to state defi- 
nitely from what part of the urinary apparatus it proceeds. Dr. Crooke is 
of opinion that it often precedes that condition in which albumen is present 
in the urine, viz., “ chronic albuminous nephritis /” and that it often in- 
sidiously follows “ acute desquamative nephritiswhich is supposed to 
have yielded to treatment.] 
/Symptoms.—Passive renal hemorrhage offers to our notice two classes 
of symptoms—the general and the local. The general are those of anemia, 
the result of a continual draining away of that vital fluid, the blood ; the 
local refer chiefly to the bladder. The general symptoms are, a pallid 
complexion, of a dirty-white or muddy color; with dilated pupils; occa- KIDNEY AFFECTIONS. 
111 
sional headache and singing in the ears; the tongue is large, flabby and 
furred, the edges thereof indented by the teeth; the bowels are open and 
loose ; there is much flatulence and nausea, with irregular appetite; palpi- 
tation is frequent; the surface of the body is cool; the skin soft and re- 
laxed, but dry ; the pulse full, soft and bounding, or small and soft, putting 
on the former condition upon change of posture; there is gradual but pro- 
gressive emaciation, irritability and gloominess of temper, with great dis- 
inclination to any exertion, bodily or mental. These symptoms vary in 
degree according to the longer or shorter duration of the disease. 
2d. The local symptoms are in some cases an aching pain in the loins, 
but this is, perhaps, rather an exception than the rule. They, the loins, 
are rather the seat of an uneasiness and feeling of weakness, which is in- 
creased upon pressure; the calls to micturate are frequent and urgent, 
attended with pain, sometimes referable to the penis, sometimes to the 
inside of the thighs and to the perineum; the urine is not much, if at all, 
increased in quantity when compared with the amount of fluids imbibed. 
Treatment.—The therapeutical indications are tln-ee in number. First, 
to check the hemorrhage by relieving the congestion; secondly, to restore 
the general health; thirdly, to guard against relapse, and this is an import- 
ant point, as there is a great tendency thereto upon the application of any 
exciting cause. The first indication may be effected by rest, daily use of 
the warm bath, with friction to the bodily surface, local depletion, absti- 
nence from diuretic drinks, bland farinaceous diet, and the use of astringent 
remedies. To relieve the gastro-hepatic derangement, a small quantity of 
blue pill, with a sedative saline draught, will be found useful at intervals 
during the exhibition of astringent remedies, the best of which is gallic 
acid. It has been given in the following form: Gallic acid, a drachm; 
dilute hydrochloric acid, two drachms ; solution of hydrochlorate of mor- 
phia (E. P.), one drachm ; distilled water, five ounces and a half, as a mix- 
ture ; a tablespoonful to be taken every fourth hour. The therapeutical 
effects of gallic acid are well described by Dr. Golding Bird : “ Gallic acid 
acts as a direct astringent, reaching the renal capillaries, and finding its 
way into the urine, which becomes strongly charged with it,” etc. To 
relieve the irritability of the bladder, five grains of soap-and-opium pill 
should be used every night as a suppository. These medicines should be 
continued until the hemorrhage ceases, and the vesical irritability which 
remains for some time after the cessation of the hemorrhage is relieved by 
tincture of eantharides, in doses of from ten to twenty drops, combined 
with an anodyne. When the urine is free from blood discs, the general 
hygienic rules for restoring tone to the system should be enforced; animal 
diet, with a few glasses of sherry daily, may be allowed, and quinine with 
iron prescribed. As preventive measures, the warm bath with friction 
should be daily persisted in; flannel should be worn next the skin, and all 
exposure to exciting causes studiously avoided. Part xxix., p. 147. 
Kidney—Irritation and Inflammation of, from a Calculus.—Prevent 
the increase of the concretion by correcting the unhealthy state of the 
urine according as acid, alkali, or oxalate of lime, predominate. Avoid 
severe exercise. Allay pain by the hottest hip-bath, at a temperature of 
110° or 112° Fahr.; by chloroform internally and externally; by opium 
and the injection of warm water into the rectum. Guard against inflam- 
mation, by general or local bleeding; by aperients and sudoritics. 112 
KIDNEY AFFECTIONS. 
The complaints which may be mistaken for a nephritic attack are lum- 
bago and colic. The absence of vomiting in lumbago, and the seat of pain 
in colic, may lead you to a correct opinion; but the presence of blood- 
globules when the urine is examined with the microscope, is the sure indi- 
cation that the attack is caused by the descent of a renal calculus, and the 
affection of the testicle may be generally found confirmatory of this opinion. 
Do not think that in every case in which blood is found by the microscope 
in the urine a calculus necessarily exists in the kidney. Blood globules 
may appear in the urine from simple congestion of the kidney in many dis- 
eases—from Bright’s disease, from inflammation of the mucous membrane 
alone, from congestion or disease of the prostate, from scrofulous disease, 
or malignant disease ; and in some of these diseases the difficulty of dis- 
tinguishing between them and renal calculus is by no means easy. (Jones.) 
Part xxx., p. 85. 
Malignant and Scrofulous Penal Disease.—Renal diseases are often 
very difficult of diagnosis. We ask ourselves first, perhaps, whether it be 
Bright’s disease; next, whether any concretion be present, or whether in 
flammatory action exist; and, lastly, we ask whether the case be one of 
malignant or scrofulous disease. Neither malignant nor scrofulous disease 
admits of easy relief, and, therefore, the medical attendant should be care- 
ful in giving his prognosis. 
Sometimes, says Dr. II. B. Jones, no urinary symptoms whatever are 
observed, the malignant disease existing in another more vital part, caus- 
ing the renal disease to be entirely overlooked. 
Sometimes another urinary disease exists at the same time, and thus the 
symptoms are made obscure. Thus granular disease of the kidney may 
exist with encephaloid disease, and the secondary symptoms produced by 
the former may alone force themselves on the attention. 
As far as I have hitherto observed, the microscope has not enabled me 
certainly to predict the presence of malignant disease of the kidney. I 
must say the same of incipient malignant disease of the bladder. The 
symptoms of this disease are more distressing than when the kidney is 
alfected; but even when I have felt confident of my diagnosis, I have some- 
times been unable to confirm it by the microscopic discovery of malignant 
cells, in consequence of the highly alkaline urine acting on the cells. In 
other cases, in which small masses of malignant matter were passed, the 
microscope has confirmed the diagnosis which the general symptoms had 
made most probable. Nor has the microscope as yet enabled me to speak 
certainly regarding the commencement of scrofulous disease. The means 
of distinguishing between scrofulous disease and calculus of the bladder 
or kidneys, are very insufficient; but by careful attention to the progress 
of the symptoms, more certainty may be attained than by help of the 
microscope. 
In conclusion, then, as no certain microscopic or chemical test exists for 
the early stage of scrofulous and malignant disease, it will be best, in 
doubtful cases, to refuse to give a positive opinion. Suspend your diagno 
sis until, by carefully watching the progress of the case, you find sufficient 
evidence of the nature of the disease. Part xxx., p. 87. 
Morbus Prightii.—According to Dr. Handheld Jones, this is net an 
inflammatory affection, but purely a disease of depraved nutrition; there- 
fore, you must endeavor to improve the general vigor and power of the KIDNEY AFFECTIONS. 
113 
system, and therewith its nutrition, in every possible way. After the 
dropsy is removed, you must still continue your treatment until the urine 
is restored to its healthy condition, the blood improved, and the system 
reinvigorated. The following is very useful in these cases: R Acid, nitrici, 
ntiij.; tinct. cinchon., 5j.; inf. gent, co., $j. Ter die. R Tinct. ferri mur., 
rnx.; aquje, jj. Ter die c. cibo. Part 100. 
Iodide of Potassium in Dropsy, with Bright1 s Disease of the Kidney. 
—In the sub-acute or chronic form, give five grains of iodine and five 
grains of bicarbonate of potass in one ounce of water three times a day. 
It has been very successful in reducing the general anasarca and improving 
the condition of the health. Part xxxii., p. 103. 
Supra-Benal Capsules—Disease of—The combination of the bronzed 
state of the skin with great systemic debility may be held indicative of dis- 
ease of the supra-renal capsules; and the more marked these conditions 
are, the more positively may the opinion be formed. A differential diag- 
nosis may sometimes be requisite, however, as regards the following dis- 
eases : 1. Jaundice. In some states of chronic jaundice, the skin maybe 
brown rather than yellow, and great vital depression may exist. Here, 
however, the conjunctiva and the matrices of the nails would, by their dis- 
colored state, prevent the possibility of deception. The tint in jaundice 
is also a diffused one, and does not occur in patches, as in true bronzing. 
2. Browning from exposure to the sun, etc. In these, the examination of 
parts protected by the clothes would generally be sufficient to prevent 
error. 3. Pityriasis versicolor. The patches of pityriasis versicolor some- 
times remarkably resemble those of the bronzed skin. Their limitation 
to the abdomen and chest, their defined outline, their furfuraceous surface, 
the slight itching which attends them, their contagious character, and 
above all, the microscopic examination of the cuticle, furnish, however, 
abundant means by which to distinguish between the two. 4. The dif- 
fused brown muddiness of some other cachexice. The dark areola round the 
eye, so often seen in states of disordered menstruation, is in rarer cases 
found coincident with a loss of healthy tint in the skin generally, which 
assumes a dirty, sallow brownish appearance. This, in exaggerated in- 
stances, might be mistaken for bronzing. 
It should be borne in mind that in all cases, in which bronzing is to be 
held as positively indicative of diseased capsules, there ought to be traces 
of patching and mottling in some parts, and that in proportion as the tint 
is equally diffused over the whole body is the diagnosis doubtful. 
We can never give any other than an unfavorable prognosis—no re- 
covery from true bronzing of the skin has ever been recorded; but as we 
believe that the changes which the supra-renal bodies undergu, are allied 
to inflammation, we should expect the most benefit from mercury, in very 
small doses, or the use of iodide of potassium—the patient’s strength be- 
ing meanwhile supported by a nutritious, but non-stimulating diet. 
Part xxxiii., p. 129. 
Brights Disease.—Liquor ammonije acetatis, by acting on the skin and 
relieving the congested condition of the kidneys, is the best of all remedies 
for this disease; diuretics at the same time being strictly avoided, but not 
mercurials. (Dr. Addison.) Part xxxiii.,p. 237. 
Frequent Micturition.—Dr. G. Owen flees, gives the following: 
VOL. II. 8 114 
KIDNEY AFFECTIONS. 
Among the causes of frequent micturition is renal calculus. In this dis- 
tressing affection little or nothing can be done. To the patient’s own 
feelings the bladder is often the seat of the disease, and even by medical 
men these cases have been mistaken for irritation of the neck of the blad- 
der caused by stricture, and the most lamentable results brought about by 
the violent measures resorted to for relief. A correct diagnosis may how- 
ever generally be formed. 
Frequent micturition, with small quantities of pus in the urine, loin pain 
and lassitude, if we have an early history of hematuria, should guide us to 
diagnose renal calculus ; and even if frequent micturition and a small 
quantity of pus be the only symptoms, we shall generally be right in giv- 
ing the above opinion, even if history fail to afford us evidence of hema- 
turia. The presence of a small quantity of pus in the urine would appear 
easily explained in its relations to renal calculus. 
The hollowing out of the nephritic structure, which we find occurring in 
order to make room for calculi about to become encysted in the kidneys, 
must have been effected by a gradual process of disintegration, and this 
we know is preceded by inflammation. The purulent discharge would 
thus seem to attend the formation of a convenient cavity for the lodgment 
of the calculus. So long as this action is going on, the patient will pass 
pus in the urine, and it may be some years before matters are adjusted. 
The constitution has much to go through. A scrofulous taint leads to ab- 
scess in the kidney, and death. The more fortunately constituted gene- 
rally do well, provided they can be induced to avoid the catheter and the 
sound. 
In speaking of the condition of the urine in this calculous affection of the 
kidney, I have made use of a somewhat indefinite expression, viz., “ a 
small quantity of pus.” By this I would wish my readers to understand 
a urine depositing a yellowish-white sediment, but not in such quantity 
that the patient’s attention need be attracted by it. It renders the urine 
but slightly turbid as it is passed, or when the deposit is shaken up 
in it. 
This is the general state of things when nephritic calculus is encysting, 
or when it fails to find its way down the ureter, provided constitutional 
causes do not interfere to produce suppurative disease, which may appear 
in the form of pyelitis or of general abscess of the kidney. This purulent 
impregnation is constant, and, if it fail to show itself so as to be evident to 
the unassisted eye, the microscope rarely fails to demonstrate the presence 
of pus so long as the bladder is irritable. 
There is a cause for frequent micturition so nearly connected in its 
symptoms with that last noticed, that it naturally suggests itself in this 
place. It consists in a state of kidney known as strumous kidney, or 
phthisical kidney, as some authors have designated it. If calculous disease 
develop itself in a strumous subject, we find very early that abscess 
results; but in all subjects some amount of pus may be expected during 
the time of encysting. In phthisis of the kidney, however, the bladder 
becomes irritable without any evidence of a calculous disposition ; and we 
find that pus can be clearly proved in the urine. The symptoms are gene- 
rally at first considered to depend on calculus, and it too often happens 
that the disease has made great progress before the real state of the case 
becomes evident. The symptoms are at first nearly identical with those 
of nephritic calculus. The same degree of sharp lumbar pain, however, is KIDNEY" AFFECTIONS. 
115 
not present, and there is no history of hematuria; but the symptoms pre- 
senting themselves at the time of examination bear a striking similarity ; 
and if the previous history be not ascertained, a diagnosis is next to impos- 
sible. It is both for the advantage of the practitioner and of the patient 
that this distinction should be early made; for if calculus be the exciting 
cause, of course our prognosis will be more favorable. 
The two points for consideration are—1st. The diathesis of the patient. 
2nd. The history as to hematuria. If frequent micturition and purulent 
urine, such as 1 have described, be present in a strumous person, and we 
have no history of hematuria, we may diagnose phthisis of the kidney. 
If frequent micturition and purulent urine coexist with a history of hema- 
turia, then, in all probability, there is calculus. We must not conclude, 
however, that because calculus is present we have no fear of the worst 
results, for if the patient be of strumous habit, abscess may result as a con- 
sequence. In all cases, however, the history of hematuria is an advan- 
tage, inasmuch as even should the patient be strumous, the calculus may 
be voided, and, the exciting cause of mischief being thus removed, the 
kidney may recover itself, and the patient do well. 
Amongst causes for frequent micturition, we find diabetes enumerated. 
The quantity passed on each occasion is, however, so large, compared with 
that characterizing most of the other states I have described, that the pa- 
tient’s attention is attracted by the large discharge, as well as by the frequent 
call, and the former is related as the more prominent symptom. This should 
lead at once to the examination of the urine for sugar, and if that be not 
found, we may perhaps determine the presence of insipid diabetes by the 
low specific gravity, the increased flow, great thirst, and other character- 
istic symptoms. It does, however, now and then happen in diabetes that 
frequent call to pass urine has been the symptom most noticed by the 
patient, and then, if due care be not taken, the practitioner is a long time 
led astray. Cases such as these by no means infrequently occur. They 
are sometimes treated as dependent on the gouty diathesis, a uric acid 
deposit having attracted the attention of the medical attendant. Treat- 
ment is then persevered in until all the more aggravated symptoms of dia- 
betes appear. The early detection of this disease, which is so important 
for its relief, is thus prevented. 
I now have to speak of two forms of cancerous affection which may pro- 
duce frequent micturition, viz., malignant disease of the kidney and of 
the bladder. These two states are characterized by hematuria. It some- 
times happens that the irritability of the bladder is so great, when the 
kidney alone is involved, that this sympathetic affection may be mistaken 
for the primary disease, and the nephritic mischief entirely overlooked. 
What I would wish to enforce is, that these two symptoms, hematuria 
and frequent micturition, taken together, should be regarded (the pros- 
tate being excluded) as indicating calculus or malignant disease, and that 
either the kidney or the bladder may be in fault. The indications of 
cystitis, shown by the urine when calculus exists, have been already dwelt 
upon; but when malignant disease is present, there may be none of these. 
The urine may be clear, or may only contain such a small quantity of 
blood that very careful examination is requisite in order to detect it by 
the naked eye. Here the kidney might be considered in fault, and the 
diagnosis is not always to be made. 116 
SIDNEY AFFECTIONS. 
If we have a tumor of the abdomen over the region of the kidney, 
then we may safely diagnose that organ involved ; but this indication is 
not always afforded us, and then we should examine the bladder very 
carefully. If, on sounding, hemoi’rhage occur to an extent exceeding that 
usually produced by exploration, there is most likely a growth on the 
mucous surface of the bladder. 
Before leaving this part of my subject, I must say a word or two 
respecting the seat of tumor in these forms of disease. First, with regard 
to the kidney. It is necessary to guard against being led astray by the 
tumor appearing in a position somewhat removed from that in which it 
ordinarily exists. Nephritic enlargement sometimes occurs at the upper 
portion of a kidney, and in abscess of the organ especially, there is often 
considerable bulging upward. This may occur to such an extent that the 
tumor eventually may be felt in that part of the abdomen usually occu- 
pied by the liver, and in malignant affections also, if the right kidney be 
involved, the tumor may exist over nearly the whole of the right hypo- 
chondriac region. An able paper will be found in the “ Guy’s Hospital 
Reports,” in which Dr. Bright has given sketches illustrative of this fact. 
As regards the production of frequent micturition by malignant disease 
of the bladder, the tumor must be situated near the neck of the organ in 
order to cause the symptom. I have had two cases within the last few 
years especially illustrative of this point. In the one, so little inconve- 
nience was felt that had it not been for the microscopical indications of the 
urine, I should have inevitably mistaken the disease. There was no in- 
creased desire to pass urine, and no pain; and hematuria was only an 
occasional symptom. Post-mortem examination showed the advantage to 
be derived from microscopic research, the diagnosis being verified by the 
presence of a large mass of villous growth on the fundus of the bladder. 
The situation of the tumor, far removed from the neck of the organ, 
explained the absence of the symptom of frequent micturition. In the 
other case, a tumor of the same kind existed near the neck of the bladder, 
and the irritation was most torturing. The symptoms otherwise exactly 
resembled those of the former case. There was the same hemorrhage 
after sounding, and hematuria was of very frequent occurrence. I have 
spoken of certain microscopical appearances which determined my diagno- 
sis : these were merely such as I have detailed in former lectures, consist- 
ing in the presence of those corpuscles or cells which are found in the 
villous growths from mucous membranes, and which, when they can be 
satisfactorily determined to exist in the urine, are always most significant. 
Before leaving the analytical symptomatology of frequent micturition, I 
•would speak of the influence of habit and of nervousness in continuing the 
symptom, even after the obvious causes producing it are removed. With 
regard to habit, it is in some cases of the greatest importance to inform the 
patient of his position, and to instruct him to restrain himself as much as 
possible. If he will do this, his malady becomes of necessity of shorter 
duration. We often find the subjects of this symptom acquainted with 
every corner suitable for the relief of their wants. They are reminded of 
their malady on approaching their vronted haunts. An effort is required 
to pass them, and it is well to instruct such patients to make a point of 
doing so if they possibly can. The nervous feeling which arises in suffer- 
ers from tins infirmity when they find themselves in company is very dis- 
tressing. They are certain to feel the inclination when there is the greatest KIDNEY AFFECTIONS. 
117 
difficulty in gratifying it. They consequently refuse to go into society. 
They are, perhaps, urged to do so; they suffer great misery, and their 
complaint becomes aggravated. This should never be allowed. Let them 
avoid company, and as their complaint improves they get more courage ; 
and there is no fear of a return of this nervousness, except they again 
become the subjects of those physical ailments which originated the 
disease. Part xxxv., p. 310. 
Movable Kidneys.—A knowledge of the fact that the kidneys may, in 
a healthy person, be in abnormal position in the abdomen, and detectible 
by external manipulation, is important, lest any errors in diagnosis should 
be caused from suspecting the presence of some malignant or otherwise 
dangerous tumor. In these cases the mass is smooth, hard, and resisting, 
rounded in outline, can be moved upward and slightly downward. 
Part xxxvii., p. 84. 
Brighfs Disease.—Our diagnosis as to the state of advancement of this 
disease will be materially assisted by observing the size of the waxy casts, 
which increases in diameter as the disease progresses, owing to the tubes 
becoming denuded of their epithelial lining. 
The larger casts, which have the full diameter of the uriniferous tubes, 
and a remarkably sharp outline, having been formed in tubes which have 
lost their epithelial lining, and with it their proper secretory function. 
These large casts then indicate a more serious degeneration of the tubular 
structure than the small ones. They are often combined in the urine of the 
same patient, but the existence of a large proportion of the full-sized wax- 
like casts in the urinary sediment is usually a sign of serious import, and 
indicates an advanced form of disease. Part xxxvii., p. 89. 
Employment of Sugar in the Dyscrasia attending Bronzed Skin.—Dr. 
Todd, in a case of bronzing of the skin under his treatment in King’s 
College Hospital, ordered the free dietetic employment of sugar. The 
patient, a woman, is believed to have derived considerable benefit from it 
in relief to the malaise and debility from which she suffered. The theory 
of the treatment is, we believe, based on the belief, founded on analyses of 
the blood, that the sugar-making function of the liver is interfered with by 
the disease. Part xxxvii., p. 104. 
Addison’s Disease—Case of Diseased Super-renal Capsules, with 
Asthenia.—A young man died lately at Guy’s Hospital, who was affected 
with the asthenia or debility to which Dr. Addison has drawn attention in 
his curious monograph—an affection now pretty generally known in prac- 
tice as “ Addison’s Disease.” The duskiness or blotching of the skin was 
peculiarly well marked, for a period extending over two years, and of a 
deeper tinge at the navel, nipples, and scrotum. He had dizziness and 
failure of vision on attempting to walk, and no appetite. He was laboring, 
in fact, under what is called at Guy’s, by some, as “ Asthenia Addisonii.” 
We believe the term “Melasma” gives a very absurd idea of the dis- 
ease ; and the word “ bronzing ” Dr. Addison has, over and over again, 
repudiated, as not occurring in any of his writings on the disease. 
Post-mortem Apjpearance.—The color of the darker portions of the skin 
was very deep, something between the tinge of the quadroon, and the 
greenish brown of some bodies long kept in the dead-house ; the axilla, 
umbilicus, and genital organs, were particularly dark or blotched; the 118 
LABTUM. 
margin of the lips also were dark; the hair darkish ; eyes grey; the mucles 
were red and of good size; the contents of the chest presented nothing 
abnormal; the brain was healthy ; the lungs—with the exception of the 
apex of the right lung—were healthy; the heart was small, but firm, red, 
and healthy ; the veins full of blood ; the mucous membrane of the stomach 
was very much injected, and the surface covered with tenacious mucus, as 
if a low form of gastritis existed ; intestines healthy ; mesenteric and other 
glands healthy, as were the liver, spleen, and pancreas. Coming to 
the suprarenal capsules, they were found to be entirely destroyed, by a 
deposit of an albuminous cretaceous deposit; there appeared, also, signs 
of inflammation of their investing capsules, as the latter were firmly adhe- 
rent to surrounding parts; the right capsule was thus united to the liver 
and top of the kidney, and the surrounding fat could not be removed in 
the ordinary way ; the right capsule was about the size of the healthy 
organ, but the left was puckered into a roundish mass about the size of a 
walnut; both, in fact, seemed filled with a cretaceous matter, or white 
amorphous substance like tubercle; the right capsule was softened in its 
middle, containing a fluid like pus. In rough terms we would say the cap- 
sules, as is usual while they are diseased, in this affection, were full of a 
chalky, tuberculous matter that injured the nervous tissues around them. 
The most suggestive feature in the case, in fact, was the condition of 
the semilunar ganglion, the nerve branches of which ran quite into the 
diseased capsules, and were lost in them. 
We need only say the pigmentary matter in the skin presented nothing 
of importance, being found in the rete mucosum, where it was probably 
deposited in a passive manner; the destruction of the semilunar ganglia 
prevented its normal assimilation or absorption. 
This disease is not so much due to any vital action which the supra-renal 
capsules perform in the economy, as to the pressure or injury exerted by 
the enlarged organs on the semi-lunar ganglia and solar plexus, with both 
of which the capsules are intimately associated. Dr. Habershon adopting 
this view, first proposed by Dr. Copland, treated this case by the use of 
electricity, together with bark and iodide of potassium. Considerable relief 
was afforded. Part xxxviii., p. 114. 
Case of Encysted Tumor of the Labium.—Dr. Macdonnell was con- 
sulted by a lady on account of a tumor in the labium, of three years’ du- 
ration, which presented some of the characters of hernia. It differed, how- 
ever, from that disease in so many respects as to justify, in Dr. Macdonnell’s 
opinion, exploration. The following is the account he gives of the treatment: 
March 20th. An exploratory puncture was made, and water of a dark 
olive color, devoid of odor, escaped. The opening was enlarged, and a 
tumblerful of thick fluid flowed out, which was of a creamy consistence, 
and on microscopic examination was found to be composed of decomposed 
pus globules, with a large quantity of what appeared to be epithelial 
scales intermixed. The sac of the tumor was freely cauterized with 
nitrate of silver conveyed on a probe, and the orifice kept open by means 
of a plug of lint. 
LABIUM. 119 
LABOK. 
27th. The sac of the tumor has been filled up with solid secretion, and 
has undergone great diminution in siz'e; no general disturbance. 
April 1st. Scarcely any trace of the tumor to be detected, except some 
thickening of the labium, giving to it a greater fullness and prominence 
than the other. Ordered to apply mercurial ointment. 
10th. Perfectly recovered ; no traces of the disease left. 
Four plans of treatment have been recommended for the cure of these 
tumors: 1st. Complete dissection out of the whole cyst—apian which must 
be extremely difficult in most cases, in all extremely painful, and in such 
a case as mine quite impracticable. 2d. Laying open the cyst, and fill- 
ing it with charpie. 3d. Seton. 4th. Removal of the fluid, and then com- 
pression, so as to bring the walls of the cyst into close apposition. The 
plan of treatment which I have employed for some years past has been to 
cauterize with nitrate of silver the lining membrane of the cyst, so as to 
cause adhesive inflammation, and this process I have found to be so readily 
excited by the caustic, that I have never been obliged to repeat it a second 
time. Part xix., p. 271. 
Fibrous Tumor of the Labium.—In a case of this nature, in Guy’s Hos- 
pital, Mr. Massey made an incision in a longitudinal direction from one ex- 
tremity of the labium to the other, to the inner side of the large venous 
trunk, and just within the mucous surface. A finger was then introduced 
between the integuments and tumor, and its loose connections with the 
surrounding tissues forcibly torn through, and the mass completely enu- 
cleated. It is of some practical importance to remember that these tumors 
are closely coated with cellular tissue of a dense character, and it is neces- 
sary to cut through this in order to turn out the growth. It is quite easy 
for the operator to mistake the capsule for the surface of the tumor, and 
to be trying to separate the integument from it, which would be a long 
process; and to prevent this it is better to cut slightly into the tumor 
itself, when the edge of the capsular covering is at once indicated, from 
whence the enucleation is readily completed. Part xxv., p. 290. 
LABOR. 
Case of Complete Detachment of the Os Uteri during Labor.—[In this 
extraordinary case the os uteri remained obstinately closed for a consider- 
able period, and notwithstanding the regular action of the womb, aided by 
the gentle use of ergot, it remained but little dilated to the last. Mr. Car- 
michael proceeds to say:] 
The os uteri did not yield, but the head was propelled fully into the 
pelvis, pushing the cervix before it. In the course of the evening of the 
second day the patient’s condition grew worse, she became delirious, the 
pulse quick and irregular; and, in a word, she must have quickly sunk if 
interference had not been resorted to. To apply the forceps, I can only 
say, the circumstances of the case were such as decidedly to preclude it. 
The perforator was resorted to, and the cranium evacuated of its contents; 
the crotchet was then introduced, and traction, of a very gentle nature, 
made on one of the parietal bones. During this, however, a strong con- 
traction of the uterus succeeded, when the head was at once expelled, car- 120 
LABOR. 
rying before it the os uteri and a part of the cervix of the womb, the dia- 
meter of which measured about three inches and a half. 
The placenta came away in the usual manner; there was, however, con- 
siderable hemorrhage, and such difficulty in getting the womb to contract, 
that the cold affusion became necessary. Two hours after the delivery I 
became much alarmed for my patient; jactitation, restlessness, difficulty of 
breathing, etc. I gave her a full anodyne, and having procured tranquil- 
lity and given all the necessary instructions to a competent person as to the 
state of the uterus, which was padded, and other parts to be attended to, 
left her for the night. On my visit the next morning, to my surprise, she 
was sitting up in bed, eating her breakfast, expressing how comfortable her 
condition was compared with that of the preceding day. Part ii., p. 148. 
Use of the Perforator and Crotchet.—The following series of aphorisms 
from the researches of Dr. Churchill, will be found useful to be known at 
the bed-side. * 
It may be asked, when the responsibility is so serious, what evidence 
will be sufficient to satisfy a conscientious practitioner that he may not be 
committing a crime in his anxious endeavors to afford relief? To this it 
may be answered: 
1. That the continuance of strong labor pains for a certain time, without 
any advance of the head of the child, is so far evidence of a fixed obstacle 
to the passage of the child. 
2. The failure of a cautious attempt to introduce the forceps will, to a 
certain extent, demonstrate the amount of the disproportion between the 
head and the pelvis; and the failure of a careful, yet firm attempt at ex- 
traction by the forceps (when the application has been effected), will prove 
that the disproportion cannot be remedied by compression. 
3. A well educated finger will enable us in most cases to ascertain whe- 
ther the diameters of the pelvis are such as will allow of the passage of a 
living child. And even though this mode be uncertain, wTe have a means 
of correcting our estimate, by comparison with the child’s head in apposi- 
tion with the pelvis. If the natural efforts after several hours, or the for- 
ceps with a proper and safe amount of compression and force, cannot bring 
the widest part of the head of the child through the narrow part of the 
pelvis, we may fairly conclude that the only resource is craniotomy. 
4. The general condition of the mother will also aid our decision. If she 
be much exhausted, if fever be present, the uterus powerless, the life of the 
child doubtful, and the success of the forceps dubious, we may shrink from 
inflicting the double shock of an unsuccessful application of the forceps and 
subsequent delivery by the crotchet. But these cases are very rare: they 
only happen when the patient has been mismanaged, and it requires expe- 
rience and judgment to decide upon the propriety of terminating them by 
embryotomy. 
The cases in which the operation is demanded are: 
1. When the child is dead, and the labor tedious. But we must be quite 
sure that the child be dead, before this is made the ground of interference. 
2. In distortion of the pelvis, when the antero-posterior diameter of the 
brim is less than three inches, we have no chance of delivery by the natu- 
ral efforts, or by the forceps; so that to save the mother we must destroy 
the child. 
3. When the transverse diameter of the lower outlet is diminished to the 121 
LABOR. 
same extent by tbe approximation of the tubera ischii, if the forceps, applied 
antero-posteriorly, are insufficient to move the head, we must have recourse 
to craniotomy. 
4. When the calibre of the pelvis is diminished to a certain degree by a 
fixed obstacle—as, for example, a fibrous tumor, or an exostosis growing 
from the bone or periosteum, it may not be possible for the natural efforts 
ulone, or aided by the forceps, to expel the child. In such a case, it will 
be necessary to lessen the head, and apply the crotchet. 
In these three latter classes of cases, the passage through the pelvis may 
be so much diminished as to render it necessai’y to break up the skull, or 
to eviscerate the child. 
5. In some cases of ovarian disease, where the tumor has formed adhe- 
sion within the pelvis, so as to prevent its being pushed above the brim, it 
has been found necessary to lessen the head before the child could be ex- 
tracted. We are not, however, to decide upon this measure until the 
natural powers have had a fair trial, as it sometimes happens, that in the 
progress of labor, the tumor is so much displaced as to allow of the passage 
of the child. Further, it will be worth while, before sacrificing the infant, 
to ascertain whether the contents of the tumor may not be drawn off, by 
passing a long trocar into it. If a small quantity of fluid escape, it may 
allow of the application of the forceps, and so enable us to save the child. 
If, however, the tumor prove to be solid and immovable, we must, as a 
“ dernier ressort,” have recourse to the perforator and crotchet. 
6. When a child is hydrocephalic to such an extent as to prevent its en- 
tering or passing through the pelvis, whether distorted or of the natural 
size, there can be no question as to the propriety of opening the head. 
7. In some cases of convulsions, rupture of the uterus, etc., where imme- 
diate delivery is necessary, and where the forceps cannot be appMed, crani- 
otomy must be performed. 
8. If an arm descend along with the head, the diameters of which corres- 
pond closely to those of the pelvis (whether the latter be of the usual 
size or not), it may be necessary to terminate the labor by opening the 
head. 
9. I have already alluded to a class of cases, where, from mismanage- 
ment the patient has been allowed to continue too long without help, and 
in consequence is greatly exhausted with fever, quick pulse, delirium, etc. 
In such cases the patient will die if she be not assisted ; and from the un- 
favorable state in which she is, she cannot bear a prolonged or very painful 
operation. Now, if there be sufficient space for the forceps, they ought to 
be preferred, and it would be very wi’ong to use the perforator ; but if this 
be doubtful, and the probabilities against our succeeding with that instru- 
ment, then the consideration of the patient’s inability to bear a severe ope- 
ration may in some cases decide us in favor of embryotomy. These cases, 
however, are but few, and they must be well marked, to justify our adopt- 
ing at once such extreme measui’es. 
10. In footling or breech cases, when the head (separated or not from 
the body) cannot be extracted, we must evacuate its contents. 
The next question to be decided, is the period of labor at which the 
operation should be performed. 
1. In all cases where the diminution of the pelvic diameters is so 
great as to render it impossible that a living child can be born naturally 
or extracted, there can be no hesitation in recommending that the head 122 
LABOR. 
should be opened at an early period of the labor, say as soon as the o\ 
uteri is dilated, or fully dilatable. 
2. When the distortion is less, we cannot be sure as to the result of the 
natural efforts, and we must wait until it is evident that they are inade- 
quate ; then an endeavor should be made to use the forceps, and if this 
fail, there should be no delay in the performance of embryotomy. 
3. These observations will apply equally to the case of morbid growths, 
ovarian disease, etc., obstructing the passages. 
4. In cases of convulsions, ruptured uterus, etc., the time for the opera- 
tion is determined by circumstances connected with those accidents, and 
which will be found laid down in the works on the subject. 
5. In the mismanaged cases to which I have alluded, the condition of the- 
woman, which determines the necessity for the operation, will also point 
out the importance of promptitude. If the case be so bad that we dare 
not risk a failure with the forceps, it is clear that we cannot afford to delay 
embryotomy. 
After the head is extracted, the body generally follows without much 
difficulty ; but should this not be the case, we must have recourse to evisce- 
ration. The scissors must be plunged into the chest and the contents 
broken up; the crotchet hooked upon the ribs, and traction exerted. 
The contents of the abdominal cavity may be evacuated in a similar way, 
and after this we shall generally be able to extricate the child. 
Part iii., p. 121. 
Parturition without Consciousness.—Mr. Rawson was called to this 
case immediately on the waters being discharged. No pain was present, 
and she was asleep on his arrival. 
On examination, I found the os uteri dilated, and the head presenting. 
The child was slowly and unintermittingly, but forcibly, expelled. She 
betrayed no symptoms of uneasiness whatever, and though I watched her 
countenance, she did not exhibit the least consciousness of the child’s ex- 
pulsion, but expressed her surprise on seeing it. The child was strong and 
lively, and, with the mother, did well. The mother was about two-and- 
twenty, short, plethoric, and healthy. 
1 conceive the above case is interesting in a medico-legal point of view. 
Dr. Montgomery doubts the possibility of such an occurrence, “ excepting 
under peculiar circumstances, certainly not in a first delivery.”—(Dr. M.’s 
“Exposition of the Signs and Symptoms of Pregnancy.”) In Beck’s 
“ Medical J urisprudence,” it is said that “ the possibility of a woman being 
delivered without being conscious of it, is disbelieved, excepting some 
extraordinary and striking cause intervene.” But if such a circumstance 
can happen with a first child, it must have its full weight in cases of infan- 
ticide. Part iv., p. 135. 
Advantages of keeping the Umbilical Cord whole for some short time 
after Birth.—In all cases where the infant is born weakly or in a state of 
asphyxia, M. Baudelocque recommends not to cut the umbilical cord for 
some time at least after birth. He relates that since he has followed the 
opinions of Smellie, Levret, Chaussier, etc., on this subject, he has not 
lost a single case, although when born the child might be in a state of 
pretty complete asphyxia or apoplexy. He states that, though a child 
be born in an apoplectic or asphyxiated state, the circulation still con- LABOR. 
123 
tirmes through the umbilical vein, even though the umbilical arteries 
should have ceased to beat, and that premature section of the umbilical 
cord takes away one of the chief aids to its revival. Part iv., p. 135. 
Remarkable Birth of Twins.—Dr. Schroder gives the following case : 
On the 10th of November, I was sent for, to a robust healthy woman, 
who, three days before had been delivered of a first child about 29 weeks 
old, in order to remove the after-birth. I very soon discovered that there 
was a second child in utero. The woman appeared to be vigorous ; there 
had been no pain since the birth of the first child ; there was no hemor- 
rhage ; the bladder was not distended ; the situation of the child was not 
high, the head presenting: and I saw no reason for forcing delivery. I 
visited the woman several times, to ascertain the progress. At last on the 
sixth day the second child was born, and immediately afterward the alter- 
birth came away, without any assistance. Both children are living. 
Part v., p. 160. 
Alternate Warmth and Cold as an Excitement to XJterine Action.— 
Mr. C. Simpson writes as follows: • 
Some little time ago I had under my care a case of puerperal convul- 
sions which terminated well. The patient became conscious, but was 
obstinate. With great difficulty I forced some liquid into the mouth, but 
she would not swallow; I therefore dashed cold water in the face, and the 
contents of the mouth were instantly gulped down. This novel mode of 
making patients swallow was repeated, 1 should say, a dozen times, and 
with the same invariable effect. During the convulsions the labor stopped. 
There was, as it were, a metastasis of muscular action, from the apparatus 
of parturition, distributed over the whole system. Every resource in this 
state of things which was employed to produce uterine pains did but 
aggravate the general convulsions without acting on the uterus itself. 
After the lapse of many hours, however, the labor was resumed, and now 
the cold water, applied suddenly to the abdomen, was most effective in 
producing uterine contractions. After a little while, however, this lost its 
utility. The abdominal surface becoming cold from the repeated applica- 
tion, the water no longer acted as an excitant. Accordingly warm flan- 
nels were applied to restore the temperature, and then cold water was 
again applied with decided effect. This alternate application of cold and 
heat is of great value in cases of hemorrhage from the uterus. 
Part vii., p. 182r 
Tartar Emetic in Tardy Labor.—Kamsbotham, speaking of rigidity of 
the os uteri, says that antimony, in doses sufficient to keep up a feeling of 
nausea, has been exhibited in these cases with marked effect. Dr. Gilbert 
also highly recommends the same in doses sufficient to induce and main- 
tain emesis, retching, etc., in cases of tedious labor consequent upon insuf- 
ficiency of uterine contractions, and rigidity of the os tincae. These cases 
arc most frequently found to occur in patients of tense fibre and robust 
constitutions. Part ix., p. 203. 
Injection of the Uterus as a means of Expediting Delivery.—The 
editor of the “ Medical Gazette ” mentions a singular process which was 
adopted near Edinburgh, at the suggestion of Mr. Dick, the veterinary 
surgeon, to expedite the delivery of a cow. The animal had been in labor 124 
LABOR. 
a considerable time, and was nearly exhausted; six or eight quarts of 
tepid water were now injected into the uterus, which in five minutes 
caused such vigorous pain that the animal was speedily released. This 
plan has since been adopted in the human subject, by a surgeon, in a case 
where nothing but the long forceps could have effected delivery. lie 
injected about a quart of tepid water, with similar success. 
Part x., p. 195. 
Obstructed Labor—Division of the Symphysis Pubis in certain Cases 
of.—Dr. Smith says that division of the symphysis pubis is a much less 
formidable operation than either caesarean section or craniotomy, and ad- 
vocates its adoption in certain cases. The operation was founded on the 
opinion that the ligaments of the pelvis relaxed during labor, a fact well 
known to occur in many of the lower animals, and which authors of the 
highest respectability, as Ruysch, Harvey, and Denman, affirm to be not 
uncommon in the human female ; Dr. Denman also mentions a case where 
it existed in a woman who died three or four days after delivery. 
Dr. Churchill mentions three cases in which the operation was performed, 
and all the patients recovered, after having the ossa pubis separated for 
three inches, two inches and a half, and two and a sixth respectively. 
Dr. Menzies and Dr. Smith made a number of examinations on recently 
dead females, and found that an inch and a sixth was the greatest extent 
to which the pubic bones could be separated without injuring the sacro- 
iliac ligaments. But experiments on the recent subject are far from satis- 
factory, since in the one case the ligaments seem possessed of an unusual 
degree of elasticity, while in the other they have the rigidity of dead 
animal fibre. They satisfied themselves also that the antero-posterior was 
the diameter least increased by it; that the distance to which the bone 
could be separated was greatly influenced by the position of the trunk 
and limbs; that the force required to separate them, such as drawing 
down a foetus into and through the pelvis, was much greater than could be 
justifiably applied to the structure of the living female, and lastly, that, 
with care, neither bladder, peritoneum, nor urethra, need be injured. 
The fatal result of many of those cases in which this operation was per- 
formed on the continent, show that these structures had been injured. 
[The gist of this paper rests on the assumption, that in the human race 
the maternal passages and foetal head are so adapted, that a slight devia- 
tion from their relative normal proportions becomes a cause of obstructed 
labor, and Professor Simpson has shown that the slight difference between 
the head of the male and female child is quite sufficient to account for 
many of the difficulties and dangers of parturition.] 
The conclusions may be summed up as follows: 
1. Craniotomy is, in all cases of obstructed labor, justifiable when the 
entire foetus cannot be extracted through the pelvis, from deformity at the 
brim, from osseous and certain other tumors, and from great contraction 
of the outlet by the near approach of the tuberosities of the ischia to each 
other—the obstruction being more than can be overcome by the forceps, 
or other means, yet not so much but that a mutilated foetus may pass. 
2. The caesarian section niust be resorted to whenever the deformity is so 
great that a mutilated foetus cannot be extracted through the natural 
openings; and for which operation symphysotomy can never be substi- 
tuted. 3. Symphysotomy is only applicable to cases in which the de- 125 
. LABOE. 
livery cannot be accomplished by the forceps, and would require that cra- 
niotomy should be performed—the obstruction being dependent on the 
funnel-shaped form of the pelvis, and satisfactorily ascertained to be such 
that a slight increase to the contracted diameter would permit an entire 
child to pass; but in no instance would it be justifiable to resort to this 
operation if any uncertainty existed either as to the degree of deformity 
of the pelvis, or the vitality of the child. Part xi., p. 205. 
Turning.—[Many writers on midwifery recommend that in the ope- 
ration of turning, both feet should, if possible, be grasped and pulled 
down. We entirely agree with Professor Simpson in the following very 
judicious remarks.] 
In most cases I hold this method to be improper and unjustifiable, be- 
cause it is almost always more difficult to seize both extremities than to 
seize one; because one is quite sufficient for our purpose, and more safe for 
the life of the mother; and because by pulling at one extremity (when 
pulling does happen to be required after the version is accomplished) we 
more perfectly imitate the natural oblique position and passage of the 
breech of the infant, than when we drag it down more directly and more 
upon the same plane, by grasping and dragging at both limbs equally. 
The infant also assuredly incurs less risk of impaction of the head, and 
above all, less chance of fatal compression of the umbilical cord, when the 
os uteri and maternal canals have been dilated by the previous passage of 
the breech, increased in size by one of the lower extremities being doubled 
up on the abdomen, than when both extremities being seized and ex- 
tended, these same passages are more imperfectly opened up by the lesser- 
sized wedge of the breech alone. Notwithstanding, however, the great 
difficulties, and consequently the greater dangers attendant on the opera- 
tion, when we search for and grasp both lower extremities, instead of one, 
it is still so dogmatically laid down as a rule by most obstetric authorities, 
that many practitioners seem to deem it a duty, not to attempt to turn 
the child without having previously secured both feet. 
In few or no cases of turning is it proper or reqiflsite to bring down both 
extremities, unless in the complication of turning under rupture of the 
uterus. In that case, but in that only, ought we to follow at once this 
procedure—and here we follow it because, if we left the other extremity 
loose in the uterus or abdomen it would be apt to increase the lesion in 
the walls of the organ, if it happened to get involved in the aperture, or 
impacted against its edges. In some very rare instances in which, after 
version by one leg has been effected, and immediate delivery is necessary, 
the cervix and os interuni occasionally contract so forcibly and strongly 
upon the protruded limb, whenever we drag upon it, as not to allow a 
sufficient amount of traction being applied to this extremity without 
fear of lacerating its structures. In such cases it may be well to attempt 
to repass the hand to secure the other extremity, for then by pulling at 
both extremities together, we incur less chance of injuring them than 
if we applied the same required amount of force to either of them singly. 
I believe the seizure of the knee to be preferable, in most, if not in all 
cases, to the seizure of the foot, or, rather, as it should be more correctly 
stated, to the seizure of the ankle of the child. I speak, you will recollect, 
of turning in cases of shoulder or arm presentation, in which the liquor 
amnii has been for some time evacuated, and the uterus by its tonic con- 126 
LABOR. 
traction, has clasped itself around the body and head of the child. Under 
such circumstances, it is an object of importance not to be obliged to in- 
troduce our hand further than is absolutely necessary, into the cavity of 
the uterus, because the contraction of the organ, in many cases, opposes 
its introduction, and the forced introduction of it is apt to produce lacera- 
tion. It is an object also of equal moment to attempt to turn by a part 
which produces as little change as possible in the figure and form of the 
infant; because, if we thrust any of the angulated parts of the child 
against the interior of the contracted uterus, we should also thus be still 
more liable to produce rupture of that organ. Now, holding those points 
in view, it appears to me, that the turning of the child, by seizure of the 
knee, presents several decided advantages over turning of the child by 
seizure of the foot. For, 1st. The knee is more easily reached. As we 
slip our hand along the anterior surface of the protruding arm, and along 
the anterior surface of the thorax of the child, we always, if the attitude 
of the child has not been altered by improper attempts at version, or very 
irregular uterine action, find the knees near the region of the umbilicus of 
the infant—the lower extremities, as you are aware, being folded up in 
utero so that the knees are brought up to that part, and the legs flexed 
upon the thighs in such a manner that the heels and feet lie nearly in appo- 
sitiou with the breech of the child. To seize a foot, therefore, we should 
require to pass our hand about three inches (or in fact, the whole length 
of the leg; further than we require to do in order to seize a knee. 
2nd. The knee aflords the hand of the operator a much better hold than 
the foot. 13y inserting one or two fingers into the ham or the flexure of 
the knee, we have a kind of hooked hold which is not liable to betray us. 
Every one, on the other hand, who has turned by the foot or feet, knows 
how very apt the fingers are to slip during the required traction, and how 
much in this way the difficulties of the operation are sometimes increased. 
3rd. We produce, I believe, the necessary version of the body of the child 
more easily by our purchase upon the knee—because thus we act more 
directly on the pelvic extremity of the infant’s spine, than when we have 
hold of a foot. 4th. rJftmiing by the foot appears to me to endanger 
greatly more the laceration of the uterus than turning by the knee. The 
reason of this is sufficiently evident. When we turn by the foot, we have 
to flex the leg round upon the thigh, and thus at one stage of the opera- 
tion and during one part of the flexion of the leg, we are obliged to have 
the leg bent to a right angle with the thigh, and the foot of the infant 
thus projected and crushed against the interior of the uterus. 
It is needless to say how much all this danger is increased, when, after 
having brought down one foot, we pass again our hand, and attempt to 
bring down a second foot (as is recommended by some authors), for thus 
we only double the danger of the laceration of the uterus, from the 
forced and obstructed passage along its interior, of this other extremity. 
One point remains for our consideration. Granting that it is proper to 
seize a knee, I think it matter of the very first moment to know which 
knee should be seized. On this point you will find no directions in any of 
our modern obstetric works, British or foreign, as far I know them; and 
yet l believe the secret of turning with facility and safety in a case with 
the waters evacuated and the uterus contracted—depends upon the know- 
ledge of which of the two lower extremities of the infant should be 
seized. If we turn with one of the extremities—and whether the foot or LABQE. 
127 
the knee—it should be the foot or knee of the limb on the opposite side 
of the body to that which is presenting. Thus, if the right shoulder or 
arm presents, we should take hold of the left knee or foot; and if the left 
arm or shoulder presents we should take hold of the right kneo or foot. 
When we do this, by carrying the knee diagonally across, if I may so 
speak, the abdomen of the child to the os uteri, we boihflex and rotate 
at the same time the trunk of the infant, and in doing so, the semi-rota- 
tion of the trunk inevitably carries up the presenting arm, in proportion 
as the knee which is laid hold of is pulled down by the operator. 
I have insisted upon the advantages of taking hold of the knee that is 
highest and furthest from you, and believe this to be a matter of the very 
first moment. Both knees of the child, as the infant lies folded up in 
utero, are generally in juxtaposition, and lying upon the abdomen of the 
infant, near the umbilicus. If’ therefore, in passing your hand into the 
uterus, you insinuate it as you ought to do, along the anterior surface of 
the thorax and abdomen of the child, you come in contact with both 
knees at the same time. And the rule which I would give you is this, 
that instead of hooking your finger or fingers into the flexure of the 
lower or nearer knee, you hook them instead into the flexure of the 
upper, more distant, or opposite one. Both are so far, in general, equally 
near, or equally distant, and you seize the one or the other according as 
you take care to turn your finger so as to hook it into the flexure of the 
lower or the flexure of the upper. Part xi., p. 213. 
Protracted Labor f rom Insuperable Rigidity of the Os Uteri—Opera- 
tion.—Dr. Lever makes the following observations respecting the propriety 
of incising the rigid ring-like edge of the os uteri in cases of protracted la- 
bor arising therefrom: The operation itself is exceedingly simple and 
painless; and, if performed in the way I shall recommend, unattended 
with hemorrhage. The patient should be on her left side, in the usual 
obstetric position, and brought to the edge of the bed; the forefinger of 
the left hand should, in the absence of pain, be passed to that part of the 
os uteri intended to be incised, and, if possible, its point should be slipped 
within; then, directing a probe-pointed bistoury or hernia-knife along the 
finger, we should wait for the occurrence of pain, when the incision may 
be made by passing the cutting edge of the instrument against the indu- 
rated margin of the os. The immediate elfects of the incision will be the 
discharge of a small quantity of thin watery blood; especially in those 
cases where oedema of the cervix is present. In the case under consider- 
ation, the external tissues of the uterus contracted more than the inter- 
nal, so that the wound seemed longer without than within. I selected 
the sides of the mouth for the situation of the incision, for several rea- 
sons: firstly, at the sides of the womb, the rigidity was the greatest; 
secondly, it is at the sides of the womb we usually find lacerations, when 
they take place spontaneously, as is frequently seen in protracted labors. 
Where the waters pass oft’ early, and when the os uteri is thin and tense, 
such a lesion is by no means unusual. 
Again, in making the incision at the sides there is no danger of wound- 
ing the bladder in front, or the rectum behind ; and, lastly, as in most 
cases there will be found an elongation, swelling, and congestion of the 
anterior lip, serious hemorrhage might result if this part of the womb 
were divided. Some writers have recommended a crucial incision; but, 128 
LABOR, 
in my opinion, such will be found unnecessary. A further tearing of the 
parts may take place during the passage of the head; but it is usually 
slight, and confined to the vagina. Before the operation a careful exami- 
nation of the os uteri should be made; for we sometimes find this part of 
the womb communicating to the finger a strong pulsation, from the pre- 
sence of a large vessel coursing along the rim; and in the truth of this 
observation I am confirmed by the experience of Mr. Power. After the 
incision the pains may moderate, or may subside for a time ; but on their 
renewal the obstruction will give way; and, if there exist no pelvic de- 
formity, they will suftiee to terminate the delivery. Not unfrequently a 
slight and temporary degree of faintness follows the operation, during 
which uterine contraction is lulled. 
[Dr. L. concludes his paper by a few remarks on artificial dilatation, 
which are well worthy of attentive perusal. He affirms that, when at- 
tempted in cases like the foregoing, it is almost certain to produce lacera- 
tion with irritation, inflammation, gangrene, or even death. At a 
post-mortem on a female at which he was present, who died within forty- 
eight hours after her delivery, in which this practice was used, extensive 
peritonitis with effusion of lymph, and lacerated os uteri in several placet 
were found. This affords strong confirmation of the above opinion. At 
the same time it is needful to warn the young and enthusiastic practi- 
tioner that none of the gentler modes of producing relaxation, such as 
tartar emetic, the warm bath, etc., should be neglected; nor should the 
use of the knife be delayed until symptoms indicative of an approaching 
state of collapse appear. The following propositions are submitted as the 
result of experience on this subject:] 
1. That insuperable rigidity of the os uteri occasionally occurs, over 
which the usual remedies exercise no influence. 2. That such insuperable 
rigidity may lead to a partial or complete separation of the cervix, 
S. That to prevent such a serious lesion, two methods of treatment have 
been recommended: the one consisting in artificial dilatation; the other, 
in incising the rigid and conti’acted os uteri. 4. That artificial dilatation, 
in most cases, is unjustifiable, from the serious injuries it occasions, and 
the consequent irritation and inflammation. 5. That, under such circum- 
stances, an incision of the os uteri, in one or more places, should be per- 
formed. C. That the operation is unattended with danger, unaccompanied 
by pain, and, if rightly performed, free from copious or dangerous 
hemorrhage. 7. But the operation, to be successful, must be per- 
formed before there are symptoms of approaching collapse. 
Part xii., p. 290. 
Use of the Forceps—How to Apply.—Having ascertained the exact posi- 
tion of the head, introduce the hand well smeared with lard, within the 
os uteri; search for, and pass the fingers over the ear, so as to guide the 
blade over that organ, whatever may be its position. When the in- 
strument is locked, do not tie the handles with tape, as it keeps 
up a degree of pressure on the child’s head not consistent with 
its safety. In acting with the forceps, always bear in mind the different 
axes of the pelvis, viz., of its brim, cavity, and outlet; therefore, keep the 
handles of the instrument back to the perineum, till some part of the oc- 
cipital bone has cleared the arch of the pubis, and when tins occurs, grad- 
ually bring the handles toward the pubis, when the chin will pass over LABOR, 
129 
the perineum. The three powers of the forceps are brought into operation, 
viz., compression, traction, and leverage ; but compression ought never 
to be made beyond diminishing the child’s head to three inches, 
indeed, instruments are seldom constructed to admit of more. 
Part xiii., p. 349. 
Inversion of the Uterus from Short JPimis.—[Mr. Smith’s patient was 
enduring very severe labor-pains, which suddenly subsided as soon as the 
child’s head rested upon the perineum, and the most violent rigor set in. 
She became deadly pale, and covered with a cold clammy perspiration. 
Mr. Smith suspected rupture of the uterus to have taken place; he gave a 
stimulant, and afterward an opiate. The rigor soon ceased, but as soon 
as it had done so, she gave a most terrific scream, and the child’s head and 
shoulders were born. The bystanders, apparently suspecting, by their 
looks, that there was some mismanagement, could scarcely be persuaded 
to stay to give assistance. The patient still endured agonizing pain, and 
begged for the child to be taken away. Mr. S. extracted the arms, and 
on turning down the bed-clothes, the following appearances presented 
themselves :] 
The infant, a boy, was lying on his back, apparently lifeless, his legs and 
part of the thighs retained in the vagina, and the funis so much on the 
stretch, that the skin of the abdomen was dragged out about an inch and 
a half. Having used smart friction over the region of the heart, he gave 
a slight scream, and having lifted him up toward the body of the mother 
so as to relax the cord, the extremities passed out with a little assistance. 
The child was immediately separated, and handed to an assistant; but the 
mother still continued to complain of the most acute pain. On making an 
examination, I found the placenta so near the os externum, that I thought 
I had nothing to do but to lift it out; but such was not the case, for I 
found it attached to the uterus. I immediately nibbled away the attach- 
ments with my finger and thumb with the greatest caution, and on remov- 
ing the placenta, the pain still continuing with great severity, I immedi- 
ately examined again and found the uterus (fully three fourths, according to 
the feel of it) inverted, the os girding it round like a cord, and of course I 
lost no time in reducing it; this was done with the greatest ease ; and in 
order to insure permanent contraction, I thrust my hand into the cavity, 
which gave no pain, and having kept my doubled fist there for about half 
a minute, it gradually closed upon it, and thrust it out,. precisely 
as if it had been another placenta. The mother was immediately 
bound up firmly, the pains having entirely ceased, and in the evening she 
was sitting up in bed, suckling her baby as if nothing had happened. 
The patient lost very little blood, and complained of no pain whatever 
after the uterus was reduced. The funis was not more than six inches long, 
perhaps about eight when on the stretch. The placenta w'as remarkably 
small; the child was of full size. Part xiii., p. 359. 
Inversion of the Uterus.—Syncope without hemorrhage may depend, 
according to Dr. Mitchell, upon the following causes: 
1st. The labor may have been tedious and the patient faint from mere 
exhaustion. 2nd. From rupture of the uterus or bladder. 3rd. From 
internal uterine hemorrhage; or 4th. From inversion of the uterus. How 
necessary, therefore, that the practitioner should at once be aware of the 
cause of syncope. In the three first to which I have all ruled, the uterus 
von. ii.—9 130 
LABOR. 
may be felt over the the pubes; in the last it cannot. As a general rule, it 
will be well in every case of doubt, at once to make a vaginal examination, 
as it has ere this occurred that the accident has not been detected until 
after the woman’s death, or where it has not proved fatal until all chance 
of reduction has passed by. In cases of this description, the accoucheur 
should be certain that there is no escape of blood externally, to ascertain 
which, he ought nut to be content Avith merely examining posteriorly, but 
in every instance he ought to look if any has escaped in front, as I have 
several times found the bed soaked with blood in consequence of a constant 
stream running over the woman’s thigh, although none appeared to come 
from between the vulva. 
Inversion of the womb may be mistaken for polypus, prolapsus uteri, or 
vaginae. It has also been ignorantly removed by the crotchet, supposing 
it to be the head of a child. It may be distinguished from polypus 
by being rough externally, and very sensitive to the touch. Polypi are 
smooth and glistening, and the mouth of the uterus can be felt by encir- 
cling their necks. From prolapse of the uterus it may be known by the 
absence of the os uteri, and from that of the vagina (which rarely 
assumes so large a size), by our being able to discover a second opening 
above the tumor—the true os. I may mention, however, that many first- 
rate practitioners have mistaken polypus for inversion—accounts of Avliich 
will be found in the different periodicals. 
The treatment of inversion of the uterus will greatly depend upon the 
fact, whether the placenta be attached to the inverted organ, or if it has been 
expelled. In the former case—viz., where the placenta is attached, there 
is less danger to the patient from flooding, as the uterine sinuses are closed 
by the adherent placenta. In either base, as soon as the accident is disco- 
vered, reduction should be accomplished as soon as possible ; but a very 
important practical question remains to be decided. In the e\rent of the 
placenta being adherent to the displaced uterus, ought we first to detach 
it, and then reduce the uterus; or, on the other hand, should we attempt 
the reduction, the placenta being still adherent? Noav, in answering this 
question, I should state that there is considerable difference of opinion 
amongst the highest authorities. 
I think the practitioner can haAre no difficulty in making up his mind as 
to the proper plan of treatment, Avhich appears to be in every case to at- 
tempt the reduction of the displaced organ Avithout detaching th< 
placenta, but if that be impracticable, he should then detach it and 
proceed Avith the greatest promptitude to reduce it. 
There can be no doubt that in all cases of inversion, whether attended 
with hemorrhage or not, the presence of syncope renders the reduc- 
tion much easier than it Avould be Avithout it. Sir C. M. Clark says that 
he has been called by other practitioners to cases of inverted uterus, 
Avhere the patient has expired from hemorrhage before the accident 
Avas discovered, and that in every instance the displaced uterus Avas 
reduced Avith very little trouble, all difficulty being removed by the de- 
pressed condition of the Avoman prior to death. Upon the same principle 
Ave find that DeAvees recommends bleeding to syncope in cases of inversion 
unattended with hemorrhage. 
Foav as to the termination of this difficulty w'e have seen that it may 
prove fatal in a feAV hours from flooding. In some instances the hemor- 
rhage has been followed by inflammation terminating in gamrrene, induced LABOR. 
131 
by a kind of strangulation of the uterus in its cervix. There are several 
cases mentioned by Rousset, in which recovery took place after the spon- 
taneous separation of the mortified organ. It may become chronic, and 
either prove fatal by exhausting discharges, or as in some rare instances be 
spontaneously cured. It has been fully proved that the inverted organ 
may be removed with impunity by ligature or excision ; successful cases 
are given by Granville, Gooch, Newnham, etc. Part xiv., p. 276. 
Hemorrhage during Labor.—When the patient is sinking from loss of 
blood, administer ether vapor as a stimulant / and after the labor, even if 
the uterus has contracted well, give a dose of secale cornutum. 
Part xvi., p. 251. 
Treatment of Post-Partum Hemorrhage—Dr. Torbock proposes to 
arrest flooding by the injection of stimulants into the uterine cavity. lie 
gives two cases in support of the proposed practice. 
The first was the subject of recto-vaginal fistula; the head was delayed 
at the mouth of the womb by bands of adhesion, the results of violence 
used in a previous labor, but after these were divided, the uterine efforts 
were inefficient to effect delivery, which was therefore accomplished by 
the aid of the forceps. 
It was at this moment, from the atonic state of the uterus, frightful 
hemorrhage followed. The ordinary means were used to produce uterine 
contraction, as pressure, grasping the uterus, secale, and the introduction 
of the hand into the uterus. At this critical moment was suggested the 
introduction of a piece of rag, saturated with brandy, diluted one-third 
with water, into the uterine cavity, which was very promptly done; when 
on a second application it was grasped by the contracting uterus, all he- 
morrhage ceased ; the patient progressed favorably. The stimulant used 
in the second case was rum. Part xvi., p. 273. 
Rigidity of the Os Uteri.—When there is a hot skin, and a quick, full 
pulse, we may bleed, and nauseate with tartar emetic, give a turpentine 
or emollient enema to clear out the bowels, and then a full opiate, and 
smear the os and cervix freely with extract of belladonna. If these 
means fail, incise the os uteri on each side with a probe-pointed bistoury. 
Part xvii., p. 241. 
Turning as an Alternative for Craniotomy and the Long Forceps, in 
Deformity of the Brim of the Pelvis.—It is proposed to turn the child, 
and extract by the feet, instead of performing embryotomy, or applying 
the long forceps. By this operation, the narrowest portion of the cone 
formed by the foetal head is first engaged in the contracted brim, and the 
skull will usually become so indented and compressed in its biparietal 
diameter, as to allow of its extraction by such force as may be safely 
applied to the child’s neck. Thus the best chance of life is afforded to the 
child, while, from the early period of labor at which the operation is per- 
formed, the mother is spared all the evils which result from protracted 
pain and long-continued pressure on the soft parts. 
* * * * * * * * 
When the head is prevented from entering the brim of the pelvis by 
reason of the diminished diameter of the latter, turning should be had 
recourse to, in preference to embryotomy or the long forceps; and should 
be performed early—the earlier the better. But it should not be under- 132 
LABOR. 
taken when labor has been long continued—when the strength is exhausted 
—the uterine energy gone, or the uterus painfully and permanently 
contracted; nor is it recommended when the child is dead, the pelvis very 
much contracted, or when the accoucheur is not familiar -with the opera- 
tion. Part xvii., p. 242* 
Deformity of the Brim.—When the use of the long forceps comes into 
competition with the employment of craniotomy, the former is generally 
to be preferred. Now, when the pelvis is contracted in its conjugate or 
antero-posterior diameter, the long or fronto-occipital diameter of the 
child’s head occupies the transverse diameter of the brim. The blades 
of the long forceps should, therefore, be placed obliquely upon the child’s 
head; one, the posterior, over the side of the occiput; and the other, or 
anterior, over the side of the brow or temple; or, in other words, they 
should be applied in the oblique diameter of the brim, for in this situation 
there is the most room for them. Part xviii., p. 276. 
Unusual Cases of Utero-Gestation.—On the 16tli of Nov., 1822, a 
woman in the parish of Farnham, Surrey, after having had irregular 
uterine action for two days, was delivered by a midwife of a dead tbetus, 
of a little more than thirteen inches long, and having the appearance of a 
seven months’ foetus. The placenta was shortly afterward expelled, and 
it was then found that there was a second foetus, living and active, in 
utero: but as there were no pains and no hemorrhage, it was determined 
to wait the event. The woman recovered favorably : and on the 14th of 
January, 1823, or fifty-nine days from her premature accouchment, she 
was again taken in labor, and delivered of a fine healthy child. She had 
been regularly unwell on the last week of March, and expected her con- 
finement to take place about Christmas. 
In the “London and Edinburgh Monthly Journal of Medical Science,” 
Dec., 1842, a case is related by Dr. Jameson of a blighted twin being 
retained, with its placenta and membranes, for seven weeks after the birth 
of its fellow twin alive, and which was presumed to have arrived at the 
full period of utero-gestation. This is very remarkable I We can easily 
conceive the uterus to be endowed with the power of ridding itself of a 
blighted or dead foetus before the period of utero-gestation is accomplished, 
even allowing the second foetus to be retained to the full period; but to 
throw off the healthy, and retain the blighted one, and that beyond the 
usual period of pregnancy, is an anomaly proving that the laws of nature, 
in many cases, are extremely difficult of explanation. In the “ Lancet,” 
Jan., 1843, a Mr. Yale recites the case of a woman, being pregnant with 
twins, giving birth to the first alive, at the seventh month; and the second 
also alive, two months afterward, being the completion of the proper 
period of utero-gestation. Drs. M‘Clintock and Hardy, in their work, 
entitled, “Practical Observations on Midwifery,” 1848, record the case of 
a female at her sixth pregnancy producing twins, both children being 
girls, the first of which was strong and healthy, and apparently at full 
time—the second much smaller, dead, copper-colored, and in a state of 
putrefaction. In this case there was but one placenta, and that part of it 
which was inclosed by the membranes of the dead child was slightly 
darker and more consolidated than the rest. We (the Ed.) have in our 
practice experienced three cases in which the births of twin children wcjc LABOR. 
133 
separated by a space of time; in two cases an interval of three weeks 
occurred, and in the other fourteen days. In all three cases the first-born 
foetus was dead. Such examples go far to prove that in cases of plural 
births each foetus possesses its independent involucra. We do not detect 
any of the characteristics of super-fcetation in these cases; in fact, we 
experience considerable doubts respecting the majority of cases published 
under that title.—Ed. Brit. Record. Part xviii., p. 284. 
Ilysterocele.—[Hernia of the uterus, whether inguinal, femoral, or 
ventral, is a very rare occurrence, but Mr. Bell has met with tAvo cases.] 
1 attended Mrs. M , at her fourth confinement. At five o’clock, 
a.m., after a tolerably severe labor of sixteen hours’ duration, a fine female 
child was born. As soon as the cord was separated, and the child handed 
to the nurse, in accordance with my usual practice, I applied my hand to 
the abdomen, Avhen, to my astonishment, I found the anterior-superior 
part of the uterus protruded through a rent in the linea alba, which was 
completely torn through from the ensiform cartilage to pubis. The 
uterus felt so large and firm, that little doubt existed of its containing 
another child. 
On making a vaginal examination, a second set of membranes Avas 
detected, on rupturing which the child was ascertained to present with 
nates to mother’s abdomen. The uterus was pressed back into the abdo- 
minal cavity, and firmly maintained in this position with both hands until 
the child (a male) was born; this occurred half an hour after the first 
birth. The conjoined placenta came away immediately—the uterus con- 
tracted firmly, and descended into the hypogastrium. A compress Avas 
placed on each side of the rent along its Avhole extent, and a bandage 
firmly applied. A smart attack of peritonitis occurred, but it was fortu- 
nately subdued by the ordinary treatment. Three months after deli- 
very I carefully examined the abdomen, and could detect no trace of the 
rupture. 
The great distention to which the abdominal parietes were subjected 
from the uterus containing two very large children, must have stretched 
the fibres of the linea alba to the utmost extent, the contraction of the 
abdominal muscles during labor producing the complete separation of 
the tissues. Part xviii., p. 301. 
Treatment of Rigidity of the Os XJteri.—Dr. Scanzoni, who has care- 
fully examined the conditions of the os and cervix, in the latter months of 
pregnancy, believes that the constriction, which sometimes declares itself 
in the first stage of labor, is due to rigidity of the upper orifice of the 
uterine neck, and not the lower, which is generally sufficiently dilatable. 
Instead of the treatment usually recommended, viz., bleeding, antimony, 
belladonna, frictions, etc., he advises a continuous douche of warm water 
upon the os and cervix, directed by means of an appropriate instrument. 
Part xix., p. 225. 
Excision of Malignant Tumor of the Os Uteri during Labor.—When 
the disease involves only a portion of the os uteri, and proves an impedi- 
ment to the dilatation of the latter during labor, it may be excised with 
safety and advantage. Part xix.,jt?. 226. 
Use of Ice in Promoting Uterine Contraction.—Dr. Mackall, in a 
communication to the committee of the American Medical Association, 134 
LABOK. 
states, that for several years past he has been in the habit of employ- 
ing pounded ice in cases of suspended or protracted labor. That when 
this had been swallowed freely, the pains had immediately returned, 
the uterus had contracted strongly, and the labor been speedily com- 
pleted. 
In cases where labor pains had been suspended for twelve or twenty- 
four hours, they have been renewed promptly and efficiently. In cases of 
inevitable abortion, where the uterine contractions are feeble and inef- 
ficient, and where hemorrhage is considerable; in retention of the pla- 
centa from imperfect contraction of the uterus, and in cases of alarming 
hemorrhage after delivery and expulsion of the after-birth, it is equally 
applicable—in short, whenever the firm contraction of the uterus is de- 
sirable, that object will most certainly be attained by the administration 
of ice. 
Decoction of the Roots of Cotton Plant.—Dr. Blackburn of Barnes- 
ville, states that he has used a strong decoction of the roots of the cotton 
plant in two cases of labor with successful issue, to promote uterine con- 
traction where ergot failed. Part xix., p. 233. 
Treatment of After-Pains.—Consists in the removal of coagula from 
the vagina and os uteri, the avoidance of all the extra-uterine causes 
of uterine contraction, and the administration of opiates. Gentle fric- 
tion with the linimentum opii over the abdomen is often very useful; 
but I have found still greater benefit from the application of this liniment 
to the mammae. By a reflex action, it allays the excessive sensibility of 
the uterus, when thus applied. 
In excessive after-pains, without hemorrhage, without the presence of 
coagula, and in the absence of other signs and consequences of inertia, the 
infant should never be applied to the breast for some hours after delivery ; 
not, in fact, until the uterus has become calmed from its state of morbid 
excitability. Early and constant stimulation of the breasts by the child is 
a common cause of irritable uterus for many days after delivery. This 
agent, so salutary in all cases of impending inertia, is often made, unneces- 
sarily, a cause of suffering, at a time when the patient is little able to en- 
dure it, and without any counterbalancing good, if the uterus has con 
tracted healthily. I repeat, we want no more than safe contraction ; ever) 
after-pain beyond this point is both unnecessary and mischievous. 
Part xix., p. 258 
Breech Presentations.—The child dies from hemorrhage into the pla- 
centa, caused by compression of the umbilical vein. To obviate this, tie 
the cord early, before the complete birth of the child ; and endeavor to 
get respiration carried on while the head is still in the vagina. 
Part xix., p. 275. 
Impropriety of Frequent Op>erative Interference in Midwifery.—Never 
be anxious to promote hasty delivery, and use all operative measures as 
seldom as it is possible. The late Dr. J. Clarke, of Dublin, who used the 
forceps only once in 3,847 labors, was singularly successful in saving the 
lives of both mothers and children. Part xx.,p. 193. 
Hemorrhage—Post-Partum.—In extreme cases, pass one hand into the 
uterus ; introduce the pipe of an enema apparatus by the side of the arm a LABOE. 
135 
little way into the vagina, and inject suddenly ice-cold water, which will 
pass up into the uterus. By the ordinary plan of injecting the vagina, we 
are not sure that the injection enters the uterus; hut by having one hand 
introduced into this organ, we learn whether it is really injected, and we 
ascertain also the effects of the injection. This method is very much bet- 
ter than that of introducing a bladder into the uterus and then distending 
the former, as it is the influence of the cold, and not the pressure, that we 
want to employ. Part xx., p. 194. 
Labor—Use of Chloroform in.—The careful inhalation of chloroform is 
quite innocuous. It may therefore be given in natural labor, simply for 
the purpose of allaying pain, if the patient requests it. And it ought to 
be given when the regularity and efficiency of the pains are interfered 
with by emotion, nervous excitement, or cerebral congestion. In all such 
cases the inhalation must only be carried to the extent of allaying pain— 
not to make the patient unconscious. In operative midwifery, chloro- 
form should be given in difficult cases of turning, and of retained placenta ; 
and the full surgical effect, of unconsciousness and muscular relaxation, 
should be produced. In forceps and craniotomy cases, chloroform should 
not be used. Part xxi., p. 315. 
Prolapsus of the Pregnant Uterus.—Mrs. P., a delicate woman, had 
already two children. After the birth of the second, she was much 
troubled with a sensation of bearing down, and sometimes of a slight pro- 
trusion of the uterus, which she endeavored, very ineffectually, to remedy, 
by wearing some kind of bandage. The protrusion became greater when 
she next became pregnant, but diminished, and was at length wholly re- 
moved, as the uterus enlarged from gestation. When, however, the labor 
drew near, she was again sensible of much weakness and bearing down ; 
and at length when the pains actually came on, she was much alarmed by 
finding that a large fleshy mass had passed through the os externum with 
a good deal of fluid discharge. She sent for Mr. Gristock, who found 
that not only a considerable portion of the vagina was protruded, but that 
the os uteri was to be felt considerably without the os externum. He 
ordered her to bed, had the parts freely fomented, and requested a friend 
to visit the patient with him. They found her much alarmed, but pre- 
senting no symptoms indicative of danger. It was, therefore, determined 
not at present to employ any active interference. The pains at first were 
not strong, but as they increased in strength, it was thought advisable to 
expand the hand over the protruded part, so as to make the ends of the 
fingers afford five points of support to the prolapsed vagina. By degrees 
it appeared to recede during the pains, and, at last, during a very strong 
pain, the whole mass slipped up into the pelvic cavity ; the infant was 
speedily born, the placenta came away, and the uterus contracted firmly, 
remaining in its proper situation. This woman got quite well, and in less 
than two years became pregnant again ; she then came under the care of 
Dr. Hugh Ley. The same procedentia again took place, and was ma- 
naged in the same way, with the same happy result. 
Part xxii., p. 274. 
Entrance of Air by the Open Mouths of the Uterine Veins After Par- 
turition.—Dr. Cormack arrives at the following conclusions. He says: 
1. The entrance of air into the veins does not necessarily give rise to 136 
LABOK, 
exactly the same symptoms; the intensity of the effects depending upon 
the degree in which the action of the right side of the heart is arrested or 
impeded by its over distention, and upon the degree of asphyxia induced 
by the impediment to the passage of the blood through the lungs. 
2. The indications of treatment are three-fold ; first, to relieve the dis- 
tended right auricle; secondly, to treat the impending or actually present 
asphyxia; and lastly, to prolong life by every possible means, in the hope 
that the air may be all absorbed, and the passage of the blood through the 
small vessels of the lungs again be made easy. 
3. In the most rapid class of cases, in which death is suddenly threatened 
from paralysis of the heart from over-distention, we must first strive to 
relieve the organ from that condition; when the phenomena are chiefly 
those of asphyxia from more gradually increasing obstruction of the lungs, 
the various means for treating asphyxia must be resorted to, and among 
these, in many cases, I believe the alternate use of the hot and cold 
douches will be found to be very valuable, especially if combined with 
stimulants judiciously varied and skillfully administered externally and 
internally. In many cases, repose, dashing cold water in the face, keep- 
ing the surface warm, and time may be the only means which ought to be 
used. 
From the facts already stated, it is plain that the treatment, both pre- 
ventive and curative, is to obtain natural and permanent contraction of 
the uterus after delivery. As it is extremely probable that loss of blood, 
and the entrance of air, in many cases conjointly cause death, it is satisfac- 
tory to feel assured that the proper treatment for the one is the best also 
for the other, so far as the one thing primarily essential is to strive to get 
the uterus to contract. Plugging will also be specially proper when there 
is convulsive contraction and expansion of the uterus, with or without 
much hemorrhage ; for then there exists the greatest aptitude for the 
atmospheric air to enter, or be forced into the uterine veins. 
If a large quantity of air have entered the circulation, unequivocal evi- 
dence of this will be found by listening to the heart, when the churning 
sound will be heard. Part xxii., p. 309. 
Indian Hemp as an Oxytoxic.—The administration of the Indian hemp 
seems markedly and directly to increase parturient action, and Dr. 
Churchill states that it possesses powers similar to those of the ergot of 
rye in arresting hemorrhage, when dependent upon congested states of 
the impregnated uterus. Part xxii.,y>. 316. 
Ergot of Rye in Labor.—Dr. Meigs, of Philadelphia, only uses ergot 
of rye at the moment or just before the birth of a child ; in order to 
secure, if possible, a permanent and good contraction of the womb after 
labor, in women who are known in their preceding labor to have been 
subject to an alarming hemorrhage. Part xxiii., p. 257. 
Head Presentation—Turning in.—On this subject, Dr. Ramsbotham 
says, the following are the circumstances only under which he would re- 
sort to this operation: If the clear available space in the conjugate 
diameter were about inches, or from that to 3^—if the woman’s chil- 
dren had all previously been born dead—if the membranes were still 
whole, or the liquor amnii having been evacuated, the uterus had not con- 
tracted closely round the child’s body, the head being perfectly free 
above the pelvic brim, not having as yet descended into the pelvic cavity; 137 
LABOR. 
and if the attendant, by being in the habit of performing obstetrical 
operations, had acquired a certain dexterity in regard to them, and had 
perfect confidence in himself. Part xxv., p. 276. 
Galvanism in Obstetric Practice.—Do not employ the apparatus in 
which two currents are produced, but simply the single current machine, 
for a direct current tends to produce contraction, an inverse current, 
paralysis. In using the single current machine, place the positive conduc- 
tor over the lumbo-sacral region, and carry the other over the abdominal 
surface, with a gentle friction. In this way powerful uterine contractions 
may be easily excited. Part xxv., p. 278. 
Treatment of unavoidable Hemorrhage.—In treating unavoidable he- 
morrhage, attended with exhaustion, Dr. Murphy very much prefers hav- 
ing resource to Dr. Simpson’s plan of artificial separation of the placenta, 
to turning; and thinks this last operation is quite unjustifiable, on Smellie’s 
plea that the woman must not die undelivered—the very attempt to pre- 
vent her doing so being, in fact, sometimes the cause of her death. His 
rules are thus summed up. (l.) In cases where no exhaustion has taken 
place, or where this is only commencing, the child should be turned and 
delivered the moment the os is sufficiently dilated or dilatable. When 
this is not so, the placenta should be compressed by the plug and by the 
discharge of the liquor amnii, and other means employed to prevent 
exhaustion, until delivery is practicable. (2.) In extreme exhaustion, 
turning should not be performed, but the placenta should be separated, 
and the child left undisturbed until decided reaction takes place. (3.) 
When the os is rigid, means should be employed to compress the placenta 
and increase the action of the uterus, so as to give time for dilatation 
and turning. Should exhausting hemorrhage, however, come on in the 
meantime, the placenta should be removed, rather than the hand be 
forced into the uterus. Part xxvi., p. 312. 
Hemorrhage after Delivery accompanied by severe After-pains.—In 
several cases which Dr. Ramsbotham has met with, there have been 
most severe after-pains, with great hemorrhage, though the uterus was 
still firm and comparatively small. His explanation is, that a clot having 
filled the cavity of the uterus, the womb is unable to expel the offending 
mass. The more fluid parts are squeezed out, and the firmer remain 
behind, clinging with such tenacity to the uterine walls as to be almost as 
difficult of removal as a piece of adherent placenta. The treatment of such 
cases is to introduce the hand, remove the clot from the cavity of the 
uterus, and immediately the after-pains and the hemorrhage dependent 
thereon will cease. 
Dr. R. gives the following, among other cases: 
My assistance was sought by a medical practitioner, for Mrs. C. II., 
who had been delivered of her first child three hours. The placenta had 
been retained by irregular contraction, and removed from the uterus by 
the hand ; previously to which she had lost about two pounds of blood. 
When I arrived, she was faint, cold, and pale ; the pulse was very small; 
the uterus was excessively hard, and rather larger than natural; there was 
an uninterrupted draining going on, and she was suffering excruciating 
pains at intervals, evidently proceeding from uterine contractions. She 
had taken three drachms of laudadum without relief. I passed my hand 
into the cavity with considerable ease, notwithstanding the strength of the 138 
LABOR. 
uterine contractions, and removed a quantity of tough, fibrinous coagula, 
considerably larger than an orange. She felt immediate freedom from 
pain, and the discharge ceased almost as suddenly. She became a little 
faint, but soon rallied ; at four she was sleeping comfortably; and her 
recovery was uninterrupted. Part xxvii., p. 180. 
Peculiar Accidental Uterine Il&morrhage.—Sudden syncope or faint- 
ness, with great distention and pain of the abdomen, supervening in cases 
of advanced pregnancy, should lead you to suspect internal uterine 
hemorrhage. Mr. Harrinson asks: 
What would stop the bleeding most effectually for the time till the 
patient could rally ? The coagulum at the mouths of the vessels supported 
in its position as it would be by the foetus, membranes, etc. Withdraw 
this plug, and the hemorrhage would almost certainly return. Therefore 
the practice would naturally be to keep the plug there till we saw a lit 
occasion to allow it to come away. Bringing the child away, and empty- 
ing the womb by artificial means, would insure the separation of this plug 
at a time perhaps when the woman was not fit for such a process. We 
should say, therefore, in such a case : 
1. Give stimulants in moderation and keep the woman horizontal. 
2. If syncope continued, rupture the membranes, give a dose of ergot 
of rye, and keep up the patient as well as you can by stimulants and food, 
but don’t bring away the child yourself—let the womb expel it, and be 
ready the moment the child is born to compress the fundus uteri with a 
cold hand or cold wet towel, so as to compel it to contract rapidly 
and to expel placenta and coagula. If you save the woman from the first 
gush of blood, you will probably save her altogether. Part xxvii., p. 183. 
Galvanism in Obstetric cases.—A continual current is by no means so 
effectual as repeated shocks; these rarely fail to excite muscular con- 
tractions, for this stimulus acts directly on muscular fibre. The discs 
of the apparatus may be covered with thin flannel, and applied on either 
side of the uterus, the flannel being moistened with water. This plan is 
equally effectual as the application of the discs to the spine of the cervix 
uteri. 
In cases of hemorrhage before the birth of the child, apply the poles of 
the galvanic battery to the side of the uterus. Part xxix., p. 259. 
Galvanism as an Obstetric Agent.—[Dr. Radford was first led to the 
use of galvanism in midwifery from observing its value in a case of atony 
of the bladder. He has used it] 
1st. In cases of tedious labor arising, from uterine inertia. 
2d. In cases of accidental hemorrhage, either before or after the rup- 
ture of the membranes, and especially when exhaustion from loss of blood 
exists. 
3d. In cases of “ placenta praevia,” in which the praotice of detaching 
the placenta is adopted, and the vital powers are greatly depressed. 
4th. In cases of internal flooding before or during labor. 
5th. In cases of post-partum floodings. 
6th. In cases of hour-glass or irregular contraction of the uterus. 
Yth. To originate, de novo, uterine action, or in cases in which it is 
desired to induce premature labor. 
8th. In cases of abortion, when the indications show the necessity, or 
justify the expulsion of the ovum. LABOR. 
139 
9th. In cases of asphyxia in infants. 
Galvanism is especially advantageous as a general stimulant in all those 
cases in which the vital powers are extremely depressed from loss of blood. 
Its beneficial effects are to be observed in the change of the countenance, 
restoring an animated expression; in its influence on the heart and arteries; 
in changing the character of respiration; and its warming influence on the 
general surface. Part xxix., p. 268. 
Uterine Douches in Tedious Labor.—The tepid douche, used in the way 
adopted to induce premature labor, may sometimes stimulate the uterus 
when inactive. You may use the douche for ten minutes or a quarter of 
an hour at a time. The same means may assist in dilating a rigid os uteri. 
Part xxxi., p. 207. 
Flooding after Delivery.—Inject cold water into the womb. Use a 
Weiss’s syringe, and introduce the nozzle of the tube an inch or two fairly 
into the os uteri. Part xxxi., p. 208. 
Hemorrhage after Delivery.—Generally the more powerfully the uterus 
Contracts after delivery, the less the danger of flooding; not so, however, 
in all cases; if a portion of the placenta, a fold of the foetal membranes, or 
a quantity of coagulated blood, be retained in its cavity, it may be adhe- 
rent to the internal surface, so that no efforts of the uterus can dislodge it; 
the more fluid parts may be squeezed away, but the tougher particles 
remain, and bleeding still go on so as to endanger the life of the patient. 
By the introduction of the hand, and the withdrawal of the coagula, the 
agonizing pains and the further loss of blood are at once put a stop to, and 
instantaneous ease and immediate safety secured. Part xxxii., p. 221. 
Uterine Hemorrhage.—When threatened abortion is from a debilitated 
condition of the uterus, which, in its relaxed condition, opens the os, 
small doses of ergot act as a tonic, and close the bleeding orifices of the 
vessels. If the patient be near the full time, and delivery cannot be pre- 
vented, whether a case of placenta previa, or not, rupture the membranes 
at one side, and give a good dose of ergot, so as to force the presenting 
part of the child firmly down upon the bleeding surface, and thus to dam 
up the stream; if this be not successful, deliver, if you can pass the hand; 
but if you cannot without much force, plug, until such time as you can de- 
liver. 
In women peculiarly liable to flooding, as soon as the child is born, be 
careful not to interfere unnecessarily during delivery. Imitate nature, or 
rather let nature alone. When the head is expelled, don’t seize upon it 
and pull for your life, like a madman, but wait patiently, not only until 
nature has expelled the shoulders, but the hips also, for the body and legs 
of the child will stimulate the uterus to action as effectually as the hand 
of the accoucheur, and thus prevent flooding. But some may say, sup- 
posing the head is expelled and the pains cease, would you not employ 
traction then? No! certainly not! you must not lend so much as the 
strength of a finger toward completing the delivery, but “ compel the 
uterus to do its own work.” Besides being careful not to interfere in 
these cases, as soon as the head presses upon the perineum, give a full 
dose of ergot as a precaution against flooding, and repeat if necessary. 
In cases of abortion, if the flow of blood be great, give large and re- 
peated doses of ergot, so that the presenting part may be forced down, 140 
LABOR. 
to act as an internal plug. In addition to this, it may be advisable to em- 
ploy the plug, by pushing a piece of alum into the vagina before the 
plug. 
After the child is delivered, the first aim is to secure uterine contrac- 
tions ; it is worse than useless to deliver the placenta if this is not effected ; 
it must be excited by ergot, firmly grasping the uterus, abdominal fric- 
tions, ice, the cold and hot douche alternately; if these means are not 
sufficient, introduce the hand and remove the placenta. In cases of abor- 
tion where the placenta is retained, the general treatment is to trust to 
time; if there is hemorrhage, plug and give ergot; but there is a great 
deal of uncertainty about this. The placenta should be removed if possi- 
ble ; some recommend hooking it down with one finger, but this cannot 
always be done ; in such cases, perhaps, a pair of polypus forceps would 
be best to seize the placenta, twist it round and round again so as to 
detach it and bring it away. After the placenta is expelled, there may be 
hemorrhage from irregular contraction, loss of power and nervous energy, 
or from some mechanical impediment to contraction, as a clot of blood. 
In all these cases you must introduce the hand, and when it is contracted, 
keep it so, by external pressure and ergot. 
In cases of severe flooding, don’t apply the bandage ; it is in the way, 
and prevents more certain manipulations; after all danger has passed, it 
may be applied for support to the abdomen. Part xxxii., p. 222. 
Labor—Induction of.—The uterine douche possesses many advantages 
over ergot—1st. It will excite contractions; 2d. It does not endanger 
either the mother or the child; 3d. Its action can be better regulated ac- 
cording to the effect required; and, 4th. It may be employed at the com- 
mencement of labor, and in all degrees of dilatation of the neck. 
Part xxxiii., p. 262. 
Turning— Use of Forceps.—In all cases where the head is detained 
after the delivery of the body, the use of the forceps is greatly preferable 
to pulling by the body or neck of the child. They may be applied easier 
than in vertex presentation, because you have the head fixed and know 
its exact position. The extracting force is certainly safer. 
Part xxxiii., p. 263. 
Tartar Emetic, in Obstetric Practice.—In the early stages of primi- 
parEe, where the os uteri is hard, undilatable, and fails to yield to time and 
the ordinary remedies, one grain of tartar emetic with six ounces of soap- 
water may be given by the rectum with very beneficial and relaxing ef- 
fects. It is particularly applicable for the robust and plethoric. 
Part xxxiii.,p. 273. 
Post-Partum Hemorrhage.—In cases where women have suffered from 
flooding in several previous labors, you should give one or two doses of 
ergot during the last pains which expel the child. Immediately after 
delivery, in suspicious cases, the hand should be placed on the abdomen, 
and pressure made until efficient contraction is felt to take place. The 
uterus should be grasped and held firmly by the hands. The application 
of cold to the vulva and abdomen, by douching with a wet towel, or dash- 
ing the water on, is very effectual in rousing the uterus to contraction. 
If these means fail, the hand should be washed and introduced into the 
uterus. In addition to this, if the uterus appear paralyzed, cold water LABOK. 
141 
may be injected in a full stream into its cavity, or galvanism may be tried 
if there be time and convenience. Cold and heat applied alternately are 
much more efficacious than cold applied alone to excite reflex action. 
When one reflex surface is exhausted you may appeal to another, dashing 
cold water on the face, swallowing a gulp of cold water, an enema to the 
rectum, etc. Whenever coagula collect in the uterus or vagina, they pro- 
duce irritation, keep up the hemorrhage, and must be turned out with the 
hand. If the placenta be only partly separated, or remain in the uterus, 
it must be immediately removed ; if the patient is very much reduced, do 
not wait, pour some brandy down her throat, and proceed at once. 
Part xxxiv., p. 233. 
Elm Tents for Dilating the Cervix Uteri.—Elm bark possesses many 
advantages over sponge for dilating the cervix uteri. It is less expansible, 
and so dilates more gradually; it is not decomposed, and furnishes an 
abundant mucilage, which protects irritated or diseased surfaces. 
Part xxxiv., p. 247. 
Metastatic After-pains.—Among the different cases noted by Dr. 
Power, we find a marked instance of uterine metastasis upon the bladder: 
Mrs. P., at the beginning of the labor, had genuine uterine contractions, 
which dilated the os uteri with sufficient rapidity, when we remarked that 
the pains became suddenly more distressing, though they had no longer 
their former influence upon? the mouth of the uterus. Placing our hand 
upon the fundus uteri during a pain, we could not perceive any contrac- 
tions at all, but the woman complained of a very painful sensation just 
above the symphysis pubis, which ceased after some time, and came back 
in regular intervals. Mrs. P. had not evacuated her bladder for a consi- 
derable time, and was prevented from doing so by the pressure of the 
head against the symphysis pubis. We considered this a case of metastatic 
pains in the bladder, produced by an irritation of this organ, arising from 
its being overloaded with urine, and the vain attempts to empty itself. 
We therefore introduced the catheter, and drew off a considerable quan- 
tity of water. This being performed, regular uterine contractions set in, 
and labor was soon ended in the most satisfactory manner. Prof. Stein 
gives, among other cases, one of metastasis to a part of the nervous sys- 
tem, which is quite removed from the sphere of the uterine nerves. He 
says: “ In this case a great quantity of liquor amnii wTas present, and, in 
consequence, the pains were very irregular. Suddenly, all uterine action 
ceased, and the woman was taken with a violent facial neuralgia. This 
affection lasted for one hour, when it gave entirely away, and another 
succession of labor pains set in ; these, after some time, ceased, and the 
prosopalgia commenced, which was exchanged once more for activity of 
the womb, and so on by turns. At length the membranes were ruptured; 
after which, regular uterine action began and continued till the child was 
born.” 
Another very singular case was observed by the same author. A 
woman, when at the full term of her confinement, was taken with general 
convulsions, which ceased suddenly, but continued in the musculus orbicu- 
laris of both eyes, so that she could not open them for two days. Now 
the womb began its work, and with the first contraction her sight was re- 
established. 
Pilger observed that, during a confinement the pains gave way, and the 142 
LABOR. 
patient was suddenly taken with an alarming dyspnoea, which ceased as 
soon as another contraction of the uterus commenced. Others witnessed 
that the abdominal muscles were the seat of metastatic labor. 
This kind of dystochia is of rare occurrence. But there is another very 
severe and most tormenting affection occurring after confinement, namely, 
those very painful affections of the lower extremities, which commence a 
few hours after the child is born, and last sometimes for two or even eight 
days. The authors who treat of the said affection, call it “ the crural neu- 
ralgia of women in childbed,” and believe it to be the result of pressure 
of the fcetal head, or the forceps, or of an inflammatory exudation upon 
the crural nerves as they pass through the pelvis. This is the case in a 
few instances. But when these pains follow after an easy confinement, 
where neither a large-sized head, nor a forceps operation, nor an inflam- 
mation of the bowels, can be referred to as explaining this symptom, then 
we have to seek for another explanation. 
[Dr. Nceggerath has had several cases under his observation which have 
exhibited this curious phenomenon. In one remarkable case, the pains 
began to come on about nine hours after delivery of a living, full-grown 
child.] 
This morning, at about seven o’clock, the right thigh was suddenly 
seized with a pain, which soon increased to such violence, nay, fury, that 
the patient was afraid to move the leg the slightest degree from its posi- 
tion. The lower part of the thigh was the seat of the greatest pain, and 
especially its external surface extending over the dorsum pedis. The least 
pre-sure could not be endured. After the child was born, the woman had 
not the slightest perception of after-pains. She felt as if her abdomen was 
empty, or rather not existing. The uterus was enormously distended, its 
limit or outlines being scarcely distinguishable, texture remarkably soft 
and relaxed. Considering this to be a case of metastatic after-pains, I 
thought the chief indication would be to bring on uterine activity, after 
which the pain in the thigh should disappear. The result of my treat- 
ment proved that I was right. 
Shortly after ten o’clock I gave her a large teaspoonful of powdered 
ergot of rye (secale cornutum). Ten minutes after, the patient remarked 
a discharge of blood from the vagina, the tirst after her delivery; a quar- 
ter of an hour after the administration of this remedy, the woman became 
more quiet, she ceased to cry, except occasionally, and a painful expression 
was noticed in her features. Twenty minutes past ten o’clock she said 
that the former kind of pain had left her thigh and yielded to a very 
bearable sensation of smarting., At half-past ten o’clock she took the same 
quantity of ergot, and fifteen minutes later I had the pleasure to see that 
the patient moved to lie upon her right side; she could bend her knee, 
and move her leg up and down; she even told me now that she had not 
the least pain. When I left her (before eleven o’clock), I could ascertain 
that the uterus was well contracted, lessened in size, and considerably 
harder than when I made the first examination. The woman had no 
relapse afterward. 
In explanation of these singular pathological occurrences, we must bear 
in mind, that thei*e is always present a limited amount of nervous power in 
the central organs. Therefore, if one part of the body receives a nervous 
impulse in excess, other organs must be more or less deprived of it; or, 
when there is prepared in the nervous centres a certain amount of mate- LABOK. 
143 
rial for the purpose of setting one department of nerves into action, and 
this department being in itself not properly disposed to receive it, then, 
another portion of the nerves must attract this amount, and show a 
greater activity. The same result must happen, when some other part of 
the system is in such an unnatural condition, that it attracts more nervous 
force from the centres than is due to it. In this case another organ must 
lose part of its activity. 
These principles applied to the uterine system, we are able to explain 
the pathology of metastatic pains. When labor begins, the sympathetic 
nerves and the spinal cord secondarily are called to a physiological energy, 
which is seen in no other instance of life. Their activity is provoked by 
the uterus, and in ordinary circumstances directed to the uterus. But in 
order to perform their duties properly, the womb must be sufficiently dis- 
posed to attract the nervous fluid to its own sphere. In case of its being 
in a state of weakness, other organs receive the effect of the overloaded 
centres, and thus exhibit the phenomenon of metastatic pains. Therefore, 
this complaint is most commonly observed in connection with atonic labor- 
pains. But if some part or other of the system was previously, or during 
parturition, in an unhealthy condition, it would be liable to attract to 
itself the nervous energy originally due to the uterus, even if the latter 
was in a state of health. Therefore, we see that, in very many instances 
of metastasis, the affected organs stood under some morbid influence 
before or during confinement. Part xxxvi., p. 230. 
Tedious Labor.—In cases where labor is arrested, not from any obstacle, 
but from simple atony and want of pains, where in fact the polarity of the 
cord is exhausted, try the effect of strychnia; in doses of one-sixteenth of 
a grain to commence with, repeated and gradually increased as necessary. 
It induces uterine contractions in a very remarkable manner, each dose 
being distinctly followed by this effect; it does not cause violent or con- 
tinued action of the womb. In not one of nine cases in which it was ad- 
ministered, did any bad effects follow, and in all the labor was accomplished 
within an hour and a half after commencing the use of this drug. 
Dr. Vernon prepares a solution of strychnine in very dilute hydrochloric 
acid, of the strength of one grain to the fluid ounce, and administers in di- 
vided doses, repeated upon each subsidence of uterine contractions. He 
says: 
In the “Lancet,” of June 14, 1856, I published a short letter in which I 
incidentally referred to the use of strychnia as an oxytoxic. Curiously 
enough, a letter from Dr. Matthew Corner appeared in juxtaposition with 
my own, detailing a case of poisoning by strychnia. The patient swallowed 
two grains of strychnia by mistake. She was pregnant, and aborted in the 
course of the action of the poison. The case terminated favorably. I have 
since become acquainted with the case of a lady who aborted five times 
consecutively whilst under the influence of nux vomica given as a tonic. 
Part xxxvii., p. 234. 
Galvanism in Obstetric Practice.—Individual shocks applied to the ute- 
rus produce no appreciable effects upon it; and a current directed trans- 
versely through the organ produces only a partial contraction of it in the 
direction of the current; but a sustained current of electricity directed 
longitudinally through the uterus, from the upper portion of the spinal 
cord, excites the action of the uterus, and singularly enough also accelerates 144 
LABOE, 
the dilatation of the os uteri. A case of placenta praevia is mentioned, in 
which several alarming hemorrhages had occurred before labor had com- 
menced. A sustained current of electricity applied in the manner stated 
for six hours, not only prevented further hemorrhage, but so accelerated 
the dilatation of the os uteri, that the hand was readily introduced and de- 
livery completed with safety to the patient, although the child, from the 
extensive separation of the placenta, was still-born. In another case this 
mode of treatment sjieedily induced the expulsion of an organized mem- 
brane remaining after an early abortion, the ovum having been previously 
expelled. The patient w'as much exhausted by repeated floodings. 
Part 271. 
Chloroform in Natural Labor.—The great rule in administering chloro- 
form in natural labor, is to give it so as to allay pain, without destroying 
consciousness. You may thus, without danger, give chloroform for any 
length of time. Part xxxviii., p. 206. 
Uva Ursi in Labor.—In ordinary delayed labor, fifteen grains given in 
infusion every hour is as eflicacious and far more innocent in its operation 
than secale cornutum. When rapid effects are desired, as in metrorrhagia 
a decoction of 4 drachms to a quart of water should be employed, and giver 
in frequent and divided doses. Part xxxviii., p. 206. 
Dilatation of the Os Uteri.—The natural sickness of labor always has a 
beneficial influence in inducing relaxation, unaccompanied by a subsequent 
evil; and for the same reason artificial nausea has a powerful influence in 
subduing rigidity of the os uteri or vagina, and is so safe in the adminis- 
tration that it is a well-known fact that puerperal or peritoneal inflamma- 
tions are rarely seen where tartar emetic as a nauseant has been judiciously 
given; there seems an almost perfect immunity of system from these dis- 
eases afterward. An emetic dose should be given at first, and the nausea 
continued by diminished doses. It must always be first ascertained that 
there do not exist certain unhealthy conditions of system, as organic dis- 
ease of the heart or lungs, etc., in which case continued nausea might be 
productive of serious mischief. 
[Dr. Gilmour lias omitted what we consider the most important and 
safest medicines to accomplish dilatation of the os uteri, viz., chloroform 
and ipecacuanha. We have been highly pleased lately with the effects of 
chloroform. Early in labor, when the pains are regular and the os uteri 
rigid and small, by slightly influencing the patient with chloroform during 
almost every pain, the parts become much more rapidly softened and di- 
lated. We have simply dropped a little chloroform on the pillow, near 
the nose of the patient, and told her to inspire it pretty freely each time, 
or just before the pain conies on. Instead of waiting six or eight hours for 
the dilatation of the os, we have thus accomplished it in less than two 
hours. One grain or two grains of ipecacuanha every half hour, will have 
also a good effect; but in a less pleasing way, and not so certainly.—Ed. 
“Retrospect.”] Part 322. 
Passage of the Foetal Head.—The diameter of the different parts of the 
pelvis are so managed that the foetal head undergoes a screw-like twist in 
its transit. It behooves the accoucheur to be mindful of this in applying 
the forceps. Part xxxix., p. 279. LABOR. 
145 
Treatment of PlacentalPresentations.—The practice of removing the pla* 
centa, in cases of placental presentation, seems to have been well known 
and practised in Manchester for years, and originated in the practice of 
the late Mr. Kinder Wood. Mr. Wood says:] 
If we find so much exhaustion as to make us fear the effects of further 
hemorrhage, during artificial delivery, the first step after passing the hand 
must be to detach the w hole of the placenta; by this the hemorrhage will 
be completely suppressed, for the effect of passing the hand through the 
os uteri, and throwing off the placenta, w ill always be to produce so much 
contraction as to arrest the bleeding from the small decidual or uterine 
mouths. It is satisfactory to know that the child is rarely living in these 
cases of exhaustion, its blood being poured out through branches of the 
placental structure, along with that of the mother; and when brought 
down, its appearance, like that of the mother, is bleached and exsanguined. 
The time required to separate the placenta is very short, and the loss of 
blood during the attempt exceedingly trifling. I know from experience, 
that when the placenta is wholly detached, the hemorrhage will cease. 
In some cases I have been called to attend, when the ordinary method 
of delivery has been adopted, the patient died, and this led me to modify 
the practice, by detaching the placenta, rupturing the membranes, and then 
delivering the child; but after due consideration I was again induced to 
vary my plan, and in those cases where wre can have no hope in saving the 
patient if we proceed to delivery, howrever wrell the operation be conducted, 
I have no hesitation in recommending that the placenta be separated com- 
pletely, and the membranes ruptured, and that the hand be withdrawn 
immediately upon this being effected, leaving the child and placenta behind. 
By this practice the patient will be placed precisely in the situation which 
occurs in the most favorable cases of recovery by the natural efforts. I con- 
ceive no fact in midwifery rests upon a more solid foundation, than that 
this hemorrhage will cease upon separating the placenta, and by this 
practice( the patient is placed in as favorable a situation as is possible for 
recovery. Time will be gained to support her by proper means, and which 
can be used Avith greater freedom, as the hemorrhage is infallibly sup- 
pressed by this operation. Part xi,,p. 195. 
Placental Presentation—Extraction of the Placenta before the Child 
in Cases of—All obstetric authors agree that no complication in midwifery 
occasions more anxiety to the practitioner, or danger to the patient, than 
hemorrhage from placental presentation, and the results of pi’actice fully 
support this opinion. Of 174 cases which Dr. Churchill has collected, 48, 
or nearly one-third of the mothers died. Dr. Simpson has attempted a still 
more extensive analysis, and finds that of 399 cases recorded, in 115 the 
result wras fatal to the mother, a mortality as great as that of malignant 
cholera in 1832-33, and twice as great as the average in cases of lithotomy. 
Looking at the results, any attempt to diminish such fearful mortality is 
entitled to the most careful notice of the profession. Hitherto twro great 
principles of treatment, which some have supposed to be applicable to the 
two different stages of the complication, have been pursued, viz.: 1st, 
the evacuation of the liquor amnii • and 2d, delivery of the child by turn- 
ing. 
PLACENTAL COMPLICATIONS. 
'VOL. IX.—IQ 146 
LABOB. 
[Some accoucheurs, as Drs. Burns and Hamilton, Baudelocque, Capuron, 
and others, think this the only mode of treatment advisable under any cir- 
cumstances in these cases. Drs. Merriman, Conquest, Dewes and Denman, 
are unanimous in the opinion that turning must be resorted to.] 
Cases of placenta praevia, says Dr. S., frequently occur in practice in 
which neither of the two preceding plans can be successfully adopted— 
where the artificial evacuation of the liquor amnii is insufficient to moderate 
the hemorrhage to a safe degree, and where forced delivery by turning is 
inapplicable or extremely dangerous if adopted. In these and other cases, 
I would beg to submit to my obstetric brethren an additional principle of 
treatment, viz.: The complete separation, and, if necessary, extraction of 
the placenta before the child. Obstetric pathologists seem unanimous in 
the opinion that all the more formidable varieties of hemorrhage, which 
occur from the uterus in the latter months of utero-gestation, or the earlier 
periods of labor, are attributable to the separation of the vascular connec- 
tions between the placenta and the interior of the uterus, and the escape 
of blood from the vessels which are laid open in consequence of this separa- 
tion. Paradoxical as it may appear, there are sufficient grounds and facts 
for believing, that when the placenta is separated slightly and partially, 
the chance of fatal hemorrhage to the mother is greater than when the 
disunion of the organ is more entire and complete. Various authors have 
detailed cases in which the death of the mother speedily took place 
though the portion of the placenta separated from the uterus was exceed- 
ingly small. 
Dr. S. has collected notes of 141 cases in which the placenta was ex- 
pelled before the child, which he throws into a tabular form, and divides 
into—1st, Cases in which a considerable interval elapsed between these two 
occurrences; 2d, Cases in which the interval was less than ten minutes; 
3d, Cases in which the child was born immediately after the placenta, or 
along with it; and 4th, Cases in which the period is not mentioned. I 
believe, says Dr. S., that the data which I have collected are amply suffi- 
cient to establish, as a great physiological and practical fact, that, when 
the placenta, in cases of unavoidable hemorrhage, is once completely de- 
tached from its connections with the interior of the uterus, the accompany- 
ing flooding in general entirely ceases, or become quite moderate and in- 
considerable in quantity. 
Summary of llesults.—1. The total separation and expulsion of the 
placenta before the child, in cases of unavoidable hemorrhage, is not sc 
rare an occurrence as accoucheurs appear generally to believe. 2. It i 
not by any means so serious and dangerous a complication as might o 
priori be supposed. 3. In nineteen out of twenty cases in which it has 
happened, the attendant hemorrhage has either been at once altogether 
arrested, or it has become so much diminished as not to be afterward 
alarming. 4. The presence or absence of flooding after the complete 
separation of the placenta, does not seem in any degree to be regulated by 
the duration of time intervening between the detachment of the placenta 
and the birth of the child. 5. In ten out of one hundred and forty-one 
cases, or in one out of fourteen, the mother died after the complete expul- 
sion or extraction of the placenta before the child. 6. In seven or eight 
out of these ten casualties, the death of the mother seemed to have no con- 
nection with the complete detachment of the placenta, or with results aris- 
ing directly from it, and if we do admit the three remaining cases (which 147 
are doubtful), as leading by this complication to a fatal termination, they 
would still only constitute a mortality from this complication of three in 
one hundred and forty-one, or about one in forty-seven cases. 7. On the 
other hand, under the present established rules of practice, one hundred 
and thirty-four mothers died in three hundred and ninety-nine placental 
presentations, or about one in three. Part xi., p. 203. 
Placenta Prcevia—Partial.—Rupture the membranes as soon as possi- 
ble, and excite uterine action by friction, the application of a binder, ergot 
of rye, or galvanism. 
Complete.—If the os is undilated and rigid, plug with a sponge dipped 
in vinegar and water; when the os is sufficiently dilated, seize a foot and 
deliver cautiously. In head presentation with a dead child, use cranioto- 
my ; and in both this case and that of foot presentation, rupture the mem- 
branes early through the placenta, by a silver catheter. (Dr. Tyler.) 
LABOR, 
When the vital powers are much depressed, and the placenta partially 
detached, plugging is dangerous. So are the administration of secale cor- 
nutum, and delivery of the child, because they lower still more the powers 
of the system. Detach completely the placenta, and employ galvanism, 
which both rouses the uterus, and stimulates generally.—(Dr. Radford.) 
Turn as soon as possible, extract the placenta, and get the uterus to con- 
tract : taking care to keep up the pulse. If the strength is too much ex- 
hausted for this, or if the os uteri will not admit the hand, separate the 
placenta if possible; rupture the membranes with the nail, and plug the 
vagina completely, then give ergot of rye, and apply cold, or galvanism. 
When the pulse rallies withdraw the plug, and if possible turn; if this can- 
not be done, plug again and wait. It is plain that if we cannot deliver, we 
must directly stop the bleeding; and plugging in the case supposed, where 
the placenta is low down, is quite effectual. 
Dr. Simpson advises when the hemorrhage and exhaustion are very 
great, and when turning, etc., are impracticable, on account of the undi- 
lated state of the os and cervix, especially in primiparse, or the contracted 
state of the uterus itself, or the narrowness of the pelvis; or when turning 
is dangerous on account of the exhaustion of the mother, or not required 
for the safety of the child, on account of its death or prematurity, to de- 
tach the placenta, and leave the expulsion of the child to nature, if the 
hemorrhage, as is usually the case, ceases, and no particular complication 
arises. Part xv.,y>. 274-279. 
Retained Placenta.—Empty the umbilical vein, and forcibly inject cold 
water slightly acidulated with acetic acid ; or if there is much hemorrhage, 
cold decoction of ergot, or solution of tannic acid. Part xv., p. 280. 
Placental Presentations.—The practice recommended by Dr. Simpson, 
of entirely detaching the placenta, and leaving it, is likely to be of use in 
very many instances; as where there is such an unyielding condition of 
the soft parts as to prevent speedy delivery, or where the flooding has 
been going on for a considerable time, and the practitioner, on his arrival, 
finds the bleeding still continuing, and the woman go much exhausted that 
the sudden emptying of the womb would be dangerous. But this plan by 148 
LABOR. 
no means supersedes delivery by turning, which, if adopted in a prompt 
and energetic manner, is a safe and proper method of treatment. 
The practice of detaching the placenta is inapplicable in the most formi- 
dable cases—is as difficult to accomplish as turning, and does as much 
violence to the uterus—is almost certainly fatal to the child, and affords no 
increased chance of safety to the mother. If the cause of hemorrhage is 
ascertained to be placenta praevia, rupture the membranes, introduce the 
hand, and turn and deliver the child—provided that the os is sufficiently 
dilated, or easily dilatable ; if it is not, wait, and act upon general princi- 
ples, till sufficient relaxation has taken place.—(Mr. Newnham.) 
When copious and repeated hemorrhage occurs in the eighth or ninth 
month of pregnancy, and signs of labor do not appear, evacuate the liquor 
amnii, pass a conical plug into the os uteri, fill up the vagina behind it, and 
then give one or more doses of secale. The plug occasions the formation 
of a large coagulum within the uterus, the presence of which, combined 
with the irritation caused by the plug, excites uterine contraction. By 
the expulsion of the clot, the os is dilated, and we are then able to introduce 
the hand and turn with more facility. (Dr. Reid.) Pt. xvii., pp. 225-237. 
Placenta Prcevia.—The chief methods of treatment are: 1. The plug. 
2. Puncturing the membranes. 3. Turning the child. Plugging is adapted 
to those cases which occur at the sixth or seventh month, when a continu- 
ous drain is going on after the first loss. The best method of plugging is 
to introduce strips of lint, pieces of sponge, or a silk handkerchief dipped 
in vinegar and water. Do not plug too tightly, or uterine contraction 
may be excited, and further separation take place. Puncturing membranes 
is adapted to those cases, not very severe, where the os uteri is only dilat- 
ed to a slight extent, and turning is impracticable; it arrests the hemor- 
rhage by lessening the vascular supply, and bringing down the presenting 
part of the child to act as a plug to the placental site. Turning is the 
grand remedy in placenta praevia; if performed at the proper time, it 
affords the greatest chance of safety to both mother and child. 
The most prompt and efficient method in almost all cases is to introduce 
the hand, dilate the os uteri, separate the intermediate portion of placenta, 
rupture the membranes, seize one foot, turn, and deliver. In selecting 
the time when to do this, the great thing is to distinguish the dilatable 
character of the os uteri; if this be present, the extent of dilatation is of 
no importance comparatively. It requires great care that the dilating 
force be steadily applied and evenly distributed, so as to guard the cervix 
from laceration, which might prove fatal from hemorrhage. Version is 
sometimes prohibited by the immediate exhaustion of hemorrhage, or from 
rigidity of the os uteri, in spite of hemorrhage; in the foi’mer case plug and 
give stimulants freely, as a temporary resource. In the latter case, sepa- 
rate the entire connection of the placenta, rupture the membranes, and 
excite uterine action. (Dr. Tyler Smith.) Part xxxiv., p. 226. 
Encysted Placenta.—That is, where the placenta is retained by the con- 
traction of the os uteri after parturition, must be removed by gently dilat- 
ing the os first by the placenta itself, if possible, or if this do not succeed, LABOR. 
149 
by the fingers, drawing gently at the cord, and at the same time having 
firm pressure made on the abdomen. Part xxxiv., p. 227. 
Placenta Prcevia.—In those terrible cases where the os is rigid and un- 
yielding, and the flooding profuse, do not delay, but introduce one or two 
fingers through the os, and detach all that part of the placenta which ad- 
heres within the cervical zone, or region of dangerous placental seat. The 
contraction of the womb present in such a case as this, is the very element 
which will secure the success of this operation, as it constricts the mouths 
of the bleeding vessels. If contraction is not present, it must be induced 
by ergot of rye or galvanism. By the performance of this operation, 
moreover, the os and cervix are released from a mechanical impediment to 
dilatation. If necessary, the hemostatic process may also be assisted by 
the use of the plug. By these means the hemorrhage will have been 
arrested in the great majority of cases, but, if not, time will have been 
gained, and forced delivery rendered more easy. Part xxxvi., p. 221. 
Placenta Prcevia.—A case is related in which, the os being dilated to 
the size of a small teacup, the separation (as advised by Dr. Barnes) of the 
whole circumference of the placenta which was presenting, sufticed at once 
to check the hemorrhage. By further separating the posterior portion of 
the placenta the membranes were reached, and the presentation disco- 
vered to be a footling. The child was delivei'ed in a short time alive, and 
the mother did well. Part xxxix., p. 292. 
Placenta Prcevia—Air Pessary.—An interesting case is related by Mr. 
Jardine Murray, of Brighton, in which the os uteri being dilated suffi- 
ciently to admit two fingers, and syncope impending from hemorrhage, a 
flattened caoutchouc air-pessary was introduced between the wall of the 
uterus and the presenting surface of the placenta. The pessary being then 
inflated by means of the attached syringe, it acted admirably as a direct 
plug and dilator of the os uteri. Whenever, from time to time, the trickling 
of blood recurred, it was effectually checked by further dilatation of the 
pessary, by a few strokes of the syringe. In two hours the os was suffi- 
ciently dilated to admit the hand, and though turning was necessary, as 
the shoulder presented, the case was soon brought to a favorable conclu- 
sion. Part xl., p. 196. 
PREMATURE LABOR. 
Mode of Inducing.—Dr. Meissner’s mode of operating, which is a modi- 
fication of that by puncture of the membranes was the following: A very 
slender canula is provided of about 13 to 14 inches in length, and bent re- 
gularly in the form of a segment of a circle. It has a ring soldered on the 
convex side of its lower extremity, in order to give a more secure hold, 
and allow of the point of the instrument being accurately guided. This 
canula is provided with two trocars, one with a blunt point and the other 
with a sharp-cutting point. When the instrument is to be used, the blunt 
pointed trocar is introduced into the canula, and projects beyond its orifice 
so far as to prevent the edge of the tube injuring the parts. The patient 
then stands before the practitioner, who kneels before her, the usual man- 
ner in which vaginal examinations are made on the continent, or she may 
sit on the very edge of a chair, or of the bed. The forefinger of the left 
hand is then introduced into the vagina, and the canula guided along it to 150 
LABOE. 
the orifice of the uterus, making the convexity of the instrument corres- 
pond to the curve of the sacrum. The point of the instrument is then 
pushed slowly backward and upward, so as to make its rounded point 
slide between the uterus and the back of the membranes. When the point 
is once past the neck of the uterus, it advances easily, care only must be 
taken to detach the membranes as little as possible. When the point of 
the instrument is about 10 or 11 inches within the os uteri, the blunt-point- 
ed trocar is withdrawn, and the handle of the instrument is pressed against 
the perineum, to detect, if possible, against what the point of the canula 
is pressing. If it be felt to be a hard body, the point is made to move to 
one side or other till an elastic fluctuating spot be reached, which shows it 
is opposite the membranes alone ; the sharp-pointed trocar is then intro- 
duced and perforation of the membranes is made. The trocar is then 
withdrawn, and about a tablespoonful of the liquor amnii is allowed to 
escape; after this the canula also is removed, and the woman is allowed to 
walk, sit, or lie down at her own pleasure. Part iii., p. 124. 
The Use of the Plug to produce Premature Tabor.—Two modes of pro- 
ducing premature labor are resorted to at the present day. Either the 
membranes are punctured, or a tent of sponge is introduced into the os 
uteri, as recommended by Professor Kluge. The former method is liable 
to the objection of causing the too rapid escape of the liquor amnii, and 
thus endangering the life of the child when labor pains are tardy in their 
occurrence. The second is often extremely difficult to accomplish, or even 
impossible when the os uteri is directed very much backward, or when 
the patient has never before been pregnant. 
Dr. Scholler was led to try the plug, from having observed that when 
used to suppress hemorrhage, in cases of placental presentation or of 
threatening abortion, it had a considerable influence in exciting uterine 
action. lie had observed, also, one case where its employment to restrain 
hemorrhage was followed by premature labor, which it seemed to have 
occasioned. He recommends tilling the upper part of the vagina with 
balls of charpie, which, for the sake of cleanliness, should be renewed 
every twenty-four hours. The action of the uterus is usually very speedily, 
excited, and, when fully established, the plug may be withdrawn and se- 
cale cornutum administered to prevent the diminution of labor pains. 
The finger may likewise be used to aid the dilatation of the os uteri, but 
great care must be taken to leave the membranes uninjured. 
The average length of time which elapsed between the application of 
the plug and the birth of the child was five days and fourteen hours. 
Part v., p. 162, 
Induction of Premature Labor.—M. Dubois confines himself to those 
cases where the safety of the mother is in question, not regarding in any 
respect whether the child is viable or not. This absolute abandonment ot 
the interests of the infant, when the life of the mother is seriously endan- 
gered, although not admitted by many accoucheurs, now finds less and less 
opposition every day. 
The first mechanical condition requiring the operation, is excessive dila- 
tation of the uterus by superabundance of the liquor amnii. 
The second set of cases sometimes demanding the operation are those 
where, in addition to the pregnant uterus, the abdomen contains a large 
tumor. Thirdly, cases where, from malconformation of the pelvis and LABOR. 
151 
trunk, there is not sufficient space for the uterus to develop itself. We 
may remark, however, that in these last sets of cases, premature labor 
generally comes on spontaneously. 
Fourthly, cases of retroversion of the uterus, in which it becomes im- 
pacted in the small pelvis. 
Fifthly, those cases of uterine hemorrhage where nothing but the eva- 
cuation of the ovum, and the contraction of the uterus, will stop the bleed- 
ing. We now come to another series of cases demanding the operation ; 
and, firstly, we mention those nervous diseases which may demand it when 
they exist to an excessive and dangerous degree, as chorea, convulsions, 
etc. But M. Dubois inculcates extreme caution in such cases, as also in 
cases of obstinate vomiting during pregnancy. Two cases are mentioned 
in which cholera supervened upon pregnancy ; in one labor was induced, 
in the other it came on spontaneously ; both women recovered. 
There is another series of cases sometimes demanding the operation, 
namely, where there exists chronic disease, very much agravated by the 
mechanical distention of the uterus, as disease of the heart, of the aorta, 
asthma, etc. 
Again, it is proprosed to bring on labor in cases where the child has 
been previously found to die at some regular time, before the completion 
of the ninth month. But this ought to be done only when the infant is 
alive and viable, and even then it should be resorted to with reserve, as 
there may be hope that the disease which caused the death of the child in 
a former pregnancy may have now disappeared. Part xix., p. 234. 
Premature Labor.—The following method, proposed by Kirnsch and 
Cohen, has been successful in inducing premature labor: Pass the noz- 
zle of a large syringe, containing 11 or 12 oz. of water, at 92° F., half an 
inch within the cervix, and inject the water with some degree of force for 
a number of times (e. g. eight or ten, up to seventeen times) ; and repeat 
this process twice a day until labor is induced. Part xxi., p. 308. 
Premature Laboi—Induction of.—Dr. Simpson recommends the dila- 
tation of the os uteri by sponge tents, gradually increasing them in size. 
The membranes are also separated to a certain extent. This he had never 
found to fail, although he had employed it in numerous cases. In this 
manner the first stage of the labor is almost entirely accomplished before 
labor begins, and consequently, the child is saved from the pressure, etc., 
incidental to the earlier and protracted part of the first stage. 
Part xxiv., p. 348. 
Premature Labor—Induction of.—The following is the method of Pro- 
fessor Kiwisch: A piece of India-rubber tubing, about eleven feet long 
and half an inch in diameter, is connected with a straight tube from an in- 
jecting apparatus five or six inches in length, the latter forming the ex- 
tremity of the siphon. A vessel containing about two gallons of water 
of about 110° Fahr., is placed nine or ten feet from the ground, the pa- 
tient being placed in an empty hip-bath. The proper end of the tube is 
to be passed into the vagina, and directed toward the os \iteri, where it is 
to be held steadily. After exhausting the tube, the other end is to be 
placed in the warm water. The stream flows with considerable foree 
against the os uteri, and continues until the whole contents of the vessel 
are discharged. Two gallons of cold water are then to be placed in the 152 
LACTATION. 
vessel, and discharged in the same way. The douche may be repeated if 
necessary on the next day. 
In another case the plan adopted was somewhat different. The common 
elastic bottle-syringe, manufactured by Roberston, of Dublin, was used. 
To this was attached a flexible tube, with a bone pipe at the end. This 
was introduced into the vagina, and directed against the os uteri. Tepid 
water was then forced, by means of the syringe, along the tube, from some 
convenient vessel, another smaller one being placed to catch the water as 
it poured from the vagina. The process had to be continued about five 
minutes. A second and third application was made on successive days; 
and on the third, labor came on at half-past three o’clock p. m., and ter- 
minated at half-past ten at night. Part xxvii.,7?. 170. 
Premature Labor.—There is a great and undoubted sympathy between 
the breasts and other parts of the sexual apparatus. It was supposed that 
irritation of the mammary nerves might induce uterine action. This was 
tried. Sucking pumps, made of caoutchouc, were applied for two hours 
seven times during three days: after the third application the cervix uteri 
was shortened, after the sixth severe labor pains came on, and after the 
seventh the child was born. Part xxviii., p. 263. 
Premature Laboi—Induction of.—To give the child the best chance 
of surviving, instead of rupturing the membranes, you must separate them 
from their connection in the vicinity of the os. Various plans have been 
devised for this purpose ; but perhaps Dr. Weir’s instrument, which com- 
bines the uterine introduction of a female catheter, with the injection of 
tepid water, is the best. It consists of a large flattened female catheter, 
to which can be attached a common injecting syringe. In using it, the 
tube is first cautiously introduced within the os for about three inches, 
and then by means of the syringe a quart of tepid water is injected so as 
to act by slowly separating the' membranes. A sponge tent should now 
be introduced within the os, and the injection may be repeated, at inter- 
vals of two or three hours, until successful. Part xxxii., p. 229. 
Premature Labor—Induction of.—In the early months, while the cer- 
vix uteri is as yet undeveloped, and the ovum is contained in the cavity 
of the fundus uteri, the douche cannot be relied upon, and the better plan 
will be to introduce the uterine sound and turn it round once or twice ; 
this will never fail to produce expulsion. When the life of the child is no 
object, as before the seventh month, the stilette may be used, but before 
the fifth month this is a dangerous instrument. Part xxxv., p. 208 
LACTATION. 
Use of the Pofareira, llicinus Communis, or Palma Christi.—In cases 
of child-birth where the appearance of milk is delayed, a decoction is made 
by boiling well a handful of the white Bofareira (Ricinis Communis ot 
botanists) in six or eight pints of spring water. The breasts are bathed 
with this decoction for fifteen or twenty minutes. Part of the boiled 
leaves are then spread thinly over the breasts, and allowed to remain LACTATION. 
153 
until all moisture has been removed from them by evaporation, and pro- 
bably, in some measure, by absorption. This operation is repeated at 
short intervals, until the milk flows upon suction by the child, which it 
usually does in the course of a few hours. If the milk is required to be 
produced in the breasts of women who have not given birth to or suckled 
a child for years, the mode of treatment is as follows : A similar decoction 
is made, and it is poured, while yet boiling, into a large vessel, over which 
the woman sits so as to receive the vapor over her thighs and generative 
organs, cloths being carefully tucked around her, so as to prevent the 
escape of the steam. In this position she remains for ten or twelve mi- 
nutes, or until the decoction cooling a little, she is enabled to bathe the 
parts with it, which she does for fifteen or twenty minutes more. The 
breasts are then similarly bathed and gently rubbed with the hands, and 
the leaves are afterward applied to them in the manner described. These 
operations are repeated three times during the first day, on the second the 
process is repeated as to the breasts three or four times; on the third day 
the whole process is repeated. A child is now put to the nipple, and, in 
the majority of instances, it finds an abundant supply of milk. In the 
event of success not following, the treatment is continued for another day; 
and ifthere be still want of success, the case is abandoned. 
jPart xxii., p. 316. 
Case of Lactation in a Male.—Dr. Horner gives a case of lactation 
occurring in an adult male, aged 22 years. The patient’s attention was 
first drawn to his left breast, which appeared to be enlarging, and con- 
tinued to increase in size for three weeks, when he came to Philadelphia. 
After being in this city for three weeks, he became quite anxious in regard 
to his condition ; for, although he suffered very little pain, the mamma had 
become quite as large as that of a female nursing. 
He was induced to apply at the Clinic of the Jefferson Medicai College 
to consult the faculty of that Institution. His case came up before Prof. 
Mutter, who, upon examination, found the mammary gland largely deve- 
loped, and filled with lacteal secretion, •which differed in no wise from that 
of a mother. He could assign no cause for this freak of nature: his 
health was very good, and the other breast natural. A soap plaster was 
prescribed, and compression ordered to be kept up, which he persisted in 
for full six weeks, when the gland returned to its usual size. 
Part xxiii., p. 258. 
Suckling—Impairment of Vision during.—This affection arises from 
the drain there is upon the system ; therefore, if severe, the child should 
be immediately weaned; if slight, it should not be put to the breast more 
than twice in the twenty-four hours. The anaemic condition of the patient 
naturally indicates the employment of a stimulating plan of treatment. 
You must give iron in some form, combined with ammonia, which is the 
most generally useful of all stimulating medicines; quinine also maybe 
necessary. If the patient does not improve, try mercury, but you must 
give it very cautiously in these cases. Leeches or blisters should never 
be applied ; you must increase the quantity and improve the quality of the 
blood. 
[Whatever reduces the powers of the system, and impairs the quality 
of the blood, such as diarrhoea, leucorrhcea, or excessive natural secretions, 
so as to act as a drain on the system, may be followed by impairment or 154 
LACTATION. 
loss of vision, whie’n, when detected early, is very amenable to treatment, 
whereas, when neglected, it not unfrequently terminates in total blindness.] 
Part xxxii., p. 231. 
Effects of Belladonna in arresting the Secretion of Millc.—Dr. Burrows 
of Liverpool cites the following striking case : The child was dead owing 
to the nature of the labor, and the resuscitative measures adopted did not 
prove successful. On the fourth day the breasts assumed their maternal 
functions; on the seventh day they were full, tense, painful, and knotty, 
with a slight inflammatory blush, though spirit lotion had been applied. 
I directed the areola, and a circle extending half an inch beyond it, of 
each breast, to be painted thickly over with the extract of belladonna, 
reduced to the consistence of thick paste by the addition of the acacia 
mixture. As the late Mr. C. T. Haden recommended the use of colchicum 
for the purpose of controlling arterial action in inflammation of the breast 
and nipples, with the same intention I gave the following mixture: 
R Infusi rosae comp. gvj.; magnesia) sulphatis § j.; vini colehici 5iij.: aquae 
menthae piperitae 3xv. M. Fiat mistura cujus sumatur §j. 4taquaque hora. 
The result was most satisfactory. In thirty-six hours after the applica- 
tion of the extract, the mammae were cool, pale and flaccid; and the. knots 
softened and reduced in size. I advised the repainting of the areolae; and 
in two days after—i. e. three and a half days from the first application— 
they were so reduced in size that they were smaller than during the latter 
period of pregnancy, and the knots could scarcely be felt. 
Part xxxv., p. 234. 
Suppression of Milk.—If from any cause the lacteal secretion should 
become suppressed, and it is desirable to again renew it, it may be accom- 
plished by the ajrplieation of electricity. Part xxxvi., p. 236. 
Abortive Treatment of Milk Abscess.—Dr. Goolden has found this mode 
of treatment eminently successful.— Case.—M. S , confined of her first 
child. According to her reckoning and the appearance of the infant at its 
birth, the labor was premature. On the third day the breasts were swollen, 
hard, tender, throbbing, and red ; the superficial veins enlarged, with 
feeling of great distention. The nipples were retracted and cracked, and 
the child was too feeble to suck, even if the nipples had been more pro- 
minent. The milk partially oozed away, and a little was drawn by means 
of a breast pump, but not enough to produce any sensible diminution of 
their bulk; besides which, the abortive efforts were attended with the 
greatest suffering. There was fever, anxiety of countenance, and depres- 
sion of mind; as she had a great dread of a “ bad breast.” This was 
evidently one of those cases that must inevitably result in abscess, unless 
something more than the ordinary remedies "were resorted to. I gave 
directions to paint the areolae and nipples with extract of belladonna, and 
to take a saline mixture with half-drachm doses of colchicum every six 
hours. Upon visiting her on the following day I was as much gratified as 
surprised at the result of the treatment. The fever had entirely disap- 
peared ; the breasts were quite soft; the milk had flowed away in great 
abundance into a bread and water poultice ; a cheerful expression of counte- 
nance was exchanged for the former one of anxiety and dread ; and all 
apprehension of evil had disappeared. I ordered the mixture to be omitted, 
but to continue the local application. The case required no further treat- 
ment, and she was “ about ” in the course of a few days. LARYNGEAL AFFECTIONS. 
155 
In the cases related by Dr. Goolden, the belladonna, with the internal 
administration of colchicnm, appeared to have had the effect of arresting 
the secretion of the milk. In the case above detailed it is seen that the 
milk flowed away abundantly, and that the mother was enabled to con- 
tinue lactation shortly after the application. 
The long-recognized power which this drug is known to possess of 
relaxing muscular contraction, at once suggests the modus operandi in 
these cases. 
Doubtless, any of the active forms of belladonna would answer the pur- 
pose equally well with the extract; such as a solution of its active principle, 
atropine. 
The latter is undoubtedly more elegant, and I dare say would be more 
speedy in its effect; but the extract, from its being a messy and unsightly 
application, is much more likely to be carefully washed off, so as not to be 
injurious to the infant when replaced at the breast. Part xxxvi., p. 23?. 
Dispersion of the Milk.—Iodide of potassium given in doses of from six 
to eight grains per diem, has the effect of suspending, and in less doses, of 
moderating, the secretion of milk. This property may be made of the 
greatest use in arresting impending inflammation and abscess; the pain 
and fever will often disappear next day. After the cure the milk returns 
again two or three days after the suspension of the iodide. 
[Probably this treatment might be advantageously combined with the 
external application of belladonna, first recommended by Dr. Goolden, and 
since found so eminently successful by other practitioners.] 
Part xxxviii., p. 221. 
Defective Lactation—Dietetic Treatment.—Experience proves that much 
may be effected by proper diet; the food should be “ analogous.” First 
among the grains are lentil powder, or the so-called revalenta: but pea- 
soup and bean-soup have also a marked effect in improving the flow and 
richness of milk. The lentil and bean, however, are preferable to peas, 
when they are as easily procurable. Shell-fish, as oysters, are peculiar in 
containing much phosphorus. If, on trial, they do not produce urticaria 
or roseola in the child, they will on the above account be advantageous, as 
the phosphates are beneficial to both mother and child. Part xh, p. 310. 
LARYNGEAL AFFECTIONS. 
Transverse Divisions of the Larynx and Trachea.—In eases of divi- 
sions ot the trachea, or larynx, we would strongly recommend surgeons to 
bear in mind the advice given by Mr. Stanley, viz., not to be satisfied to 
bring the outward parts together by means of ligatures, etc., trusting af- 
terward to position to complete the cure, but to introduce a ligature or 
two through the windpipe itself, or through the fibrous tissue connecting 
the cartilages, so as to prevent the lower portion retracting. In a case of 
cut throat, however, the surgeon must not apply his sutures immediately, 
as he might very naturally feel inclined to do, but wait a little to see what 
blood has escaped into the windpipe, and allow it to make its escape before 
closing up the aperture. 
Rust, of Berlin, observes, that “ in wounds dividing only partially the 156 
LARYNGEAL AFFECTIONS, 
trachea or larynx, a suitably inclined position of the head and neck is 
generally all that is required to effect a speedy union ; but where the lar- 
ynx or trachea is completely cut across, it becomes expedient to have re- 
course to sutures. The tendency of the lower portion to sink down from 
the upper is often so great, that we must not limit our sutures to the cel- 
lular tissue, but pass them through the substance of the trachea itself, and 
even through the cartilages of the larynx.” He relates a case of cut 
throat which occurred in Charite Hospital at Berlin, where the thyroid 
cartilage was divided, and adds, “ that in this patient, the tendency of the 
lower end of the divided larynx to sink down from the upper, was such as 
to occasion the necessity of a suture through the substance of each portion 
of the cartilage (thyroid), that sutuies passed simply through the soft tex- 
tures repeatedly gave way, and that the healing in this case was perfect. 
Mr. Stanley remarks that in such cases when a liquid is swallowed, it 
often passes down the trachea, and comes out at the wound, giving rise to 
a suspicion that the oesophagus is also wounded, but this is owing to a loss 
of irritability of the glottis, which thus allows the liquid to pass. . 
Part x., p. 136. 
Coin removed from the Larynx by Inversion of the Body.—Dr. Dun- 
can relates a case of this accident which occurred to a man who was amus- 
ing himself with tossing up a shilling, and catching it in his mouth, when 
it slipped into the larynx. At first, violent coughing with great dyspnoea 
were produced, but these after some time subsided. From the favorable 
result of Sir B. Brodie’s case, it was determined to try inversion of the 
body, which plan had also occurred to the patient himself. Instruments 
•were, however, kept ready in case the shilling should change its position 
so as to produce suffocation. The mode in which the experiment was per- 
formed, though rough, was quite effectual. 
The man was placed with his shoulders against the raised end of a pretty 
high sofa, and then being seized by three of the most powerful of those 
present by the loins and thighs, he was rapidly inverted, so as to bring the 
head into the dependent position, and, after a shake or two, Dr. Simpson 
at the same time moving the larynx rapidly from side to side, the shilling 
passed into the mouth and fell upon the floor. Not the slightest cough 
or dyspnoea was produced, and the patient immediately started up, de- 
lighted with the result. He was now perfectly free from uneasiness, and 
there was a marked change in the character of the voice. He had not the 
slightest subsequent bad symptoms. Part xi., p. 173. 
Cynanche Laryngcea.—Dr. Budd believes that this disease is really 
erysipelas, and that its not being recognized as such, is owing to its so fre- 
quently proving fatal, before it has had time to spread. In support of 
this, he relates in his paper read to the Medico-Chirurgical Society, five 
cases which have recently occurred in the London hospitals. 
These cases, the author observes, were clearly examples of the same dis- 
ease ; but they did not all begin exactly in the same manner. In three, the 
inflammation commenced in the fauces; in one, it commenced in the paro- 
tid gland; and in one, the first appearance of it was an erysipelatous blush 
at the angle of the lower jaw. In all the cases the inflammation soon 
spread to the glottis, and produced there the same effects—namely, red- 
ness and great thickness of the epiglottis, and of the lips of the glottis, 
with effusion of sero purulent fluid in the submucous cellular tissue—to LAKYNGEAJL, AFFECTIONS. 
157 
such a degree as, in three of the cases, to produce almost sudden closure 
of the glottis, and consequent suffocation. 
The occasional connection of laryngitis with erysipelas was noticed by 
Dr. Cheyne in his article on laryngitis in the “ Cyclopedia of Practical 
Medicine 
The author cites the facts related by Mr. Ryland, and observes that they 
prove conclusively that inflammation of the larynx, causing great swelling 
of the lips of the glottis, and infiltration of the fluid in the submucous cel- 
lular tissue, and thus leading to speedy suffocation, occasionally results 
from the poison of erysipelas. He considers the following circumstances 
favor the opinion he has expressed as to the nature of the disease. That 
the inflammation spreads in the same mode as in erysipelas of the skin, 
presenting the deep redness and swelling, and infiltration of a serous or 
sero-purulent fluid, which occur in that disease; that it is more fatal than 
ordinary laryngitis; and that it occurs most frequently among the inmates 
of hospitals in which erysipelas prevails, and among such of them as are 
peculiarly liable to erysipelas, viz., convalescents from continued fever or 
eruptive fevers, and those laboring under secondary syphilitic ulcers. 
Mr. Arnott, to show the erysipelatous nature of the disease under dis- 
cussion, related the following cases: A gentleman was seized with a pain in 
the back of the throat, attended by difficulty of swallowing. Nothing 
could be seen. Leeches were applied, and blood afterward taken from 
the arm. The blood was buffed and cupped. He appeared better; but 
a few hours after was suddenly seized with dyspnoea and died. The only 
disease found was inflammation of the glottis, one of the margins of which 
had sloughed. Four days after, his wife, who had attended him, was 
seized with an affection of the throat; the tonsils were enlarged. Ery- 
sipelas of the head and neck shortly afterward developed itself. The 
daughter, who came from the countiy to see her mother, suffered from in- 
flammation of the larynx and pharynx, and afterward from erysipelas of 
the head and face. When there was infiltration of purulent matter, he be- 
lieved that in these cases the operation was always fatal. He did not 
know what to do after the operation in these cases. Part xv., p. 93. 
Syphilitic Laryngitis.—Dr. Watts relates the case of a man who, when 
suffocating with syphilitic inflammation of the larynx, was saved by tra- 
cheotomy. 
Dr. W. saw him for the first time Sept. 29th, after he had been given up 
for death by three medical gentlemen; the patient wTas then so breathless 
as to be scarce ablfe to make the effort to whisper single words at inter- 
vals ; his voice was nearly extinct, and the inspirations were accompanied 
with a loud hissing noise in the larynx. The friends stated he had not 
slept for twelve days, owing to the intensity of the orthopoena. After a 
careful examination of the chest and air passages, and having obtained a 
perfect history of the circumstances, syphilitic laryngitis was diagnosti- 
cated ; the iodides of mercury and potassium, with other appropriate treat- 
ment were prescribed, and the case was viewed as being favorable for the 
performance of tracheotomy. In consultation with Dr. Dumville, the plan 
of operation was agreed upon ; but it was determined to wait until the last 
extremity before having recourse to it, and in the meantime the patient 
was carefully watched. In the evening of Oct. 1st, the powers of life 
seemed fast failing, and it appearing impossible for him to continue the 158 
LARYNGEAL AFFECTIONS. 
struggle for breath longer with safety, the operation was undertaken at 
his own instance, and most happily performed by Mr. Dumville. The fit 
of spasmodic coughing usually attendant on the introduction of the tube 
having subsided, the man fell into a sound sleep even before the dressings 
were completed: so signal was the relief from suffering, so completely was 
he worn out by anxiety and fatigue, and deprivation of rest. The case 
progressed favorably; the patient continuing to take the medicines, was 
soon under mercurial influence, and gradually improved in health. On the 
30th Oct., precisely thirty days after the operation, the use of the tube was 
finally dispensed with; the wound closed up within a week, but required 
other seven days before the skin healeii perfectly. The iodide of potassium 
was administered for a few months longer, to insure the thorough eradica- 
tion of the lues; but from the period of the removal of the tube he con- 
tinued steadily improving, until he regained more perfect health than he 
had enjoyed for many years. 
Dr. Watts remarked, that notwithstanding the case had been treated by 
others as asthma, the circumstance of the syphilitic constitution, the chro- 
nic cough without pulmonary disease, the apparent origin of the cough in 
the larynx, the periodical relapses of the laryngeal affection, and the pecu- 
liar aching in the bones, appeared to him as sufficiently indicative of sy- 
philitic laryngitis—an opinion which was further strengthened by the radi- 
cally curative effect of the remedies employed. As promoting the suc- 
cess of the operation, he dwelt on the importance of the patient’s room 
being made very warm before operating, as also on the propriety of main- 
taining a high temperature afterward. He had known death follow, as if 
by shock or spasm, the sudden inhalation of the chilly atmosphere of the 
operating theatre in winter when this precaution had been neglected. 
Part xv., p. 201. 
Follicular Disease of the Throat and Larynx.—Dr. Green advocates 
the use of nitrate of silver as a local application in chronic laryngitis, “ cler- 
gyman’s sore throat,” and similar affections, some of which not unfrequent- 
ly simulate, or complicate phthisis. The mucous membrane lining the fau- 
ces pharynx, and larynx, is abundantly studded with muciparous follicles. 
At the back of the tongue they open into the foramen caicum and the len- 
ticular papillae ; in the uvula and pharynx they are large ; and the tonsils 
seem to be entirely composed of them; in the cesophagus they are like 
Brunner’s glands, and are imbedded in the submucous tissue. In the up- 
per part of the larynx these follicles are numerous, and still more so in the 
trachea : they secrete a fluid to lubricate the passages, which in the healthy 
state is bland, transparent, and not abundant in quantity, but is increased 
and vitiated by disease. 
Apply solution of crystallized nitrate of silver, of from one to four 
scruples to the ounce of distilled water. Use a piece of whalebone, ten 
inches long and curved at the extremity, having a small round piece of 
fine sponge securely attached to it. The mouth being opened wide and 
the tongue depressed by a spatula of a peculiar form, carry the sponge, 
dipped in the solution, over the top of the epiglottis, and while the patient, 
breathes gently out, press it downward and forward through the aper- 
ture of the glottis into the laryngeal cavity. Apply this every other day 
or oftener, for two or three weeks, and then twice a-week till the surface 
assumes a healthy appearance. If there are extensive ulcerations on the LARYNGEAL AFFECTION8. 
159 
epiglottis, and about the month of the larynx, apply for once or twice a 
solution of double the strength of that above mentioned. Fora few days 
before cauterizing the interior of the larynx, educate the parts by applying 
the solution to the more external parts. Give iodide of potassium inter- 
nally ; or sesqui-oxide of iron ; with sedatives, such as belladonna, conium, 
hyosoyamus, morphia; and expectorants. Part xvi.,jt>. 119. 
Ulceration of the Epiglottis, and Opening of the Larynx.—In a case 
of ulceration of the epiglottis, and opening of the larynx in a child, con- 
sequent upon swallowing sulphuric acid, Dr. Green used the solution of 
crystallized nitrate of silver with the greatest success. Part xvi., p. 126. 
Spasm of the Windpipe in Infants.—During the paroxysm dash cold 
water in the face, and expose it to the fresh air. Lance the gums if there 
is the least fullness or tenderness ; and unload the bowels by a dose of cal- 
omel, followed by castor oil, and a warm water injection. Afterward 
give small doses of calomel or grey powder, and the following mixture; 
Fetid spirits of ammonia, half a drachm ; dilute hydrocyanic acid, five mi- 
nimi ; tincture of henbane, seven minims ; spirit of aniseed, one drachm ; 
sirup of orange peel, four drachms; water an ounce and a half. A tea- 
spoonful twice or thrice daily. And rub a little liniment upon the chest 
and spine occasionally; as a drachm of tincture of cantharides, a drachm 
of laudanum, and an ounce of soap-liniment. Or give assafoetida enemeta. 
Depletion is rarely required. Take the child into the country, and keep 
it as quiet as possible. Part xvi., p. 131. 
Laryngismus Stridulus.—Inhalation of Ether recommended, by means 
of a sponge saturated with ether and held to the nose and mouth of the 
patient upon the first indication of an accession of the spasm. 
Part xvi., p. 132. 
Laryngitis—Acute.—Besides the ordinary treatment by leeches and 
tartar emetic, if there isoedema of the epiglottis (indicated by there being 
difficulty in swallowing, and a sensation of a swelling in the throat, with- 
out affection of the tonsils) blow powdered alum into the throat, through 
a quill. Part xvii., p. 71. 
Application of Nitrate of Silver to the Fauces and Larynx.—[A vari- 
ety of methods have been adopted to apply nitrate of silver, either solid 
or in solution to the fauces and larynx. We have seen several methods 
of applying the solution to the larynx ; but we would warn the practitioner 
to be very cautious how he adopts this method, for fear of suffocation. 
There is no doubt, however, that if nitrate of silver could be safely and 
easily applied to the laryngeal and bronchial surfaces, it would have a won- 
derfully beneficial action, as it-has upon all mucous surfaces.] 
Mr. Coxeter's Laryngeal Shower Syringe, is by far the most conve- 
nient form in which a syringe can be used for these applications to the in- 
terior of the throat and the posterior nares. It consists of a seamless 
tube, composed of silver—not unlike that of a medium-sized catheter. 
It is curved in a form suitable to its intended uses. The distal extremity 
is somewhat flattened from side to side, and is perforated by fine openings, 
which admit of the emission of the contained fluid in the form of a deli- 
cate shower. The proximal extremity is fitted with an elastic suction-bot- 
tle, which, by its own action, charges the instrument with the fluid, which 
is then emitted by simply compressing the bottle with the thumb. Rings 160 
LARYNX. 
are attached for holding the little instrument, and an ingenious arrange* 
ment is made, by which the quantity of fluid ejected can be accurately re- 
gulated. The inventor says that his shower syringe possesses the advan- 
tage of applying gently, and without friction, to an irritable surface, the 
remedial agent intended to be employed. It does this more generally 
and uniformly than the sponge, and is entirely free from the risk to which 
the latter, ha becoming detached from the whalebone, is liable. 
Part xxvii., p. 74. 
Laryngotomy.—Place the patient on his back, and completely expose 
the crico-thyroid membrane by dissection before opening the larynx. This 
is necessary, as an artery (the inferior laryngeal) is often passing this space, 
and requires a ligature. Then make a vertical incision into the larynx, 
through the crico-thyroid space, and insert a full sized trachea tube. It is 
sufficient, in dyspnoea arising from causes in the larynx of the adult, to 
make the opening in the crico-thyroid space, but not so in the child. In 
the adult, any inflammatory effusion, or thickening, arising from acute 
affections of the larynx, takes place in the submucous tissue, and is more 
local. In the child, it t ikes place more on the free surface of the mucous 
membrane, and spreads downward, thus becoming tracheal as well as 
laryngeal. Laryngotomy, therefore, is not so applicable to the child as to 
the adult. Part xxx., p. 132. 
Larnyx—Inflammation of.—In the first stage of an inflammatory attack 
of the larynx or trachea, when the mucous membrane is dry, an emetic 
will restore the moisture. Cauterization should be used locally at the same 
time that the emetic treatment is adopted internally. In treating these 
inflammations by the application of the nitrate of silver, it is important to 
bear in mind that the more intense the degree of inflammation of the lining 
of the larynx is, the weaker ought to be the solution of the nitrate applied 
to it. The first effect of the application is to coagulate the albuminous 
film upon the surface of the membrane which has been stripped of its 
epithelium, and thus to cover and protect it. As the good effects of the 
application are worn off* in a few hours, the touching of the larynx must 
be repeated frequently for some days, until all the symptoms of laryngitis 
have completely disappeared; as in most severe cases, especially in adults, 
a chronic thickening is liable to be left, it is a good precaution to give a 
little mercury toward the end of the acute attack. In true exudative 
croup, where the inflammation is of a much more intense and fibrinous 
character, and where it is almost of a pairely local nature, seizing at once 
on the larynx or trachea, the treatment by the application of caustic is 
unsuitable, the symptoms being increased rather than diminished, by its 
use. Part xxvi., p. 63. 
Topical Medication of the larynx.—Instead of thrusting a piece of 
sponge into the larynx, in applying the solution of nitrate of silver, Dr. 
Cotton, by means of a pair of forceps made by Mr. Coxeter, squeezes the 
sponge saturated with the solution over the larynx, so that it passes into 
its interior. This plan is stated to be much less irritating than the one 
commonly employed. Part xxvi., p. 70. 
LARYNX. 161 
LEAD—LEECHES. 
LEAD. 
Acetate of Lead.—[It is important that the prejudice of the poisonous 
nature of the acetate of lead should be exploded, and its value as a medi 
cament established.] 
Several interesting cases wherein acetate of lead has been administered 
in large quantities without destroying life, are recorded by Dr. Christison 
and Professor Taylor. 
A woman was admitted into Guy’s Hospital in May, 1846, having 
swallowed an ounce and a half of sugar of lead dissolved in water, from 
which she recovered, and left the hospital in five days. 
Mr. Gorringe reported two cases in which two girls swallowed by mis- 
take one ounce of the acetate, and another in which a girl swallowed one 
drachm, and all recovered. 
Dr. Hirding gives a case in which a girl swallowed three drachms ; she, 
too, recovered. 
Dr. Uiff records four cases in which individuals swallowed each an 
ounce ; and Dr. Evans one, in which three drachms were swallowed, and 
all in a very short time recovered. These cases, with the “ observations 
and experiments of Orfila, prove that the belief that sugar of lead is an 
active poison, is erroneous.” 
Dr. Sweeting suspects that where acetate of lead, internally adminis- 
tered, has occasioned dangerous symptoms, the preparation has not been 
free from oxidation—it is the oxide which is injurious. 
The same obtains in painter's colic; these people mix considerable 
quantities of litharge and red lead, technically called driers, with their 
oils, and neglecting careful ablution before taking their meals, impercepti- 
bly swallow a material of a very dangerous character. Part xxiv., p. 114. 
Use of Acetate of Lead.—The only point on which I presume to differ, 
says Dr. Burridge, from Mr. Sweeting, is this—that of combination. In 
accordance with the practice of Dr. Christison, and the rule laid down by 
the late Dr. A. T. Thomson, of University College, I always give acetate 
of lead in a fluid form; never without acetic acid, and very rarely indeed 
without Battley’s liq. opii sedativ. Part xxiv., p. 116. 
Saturnine Poisoning.—Neither sulphuric acid nor sulphates can serve 
as antidotes to slow poisoning by the salts or compounds of lead, the 
sulphate of lead being itself a slow but sure poison, capable of killing 
vigorous dogs in twenty or thirty days. Part xxvii., p. 240. 
How to malce Leeches bite.—The leech which it is intended to apply, is 
thrown into a saucer containing fresh beer, and is to be left there till it 
begins to be quite lively. When it has moved about in the vessel for a 
few moments, it is to be quickly taken out and applied. This method 
will rarely disappoint the expectation, and even dull leeches, and those 
which have been used not long before, will do their duty. It will.be seen 
with astonishment how quickly they bite. Part viii., p. 157. 
LEECHES. 
YOL. II.—11 162 
LEECH BITES. 
Leeches—Mode of apply big.—Place the leeches on the skin and slightly 
exhaust the air around them by means of a cupping glass placed over 
them, after the air is rarefied in it in the ordinary manner. 
Part xxvi., p. 327. 
Leeches—Revival of.—As soon as the leeches come off, they should be 
submerged in a mixture consisting of one part of vinegar and eight of 
water ; they immediately begin to disgorge, and must then be pressed 
gently toward the mouth between the thumb and finger. After disgorge- 
ment the leech must be washed twice in common water, and then placed 
in an earthen vessel with plenty of water, and kept at a uniform tempera- 
ture. The water must be changed every morning, and the dead leeches 
cast out. In four or five days the leeches will bite and draw as much as 
before. Part xxxiv., p. 283 
LEECH BITES. 
Hemorrhage from Leech Bites—Modes of Arresting.—Wipe the orifice 
with a bit of lint or fine linen, and when nearly dry, seize a small portion 
of integument around the bite wdth the thumb and finger, and make mo- 
derate pressure, until the hemorrhage is completely suppressed, which will 
be from five to fifteen minutes. 
Or, take a small pinch of down from a beaver hat, and pile it upon the 
orifice ; then put over the down a piece of thin muslin, and draw it tightly. 
If blood oozes through both, dry it, until the hemorrhage ceases, and in a 
short time the down and muslin will have become matted with coagulum. 
All superfluous down may be cut off, and in two days the orifice will have 
healed, and the matted matter will fall off. 
Or, apply a piece of lint dipped in a strong solution of alum, or apply to 
the place, tobacco, such as is used for smoking. Part xiv., p. 194. 
Leech Bites—Bleeding from.—Roll a very small piece of lint into a hard 
knot, smaller than a pea, and wiping the orifice clean, place this little pad 
upon it, and draw a long strap of adhesive plaster over it. The elasticity 
of the skin, pulling upon the plaster, supplies the requisite pressure. 
Part xvii., p. 291. 
To Arrest the Bleeding from Leech Bites.—Dr. Tucker states that he 
has arrested bleeding from leech bites by dipping some of the flocculent 
portion of lint in collodion, and pressing it on the orifice ; and then applying 
collodion freely over the whole surface with a camel-hair pencil Mr. E. 
Wilson advises that the compress of lint should be covered by a little disc 
of thin paper as soon as applied, so as to prevent it sticking to the finger 
or the instrument (a pencil or pencil-case), by which pressure is applied. 
Part xix., p. 144. 
Hemorrhage from Leech Bites.—This may be arrested by the applica- 
tion of caustic. To apply this properly, crush a small piece of lunar caustic 
to powder, heat the point of a silver probe in a candle, and dip it into the 
powder ; it thus becomes crusted over with the nitrate, and forms a fine 
button of caustic, which will easily reach the bottom of any such wound. 
Part xxii., p. 347. 163 
LEUCOBBHGEA. 
Tincture of Mastic as a Hemostatic.—It is stated in “ Schmidt’s Jahr- 
bucher,” that Dr. Frankl has found the tincture of mastic an excellent 
hemostatic. He employs it in epistaxis, and in troublesome bleeding from 
leech bites. It is applied to the points whence the blood issues, by means 
of a eamel’s-hair pencil. Terzer, a dentist of Vienna, is also reported to 
have used it successfully in hemorrhage following the extraction of teeth. 
Part xxvii., p. 132. 
Styptics.— Vide “Matico,” “Oil of Ergot of Rye,” “Creasote,” etc. 
LIHJCORRHCEA. 
Decoction of Elm Dark.—Four ounces of the fresh hark, bruised, and 
boiled in four pints of water, form a thick decoction. Dose, four ounces 
three times a day; may also be used locally as a wash in almost every stage 
of cutaneous disease, and in that disordered state of the functions of the 
skin induced by dram-drinking, attended with redness of the skin. 
Part i., p. 61. 
Tincture of Muriate of Iron.—Recommended in leucorrhoea as follows: 
$ Tinct. of muriate of iron, one drachm; tinct. of opium, half a drachm; 
infusion of Iceland moss, infusion of gentian, of each four ounces. M. Dose, 
an ounce every three or four hours. A wash of sulphate of zinc may be 
used locally at the same time. Part iii., p. 30. 
Secale Cornutum.—Suggested in cases of leucorrhoea entirely devoid of 
inflammation. Part iv., p. 15. 
Ioduret of Silver.—Suggested in cases of leucorrhoea of long standing, 
in doses varying from one-eighth of a grain to one or two grains, in the 
form of pills, two or three times a day. Alum lotion, locally. 
Part vii., p. 82. 
Creasote in Leucorrhoea.—Dr. Allnatt says: The following is the formula 
I generally adopt for adults : 
R Creasote, minims xx.; solution of potash, 3ij.; white sugar, 5ij. 
Rub together in a mortar; afterward add, by degrees, eight ounces of 
water. Mix. Make an injection, to be used three times a day. 
In obstinate cases of gleet, occurring in flabby leucophlegmatic males, I 
propose this remedy to the notice of the practitioner with great confidence. 
Part vii., p. 86. 
Use of Astringents—Tannin.—Mr. Druit says: 
In obstinate leucorrhoea, I have used it as a vaginal suppository, ten grains 
being made into a mass with tragacanth, and introduced and allowed to 
dissolve. But in this disorder I believe alum and the other mineral as- 
tringents to be of more service; and that in many cases such treatment as 
will reduce a swelled and congested uterus is of more consequence than 
any mere local application. Part x., p. 139. 
Treatment of Leucorrhoea by Iodine.—M. Van Steenkiste has made use 
of a dilute tincture of iodine with great success in cases of obstinate 
chronic leucorrhoea. 164 
LIGATUKES 
R Iodine, gram. iv.; alcohol, gram. lx.; solve ; et aquae destil., gram- 
mes cxxv.; about 30 fluid grammes (or f.3xv.) are to be thrown into the 
vagina as an injection, and repeated every day, or every other day, ac- 
cording to the excitement it occasions. Part x., p. 195. 
Leucorrhoea.—There are two species of uterine leucorrhcea; in one the 
disease is in the cervix, and the secretion is alkaline; and in the other, 
the secretion is acid, and the disease in the fundus. Introduce the specu- 
lum and pass a gum tube containing a stilet armed with litmus paper, 
for about an inch into the cervix: protrude the stilet and let it remain till 
moistened. Thus we find the nature of the secretion; if it is alkaline, 
again introduce the tube without the stilet, and inject by means of a gum- 
elastic bottle, a solution of sulphuric acid, half a drachm of acid to an 
ounce of water, or of acetate of lead of the same strength. If the lips 
of the os are abraded, touch with arg. nit. before passing the instrument. 
If the mucous glands of the cervix are enlarged, pass the tube; and hav- 
ing wiped it clean from mucus, smear the end with ointment of arg. nit., 
gr. x.; to ung. cetac., 3j., and again pass it. (Dr. Mitchell.) Pt. xv., p. 320. 
New Remedy for Leucorrhoea.—Dr. Braman states that for nine years 
he has been in the habit of using preparations of helonias dioeca (unicorn 
plant) as a remedial agent. “ In leucorrhoea,” he says, “ I consider it in- 
valuable. I use it with a confidence I attach to no other medicine. 
Under its influence the patient, whose life has been almost a burden, soon 
revives. Iler uncomfortable sensations vanish, and ultimately, an entire 
recovery of health and strength is established.” It may be given in the 
form of powder, tincture, or sirup ; but the latter is the most eligible. 
The doses which Dr. Braman recommends are of the powder, one drachm 
and a half; of the tincture, one fluid drachm; of the sirup, three fluid 
drachms. These doses are to be taken thrice a day, half an hour before 
the ordinary meals; and according to the urgency of the case, the quan- 
tity administered may be increased, if the patient bears it well. In 
irritable stomachs, nausea is sometimes produced; and -when this occurs, 
the dose must be diminished. Part xx., p. 229. 
Vide Selections from Favorite Prescriptions, Art. “ Medicines.” 
Iodide of Potassium in Leucorrhoea.—Dr. Payne recommends the 
iodide of potassium as an injection in leucorrhoea. It is to be used (3iss. to 
a pint of water) three or four times daily. Part xxxvii.,p. 211. 
Bichromate of Potash as an Astringent.—To remove the fetor from 
sloughing wounds, syphilitic sores, ulcers, etc., and where an astringent is 
useful, a lotion of bichromate of potash, five grains to the ounce, and in- 
creased, is very serviceable. In a case of chronic leucorrhoea, where the 
lips of the os uteri were swollen and spongy, it effected a complete cure 
after many other remedies had wholly failed. Part xxxvii., p. 268. 
LIGATURES. 
Use of Ligatures formed of Animal Substances.—The substance 
which Mr. Wragg prefers is the fibrous tissue of the deer, dried, then 
twisted so as to form a small round thread, smooth and regular on the LIGAMENTS—LINIMENT. 
165 
surface, non-elastic, sufficiently strong to resist the traction made on it by 
the surgeon in tying the knot. The mode of preparing these ligatures 
appears to the author to be a matter of great importance, and one capa- 
ble of insuring or compromising the success of the operation: These ten- 
dinous slips ought to be dried slowly, and not used until all the moisture 
has disappeared; the author prefers those which have been dried for some 
years. During the ten years he has employed these ligatures, he has 
never used any others; and during this period he has tied arteries in fin- 
gers, hand, forearm, arm, leg, and thigh, and has never seen any symp- 
toms to show that the absorption of the knot had not taken place. Some 
cases, chosen from a large number, will confirm the truth of these propo- 
sitions: In 1836, Mr. Wragg amputated the leg of a woman above sixty 
years of age for a malignant ulcer; the ligatures made of the fibrous 
tissue of the deer were cut close to the knot, and the wound brought 
together; the stump was healed at the end of three weeks. No part of 
the ligature could be seen; no abscess, no ulceration, indicative of the 
threads having been on the tissues as foreign bodies. 
In the case of a young man, one of the cutaneous branches of the pos- 
terior tibial artery was cut by a blow from a hatchet. Mr. "YVragg tied it 
with one of these ligatures, which he cut close to the knot; lie then 
brought the wound together by four points of the interrupted suture 
made of a thread of the same substance. Nothing further was seen of 
the knot of the ligature ; as to the threads used for the suture, they be- 
came softened, and, from the time suppuration commenced, had a mace- 
rated appearance, their volume diminished by degrees, so that at the end 
of a certain time he saw, by the effect of a gradual eating away, a seg- 
ment of the circumference of the thread disappear, and at last the knot 
gave way just as if it had been divided by scissors. Part xix., p. 141. 
LIGAMENTS. 
Diagnosis of Inflamed Ligaments.—According to Prof. Cooper, if in- 
flammation of ligament be primary, it may generally be diagnosed by the 
slight degree of swelling which occurs at the joint, and by the absence 
of acute pain while the patient is standing on the diseased limb in the 
erect posture. The least attempt at motion is, however, productive of 
severe suffering, and this constitutes an important distinction between 
disease of ligament and that of synovial membrane or cartilage; as in the 
latter case, the most painful position is when standing upright, with the 
weight of the body pressing on the affected articulation. 
Part 130. 
LINIMENT. 
Exanthemic Liniment.—The following liniment is particularly recom- 
mended by Dr. Morris, when desirous of keeping up a mild rash upon 
the skin: R 01. crot., ntxx.; antim. tart., 9j.; liq. potassae, 3j-; aq, 
purse, 3vij. M., while Dr. Hannay, of Glasgow, considers ipecacuanha one 
of the most manageable and efficient applications. His formula is pulv. 166 
LINT LIP. 
ipecac, ol. olivse, aa. 3ij.; adipis suill 3ss. M. It requires to be rubbed 
in for fifteen to twenty minutes, and is, he thinks, peculiarly adapted to 
cases of cerebral irritation in children, dependent on receded eruption. 
Part xii., p. 254. 
LINT. 
Preparation of— With Nitric Acid.—Dr. Rivallie lately communicated 
to “ L’Union Medicale,” his mode of cauterizing cancerous tumors with 
solidified nitric acid. He proceeds as follows: Some lint is placed in an 
earthen vessel, and a certain quantity of nitric acid, in its highest degree 
of concentration, is gradually dropped upon it. A gelatinous paste is the 
result, and to this, a shape in keeping with the tissues to be cauterized, is to 
be given. The caustic mass is then seized with long forceps, and placed 
upon the part. After a quarter of an hour, or twenty minutes, it is care- 
fully to be taken off, and an eschar, four or five lines in thickness, is thus 
obtained. There are cases, however, where the caustic may be left for 
twenty-four hours, when the surgeon wishes to destroy a large encepha- 
loid cancer. The pain is trifling except the skin intervene; and when the 
caustic is left a long time, there is no pain after the first three or four 
hours. With large diseased masses the cauterization should be repeated 
every day after the eschar has been carefully removed. When the caustic 
is applied for a few minutes only, the part should, on its removal, be 
dressed with lint dipped in a solution of alum. Part xxi., p. 24. 
LIP. 
Case of Enlargement of the Labial Glands.—[This was a curious case 
of enlargement of the upper lip. The lip had been increasing in size for 
two years; its progress had been unattended with pain, but he had had 
some irritation from exposure of the mucous membrane to the air. He 
had no scrofulous or venereal taint. Mr. Wilde says:] 
Upon examination, I found the lower lip totally unaffected, as well as 
the extreme angles of the upper ; but all the rest of the red border of this 
lip was immensely thickened, and so much enlarged that, when the mouth 
was closed, it formed a large, projecting, red mass, not unlike a pair of rip< 
strawberries, the division between them being caused by the natural cen- 
tral sulcus of the lip. If these projections were allowed to remain un wiped 
for some time, a number of globules of a clear fluid formed upon the sur- 
face of the mucous membrane. The membrane itself was rather more vas- 
cular than usual; where the drops exuded, it was particularly smooth and 
polished, but toward the edge of the lip it had become thickened, covered 
over with adhesive crusts, and cracked in several places. The external 
surface of the lip was natural. 
As the young man was very anxious to be relieved of this deformity, I 
removed it in the following manner. Assistants having commanded the 
coronary circulation, by holding the angles of the lip, as in the operation 
for the removal of cancer of this part, I made an incision, with a small, 
sharp scalpel, through the mucous membrane, parallel with and about three- LIP. 
167 
eighths of an inch from the edge of the lip, and about two inches and a 
half in length. Bv another incision, through the membrane, upon the den- 
tal surface of the lip, which was everted for the purpose, I completely in- 
cluded and dissected out the diseased mass, which, during the progress of 
the operation, I found to consist of a congeries of small globular bodies, 
nearly transparent, and about the size of advanced trout-spawn. There 
was scarcely any hemorrhage during the operation, and any granules of 
the disease which were cut across, or adhered to the surface of the wound, 
having been completely removed, the edges of the incision were accurately 
adjusted, and sewed together by a fine silk ligature, after the manner of 
the continued suture. Upon shutting the mouth, the deformity was found 
to have been completely removed, and the edges of the lips met as before 
the supervention of the disease. A few hours after, a smart hemorrhage 
occurred from the surface of the wound, but it was checked by the use of 
tincture of matico, and occasional pressure, which the patient was able to 
effect for himself. Partxs i., p. 184. 
Hydatids of the Lower Lip.—Dr. Heller, of Stuttgard, has seen five 
cases in which aoephalocysts were developed in the lower lip, and always 
on its inside. This affection appears first as a small and hard lump, which 
rapidly increases, so that in one month it may attain the size of a cherry; 
it gives rise to pain, deformity, and difficulty in moving the lip. The hy- 
datids are seated immediately beneath the mucous membrane, and are 
transparent. If they can be removed without opening their cavity, they 
are found to be made up of a rounded vesicle, full of fluid, transparent as 
water, and with a diaphanous and tender wall. The only cure consists in 
extirpating the cyst, which must be total, or it will reappear; hence nitrate 
of silver may be applied after the operation. 
In a case which came under our own notice about six months ago, in a 
young, delicate lady, seventeen years of age, the hydatid, situated on the 
internal part of the lower lip, had, in the space of three months, acquired 
the size of a small hazel-nut. "VVe touched it with tincture of iodme once, 
twice, or thrice a-day, as the patient could bear it, and in three weeks the 
transparent sac entirely disappeared, leaving a small ulcer with a hardened 
base ; to this we applied occasionally nitrate of silver, which healed the 
wound. Gentle external friction twice a-day, with a little iodine ointment, 
eventually removed every vestige of hardness. Part xvi., y>. 229. 
Malignant Tumefaction of the Tinder Lip, rapidly following the 
Appearance on its Surface of a Papula near the angle of the Month.— 
(The following was communicated by Dr. Samuel B. Wells, of Middle- 
burgh, N. Y.) 
As some benefit might accrue from the communication of a few cases of 
an anomalous character, which have occurred during a somewhat exten- 
sive practice in the Valley of the Schoharie, I herewith transmit a short 
account of them which you are at liberty to make public for the use of the 
profession. 
In the summer of 1842 I was called to see a case of disease of the under 
lip, then in charge of Dr. P. S. Swart, in the village of Schoharie. The 
patient was a man about 25 years of age, and had enjoyed good health up 
to the time of the attack, although his habits had been somewhat intem- 
perate. Three days before I saw him, a small pimple appeared on the 
surface of the under lip, toward the left angle of the mouth. It com- 168 
LIP. 
menced with swelling and redness, which soon assumed a purple hue, and 
increased rapidly. At first there was not much constitutional disturbance, 
very little pain, fever, or acceleration of the pulse. In less than thirty-six 
hours the lip had attained four times its normal size, and had assumed a 
gangrenous aspect, the swelling extending downward as far as the clavi- 
cle, involving the areolar tissue, together with the integuments of the parts 
concerned, occasioning great difficulty of respiration, from pressure of 
the larynx. During the incipient stage of the disease, the patient had 
been freely evacuated, and an antiphlogistic regimen adopted. Externally,' 
discutients, such as solution of muriate of ammonia and acet. plumb., had 
been applied. But as soon as the septic tendency of the disease became 
manifest, cataplasms of yeast and Peruvian bark were substituted, and a 
corresponding change was also made in the use of internal remedies—the 
infusion of serpentaria, quinine, wine and ammonia being substituted. 
Notwithstanding, the patient grew worse every moment—the engorge- 
ment of the lip and the adjacent parts continued to inci’ease until mortifi- 
cation ensued, when, on the following day, he died. 
An interval of ten years elapsed, when I was called to see a second case 
of the kind: Mrs. B , a lady of robust constitution, and who, up to 
this time, had enjoyed excellent health. She had been taken ill the preced- 
ing day. A small pimple occupied the surface of the lower lip, as in the 
foregoing case. This was accompanied with pain, redness and swelling. 
There was also considerable increased excitement of the system, together 
with much cerebral disturbance. This patient was bled freely, and gen- 
eral antiphlogistic measures speedily adopted. Notwithstanding, the 
violence of the symptoms continued unabated. During the night, the lip 
became greatly enlarged, and on the following day, gangrene and mortifi- 
cation ensued, terminating fatally. 
The next case, I witnessed in 1855. This occurred in a middle-aged 
lady, of good constitution and plethoric habit. Five days before I was 
called, a small pimple made its appearance on the under lip, to which she 
called the attention of her physician, who was then treating a case of fe- 
ver in the family. The nature of the disease was fully explained to her by 
the doctor, who advised that immediate measures be taken to arrest it in 
its present stage. 
Feeling but little inconvenience from its presence, nothing was done until 
the following day, by which time the swelling had greatly increased, and 
the lip had assumed a purple aspect. The parts having put on a low grade 
of inflammatory action, the patient was treated with active catharsis, and an 
antiseptic cataplasm was applied to the lip. These, together with such re- 
medies as appeared adapted to the most prominent symptoms, were used. 
Still, the disease continued to advance, as in the foregoing cases. The lip 
having assumed a gangrenous, appearance, its fatal tendency too soon be- 
came alarmingly evident. Mortification ensuing, the patient died three 
days afterward. 
In the summer of 1856, a Miss G. consulted me in relation to a small 
pimple which appeared the preceding day on the surface of the under lip, 
attended with redness and swelling, but unaccompanied with any other 
disturbance of the system whatever. With a view of discussing* it thus 
early, I gave her an antimonial emetic, and in due time followed with 
twelve grains of submur. hyd., and in six hours thereafter with the black 
dose. These evacuated the system freely. I applied, locally, a solution LITHECTASY. 
169 
of acet. plumbi. The following day there was no amendment, but, on the 
contrary, an increased tumefaction of the lip, with a deep purple ap- 
pearance. 
Having failed in arresting any one of these several cases with the ordi- 
nary remedies adapted to analogous diseases, it occurred to me that if 
suppuration could be established before the vital forces of the parts be- 
came exhausted, a more favorable result might be reasonably expected. 
With this in view, I passed an ordinary sized lancet from near the angle 
of the mouth, through the substance of the lip, transversely to a corre- 
sponding point on the opposite side. I then introduced a small strip of 
muslin, about three lines in width, to the extreme end of the puncture, 
and covered the parts with a cataplasm of yeast and Peruvian bark. A 
slight suppuration followed in thirty-six hours, and a speedy recovery took 
place in a few days. 
It would be superfluous to give the details of five other similar cases 
which have occurred in my practice since the above mentioned. Suffice it 
to say that the latter is an index of each one. They severally exhibited 
the usual characteristics of the foregoing cases in their incipient stage, and 
were readily controlled and brought to a favorable termination by adopt- 
ing this plan of treatment—free incision of the affected lip, introduction 
of a tent, and the local application of a cataplasm of yeast and Peruvian 
bark to the wound, with a view to the establishing of suppuration—so 
successfully pursued in the case of Miss G. 
I practised here twenty years before I saw a case of this kind, and pre- 
sume there are many physicians with an extensive business who have never 
met Avith one. 
LITHECTASY. 
Lithectasy.—The removal of stone from the bladder, by the operation 
of lithectasy, as described by Dr. Willis, has hitherto attracted too little 
notice. The opinion seems to be gaining ground among our best surgeons, 
that the dangers of lithotomy consist in the too free use of the knife in 
the deep incisions, and that the most successful operators have been those 
who have made free external, and very small internal incisions, trusting 
more to a certain degree of stretching, or dilatation, in order to enter the 
bladder, and thus preserve that organ as free from injury as possible. It 
is probably for the same reason that lithectasy may some day prove a 
more useful improvement than is now generally acknowledged. It is Avell 
known that Sir Astley Cooper, in the year 1819, performed this operation, 
at the suggestion of Drs. Neil and James Arnott. It consists simply in 
opening the urethra upon a grooved staff, in the mesial line, behind the 
bulb, to the extent of a few lines, and then making gradual dilatation by 
means of the fluid pressure dilator of Dr. Arnott, “ consisting of a cylin- 
drical tube of silk, lined with the thin gut of a small animal to make it 
water-tight, and fixed upon a canula which traverses its axis, and having 
attached to its outer end a syringe guarded with a stop-cock, by which it 
may be forcibly distended with water or mucilage.” This instrument, 
when empty, exceeds but little in size the bulk of the canula or catheter 
with which it is connected, and is therefore easily introduced along the 170 
LITIIECTASY 
groove of the staff into the bladder, and when there it can be gradually' 
distended to its utmost limits. Mr. Elliot thinks it well, previously, to 
accustom the urethra to the presence of a foreign body, by the use of 
bougies, gradually increased in size, so as at the same time to produce a 
certain degree of preparatory dilatation. He also recommends that the 
external incision should be free, “since if the prostate were unlit to under- 
go the process of dilatation, either from great rigidity, as is frequently 
found in old subjects, or from morbid irritability, the operation could be 
at once completed by lithotomy.” Mr. Elliot also suggests various im- 
provements in the dilator, as, that it should be cylindrical and not taper- 
ing toward each end, as it will then preserve its situation more easily 
when introduced,” etc. 
He suggests that the dilatation should be not only gradual, but at inter- 
vals of a quarter of an hour at a time, instead of being continued for 
thirty or forty hours. It seems surprising that these parts can be dilated 
so completely, so easily, and so safely, and yet that surgeons have not 
tried the practice more generally. Mr. Elliot states, that although he con- 
tinued the dilatation for twenty-five hours, he has no doubt that a suffi- 
cient degree of dilatation was accomplished in three hours, since no addi- 
tional fluid was injected after that period, and he could easily introduce 
two fingers along with the scoop into the bladder, and if necessary 
could have extracted a stone as large as a hen’s egg, or four and a 
half inches in circumference, the size of the instrument. Mr. Elliot 
remarks, that his patient, from beginning to end, was never in danger, 
that “ the presence of the dilator effectually prevents any oozing, as well 
as the injurious contact of the urine with the raw wound. There was no 
chance of shock, no risk of peritonitis, infiltration of urine, inflammation 
of the veins of the neck of the bladder, or any of the grave sequelae that 
too often supervene on the operation of lithotomy.” Part vii. p. 102. 
Calculi in the Female Bladder.—Experience appears to show, that the 
removal of a calculus from the female bladder, after the neck of the latter 
and the canal of the urethra have been gradually dilated by forceps con- 
structed for the purpose, sponge tents or otherwise, is a preferable pro- 
ceeding to its removal after the urethra has been incised. It also demon- 
strates, that dilatation can be carried on to an extent which, in the 
absence of well-authenticated facts, would appear almost incredible. 
One of the most remarkable cases on record occurred in the practice of 
Mr. Okes, of Cambridge. The patient was eleven years old. Sponge 
tents, gradually increased in size, with string attached, were introduced 
into the urethra, opium, preceded by purging, being administered. The 
sponge was used morning and evening, for three successive days. The 
urethra was sufficiently dilated on the third day to allow of the calcu- 
lus being withdrawn. It is stated, that the stone measured in circumfer- 
ence, at its major axis, 3f inches; in its minor, inches. The calculus 
was seized in its long axis, and therefore the urethra must have been dis- 
tended by the calculus and the thickness of the forceps to a circle of at 
least of. Incontinence of urine lasted only three days. 
This plan of treatment by dilatation is in imitation of that made use of 
in the natural efforts to get rid of a calculus from the female bladder, the 
stone itself acting as the dilating power; and numerous remarkable in- 
stances are on record of calculi thus voided, without any subsequent LITHOLIBY. 
171 
incontinence of urine. In far the greater number of cases, however, in 
which the calculi have been large, incontinence of urine, which was a 
marked antecedent symptom, has persisted; this, probably, arising from 
ulceration at the neck of the bladder, in consequence of the pressure of 
the foreign body. Thus, there is in the London Hospital Museum a calcu- 
lus which was removed from a woman by the late Mr. Headington. Its 
anterior extremity was found sticking in the urethra, and the entire stone 
was removed easily by traction of the two index fingers. It measured 31- 
inches long, 2 inches broad, l£ inch thick, 7f inches round its larger, and 
inches in its smaller circumference. Incontinence of urine lasted till 
death. The fact of incapability of retaining the urine usually following 
the natural method of expulsion, when the calculus has been large, sug- 
gests the propriety of. operating without any unnecessary delay, in order 
to avoid this inconvenient and distressing sequence. Part xxvi.,jp. 249. 
Litholiby.—Dr. Denamiel designates by this term an operation consist- 
ing in the crushing of the stone, as it lies in the trigon vesicle, behind the 
prostate, between an instrument introduced by the urethra into the blad- 
der, and the fore and middle finger of the left hand, introduced per anutn. 
He affirms that some calculi are so friable as to break under the least 
pressure; that the trigon vesicae, where free calculi generally lie, is acces- 
sible to the finger introduced into the rectum ; and that a sound passed 
into the bladder may serve as the point d'appui. He also states that the 
action of alkaline fluids upon the mucus, which forms the common cement 
of the elements of calculi, leads to the disintegration of the mass, what- 
ever may be the chemical composition of the layers which compose it. 
The distance from the integument to the neck of the bladder is com- 
monly inches; it varies between 1 inch and 4 inches. The prostate 
gland and the trigon vesicse are separated from the rectum by only a 
very thin layer of areolar tissue, in which fat is never deposited ; conse- 
quently, any hard body may be easily felt and compressed. 
The patient, having the bladder moderately distended, is put into the 
horizontal position, upon a properly constructed bed; the thighs separated 
and raised ; and feet resting upon chairs. The left fore and middle fingers 
of the operator are then introduced into the rectum, and the stone is felt. 
A curved sound, grooved upon its convexity, as far as its vesical extrem- 
ity, that it may the more readily hold the stone, is next passed into the 
bladder. Then pressure is made, until the calculus gives way. In many 
cases, a very slight amount will suffice. Should any difficulty arise, the 
pressure may be directed alternately toward the right or the left, that 
every part of the surface of the stone may be acted upon. In cases where 
the calculi are hard, several sittings are required, and the use of alkaline 
fluids becomes needed, to favor their disintegration. A quantity of warm 
water should be injected into the bladder after each operation, that the 
smaller fragments may be immediately washed away. 
Part xxviii., p. 208. 
LITHOLIBY. 172 
LITHOTOMY, 
LITHOTOMY 
Treatment after lithotomy.—These remarks were called forth by a 
case on which Mr. Sherwin operated, a child of nine years, the day follow- 
ing a journey of seventy miles; and although the operation was satisfac- 
torily performed, the case soon assumed a dangerous aspect. On the 
second day, Mr. Sherwin says: 
I now felt convinced that I should lose him; as, from the very onset of 
the attack the vital powers seemed unable to sustain any depleting mea- 
sures, and though having most of the characteristics of peritonitis, the 
symptoms precluded the antiphlogistic treatment. On referring the 
same evening to Sir B. Brodie’s published “ Lectures,” I felt impressed 
with the fidelity of his description of the untoward symptoms following 
lithotomy. I caught at a suggestion he offers in a similar case, which he 
rescued by laying open the rectum with the wound, so as to give exit to 
a quantity of sanies : 
11th, 7 am.—Found matters looking still worse.; the boy had passed a 
wretched night, rolling from side to side in great pain ; the belly hard 
and tympanitic; pulse feeble and fluttering, and hardly to be felt or 
counted, with more frequent intermissions; countenance of dusky leaden 
hue ; occasional sighs and hiccoughs; tongue quite brown and dry. I 
now determined to open the wound, which was externally united: this 
was done with the handle of a scalpel, and having pushed up my finger to 
explore the parts, I gave exit to about two or three ounces of a pink 
colored sanies, having a fetid and ammoniacal odor. 
I broke up the entire wound in the peritoneum, and had the patient 
raised out of the hollow of his bed into a more depending position ; gave 
a little brandy and water with a teaspoonful of castor oil. 11 a.m.—Much 
improved in every respect; countenance calm ; had slept a little, and 
parted with a good deal of flatus; the pulse settled to 100. 9 p.m.—Has 
slept well; looks happy; pulse slower; tongue moist; has asked for 
tea, and bread and butter. From this time the boy did well; and he 
returned to his home quite free from ailment in about three weeks after. 
Pemarks.—The urine was alkaline, with considerable deposit of lime 
and mucus; this (which ought to have been done before) was afterward 
corrected by mineral acids, with decoct, pareirae bravse, and quinine. If 
instead of giving a free vent to the sanies, I had treated the case as one 
of pure peritonitis, there can be no doubt but that he would have sunk in 
a few hours. Yet I committed an error in the first instance by operating 
so soon after a long journey. I relied too confidently on the youthfulness 
of the patient; time ought to have been allowed for the bladder and con- 
stitution to become tranquil before he incurred the additional risk of a for- 
midable operation. Again, his bed was an inconvenient one ; it allowed 
his pelvis to sink into a hollow, which, with my neglecting to leave a 
canula in the wound, allowed some of the urine to lodge between the rec- 
tum and bladder ; a circumstance that has proved, probably, a more fre- 
quent source of mischief after lithotomy than is generally suspected. 
Part viii., p. 94. 
Lateral Operation of Lithotomy.—Dr. Keith thinks that in the first 
incision, many good operators commit an error in going too near the sym- 
physis pubis, the consequence of which may be, that when the stone is LITHOTOMY. 
173 
grasped in the forceps, it is driven out of the hold of the operator by 
coming against the arch of the pubes, and he cannot, as he ought, draw 
downward, because the incision is not low enough. With this difficulty 
in view, most surgeons now make the first incision as far as is safe from 
the symphysis pubis ; and Dr. Keith seems to extend this incision quite 
as far as he is warranted past the side of the rectum. 
But the most important incision is the deep one; and in using his pecu- 
liar instrument, Dr. Keith was influenced by the fact, that the success of 
all the most fortunate lithotomists lias depended upon the narrow limit to 
which they restricted themselves, in dividing the neck of the bladder. 
His instrument is “ a gorget neither blunt nor sharp—an edge on it that 
behoved to cut through a substance so solid as a prostate gland, yet so 
blunt that such a tough elastic membrane as the bladder would stretch 
upon its edge.” When the perineum is very shallow, this gorget will not 
be required, the bladder may be entered and the prostate notched by a 
knife, long in the handle and short in the blade, with its cutting edge 
limited to an inch and a quarter from the point; but in most cases it will 
be necessary to slit the neck of the bladder and prostatic urethra ob- 
liquely downward and outward to about half an inch, and then Dr. Keith 
brings his gorget into use to finish the operation. This instrument has its 
left edge quite rounded, the other ground to an edge, and then blunted 
with a file ; the point well rounded into a blunt bottom—a copy, in fact, 
of “ Cheselden’s Conductor.” Dr. Keith says that by these means he in- 
sures a positive entrance into the bladder, “ obviating the chance of merely 
dilating the sphincter vesicce, as Cheselden and Martineau are alleged to 
have often only done ; and avoiding the cutting of parts that never should 
be cut.” Part ix., p. 134. 
Lithotomy.—Dr. Warren, of Boston, has practised the bilateral opera- 
tion of lithotomy, and strongly recommends it, saying that he would feel 
disposed to employ it in most cases where lithotomy is required, in prefer- 
ence to the lateral operation. In his opinion, its simplicity, the compara- 
tively small pain from the incision, the facility of seizing and removing the 
stone, the very slight loss of blood, and the absence of any severe conse- 
cutive symptoms, all concur in producing a favorable impression with re- 
gard to this mode of operating. The chief objection to this mode, arising 
from the great danger of wounding the rectum, he fully acknowledges, 
but thinks it will be found even less than in the lateral operation, if the 
staff, with the urethra and prostate gland be drawn toward the symphysis 
pubis, at the same time drawing out the rectum in the direction of the 
sacrum, with the left hand. Part xi., p. 138. 
PemarJcs on Lithotomy.—[Much difficulty is sometimes experienced by 
the surgeon in seizing a calculus with the forceps, after the bladder has 
been opened. In two cases where this occurred at Guy’s Hospital, under 
Mr. Key from the stone slipping up further into the fundus on every at- 
tempt to seize it, it was remedied by making considerable pressure exter- 
nally on the fundus of the bladder; when in each case it immediately 
slipped between the blades of the forceps, and was extracted.] 
The two cases alluded to presented difficulties of a similar kind, the 
stone in each being lodged high up in the fundus of the bladder, so as to 
elude the grasp of the forceps, until it was dislodged by pressure made on 
the lower part of the abdomen. The cases elicited from Mr. Key, the fob 174 
LITHOTOMY. 
lowing clinical remarks on the principle of obviating this not unfrequent 
occurrence in the operation of lithotomy. A calculus usually lies free in 
the bladder as long as the mucous coat of the organ preserves its healthy 
condition. The oxalate, urate, and even the phosphatic stones, are found 
in the base of the bladder, until the surface of the membrane becomes 
villous from inflammation, and its secretion becomes alkaline and viscous. 
The bladder, inflamed and irritated by the stone, contracts upon it with 
more force, and secretes an abundance of alkaline mucus, the phosphatic 
salts of which crystallize on the surface of the stone, and make it adhere 
often with considerable tenacity to the surface of the organ. 
The part of the bladder usually occupied by a calculus under these cir- 
cumstances is the fundus, which retains the stone with tenacity, while the 
lower part of the organ receives the urine as it passes from the ureters ; 
and in sounding such a bladder, the calculus is felt either on the concave 
surface of the instrument, or by withdrawing it toward tile pubes—a cir- 
cumstance that always portends some difficulty in seizing it after the blad- 
der is opened. 
It has happened more than once that a patient has been removed from 
the operating table with the stone remaining in the bladder, after long and 
continued efforts made in vain to seize it; and the failure has arisen, not 
from the extraordinary size of the calculus, but from its peculiar position. 
The forceps, at first, though opened to their full extent, obtain but a slight 
hold of the stone, the extremity of it only is seized, and it soon escapes 
from the grasp of the operator. Repeated attempts are made to gain a 
firmer hold of it, and at each attempt the stone is pushed further from the 
opening, until the forceps are obliged to be buried nearly to the handles 
before the stone can be felt. It is in the retreat of the stone before the 
forceps that the difficulty of seizing it lies. The stone, instead of retreat- 
ing in a direct line from the opening into the bladder, ascends behind the 
pubes, where the forceps cannot, without assistance, reach it, much less 
grasp it. 
It is more than probable that in many of the cases recorded of insuper- 
able difficulty in extracting calculi of ordinary size by lithotomy, the ope- 
rator has not sufficiently borne in mind the impossibility of directing the 
blades of the forceps to the altered position of the stone, which, from the 
pressure of the forceps in the unsuccessful attempts to seize it, retires, not 
backward, but upward, so that it becomes placed in a line little less than 
perpendicular in relation to the external incision. In such a situation, 
even in very young children, it becomes difficult to seize it; and in the 
adult, especially when the prostate gland is enlarged, impossible to reach 
it. The advantage of pressure made above the pubes was forcibly shown 
in these cases. Part xii., p. 208. 
Lithotomy.—There are four steps (says B. B. Cooper) in the operation, 
as I perform it, viz.: open the perineum, open the pelvis, open the bladder, 
and take out the stone. Well, the first thing you do when the patient is 
laid on the table, is to sound him, and be sure that you feel the stone be- 
fore you operate. Having ascertained the position of the stone, he is then 
to be tied up in the usual manner; and it is as well to tell the patient to 
practise the position, in order that he may become somewhat accustomed 
to one so unnatural; then pass the straight staff, and give it to an assistant 
to hold. Then, having examined the perineum, and ascertained the point LITHOTOMY. 
175 
of junction of the raphe of the perineum with that of the scrotum, place 
the tip of the fore-finger of your left hand upon it, and commence your in- 
cision about one finger’s-breadth to the left of it, carrying your knife down- 
ward and outward to a point midway between the margin of the anus and 
left tuberosity of the ischium. By this incision you lay open the perineum; 
next pass your finger into the wound, and feel for the staff in the mem- 
branous portion of the urethra, and keeping the bulb out of the way, place 
the point of the knife in the groove of the staff, and make your second in- 
cision through the deep perineal fascia, in the same direction, and to the 
same extent, as the first. You have now completed the second step, and 
opened the pelvis : I know my anatomical friends will cavil at this, and say 
that I have not opened the pelvis ; but there is only a slight fascia inter- 
vening. 
Next commence your third step in the same place in which you did the 
second, by again placing the point of the knife in the groove of the staff; 
and, taking the handle of the latter in your left hand, from the assistant 
who has been holding it, depress it, till it is nearly parallel with the handle 
of the knife. Then push the knife along the groove in the staff, through 
the prostate, into the bladder, which you will know to have entered, by the 
resistance offered to its passage ceasing. This is a difficult part of the 
operation ; for if you let the knife slip out of the groove, between the blad- 
der and rectum, much mischief must accrue. You should have the groove 
of the staff turned a little to the left, in order that your incision through 
the prostate may correspond with the other incision. Next pass your left 
fore-finger*into the bladder, and the staff being withdrawn, feel for the 
stone. In order that you may not make a larger incision through the 
prostate gland than is necessary, your lithotomy knife should be of the 
same breadth as your fore-finger, so that it may make an opening just big 
enough to admit it; and trust to enlarging the opening of the prostate by 
lacerating it with your finger: lacerating is an ugly word, gentlemen, but 
it is a safe one. You have now finished the third step, viz.: opened the 
bladder. All that you have hitherto done is what every good surgeon 
ought to do without difficulty; but the rest is beyond his control. I mean 
the fourth step—removing the stone. I have seen the very best lithoto- 
mists fail in seizing it, and the patient has been removed to bed with the 
stone still in his bladder. When you have your finger on the stone, and 
you introduce • the lithotomy forceps along it into the bladder, with the 
blades of course shut, keep them so, until you have felt the stone with 
them. Then open them, and, seizing the stone, gently and gradually with- 
draw it. You should hold the forceps with their flat surfaces looking 
upward and downward, in order that you may be able to open them suffi- 
ciently, and also to protect the soft parts from injury in the abstracting of 
the stone. 
They should also be of good length, so that the hinge may be in the 
perineum ; then you will be able to open the handles. Part xii., p. 209. 
Use of the Canula after Lithotomy.—The use of the canula after the 
operation of lithotomy, though practised by some, is by too many surgeons 
altogether neglected and despised. We say too many, because we believe 
that a neglect of this simple precaution is, from infiltration of urine, not 
unfrequently the cause of death. 
The principal objection to the use of the canula is the fear of its causing 176 
LITHOTOMY. 
inflammation of the lining membrane of the bladder, but this has been 
found by experience to be futile. And surely, if authority or precedent 
have any weight, its use by Dionis, Le Dran, Ambrose Pare, and in our 
own times by Sir 13. Brodie and Mr. Liston, are enough to sanction its 
employment. 
According to Dr. O’Ferrall, there is neither pain nor irritation, nor con- 
stitutional disturbance occasioned by the insertion of a properly made tube 
after the operation of lithotomy; and many sources of pain and danger 
are avoided by its use. 1st. The scalding pain, inseparable from the pas- 
sage of urine through a fresh wound, is prevented. 2d. That insidious, 
but too surely destructive accident, infiltration of urine into the cellular 
tissue is rendered nearly impossible. 3d. If hemorrhage should occur, it 
may be, as is well known, generally arrested by its aid. 4th. The peri- 
tonitis and the diffuse inflammation, phlebitic or cellular, which might be 
supposed to spring from the alternate expansion and contraction of parts, 
newly subjected to operation, is, as far as the repose of the pelvic viscer? 
is capable of effecting that desirable object, averted. Part xii., p. 210 
Lithotomy in the Female.—Mrs. , aged forty-five, was admittec 
upon the 10th of June, on account of stone in the bladder, (from which sh( 
had suffered the usual symptoms for ten months. On the 12th, aftei 
dilating the urethra by the successive introduction of bougies, gradually 
increased in size, I passed my finger into the bladder, and divided the 
ring at its orifice outward and downward, by means of a straight bis- 
toury. This incision was of very small extent, hardly exceeding the 
breadth of the blade, which was rather narrow. The textures then rea- 
dily yielded, so as to allow me, without the use of violence, to introduce 
the forceps, and extract a stone about the size of a chestnut. Xot the 
slightest inconvenience followed the operation. The patient regained the 
power of retaining urine in the course of eight days, and returned home 
quite well on the 23 d. 
Lithotomy in the female, continues Professor Syme, affords an instruc- 
tive illustration of the principle on which this operation may be performed 
with safety on the male. However much the facility and rapidity of the 
operation may be promoted by cutting instead of tearing the textures thus 
far, it does not appear that the choice of these means materially affects the 
patient’s chance of recovery, provided the opening from the skin to the 
prostate be made sufficiently free. But in both sexes there is still an 
obstacle remaining which admits of ready removal by incision, and cannot 
be overcome by tearing without almost certain death. This is the sensitive 
ring which surrounds the neck of the bladder, at the base of the prostate 
in the male, and at the corresponding part in the female. 
In dilating the urethra, to accomplish any of the purposes which require 
its capacily to be temporarily increased, I find no means so convenient as 
the introduction of bougies. Part xii., p. 212 
Lithotomy with Albuminous Urine.—Mr. Phillips describes a case of 
lithotomy, performed upon a patient whose urine was so highly albuminous, 
that, on the application of heat, nearly one-fourth of the fluid in the tube 
became solid ; there was also a slight excess of lithate of ammonia pre- 
sent. When the patient came under Mr. Phillips’s care, he was much 
afflicted with the ordinary symptoms of stone; the bladder was very irri- 
table ; he was fifty-six years of age. A consultation was held on the case, LITHOTOMY. 
177 
and it was decided that the presence of the albumen was probably caused 
by the irritation excited in the kidney by the presence of the stone in the 
bladder, and an operation was decided upon. Before the operation, the 
albumen slightly decreased in quantity. 
[In six weeks after the operation, this patient was discharged cured ; 
the urine was quite free from albumen. Mr. Phillips observes : 
This point is one of great interest in practice, and it has been laid down 
by an eminent authority, that under such circumstances it is imprudent to 
operate at all. Whatever may be the value of that rule in other cases, I 
am by no means satisfied of the propriety of its application in cases of 
stone in the bladder; and if it had been acted upon in the present case, 
the patient would still be suffering from his disease. The question is un- 
doubtedly a very delicate one; does the albumen result from irritation 
within the bladder extending to the kidney, or is the irritation confined to 
the kidney itself?—in the one case removable by operation, in the other 
beyond its reach. I know no test by which we can distinguish between 
them, but the present case is a proof that such a distinction does really 
exist, though we are at present unable to detect it. Part xiii., p. 273. 
Operation.—Mr. Liston observes the following rules : 1. Use the sim- 
plest instruments. 2. Interfere as little as possible with the ileo-vesical 
fascia. 3. Know well the exact position of the stone, for the use of the 
forceps is the most annnoying part of the operation. 4. Dilate internally, 
if necessary, for a large stone; or make a bilateral incision, but it is very 
seldom necessary. 5. Introduce a gum-elastic tube through the track of 
the wound into the bladder, to secure the flow of urine from it, and keep 
it there, in children 20 hours, in adults 40 or 50. Part xiv., p. 207. 
General Treatment of Lithotomy Patients.—The general treatment of 
lithotomy patients at St. Thomas’s Hospital, is the following : Before the 
operation he is kept in a quiet ward for ten days or a fortnight, his diet 
attended to, and his bowels regulated ; the day before the operation (for 
which, if possible, temperate weather is chosen) he has low diet, and a 
dose of castor-oil; and on the morning an enema of gruel, with or with- 
out castor-oil. After the operation he is put to bed with his legs straight 
and close together, and a napkin put on in the same way as a child’s nap- 
kin ; this is changed throughout the treatment, when it becomes wet. In 
the evening or next morning a piece of lint is pushed up the wound by the 
finger, and changed whenever the patient wets; and when all the urine 
comes per urethram, the wound is dressed with wax and oil spread on the 
lint, and introduced as before. If the urine does not flow through the 
wound at first, the finger is introduced to remove any obstruction ; and if 
the discharge stop from swelling of the wound, no lint is introduced, but 
a bread poultice applied. Cold is not applied, and an opiate rarely given. 
For the first week or ten days the belly is fomented with chamomile. The 
diet is at first farinaceous, and is gradually improved; and castor-oil is 
given on the third day. Part xvi., p. 206. 
Hint on Sounding.—When you sound for stone, use rather a short and 
straight instrument at first. Introduce it very slowly and cautiously, so 
that the point of the instrument sinks into the post-prostatic fossa, in which 
the stone is generally situated. If you do so, you will generally strike the 
stone at once ; but if you sweep a sound, with a good full curve, into the 
VOL. II.—12 178 
bladder rapidly, you carry your instrument over the stone, and you may 
turn the point of it all round the bladder in vain. Part xix., p. 171. 
Incontinence of Urine after Lithotomy.—When incontinence of urine 
follows lithotomy, give the extract of nux vomica, beginning with an 
eighth of a grain thrice a day, and gradually increasing the dose. 
Part xix., p. 172. 
Piet after Lithotomy.—According to Bransby Cooper, patients should 
not be kept on spare diet after the operation of lithotomy, nor, indeed, 
after any severe ordeal of the kind. It should always be remembered that 
you cannot diminish constitutional power without increasing irritability ; 
and that, consequently, support is generally requisite, and should be early 
prescribed. Part xix., p. 173. 
Extraction of large Calculus—Bilateral Operation with the double 
Lithotome of Pupuytren.—Prof. May gives the following: G. H., aged 
18, entered the Washington Infirmary for stone in the bladder. On sound- 
ing him a few days after his entrance, a calculus was at once detected, and 
from several subsequent examinations, I believed the stone to be so large 
that I did not deem his case a favorable one for lithotrity. I therefore de- 
cided to cut him, and, on the 15th of April, performed the bilateral section 
before the medical class in the following way: 
The patient having been etherized and placed in the usual position, a 
deeply-grooved staff was introduced into the bladder, and pressed firmly 
against the perineum, as near as possible in the median line. A crescentic 
incision was then made over the staff, which, commencing on the right 
side at a point equi-distant from the anus and the tuberosity of the ischium, 
was terminated at a similar point on the opposite side, the centre of the curve 
being three-fourths of an inch above the anus. The incision was, by a few 
strokes of the scalpel, deepened, the fascia and perineal muscles divided, 
and the membraneous portion of the urethra exposed, which was then 
opened upon the groove of the staff longitudinally, and to a sufficient de- 
gree to admit the beak of the double lithotome of Dupuytren, which be- 
ing fairly placed in the groove, was introduced upon it into the bladder. 
The stone being felt with the end of the lithotome, the staff was extracted, 
and the instrument being reversed, the blades were sprung to No. 18 on 
the graduated scale, and it was withdrawn from the bladder, thus dividing 
the prostate equally, on both sides nine lines. 
The calculus was then readily seized with the forceps, but, finding that 
from its size it would not pass through the incision that had been made in 
the prostate, the forceps were extracted, the lithotome again introduced, 
and the gland further divided by the blades being sprung to their maxi- 
mum point of twenty-one lines. The stone was then seized with curved 
forceps, and extracted entire with not more than the usual force required 
in the extraction of a calculus of medium size by the lateral operation. 
The following were its dimensions : Longest diameter, two inches within 
a fraction ; shortest diameter, one and five-eighths of an inch ; circum- 
ference, five and five-eighths inches. It was hard, being a triple phos- 
phate, and round. The patient recovered from the operation in about the 
usual time, and being sufficiently strong to travel, left for his home in Vir- 
ginia in about two months after the operation was performed. 
The measurement of the several diameters of the prostate, from the 
urethra as the starting-point, to the periphery of the gland, is as follows: 
LITHOTOMY. LITHOTOMY. 
179 
and gives the average size of the gland in a healthy state in the adult. In 
old men and children there is, of course, considerable variation from it. 
The anterior face of the gland is considered. Transverse diameter, nine 
lines; oblique diameter, ten to eleven lines; inferior vertical diameter, 
seven lines; superior vertical diameter, three lines. The oblique diameter, 
the greatest, is the one divided in the lateral operation. This is eleven 
lines, or one line less than inch. Add to this the dimensions of the urethra, 
about four lines, and this section will give us but fifteen lines. Now, it is 
very certain that a calculus of over sixteen lines in its shortest diameter 
could scarcely be extracted through this opening without either tearing or 
incising beyond the limits of the gland, for although something must be 
allowed for the stretching and yielding of the parts, yet this is fully coun- 
terbalanced by the increased volume which the blades of the forceps would 
add in grasping the stone. The surgeon, therefore, is obliged either to 
tear the parts by main force, or to incise them freely beyond the prostate. 
Now, in the bilateral division of the gland in which both the oblique di- 
ameters are incised, we have, allowing four lines for the urethra, a section 
of twenty-six lines ; and if to this we allow for the stretching of the curve, 
approaching as it does toward a straight line during the passage of the 
calculus, it is evident that it will permit, without great difficulty, the pas- 
sage of a stone of two inches in its short diameter, leaving, at the same 
time, intact the parts beyond the gland. None of the methods of peri- 
neal lithotomy, can, therefore, in its free and safe incision, be compared 
with the bilateral operation, permitting, as it does, the passage of a calcu- 
lus of two inches in diameter and six inches in circumference, without 
causing any laceration. 
In speaking of this operation, Yelpeau remarks that “a calculus of 
twenty to twenty-four lines in thickness, and from five to six inches in 
circumference, might, strictly speaking, pass through the opening without 
causing any laceration.” 
If, says Prof. May, the stone be larger than this, it had better either be 
broken, if possible, through the wound, or extracted by the high opera- 
tion. There are surgeons who prefer performing the bilateral section 
with a common scalpel, for the purpose of simplifying the operation, and 
from the belief also that the incision through the gland does not corre- 
spond to the expansion given to the blades of the lithotome, from the 
yielding of the latter on account of their length and slenderness. I do not 
think the last objection to oe correct. If the instrument is made properly, 
and the blades are well and firmly articulated and sharp, I have not been 
able to discover any such defect. The operation can, no doubt, be very 
well performed with the common scalpel or bistoury, and if the litriotome 
of Dupuytren did not possess positive advantages over it, it ought to be 
preferred upon the ground of being the more simple instrument. But the 
lithotome, as Yelpeau remarks, renders the parts more tense as it divides 
them, gives greater regularity to the wound, terminates the operation, 
with a single cut, and especially makes “ an actual curved, instead of a 
simple V incision, which latter is the only one which can reasonably be 
expected, if we use the bistoury or other lithotomes.” It is an instrument, 
moreover, that can be safely used at all ages, as the blades can be sprung 
by the graduated scale on the handle from four to ten and a half lines on 
each side. I first used the double lithotome in 1842, and then on a child 
of three and a half years. The blades were set to four lines each, thus 180 
LITHOTOMY, 
making an incision of eight lines through the prostate, and through this, 
with a pair of ordinary polypus forceps, I extracted a calculus one inch 
in its long, and five-eighths of an inch in its short diameter (about as large 
as a common sized almond in the shell) without the wound being even 
stretched by its passage. The child did not lose over §j. of blood, and the 
recovery was very rapid, the wound being nearly closed in two weeks 
after the operation was performed ; a fact which goes far to disprove the 
assertion made by some, that cicatrization is much slower after the bila- 
teral than the lateral section. 
There are, moreover, other reasons, besides those already mentioned, 
which, it appears to me, render this operation safer in many respects than 
the lateral method, and which I, therefore, think should cause it to be 
adopted, not only specially, for the removal of small calculi, but also as a 
general method. 
In the first place, there are fewer vessels divided by it, and the bulb of 
the urethra is not touched, for the incision is made between the anus and 
the bulb, and the latter with its transverse artery can be always avoided. 
In the lateral operation, from the position and extent of the incision, I do 
not see how the bulb and artery can well escape, notwithstanding the 
directions in the books. Without attaching to their division great im- 
portance, it is yet undoubtedly preferable to avoid them when it can be 
done. If the double lithotome is used, the pudic artery cannot by any 
possibility, except anomalous distribution, be reached. Even the super- 
ficial artery, when in its usual position, is not usually divided; so that the 
operator is incomparably less incommoded by hemorrhage, as the-poste- 
rior branches of the transverse, and the anterior twigs of the hemorrhoidal 
artery are really the only arteries that are usually divided. Again, as the 
lithotome cuts outward and backward, there is less danger to the rectum. 
Indeed, I do not see how the intestine can be injured, unless it should be 
greatly distended from neglect, prior to the operation; and lastly, the 
ejaculatory ducts and vesiculae semiuales are not exposed to risk, for it 
will be recollected that the membranous portion of the urethra is first 
opened, and then the blades of the lithotome are sprung. Their obliquity 
outward, from this point, is such that the ducts cannot be injured, while, 
the blades not passing the limits of the prostate, the vesiculae cannot be 
reached. Part xxvi., p. 246. 
Causes of Death from Lithotomy.—The accidents which are of the 
most formidable nature after this operation are—hemorrhage, infiltration 
of urine into the cellular tissue with suppuration and abscess of this struc- 
ture, inflammation of the bladder, peritonitis, purulent infection, and 
secondary disease of kidneys. Dangerous hemorrhage is stated to be of 
uncommon occurrence. Mr. Liston stated that he had lost but one patient 
from bleeding out of 100 operations. 
Hemorrhage, properly so called, may arise from division of the superfi- 
cial artery of the perineum, the transverse artery, or the artery of the 
bulb, and the internal pudic itself. In some cases the accident arises from 
the surgeon’s making his incisions in an irregular manner ; but the most 
frequent cause is some irregularity in the origin, course, or relations of the 
numerous blood-vessels distributed to the perineum. The operator may, 
in making his incisions, err in three ways ; he may commence his incision 
too high, or he may incline it too much laterally toward the tuberosity 181 
LITHOTOMY, 
of the ischium. Each error may bring its peculiar consequences after 
it. 
When the incision is commenced very high up, the point of the knife is 
apt to fall on the bulbous portion of the urethra, or divide to one side of 
it the artery of the bulb. 
By prolonging the incision too far downward, that is to say, carrying 
it much beyond the level of the tuber ischii, the superficial branches which 
the internal pudic sends to the margin of the anus are almost sure to be 
divided; but here again the superficial situation of the vessels, which are 
not usually large, enables the operator to secure them without difficulty. 
The trunk of the pudic artery itself may be divided when the incision is 
lateralized too much, and its lower angle made to terminate very close to 
the ramus of the ischium. This accident has happened in the hands of the 
very best surgeons: 
M. Blandin, and many other anatomists, think that it is impossible for it 
to occur, unless there be some irregularity which disturbs the normal 
relation of parts at the floor of the pelvis. Finally, the superficial artery 
of the perineum may be implicated, because, in some subjects, it is near to 
the median line; but the artery can be taken up without difficulty in this 
situation. Primary hemorrhage may occur during the external or internal 
incisions. In the latter case, the danger is proportionate to the extent of 
the incision through the prostate; in the former case, to the amount of its 
deviation from the median line. 
Venous hemorrhage is another accident of lithotomy which occasionally 
occurs. A serious form occurs from division of the venous plexus about 
the neck of the bladder and prostate. In aged patients, and after long 
continued irritation of the urinary organs, these veins are apt to become 
abnormally developed, even to a varicose state. Besides this, they are 
enveloped in prolongations of the deep pelvic fascia, and thus prevented 
from retracting or becoming quickly closed after division. From these 
causes, troublesome venous hemorrhage may come on in old patients sub- 
mitted to the operation. Sir B. Brodie lost a patient within a few hours 
from this cause, having been foiled in all his efforts to restrain the bleed- 
ing. It may take place in adults, or even in children, under peculiar cir- 
cumstances. M, Robert witnessed two examples at the Hotel Dieu of 
Paris. In one case, that of a young man, the venous plexus continued to 
pour forth blood until death ensued. No artery had been wounded. The 
second case was that of a child addicted to masturbation. The enlarged 
veins furnished a copious bleeding, which became suddenly fatal after an 
act of that vice. These are altogether exceptional cases, for we may lay 
it down as a rule that the danger of venous hemorrhage is in direct pro- 
portion to the age of the patient. 
The period at which secondary hemorrhage sets in is very uncertain. 
You should make it an invariable rule to examine the patient’s linen 
every day for any traces of blood, more especially if the pulse become 
feeble and the face pale. Secondary hemorrhage, however, usually com- 
mences about the filth or sixth day—sometimes earlier, on the third or 
fourth—sometimes later, on the eighth or tenth day. 
Infiltration of urine into the cellular tissue is one of the most frequent 
causes of death. It may take place under two different circumstances. It 
may occur whenever the internal incision is carried beyond the limits of 
the prostate, or when the neck of the bladder and prostate are injured 182 
LITHOTOMY. 
and lacerated during the efforts made to extract a large calculus. In both 
these cases, the fibrous capsule of the prostate is divided or lacerated; the 
Urine becomes infiltrated into the subjacent cellular tissue, inflammation 
sets in, and, according to its seat or extent, excites peritonitis or gives 
rise to sloughing and gangrene of the soft parts within the pelvis. 
Infiltration, again, may occur, not from a too free internal incision, but 
because the external one has not been made on the same plane as the in- 
ternal ; because it has been too small, or the soft parts which constitute its 
walls have been lacerated and rendered irregular during the extraction 
of the stone; anything, in a word, which impedes the free discharge of 
urine through the external wound, may become an occasional cause of this 
infiltration, which takes place in the perineum, and not in the sub-perito- 
neal cellular tissue as in the former species. Simple inflammation of the 
pelvic cellular tissue, not caused by urinous infiltration, is a very rare acci- 
dent. 
The symptoms of urinary infiltration are extremely various, for the 
effects of the accident are modified by several circumstances. In some 
cases, the symptoms set in a few hours after the operation, and terminate 
fatally in a few hours more, or within a day or two ; in other cases, the 
progress of the disease is slower, and the patient does not sink until after 
a considerable period. 
The sub-peritoneal is, as might naturally be expected, the most rapid 
and dangerous. The patient complains of pain about the neck of the blad- 
der, and from the very outset has a peculiarly unfavorable and anxious 
expression of countenance; the pulse is small, weak, and rapid; the tongue 
Soon gets dry; and the lower part of the abdomen tumid and painful; 
often there is vomiting; prostration now rapidly ensues; there is low 
delirium, and the patient dies within forty-eight hours. 
In other cases the typhoid symptoms and prostration are not so great; 
the fever at first is of a more irritative character, and is occasionally inter- 
rupted by rigors; still, as the urine continues to work its way between 
the layers of the fascia, and the inflammation ascends along the sides of 
the rectum, more unfavorable symptoms do not fail to present themselves. 
Purulent infection is not often a cause of death in English surgery. 
Inflammation of the bladder is somewhat common; but we should esti- 
mate the inflammation caused by the stone, and that also of the operation, 
In alluding to the last cause of death after lithotomy, Mr. Gay, in his con- 
cluding remarks, says, that calculus vesicre can never long exist without 
producing deterioration of the system and latent disease of the kidneys 
and with such cases as these, lie observes, lithotritists are very careful not 
to meddle. Part xxvii., p. 150. 
Lithotomy—New Method: (Pecto- Urethral.)—This operation maybe 
described briefly as follows: The rectum is cut into from the median line 
of the perineum, and thus freely dividing the commissure of the sphincter 
ani. Prom this dissect upward in the median line to the membranous 
urethra, which is slit up as far as the edge of the prostate, the knife being 
guided by a previously introduced staff. The prostatic urethra is then 
dilated until of sufficient size to allow of the introduction of the forceps 
and the extraction of the stone. The bladder and the prostate are there- 
fore not wounded. Part xxviii.,y>. 205. 
Lithotomy.—If a patient be relieved by making water, says Prof. LITHOTOMY, 
183 
Syme, the case is probably one of urinary irritation, If the pain occurs 
during micturition only, there is probably stricture, but if the pain be 
slight before micturition, increases during the process, and becomes severe 
for a short time afterward, we have probably a case of stone. The success 
of lithotomy depends in a great measure on the manner in which the pros- 
tate is divided. There is one part which cannot bear injury, this is at the 
base of the gland where it joins the base of the bladder ; it is a dense tex- 
ture, very tough and unyielding, forming a sort of ring around the urethra, 
endowed with an extraordinary degree of sensibility. Now, if this tex- 
ture be torn, the patient will die, or if injured, the danger will be in pro- 
portion. The different success of different surgeons depends upon this 
ring being divided sufficiently by some and not by others: therefore, if 
on introducing your finger to dilate the deep part of the incision, you feel 
you have not cut enough, pass a straight probe-pointed bistoury along 
your finger, and, by a gentle sawing motion, carry the incision on to the 
extent you find necessary, in order to enable you to dilate with facility. 
Part xxxi., p. 295. 
Prevention of Hemorrhage after Lithotomy.—There are many objec- 
tions to plugging the wound. It pi'events the flow of urine, which creates 
much irritation, and on its removal fresh bleeding is often excited. To 
obviate this, attach to the common tube a conical bag of oiled silk, about 
an inch and a half from its inner extremity, pass the tube into the neck of 
the bladder, and then fill the oil-silk bag with sponge. The wound may 
in this way be most effectually plugged, and the escape of urine is secured 
by means of the tube. Part xxxi., p. 298. 
Median Operation of Lithotomy.—In reference to the comparative 
mortality of the lateral and median operations of lithotomy, Dr. King 
having considered shock, hemorrhage, and infiltration of urine, which are 
less liable to occur in the latter than in the former operation—and puru- 
lent deposits and peritonitis which are accidents occasionally attendant on 
all operations, observes that the remaining source of danger, viz., inflam- 
mation of the neck of the bladder, is the most frequent cause of death after 
lithotomy, and we have to consider whether it is more likely to occur 
when the prostate is partly divided and partly lacerated, or when it is 
simply dilated. The prostate when once cut into very readily tears, and 
the inflammation excited by the urine getting into these fissures pro- 
duces more fatal results in lithotomy than all the other sources of danger 
put together. But if the prostate be not incised at all, this condition of 
things is entirely altered. In the old Marian operation the prostate was 
actually torn asunder, by instruments, and there is no wonder that death 
so often resulted. 
Mr. Allarton’s proposal is of a very different nature. He recommends 
that the finger should be introduced, in the first place, and dilatation 
effected by careful pressure—that long-bladed forceps should next be 
passed into the bladder, and, the stone having been seized, should be care- 
fully and steadily withdrawn—the length of the blades causing the instru- 
ment, with the stone in its grasp, to act as a wedge, and thus assist in 
the proces of dilatation. Even should the structure of the prostate tear 
under this gradual pressure, it is of little moment so long as the mucous 
membrane remains entire, the urine being thus prevented from having 184 
LITHOTRITY, 
access to the lacerated portions, which access, and not the mere fact of 
laceration of the prostate, constitutes the grand danger in lithotomy. 
Fart xxxv., p. 118. 
Rectangular Catheter-Staff for Lithotomy.—Mr. Hutchinson recom- 
mends the use of an instrument combining the advantages of both a grooved 
staff and a catheter. It is rectangular in form, and the groove commences 
only from the angle, being broader at that point to allow its being more 
readily found, and the angle being very prominent in the perinseum is 
more readily reached by the knife. There are also other important ad- 
vantages : from the straight direction which the knife runs it does not 
readily leave the groove—from the groove only commencing at the angle, 
the urethra cannot be opened too far forward, or the artery of the bulb 
wounded. From its being a catheter as well as a staff, the surgeon may 
be quite certain it is in the bladder before commencing the operation, and 
the bladder can be injected without any change of instruments. There is 
no difficulty whatever in its introduction. 
One of the great advantages of this over the curved form of staff is, that 
the rectum is quite secure from being wounded if the finger be kept in the 
rectum whilst making the incisions. Part xxxv., p. 120. 
Sir B. Brodie adverts to the inconveniences or dangers of lithotrity, as 
follows: 
1. Hemorrhage. This may arise from the forcible passage of the litho- 
trity forceps through the neck of the bladder. Sir Benjamin has known it 
discolor the urine for two or three days. But it has never interfered with 
the operation. 
2. Rigors may follow lithotrity. The rigor is usually produced by the 
stretching of the urethra by the withdrawal of the forceps: or it may be 
occasioned by a fragment of calculus sticking in the urethra. A dose of 
opium may prevent the rigor altogether, or defer it till the next day. 
Rigors do not appear to interfere materially with the patient’s recoveiy. 
3. Sir Benjamin refers to two cases in which fragments of calculus im- 
pacted in the urethra gave rise to urinous abscess in the perineum. One 
patient died two months after with symptoms of diseased kidney. The 
other patient got well. 
4. Sometimes the patient suffers from pain in the whole canal of the 
urethra, from the simultaneous escape of many fragments. Sometimes he 
labors under great irritation of the bladder, apparently from a fragment 
lodged near its neck. lie may have complete retention, but Sir Benjamin 
has never seen it last for any time. 
The patient should partake plentifully of diluting drinks. If fragments 
lodge, a middle-sized catheter may be introduced into the bladder, when 
they may be either dislodged and come away, or pushed back and after- 
ward crushed. Sir Benjamin has removed fragments from the anterior 
part of the urethra by long, slender forceps. It might be necessary to 
make an incision in the penis or the perinseum. Sir Benjamin, however, 
LITHOTRITY. LITHOTKITY. 
185 
believes that if perfect repose is enjoined, after the operation, the passage 
of fragments will seldom occasion any serious inconvenience. 
5. Inflammation of the mucous membrane of the bladder may occur. It 
generally subsides spontaneously in two or three days, or continues till a 
fragment is either discharged from the urethra, or pushed back into the 
bladder by the catheter. In one instance, Sir Benjamin saw this inflam- 
mation prove fatal. The stone had been large—perhaps the patient had 
not been kept quiet. 
On the whole Sir Benjamin is of opinion that lithotrity has great advan- 
tages over lithotomy. He touches on the cases to which it is not applicable. 
1. In boys, under the age of puberty, lithotomy is too successful to 
be abandoned. The urethra is not wide enough to be favorable to litlio- 
trity. 
2. Lithotomy is attended with little danger in the female, while her 
short and wide urethra admits too readily of the escape of the injected 
water by the side of the lithotrity forceps. 
3. Large stones are not well adapted for lithotomy, but they are still 
worse adapted for lithotrity. Sir Benjamin inquires whether it would not 
be well to crush first and cut afterward. 
4. Lithotomy is not well adapted for cases of enlargement of the pros- 
tate gland, where the patient cannot empty the bladder, unless the calcu- 
lus is small; then the fragments may be washed out of the bladder 
through a large catheter. When the tumor of the prostate projects into 
the bladder, it is difficult to elevate the handle of the instrument suffi- 
ciently to catch the stone readily. 
5. Lithotomy is very fatal where the kidney is diseased, especially Sir 
B. Brodie supposes from the loss of blood that it entails. Crushing he 
thinks safer. But any shock to the system must be hazardous, and it 
must, usually, be more advisable to palliate. 
Sir Benjamin sums up what he has to say in favor of lithotrity in these 
words: 
“ With the exception of such cases as those which have been enumerated, 
there are few to which this method of treatment may not be advantage- 
ously applied. It may be said that the exceptions are numerous; but they 
are the result chiefly of delay. If a patient seeks the assistance of a com- 
petent surgeon within six or even twelve months after a calculus has 
descended from the kidney into the bladder, the urine having remained acid, 
it will rarely happen that he may not obtain a cure by a single operation, 
and with so small an amount of danger that it need scarcely enter into his 
calculations. As time advances the facility with which he can be relieved 
diminishes, and after the lapse of tw'o or three years, especially if the urine 
has become alkaline, it is probable that the calculus will have attained such 
a size as to render the old operation preferable, and that the access of dis- 
ease in the bladder or kidneys may render any operation hazardous. It 
wrould be absurd to say, and it would be unreasonable of human-kind to 
expect, that an operation that has for its object to relieve them of a disease 
so terrible as stone in the bladder, can be always free from inconvenience, 
and difficulty, and danger. Nevertheless, from what experience I have 
had, I am satisfied that the operation of lithotrity, if had recourse to only 
in proper cases, is not only much more successful than that of lithotomy, 
but that it is liable to fewer objections than almost any other of the prin- 
cipal operations of surgery.” Part vi., p. 106. 186 
LITHOTRITY. 
Lithotrity.—The first case of lithotrity performed in Ireland, -vras by 
Sir Philip Crampton, in 1834, in the Meath County Hospital. The opera- 
tion was only repeated once, and in less than a week’s time the Avhole of 
the detritus had come away. Sir Philip asks what is the problem which 
lithotrity has to solve ? According to Civiale it is as follows : 
1st. The reducing of calculi within the bladder into fragments suffi- 
ciently small to be discharged or removed through the natural passage. 
2dly. The effecting this by such means as shall excite no dangerous irrita- 
tion in the urinary organs. 3dly.„The freeing the bladder or urethra 
from the fragments which these organs may not have the power to expel. 
The best instrument for performing the operation of lithotrity, is Baron 
Heurteloup’s or Weiss’s curved percuteur. The late Mr. Oldham improved 
this instrument by carrying out a suggestion by Sir Philip Crampton, by 
which fragments of the calculi are prevented from accumulating between 
its jaws. The invention of the scretv is due to Mr. L’Estrange of Dublin. 
Sir Philip would prepare the patient for the operation by enjoining a light 
diet, abstinence from fermented liquors, clear out the boAvels, and order the 
hip-bath : if the urine be acid, give alkalies combined with uva ursi or Pe- 
ruvian bark; if alkaline, give the mineral acids; and if mucous deposits, 
infusion of Pareira brava ; enjoin absolute rest, and use occasionally an an- 
odyne enema. The urethra is to be gradually dilated, if necessary; Avhen 
preternatural contraction of its orifice exists, divide it. Introduce the ca- 
theter frequently, as it allays the irritability of the bladder and urethra. 
The objects of the operation are to reduce calculi within the bladder to 
such a size that the portions may be removed or discharged through the 
natural passages, to effect this by such means as shall excite no dangerous 
irritation in the urinary organs, and to free the bladder from the small 
fragments which remain. Great care should be taken that the case be a 
suitable one for the operation, as in some cases cystotomy must be pre- 
ferred. Lithotrity may be performed where the bladder is perfectly healthy 
and the stone is small; and it is decidedly advantageous AArhere there is 
phthisis or albuminuria. It is a great and valuable addition to chirurgical 
therapeia, but cannot be considered as a substitute for cystotomy, since 
there are numerous cases in which the last operation will prove the safest 
and most effectual. 
Cystotomy, for example, is preferable in boys before the age of puberty ; 
it is so simple and the urethra is so small as not to admit of the lithotrite. 
Cystotomy is also preferable in the female ; also Avhere the calculus has at- 
tained a Amry large size; also where the prostate gland is enlarged, unless 
the calculus be of very small size. Part xiii., p. 266. 
Lithotrity.—According to Mr. Liston, this operation is applicable, 1st, 
to patients above puberty, if the stone is not large, say \ to | inch in di- 
ameter, or as large as a chestnut; 2nd, when the bladder and urethra are 
tolerably healthy, as shown by retaining the urine for hours, and being 
able to pass it in a good stream, and Avhen the bladder Avill admit of injec- 
tion and careful exploration. Part xiv., p. 207. 
Treatment after the operation of Lithotrity .—Dr. Adams, of the Lon- 
don Hospital, says: In regard to the getting rid of the contents of the 
bladder, I am strongly of opinion that the less interference there is on the 
part of the surgeon the better. Let the patient drink freely of barley-wa- 
ter, and give him an alkaline mixture Avith tincture of hyoscyamus, and you 187 
LITHOTErrT. 
will find the bladder relieve itself much better than you can relieve it by 
the aid of any instruments, however ingeniously contrived. I am averse 
to the exhibition of opium after the operation, unless the patient should 
have a shivering fit, and then it may be desirable to employ it; opium has 
the effect occasionally of inducing the retention of urine, and therefore I 
would not use it unnecessarily : a dose of castor-oil may also be given the 
morning after the operation, and the hip-bath is to be employed night and 
morning. Part xix., p. 171. 
Lithotrity and Lithotomy.—In the course of his remarks on the Patho- 
logy and Surgery of urinary concretions, Mr. B. B. Cooper says : The 
choice between lithotrity and lithotomy is often one requiring considerable 
judgment on the part of the surgeon ; and this is a question in which a 
knowledge of the chemical nature of the stone must always be of great 
service : not that the chemical composition of the stone has anything to do 
with either of these operations directly ; but the physical character of the 
different kinds of stones varies as much as their composition, and that 
character can be judged of pretty correctly as soon as the composition of 
the calculus is known. Uric acid, for instance, often occurs in a form in 
which it easily breaks into pieces under a crushing force ; and the crys- 
tallized variety of the triple phosphate also crumbles away completely un- 
der pressure. By means of the lithotrite it is easy to comminute such 
stones as these; but there are others which yield with great difficulty to 
the action of that instrument. The oxalate of lime calculus is of this na- 
ture ; the tuberculated portions break off* readily enough, but the mass of 
the calculus is crushed with great difficulty; and when it is broken, the 
fragments are so sharp that they are likely to produce extreme irritation 
in the bladder, and then a secondary action may be established, in which 
these fragments become the nuclei of other calculi, or at least cause the 
deposition of fresh quantities of earthy matter from the urine. Whatever 
may be the nature of the stone, I think it is always inadvisable to employ 
the crushing process if there be evidence of a tendency to the deposition 
of the earthy phosphates. Of course this must be judged of by the urine ; 
and unless the tendency can be removed, it seems to me that the operation 
of lithotomy should be preferred ; for I believe that the incision through 
the prostate gland causes less irritation than the use of the lithotrite, and 
the consequent presence of the calulous fragments. The advantage of 
lithotomy is, that the chief source of irritation is removed at once; and 
although there may remain the constitutional tendency to deposition from 
the urine, there would be no nuclei to promote that tendency, and it 
would be therefore the more likely to be counteracted by therapeutical 
agents. 
Whenever, also, from the diathesis of the patient, the state of the urine, 
and the examination by the sound, the stone is believed to be of that kind 
which is crushed with difficulty, the operation of lithotomy is certainly 
indicated. 
With regard to the constitutional condition of the patient, the same con- 
siderations would weigh with the surgeon in lithotomy as in lithotrity; and 
one of the chief points would be, to overcome, before the operation was 
performed, the constitutional tendency, if any still continued to exist, to 
further deposition. Generally speaking, the physical character of the stone 
bears little immediate relation to the operation of lithotomy; but I may 188 
LITHOTRITY, 
say that the kind of stone most suitable to lithotrity is perhaps that most 
difficult to deal with in lithotomy. The more friable a stone, and the less 
the cohesion of its particles, the better suited it is to the lithotrite; but 
such a stone would be more likely to increase the difficulty of the opera- 
tion in lithotomy, as it would probably crumble and break away when 
seized by the forceps, and so lead to the necessity of some modification of 
the operation, in order to get rid of the whole of the fragments. The 
hardness of the stone can be no objection in lithotomy, unless it be too 
large to be removed whole, in which case great irritation may be produced 
in the efforts of the surgeon to break it while in the bladder. I believe 
that the operations of lithotrity and lithotomy may, in a certain manner, 
be very advantageously combined. For instance, it sometimes happens 
that a stone is so large, that, although it may be removed without previous 
crushing, it requires a very extensive incision through the prostate. In 
such a case, I think that a strong kind of lithotrite may be introduced 
through the wound, and the stone easily broken down, without producing 
so much irritation as would arise from the extension of the wound by the 
forcible extraction of a large stone. Part xx., p. 158. 
Lithotrity.—Mr. C. Hawkins says: 1STo attempt to extract any portion 
of stone through the urethra should be made with the lithotrite ; the op- 
erator should be content with crushing the stone in the bladder. If a por- 
tion of the stone should become impacted in the urethra, it is much safer 
to cut down upon it and remove it, than lacerate the urethra by efforts at 
extraction. Part xxiii., p. 200. 
Lithotrity.—After the operation of lithotrity, it sometimes happens that 
a fragment of the stone becomes impacted in the membraneous part of the 
urethra. To ascertain the nature and seat of the fragment pass a soft 
bougie down the urethra; the fragment seldoms fails to leave a mark on 
the bougie, whereas a metal sound would pass over it and communicate no 
impression. Where impaction is to be apprehended, the patient should 
not be allowed to make water while on his knees, but must endeavor to do 
so while on his back. Immediately after the operation several injections 
of warm water should be thrown into the bladder by means of a large ca- 
theter, with large eyes, for the purpose of removing as much of the detri- 
tus as possible. If a fragment should be impacted, and if it should be 
near the neck of the bladder, it may be gently pushed back, but in all cases, 
if there is any resistance, injections of warm water should be used through 
the catheter. If it is impossible by these means to push back the frag- 
ment, there is only the choice between extraction and crushing, and when- 
ever the former can be effected without much difficulty it is to be preferred. 
Part xxvi., p. 230. 
Lithotrity.—In the choice of subjects for this operation, take care, if 
possible, 1st, to let the age be between thirty and sixty, with neither the 
irritability of youth, nor the debility of old age. 2d. The urethra should 
be large enough to admit instruments of considerable size. 3d. The blad- 
der should be healthy, and capable of holding six or eight ounces of fluid. 
4th. The kidneys should also be healthy. 5th. The calculus should be 
loose in the cavity of the bladder. 6th. The diameter of the stone oug it 
not to exceed an inch and a quarter, as near as can be calculated. Whe e 
the above kind of case occurs, lithotrity and not lithotomy ought to be 
performed. LITHOTRITY. 
189 
Simple enlargement of the prostate need not prevent the operation, but 
where there is inflammation or suppuration it is inapplicable, and lithotomy 
should be performed. Lithotrity should never be adopted, unless the 
bladder be free from inflammation, and one great means of knowing this is 
to ascertain the quantity of water which the bladder can hold. A blad- 
der violently inflamed, is like a stomach inflamed, neither can contain much 
without parting with it. If the bladder can hold eight or ten ounces 
(other circumstances being favorable), lithotrity will generally succeed; 
but if it will contain only three or four ounces, this operation is not 
proper. As soon as the surgeon has filled the bladder, he should suddenly 
change the position of the patient backward, so as to throw the stone into 
the back of the bladder. The manipulations can be carried on better in this 
place than nearer the prostate and the anterior pai't of the bladder, which 
is always more irritable and sensitive than the back part. Part xxx.,p. 163. 
Lithotrity.—[In a case of lithotrity on a rather old patient, at St. 
Bartholomew’s Hospital,] Mr. Skey, alter carefully injecting the bladder 
with warm water, was observed to break the stone once, and then order 
the man to bed. Mr. Skey then explained to his class that this is a rule he 
adopts at the advice of Sir B. Brodie, never at the first sitting to break 
the stone more than once, so that the bladder may thus become accus- 
tomed as well to the instruments as the altered state of the stone. 
Part xxxv., p. 122. 
Lithotritic Instruments in Cases of Enlarged Prostate.—Supposing 
you have to perform lithotrity in a case of enlarged prostate, you must, in 
order to success, take into account the alterations which have taken place 
in consequence of the prostatic disease. The two principal are: first, 
elongation of the passage by an inch or more; second, formation of a sort 
of a pouch beneath the neck of the bladder, in which pouch the stone 
usually lies; to overcome the first, you require to have your instruments 
several inches longer than usual; you will best overcome the second by re- 
versing the beak of the instrument when introduced into the bladder, or 
by tilting the pelvis of the patient backwai d, to execute which proceeding 
quickly, every lithotrity couch should be provided with some mechanical 
contrivance. Part xxxvii., p. 161. 
lithotrity.—According to Mr. F. C. Skey, cases should be rejected if 
there be—1. Manifest disease of the kidney. 2. The urethra so con- 
tracted as not to admit with facility a lithotrite of ample size. 3. The 
bladder so intolerant as to be incapable of retaining its urinous contents 
for three or four hours; and, on the other hand, a bladder of low nervous 
susceptibility. 4. Much enlargement of the prostate gland. Moreover, 
in performing the operation, the following cautions should be observed: 
The quantity of water injected should not exceed four or five ounces. No 
attempt should be made to open the instrument till it has been pushed 
thoroughly home into the bladder. In the act of separating the blades, 
pass the lower blade doAvnward toward the bottom of the bladder, that 
the upper blade may not be painfully pressed against the neck. The in- 
strument should retain the mesial line throughout the entire operation, 
there being neither necessity for, nor advantage in, directing the instru- 
ment to the right or left. At the first operation do as little as possible, 
breaking the stone only once. No advantage is gained by an abstemious 
diet. Part xl.,y>. 123. 190 
LOBELIA INFLATA—LOCK-JAW. 
LOBELIA INFLATA. 
Uses of Lobelia Inflata.—In pertussis, combining the tinct. lobeh, of 
which Professor Eberle speaks so highly, with the acid hydrocyan., 
extolled by Thompson and Roe, with equal propriety might I vaunt the 
recipe as a specific, as they do theirs, although such a thing as a specific 
probably does not exist, except it be sulphur for psora. In asthma, espe- 
cially of a spasmodic kind, the most marked benefits result from the use 
of this plant singly, or combined as above—the existing disturbance of the 
nervous fibre of the bronchial surface, or the spasms of the mucous mem- 
brane of the bronchia are speedily allayed, and, by a short course, a cure, 
or a suspension of some length at least, is the sequence of its administra- 
tion. For an adult, R Tinct. lobel. inflat., 3j-; acid hydrocyan., gtt. i-ii 
Ter quatuorve die. But if the paroxysm be severe, the tincture may be 
given in much larger doses, and repeated at short intervals, till entire re- 
lief is obtained. By this combination, I have enabled several inveterate 
cases of asthma (which had been repeatedly prescribed for by various 
physicians, quacks, and old women) to pass for several months with a com- 
plete suspension of all their sufferings. 
In diphtheritic laryngo-tracheitis, continues Dr. Livezey, where the 
excitation of emesis cannot be readily accomplished, which frequently 
arises from the nature of the disease as well as the difficulty and unplea- 
santness of medicineto infants, this difficulty may be obviated by enemata, 
containing a portion of the tinct. lobel. or pulverized plant, which at once 
relaxes the system, removes the tension of the chest, changes the seat of 
excitement to a distant part, and emesis readily ensues ; the bowels in the 
meanwhile are emptied of their contents, and recovery from every dis- 
tressing symptom immediately follows. 
In all cases of coughs, especially when inflammatory symptoms mani- 
fest themselves, as in catarrhal affections in children as well as in adults, I 
consider the tincture of this plant (or infusion, when the stimulus imparted 
by the alcohol might be objectionable) far preferable to ipecacuanha or the 
tartrate of antimony and potassa, being more decisive in its effects than 
the former, and a better and safer nauseant than the latter, without that 
fear of irritating the gastro-enteric mucous membrane, the pathological 
condition of which has been too much overlooked by earlier writers, but 
which is now claiming deserved attention. 
In febrile disorders, incident to every section of country, more or less, 
in summer and autumn, when it is desirable (as in fact it is always so) to 
lessen vascular action, and as a febrifuge, the “ nitrous powders ” sink into 
utter insignificance in comparison with this plant, which is not liable to the 
same objection as the tartarized antimony used in combination with calo- 
mel and the nitrate of potassa by many of the older practitioners, which 
too frequently increases that tenderness and erethism already existing in 
the mucous membrane of the stomach and intestines. Part xvi., p. 134. 
Acupuncture in Protracted Lock-jaw.—[The patient, 25 years of age, 
unmarried, had for years been subject to attacks of suppurating sore 
LOCK-JAW. LOCK-JAW. 
191 
throat, in which the jaw often became nearly immovable for two or three 
days before the discharge of the matter. In 1826 she had a severe attack, 
from which resulted complete lock-jaw, accompanied with hysterical symp- 
toms,' which attack yielded after six weeks of treatment so far that she 
could put a teaspoon into her mouth. After nearly a year the jaw again 
became completely fixed, without accompanying sore throat, and the same 
treatment, with galvanism, was tried without effect. Although unequivo- 
cally connected with hysteria, there was reason to think, from the inflam 
inatory symptoms with which the disease set in, that the affection was not 
purely spasmodic, but was kept up by rigidity of the muscles closing the 
jaw, produced by inflammation, in consequence of which the antagonist 
muscles had become inadequate to the effort of opening the mouth, under 
the mere influence of volition.] 
It was this view of the case which made Dr. Seller consider it more rea- 
sonable in making trial of the needles, to insert them into the muscles 
which open the jaw, in the expectation of exciting these to such a contrac- 
tion as might overcome the rigidity of their antagonists. 
On each of the two following days, two needles were inserted, one on 
each side of the mesial line, between the chin and the hyoid bone, the 
effect being short convulsive efforts, the teeth began to grate on each 
other, and the jaw was drawn from side to side, not by single alternate 
contractions, but by several convulsive movements on one side, followed 
by a nearly equal number toward the other side, interrupted occasionally 
by a momentary opening of the mouth to the extent of about two fingers’ 
breadth. 
The convulsion continued after the needles were withdrawn, ceased and 
became renewed again after a few minutes, and returned spontaneously in 
the evening on both occasions. Some increase of voluntary power over 
the jaw followed both applications of the remedy. After each trial of the 
acupuncture, some improvement was observable ; but as the spontaneous 
convulsion was almost always followed by a slight loss of motion, the 
progress made was but slow. 
The needles were usually inserted to the depth of half an inch, and some- 
times to the depth of an inch. 
[The acupuncture, together with the leeches, was used for ten days, by 
which time the patient could open the mouth two fingers’ breadth, and chew 
soft substances. She then went into the country for five weeks, by which 
she derived great benefit, but being exposed to cold and wet on her return, 
had another severe attack, the consequence of which was the loss of much 
of the voluntary power over the muscles of the jaw. The needles were 
again resorted to with the same effects as before, but the pain produced by 
the convulsions were greater, and lasted longer, while the spontaneous 
convulsion recurred several times in the evenings, after each of the first 
trials. As leeching did not succeed in mitigating the convulsion, the tem- 
poral artery was opened with the desired result, and with the effect at the 
same time, of restoring, to a considerable extent, the sight of the right 
eye, which she almost lost with the first attack of lock-jaw. A second de- 
traction of blood from the same vessel diminished the force of the convul- 
sion so much as to permit the acupuncture to be used twice a day. Nine 
days after the renewal of the operation, the jaw had recovered its natural 
extent of motion. The aphonia, which had come on at the same time as 
the affection of the eye, was completely cured by a smart shock of elec- 192 
LOINS. 
tricity. So great was the effect produced by the recovery of her voice, 
and complete power over the jaw, that from a mere spectre, she reas- 
sumed her natural robust, ruddy appearance.] 
Vide “ Tetanus.” Part xi., p T89. 
LOINS. 
Pain of the Loins.—Dr. Oke says : Pain of the loins may be derived 
from the muscles, from the liver, from the duodenum, from the kidneys, 
from the colon, from the uterus, from the aorta, from the spine, or from 
matter collected on the psoas muscle independent of spinal disease. In 
order to arrive at its true cause, we must endeavor to ascertain what func- 
tion is principally involved which will at once lead us to it. 
If the pain he rheumatic, it will be increased by pressure, and by the 
slightest action of the muscles affected. There will probably be also 
rheumatism in other parts of the body, the system will not evince mucl' 
disorder, the urine will be high colored, and deposit a lateritious sediment 
If derived from the hepatic function, the pain will shoot upward along 
the splanchnic nerves to the scapulae ; the alvine evacuations will be either 
deficient in, or exuberant with, bile ; or show a morbid quality of that 
secretion ; the urine will have a bilous tinge ; there may be congestion of 
the hemorrhoidal veins ; and the spirits will be depressed. 
If from the duodenal function, three or four hours after the meal the 
pain will be aggravated, shooting through toward the right side of the 
abdomen, and remaining till the food has passed into the jejunum. Dys- 
peptic symptoms will prevail, and there will frequently be painful pustules 
breaking out about the face. I hava lately met with a case in which the 
boils were extremely annoying. 
If from the kidneys, the pain will shoot down the course of the sper- 
matic nerves toward the round ligament in the female, and toward the 
testis in the male, which will often be retracted by the action of the sper- 
matic nerves upon the cremaster muscle. There will be more or less 
irritation communicated to the mucous membrane of the bladder. The 
urine also will be diagnostic in this instance; it may deposit mucus, calcu- 
lous matter, blood, pus, or albumen, according to the nature of the case; 
or it may be otherwise morbid in its constitution. 
If from the uterus, the pain of the back will arise either from disordered 
function or disease of that organ. In the former case the pain will be of a 
neuralgic character, will return in forcing paroxysms extending around the 
hips and hypogastric region, will be attended with hysteria, and often with 
increased quantity of the menstrual discharge. In the latter case the pains 
will be constant and severe, extending along the anterior crural nerve half 
way down the thighs. There will be a thin, offensive discharge from the 
vagina. The countenance will be wan and sallow, exhibiting the wear and 
tear of organic lesion. 
If from the colon, there will be constipation, and inflation in the course 
of the bowel, or the faecal discharges will be of small diameter, or there 
will be soreness of the intestine under pressure, especially at its ascending 
or descending portions, accompanied by mucus, or shreds of lymph in the 
form of boiled vermicelli, amongst the excretions. LUMBAGO. 
193 
If from arterial dilatation, an abnormal pulsation of the vessel involved 
—the aorta, for instance—may possibly be detected by auscultation in the 
incipient stage of the disease, if such were suspected y but in a large 
majority of cases such a cause may reasonably escape the attention of the 
ablest surgeon, from there being no tangible symptom that might lead him 
to suspect it; and even after the dilatation has considerably advanced, it 
may be sufficiently large to press upon and disturb the spermatic nerves, 
but not large enough to project and pulsate externally, and this may, at 
this stage, be confounded with disease of the renal function. A few years 
ago I met with a case of this kind in a man of middle age. The pain had 
been constant and wearing, shooting from the loins down the course of the 
spermatic nerves, and for a considerable time was reasonably attributed to 
the renal function, especially as there had been constant disturbance of this 
function. At length the aneurismal sac began to approach the surface, 
and then, of course, the cause became apparent. 
If from disease of the spinal column, the pain will be aggravated by 
percussing the spinous processes at this part of the spine, or by suddenly 
striking the toes against an uneven surface. There will be involuntary 
action of the muscles, especially of the flexors of the legs, diminished tem- 
perature, abnormal feelings, and more or less loss of power of the lower 
limbs. Should there be at the same time any unnatural projection of the 
spinous processes, the disease will be confirmed. 
If from a collection of matter upon the psoas muscle, unconnected with 
spinal disease, the pain will be continued, dull, and deep-seated, extending 
from the loins down the psose, or in whatever direction the matter may 
have taken its course. The pain will be aggravated by flexing the thigh 
toward the abdomen, and there will be difficulty in walking; moreover, 
there will be marks of a strumous habit, and more or less symptoms of hectic 
fever. Should any fluctuating tumor present at the groin, or at any other 
point where the matter may find its way out of the body, it will be conclu- 
sive as to the nature of the case. Part ix., p. 50. 
LUMBAGO. 
Nature and Treatment.—Lumbago is a very characteristic form of mus- 
cular rheumatism. It occupies the loins, and is often aggravated to tor- 
ture by an unguarded movement implicating the muscles of the part; but 
if the patient remain perfectly quiet, he is comparatively free from suffer- 
ing. When very severe, he may be obliged to remain in bed, and very 
often is confined to the sofa. Even when he is able to walk about, he 
often does so in a semi-bent position, being unable to raise his body into a 
complete erect posture for some time after he has risen ; nay, in some cases 
he cannot straighten himself at all. 
Purgatives are very frequently of great service in the different forms of 
muscular rheumatism, more particularly in lumbago, and as a general rule 
ought to precede the use of other remedies. The best plan, where there 
is nothing to contra-indicate its adoption, is to give from three to four 
grains of calomel at night, followed by a black dose next morning, and to 
repeat this once or twice during the first week ; after which it is sufficient 
VOL. II.—13 194 
MALARIA. 
to regulate the action of the bowels, and to give rather a brisk purgative 
about once a week. Part v., p. 77. 
Treatment of Lumbago.—Dr. Macleod advises a brisk calomel purge 
once or twice a week, and considers half a drachm to two drachms of the 
compound tincture of guaiacum three times a day, with a grain of opium 
at night, the best plan. Part viii., p. 25. 
Lumbago, Sciatica, Paralysis from Arsenic, etc., vide “ Firing.” 
The active Principle of Malaria.—Dr. Gardner, Professor of Chemis- 
try in Hampden Sidney College, submits the following propositions : 
1st. Sulphureted hydrogen gas exists in the stagnant waters and atmos- 
phere of certain marshes. 
2d. The character of malarious regions is similar to that of those in 
which sulphureted hydrogen is generated. 
3d. Certain agents have been supposed to give activity to the exhala- 
tions arising from marshes, called malaria. 
4tli. The properties of malaria are fully recognized by the profession. 
5th. Sulphureted hydrogen is the active agent in the production of 
those forms of malarious fever met with on the sea coast, and the diseases 
belonging to the same class found inland. 
He shows from carefully instituted experiments, that sulphureted hy- 
drogen gas exists in the stagnant waters and atmosphere of certain marshes 
where malarious diseases are prevalent, and that certain agents give ac- 
tivity to the exhalations arising from these marshes. On account of the 
difficulty of procuring a sufficient quantity of atmospheric air to detect the 
presence of the gas, he prepared pure surfaces of silver and brought them 
into contact with the air and water in the suspected regions. Silver is 
one of the most delicate tests for sulphur, and is not so liable to be attacked 
by the agents which act upon lead, copper, etc., and so delicate a test of 
sulphur is metallic silver, that it will detect it in a solution containing one 
part in three millions of water ; and as a means of determining the amount 
of sulphureted hydrogen in mineral waters, it is perhaps one of the best 
tests which we possess. 
Dr. Gardner having prepared his silver plates (polished coins), exposed 
them to the action of the air and water of marshes in different localities. 
The polished coins were first perforated in a marked place so as to be re- 
cognized, next cleaned and dried, then carefully weighed, furnished with 
strings, and lastly, suspended in the places fixed upon. Thirty different 
coins were thus suspended in different places ; some were soon stained, and 
others, as in the Buffalo River, were not affected for some time. Ulti- 
mately, however, most of them were more or less stained; and it was 
found that the shallow waters of marshes contained the most, and rivers 
the least amount of gas, the coins suspended in the latter somet mes re- 
quiring a month, and those suspended in the air even more time for dis- 
coloration, while those suspended over the stagnant marshes, would be 
affected in a week or even less. 
Sulphureted hydrogen has been discovered on the most deadly coasts. 
MALARIA. MANGANESE, 
195 
It is produced in marshes where sulphates exist either in the vegetable 
matter, water, or soil. The destruction of the sources of the gas, by the 
exclusion of the sea, has annihilated the fatal malaria of some of the Ita- 
lian marshes and given health to the pestiferous town of Viareggio. 
The agents which decompose sulphureted hydrogen are also inimical to 
malaria. Fire is of this number, for by means of it the gas is converted, 
in the open air, into sulphurous acid and water. Chlorine destroys both 
malaria and sulphureted hydrogen, the latter by combining with its hy- 
drogen and precipitating the inert element sulphur. The value of chlorine 
has been proved both in the American and British squadrons. 
The existence of trees, by decomposing the organic compound, and ap- 
propriating its water, is calculated to destroy malaria. 
Its weight, and the readiness with which water may be separated from 
it, preclude its rising to any altitude in the atmosphere. 
It is produced in the autumnal months : because, then, the amount of 
moisture, the coolness of the nights over the temperature of the days, and 
the fresh deposition of leaves, furnish the most abundant materials for the 
formation of the organic compound. 
The poisonous effects of sulphureted hydrogen are too well known to 
require comment. There is no agent, which marshes evolve, that is so de- 
structive to life. Messrs. Thenard and Dupuytren killed birds in an atmos- 
phere containing l-1500th part of the gas. Nysten found that it was ab- 
sorbed at once by the blood. Two or three cubic inches caused immedi- 
ate death when injected into a vein, the cavity of the chest, or the cellu- 
lar tissue of a dog. The same authority, with Lebkuchner, and Chausier, 
found that it was absorbed through the healthy skin, and produced danger- 
ous effects. The gas is a narcotic poison, prostrating the nervous system, 
and destroying muscular energy. In small quantities it produces colic, 
and internal congestion. 
Liebig states, that sulphureted hydrogen produces immediate decompo- 
sition of the blood. Part viii., p. 5. 
Malaria.—For producing malaria it appears to be necessary that a sur- 
face should be flooded and soaked with water and then dried. The quicker 
the drying process, the more virulent is the poison that is evolved. For 
this reason Dr. A. T. Thompson recommended that the floor of a sick room 
should only be swept, never washed. An invalid might as well sleep in a 
swamp as in a room the floor of which is frequently washed. Dr. Alison 
has observed the more frequent occurrence of croup on Saturday night, 
the only day of the week on which the lower classes of Edinburgh wash 
their houses. Part xxxiv., p. 18. 
Pharmaceutical Preparations of Manganese— Oxide of Manganese.— 
This is a very good preparation, especially when obtained by the humid 
method ; it should therefore be made only when it is wanted for use. 
The best mode of prescribing it is to add to an ounce of simple sirup, half 
a drachm or a drachm of the hydrated oxide, with some oily emulsion, to 
prevent the contact of the air. 
Carbonate of Manganese is best prepared by dissolving seventeen 
MANGANESE 196 
MANGANESE. 
ounces of pure crystallized sulphate of manganese, and nineteen ounces of 
carbonate of soda, in a sufficient quantity of water. Double decomposi- 
tion takes place ; one ounce of sirup is added to every seventeen ounces 
of the liquid, and the precipitate is allowed to settle in a well-stopped bot- 
tle. The supernatant fluid is then decanted off; the precipitate is washed 
with sugared water, and allowed to drain on a cloth saturated with sim- 
ple sirup; it is then expressed, mixed with ten ounces of honey, and 
rapidly evaporated (the access of air being prevented) to a proper con- 
sistence for making pills. The dose is from four to ten pills, each four 
grains, every day in chlorotic cases, where iron has not succeeded. The 
hyperoxidation of the carbonate of manganese may be prevented by 
adding freshly prepared vegetable charcoal to the pills. 
Neutral Malate of Manganese.—This is procured by treating cax-bo- 
nate of manganese with malic acid. It is an eligible preparation, as the 
base of the salt is in the form of protoxide, and the acid is easily digested. 
The dose is from two to four grains, in pills. 
The preparations of manganese have this immense advantage over those 
of iron, that they can be combined with vegetable tonics and astringents, 
namely, tannin, and the substances which contain it, as gall-nuts, rhatany, 
catechu, dragon’s blood, kino, monesia, canella, and cinchona. These can 
all be combined with malate of manganese. Sirup of malate of man- 
ganese consists of simple sirup, §xvj.; malate of manganese, §j.; essence of 
lemon, 5ij.: an ounce of sirup contains 29 grains of malate of manganese. 
Pills of malate of manganese.—Malate of manganese, gr. xv.; powder of 
cinchona, gr. xv.; honey, a sufficient quantity to make twenty pills. 
Lozenges of malate of manganese.—Malate of manganese, |j.; sugar, §xj.; 
mucilage of tragacanth, a sufficient quantity. To be formed into lozenges, 
each 12 grains in weight; each of which contains a grain of the salt. 
Tartrate of Manganese is prepared in the same way as the malate, tar- 
taric acid being used. It may be substituted for the malate in all the 
above mentioned formulae; and is used to prepare the following highly 
tonic sirup. Sirup of tolu, gxvij.; extract of rhatany, 3iiss.; tartrate of 
manganese, 5iiss. Dose, from four to five spoonfuls daily. 
Phosphate of Manganese is best prepared by dropping a solution of 
phosphate of soda into a solution of sulphate of manganese. The precipi- 
tate is collected after filtration, dried, and preserved in well-stopped bot- 
tles. 
This preparation may be employed, like the phosphate of iron, in can- 
cerous affections. Pills of phosphate of manganese.—Phosphate of man- 
ganese, 3iss.; powder of cinchona, 3ss.; sirup of catechu, a sufficient quan- 
tity. To be divided into four grain pills. Sirup of phosphate of man- 
ganese.—Phosphate of manganese 5ss.; sirup of tolu, §iij., 3iij.; sirup of 
cinchona, §v.; essence of lemon, 3iss.; powder of tragacanth, gr. x. This 
preparation must be made quickly, and preserved in a well stopped bottle. 
Lozenges of phosphate of manganese.—Phosphate of manganese, §j.; 
sugar, §xij. Mix and divide in twelve grain lozenges, each containing 
one grain of the phosphate. 
Iodide of Manganese is prepared by digesting recently precipitated 
carbonate of manganese with fresh hydriodic acid; then filtering, and 
evaporating, the access of air being prevented. It may more conveniently 
be prepared extemporaneously, by mixing together an ounce of iodide ol 
potassium, and the same quantity of sulphate of manganese, perfectly 197 
MANGANESE. 
dried, and in the state of powder. It is then made into a pill-mass with 
honey, and divided into pills, each containing four grains of the iodide; 
which should be kept in a well-stopped bottle. The dose is at first one 
pill daily, gradually increased every three days, to six pills; the medicine 
is then omitted for eight days, after which it is resumed again. Sirup of 
iodide of manganese is prepared by adding concentrated hydriodic. acid 
to a drachm of perfectly pure hydrated carbonate of manganese, until it 
be entirely dissolved; then mixing with the solution 17 oz. of a sirup of 
guaiacum and sarsaparilla. Dose, from two to six spoonfuls daily. 
In cases where iron has not succeeded, it is desirable not to make a 
sudden transition to manganese, but to combine the two remedies as in 
the following formula. Pure crystallized sulphate of iron, §xiij.; pure sul- 
phate of manganese, giiiss.; pure carbonate of soda, gxviiss.; honey, §x.; 
sirup as much as may be sufficient to make a mass to be divided into 
four-grain pills. Dose from two to ten pills daily. The insoluble pre- 
parations of manganese should be first used, as the carbonate, phosphate 
and oxide: then the more soluble preparations, the tartrate, malate, 
etc., may be employed. The use of this medicine should not be perse- 
vered in so long as that of iron, as its preparations are more rapidly 
assimilated. Manganese is not, like iron, found in the excrements of per- 
sons who take it—at least it is in very small quantity. 
In the depraved state of the blood which succeeds intermittent fevers, 
manganese is useful; it is the most certain remedy for preventing a re- 
turn of the attacks. Leucophlegmasia and engorged spleen, of long dura- 
tion, are rapidly reduced by the use of iodide of manganese with sirup 
of cinchona. The preparations of manganese should also be used in 
urethro-vaginal catarrh in chlorotic patients, and in chronic blennorrhoea, 
especially in individuals weakened and rendered anaemic by excess. The 
salts of manganese with which we are acquainted, are powerfully astrin- 
gent, and may be used as external applications, in all cases where other 
astringents are not indicated. In this respect they possess no other 
peculiarity. Part xx., p. 295. 
Use of Manganese as an Adjuvant to Iron.—It is especially in dis- 
eases of the blood that ferro-manganic medicines are useful. They have 
a special action on the vascular apparatus, on the formation of the blood, 
and on the circulating fluid itself. They do not act merely as tonics or 
astringents; but are regenerators of the blood. They have succeeded 
admirably in anaemia following hemorrhage, operations, polypi, metrorrha- 
gia, etc.; also in the chlorosis attending puberty, which is a more com- 
mon disease than is generally supposed, and occurs even in males. M. 
Petrequin has also frequently found the combinations of iron with manga- 
nese of benefit in the diseases of women at the critical period. He has 
often seen, in these subjects, metrorrhagia, accompanied with an aspect 
of the surface which would lead to the suspicion of organic uterine dis- 
ease ; the hemorrhage, however, was but a complication, and the patients, 
apparently in a hopeless state, have recovered under the use of ferro-man- 
ganic preparations, conjoined with tonics and ergotine. 
In amenorrhoea and dysmenorrhoea, the patients often imagine that 
they require to be bled; but care must generally be taken not to comply 
with this request. 
These medicines are no less efficacious in the treatment of anaemia 198 
MANGANESE. 
resulting from prolonged intermittent fevers, prolonged suppuration, 
strumous, syphilitic, or cancerous affections, phthisis, etc. Pills and the 
sirup of the iodide of manganese and iron are preferable in these cases. 
In the functional affections of the heart connected with chlorosis and 
anaemia, and which must not be mistaken lor organic disease, a combina- 
tion of iron and manganese with digitalis and other moderators of the 
heart’s action is advantageous. The same remark applies to the func- 
tional disorders of the lungs, attending the same constitutional states. 
Disordered states of the nervous system are intimately connected with 
those of the blood. M. Petrequin has found that the ferro-manganic pre- 
parations succeed well in these, even though uncomplicated with chlorosis. 
He has also seen benefit from the use of iron with manganese in many 
cases of dyspepsia, gastralgia, and gastro-enteralgia. 
In nervous affections connected with exhaustion from venereal ex- 
cesses, onanism, rapid growth, etc., as well as in leucorrhoea, diabetes, 
etc., M. Petrequin has a high opinion of these medicines. 
It has been observed that manganese not only preserves water, but 
purifies that which has undergone change (Martin-Lauzer). 
M. Petrequin commences by giving the powder of iron and manganese, 
with some vinous drink; he then administers two pills daily, one before 
breakfast and one before dinner, replacing them soon by the lozenges. 
The sirups and chocolate complete the treatment. He gives the medi- 
cines at meal-time. The sirup he gives before breakfast, in doses of a 
teaspoonful; and he finds it useful to administer directly after it some 
infusion of centaury, or of chamomile flowers and orange. 
Large doses are unnecessary and useless. 
Preparations of Manganese and Iron.—M. Burin-Dubuisson, of 
Lyons, who prepared most of the ferro-manganic combinations used by 
M. Petrequin, has published an interesting brochure, from which the fol- 
lowing formulae are extracted: 
Powder for Effervescing Solution of Manganese and Iron.—Take of 
coarsely powdered bicarbonate of soda, 20 parts; tartaric acid, 25 parts; 
powdered sugar, 53 parts; finely powdered sulphate of iron, parts; 
finely powdered sulphate of manganese, £ part: mix carefully, and keep 
in well-stopped bottles. A teaspoonful is mixed with each glass of wine 
and water drank during meal time. 
Pills of Carbonate of Iron and Manganese.—Take of pure crystal- 
lized sulphate of iron, 75 parts; pure crystallized sulphate of manganese, 
25 parts; crystallized carbonate of soda, 120 parts; honey, 60 parts; 
water, sufficient quantity. Pills of 20 centigrammes (3 grains) are made ; 
they keep easily, without becoming oxidized, in well-closed vessels. From 
two to four are given daily. 
FerroManganic Chocolate.— One part of carbonate of iron and man- 
ganese is first mixed with four of sugar, and divided into large lozenges; 
of these 100 parts (grammes) are mixed with 500 of chocolate paste, in 
the preparation of which 100 parts of sugar have been left out. This will 
make 800 lozenges, each of which contains about 3 centigrammes (nearly 
half a grain) of carbonate of iron and manganese. The chocolate decom- 
poses the hydrated carbonate of manganese and iron of the saccharate into 
hydrated sesqui-oxide of iron and manganese; there is no metallic taste. 
Sirup of Lactate of Iron and Manganese.—Take of lactate of iron 
and manganese, 4 parts; powdered sugar, 16 parts; rub together, and MANIA. 
199 
add of distilled water, 200 parts; dissolve rapidly, and pour into a matrass 
over a water-bath, containing 384 parts of broken sugar; filter the solu- 
tion. This sirup contains about 15 parts of lactate of iron and 5 of lac- 
tate of manganese in 3,000 parts. One or two spoonfuls are taken daily. 
Lozenges of lactate of iron and manganese are made by adding 20 
parts of the lactate to 400 of fine sugar, with a sufficient quantity of 
water. The mass will make 840 lozenges ; of which six or eight are taken 
daily. 
Pills of Iodide of Iron and Manganese.—M. Burin-Dubuisson forms a 
solution of iodide of iron and manganese, in the proportion of one part 
by weight to two of water: the proportion of the salts is about three of 
iodide of iron to one of iodide of manganese. Six parts of this are 
mixed with 294 of simple sirup; of this, M. Petrequin gives one or two 
spoonfuls daily. 
Pills of Iodide of Iron and Manganese.—Take of the officinal solu- 
tion prepared by M. Burin-Dubuisson, 16 parts (grammes) ; honey, 5 
parts; some absorbent powder, 9i parts. Divide into 100 pills. The 
honey and the solution are first mixed, and evaporated at first rapidly, 
then more slowly, to 10 parts. Then add the powder, and divide the 
mass into four parts, which must be rolled in powder of iron reduced by 
hydrogen; each of these must then be divided on an iron plate into 25 
pills, and again rolled in the iron powder. Finally, they are covered with 
a layer of tolu, according to M. Blancard’s process. 
All these preparations must be made very carefully. M. Burin-Dubuis- 
son has ascertained that the commercial salts of manganese frequently 
contain copper, and even arsenic ; he hence insists on the necessity of 
calcining the sulphate of manganese twice, or more frequently, at a dark 
red heat, and of carefully testing the solution. Part xxvii.,j». 337. 
MANIA. 
Antimony in Mania.—Dr. Sutherland states that the employment of 
antimony in the treatment of mania is of the highest value. A fourth of 
a grain of the potassio-tartrate may be given every fourth hour, or at the 
commencement of the paroxysms of furor. It is powerful as a means of 
controlling the action of the heart and arteries. In many cases in which 
it has been given, it has acted like a charm in instantly subduing the ex- 
citement and violence of the patient; and in some cases an alteration in 
the symptoms for the better has been traced from the commencement of 
its administration. Part viii., p. 73. 
Digitalis in Mania and Epilepsy.— Vide “Epilepsy.” 
Musk in Certain Cases of Delirium, Mania, etc.— Vide “Delirium.” 
Treatment of Mania and Nervous Excitement.—[Dr. J. Williams 
strongly recommends the use of narcotics and other remedies calculated 
to produce sleep, not only in order to put off, but even to cure an attack 
of mania. He observes that.] 
Some of the mildest cases which occur, where there is preternatural 
excitement with vigilantia, are those of persons having over-fatigued the 
mental powers by continued application, more especially if confined to 200 
one subject; and the ill effects seem to "be produced more frequently in 
those whose hopes and fears are in addition adding to the excitement, as 
is often noticed in junior barristers and students at our universities. 
Now, in such instances, if a young man apply early, the case is usually 
cured very rapidly, sometimes even within twenty-four hours; if passed 
over for a few days, recovery is retarded, and if totally neglected, phreni- 
tis or mania by no means unfrequently ensues. In such cases there is 
a great action, wdrich is but too frequently mistaken for power; the pulse 
is quick, perhaps 100, 120, or even more, tongue white, face flushed, 
throbbing and heat of the temples, rolling, sparkling, and injected eye, 
rapidity of speech, and everything showing great excitement; now this 
description is not sufficient to guide us as to the treatment, for all these 
symptoms may depend on excessive nervous irritation, but more attention 
must be given to the pulse; if the pulse, in addition to being quick, is 
also full, hard, and bounding, and if the skin is dry and hot, then the ab- 
straction of blood, both general and local, will usually be necessary, and 
often within an hour or two after depletion, the skin becomes moist, and 
the patient falls asleep. But what I am the more anxious to particularize, 
is the opposite condition, where bleeding is unnecessary and unsafe. Sup- 
posing the pulse to be quick, soft, and fluttering, weak or intermittent, the 
skin moist and clammy, and yet the excitement just as decided as in the 
other case, to bleed here is most improper, and many cases of insanity 
have arisen from such practice. The judicious administration of a nar- 
cotic will frequently act as a charm, and we have often found the follow- 
ing prescription very useful: 
R Tr. hyoscyami, ntxxx.; tr. humuli, 3ij.; camphor®, gr. v. ad x. aut 
xv.; sir. auranti, 3ij-; mist, camphor®, 3vj.; M. et fiat haustus, h. s. s. 
This has often caused calm and refreshing sleep; and the patient, who 
has previously passed two or three nights with great restlessness and 
watching, feels himself invigorated. 
A very efficient way of relieving head symptoms, tvhen dependent on 
visceral congestion, more especially of the liver, is applying leeches to the 
rectum, and if considered necessary, subsequently placing the patient in a 
warm bath; a large quantity of blood may be lost in this way without 
producing much prostration. Many cases of insanity arise from extreme 
irritability dependent on prostrated power; and to support this power by 
good nutritious food, and sometimes even with brandy and wine, at the 
same time soothing the system by procuring refreshing sleep at night by 
morphia, will speedily evidence the advantages of such treatment. 
The great error originally was, allowing the power to sink; it is of the 
greatest importance that these powers should be supported—the nervous 
excitation must be calmed. In these cases, mistakes are but too fre- 
quently made; irritation is confounded with inflammation. 
Purgatives may procure sleep, by diminishing vascular action, where 
bleeding is inadmissible. Narcotics, when given in insanity to procure 
sleep, should be administered in full doses. 
Combining opium with camphor or henbane, or digitalis, will often be 
very judicious. With tartar emetic, calomel and opium in large doses will 
often calm the system when there is great restlessness and fever, especially 
if the head be kept cool. Opium should never be omitted where insanity 
has succeeded constant intoxication; and in those cases where the counte- 
nance is exsanguined, with cold, clammy skin, it is especially indicated, and 
MANIA. MANIA. 
201 
is no less useful in that ancemial state of the brain where there is great ex- 
haustion, in whatever way produced. 
Where there is constant vomiting, opium may be administered in an 
effervescing draught. 
The infusion of opium with a bitter, as recommended by Dr. Paris, will 
secure the narcotic principle without interfering with the intestinal secre- 
tions. 
It is impossible to limit the extent to which opium may be required; 
but in stating that a full dose is necessary, from two to five grains may be 
considered a large dose for most constitutions ; -where habit has impaired 
its effect, one, and even two drachms of solid opium have been taken in a 
very limited period. Pinel knew 120 grains of opium given in one dose 
to a patient suffering with cancer of the uterus ; and I have seen a wine- 
glassful of laudanum taken at a draught, and this has been repeated three 
times daily for months—such cases, however, necessarily form the excep- 
tion. 
When opium has disagreed with a patient, a strong cup of coffee wfill 
often remove the unpleasant effects. 
Administering an opiate in the form of enema renders it much milder, 
and at the same time secures its sedative and narcotic influence, without- 
producing that headache, sickness, and dryness of the fauces, so often com- 
plained of when opium is taken by the mouth. 
If narcotism be highly desirable, and neither of these modes seem prac- 
ticable, rubbing the abdomen with laudanum and oil will sometimes be 
found effectual. These narcotic frictions over the head will be often found 
useful: even brushing the hair with a common hair brush for half an hour, 
will frequently tranquillize a nervous and irritable patient. In some cases 
it may be necessary to rub the scalp writh liniments, or ointments, contain- 
ing morphia, belladonna, veratria, or aconitine. 
Antiperiodies.—Insanity is somewhat periodical: and it should be 
remembered, that, when it is intermittent, it is not inflammatory, and in 
such cases arsenic, tr. ferri sesquichloridi, the preparations of zinc, and 
copper, with tonics, may be often usefully prescribed. Arsenic can be 
strongly recommended in these cases, and has been given with the greatest 
advantage; it appears to alter the sensibility and irritability of the brain. 
Quinine is sometimes given with the same intention; thus, a case of in- 
somnolence, was cured by giving gr. vj. of quinine at bed-time. 
The douche, the author most properly remarks, should never be resorted 
to, except when imperatively necessai'y; and the application of the ice-cap 
will generally be found far more efficacious. 
Our object is to keep the head cool—and not to make it suddenly cold. 
Part xiii., p. 35. 
Periodic Mania.—Large doses of tincture of henbane (one or two 
drachms), preceded by an active purge, sometimes affords singular relief 
in cases of periodic mania. Vide Art. “ Testes.” Part xviii., p. 214. 
Cerebral Excitement—Mania.—In cases of violent cerebral excitement, 
delirium tremens, and mania, everything points to the necessity of some 
sure, speedy, and active mode of allaying excitement and procuring sleep 
—yet the stomach is often highly irritable, or in such a state that it will 
not absorb medicines, or the patient even refuses to swallow at all. Of all 
cases, says Mr. C. Hunter, perhaps this is the one in which the value of 202 
MARASMUS, 
the hypodermic injection of morphia is most clearly seen. Inject one-third 
to half a grain of acetate of morphia beneath the subcutaneous cellular 
tissue of any part of the body, and in a few minutes sleep will be pro- 
cured. Part xl., p. 279. 
Inspissated Ox-Gall.—[Dr. Clay has also found that the inspissated gall 
has a remarkable tendency to counteract the constipating effects of opium, 
which drug not only checks the secretion of bile, but almost all the other 
secretions of the body. The administration of gall, therefore, if this fact 
be further corroborated, will be a valuable addition to our list of remedies 
when we are wishful to give opium but dread its constipating effects. In 
the case alluded to by Dr. Clay, the patient was taking large doses of the 
pil. scillse comp. c. opio at bed-time, for a constantly irritating, dry, 
asthmatic cough : eight grains of the inspissated gall were also given 
every night, which completely counteracted those constipating effects of 
the opium which had previously existed. Dr. Clay further states that,] 
In all cases of marasmus, whether of children or in the atrophy of adults, 
I have in ox-gall a valuable remedy. In acidity of the stomach, etc., of 
children, it is of most decided, effectual, and immediate relief. The 
curdled vomitings, green motions, abdominal gripings, and restlessness 
immediately disappear, and a better state of general health is substituted; 
in all such cases there was a decided action on the kidneys, increasing the 
secretion. On looking at its effects upon children as just stated, particu- 
larly whilst at the breast, living almost entirely on milk, the result is not 
different to what we might suppose when considering the experiments of 
Bagliva, Lewis, etc. “ That it prevents milk from turning sour, and dis- 
solves it when in a state of coagulation /” an antacid preparation is in- 
dicated, which is one of the peculiar properties of this remedy. To show 
its direct effect upon hardened faeces, a child of sixteen months old passed 
a very hard motion with very great difficulty, not having had one for three 
days. I poured a solution of ox-gall over it in a vessel, immediately its 
chalky appearance was changed to a more healthy bilious color, and re- 
duced to a pulpy mass in half an hour; from this fact, I will suppose a 
case (one which has frequently occurred in my practice), an adult with 
hardened faeces in the rectum, almost, if not quite impossible, to pass 
without assistance ; under such circumstances, what could afford a better 
prospect of relief than two or three ounces of recent gall diluted with as 
much water, used as an injection. It is needless to observe I would 
pledge myself as to the result, viz., an immediate softening of the mass 
facilitating its propulsion. 
The preparation I have been in the habit of giving, is simply the recent 
gall of the ox slowly evaporated to the consistence of an extract, and 
afterward made into pills. 
I prefer the simple extract made into pills without any addition ; and 
if the gall be recent, it has very little smell, but an intensely bitter taste. 
The gall-bladder of a moderate sized ox will afford as much extract as will 
make one hundred four grain pills, and is an article both cheap and easy to 
procure. Part vi., p. 68. 
MARASMUS. matico. 
203 
Iodide of Potassium.—Recommended in certain cases of, by Lisfranc. 
Vide “ Iodic Preparations.” 
Mal-assimilation in Children.—Mr. Henry, surgeon to Middlesex 
Hospital, observes: 
Sometimes a pallid cachectic emaciated child w ill in a few days gain 
some pounds in weight, after the operation of a brisk cathartic. What 
explanation can be offered of this fact ? If the intestines of such children 
be examined, the mucous absorbent surface will be found to be covered 
by a thick tenacious mucus, completely preventing assimilation of the 
chyle. A brisk cathartic, especially calomel, which may be combined 
with rhubarb and scammony, will wash this away, and the lacteals thus 
be left free to absorb the chyle, with wThich, for the first time they come 
in contact. Part xxxix., p. 264 
Remarks on Matico.—When applied externally, Dr. Jeffreys recom- 
mends the inner side of the leaf as most powerful. “ To leech-bites, and 
bleeding from cuts or other recent wounds, the inner side of the leaf 
should be pressed upon the bleeding part for a few minutes, when it will 
be found to possess not only an adhesive, but also a healing quality, not 
easily separated by washing the hands or other ordinary means.” In 
bleeding from the nose, the powdered herb used as snuff has been found 
a very convenient mode of applying it. We subjoin the formulae for pre- 
paring an infusion, a decoction, and a tincture : 
Inf usion of Matico.—Take of matico-leaves, one ounce. Boiling 
water, one pint. Macerate for two hours, or until cold. Dose— 
two tablespoonfuls for an adult, twice or three times daily, or oftener, 
if the case is a severe one or the symptoms urgent. 
Decoction of Matico.—Take of matico-leaves, one ounce; water, one 
pint. Boil for ten or fifteen minutes, and strain. Dose, the same 
as that of the infusion. 
Tincture* of Matico.—Take of matico-leaves, three ounces ; Proof 
spirit of wine, one pint. Digest for fourteen days, in the usual 
way, and filter for use. Dose—from thirty to sixty drops in water. 
[By the term inner surface, Dr. Jeffreys means the underand reticulated 
surface of the leaf.] Part x, //. loo. 
Use of Matico.—Dr. Ruschenberger says: In enlarging a burrowing 
bubo, I divided the arteria ad cutem abdominis, which bled freely. 1 directed 
that an attempt should be made to arrest the hemorrhage by lint and press- 
ure. After a trial of ten minutes, which totally failed, 1 directed moistened 
matico leaves to be applied. The assistant reported in a few minutes that 
the matico exerted no influence, and proposed to secure the bleeding ves- 
sel by ligature. I now visited the patient, who had lost six or eight ounces 
of blood, and was still bleeding. After coarsely powdering some matico 
leaves in the palm of my hand, I formed the mass into a paste with cold 
water; I then removed the clot, through which the arterial blood formed 
a passage of the size of a crow-quill: the blood flowed per saltern, forming 
a jet of at least three-fourths of an inch high. The paste was applied 
o 
MATICO. 204 
lightly with the fingers, and filled the wound. The surrounding skin was 
immediately sponged clean; the hemorrhage ceased instantly, and not a 
single drop of blood flowed afterward. No pressure was used, or dress- 
ing applied. In the first application the entire matico leaf had been simply 
dipped in water and then applied. It failed, as already stated. 
I exhibited drachm doses of finely powdered matico in a case of pro- 
fuse menorrhagia, repeated every two hours. The flow ceased after the 
third dose. The powder was simply mixed in about two ounces of wa- 
ter. The patient experienced no unpleasant effects from its use. 
Part xvi., p. 319. 
MEASLES—MEDICINES, 
MEASLES. 
Iodide of Potassium.—M. Ricord observes: The iodide of potassium 
possesses the remarkable property of causing determination of diseased 
action to the skin. In cases of what may be termed “ suppressed measles” 
and “ scarlatina” it will frequently induce a healthful reaction under the 
most desperate circumstances. One or two grains, according to the age 
of the patient, under twelve years, may be dissolved in a quantity of su- 
gared water, and administered, repeatedly, as an ordinary drink, the -whole 
quantity being given in twenty-four hours, for three or four days. In 
measles, a small plaster to the chest assists the peculiar action of the iodine. 
In scarlatina, the compound tincture of iodine, diluted with three or four 
parts of water, may be frequently applied, by means of a camel-hair brush, 
to the front and sides of the throat and neck. Milk is injurious during the 
first two or three days, in cases either of measles or scarlatina. 
Part vii., p. 43. 
Turpentine in Collapse of.—In a case of collapse coming on in a boy three 
and a half years old, during an attack of measles, forty minims of turpen- 
tine, combined with two drachms of ipecacuanha wine, proved a most val- 
uable diffusible stimulant. Part xxvi., p. 325. 
Charcoal in Epidemics of Measles.—Dr. Wilson observes that through- 
out the course of the epidemic (measles) he has never observed diarrhoea 
to be beneficially critical, but otherwise, and has hence never hesitated to 
check it, for which purpose he has found no remedy so efficient as the or- 
dinary wood charcoal in powder, and when assiduously and promptly exhi- 
bited, it has never failed, within his knowledge, to have a promptly benefi- 
cial effect. Part xxxv., n. 26. 
Liquor Ilydriodatis Arsenici et Ilydrargyri.—Of this liquor hydrioda- 
tis arsenici et Ilydrargyri, each drachm measure consists of—water, one 
drachm; protoxide of arsenic, one-eighth of a grain ; protoxide of mer- 
cury, one-fourth of a grain : and iodine (converted into hydriodic acid) 
four-fifths of a grain. The color of the solution is yellow, with a pale 
tinge of green ; its taste is slightly styptic. It cannot he properly con- 
joined with tincture of opium, or with sulphate, muriate, or acetate of 
morphia; for all these produce immediate and copious precipitates in it. 
Hence, if opiates are to he used during the exhibition of this arsenico- 
MEDICINES. MEDICINES. 
205 
mercurial compound, they must be taken at different periods of the day. 
Tincture of ginger produces no bad effect. 
The following formula is proper: 
Liquoris hydriodatis arsenici et hydrargyri, 5ij.; aquae destillatae, 
Siiiss.; syrupi zingiberis, §ss. Misce. Divide in haustus qua- 
tuor. Sumatur unus mane nocteque. 
Thus, one-sixteenth of a grain of protoxide mercury would be taken in each 
dose, along with two-fifths of a grain of iodine, which, being in the state of 
combined hydriodic acid, will be much diminished in energy of medical 
effect. This is no doubt the proper dose to begin the exhibition of arse- 
nic with, but it will soon be necessary to increase it. The division into 
draughts is here necessary; first, to insure accuracy in the dose, so essential 
in the case of this active medicine; and, next, to prevent injury to the in- 
gredients by the use of a metallic spoon as a measure—the general way in 
which, unfortunately, the dose of a medicine is determined. Part iv., p. 67. 
New Glassification of Medicines.—M. Mialhe, states that his researches 
have led him to conclude that the greater number of substances intro- 
duced into the economy act chemically either mediately or immediately on 
the serum of the blood, some coagulating and othersfluidifying its albu- 
men. In the class of coagulants are ranged all tonic, astringent, and 
styptic agents, as most of the mineral acids, a great many of the metallic 
salts, tannin, creasote, ergot of rye, etc. The class of fluidificants comprises 
all true diuretics, with many alteratives and general excitants, including 
most of the vegetable acids, ammonia and its salts, the iodides, sulphurets, 
and alkaline chlorides, etc. But some medicines, which at first act as coag- 
ulants, afterward become fluidifiant; this is the case with bichloride of mer- 
cury. Others, which have not any perceptible action on the albumen 
when first introduced into the circulation, become afterward coagulant in 
a high degree. Of this class is ergot of rye. This substance, according to 
Mialhe, having after a time effected a thickening of the albumen, ultimately 
produces a firm coagulation, “ or rather a process of organization more 
than simple coagulation.” By this action Mialhe explains all the known 
effects of the ergot; and he supposes the agaric used for stopping bleeding, 
the champignon, etc., to exert a similar coagulant agency. Part viii., p. 75. 
Action of different Medicines on the Mental Faculties.—All stimulants 
and exciting medicines increase the quantity of blood that is sent to the 
brain. If this quantity exceeds a certain amount, then most of the facul- 
ties of the mind become over-excited. Nevertheless, the degrees of this 
action is observed to vary a good deal in different cerebral organizations; 
and it is also found that certain stimulants exercise a peculiar and charac- 
teristic influence upon special or individual faculties. Thus ammonia and 
its preparations, as well as musk, castor, wine, and ether, unquestionably 
enliven the imaginative powers, and thus serve to render the mind more 
fertile and creative. The empyreumatic oils are apt to induce a tendency 
to melancholy, and mental hallucinations. Phosphorus acts on the instinct 
of propagation, and increases sexual desire; hence, it has often been 
recommended in cases of impotence. Iodine seems to have a somewhat 
analogous influence ; but then it often diminishes, at the same time, the 
energy of the intellectual powers. Cantharides, it is well known, are a 
direct stimulant of the sexual organs; while camphor tends to moderate 
and lull the irritability of these parts. 206 
MEDICINES. 
Of the metals, arsenic has a tendency to induce lowness and depression 
of the spirits; while the preparations of gold serve to elevate and excite 
them. Mercury is exceeding apt to bring on a moi*bid sensibility, and an 
inaptitude for all active occupation. 
Of narcotics, opium is found to augment the erotic propensities, as well 
as the general powers of the intellect, but more especially the imagination. 
Those who take it in excess, are, it is well known, liable to priapism. In 
smaller doses, it enlivens the ideas and induces various hallucinations, so 
that it may be truly said that, during the stupor which it induces, the 
mind continues to be awake while the body is asleep. In some persons, 
opium excites inordinate loquacity; Dr. Gregory says, that this effect is 
observed more especially after the use of muriate of morphia. He noticed 
this effect in numerous patients, and he then tried the experiment on him- 
self with a similar result. He felt, he tells us, while under its operation, 
an invincible desire to speak, and possessed, moreover, an unusual fluency 
of language. Hence he recommends it to those who may be called upon 
to address any public assembly, and who have not sufficient confidence in 
their own unassisted powers. 
Other narcotics are observed to act very differently on the brain and its 
faculties from opium. Belladonna usually impairs the intellectual ener- 
gies ; hyoscyamus renders the person violent, impetuous, and ill-mannered. 
Conium dulls and deadens the intellect; and digitalis is decidedly anti- 
aphrodisiac. Hemp will often induce an inextinguishable gaiety of spirits; 
it enters into the composition of the intoxicating drink which the Indians 
call bauss. The use of the Amanita Muscaria is said to have inspired the 
Scandinavian warriors with a wild and ferocious courage. Tobacco acts 
in a very similar manner with opium, even in those persons who are 
accustomed to its use; almost all smokers assert that it stimulates the 
powers of the imagination. Part ix., p. 82. 
Pleasant substitute for Epsom Salts as a Purgative.—M. Garot recom- 
mends the following formula for the preparation of tasteless purgative salts 
(citrate magnesia)—Carbonate of magnesia 15 parts ; citric acid 21 to 22 ; 
aromatic sirup 60 : water 300. The citric acid is separately dissolved and 
added to the carbonate of magnesia diffused in water. As thus prepared 
it is not effervescing; but it is easily rendered so by adding only half the 
quantity of acid, and reserving the addition of the other half, until the 
dose is taken. The above proportions in grains would constitute a dose. 
Dr. Pereira long since suggested the use of citrate of magnesia in nearly 
similar proportions. He found that one scruple of crystallized citric acid 
saturated about fourteen grains of light or heavy carbonate of magnesia. 
Part xvi., p. 296. 
How to mash the bitter taste of Epsom Salts.—Mr. Combes has found 
that coffee possesses the power of covering the nauseous taste of sulphate 
of magnesia; we are told that— 
The following is his formula for an ordinary dose of about an ounce of 
the salt. Sulphate of magnesia 30 parts ; ground coffee 10 ; water 700 or 
800. Boil them briskly together for two minutes in an untinned vessel. 
Remove from the fire, and having allowed the mixture to infuse for a few 
minutes, strain it. Sugar it and drink it hot or cold, according to taste. 
To insure the effect, the coffee must be boiled with the salt as directed 
above ; adding the latter to it afterward or to an infusion does not suffice. MEDICINES, 
207 
If the quantity of the sulphate he much increased, and it is desired not 
yet to add more coffee than the above, that will suffice if, while the fluid 
is boiling, a grain or two of tannin be added. Part xvi., 296. 
How to make Senna pleasant to the Taste.—The “ Bulletin de Thera 
peutique” signalizes another use of coffee in disguising the taste of purga 
tives for 'lildren ; MM, Guersant and Blache frequently employing it foi 
this purpose. A weak decotion of coffee is made, to which some milk 
and sugar are added, care having been taken while boiling the coffee, to 
put in a few follicles of senna. If it is given to the children with a little 
bread, they will generally take it with avidity. This medicine generally 
acts freely upon children, and thus administered does not induce the vio- 
lent griping it sometimes does in the adult. (As a matter of taste, we 
think the senna tea and prunes of our grandmothers is a more delicious 
preparation). Part xvi., p. 297. 
Formula for Frank's Solution of Copaiba.—Balsam of copaiba 
two parts, liquor of potassa (P. L.) three parts, water seven parts; boil it 
for two or three minutes, put it in a separator, and allow it to stand 
for five or six days, then draw it off from the bottom, avoiding the 
upper stratum of oil. To the clear liquid add one part, of sweet spirits of 
nitre, perfectly free from acid, to which a few drops of liquor of potassa 
has been added, until it slightly browns turmeric paper; should it turn 
foul or milky a very little liquor of potassa will usually brighten it; if not, 
place it in a clean separator, for a few days, and draw it off from the bot- 
tom as before, when it will be perfectly brilliant without filtering. 
Part xvi., p. 297. 
Medicines—To disguise the taste of.—We should prepare the mouth 
before instead of after swallowing nauseous medicines, in order that their 
taste may not be perceived ; aromatic substances chewed just before, as 
orange or lemon peel, etc., effectually prevent castor oil being tasted. 
Part xxiv., p. 349. 
Cod Liver Oil—Mode of taking.—Let it be taken in a simple weak in- 
fusion of quassia. This would seem the more valuable as it is in itself a 
mild and agreeable tonic bitter, assisting in improving the tone of the 
general system. Part xxvi., p. 327. 
Administration of Phosphorus.—It has long been a desideratum in 
medicine, says Dr. Glover, to find some safe mode of administering phos- 
phorus. I have given phosphorus lately in the following ways; first, in 
the form of a solution in chloroform ; secondly, in cod-liver oil. Chloro- 
form dissolves about one-fourth of its weight of phosphorus; and the solu- 
tion is not inflammable. I have given four or five minims of this solution, 
shaken up with a drachm of ether, in a wineglassful of port wine, twice a 
day, with great benefit in rallying the forces of the patient, as I fancied 
at least, in cases of typhoid fever. The solution in the oil is made by 
cutting the phosphorus into chips, and putting it into a bottle of the oil, 
in the proportion of half a grain to the ounce, then immersing the bottle 
in hot water, and with a little shaking, solution is easily effected. I think 
I have seen this beneficial in strumous cases. Part xxvii., p. 246. 
Wine—Medicinal Use of.—As a diuretic, Moselle may be as useful as 
gin or whisky. It contains an excess of salts, and may prove as energetic 
aSj and less heating than, the essential oil in gin or whisky. 208 
MEDICINES. 
In diabetes, use the claret wines, which are free from sugar, and contain 
much tannic acid. 
In dyspepsia and gout, use the wine most free from ultimate acidity 
and least stimulating. The best is the least acid claret wine; next, strong 
or perfectly dry champagne. Good Mansanilla will answer the purpose, 
and is much cheaper than Amontillado sherry. But, after all, weak 
brandy and water, or some pure spirit and water, is most free from acid 
and sugar, and answers best in dyspepsia. Part xxx., p. 298. 
Phosphate of Lime.—ldr. Kuchenmeister recommends the following 
formula in cases in which phosphate of lime is indicated: Calcis phosphat., 
5ij. ; calcis carbon., 3j.; sacch. lactis, 5iij. M. 3ss. bis terve in die. In- 
stead of the milk sugar, lactate of iron may be substituted, if iron b'' 
required. The especial use of the carbonate of lime appears to be that 
carbonic acid is liberated by the acid of the stomach, and dissolves the 
phosphate. Lactic acid also is formed from the sugai’, or is set free from 
the lactate of iron, and dissolves the phosphate. The most ready way of 
absorption is, however, when the phosphate is given with food, especially 
with milk, with which it forms a soluble combination. Part xxxi., p. 234 
Employment of the Chlorate of Potash as a Topical Application.— 
The chlorate was used in solution in the proportion of from one drachm 
and a half to three drachms to one pint of water. He (Mr. Moore) had 
found it very useful in cases of indolent ulcer and phagedena, in cleansing 
cancerous sores, and as an application to the mucous membrane of the 
nose, mouth, and tongue in cases of ozena and secondary ulceration. The 
author suggested that the beneficial effects of the application were proba- 
bly due to its setting free oxygen, and proposed its use in some forms of 
dysentery, with affections of the lower bowel. 
Dr. Mayo said he believed Mr. Stanley used the same remedy (scruple 
doses every four hours) for phagedenic syphilitic ulceration. 
Mr. C. Hawkins generally combined it in such cases with tincture of 
myrrh. The remedy was very useful in cases of cancer, in removing the 
odor, independently of its effect upon the sore itself. Scruple doses he 
thought scarcely sufficient to administer internally. Part xxxi., p. 310. 
Selections from Favorite Prescriptions.—Dr. Horace Green gives the 
following prescriptions, many of which are the result of years of collect- 
ing from the most experienced and practical men who have visited the 
hospitals of New York: 
Narcotics and Sedatives.—The narcotic principle in medicine differs 
from that of the sedative in this, that its primary action is in some degree 
stimulant, whilst the sedative principle tends directly to depress the vital 
powers without inducing any previous excitement. The ultimate action 
of both narcotics and sedatives is to diminish the sensibility of the ner- 
vous system, thereby allaying pain and promoting sleep. 
Among the direct sedatives hydrocyanic acid is one of the most 
prompt and efficient. Administered in appropriate doses, it tends direct- 
ly to lower the sensibility of the nervous system, to diminish the fre- 
quency of the pulse, and to induce a sensation of quiet and calmness 
throughout the whole system. Alone, or in conjunction with other reme- 
dies, prussic acid constitutes one of our most valuable therapeutic agents. 
The following combinations with this remedy have been proved to be 
of great service in the treatment of disease: MEDICINES. 
209 
R Acidi hydrocyanici, medicinalis, gtt. lx.; morphia) sulph., gr. iij.; 
tinct. sanguinariae, vini ipecacuanha), aa. f. gss.; sir. pruni virginianae, vel 
misturae amygdalae, f. gv. M. fiat mistura cujus sumat cochlearium par- 
vum bis terve in die. 
We have found the above a most valuable remedy in the treatment of 
chronic bronchial disease / in allaying the cough present in tuberculosis, 
and in all pulmonary catarrhal diseases, unattended with fever. As the 
acid is apt to float on the top of the liquid, the phial should be shaken on 
the administration of each dose. 
R Acidi hydrocyanici, gtt. xl.; vini antimonii, f. gss.; syrupi tolutan., 
f. giss.; mucil. acaciae, f. gij. M. fiat mistura, capiat cochl. parvum ter 
quaterve die. 
This may be used in the same cases as the former, when the cough is 
troublesome, and is attended with some degree of fever. 
As a remedy in the treatment of hooping-cough, hydrocyanic acid sur- 
passes in efficiency every other known general remedy. We have em- 
ployed it for many years in this disease, and can fully substantiate the 
declaration ©f Dr. Hamilton Roe, that “ Hydrocyanic acid of Scheele’s 
strength will, if exhibited as soon as the whoop is heard, effect a cure in 
almost every case of simple hooping-cough.” If the disease has been 
going on for many weeks, its effects are not so immediately felt, but 
nevertheless it will cure in most instances. 
The following formula we are accustomed to employ: 
R Acidi hydrocyanici, medicinalis, gtt. xxv.; vini ipecacuanhse, f. 3ij.: 
syr. tolutan., f. gj.; aquae destillatae, f. giij. Fiat mistura, cujus sumatur 
cochl. parv. quarta quaque hora. 
It is important that its use be entered upon as soon as the presence of 
the characteristic whoop determines the nature of the disease. If the 
breathing is oppressed, or the symptoms present indicate the existence of 
bronchial inflammation, the administration of the sedative should be pre- 
ceded by the exhibition of an emetic, and perhaps by the application of a 
few leeches to the chest. 
If administered too freely, the acid will produce a greatly depressing 
effect on the vital powers. Should much debility, therefore, occur during 
its employment, the remedy should be omitted, and mild tonics, with a 
more stimulating expectorant, be exhibited for a few days, when the uso 
of the hydrocyanic acid may be renewed. 
“ The dose of hydrocyanic acid for an infant,” says Dr. Roe, “is about 
three-quarters of a minim of Scheele’s strength, gradually increased to a 
minim, which may be given every fourth hour; for a child- of three years 
of age, about one minim, gradually increased, if necessary, to a minim and 
a half every fourth hour; for children of ten or twelve years of age, a 
minim and a half, increased to two minims every fourth hour. It is safer 
to give this medicine in small doses at very short intervals, than to run 
any risk of producing too great depression by a large dose. The fre- 
quency of its exhibition must depend upon the strength of the patient 
and the severity of the attack. The dose should be repeated when the 
effects begin to subside, which in mild cases generally happens in three or 
four hours ; but when much fever is present, its influence is felt but a very 
short time; under such circumstances, a larger quantity may be given 
and at shorter intervals, without any apprehension of danger, so long as 
the fever lasts.'1'' 
VOL. II.—14 210 
MEDICINES. 
R Acidi hydrocyanici, medicinalis, f. 3j-; liquor potassa3, f. §ss.; infus. 
caluinbaj, f. §ij. ; misturae amygdal., f. §iv. Misce. capiat cochl. minim, 
ter die. 
In cases of long-continued chronic bronchitis, the physician occasionally 
finds this disease complicated with a peculiar irritable condition of the 
gastric mucous membrane, manifested by tenderness of the epigastrium, a 
red tongue, frequent headache, and a feverish condition of the system. 
In such cases where the inflammation has extended to the mucous mem- 
brane of the stomach, producing this not uncommon form of broncho- 
gastritis, the exhibition of the above combination with the hydrocyanic 
acid, the alkali, and the bitter vegetable infusion, will exert a prompt and 
a decidedly happy influence on this diseased action. 
Combined with the extract of belladonna, hydrocyanic acid has also 
been found very useful in the treatment of gastralgia and in “ irritable 
gastric dyspepsia.” 
The following mixture prepared, and a teaspoonful of the medicine ad- 
ministered three or four times daily in these affections, will, by acting on 
the nerves of the stomach, greatly diminish their irritability. 
R Extract belladonnas, gr. x.; acidi hydrocyanici, medicinalis, gtt. lx.; 
tinct. calumbse, sir. simp., aa. f. |j.; aquae destillatae, f. §ij. Misce. 
The above combination has likewise been employed with great benefit 
in the treatment of spasmodic asthma. 
These, then, are some of the useful combinations of one of our most 
important therapeutic agents; and we can assure the practical physician 
that not only in these affections, to which allusions have been made, but in 
the treatment of many other diseases, he will find these remedies invalu- 
able aids in controlling diseased action. 
The anhydrous, or pure hydrocyanic acid, which consists of one equiv. 
of cyanogen, and one equiv. of hydrogen, is of a nature so exceedingly 
poisonous, that it cannot be employed with safety in medicine. The medi- 
cinal acid, which is the preparation that should always be directed to be 
used in our prescriptions, contains only 2.5 per cent. (United States Phar- 
macopoeia) of the pure acid. That of the Apothecaries’ Hall, London, 
contains 3.2 per cent.; whilst the medicinal acid of the French Apothe- 
caries is nearly equal to that of the United States Pharmacopoeia—namely 
2.4 per cent, of the pure acid of Gay Lussac. 
As the strength of the different medicinal acids cannot be depended on 
as being always of the same uniform power, it has been proposed that the 
cyanide of potassium be substituted in medicine for the hydrocyanic acid. 
R Cyanidi potassii, gr. xxij.; alcohol, officinalis, f. 3xj. Misce. 
This preparation of cyanogen, which possesses the same medicinal 
qualities, and is of the same strength with the hydrocyanic acid, is greatly 
preferred by many practitioners as a therapeutic agent, inasmuch as it can 
be depended on as being always of a uniform strength. It may be used 
in the same doses and under the same circumstances in which the hydro- 
cyanic acid is administered. 
As palliatives in the treatment of all forms of neuralgia, the narcotics 
and sedatives are very generally resorted to by practitioners, especially 
during the paroxysms of the disease. When appropriately combined, 
their efficacy in these aflections is more prompt and decided than when 
separately administered. 
Ii Extracti hyoscyami, 5ss.; morph he sulphatis, gr. iij.; strycnnise, MEDICINES. 
211 
gr. ij.; capsici pulv., 3ss.; zinci sulphatis, gr. xv. M. Fiat massa, in 
pilulae xxx. dividenda; capiat unam, ter quaterve in die. 
In neuralgia, unattended by organic lesions, the above pills, exhibited 
every sixth pr fourth hour, according to circumstances, will be found to 
be an excellent remedy. They have proved especially serviceable in that 
form of neuralgia in which the division of the fifth pair of nerves is so 
frequently involved. Not only in facial neuralgia, but in all cases where 
the disease has been caused by malaria, this combination may be adminis- 
tered with confidence that the result will be favorable. The valerianate 
of iron conjoined with the extract of hyoscyamus is an excellent anti- 
spasmodic and tonic, and may be employed with great advantage for the 
treatment of chorea and all the neuralgic affections of anaemic and de- 
bilitated females. 
R. Extracti hyoscyami, 3ss.; ferri valerianatis, 5j- Fiat massa, et in 
pilulas triginta dividendas: quarum date unam ter in die. 
The valerianate of iron and the valerianate of zinc are two highly valuable 
remedies, and wrere the therapeutic powers of these medicines better un- 
derstood by the profession, they would be much more extensively employed 
than they now are for the treatment of disease. The valerianate of zinc, 
Dr. Neligan says, “is one of the most valuable modern additions to the 
Materia Medica.” 
R. Extracti hyoscyami, 9iss.; zinci valerianatis, 9j. Fiant pilulae xxx. 
Capiat unam bis terve in die. 
The above pill is a valuable remedy in the treatment of facial neuralgia, 
and, indeed, is equally serviceable in all the nervous and neuralgic affec- 
tions for which the valerianate of iron has been advised. 
R. Extracti belladonnae, gr. viij.; camphori pulv., 3j.; quiniae disufphatis, 
Bij. Misce; Fiant pilulae triginti. 
These pills are very effective in the treatment of dysmenorrhcea. One 
pill may be exhibited every hour or two hours till the pain ceases. In fe- 
males of a nervous temperament, when painful menstruation occurs, inde- 
pendent of organic lesions, these pills, administered as above directed, sel- 
dom fail of affording relief. In those cases of dysmenorrhcea where a tonic 
is not particularly indicated, the following are more appropriate, and 
are equally efficacious. 
R. Extracti belladonnae, gr. viij.; ipecacuanhas pulv., gr. x.; zinci sulpha- 
tis, 3ss. Misce; Fiant pilulae xxx., quarum capiat unam quaque hora, do- 
nee leniatur dolor. 
The following pills are highly recommended by an intelligent and experi- 
enced practitioner in the treatment of leucorrhoea occurring in anaemic and 
nervous females: 
R. Extracti hyoscyami, 3j-; argenti nitratis, gr. x.; cantharidis pulv., 
gr. xij.; quiniae disulphatis, Bij. Fiant pilulae xl. Sumat unam mane et 
nocte. 
The same physician advises the subjoined foi’mula as a combination that 
may be employed with great advantage as a diuretic and alterative in the 
treatment of cellular dropsy. 
R. Extracti conii, 3j.; cantharidis pul., Bij* 5 hydrarg. submur., 5ss.; 
ipecacuanhae pulv., Bj* Misce; Fiat massa; in pilulae xl. dividenda, cn- 
jus capiat unam ter quaterve in die. 
A combination of the extract of belladonna with quinine has been em- 
ployed very efficaciously in the treatment of gastralgia. 212 
MEDICINES, 
R Extracti belladonnae, Bss.; quiniae disulphatis, 5j. M. Fiant pilulae 
xxx. Sumat unam ter in die. 
In that variety of gastralgia which is not unfrequently occurring in the 
course of chronic gastritis, we have derived the greatest benefit from the 
employment of the following pills. 
R Extracti hyoscyami, 5j-; argenti nitratis, gr. x.; bismuthi subnitra- 
tis, 3iss. Fiant pilulse xl.: quarum sumatur una mane ae nocte. 
The nitrate of silver combined with some one of the sedative extracts 
may be employed advantageously in the treatment of almost all chronic 
gastric affections. In cases of obstinate, chronic gastritis, or long continued 
dyspepsia, we have found the following pills more efficacious than any other 
single remedy. They should be continued for several Aveeks: 
R Extracti conii, vel lupuli, 5j.; argenti nitratis, gr. x.; capsici pulv., 
quinise disulphatis, aa. Bij. Misce; Fiat massa, in pilulas xl. dividenda. 
Capiat unam bis terve in die. 
There is a troublesome and often an obstinate form of gastric irritabi- 
lity, denominated by the French estomac glaireuse, in which the patient 
occasionally ejects by eructation, a tasteless, watery fluid, and which is 
accompanied often by a severe burning pain in the epigastric region. This 
variety of the disease is arrested with great certainty by the exhibition of 
either the preceding, or the following pills. 
$ Extracti lupulinse, 5j.; argenti nitratis, gr. x.; bismuthi subnitratis, 
3iss.; quinise disulphatis, 9ij. Fiant pilulse xl.; cujus sumatur unam bis 
terve in die. 
In all forms of chronic disease, attended with acute pain, as well as in 
all painful nervous affections, in the treatment of which, for any cause, full 
doses of opium are contra-indicated, the following combination may be 
administered with great advantage : 
R Extracti hyoscyami, gr. xv.; extracti stramonii, gr. iv.; extracti hu- 
muli, 3j.; morph, sulphatis, gr. iss. Misce. Divide in pilulas xxx.; qua- 
rum capiat unam omni semihora, donee leniatur dolor. 
Of the therapeutic effects of muriate of ammonia, when internally ad- 
ministered, but little is known, as in this manner it is but rarely employed 
in this country. With the German physicians it has obtained a high repu- 
tation as a good alterative, and a promoter of healthy secretions in chronic 
diseases of the mucous and serous tissues. It not only promotes the mu- 
cous secretions, says Dr. Sunderlin, but the cutaneous exhalations, and im- 
proves also nutrition and assimilation. Combined with a sedative and nar- 
cotic, we have found it highly valuable in allaying irritation and in pro- 
moting expectoration, in the early stage of phthisis. 
R Ammon, muriatis, 3 ss.: opii pulv., gr. x.; digitalis pulv., scillrn pulv., 
aa. Bj. Misce. Divide in pilulas triginti. Sumat unam quaque sexta 
hora. 
Sleeplessness occurring in hypochondria, hysteria, and indeed in all ner- 
vous affections, may be overcome with great certainty by the administra- 
tion of the following pills: 
R Assafoetidae, 5j.; morphiae sulphatis, gr. iij. M. Fiant pilulae triginti, 
quarum exhibe unam vel duas hora decubitus. 
The above pills—two to four exhibited daily—are very efficacious in ar- 
resting the dry cough which is occasionally consequent on disordered men- 
struation in nervous females. 
Tonics and Stimulants.—The following combination of a chalybeate 213 
MEDICINES, 
with a stimulant and a sedative has, for many years in our hands, proved 
a most valuable tonic, particularly when administered during convales- 
cence from disease, and in all debilitated and a7icemic cases. 
R Extracti conii, 5ij.; sesqui-oxydi ferri, 3hj-; tinct. calumbae, giss.; 
sir. toluta. gss.; ol. gaultheriae, gtt. x.; aquae fontanae, gij. Fiat mistura ; 
cujus sumat coch. parv. mane ac nocte. 
Or the following may be substituted: 
R Sesqui-oxydi ferri, extracti taraxaci, aa. gss.; vini Xeris, gvj.; tinct. 
gaultheriae, gss.; aquae font., giv. M. capiat coch. magn. bis in die. 
The following is a very excellent tonic, and may be exhibited whenever 
any of the ferruginous preparations are indicated. 
R Ferri citratis, 3ij-; sir. citri, vel aurantiae, aquae menth. pip., aa. gij.; 
aquae purae, giv. M. exhibe cochlearium purum ter quaterve in die. 
In young anaemic females, with indications of a chlorotic condition of 
the system ; and also in children of strumous habits, the phosphate of 
iron, exhibited in combination with the sulphate of quinine, is a thera- 
peutic agent of great value. 
R Ferri phosphatis, 3j.; quinae disulphatis, gr. xij. M. Fiant pulv. 
xij., quarum capiat unam bis terve in die. 
A physician of great experience, and celebrated for his successful treat- 
ment of diseases of females, has employed for many years, and with much 
advantage, the subjoined combination of an alterative and a tonic in the 
management of certain forms of uterine diseases. 
R Sirup, ferri iodidi, gj.; tinct. actasoe racemosae, 3v.; tinct. rad. ac- 
coniti, 3iij- Fiat mist, cujus cap. gtt. xx. ter in die. 
We have seen engorgement of the os tincae and non-malignant indura- 
tion of this organ disappear rapidly under the persevering internal admi- 
nistration of the above tonic ; while at the same time, the following oint- 
ment was applied once a week, by means of friction with the finger, to the 
indurated os. 
R Extracti hyoscyami, extracti conii, extracti belladonnae, aa. p. e. 
To each ounce of which mixture add one drachm of iodide of potassa— 
mix thoroughly, and apply as above. 
R Ferri sulphatis, 3ij-; potassae iodidi, 3iss.; tinct. calumbae, sirup zin- 
ziberis, aa. gij. Fiat mist, capiat coch. parv. ter in die. 
This mixture may be exhibited with advantage whenever we desire to 
promote the absorption of glandular enlargements, and in all cases where 
a tonic and an alterative are indicated. 
Not unfrequently the general practitioner will encounter cases of ob- 
stinate intermittent; and of uncontrollable neuralgic affections, which 
will resist, altogether, the effects of the ordinary antispasmodics, when 
singly administered. In such instances, we have often succeeded per- 
fectly, by the combination and exhibition of a vegetable and mineral tonic 
—as the following : 
R Liquor potassae arsenitis, f. 3iss.; tinct. cinchonae, giij.; sir. auran- 
tiae, gj. M. Hujus mist., sumat cochl. min. bis terve in die. 
During the last two years, mtermittent fevers have occurred more fre- 
quently, in some parts of this city, and in the vicinity of the city, than for 
many previous years. In some of these cases, where the disease has 
proved obstinate, not yielding to large doses of quinine, long continued, 
we have found it to be promptly arrested by the administration of a tea- 
spoonful of the following mixture, twice or three times a day—the last 214 
MEDICINm 
dose being administered a short time before the period of the anticipated 
paroxysm. 
R Quin® sulp. 3j.; liquor potass® arsenitis, f. 3ij.; acidi sulph. aro- 
mat., f. 3j.; tinct. cinch, co., sir. zingiberis, aa. gij. 
When the preparations of arsenic are employed, it is safest to give the 
medicine after a meal. When thus exhibited, larger, or more effectual 
doses may be given with more safety than when taken fasting. Should, 
however, gastric irritation arise, under its use, or swelling or stiffness of 
the eyelids occur, the medicine should be immediately discontinued. 
Should it from any cause be desirable to administer these remedies in 
the form of a pill, we may employ the following formula: 
ffc Acidi arseniosi, gr. ij.; quin® disulphatis, 3j.; conserv. ros®, 3ss. 
Misce optime, et fiat massa, in pilulas xxx. dividenda; sumat unam bis 
quotidie. 
We have had recently much experience in the use of the different pre- 
parations of manganese, and have become fully satisfied, that this mineral 
tonic, in its different combinations, will prove a most valuable addition to 
our pharmaceutic preparations. 
The most important preparations of manganese for pharmaceutical pur- 
poses, are the phosphate, the malate, and the iodide of manganese. 
After the subjoined formula, we have administered, in tuberculosis, to 
a large number of patients, the phosphate of manganese, with most favor- 
able results. 
fi!; Manganesii phosphatis, 3ij-; tinct. cinchon®, giij.; sir. sars®, §iv.; 
mucil. acaci®, gj.; ol. gaultheri®, gtt. xx. Fiat mistura, cujus sumantur 
coch. duo vel tria minima bis terve in die. 
Or we may administer, under similar circumstances, and to the same 
amount, the manganese combined with some of the preparations of iron ; 
as in the following: 
R Manganesii phosphatis, 5iss.; ferri phosphatis, 3iij-; tinct. calumb® 
gij.: sir. tolutan. giv.; ess. gaultheri®, f. 3j. 
These mixtures should be kept in well-closed bottles, and as the manga- 
nese is not altogether soluble, the medicine should be shaken before being 
administered. 
The malate of manganese is considered, by some practitioners, a more 
eligible preparation, inasmuch as it is quite soluble, and the base of the 
salt is in the form of proto-oxide, the acid being easily digested. 
R Manganesii malat., 3\j.; tinct cinch., gij.; sir. simp. giv.; ess. limon, 
f. 5j. Fiat mistura, date coch, parv. mane ac nocte. 
The iodide of manganese is an efficient remedy in the treatment of glan- 
didar enlargements, especially those of the neck, and of the spleen, in con- 
stitutional syphilis, and in the anemia arising from scrofula and from can- 
cerous affections. 
It may be administered in the form of pills; or as a mixture in the fol- 
lowing formula: 
R Manganesii iodid., 3ij.; tinct. cardamom., gj.; sir. sars®, gv. Misce. 
Sumat coch. parv. bis terve in die. 
M. Petrequin has found manganese and iron, especially useful in blood 
diseases, such as the chloro-an®mia, after hemorrhage, operations, metror- 
rhagia, etc. In the chlorosis which appears about puberty, in that also 
which occurs at the critical period of woman, especially w hen profuse 
hemorrhage prevails, and in the depraved state of the blood, which sue- MEDICINES. 
215 
ceeds intermittent fevers, M. Petrequin has found the ferro-manganese 
preparations of remarkable efficacy. Part xxxii., p. 271. 
Phosphate of Lime.—This substance may be rendered much more so- 
luble, and therefore useful, by uniting it with carbonate of lime in the fol- 
lowing proportions: phosphate of lime, 4 grammes; carbonate of lime, 8 
grammes; sugar of milk 12 grammes. Part xxxiii., p. 284. 
Muriate of Ammonia, internally.—It may be given in many chronic 
inflammatory diseases, as chronic bronchitis, enlargement of the lymphatic 
glands, chronic skin diseases, and chronic rheumatism. Dr. Watson testi- 
fies to its efficacy in certain forms of facial neuralgia, nervous headache, 
toothache, and sciatica. Its action is sometimes remarkably beneficial; 
when the secretion from the pulmonary mucous membrane is tough and 
tenacious, it speedily becomes altered in quality and consistence. In 
chronic periosteal inflammation, having a syphilitic origin, it seldom fails 
to give relief. In indolent bubo a strong solution (3ij. to §j.) may be 
kept constantly applied, and five to ten grains may be given internally 
three or four times a day. In neuralgic affections, Dr. Ebden has given 
from 25 to 30 grains for a dose. Part xxxiii., p. 288. 
Bichromate of Potash for Preservative Solutions.—This salt, in pro- 
portion of about four grains to an ounce of water, constitutes a solution 
quite equal to alcohol in its antiseptic powers, and which costs only about 
twopence a gallon. It will deprive a specimen already partially decom- 
posed, of all odor, and preserve it for any length of time. As, instead of 
hardening, it a little softens tissues immersed in it, it has a great advan- 
tage over both alcohol and Goadby’s solution, for all objects which are in- 
tended to be reexamined, especially if the microscope is to be used. 
Preparations long kept in it become of a light olive green color externally, 
but retain most perfectly their natural appearance at a little depth from 
the surface. The change of color in the case of red structures such as 
muscle, may be prevented by the addition of a little nitrate of potash. In 
the same way, if it is desired, the softening may be prevented by the use 
of alum. Unless in combination with both the two last-named ingredients, 
it is scarcely adapted for a permanent solution. The great advantage over 
all others is, in respect to specimens intended to be kept for limited periods, 
either for private dissection or for exhibition. Those intended for the micro- 
scope are far less spoiled by it than by any other which I am acquainted 
with. The only odor which it gives to specimens is a very peculiar one, 
resembling that of new kid gloves. The cheapness and efficacy of this 
salt will, I think, make it quite a boon to pathologists. 
Part xxxiii., p. 292. 
Chlorodyne.—This agent given internally in doses of about twelve mi- 
nims in a little water is a most pleasing anodyne. Its effects last for seve- 
ral days. It is particularly useful where opium cannot be tolerated. 
Part xxxvi., p. 299. 
Strychnia, Uses of.—In cases of organic lesion of the nervous centres, 
epilepsy, chorea, paralysis agitans, it is useless or even injurious. It is in 
cases oi functional derangement where the nervous poviers are wanting in 
vigor, where lassitude is a prominent symptom, as in dyspepsia ot literary 
men and delicate females; chlorosis is perhaps the typical disease where 
it is of most use ; if you substitute strychnia for quina in the usual pre- 216 
MEDICINES. 
scription of quinine and iron in this disease, the effects will be truly aston- 
ishing. There is a double citrate of iron and strychnia analogous to the 
well-known preparation of iron and quina ; this is particularly applicable ; 
it contains one grain of strychnia to every hundred o? the salt. Another 
convenient way of giving strychnia is to dissolve a grain in two minims of 
sulphuric acid, and add this to thirty ounces of water in which one drachm 
of ammonio-citrate of iron has been dissolved; the whole may be then 
placed in a gazogene and charged with carbonic acid. Give a wine-glass 
full of this daily, immediately before lunch. A very remarkable case of 
the efficacy of the above is related by Dr. De Ricci. Part xxxvii., p. 49. 
Pepsine.—This must not be expected to digest a large quantity of meat 
at once. A patient taking it must not eat more meat than a mutton chop 
at once. Pepsine loses its power in a week or ten days, by which time 
either the stomach has regained its tone, or some other remedy must be 
employed. About fifteen grains of Boudault’s pepsine must be given 
about twice a-day, before meals, and spread between two thin slices of 
bread like a sandwich. Part xxxvii., p. 78. 
Prescriptions containing Henbane or Belladonna.—Never in any 
prescription combine any caustic-fixed alkali with tincture or extract of 
henbane, as the latter is thereby completely neutralized. Where it is 
desirable to administer an alkaline remedy with henbane, order either a 
carbonate or bicarbonate, which are quite as efficacious. The same pre- 
cautions apply to belladonna and stramonium. Part xxxvii., p. 258. 
Cocoa-Hat Oil Ointments.—The cocoa-nut oil is a more eligible body for 
the formation of ointments than lard, keeping much better, not staining the 
linen, and admitting of more complete absorption. To render the oil of 
commerce fit for pharmaceutical employment, it is in general sufficient to 
liquefy it at a moderate temperature, and strain it through linen. But if 
it retains its peculiar odor too strongly, and is of too yellow a color, it 
may be purified by digesting it for some hours in a water-bath, with 
some coarsely powdered vegetable charcoal, and filtering it while warm 
through paper. The following are some of the formulae that have been 
tried with success: 
R Iod. pot. !]., ol. cocos. §j. 
R Ext. bellad. 9j., ol. coc. 3iij. 
R Veratrini, gr. iij., ol. coc. 5iij. 
R Sulph. quin. Bj, ol. coc. §j., ol. rosar. gtt. x. (very useful in pityriasis 
capitis.) 
R Chlorof., ol. coc., aa. §j. (of great service in neuralgic and rheumatic 
pains, rendering the chloroform more fixed, and its action more durable.) 
R Ol. terebinth., ol. coc., aa. |j. 
R Hydr. ox. rub. gr. iv., ol. coc. §ij. Part xxxvii., p. 265. 
Citrate of Iron and Strychnia.—The citrate of iron and strychnia is a 
preparation which has lately been used with considerable success at the 
Royal Free Hospital, by Dr. O’Connor. The dose is about three grains 
three times a day, and taken immediately after a meal. In cases of dys- 
pepsia of an atonic character, in atonic affections of the uterus, as an em- 
menagogue, and in chorea, it has chiefly proved useful. 
Part xxxvii., p. 272. Glonoine—Nitrate of Oxide of Glycil.—If nitric and sulphuric acids 
be added to glycerine, and the whole be kept at a freezing temperature, 
a compound is obtained, which is a nitrate of oxide of glycyl; this is 
possessed of the most powerful properties. For use, one drop diluted with 
ninety-nine of rectified spirit is the proper quantity, so energetic are its 
properties ; of this, give a quarter of a drop in a dessertspoonful of water. 
In all spasmodic and painful affections, this will give instant relief; it has 
not been tried in tetanus and hydrophobia. If the paiu or spasm be not 
simply neuralgic, but dependent on some deeper seated cause, it will of 
course only act as a palliative. Great caution must be exhibited in its use. 
Part xxxvii., p. 295. 
MEDICINES. 
217 
Opium and Sulphate of Quinine—Antagonistic Action.—M. Gubler, 
in a paper read before the Societe Medicale des Hopitaux, has attempted 
to establish a direct antagonistic action between the sulphate of quinine 
and opium. He states, that while opium causes cerebral congestion, qui- 
nine possesses a diametrically opposite influence. 
In support of his theory, the author relates a case in which 30 grains of 
quinine and 5 grains of extract of opium simultaneously administered, 
failed to produce either the characteristic intoxication of quinine or the 
somnolency to be expected from opium. Part xxxviii., p. 248. 
Imitation of Natural Spas.—Dr. Aldridge gives the following: 
The spas that I have hitherto succeeded in imitating are the Rakoczy 
and Pandur Brunnens at Kissingen, and the Elizabethan Brunnen at 
Homberg. These are all so similar to each other—only varying in the 
proportions of their constituents—that it will be only necessary, at pre- 
sent, to give the formula for one of them. The one that I propose for this 
purpose is that of the Rakoczy: 
Lime water, 3 wine pints; carbonated solution of magnesia, 11 ozs.; 
Bewley and Evans’ soda water (No. 4), 12 drs.; sulphate of iron, 8 grs.; 
sulphate of manganese, 1 gr.; phosphate of soda, 2 grs.; chloride of 
sodium, 1 oz.; carbonate of potash, 10 grs.; muriatic acid (1160), 4 drs.; 
bicarbonate of soda, 5 grs.; silicate of soda, 30 grs. 
Dissolve and filter the solution ; divide into twelve equal parts; put 
each part into a bottle capable of holding a wine-pint; fill up with Bewley 
and Evans’ soda water (No. 1), and cork rapidly. 
The contents of one of the above bottles, taken in divided portions, 
about an hour before breakfast, will be found to possess all the physiologi- 
cal effects of the spa drank at the source. It will be found useful in cases 
of gout, dyspepsia, epigastric fullness, habitual constipation, neuralgia, 
obesity, etc. ~t is well not to continue its use for a longer period than 
nine days or a fortnight, and to follow the treatment by the exhibition of 
some mild tonic. Its employment is unsafe when there is weak action of 
the heart or where there is a tendency to cerebral congestion, or hemor- 
rhage from any surface. Part xxxviii., p. 292. 
Iodide of Calcium.—This salt is very valuable in cases in which the 
iodide of potassium is inadmissible. It does not occasion iodism, or re- 
sorption of the healthy tissues. It does not excite the circulation, nor 
irritate the stomach and bladder, by passing off too rapidly by the kid- 218 
MEDICINES. 
neys. Its solution in milk is perfectly tasteless. It is particularly useful 
in squamous diseases of the skin, and chronic metallic poisoning by mer- 
cury, lead, and copper. Part xxxviii., p. 292. 
New Method of Preparing the Phosphate of Lime of Pones.—On 
the ground of the necessity which exists for the administration of phos- 
phate of lime in the molecular state which is best adapted for its incorpo- 
ration into the living organs, M. Dannacy, of Bordeaux, proposes the 
following preparation of this salt: Beef-bones washed and powdered, com- 
mon water, and pure carbonate of potash or soda, are boiled together for 
an hour, when a perfectly homogeneous substance is formed ; this sub- 
stance is thrown upon a paper filter, and the alkaline liquid flows out; the 
mass is washed at several intervals with hot water; it is then dried and 
passed through a silk sieve, when a poAvder of excessive tenacity is ob- 
tained, soft to the touch, and of a mobility equal to that of lycopodium. 
This powder contains all the natural elements of bones, but without the 
gelatine which holds them together ; the disaggregation attains its utmost 
limit, and is truly molecular. The phosphate of lime of bones thus pre- 
pared is easily kept in suspension in potions and in cod-liver oil, and it is 
easily molded into different pharmaceutical forms, as pastilles, pills, etc. 
Part xxxviii., p. 293. 
Substitute for Human Milk.—[The human milk contains, besides salts 
of lime, chloride of potassium. Now, in common with carbonic acid, this 
salt enjoys the peculiar property of dissolving carbonate of lime or chalk. 
An absence of it in the food, as in wheat bread, is very injurious to a 
growing child, lienee a child fed on pap for a time grows fat, but the 
bones are soft; frequently it sickens, and severe symptoms supervene.] 
Amongst the vegetable substances, that which comes closest to milk in 
its composition is, without doubt, lentil powder, or, as it is called for the 
purposes of obtaining a better sale, Revalenta Arabica, containing both 
phosphoric acid in abundance, and chloride of potassium; it also includes 
casein, the same principle which is found in milk in its constituent parts. 
Moreover, its nutritive matter is to its calorifiant matter in the proportion 
of 1 to 2£, milk being in that of 1 to 2. No wonder, therefore, that under 
its influence many children affected with atrophy and marked debility 
have completely recovered. 
Lentils have also a slightly laxative effect, and therefore, in many in- 
stances, where the child is of a constipated habit, they are to be recom- 
mended. Peas and beans in this respect resemble lentils; the former, 
however, are objectionable, on the ground that they produce much flatu- 
lency. The latter is not generally obtainable ; still the bakers take advan- 
tage of this fact in regard to beans, and usually, where wheat by partial 
germination has lost some of its nitrogenous aliment, or where the flour 
used is poor in quality, they add a proportionate quantity of white bean 
flour, to restore it to its proper nutritive value. Part xxxviii., p. 294. 
Tests for Adulterations of Medicinal Substances.—Dr. Squibb having 
had much practical experience in the preparation of officinal substances 
for the United States’ navy, believes that advantage may attend the pub- 
lication of a few simple tests of their purity, requiring little time, skill, or 
apparatus for their application. MEDICINES, 
219 
Ether.—A strip of unsized paper, or a clean glass rod dipped into the 
ether and allowed to dry for a moment or two, will, by the odor it gives, 
afford evidence of the less volatile impurities it commonly contains. 
There usually remains a somewhat aromatic, slightly pungent odor, that 
is not hurtful in the more dilute ether used for common medicinal pur- 
poses, but the disagreeable oily odor often found is more objectionable, 
while really good ether should have no odor whatever. The ether ust-d 
for inhalation should leave no foreign odor whatever. The strength of 
ether is less easily ascertained; but with a little practice, and having a 
good specimen for comparison, a very satisfactory estimate may be found 
in the slowness or rapidity of its evaporation from the palm of the hand. 
Ether for inhalation should give off bubbles of vapor rapidly at the tem- 
perature of the palm. A thin test tube, containing the specimen, should 
be grasped firmly for a minute or two, and then the ether should be 
stirred at the time of observation. 
Hoffman's Anodyne.—Two drops of officinal compound spirit of ether, 
stirred into a pint of water, give to the mixture a distinct oily surface, and 
the peculiar fruity, aromatic odor of the heavy oil of wine free from the 
odor of ether and alcohol. Sixty drops render the water decidedly tur- 
bid: while, with four fluid drachms, a scanty precipitate of minute oil 
globules occurs after a few minutes standing. The fruity, apple-like odor 
is characteristic of the chief anodyne ingredient, the oil of wine, and is 
entirely wanting in the ordinary commercial article; and without this oil 
the preparation is a stimulant antispasmodic. With the oil it is a highly 
valuable anodyne antispasmodic, particularly adapted to nervous irritation 
and hysteria. The liquid universally sold is a residue of the ether-making 
process, containing varying proportions of ether and alcohol, with a little 
etherole or light oil of wine; but in no instance of the many examinations 
made by the writer, has any true heavy oil of wine been found. 
Spirit of Nitric Ether.—Two or three fluid drachms of good sweet 
spirit of nitre, not more than seven or eight months old, plunged in an or- 
dinary test tube, into water heated to 164°, will boil pretty actively; and, 
if fresh, or if well preserved from light and air, no matter what its age, it 
will boil actively in water at 156°. From the fact that this, among other 
liquids, may be heated far above its boiling point without ebullition, it 
becomes necessary to drop a few fragments of broken glass into the test 
tube with the spirit, after the latter has been heated and while still held 
in the water. Again, the formation of small gas bubbles around the 
fragments of glass, which occurs, as a fine effervescence, at any tempera- 
ture above 140°, in any spirit that contains hyponitrous ether at all, must 
be distinguished from true ebullition, in which the bubbles are much 
larger, and form, as they successively reach the surface, beads around the 
edge of the liquid—this latter only occurring at the temperatures named. 
The preparation should not be quite colorless, but of a pale straw' tint, 
and it should effervesce very slightly on the addition of carbonate of 
ammonia. When slightly acid the ammonia is the best corrigent, as the 
salts formed are therapeutically similar. The officinal preparation is a 
solution of five per cent, of hyponitrous ether in alcohol, while in com- 
merce it is rare to find it containing more than three per cent., and in a 
great majority of cases it is below two per cent., and often in a proportion 
too small to be detected except by the odor. It thus happens that the 
physician who prescribes it for its diuretic or diaphoretic effects is disap- 220 
MEDICINES. 
pointed, so much alcohol being substituted; and the preparation is falling 
into consequent disuse. 
Choroform.—When equal volumes of chloroform and colorless concen- 
trated sulphuric acid (or the strong commercial oil of vitriol) are shaken 
together in a glass-stoppered vial, there should be no color imparted to 
either liquor, or but a faint tinge of color, after twelve hours standing. 
Nor should there be any heat developed in the mixture at the time of 
shaking it first. All particles of dust, cork, or other organic matters 
must be excluded, or coloring will be produced; and if at the end of 
twelve hours the acid be only faintly tinged, it may be attributed to some 
such accidental cause. If, however, then or sooner it has become yellow, 
brown, or any dark color, the chloroform should be rejected. If warmth 
takes place on first shaking the mixture, it indicates an admixture of alco- 
hol. One or two drachms of chloroform, spontaneously evaporated from 
a clean surface of glass or porcelain, or from clean, unsized paper, should 
leave no odor. Commercial chloroform will generally turn the acid brown 
in two or three hours, and will often render it black and tarry-looking 
within two or three days; while with chemically pure chloroform there is 
absolutely no reaction within many days. 
Calomel.—The most common and injurious contamination is corrosive 
sublimate, which is easily detected by shaking a drachm or two in a test 
tube, with distilled water, and when the water has become clear, adding a 
drop or t#o of liquor ammonia. This will precipitate the sublimate, and 
render the water cloudy. 
Iodide of mercury is often irritant and harsh in its action, owing to 
contamination with biniodide from faulty preparation. This is detected 
by rubbing a little of the iodide in a mortar with strong alcohol, and 
leaving it a few minutes to dry. The evaporation of the alcohol leaves 
the red iodide as a border to the iodide around the pestle, and in this way 
a minute contamination is detected. 
Mercury with chalk has of late been often found harsh and irritating in 
its action, owing to faulty preparation, a portion of the mercury becoming 
oxidized, instead of being simply comminuted. To detect the peroxide a 
drachm or two should be treated with an excess of acetic acid, filtered, 
and then a few drops of hydrochloric acid added to the clear solution. 
If the preparation be good only a slight precipitate of insoluble subchlo- 
ride will take place, from the small quantity of acetate of suboxide 
formed. If the preparation be old or badly kept, a pretty copious precipi- 
tate results. The clear solution is again filtered or decanted off this pre- 
cipitate, and liquor ammonia is added. If the preparation is contaminated 
by the peroxide it will be thrown down in the form of white precipitate. 
Blue pill may also contain the oxides of mercury, and thus lose its 
mild character. They may be detected in the same way as in the mercury 
with chalk. 
Iodide of potassium is occasionally contaminated with carbonate of 
potassa, to the extent of impairing its medicinal power. This is easily 
detected, by adding lime-water to the solution of the iodide, when car- 
bonate of lime will be precipitated, rendering the mixture cloudy. 
Bitartrate of potassa frequently contains much tartrate of lime, 
which may be detected by stirring a few drops of liquor ammonia into a 
mixture of a few grains of the specimen in two or three drachms of cold 
water. The ammonia renders the otherwise insoluble potassa quite • 
soluble, while it has no immediate effect on the tartrate of lime. If then 
a portion remain undissolved after the application of this test, it may be 
regarded as an impurity. Part xxxviii.,/>. 294. 
Preserving Fluid for 3£icroscopical Preparations.—M. Pacini strongly 
recommends the following fluid for the preservation of blood globules, 
nerves, ganglions, the retina, and all the soft tissues, which keep their 
form and appearance while they become hardened; perchloride of mer- 
cury 1, chloride of iodine (chlorure iodique) 2, glycerine (at 25° of 
Baume) 3, and distilled water 113 parts. The mixture should stand for 
two months, and then one part of the liquid is to be diluted with three 
parts of distilled water and filtered. Part xxxviii., ft. 296. 
Iodate of Potash.—Messrs. Demarquay and Custin consider that the 
action of this salt is more powerful than that of the chlorate of the same 
base, and that it has yielded excellent results where the chlorate of pot- 
ash had failed. The dose varies from five to twenty-two grains, and it 
has been used in diphtheritis, mercurial and gangrenous stomatitis, etc. 
Part xxxviii., p. 296. 
MELANCHOLIA MELANOSIb. 
221 
MELANCHOLIA. 
Use of Seton.—In cases of obscure melancholia, a seton to the nucha; 
sometimes acts like a charm. It is particularly beneficial, in the shape of 
thin single filaments of gutta percha, or some other substance not perme- 
able to pus. Part xxxiii., p. 237. 
Vide “ Insanity.” 
3Ielanosis.—[There is an error in applying this terra to all tumors and 
deposits of a dark color, no matter what their character or situation. 
Melanotic swellings appear to be pigment-colored morbid products, very 
variable in character, especially cancerous. Mr. Coote thinks the charac- 
ter of this affection, as described by Mr. S. Cooper, is calculated to put it 
in an improper light. He says:] 
Chemical analysis by MM. Lassaigne and Foy, has shown that melan- 
otic matter differs but little from blood in its ultimate elements. A solu- 
tion of chlorine will bleach the black mass from a melanotic eye, conse- 
quently, it differs essentially from the carbonaceous deposits in the lungs 
of miners. This statement receives further confirmation from microscopi- 
cal examination. Melanotic tumors do not consist of an unorganized 
deposit; the cells have their periods of growth, maturity, and decay; 
neither can they be regarded as mere accumulations of pigment, for the 
cells have a totally different form from those of healthy choroid. 
In order to establish the view that melanosis, when fatal, is combined 
with the elements of cancer, it is necessary to define what these cancerous 
MELANOSIS. 222 
MELANOSIS, 
elements are. In the sooty-black non-vascular patch, characterizing cuta- 
neous melanosis (an affection which Mr. Lawrence regards as malignant), 
I never could discover any structural affinity with cancer, medullaiis, or 
fungoides. It is true, that cancerous tumors may be sometimes colored 
by pigment deposit, but that is no proof of the patient being affected with 
melanosis. The cavity of the globe may be occupied by a mass partially 
black and partially white, or of reddish hue; but it must be remembered 
that diseases of different characters often manifest themselves in the same 
tumor. Melanotic tumors occasionally present a spotted appearance, 
some parts being of a lighter color than others ; but this may dejjend upon 
variations in the quantity of the pigment granules contained in the cells. 
The constant occurrence of primary melanosis in situations where, in the 
healthy state, pigment is often deposited ; the chemical composition of 
such tumors; the appearances which they present both to the naked eye 
and when placed under the microscope, warrant the inference that this is 
a disease sui generis, manifesting itself by the accumulation of pigment 
cells in a morbid state. It is difficult exactly to define the meaning of the 
term “ malignant.” In man, however, melanosis is a rapidly fatal disease. 
When once fairly established, whether the primary tumor be extirpated 
or not, the patient dies, in the course of one or two years, of accumula- 
tions of similar character in all parts of the body. In the horse the disease 
is not so fatal. Mr. Spencer has known an animal live for ten years after 
the removal of the primary tumor, being fit for work the whole time. 
[In the human subject, melanosis is most frequently met with from the 
40th to the 60th years. Mr. Coote goes on to say:] 
Melanosis of the eye commences between the choroid and retina; the 
former membrane remains of its natural consistence ; the latter is com- 
pressed, pushed to one side, or to the centre of the globe, but not other- 
wise altered. In the earliest stage the eye becomes amaurotic, without 
obvious cause; frequent attacks of inflammation come on; but from five to 
eight years may elapse without any morbid change being observable. 
Then, if the growth proceeds from the posterior part of the eye, the retina 
is pushed forward ; the vitreous humor is absorbed; the posterior capsu- 
lar vessels are destroyed, and the lens, rendered opaque, protrudes, to- 
gether with the iris, into the anterior chamber. The conjunctival vessels 
become enlarged, tortuous, and distended with blood ; the sclerotic coat 
yields unequally, and presents an irregular lobulated appearance, resem- 
bling staphyloma. Sudden attacks of inflammation, attended with pain 
and chemotic swelling, come on; the sclerotic coat gives way, either a 
few lines from the margin of the cornea, or near the entrance of the optic 
nerve; and the melanotic mass, freed from restraint, protrudes, covered 
by conjunctiva, from the eyeball. Primary melanotic tumors of the skin 
are either cutaneous or subcutaneous. The two commonly occur to- 
gether. 
Cutaneous deposits (melanose membraniforme, Andral) appear as 
smooth black spots, with a defined margin, varying in size from a pin’s 
head to a shilling, lying upon the cutis, and covered by the cuticle, which 
is not raised. Subcutaneous deposits (melanose tuberaforme, Andral) 
exist as dark colored tubercles, varying in size from a pin’s head to a 
small orange. Invisible when small, they distend the skin as they acquire 
bulk, and appear as prominent bluish-black spots; the color deepest in 
the centre, gradually fading away to the circumference. MELiENA MENINGITIS. 
223 
The integuments at last give way, and a black mass protrudes; the sur- 
rounding vessels pour forth some blood, and a dark-colored fluid flows 
from the open surface. If the mass be removed wholly, by the knife, or 
partially, by ligature, the wound will heal, but the disease inevitably re- 
turns, either in the cicatrix or some distant part. 
The primary disease advances with unequal rapidity, but secondary 
accumulations generally form before the primary tumor has attained very 
considerable size. The absorbent glands are rarely affected. The deve- 
lopment of internal disease is marked by general lassitude, and undefined 
pains over the trunk and limbs ; the rest is disturbed ; the appetite fails, 
and emaciation commences. The liver, rapidly increasing in size, projects 
with irregular surface from the lower margins of the ribs, apd distends 
the abdomen; dark-colored matter is voided by the bowels or ejected 
from the stomach ; the diarrhoea, if arrested, alternates with violent and 
uncontrollable pains in the head, and the patient dies exhausted, but 
retaining his faculties to the last. 
Upon examining such a case after death, melanotic matter is found 
accumulated in every part of the body, except, perhaps, the cornea, syno- 
vial membranes, and tendinous structures. Part xi\.,p. 128. 
Acute Melcxma cured by Gallic Acid.—Dr. Durrant, secretary to the 
Ipswich Medical Society, mentions the case of a cachectic young man 
with acute melama, in which antiphlogistic remedies, acetate of lead, and 
turpentine with tincture of opium, were given without benefit. Four 
grains of gallic acid were then administered every four hours, with tine- 
ture of opium, and the discharge shortly ceased. Tart xv.,p. 120. 
Treatment of Melcena.—Give oil of turpentine (which by its stimu- 
lant properties will excite the intestines to contract, and so mechanically 
check the bleeding) and small doses of gallic acid in the solid form. And 
let the diet be liquid, concentrated, cold, and given in very small quanti- 
ties at a time. (Dr. Neligan.) Part 362. 
MELiENA. 
MENINGITIS. 
Tubercular—Case of.—A fine boy of nine months old, was suddenly at- 
tacked with convulsions. He recovered from these, and cut his first teeth 
shortly afterward; lie was soon observed to fall away, to become listless, 
and to lose his appetite, without any condition of tongue which could in- 
dicate intestinal derangement. His bowels became constipated, his pulse 
irregular, and he began to vomit and to become torpid. Fever was soon 
added to his symptoms, and it was evident that he was the subject of 
meningitis. Leeches were applied, and calomel given, but in spite ot 
treatment he lapsed into complete coma. As soon as the latter symptom 
became distinct, tartar emetic ointment was rubbed into the scalp every 
four hours over a space the size of a crown piece. Free suppuration en- 
sued, and signs of amelioration were speedily witnessed. The child be- 224 
MFNOKKHAGIA. 
came gradually more sensible, his appetite returned, and in a fortnight all 
traces of his malady had vanished. Dr. Hahn continues : 
When there have been no previous symptoms indicative of tubercular 
diathesis, bleeding must be employed and calomel given. The latter is 
chiefly to be relied on ; but we must not salivate unnecessarily. Cold 
efiiisions will be found useful, sometimes availing to arouse the child after 
the supervention of complete coma. But in the comatose condition, fric- 
tion of the scalp with tartar emetic ointment, repeated every two hours 
till pustulation is established, will be of the greatest value. When symp- 
toms denoting general tubercular cachexia precede the cerebral affection, 
blood-letting, except locally and sparingly, is contra-indicated, and calomel 
cannot be pushed to the same extent. But the counter-irritation may be 
employed as in the previous case. Part xxi., p. 73. 
Meningitis, Tubercular.—By judicious management blood-letting may 
be almost dispensed with, in this as in most other diseases of infancy. Its 
effects may be obtained by the use of the warm bath, antimonials, and 
diuretics, the latter medicines having a very striking antiphlogistic effect | 
purgatives would serve the same end, but they cannot, except enemata. 
be safely used in many diseases of children. In the more advanced stages, 
“calomel for the removal of lymph, and iodine (liq. potassse iodidi comp.) 
for the absorption of effused fluid, are well known and trustworthy re- 
medies.” 
It is very difficult in the cerebral affections of childhood, to distinguish 
cases which require antiphlogistic treatment from those requiring stimu- 
lants. The occurrence of febrile disturbance will generally show that 
active treatment is required ; but if the fever is intermittent, leaving the 
patient depressed in the intervals, we must be very cautious how we use 
lowering measures. (Dr. Copeman.) Part xxi., p. 74. 
Syphilitic Miningitis.— Vide Art. “ Brain.” 
Et'got of Rye.—Speaking of the effects of ergot of rye in menorrhagia, 
Dr. Burne says: 
I have heard persons express doubts of its efficacy; but so many cases 
under my own care have been benefited or cured by it, that I cannot but 
regard it as a most valuable addition to the materia medica. . . . Cases 
in which an exhausting draining hemorrhage has persisted for five or six 
weeks after abortion, have yielded at once to the influence of the ergot. 
It is very important that the ergot should not be at all in a state of 
decay. " Part ii., p. 33. 
Gallic Acid in Menorrhagia.—In a paper read before the Medico- 
Chirurgical Society of Edinburgh, Professor Simpson stated that for the 
last year he had employed gallic acid in some cases of menorrhagia, with 
the most successful results. Like all the other remedies directed against 
that disease, it had also occasionally failed in his hands. Some of the cases 
which had completely yielded under its use were of an old standing, and 
aggravated description. He gave it during the intervals, as well as during 
MENORRHAGIA. MENORRHAGIA, 
225 
the discharge, in doses of from ten to twenty grains per day made into 
pills. It had this advantage over most other antihemorrhagic medicines, 
that it had no constipating effect upon the bowels. Part viii., p. 65. 
Treatment of Menorrhagia.—Dr. Ditterich recommends the interna! 
use of nitrate of silver as a remedy for this troublesome and obstinate 
complaint, as well as for the leucorrhcea which is present during the inter- 
vals and the nervous symptoms. The prescription is: R Nit. argenti, 
gr. iij.; aquas destil. 3ij. solve. Of this solution ten drops are to be taken 
two or three times daily, and gradually increased to fifteen drops. The 
author affirms that the use of this solution, for a period of from four to six 
weeks, will perform a certain cure. After the lapse of about ten days, 
the leucorrhcea diminishes, and by the second menstrual period, the cata- 
menial secretion is reduced to the proper quantity, and the nervous symp- 
toms disappear. Koph has also recommended the nitrate of silver for the 
same disease in doses of one-tenth to one-twelfth of a grain every two 
hours. Part xiii., p. 361. 
Treatment of Menorrhagia by Indian Hemp.—[It appears that the 
value of Indian hemp is not confined to neuralgic cases. Dr. Mitchell re- 
commends it in uterine hemorrhage. Dr. M. says,] 
There are two tinctures in use, one of the herb, and the other made 
with the resin—the former is of little use, but the latter is a powerful 
medicine; when mixed with water it becomes milky, owing to the sepa- 
ration of the resin, to obviate which it is better to combine it with muci- 
lage, or a small quantity of spirit: the dose that I have given of it is ten 
minims repeated every four hours; sometimes the first dose succeeds in 
checking a discharge which has lasted months, and that notwithstanding 
the employment of the most energetic means usually resorted to, includ- 
ing the whole range of astringents and plugging the vagina. In these 
cases it acts almost like magic. There is another form of hemorrhage 
which the practitioner will also find it of great value in; I allude to that 
distressing, debilitated sort of draining which occurs in some women 
when pregnant. In these cases the ordinary astringents frequently fail, 
and the ergot of rye, in consequence of inducing uterine contraction, is 
inadmissible. In these cases the tincture of hemp will be found peculiarly 
useful. Part xvi., p. 276. 
Thlaspi Pnrsa Pastoris, in Menorrhagia.—Give decoction of thlaspi 
bursa pastoris (shepherd’s purse) ; a handful of the fresh plant in three 
teacupfuls of water, boiled down to two—dose, a cupful twice a day. 
Part xix.,p. 270. 
Oxide of Silver in Menorrhagia.—Give oxide of silver, in doses of 
half a grain or a grain three times a day, combined with a small quantity 
of morphia or opium. It is almost a specific for those cases in which 
there is no organic lesion. If there are high inflammatory symptoms, 
these must be subdued before beginning with the remedy. Oxide of sil- 
ver blackens the stools. Part xx., p. 228. 
Menorrhagia.—During an attack of the hemorrhage, let the patient 
take of ext. matico alcohol, gr. v.; plumbi diacet., gr. ij. M., ft. pil. ij. 
quartis horis. R Secalis cornuti, sodse biborat., aa. 9j.; mist, acaciae, gss. 
aquae cinnam., giij. M. ft. haust. sumat demid. cum pilulis. Mr. Hooper 
VOL. II.—15 226 
MENOBRIIAGIA. 
prepares a combination of the diacetate of lead with the spirituous ext. 
of matico, than which no styptic appears more powerful. 
Part xxvii., p. 354. 
Profuse Menstruation, commonly termed Menorrhagia.—When Me- 
norrhagia takes place in plethoric habits, says Dr. Oke, it is manifestly 
remedial, and ought not to be hastily restrained. In such a case the 
plethora is the object to be kept in view, rather than the discharge ; and 
it will be best treated by a cooling diet, the recumbent position, and the 
mixture (a). 
(a) R Magnesise sulphatis, 3vj.; infusi rosas comp., §vss.; sirupi simpli- 
cis, §ss.; acidi sulphurici diluti, §ss. Misce. Fiat mistura, cujus capiatur 
fluiduneia ter quotidie. 
But when the discharge has continued for a considerable length of time, 
producing an anajmic condition and great debility, the indication of cure 
will clearly be to restrain the uterine flux as speedily as possible by gene- 
ral and local means. 
The system may be strengthened by (h). 
(b) R Confectionis rosae, §ss.; infusi rosae comp., §iij.; decocti cinchonae, 
|iij. Misce et cola. 
Colaturae adde 
Acidi sulphurici diluti, 3j.; tincturae opii, jnxxx. Fiat mistura, cujue 
capiat quartam partem ter quotidie. 
Opium, in menorrhagia, from this cause, is a valuable remedy, as it is 
found to increase the force of circular muscles; whilst henbane, hemlock, 
and belladonna relax them. Hence it is that the former contracts whilst 
the latter dilates the iris ; and hence, also, the great use of opium in re- 
straining profuse and dangerous hemorrhage after parturition, by causing 
contractions of the muscular walls of the uterus. 
The bowels, if necessary, should be regulated by gentle aperients, such 
as the following: 
R Pulveris rhei, balsami copaibas, aa. 5ss. Misce ; ct divide in pilulas 
xij., quarum capiat duas hora somni pro re nata. 
Turpentine and the sccale cornutum have also been found efficacious in 
restraining menorrhagic discharge. 
The best local remedy is the sulphate of alum hip-bath, which may be 
made in the proportion of twelve ounces of alum to two gallons of water. 
It may be used daily for about twenty minutes, first tepid, thence gra- 
dually reducing it to the normal temperature. 
Should the discharge continue unabated, notwithstanding the use of the 
above remedies, a polypous growth or some morbid condition of the 
uterus is to be suspected; and the uterus must then be examined. 
Part 287. 
Use of Cinnamon in certain Examples of Menorrhagia.—The symp- 
toms usually presented are briefly these: the catamenia appear regularly 
every twenty-eight days, and are at first only of the proper quantity; 
but, instead of ceasing after a duration of three or four days, they con- 
tinue unabated for ten or fourteen, and occasionally even for three weeks. 
The general symptoms which arise from this debilitating discharge are 
just such as might be expected. There is general weakness, languor, 
mental depression, with pains in the head, loins, and so on ; the patient 
suffering, it is to be remembered, not from any diseased condition, giving MENSTRUATION. 
227 
rise to the hemorrhage, but merely from the loss of blood itself. In other 
instances the discharge continues a less time, but the flow is more abun- 
dant, clots being frequently discharged; this variety.is generally followed 
by leucorrhoea. 
Dr. Tanner was led to try the use of cinnamon, and having derived the 
most beneficial effects from its employment, recommends 3j. doses of the 
tincture of cinnamon every six hours, to be continued for fourteen days 
after the symptoms have disappeared. If the case has been an obstinate 
one, continue the dose once daily for a month. Part xxviii., p. 288. 
Menorrhagia.—A very common cause of menorrhagia is uterine poly- 
pus. Vide x\rt. “ Polypi.” 
Use of Digitalis.—When unconnected with organic disease, it may be 
readily checked by infusion of digitalis. If there be organic disease, it 
will control the discharge, but its effects will not be permanent. 
Part xxxiii., p. 265. 
Obstinate Menorrhagia.—In two cases under the care of Dr. Henry 
Savage, of London, after all other remedies had failed, a cure was effected 
by injection into the uterine cavity, in one case, of three drachms of tinc- 
ture of iodine of the London Pharmacopoeia, and in the other of four 
ounces of a mixture (equal parts) of tincture of iodine and water. In 
the second case the injection was repeated every third day for a fortnight. 
Both cases were unconnected with pregnancy in any way. In both the 
uterus was rather increased in size, and softer than natural, the os being 
slightly open. Injections of alum and tannin had previously been 
productive of temporary benefit in one of these cases. 
Part xxxvii., p. 209. 
MENSTRUATION. 
In the Negress—Is not earlier than in the European. Part vi., p. 166. 
Treatment of Remittent Menstruation.-—Dr. Tilt says he uses the term 
remittent here in the same sense as in the pathology of fever. This 
variety of menstrual derangement being characterized by a change from 
the habitual type to some other, so that the menstrual periods are brought 
nearer, and tend to run into each other. The first case occurred in a tall, 
slender woman, aged twenty-nine. In this case menstruation commenced 
between fourteen and fifteen, and continued regular until six months 
since, when she left her native country, Lincolnshire, for town. For two 
months, although she menstruated as usual, she was troubled with 
leucorrhoea between each menstruation. The menstrual periods then 
came on every fortnight and lasted eight instead of five days. The pa- 
tient was weak and exhausted, but not chlorotic; she had just passed a 
menstrual period; there was an absence of pain and of other symptoms 
of uterine disease; therefore, notwithstanding a discharge of which she 
complained, I omitted all local treatment, and ordered the following pills 
and mixture: sulphate of iron, two scruples; sulphate of quina, ten 
grains; extract of hyoscyamus, a scruple ; mix for twenty pills, one to be 
taken night and morning. Camphor mixture, six ounces; liquor potass®, 228 
MENSTRUATION. 
four drachms; tincture of hyoscyamus, six drachms; tincture of carda* 
moms, two drachms. Half an ounce to be taken thrice daily. An opium 
plaster to be applied to the pit of the stomach. 
The patient’s general health improved, menstruation returned to its 
wonted type, and from that time she only took one pill every night, until 
the approach of the ensuing epoch, which passed on as it ought to do 
and the patient was discharged. 
Miss L , aged sixteen, first menstruated between fourteen and fif- 
teen ; and regularly, for four months after its first appearance, did men- 
struation adopt the monthly type. Since seven or eight years of age she 
had been subject to leucorrhoea, which for the last three months has pre- 
ceded and followed the menstrual flow; the latter has made its appear- 
ance every fortnight. Still there was no intermediate leucorrhoea ; there 
were no pains in the back, none in front, and none were determined by 
pressure on the abdomen; but the thighs were so painful that she could 
scarcely walk, and her legs were at times much swollen. For this symp- 
tom my opinion was requested by her mother. The girl had very much 
fallen off, was much debilitated by loss of blood, and the undue influence 
of the generative organ on her system had caused catamenial headache, 
heaviness for sleep, momentary loss of her senses, and often fits of lowness 
and shedding of tears. I ordered the following pills: Sulphate of quiua, 
ten grains; extract of gentian, a scruple; extract of aloes, ten grains ; 
extract of hyoscyamus, a scruple. Mix for ten pills, one to be taken night 
and morning. I prescribed the compound camphorated mixture, and bel- 
ladonna plasters to each of the’ovarian regions. 
The symptoms rapidly abated, and menstruation was forthwith brought 
back to its original type. 
The preceding cases are, in my opinion, samples of an idiopathic aber- 
ration from the normal type of menstruation, and perfectly independent 
of any inflammatory lesion of the ovaries or uterus. I strongly recom- 
mend this practice to the profession, premising that the treatment will not 
be so rapidly effectual, and may even be attended by mischief if the 
remittance of the menstrual flow depends, as it sometimes does, on ovarian 
or uterine subacute inflammation, as in the following case: 
E. II , aged twenty-one, of florid complexion, full habit, and of 
middling stature; menstruation first appeared between thirteen and four- 
teen, became regular from the first, was very abundant, and lasted five 
days at each period. 
A few months ago the patient was attacked by a severe cold with fever, 
wdnch stopped menstruation for two months. When the latter returned 
it was scanty, and accompanied by more than usual pain in the back, the 
stomach, and head; and, attended by these symptoms, it made its appear- 
ance every three weeks instead of every month, giving rise also to sensa- 
tions of weakness, trembling, and lowness of spirits, Avith which she had 
previously been wholly unacquainted. 
The patient localized her pains in the ovarian regions: pressure in- 
creased them, so did walking or any unusual exertion ; she Avas slightly 
feverish; the tongue was furred, and the bowels were costive. 
I considered this case as one wherein the remittance of menstruation 
was dependent on subacute inflammation of the ovaries, and I oi’dered six 
leeches over each ovarian region; poultices to be kept to the same region 
at night; and a flannel, sprinkled with camphorated liniment, to be ap- MENSTRUATION. 
229 
plied over the abdomen during the day. Aloetic purgatives and a seda- 
tive mixture were also prescribed. The pain subsided; the patient felt 
well; but menstruation returned at the morbid period of three weeks, and 
was still painful, and left behind it a certain amount of abdominal pain. 
After giving a brisk purgative, I applied belladonna plasters to the ovarian 
regions, and gave pills similar to those taken by Miss L . The 
patient now says she feels well, and as menstruation has resumed its phy- 
siological type, I believe her to be cured. Part xxiii., p. 240, 
Management of Women after the Cessation of Menstruation.—[The 
superabundance of blood and nervous energy after the cessation of the 
menstrual flow may be safely and effectually kept dowm by the habitual 
use of small doses of purgatives; and as they may have to be continued for 
some length of time, it is best to consult the patient as to what medicine 
would be best tolerated. The'purgative to be used depends upon the con- 
stitution of the patient. Perhaps the best is some mild purgative which 
has been found to agree with the patient. Dr. Tilt continues:] 
I frequently prescribe the soap and aloes pill of the Edinburgh Ph. 
ordering five or ten grains to be taken with the first mouthful of 
food at dinner. Hemorrhoidal affections I have never seen caused by 
this frequent use of aloes, but I have seen them relieved by it. There 
must be some exaggeration as to the extraordinary property generally 
ascribed to this valuable drug, w’hich can be associated with hyoscyamus, 
and is thus said to be less liable to induce piles. Kemp and Hufeland 
recommend the following powrder to be given to those who are advanced 
in years, and wrho complain of a tendency to vertigo—Guaiacum resin, 
cream of tartar, of each half a drachm, to be taken at night. This, no 
doubt, will sometimes be found a useful laxative; so will the popular 
remedy called the Chelsea Pensioner, of w’hich Dr. Paris has given the 
following formula in his excellent Pharmacologia: Of guaiacum resin, 
one drachm; of powdered rhubarb, twTo drachms; of cream of tartar and of 
flowers of sulphur, an ounce each; one nutmeg finely powdered, and the 
wdiole made into an electuary with one pound of clarified honey: a lax-ge 
spoonful to be taken at night. I generally administer the flowrers of sulphur 
alone, or else to each ounce of it I add a drachm of sesquicarbonate or 
biborate of soda, and sometimes from five to ten grains of ipecacuanha 
powder. One to twTo scruples of these powders taken at night in a little 
milk, is generally sufficient to act mildly on the bowels, and I consider 
such combinations as very valuable when a continued action is i-equired. 
Whether sulphur cures by acting on the nerves or on the bloodvessels, 
or by modifying the composition of the blood itself, is difficult to tell, but 
it does certainly cure the diseases I have enumerated. It forms part of 
maqy popular remedies for the infirmities of old age, was l’ecommended 
by Hufeland, and is lauded by Dr. Day in his work “ On the Diseases of 
Old Age ;” but its utility is not generally knowm in all derangements of 
the menstrual function, at whatever period of life they may occui-, and 
particularly at the change of life, where, if required, its action may be con- 
tinued with impunity for months and years. Part xxiv., p. 299. 
Difficult Menstruation.—Dysmenorrhoea sometimes takes place from 
the very commencement of menstrual life, and there is good reason 
for believing that it depends on the small size or sti'ictured condition of 
the os uteri. The menstrual fluid, after it is formed, or while forming, 230 
MERCURY < 
cannot readily escape; distention of the organ speedily follows, which, by 
exciting the contraction of the uterine fibres, produces pain almost simu- 
lating that of labor. Even the action of the abdominal muscles is called 
into play, and many cases of Avhat are termed “spurious pregnancy ” may 
be very possibly explained in this manner. It is believed, too, that 
women thus affected rarely, if ever, conceive or bear children, t he normal 
healthy function of the uterus being interfered with, as well as the 
woman’s health reduced by the constant suffering and pain. Of all the 
means of cure hitherto tried, dilatation of the canal of the cervix uteri 
seems to be the best, to which more recently has been added the intro- 
duction of a silver canula, as tried by Dr. Tyler Smith. 
Part xxxii., p. 298. 
Menstruation during Pregnancy.—That a discharge, more or less 
identical with the ordinary catamenial flow, may occur during pregnancy, 
is admitted by the majority of experienced observers. The following 
case, under the care of Dr. G. Hewitt, is an interesting example of this 
kind: 
M. B., aged twenty-five, had been married six years. She became 
pregnant for the first time rather less than six years ago, and was de- 
livered of a healthy child, now alive. During this first pregnancy, it is 
stated that every fourteen days a bloody discharge occurred, lasting three 
or four days, and this periodic discharge persisted during the whole period 
of gestation. The discharge was rather paler than that observed befor« 
she became pregnant. The child was suckled for six months, and during 
lactation no trace of bloody discharge was noticed. A second pregnancy, 
attended with precisely the same phenomena, terminated favorably three 
years ago. The second child, also now alive, was suckled for fifteen 
months, and the catamenial discharge is habitually rather excessive in 
quantity, continuing usually six to seven days; it occasionally extends 
over twelve or thirteen, and this has been the case since she was married 
only. Part xxxviii., p. 203 
MERCURY. 
Mercury and Antimony—Methods of forming various Preparation.• 
of.— Vide “ Antimony.” 
Fenruginated Pill of Mercury.— Vide Art. “ Pills.’ 
Different Preparations of Mercury and best Modes of administering 
them.— Chloride.— Calomel is chiefly useful when we wish to produce a 
speedy and powerful action on the constitution, as in venereal iritis or 
orchitis, but is less adapted to the ordinary symptoms. On the Continent 
it is extensively employed in tubercles of the labia, with or without ulcer- 
ation, in various forms of creeping ulcers, and also in ulcerations of the 
throat and nasal fossae. Desruelles says, that he cannot too much recom- 
mend this preparation, which, united to opium and an antiphlogistic 
regimen, may produce the most beneficial results. Rieord employs the fol- 
lowing pills in the treatment of enlarged testicle, which remains after 
inflammation of that organ : 
R 11yd. chlor. Bj.; pulv. conii, sapon. liisp. aa. Bij. M. ft. pil. xxiv. 231 
Bichloride.—M. Dupuytren ordered this remedy in small doses, bne- 
sixth of a grain three times a day, in constitutional syphilis, and on tho 
Continent it still continues to be extensively used for this purpose. In 
some chronic cases of syphilitic skin disease, I have seen it used with 
advantage; but as a general remedy in secondary syphilis it requires more 
care, is more dangerous, and altogether is a less eligible medicine than 
blue pill. . 
Pilula Hydraryyri.—This medicine is the form most used and relied 
on in England, and as it is one of the mildest, safest, most certain, and 
most manageable preparations of mercury, it justly deserves the prefer- 
ence given to it. In doses of five grains two or three times a day, it is 
applicable to nearly all those conditions which we have shown to be bene- 
fited by mercury. 
Proto-ioduret.—MM. Cullerier, Biett, Ricord and others employ this 
remedy in many forms of constitutional syphilis, especially where second- 
ary and tertiary symptoms are combined, and in primary sores in strum- 
ous habits. Cullerier says, that it is chiefly in constitutional syphilis that 
the proto-ioduret of mercury is administered with success. Its effects 
are principally evident in secondary ulcerations of the mucous membrane, 
cutaneous tubercles, exostoses, and chronic affections of the joints, where 
the other preparations of mercury have had little effect. It should always 
be guarded by opium, and given in half grain doses twice or thrice a day. 
The deuto-ioduret is more stimulating, and consequently its dose is 
smaller. Either of these may be employed in friction upon tumors and 
indolent buboes, after the removal of all acute inflammatory symptoms. 
The cyanuret and deuto-phosphate of mercury are occasionally em- 
ployed. The former is said to be preferable to the bichloride, being less 
apt to disagree, and less readily decomposed. It is an useful external 
application in some skin affections, allaying the violent itching and irrita- 
tion of what M. Alibert terms herpes squarnosus. 
Inunction.—Inunction by the mercurial ointment was formerly em- 
ployed to mercurialize the system more frequently than at the present 
day. In this way the mineral is less apt to disagree with the system, 
especially the alimentary canal, although, when used alone, it is less 
speedy in its effects. In buboes, I imagine that Hunter tvas correct in his 
opinion concerning the advantages of making mercury pass through the 
affected absorbents. The ung. hydrarg. is used in the quantity of half a 
drachm to a drachm night and morning, to be well rubbed in, before a 
fire, on the more delicate portions of skin. Cullerier prefers using mer- 
cury by friction in primary sores: he orders from a quarter of a drachm 
to a drachm and a half of mercurial ointment at each fiction, leaving an 
interval between them of one, two, or three days, with the view of not 
irritating either the sore or the constitution, by bringing the latter sud- 
denly under the influence of the remedy. Ricord frequently orders the 
frictions to the axillce, and they are employed in this manner by Cullerier. 
in certain forms of ulcerations of the mouth and fauces. He narrates two 
cases cured by mercurial frictions in this situation, which had resisted its 
employment on other parts. 
Fumigation.—Fumigation of the whole surface of the body is at pre- 
sent, rarely used as a method of affecting the system, but the apparatus 
formerly employed is still to be found in some ot our hospitals. It is very 
speedy in its action. The remedy is, however, employed locally, and with 
MEECUEY. 232 
MERCURY, 
greAt advantage, in some affections of the throat and nasal fossje, directed 
to the part by a suitable apparatus, and more generally in some obstinate 
diseases of the skin. For patients who have not strength to rub in mer- 
cury, and whose bowels will not bear the use of internal remedies, it has 
been esteemed highly advantageous. 
Topical Applications.—As mere local applications, calomel, black wash 
(hydrarg. chlorid. x, vel xv. grs., aquae calcis, §j.), yellow wash (hyd. 
Bichlorid. j. vel ij. grs., aq. cal. §j.), solutions of the bichloride in dis- 
tilled water, the nitric oxide ointment, the nitrate ointment, the simple 
blue ointment, and the ung. hyd. c. ammoniaco, are all of them occa- 
sionally applied. We select from these in proportion to their stimulating 
properties, adapting to the condition of the symptoms we treat. 
Part ix., p. 20. 
Mercurial Ointment— Use of “ Prepared S'evumP—Under this title a 
very elegant and valuable preparation has been for some time before the 
public. It is employed in the manufacture of mercurial ointment (ungueh- 
tum hydrargyri), and possesses the singular property of immediately ex- 
tinguishing the globules of metallic quicksilver, and producing the neces- 
sary degree of oxidation, without at all interfering with the intentions of 
the Pharmacopoeia. It resembles in every point very pure suet, as its 
name implies, and pi*oduces a finer article of ointment, both as to color 
and quality, than by the old and laborious process of patient trituration. 
Strong Mercurial Ointment.—R Prepared sevum, 1 oz. or part • quick- 
silver 7 do.; mix in a warm mortar, then add lard (softened with heat). 
13 ounces or parts; mix well. 
Weak Mercurial Ointment.—R Prepared sevum 1 oz. or part; quick- 
silver 7 do.; lard (softened) 3 4 lbs., or 56 do., as before. Part ix., p. 84. 
Mercury, Administration of.—After mercury has been given for some 
time, a portion of it would seem to be retained in the system in the form 
of some insoluble compound. If iodide of potassium is now given, it com- 
bines with the mercury, forming a new and soluble salt, dissolving out the 
mercury, and setting it once more afloat in the circulation. This new salt, 
a double iodide of mercury and potassium, is eliminated from the system 
along with the excess of iodide of potassium, so that the cure would then 
seem to be radical and complete. 
Mercurial Poisoning.—It is important to know that iodide of potassium 
renders medical treatment in poisoning by certain salts of mercury more 
active, and may, therefore, occasion accidents. M. Dumas recommends, 
that when calomel (the chloride of mercury) is taken, and is wished to 
remain as such, common salt (chloride of sodium) should not be taken. 
When corrosive sublimate is taken (the bichloride), to prevent its being 
decomposed, sal ammoniac (the hydro-chlorate of ammonia) is to be 
given with it. If doses of calomel are given to two dogs, and at the same 
time iodide of potassium is given to one of them, the dog so treated will 
die first. 
Chloride of sodium (common salt) would seem to be of value in pre- 
venting the attacks of mercurial poisoning. Those workmen who are ex- 
posed to its influence, and who are fond of salt, resisting the contamina- 
tion longer than those who are not. Part xxvii., p. 240. 
Mercurial Fumigations.—A very simple and effectual plan is to have 
the patient seated on a caned chair; underneath this you must have a 233 
MILK. 
spirit lamp so placed that the flame impinges on a thin metallic plate, 
which contains the mercury to be volatilized; this ihay bo from one to 
three drachms of calomel for each fumigation, or if the patient inhale the 
mercury according to Mr. Lee’s practice, fifteen grains will be sufficient. 
The chair and patient must be closely surrounded with a blanket. 
Part xxxiv., p. 222. 
Rapid Mercurialization.—Pass ten or fifteen grains of the ung. hyd. 
fort, within the sphincter ani three times a day, and in twenty-four or 
thirty-six hours ptyalism will be established. The patient must be care- 
fully watched lest it run too far. Fart xxxiv., p. 274. 
Mercurial Fumigation.—The efficacy of calomel fumes is much en- 
hanced when combined with the vapor of hot water. For this purpose, two 
separate processes have been had recourse to, one to volatilize the calo- 
mel, and the other to give off steam; but by a very ingenious lamp, 
made by Mr. Blaise, both these processes are combined into one. Mr. 
Pollok, who had used it at St. George’s Hospital, finds that it is very 
useful in private practice for volatilizing sulphur, iodine, etc. 
Part xxxv., p. 187. 
Extemporaneous Production of Milk.—M. Dichost, a Russian chemist, 
proposed the following plan for the preservation and extemporaneous pre- 
paration of milk. He evaporates newly drawn milk, at a very gentle heat, 
till it is all brought into a state of fine powder. It is then put into small 
glass bottles, which are completely filled and hermetically sealed, with 
ground glass stoppers. A small quantity of the powder thus obtained, 
dissolved in an appropriate quantity of water, affords on the instant a milk 
of a very good quality. The powder will remain good for a great length 
of time. Part vi., p. 85. 
Artificial Maternal Milk.—The maternal milk differs from the cow’s, 
principally in containing less caseine or curd, and more lactine, or sugar of 
milk, and from ass’s milk in containing a little more curd and butter. 
Therefore a very perfect substitute for maternal milk may be made by 
adding about two and a half per cent, of cream to ass’s milk, or by remov- 
ing a portion of curd from cow’s milk, and adding a little sugar. 
Part xxxvi., p. 238. 
Substitute for Human Milk.—Lentil powder, or, as it is called, Reve- 
lenta Arabica, contains phosphoric acid, chloride of potassium, and casein. 
Its nutritive is to its calorifiant matter in the proportion of 1 to 2’-, milk 
being in that of 1 to 2. Of all vegetable substances it forms the best 
substitute for human milk, being far preferable to pap, or pulp of wheat 
bread, which, from the absence of chloride of potassium and the too fre- 
quent presence of alum (the former of which is necessary to the solution 
of carbonate of lime, and the latter of which forms with phosphate of 
lime :m insoluble salt,) is totally unfit for this purpose. As a food for 
children with atrophy and debility lentil powder is invaluable. 
Part xxxviii., p. 294. 
BULK. 234 
MOLES MORBUS OOXAEIUS. 
Tattooing of Moles on the Skin.—The part should be washed with soap 
and water, and rubbed till the blood is introduced into the most delicate 
branches of the erectile tissue; the skin is then made tight and covered 
with color similar to the natural color of the skin, which is formed ot white 
lead and carmine. Three needles, sunk into a cork pad, so that their 
points project, are then thrust into the skin, and their points from time to 
time dipped in the paint. In extensive spots, we must proceed gradually,, 
so as not to produce too great swelling. The most difficult part is the 
choice of color corresponding to that of the skin. Part xiv., p. 190. 
Treatment of Moles by Acid Nitrate of Mercury.—Small moles on the 
face, if superficial and not too thick, may be readily destroyed by the acid 
nitrate. A cicatrix of course results, but it is small, and far less unsightly 
than the original disease. Small cutaneous nsevi are often treated at the 
various London hospitals, by means of the nitric acid. Unless the 
disease be of very small extent, the employment of a ligature appears to 
be a much more certain means of effecting the end desired. If there be a 
subcutaneous base to the morbid structure it often persists in growing, de- 
spite frequent applications of escharotics. There is a mild form of dilated 
cutaneous capillaries which produces the marks known as “ port-wine 
stains,” “ spiders,” etc., in the treatment of which much benefit may be 
obtained by the dexterous application of fluid caustics. With a finely- 
pointed glass brush, charged either with nitric acid or the acid nitrate of 
mercury, the tortuous vascular trunks should be severally painted, a 
minute streak of the caustic being thus left along the vhole course. In 
this way, by repeated applications, the whole of the larger vessels may be 
destroyed, and the disfigurement, to a large extent, diminished. The 
“ port-wine stain” is of course very much more difficult to remove than the 
less diffused forms of this condition, such, for instance, as are of frequent 
occurrence on the cheeks or nose; even in it, however, much benefit may, 
by patient treatment, be gained. Part xxxi., p. 241. 
MOLES. 
MORBUS COXARIUS. 
When warranted in Removing the Carious Rone.—According to 
Mr. H. Smith: When the head of the femur is carious, and is acting as a 
source of irritation and wearing the patient down, when we are satisfied 
that nature cannot accomplish a spontaneous cure, and when at the same 
time the caries is confined, or nearly so, to the femur, and there is no 
disease of other and internal organs, we are warranted in removing the 
carious bone. The operation consists in making a longitudinal incision 
over the head and for a convenient distance down the shaft of the femur, 
and another transverse one; clearing away the tissues down to the bonej 
turning it out, and sawing off the diseased portion; lastly, in uniting the 
edges of the wound by suture. Part 115. 235 
MORTIFICATION. 
MORTIFICATION. 
Treatment of Mortification.—In the treatment of mortification, according 
to Prof. Cooper, three primary indications are concerned: 1. To stop the 
progress of mortification. 2. To promote the separation of the dead part 
from the living. 3. To heal the wound, if an operation has been necessary, 
or otherwise the ulcer resulting from loss of substance. These indications 
are common to all species of mortification. In fulfilling the first of these 
—in endeavoring to arrest the progress of mortification, supposing it to 
be acute—you will seek to remove the exciting cause. 
Where mortification is evidently the result of inflammation—where in- 
flammatory fever and an excited action of the blood-vessels surrounding 
the mortified part exist—a moderate antiphlogistic treatment is indicated. 
The excessive action of the sanguiferous system should be cautiously re- 
duced by leeching, purgative, diaphoretic, diluent medicines, and absti- 
nence from animal diet; but this treatment is only to be continued so 
long as the local inflammation and inflammatory fever exist concurrently 
with mortification, since by the mortification of any large portion of the 
body the system itself is greatly shocked, and rendered unable to stand 
against violent treatment. In such cases too much circumspection cannot 
be employed, since frequently immediately upon the subsidence of the 
inflammatory fever, the patient sinks into a state of prostration and nerv- 
ous agitation; and in every case there is more or less of weakness, and, if 
the system has been too much reduced, the consequences are likely to be 
disastrous. 
After the abatement of the inflammatory or symptomatic fever, which 
usually takes place in the transition from gangrene to sphacelus, the oppo- 
site system of treatment must be pursued : stimulants, anodynes, and a 
more generous diet are to be given. 
At one time, bark Avas considered by the surgeons of this country as 
almost a specific in resisting the progress of this disorder ; without deny- 
ing, however, its usefulness in particular cases, this opinion is altogether 
untenable, and is now rejected by men of experience. So far from being 
valuable in all cases, its exhibition would frequently be very injurious. 
After the first stage of mortification, when the inflammation surrounding 
the mortified part has abated, it will often be advisable to employ it as a 
tonic, especially if the appetite is bad and the patient low ; it should then 
be administered with wine and light diet. Also, when the constitutional 
disturbance is of the typhoid kind, bark and quinine may be useful. As 
stimulants, however, ammonia and wines—those of Spain or Madrid—are 
tar preferable. Opium is also very serviceable where severe pain or 
nervous symptoms are present; the best forms of it are the muriate and 
acetate of morphia ; and they should be given frequently in the day, in 
order to keep the constitution under their influence during the whole of 
the twenty-four hours. 
Surgeons trust now more to common means, such as linseed poultices 
and fomentations for stopping the progress of mortification. 
The second indication I named was to promote the separation of the 
slough. Although the slough is dead, and may be cut, pricked, or 
scratched, without pain, and no functional connection exists, there remains 
the attachment of cohesion, from which it cannot forcibly be wrested with- 
out pain or danger. 236 
MORTIFICATION-. 
Where amputation is not strictly indicated, the parts should be left as 
much as possible to nature, only applying moist and emollient applications. 
In the derangement and prostration of the system, always implied in mortifi- 
cation, a little violence will bring on an extension of the evil; and therefore, 
besides the use of the emollient poultice, with or without a solution of 
chloruret of soda, or with a small proportion of finely-powdered charcoal, 
it is to a general treatment that we are to look as the most efficient 
method of expediting the removal of the slough. Let the patient have 
the benefit of the fresh air; let his linen be frequently changed, and his 
chamber be well sprinkled with chloride of lime, and his constitution be 
supported in the manner I have described, and he will then be in the most 
favorable circumstances for losing the slough. Sometimes you will find 
one half of the slough healing much better after the other half has been 
cut away; and, as this proceeding involves no injury of living textures, it 
is, under some circumstances, advisable to adopt it. I ought to mention 
that when a slough separates no hemorrhage generally takes place; the 
blood-vessels are loaded with coaguluin ; and this will explain why, when 
amputation in mortification is performed a little above the line of separa- 
tion, there is often no hemorrhage of importance. 
The third indication—to heal the ulcer, or wound, if amputation has 
been necessary—need not to be dwelt on, as it will be considered when 
we come to speak of the treatment of ulcers, wmunds, and amputations. 
Part xvi., p. 301. 
Chronic 3fortification, or Dry Gangrene.—[The causes of this state 
are often diseases of the valves of the heart, ossification of the large 
arteries, and obstruction of the smaller ones by fibrin. Mr. Cooper ob- 
serves :] 
The first example of chronic mortification, or dry gangrene, is the gan- 
grena senilis, or mortification of old persons. This kind of mortification 
differs in many respects from any other example ; it is peculiar in the dis- 
coloration which takes place being always preceded by severe burning 
sensation in the parts. It commonly occurs in elderly persons—in nine- 
teen cases out of twenty. Not that you may not have similar cases in 
youth. Dupuytren relates several instances of young persons suffering 
from this disorder. It commences at the greatest distance from the 
centre of the circulation, generally one of the toes, in the form of a dark 
purple spot at the side of one of the small toes. Previously, however, 
you find the patient has been suffering pain about the toe, which is often 
supposed to be gout; and you find that the extension of the disease is 
preceded by burning sensation. Its progress is variously marked in differ- 
ent cases : you find that the foot is gradually, sometimes quickly, affected 
as far as the ankle, and has a dark livid color; the leg higher up presents 
a reddish-brown color, and the whole limb has a mottled appearance. 
When the surgeon examines the part of the leg higher up, he finds the 
temperature of the limb much lower than natural, and this loss of heat is 
found to extend along the limb. 
Although this is called dry gangrene, in most cases there is a separation 
of the cuticle, and a dark bloody serum effused into vesicles, as in acute 
mortification, and at the bottom of the vesicles is seen the cutis, dark- 
colored and livid. Whether you are to have much swelling depends on 
the rapidity with which the disease extends: when it advances rapidly MOUTH. 
237 
there is much swelling, but where the progress is slow the swelling is gene- 
rally very slight. 
The patient sometimes suffers a good deal of disturbance in the sto- 
mach ; he suffers from eructations, and delirium and coma come on early 
in severe cases. Where the disturbance is great in the beginning, the 
patient often dies before the mortification has reached to the ankle, about 
the tenth or twelfth day, from constitutional disturbance. 
Now, what are the causes of gangrena senilis? It has been generally 
supposed that there is ossification of arterial trunks, and sometimes we can 
feel very distinctly that the artery is ossified. The larger arteries are not 
invariably ossified in this disease. 
Cruveilhier always referred gangrena senilis to ossification. There 
must be some unfavorable circumstances combined with the ossification, 
as impaired health, diseases of the heart or its valves, producing disorder 
of the circulation. Then the venous blood cannot pass freely, and accumu- 
lates in the lower extremities, impeding the circulation ; and this will ex- 
plain to you the cause of gangrena senilis. It is doubted by many good 
surgeons whether ossification of the arteries alone is capable of producing 
gangrena senilis. I think it is not. No doubt in a broken constitution, 
joined with ossification, it may act as the exciting cause. Dupuytren 
thought the cause was arteritis, by which the arteries became blocked up 
by fibrin. It was observed that the blood was huffy ; in consequence of 
his view, he tried venesection, and three-fourths of his patients were 
saved. This mode of treatment, when tried in this country, did not give 
such favorable results. 
We found that bark was insufficient in this disease, and that opium was 
a much more available remedy ; and the opinion is retained by the best 
surgeons that opium is better than bark in the treatment of gangrena 
senilis. If opium or its preparations be used, half-grain doses of hydro- 
chlorate of morphia should be given every four hours. 
Musk, too, has been tried, and was found to be a most useful medicine. 
Stimulants, brandy and wine, ought not to be forgotten. With respect to 
the local treatment, fomentations and emollient poultices are the most em- 
ployed. I have seen other applications tried; I have seen Laburruque’s 
solution of chloruret of soda, and this, in one case I attended, had the 
effect of diminishing the fetid smell, but did no other good. 
Applications of charcoal were also tried, but these were no better than 
the other. A new practice of late has been introduced; in Chelsea Hos- 
pital, where gangrena senilis is very common among the pensioners, it was 
suggested that it would be a very rational plan to maintain the tempera- 
ture of the limb by enveloping the whole in carded wool. This was tried 
in a case by Sir Benjamin Brodie; the patient got better, and recovered 
with the loss of two toes. Part xvi., p. 302. 
Cancrum Oris, and Phag edema of the Cheek.—Dr. Hunt describes 
these diseases as being identical, varying only in the degree of severity— 
both commencing by ulceration of the mucous membrane of the cheek, or 
where it joins the gums, and that the external eschar is the consequence 
MOUTH. 238 
MOUTH. 
of the internal ulceration. lie considers them to proceed from a cachectic 
state of the system; that they occur more commonly in cold and wet 
weather—sometimes attacking several members of the same family simul- 
taneously, and occasionally prevailing almost like an epidemic. The 
author has treated them very successfully by a free exhibition of the chlo- 
rate of potash, the beneficial influence of that salt being generally appar 
rent within forty-eight hours of its being given, that it seldom fails to 
arrest the progress and to effect a cure, if administered prior to the pa- 
tient being very much exhausted. The quantity of the salt he has been 
in the habit of prescribing, varies from 9j. to 9ij. in twelve hours, accord- 
ing to the age of the child. Part vii., p. 87. 
Aphthous Ulcers of—Use of Pure Tannin.—Mr. Druittsays : In one or 
two cases of lingering atonic phagedasna, I have found it of some service, 
sprinkled thickly on the sore; but more particularly so in those aphthous 
ulcers which sometimes occur in the mouths of adults, from acidity of the 
stomach, and congestion of the liver. Part x., p. 139. 
Treatment of Aphthae by Sulphuric Acid.—Professor Lippich, of Padua, 
has recommended the following liniment in the treatment of aphthae: 
honey, 15 parts; diluted sulphuric acid, 1 part by weight. The ulcerated 
surfaces should be occasionally brushed over with this liniment by means 
of a camel’s-hair pencil. The proportion of sulphuric acid may be in- 
creased if the case is obstinate. Part xiv., p. 90. 
Aphthous Ulcerations of the Mouth and Tongue.— Vide Art. “ Gallic 
Acid.” 
Aphtha.—Apply solution of the sub-carbonate of soda, or of borax, 
of varying strength. (When the aphthous crusts have a disposition to fall 
off, it is only necessary to pencil them with a soft brush dipped in water.) 
A long continued use of alkaline applications is inadvisable ; change them 
therefore for astringents and the mineral acids. Or apply a solution of 
nitrate of silver, eight grains to the ounce. Internally give soda, aqua 
calcis, or magnesia usta. If there is a vomiting of the milk, give an emetic; 
if the stools are cheesy-looking, give purgatives, especially castor-oil, or if 
there is much secretion of mucus, rhubarb or jalap. To relieve the colicky 
pains give rhubarb and magnesia, or liq. succin. amnion, by the mouth or 
rectum. Avoid giving medicines in sugar, which being changed into lactic 
acid, favors the growth of the aphtha. Take care that the milk is of good 
quality, and that the child is exposed to a free and pure atmosphere. 
, Part xvi., p. 144. 
Ulcerative Stomatitis or Noma.—[By this name, Dr. West describes an 
affection of the mouth, distinct from follicular or aphthous stomatitis on 
the one hand, and from cancrum oris or gangrenous stomatitis on the other. 
It attacks the gums, and destroys them extensively by a process, not of 
gangrene, but of ulceration. It occurs chiefly in children who have had 
deficient food and have lived in damp, unhealthy places: but is not preceded 
by any special derangement of the general system. The symptoms are as 
follows:] 
On opening the mouth, the gums are seen to be red, swollen, and spon- 
gy, and their edge is covered with a dirty white or greyish pultaceous de- 
posit, on removing which their surface is exposed, raw and bleeding. At 
first only the front of the gum is thus affected; but as the disease advan- 
ces. it creeps round between the teeth to their posterior surface, and then, MOUTH. 
239 
destroying the gum both in front and behind them, leaves them denuded, 
and very loose in their sockets, but it is not often that they actually fall 
out. The gums of the incisor teeth are usually first affected; those of the 
lower jaw more frequently and more extensively than those of the upper; 
but if the disease be severe, the gums at the side of the mouth become 
likewise involved, though it is seldom that the two sides suffer equally. 
Sometimes aphthous ulcers, like those of follicular stomatitis, are seen on 
the inside of the mouth in connection with this state of the gums; but 
oftener it exists alone. On those parts of the lips and cheeks, however, 
which are opposite to, and consequently in contact with, the ulcerated 
gums, irregular ulcerations form, which are covered with a pultaceous 
pseudo-membranous deposit, similar to that which exists on the gums them- 
selves. Sometimes, too, deposits of false membrane take place on other 
parts of the inside of the mouth, the surface beneath being red and spon- 
gy, and bleeding, though not distintly ulcerated. If the disease be severe 
and long-continued, the tongue assumes a sodden appearance, and is indent- 
ed by tlie teeth, and the cheek on one or other side is somewhat swollen, 
while the saliva, though rather less abundantly secreted than at the com- 
mencement of the affection, continues horribly fetid, and is often streaked 
with blood, the gums themselves bleeding on the slightest touch. But 
even if left alone, the affection usually subsides in the course of time, 
though it may continue almost stationary for days or weeks together, and 
this notwithstanding that the general health is tolerably good. It would 
be too much to say, that this unhealthy ulceration never degenerates into 
gangrene; but though a very large number of cases of ulcerative stoma- 
titis have come under my notice, I have seen only one instance in which 
it was succeeded by true gangrene of the mouth. When recovery has 
commenced, the disease ceases to spread; the drivelling of fetid saliva 
diminishes; the white pultaceous deposit on the gums, or on the ulcera- 
tions of the cheek or lips, becomes less abundant; the ulcers themselves 
grow less ; and finally, the gums become firm, and their edges of a bright 
red, though still for a long time showing a disposition to become once 
more the seat of the ulcerative process, and continuing for a still longer 
time to cover the teeth but very imperfectly. 
Various internal remedies and local applications have been at different 
times recommended for the cure of this affection. Tonics have been much 
employed, and the supposed analogy between this state of the gums and 
that which exists in scurvy, has led practitioners to give the preference to 
remedies supposed to be possessed of antiscorbutic properties. Lotions of 
alum, or burnt alum in substance, or the chloride of lime in powder, have 
all been used locally with more or less benefit. It was my custom also to 
prescribe these remedies in cases of ulcerative stomatitis; but since the 
chlorate of potash was introduced to the notice of the profession by Dr. 
Hunt, I have learned to rely upon it almost exclusively. It appears, in- 
deed, almost to deserve the name of a specific in this affection; for a 
marked improvement seldom fails to be observed in the patient’s condition 
after it has been administered for two or three days, and in a week or 
ten days the cure is generally complete. Three grains every four hours, 
dissolved in water, and sweetened, is a sufficient dose for a child three 
years old, and five grains every four hours is the largest quantity that I 
have administered to a child eight or nine. If* the bowels be constipated, 
a purgative should be previously administered ; but there seems to be no 240 
MOUTH. 
form nor any stage of the affection in which the chlorate of potash is 
not useful. The diet should be light but nutritious, and quinine and other 
tonics are sometimes serviceable if the child’s health should continue feeble 
after the local malady has been cured. Part xviii., p. 111. 
Gangrenous Stomatitis, or Cancrum Oris.— [Ulcerative stomatitis is an 
affection of such frequent occurrence that many instances of it come under 
my notice every year, especially during the damp autumnal months; while 
it is attended with so little danger, that the only case in which I have 
known it prove fatal was one in which gangrene of the mouth supervened 
upon it. Gangrenous stomatitis, on the other hand, is a disease so rare 
that I have only five times had the opportunity of witnessing it: but so 
fatal, that in four out of these five cases the patients died. 
Dr. West proceeds to the treatment. He says :] 
The arrest of the sloughing is the one point to which in the treatment of 
this affection the attention of all practitioners has been directed. The small 
amount of success which has attended their efforts is partly attributable to 
the circumstance that the affection has frequently been overlooked, until it 
has already made considerable progress ; in part also to the fact that when 
recognized, the local remedies employed in order to check the gangrene 
have either been too mild, or have been applied with too timorous a hand. 
Unfortunately, too, there is considerable difficulty in applying any caustic 
effectually to the interior of the mouth—for not only does the tense and 
swollen condition of the cheek prevent our obtaining easy access to the 
gangrenous parts, but the child naturally resists an operation which cannot 
but occasion it most severe pain. Ineffectual cauterization, however, is use- 
less, or worse than useless ; and though every endeavor should be made to 
prevent the needless destruction of healthy parts, yet of the two evils, that 
of doing too much is unquestionably less than that of doing too little. It 
is of importance, moreover, not only that the cauterization should be done 
effectually, but also that it should be practised early. 
When once the mortification has extended through the substance of the 
cheek, the chances of arresting its progress must be very few. As the slough- 
ing advances from within outward, it is to the interior of the mouth that our 
remedies must be applied, and since the advance of the disease is too rapid 
to allow of our trying mild means at first, and afterward resorting, if neces- 
sary, to such as are more powerful, we must employ an agent sufficiently 
energetic at once to arrest its progress. Various caustics have been re- 
commended for this purpose, but none appear to be so well fitted to accom- 
plish it as the strong hydrochloric or nitric acid. I am accustomed to 
employ the latter, applying it by means of a bit of sponge, or of soft lint or 
tow, fastened to a quill, while I endeavor, by means of a spoon or spatula, 
to guard the tongue, and other healthy parts, as far as possible, from the 
action of the acid. In the only case that I saw recover, the arrest of the 
disease appeared to be entirely owing to this agent, and though the alveo- 
lar processes of the left side of the lower jaw, from the first molar 
tooth backward, died and exfoliated apparently from having been destroyed 
by the acid, yet it must be owned that life was cheaply saved even at that 
cost. Some increase of the swelling of the cheek almost invariably follows 
the application of this agent—a circumstance which may at first occasion 
unfounded apprehensions lest the disease be worse. Twelve hours, how- 
ever, must not be allowed to elapse, without the mouth being carefully ex- MOUTH. 
241 
amined, in order to ascertain whether the disease has really been checked, 
or whether there is any appearance of mortification in the parts beyond 
the yellow eschar left by the first application of the acid. The cauteriza- 
tion may now be repeated, if it appears necessary, and even though the dis- 
ease had seemed completely checked,; yet reliance must not be placed on 
the improvement continuing, but the mouth must be examined every twelve 
hours, for fear the mortification should spread unobserved. During the 
whole progress of the case the mouth must be syringed frequently with 
warm water, or with chamomile tea mixed with a small quantity of the solu- 
tion of chloride of lime, in order to free it from putrid matters that collect 
within it, and to diminish, as much as possible, their offensive odor. Should 
the case go on well, the frequent repetition of the strong acid will be un- 
necessary, but the surface may still require its application in a diluted 
form, or it may suffice to syringe the mouth frequently with chloride 
of lime lotion, or to apply the chloride in powder once or twice a day, 
according to the suggestion of MM. Rilliet and Barthez. In the last two 
cases of this affection that came under my notice, I likewise employed the 
chlorate of potash internally, as recommended by Dr. Hunt, but it did not 
appear to exert any influence over it; and valuable though the remedy is in 
ulcerative stomatitis, it would, I think, be merely trifling with your patient’s 
chances of recovery to trust to it in true gangrene of the mouth. 
During the whole course of treatment you have another indication to 
fulfill—namely, to support your patient’s strength by nutritious diet, and by 
the employment of wine and other stimulants, and the administration of 
quinine, or of the extract or tincture of bark, or whatever form of tonic 
might seem best suited to the peculiarities of the case. 
In conclusion let me remind you, that during the whole progress of the 
case, your prognosis must be regulated by the state of the local disease, 
rather than by the urgency of the general symptoms. So long as the 
sloughing is unchecked, the affection is tending rapidly to a fatal issue, and 
this even though the pulse be not very feeble, though the appetite be good, 
and the child still retain some show of cheerfulness. Part xviii., p. 113. 
“ Nurses' Sore Mouth."—Dr. Holt states that every case he has treated 
of this disease “ has yielded within forty-eight hours to the use of iodide of 
potassium, in gr. v. doses three times a day.” Part xviii., p. 303. 
Cancrum Oris.—Apply strong nitric acid freely to the edges of the 
slough, all around, taking care that the little patient takes a full inspiration 
previous to the application of the acid, so as to obviate the danger of the 
vapor getting into the lungs ; and repeat the application every day, as long 
as it may be necessary. Put on a linseed poultice, which should be changed 
twice a day; and detach each slough as soon as it can be done. Let the 
patient have meat diet, and wine. And give chlorate of potash, fifteen 
grains and upward (for children of six or eight years old) daily, in divided 
doses. Partfxxi., p. 223. 
“ Stomatitis Ulcerosa ” of Children.—[These ulcerative affections in 
the mouths of infants and young children are often exceedingly troublesome. 
They may not depend upon any specific cause, but chiefly on debility, with 
possibly some trivial local affection superadded. Mr. Mackenzie has em- 
ployed the following simple method of treating the disease with much suc- 
cess :] 
The term “ stomatitis ulcerosa ” sufficiently and accurately expresses the 
VOL. TT. 16 242 
MOUTH, 
nature of this affection ; but in its mode of origin, situation and extent, it 
presents many varieties. Thus, in one form, it commences as a small in- 
flammatory spot, either on the frenuin of the tongue, the outer surface of 
the gums, or the mucous membrane of the cheek or lip; but wherever it 
commences, ulceration speedily supervenes, attended with febrile disturb- 
ance, a coated tongue, profuse salivation, and a disordered state of the 
tomach and digestive organs. In another form, it is found to be connected 
with the passage of some of the larger teeth through the gum, more espe- 
cially when several are about to make their appearance together. In this 
case, the gum becomes swollen, painful, and dark-colored; and, after a few 
days, the portion over the protruding teeth gives way by ulceration, which, 
in some cases, extends considerably, attended with tumefaction of the 
mouth and cheeks, increased salivary discharge, and febrile disturbance. 
More frequently, however, it commences with a general swelling and irri- 
tation of the gums, together with much fetor of the breath, a coated 
tongue, and much gastric disorder. Along the upper margin of the gum, 
or rather that which is in contact with the teeth, a line of ulceration now 
soon becomes developed; and this, when once begun, rapidly spreads, 
the gums, at the same time, being spongy, swollen, and very painful. 
Unless excited by some local cause, such as the irritation of a decayed 
tooth, it usually commences in the lower jaw, and from thence is com- 
municated to the mucous membrane of the corresponding cheek. The 
irritation attending it affects the salivary and cervical glands in a remark- 
able manner; both become swollen, and the former secrete so profusely 
that the child appears to be constantly dribbling. In this form there is 
generally some febrile disturbance, and much gastro-intestinal disorder. 
If severe, it may not only cause destruction of the gums, but loosening of 
the teeth, suppuration of their sockets, and partial necrosis of the jaw. Its 
intensity, however, varies very considerably in different cases; in some it 
is so slight as to require little or no special treatment, whilst in others it 
can only be controlled by very prompt and energetic measures. 
In the general management of these cases, we are directed to employ, 
locally, strong solutions of the nitrate of silver, or of the sulphate of cop- 
per or zinc, with or without astringent, stimulating, or detergent gargles, 
and to administer, at the same time, quinine, tonics, and a liberal diet. I 
formerly followed these instructions closely, but sometimes with equivocal 
success; and I am now, after repeated trials, disposed to give the prefer- 
ence to the following method of treatment. It consists in removing, in 
the first place, any apparent cause of irritation, such as a decayed tooth, 
should it exist, and applying, daily, the dilute nitric acid of the pharmaco- 
poeia, to the whole of the ulcerated surfaces, by means of a sponge, or 
camel's-hair pencil; whilst, at the same time, the sesquicarbonate of 
ammonia is given in full doses, combined with citrate of iron. When the 
tongue is coated, and the alvine discharges are unhealthy, it is necessary 
to premise an emetic of ipecacuauha and squills, as well as a purgative of 
calomel and rhubarb. It is also necessary that the patient should be well 
supported by a nutritious diet, an adequate allowance of malt liquor, or 
wine. 
I will briefly add, that the employment of ammonia in these cases was 
first suggested to me from observing its beneficial effects in the ulcerative 
affections of the mouth and throat, which occur in children in connection 
with scarlet fever. Part xxvi., p. 95. 243 
MOXA. 
Stomatitis ( Ulcerated) and Cancrum Oris.-—In a severe epidemic of 
this disease, the cases were treated by a mild aperient of magnesia and 
rhubarb, and by chlorate of potash dissolved in water sweetened with sirup, 
in doses of 4 grains every fourth hour. The mouth was also washed with 
a weak solution of chloride of sodium. They all recovered in about six 
days. jPart xxvii., p. 83. 
Thrush.—Dr. Jenner says this disease depends upon the presence of a 
parasite. It is speedily removed by applying a solution of sulphite of 
soda, 3j. to the §j. of water. The secretions of the mouth, being acid, 
combine with the alkali and set the sulphurous acid free, which is the 
active agent in destroying the parasite. Part xxviii., p. 227. 
Cancrum Oris.—According to Dr. Fleming, this disease is generally 
preceded by some other malady, as measles, croup, etc., followed by 
bilious diarrhoea, which induces a state of the system in which there is a de- 
ficiency of sulphur. The treatment must consist in the local application 
of a solution of the biborate of soda. The constitutional remedies are 
Fleming’s tincture of aconite, six drops to two ounces of -water; a tea- 
spoonful to be given every three hours. This will subdue the vascular 
excitement. The tincture of nux vomica must afterward be given to 
stimulate the secreting vessels of the liver, and also sulphur to supply the 
deficiency of this element in the system. 
If you meet with the case before it has spread far, remove the slough 
with the knife, apply the strong solution of the nitrate of copper freely to 
the exposed surface, and pai,nt the surrounding cheek with collodion. 
• * Part xxxiv., p. 80. 
Mouth— Congelation in Operations on.—It will be very difficult to 
produce the required benumbing effect, says Mr. Quinton, except with 
great care. It is necessary that the cold be applied equally and with some 
pressure. It is much better to inclose the freezing mixture in a thin 
India-rubber bag, to prevent the ingredients escaping and irritating the 
mouth. It will also be necessary repeatedly to change or mix the fluid so 
as to maintain the desired cold. Part xxxiv., p. 137. 
Ulcerous Stomatitis in the Army.—M. Bergeron writes that during 
the Crimean war, ulcerous stomatitis, amongst the young soldiers, assumed 
an “ endemo-epidemio ” form. The most rapidly efficacious method of 
treatment was found to consist in the exhibition of chlorate of potash, pre- 
ceded or not by an emetic. If, after some little time, no benefit followed 
this treatment, the dry chloride of lime was substituted for the chlorate 
of potash. In most instances, however', speedy cure resulted from the use 
of the chlorate alone. Part xl., p. 58. 
MOXA. 
Lime Moxa.—When it is recommended to apply a moxa to any part of 
the body, Dr. Osborne, of Dublin, has found quicklime to answer the 
purpose admirably. The quicklime is to be placed on the skin, inside a 
porte moxa, or a strip of card bent together and tied so as to form a cir- 
cle ; some water is then dropped on and mixed with it. “In about two 
minutes the mixture swells and becomes dry, and at the same time a 244 
MUSCLES, 
high degree of heat is produced, which, according to some experiments, 
may amount to 500° Fahr.” This is certainly a very convenient and cheap 
mode of applying the moxa, and may be useful in making issues of any 
depth. Dr. Osborne thinks “ that the heat produces a contraction and 
change in the action of the vessels of the parts over which it is applied, 
with great excitement of the absorbents, enabling them to return to a 
state of health after the failure of all other means,” as is well known and 
acted upon by veterinary surgeons when they use the actual cautery. 
Part v., p. 129. 
New 3Iethod of Applying Counter-Irritation—“ Electric Moxa ”—Dr. 
Bird has proposed a novel method of producing a persistent discharge 
from the skin by means of galvanism. The making an issue, the insertion 
of a seton, the application of a moxa or cautery-iron, all apj>ear formid- 
able operations to timid patients. 
Apply a blister the size of a shilling to the part where you wish to es- 
tablish a counter-irritation, and another of the same size a few inches from 
it; when the cuticle is raised, snip it, and apply to the first one a piece of 
zinc foil, and to the other a piece of silver; connect them by a copper wire, 
and cover with wet lint and oiled silk. In forty-eight hours an eschar will 
appear under the zinc plate. Keep the plates on until the eschar 
separates, and then apply a poultice to the sore that remains. 
Part xvi., p. 293. 
MUSCLES* 
Affections of Voluntary Muscles—Some of the Consequences of 
Blows and the lilce Injuries of Muscles.—A blow on a muscle or on its 
nerve may be followed by complete wasting. Total atrophy of the abduc- 
tor indicis and adductor minimi digiti has followed a sharp and very severe 
blow in front of the anterior annular ligament. 
After a severe injury to a joint, the muscles acting on it may pass into 
a state of fixed contraction, or may start into contraction at any effort to 
move them, whether actively or passively. The joint thus stiffened is 
likely to be regarded as one that has been wrongly treated; the fracture 
or the dislocation, if either have occurred, may be thought to have been 
left unreduced, and an incurable anchylosis may be talked of. But the 
stiffness of the joint is due to the muscles alone; and if, by giving the 
patient chloroform, they be relaxed and put beyond the influence of his 
will, the joint becomes at once naturally movable, or nearly so. This con- 
dition has been noticed at the elbow, the knee, and the hip. Chloroform, 
which may first serve as a test of the state of the joint and muscles, may 
afterward be used, to give opportunity for painless and free motion of the 
joint while the muscles are recovering. And their recovery may be ac- 
celerated by friction, warmth, passive motion to any extent that they will 
allow, and (which is far better) every possible effort of the patient’s own 
will to move them. Part xxxvii., p. 245. 
Myalgia, or Muscular Pain.—Dr. Inman has written an article on 
myalgia or muscular pains. The importance of this affection does not 
arise from it, per se, but from its great resemblance to other painful affec- 
tions, as hysteria, neuralgia, pleurisy, peritonitis, disease of the liver, kid- NjEVI, 
245 
ney, bladder, or uterus; for all which affections the author has seen it mis- 
taken, of course causing needless alarm to both patient and physician. It 
is generally attended with want of power of the system; the fleshy parts 
of the muscles, or their tendinous prolongations, will not bear the least 
stretching, and in many cases the pain arises solely from this cause, from 
over fatigue, etc. The pain is independent entirely of the course of 
nerves, is hot and aching, and attended commonly with tenderness on the 
least pressure. This affection will be aggravated by antiphlogistic treat- 
ment, but relieved by measures calculated to raise the tone of the system, 
as stimulants, tonics, generous diet, etc. Part xxxix., p. hi>1. 
Hysterical Muscular Ilypercesthesia.—In addition to general treatment, 
M. Briquet recommends faradization of the skin, as performed by M. D«- 
ehenne. By his apparatus the electrical current is limited to the skin. 
The hypersesthesia is usually at once dissipated. Stimulant applications, 
as very hot cataplasms, dry heat, chloroform, and acetic ether, locally ap- 
plied (which act more as irritants than narcotics,) sinapisms, and blisters 
will also be of the greatest use in the relief of the local symptoms. 
Part xxxix., p. 87. 
NiEVI. 
Treatment by Caustics.—Speaking of caustics, Sir B. Brodie says, 
Caustics may be used with advantage in congenital tumors, naevi, etc. 
Little vascular spots on children’s laces are an object of anxiety frequently 
in the upper classes ; if you look at these you will see one large vessel and 
several branches supplying them. You may destroy these in the follow- 
ing manner: Take a glass pen (pointed glass made into the shape of a 
pen), which will hold nitric acid, and apply it to the principal vessel; or, 
in this Avay, look for the principal vessel, puncture it, and insei’t into the 
puncture a fine point of pot.assa fusa; a moment’s touch will be sufficient 
to destroy the vessel; if the potassa extend further than you intended, 
apply vinegar. You may thus obliterate the vessel without leaving a scar. 
There are some congenital naevi abounding in the skin, formed by a very 
intricate mesh of vessels; the skin is elevated and of a mulberry color. 
If these are of large size, they must be destroyed by ligature or the knife ; 
if of smaller size, you may use caustics not unprofitably. The nitric acid 
is the best application; this makes a slough, the blood coagulates, and the 
parts become indurated. This is only applied when naevi are of small 
size. In subcutaneous naevi, which are not of the same color, but purple, 
caustics may be applied to effect their destruction, whether of a large or 
small size; the great object is to destroy them with caustic rather than 
ligature. These naevi have been cured by the application of vaccine mat- 
ter, which acts by producing a slough, but I cannot depend upon it, not 
having tried the matter myself. You may cure these subcutaneous naevi 
on the same principle; by this method puncture them with a finely- 
pointed lancet, then, having a probe armed with nitrate of silver by dip- 
ping it into fused nitrate of silver, introduce it into the puncture, the 
caustic presently causes sloughing, and the vessels are obliterated. If the 
tumor be of a large size, the application must be repeated. I have used 
this plan with great advantage, when it was necessary save the skin. 246 
NJ5VI. 
I was called to see a child with naevus of the nose; to have cut it out, 
would have disfigured her for life; so I used a narrow instrument for di- 
viding the skin, and inserted the caustic-armed probe into the wound ; the 
operation, after having been performed a few times, succeeded perfectly, 
and a scarcely observable mark only was left. I have destroyed extensive 
naevi in this way, without leaving a scar. The nitrate of silver is the best 
caustic for such tumors, and when you apply it, use olive oil to prevent it 
excoriating the skin. I may observe once for all, that it is neees ary to 
use this precaution. If you are employing caustic potass, have vinegar 
by you; if chloride of zinc, bicarbonate of potass, and so with the other 
caustics. Part iii.,/>. 72. 
Treatment of Naevus—Operation by Prof. Pattison.—An assistant, 
by means of a spirit lamp, made the needles red-hot, and they were 
passed in rapid succession about twenty times into the tumor in all direc- 
tions. There was no hemorrhage, and the child apparently suffered very 
little pain. The operation was repeated twice afterward, after intervals 
of a week, and in the course of a month the tumor had entirely sloughed 
away, and the part healed. Part vi., p. 157. 
Treatment of Vascular Naevus.—Prof. Smith, of Baltimore, has de- 
vised the following method of treating vascular naevus. lie saturates a 
thread with a saturated solution of caustic potash. This is dried by a 
fire, and a needle being armed with it, the base of the tumor is transfixed 
with the needle, and the thread quietly drawn through the part. This it 
repeated in different parts of the tumor. Dr. S. states that he has now 
under care a case treated by this plan, and the tumor is rapidly wasting, 
without any distressing symptoms having occurred. Part viii., p. 160. 
Blepharoplastie.—Dr. Baumgarten was consulted about a child, six 
months old, which had a large oval naevus maternus on the lower eyelid 
of the right eye, extending down to the cheek. Pulsations isochronous 
with the pulse could be both seen and felt, and as the period of its burst- 
ing could not be far distant, to judge from its appearance, Dr. Baumgar- 
ten determined to remove it by extirpation, and to replace the loss of sub- 
stance by blepharoplastie. In effecting the extirpation of the naevus, it 
was found that the vascular dilatations extended so deeply, that the orbi- 
culus muscle was cut across, and the incisions penetrated into the cavity 
of the orbit. The hemorrhage was less than might have been expected. 
The flap to cover in the large wound that had thus been made was taker 
from the temple and united to the vicinal parts by four sutures. In spite 
of the continual application of cold water, some swelling of the face fol- 
lowed, but soon subsided. Union by the first intention took place 
throughout the part operated on by the third day, and by the fourth the 
last suture was removed. The wound by the temple suppurated freely, 
the edges, however, being drawn together, and the bottom filled with 
healthy granulations. In another week the loss of substance on the tem- 
ple was replaced, and the cicatrices of the eyelid •were scarcely visible. 
Part viii., p. 165. 
Cure of Ncevi by Croton Oil.—M. Lafavque states his method of cur- 
ing naevi, by inoculating with croton oil, as follows: Five or six punctures 
should be made on and around the tumor, with a lancet dipped in the oil, 
just as in vaccination. NuEVI, 
247 
Each of the punctures causes immediately a pimple, which in thirty-six 
hours is developed into a little boil. These boils unite and form a*red, 
hot, painful tumor, covered with white crusts, and resembling a small car- 
buncle. Two days afterward the scabs separate, and in lieu of the ncevus 
is seen an ulcer, which is to be treated on general principles. It would 
be dangerous to make more than six punctures on a very young infant, as 
the irritation and fever are considerable. Part ix.,p. 179. 
Creasote in JVcevxis Maternus.—Dr. Thornton informs us that of all the 
applications he has tried against nsevus, the most effectual is creasote. He 
had treated three cases in the course of the year successfully with this 
substance. It is applied two or three times daily, more or less diluted. 
Excoriation, ulceration, and gradual disappearance of the naevus ensues ; 
the cicatrix had always been smooth and sound. Part xi.,p. 186. 
Aneurism by Anastomosis.—Aneurism by anastomosis, or mevns ma- 
ternus, as it is termed, when congenital, consists, as is well known, of a 
congeries of enlarged and dilated arteries and veins, which can be emptied 
of their contents by pressure, and gradually relill when the pressure is re- 
moved. Mr. Cooper considers the disease to be of an atonic character, 
dependent, not upon excessive action, but upon a defective condition of 
the coats of the vessel, arising from arrest of nutrition; so that the dis- 
ease may be said to originate in the vasa vasorum. 
When the tumor is small, it is often sufficient to keep the surface con- 
stantly wetted with a strong solution of alum ; #r a saturated solution of 
alum may be injected into the tumor with a very fine syringe, but this 
must not be done if the tumor is large. Pressure, by means of a plaster- 
cast bound upon the part is only applicable when the disease is situated 
over bone, and is not always successful; neither is vaccination. The ap- 
plication of nitric acid is objectionable, from the hemorrhage which re- 
sults when the slough separates; the same danger, that of hemorrhage, 
attends the practice of excision. The ligature is the most generally appli- 
cable mode of treatment, and may be applied, if the tumor is small, by 
passing two needles through its base at right angles to each other, tying 
the ligature tightly' round them,'and replacing it by another when it be- 
comes loose. Part xx, p. 124. 
Treatment of JVcevus by a Solution of Iodine.—[Dr. Bulteel has used 
wfith the most satisfactory result, a solution of iodine Bj., in sp. vin. rect. 
§ss. He says:] 
The preparation was applied freely once every day, not exciting the 
slightest constitutional derangement, and the disease every two or three 
days scaling itself, if I may use the expression, and thus disappearing gra- 
datim till nothing more could be seen but two little spots of the size of a 
pin’s head. The application at once arrests the growth of the naevus and 
nothing but a regular daily application is needed for its final removal. 
Part xx., 126. 
Use of Collodion in JVcevus.—Dr. Brainard. of Chicago, struck with 
the contractile power possessed by the etherial solution ot gun-cotton, 
was induced to test its application to the surface of erectile tumors. The 
first case which he treated in this way was an erectile tumor, the size of a 
strawberry, situated over the anterior fontanelle of a very young infant. 
Although the tumor was considerably elevated above the general surface 248 
N^ETVI. 
of the scalp, it was at once reduced when the solution had dried, and, after 
a second application, at the end of six weeks, seemed to be cured. 
Part xxi., p. 197. 
Use of Nitric Acid.—Apply a drop of strong fuming nitric acid, by 
means of a glass rod, and let it dry on. If the naevus is very small, not 
even a scar will be left. Part xxi., p. 261. 
Use of the Actual Cautery.—Pass a flat platinum needle, heated to 
whiteness, through the substance of the naevus. Part xxi., p. 261. 
Treatment of Ncevi.—The following methods of treatment for the 
cure of naevi have each their advocates, and are more or less benficial, 
according as the naevus may be of the cutaneous, subcutaneous, or mixed 
variety. 
They may be severally arranged under the three following heads: 
1. To induce atrophy of the new growth, by— 
a. Compression. 
h. Astringents or refrigerants. 
c. Ligature of the vessels of supply. 
2. To excite inflammation in the tissue of the naevus, and thus obliter- 
ate the cells of the new tissue, by— 
a. Seton. 
h. Acupuncture. 
c. Laceration of the tissue by punctures. 
d. Incision and the ftisertion of sponge. 
e. Cauterization with potassa fusa, chloride of zinc, etc. 
f. Injections of stimulating solutions. 
g. Punctures with a probe coated with argenti nitras. 
h. Vaccination. 
i. Punctures, with a lancet’s point covered with croton oil. 
3. The entire removal of the new growth, by— 
a. Excision of the disease only. 
b. Amputation of the part affected, as of lips, prepuce, labium pu- 
dendi, fingers, etc. 
c. Ligature in various ways. 
d. Complete destruction with caustics. Part xxiv., p. 196. 
Pemoval of a Ncevus by Platinum Wire, heated by a, Galvanic Cur- 
rent.—[Cases of fistmla in ano and hemorrhoids having been successfully 
cured in this manner, in University College Hospital:] 
Mr. Ililton has been trying this plan of cutting and searing at the same 
time upon a naevus of the flat kind, situated in front of the ear of a child 
two months old. The operation was performed with Cruikshank’s bat- 
tery and a very thin wire, which was first intended to tie around half the 
tumor, which was about the size of a crown piece. Hut the wire ran so 
easily through it, that the whole was completely removed, and the parts 
are now fast cicatrizing. This is rather a quicker measure than the liga- 
ture, and just as secure, since hemorrhage is so rare. Part xxv., p. 19o. 
Treatment of Ncevi.—Mr. Lloyd destroys naevi slightly raised above 
the surface with potassa fusa, and there is hardly ever a return of the 
growth. We have seen him use the caustic upon very young children, 
and the latter did not seem to suffer much pain. With erectile tumors, 
Mr. Lloyd excites the sloughing action, by injecting into the substance of J5LEVI. 
249 
the growth the aromatic spirit of ammonia, by means of a small syringe, 
with a long and delicate pipe. The naevi seldom resist the action of the 
c austic fluid, and generally become obliterated in a few weeks. 
Part xxv., p. 196. 
New Instrument for injecting the Perchloride of Iron in Cases of 
Ncevus, etc.—In several cases in which this remedy had been employed in 
cases of naevus, two circumstances proved unfavorable to its success. Iu 
the first place, by its being in some too freely used, inflammation and 
sloughing had been produced; and, in the second, the flow of blood had 
prevented the defective instrument acting efficiently. To remedy this lat- 
ter defect, Mr. Furgusson has invented the following: 
It consists of a very small glass syringe, the point of which terminates 
in a fine platinum tube. This tube is incased in another one, about a quart 
ter of an inch longer than the first, ending in a sharp trocar-like point, 
and having, near its extremity, an oblique opening in one side. By rota- 
ting the outer tube on the contained one, their apertures may be made to 
correspond or otherwise, at the will of the operator. Thus, then, the ne- 
cessity for two instruments is quite done away with. The syringe having 
been charged, the operator rotates the outer tube, so as to conceal the 
orifice of the inner one entirely, and protect it from the ingress of blood. 
In this state the instrument is passed into the centre of the tumor, and, 
having been stirred about as much as may be thought desirable, the tube 
is turned back so as to expose the orifice ; and the piston being at the 
same moment depressed, a drop or two of the solution is squeezed out. 
Part xxviii., p. 172. 
Erectile Tumor of the Orbit.—The following mode of treatment was 
quite successful. A solution of lactate of iron (eight grains to one drachm 
of distilled water) was injected into the centre of the tumor. Violent 
pain in the head and vomiting succeeded, but these gradually disappeared, 
and the recovery was perfect. Dr. Brainard, the author of this paper, 
believes the injection of the perchloride of iron into the blood to be ex- 
ceedingly dangerous, because it is a substance abnormal to the constitution 
of the blood, and because it produces instant coagulation. In the case of 
the lactate of iron, its components already exist in the blood, and its 
effects are not sudden coagulation, but a thickening of the coats with de- 
position of coagulable lymph from subacute inflammation being induced. 
Part xxviii., p. 174. 
Treatment of Ncevus by Tartar Emetic.—Apply on a piece of thin 
leather, cut accurately to the size of the tumor, a compound of fifteen 
grains of tartar emetic to 5j. of galbanum plaster. Inflammatory action 
is set up and the vessels obliterated. Part xxix., p. 207. 
Use of Acid Nitrate of Mercury.—In moles and nsevi of the face,.if 
superficial, apply a solution of the nitrate of mercury in strong nitric acid. 
There is a mild form of dilated cutaneous capillaries which produces the 
marks known as “ port-wine stains,” “ spiders,” etc., in the. treatment of 
which-much benefit may be obtained by the dexterous application of fluid 
caustics. With a finely-pointed glass brush, charged either with nitric 
acid, or the acid nitrate of mercury, the tortuous vascular trunks should 
be severally painted, a minute streak of the caustic, being thus left along 
the whole course. In this way, by repeated applications, the whole of 250 
N^EVI. 
the larger vessels may be destroyed, and the disfigurement to a large ex- 
tent, diminished. 
Vide Art. “ Boils.” Part xxxi., p. 240. 
JVcevus—Caustic Collodion.—In cases where excision is impracticable, 
there is no better caustic, when it is desired that they should disappear 
quickly and certainly, than a solution of four parts of deuto-chloride of 
mercury in thirty of collodion. It should be applied with a camel’s-hair 
brush. Part xxxiv., p. 277. 
More than a Hundred Ncevi on the same Infant.—A case lately occurred 
to Mr. Hutchinson of the Metropolitan Free Hospital where there were 
more than a hundred distinct nsevi of the most superficial character on the 
same child ; all were cured, except about twelve on the scalp, by the con- 
tinued application of the compound iodine ointment. To the remainder it 
is proposed to apply nitric acid should they not diminish under a conti- 
nuance of the former treatment. Part xxxvii., p. 138. 
Treatment of Mcevus by Injections with Tannic Acid.—Mr. Haynes 
Walton has recently treated several cases of naevus in the following man- 
ner : A small tendon knife having first been pushed into the base of the 
tumor and moved about slightly, to break up the tissue, a solution of 
tannin, a drachm to an ounce of water, is injected by means of a syringe 
with a small nozzle. This must be slowly performed, and must be given 
up directly the tension of the tumor becomes apparent; by this means the 
blood coagulates, and after the lapse of some weeks the tumor disappears. 
There is no risk of sloughing taking place as when the muriated tincture 
of iron is used. Part xxxvii., p. 269. 
Subcutaneous Ncevus over the Anterior Fontanelle.—Mr. Erichsen 
treated a congenital naevus over the anterior fontanelle of an infiint a few 
weeks old, at University College Hospital in the following manner: A 
puncture was made through the scalp on one side of the naevus, and a blunt 
needle-eyed probe armed with a ligature was passed through the base of 
the nan us to the opposite side, which emerged through another opening 
made with a knife. This was repeated at right angles to the first thread, 
and the four double cords were firmly tied, through fissures made in the 
skin, around the tumor, and complete strangulation effected. No cerebral 
symptom was manifested during the process. In such cases as these Mr. 
Erichsen does not use needles in the usual way, because the membranes of' 
the brain might be punctured, and death might ensue. But when per- 
formed in the manner described, there is not the same risk, and in about 
half a dozen cases thus treated by him no accident or untoward symptom 
occurred, and the naevus was got rid of. When a naevus is situated over 
a bone, ol course the sharp needles may be employed, as is commonly 
witnessed. 
A naevus over the anterior fontanelle, common prudence would teach us 
requires to be managed differently fro fi naevi in ordinary and less impor- 
tant situations. Part xxxviii., p. 147, 251 
NECKJSMIA. 
NECR-ZEMIA. 
Necr(Praia.—This term is applied by Dr. Williams to that condition of 
the blood, in which it appears to be itself primarily and specially affected, 
and to lose its vital properties. It is, in fact, death oeginning with the 
blood. The appearance of petechite and vibices on the external surface, the 
occurrence of more extensive hemorrhages in the internal parts, the general 
fluidity of the blood, and frequently its unusually dark or otherwise altered 
aspect, its poisonous properties, as exhibited in its deleterious operations 
on other animals, and its proneness to pass into decomposition, point out 
the blood as the first seat of disorder; and, by the failure of its natural 
properties and functions, as the vivifier of all structure and function, it is 
plainly the medium by which death begins in the body. The blood, the 
natural source of life to the whole body, is itself dead, and spreads death 
instead of life. The heart’s action is faltering and feeble ; the atonic vessels 
become the seat of congestions, and readily permit extravasations. The 
brain, insufficiently stimulated, after slight delirium, lapses into stupor ; the 
medulla no longer regularly responds to the besoin de respirer/ and the 
respiratory movements become irregular. Muscular strength is utterly 
lost; offensive colliquative diarrhoea, or passive intestinal hemorrhage 
often occurs; sloughing sores, or actual gangrene of various parts are 
easily produced; and putrefaction commences almost as soon as life is 
extinct. The track of the superficial veins is marked by bloody stains ; 
hypostatic congestion takes place to a great extent; the blood remains 
fluid, and stains the lining membranes of the vessels. Rokitansky describes 
the blood as often foamy, from the development of gas, and of a dirty red 
raspberry-jelly color; its serum dark from exuded hematine ; and its glo- 
bules swollen up by endosmosis. Coagula are either totally absent, or are 
very soft and small. The exudations are of a dirty red—turbid, thin. 
There is scarcely any rigor mortis; the tissue of the heart and of other organs 
is flaccid and softened, and stained by imbibition of the serum. Gas is 
quickly formed in the vessels and in the areolar tissue, giving rise to a kind 
of emphysema. It is very remarkable that this necroemic condition, or one 
closely resembling it, may be brought on by violent shocks inflicted on the 
nervous system, as well as by the introduction of miasmatic or animal poi- 
sons into the circulation. Violent convulsions, overwhelming emotions, 
the shock of an amputation, a stroke of lightning, even a severe exhausting 
labor, are mentioned by the German pathologists as having produced this 
effect. More common causes are, however, malignant scarlatina and 
typhus, yellow fever, the plague, and the disease called glanders. It may be 
said, generally, that the early appearance of sinking and prostration in any 
fever, indicates that the blood is thus seriously affected. We are ignorant 
what is the exact nature of the changes which take place in this condition 
of the blood. Probably they are more of a vital than merely chemical 
kind—that is, they affect the properties of the blood more than its compo- 
sition. The blood globules do not appear to be destroyed; but they circu- 
late probably some time before death, as so many dead particles pi’ove to 
be enlarged and to stagnate in the capillaries, and to part with their con- 
tained hematine. The fibrin is in great part destroyed ; but how this 
comes to pass we are ignorant. We can perceive, on the whole, scarce 
anything more than that the nowers of vital chemistry rapidly decay, and 
those of ordinary chemical affinity supply their place. Part xxxi., p. 52. 252 
NECROSI8, 
NECROSIS. 
Chloride of Zinc in Necrosis.—The difficulty of penetrating the hard- 
ened case of new bone when long formed, is too well known to require 
any comment; and it not unfrequently happens that any attempt to reach 
the sequestrum is either rendered abortive thereby, or occasions such a 
degree of disturbance to the whole shaft, as to produce more harm than 
good. Mr. Guthrie, has availed himself of the peculiar properties of the 
chloride of zinc, which, attacking the animal tissue of the bone, destroys 
it, and thus causes the earthy matter to soften and become detached. The 
sequestrum is by this means exposed, with little pain or disturbance of the 
part, and may be dealt with according to circumstances. Part ii., p. 137. 
Necrosis.—The opinions of medical men, as to the source from which 
bones are repaired after necrosis, have been divided between the soft parts 
and periosteum on the one hand and the bone on the other. Bone may 
be deposited in most parts of the body, and also by the periosteum and 
soft parts in the neighborhood of bone ; but it does not seem probable 
that these are the efficient agents in the process when any extensive form- 
ation of bone is required. It seems more probable that this is accom- 
plished by bone, and especially by the epiphyses in the long bones, after 
certain dead portions have been extracted. Hence when no epiphysis is 
present, as in the cranial and other flat bones, we percieve little effort to 
be made for the renewal of any displaced portions. So great is this power 
of reformation in the long bones of young people that in a very interesting 
case related by Dr. Lawrie, of Glasgow, almost the entire tibia, with the 
exception of the epiphyses, was removed and completely renewed, the leg 
becoming as useful as ever. 
In the treatment of extensive necrosis, two practical difficulties present 
themselves: first, in supporting the constitution, and preventing hectic; 
and second, in the very tedious process of production of new bone, and 
the ultimate cure, by discharge of the dead portion. The latter is known 
to consist in the deposit of new bone around the old and dead bone, in- 
casing it, and subjecting it to the very doubtful process of absorption, or 
of separation, and escape, through the cloacte in the new bone, and the 
ulcers in the soft parts. 
How soon may the dead bone be removed by operation ? The answer 
appears to be: As soon as the inflammatory stage has passed, suppuration 
been fairly established, and the constitutional symptoms will permit. The 
nature of the operation to be performed must depend on the extent of the 
disease. When the entire thickness is involved, the necrosed part should 
be exposed and a pox-tion cut out, and occasional attempts made to exti'act 
the portions connected with the epiphyses. There is little risk in hurrying 
them away too soon, provided violence is not used in the attempt; they 
will become loose when the natural process of separation is complete, and 
then comparatively little force will be required for their extraction. When 
the surface of a bone only is exposed and neci'osed, it seldom happens that 
the dead part is incased in a new bone. It generally scales off, and finds 
its way through the ulcer in the soft part, or through an abscess. Should 
the dead portion be extensive, and the position of the bone admit of it, it 
would save time to lay open tlie sinuses, expose the bone, and remove with 
a sharp chisel all the dead portion. Part viii., p. 103. NEEDLES. 
253 
Iodide of Potassium.—Recommended in cases of Necrosis, by Lis- 
franc.— Vide “ Iodic Preparations.” 
Observation on Necrosis.—Never attempt any operation until the 
sequestrum is completely detached; and even then, do not interfere, if tlm 
extrusion of the dead hone is going on favorably. Part xix., p. 133. 
Necrosis, caused by Exposure to Phosphorus Vapors.—[Mr. Stanley 
recently had a patient at St. Bartholomew’s Hospital, Avho had lost the 
whole of his lower jaw by necrosis. The affection was ascribed to the 
influence of phosphorus vapor, to which the man was exposed in his trade 
of a lucifer-match maker. It appears, however, that means are now 
adopted to prevent such disastrous effects occurring in this occupation. 
We are told that] 
Workmen in lucifer-match manufactories have now a chance of escaping 
the baneful effects of the evolution of phosphorous acid, by placing saucers 
tilled with oil of turpentine about their work-rooms. As oil of turpentine, 
is a solvent of phosphorus, it is expected that it will absorb the vapors 
which do so much mischief. This precaution is taken at a large lucifer- 
match manufactory in the neighborhood of the London Hospital, and the 
very best results are expected from it. Part xxi., p. 189. 
Necrosis.—Whenever tendons pass over newly developing bone, it is of 
the greatest importance that union should be averted between them, by 
commencing passive motion as soon as it may safely be done. 
Part xxxiii., p. 326. 
NEEDLES. 
Detection of Needles, etc., imbedded in the Body.—[Portions of iron or 
steel are extremely liable to be introduced into the body, frequently prov- 
ing very injurious. There are means, however, by which their presence 
may be readily determined. Mr. Smee, after some remarks on a case 
which came under his care, where a needle was introduced into one of the 
joints of the finger, and caused suppuration and subsequent anchylosis, 
which might have been prevented could it have been shown that the 
needle was actually present, and its exact spot demonstrated, says :] 
You are all acquainted with the curious condition which steel assumes 
under certain circumstances, whereby it evinces properties which are called 
magnetic; you know, moreover, that magnetic poles repel, and opposite 
attract, each other. You have, therefore, but to render a piece of inclosed 
steel a magnet, and you will be able not only to ascertain its presence, 
but to determine by its polarity its general direction; and by the amount 
of magnetism it evinces, you may even infer its probable bulk. When 
you suspect the presence of a piece of needle, or other steel instrument, 
you must subject the suspected part to a treatment calculated to render 
the needle magnetic; and there are two principal methods by which this 
object may be effected. The first, by transmitting a galvanic current at 
right angles, to the suspected part; the second, by placing a large magnet 
near the part affected, so that the object may be magnetized by induction. 
For my own part, I should use the second plan, or the plan of magnetiz- 
ing by induction, to render the needle magnetic. For this purpose, I 254 
NERVOUS DISORDERS. 
have employed a temporary electro-magnet, which I magnetized by the 
voltaic battery, and you will find, that by keeping the part affected as 
close as possible to the instrument, for about half an hour, you will suffi- 
ciently obtain the desired object. To test the existence of a magnet within 
the body, we may take a magnetized sewing needle, and suspend it by a 
piece of silkworm’s silk, when it will exhibit certain phenomena upon the 
approach of the suspected part, provided it contain a piece of magnetized 
steel. Although this simple contrivance will amply suffice, I, myself, pos- 
sess a needle, which wTas made for me, and which is well adapted for the 
purpose. It consists of a delicate needle, about six inches long, centred 
upon a small agate cup, resting upon a steel point, so that the smallest pos- 
sible amount of resistance is offered to its free play. When a part, con- 
taining magnetic steel, is brought near the needle, it may be attracted or 
repelled, it may move upward or downward, or it may exhibit disquietude 
according to the position in which the new magnet is held. We may de- 
tect the position of the foreign body, when it is of any size, by ascertaining 
where its north and south poles lie, and these are determined by their 
repelling and attracting the opposite poles of the magnetic needle. The 
disquietude or motion upward and downward, merely indicates magnetism, 
but not the direction of the magnet. 
You will doubtless be surprised when I tell you, that, in this manner, 1 
have detected a piece of needle impacted in the finger of a young woman, 
although it weighed but the seventh of a grain. Dart xi., p. 184. 
Exploring Needle—Use of, in Pelvic Abscess.—Prof. Simpson states 
that the exploring needle is never used to more advantage than when em- 
ployed for the exploration of pelvic abscesses, when they happen to be 
unusually difficult or doubtful in their diagnosis. The best exploring needle 
is a long, slender thread-like trocar, with a wire stylet passing through it, 
and this instrument may with safety be passed into the most important 
organs, and the most malignant tumors. Inflammatory pelvic tumors feel 
fixed and immovable to a degree seen in the case of no other morbid 
growth, and more particularly when occurring in the broad ligament—their 
most common seat—and lying close to the ilium, they feel so hard and 
adherent that they might almost be mistaken for an osseous tumor. 
Part xl., p. 205. 
Croton Oil in Nervous Disorders.—Mr. Cochrane of Edinburgh relates 
the following: 
Some time ago I was called to attend a patient aged about 30, of a 
strong and robust constitution. When I first saw him, he was outrageous, 
and could not easily be managed by four strong individuals. His gestures, 
deportment, and violence were such as would have induced many prac- 
titioners to have had recourse at once to the strait jacket, but to me they 
occasioned little alarm, as I well knew the certainty of my remedial 
agent speedily producing an effect, at once useful to the patient, and gra- 
tifying to those around him. I prescribed as follows : 
R 01. tiglii gtt. x.; mucilag. gum. arab.; sirup simp. aa. §j. Misce. Sign. 
Give a teaspoonful every ten minutes until he become calm. 
Half an hour had scarcely passed when he became quiet, and at the end 
NERVOUS DISORDERS. NERVOUS DISORDERS. 
255 
of an hour, lie had so far recovered as to be able to sit up in bed, and give 
rational replies to every question. 
I was called to attend a female patient, whom I found in bed completely 
prostrate, and apparently insensible to everything around her. In fact 
she was completely comatose, her pupils were greatly contracted, her pulse 
could scarcely be ielt, and, in fine, she seemed all but sunk into the sleep 
of death. The remedy which I employed in this case, was the croton oil, 
in combination with mucilage and castor oil, thus proportioned : 
R 01. tiglii, gtt. viij.; ol. ricini, giij.; mucil. G. arab. Sj. Misce bene. 
Sign, enema. To be administered in a quart of gruel. 
Though I scarcely expected any good to result from the above potent 
remedy, I must say, it had a most beneficial effect upon the patient, not by 
producing an alvine torrent, but by occasioning a very copious discharge 
from the bowels per anum, as well as from the stomach, by vomiting, to- 
gether with a return of sensation and motion, and the use of her mental 
faculties. Part iv., p. 36. 
Diseases of the Nervous System icith the same Symptoms, hut arising 
from different Causes.—[We cannot be too frequently reminded how im- 
portant it is in practice to treat each case according to its own merits, 
without being influenced by the name affixed to the disease. Dr. Cham- 
bers judiciously points out the following instances, in which similar symp- 
toms arise from totally opposite causes, and therefore require very different 
treatment:] 
In apoplexy we have a suspension of the functions of the brain, depend- 
ent upon an excess of blood in that organ. In syncope we have a similar 
state of the cerebral functions from a deficiency of blood. We have con- 
vulsions dependent upon an excess of blood in the brain, as in cerebritis ; 
and,per contra, we have convulsions dependent upon a deficiency of blood; 
as in excessive hemorrhage. In the varieties of delirium tremens, in the 
varieties of puerperal convulsions, and in continued fever, as contrasted 
with inflammation of the brain, we have a similar type of symptoms, aris- 
ing under opposite conditions of the system, and requiring opposite 
modes of treatment. 
The delirium tremens which attacks the habitual drunkard, who be- 
comes suddenly deprived of his drink, is in appearance similar to the deli- 
rium that attacks the individual of usually temperate habits, during an 
excessive debauch. But experience tells us that in the one case we have 
to deal with exhaustion; and in the other, with a state closely bordering 
upon (if not actually), inflammation of the brain. The puerperal con- 
vulsions that arise during the efforts of parturition, are in appearance the 
same as the convulsions that come on after the birth of the child, which 
merely depend upon fatigue, combined, it may be, with too great a loss of 
blood ; and the delirium of fever has so close a resemblance to the delirium 
of cerebritis, that writers of no mean authority have been induced to view 
the two diseases as identical, or more properly speaking, to consider the 
former disease as the consequence of the latter, and to regulate the treat- 
ment accordingly. There is not, I am convinced, in the whole range of 
practical medicine, a more fatal error than this; it induces its disciples 
(and they are numerous) to have recourse to blood-letting at a period 
when their efforts should be directed to the increase and restoration of the 
vital fluid. I have alluded to blood-letting because it generally stands first 256 
NERVOUS DISORDERS. 
on the list of remedies; but it is quite possible to do an equal or even 
greater amount of mischief by the improper use of purgatives and mercu- 
rials. Part xv., p. 45. 
Effects Produced on the Blood by Mental Labor.—Intellectual, like 
muscular action, probably involves an expenditure of living material, and 
introduces a changing series of particles, those which have been used giv- 
ing place to others which come with the energy of new life to perpetuate 
the action. Stagnation may induce decay, but undue persistency, haste, 
or intensity, especially in creative efforts, may occasion waste. The author 
proceeded to adduce examples. One instance was an account-keeper, who, 
after being for some weeks engaged twelve hours daily at the desk, lost 
the power of fixing his attention, and became affected with such sensitive- 
ness of the nervous system as to be frequently kept awake at night by 
tingling of the skin, and, when he fell asleep, disturbed by frightful 
dreams. There was no emaciation, loss of appetite, or disturbed digestion, 
and the urine was natural with the exception of a few oxalate-of-lime- 
crystals ; but there was a strong venous hum in the jugular veins, a slight 
cut bled freely, and the blood under the microscope exhibited a remarkable 
deficiency of pale corpuscles, the proportion not being more than a fourth 
of the average in health, or a twentieth of what is common in phthisis. 
This patient, with better regulated habits, and the use of cod-liver oil and 
nitro-hydrochloric acid, has rapidly improved. The author observed, that 
the clergy, being specially exposed to the wmar of thought and sympathy, are 
peculiarly liable to this disordered condition of the blood, their nervous 
system becoming unduly susceptible, and their minds rendered too easily 
accessible to the delusions of pseudo-science and quackery. He described 
the case of a popular clergyman, who, wdthout impairment of digestive or 
muscular power, became affected Avith sleeplessness and disturbed con- 
tinuity of thought, the principal physical symptom being jugular murmur. 
Nitro-hydrochloric acid, cod-liver oil, and subsequently phosphate of iron, 
with phosphoric acid, were employed with most satisfactory results. Dr. 
Thompson was disposed to think, that the wear of inordinate and anxious 
work acted as a succession of shocks through the nervous system on the 
blood, and he illustrated his views hy histories of effects produced by sud- 
den and violent shocks physical and mental, showing that railway collisions 
occasionally produced results analogous to those depending on intellectual 
causes, and adducing an instance from the practice of Sir Henry Marsh, of 
death from entire change in the condition of the blood, without any other 
organic disease, induced by the mental shock occasioned in a young lady 
by having accidentally administered poison to her father. After relating 
instances illustrative of the exhausting effects of exclusive attention to one 
object, and remarking on the varying phenomena resulting from differ- 
ences of temperament, or from association with indigestion and other 
collateral ailments, the author proceeded to show, that in addition to 
measures directed to regulation of the mental habits, medicines calculated 
to enrich the blood were most important auxiliaries, and that oils could 
often be employed when chalybeates proved too exciting. The class of 
cases referred to pointed to the conclusion, that over-work of the brain 
may often occasion deterioration of .the blood before the condition of other 
organs disturbs the brain. Part xxxv., p. 30. NEUEALGIA. 
257 
NEURALGIA. 
Abstracts from the best Writings on Neuralgia.—The following is the 
formula of Rauque’s celebrated liniment, and we haWe found it in several 
instances a valuable and powerful application: 
R Extract of belladonna, two scruples : laurel water, two ounces ; sul- 
phuric ether, one ounce. Mix. 
Let it be rubbed on the part, and a flannel moistened with it left applied, 
Dr. Johnson says, that steeping two or three folds of lint or rag in the 
liquor ammoniacse, and inclosing them in the top of a wooden pill-box, and 
applying it to the skin from one to two minutes, is a very valuable means 
of counter-irritation, producing a crop of vesicles, and requiring no subse- 
quent dressing. 
The endermic application of morphine is very strongly recommended 
by Dr. A. T. Thomson, in all cases where pain is the prominent symptom. 
Dr. T. employs the hydrochlorate, mixing one or two grains with six of 
sugar, and sprinkling it on the denuded blistered surface twice a-day. To 
affect the general system, the nearer it is applied to the head the better. 
Smaller doses may be used at first. A pustular eruption, often of some 
severity, usually follows, and is itself a source of relief. 
Dr. Iiichab, of Strasburg, attributes great good to one grain of quinine 
and two of common snuff, introduced into the nostril of the affected side. 
It has been found to act as a charm, and may at all events be safely tried. 
Perhaps errhines are too much forgotten in affections of the fifth pair. 
Frictions with the veratria ointment, or by the endermic method, are doubt- 
less of value, and perhaps failure not unfrequently depends on their imper- 
fect mode of application. 
Dr. Churchill advises the following form of plaster: 
R Carbonate of ammonia, one drachm; extract of belladonna, three 
drachms. 
Pareira speaks favorably of the tincture of aconite rubbed in with a 
sponge attached to a stick, till the pain ceases. One to three drachms 
were used at each application. Three minims may be given internally for 
a dose. 
Mr. Jeston after giving one or two doses of calomel and rhubard, gave— 
R N arcotine, two grains; dilute sulphuric acid twenty minims ; infusion 
of roses, one ounce and a half. Every two hours during the intermission. 
It frequently arrested the disease at once. The same observer advises col- 
chicum, especially in rheumatic and intermitting pains. 
Mr. Daily, of Harwich, obtained much credit from the following prepa- 
ration of belladonna: Macerate for twenty days, two ounces of the dried 
leaves in a pint of proof spirit. Dose from twenty to forty drops. 
M. Valleix, in his elaborate treatise on neuralgia, in addition to fly blis- 
ters, quinine, steel, etc., states that much benefit resulted from pills com- 
posed of equal parts of henbane, valerian, and oxide of zinc, given in in- 
creasing doses of from one to thirty per day. 
The liydrochlorate of ammonia, in doses of a scruple to half a drachm, 
three times a day, is recommended by the German and some British prac- 
titioners, as of great value in cases of facial neuralgia and hemicrania. 
A pound of quicksilver laid on the affected eye in oil silk, pencilling the 
part with Gourlard extract, equal parts of eau de cologne and sulphuric 
VOL. II.—17 258 
NEURALGIA. 
ether poured on the cheek and forehead, a plaster of opium and bella- 
donna, were also the means of temporary relief. 
Dr. Baillie was very partial to three or four grains of the extract of hen- 
bane twice or three time a-day in facial neuralgia ; and Dr. Warren placed 
his chief reliance on small doses of blue pill and belladonna. Shaving the 
head, and washing it with cold water, and the use of the cold douche for 
two or three minutes on alternate days, has at times succeeded. 
In the “ Bulletin Gen. de Therapeutique,” it is stated that the principle 
of treatment is to check or mitigate the paroxysm by a full dose of opium 
and ether, given immediately before the paroxysm, and to administer large 
and frequent doses of bark during the remission. Ten to fifteen grains of 
quinine, exhibited after the pain has ceased, will at once make an impres- 
sion, and often abridge the next paroxysm. 
Many very obstinate cases were cured by giving opium until narcotism 
was produced. Some were bled during its continuance, and the pain ceased 
in the majority. 
Dr. Christin speaks highly of the following plan: 
R Acetate of morphia, one grain; distilled water, four ounces; sirup 
of acacia, one ounce. Mix. A tablespoonful every hour. 
When the pain is relieved, and sleep commencing, every two hours, sus- 
pending if narcotism is induced; the patients to avoid fluids during its 
administration. It often caused perspiration, diarrhoea, and diuresis. 
We think well ourselves of small and repeated doses of opium. Dr. 
Bardsley, in his Hospital Reports, relates several successful cases from the 
free use of morphine. 
Mr. Greenhow read a paper at the meeting of the British Association 
at Newcastle, insisting upon the value of inducing rapid but moderate 
salivation, and relates several cases of success. It would, no doubt, prove 
useful in many cases where the visceral health was principally disturbed. 
The suggestion is worth remembering. 
Dr. Burgess strongly advises ten grains of the extract of aconite made 
into 12 pills with liquorice powder, and one to be given every two hours, 
repeating it till the pain was relieved. 
Croton oil, has also lately been much recommended by Sir Charles Bell 
and Drs. Newbigging and Allnat, as possessing some specific influence on 
the ganglionic nerves, apart from its purgative action. 
Dr. Bennett has found the iodide of potass of great use in cases of ner- 
vous headache, when the circulation was not affected. 
Dr. Martinet, particularly in cases of crural and sciatic neuralgia, advises 
the use of turpentine as follows : 
R White of egg, No. 1 ; tui’pentine, three drachms; sirup of pepper- 
mint, two ounces; sirup of orange, two ounces. Mix. A tablespoonful 
three times a-day, adding laudanum if sickness is present. In most instan- 
ces the pain has ceased in a week. 
A drachm of creasote to the ounce of lard has been strongly recom- 
mended as a local application. 
Magendie has found great benefit from inserting two platinum needles 
in the nerve, and passing the current from Clark’s electro-magnetic ma- 
chine, connecting the positive pole with the needle nearest the origin 
of the nerve. If the pain shifts, we must follow it in the affected 
branch. 
The following is Dr. Graves’ neuralgic plaster: NEURALGIA, 
259 
R Powder of opium, two scruples; camphor, half a drachm; Burgundy 
pitch, and plaster of lead, of each as much as may be necessary. Mix. 
This is enough for the largest plaster. Steep the part with warm water 
before applying it. Part viii., p. 28. 
Neuralgia of the Urethra.—A woman thirty-two years of age, mother 
of four children, suffered for eight months from pain at the lower pait of 
the abdomen, with scalding on making water, and a constant sense oftitil- 
lation at the orifice of the meatus. The pain became so severe as to pre- 
vent the patient from sleeping. The bladder was examined, but no sign 
of calculus found. Various remedies were tried without effect. Two 
issues, with the Vienna caustic, were now made over the hypogastric re- 
gion. The patient had tepid baths, containing two drachms of the sul- 
phate of potass, and some pills composed of hyoscyamus and extract of 
lettuce. This mode of treatment effected a cure. Part viii., 168. 
Extract of Tobacco in Neuralgia.—Extractum nicotian® will cure neu- 
ralgia so that it shall not return again, and this with once using. It has 
been known to cure toothache speedily with one rubbing on the face. 
Part xii., p. 43. 
Periodic Neuralgia.—Sir B. Brodie recommends in those cases of neu- 
ralgia assuming an intermitting character, large doses of sulphate of qui* 
nine, from a scruple to half a drachm daily. Combine it if necessary with 
Fowler’s solution of arsenic; but omit the arsenic unless unsuccessful with 
quinine and other remedies. Part xiii., p. 62. 
Aconitum Napellus in Neuralgia.—It is of the greatest importance that 
it be used with caution, or serious mischief will be the result. Dr. Ivirby 
directs a liniment made with one drachm of tincture of aconite of the 
shops, and seven drachms of fresh palm oil, or with two ounces of camphor 
liniment. Rub half a drachm or a drachm of the former, or double the 
quantity of the latter, into the part affected, twice or thrice a-day, accord- 
ing to its effects. It must be watched attentively, as the medicine is cumu- 
lative. If its poisonous effects appear, give a stimulant, as wine, or get 
the patient into the fresh air. . Part xiii., p. 65. 
Intermittent Facial Neuralgia—Mr. Hargrave recommends three grains 
of sulphate of quinine, with one-eighth of a grain of sulphate of morphia, 
an hour before each expected attack, and then give five drops of tincture 
of Indian hemp three times a day, and rub some cajeput oil on the part 
affected. Continue the quinine three times a day, and increase the Indian 
hemp to seven and ten drops three times a day till relieved. 
Partxiii., p. 66. 
Cardiac Neuralgia treated by Colchicum.—In cardiac neuralgia, accord- 
ing to Dr. Fife, colchicum was especially useful, either with or without a 
few drops of the tincture of digitalis with each dose, when the action of 
the heart was much increased as well as irregular. A local application in 
these cases, of great efficacy in relieving both the inordinate action and 
intense pain, was the tobacco-leaf, slightly moistened and placed over the 
region of the heart, care always being taken to remove it so soon as any 
feeling of giddiness, faintness, or sinking, was experienced by the patient. 
Part xiii., p. 67. 
Valerianate cf Zinc.—Recommended in most of the protean forms of 260 
NEURALGIA. 
hysterical neuralgia. Dose, three-fourths of a grain to one grain twice or 
three times a day, made into pills with mucilage or conserve of red roses, 
or in a solution in orange-flower water, or in distilled water flavored with 
sirup of orange-flowers. The compounder must bear in mind that the 
crystals of valerianate of zinc do not dissolve readily in cold water, float- 
ing on the surface in consequence of their lightness ; they should, therefore, 
be first incorporated with a few drops of water in a mortar. 
Incompatibles.—All acids ; the solid carbonates; most metallic salts ; 
and astringent vegetable infusions or decoctions. Part xv., p. 64. 
Facial Neuralgia from Uterine Disease.—May depend upon ulceration 
of the os uteri; if so, cauterize the ulcer with nitrate of silver, or the acid 
nitrate of mercury; as the ulcer heals the facial affection will probably 
cease. Part xv., p. 65. 
Tic Douloureux.—Cautiously apply an atropine lotion to the side of the 
face, night and morning: R Atropinae sulphat, gr. ij.; aquaj rosa, §ss. M. 
fiat lotio ; and give the following pills: R Ext. belladonna, gr. one-fourth; 
fel. tauris, inspis. gr. iv.; pulv. scammon. gr. iij.; soda sesquicarb. gr. iij.; 
assafoetida gr. ss. M. ft. pil. ij. hora somni sumend. Give an alkaline 
warm bath twice a-week, and insist upon abstinence from stimulating food 
and drink, and upon the patient taking plenty of exercise. Or try etheri- 
zation. Put two drachms of ether into a water jug with a mouth wide 
enough to receive the face, and place this in a hand-basin containing a little 
hot water. Direct the patient to breathe into and out of the jug, placing 
a towel over his face to prevent the escape of the vapor. To prevent the 
recurrence of the attacks give 5 minims of turpentine three or four times 
a-day, and let the alkaline baths, and the effervescing Pitville waters be 
used. Part xvi., p. 88. 
Morphine in Frontal Neuralgia.—Let from a quarter of a grain to a 
grain of muriate of-morphia be snuffed up the nostril of the affected side, 
daily, having previously cleansed the mucous membrane by an emollient 
application. Part xvi., p. 89. 
Neuralgia.—Rub in fifteen or tweijty drops of chloroform, and repeat 
the application if necessary. Part xix., p. 67. 
Sciatica, Chronic.—Where all the usual remedies have failed, electro- 
galvanism may be safely recommended, with every chance of success. 
In severe cases, put the patient under the influence of chloroform, and 
with a red-hot iron make an eschar along the outer part of the dorsum of 
the foot. Part xix., p. 308. 
Neuralgia accompanying Herpes Zoster.—Apply a blister near or over 
the affected part; and when the blistered surface has healed, apply a bel- 
ladonna plaster. 
Give grain doses of oxide of silver, combined with compound galbanum 
pill and extract of hyoscyamus; and use a liniment containing tincture of 
arnica montana, tincture of opium, and soap liniment. Part xxi., p. 79. 
Tic Douloureux remedied by Operation.—A young woman, aged 25, 
was brought to Dr. Allan, a perfect martyr from tic, beginning over the 
right eyebrow and extending over the face. Her complaint had been of NIPPLES. 
261 
six years’ duration, and was gradually becoming more severe. It com- 
menced with characteristic exactness at a certain hour in the morning, at 
times changing its time of visit until night. On feeling the pained eye- 
brow, the cellular substance on both sides seemed very thick. A hard 
body was detected ; and on cutting down, a calcareous concretion was 
dislodged from its position immediately over the supra-orbital foramen, 
where it was attached to the nerve. Since its extraction, the girl has been 
comparatively free from pain. Dr. Allan asks: “ May not inveterate tic 
be often caused by similar deposits in inaccessible portions of nervous 
channels fn Part xxv., p. 73. 
Neuralgia, Facial.—M. Cazenave rubs the following pomade over the 
affected nerve, renewing the application according to circumstances:— 
Pure chloroform, 4 drachms; cyanide of potassium, 3|- drachms; axunge, 
3 ounces; wax sufficient to give consistence. If the neuralgia is in the 
scalp, a piece of the ointment the size of a pigeon’s egg is to be rubbed 
over the part, and the head is then to be covered with an oilskin cap. 
Part xxvi., p. 43. 
Use of Strychnia.—Dissolve two grains of strychnia in §j. of phospho- 
ric acid (P. L.), and give five minims three or four times daily, either 
alone or combined with some other remedy adapted to the nature of the 
case. Part xxix., p. 54. 
Neuralgia.—Where the simple carbonate of iron fails to give relief, 
give the saccharine carbonate of iron and manganese. Part xxix., p. 315. 
Hypodermic Injections.—In Edinburgh the use of narcotic injections 
by means of a small glass syringe, with a sharp hollow needle, like the 
sting of a wasp, has become almost universal; if, in a case of neuralgia, it 
be introduced at the point where there is most pain on pressure, and a 
few drops of narcotic fluid be injected, instantaneous relief will often be 
afforded. In the case of elderly people caution is required, as the injec- 
tion is apt to take a strong effect. 
For the relief of a localized pain, it is not necessary to confine the in- 
jection to the painful part: the injection may be inserted with quite as 
striking results in any other part of the body, and thus the tendency to 
abscess in the part, from repeated injection, is avoided. 
Part xxxviii., p. 31. 
Pental Neuralgia.—Place in the ear, on the side on which the neural* 
gia prevails, a little of the following, on cotton wool: acetate of morphia, 
one and a half grains, acetic acid, two drops, and eau de cologne, §ij. 
Part xxxix., r>. 76. 
Vide Art. “ Medicines.” 
NIPPLES. 
Treatment of sore Nipples.—The tincture of catechu holds a high place, 
and has been found a very excellent astringent; like the other remedies 
of this class, it is best adapted for the simply excoriated or abraded nip- 
ple. Nearly similar to it is the solution of pure tannin, so highly recom- 262 
NIPPLES. 
mended by Mr. Druitt. It is made by dissolving five grains in an ounce 
of distilled water. The following is a favorite lotion with Dr. Johnson, 
who has been in the habit of using it for many years : 
R Sub-borat. sodae, 3ij.; cretae precipitat, §j.; spiritus vini, aquae rosae, 
aa. §iij. M. fiat lotio. 
• This may be applied alternately with the following ointment, or the 
latter may be used alone: 
R Cerae albae, givss.; ol. amygdal. dulc. Sj.; mellis despumat. §ss.; dis- 
solve ope caloris, dein adde gradatim, bals. peruviani, 3iiss. M. fiat un- 
guentum. 
In some cases we have seen benefit result from the use of tincture of 
galls and compound tincture of benzoin (Friar’s balsam), in equal pro- 
portions. 
It is always well to have in mind a number of these different prepara- 
tions, for it not unfrequently happens that one will answer our purpose 
when others have failed. For fissured nipples some authors strongly ad- 
vise the application of solid nitrate of silver ; Dr. Johnson thinks it some- 
times a good remedy in such cases, at a remote period from delivery; but 
that during the puerperal state its use is not advantageous, as it is apt to 
be followed by mammary abscess. Part xviii., p. 303. 
Treatment of sore Nipples by Collodion.—The following observations 
are quoted from Professor Simpson’s paper on gun-cotton solution : It has 
been proposed to use the ethereal solution of gun-cotton for other purposes 
than the dressing and curing of wounds—for example, as a substitute for 
the starch bandage in fractures; as an application and dressing to ulcers, 
etc. In abrasions, and slight injuries of the skin about the fingers, it 
forms an excellent and adhesive dressing. There is one extremely painful 
and unmanagable form of ulcer in which I applied it eight or ten days ago, 
at the Maternity Hospital, with perfect success. I allude to fissures at the 
base of the nipple. 
It acted successfully by maintaining the edges so firmly together that 
they were not again re-opened by the infant: the gun-cotton dressing was 
not, like other dressings, affected by the moisture of the child’s mouth; 
and as a dressing, and at the same time, by securing rest to the part, it 
allowed complete adhesion and cicatrization speedily to take place. I have 
applied it also repeatedly to ulcers of the cervix uteri and over various- 
cutaneous eruptions. Its application relieves at once the smarting of slight 
burns. Part xix., p. 272 
Sore Nipple.—Apply lycopodium powder mixed with a little oxide of 
zinc. It must be powdered well over the part after every time the child 
sucks. Part xxi., p. 260. 
Chapped Nipples, M. Cazenave's Balm for.—Olive oil, §x.; Venice 
turpentine, §ij.; yellow wax, ; alkanet root, §ss.; boil together, strain, 
and add of balsam of Peru, 3iis.; camphor, gr.; stir constantly until 
cold. Part xxvii., p. 161. 
Sore Nipples.—M. Bourdel recommends the application of a piece of 
lint dipped in the tincture of benzoin placed over the part, then removed, 
wetted with the tincture, and replaced so as to cover the ulcer with a 
layer of liquid. The first application is painful, but the pain seldom lasts 
more than fifteen minutes; the tincture forms a coating, which the action 
of sucking does not displace. Part xxx., p. 228. NITRIC ACID. 
263 
Sore Nipples.—M. Legroux has found the following treatment very effi- 
cacious. Collodion is rendered elastic by the addition of half a part of 
castor oil, and l£ parts of turpentine to 20 of collodion. It is applied by 
means of a pencil over a radius of some centimetres around but not on the 
nipple. Over this is applied a piece of gold-beater’s skin, having some pin- 
holes opposite the nipple to allow of the passage of the milk. This, by the 
drying of the collodion, becomes rapidly agglutinated. Before suckling, 
the gold-beater’s skin is moistened Avith a little sugar and water, and 
becoming soft and supple, easily admits of sucking. If it is cracked it 
must be replaced. Part xxxv., p. 255. 
Sore Nipples.—An excellent application is a mixture of equal parts by 
weight, of glycerine and tannin ; the tannin readily dissolves in the gly- 
cerine. Part xxxvii., p. 239. 
NITRIC ACID. 
Nitric Acid in Diseases dependent on Vascular Debility.—[Mr. Wil- 
kinson acknowledges that mercury is the only remedy to be relied on in 
cases truly venereal, but contends that nitric acid acts almost as a specific 
in many diseases dependent upon vascular debility. The remedy, he re- 
marks, is by no means new, but it has not been properly understood ; that 
it has cured many cases for which he recommends it, there is abundance 
of testimony on record. 
The first case in which he tried it, was one of dropsy of the abdomen, 
with diseased liver.] 
His countenance was sallow and shrunken, his abdomen and legs swelled 
to an enormous size, the latter resembling in shape the limbs of an ele- 
phant. His scrotum hung half way down his thighs, and the skin of his 
penis was distended to the thickness of a man’s arm. His pulse was small 
and weak, and beat not more than thirty strokes in a minute. His history 
was soon told. He had been a constant frequenter of a public hou e, had 
been ill about two years with diseased liver, and then dropsy had super- 
vened about ten months before paying me his first visit. 
[He was ordered six grains of calomel and ten of colocynth at bod-time, 
which brought away two motions, resembling melted pitch. The dose 
was repeated; two motions like the former followed, a third was brown 
and looser. From his uneasy state and difficulty of breathing, a trocar 
was passed, and a pail and a half of highly albuminous fluid drawn off. 
Hyd. c. cret., cream of tartar and jalap, at bed-time, produced a watery 
evacuation, containing yellow bile.] 
I now determined to give the nitric acid, beginning with thirty drops 
of the dilute every four hours, in a glass of decoction of cinchona. This 
was increased ten drops per diem, till he took 250 daily, and continued it 
for two months. The dropsy had entirely disappeared, and his pulse risen 
to 90 in a minute, and full. The secretion of bile and urine had returned ; 
he could eat a beef-steak for breakfast, and was ready for another before 
his accustomed hour of dining, which was one o’clock. In less than six 
months he was as fat and well as ever he had been during his life. The 
most singular part of this case is, that my patient afterward returned to 
his old habits of drinking, but, I believe not to his former excess. I saw 264 
NOSE. 
this person three years afterward; he had no return of his complaint 
whatever. He took the nitric acid nearly three months. There is one 
thing here I wish to point out, viz., that in all cases of obstinate obstruc- 
tion of the liver, a large dose of calomel must be given: small doses are 
worse than useless. 
I make it a practice of giving the nitric acid and bark before and after 
operations for scirrhous breast, in chronic erysipelas, and immediately 
after the acute stage of that disease ; in debility, after an attack of gout, 
and in most nervous diseases; in extreme old age I have found it increase 
the appetite, raise the spirits, and induce sleep, where opium and other 
narcotics have tended to keep up the disorder they were intended to 
remove. In valvular affections and enlargement of the heart by dilatation, 
I have found the most decided benefit, especially if the liver perform its 
office tolerably. Of course, in such cases as the last, a cure could not 
be expected, or even looked for, and I have seen quite enough of digitalis 
to discard it in toto. If the nitric acid is taken for some time, it raises 
the pulse, it renders it fuller, but deprives it of its wiry hardness. It 
does not destroy the teeth, like the other mineral acids, nor turn them 
black. I have never seen it produce salivation, but it will cause great 
redness of the mucous passages, the tongue and fauces. Part xii., p. 139. 
NOSE. 
Cure of Crooked Nose by Subcutaneous division of the Cartilages.— 
[Dr. Dieffenbach remarks that the wrynose is either a natural deformity, 
or is caused by accident. He has operated in two cases with complete 
success: in one, the deformity was congenital, and in the other, it was 
caused by a fall. lie thus describes the operation :] 
With a small curved bistoury I made a puncture by the side of the 
bridge of the nose, at the point of union between the cartilage and the 
bone, the bistoury was then carried under the skin, so as to separate the 
cartilage of the side and bridge of the nose from the bone. By a second 
puncture, on the other side, the middle partition of the nose and the car- 
tilage of that side were divided. 
The nostrils were then stuffed with lint, and the nose retained in its 
proper position with strips of plaster. The parts healed quickly, without 
inflammation or suppuration. Part iv.,p. 107. 
Case of Nasal Enlargement successfully treated.—This was a case of 
peculiar enlargement of the nose, in a young lady, unaccompanied with 
pain or any other inconvenience than the size. Besides constitutional 
treatment, Dr. Clay made pressure on the organ, by means of a mold 
made of plaster of Paris, which was useful not only by pressing uniformly, 
but also by its mere weight. The mold was secured to the head by differ- 
ent tapes, which were applied so as to increase the pressure. In a week 
the mold was found too large, and a second one was made; a third, fourth, 
and fifth were obliged to be made, as the nose diminished in size till it re- 
gained its natural dimensions. Part v., p. 143. 
Suggestions for the improvement of the Rhinoplastic operation. — It 
often happens that when a lost nose is restored by this operation, it NOSE. 
265 
becomes a skinny, shrivelled appendage, and out of all proportion, small. 
This may be owing to the circumstance that when union of the trans- 
planted portion has taken place, the connecting slip between the nose-flap 
and the forehead is divided. This proceeding would cause inadequate 
nourishment to be communicated to the new nose, which would only be 
kept alive by the new vessels that inosculated in the cicatrix all round: 
whereas if the connecting slip were allowed to remain for a much longer 
time than is often done, it would assist materially in keeping up the life 
and vigor of the transplanted nose. Dr. Keith therefore recommends that 
the connecting slip be allowed to remain undivided for a much longer time 
than is generally done, and even left undivided altogether. 
Part ix., p. 176. 
Enlargement of the Nose.—[This often consists, according to Mr. Lis 
ton, of a kind of hypertrophy of the skin.] 
There is a great enlargement of the follicles, some of them are so larg 
that on opening them you can insert the point of the finger—in fact, they 
may often be described as a series of small encysted tumors, containing a 
quantity of sebaceous matter, and of different sizes. 
Where these tumors only involve a portion of the skin they can be 
easily removed; and even where they are of a large size the whole may be 
taken away. 
The tumor is of the simplest possible character, and if you take it away 
entirely there will be no reproduction of it, and if this is properly gone 
about there is no risk from bleeding, or from any other cause. If the 
tumor is extensive, involves the apex and both alse, an incision must be 
made right down the median line of the nose, through the whole thickness 
of the diseased skin; your assistant puts his finger in the nostril and with 
a pair of hooked forceps and a knife you dissect the tumor from one side, 
and make the nose as like as possible, in size and shape, as it was before. 
There is often a good deal of bleeding, but you need not stop on that ac- 
count. Having completed the operation on one side, you proceed with 
the other, and make the two sides as nearly as you can of the same shape. 
This may occupy some few minutes. In this peculiar tissue you cannot 
expect to pull the vessels out and tie them, so that if they continue to 
bleed very profusely, small sewing needles must be put through the bleed- 
ing points and threads tied round them, the ends of the needles are then 
cut shoit off. In general, stuffing the nostril with lint and putting on a 
compress and bandage will completely arrest the flow of blood. 
Part x.,p. 163. 
Case of Aneurism by Anastomosis in the anterior Nares.—[The sub- 
ject of this remarkable case was a woman aged thirty, who became a 
patient at Steevens’ Hospital, Dublin. Dr. Wilinot says.] 
About four years and a half ago she observed a small tumor, not larger 
than a pea, situated on the inside of the left ala nasi. The formation of 
this tumor was preceded and accompanied by a good deal of pain, which 
was not confined to that spot, but occupied the entire left side of. the nose; 
she also experienced a sense of fullness and tension about that side of the 
head, and in a few months the tumor increased so much as to attract the 
notice of her friends. She was now sent to me from the country by a 
friend, who conceived the tumor to be a polypus. Upon examination, I 
found the tumor, which was about the size of a small olive, attached to 266 
NOSE. 
the inner surface of the ala of the left nostril. It was of a dark bine color, 
soft, smooth, and equal on its surface, and upon pressing it, an obsnre pul- 
sation could be felt in it. The coronary artery of the lip and the lateralis 
nasi pulsated strongly, and appeared to feed the tumor. 
In consultation with Mr, Cusack and Mr. Colles, it was agreed to try 
the effect of nitrate of silver applied to the interior of the tumor: to 
accomplish this the tumor was punctured with a cataract needle, and 
through the punctures a small probe, coated with the nitrate of silver, was 
introduced. A rapid flow of blood followed each operation, but was soon 
stopped by pressure. The caustic was applied in this manner three or 
four times, and during the intervals astringent lotions and pressure were 
employed. This plan brought about some reduction in the size of the 
tumor, but it was not of long duration; in a very short time it acquired its 
former size, or perhaps became rather larger; the headache, also, became 
very great with intense throbbing, not only in the tumor, but round the 
entire left side of the head and face. 
In this unrelieved state she was obliged to leave the hospital; but she 
returned, after an absence of nearly half a year. The tumor was now 
observed to have undergone a remarkable change in size and shape. It 
was much larger, and had altered its oval shape to a round form. It now 
bore some resemblance to a large hemorrhoid ; it filled the anterior cavity 
of the left nostril, and extended a little beyond its margin ; its free surface 
lay against the septum, and completely blocked up its passage. The 
tumor preserved the same bluish color and smoothness on its surface, and 
its pulsation could now be seen as well as felt. All the circumjacent arte- 
ries were enlarged, the lateralis nasi was dilated to the size of a crow-quill, 
the coronary artery of the same side was also greatly enlarged, and pres- 
sure on either of these arteries commanded the pulsation in the tumor. 
She complained at this time of want of sleep from the pain and throbbing 
in the head; she also stated that vision had been rather dull in the left 
eye for some short time back. 
Finding that all the symjffoms were rapidly increasing, and that the 
several plans of treatment adopted were unsuccessful, we resolved on per- 
forating the tumor with the actual cautery. The operation consisted in 
perforating the tumor in two distinct places with a nail-shaped cautery 
iron. This operation was repeated six times, at intervals of 14 days be- 
tween each. After every application the tumor swelled, became painful, 
and in about three days pus was observed to ooze through the openings. 
By following up this plan the tumor gradually diminished, and the en- 
larged arteries lessened. At the expiration of three months she was dis- 
charged from hospital perfectly well. There was then no trace of the 
tumor, the lateralis nasi artery could not be felt, and the other arteries 
which had been enlarged, were restored to their natural size. 
Part xv., p. 194. 
Operation for Restoration of the Rose.—[In this case the loss of the 
nose was due to a blow, received a long time previously; the patient was 
now forty years of age. We are told that] 
Mr. Ferguson gave, in this instance, the preference to the Indian 
method ; and the patient having been placed under the influence of chlo- 
roform, a triangular piece of leather, cut into the shape of the new organ, 
and made to suit the irregularities of the stump, was spread flat upon the NOSE. 
267 
forehead, with its base uppermost; deep incisions, with subsequent 
parings, were then made along the margins of the deformed nose, follow- 
ing the line, where the sides of the flap, to be presently cut from the fore- 
head, were to be implanted. When the paring had been carefully and re- 
gularly done on both sides, Mr. Ferguson cut out the skin and cellular 
tissue of the forehead, down to the periosteum, according to the shape 
above mentioned, and this being carefully dissected from above, downward, 
to the root of the nose, where the dissection was carried deep, to render 
the vascular connection more extensive ; the flap was twisted on itself, 
and its edges were brought into contact with the grooves previously 
made. The hemorrhage was rather considerable, and somewhat incresfced 
the already great amount of trouble which this operation entails upon the 
surgeon ; the sutures were, however, very neatly applied, three each side; 
they kept the transplanted structure very steadily in situ, and the angles 
of the raw surface on the forehead were likewise approximated by sutures. 
The cavity of the new nose, w hich was partly supported by the shrivelled 
of the old, was borne up by a small quantity of lint; the same 
was likewise put on the raw surface of the forehead; the parts were care- 
fully and warmly wrapped up, and the patient removed. 
Part xxi., p. 197. 
Mode of Extracting Foreign Bodies from the Nostrils.—Dr. Homans 
for many years has practised the following : Closing the nostril which is 
free, he blows forcibly with his own mouth into the mouth of the patient, 
and the result is the discharge of the body. He states that in no case 
where such substance completely obstructed the passage, as beans, peas, 
grains of corn, etc., had this method failed of success; but when the sub- 
stance introduced was so shaped as not entirely to obstruct the passage, 
as a button, the air blown in might pass through and not remove the 
body. Part xxi., p. 199. 
Ozoena : or Fetid Pischarge from the Nostrils.—Dr. Druitt of London, 
gives the following: 
[The fetid odor in oztena is dependent on putrid or decomposing organic 
matter ; there are several diseased conditions of the nose attended with 
these symptoms: in all, our local treatment must be calculated to remove 
or destroy putrescent matter, and unless this be attended to, the disease, 
no matter what its original cause, may be prolonged to an almost indefi- 
nite period.] 
What the local treatment should be may be seen from the following 
case which I have lately treated: 
A young lady, aged 20, consulted me for an offensive discharge from the 
left nostril, of twelve months’ duration. It followed a cold in the head, 
which had been unusually severe, and attended with much pain in the 
bones of the face. Since that time she had been infested with nauseous 
taste in the mouth, stuffiness and obstruction in the nostril, and profuse 
yellow, offensive discharge, sometimes streaked with blood. The stench 
of her breath was most unbearable. There was no tenderness ot the nose 
nor any other outward sign of disease. Her appetite was bad, and spirits 
low, inasmuch as she felt herself a nuisance to her friends, and her family 
doctor had pronounced the case one of disease of the bones, and had pre- 
scribed some zinc ointment, which had done no good. 
I immediately caused the affected nostril to be syringed by means of a 268 
NOSE, 
large brass syringe, with warm water, to which a few drops of Condy*s 
disinfecting fluid had been added. Several syringefuls were used without 
any effect or any decrease of the odor ; but after persevering a little 
longer, the patient blew her nose, and expelled a small fragment of yellow 
putty-like stuff—consisting evidently of pus, in that state of decay to 
which the name yellow, or cheesy-tubercular matter is applied. The 
syringing was proceeded with, and in the course of half an hour the 
nostril was completely emptied of quite a large quantity of this yellow 
stuff, the fetor of which was so terrible that it clung to the clothes of those 
present for some hours. The result was, that the nostril was entirely 
freed from smell, and although there was great irritation, and the eye was 
rendered very vascular and swelled, the patient expressed herself greatly 
relieved, and quite comfortable by comparison. 
On the following day the irritation had subsided, and there had been 
no return of ill odor. There appeared some swelling and excoriation at 
the anterior extremity of the turbinated bone. A small quantity of very 
dilute citrine ointment was directed to be put up the nostril with a hair 
pencil every night. 
On the eighth day she called, and reported that there had been no 
return of the ill odor. This case is a good example of its kind ; accumu- 
lation of muco-purulent matter, following catarrhal suppuration, and keep- 
ing up a diseased suppurating state of membrane by its presence. 
Slighter and earlier cases of the same class are very common. An 
ordinary “ cold,” i. e., catarrhal mucous discharge from nose, throat, and 
internal ear, is aggravated by a feeble condition of health, or by residence 
in a damp situation, and is followed by suppuration of one or both nostrils. 
If the health improves, the malady gets well of itself; or if it comes under 
treatment early, it is effectually treated without any troublesome local 
applications, as in the following example: 
A lady, aged 38, of consumptive family and appearance, consulted me 
for offensive discharge from the nostrils, the consequence of a cold that she 
could not get rid of. There was an immense discharge of yellow muco- 
purulent offensive matter, and great general debility. She was speedily 
relieved by bark and nitric acid, ten minims of dilute nitric acid, and an 
ounce and a half of decoction of yellow bark twice daily; and a visit to 
Tunbridge Wells completed the cure. Moreover, she inhaled every night 
the vapor of creasote, ten drops of which were dropped into a large basin 
of boiling water, so that she might snuff up the steam. 
The sum of the matter is this : 
Ozoena is an accidental complication of any suppurating or ulcerative 
disease of the nose. 
It is the tendency of muco pus to accumulate; and it is the tendency 
of the mucous membrane of the nose, if ulcerated, to exude flakes and 
clots of lymph or false membranes, which matters putrefy, and cause the 
smell. 
If these putrefying substances be washed away, and the cavity kept 
clean, there can be no smell; and this process carried out, as I have 
described it, makes the patient at once more comfortable, and conduces to 
the radical cure of the ulcer, no matter what the first origin of that ulcer 
may have been. 
As auxiliary measures the citrine ointment diluted, the vapor of crea- 
sote, and other astringents may be of use; and of course such constitu- 269 
tional remedies as may be adapted to relieve any existing cachexia. 
Bark and nitric acid are my favorite remedies; bat the iodide of potas- 
sium, cod-liver oil, etc., have their uses. Part 324. 
NYMPHOMANIA—(EDEMA. 
NYMPHOMANIA. 
Anaphrodisiac Properties of Bromide of Potassium.—Thielman re- 
commends this remedy as an excellent anaphrodisiac in satyriasis, in the 
frequent and painful erections during gonorrhoea, in spermatorrhoea, and in 
nymphomania. He administered it in doses of from 2 to 3 grains every 
two or three hours ; and, at the same time, enjoins a mixed vegetable and 
milk diet, and forbids all acid substances. Part xxxi., p. 222. 
(EDEMA. 
Acute (Edema of the Lungs.—It occasionally happens, says Dr. West, 
that children are attacked with intense dyspnoea, and other symptoms of 
disorder of the respiratory organs, which terminate rapidly in death; while it 
is discovered, on an examination of the body, that the thoracic viscera gener- 
ally are free from disease, but that the cellular tissue of the lungs is loaded 
with serous fluid. This oedema of the lungs, however, though it sometimes 
destroys life very speedily, is seldom, if ever, a purely idiopathic affection, 
but occurs generally as one of the complications of that acute anasarca 
which not unfrequently succeeds to scarlatina, and even then is not of com- 
mon occurrence. 
Bleed freely, and give large doses of tartar emetic. If the extremities 
are very cold, and the surface livid, apply a large mustard poultice over 
the chest, and give a large dose of nitrous ether every two hours, till the 
patient rallies sufficiently to bear bleeding. Afterward treat the general 
dropsy. Part xvii., p. 92. 
(Edema of the Glottis from sicallowing Boiling Water.—Dr. Jameson 
says : In all cases where boiling water has been taken, or attempted to have 
been taken, into the mouth, the danger at all times is imminent; for, al- 
though the little patients seem to suffer comparatively very little for the 
first few hours, still symptoms of grave importance set in, sooner or later, 
which, if not combated by appropriate treatment, will either kill the pa- 
tient, or call for the operation of tracheotomy. The operation is, therefore, 
I think, imperatively called for, when the usual remedies, such as emetics, 
leeches, and the application of heat to the surface, etc., fail in allaying the 
urgent symptoms. But when the breathing becomes stridulous and croupy, 
or amounting to a mere pant, from spasm of the glottis, the pulse quick 
and small, the temperature of the body diminished, the head drawn back, 
face congested, eyes half open, inclination to coma, and difficult deglutition, 
I should, on the first accession of these symptoms, at once be inclined to 
operate; but when these have lasted a sufficient length of time to cause 
complete coma, or if bronchitis or laryngitis has set in, then, I think, it 
will be found useless ; for when patients under such circumstances die after 270 
(ESOPHAGUS. 
operation, provided it is not produced by the shock inflicted on the nerv- 
ous system, it is from the accession of bronchitis, laryngitis, or pneu- 
monia; consequently, if any of these exist before we operate, we can en- 
tertain but small hopes of recovery. Part xvii., p. 147. 
(Edematous Glottis—Apply a solution of nitrate of silver, where it 
arises from a sub-acutely inflamed mucous membrane. Part xxvi., p. 69. 
(ESOPHAGUS. 
Extraction of Foreign Bodies from the (Esophagus.—To extract for- 
eign bodies from the oesophagus, use a slender piece of whalebone to the 
end of which a thread is attached. When the instrument is passed be- 
yond the obstruction, the thread is to be drawn tense, so as to bring the 
whalebone into the form of a Y, and it is then withdrawn, bringing up 
the foreign body. Part xvi., p. 186. 
Extraction of a Fish Ilook from the (Esophagus.—Two children 
amused themselves by playing at angling, the younger taking the part of 
the fish. After several endeavors to catch the hook in his mouth, the 
child succeeded too Veil, and, determining, it appeared, to play his part to 
perfection, swallowed the hook. The consequence was, that his brother 
drew the line, and fixed it at once in the oesophagus. All attempts to ex- 
tract it proved futile, till the surgeon took a pistol bullet, and having 
pierced it, put it on the line, and allowed it to slip down to the impacted 
hook. The weight removed the latter, the point of which, sticking into 
the lead, it was safely returned. Part xvii., p. 300. 
Stricture of the (Esophagus.—In some of those cases where no food can 
be taken, employ transfusion of blood, to give the patient time to rally, so 
as to admit the introduction of bougies subsequently. Part xx., p. 130. 
Vide “Transfusion.” 
Extraction of Foreign Bodies from the (Esophagus.—If the body be 
small and sharp, as a needle or fish bone, use a large goose or swan quill 
feather, with the barbed portion ruffled, and imbued with oil. The pa- 
tient’s head being supported against the breast of an assistant, lower the 
tongue, introduce the feathei’, with its concave side downward, into the 
throat, turn it rapidly round, and draw it out. If the body be large, use 
a rather straight lithotrite with an imperforate scoop. Introduce it with 
the blades closed, down to the foreign body, separate the blades sufficiently 
to grasp the substance, and after a few gentle turns, withdraw it. If the 
substance is a piece of flesh, and near the cardiac orifice, propel it onward 
to the stomach with a probang. For extracting coins, use the double ring 
of Graefe, attached to the end of a rod of whalebone, with a steel spring. 
Part xx., p. 132. 
(Esophagus—Foreign Bodies in the.—Do not use the probang indis- 
criminately, to push down everything into the stomach. If the substance 
impacted be meat, or any soft, non-irritating and digestible substance, it 
is proper to use the probang. But all sharp and pointed bodies should 
be extracted; and the best instrument for the purpose is a whalebone rod, 
having at one end a piece of watch-spring, which is connected securely to a 271 
OIL. 
flat hook, having a hole in the centre for the attachment of some loops of 
silk Avliich may aid in entangling the foreign body. If the attempt at ex- 
traction is not successful, give an emetic of speedy operation, in the hope 
that the foreign body may be either expelled completely, or so altered in 
position that it may iioav be easily caught hold of. Part xxi., p. 220. 
CEsophayus—Stricture of.—According to Dr. II. Bennet, If caused by 
aneuiioin pressing on the trachea and nerve-trunks, the voice will be stri- 
dulous, and paroxysmal attacks of suffocative dyspnoea will occur. If 
caused by an abscess, the voice will not be lost; if caused by malignant dis- 
ease, the recurrent laryngeal nerves Avill soon be involved, and paralytic 
aphonia will result, although the larynx may not be affected. 
Part xxx., p. 135. 
OIL. 
Local Application of Cod-Liver Oil.—The class of cases for which it 
appears most applicable, is that of chronic eczematous eruptions, unat- 
tended by acute inflammation of the skin or general pyrexia. In abating 
the troublesome itching which frequently accompanies this disease, espe- 
cially in old people, it has manifested powers decidedly superior to those 
of any other application with which we are acquainted. In the majority 
of instances it can, of course, only be expected to assist constitutional 
treatment, not to supersede it. We are inclined to recommend the prac- 
tice of exhibiting it simultaneously with tonics, as iron, quinine, etc., 
which is now adopted with great success at several hospitals. The diges- 
tion and assimilation of the oil appears to be much aided by such combi- 
nation. In the treatment of cutaneous struma and lupus at the Hospital 
for skin diseases, it is usual to administer along with the oil small doses of 
mercurials, which are often continued for many months. The success at- 
tending this practice is very great, and appears to much exceed that which 
results from the administration of either drug alone. Part 76. 
Substitute for Cod Liver Oil.—Cocoa-nut oil seems to possess the same 
valuable properties as cod-liver oil, and in some cases was efficacious where 
the latter had been useless. Part xxix., p. 92. 
Cod-Liver Oil.—1. When too nauseous for the patient, give it floating 
on some bitter menstrum, in coffee, ginger wine, infusion of quassia, or, 
better still, in a solution of quinine, with a drachm of the tincture of orange 
peel, or give it in very hot milk, or smear the mouth with marmalade or 
black currant preserve, and having thus absorbed the attention of the gus- 
tatory nerve, immediately swallow the oil. 2. When the oil excites sick- 
ness. Prepare the stomach by hydrocyanic acid and bismuth three times 
a-dav. Give first a little dry biscuit or bread crumb, and then float the 
oil on the coldest spring water, and give it immediately; give it in the 
recumbent posture, an hour or two before getting up or after going to 
bed. 3. When the oil cannot be digested, the following is useful: R Had. 
rhei, 3iij.; rad. zingiberis, 3ij-; rad. gentian, giss.; sodae carbon, giij.; aquae 
lbs. viij. The roots to be cut into small pieces ; the infusion to be made 
with cold water, and to stand twelve hours. Take a wine-glassful thrice 
a-day for a week before beginning the oil, and then give it with the oil. 
Part xxix., p. 325. 272 
OMENTUM. 
Cod-Liver Oil, Test for.—Drop a little sulphuric acid, guttatim, into 
the oil. It causes a centrifugal movement, and a beautiful violet color, 
which changes to purple on agitation, and ultimately to a rich sienna 
brown. This is best seen by adding one or two drops of the acid to half 
a teaspoonful of the oil spread out on a white porcelain plate. Sulphuric 
acid when added to olive oil causes a dirty grey color—to poppy-oil a 
deep yellow color—to ordinary fish-oil a deep brown color. 
Part xxx., p. 236. 
New Mode of Giving.—Take the yolk of one egg; sugar, two ounces ; 
orange-flower water, one ounce ; cod-liver oil, three ounces ; essence of 
bitter almonds, one drop. Either the sixth or eighth part will be a dose, 
according to the quantity of oil which is intended for the patient. 
Part xxx., p. 319. 
Cod-Liver Oil Oleine.—When cod-liver oil is constantly vomited, give 
oleine prepared from the same oil in the same dose; it will have all the 
beneficial without any of the disagreeable effects of the oil itself. 
Part xxxii., p. 77 
Glycerine as a Substitute for Cod-Liver Oil.—Give one to threi 
drachms of glycerine in an ounce of water daily as a substitute for cod 
liver oil; it is quite as efficacious, much less disagreeable, does not disor- 
der digestion, and may be combined with any other remedy. 
Part xxxii., p. 79. 
Cod-Liver Oil Solidified with Gelatine.—Take of pure gelatine, half 
an ounce ; water, simple sirup, of each four ounces; cod-liver oil, eight 
ounces; aromatic essence, as much as may be sufficient. Dissolve the ge- 
latine in the boiling water, and add successively the sirup, the oil, and the 
aromatic essence ; place the vessel containing the entire in a bath of cold 
water; whip the jelly for five minutes at most, and then pour it, while 
still fluid, into a wide-mouthed glass bottle, furnished with a cork, or with 
a pewter cap, or if a bottle be not at hand, into a porcelain or earthen- 
ware pot, which should be carefully closed. Cod-liver oil gelatinized with 
Carrageen or Irish Moss.—Take of fucus crispus half an ounce ; water, 
eighteen ounces; simple sirup, eight ounces; cod-liver oil, eight ounces ; 
any aromatic, according to taste. Boil the carrageen in the water for 
twenty minutes ; pass the decoction through flannel; concentrate” it until 
it is reduced to four ounces by weight; add the sirup, the oil, and the 
aromatic ; whip the mixture briskly, having first placed it in a cold bath, 
and pour it, while still a little warm, into the vessel intended to receive it. 
The sirup may be replaced by an equal quantity of Garus’ elixir, mint or 
vanilla cream or rum, etc. Part xxxvi., p. 291. 
OMENTUM. 
Returning the Omentum in cases of its protrusion.—[A young man 
was pushing open a door with a gardener’s knife, the point of which was 
toward himself. As the door was shut he thrust himself against the point, 
which entered the abdomen close to the left side of the umbilicus. About 
three inches of the omentum protruded, which, as the surgeon was unable 
to return, was pushed back with a bougie. Mr. Cooper says:] ONYCHIA. 
273 
Now I have to make some remarks about returning the omentum in 
cases of its protrusion ; in this instance, a concentrated force was em- 
ployed in order to effect its reduction, but I think some little precaution 
is necessary in handling so delicate a tissue as a serous membrane. If it 
has protruded through an opening too small for it to be returned, the usual 
method is to enlarge the wound sufficiently to allow of its being replaced ; 
but if it has been so long exposed to external agents as to be altered in 
its character, and be unfit to be returned into the abdomen, it should be 
allowed to remain to slough away, or, perhaps, in order to avoid the incon- 
veniences attending upon a large slough, it may be cut off, and any ves- 
sels that may bleed tied, but do not push the ligatures in that case into 
the abdomen. It might be a question whether any means for the preven- 
tion of symptoms were to be adopted in apparently so simple a case; if 
so, what should be the means ? Some may say bleed, but in my opinion, 
you only disturb the natural functions by abstraction of blood, and render 
the patient irritable, and therefore more prone to inflammation. In this 
case, perfect quietude, and regulation of diet, were the means adopted, 
and they have proved sufficient.. Purging is certainly wrong; for, by in- 
creasing the peristaltic motion of the bowels, you interrupt nature in her 
process of cure, by uniting the omentum to the cut edges of the wound 
of the peritoneum lining the abdominal walls. This patient, you observe, 
was four days without a motion and even then I ordered only a small 
dose of castor-oil, but it proved sufficient. Part xii., p. 197. 
Onychia.—Mr. llamilton gives the following: Sometimes, in conse- 
quence of a tight shoe, the flesh of the side of the nail of the great toe is 
pressed against the side and upper angle or corner of the nail. Now, Du- 
puytren observed very truly, that in consequence of this corner of the nail 
being a little overlapped by a fleshy prominence, the scissors in cutting the 
nail are prevented from going far enough to cut this part of the nail com- 
pletely, so that the angle projects in a sharp little point, which irritates the 
flesh pressed agains't it, and finally ulcerate* a way into it. This is further 
accomplished by the pressure from above on the arch of the nail; which 
being flattened and straightened, the sides are forced out. The flesh, 
therefore, irritated and inflamed, swells, reddens, and ulcerates, and there 
is a thin fetid discharge from the corner of the nail; standing or walking 
is painful; and the pressure of a shoe can scarcely be borne; the whole 
foot, when the irritation runs high, gets swollen and red, and even the 
lymphatics up the leg are inflamed. This is called the onychia simplex. 
Sometimes only one side is affected, and if so, it is generally the outside; 
at other times, both sides of a nail, and in some instances, both great toes, 
suffer from this painful disease. I am inclined to think that, besides the 
local cause I have mentioned, the constitution has something to do with it. 
I have observed so many cases in delicate strumous people and in those 
who labor under other diseases. I operated on a gentleman who was par- 
alytic of the whole side of the body and of speech, who had it in both 
great toes. There is also a young lady who is at present, and has been for 
the last three years, laboring under paraplegia, with cataleptic attacks, and 
ONYCHIA. 
VOL. II.—18 274 
ONYCHIA. 
who has been bed-ridden for that period, and, consequently, never wore a 
shoe, yet for a year and a half has had onychia simplex of the right great 
toe nail at the outside. The onychia simplex is not a disease that gets well 
of itself; its progress is usually from bad to worse; the swelling of the 
toe becomes very great, so much so, that a case is given by Dupuytren, 
where from the size and redness of the toe, the patient was for a long pe- 
riod treated for gout—a mistake, however, scarcely credible. The more 
the llesh swells, the greater is the pressure on the toe nail, the deeper 
and more extensive the ulceration, from which fungoid granulations are 
seen to rise. 
If you see this disease early, when the upper end at the side of the nail 
is alone engaged, you may stop it in this way: Let the patient lay up, and 
poultice the toe with bread and water; this lessens the irritation and in- 
flammation, and you will find that you will be able to insinuate, by means 
of a small lachrymal probe, a minute shred of lint under the angle and 
side of the nail, and between it and the flesh ; after it is fixed in, wet it 
with a solution of nitrate of silver, 3j. to the ounce ; if the lint remains in, 
it need not be removed for forty->eight hours. You will then find the irri- 
tation and its consequences lessened, and by renewing the application two 
or three times the disease will be cured; and to avoid a return, you should 
caution the patient when cutting his nails, to cut them straight across, to 
be sure there is no little projecting point at the angle, but also most par- 
ticularly against rounding olf the angle, which allows the flesh to be pressed 
over it the more readily. I cured in this way a large, heavy man, who had 
been previously treated by caustics, poultices, and ointments, without any 
good. 
When, however, the disease is more advanced, the pain and irritation 
excessive, it is better, after rest and poultice, and a purgative if required, 
to proceed with an operation, one of the most painful in surgery, though 
happily of short duration, by slitting up the nail and removing it. It is 
done in this way: the blade of a strong, short-bladed, sharp-pointed scis- 
sors is passed under the nail, quite to the root, the nail is slit up in the cen- 
tre, one side is seized at its middle angle with a strong forceps, and torn 
out by turning it over on itself. If both sides are diseased, then the other 
half of the nail is served in the same manner, a poultice is applied, and in 
a few days the part will be weTl. It is quite remarkable how soon a case 
of a year’s standing is thus cured in so short a time. 
Chloroform happily enables us to perform this painful operation without 
the consciousness of the operation. 
Sometimes the toe is bruised by a heavy body falling on the nail; blood 
is effused under the nail, inflammation, suppuration, and ulceration of more 
or less of the matrix ensue, with a loosening and separation of part of the 
nail from its bed. In this case the nail acts as a foreign body, and no relief 
is afforded until it is torn out. You have an instance of this in a boy for- 
merly in the house, on whose toe the edge of a pail fell; also in a young 
woman, a patient of Mr. Adams, to whom a nearly similar cause originated 
the injury, a bucket having crushed her toe, and with so much subsequent 
inflammation, that it extended to the periosteum, matter formed between 
it and the bone, with death of the last phalanx, which had to be removed. 
In an unhealthy constitution onychia simplex may run into the second 
variety, which has been called onychia maligna, from the severity of its 
Bymptoms, not from any cancerous character it possesses: it is a disease of ONYCHIA. 
275 
the matrix which secretes the nail. This diseased action may be caused by 
an injury which crushes or tears the root of the nail in its bed, or by dis- 
ease originally commencing at the root of the nail, with inflammation and 
ulceration, and finally an alteration in the nail itself, as we might expect 
from its secreting structure being diseased. 
The toe is very much swollen, of a deep red color, the nail is either gone, 
and its whole matrix converted into a large, unhealthy looking ulcer, the 
surface greenish or black looking, with raised white callous edges, and pro- 
fuse, thin, fetid, oily, and often bloody discharge; or if there is a nail, it 
is quite altered, dark, thin, and even shrivelled like wet parchment, and is 
evidently not the cause of the state of the toe, as in onychia simplex. The 
swelling and redness very constantly affect the foot, and I have even seen 
them extend some distance up the leg. Sometimes there will be a fungoid 
granulation springing up from the centre of the ulcerated matrix, even 
from the bone itself; after the nail is gone and the disease is lessening in 
violence, an attempt at a new nail will be seen to be made by some white 
horny prominences here and there. 
It is not always confined to the great toes, as I have seen it affect some 
of the smaller toes at the same time. 
The pain is very great, and the least touch of the part gives exquisite 
pain ; wearing a shoe is out of the question, unless the leather over the 
toe is cut out. There is great irritation in the system : and from that and 
restless nights, and want of exercise, the patient gets pale, and thin, and 
low-spirited. The fetor of the discharge, in spite of every care on the 
part of the patient, is most offensive. 
It is a disease of youth rather than age : I have seen a girl ten years old 
affected with it. 
The treatment that Dupuytren was the first to propose, is very severe, 
indeed, though certainly very effectual; it was to remove the entire ma- 
trix of the nail; he made a deep incision with a sharp straight bistoury, 
in a semi-circular form, a little above the root of the matrix, and carried 
it round the sides; he raised with a forceps the edge of the integument 
next the matrix, and cut under it toward the end of the toe, keeping close 
to the bone, so as to remove the diseased matrix entirely. The part was 
to be examined closely, to see if there was any portion of the nail remain- 
ing, which was to be removed; it wras then to be covered with a pledget 
of lint, with holes in it and smeared with cerate, and dry lint outside it, 
and not opened for five days. 
In about a fortnight it had generally healed. You will sometimes have 
to perform this operation, but not often. Mr. Wardrop found that mer- 
cury given to salivation effected a cure; and the late Mr. Colles was in 
the habit of treating such cases very effectually with mercurial fumigation. 
You may combine these, giving three grains of blue pill three times a 
day, and apply mercurial fumigation daily till the sore assumes a healthy 
granulating surface, and the surrounding inflammation and swelling sub- 
side ; the simple applications, bread and water poultice, or simple cerate 
dressing, may be used; sprinkling the ulcerated surface with red precipi- 
tate powder nearly answers as well as the fumigation. 
Part xxxii., p. 191. 276 
OC HORITIS, OR OVARITIS. 
OOPHORITIS, OR OVARITIS. 
Oophoritis—Sterility dependent on— [As this affection is not well 
known, Dr. Rigby relates a case:] 
C. C., aged 31, brunette; tall; married six years. One child born about 
a year after her marriage. 
Complains of constant and severe pain of both groins, especially the left, 
with severe dragging pain in the loins and lower part of the abdomen, 
both of which are increased by stooping, but relieved by standing. The 
catamenia come regularly and last three or four days ; they are preceded 
for nearly a week by much suffering, which also continues during the 
whole period; the discharge is very profuse with clots and exudations ; 
constant urging to pass water, which is turbid; bowels unhealthy ; toifgue 
red and dry ; has had profuse and painful menstruation from her youth. 
Since the birth of the child, the pain has been considerably relieved, 
although the discharge has been increased. 
Examination per Vaginam.—Nothing wrong about the os or cervix 
uteri; the uterine sound passes easily to the full distance (2£ inches) with- 
out pain, but is followed by profuse discharge of blood. 
Examination per Rectum.—High up in the direction of the left ovary 
a hard body can just be reached, which is acutely sensitive to the touch, 
and which she describes as the centre of her pain. 
The following remedies comprised the principal treatment of this pro- 
tracted case, and were varied from time to time, pro re nata. 
R Ung. antimonii pot. tart, inguini sinistro omni nocte applicand. 
R Pil. hydrarg. chlorid. co. gr. v., alternis noctibus. 
Sod® potassio tart. 5j. o.m. 
R Acidi nitr. dil. ntxv. ex infus. gentian® comp., ter die. Hirudines 
vj. ovario sinistro. 
R Aquae menthae viridis, aquae destillat®, aa. 3vss.; acidi sulph. dil., 
mx; sirupi rhaedos, 3ss. M. ft. haustus ter die sumendus. 
It is difficult, and sometimes impossible, to trace the history of these 
cases to their origin ; but from the fact of her having suffered from dys- 
menorrhoea up to the time of her marriage or pregnancy, and never after- 
ward, we have reason to conclude that the canal of the cervix, or os uteri, 
had been unusually small, and produced considerable resistance to the free 
discharge of the catamenial fluid. That this form of dysmenorrhcea is not 
necessarily a barrier to conception is a well-known fact, although it is 
equally certain that sterility is the more frequent result; but when preg- 
nancy does occur under these circumstances, the expulsion of the foetus, 
even when very premature, produces such an amount of dilatation in the 
contracted canal as effectually to remove the cause of dysmenorrhoea. I 
have long since pointed out the fact, that obstructive dysmenorrhoea, when 
of sufficient severity and duration, is frequently attended with ovarian 
inflammation, which may be reasonably accounted for by the severe strug- 
gle and painful efforts which the uterus is excited to make at the men- 
strual periods, for the purpose of expelling the catamenial fluid which has 
accumulated within its cavity. This state of uterine excitement must be 
a source of considerable irritation to the ovaries, occurring at a time when 
they are known to be highly congested, and their vessels in a condition 
near akin to that of inflammation. That the uterus suffers great distention OOPHORITIS, OR OVARITIS. 
277 
from the menstrual fluid accumulated within its cavity is known by the 
fact that the patient herself will frequently feel it like a hard painful ball 
behind the symphysis pubis, which disappears as soon as the discharge 
comes on. In a great many instances I have reason to know that the 
uterus never entirely clears itself of the catamenial fluid, but remains full 
for many days afterward, and probably retains a certain quantity until it 
is expelled at the next period, as in many of these cases the moment a 
dilator is introduced, a quantity of brownish-red shiny discharge comes 
away, the characters of which are also evident from its peculiar smell. I 
may also add that, in almost all cases of long-standing obstructive dys- 
menorrhoea, the cavity of the uterus is considerably enlarged, being fre- 
quently half and sometimes a whole inch longer than natural, and allowing 
the sound to move about with an unusual degree of freedom. 
[One of the most prominent symptoms in another case was profuse and 
long continued menorrhagia. Dr. Rigby observes :] 
I know no form of menorrhagia where the discharge is more profuse or 
the disease more obstinate, than when it is dependent on an inflamed state 
of one or both ovaries ; and here again I may observe that in by far the 
majority of cases, it is the left ovary which is affected—indeed, it is quite 
an exception to the rule when we find that it is the right one. It is diffi- 
.cult always to account for these peculiarities, and we are apt to theorize 
in attempting their explanation ; but it has frequently struck me that a 
loaded state of the sigmoid flexure of the colon, from the pressure which 
it must exert on the neighboring parts, would render the left ovary more 
liable to congestion by obstructing its returning circulation. As in the 
case above alluded to, which had also been for many years of her life one 
of obstructive dysmenorrhoea, the history of the symptoms and the exami- 
nations distinctly prove the existence of ovarian inflammation; and its 
relief by appropriate treatment also shows that this affection was the cause 
of the menorrhagia, which ceased as soon as the oophoritis was relieved. 
The symptoms of oophoritis varied somewhat in this case from the ordi- 
nary course, and depended upon the position of the ovary, being much 
more backward than usual, and almost approaching the hollow of the 
sacrum; hence she had none of the inguinal pain which is so frequently 
observed in these cases, but it was confined to the region of the sacrum, as 
is usually seen in cases of retroversion, and was necessarily greatly 
increased by the passage of faeces down the rectum. This displacement 
of the ovary downward and backward into the recto-vaginal pouch, wdien 
in a more marked degree, forms one of the most agonizing affections with 
which I am acquainted; the paroxysms of suffering are really frightful, 
and whilst they last the patient is nearly wild with torture. In three or 
four cases which I have seen the ovary has been found lower than usual, 
and approaching very nearly to the central line of the sacrum. 
The slightest touch produces severe pain, of that sickening and intolera- 
ble character which pressure on the corresponding organ of the male pro- 
duces, especially when inflamed. In the present case, no movement of the 
ovary was produced by pressure in the left groin, while the finger of the 
other hand was examining per rectum, but the anterior wall of the uterus 
was felt inclining more than usual toward the bladder, as in anteversion, 
from the uterus being probably pushed somewhat forward by the ovary 
behind. The attacks of heat and swelling of the vagina, and the great 
tenderness of the os externum, were connected with considerable derange- 278 
OPERATIONS. 
ment of the assimilating organs, and form a part of a series of affections 
which I have endeavored to describe under the term of uterine gout—the 
general state of the circulation indicating a close resemblance to that of it 
in a gouty diathesis, but the affection localizing itself on the uterus and 
organs belonging to it. 
[In the next case reported by Dr. Rigby the sterility appeared to be 
owing to a contracted state of the os and cervix uteri, attended, as this 
state often is, with ovarian irritation or inflammation. The principal sym- 
toms were irritability of the bladder, and severe pain in the right groin 
and front of the right thigh, with exacerbations at the menstrual periods.] 
Oophoritis, or, at least, ovarian irritation is a frequent attendant upon 
that form of dysmenorrhoea which arises from a contracted os and cervix 
uteri; the continued repetition of uterine irritation, at the catamenial 
periods, arising from the efforts which the uterus is excited to make for 
the purpose of expelling the fluid which has been secreted’into its cavity, 
after a time brings on an irritable state of that organ (the ovary), which 
is so closely connected with the process of menstruation. 
Part xviii., p. 259. 
OPERATIONS. 
Necessity of Preparatory Treatment, before Operation.—[Mr. Cooper 
strongly insists upon the necessity of well ascertaining the state of a 
patient’s health, as to the absence of organic disease, the condition of the 
bowels, state of the urine, etc., before undertaking an operation. We 
are often tempted to perform slight operations at the moment, but it is 
dangerous to do so, especially as to operations on the head and face— 
encysted tumors of the scalp, for instance. On this subject, Mr. Cooper 
says:] 
A lady applied to an eminent surgeon, to ascertain from him whether 
a small encysted tumor could be removed with perfect safety from her 
head ; to which he replied, “ certainlythe operation was immediately 
performed, but seven days afterward she was dead from an attack of ery- 
sipelas. 
A short time ago, an individual came under my care with an external 
pile and a fissure in the mucous membrane of the rectum; he was con- 
siderably out of health and attributed all his ailments to the sufferings he 
experienced in the passing of his motions, owing to the local disease : he 
urged me to relieve him by operation. I kept him, however, a week or 
ten days under my care before I operated, and by soothing remedies had 
somewhat improved his condition, when I removed the external pile, and 
drew the bistoury across the fissure, the whole time of the operation not 
exceeding half a minute. The patient felt immediate relief after the ope- 
ration, he had little or no pain in passing his motions, but in the course of 
four or five days he was seized with symptoms of subacute peritonitis : 
calomel and opium, and leeches, were ordered; but four days afterward ho 
died. 
Upon examination of the body, he was found to be the subject of granu- 
lar kidneys (the morbus Brightii), which no doubt had caused his death. 
It had been ascertained, during life, by my dresser, that his urine was 279 
OPERATIONS 
albuminous ; but I considered the severity of his suffering demanded the 
performance of this slight operation : although the sequel renders it a mat- 
ter for consideration whether I was right, under these circumstances, in 
subjecting him to a fresh source of irritation. 
From such cases as these you must be impressed with the necessity of 
doing everything which the science of surgery can insure, so far as lies in 
your power, to place your patient in the greatest state of security before 
you subject him to any surgical operation, and even then never promise 
that any operation, however simple, will be perfectly free from danger, for 
depend upon it, it is as unwise to treat slightly the most trifling incisions 
of the skin, as it is dishonest to attach to an operation more importance 
than it justly deserves. 
Some surgeons suppose that it is better to perform what are usually 
considered simple operations at the moment than to allow the dread of 
anticipation to remain on the mind of the patient, and then proceed to act 
upon this opinion without any preliminary precaution. There are, how- 
ever, I believe, but few patients who will not duly appreciate the cautious 
recommendation of a surgeon to submit to some little preparatory dis- 
cipline, and he will gain much more confidence from the patient by this 
display of judgment, than from the hasty recklessness which evinces bold- 
ness and self-reliance, rather than judicious precaution. 
Part xvii., p. 140. 
Plastic Surgery—Hints on.—A transplanted flap of skin will not unite 
readily to the denuded edges of a defective part, such as an old cicatrix. 
Even if it did unite, it would become raised and thickened. The whole 
of the epidermoid surface of the old cicatrix should, therefore, be pared 
away, so that two raw surfaces may be brought into contact. Before 
applying the transplanted flap, the pared edges of the defective part 
should be loosened from their attachments to the extent of two or three 
lines, by flat strokes of the knife. If this be not done, it is probable that 
the two edges will not be on the same level, the transplanted part will be 
raised. Part xxxi., p. 181. 
Contributions to Operative Surgery.—Dr. Knox remarks : 
Systematic writers on surgical anatomy and operative surgery usually 
devote a consfderable section of their works to what they term “ simple 
operations,” practised indifferently on all, or nearly all parts of the body; 
such’ as division, cauterization, compression, dilatation, extraction, reduc- 
tion, reunion, etc. But it seems to me superfluous to speak of such ope- 
rations at any length. The student can only acquire a knowledge of them 
by seeing them put in practice by others, and by practising them himself. 
The reunion of divided parts by needles, stitches, adhesive and other plas- 
ters ; the reduction of dislocations ; the extraction of foreign bodies ; dila- 
tation by means of the fingers or by instruments; the application of the 
heated iron; compression by bandages; and division with the knife or 
scissors, constitute nearly the whole of the surgeon’s manipulative educa- 
tion. Should he neglect practising it on the dead, he will have to learn 
it on the living; sometimes at his own cost, sometimes at that of hig 
patients. 
In the selection of instruments the young surgeon should follow the ex- 
ample of the best operators of his day, selecting the form they prefer. Let 
him remember always that an operation is not a dissection, but a series of 280 
OPERATIONS. 
incisions and steps taken agreeably to a plan previously laid down toward 
accomplishing a clearly understood object. Where the fingers can be 
used, they are preferable to knives or forceps. Never press on inflamed 
or suppurating parts, lest the pressure cause sloughing. To employ 
caustics advantageously merely requires judgment and a little dexterity. 
Rust, of Vienna, made the actual cautery fashionable for a time, and with 
Baron Larrey the moxa was a universal remedy. A sounder pathology 
has greatly diminished the frequency of appeal to these violent remedies. 
Nevertheless they are of easy application, and prove sometimes suc- 
cessful. 
Hemorrhage is the accident which the surgeon most dreads, whether 
occurring in consequence of accidental wounds, or caused by operations. In 
whatever way it happens, the surgeon must look carefully to it, and ascer- 
tain its source. Be in no hurry, but lose no time. If the bleeding come 
from a vessel of any appreciable size, seize it carefully and steadily with 
the forceps used in dissection, and request an assistant to place a ligature 
around the vessel, clear of the points of the forceps. If the bleeding 
come from a vessel or vessels which cannot be discovered, the surface may 
be exposed for some time to the air, or moistened with cold water and 
vinegar, or a thin linen rag dipped in these, and kept moist, may be laid 
over the part. Occasionally simple pressure applied for a time by the 
fingers of an assistant will arrest a hemorrhage; the elevation of the limb, 
should the bleeding occur there, is at times very successful. Other means 
for arresting hemorrhage occurring from the division of small vessels have 
been recommended, such as torsion or twisting, which may be done with 
the common forceps, touching the part with lunar caustic, applying tur- 
pentine, tincture of the muriate of iron, etc. I have followed Mr. Aber- 
nethy’s mode of treating certain hemorrhages with marked success. 
In the terrible hand-to-hand conflicts which took place on the memo- 
rable 18th of June between the French and English cavalry, a young 
soldier of the English received a wound in the parotid region, immediately 
below the ear. I did not see this soldier until about three weeks after the 
accident, when it fell to my lot to bring to England the first ship-load of 
those who, though wounded, but not yet recovered, had escaped the ter- 
rible field. These wounded men, about ninety in number, embarked at 
Ostend, and were placed ultimately by me in Ilaslar Hospital. The first 
object which caught my attention, on gaining the upper deck of the ves- 
sel, was this young man. He lay extended on the deck, pale, exhausted, 
almost exsanguineous, and seemingly dying. He spoke with difficulty. 
The wound below the ear had never closed, and it bled daily, so that he 
could no longer sit upright. As usual, a pile of rags, lint, portions of 
bandages, etc., steeped in blood, and now hardened, concealed the wound, 
and kept the danger out of sight. The sergeant, my only assistant, 
cautioned me not to remove this pile, as he had seen dangerous results 
repeatedly in this case, whilst on their route from Brussels to Ostend. Re- 
gardless of this, I put Mr. Abernethy’s plan in force, removed all pressure, 
exposed the wound to the air, applied a rag loosely to the wound, directing 
it to be constantly wetted with vinegar, and directed his head to be raised 
on pillows. The hemorrhage never returned, and he rapidly recovered. 
In some persons there exists a hemorrhagic constitution, amounting to 
a serious disease. 
A retired officer of the Cape Regiment of Infantry had been for some years subject to this hemorrhagic tendency. The slightest wound of the 
skin occasioned a considerable loss of blood, which flowed all the more 
that he continued to wash the wounded part with cold water. I found 
that pressure with the fingers, employed for but a short time, closed the 
wound uniformly, and arrested the hemorrhage. 
In unhealthy sores, whether originating in wounds or otherwise, great 
caution is required in the avoiding incisions into such diseased structures. 
A soldier in the Royal African Regiment of Infantry had for some time 
suffered from a corroding, ill-conditioned ulceration of the fingers and back 
of one of his hands. The surgeon under whose care he was wrote to me 
to come to head quarters, to assist him in amputating this hand. 
On examining the disease, I found that the bones of one finger were 
carious, and at least contributed to maintain the disease. I recommended, 
therefore, that instead of amputating in the forearm, the three phalanges 
of this finger should be removed; but the surgeon, aware of the alarming 
hemorrhages which had followed all incisions, however slight, made into 
the semi-putrescent fingers and hand, declined attempting it. Persisting 
in my opinion, the case was handed over to me, to act as 1 thought fit. A 
straight probe-pointed bistoury was passed close to the bone, as high as 
the lateral ligaments connecting the first phalanx to the metacarpal bone, 
and these ligaments were cautiously divided successively, and the three 
phalanges withdrawn from the ulcerating mass. No bleeding followed, 
and the hand recovered under the use of lotions and nitrate of silver. 
In general, the common dissecting-forceps is the best instrument for 
seizing hold of the divided artery, and securing it until a ligature can be 
applied, but the surgeon should also be provided with a tenaculum. 
When the tongue is wounded, for example, by a tooth accidentally 
driven into it, the closeness of the tissue renders the forceps useless. You 
must transfix the bleeding orifice of the vessel with the tenaculum, and tie 
in a small portion of the surrounding texture. The arteries in the palm 
of the hand are difficult to be secured, and may require the use of a tena- 
culum. They must be tied where divided, and, if possible, a ligature put 
upon both orifices, lest the freedom of anastomosis render your ligature 
of no avail. 
Lastly, when a large trunk, such as the bronchial, femoral, etc., has 
been accidentally punctured or wounded, the vessel must be secured where 
wounded, by placing a ligature above, and another below, the wounded 
part. In my younger days, surgeons mistook wounded arteries for aneu- 
rism, and to the tumor caused by the effused blood they gave the name 
of traumatic aneurism. One error naturally produces another ; they mis- 
applied Mr. Hunter’s ingenious treatment of aneurism by employing it in 
cases of wounded arteries. I denounced this extraordinary practice in my 
earliest lectures on anatomy, but it continued to be in vogue for a long 
time. When the brachial artery was wounded at the bend of the elbow, 
the hospital surgeons of the day persisted in making another wound higher 
up, and. tying the artery where it was not wounded, but sound. This 
practice, beneficial only to the student, as it afforded him generally an 
opportunity of witnessing several operations instead of one, has at last, I 
believe, been reluctantly abandoned, I am at a loss to comprehend how 
it ever got a footing amongst surgeons. Part xxxiv., p. 265. 
Painful Cicatrix after Amputation.—Mr. Hancock thinks that this is 
OPERATIONS. 
281 282 
not so much induced by the nerve or its bulb being implicated with the 
cicatrix, as by the adhesion and connection of the cicatrix by firm, un- 
yielding, cartilaginous structure to the periosteum or bone. Separate the 
cicatrix from the periosteum by a subcutaneous incision, and prevent re- 
union by from day to day moving the skin backward and forward. It is 
no use excising the cicatrix ; in the end matters are only made worse. 
Part xl., p. 96. 
oriUM. 
OPIUM. 
Tests for Opium.—Where opium cannot be detected by the smell, Mr. 
Taylor prefers the sesquichloride of iron as a test, discovering as it does 
meconic acid in one hundred and sixtieth of a gr. of opium. It might be 
supposed, says he, that if, on adding strong nitric acid to a portion of the 
liquid, a bright red color resulted, this would be a sufficient indication of 
the presence of morphia, and therefore of opium ; but a serious mistake 
might be committed in such a case, unless the operator had previously 
employed the iron test, and determined the presence of meconic acid in 
the liquid. It is worthy of remark, that the nitric acid test, while it 
destroys the color given by the ineconate of iron (a dark red), will bring 
out, when added to excess to the same portion of liquid, the peculiar bright 
amber-red tint which it is known to give in a solution of morphia. The 
tests for meconic acid and morphia may be thus applied to one quantity of 
liquid. 
Mr. Taylor found that nitric acid detected one-fifteenth gr. of muriate of 
morphia, diluted in 300 parts by weight of water; sesquichlor. iron de- 
tected the one-eleventh gr. in 231 parts of water ; and iodic acid the one 
hundredth grain in 1300 parts of water. Thus, iodic acid is by far the most 
delicate test, discovering as it does morphia in less than one-fifth of a 
grain of opium; but it is also the one most open to fallacy, and cannot 
be employed in colored organic liquids, containing these small quantities. 
Practically its utility is far less than would be anticipated from the re- 
sult of experiments upon the pure salts of morphia. Other experiments 
were performed for the purpose of ascertaining how small a quantity of 
meconic acid need be present in a fluid to admit of its separation by acetate 
of lead, and subsequent identification by sesquichlor. of iron. No precipi- 
tate of meconate of lead occurred when the proportion of meconic acid was 
less than one-forty-eight gr., i. e., about 0.34 gr. common opium. Unless, 
indeed, soluble matter of several grains of opium exists in the liquid for 
analysis, it will be difficult to obtain meconic acid and morphia separately. 
The iron test for meconic acid is far more delicate than any of the tests for 
morphia, and is much less liable to be interfered with. The one-fiftieth gr. 
or smallest visible portion of solid meconic acid is easily detected when free, 
while in solution, in a small quantity of liquid, even one-five hundredth gr. 
may be discovered. Thus, the presence of this acid may be determined in 
a liquid from a much smaller quantity than would suffice to form a separa- 
ble precipitate of meconate of lead; for, while for this latter one-third of 
a grain of opium is required, less than one-hundredth of a grain suffices for 
the exhibition of the acid by the direct application of the iron test. The 
procural of the precipitate of meconate of lead does not increase the cer- 283 
opium. 
tainty of the iron test, hut merely enables us to obtain the meconic acid in 
a concentrated and solid form. Part xip. 100. 
Opium.—In reference to the employment of opium generally, the con- 
stipation which it causes renders it obnoxious to some constitutions. If 
this (as is believed) arises from an arrest of the biliary secretions, the com- 
bination with mercury, rhubarb, or colchicum, will obviate it. In cases 
where any of these are not admissible, the ox-gall comes to our aid ; and 
whether it is by directly stimulating the secretion of bile, or acting as a 
substitute for it, there can be no question of its being able to counteract 
the constipating tendency of opium. But this power of causing constipa- 
tion becomes available in the treatment of a very formidable disease— 
namely, in peritonitis from perforation of a portion of the intestinal canal; 
and as our object here is to arrest the action of the intestines, to enable the 
opening to be sealed up with organized lymph, it is evident, that to effect 
this object, the uncombined use of opium can only be relied on. Should 
the aid of mercury be required to combat the consequences of the inflam- 
mation, its administration must be postponed to an after-period. 
Part xv., p. 87. 
Muriate of Opium.—The following is Dr. Nicol’s formula : Take of the 
best powdered opium, §j.; muriatic acid, §j.; distilled water, gxx. Mix. 
Shake this mixture very frequently every day, during fourteen days, then 
strain and lilter. The dose is from twenty to forty drops, according to 
circumstances. 
Dr. N. says : I have found by experience, that this is the best anodyne 
I am acquainted with. I may mention that I prepared solutions of opium 
with acetic, nitric, sulphuric, citric, tartaric, and muriatic acids, and also 
prescribed them, but the muriatic solution was vastly superior to any one 
in every respect. All of them produced headache, with the exception of 
the muriatic. I prefer muriate of opium to the tincture, wine, or powder 
of opium, and also to the muriate and acetate of morphia; in tact, to any 
other preparation of opium. It never makes my head ache, but all other 
preparations do. Part xvii., p. 303. 
Opium—Nausea from.—To counteract the nausea from opium, combine 
with it 30 minims of dilute sulphuric acid. The nausea from hydrochlorate 
of morphia is best controlled by dilute hydrochloric acid. 
Part xxix., p. 326. 
Opium in the Treatment of Chronic Ulceration of the Legs, etc.—Mr. 
Skey of St. Bartholomew’s Hospital, says: I venture to attribute to this 
remarkable drug the property of promoting the formation of healthy gra- 
nulations on a surface that, notwithstanding all the previous appliances of 
surgery, is yet flat, pale, and ungranulating. Now, there is no example of 
the power of opium to effect this object, more conclusive, or in which there 
is more work to be done, than that form of disease of which I am speaking, 
—which consists of a gap formed on the surface of the body, of greater or 
less depth and diameter, and in which there exists not even a trace ot a cu- 
rative action,—and yet the object is accomplished by means ot this agent, 
and often with remarkable celerity. We call opium a stimulant and a se- 
dative. As a stimulant, it is not very often employed in practice : wdiile 
its properties, as a sedative, are well known, and are in daily requisition. 
Its property of mitigating pain and of promoting sleep, is that for which it 
is almost exclusively employed, and so completely is its action associated 284 
with this sedative principle, that its occasional influence as a stimulant is 
almost entirely lost sight of, and the stimulating property has merged in 
the supposed sedative. 
I believe that its sedative properties have little concern with the result. 
In truth, opium is a most valuable stimulant of the vital powers, and whe- 
ther its action originate with the centre or the periphery of the circulation, 
whether primarily on the heart or on the capillary vessels, I do not pretend 
to know ; but there is no drug, simple or composite, known to our phar- 
macologists that possesses an equal power with opium, of giving energy to 
the capillary system of arteries, of promoting animal warmth, and thus 
maintaining an equable balance of the circulation throughout the body. 
To maintain the balance of the circulation ! How much of meaning is at- 
tached to these words! How many affections of the bodily frame may not 
be brought within the range of this definition ! Take the common chil- 
blain ; what is it but a local congestion of blood caused by defective capil- 
lary power ?—there is no better remedy than opium ; cold feet, as charac- 
terizing a person or a constitution, equally relieved ; senile gangrene, the 
result of arrest of the capillary circulation, or its apparent opposite, 
local hyperemia—these diseases, one and all, manifest a loss of local power, 
a failure in the balance of the circulation. The term “inflammation,” a 
word formerly in the mouths of our professional brethren on all occasions, 
is now limited in its application, and should be yet more limited, and I be- 
lieve, in a yet more advanced state of medical science, will be restricted to 
an actually rare condition of the system. The influence of opium in such 
conditions is that of promoting a genial warmth over the system, a glow 
exactly resembling, and in fact identical with, that produced by the reac- 
tion on the system which is caused by the cold-bath. It is local health, 
and the sensation is most agreeable. The benefit derived from opium, 
when administered for the purpose of arresting inflammatory action of the 
vessels, admits, I think, of much doubt, and should be resorted to with 
some hesitation as a remedial agent, though I am quite persuaded that the 
evil of its administration is greatly overrated. But who will profess igno- 
rance in these days of the inestimable value of this agent when resorted to 
immediately after an attack of inflammation has been subdued by a local 
or general bleeding ? Here we can imagine that, the activity of the dis- 
ease being checked, the diffusing influence of opium on the circulation may 
act as a simple derivative, operating on the vessels at the moment they are 
not indisposed to yield up their blood, and to which indeed they are com- 
pelled by the diffusive power of the general stimulus. 
Many years ago, and before the introduction of railway travelling, I was 
summoned late one afternoon to see a patient some eighty miles from Lon- 
don. I travelled outside the mail. This occurred in the month of Decem- 
ber, and the night was extremely cold. By some mistake I omitted to 
bring my great-coat; and, for the first hour, I suffered a good deal. On 
reaching a town at some ten miles’ distance from London, I took the op- 
portunity, while changing horses, to run across the street to a druggist’s 
shop, where I ordered a draught, containing twenty-five drops of tincture 
of opium. I believe I was the only person outside the coach that night 
who did not suffer the slightest sensation from cold. 
But it will be urged by many, who have experimented on, and who have 
observed less than I have done, the medical properties of opium, the infi- 
nite importance of studying the reactive effects of this daily poison, and 
OPIUM. opium. 
285 
they would inquire into the condition of a person so treated on the follow- 
ing day. You may be assured that it amounts to nil. You will, I am 
sure, readily understand what I mean when I say the cold and the opium 
mutually balanced and mutually neutralized each other. There could be 
no reaction, because the influence of the depressing agent—viz., the cold, 
rather than otherwise, exceeded in duration that of the stimulant. If the 
period of prostration were brief, and limited to one or two hours, the ar- 
gument might hold ; but it is but a sorry objection to be urged after all. 
I wish I could impress on the minds of the medical authorities in the 
Crimea the real benefit that might be derived to our troops, beaten down 
by intense cold and suffering in its various forms, from the judicious ad- 
ministration of opium. If twenty-five or thirty drops of tincture of opium, 
in addition to his ordinary quantum of rum, were administered to each 
soldier whose nightly services are required in the trenches or on guard, 
you would hear little complaint of cold for that night, neither would it 
produce the smallest tendency to sleep. 
If cold beget suffering, opium is the antidote to that suffering, and the 
one will assuredly neutralize the other. 
Notwithstanding the prejudices and the bigotry that have long beset 
the public mind on this subject, and from which our profession is not 
totally exempt, there is no comparison to be drawn between the practice 
of dram-drinking and the excessive indulgence in the use of opium. 
The man who indulges in spirituous liquors makes daily inroads on his 
digestive powers not less than on his brain. His appetite is destroyed, 
and the pabulum for his blood is withheld from his circulation. He is 
stamped for life, and his perfect health is irrecoverable. The influence of 
opium, when taken as a means of indulgence, though deleterious, is not 
permanently injurious. It exercises no serious influence on his digestion 
or on his cerebral organs, and, the practice once controlled, leaves him in 
a condition to regain, without difficulty, the fullest vigor of both bodily 
and mental health. 
I have related to you the particulars of several cases of chronic ulcer in 
w'hich recovery was attributable to the medicinal properties of opium, 
and almost to opium alone. The character of these ulcers strongly marks 
the inactivity of their nature, and hence the class of society to which they 
belong. They are marked by a flat base, which indicates, by its pale, 
flabby uniformity of surface, that no reparatory action has approached it. 
It is often surrounded by a thick, high ridge of lymph, covered by un- 
healthy integuments. The depth of the ulcer, which may be seven or 
eight lines, is caused partly by the ridge, and partly by the excavation of 
the ulcer below the natural level of the healthy integuments. So long as 
this ridge exists," although granulations may form, and will form, from the 
date of the employment of the opium, yet cicatrization will never com- 
plete the process of cure unless the wound or ridge be absorbed. Now 
the action of opium is not alone exhibited in the development of healthy 
granulations, but in the entire complement of such actions as are required 
by the sore, viz., the formation of new material, and the absorption of the 
old. 
The influence of the stimulant is exhibited therefore not on one particu- 
lar function. It does not merely promote secretion, but it stimulates the 
healthy vital actions in their entirety—viz., secretion, organization, and 
absorption contemporaneously ; the granulations are secreted and or^an- 286 
ORCHITIS, 
ized, while the circumvallation of unsound material, the product of years 
of growth, is gradually absorbed and reduced to the level of the surround- 
ing integument; for the removal of this wall is quite as indispensable to 
the ultimate result as the obliteration of the cavity by granulation. With- 
out the two surfaces be brought to the same level, the process of cicatri- 
zation. o’- skinning over, will never be perfected. 
If, therefore, we find that a disease like that I have described, and 
which exhibits Sv, palpably a dormant condition of the remote capillaries, 
is amenable to this form of stimulant, which can only accomplish the cure 
by the substitution of healthy for morbid actions, why should we restrict 
its employment to this class of diseases ? Why, as I have elsewhere in- 
quired, may we not experiment with success on any local disease depen- 
dent on the same cause—viz., an inert condition of the remote vascular 
system ? 
In claiming for opium the merit of rousing into healthy action the dor- 
mant capillary system, to the end of accomplishing the permanent cure of 
ulcer of the legs in old persons, I by no means wish you to infer that I 
consider all other modes of treatment unworthy of trial. Indeed, I attach 
great value to that recommended by Mr. Baynton, of Bristol, and others ; 
but, having tested their value, I have no hesitation in pronouncing that 
which I have recommended, so far as I am competent to judge, as by far 
the most certain and efficacious. Dart xxxi., p. 192. 
ORCHITIS. 
Treatment of Diseases of the Testicle by compression.—Mr. Langston 
Parker states that in common swelled testicle compression may be em- 
ployed as soon as the patient is able to bear the application of the plasters; 
and this is generally much sooner than might be supposed, however acute 
the disease may be. The great advantages possessed by compression, are 
almost immediate relief to pain; the patient can usually pursue his ordi- 
nary duties. Compression is also advised in chronic enlargement and in- 
flammation of the testis—the result of constitutional syphilis. 
Compression of the testis is to be practised by surrounding the organ 
by straps of plaster, applied as closely and tight as the patient can bear. 
The plasters I generally use are those of ammoniacum, with mercury, or 
iodine and belladonna. These are to be smoothly spread upon thick wash- 
leather and cut into thin straps; an assistant then grasps the testicle, and 
draws it as far downward as he can in the scrotum, which should previously 
be washed with a little spirits of wine. The first strap Should be placed 
at the upper part, circularly round the testis, and succeeded by others, 
placed in the same direction, till the whole is covered : a second series of 
straps is then to be placed in an opposite direction to the former, crossing 
them at right angles, from behind forward. One or two long ones may 
then be placed over these where they appear to be most needed, to keep 
the whole in place. The parts should be supported by a well-fitting sus- 
pensory bandage, although the plasters at once relieve any inconvenience 
or pain that may have been occasioned by the dragging or weight of the 
testicle. Dart ii., p. 109. 
Pressure by Condensed air as a Surgical Remedy.—Pressure applied ORCHITIS. 
287 
to diseased parts, when judiciously employed, has long been regarded as a 
valuable remedy in particular diseases, in some cases testicle 
for example; this has generally been applied by means of straps of plaster, 
or some such application, which, however, cannot be properly or durably 
applied. Dr. Krauss suggests the adoption of compression by condensed 
air, in Mackintosh bags, variously shaped, so as to fit the different parts 
of the body which are most liable to require such applications. He would 
surround a diseased testicle with one of these air cushions, consisting of 
two bags, one hanging in the other, and both narrow on the top, to sur- 
round the spermatic cord. Each bag is open on one side, from the top to 
the bottom, and they are attached to each other by their corresponding 
edges, so as to leave between them an air-tight space, accessible only by 
means of an air-tight screw, fixed to the bottom of the outer bag. Along 
the side opening are holes to lace the double bag, previously to its being 
inflated, around the testicle, and it is subsequently filled with air, by 
means of a simple air pump. The inside bag is thus uniformly pressed 
against the whole of the scrotum contained in the air bag. On the swell- 
ing of the testicle decreasing, more air can easily be introduced, or, on the 
other hand, if necessary, the degree of pressure can be reduced by allow- 
ing part of the air to escape. 
Dr. Krauss proposes an air bag, made in the shape of a cylinder, to 
replace the solid bougie for dilatation of strictures, also an air pessary, on 
the same principle, for the support of prolapsions of the womb, and an air 
bag, for the purpose of Tamponnement in hemorrhage of the uterus. 
He further suggests the application of pressure by condensed air, as a 
curative means in certain diseases of the joints—in perforation of the roof 
of the palate—for the cure of ulcers, and for the dispersion of tumors. 
Dr. Krauss concludes by directing attention to the application of air and 
water-cushions to diminish the pressure that artificial legs frequently pro- 
duce upon the stumps to which they are applied. 
Part viii., p. 146. 
Acute Orchitis.—Mr. T. B. Curling strongly recommends tartarized an- 
timony. “ A quarter of a grain of tartar emetic may be exhibited every 
three or four hours, and the dose, if necessary, increased until nausea is 
produced. This is one of the most valuable remedies that can be employed 
in acute orchitis; and when patients are desirous of avoiding the trouble, 
mess, and exposure consequent upon the application of leeches, the exhi- 
bition of tartar emetic will generally render local depletion unnecessary, 
whilst its depressing influence being only temporary, the patient quickly 
regains his health and strength. I have seen most acute orchitis arrested 
and subdued in thirty hours by keeping up constant nausea by means of 
this remedy. When there is much pain or constitutional derangement, 
two or three grains of calomel, combined with eight or ten grains of Do- 
ver’s powder, or with small doses of morphia, may be given at bedtime. 
In consecutive orchitis, in which the tunica vaginalis is so generally affect- 
ed, considerable benefit is derived from mercury. In acute cases, after the 
bowels have been freely acted on, and the pulse has been lowered by tar- 
tar emetic, I usually prescribe mercury, and continue it until the gums be- 
come slightly affected. I am confident that by this treatment the dura- 
tion of this form of the disease is often materially abridged, and, what is 
of some importance, it is succeeded by much less induration and thicken- 288 
OECHITIS, 
ing of the epididymis than when the exhibition of mercury has been de- 
ferred to a later period.” Part vim, p. 207. 
Enlarged Testicle.—Ricord employs the following pills in the treatment 
of enlarged testicle, which remains after inflammation of that organ : 
Ilyd. chlor. Bj-; pulv. eonii; sapon. hisp. aa. Bij. M. ft. pil. xxiv. 
Part ix., p. 20. 
Treatment of Hernia Humoralis, or Gonorrhoeal Orchitis, by Opium. 
—In the reports of cases of this description under Mr. Gay, in the Royal 
Free Hospital, London, we find that the gonorrhoeal inflammation of the 
testicles and appendages were speedily and completely cured, by purga-. 
fives and opium. Hyoscyamus has been given with equally good effects. 
The full and free purgation was always necessary before giving the opium. 
Fifteen minims of laudanum may be given every four hours, and the 
previous purgative may be composed of five grains of calomel with 
twenty-five grains of jalap, or a strong black draught. Part ix., p. 186. 
Orchitis—Incision into the Tunica Albuginea.—M. Velpeau consider; 
that the excruciating pain experienced in orchitis depends on a species of 
strangulation ; the tunica albuginea, not yielding, compresses the swollei 
and inflamed testicle, and thus gives rise to the intense pain. He accord 
ingly, acting on these views, recommends an incision into the tunica albu 
ginea. He has performed it with success fifteen times, nor did permanent 
injury of the testicle occur in any one case. Part xii., p. 302. 
Treatment of Gonorrhoeal Orchitis.—In taking a review of the method 
of treatment usually employed in this disease, Mr. Phillips states that punc- 
t.ures, frictions, and compressions, are of limited application ; purgatives 
are not of use except in moderation, to keep the bowels open ; local blood-- 
letting produces as much inconvenience as it does good; and general bleed- 
ing is usually uncalled for. The plan of treatment which Mr. Phillips pre- 
fers, is that by nauseants. 
Give a mixture containing epsom salts, and a sufficient quantity of tartar 
emetic to produce decided nausea from the first; say half a grain for the 
first dose, and then a fourth or a sixth of a grain every four or six hours, 
so as to keep up the nausea for two or three days. Part xviii., p. 215. 
Treatment of Orchitis.—Mr. Cooper advises active antiphlogistic 
treatment. Thus, in persons of plethoric habit, bleed from the arm ; in 
others, in addition to the application of leeches to the affected organs, cup 
from the loins to about eight ounces. Give also a pill containing a grain 
and a half of calomel, one-third of a grain of tartarized antimony, and 
half a grain of opium ; and the following mixture : R Magn. sulph. giij.; 
liq. ammon. acet., 3j.; liq. antim. tart., giss.; tinct.hyoscy., 3iss.; aq. menth., 
gvij. M. capt. gj. 3tis horis donee alvus bene respondent. Keep the pa- 
tient on low diet, and in the recumbent position. And as a local applica- 
tion use a lotion containing a drachm and a half of muriate of ammonia, 
two ounces each of rectified spirit and liq. ammon. acet., and four ounces 
of water. If the inflammation does not abate, open the congested vessels 
of the scrotum, and promote bleeding from them by warm fomentations. 
If enlargement and harshness of the testicle remain after the subsidence 
of the inflammatory symptoms, apply strips of lint spread with the follow- 
ing ointment: R Ung. hydrarg.; cerat. saponis, aa. gij.; camphor®, gr. 
v. M.; and over this, apply adhesive plaster, so as to make considerable 
pressure. Do not, however use pressure in the early and acute stage. OVARIAN AFFECTIONS. 
289 
Rheumatic and Gouty.—Give alkalies, and a small dose of colchicum 
at bedtime. 
Gonorrhoeal.—Apply warm fomentations to the scrotum, perineum, and 
penis, so as to reestablish the discharge, and then give calomel and opium 
every night. Part xix., p. 174. 
Collodion in Orchitis.—Prof. Costes relates cases of this disease in 
\AThich, after covering the scrotum with a mixture of 20 parts of collodion 
and 6 of ol. ricini, the swelling and pain were quickly relieved, and a rapid 
and complete cure was obtained. Part xxxii., p. 293. 
Ovarian Tumors—Diagnosis.—It has occasionally happened that soli<J 
growths or tumors of the ovaries, whether of a malignant or non-malig- 
nant character, are attended with an effusion into the peritoneum, or an 
ascites, and may thus be mistaken for the more usual form of the ovarian 
disease, viz., the encysted dropsy. Dr. Kilgour furnishes us with some 
valuable hints on the diagnosis of these affections. 
The non-malignant, solid enlargement or tumor of the ovary, and which 
sometimes attains a very great size, is, generally speaking, of the same 
character as the fibrous tumor of the uterus, and unless improperly inter- 
fered with, may exist for many years without giving more disturbance 
than is occasioned by its bulk. The malignant disease is similar to that 
met Avith in the mamma, and sometimes is of the hard form ; in other cases 
it presents the characters of soft scirrhus, or encephaloid disease. The 
non-malignant disease is not attended Avith pain—the malignant one is so 
generally, but not ahvays. The latter is almost hrvariably attended with 
much constitutional disturbance; it is much more rapid in its course; and, 
whilst it indicates almost its nature by this quickness in its fatal pace, it 
frequently still further demonstrates itself by attacking the mamnue, the 
uterus, or the pylorus. 
The fibrous and the scirrhous tumors, when felt through the abdominal 
wall, are smooth or rough, or knobbed or tuberose, on the surface; and 
no diagnosis of the tivo diseases can be made by this means; but the 
semi-solid or gelatinous cyst is almost always smooth, and invariably to a 
practised hand, gives more a feeling of elasticity than solidity, Avhilst 
traces of fluid, perhaps faint, will be discovered in partial spots of the ab- 
domen, viz., in some of the other cysts. The semi-solid or gelatiniform 
and elastic cyst is always fixed, but the solid tumor is often mo\Table, 
and, Avhen attended with effusion, it moves about by slight pressure in 
the fluid. 
Now, are there any accurate means of distinguishing solid ovarian dis- 
ease with ascites, from encysted dropsy of the ovarium ? But, first, how 
is encysted dropsy itself knoAvn from ascites ? 
Cruveilhier furnishes us Avith two very important diagnostics. 1st. In 
ascites the liquid ahvays occupies the most dependent parts, viz., the pelvis 
and lumbar region ; whilst the small intestines floating in the fluid, corres- 
pond to the umbilical region, and the arch of the colon and stomach 
occupy the epigastrium. Percussion, therefore, elicits a dull sound over 
OVARIAN AFFECTIONS. 
VOL. II. 19 290 
OVARIAN AFFECTIONS. 
the hypogastric and lumbar regions; whereas, in encysted dropsy, the 
cyst develops itself anteriorly to the intestines which it pushes back, so 
that here the tympanitic sound does not exist. In ascites the fluctuation 
is more decided than in encysted ovarian dropsy. 2d. In ascites the neck 
of the womb is in its proper place, while in encysted ovarian dropsy it is 
actually drawn upward, so that it is difficult to reach it; the pelvic cavity 
being also in some measure filled by the tumor; and the general health is 
often good ; while in ascites this is not the case, anasarca also often accom- 
panying it. If a solid ovarian tumor co-exist with ascites, it may gene- 
rally be known by its mobility ; it moves up and down in the fluid, strik- 
ing the finger exactly like a child in utero, in what is termed the ballote- 
ment. In the encysted dropsy, if a solid tumor is present, it is fixed ; it 
is outside the cyst of the bag of water, or forms part of the wall of the 
cyst, and cannot readily move about. But we apprehend that in these as 
well as in most, if not all the diseases of the womb and the contiguous parts, 
we shall find Dr. Simpson’s uterine sound or bougie one of the most im- 
portant means of diagnosis which has lately been brought before the 
public. Part viii., p. 95. 
Treatment of Ovarian Cysts.—Mr. Phillips states it as his opinion, “ that 
we have not the means of determining with absolute certainty whether 
a tumor be an ovarian cyst or not; and that we have no sure means of 
ascertaining the contents and connections of tumors presumed to be ova- 
rian.” There have been numerous cases, however, in which it may have 
been perfectly correct to operate, but we suspect that these form the ex- 
ceptions rather than the rule. Mr. Isaac Brown brings forward cases of 
ovarian tumors which were dispersed without these severe proceedings. 
He made use of mercurials, diuretics, tonics, tight bandaging, and tapping. 
These cases, however, were of young unmarried women, in whom the re- 
parative powers of nature may have been more vigorous, or in whom the 
disease may not have been so obstinate. 
The treatment was adopled at the suggestion of Mr. Gibson, of Hal- 
stead. It consisted of mercurial friction over the abdomen, with flannel 
bandages tightly applied, mercurial alteratives, and steel medicines, varied 
by diuretics, such as acetate of potash, spirit of juniper, and squills. 
When the health was improved, and the size of the abdomen somewhat 
diminished, showing that the cause of mischief tvas somewhat arrested, 
tapping was resorted to; and after this a pad was made of napkins, and 
tightly bandaged, so as to produce a good deal of pressure in the situation 
of the tumor : this pad was increased in thickness next day, and firm com- 
pression continued. The mercurial friction was continued on the inside 
of the thighs, and the diuretics again commenced. The pad was con- 
tinued, and the compression increased as the patient could bear it. Seve- 
ral cases are related in which this treatment was successful. It will be 
necessary, however, to continue the treatment for a considerable time 
after the tumor seems to have been dispersed, otherwise it will be likely 
to return. Part x.,p. 124. 
Case of Ovariotomy.—The following case of extirpation of an ovarian 
tumor seems to have been one of the most successful yet recorded. Much 
credit is due to Mr. Southam for having added to our capabilities of form- 
ing a true diagnosis in these formidable diseases. [Having determined on 291 
OVARIAN AFFECTIONS. 
extirpation, the room being heated to 15°, and the bladder emptied, etc., 
it was performed in the presence of Drs. Radford, Clay, Watson, and seve- 
ral surgeons, as follows] : 
An exploratory incision, midway between the umbilicus and pubes, was 
first made, and the peritoneal cavity opened sufficiently to admit the finger, 
A characteristic membrane of a bluish white and shining surface appearing 
at the opening at once satisfied me of the existence of a cyst, and the finger 
introduced between it and the peritoneum, discovering no adhesions in the 
immediate neighborhood, I punctured it with a full-sized trocar. x\fter 
from sixteen to eighteen pints of clear, lemon-colored slightly mucilagi- 
nous fluid had been evacuated, pressure on the parietes being well sustained 
during its escape, the canula was withdrawn, and using the index finger as 
a director, the opening was enlarged above and below with a probe-pointed 
bistoury, to the extent of between six and seven inches. Having ascer- 
tained by the hand introduced into the abdominal cavity, that there were 
no impediments to the extraction of the tumor, it was carefully drawn out, 
gentle pressure being continued on the abdomen. Finding that it was at- 
tached to the uterine extremity of the left broad ligament by a short and 
slightly vascular pedicle, I tied it firmly with a single ligature of the strong- 
est dentist’s silk. The pedicle was now divided, and the tumor being re- 
moved, the margins of the wound were immediately approximated to pre- 
vent the ingress of air. After a brief interval, the wound was again 
opened to remove what blood had escaped internally, and to ascertain that 
the vessels of the broad ligament were firmly secured. The uterus and 
opposite ovary were also examined and found healthy. One end of the 
ligature being cut off, the other was left dependent at the lowest point of 
the wound, the edges of tvhich were brought together by four interrupted 
sutures and straps of transparent tissue plaster. Upon these a broad pad 
■was applied, and the whole being adjusted by a bandage, the patient was 
lifted into bed, within twenty-five minutes from the commencement of the 
operation. 
[The case proceeded uninterruptedly to a favorable termination; the 
ligature came away on the forty-ninth day, and the fistulous opening then 
closed. After remarking that the difficulty in making a correct diagnosis 
forms the chief objection to the operation, which must continue so long as 
mere examination of the abdomen, and the history of the case alone, are 
relied on in forming it—we are told that in the present case, though the 
enlargement was uniform and fluctuation distinct in every part—] 
An examination per vaginam et rectum, cleared up all doubts, not only 
of the existence of an ovarian tumor, but of its exact nature. The absence 
of any protrusion of the vaginal parietes, the elevated position of the uterus 
in the pelvic cavity, and the inability to cause it to bound away from the 
finger, proved that the fluid could not be ascitic, whilst the projection ofthe 
swelling on the left side, the decided influence which raising and depress- 
ing the abdomen produced on the position of the uterus, with its inclina- 
tion to one side more than the other, evidently indicated that the disease 
was connected with the left uterine appendages. The uniformity in the 
abdominal distention, the distinct fluctuation in every part of it, and the 
inability to discover any solid matter encroaching on the pelvic cavity, led 
me to infer that it consisted of one or two cysts only; and the comparative 
immunity from any great degree of suffering until within the last twelve 
or eighteen months, the absence in the history of any previous attacks of 292 
OvAKIAN AFFECTIONS. 
peritonitis, together with the slight impediment to the action of the bowels, 
rendered the existence of adhesions doubtful. 
Though somewhat emaciated, her general health did not appear im- 
paired ; appetite good ; tongue clean ; pulse natural; bowels occasionally 
constipated, but easily acted on by medicine ; catamenia regular, though 
in less quantity than formerly ; felt pain at times in the left inguinal re- 
gion, or whenever she lay on the left side, and in consequence of the pres- 
sure of the tumor upward, she has been unable to lie on her back, or in 
any other position, excepting on the right side, for the last twelve months. 
The symptoms clearly indicating encysted dropsy of the left uterine appen- 
dages, advanced to such a stage as to render surgical interference neces- 
sary, and her constitution not being much affected, I considered the case 
was peculiarly favorable for the operation. In the operation, the evils of 
both the major and minor incisions were guarded against, by making the 
opening no larger than was necessary to ascertain the nature and connec- 
tions of the disease, and to admit of its removal after reducing it by para- 
centesis, without occasioning the least violence or displacement of any of 
the neighboring parts. Had the slightest obstacle occurred previous to the 
successful termination to the operation, this plan would also have enabled 
me to have receded without much danger to the patient, lPart xii., p. 247. 
New Operation for Ovarian Dropsy.—Prof. Kiwish relates the case of 
a peasant, set. thirty, mother of four children, who was received into the 
hospital at Prague on account of obstinate ischuria and constipation. The 
cause of these affections was found to be a tumor, the size of a head, lying 
between the rectum and the vagina. By careful examination the operator 
was satisfied that this tumor was not formed by the uterus, but by an en- 
larged ovary containing fluid. 
With a curved trocar a puncture was made in it, through the vaginal 
parietes. Through this about nine pounds of a chocolate-colored fluid 
was drawn off, upon which the sac completely collapsed, and the uterus, 
which had been pushed high upward and forward on the brim of the pel- 
vis, returned to its natural situation. The canula was left for thirty hours 
in the wound, to permit all the fluid to drain off. In ten days it was ne- 
cessary to repeat the operation, and on this occasion the opening made by 
the trocar was so far dilated with a bistoury that a finger could be intro- 
duced into the sac ; several pounds of fetid bloody pus and numerous 
flakes of lymph were removed. Water was injected into the sac Avith 
considerable force, and in order to keep the opening pervious, a thick 
curved uterine tube of tin was introduced into it, and fastened in front of 
the external genitals. During the ten days following the operation there 
was considerable fever and a good deal of fetid discharge ; but at the end 
of a fortnight the discharge improved in quality, and diminished in quan- 
tity ; the tube was then removed for some hours daily, so that the patient 
was permitted to take some exercise, and from this time she gradually re- 
covered. In four weeks the wound had contracted so much that the tube 
could not be again introduced ; and in about six weeks from the date of 
the second operation, the patient was dismissed cured. A year after this 
the author again saw the patient; she was then in perfect health ; the 
uterus was in its normal condition and situation, and behind it the remains 
of the sac could be felt as a small, hard and easily mobile body, causing 
not the slightest inconvenience. OVAKIAN AFFECTIONS. 
293 
The author states that the following conditions are necessary to insure 
success: 1st. That there be no other complication, and that the tumor be 
unilocular; this is to be proved by its being entirely emptied by an explo- 
ratory puncture with a trocar. 2d. That the cyst contain not more than 
fifteen pounds of fluid. 3d. That the opening made be large enough to 
permit the easy introduction of the finger. 4th. That the injections of 
water be of such a temperature as shall be agreeable to the patient, and 
that they be thrown deep into the sac. 5th. That the tube introduced into 
the opening be withdrawn at intervals, and that its use be not entirely laid 
aside until the opening has become contracted, and the discharge has be- 
come solely purulent; if the opening contracts prior to this, it must be 
again enlarged with the knife. Part xiv., p. 319‘. 
Ovarian Dropsy.—As palliatives, Dr. Allison advises iodide of pot as- 
sn m with squill and juniper. After tapping, introduce a small silk cord 
as a tent, by which the water may be occasionally evacuated. For a radi- 
cal cure, inject a solution of iodine into the sac. Part xv.,p. 30>. 
If the tumor is solid, says Dr. Locock, do not meddle with it. If a ft 
unilocular cyst, tap once, and apply pressure for several months; mercury 
and diuretics do harm. If the tumor is malignant or many-cysted, tapping 
and pressure will do no good : in these cases alone is extirpation indicated, 
and in these is it least likely to do good. Part xv., p. 308. 
Case of Ovarian Disease.—[A lady with all the symptoms of ovarian 
dropsy, having a large and tense abdomen, and distinct fluctuation, was 
tapped ; no fluid issued from the canula, nor did any follow its withdrawal. 
The symptoms were not aggravated by the operation, but in a few weeks 
she died ; and post mortem, the trocar was again passed without giving 
exit to fluid.] 
On opening the abdomen, the cavity of the peritoneum was found full 
of a gelatinous substance like glue, which could be drawn out in long 
strings, and would not drop. This tenacious fluid could with difficulty be 
removed, though a bucketful was taken out. There was then found a 
cyst of the right ovary, not capable of holding a quarter of the fluid taken 
out. The cyst appeared to have burst, then lessened in size, while the se- 
cretion still went on from its lining membrane into the cavity of the abdo- 
men, causing the sense of fluctuation. 
[A case similar to the above in the character of the fluid occurred iu 
the practice of S. Smith, Esq., of Leeds. On tapping, the contents of 
the cavity were found of such a consistence that they could only be evac- 
uated by taking hold of the portion which protruded through the canula* 
and drawing it out by winding it over the hands, as one would wind a 
rope. In this manner many gallons were evacuated.] Part xv., p. 311. 
New Plan of treating Ovarian Dropsy.—It is proposed by Dr. Tilt 
to treat certain cases of ovarian disease by establishing solid adhesions be- 
tween the tumor and the abdominal walls ; effecting a very small ulcerative 
opening of the cyst through the centre of these adhesions; and so inducing 
gradual discharge of the fluid, and contraction of the walls of the cyst. 
The cases to which this method is applicable, are those where the cyst is 
monolocular, and without any amount of solid deposit. These points majf 
be ascertained by a preliminary tapping, by which we may judge also of 294 
OVARIAN AFFECTIONS. 
the degree of tendency to peritonitis. If, after tapping, the case is thought 
to he a suitable one, the cyst is to be allowed to refill to half its previous 
size, and the treatment is then to be commenced. It consists in applying 
a portion of Vienna paste, so as to produce an eschar of the size of a half- 
crown, at some part of the abdomen ; either at the spot where the fluctu- 
ation is most superficial, or, if there be no such spot, in the mesial line, an 
inch or two below the umbilicus. The eschar is to be left to separate of 
its own accord, and then, if the thickness of the abdominal walls requires 
it, another portion of caustic applied to the abraded surface. The second 
step in the treatment, the formation of a valvular opening into the cyst, 
is not to be attempted by surgical interference ; it will take place by ulcera- 
tion spontaneously, a few days or weeks after the separation of the eschar. 
When the contents of the cyst begin to escape, abdominal pressure must 
be used; at first, moderate, with a view, not of emptying the cyst, but of 
giving support: afterward gradually increased, with a view of diminish- 
ing the size of the cyst, now become too large for the quantity of fluid 
secreted by its lining membrane. The contraction of the cyst will neces- 
sarily be slow, and it is of great importance to keep it quite full. For this 
purpose injections should be used, and their employment should commence 
when the secretion becomes very fetid. The point of an india-rubber tube, 
eight inches long, and funnel-like in shape at its other extremity, is to be 
gently passed trough the opening, into the cyst, and tepid water gradu- 
ally and gently injected in sufficient quantity, cure being taken to exclude 
air ; the patient is then told to strain, when the overplus of the fluid will 
trickle out through the tube. When the use of injections has been com- 
menced, they should be used regularly, every day before breakfast; and 
oftener, if the fetidity of the secretion requires it. As to the other modes 
of treatment—small tumors may be cured by giving large doses of the 
preparations of iodine internally, and using them externally. When the 
cyst is voluminous, and bulges into the vagina, it may be punctured per 
vaginam, and an india-rubber sound left in its cavity, and moderate press- 
ure applied to the abdomen. Subcutaneous incision into a monoloculai 
cyst is sometimes warrantable. Tapping, as a palliative, is to be deferred 
as long as possible; and ovariotomy is to be reserved for multiloculai' 
cysts, and those monolocular ones which contain much solid deposit. 
Part xviii., p. 289. 
Case of Ovarian Tumor containing Teeth and Ilair.—The patien' 
was an unmarried woman, fifty-eight years of age, who had had a tumo' 
in the abdomen, presumed to be ovarian, for twenty-eight years. The 
swelling having latterly increased very rapidly, so that respiration was im- 
peded by the distention of the abdomen and pressure on the diaphragm, 
she was tapped, and about seven quarts of serum withdrawn. She died 
forty-eight hours afterward, with symptoms of exhaustion and peritonitis. 
The tumor, on being removed, proved to be a cyst varying in thickness in 
parts, but generally about that of a shilling: 'its contents consisted of 
teeth, hair, bony deposit, some transparent masses of a cellular structure 
(as examined by the microscope), serum, sebaceous matter, and granular 
tat; which were contained in numerous small cysts. Teeth were found in 
all parts of the tumor, and were counted to the number of forty-three: 
some were contained in cysts; others imbedded in the semi-transparent 
masses, and two or three were gi’owing from the walls of the parent cyst. 295 
OVAKIAN AFFECTIONS. 
In one part a few were imbedded in a mass of bone, bearifig a strong re- 
semblance to an upper jaw ununited in the mesial line. Part xx., p. 235. 
Ovarian Dropsy is liable to be confounded with, 1. Retroflexion and 
retroversion of the uterus. 2. Tumors of the uterus. 3. Ascites. 4. 
Pregnancy. 5. Pregnancy complicated with ovarian dropsy. 6. Cystic 
tumors of the abdomen. 7. Distended bladder. 8. Accumulation of air 
in the intestines, especially if there has been chronic peritonitis leaving 
some ascitic fluid. 9. Enlargement of the solid viscera of the abdomen, 
the liver, spleen and kidney. 10. Accumulation of faeces in the intestines. 
Part xxii., p. 289. 
Mr. I. B. Brown’s new operation for treating ovarian dropsy consists of 
excising a portion of the sac, returning the remaining portion into the 
peritoneal cavity, and closing the wound by sutures, allowing any fresh 
portion of the fluid secreted by the remainder of the cyst to escape into 
the peritoneal cavity, and to be there taken up by absorption, and dis- 
charged by the kidneys. This plan was brought to Mr. Brown’s mind 
by reflecting upon the numerous cases in which a spontaneous cure fol- 
lowed an accidental rupture of the cyst, succeeded by a copious discharge 
of urine. Mr. Brown relates three cases thus treated, which, though fol- 
lowed by severe peritonitis, ultimately did well. Part xxvi., p. 347. 
Diagnosis of Chronic Ovarian Tumors.—According to. Dr. Tilt, ova- 
rian tumors many be confounded with tumors of the unimpregnated womb. 
Retroversion and retroflexion of the womb have been mistaken for inci- 
pient ovarian tumors, fallen into the recto-vaginal pouch, or confined there 
by false membranes. The mobility of the tumor, by the uterine sound pre- 
viously introduced, will show whether or not it be uterine. 
Retroflexion of the womb is more likely to simulate incipient ovarian 
cysts: 
Ovarian Tumors may be confounded with Abscess of the Walls of the 
Womb — Case.—Some years since Professor Recamier was consulted by a 
medical man for his wife, who had long suffered from what was called 
ovarian dropsy. On making a very careful examination, Recamier dis- 
covered a round tumor about the size of a pigeon’s egg, situated between 
the rectum and the uterus. On exploring the rectum with the index of 
the left hand, while that of the right remained in the neck of the womb, 
more than usually dilated, he felt fluctuation, and as the pus seemed near- 
est to the posterior wall of the neck of the uterus, Recamier determined 
on making an incision there. To perform this operation he placed the in- 
dex of the left hand in the neck of the uterus, and guiding a convex bis- 
toury on the pulp of the finger, he plunged the extremity of the bistoury 
into the abscess; a few teaspoonfuls of pus came out, and to facilitate its 
egress he enlarged the inferior angle of the wound, by completely cutting 
through the posterior lip of the os uteri, the index of the left hand placed 
in the rectum serving to guide the bistoury, and preventing too deep an 
incision. During the following day a small quantity of pus was voided. 
Frequent injections were made, and the patient soon got well. This case 
shows how to detect and to cure similar instances of disease. 
Ovarian Tumors may be confounded with Abscess of the Cavity of 
the Womb.—Husson presented to the Anatomical Society of Paris a case 
of this description, the neck of the womb was completely obliterated, and 
its dilated cavity contained two tumblers of pus. 296 
OVAKIAN AFFECTIONS. 
Ovarian Cysts may be confounded with Ilydrometra or a Collection of 
Water in the Womb, and we do not doubt but that some of the cases de- 
scribed as cases of spontaneous cure of ovarian cysts are to be referred to 
the rupture of such uterine tumors. 
After fully ascertaining the impossibility of the womb being distended 
by a child, it would be well to imitate Lisfranc, who in one of his cases in- 
troduced a sound into the womb, and cured the patient in a month. 
Ovarian Tumors may be confounded with Cystic Tumors in the sub- 
stance of the Uterus.—By means of the sound such a tumor might be 
shown to be uterine, before it attained to a considerable size, or after it 
had been emptied. 
Ovarian Tumors may be confounded with the Uterus distended by the 
Menstrual Secretion.—Dr. Williams had such a case in St. Thomas’s Hos- 
pital. Examination per vaginam detected a fluctuating tumor, which was 
freely opened with an abscess-lancet, and a large washhand basin was filled 
with the retained menstrual fluid. 
The uterus, distended by retained menses, is not always regularly devel- 
oped, but may increase to the right or the left, and give that obscure per- 
ception of fluctuation which is frequently found in a malignant mass. On 
each side of a central tumor may also be found smaller elongated tumors, 
formed by proportionally-distended oviducts, with obliterated abdominal 
ends, as in the case related by Dr. Jackson, in the “ American Journal of 
"epical Sciences.” 
Ovarian Tumors may be confounded with an Accumulation of Gas 
in the Womb.—Mauriceau, Schmitt, M. Lefevre, and many other authors, 
nave seen examples of this singular occurrence. 
The obliteration of the os uteri on the one side, and the clear sound 
furnished by the distended womb, will point to a correct diagnosis. 
Ovarian Tumors may be mistaken for Uterine Fibrous Tumors.—This 
mistake is much more liable to occur than any of the preceding, because 
the frequency of such tumors is great. 
The absence of fluctuation, the hardness of the tumor, the very gradual 
progress of the disease, may indeed allow one to affirm that the tumor is 
solid; but were it not for the uterine sound, it would be difficult to affirm 
that it is not ovarian. 
If we find that the uterine sound passes, as it were, into the morbid 
mass, if there is no possibility of separating the womb from the tumor, and 
if every movement given to the tumor conveys similar movements to the 
sound, we may consider the tumor uterine; but if we find the uterus small 
and movable, if the sound passes anteriorly to the tumor, and can be 
separated from it, and when thrown upon the rectum it appears healthy, 
then we may confidently affirm the tumor to be ovarian. The cavity of 
the womb may be lengthened, and the sound will indicate the modifica- 
tion of structure; but although the sound may only penetrate the womb 
to its normal depth, or two inches and a half, still the uterus may not be 
normal, for its enlarged cavity may be filled with a fibrous tumor. 
Part xxvii., p. 292. 
Differential Diagnosis of Ovarian Dropsy and Ascites.—The diagnosis 
of these two diseases, the one from the other, is in some cases a matter of 
considerable difficulty. There is, says Mr. I. B. Brown, one symptom of 
great value, which is not generally known. In a case of ascites in which 297 
OX-GALL 
the distention is so great, that the hydrostatic line of level in front is not 
changed by posture, the lumbo-lateral regions of both sides will be found 
equally dull on percussion, OAving to the intestines floating as far forward 
and upward as their attachment will permit. In an ovarian case, no mat- 
ter hoAv great the distention, one loin will be found clear, and the other 
quite dull, owing to the intestines being pushed over to the healthy side. 
Thus is indicated also, and with unfailing accuracy, on which side the ova- 
rian cyst, if it exist, has originated. Part xxxviii., p. 221. 
OX-GALL. 
Flatulence.—Administration of ox-gall recommended. Fart vii., p. 92. 
Ox-Gall.—Dr. Allnatt gives the following among other cases : 
I was summoned hastily into the country to see a lady, seventy-seven 
years of age, who was apparently sinking from the effects of unrelieved 
constipation. Excrementitious vomiting had taken place, and the powers 
of life seemed waning. The question was, whether or not, from the vio- 
lence of the inverted action of the intestines, intus-susception had occurred. 
On examination, I thought I could detect a hardened mass, impacted about 
the head of the colon, and evidences of accumulation below that point 
therefore advised, as a last resort, an enema of ox-gall and turpentine (the 
latter ingredient more as a stimulant to the inactive bowel than for any 
specific effect), with thin gruel, to be vigorously injected, warm, as far ad 
possible into the intestine. In less than half an hour, a mass of scybala 
was expelled, the exterior portions of which had been imperfectly softened 
by the action of the gall, covered with a coating of thick mucus. Other 
portions speedily followed, and convalescence ensued, with no other unfa- 
vorable symptom than that of slight pain, which might have been pro- 
duced by the action of the turpentine in immediate contact with the 
mucous membrane of the bowel. There is one point, in connection with 
the present subject, of considerable importance, and that is, the destruction 
of the narcotizing property of opium, when combined with ox-gall. The 
constipating effect of opium is principally produced by its action upon the 
liver, the secretion of which it arrests, and renders insufficient for the due 
stimulation of the alimentary canal. In many cases, this is a serious draw- 
back to the exhibition of opium, for we often require its sedative, when its 
constipating effects would be sufficiently injurious to preclude its use. 
Five or eight grains of inspissated ox-gall will neutralize the effect of a 
grain of opium, without destroying its sedative efficacy. It also prevents, 
in a great measure, its injurious action upon the brain. 
[In another communication, Dr. Allnatt recommends the following pro- 
cess for the preparation of the inspissated ox-gall:] 
An open vessel, containing any quantity of perfectly recent ox-gall, 
should be plunged into a saucepan of boiling water, and simmered until 
the bile is of sufficient consistence to be formed into pills. It should be 
frequently stirred during the operation to prevent an unequal hardening 
of the mass. The addition of a little calcined magnesia will expedite the 
process. If carefully prepared, it will keep for years, and when required 
for use should be gently warmed before the fire. Two drachms dissolved 298 
PALATE. 
in a pint of hot water, or thin gruel, will be of sufficient strength for ena- 
mata. One or two five-grain pills may be given twice or thrice daily, 
according to the exigency of the case. Part xii.,j». 91. 
PALATE 
Perforating Ulcer of the Palate.—The patient, under the care of Dr. J. 
Ross, was a girl, aged 22: the opening was of the size of a goose quill in 
the soft palate, a little to the left of the mesial line, just behind the edge 
of the osseous palatal arch ; no bone could be detected by the probe ; her 
speech was considerably affected, and a portion of everything she at- 
tempted to swallow escaped by the nose. There was no reason to suspect 
syphilitic affection. On the 19th March the opening was touched with a 
red-hot wire; on the 23d the eschar came away, and the raw surface was 
now touched every second day with tincture of iodine. By the 13th April 
the opening had become much less ; she spoke better and could also swal- 
low better ; very little escaping by the nose, and that only of any thin 
liquid, such as water. The cautery was reapplied: on the 16th of April 
the tincture of iodine was resumed as before; on the 25th the opening had 
still further diminished, and on the 13th of May it was closed so that no- 
thing came through it; the powers of speech and deglutition being also 
quite restored. In this case, after a raw surface had been produced by 
the separation of the eschar, consequent upon the application of the 
cautery, the tincture of iodine seemed powerfully to excite the granulating 
or reparative action. It might also, perhaps, be used in a similar manner 
in fistulous openings in other situations. Part vi., p. 119. 
Cleft Palate—Bead Suture.—The operation for cleft palate has been 
improved by an ingenious suggestion of Mr. Maclean, of Dublin, and 
carried into effect by Sir P. Crampton and Dr. Cusack. It consists in the 
mode of tying the ligatures, a part of the operation of acknowledged diffi- 
culty. After the ligatures are passed through the edges of the fissure and 
brought out at the mouth, their ends are to be passed through a small per- 
forated metallic bead, such as are used in making purses ; the bead is then 
to be pushed down along the ligatures, closing them as it descends, until it 
touches the approximated edges of the wound; it is then to be compressed 
by a pair of strong blunt-pointed forceps, and the ligatures are thus firmly 
secured, without a knot at the required degree of tension. This ingenious 
method of securing the ligatures might be extended to other surgical ope- 
rations where a knot would be difficult to tie, such as applying a ligature 
to hemorrhoidal tumors and polypous masses, which are situated in parts 
difficult of access; in short, with some modifications, Ave have no doubt the 
principle might be made exceedingly useful in many surgical operations 
where parts to be tied are deep-seated, in the same way as Ave should 
apply the double canula in polypi of the tvomb. Part vii., p. 115. 
Treatment of the over-large Openings of the soft Palate.—Very small 
openings in the soft palate, that either remain after a partially successful 
stitching, or are caused by penetrating sores, may be closed by exciting 
inflammation in the borders. For this purpose concentrated tinct. of can- 
tharides is the most effectual: lapis infernalis causes the loss of a layer of PALATE. 
299 
the organized mass, and the process of inflammation that follows produces 
an insufficient granulation, so that the hole generally increases in size. The 
concentrated acids recommended by many surgeons for exciting inflamma- 
tions, only produce a superficial corrosion of the borders; nor does such 
a quick granulation follow their use as that of the cantharides. If the 
opening is large and oval, and the palate soft, the edges are cut evenly to 
fit to each other, leaden sutures are then put through the edges with a 
small-eared hook, and twisted. Part xii., p. 191. 
Cleft Palate and Staphyloraphy.—The observations of Graefe and 
Roux in Europe, and Warren in America, first showed that this congeni- 
tal deformity may be treated on the same principles as the management 
of hare-lip. Mr. Ferguson observes that: 
The fissure in cleft palate may be such as only to divide the uvula, or it 
may extend forward through the soft and hard parts as far as the lips, in 
which latter instance there is generally a hare-lip as well. In the uvula, 
soft palate, and even through the palate bones, as also a portion of the 
superior maxillae, the fissure is invariably in the medial line, but when the 
alveoli in front participate in the malformation, it is somewhat to one side. 
In certain instances the fissure is double in front, when the whole of it 
may be likened to the letter Y; the two lines in front leaving between 
them the intermaxillary bone. 
The soft velum ought to remain in a state of perfect repose, and for this 
purpose the levator palati, the palato-pharyngeus, and the palato-glossus 
muscles should be divided. This cuts off all motor influence in an outward, 
upward, or downward direction. For this purpose use a knife with a blade 
like the point of a lancet, the cutting edge being about a quarter of an 
inch in extent, and the flat surface being bent semi-circularly. Make an 
incision half an inch long on each side of the posterior nares, and divide 
the levator palati muscle on both sides, just above its attachments to the 
palate ; then pare the edges of the fissure, and with a pair of long blunt- 
pointed scissors, divide the posterior pillar of the fauces, and, if it seems 
necessary, the anterior pillar too, the wound in each part being a quarter 
of an inch in extent; then introduce stitches by means of a curved needle 
set in a handle, the threads being tied so as to keep the cut edge of the 
fissure in exact contact. The first incision, that for the division of the leva- 
tor palati, should be made midway between the hard palate and the pos- 
terior margin of the soft flap, just above the thickest and most prominent 
part of the margin of th6 cleft. You may commence cutting either at the 
end nearest you, as you stand behind the patient, or that furthest off, 
as may seem most convenient. For ligatures, those of stout silk, or flaxen 
thread, are the best; and it is of great importance that a stitch be used 
close to the lower end of the uvula, as there is a great tendency to separa- 
tion there. The after treatment the same as after ordinary operations, 
except that the parts are to be kept at rest as much as possible, and nutri- 
ment to be given by means of enemata of gruel and soups. 
It is only of late that it has been thought possible to remedy the cleft 
in the hard palate, except by plastic operations, succeeding the union of 
the soft parts. Dr. Warren says it may be closed in the same way as the 
soft velum: dissect the soft tissues from each side of the fissure in the 
palate, to such an extent as to make a flap broad enough to join its fellow 
of the opposite side in the mesial line, and stitch the whole between the 300 
PALATE, 
uvula and the anterior extremity. Reunion to a considerable extent, 
takes place and toward the inner margin of the bones, and also on the 
upper surface of the soft portion in the middle, there will be a cicatrix 
analogous to mucous membrane. Part xiii., p. 240. 
Piejfenbacli's Operations on tlie Palate.—In cases of small holes in the 
soft or hard palate, pencil their borders several times a day with a concen- 
trated tincture of cantharides. Inflammation and granulation come on 
and close the opening. Large openings are to be closed by suture, after 
paring the edges; and leaden wire is said to be preferable to silk, for liga- 
tures, as it keeps the edges close together, and does not cut through the 
textures. 
When there is adhesion between the velum palati and posterior wall of 
the pharynx occasioning deafness, and stopping the communication be- 
tween the nares and air-passages, the adhesion must be divided trans- 
versely, by means of a long scalpel, about half an inch below the adhe- 
rent border of the velum. The edge must be fixed by a hook, and drawn 
from the wall of the pharynx, then, with a lancet-formed knife, the surface 
of which is curved, directed upward, the velum is to be loosened, and the 
separation completed by scissors, also curved upon their flat surface. 
The upper adhesions are to be destroyed by passing a blunt curved iron 
instrument, like a very small spatula, along the inferior nares. Next pre- 
pare a ligature with a small curved needle at each end; with one of the 
needles transfix the velum, a few lines from its edge, and bring it out at a 
high point on the anterior surface of the palate ; the other needle must be 
used in same manner, a short distance from the side of the other ; and the 
edge of the velum must be brought about half an inch from the palate, 
All mechanical means for closing the fissured palate, are not only injurious 
but dangerous; but if the size of the cleft, or other circumstances, render 
an operation unadvisable, then it may be covered with a gold palate, fixed 
to the teeth. In cases of holes in the palate, the edges of which are so 
callous that an operation be unsuccessful, the opening may be 
stopped by wearing a double piece of India rubber, without fear of its 
being enlarged. Two pieces of India rubber, the thickness of pasteboard, 
are cut about four or five times larger than the opening, and between 
them a small round piece, and they are to be transfixed by waxed thread: 
thus, one plate lies on the anterior, the other on the posterior side of the 
palate, and the small middle strip in the opening. The patient can apply 
it himself, and it should be taken out to be cleaned once a week. 
Part xiii., p. 244. 
Pemoval of Scirrhous Tubercle from the Soft Palate.—[Mr. Adams re- 
cords a very successful case of recovery from the application of ligature in 
this rare disease. A man applied at the London Hospital in consequence 
of a tumor on the left side of the velum palati. He first perceived it three 
years ago, and since that time it had gradually increased in size, but was 
unattended with pain or inconvenience until lately.] 
The tumor, when examined, appeared about the size of a small walnut, 
was somewhat oval in shape, the long axis being from above downward, 
and was evidently situated in the substance of the velum palati between 
its interior and posterior mucous surfaces. It presented a somewhat 
whitish aspect from the stretching of the anterior layer of the velum over 
its surface, to which it was formerly adherent. The velum was perfectly PALATE, 
301 
movable, and the tumor was drawn up at every movment of the palate, 
and a bent probe could be introduced behind it. It had a remarkably 
hard feel, and on running the finger over it, it gave the idea of true 
scirrhus. 
Mr. A. proceeded to strangulate the tumor by ligature. This was ac- 
complished with some difficulty by the introduction of armed needles, and 
with an instrument of firm, though inflexible silver, having a steel point, 
armed with a long ligature, and let into an ivory handle. By these means 
the whole of the tumor was encircled, and the ligatures being tightened, 
it W'as at once apparent that its complete strangulation had been effected. 
Very slight constitutional disturbance ensued, and on examination on the 
following day the tumor was evidently sloughing. Five days after the 
operation he removed the greater part of the mass, leaving a large sloughy- 
looking wound: the slough, however, had no tendency to spread. By 
the frequent gargling with a solution of chloride of lime, a healthy granu- 
lating action was induced, and it began to heal rapidly. In the course, 
however, of a few days a warty vegetation sprang up from its surface; 
this was gradually destroyed by the repeated application of solid nitrate of 
silver, and the disease was perfectly cured.] Part xy.,p 211. 
Cheap kind of Artificial Palate.—[An anonymous correspondent of 
the “ Lancet ” says:] 
I have found the substance, gutta percha, suitable for making artificial 
palates, very easily molded on a cast of the mouth into the necessary 
shape, and retaining its firmness and smoothness unimpaired by the tem- 
perature to which it is there subjected. Kneaded out into a smooth sheet, 
about the thickness of a sixpence or a shilling, and pressed into the proper 
form—-the edges accurately following the sinuosities of the teeth, and a 
hooked.process or two of the same material adjusted in the usual way—it 
will be found to answer very well, being smooth, light, and firm. If re- 
quired, a slight rim of gold, fitted to a few of the teeth, may be fixed to the 
edge of the gutta percha. If care be used to mold the material equally 
and smoothly, it will be more agreeable in the mouth than a metallic body. 
Part xviii., p. 174. 
Operation for Cleft Palate.—According to Prof. Syme the best way 
of proceeding is to place the patient on a chair in a good light, then to 
seize one edge of the fissure at its middle by sharply pointed forceps, and 
introduce the knife, which should be thin and lancet-shaped like the one 
of this form used for the extraction of cataract, a little above the com- 
mencement of the cleft, and cut evenly down from this point to the extre- 
mity of the uvula so as to detach a slice of sufficient thickness to expose 
the submucous textures. The same process being repeated on the other 
side of the fissure, nothing remains but to introduce the stitches, which is 
best done by means of a slightly curved needle with fixed handle, which 
should be directed from without inward, first on one side of the fissure, 
and then on the other. The two inner ends of the threads being then tied 
together, one of the other ends is to be pulled until the knot is drawn 
through the edge of the palate, and sufficiently far out of the mouth for 
the purpose in view. Two stitches are sufficient, one being placed at the 
root of the uvula, and the other midway between this point and the angle 
of the edges of the fissure. The threads should be tied with the “ reef 
knot,” and, in doing so, resiliency of the textures may be counteracted by 302 
PANCREAS PARACENTESIS. 
keeping the threads in a state of tension. For at least t.. n uays the 
patient should subsist entirely upon fluids, and of these even have a very 
sparing allowance. lie should also, of course, avoid talking, coughing, 
sneezing, and all other actions calculated to disturb the uniting process : 
Prof. Syme objects to Mr. Fergusson’s advice to take out the sutures on 
the second or third day—since the union, howrever perfect in the first in- 
stance, can then have little powrer of resisting pressure, either from food 
or the tongue, independently of the disturbing influence of the pharyngeal 
muscles. The threads should penetrate the whole thickness of the palate, 
and be tied with no more force than is suflicient to retain the edges in 
contact, so that in the event of union taking place, they may neither cause 
sloughing of the portion included nor cut their way out by ulcerative ab- 
sorption. Part xxix., p. 209. 
PANCREAS. 
Use of the Pancreatic Juice.—The experiments of Dr. Bernard go to 
show an error which has been long entertained by physiologists, namely: 
That the bile is the fluid by which tatty matters are acted upon—a 
property clearly proved by M. Bernard to belong most exclusively to the 
pancreatic juice, which must, therefore, now be regarded as the true agent 
by which fatty bodies are digested. 
When fat is introduced into the stomach of the rabbit, the contact of 
the gastric juice produces no alteration, nor is it in any degree changed in 
its passage along the intestinal canal, until it arrives at that portion where 
it is brought into immediate contact with the pancreatic juice: and it is 
exactly at the mouth of the pancreatic canal that the lacteals convey chyle 
of a white color ; higher up they contain only chyle of a transparent hue. 
No one can read these details, and not arrive at the same conclusion as 
Dr. Bernard, that the pancreatic juice, hitherto considered as the abdominal 
saliva, the use of which was to soften the food, is in reality charged with 
the important office in the exhibition of the cod-liver oil, already alluded to. 
We know, also, that the best time to give it to the patient, is one or two 
hours after breakfast, after dinner, and after tea. If given at these times 
it does not occasion those disagreeable eructations which are apt to occur 
when it is taken either with, or immediately before food; by taking it at 
this time we can now see how these eructations are avoided by the newly 
discovered and peculiar action of the pancreatic juice. In no disease is 
cod-liver oil more valuable than in scrofula mesenterica. Part xix., p. 98. 
PARACENTESIS. 
Paracentesis Thoracis.—Dr. Hughes, advises, not to allow air to be ad- 
mitted through the canula if it can be avoided. It may rekindle inflam- 
mation, or convert the adhesive into the suppurative inflammation. Unless 
the lung is capable of free and full expansion, do not attempt to draw off 
all the fluid; remove only so much as the expanding lung and the sur- 
rounding compressed organs are capable of replacing. Watch the open- 
ing carefully, especially during inspiration and coughing, and when the PAKACENTE8I8. 
303 
stream begins to fail, turn the patient on his punctured side till there is an 
alternate How and stoppage of the stream during inspiration and expira- 
tion, then immediately withdraw the canula. Apply a flannel bandage 
with moderate firmness around the chest. Precautions.—1. Always intro- 
duce an exploring needle first, to know if the diagnosis be correct. 2. Do 
not puncture one side before it is presumed that the other is sound 
enough to carry on respiration. 3. Draw olf the fluid slowly through as 
small a canula as the density of the fluid will admit. 4. Only draw off the 
fluid till the air seems to threaten to be admitted. Part xiii., p. 86. 
Paracentesis of the Scrotum.—[The subject of these remarks, by Mr. 
Skey, was a publican, about 55 years of age, who was laboring under an 
advanced stage of ascites and anasarca.] 
The legs and the scrotum were both largely distended with fluid. 
Before operating, my attention was directed by Dr. Lobb to the fact, that 
pressure on the scrotum entirely emptied that appendage, when steadily 
persisted in for some short time, and on removing the pressure and plac- 
ing the man in the upright posture, the fluid again gravitated into the 
bag, which became distended as before. It was obvious that the continued 
pressure caused by the water had broken down or elongated the fibrous 
and cellular tissues about the cord, and thus opened the communication 
between the abdomen and the tunica vaginalis. 
Under these circumstances, I determined to evacuate the serous contents 
of the abdomen through the scrotum, and with this view I introduced a 
full-sized hydrocele trocar into its lower and most pendulous part. The 
fluid flowed readily and continuously till some quarts had escaped. 
Practically this case affords matter for more than a passing observation. 
Anasarca of the scrotum is a common attendant on ascites in the male sub- 
ject. As a general rule, it commands but little attention, the interest 
which would otherwise attach to it being merged in the larger evil. If 
the question were now asked of the surgical world, how often does the 
relation that existed in the above case prevail in other cases ? I doubt 
whether a very positive, or even a satisfactory reply could be obtained. 
The fact of the communication is curious, if it be nothing more. It is very 
true that the operation of paracentesis abdominis is neither a difficult nor 
a dangerous operation, but it will hardly be denied, that simple as it is, 
paracentesis of the scrotum is yet more so. Part xxxiii., p. 213. 
Paracentesis Abdominis.—Use neither pressure nor bandage; allow as 
much of the fluid to flow out gradually as the natural elasticity of the cyst 
or abdominal parietes will expel; when the flow has quite ceased of itself, 
close up the orifice, keeping the patient recumbent. Part 272. 
Paracentesis Thoracis.—The best point for the operation is close on 
the upper edge of the sixth rib, midway between the sternum and spine. 
The chief danger is from the admission of air into the chest after the ope 
ration ; this may be very much obviated by having an India-rubber appara- 
tus fixed to the instrument, which, by its elasticity, sucks, as it were, the 
purulent secretion from the pleura, and at the same time allows the lung 
ample time to expand. Part xxxiv., p. 284 304 
PARAPHIMOSIS—PARALYSIS. 
PARAPHIMOSIS. 
Extract of Belladonna in the Reduction of Paraphimosis.—A child, 
three years and a half old, was the subject of severe paraphimosis ; the 
glans red, swollen, and tender ; the prepuce strongly drawn back, form- 
ing a thick and apparently adherent ring, the constriction of which com- 
pletely stopped the circulation. This state had lasted eight days, and the 
sufferings were excessive. 
The strangulation became more menacing, and all the symptoms were 
aggravated ; the glans was bluish and gangrene was threatened, when M. 
Mignot employed frictions around the glans, with an ointment composed 
of thirty parts of simple cerate to twelve parts of extract of belladonna, 
Under the influence of this remedy the circle of constriction relaxed, di- 
lated, and the tissues gradually recovered their normal condition, without 
loss of substance or suppuration following. 
The second patient had acute balanitis, brought on by a severe gonor- 
rhoea, and followed by paraphimosis. The patient refused operation 
although gangrene was threatened, when the belladonna was applied 
which induced relaxation and rapid amendment. Part iv., p. 105 
Reduction of Paraphimosis.—It is necessary to reduce the swelling of 
the prepuce as well as that of the glans. Prof. South advises, to squeeze 
the prepuce gently but steadily for a few minutes, and if this does not 
suffice, make a few punctures to let out the serum. Then press the glans 
with the thumbs of both hands while the two forefingers grasp the penis 
behind the prepuce; or grasp the whole penis with the left hand, and with 
thumb and forefinger of the other hand, empty the glans. As soon as 
ever a little of the glans gets beneath the constricting band, continue the 
pressure until the whole is returned. After the reduction keep the penis 
in cold wet cloths for some hours, and afterward apply a warm poultice. 
Part xvi., p. 216. 
PARALYSIS. 
In no Case of Paralysis or Apoplexy should a careful examination of 
the heart’s action he omitted. Part i., p. 69. 
Aphorism of Practical Surgery.—No disease is more difficult of cure 
than paralysis of the arm induced by dislocation of the humerus. The 
paralysis seems to arise from the stretching, compression, and perhaps also 
partial rupture of the nerves, Avhich form the brachial plexus. Often no 
remedial means are of any avail. Part iii., p. 115. 
Paralysis of the Seventh Pair of Heroes.—The patient, a young female, 
presented herself to M. Magendie, having a complete'paralysis of all the 
facial muscles supplied by the seventh pair, on the left side, with great 
exaltation of sensibility in the auditory nerve. The whole face was drawn 
toward the right side. Sensibility continued perfect in the face, tongue, 
etc. Galvanism was prescribed, one needle being placed over the parotid 
gland, the second successively over the supraorbital, infraorbital, and 
mental foramina. The patient was cured. Part iv., p. 63. PARALYSIS. 
305 
Paralysis treated with Cantharides.—The tincture of cantharides is 
given, by Dr. Seymour, in very large doses, in cases where the paralysis 
cannot be traced to any affection of the sensorium, and where there is no 
trace of organic disease. In the case which was commented upon by Dr. 
Seymour in one of his clinical lectures, the patient had entirely lost the use 
of the upper limbs and had a weakness of one leg. In a great majority of 
such cases, we should find a disease of the vertebra above the seat of the 
injury, and there would be pain on pressure or on percussion; but in this 
case this symptom was entirely absent, and if there had been any actual 
disease of the spinal marrow, we might have expected to find the diseased 
action continued to the lower extremities, as well as to the upper : but such 
was not the case, as every part below the upper extremities appeared per- 
fectly sound and healthy. In such a case as this Dr. Seymour ventures to 
give 40 minims of the tincture of cantharides twice a day. Part v., p. 52. 
Strychnine in Paralysis of the Face.—Although paralysis of the mus- 
cles, those of the face, for example, seldom exist without some organic 
lesion, yet we sometimes have reason to believe that it is truly functional, 
and unattended with any particular disease. In such cases we shall find 
strychnine of value; and we think that its powers have been miscalculated, 
on account of the indiscriminate use which has been made of it. Even 
when the paralysis is originally owing to some lesion or effusion, that 
cause may have been remedied, and nothing remains but a continued 
inability on the part of the muscles to regain their powers. Here, then, is 
a case in which strychnine would be of great use, as well as when the 
paralysis is strictly functional. When the face is the seat of the affection, 
the strychnine may be applied to the cuticle in the following way : About 
one drachm of a solution containing about three grains of strychnine to an 
ounce of alcohol, may be applied to each side (when both sides are affected), 
three times a day, and the absorption assisted by friction; when only one 
side is affected, it will be sufficient to confine the application to the muscles 
implicated. In a case reported by Dr. Joslin, of New York, this was per- 
severed in for about two months, with success. A blistered surface renders 
the effects of the application more powerful. Part vii. p. 46. 
Paralysis from Exostosis of the Spine.—Exostosis, or bony vegetations, 
arising from the bodies of the vertebra (independent of any disorganiza- 
tion of these bones) are by no means of rare occurrence ; most pathological 
collections contain numerous examples of their different stages, especially 
of what seems their natural termination, viz., perfect anchylosis of the 
affected bones. This anchylosis may be more or less extended, affecting 
but two neighboring vertebra, or perhaps the greater part, more rarely the 
entire of the vertebral column, while the new bony material is found to 
vary from a thin lamina to a prominent and rough projection, occupying 
the situation of, or more properly covering, the subjacent intervertebral 
cartilage. 
[Although the affection may have advanced to complete anchylosis,, 
there may be an absence of all severe pain when the bone is handled • 
which is remarkable, considering the displacement and injury those 
important nerves must undergo which are so closely connected with the 
front of the spine, more particularly in the lower part of the dorsal and 
lumbar regions. Dr. Battersby relates some interesting cases to prove 
that these nerves do occasionally suffer from the disease giving rise to a 
VOL. II.—20 306 
PARALYSIS, 
train of most painful symptoms which have baffled the diagnosis of the most 
skillful practitioners. One case particularly is related which proves this. 
A train of the most painful symptoms terminated in the death of the 
patient.] 
On displacing the abdominal viscera, the inter-vertebral spaces of the 
lumbar region were at once observed to be singularly prominent, the 
cartilages being partially faced with irregular bony protuberances, so as 
nearly to unite the adjoining bones. A section of the vertebrae was re- 
moved, and a large nervous twig was discovered lying stretched over the 
most prominent of the new formations which engaged the sides of the 
vertebrae. The anterior vertebral ligament had a marked glistening appear- 
ance, and on dissection proved to be very much thickened, while under- 
neath it was formed a new dense structure of a fibrous nature, in which all 
the characteristics of the periosteum were lost, and the surface of the 
bones, to which it was intimately adherent, was rough and irregular. 
There was no distinction between the fine cancellated structure of these 
and their new processes. The bones were quite healthy, as also the 
cartilages. The spinal canal was opened from the sacrum to the middle of 
the dorsal region. There was about an ounce of clear fluid in the interior 
of the sheath of the cord, which, like its membranes, were perfectly 
natural. The only irregularity here discovered was two little points of 
bone on the posterior aspect of the bodies of the dorsal vertebrae, which 
felt through the dura mater, which was unremoved, about the size of 
pins’ heads. The opening for the nerves were perfect. 
This gentleman’s sufferings, for the space of nearly two months, could 
not be surpassed; toward the conclusion, he used to consume more than a 
scruple of the muriate of morphia daily, and that merely with the effect of 
mitigating the pain. The new bone, in occupying the situation of the 
lumbar ganglia of the sympathetic, gave rise to the symptoms of visceral 
neuralgia, by irritating these and their branches, while the same irritation 
communicated through the lumbar nerves (which are in direct connection 
with the former) to the spinal cord, its functions became deranged both 
above and below the point of irritation, exhibiting what Dr. Marshall Hall 
denominates the morbid, direct and retrograde action of that part. 
The progress of the paralysis was very remarkable as pointing to the 
spinal origin of the symptoms. It first appeared over the upper part of 
the abdomen, then attacked the lower extremities, and lastly, the integu- 
ments of the chest and arms. Part viii., p. 53. 
Diagnosis In Cases of Paralysis of the Face.—[It is of the greatest 
consequence in practice that we distinguish between hemiplegia of the face 
and paralysis of the facial nerve, and of this latter as it occurs within and 
without the cranium.] 
I had recently, says Dr, Hall, an urgent summons in such a case. The 
patient was situated in a lunatic asylum, a circumstance which rather dis- 
posed the mind to expect cerebral disease. Beside, the patient complained 
of pain of the head at one time, and was apparently drowsy at another. 
The face was drawn exceedingly to the right side. In the first place I 
desired the patient to close the eyelids; the right eye remained open. In 
the second place I inquired whether the arm or leg were affected, and 
found that they were not. In the third place I begged the patient to put 
out the tongue; it was protruded in the direct mesial plane. In the fourth PAEALYSIS. 
307 
place, I inquired where the patient had been sitting, and we went upstairs 
and placed the chair near the window, precisely as it had been occupied 
the day before; it was so placed as to expose the right side of the face to 
the draught from the window. 
Taking these facts together, I did not hesitate to declare that the case 
was one of paralysis of the facial nerve : in hemiplegia the eyelids of the 
atfected side can always be closed, though not so firmly as those of the 
other side. In so severe a case of facial hemiplegia the limbs are almost cer- 
tainly paralyzed, and the tongue is generally affected and protruded to the 
affected side. Still a question was raised, whether this nerve Avas affected 
within or without the cranium ; there was pain of the head and drowsiness. 
Now, the portio dura and the portio mollis of the seventh pair (the 
facial and the auditory) are placed so immediately together within the 
cranium that it is scarcely possible for one of these nerves to be affected 
without the other ; yet there teas no deafness. 
I remained therefore of opinion that the case was one of paralysis of the 
facial nerve, external to the cranium, confirmed, as it had been, by the fact 
which I had almost anticipated, of the special position and exposure of the 
patient, as she had sat sewing in her bedroom. The issue has proved my 
opinion to be the just one. No affection of the cerebrum has occurred, and 
the facial paralysis is gradually subsiding under the usual local remedies, 
viz., leeches, fomentations, sinapisms, etc. Part ix., p. 40. 
Paralysis.—Sir Benj. Brodie gives cases of the different forms of 
paralysis, Avith the morbid appearances in the brain or spinal column, 
which he detected; but after most careful examination of these cases 
during life, he acknoAvledges that their treatment is often exceedingly 
difficult, as we have not yet sufficiently advanced in our knoAvledge of this 
complaint, to be able to state positively AA'hether the disease is of one kind 
or another. If the disease be an inflammatory affection of the membranes, 
Ave may distinguish it tolerably Avell; but if it be of a chronic character, it 
is difficult to discriminate between softening of the spinal marroAV, tuber- 
cles in the spinal cord, and effusion of fluid in the theca vertebralis ; be- 
sides, these three affections may be combined together, or there may be 
one first and the others may supervene. 
However, let us suppose that there is a case of inflammation of the 
membranes of the spinal marrow.* The patient comes to you with a severe 
attack of dreadful lumbago, and by and by he states that there is numb- 
ness in his legs, and then difficulty in moving them. In this case you may 
be pretty sure that there is inflammation of the membranes of the loAver 
part of the cervical cord. IIoav is that to be treated ? In the first place 
take blood by cupping from the loins, and repeat it according to circum- 
stances. Begin by purging the patient, clearing the bowels well out—a 
right plan to pursue in all cases of inflammatory disease. Then put the 
patient under the influence of mercury, exhibit calomel and opium, and 
treat him as you would a patient laboring under pleuritis or iritis. 
But if you are called in at a late period, when the inflammation has 
subsided, and the paralysis consequent on it remains, even then you cannot 
do better than put the patient under a course of mercury, a mere alterative 
course—five grains of Plummer’s pill, night and morning—the eighth of a 
grain of bichloride of mercury, twice a day, in addition to which you may 
' apply blisters to the loAver part of the back. 308 
PAKALYSIS. 
The treatment of a chronic affection of the spinal cord producing 
paralysis must be, to a great extent, empirical, because you cannot make 
a certain diagnosis. Let me repeat what I just now observed, that I have 
never seen any beneficial results arise from the use of counter-irritation. 
Probably the bowels are very torpid—they will require to be kept open, 
and it is very difficult to effect it. The stools will be black, like tar, and 
the lodgment of the black secretion in the intestinal canal appears to 
be productive of great mischief to the system. Calomel and a black 
draught may be exhibited every now and then, but a patient cannot take • 
them from day to day. Sometimes the comp. ext. colocynth will be 
sufficient, but simple purgatives, often fail. The pills which I am about to 
mention, I have found to be convenient in cases of this kind. Two scruples 
and a half of comp. ext. colocynth; half a scruple of soap ; one drop of 
croton oil. Let these be well rubbed up and carefully mixed, and divided 
into a dozen pills, one or two of which may be taken every night, or every 
other night, when wanted. These are excellent pills ; they cause nothing 
like the inconvenience produced by a large dose of croton oil, and are very 
efficient indeed. 
The treatment which I have found to be the most successful, and under 
which I have seen the greatest benefit arise, is a grain of zinc made into a 
pill and given three times a day, and then a draught of twenty minims of 
tincture of eantharides, to wash it down. 
It is from the continued use of the zinc, and not from the exhibition of 
large quantities, that benefit is to be derived. 
In other cases I have thought that benefit has arisen from the long-con- 
tinued use of very small doses of bichloride of mercury, combined with 
tincture of eantharides. Small doses do not seem to act as mercury on the 
system. I apprehend it acts much in the same wav as the sulphate of 
zinc. Exhibit the sixteenth of a grain of bichloride of mercury in a certain 
quantity of tincture of eantharides, in a draught three times daily, and such 
plan of treatment will sometimes be useful. But it is right to state, that 
in a great number of cases of chronic paraplegia, the disease is incurable. 
The disease, however, may go on for years before it ascends to the brain 
and destroys life. Part ix., p. 100. 
Brucine in Obstinate Paralysis.—Brucine is substituted by M. Briche- 
teau for strychnine, in the treatment of obstinate paralysis remaining after 
an attack of apoplexy, with equally good effect, and with the additional 
advantage over strychnine of being able to employ it in larger doses with- 
out danger of fatal accidents. 
Bose.—A centigramme (1-154 gr. Fr.,=l-6th gr. avoir.) in infusion of 
arnica; increase the dose one centigramme daily, until its effects are 
evident, and then proceed discretionally. Part xiv., p. 59. 
Paralysis of Sensation.—This form of paralysis is less dangerous than 
that of motion, inasmuch as it is cured with less difficulty. In fact it is 
almost always curable, and generally follows hysterical affections. 
Part xv.,p. 45. 
Facial Paralysis cured by Quinine.—Dr. Durant, of Ipswich, mentions 
a case of paralysis of the side of the face occurring after a course of mer- 
cury, which was cured by the administration of quinine. Part xv., p. 62. 
Electricity in Paralysis.—In the use of electricity, says Prof. Matteucci, ' 309 
PARALYSIS, 
we must remember that the excitability of the nerves appears to be lost. 
Now though the contractions excited by an electric current passed down 
a nerve in the direction of its ramifications, i. e. a direct current, are more 
powerful than those produced by the passage of a current in the inverse 
direction, yet the direct current weakens and destroys the excitability of a 
nerve, while the inverse current augments it. The best form of electricity 
that can be used in paralysis is that from the electro-magnetic machine. 
Apply the interrupted current, and at first a very feeble one; and after 
twenty or thirty shocks, let the patient rest for some seconds. 
* jParalysis following Local Injury.—In paralysis following local injury, 
as concussion of the nerves, Dr. G. Bird would apply electro-magnetism 
from the single current machine, taking care to transmit it in the direction 
of the vis nervosa, or in other words, in the direction of the nervous rami- 
fications. 
From Lead (Dropped Hands').—Take electric sparks from the cervical 
and dorsal vertebrae thrice a week ; also from the paralyzed parts, and in 
recent cases transmit small shocks along the course of the affected nerves. 
Hysterical.—Employ electricity either in the form of shock, or the 
interrupted current from the electro-magnetic machine. If the paralysis 
is simulated, it will rarely resist the pain and surprise of the shock; and 
if the aflection, however excited at first, is now uninfluenced by the 
patient’s will, the electro-magnetic current is a most valuable therapeutic 
measure. 
Of the Portio Dura.—Use electricity: any form will do, as it is merely 
the stimulus which is required, acting on the paralyzed muscular fibres, 
and arousing their normal irritability. 
Rheumatic.—(Following the sudden application of cold, independently 
of any evidence of central spinal lesion.) Take electric sparks thrice a 
week from the spine and the paralyzed muscles. 
From Effusions, etc.—When the primary cause is removed, and the 
paralysis is still persistent, apply electro-magnetism, the single current 
transmitted in the course of the nervous ramifications, and patiently con- 
tinued for some time. Be very careful not to use this agent where rigid 
arteries are suspected, or ramollissement of the brain exists. Fatal 
apoplexy has been known to follow the use of electricity in such cases. 
When it continues, after the disease in the brain is removed, the muscles 
must be artificially excited to action, by electricity or otherwise, to insure 
their nutrition. Part xvi., p. 103. 
Paralysis—Cerebral.—Dr. Todd says: It is important to notice the 
state of the muscles of a paralyzed limb; for if rigidity of the muscles 
exists at an early period, local depletion and counter-irritation will be 
attended with benefit, whereas such measures are not applicable when 
complete relaxation exists. Part xviii., p. 80. 
Paralysis of the Portio Dura.—[As facial paralysis, Dr. Todd observes, 
is to a patient and his friends a very alarming disease, it is important for 
the practitioner to be well acquainted with the various kinds of palsy affect- 
ing the face, so that a favorable prognosis, when the case will admit of it, 
maybe at once given. The case which formed the subject of the following- 
observations by Dr. Todd, was one of paralysis of the facial portion of 
the seventh pair of nerves, accompanied by severe pain behind the right 
ear. Dr. Todd observes:] 310 
PARALYSIS 
The leading character of these cases of facial palsy is the inability to 
close the eyelids, from paralysis of the orbicularis palpebrarum muscle; 
this is the pathognomonic sign which determines the peculiar nature of 
the palsy, and distinguishes it from the more serious form of facial palsy 
which is dependent on disease of the brain and palsy of the fifth nerve. It 
is remarkable how seldom the seventh pair of nerves is alfected by disease 
of the brain. I cannot say that I ever saw a single instance of paralysis of 
the orbicular muscle of the eyelids due distinctly to diseased brain; and I 
have only seen a few in which the power of the muscle appeared to be 
enfeebled from that cause. Thus we have a point favorable and con sola* 
tory to a patient affected with portio dura paralysis; namely, that the 
affection being seated in that nerve affords a strong probability that he is 
free from disease of the brain; for diseased brain would give rise to a dif- 
ferent form of facial palsy, and very rarely, if ever, cause this. 
You have only to examine this patient with care, and you will find that 
he has almost every sign which indicates that the paralysis has its seat in 
the portio dura nerve. He cannot close his right eyelids; in making the 
attempt, however, he seems not to have lost the power altogether, for the 
upper lid is slightly depressed; yet if you put your finger on the orbicular 
muscle you do not find the slightest contraction of it. 
Our patient is unable to frown on the right side, while he does so dis- 
tinctly on the left; neither can he move his scalp on the right side; the 
corrugator supercilii, and the frontal portion of the occipito-frontalis 
muscles, are paralyzed—and hence these movements cannot be effected. 
The levatores alse nasi, and the zygomatic muscles, are likewise, paralyzed 
on the right.side, and therefore, the right nostril is motionless, and the 
angle of the mouth hangs on that side. The orbicularis oris muscle is 
paralyzed as to its right half; the patient is consequently unable to purse 
up his mouth, and if you ask him to whistle, he will afford you indications 
of his inability to perform this as well as other actions. The act of smiling 
or laughing is exaggerated on the left side, and the reason is because the 
left muscles have lost completely the resistance of those of the right side, 
which remain perfectly motionless, and which from disease have lost then- 
tone, and have suffered much in their nutrition. For the same reason all 
the movements of the features which act in symmetry, and which at the 
same time counterbalance each other, are found to take place to an exagge- 
rated extent on the healthy side. Hence in smiling, laughing, and speak- 
ing, the face is drawn more or less to the right side : the distortion takes 
place on the healthy side, the paralyzed side remaining unmoved. The 
popular notion, in cases of this kind, is that the disease is on the side to 
which the mouth is drawn. No medical man, however, can fall into this 
mistake if he be at all acquainted with the real condition of the patient. 
Another muscle which is paralyzed in this case, and in all cases of the 
same kind, is the buccinator. Hence the cheek hangs loose, and as the 
patient speaks, it flaps to and fro. This extreme looseness of the cheek 
is not an early symptom of this form of paralysis; it manifests itself more 
and more, the longer the duration of the disease, and ultimately becomes 
the cause of symptoms very troublesome to the patient. It interferes not 
only with articulation, from its looseness and flapping movements while 
the patient is speaking, but mastication likewise. The palsied muscle 
allows the food to accumulate between the teeth and the jaw, and fails in 
its functions of supplying the mill with its proper amount of material to 311 
PARALYSIS. 
be ground. After a little time, patients learn to remedy the defect of 
articulation which the paralytic condition of the buccinator muscle causes, 
by supporting the cheek with the hand; and a similar kind of support 
serves to remove the inconveniences of mastication. 
You will observe that all the muscles paralyzed in this affection are 
superficial: they are all muscles more or less concerned in the expression 
of the countenance. The deep-seated muscles are not affected—these are 
muscles of mastication—the only muscle paralyzed, which is concerned in 
mastication, being the buccinator, which is, however, only accessory to 
that function, and is as much or more a muscle of expression. 
[As the buccinator receives a motor branch from the fifth, in addition 
to its supply from the seventh, the circumstance of its being paralyzed, 
when the disease or disorder is confined to the seventh pair, is very curious, 
and has not as yet, Dr. Todd remarks, received an adequate explanation. 
As to the treatment of this affection, much treatment is not generally 
required when it has arisen from cold or from constitutional causes; mild 
purgatives, alkalies or sudorifics, or iodide of potassium, and locally warm 
fomentations. Leeching or blistering are not so distinctly useful; and strych- 
nine, Dr. Todd remarks, is of no use in these cases. If recent otitis be the 
cause of the attack, more antiphlogistic treatment will be needed, and some- 
times even salivation will be beneficial.] Part xviii., p. 83. 
Treatment of Paralysis from Lead.—Prevent the further introduction 
of the poison by cleanliness and frequent washings; stimulate the skin by 
friction and exercise ; Dr. Todd would also give baths containing sulphuret 
of potassium, in the proportion of one, two, or three ounces, to as many 
gallons of water ; let the patient have good food, and breathe pure air; and 
apply galvanism as a local stimulant, for ten or fifteen minutes at a time, 
three times a day. Part xviii., p. 88. 
Paralysis, Facial.—In paralytic affections of the facial muscles, when 
the antagonist muscles distort the features, the distortion may be remedied 
by the application of collodion; the parts being adjusted to their normal 
position before the solution is applied, and being held in that position with 
the finger until the solution is dry. (Dr. J. Starlin.) Part xix., p. 319. 
Paralysis Facial.—In facial paralysis from exposure to cold, apply the 
“heated hammer,” a modification of the iron recommended by Dr. Corri- 
gan, which is to be heated for fifteen or twenty seconds in the flame of a 
spirit lamp, and then run lightly, being alternately raised and depressed, 
over the affected surface. Part xx., p. 54. 
Paralysis Agitans.—Paralysis agitans, says Dr. Swan, is emphatically 
a disease of emotion. Emotion is its first and last cause; without emotion 
it would never be called into existence, or, being once induced, it would 
never manifest itself. This at least is true, of its first phase ; whether any 
physical lesion may supervene in its protracted course, remains a deeply 
interesting question. 
Alone, reposing, asleep, the agitation is absent. It is renewed when cause 
of emotion comes into operation. It frequently subsides in the society of 
the patient’s immediate relatives or friends, as his wife and children, and 
is reexerted on the appearance of a visitor or a stranger. 
The peculiar shaking, and the equally peculiar povverlessness, or shall I 
call it paralysis, cease on giving confidence to the patient. I may here ad- 312 
PARALYSIS. 
duce an anecdote: A gentleman, a magistrate, confined to his chair by 
paralysis agitans, wished to consult a legal book, lie asked for it, and his 
servant gave it to him, as he supposed. On opening it, he found it the 
wrong book. In his anger he rose from his chair, and reached it himself. 
Surprised at discovering his power of walking, he endeavored to repeat the 
experiment, and remembering that before he had risen from his chair, he 
had rather violently closed his book, he repeated this manoeuvre, and ever 
since, on doing this—but only on doing this—he regains his power of 
walking. 
One patient could walk whenever he pleased, with the tips of his fingers 
merely on his wife’s arm, but not otherwise. 
It is essential to replace a (unfounded?) conviction in the patient’s 
mind, that he is powerless, by another, viz., that he really possesses power, 
the circumstances being changed. The prepossession—the depressing 
emotion must be removed, and replaced by an emotion of the opposite ■ 
kind. 
In speaking of emotion as the cause of paralysis agitans, we ought to 
notice that this emotion is of the painful and agitating kind, and not unal- 
lied to fear and vexation. The elevating emotions or mental states, as hope, 
confidence, energy, have a marked beneficial effect. The movements 
made with firmness and resolution are always least attended by agita- 
tion. 
There is, in consequence, a disposition in this malady, to rapid move- 
ment. The patient is apt to run instead of walking deliberately. An 
energetic volition overcomes the influence of emotion ; volition of less energy 
is more or less defeated by emotion in its turn. 
The paralysis agitans has hitherto made an exceedingly slow, but not the 
less fatal, progress. 
Unfortunately, we possess no post-mortem examinations of this disease. 
I suspect no morbid lesion would be detected. No such lesion, hitherto 
known, would lead to the peculiar phenomena of this malady, except toward 
its close, when a sort of general paralysis takes place, which may be the 
effect of effusion and consequent pressure. 
As emotion is the original and continued cause of this trying malady, an 
important question arises—What would be the effect of a sustained removal 
of all sources of emotion, if, and when this may be possible ? 
Seclusion in a cottage, a judicious companion, books of quiet interest, 
repose in the nearly recumbent position (the head especially being sup- 
ported), free exposure to the open air, the gentlest exercises, the farm, the 
fields, the garden—the plants, the corn, the cattle, the poultry (not his 
own). It becomes an important question also, whether the shower-bath, 
douche along the spine, etc., may be useful; various sedative or narcotic 
medicines long given to subdue emotions, as we w’ould give them to subdue 
pain, in stated forms and doses, regularly and systematically. 
The bichloride of mercury, quinine, strychnine, etc., should be put to a 
cautious trial by competent judges. Part xxiii., p. 83. 
Rheumatic and Local Paralysis, treated by Pidvermaclier’s Chain 
Battery.—Mr. Yallance highly recommends this chain battery in preference 
to the same strength of currents from the ordinary machine, believing that 
the current from the hydro-electric chain of Pulvermacher has a much 
greater effect. Part xxv., p. 57. PAPAPLEGIA. 
313 
Paralysis of the Lower Limbs.—M. Gerard recommends the ergot of 
rye in daily doses of from 8 to 40 grains. Part xxv., g>. 59. 
Lead Palsy.—The state of lead cachexia, according to Dr. Todd, is very 
greatly improved by the long continued use of sulphur baths. 
Part xxv., p. 69. 
Lncomplete Paralysis of the LiowerExtremities, connected with Diseases 
of the Urinary Organs.—Mr. Wells, surgeon to Samaritan Hospital, says : 
There is a form of incomplete paraplegia—mere weakness and loss of con- 
trol over the muscles of the limbs—the effect of disease of the bladder, 
kidneys, or urinary passages, and only cured by the relief of this primary 
disease. There may be no pain in the dorsal region on pressure, but cases 
have occurred where the pain, on pressure in the dorsal region, led to the 
diagnosis of spinal disease, and after death the spine and its contents were 
found perfectly healthy and the kidneys diseased. The intimate nervous 
connection between the urinary organs and the cord by means of the sym- 
pathetic, is probably the cause. Some impediment to the discharge of 
urine is one of the earliest symptoms. There is generally obstinate gastric 
derangement. The sensibility of the limbs is not impaired, or very slightly, 
and they do not become atrophied or lower in temperature than natural. 
The sphincter ani is not paralyzed. The bladder, to a great extent loses its 
contractility, but not entirely. There is no history of violent neuralgic 
symptoms at the commencement of the disease. Great amendment will 
often follow catheterism and the removal of any obstruction to the free dis- 
charge of urine. Exercise, warm clothing, bathing, and change of air, are 
important. Avoid aloes and saline aperients, as they tend to increase the 
urinary irritation. ' Gregory’s powder is the best aperient. The patient 
may wear an elastic belt to support the lax abdominal parietes. A mixture 
of cantharides and iron tends much to restore the contractile power of the 
bladder, and relieve the urinary irritation. Opium relieves irritability very 
much. That which is productive of most good effects is a complete change 
of life, as a long sea voyage. Paraplegia is a common result of frequent 
seminal emissions, voluntary or involuntary; it is undeniable that the fre- 
quent agitation of the nervous system, so caused, leads to chronic inflam- 
mation and softening of the cord, with paraplegia as a necessary conse- 
quence. Part xxxvii., p. 37. 
Paralysis.—Dr. Althaus states that in cerebral paralysis, the excitability 
of the muscles in the paralyzed limb is often, but not always, increased. In 
lead palsy and traumatic paralysis, the muscular excitability is almost lost. 
In hysterical rheumatic, and spontaneous paralysis, the paralyzed muscles 
respond normally to the electric current. Part xl., p. 314. 
PARAPLEGIA. 
The Use of Setons in Paraplegia.—Dr. Marshall Hall strongly recom- 
mends the use of setons in preference to issues, on the course of the spine 
in paraplegia, and in acute or chronic local or limited inflammation of 
different parts, as in hepatitis or nephritis. In cases of diseases of the 
spinal marrow, with paraplegia or paraplegic spasm, setons are more 
especially valuable; hut Dr. Hall looks upon the usual seat of application 314 
PARASITES. 
of these setons as improper. He thinks the great error committed by- 
medical men is the applying the seton below the seat of the disease. “ The 
spinal nerves proceed for some distance, from above, directly rather than 
obliquely, downward, and the seat of the disease is at or above their 
junction (insertion or origin) with the spinal marrow.” Partly., p. 46. 
Ergot of Eye.—M. Payan states that we may find ergot of rye very 
useful in paraplegia. When we consider its effects, not on the uterus 
only, but also on the rectum, bladder, and lower extremities, and, indeed, 
occasionally on the whole system, causing the patient to feel universally 
benumbed, as she frequently expresses herself, followed by powerful ex- 
citement, we must suppose that it acts primarily and especially on the 
spinal cord ; and we may consequently believe that in some cases of para- 
plegia it will be found useful. Part vi., p. 88. 
Paraplegia from Ascarides.—In the proceedings of the Ipswich Medi- 
cal Society, there is recorded the case of a child, twelve months old, which 
was attacked with sudden loss of power in the lower extremities, while 
the sensibility, of those parts was exhausted. After purgatives had been 
given without advantage, the administration of sesquioxide of iron was 
followed by the expulsion of a “ firm ball of ascarides,” and the relief of all 
the symptoms. Part xv.,p. 68. 
Paraplegia.—The alkaline and phosphatic condition of the urine, says 
Dr. Garrod, may be remedied by the administration of benzoic acid in 
large doses, two scruples four times a day. Part xix.,p. 28. 
Peflex Paraplegia.—Dr. Brown-Sequard remarks, that if strychnia be 
administered in the reflex form of paralysis, it will be advantageous. This 
is well illustrated in a case of paraplegia produced by exposure to cold and 
wet. But, given in cases of paraplegia consequent on congestion or actual 
inflammation of the cord, strychnia will only aggravate the affection. 
Part xl., p. 40. 
PARASITES. 
Benzin or Benzole, as a Bemedy for Animal Parasites.—Our readers 
are probably aware that benzin or benzole is a clear, colorless fluid, pos- 
sessed of a pungent etherial odor, which is produced by the decom- 
position of benzoic acid, or other organic substances, at a light tempe- 
rature. It was long ago ascertained by Milne Edwards that its vapor was 
very fatal to insects. This property has led M. Ileynal, of the veterinary 
school at Alfort, to employ it for the treatment of pedicular maladies 
among animals. He has found that it destroys the parasites in these dis- 
eases, more surely, and with more safety to the animal, than tobacco- 
juice, mercurial ointment, or any other of the many remedies used. It 
destroys the epizoa without at all injuring the skin. 
It is proposed to use this fluid in the parasitical diseases of the human 
skin, especially in plitheiriasis or morbus pedicularis, and in scabies, etc. 
Part xxxi., p. 190. 315 
PAEON Y CHI A. 
PARONYCHIA. 
Lotions and Medicated Poultices in Phlegmonous and Erysipelatous 
Inflammations, and especially in Paronychia.—In all these cases Dr. F. 
J. Brown urgently recommends the employment of astringent and sedative 
lotions, and poultices made with these instead of water, for not only, he 
says, may the disease by these means be sometimes checked before sup- 
puration takes place, but when matter is formed the inflammation is not 
so great, and the parts are much sooner healed. He says: 
The astringents that I employ are the sulphate of zinc and burnt alum 
mixed with acetate of lead. This is an unchemical mixture, but its use is 
satisfactory. I am indebted, to my father, an old staff surgeon, for the 
prescription, which is, for each ounce of water three grains of burnt alum, 
two grains of zinc, and two grains of lead. The lotion should be used 
warm. It is advisable to omit the lead after the disease has been subdued, 
for fear of its effects on the muscular system, although I have never seen 
ill effects from perseverance in its application for many weeks. These in- 
gredients, placed in paper as a powder, in sufficient quantity for a wine- 
bottleful of water, enable a patient to use the lotion both freely and 
cheaply. 
I have no doubt but that many surgeons use lotions for the affections 
mentioned, and I must therefore apologize for bringing forward this mode 
of treatment; but I have seen so many fingers crippled by the persistence 
of inflammation under the water-poultice treatment, that I consider the 
subject worthy of attention. Surgeons can see the improvement that 
occurs in many diseases of the eye, ear and throat, from the use of as- 
tringent lotions, yet they commonly neglect such applications in phleg- 
monous inflammation occuring in the trunk and limbs. 
Nitrate of silver is sometimes applied over surfaces affected by erysi- 
pelatous inflammation, but I am not aware that astringent lotions are 
usually applied by means of cloths laid upon the parts. I recollect reading 
in one of the periodicals of sulphate of iron lotion for erysipelas, and I have 
employed it with advantage. 
I presume that the astringents diminish the calibre of the bloodvessels, 
and effect some change upon the nutritive process by which the profuse 
formation of cells is restricted. Certain it is that the inflamed part be- 
comes diminished in size and whitened; and suppurating parts yield secre- 
tion in greatly diminished quantity (without becoming hot and dry, as 
might be anticipated), whilst their bulk is reduced. 
The internal treatment that exerts most influence on paronychial inflam- 
mation is sulphate of quina in Epsom salts mixture, preceded (in severe 
cases) by a few doses of tartrate of antimony in Epsom salts mixture. 
The same internal treatment is peculiarly efficacious in erysipelas and 
phlebitis, and in the unhealthy inflammations generally, as they are termed. 
In concluding these few remarks, I would mention that the ancient lapis 
divinus (alum, nitre, and sulphate of copper) constitutes a gargle that will 
quickly remove inflammation of the throat; and the same (with the 
omission of the nitre) forms a lotion under the use of which sores on the 
penis heal with rapidity. 
The medication of poultices by means of ointments is advantageous in 
certain cases. Resinous ointment mixed with a poultice considerably 316 
PEDICULI—PENISi 
hastens the suppuration and cure of a boil, and it will cause the skin to 
yield much sooner in abscesses of the breast and neck than occurs under 
simple poulticing. Red oxide of mercury ointment mixed with a poultice 
cleanses foul sores, and expedites their healing. Medicated fomentations 
and poultices were in great esteem formerly, but they have fallen into a 
neglect which I consider to be unmerited. Part xxviii., p. 23?. 
PEDICULI. 
Pediculi Pubis. — Dr. Haural recommends the following treatment; 
Wash the parts thoroughly, first with soap and water, then with pure 
water; dry them, then pour chloroform on drop by drop, and rub it in: 
then cover the parts with a folded handkerchief for half an hour, when 
another washing with soap and water should be performed, in order to 
detach the debris of the pediculi. Part xxxvii., p. 182. 
Pediculi Pubis.—Dr. Ryding, of Oakham, uses the following lotion: 
Bichloride of mercury, twelve grains; rectified spirit, two ounces; distilled 
water, two ounces. Apply this carefully for ten minutes with a flannel, 
and immediately afterward well dust the parts with ammonio-chloride of 
mercury. Repeat this night and morning for two days, then use a 
warm bath and soap. The ova will be destroyed effectually by this pro- 
cess 
Apply the following liniment for forty-eight hours: Finely levigated 
nitric oxide of mercury, two drachms; olive oil, one ounce ; mix 
Apply an ointment containing half a drachm of iodide of potassium to an 
ounce of lard 
Rub in a large quantity of calomel at bed-time. One application will 
usually be sufficient. Part xxxviii., p. 176. 
PENIS. 
Amputation of the Penis.—[Mr. Barnes publishes an account of the 
mode in which M. Ricord avails himself of the process of contraction after 
amputation of the penis to keep the urethra open. The principle of most 
surgeons in this operation is to counteract contraction.] 
M. Ricord’s principle is to avail himself of this process of contraction, 
and turn it to account in preserving the orifice of the urethra patent. The 
proceeding is this: having performed the amputation, with the precaution 
of preserving sufficient skin, and no more, to sheathe the corpora cavernosa, 
and secured the vessels, the surgeon seizes with the forceps the mucous 
membrane of the urethra, and with a pair of scissors makes four slight in- 
cisions, so as to form four equal flaps; then using a fine needle, carrying a 
silk ligature, he unites each flap to the skin by a suture. The wound unites 
by the first intention ; adhesion being formed between the skin and mucous 
membrane, which become continuous, a condition analogous to what is 317 
PENIS. 
observed at the other natural outlets of the body. The cicatrix then con- 
tracting, instead of operating prejudicially, as in the old methods, tends, on 
the contrary, constantly to open the urethra, whilst a perfect covering is 
provided for the ends of the corpora cavernosa. The difficulty of direct- 
ing the stream of urine, is one which becomes troublesome in proportion to 
the shortness of the stump. The patient must provide himself with a funnel- 
shaped canula, made of box, ivory, or metal, the base of which being ap- 
plied over the stump, and resting on the pubes, the other end will serve to 
carry the urine clear of the person. Part xi., p. 170. 
Penis—Cancer of.—M. Bonnet employs the actual cautery to execute 
the amputation. The patient being put under the influence of chloroform, 
and wet cpmpresses disposed round the penis, the organ is held by means 
of forceps, and the heated iron applied perpendicularly to the back of the 
penis. When the fibrous structure is divided, the iron is to be passed into 
the corpora cavernosa, and so through the penis. Four or five applications 
will be wanted in all. When the cancer extends to the scrotum or abdo- 
men, the operation is more tedious, as the ramifications must be followed by 
the cautery, though the pubis itself has to be reached. If the inguinal 
glands are affected, they should be removed by a bistoury, and the cautery 
applied. There is generally far less reaction than after ordinary amputa- 
tions of the penis. In about a week the eschars begin to be detached in 
fragments, and they have all fallen in fifteen or twenty days. By this 
operation, then, we can much more readily act on healthy tissue, we are 
enabled to attack cases the knife could not reach, and we prevent hemor- 
rhage. Part xx., p. 1G5. 
Case of Considerable Sprouting of Warts on the Gians Penis.—[Ricord 
believed that warts upon the penis were non-syphilitic, other eminent sur- 
geons think they are; but there cau be no question that these excrescences 
may be implanted on the organs of generation in the same way as they are 
present upon the fingers. From the narrow space in which they grow, 
they are liable to produce great irritation and inflammation, and their 
removal rendered a matter of anxiety. The patient in the case of Mr. 
Hancock, was a married man, aged 35, and stated positively that he had 
never had any venereal affection whatever. He had never noticed anything 
the matter with the penis until four months before admission, when the 
warts began to grow.] 
The patient has congenital phimosis, and noticed at the time just men- 
tioned, that some tumor was developing between theglans and the prepuce 
in the neighborhood of the corona. The pressure from within soon caused 
slight pain in the prepuce, and inflammation ensued, marked with a vivid 
redness on its external surface near the corona glandis. The patient applied 
poultices; ulceration and perforation took place, and the mass of warts, 
which bad been the exciting cause of all these symptoms, protruded through 
the ulcerated opening in the prepuce. 
The verrucae having thus obtained room, seemed to grow more rapidly 
than before; the aperture just mentioned became larger, and the warts 
grew to such an extent as to cover the glans almost completely, and to 
< ouble its size. The extremity of the prepuce was, in the meanwhile, 
almost separated by ulceration from the rest of that process, abundant sup- 
puration had set in, and the parts looked, to an unpractised eye, as if the 318 
PEKICAEDITIS, 
organ had been suffering from carcinoma. Very little or no pain accom- 
panied these changes. 
The patient was brought into the operating theatre, and when he had 
been rendered insensible with chloroform, Mr. Hancock began to remove 
with the scissors the enormous crop of warts which had sprung up about 
the part, as also the thickened semi-detached pieces of prepuce which were 
giving to the organ a misshapen aspect. When the whole mass of verrucre 
had been excised, the penis was surrounded with lint dipped in cold 
water, and the patient placed in bed. The progress has been most satis- 
factory since the operation, and the parts are now quite cicatrized. 
Part xxix., p. 241. 
PERICARDITIS. 
Treatment of.—On account of the frequent occurrence of pericarditis, its 
dangerous nature, and the numerous important diseases—endocarditis, val- 
vular disease, atrophy, hypertrophy, dilatation—which are frequently its 
consequences, it is highly important that its detection should be easy, and 
its treatment simple and straightforward. Although the pericardium is 
composed of two distinct kinds of tissue, yet as they are intimately con- 
nected, and supplied by the same vessels, the character and products of 
the inflammation depend more upon the condition of the blood than upon 
the nature of the tissue primarily affected. 
Dr. Shearman would bleed, first generally, and then locally, to such an 
extent as to cut off part of the supply of blood to the part, and to decrease 
the quantity of fibrin in the blood; give opium to diminish irritability and 
vascular excitement, and to relieve pain; give purgatives moderately ; and 
blister. But all these remedies combined will be inefficient for good, ex- 
cept mercury be given. Get the patient, therefore, as quickly as possible 
under the specific action of mercury; and for this purpose the best method 
is to give calomel with opium, and to use frequent frictions with strong 
mercurial ointment. Colchicum, emetic tartar, and aconite may sometimes 
be useful in allaying excessive action ; but must be given with great cau- 
tion. Tart xvi., p. 113. 
Ptyalism in Pericarditis.—Dr. Taylor’s cases seem to show that our 
opinions on the powers of mercury in pericarditis require revision. In 
twelve cases, ptyalism was not followed by any abatement of the disease; 
and in six cases pericarditis followed upon the ptyalism. 
• Part xvi., p. 116. 
Rheumatic Pericarditis.—The treatment of pericarditis, says Dr. 0. 
Kidd, has recently undergone considerable modification. Taking blood by 
venesection, which would first suggest itself, though necessary in some 
cases, in others is all but inadmissible. It has been recently shown by 
Bouchardat, that rheumatism may even be induced by the coagulable 
state of the blood, the result of repeated bleedings. Every particular'case, 
of course, will require a different line of action. Venesection after the 
middle of the first week, as a general rule, will lengthen the period of re- 
covery, and many cases will not require bleeding at all. 
The local abstraction of blood in rheumatic pericarditis will be always PERINEUM. 
319 
found the most beneficial. The treatment must vary, as we have to treat 
patients ill fed and etiolated in cities, or healthy and full of red blood in 
the country. Antimony, alkalies, nitre, and colchicum, are very valuable. 
The exhibition of mercury has been lately dwelt upon, the general impres- 
sion being that its beneficial effect will, in a great measure, depend on the 
period at which it is given. If early in the disease, it will prove much more 
satisfactory than later, its action being more properly directed to prevent 
the deposition of organizable matter in the pericardium than to remove it 
afterward. Indeed, our late statistics would go to prove that salivation 
has no very marked effect on the disease at all, the ceasing of the friction 
sound, according to Taylor, being more of a coincidence than really brought 
about through the agency of the mineral. As to the use of tartar emetic 
to remove inflammation, perhaps there is no difference of opinion; the 
dangerous effects of this valuable medicine having little or no existence 
except in the estimate of those who have not studied its effects. 
Case.—Margaret B., aged 20, single, had suffered formerly from rheu- 
matism, and lately very much from debility, and irregular menstruation. 
She complained, on admission into Guy’s Hospital, of burning hot pains in 
the joiuts, and all the accompanying symptoms of rheumatic fever. The 
heart’s action yras found to be quite normal, as well as the impulse, a very 
feeble bruit being perceptible with the first sound, particularly over the 
valves. The second sound free. Ordered pills with antim. tart, and calo- 
mel, and a draught for the morning, with senna and vin. colchici, to be kept 
very quiet, and to get simple drinks, without food. As the symptoms of 
pericarditis gradually came on, with acute pain below the left nipple, 
between the fifth and sixth ribs, a rubbing sound was detected with the 
systole, and occasionally of a “to and fro” character. Cupping glasses 
were now put on, and §vj. of blood drawn from the cardiac region, the 
former medicines being continued. Although the “ rubbing sound ” con- 
tinued for six days longer, the general symptoms began to iinjwove ; but 
the bruit began to be traceable along the aorta. She was now, in addition 
to the same medicines, ordered a blister to the region of the heart. In a 
week after this, the pericarditic symptoms had entirely disappeared, 
although she had suffered some little relapse. Part xxii., p. 116. 
Pericarditis.—Dr. Stokes says that whenever the fever present is of a 
typhus character wine is required. Part xxix., p. 21. 
PERINEUM. 
Ruptured Perineum—Operation.—After dwelling on the difficulty of 
accomplishing the re-union of the parts in ruptured perineum, Mr. Fergus- 
son says, that “ it is generally allowed that in cases which do not heal up 
soon after delivery, the parts being kept in perfect rest, it is better to wait, 
before attempting any surgical means, until the primary inflammation has 
subsided. Mr. Fergusson has chosen the interrupted suture, certain 
objections to them being removed by precautionary measures. This 
patient, 18 years of age, had been delivered of her first child by the for- 
ceps six months previous to her admission, and ever since had been 
suffering from the effects of a lacerated perineum, extending from the 320 
PEKINEUM, 
fourchette to the margin of the anus, the faeces involuntarily passing through 
the recto-vaginal aperture. 
After this young woman had been duly prepared for the operation, by 
rest and opening medicine, she was brought into the theatre and placed 
under the influence of chloroform. The patient being secured in the 
position for the operation of lithotomy, Mr. Fergusson began by paring the 
whole length of the margins of the perineal gap, from above downward, 
and brought them in exact apposition, by three interrupted sutures. The 
next step of the operation consisted in making a longitudinal incision on 
each side of the line of sutures, in order to take oft* the tension which the 
neighboring parts would naturally exercise upon the sutures. These 
lateral wounds were filled with dry lint, cold compresses applied to the 
perineum, and the patient removed to a bed, with her knees kej)t together 
by a roller. 
Much care was subsequently used in keeping her quiet and regulating 
the action of the bowels by enemata; and about eleven days after the 
operation Mr. Fergusson was enabled to remove the three sutures, as 
pretty firm adhesion had taken place. The bowels now became regular, 
without the necessity of the injections which had hitherto been systemati- 
cally administered, and about one month after the operation, both the 
perineal wound and the lateral incisions were completely healed. The 
further progress of the patient has been satisfactory, the rectum has 
regained the faculty of retaining its contents, and the poor woman is 
delivered from a very distressing infirmity. Part xxii., p. 305. 
Rupture of the Perineum.—The plan of Mr. Brown’s operation is as 
follows: Having made a clean incision into the vagina, so as tp separate 
from each side of the rent any portion of mucous membrane, three or four 
sutures were passed deeply through the parts, and attached to a piece of 
quill or elastic bougie on each side. Three or four smaller sutures might 
be passed also through the edges of the wound, so as to bring them into 
more certain apposition. To prevent the inner edges of the wound being 
drawn separate by the sphincter, and the lochia allowed to penetrate into 
the wound, Mr. Brown divides this muscle; and this he considers one of 
the most essential features of his operation. In all cases he administers 
opium, which allays the irritability of the nervous system, and exercises a 
most salutary influence over the patient. He has never seen any harm 
arise from its constipating effects. Part xxvii., p. 196. 
Abscesses in the Perineum and Neighborhood of the Anus.—[According 
to Prof. Syme, the explanation of the origin of abscesses in this situation 
which is usually given and received, is very erroneous, so far as the rectum 
is concerned. They are said to be from ulceration in the mucous membrane, 
allowing intestinal matters to enter the cellular texture. But such an 
occurrence never does take place, since ulcers in this situation are always 
attended with an induration of the subjacent texture; and]— 
It is this firmness of base that renders ulcers at the rectum recognizable 
by touch, which from long and large experience, I may confidently assert, 
is sufficient for the diagnosis of all derangements in this part of the body, 
while speculums are not only painful and useless, but calculated to mislead. 
If further evidence were required to disprove the agency of ulceration in 
giving rise to the abscesses in question, it would be afforded by the effect 
of wounds penetrating the mucous membrane, which give rise to abscesses, PERINEUM. 
321 
it is true, but totally different in their nature and character from those of 
the ordinary purulent collections met with in this situation. The most 
frequent instances of such an injury are produced in a way that would 
not readily occur to you, viz., the administration of enemata. Many years 
ago, on making my daily visit to this hospital, I was told that a patient, 
who had been admitted with retention, was suffering from extravasation 
of urine. Upon examination, I found much swelling of the nates and 
neighboring part of the perineum, but no difficulty in passing a full-sized 
catheter, through which a large quantity of healthy urine was evacuated. 
Having then ascertained that an injection into the rectum had been 
employed as a substitute for more efficient relief, I suspected the truth, 
and introducing my finger into the anus, at once felt an aperture on the 
anterior surface of the bowel, through which the fluid injected had no 
doubt passed, so as to simulate the appearance of urinary extravasation. 
In those days, the instrument employed for throwing injections into the 
rectum, was the old metal syringe with a straight pipe, which, when 
introduced behind the patient, as it generally was, could hardly fail to 
encounter resistance from the opposite surface, requiring force which was 
sometimes employed so strenuously as to make the fluid escape in a wrong 
direction into the operator’s face. Impressed with the danger of such a 
procedure, as manifested by the case just mentioned, and others that came 
to my knowledge from the inquiries which it suggested, I recommended 
that the old injecting apparatus should be abolished, and that Read’s 
syringe should be employed in its stead. But even from his more safe 
and apparently harmless mode of administration, I have known perforation 
of the mucous membrane produced ; and in order to put you still further 
on your guard, I may mention that a most kind and attentive practitioner 
asked me to see a gentleman, in whose case he felt so much interested, as 
to administer an injection by the apparently innocuous means of a bag and 
pipe, or in other words, a bladder, with an ivory tube attached to it, with 
the effect of perforating the bowels, and distending the hip with the usual 
mixture of gruel, salt and oil. 
The fluid injected excites inflammation of a very violent character, 
attended with a corresponding degree of constitutional disturbance, the 
local result being very speedily a large collection of extremely fetid fluid 
and air. These characters of the abscess may be supposed to depend upon 
the peculiar nature of the matters allowed to issue from the bowel, but 
are more probably connected with the sort of inflammatory action which is 
excited by the wound. 
The abscesses which, under all ordinary circumstances, occur at the verge 
of the anus, differ entirely from those which we have been considering. 
Instead of being large and diffused, they are small and circumscribed ; 
instead of being preceded by intense inflammation, and attended with 
violent constitutional disturbance, they take place without either one or 
the other of these conditions ; instead of being rapidly they are slowly 
formed; and instead of dark-colored fetid matter, they contain merely a 
little of what used to be called well-conditioned pus. It is such abscesses 
which lay the foundation of fistula in ano. When allowed to open sponta- 
neously, they almost invariably do so on the external surface—that is, 
through the skin; and if, when this has happened, or the contents have 
been evacuated by an incision, a finger is introduced into the rectum, 
while a probe is employed to explore the cavity formed by suppuration, it 
YOL. II.—21 322 
PERIOSTEAL AFFECTIONS. 
will be found that the mucous membrane, although to a considerable extent 
completely denuded, still remains entire. Sooner or later an aperture is 
formed by ulceration, through this detached portion of the lining mem- 
brane, and then the fistula becomes complete or open on both the external 
and internal surface with which it is connected. 
Then, as to the urethra, it has long been taught that abscesses con- 
nected with it in general proceed from ulceration of this membrane, 
allowing urine to escape into the cellular texture. But whenever urine can 
be positively ascertained thus to issue from its proper channel, the local and 
constitutional effects are so violent and characteristic as to prevent the 
possibility of overlooking them; while the abscesses that usually precede 
the formation of a fistula in perineo take place slowly and insidiously-so as 
frequently to escape observation until they discharge their contents, which 
in the first instance are almost always simply purulent, the urine finding 
its way through them only by a secondary process of ulceration in the 
denuded mucous lining of the urethra, which, like that of the rectum, 
remains entire for a time. It is true that strictures frequently give rise to 
abscesses of the perineum, but not by impeding the flow of urine so as to 
cause the extravasation, their real agency in producing this effect being 
through the excitement of irritation, which gradually leads to the result in 
question. Part xxxiii., p. 187. 
Puptured Perineum,—In the Vienna Lying-in Hospital, Vidal’s serres- 
fine seem to have superseded every other means of approximation. It 
may be necessary to pare the edges a little ; then, as soon as the bleeding 
has ceased, two or three may be applied according to the extent of lacera- 
tion. Allow them to remain two hours, keep the parts clean, and, above 
all, keep the patient on her side till the termination of the case. 
Part xxxiv., p. 246. 
Perineo-Plastic Operation.—Dr. Savage, of Samaritan Hospital, states 
that one great element of success in this operation is to remove the entire 
thickness of the vagina as far as the perineal fascia. Part xxxvii., p. 217. 
Treatment of Periostitis.—Mr. Ferrall has tried the three principal 
modes of treatment usually adopted in this disease, viz.: 1 st, by incision ; 
2d, by mercury; and thirdly, by hydriodate of potass. By the first the 
cure was completed in twenty-eight days ; and by the last in thirteen days: 
relief was more immediately procured by incision, that is, by cutting down 
upon the bone through the periosteum for the space of about two inches, 
but the cure was, nevertheless, protracted. 
He gives from eight to twenty grains of hydriodate of potass three times 
a day in the third mode of treatment, to which he gives the preference, 
since the iodine treatment avoids a painful, though brief operation, and is 
not followed by an open sore. 
The second ground of preference, namely, the earlier period at which the 
patient can resume his occupation, is clearly on the side of the iodine, for 
the case treated by mercury occupied thirty-seven days, that by incision 
twenty-eight days, and that by the hydriodate of potass thirteen days. 
PERIOSTEAL AFFECTIONS. PERIOSTEAL AFFECTIONS. 
323 
Sarsaparilla is also spoken of as a medicine of great efficacy in sub-acute 
and chronic periostitis. Part i., p. 120. 
Periosteal Disease.—Dr Oke gives the following case: 
J. C., aged 40, a baker by trade, consulted me for an agonizing pain of 
a rheumatic character in the right tibia, which was considerably enlarged, 
and its periosteum thickened along the upper half of its anterior and inner 
Surface. This pain had existed for eight years ! It attacked him every 
night as soon as he was warm in bed, and had in a great measure long de- 
prived him of sleep. He is a married man ; and solemnly assures me-that 
he has contracted no syphilitic disease for the last twenty years, when he 
had a swelling of the groin. He told me he had spent in vain almost all he 
possessed in medical advice, and had been once in a hospital with no better 
success; that he could bear his sufferings no longer; and, that in the event 
of my treatment being also unsuccessful, he had decided on submitting to 
amputation as a last resource. I at once put him under the use of the 
iodide, of which he took five grains in' solution three times a day, and con- 
tinued the treatment for six weeks; at the end of a week the pains left 
him and never returned; the enlargement of the tibia diminished, and he 
speedily recovered. Partht., p. 61. 
Periosteal Thickening cured by Iodide of Potassium.—Mr. Alexander 
Ure relates a case of periosteal inflammation of left ulna, about its middle 
third, of two months’ standing, which, after blisters, leeching, etc., had 
been tried, was cured by taking two grains of iodide potass, twice daily, 
in infus. gent, co., and a grain of opium at bedtime, for a fortnight; bran 
poultices applied to the arm. Part xi., p. 186. 
Treatment of Periostitis.—In obstinate cases, says Prof. Miller, where 
aggravation and suppuration seem imminent, direct incision is unwarrant- 
able, but it may be done as follows : Insert a fine bistoury or tenotomy 
needle, at a little distance from the tense part, passing it over, cautiously, 
beneath the integument; then turning and pressing its edge, divide the 
tense membrane wholly to the desired extent; now cautiously withdraw the 
instrument, making a valvular, oblique, subintegumental wound; finally, 
close the single puncture immediately, with isinglass plaster or collodion. 
Part xxiii., p. 275. 
Syphilitic Periostitis.—Iodide of potassium for this disease, says Dr. 
Todd, certainly deserves the name of a specific, the chief drawback Jo it is, 
that its effects are so evanescent. To obviate this, mercury may be given 
with it, or a short alternate course of each, and then using only tonic 
means, resume the mercurial and iodine treatment if necessary. 
Part xxiii.,/). 87. 
Periosteal Disease affecting the Dura Mater.—The dura mater, says 
Dr. R. H. Goolden, is supposed to be very little liable to disease, except as 
the result of injury, or in connection with strumous softening of the petrous 
portion of the temporal bone, or with abscesses about the ear, or as the 
effect of syphilitic poison; and this poison, supported by some of our best 
authorities, seems to have diverted attention from a very common affection 
of this membrane, of the same character as the periostitis which gives rise 
to nodes on the tibia or cranial bones. 
This partial affection of the dura mater may or may not coexist with 
general periosteal disease. It is part of the same morbid state, and it has 324 
PERIOSTEAL AFFECTIONS. 
no necessary connection either with syphilis or with mercury, though 
these poisons, and especially the latter, greatly favor its development. In- 
deed, the worst cases have been those who, in the tropics, have taken 
large quantities of mercury for fevers or hepatic disease, often many years 
previously, and have been afterward exposed to cold and damp in our more 
northern latitudes. They give way, at least for the time, to very simple 
treatment, viz.: iodide of potassa, with sarsaparilla, blisters or issues to the 
head, and full doses of opium every night, with a good nutritious diet— 
in the same way as periosteal nodes are known t o do. When the pericra- 
nium is the seat of the disease, it is at once recognized by the presence of 
great tenderness, as well as unevenness to the touch; but when the dura 
mater is affected, this morbid condition is not so palpable; it is, however, 
evinced by unmistakable symptoms. The patients are often free from pain 
during the day, but at eight or nine o’clock at night the pain sets in, and 
is so agonizing that they are willing to submit to any measure for relief. 
It lasts till three or four o’clock in the morning, followed by a profuse per- 
spiration, when the patient gets some sleep. The intermittent character, 
and the time and duration of the paroxysms, are very remarkable. For 
some time the cerebral functions are not impaired, but at length the 
sufferer complains of a constant headache, though not so severe as during 
the paroxysms; he holds his head forward, with his brows knit; then fol- 
low occasionally epileptic fits, weakness of the lower limbs, paralysis, and 
the patiejit becomes greatly emaciated, despondent, and suffers colliquative 
perspirations. 
Some years ago, a sailor, who had frequently been a patient for such 
attacks, was accidentally killed. This afforded an opportunity of examin- 
ing the head, when it was found that the inner table of the skull was 
greatly thickened, and also the dura mater. 
Such is the most marked and aggravated form of the disease occurring 
in patients debilitated by climate, mercury, purpura, or syphilis, which no 
one would fail to recognize as identical (except in situation) with periosteal 
disease, when it attacks the tibia, ulna, cranial bones, crest of the ilium, 
etc., in the form of nodes, and for which the iodide of potassium seems to 
be the appropriate, if not specific remedy. 
Although this aggravated form of periosteal disease of the dura mater is 
most common in sea-port hospitals, where the patients have been for the 
most part exposed to all the predisposing causes, yet it occurs also in a 
milder., form, and therefore more likely to escape recognition, as the 
cause of many distressing headaches, ‘ultimately leading to epilepsy or 
paralysis, or at all events reducing the sufferer to the most distressing state 
of debility. 
These cases are marked by headache, having its regular nightly parox- 
ysms, morning perspirations, and gradual emaciation. The patients have 
mostly been treated for dyspepsia, rheumatism, gout, neuralgia, brow 
ague, and often for supposed obscure cases of phthisis, having, in addition 
to the above symptoms, some cough and bronchial murmurs; but by the 
peculiar expression of countenance, the pain and wakefulness during the 
first part of the night, the true nature of the disorder has been recognized. 
Part xxiv., p. 54. 
Periosteal Pisease Affecting the Ilumerus and Femur.—This disease 
often affects the upper end of the humerus, and the lower end of the femur, PEKIOSTEAL AFFECTIONS. 
325 
and is often overlooked. The shoulder is aching, tender, and cannot be 
used on account of the pain, the muscles being inserted into the periosteum. 
The pain is 'more severe at night; there is no perceptible swelling. There 
soon follows a state of permanent congestion, or subacute inflammation. 
The hip joint is liable to a similar affection, but is more rare. In these 
cases the iodide of potassa must be given three times a day. If of long 
standing, blisters or issues must be employed. The nitric acid issue is the 
best. A piece of lint is to be applied the size required, not too Avet Avith 
the acid, to the tender part anterior to the joint, as it is generally under 
the covering of the deltoid and biceps, near the joint'. It should then be 
covered over with a piece of lint, dipped in a solution of carbonate of 
soda. A linseed poultice should be then applied. The slough usually 
comes aAvay in five or seven days, and the discharge will continue till the 
pain-is removed. 
Periosteal Deposits.—Dr. Goolden also alludes to some painful swellings 
of the tarsal and metatarsal, as Avell as carpal and metacarpal bones, 
often observed to remain after attacks of gout, Avhen all active signs of 
gout have subsided—and sometimes mistaken for gout—and to the knoAvn 
success of the iodide of potassa in relieving the pain. These SAvellings of 
the fingers and Avrists are very different from chalkstone deposits, though 
they disfigure the hands. They are very common in advanced life, and 
then they rarely subside so as entirely to restore symmetry of form. But 
the same observation holds good in all other forms of periosteal deposit; 
that is to say, although the activity of the disease may be arrested by 
iodide of potassa and blisters, the absorption of earthy matter in old age is 
much more difficult; the pain will subside, but the tibia and frontal bone 
still retain the sAvelling and unevenness. 
Another set of periosteal deposits is on the fangs of the teeth, causing 
the most agonizing toothache, Avithout any apparent decay of the teeth. 
The fang of the tooth becomes thickened, too large for the alveolar cell, 
and, Avhen drawn, the membrane shoAVS unusual vascularity, and there is a 
deposit of dentine, softer than the fang of the tooth, and may be cut Avith 
a penknife betAveen the membrane and the fang, giving it bulbous form, 
and rendering it difficult to extract Avithout breaking. This is not uncom- 
mon after mercurial salivation; and in ladies who have taken metallic 
remedies for a continuance—especially salts of iron—given for the relief 
of headache, and remittent pains about the chest and other parts—some- 
times for neuralgia—all dependent upon this state of the system. 
Part xxiv., p. 57. 
Periosteal Disease affecting the Dura Mater.—[In previous notices of 
this disease, Dr. Goolden has shoAvn some important, but not generally 
recognized forms of its development, and its independence of syphilis. In 
considering its remedial treatment, he says :] 
No more valuable remedy has been introduced into medicine than the 
iodide of potassa, but its precise value is scarcely generally recognized. 
Some practitioners give it in eight-grain doses, three times a day; and 
give it with calomel or blue-pill, and colchicum ; others never venture be- 
yond tAvo grains, and even then fear the results; yet no one ventures to 
dispute its almost general efficacy in nodal periostitis. 
As far as I can draw any inference from my own cases, I should say that 
smaller doses produce the specific effect quite as soon the larger; and I 326 
PEEIOSTEAL AFFECTIONS. 
have often known two-grain doses act readily on the system, when larger 
doses have failed; but I think it necessary to combine the salt with liquor 
potassa, as any acid on the stomach will decompose the salt, and the free 
iodide will thus be very likely to act as an irritant. I may also observe, 
that it is not well borne where there is any considerable gastric irritation, 
indicated by a foul tongue, dry skin, precordial pains after food, etc., at- 
tended with acid eructations, and especially where there is urine turbid 
with lithates or lithic acid; and yet we may have all these, as well as peri- 
osteal nodes, to contend with; and I am quite sure, that during the active 
forms of gout and rheumatism, the medicine is never well borne; yet it is 
often very useful in relieving pains which are still existing after all consti- 
tutional traces of specific disease have subsided. It is therefore necessary 
to relieve the dyspeptic symptoms by appropriate remedies, before using 
the iodide of potassa; or not to set down our failure to the ineificacy of 
the salt. The disagreement of the medicine is soon detected by the exces- 
sively nauseous, metallic taste in the mouth, before the gums are affected, 
or the catarrhal symptoms so severe as to oblige us to discontinue it; and 
when that taste distressingly prevails, the salt rarely produces any bene- 
ficial effect. 
But I will even go further in asserting, that in some instances periosteal 
nodes have been the result of the very medicine we qre giving for their 
cure. 
I have met with cases of periosteal nodes, which have appeared during 
a course of iodide of potassium and sarsaparilla, taken for secondary skin 
eruptions, and which have subsided on substituting mercurial medicines 
for the iodide. 
It will be found that the different preparations of iron with quinine, 
sometimes gentian and ammonia, sometimes nitric acid, and decoction of 
sarsaparilla, may be given with advantage; but the relief is very different 
in degree and kind from that produced by the iodide of potassa or by 
mercury in the cases to which they are respectively applicable. I have 
occasionally observed some benefit to accrue from the use of the phosphate 
of ammonia, where the iodide of potassa could not be persevered in. I 
must first refer to iron as a remedial agent. I have not lately used iron in 
any form as a remedy until satisfied that the patient was intolerant of 
iodide of potassa, or else as a tonic during such intervals as it has been 
found desirable to intermit the use of that salt; but amongst those who 
have applied to me as private patients, I have been able to collect facts 
relative to the effects of iron which had been previously recommended. 
Of all remedies, next to the iodide of potassa, iron has certainly been 
generally the most serviceable; but the form in which it is exhibited does 
not appear to me at least to be of much consequence. A lady, near Dork- 
ing, consulted me for neuralgic pains on the right side of the face, from 
which she had suffered for six years. She had at different times consulted 
some of our most eminent physicians and surgeons, and derived some 
benefit from carbonate of iron, prescribed for her by Sir B. Brodie; but it 
never quite relieved her. The tic occurred in paroxysms in the evening; 
and on questioning her, I learned that she had also headache, pains in the 
crest of the ilium, and tibial nodes. She had the appearance of one who 
had been much stouter, but was emaciating and anaemic. Small feeble 
pulse; clean tongue, and had no sleep for pain. She took iodide of 
potassium, five grains; liquor potassae, half a drachm; compound decoc- 327 
PERIOSTEAL AFFECTIONS, 
tion of sarsaparilla, an ounce and a half; thrice a day. An opium pill at 
night. 
Under this treatment she gradually lost all pain. The opium was soon 
discontinued, but she slept well, and the medicine was at length omitted, 
in consequence of the disagreeable metallic taste. Her medical attendant, 
Mr. Curtis, favored me with a favorable report of her since, and she is now 
taking quinine and iron under his direction. 
The carbonate of iron was considered to have a kind of specific action in 
such neuralgic cases, and was prescribed in spoonfuls; but I think it a 
clumsy way of giving medicine ; being nearly an insoluble powder, and 
any quantity of course may be given that will pass off by the bowels. The 
more soluble salts are certainly the most effective, and none more so, or 
more agreeable, than the vinuni ferri as prepared at Apothecaries’ Hall; 
but the sulphate or hydrochlorate, or the ammoniated tincture, will answer 
equally well. The chalybeate waters are even more certain in their effects 
than any of . our medicinal potions, and this is a fact not so generally 
recognized as it should be. It matters not whether the water be natural 
or artificial. Small doses largely diluted are more readily absorbed and 
diffused than larger and more concentrated doses. 
The ansemic appearance usually observed in periosteal disease would 
seem to point naturally to iron preparations, and though they do not seem 
directly to control the morbid action going on during the activity of nodal 
deposit, as both iodide of potassa and mercury, in their appropriate cases, 
are observed to do, yet their indirect influence is very decided, and when 
the acute symptoms are relieved, it is most desirable to alternate the 
iodide of potassa with iron preparations; and there is one form of iron 
which is especially applicable, viz. the iodide, which is best given in the 
form of sirup. 
Quinine is an important agent in the treatment of this disease. Periosteal 
disease is rife in the aguish districts of Kent and Essex, and although the 
iodide of potassa will control the paroxysms, the relief must be followed 
up by such remedies as restore the constitution to a normal state, which 
the iodide will not do, and without which the relief can only be temporary. 
The anasarcous swellings indicate an obstruction in the chylopoietic 
vessels, whether in the liver, spleen, or kidneys, and Blight’s disease is no 
unfrequent attendant, evinced by albuminous urine. Without hoping to 
restore the kidney to its normal function, when that is evidently degene- 
rated, much good accrued from the exhibition of quinine, either alone, 
or in combination with sulphate of iron, dissolved in dilute sulphuric 
acid. 
Where a simple tonic is required, quinine is not the most efficacious, 
and is often observed rather to oppress than invigorate the digestive func- 
tions (I am acquainted with two persons in whom severe inflammation of 
cellular tissue is the result of a grain dose of quinine); but some of the 
simple bitters, with ammonia, are often found more useful. This holds 
good mostly in tipplers—I do not mean absolute drunkards, but those who 
are constantly drinking small quantities of wine, dilute spirits, or even 
beer, at all times and seasons, and in cases where constitutions have been 
debilitated by residence in the tropics, or by the exhausting passions. I 
have not been able to satisfy myself that there is any reason for preferring 
one bitter rather than another. I have prescribed gentian, quassia, casca- 
l'illa, cusparia, and simarouba, each for a stated time, in order to watch 328 
their comparative effects, and I am inclined to think that any preference is 
rather a matter of fashion than founded on any carefully and extensively 
watched clinical observation; but taking our Pharmacopoeia preparations, 
I think I may safely say that the dose should never exceed half an ounce 
in an ounce and a half draught. 
Concerning topical applications : I have already referred to the efficacy 
of issues and blisters, and in the severer forms of cephalalgia arising from 
the disease of the dura mater, I prefer them ; but I may also recommend 
the application of spirit of wine, the most convenient mode of using 
which, is, to wet some lint with the spirit, and having applied it over the 
head or other painful part, to prevent evaporation by covering it over with 
oil-silk: it produces a copious -swreat in the part, and with very great 
relief. I need hardly mention, that eau de Cologne, or any strong spirit 
most readily procurable, will answer the purpose. Old nodes may be 
painted with the tincture of iodine, or rubbed with the iodine ointment, 
but these are not convenient applications to the scalp, and the latter is 
objectionable where there is much tenderness. 
There is only one more remedy W’hich I must not omit to mention—that 
is, guaiacum. It is by no means universally applicable, but in some cases 
most decidedly useful, and especially where there is a cold, dry surface, 
and languid pulse, and where the iodide too readily produces catarrh. Lest 
I should confound such cases writh the catarrh rheumatism affecting the 
head or other parts, I have been cautious to draw my inferences only from 
cases in which tibial or other easily recognized nodes are seen and felt. 
Part xxv., p. 59. 
Acute Periostitis.—Mr. Curling says: The chief difficulty in diagnosis 
lies in its great resemblance to acute rheumatism. In both there is high 
inflammatory fever, with swelling of the limb and great pain, increased by 
pressure; but the point of difference is here—that in periostitis little or 
no pain is caused by pressure, unless it be made over, or in the course of, 
the affected bone. The swelling is not limited to the larger joints, to the 
ankle or to the knee, but occupies a wdder range, and is cedematous in 
character. -The conclusion in favor of periostitis will be much strength- 
ened if it be found that the attack of inflammation succeeded an injury. 
In the treatment, do not rely on local depletion, with calomel and opium ; 
make an early and free incision dowm to the inflamed periosteum, not wait- 
ing even for evidence of matter, for the mischief is then done, the perios- 
teum is already separated from the bone, and the bone will die. 
Part xl., p. 95. 
PERITONITIS. 
Opium in Peritonitis.—The pamphlet published by Mr. Bates, of Sud- 
bury, some years ago, on the treatment of severe peritonitis by opium, made 
a strong impression on the minds of some medical men. He recommended 
opium both by the mouth and rectum ; and insisted on a rigid adherence 
to the horizontal posture, till all pain had subsided. Mr. Bates’s practice, 
however, may be considered as chiefly valuable in those severe cases 
where, either from ulceration or injury, perforation of the intestine has 
taken place, and which have been supposed to be almost invariably fatal. 
Some very striking cases, however, are related by Dr. "W. Stokes in the 
PERITONITIS. PERITONITIS, 
329 
second number of the “ Dublin Journal of Medical and Chemical Science,” 
which strongly confirm the opinions of Mr. Bates in cases where perfora- 
tion is supposed to have taken place. Dr. Stokes truly remarks, that in 
many of these cases the patient sinks with awful rapidity, and gives no 
time to pursue the active treatment which is adopted in other cases. Mer- 
cury and purgatives would in such cases probably increase the evil, by 
tearing asunder recent adhesions, and thereby preventing nature closing 
the communications between the mucous and peritoneal cavities. One of 
Dr. Stokes’s cases is related as follows : 
“ The well-known symptoms of perforation of the intestines had existed 
for two days ; The exhibition of sixty drops, in the twenty-four hours, of 
the preparation called the black drop was followed by the most signal im- 
provement. The pulse regained its fullness and softness, the extremities 
became warm, and the countenance had lost the hippocratic expression. 
The patient could bear pressure on the abdomen, which the day before 
was exquisitely painful. The same treatment was continued for twenty- 
four hours longer; and by the end of that time every symptom of abdominal 
inflammation had completely subsided. The belly felt natural, there was 
no tenderness, the pulse was good, and the patient declared himself well.” 
At this period of the case, Dr. Stokes omitted the opium, and gave the 
mildest possible saline laxative, as there had been no stool for 48 hours. 
Four evacuations took place, followed by the immediate return of the 
symptoms of peritonitis, under which the patient rapidly sunk. 
Dr. Watson remarks: 
This example puts in a very strong light the good effects of opium • 
the dangerous effects of purgatives; and the mode in which recovery 
from these frightful accidents mag sometimes be brought about. 
Dr. Stokes gives another instance in which the patient did recover; after 
taking 105 grains of opium, besides what was administered in injections : 
and he alludes to a third case, in which the employment of opium was 
successful, when peritonitis had supervened upon the bursting of a hepatic 
abscess into the cavity of the abdomen. 
Dr. Watson recommends applying the same principle of treatment, as 
an auxiliary, in all cases of peritonitis. The opium is not to supersede 
the bleeding, nor the mercury; it is not incompatible with either of those 
remedies; and it may be most advantageously adopted in conjunction with 
them both. Part Y.,p. 28. 
Treatment of Peritonitis.—[ The constipation which occurs in cases of 
peritonitis should never be treated by giving acrid purgatives. Dr. Cor- 
rigan observes: ] 
Relieve the serous inflammation, and permit the peristaltic action of the 
intestines to return, but do not force it; look upon the constipation as ef- 
fect, not as cause. 
Let the first object be, therefore, to look upon inflammation as the cause 
of the constipation in peritonitis, and to endeavor to remove it by the 
application of leeches, by blistering, and putting your patient under the 
influence of mercury; and recollect what I told you of the danger of a 
relapse from the use of stimulants of any kind. 
Where accumulations occur in the colon, their removal may be advan- 
tageously obtained by the introduction once or twice of the long tube, as 
recommended by Dr. O’Beirne; but it is worse than useless to repeat this 330 
PERSPIRATION PESSARIES. 
process after, and so attempt to force a discharge of the contents of the 
intestine. Part xiv., p. 90. 
Peritonitis.—Apply a layer of collodion over the whole surface of the 
abdomen. (M. Latour.) Part, xxv., p. 325. 
Acute Peritonitis after Abortion.— Chloroform.— Chloroform, when 
given in full doses, either by inhalation or swallowing, depresses and brings 
down the rate of the pulse from 90 or 80 to 70, 60, or less. This may be 
taken advantage of in some instances of disease, especially acute serous 
inflammations. Dr. Simpson relates a case of acute peritonitis after abor- 
tion: the pulse was weak and scarcely perceptible, ranging above 150, and 
there was little hope of the patient surviving. Chloroform was given to 
relieve the intense pain, when the pulse was found to sink down to 100, or 
less, and became stronger and steadier ; and as long as the action of the 
chloroform continued, the pulse continued thus greatly lowered in rate 
and improved in power. The patient Avas kept for sixty consecutive hours 
under its influence, and the great abdominal tenderness and tympanitis 
were then almost entirely reduced, the patient being in a much more satis- 
factory state. The pulse never rose again to any very high rate, and she 
recovered nicely. Part xl., p. 180. 
PERSPIRATION. 
Pure Tannin, a remedy for Excessive Perspiration.— Dr. Charvet 
relates several cases in support of the anti-sudorific property which he 
attributes to tannin. He prescribed it in doses of from half a grain, to 
two grains, in the form of pill, in the evening, with or without opium, 
which neither checks nor favors its action. The cases occurred among 
consumptive patients who had arriv jd at the last stage of the disease. 
They are additional examples of the activity with which tannin sup- 
presses sweating, even when the disease from which it arises is beyond the 
resources of our art. Part, iii., p. 53. 
Night Perspiration of Phthisis. Dr. T. Thompson recommends four 
grains of oxide of zinc, and four grains of extract of hyoscyamus, made 
into two pills, every night for a time. Part. xxix. p. 92. 
Colliquative Sweating.— In the “ Dublin Hospital Gazette ” it is stated 
that tannin dissolved in the aromatic sulphuric acid, or dilute sulphuric 
acid, forms a good combination! in cases of colliquative sweating and 
chronic diarrhoea. Part, xxxiv. p. 277. 
Vide Art. “ Phthisis Pulmonalis.” 
New kind of Pessary.—The great advantage of a pessary of the kind 
described and recommended by Mr. Clay, would no doubt be, as he says, 
to support the womb, and, at the same time, would not so distend the 
vagina as to render the evil of prolapsion even greater than ever, the 
moment the instrument is withdrawn. It is described as follows: 
PESSARIES. PESSARIES. 
331 
It consists of a small shield of wood, ivory, etc., of a peculiar shape, 
secured to the vaginal entrance by bandages attached to a belt applied 
around the body. To the inner surface of the shield is fitted a strong coil 
of steel wire, plated over with gold or silver, the dimensions of the coil 
being such, that, when worn, the vaginal canal will not be in the least ex- 
tended, but with every facility assume its original dimensions. At the end 
of the coil is a caoutchouc ring, a little larger in dimension than the coil on 
which the os uteri rests when applied; when it is weighed with the ute- 
rine mass, it should he about the length of the vaginal canal in a healthy 
state. I think a coil, varying from three and a half to four and a half 
inches, will be found sufficient. To prevent any folds of the vaginal coats 
from getting entangled in the coil, a thin slip of caoutchouc is proposed to 
stretch along the under and outer surface of the coil. 
Advantages over the old Pessaries.—First, The elasticity of the coil 
allows of the free motion of the body in every possible direction, with per- 
fect ease. Second, The vaginal canal not being obstructed, the catamenia 
can flow through the caoutchouc ring and along the coil without any 
hindrance. Third, The dimensions of the coil and ring being so moderate, 
no undue pressure can prevent discharges either from the bladder or rec- 
tum. Fourth, The laxity of the vaginal canal may be removed, and its 
original dimensions restored (the measurements of the coil being not larger 
than the vaginal canal in a healthy condition). Fifth, Local applications 
for improving the tone of the parts are facilitated by the opening in front 
of the shield through which injections can be thrown, and retained at 
pleasure, by introducing a small piece of sponge, or plug, into the open- 
ing ; and the same plan might be a protective to females in heated or 
crowded rooms, for sudden appearances of the catamenia. Part iv., p. 119. 
Medicated Pessaries.—Dr. Simpson has been in the habit of applying a 
variety of substances in the form of medicated pessaries, particularly zinc 
and lead ointment, as simple emollients; mercury and iodine as discutients 
(and particularly the iodide of lead) ; tannin, alum, and catechu, as as- 
tringents ; opium, belladonna, etc., as anodynes. The pessaries were made 
of the size of walnuts, and could be easily introduced by the patients them- 
selves—one or two in the twenty-four hours. By their use, for instance, 
we could keep the cervix uteri, when ulcerated and indurated, constantly 
imbedded in mercurial or iodine ointment for weeks, and sometimes with 
the most marked benefit and success. They fulfilled another indication in 
cases of irritation and inflammation of the mucous membrane of the cervix 
uteri and vagina. They kept the opposed diseased surfaces from coming- 
in contact; and it was well known how important a matter this was in 
the pathology of mucous and cutaneous surfaces. They were composed of 
the medicine used, mixed up in the form of an ointment, and brought to a 
requisite degree of consistence with one or two drachms of yellow wax to 
the ounce of ointment. After being made up in the proper form, they 
were usually coated by the druggists with a firmer covering, by dipping 
them into an ointment made up with wax and resin, kept liquid by heat. 
About an ounce of the different ointments made four balls. 
1. Zinc Pessaries.—R oxidi zinci, 3j.; eerie albas, 3j*; axungiae, 5vj.; 
misce, et divide in pessos quatuor. 
2. Lead Pessaries.—R Acet. plumbi, 5ss.; ceras albai, 5iss.; axungiae, 5vj.; 
misce. 332 
PHLEBITIS, 
3. Mercurial Pessaries.—R Unguent, hydrarg. fort., 5ij.; cerae flavae, 3ij.; 
axungiae, gss.; misce. 
4. Iodide of Lead Pessaries.—R Iodidi plumbi, 9j.; cerae flavae, [)v.; ax 
ungiae 3vj.; misce. 
5. Tannin Pessaries.— R Tanninae, 9ij.; cerae albae, 9v.; axungiae, 5yj. 
misce. 
6. Alum and Catechu Pessaries.—R Sulph. aluminis, 3j.; pulv. catechu. 
3j.; cerae flavae, 5j.; axungiae 3vss.; misce. 
7. Belladonna Pessaries.—R Extr. belladonnas, 9ij.; cerae flavae, 3iss. 
axungiae, 3v.; misce. Part xviii., p. 302. 
Caoutchouc Air-Bags.—One bag may be used either as a pessary in 
displacement of the uterus, as a plug in uterine hemorrhage, or as a dilator 
of the os uteri. On the same principle, M. Gariel treats strictures of the 
urethra, oesophagus, cervix uteri, etc.; and similarly the nasal fossae might 
be plugged in epistaxis. In all cases the bags are introduced collapsed, 
and, when introduced, are inflated either by a bag-insufflator or syringe. 
Part xl., p. 240. 
PHLEBITIS. 
Actual and Potential Cautery as Means of Preventing and Curing 
Phlebitis.—The cauteries employed "by Mr. Bonnet are the potassa cum 
calce, the chloride of zinc, and the red-hot iron. The red-hot iron rapidly 
applied produces a very superficial eschar; the potassa cum calce acts 
much more deeply; the pain in regard to either is sharp, hut speedily at 
an end, and the inflammation that succeeds is trifling. The chloride of 
zinc produces much deeper eschars than either the red-hot iron or the 
potash and lime. The author quotes a case of phlebitis following venesec- 
tion, and four cases of severe constitutional disturbance following wounds 
received in dissection, which were treated by the hot-iron with immediate 
and complete success. As many as ten cauterizing irons were used at 
once in the case of phlebitis, the subcutaneous cellular tissue being found 
in a semigangrenous state. In the dissection wounds, the seat of the injury 
alone was deeply seared; the iron was elsewhere carried superficially along 
the course of the red lines. The author has applied the same method to 
the treatment of hemmorhoidal tumors and prolapsus ani. Of these dis- 
eases existing together, he gives four cases which were successfully treated— 
one, in part, by means of the potassa cum calce, the rest by the chloi'ide of 
zinc. He has alsb found the caustic an effectual agent in treating varico- 
cele. Part viii., p. 165. 
Treatment of Phlebitis.—The principles of treatment, says Mr. Cooper, 
are to promote the secretions without lowering the strength, and to allay 
irritation. For these purposes give a combination of calomel, antimony, 
and opium, and a mixture containing liq. amnion, acet., tinct. of hyoscy- 
amus, and camphor mixture. Keep the limb elevated, apply fomenta- 
tions and poultices over the whole limb, and make punctures through the 
skin ivherever it has become tense from effusion ; but do not apply leeches. 
When the local irritation has been thus subdued, give bark, mineral acids, 
porter and nutritious food, and continue them without fear so long as the 
natural secretions are duly performed. Part xx., p. 65. PHLEGMASIA DOLENS—PHTHISIS PULMONALIS. 
333 
PHLEGMASIA DOLENS. 
Phlegmasia Dolens.—In the treatment of this affection, says Professor 
Simpson, which depends essentially on a toxsemic state of the blood, the 
first and most important indication of general treatment is, depuration of 
bloodHby exciting the various organs of elimination to increased activity, 
by their appropriate stimulants. An emetic, or a mercurial purgative com- 
bined with ipecacuanha or antimony, may be given at first, but not so as 
to produce debilitating effects. Perhaps small and repeated doses of 
alkaline salts, are, as a general rule, the safest and most efficient remedies 
to fulfill this indication. Tonics and stimulants are rather required than 
any antiphlogistic measures, and of these iron and quinine are the best. 
The best local treatment is, to wrap the limb up in cotton wool, and then 
incase the whole in oil silk, to prevent the escape of the insensible perspi- 
ration ; the limb should be slightly raised in bed. Toward the end of the 
case, a flannel bandage, neatly applied from the toes upward, will greatly 
favor resorption. Part xl., p. 198. 
Employment of Sea Salt (Chloride of Sodium) in Pulmonary Con- 
sumption.—M. Latour relates three cases in the human subject, in which 
the administration of salt appears to have been followed by the happiest 
results. In one of the cases, the disease had gone so fax' that there was 
distinct cavernous rattle with pectoriloque, muco-purulent and purulent 
expectoration streaked with blood, great emaciation, hectic fever, etc., and 
yet the patient made a perfect recovery at the end of a few months, the 
sea salt having been given uninterruptedly for sixty days. 
The aliment should consist almost exclusively of beef or mutton grilled 
or roasted, of good rich soups, or animal jellies. Every fine day, when 
the sun shines, and during its warmest period, the patient should take gen- 
tle exercise in the open air ; and his chamber should be well aired twice 
or thrice a day. Flannel is recommended to be worn next the skin. 
Half a drachm to a drachm of the chloride of sodium is administered 
daily, either in a glass of beef-tea or in some pectoral infusion, or if this 
should excite cough, it may be given in divided doses made up into bread 
pills, drinking a little beef-tea afterward. It is best to commence with 
small doses. In general, some thirst is at first caused by the administration 
of the sea salt, and for this M. Latour directs a weak infusion of gentian 
flavored with orange-peel. Part i.,y>. 21. 
Inhalation of Conium and Iodine.— Advised in the treatment of 
phthisis, by Sir. C. Scudamore: 
R Iodinii puri, iodid. potassii, aa. gr. vj.; aquse destillat. §v. 3yj.; 
Alcoholis, 3ij- M. fiat mistura, in inhalationem adbibenda. 
“ I now always prefer to add the conium at the time of mixing the iodine 
solution with the water; and it should be a saturated tincture, prepared 
with the genuine dried leaves. In the commencement of the treatment, I 
advise very small proportions of the iodine mixture; for example, only from 
half a drachm to a drachm for an inhaling of eight or ten minutes, to be 
repeated two or three times a day. Of the soothing tincture, I direct half 
PHTHISIS PULMONALIS. 334 
PHTHISIS PULlrfONALIS. 
a drachm—which I usually find sufficient; hut it may be increased if the 
cough be very troublesome.” Part, i., p. 30. 
Prevention of Tubercles.—M. Coster recommends ferruginous bread, 
containing half an ounce of carbonate of iron, to the pound. 
Part i., p. 32. 
Lime Moxa.—Dr. Osborne of Dublin states that in a case of commencing 
softening of tubercles, and in another apparently of purulent infiltration 
after pneumonia the effect of lime moxa in putting a stop to the 
ulcerative process was most decided. Part, v., p. 129. 
Phthisis induced by the inhalation of Gritty and Metallic particles.— 
Dr. Holland draws attention to an ingenious contrivance to prevent the 
inhalation of that large quantity of gritty and metallic particles which cause 
so much pulmonary disease among the grinders in Sheffield. Many years 
ago a magnetic apparatus was contrived which attracted the metallic 
particles before entering the nose and mouth ; but this was of no avail in 
attracting the non-metallic substances, and moreover the grinders would 
not be at the trouble to make use of it. Since that time another plan has 
been suggested and brought into practice, which seems likely to save the 
lives of thousands of these tradesmen not only in Sheffield, but also in all 
large towns where grinding or filing is carried on, especially among those 
mechanics who prepare the different kinds of machinery for cotton, flax 
and woollen manufactories. “A wooden funnel, from ten to twelve inches 
square, is placed a little above the surface of the revolving stone, on the 
side the furthest from the grinder, and this funnel terminates in a channel 
immediately under the surface of the floor ; or we may consider the chan- 
nel simply as the continuation of the f unnel, in order to avoid any confusion 
in the explanation. The channel varies in length, according to the situation 
of the grinder, in reference to the point where it is most convenient to get 
quit of the dust. If we suppose that eight or ten grinders work in the 
same room, each has his own funnel and channel, and they all terminate 
in one common channel, the capacity of which is perhaps twice or three 
times as great as each of the subordinate or branch channels. The point 
where they terminate is always close to an external wall. At this point, 
within the general channel, a fan is placed, somewhat in form like that 
used in winnowing corn, and to this is attached a strap which passes under 
and over a pulley, so that whatever puts the pulley in motion, causes the fan 
also to revolve. The pulley is placed in connection with the machinery 
which turns the stone, so that whenever the grinder adjusts his machinery 
to work, he necessarily sets the pulley and the fan in motion. The fan 
acting at this point, whatever may be the length of any of the subordinate 
channels, causes a strong current to flow through the mouth of each fun- 
nel, which carries along with it all the gritty and metallic particles evolved, 
leaving the room in which the operations are pursued free from any 
perceptible dust.—When the whole apparatus is perfect and in excellent 
condition, the atmosphere of the place is almost as healthy as that of a 
drawing-room. Part, viii., p. 32. 
Vomiting, a cure for Phthisis.—It is stated that 176 patients under 
consumption, 47 in the incipient, and 129 in the advanced stage, admitted 
during a period of four years into the military hospital at Capua, Avere 
ultimately discharged perfectly cured, their treatment having consisted in 
the administration of a tablespoonful, night and morning, of the folloAving PHTHISrS PULMONALIS. 
335 
mixture : Tartarized antimony, three grains ; sirup of cloves, an ounce ; 
decoction of marsh mallows, six ounces; mix. The dose was to be 
repeated until vomiting ensued. Part, viii., p. 80. 
Miner’s Phthisis.—[It is well known that, besides the diseases to which 
we are all liable, miner’s are, from their occupation, peculiarly subject to 
affections of the respiratory and circulatory organs. From a very in- 
structive paper by Dr. Makellar on a peculiar form of lung disease, which 
may be termed Black Phthisis, we extract as follows ; premising that it 
is caused by small particles of coal inhaled, accumulating in the lungs, and 
giving rise to irritation, and finally ulceration. It is thus closely analogous 
to the “ grinder’s disease,” “ mason’s disease,” etc., which commit such 
fearful havoc amongst certain of the operative classes, and have all a 
common origin.] 
The rise and progress of the malady may be thus sketched: A robust 
young man, engaged as a miner, after being for a short time so occupied, 
becomes aflected with cough, inky expectoration, rapidly decreasing pulse, 
and general exhaustion. In the course of a few years, he sinks under the 
disease ; and, on examination of the chest after death, the lungs are 
found excavated, and several of the cavities filled with a solid or fluid car- 
bonaceous matter. 
[Dr. M.’s remarks are upon the disease as it appears among the colliers 
in the Lothians, but we believe that they will apply to others generally. 
In the district above named, the ventilation of the mines is, on account of 
their immunity from explosive gas, very much neglected. Hence a large 
accumulation of carbonic acid and other pernicious gases. After working 
some time in these ill-ventilated places, the lungs inspire more of the 
impure air, in order to make up for the deficiency of oxygen ; and every 
now and then a deep and sustained inspiration is taken, during which the 
floating particles are drawn in. When the mine becomes so impure as to 
be actually unable to support a light, the men are necessitated to leave it, 
until by the gradual accumulation of purer air, it again becomes capable 
of supporting respiration and combustion.] 
It is now known, that this disease originates in two principal causes, 
viz., First, The inhalation of lamp smoke with the carbonic acid gas gene- 
rated in the pit, and that expired from the lungs ; Second, Carbon, and 
the carburetted gases which float in the heated air after the ever-recurring 
explosions of gunpowder, which the occurrence of trap-dykes renders 
necessary. 
[It was long supposed that the change in color of the lungs was a form 
of melanosis, a systemic disease, properly so called. It has been lately 
proved, however, that the black color is not from any change in the system, 
but is produced by the infiltration of particles of coal, and chemical analysis 
confirms the fact. The minute bronchial ramifications are first filled, and 
the disorganization gradually extends until the whole lobe is infiltrated, 
softening going on in the meanwhile, from the irritation produced by the 
foreign substance.] 
The first indication of cure, is change of work, and a lengthened sojourn 
in pure air. The following indications should also be attended to: To add 
oxygen artificially to the hyper-carbonized blood : To remove the overplus 
of carbon in the blood, either directly or indirectly. In regard to the 
former of these, I have never ventured on the direct application of oxygen to 336 
PHTHISIS PULHONALIS. 
the lungs, because these organs have generally been in an irritable condi- 
tion, and have contented myself with recommending the free use of pure 
atmospheric air, and bathing. I have also endeavored to increase its 
amount therapeutically, by the exhibition of oxydized preparations of iron, 
which I have found most beneficial in this complaint; nor has their use 
been followed by any bad effects, as frequently happens in other diseases of 
the lungs. I endeavored to accomplish the second indication, chiefly by 
alkalies, especially the carbonate of soda, but the results were by no means 
satisfactory. Small doses of calomel had no better effect. It appeared, 
however, to act beneficially when combined with jalap, especially in the 
first stage of the disease. The treatment is modified according to the dif- 
ferent stages as follows: In the first, although the physician is seldom 
consulted, I recommend, besides the already mentioned hygienic measures, 
especially warm or cold baths, according as they are borne, and, under cer- 
tain circumstances, an emetic, and a purge of calomel or jalap. In the 
second-, the same treatment on a more extensive scale ; and, in addition, 
carbonate of soda, and other alkaline remedies, but more especially the 
extract, aloes, aquos; rhubarb, cort. rliamni franguke (especially extolled); 
and in summer, the use, four times a week, of the artificial Carlsbad water, 
in so far as the strength of the patient permits. In the third, I have seen 
the most astonishing effects from the continuous use of warm baths, and 
the artificial Carlsbad water, and after the cure, and the continued use of 
one of the above-named extracts, chosen according to the individual pecu- 
liarity of the case, I have frequently, after a time, had the felicity to see 
before me a renovated man. Preparations of iron are often here of the 
most decided service. Bleeding, and the so-called expectorants, on the 
other hand, are never of the least use. Derivative measures are only useful 
in relieving the rheumatic pains of the chest. The severe fits of coughing 
sometimes also require palliative measures. In the last stage nothing can 
be done, but by mild restoratives, and a strict attention to diet, to endeavor 
somewhat to prolong life, and strengthen digestion by bitters. At this 
period iron is especially useful, particularly the ferrum iodatum. The 
tinct. ferri pomat. and the tinct. nervin. bestusch., are also of signal 
benefit, and prolong life for a considerable period. The painful symptoms 
at this period, often require numerous remedies, and the daily use of 
opium or morphia. Anasarca generally disappears speedily under digitalis, 
squill and other diuretics, which act by producing smart diarrhoea. When 
structural change of the lungs occurs along with the melanosis, little 
relief can be afforded. All that can be done, is to alleviate some of the 
more distressing sympathetic sufferings; the dyspnoea, however, con- 
tinues most obstinate, and slowly destroys the patient. Part xii., p. 64. 
Use of Naphtha in Phthisis.—Dr. Hastings ascribes the failure of those 
medical men who have been less successful than himself in the treatment 
of phthisis by naphtha, to one or all of the following causes. First, From 
a deleterious agent being employed for a medicinal one. Second, From 
its use in cases where it was contraindicated. Third, From patients being 
treated in unfavorable situations. 
lie proceeds to say, that cases are continually occurring in which oily, 
milky, and coal-tar naphtha are administered, and most prejudicial results 
ensue. The preparation recommended by Dr. Hastings is the pyroacetic 
spirit, which is obtained by the destructive distillation of an acetate gene- PHTHISIS PULMONALIS. 
337 
rally of lead or lime, and in its natural form is scarcely distinguished from 
pyroxylic spirit. 
The author’s test was its colorless and transparent character, and its 
agreeable ethereal alcoholic odor; its increase of temperature consequent 
upon admixture with water ; its preservation of appearance on the addi- 
tion of nitric acid ; and its taste being warm, without the least sensation 
of burning. Dr. Ure has recently suggested an easy method of effecting 
this object, which is founded on the following facts. If nitric acid of 
specific gravity 1.45 be added to pyroxylic spirit, the mixture assumes a 
red color, but no effervescence takes place. If the same acid be added to 
pyro-acetic spirit, there will be no change of color, but an effervescence 
will slowly be foxmed, accompanied by an elevation of temperature, and 
copious evolution of gas, resembling in appearance the action resulting from 
the mixture of alcohol with nitric acid, but with an acetic instead of an 
ethereal odor. Pyro-acetic spirit may also be generally distinguished from 
pyroxylic spirit, by its causing no appearance of milkiness on mixing with 
water, in the state in which it is met with in commerce. 
Dr. Hocken states that “the most ready test is to be found in litmus 
paper, which is reddened by the non-medical, but is unaffected by the 
medicinal compound.” 
In stating the cases in which he recommends the use of naphtha, Dr. 
Hastings observes, that the less phthisis is complicated with other affec- 
tions, the more suitable it is for this treatment, where the pulse is at the 
ordinary standard, or thereabouts, where the hectic is slight, laryngeal and 
peritoneal disease absent, the functions of the stomach and bowels not 
much impaired, the constitutional disturbance inconsiderable, and the 
physical signs denoting only a slight deposit of tubercles in one lung—the 
prognosis is favorable, and a speedy recovery may be anticipated. In 
many cases this mild character of the disease is never witnessed, however 
early they may be seen; at the same time, for want of close observance, 
this period frequently altogether escapes notice; hence success often 
depends upon an early diagnosis of disease. If naphtha is employed in 
acute phthisis, where the cough is very harassing, with slight frothy 
expectoration, respirations thirty to forty per minute, pulse a hundred and 
twenty to a hundred and forty, hot skin, profuse night sweats, great thirst, 
appetite deficient, or altogether wanting, and the physical signs denoting 
an extensive crop of tubercles in both lungs, it will be found injurious 
rather than beneficial. If it be employed in chronic phthisis, coexisting 
with disease in other organs, its value is diminished, in proportion to the 
extent of the complications and their vitiating influence on the constitu- 
tional powers; if it be continued in certain cases where improvement had 
followed its use, after the appearance of intercurrent pneumonia, bronchitis, 
or pleurisy, it would do great mischief. Many such cases give way to a 
short course of treatment with antimony, digitalis, etc., and then the pyro- 
acetic spirit may be again employed with the greatest advantage. Where 
hemoptysis is present, or where it has recently existed, naphtha is 
generally contraindicated. When complicated with dyspepsia, little or no 
benefit will accrue from its use until that affection is removed. The author 
has also found that the disease is not amenable to this plan of treatment 
when the patients are in crowded hospitals, or in other situations where 
the atmosphere is impure. 
The dose in which the author appears generally to administer the naphtha 338 
PHTHISIS PULMONALIS. 
is from ten to twenty drops in a small quantity of water three times a 
day. Part xii., p. VO 
Treatment of Incipient Phthisis.—[The following remarks were made 
by Dr. Graves, in an obscure case of pulmonary disease, subsequent to an 
attack of fever, and are applicable to numerous cases in general practice. 
This fever soon subsided under ordinary treatment, but a troublesome and 
increasing cough was left behind, which began to keep the patient awake 
at night. This raised suspicion, and an accurate stethoscopic examination 
was made of the chest, when on the right side, below the clavicle, respira- 
tion was found feeble, and mixed with crepital and bronchial rales. 
There was nothing to point out whether this was an unexpected deposition 
of tubercles, or mere bronchitis, with effusion ; and therefore the safe side 
was taken, and the patient treated as if the former were the case.] 
I immediately ordered leeches to be applied under the clavicle, to be 
repeated as the exigency of the case might require, and prescribed the 
hydrocyanic acid in the form recommended by M. Magendie. He recom- 
mends a drachm of the cyanuret of potash to be dissolved in an ounce of 
.distilled water. This solution is stated by him to be equal in efficacy, and 
capable of producing all the advantageous effects of hydrocyanic acid, at 
the same time that it is less volatile, less liable to undergo change, and can 
be always prescribed of the same strength. He says that it possesses all 
the beneficial properties of hydrocyanic acid, in relieving the irritative 
cough of phthisis, or the excitement which accompanies gastric derange- 
ment. Of this solution I ordered the patient to take one drop in half an 
ounce of water every fourth hour, to be increased in the course of three or 
four days to double the quantity. On making an examination this morn- 
ing, I find that his symptoms are improved ; there is less dullness on per- 
cussion, respiration is clearer, and the crepitus is diminished. On the 
whole, his condition authorizes us to entertain hopes of being able to bring 
about a cure. If phthisis be curable, or if tubercular deposition admit of 
being resolved, it is only at the very commencement of the disease, and 
before that state of constitution is established in which there is a tendency 
to the formation of tubercular productions. If we happen to be so fortun- 
ate as to detect phthisis at this early period, I think that it is possible for 
us not only to palliate, but also to remove it. By free and repeated leech- 
ing, the use of blisters, a mild diet, and the insertion of one or two setons 
over the part dull on percussion, we shall often be able to remove any 
threatening symptoms, and perhaps save the patient’s life. Part xii., p. VI. 
Use of the Seeds of Phellandrium Aquaticum in Phthisis and Chronic 
Pronchitis.—Recommended as a Palliative.—M. Sandras has published 
the results of a careful investigation into its merits, conducted during eight 
years at the Beaujon. He speaks of it in the highest terms of praise as a 
palliative of the most distressing symptoms of phthisis; and believes that 
occasionally it even exerts a curative agency, and at all events, indefinitely 
postpones the progress of cases which furnish all the symptoms of incipient 
tubercle. He is, however, fully aware how deceptive these symptoms often 
are, and speaks with due caution on this point. The important agency of 
the seeds, hoAvever, in relieving suffering in undoubted and advanced cases 
of the disease seems certain ; the days of the sufferer not only being con- 
siderably prolonged, but his path to the grave materially smoothened. 
The good effects generally manifest themselves in from a week to a fort' PHTHISIS PULMONALIS. 
339 
night, by a diminution of fever and diarrhoea, a return of appetite and 
sleep, less dyspnoea, and an easier cough, so that the patient often supposes 
himself nearly well. The strength is supported in this way for a considera- 
ble longer period than it otherwise would be; and when at last it finally 
gives way, the course of the disease then becomes very rapid. Chronic 
bronchitis is obviously and speedily modified advantageously by this medi- 
cine. It is especially indicated in that form which comes on in aged per- 
sons in cold damp weather, and persists until this changes; and in young 
lymphatic subjects, deficient in reactive power, it cuts short the tedious 
cough left by colds. M. Sandras has found it of no avail in emphysema 
and nervous asthma, except inasmuch as these were connected with chronic 
bronchitis. Part xix., p. 89. 
Phthisis Pulmonalis.—Manganese has appeared to M. Hannon to be very 
useful. The sirup of the iodide seems to be the best form of administra- 
tion in these cases, but the carbonate, phosphate, or sulphate may also be 
given. Part xx.,p. 35. 
Hemoptysis, as a Symptom of Phthisis.—The diagnostic value of 
hemoptysis, as a symptom of tubercle, is estimated very highly by Dr. 
Walshe. It appears that, with the exception of cancer of the lung, aortic 
aneurism, and disease of the heart, there are very few cases in which a 
material hemorrhage takes place from the lung independently of tubercles. 
Neither those cases of apparently simple chronic bronchitis, nor those of 
irregular menstruation, in which blood is voided from the lungs to any 
extent, appear to be exceptions to this proposition, although the tubercles 
may remain for a considerable period latent after the occurrence of the 
hemoptysis. Part xx., p. 79. 
Intercostal Neuralgia as a Sign of Phthisis—This symptom is almost' 
constant in phthisis pulmonalis. Among fifteen cases under M. Beau’s 
observation at the time of writing, it was not absent in more than one; 
and only one of these cases presented the symptom of spontaneous pain. 
The author, therefore, thinks it will prove a useful diagnostic mark in 
cases where the physical signs of phthisis are marked by bronchitis. The 
predominance of the pain in the anterior part of the spaces, where the 
alteration of the nerves is least considerable, is ascribed by M. Beau to the 
circumstance that when a nerve is diseased in any part of its course, the 
morbid sensibility is always referred to its peripheric extremity. 
Another form of the intercostal neuralgia of phthisical patients is the 
pain between the shoulders which has been so frequently described as 
characteristic of phthisis. Part xx., p. 79. 
Treatment of Phthisis.—According to Prof. Bennett, faulty nutrition is 
the first element in the production of the disease; and this faultiness con- 
sists in an inability of transforming the carbonaceous constituents of vege- 
table food into fat, or of acting upon the fatty matters introduced into the 
system so as to render them easily assimilable. The first indication of 
treatment, then, is to cause a large amount of fatty matter to be assimi- 
lated, by giving food rich in fat. In most cases, however, the powers of 
the stomach and alimentary canal are much enfeebled, and unable to 
separate this fat from the food. It therefore becomes necessary to give 
the animal oils themselves, which will readily enter the system, and become 
assimilated: and this is the rationale of the good effects of cod-liver oil, 
which can be digested when no other kind of animal food can be taken in 340 
PHTHISIS PULMOKALIS. 
sufficient quantity to furnish the requisite amount of fat. The ordinary 
dose of cod-liver oil should he a tablespoonful thrice a day, but it may be 
advantageously increased to four, five, or even six. The kind of oil is of 
no importance except as regards the palate. Part xxi., p. 127. 
Use of Tannin.—Dr. Alison, of London, would give tannic acid in any 
stage of this disease, but especially in the third, when there are cavities. 
The dose may be one, two, or three grains, twice or thrice a day, dissolved 
in water or any simple vehicle, flavored with sirup, which will cover the 
taste. If there is much sweating, add a little dilute nitric acid. Tannin 
may be given at the same time as iron, cod-liver oil, or any such means. 
Part xxi., p. 326. 
Phthisis Pulmonalis.—Do not let the patient breathe an atmosphere 
warmed by stove-heat, even although equable in its temperature; it is 
stated by Dr. J. Hutchinson, to be extremely prejudicial. If the patient 
cannot rest at night for coughing, give gr. iv. of the ext. of hemlock, with 
gr. ss. of ipecac., and one-eighth gr. of muriate of morphia, at bed-time. 
Immediately on the first suspicion of pulmonary consumption, give the cod- 
liver oil, commencing with 5j. for a dose, three times a day, and seldom 
exceeding 5iv. Counter-irritation is of essential importance; employ a 
solution of §j. of iodine and iodide of potass, to §ij. of spirits of wine. 
Use it first on one side and then on the other, even if one lung only 
is affected. By these measures the cough is allayed, the weight is 
increased, rest is procured, and counter-irritation is set up. Collateral 
symptoms must be met as they arise; if hectic fever or hemoptysis appear, 
we must suspend the oil. Part xxiii., p. 105. 
Use of Cod Liver Oil.—Thinking it owing to its non-absorption, that 
the oil sometimes appeared to lose its efficacy, M. Loze, a naval surgeon, 
combined it with a mucilage containing pancreatic juice, which thus forms 
an artificial chyle. lie states it to be thus completely and readily absorbed, 
and in phthisis its effect more directly obtained. Part xxiii., p. 299. 
Diagnosis of Phthisis.—In speaking of the diagnosis of phthisis, Dr. 
Walshe lays down the following highly practical and useful propositions: 
“ (a.) A young adult who has an obstinate cough, which commenced 
without coryza, and without any obvious cause, a cough at first dry, and sub- 
sequently attended for a time with watery or mucilaginous looking expecto- 
ration, and who has wandering pains about the chest, and loses flesh, even 
slightly, is, in all probability, phthisical. (b.) If there be hemoptysis, to 
the amount of a drachm even, the diagnosis becomes, if the patient be a 
male, and positively free from aneurism or mitral disease, almost positive, 
(c.) If, in addition, there be slight dullness under percussion at one apex, 
with jerking, or divided and harsh respiration, while the resonance of the 
sternal notch is natural, the diagnosis of the first stage of phthisis becomes 
next to absolutely certain. (d.) But not absolutely certain; for I have 
known every one of the conditions in «, b, and c, exist (except hemoptysis, 
the deficiency of which was purely accidental) when one apex was infil- 
trated with enceplialoid cancer, and no cancer had been discovered else- 
where to suggest to the physician its presence in the lung, (e.) If there 
be cough such as described, and permanent weakness and hoarseness of the 
voice, the chances are very strong (provided he be non-sypliilitic) that the 
patient is phthisical, (f.) If decidedly harsh respiration exists at the left apex, 
or at the right apex behind : if the rhythm of the act be what I have called PHTHISIS PULMONALIS. 
341 
cogged-icheel, and there be dullness, so slight, even, as to require the dyna- 
mic test for its discovery, there can be little doubt of the existence of 
phthisis, (g.) If, with the same combination of circumstances, deep inspi- 
ration evokes a few clicks of dry crackling rhonchus, the diagnosis of 
phthisis, as far as I have observed, is absolutely certain. (h.) If these clicks, 
on subsequent examination, grow more liquid, the transition from the first 
to the second stage may be positively announced, (i.) If there be slight 
flattening under one clavicle, with deficiency of expansion movement, harsh 
respiration, and slight dullness under percussion, without the local or gene- 
ral symptoms of phthisis, the first stage of tubex*culization cannot be diag- 
nosed with any surety, unless there be incipient signs at the left apex also; 
the conditions in question, limited to one side, might depend on chronic 
pneumonia or on thick induration matter in the pleura (k.) The existence 
of limited though marked dullness under one clavicle, with bronchial respi- 
ration and pectoriloquy, so powerful as to be painful to the ear, the other 
apex giving natural results, will not justify the diagnosis of phthisis. I 
have known this combination when the apex of the lung was of model 
health, and a fibrous mass, the size of a walnut, lay between the two 
laminte of the pleura. I would even go further, and say, that the combina- 
tion in question is rather hostile than otherwise to the admission of phthisis, 
as, had tuberculous excavation formed at one side, the other lung would, in 
infinite probability, have been affected in an earlier stage. (l.) Pneumonia 
limited to the supra and infra-clavicular region on one side, and not ex- 
tending backward, is commonly, but not always tuberculous, (m.) Sub- 
crepitant rhonchus, limited to one base posteriorly, is not, as has been said, 
peculiar to tubercle ; it may exist in emphysema, and in mitral disease. (n.) 
Chronic peritonitis, in a person aged more than fifteen years, provided cancer 
can be excluded, involves as a necessity, the existence of tubercles in the 
lungs. To this law of Louis it is necessary to add the qualification, pro- 
vided Bright’s disease be also absent, (o.) Pleurisy with effusion, which 
runs a chronic course in spite of ordinary treatment, is, in the majority of 
cases, tuberculous or cancerous : the character of the symptoms, previously 
to the pleurisy, will generally decide between the two. (p.) Double pleu- 
risy, with effusion, is not, as has been said, significant of tubercle ; for it 
may depend on Bright’s disease. If the latter disease can be excluded, 
carcinoma and pyohaxmia remain as other possible causes. (q.) If a young 
adult, free from secondary syphilis and spermatorrhoea, and not dissolute 
in his habits, speedily lose flesh without clear cause, he is, in all probability, 
phthisical, even though no subjective chest-symptoms exist. (s.) But he is 
not by any means certainly so, for he may have latent cancer in some im- 
portant organs, or he may have chronic pneumonia. (t.) Nay, more, he 
may steadily lose weight, have dry cough, occasional diarrhoea, and night 
sweats, and present dullness under percussion, and bronchial respiration 
under both clavicles, and yet be non-phthisical. I have known all this 
occur in' cases, both when the lungs were infiltrated superiorly with pri- 
mary encephaloid cancer, and when they contained secondary nodules of 
the same kind. (u.) Failure of weight becomes less valuable as a sign of 
phthisis, the longer the thirtieth year has been passed. (v.) The discovery 
of cardiac disease with marked symptoms, deposes against, but does not 
exclude the existence of active tuberculization, (to.) The existence of can- 
cer in any organ is unfavorable to the presence of tuberculous disease, but 
tubercle and cancer may coexist, even in the same lung.” Part xxiv./>., 08. 342 
PHTHISIS PULMONALIS. 
Expectoration as a Means of Diagnosis in Diseases of the Chest.—If 
a person with some severe chest complaint coughs frequently, and expec- 
torates only frothy, salivary-looking fluid, says Dr. Theophilus Thompson, 
we suspect pleurisy; if a glairy fluid like the white of egg, we . suspect 
bronchitis; if it has a rusty tinge, and resembles gum water colored with 
blood, we are likely to find pneumonia. If there is a sudden gush of pus 
in considerable quantity, we expect to find that matter accumulated in the 
cavity of the pleura has found its way into the bronchial tubes. In con- 
sumption the expectoration assumes four characters : 1st, salivary or 
frothy; 2d, mucous; 3d, flocculent; 4th, purulent or porraceous. The 
first may proceed from irritation or slight tubercular deposit. The 2d 
may proceed from a more confirmed affection of the bronchial tubes. The 
3d is peculiarly characteristic of secretion from a vomica modified by the 
absorption of its thinner constituents ; and the 4th is indicative of phthisis far 
advanced, and (if.mixed with froth) usually involving both lungs. The 
black matter often expectorated is not carbon, as commonly supposed ; it 
is rather a pigment known to be formed under slight or not severe forms 
of bronchial inflammation. On a little heat being applied to this expecto- 
ration, and the microscope used, crystals of apparently triple phosphate 
may be seen, the proportion of the salts being in an inverse ratio to the 
degree of inflammation present. The 3d form of expectoration men- 
tioned above, viz., the flocculent, is stated to be almost a pathognomonic 
symptom of phthisis. When spat into water it assumes the form of globu- 
lar masses, like little balls of wool or cotton. Some of these masses have 
subsided, some are suspended at different depths, others float on the sui'face, 
sustained by bubbles of air, entangled in the surrounding mucus. If the 
process of contraction is going on in a vomica, a diminished quantity of 
expectoration is a favorable symptom. This is promoted by the use of 
appropriate regimen, the administration of cod-liver oil, and by the inhalation 
of turpentine. When the bronchial tubes contribute much to the supply, 
the skin being moist and the appetite defective, naphtha may sometimes be 
useful, but generally speaking, tannic acid will probably be found a more 
appropriate remedy. Dart xxiv., p. 78. 
Cod-Liver Oil.—Combine liq. potassoe with the cod-liver oil, especially 
in the early stage of phthisis. Where cod-liver oil cannot be administered 
internally, says Dr. T. Thompson, it may be rubbed into the chest, night 
and morning, combined with a little oil of lavender. If diarrhoea be pro- 
duced, one ounce and a half of cod-liver oil, four drops of creasote, two 
drachms of compound tragacanth powder, and four and a half drachms of 
aniseed water, form a suitable mixture, of which an ounce may be taken 
thrice daily. If vomiting is produced, the addition of creasote often makes 
the stomach more tolerant of the remedy. The taste of the oil may be 
covered by eating dried orange peel, or by introducing a little dinner salt 
into the mouth before or after taking the oil. Dart xxiv., p. 80. 
Hepatic Congestion attending Cases of Incipient Dhthisis.—Dr. T. 
Thompson gives a combination of chalybeates and saline aperients. The 
natural springs may be imitated by administering two grains of sulphate of 
iron, a drachm of sulphate of soda, a scruple of carbonate of soda, and ten 
grains of dinner salt, in half a pint or a pint of warm water, every morning. 
Use at the same time exercise in the open air, the shower-bath and friction 
of the skin. Dart xxy.,p. 104. PHTHISIS I’ULMONALIS. 
343 
Treatment of Cough in Phthisis.—Perhaps there is no symptom of 
which consumptive patients complain so urgently as of cough, and there 
is scarcely any which so often baffles our efforts for its relief. Dr. T. 
Thompson says : If any degree of bronchial inflammation be present, small 
doses of antimony are indicated, and in some instances the application of a 
few leeches over the windpipe affords much relief. In allaying cough in 
irritable subjects, much advantage is often derived from the administration 
of four minim doses of tincture of aconite in spermaceti mixture; and 
counter-irritation may often be resorted to with advantage. When the 
urgency of the cough has more relation to the character of the expectora- 
tion than to nervous irritability, lemon-juice has sometimes seemed to me 
to be a useful remedy. In other similar cases the solution of potash does 
good, especially in combination with squill; although this latter remedy, in 
cases complicated with any degree of bronchial inflammation, would pro- 
bably aggravate the symptoms. 
Anodynes, such as hemlock, henbane, Indian hemp, are occasionally use- 
ful, and there can be no doubt of the value of hydrocyanic acid. A draught 
containing an eighth of a grain of cyanide of potassium, an ounce of aniseed 
water, and some sirup of lemons, is perhaps more trustworthy than prussic 
acid in the usual form of administration. In a great number of instances, 
however, we are obliged to place our chief reliance on opium, or on some 
of the salts of morphia. An agreeable linctus may be composed of an 
ounce of conserve of roses, half an ounce of lemon-juice, half an ounce of 
sirup of poppies; or a drachm of tincture of opium and a drachm of diluted 
sulphuric acid may be mixed with an ounce and a half of treacle or honey, 
and a teaspoonful given occasionally. 
You have had an opportunity of observing the relief often derived by 
inhalation: an ounce and a half of the strobiles of hop in a pint of hot 
water sometimes proves very soothing. Some of our patients have derived 
still greater advantage from inhaling two grains of extract of opium, by 
means of the apparatus introduced by Dr. Snow. On the whole, however, 
no remedy has acted so promptly and satisfactorily in allaying cough, as 
the inhalation of fifteen or twenty minims of chloroform. 
Part xxv., p. 106. 
lungs, Affections of—Iodide of Potassium.—Mr. Molloy says that 
when the period of acute inflammation has subsided in broncho-pneumonia, 
pneumo-bronchitis, chronic bronchitis, pituitous catarrh, and in dry 
asthma, iodide of potassium is an exceedingly valuable remedy, although 
the theory of its beneficial influence is somewhat obscure. Part xxv., p. 108. 
Urate of Ammonia Ointment in Phthisis.— Vide Art. “ Ammonia.” 
Tannate of Quinine in the Night-Sweats of Phthisis.—M. Delioux has 
administered tannate of quinine with the effect of arresting night-sweats in 
cases of pulmonary consumption. He says that, though it is sometimes 
inferior to pure tannin, it is superior to disulphate of quinine ; and that it 
combines the action of a tonic and antiperiodic. He gives it in powder, the 
quantity taken daily being from half a gramme to a gramme (seven and a 
half to fifteen grains), in three or four doses, taken at intervals during the 
afternoon or evening, so that the last may be administered three or foui- 
hours before sleep. Part xxviii., p. 90. 
Creasote Inhalation.—To relieve the cough, Dr. Inman, of Liverpool, 
places from four to ten drops of creasote in the bottom of an old teapot 344 
PHTHISIS PULMONALIS. 
and then pours a small quantity of boiling water over it. The vapor must 
be inhaled through the spout, which must be protected by being covered 
with a little flannel. Part xxviii., p. 92. 
Appearance of the Gums in Consumption.—Dr. Thompson remarks: 
“ Considerable attention to this inquiry has impressed me with a conviction 
of the frequent existence in consumptive subjects, of a mark at the reflected 
edge of the gums, usually deeper in color than the adjoining surface, and 
producing a festooned appearance; this mark is in some persons a mere 
streak; in others, a margin, sometimes more than a line in breadth. In 
the most decided cases, this margin is of a vermilion tint, inclining to 
lake.” 
[This streak on the gums, Dr. Thompson states, is often’ among the 
earliest signs of pulmonary consumption. In reference to the value of this 
sign as an aid to diagnosis, Dr. T. observes: 
“ When in either sex it coincides with a pulse not materially altered in 
frequency by change from the sitting to the standing posture, the presence 
of phthisis may, with high probability be assumed, even before having re- 
course to auscultation.” 
Cocoa-Nut Oil as a Substitute for Cod-Liver Oil.—Dr. Thompson 
says: “ Among the patients to whom cocoa-nut oil was given, there were 
some instances of arrested phthisis, as decided as any I have been accus- 
tomed to attribute to the use of cod-liver oil, over which it possesses ad- 
vantages in reference to economy and palatableness; and it is interesting to 
remark that its efficacy was experienced by some who had previously taken 
cod oil uselessly, and by others who had discontinued it on account of 
nausea.” 
Treatment of the Diarrhoea of Phthisis.—In the diarrhoea of phthisis, 
Dr. Thompson employs trisnitrate of bismuth in doses of five grains, com- 
bined with three grains of gum arabic and two of magnesia, every four or 
six hours. 
Night Perspirations of.—Give four grains of oxide of zinc, and four 
grains of extract of hyoscyamus, made into two pills, every night for a 
time. Part xxix., p. 92. 
Palliative Treatment of Phthisis—Profuse expectoration of.—To check 
this give creasote, pyro-acetic spirit, infusion of pitch, or balsam of tolu; 
but by far the best remedy, says Dr. T. Thompson, is petroleum or Barba- 
does tar, which often moderates the cough and expectoration remarkably. 
Diarrhoea of—Give the trisnitrate of bismuth, combined with gum and 
magnesia, or with Dover’s powder. 
Cough of.—Mix one part of chloroform with three parts of spirits of 
wine, and let the patient inhale when necessary, but with caution, and under 
medical direction. The inhalation of camphorated spirit is often sufficient, 
or even the vapor of hot water, or infusion of hops. Sometimes frequent 
deglutition, as the swallowing of a little oil, will relieve the cough. Some- 
times four minims of tincture of aconite is a good palliative. 
Night Sweats of.—Give gallic or acetic acid. Dip the night dress in sea- 
water, or salt and water, and dry it before using. But the best remedy is 
four grains of oxide of zinc at bed-time, combined with a little henbane or 
hemlock. Part xxx., p. 45. 
Night Sweats in Phthisis.—Mr. Hutchinson, of the City Hospital for PHTHISIS PHLMONALIS. 
345 
Chest Diseases, shows that night sweats in this disease may be checked with 
impunity. 
Under the usual treatment of phthisis (full diet, cod-liver oil, and tonics), 
the tendency to night perspiration often ceases spontaneously. If it becomes 
desirable to expedite the process, it may be done by the sesquichloride of 
iron, the mineral acids, or, best of all, by the gallic acid. The following is 
the prescription for a night-draught containing the latter: 
R Acidi gallici, gr. vij.; morph, acet., gr. i; alcohol q. s. (a few drops); 
syr. tolutan., 5ss.; aquas, § j. 
The night-pill, as we find it in the Pharmacopoeia of the Brompton Hos- 
pital for Consumption is: 
R Acid, gallic., gr. v.; morph, hydrochh, g. i; mist. acac. q. s. Ft. pil. ij. 
It is also of advantage to adopt an astringent regimen as far as conve- 
nient. The patient should be directed to sleep on a mattress, alone, and 
not heavily clothed; he should wear no flannel in bed ; as dry a diet should 
be taken as conveniently can be borne, and fluid should be especially avoided 
in the latter half of the day, none whatever being allowed later than seve- 
ral hours before bed-time. Part xxx., p. 49. 
Remedies in Phthisis.—[In a visit to the Brompton Hospital, the writer 
notices some of the remedies which are there used. He says :] 
Among a few of the medical novelties we noticed, and which are found 
useful at Brompton, are divers forms of inhalations: one an inhalation of 
hydrocyanic acid vapors, of course in small quantities ; inhalations of chlo- 
rine and inhalations of the chemical substance chloroformyl, inhalations also 
found very useful of conium and creasote. 
A mixture of tannin, nitric acid, and lupulin is very valuable in the 
night sweats of the worst cases; the oxide of zinc also is found to answer 
wonderfully in some cases which will even resist acids and tannin; as prac- 
tical facts not generally known, these valuable results cannot be too gene- 
rally made public. 
A mixture of decoct, hematoxyli and aqua calcis, not very chemical but 
very valuable, is used in diarrhoea. A solution of iodine as a caustic, now 
general in hospitals, is also found most useful for painting the chest; it is 
simply one part each of iodine and the iodide of potassium and two of rec- 
tified spirit. Dr. Quain also finds a solution of nitrate of silver to act 
almost “like a charm,” when applied in some cases with a probang to the 
top of the larynx and to the vocal chords. 
Treatment of Irritable Stomach in Phthisis.—Give hydrocyanic acid 
and trisnitrate of bismuth, as in the following formula: Hydrocyanic acid 
three minims ; trisnitrate of bismuth ten grains. Make this into a draught 
with mucilage and green mint tea, and give it three times a day. 
Part xxxi., p. 84. 
Tubercular Infiltration.—According to Dr. C.R. Hall, greyness indicates 
that the exudation is chronic ; yellowness, that it is acute ; jelly-like con- 
sistence, that it is recent. The grey infiltration takes place while there is 
yet a fit state of blood to pour out contracted plasma; the yellow points to 
a deteriorated condition of the blood when the disease has injured the con- 
stitution ; the jelly is a still later exudation, and takes place toward the 
close of life, when the blood is very poor and unable to furnish a coagulated 
lymph. Part '70. 346 
PHTHISIS PULMOHALIS. 
Dyspepsia preceding and attending Phthisis.—Mr. Hutchinson, surgeon 
to Metropolitan Free Hospital, says: The severity of the tubercular dys- 
crasia, may be measured by the facility with which fats, oils, sugar, etc., 
are relished and digested. If a patient has acquired a liking for cod-liver- 
oil and other kinds of fat, the disease is in abeyance; and the most ominous 
symptom of all is when the patient quickly loses all relish for such things. 
In all cases accustom the patient to oils and other fats ; if the stomach will 
not bear them, give tonics, with an alkali or mercury in small doses and 
with great caution, until the stomach is improved ; then give freely hydro- 
carbons, such as pork chops, bacon, butter, cream, sugar, dried fruits, 
alcohol in various combinations, etc. Part xxxii., p. 94. 
Phthisis.— Vide Selections from Favorite Prescriptions, Art. “Medi- 
cines.” 
Phthisis.—Dr. Addison believes it to be nothing more than the acute 
stage of strumous pneumonia. Mere tubercles may lie dormant for years, 
if inflammation of an active kind be not set up. Part xxxiii., p. 96. 
Phthisis.—Dr. Bullar states that we may often very materially soothe 
the passage to the grave by the cautious administration of small doses of 
opium. If the patient be anxious, restless, tossing about, and breathing 
very bad, etc., by giving a few drops of the liquor opii sedativus every ten 
minutes, the patient will become calm, tranquil, and will die quietly. 
Part xxxiv., p. 272. 
Tuberculosis.—The proximate cause of the tubercular diathesis, accord- 
ing to Dr. J. F. Churchill, is the decrease in the system of the phosphorus 
which it contains in an oxygenizable state. Therefore give some prepara- 
tion of phosphorus in the lowest possible degree of oxidation, and, at the 
same time, one which may be directly assimilated: such a remedy is the 
hypophosphite of soda, or lime, which should be given in doses of from ten 
grains to a drachm to adults in the twenty-four hours. The general symp- 
toms will rapidly disappear. Part xxxvi., p. 55. 
Chronic Phthisis.—Dr. E. Smith, of Brompton Hospital for Consump- 
tion, says : There are various conditions of the throat met with in phthisis. 
In the earlier stages the patient complains of dryness of the throat and 
cough, and, on examination, the throat is found smooth and shining, and 
the parts attenuated. It is a state of lessened tonicity without inflam- 
matory action. A useful means of treatment here is the application of a 
mixture of equal parts of chloroform and olive oil, by means of a large 
brush; the patient should also frequently swallow about a tablespoonful 
of a strong solution of suet in milk; great relief is obtained from the ap- 
plication of a strong solution of nitrate of silver to the fauces by means of 
a large brush. When the case is more advanced, an inflammatory state 
appears, with distended vessels and enlarged mucous follicles, chiefly upon 
the pharynx, but also on the uvula. This state, and also where there is 
ulceration and fibrinous exudation, is best treated by the nitrate of silver. 
When the inflammation runs high and extends down the larynx, the ap- 
plication of nitrate of silver often causes alarming symptoms of choking; 
the best topical application is then equal parts of oil and liquor potassas 
well laid on with a large brush. Part xxxvii., p. 68. 
Use of Ergot of Eye.—A case is related by Dr. B. P. Staats, of Albany, PHIMOSIS, 
347 
New York, in which the expectoration, the diarrhoea, and other symptoms 
of relaxed fibre of atonic sympathetic neiwine system, seemed to be con- 
siderably relieved by the administration of small doses of ergot of rye. 
This was continued with small doses of ipecacuanha and morphia. 
Part xxxix., p. 93. 
Carbonate of Lead-—M. Beau observes, that it is extremely rare that 
a case of phthisis is found amongst workers in lead, and accordingly re- 
commends a trial of this mineral in cases of threatened phthisis. He ad- 
ministers from two to sixteen grains of carbonate each day in pill, sus- 
pending the use of it as soon as the patient appears to be sufficiently 
impregnated. The patient must be supported by nourishing food, wine, 
tonics, and causing him to observe all the rules of a rational hygiene. 
Part xl., p. 55. 
Ozonized Oil.—It is found, says Dr. T. Thompson, that the administra- 
tion of ozonized oils has a remarkable tendency to reduce the frequency 
of the pulse. It was administered to fourteen patients. In two no such 
effect was observed; but in the larger proportion of the remainder the 
effect was very considerable, in some cases to the amount of twenty beats. 
Oils may be ozonized by exposure for a considerable time to the direct 
rays of the sun, after previous saturation with oxygen gas. 
Part xl., p. 294. 
PHIMOSIS. 
Treatment.—Mr. Key considers it to cut away a portion of 
prepuce in a state of active phagedaona, or even when ulceration has 
stopped and has left the surface covered with a white slough. 
[In many cases] the excessive action seems to have nothing of a specific 
nature : it appears to be a common attack of inflammation, ending in gan- 
grene, the poisoned sore acting merely as an exciting cause; for as soon 
as the slough is cast away, the sore puts on a healthy appearance, and 
heals quickly under the application of astringent dressings. 
When the inflamed part is under the influence of the specific poison, the 
operation of dividing the prepuce, instead of staying it, as it does in the 
case of simple gangrene, seems for a time to increase it, by adding to the 
inflammation. Exposure of the sore, however, is indispensable for the 
preservation of the glans, and should be performed as soon as the unhealthy 
nature of the sore is ascertained. This can be known by observing the 
nature of the discharge, which changes from the common secretion of 
chancre to a dirty reddish or brown fluid, mixed with fine shreds of white 
slough. The nature of the secretion may of itself determine the propriety 
of dividing the prepuce ; but more especially will it be required, if* there 
be also much inflammation proceeding beneath the skin. The best dress- 
ing for sores of this phagedsenic character are the balsams, or turpentine, 
with the addition of opium if severe pain or extreme irritability demand it. 
When they are disposed to bleed, warm olive-oil, mixed with an equal part 
of turpentine, cheeks the hemorrhagic tendency, without increasing the 
inflammation or irritation of the part. This application is most efficient 
when the specific action does not predominate, and agrees best with a 
sore in which the action approaches to the black slough. When the pha- 348 
PHIMOSIS, 
gedcenic action is maintained by a high degree of local and general irrita- 
bility, equal parts of Peruvian balsam and the sedative solution of opium 
form a most effective application. When the part can bear it, lint steeped 
in equal parts of port-wine and tincture of opium will sometimes check the 
ulceration, and induce a healthy surface. 
The operation for phimosis presents but little choice: the mode of ex- 
posing the glans must be regulated by the state of the prepuce, and by the 
situation of the sore that is required to be exposed. 
The main point in practising is to extend far enough the division of th 
inner layer of skin ; and, when circumcision is first performed, advantages 
will be obtained by turning back the angles of the divided inner layer, and 
uniting them by means of very fine sutures to the edge of the outer layer 
of skin. This proceeding shortens the process of cicatrization, and lessens 
the deformity. Part ii., p. 100. 
Aphorisms of Practical Surgery.—It is not prudent to divide the frae- 
num for phimosis during the existence of a gonorrhoeal discharge, as the 
wound is then apt to degenerate into a troublesome ulcer. (Dupytren.) 
Part iii., p. 116. 
Belladonna.—In cases of phimosis and paraphimosis, it has been 
suggested to use an aj>plication of belladonna to the part, before resorting 
to the knife. An ointment, composed of thirty parts of cerate and twelve 
parts of extract of belladonna, should be rubbed hourly on the prepuce in 
cases of phimosis, and on the glands in cases of paraphimosis. If great 
inflammation exists, a little opium may be added, and less belladonna. 
Part vii., p. 215. 
Operation for Phimosis.—M. Ricord’s plan. The penis is allowed 
to remain in its natural position, and no traction is used. A circular mark 
is made with ink upon the prepuce, about two lines anterior to the base 
of the glans, and parallel to the corona: a long and strong needle, its 
point covered with a wax bead, is then introduced between the glans and 
prepuce, and made to pierce the whole thickness of the latter, on the 
mesial line, and a little in front of the circular mark. The mucous mem- 
brane and skin of the prepuce are thus fixed, and the needle is allowed to 
remain. Behind it, and in a longitudinal direction, a fenestrated forceps, 
with notched edges, is then firmly applied. The fenestra? of uie instru- 
ment correspond to the circular mark and the glans: at this stage of the 
operation the latter is to be pushed backward. The next step is to pass 
sutures, five or six in number, through the fenestras; and, when all the 
threads are applied, the prepuce is shaved off with a bistoury made to 
glide between the needle and forceps. The latter is then withdrawn care- 
fully, so as not to disturb the ligatures. The assistant should be desired 
to press the forceps very tightly when the prepuce is being shaved off: if 
this be neglected, the prepuce will yield, and the sutures will be cut. 
When the forceps is removed, the arteries which are noticed to bleed 
should be tied or subjected to torsion; the threads which pass above and 
below the glans are then divided in their centre, and the respective ends 
of each half resulting from this section are tied, to bring the mucous mem- 
brane in contact with the skin. Of course there will be twice as many 
sutures as there were threads passed. 
Treatment.—We should, after this operation, enforce rest, low diet, as- 
persions of cold water, and camphorated pills; union by first intention PILLS 
349 
rarely takes place completely. The submucous cellular tissue will gene- 
rally be found infiltrated with serosity on the next day, but it is gradually 
re-absorbed. The sutures ought to be removed on the fourth day ; they 
might, if left longer, lacerate the tissues. The parts are usually healed up 
by the tenth or fifteenth day, excepting in those cases where the union by 
first intention takes place as early as the fourth or fifth. Part xvii., p. 187. 
Operation of Phimosis.—Mr. Codes’ plan. I seize the edge of the 
prepuce, at its fold forming the narrow band, in the left hand, and holding 
the scalpel in the right, and at right angles with the penis, I remove a cir- 
cular portion of skin about a quarter of an inch wide. The outer fold of 
skin being loose, is then drawn back an the penis, leaving the glans cover- 
ed by the inner and tighter fold. I then divide this layer about half way 
back, more or less, slitting it up exactly in the centre, by passing a sharp- 
pointed bistoury under it. We have now the outer fold of skin loose, 
with a large circular orifice; the inner, or more contracted portion, pre- 
senting also an orifice, but larger by double the perpendicular incision, 
which forms two angular flaps. I then turn these flaps outward, and by 
a suture attach each angle to the edge of the external skin, at about a 
quarter of its circumference from the fraenum; a slight suture at the frse- 
num completes the operation. I then draw all forward so as to cover the 
glans. In two or three days I remove the sutures, and generally find the 
wound healed, leaving a covering for the glans differing in no respect from 
the natural and perfect prepuce. Part xix., p. 173. 
PILLS. 
Pilula Hydrg. Protoxydi.— Vide Art. “Antimony.” 
'New mode of making a Ferruginated Pill of Mercury.—In Dr. Collier’s 
second edition of the “ London Pharmacopoeia,” he gives the outline of a 
formula for preparing blue pill'with sesqui-oxide of iron. It is as follows : 
R Ferri sesqui-oxydi, 5j.; hydrargyri, 3ij.; confect, rosae Gallicae, 5iij. 
Contere donee globuli non amplius conspiciantur. 
It is made in five minutes; common blue pill demands a week. The 
globules are not visible, even by the microscope. It is uniform in its 
appearance and effects. It makes a smoother pill, retaining its form more 
permanently. It salivates in a few days in the usual doses. The presence 
of the iron prevents the wear and tear of the human body under the effqpts 
of the mercury. It is particularly eligible for the strumous, the irritable, 
and for reduced anemial constitutions requiring mercury. The powers 
of life are not so much (scarcely at all) prostrated under its use. Its 
resolvent power is greater than that of mercury alone, especially with 
respect to buboes. Practitioners will at all events know what they are 
using ; at present they have for blue pill all manner of alloys and sulphurets- 
mercurial-zinc pill, mercurial-sulphur pill, etc. Part vii., p. 89. 
To cover Pills or Extract of Copaiba with Gelatine.—The process M. 
Garot adopts, is as follows : Fix the pills on long fine pins; plunge them 
into thick purified glue placed in a hot-water bath ; then remove them by 
a rotatory motion, and stick the pins in paste spread out on a slab, so that 
the pills may remain elevated in the air; as soon as fifty are thus treated, 350 
PLACENTA. 
rotate them individually in the heat of a taper, to harden the external 
pellicle ; pull out the point of the pin, and the process is complete. 
It is applicable to eyery substance capable of a pilular consistence; such 
as balsam, camphor, musk, assafoetida, mercurial and ferruginous prepar- 
ations, etc. Two hundred pills can be coated with gelatine in an hour, and 
will be ready for use after the lapse of two hours. The pilular mass so 
coated remains soft for a much longer time than according to any other plan. 
Fart xiv., p. 138. 
Preparation of Flue Pill.—Mr. Stoddart gives the following directions 
for the easy and rapid preparation of blue pill. By this process, he states, 
that a pound of the pill mass may be obtained in an hour, so perfectly 
prepared, that no metallic globules are visible, even with a Coddington 
lens : “ Triturate the mercury with the powdered liquorice (adding a 
small quantity of distilled or rose water), till the globules are quite im- 
perceptible ; the confection of roses is next added, and all well mixed. 
The rapidity with which the liquorice ‘ kills ’ the mercury is really 
astonishing to one accustomed to the old way of rubbing the metal with 
the conserve.” Part xxxiii., p. 294. 
Iloney as an Excipient for Pills.—M. Thibault believes that much of 
the disappointment following the employment of pills arises from their, as 
ordinarily prepared, acquiring a degree of induration that prevents their 
solution, and enables them to traverse the alimentary canal unchanged. 
To prevent this he recommends the employment of honey ; pills prepared 
with it always remaining soft, however long they may be kept. 
Part xxxv., p. 307. 
Excipient for Pills.— Mr. Martin suggests, as preferable to honey, 
which has been recently recommended as an excipient for pills, the employ- 
ment of treacle, which is far easier of manipulation, a much less quantity 
being required. Pills so prepared last soft and flexible for years. 
Part xxxvii., p. 250. 
PLACENTA. 
Incarcerated Placenta—Incision of the Os Uteri in Cases of.—It some- 
times happens that the placenta is separated from the uterine parietes, but 
is confined within its cavity, in consequence of the os being firmly and 
rigidly contracted. This state is what is termed incarcerated placenta, 
and differs from the ordinary forms of irregular contraction of the uterus, 
in the contraction being more limited to the os and cervix. 
The result of these cases is most generally fatal, the patient dying from 
the effects of typhoid fever, probably excited by the putrescent mass 
retained in the system. When a portion of the placenta only is retained, 
a purulent discharge consequent upon inflammation is sometimes secreted, 
by the living membrane of the uterus, and by which the particles of the 
intruding body are carried off. 
In such cases after all the ordinary means have been tried in vain, and 
death seems certain, as a last resource, before the powers of life were too 
fixr exhausted, would this operation he admissible ? 
Mr. Power gives the following directions for the performance of this 
operation. The patient should be placed on her left side, close to the edge PLASTEKS. 
351 
of the bed, as in the ordinary obstetric position, the forefinger of the left 
hand should then be carried to that part of the os or cervix intended to 
be cut, and a probe-pointed knife or bistoury conveyed cautiously along 
the finger in the vagina to the point mentioned, at which the os or cervix 
may be divided. This is done by gently insinuating the point of the in- 
strument within the os, and pressing its cutting edge against the rim on 
each side, in the direction in which it is intended to be incised, the parts 
will give way readily before it: and then cautiously giving the blade a 
withdrawing motion, the openings may be enlarged as much as may be 
deemed advisable. The bladder should be previously emptied, and if the 
incision be brought forward great care should be taken to avoid its neck. 
The liquor amnii will escape after the first incision, and if the uterus act, 
the case may then be left to nature. Part ii., p. 151. 
Placenta retained Eleven Weeks.—This case is interesting in connection 
with the question which has been much debated, of the occurrence or 
non-occurrence of absorption of the placenta in cases where it is retained 
for a considerable time in the uterus. 
A poor woman, 37 years old, having overexerted herself, was taken in 
labor in the fifth month of her second pregnancy. A midwife who was 
summoned tore the funis in her endeavor to remove the placenta, and an 
accoucheur who was then sent for could not succeed in extracting it. The 
Avoman now resumed her usual occupation till she was compelled to seek 
medical advice by the occurrence of hemorrhage from the uterus. 
Ten Aveeks after her miscarraige she applied to Dr. Scholler, AArho on 
making a vaginal examination found the cervix uteri thick, the os sufficiently 
open to admit the finger, and the uterus itself felt large and as though it 
contained a foreign body. The Avoman Avas ordered to remain in bed, and to 
take gr. x. of ergot of rye every two hours. After the administration of 
twelve doses, pains like those of labor came on, and Avere folloAved by the 
expulsion of coagula mixed Avith fibrous and membranous matters, and 
having a very oft'ensive odor. 
Dr. Scholler now fancied that the case Avas at an end, and supposed that 
this Avas an instance of real absorption of the placenta, but after the lapse 
of some days, having adminstered a purgative, pains came on in the ab- 
domen and recurred periodically for some hours, until a thick mass Avas 
expelled from the uterus. This mass Avas ascertained to be the placenta, 
which had not undergone the slightest decomposition, Avas hard, surrounded 
by a coating of fibrin, and shrunk to the size of half a goose’s egg. On 
a section it presented the peculiar structure of the placenta. The patient 
did well. Part vi., p. 167. 
Placenta Prcevia.— Vide Ai’t. “Labor.” 
PLASTERS. 
Isinglass Plasters.—Mr. Liston has for many years been in the habit of 
using, after operations, and for other surgical purposes, a plaster consisting 
of oiled silk covered with a coating of isinglass. 
The following is the method of preparing it: Moisten an ounce of isin- 
glass with two ounces of water, and allow it to stand for an hour or two 
until quite soft; then add three ounces and a half of rectified spirit, pre* 352 
PLASTERS, 
viously mixed with one ounce and a half of water. Plunge the vessel into 
a saucepan of boiling water, and the solution will be complete in a few 
minutes. 
Having stretched the oil silk on a board, by nailing it round the edges, 
apply the solution of isinglass with a brush, taking care to move the brush 
evenly, and in the same direction, making it smooth as you proceed—as in 
varnishing a picture. When quite hard and dry, apply another layer, in 
the same manner, but moving the brush in the opposite direction, in one 
case horizontally, and the other perpendicularly. In this manner apply 
four coats of the solution, or even a fifth, if the surface be not entirely 
smooth. The last layer should be reduced in strength by the addition of 
a little more water and spirit. An ounce of isinglass is sufficient for about 
a square yard of the plaster. 
The following precautions should be preserved: The distance between 
the nails should not be more than an inch and a half, otherwise the oil silk 
will shrink in festoons, and will not remain flat. The isinglass must be 
well soaked in water before the spirit is added, otherwise it will not make 
a complete solution : and the spirit, when added, must be diluted with a 
portion of the water, to prevent precipitation of the isinglass. The brush 
must be a flat “ hog tool,” such as is used for spirit varnish, and well made, 
otherwise the hairs will be found to come out, and this is an inconveni- 
ence, as the operation must be performed quickly, while the solution 
is warm. The solution, when cold, should be of the consistency of blanc- 
mange. 
The oil silk has been in a great measure superseded by the use of a 
membrane, consisting of the peritoneal covering of the caecum of the ox, 
rubbed down, and carefully polished in the manner in which the com- 
mon goldbeater’s skin is prepared. The following is the report of this 
plaster: 
From the extreme thinness of the plaster, the wounds can be examined 
without its removal. It adheres much better than plaster made with isin- 
glass spread on silk; and in the first instance of its application becomes 
firmly fixed. It is difficult to fix the isinglass plaster spread on silk, unless 
it is very good. From the extreme tenuity of the membrane plaster, it is 
equally unirritating with goldbeater’s skin ; and when once applied it re- 
mains so accurately adherent, that it does not require to be changed fo; 
many days. Altogether, after a good deal of experience in all the dif 
ferent plasters, we find it the best uniting material that has ever been pro- 
duced. 
In applying the isinglass to the membrane plaster, the directions already 
mentioned, with reference to the oil silk, may be observed, but a layer 
of drying oil is spread on the other side of the membrane. Part iv., p. 100. 
India-rubber Court Plaster.—Mr. Rowland submits the following as 
the best method of making india-rubber court plaster, which does not wash 
off: 
A stout frame of wood must be made, about three yards long (or any 
length that would be most convenient), and about one yard and a quarter 
wide. Within this frame must be placed two sides of another frame, run- 
ning longitudinally and across, so fixed in the outer frame that the two 
pieces may slide, independently of each other, backward and forward about 
six inches. Tapes of canvas must be tacked around the inside of the inner PLASTERS. 
353 
frame, and the corresponding sides of the outer frame, so as to form a 
square for the material to he sewed in; which, when done, the two loose 
frames must be drawn tightly to the outer, by means of a twine passed 
round each, in order to stretch, perfectly free from irregularities, the silk 
or satin previous to laying on the composition. 
To make india-rubber plaster : Dissolve india-rubber in naphtha, or 
naphtha and turpentine, and lay it on with a brush, on the opposite side 
of that which is intended for the plaster, and when perfectly dry, and the 
smell in a great measure dissipated, it will be ready for the adhesive mate- 
rial ; to make which, take equal parts of Salisbury glue, or fine Russian 
glue, and the best isinglass, dissolved in a sufficient quantity of water over 
a water-bath, and laid on with a “ flat hog tool ” while warm. It is requi- 
site to use great caution in spreading the plaster evenly, and in one direc- 
tion, and a sufficient number of coatings must be given to form a smooth 
surface, through which the texture of the fabric is not perceptible. Each 
coating should be perfectly dry before the succeeding one is given, and 
placed in a situation free from dust, and where a draught of air would faci- 
litate the drying. The quantity of water used, and the weight of the two 
materials, must be a little varied according to the season, and the gelatine 
strength they possess. 
Lastly, the plaster being ready to receive the polishing coat, which gives 
also the balsamic effect to it, a preparation is made in nearly the same 
manner as the tinctura benzoini composita of the pharmacopoeia, with the 
addition of more gums ; this preparation must be laid on once only, and 
with a brush kept for the purpose. For making plasters on colored silk, 
it is only necessary to select the silk a shade deeper than the color required, 
as the plaster causes it to appear a little lighter. The process being 
finished, the plaster must be cut out of the frame with a pair of scissors, as 
near to the canvas to which it is sewed as it will admit. For sale, it is cut 
up in squares, which is best done by means of a compass and rule. I have 
tried various solvents for india-rubber, and find none answer so well as 
those above mentioned. Ether dissolves it with facility, and possesses the 
advantage of cleanliness, but it is much more expensive, and evaporates so 
rapidly that it is almost impossible to spread the solution smoothly on the 
silk; naphtha evaporates more slowly, and is, therefore, preferable, but the 
quality requires attention, as it may be obtained almost free from that 
creasote smell which is the only objection to its use. The addition of a 
small quantity of turpentine facilitates the solution of some specimens of 
india-rubber. The white india-rubber is better than that which has as- 
sumed a black color. 
The grand arcanum in making court-plaster is glue and isinglass. The 
polishing coat is not absolutely necessary, but it improves the appearance 
of the plaster, and the gums may probably increase its healing property, 
and by giving it a more even surface, cause it to adhere more closely. It 
has occurred to me, that a similar plaster might be made for common use, 
with calico instead of silk, which might, in some cases, supersede the use 
of strapping; and also that the adhesive material might be made the vehi- 
cle for cantharadine or other stimulants. The isinglass plaster is apt to 
crack in wrarm, dry weather, but this does not occur if it is kept in a cellar 
in an earthenware jar. Part vii., p. 169. 
An Elegant Sticking Plaster.—Black silk is strained and brushed over 
VOI,. II.—23 354 
ten or twelve times with the following preparation: §ss. of ben- 
zoin in f. §vi. of rectified spirit; in a separate vessel dissolve §j. of isinglass 
in water; strain each solution, mix them, and let the mixture rest, so that 
the grosser parts may subside; when the clear liquor is cold, it will 
form a jelly, which must be warmed before it is applied to the silk. 
When the plaster is quite dry, in order to prevent its cracking, it is finished 
off with a solution of terebinth, cilia. §iv. in tinct. benzoes f. §vj. 
Part vii169. 
Prestates Adhesive Plaster.—The following composition is said never to 
crack, and not to inflame the skin: Empl. diachyl. gum., 400 grs., puri- 
fied rosin, 50 grs., tereb. venet., 38 grs., are mixed together at a gentle 
heat, and then 12 grs. of gum mastic, and 12 grains of gum ammoniac 
incorporated, and the mass spread on linen. In winter it is advisable 
to add 10 grs. more turpentine, and 12 grs. of ol. amygdal. 
Part x., p. 176. 
Adhesive Plaster.—An excellent adhesive plaster, unirritating to the 
skin, not acted on by water, or the discharges from the wound, and pos- 
sessing all the good properties of collodion except its want of color, with 
the additional advantage of being cheaper, is made by dissolving, with the 
aid of a moderate heat, gum lac in spirit of wine, in sufficient quantity to 
make it of the consistence of jelly. It can be kept in a wide-mouthed bot- 
tle, and spread with a spatula as required. Part xxi., p. 357. 
Addition of Tannate of Lead to Adhesive Plaster.—M. Herpin states, 
that his own experience teaches him that Baynton’s treatment, l?y strap- 
ping, may be extended to every branch of surface, whether resulting from 
wound or ulcer; and the only inconvenience he has found attending it is, 
the production of eczematous eruptions, or vesications in irritable skins. 
After having tried various means of obviating this, he remembered the 
great advantage that accrued from the treatment of bed-sores, by means 
of plasters powdered with the tannate of lead. He caused some of this 
substance to be combined with adhesive plaster, which henceforth produced 
no irritation. As the addition of the tannate diminishes the adhesiveness, 
the proportion may vary accordingly, as this quality is desired or not. It 
is retained when l-20th of the tannate is added, and when not much re- 
quired the proportion may be raised to 1-12. Part xxxi., p. 235. 
Scott's Plaster.—In some affections of joints (of the knee particularly) 
it is very useful sometimes to get the part into as quiet a state as possible. 
The best plan yet known is that called Scott’s plan, much used in London 
hospitals, viz.: sponge the skin of the part (the knee for instance) with 
spirits of camphor till the skin smarts and looks red. Then spread an 
ointment composed of equal parts of the ung. hydrargyri fort, cum canx- 
phora and plain ceratum saponis, on lint; cut the lint into narrow strips, 
and apply them freely round the knee to the part, fully four inches above and 
, below the condyles of the femur: over this next apply soap plaster, spread 
on calico, cut also in strips; this may be applied lor a fortnight or longer, 
if no pain ensues in the knee ; while over the whole is rolled a bandage or 
roller, steeped in gum and chalk. The effect of this plan in removing pain 
and swelling is sometimes very remarkable. Part xxxiv., p. 284. 
Improved Adhesive Plaster.—M. Colson, as the result of twenty years’ 
PLASTEIiS, 355 
PLEURISY. 
trial, recommends the following plaster in place of the ordinary diachylon, 
as it never gives rise to irritation or erythema. 
R Olive oil 500, minium 250, yellow wax 185 parts. 
These are to be heated together and stirred round with a spatula until 
the mixture assumes a black color, when it is to be taken off the fire, and 
stirred until quite thick. It is then to be formed into rolls on a marble 
table. Part xxxviii., p. 294. 
PLEURISY. 
Treatment of Chronic Pleurisy with Effusion.—The following was 
dictated by Dr. Hope during his last illness, and concluded on his death- 
bed : 
“ Show that I used mercury in all degrees of intensity, so as to ascertain 
what quantity was the most effectual, but at the same time, least injurious. 
Show that I always used opium, in full proportion, with the mercury, and 
that I used the milder and the external forms when the others could not be 
borne—thus taking especial care to protect the mucous membrane.—Add 
that I found prompt and free salivation by calomel and opium, and the use 
of one or two drachms of ointment on each groin and axilla, night and 
morning for forty-eight hours (in conjunction with the other remedies 
presently to be specified), produce the most rapid and satisfactory effects 
of absorption, in cases where the dyspnoea and faintness seemed to be most 
urgent and dangerous. It was quite common, and, in fact, occurred in the 
majority of cases, that the fluid descended one-third, and still oftener 
one-half, down the chest, within the space of forty-eight to sixty hours, 
carrying with it the extreme dyspnoea and faintness, to the great relief of 
the patient. 
“ Say that blisters were used from the first, and that the following 
became my settled plan of managing them. One blister six inches long, 
broad, exclusive of margin, w'as placed .longitudinally over, and a little 
to the outside of the angles of the ribs, leaving space for another of similar 
size between the first and the spine. Great care was taken to not remove the 
cuticle (one means of which was to cover the surface of the blister with 
silver paper), as this forms by far the quickest healing plaster; but after 
about forty-eight hours, during which the running was absorbed by dry 
napkins, carefully prevented from adhering, it became necessary to cover 
the whole with the mildest soap plaster, spread on soft calico, to prevent 
the cuticle from being accidentally abraded. In this way all irritation 
promptly subsided, that is, in the course of from two to three days, and 
the patient was ready for the second blister, which was placed between the 
first and the spine. It was similarly treated; and, at an equal interval, a 
third was placed in front of the original one ; that is, rather forward in the 
axilla. When pain indicated the possibility of a pleuritic stitch in any part 
of the side, it is needless to say that the first blister was placed over that. 
Say that diuretics are conjoined: viz., squill; sp. eeth. nit.; juniper; 
iodide of potassium, and, when there is no irritation of the mucous mem- 
brane, the various other preparations of potass. Digitalis, by creating 
faintness, is apt to confuse the symptoms ; I do not therefore use it till 
later. Where all these remedies had failed for two or three days, and 356 
PLEUEIST. 
dyspnoea continued as urgent as ever, I have occasionally used a powerful 
hydragogue, as half a grain to a grain of elaterium, combined with calomel 
and capsicum to prevent nausea; or the pulv. jalap, comp. 5j.; so as to 
produce ten or twelve copious watery evacuations per day, stimulants being 
at hand in case of any sinking tendency. 
“ The patient is better in bed, both because it favors gentle transpiration 
and obviates faintness. 
“ Remind that, hitherto, I have been treating a case in which the 
dyspnoea seemed imminently dangerous, and the most vigorous use of 
remedies consequently indispensable; but now explain that inconvenience 
sometimes resulted from hypersalivation ; for, notwithstanding an imme- 
diate suspension of the mercury either on the first appearance of tenderness 
of the gums, or of amelioration of the symptoms—especially the dyspnoea 
and obvious commencement of absorption, untoward salivation would 
occasionally occur and greatly retard the convalescence. Explain that, on 
several times observing this, and having reason to believe that the patient 
could bear the dyspnoea with safety tor some hours longer, provided he 
were prevented from rising, which creates faintness, I used more moderate 
quantities of mercury, being content to affect the gums within three or 
four days. In this way, the action of the remedy was easily controlled, 
either by omitting the mercury for two or three days, if its action 
threatened to be considerable, or by merely diminishing it according to 
the evidence of the mouth and of the symptoms. I found, however, that 
it did not answer to suspend it altogether, but that a continuation of it 
daily in a mild form, as a blue-pill night and morning, or at night only, for 
the purpose of maintaining the first impressions for a period of two or three 
weeks, or in short, until all the disagreeable symptoms had disappeared, 
was attended with far better success. Explain, further, that the great 
acceleration of pulse, which rises commonly to 120 or 130, and in young 
persons, even to 150 or 160, and which is attended with what the patient 
calls ‘ internal fever,’ thirst, craving for cold drinks, and dryness and 
heat of skin, is not necessarily a result of fever, but it is necessarily 
a result of anaemia, occasioned by the deficiency of oxygenation from 
the total incapacity of one lung at least. Here was the error made by 
Broussais, who supposed this to be fever, and put his patient on the lowest 
diet. On the contrary, acting on the opposite principle, I always supply 
my patients with at least one or two pints of concentrated beef-tea, or 
plain ox-tail soup; and if the state of the tongue and the alimentary canal 
fully authorizes it, I permit them tender old mutton or beef for dinner. On 
this treatment the pulse and ‘ internal fever ’ rapidly fall in proportion as 
the anaemia disappears. 
“Next proceed to those cases in which hectic is established, resulting, 
for the most part, I should imagine, from the fluids being of a puriform 
character—for, after a month or six weeks, and sometimes much earlier, 
if the inflammation have been very intense, it assumes this character. 
Allude to the opinion pretty prevalent, that mercury is injurious in such 
cases, and say that I have not found it so, but that its use was still indis- 
pensable ; for I have noticed that where it has been omitted, contrary to 
my wishes and instructions, a recurrence of the efiusion has taken place, 
notwithstanding the use of mineral acids and the various other remedies 
usually considered available against hectic ; whereas, on resuming mercury 
with opium, and giving the mineral acids for hectic, I have been enabled 357 
to restore matters to their former condition, though not without an extra 
shake to the patient.” 
Dr. Hope suggests that sulphate of iron may be added to the sulphuric 
acid mixture, in order to cooperate with the animal food in removing all 
remains of antemia. Part iv., p. 68. 
Pleuritic Stitch.—Rheumatism of the intercostal muscles may be con- 
founded with the genuine pleuritic stitch. Treatment same as in ordinary 
rheumatism. Party.,p. 77. 
Pleurisy.—In young and healthy adults, Mr. Guthrie advises to bleed in 
a very “ determined manner and with an unsparing hand, until an impres- 
sion is made on the system, until the pain and difficulty of breathing are 
removed, until the patient can draw a full breath, or faintsand repeat 
it every three or four hours, according to the symptoms, not placing, 
however, much dependence upon the pulse. And give mercury to affect 
the gums ; three grains of calomel with a third or half a grain of opium, 
every two or three hours. In the later stages, when the pillse is becoming 
weak, and there is much dyspnoea, or when the disease is becoming chronic, 
apply a blister. Part xvii., p. 90. 
A neic Sign of Pleuritic. Effusion.—Dr. Roy, of Lyons, mentions, in the 
“ Revue Medicale,” the following sign of pleuritic effusion when the fluid 
has much diminished : Put the left hand on the affected side of the chest, 
the patient sitting up in bed; then percuss the ribs with the right hand. 
This will give rise to fluctuation, which will be easily perceived by the left 
hand. Dullness on percussion, absence of vesicular murmur, bronchial 
respiration, and cegophony, will of course remain the characteristic symp- 
toms when the fluid is abundant. Part xxv.,p. 109. 
Iodine Injections in Pleuritic Effusion.—Dr. Atlee relates the case of 
a gentleman (age not given) from whose side nine pints of pus were dis- 
charged on the 16th December, through a trocar passed into the left side 
of the chest between the seventh and eighth ribs, midway between the 
spine and the sternum. No further discharge took place until the 2d of 
January, but the closed wound then reopened, and from that time about a 
pint of pus continued to be discharged daily, with the effect, in spite of 
restoratives, of rapidly wasting the patient’s strength. On February 2d, 
5J- of liq. iodin. c. (U. S. Disp.) diluted with gj. of tepid water, was thrown 
in without inducing any ill eflect, no precaution against the admission of 
air being taken ; and next day the amount of discharge was diminished by 
one-half. Each day the strength of injection was increased, and on the 
7th February the iodine was used undiluted. The amount of matter dis- 
charged rapidly decreased, and by the end of February the flow had ceased, 
the patient daily recovering strength, and in a few weeks later being able 
to go to business. When seen three years later he was quite well. 
Part xxxi., p. 87. 
PNEUMONIA, 
PNEUMONIA. 
Pneumonia Treated with Spirits of Turpentine.—Mr. Martin relates 
the case in which he was so successful by means of this remedy, as follows : 
I was called to visit M— S , aged twenty-five. I found her in an ad- 
vanced state of pneumonia, severe dyspnoea, respiration 40, pulse 120, 358 
PNEUMONIA, 
a short hard cough accompanied by dark brick-colored sputa, tongue 
white (loaded), bowels confined, dull sound on jmrcussion over the entire 
of the thorax (excepting a small space, of two inches in diameter, beneath 
each clavicle). Here the respiratory murmur, which was elsewhere ab- 
sent, Avas of a loud mucous character. She had been attacked, six days 
before, with rigors and pains in her chest; and, having been treated solely 
with whisky-punch to drive out the cold, her present state was extremely 
alarming. Bleeding and calomel were of no avail in arresting the disease, 
the pulse rose to 140, the lips and cheeks were livid, and eyes sunken, with 
slight tracheal rale. Thinking the patient so near death that it would be 
fruitless to Avait for the action of mercury, I determined to have recourse 
to brisk doses of turpentine, which I had seen used Avith success in cases 
of pneumonia Avhich resisted mercury. I therefore prescribed the folloAAT- 
ing mixture : 
Spt. terebinthinse rect., gij.; vitelli ovi dimidium.; aquae rosarum, 
§vss.; tinct. opii, 3j-; Fiat mistura cujus coch. duo magna sumantur 3tia 
q.q. bora. Emplast. lyttae sterno. 
Next day 1 found the patient much easier : respiration 40, less labored ; 
the cheeks have lost their livid hue, but the lips are still of a dark purple; 
pulse 118, softer and fuller; tongue still loaded; she had six copious Ava- 
fcery stools during the night, with a copious secretion of urine; tAVO inches 
beloAv the clavicle thei*e is an audible and distinct crepitating rale ; sputa 
still dark-colored; blister vesicated well; she has finished the mixture; 
complains of slight strangury. To have the mixture repeated, camphor 
mixture being substituted for the rose-water. The patient recovered 
rapidly, and Avithout relapse. Part ii., p. 53. 
Bleeding in Sthenic Pneumonia.—Dr. Kennedy, in his Observations 
on Blood-Letting, goes on to say: In sthenic pneumonia, it frequently 
happens, that in spite of treatment the lung becomes solid; or, it may be, 
the patient does not present himself till this has occui’red. A good deal 
of difficulty often exists in deciding on the propriety of general bleeding 
in such cases: the extremities may be cold,, and the surface covered with 
clammy perspiration; the pulse, too, may be weak ; and yet there are few 
cases in which general bleeding will be found more beneficial. Reaction 
will be found to establish itself, and the lung will become much more 
rapidly clear than if less energetic means had been used. There is still 
another case connected with pneumonia, and which presents itself to the 
medical man by no means unfrequently. A person gets a slight cold, 
which is neglected; after some time he asks advice, and, on examination, 
a portion of the lung is found solid. All fever has subsided: the necessity 
for bringing back the lung to its healthy state need not here be insisted 
on. Now, this cannot be better done than by following up a plan of treat- 
ment which has been already spoken of by Dr. Stokes for the cure of em- 
pyema, only with a little more vigor. In place of local bleedings, or 
possibly in conjunction with them, one or two general bleedings will be 
followed by the most decisive results. It may be recollected, among the 
details of the treatment alluded to above, that the lowest diet is enjoined: 
hence, the modus operandi of this plan appears to me sufficiently obvious, 
by keeping in mind the principle I am endeavoring to establish. The 
system is deprived of a quantity of its blood, and the food taken is not 
sufficient to supply the deficiency. Under these circumstances, the system 359 
is, I believe, actually forced as it were to take back whatever may have 
previously been poured out—such as serum, lymph, or, possibly, even pus. 
It is curious to observe, in some cases, with what great rapidity this may 
be effected. Part ii., p. 72. 
Golchicum Autumnale.—Suggested as an auxiliary in the treatment of 
pulmonary inflammations, uncomplicated with abdominal affections. 
Part iv., p. 11. 
Treatment of Pneumonia.—[Blood-letting, tartarized antimony, and 
mercury, are stated by Dr. Watson to be the three great remedies in this 
dangerous disease; and this opinion accords with that of most other 
eminent men—for, although every one may not use the tartarized anti- 
mony and mercury in the same way, yet the general principles of treat- 
ment will be found nearly to correspond. However much we depend 
upon bleeding in the early stages of the treatment, a time arrives when it 
is no longer admissible, and is even positively hurtful.] 
We want some remedy, therefore, to assist the lancet, or to employ 
alone when the lancet can do no more; and we have two such, in tartar- 
ized antimony and in mercury. The tartar-emetic plan I believe to be the 
best adapted to the first degree of the inflammation—that of engorgement; 
and the mercurial plan to the second—to that of hepatization. 
I need not tell you that the tartarized antimony is not given in this dis- 
order with the object of producing vomiting. Dr. Thomas Davis states 
that it always acts best when it produces no effect except upon the in- 
flammation itself, i. e., when neither vomiting, purging, nor general de- 
pression are produced. The first dose may produce all these effects; but 
the second and third doses may be tolerated, and it is during this tolerance 
of the drug that its beneficial effects are chiefly perceived: if the vomiting 
and purging be excessive, it is well to combine a small dose of laudanum. 
Dr. Thomas Davis first bleeds freely in pneumonia; he then begins with 
one-third of a grain of tartarized antimony in a little water, with a few 
drops of laudanum or sirup of poppies: he repeats this dose every hour 
for twice ; he then doubles the dose for the next two hours; and goes on 
thus, adding one-third of a grain every two hours until he reaches two 
grains every hour. He has not exceeded this last dose, and has occasion- 
ally continued it for many days without injurious effects. Whatever be 
the modus operandi of this medicine, there can be no doubt that this 
treatment is both judicious and safe. 
When the dyspnoea has been put an end to by antimony thus exhibited, 
the medicine may be intermitted ; and if the inflammation show any dis- 
position to rekindle, it must be again extinguished by a repetition of the 
tartar emetic. 
When, however, the inflammation has reached the second stage, that of 
solidification, mercury is more worthy of confidence, in my opinion, than 
tartarized antimony. The object of giving it is to make the gums tender; 
and it is expedient to do this as speedily as may be. Small doses of calo- 
mel repeated at short intervals—a grain every hour, or two grains every 
two hours, or three grains every three hours—combined with so much of 
laudanum or of opium as may be requisite to prevent it from running off 
by the bowels—offer the most certain way of accomplishing our object. 
If the bowels are irritable under the calomel, blue pill, or the hydrargyrum 
cum creta, may be substituted for it with advantage; and if the internal 
PNEUMONIA. 360 
PNEUMONIA. 
use of the mercury be anyhow contra-indicated, or if it appears slow in 
occasioning its specific effect, the linimentum hydrargyri may be rubbed 
in, or the strong mercurial ointment. 
Many persons, I am persuaded, are saved by treatment of this kind, 
pushed to slight ptyalism ; the effusion of lymph, tending to spoil the tex- 
ture of the lung, is arrested, and the lymph already effused begins to be 
again absorbed; and the ease and comfort of the patient, as well as the 
alteration for the better of the physical sounds, attest the healing qualities 
of the remedy. Part iv., p. 45. 
Counter Irritation.—By means of the ung. ipecacuanha, or ung. eme- 
tinse, is preferred by Dr. Turnbull to other rubefacients in pulmonary 
affections, on account of producing little or no pain, or inconvenience to 
the patient. ’ Part v., p. 84. 
Bloody Expectoration.—Dr. Graves states, that when we find in pneu- 
monia that the expectoration is tinged with dark venous instead of arterial 
blood, we may conclude that it is of a more dangerous nature (originating 
from effusion of blood from branches of the pulmonary artery, which ramify 
on the air-cells,) than when the bronchial vessels only are implicated.— 
Vide Art. “ Hemoptysis.” Part viii., p. 54. 
Complicated with Cerebral Disturbance.—When pneumonia, as in cer- 
tain constitutions and in certain epidemics, is accompanied with marked 
symptoms of cerebral disturbance—a very embarrassing complication— 
the use of musk, either alone or in combination with calomel, has been 
found by Recamier to be often of decided advantage. Part ix., p. 77. 
Lotion of Tartar Emetic in Pulmonary Diseases.—Mr. Duncan 
M’Diarmid, an American surgeon, has found great benefit from a solution 
of emetic tartar applied externally in some pulmonary and other com- 
plaints. 
Dr. Hannay, in 1823, recommended this form of application, and in 1843 
writes, “ I still regard this lotion as a highly valuable application to the 
chest in pulmonary diseases.” Dr. H. finds that the addition of gr. v. of 
hydr. oxymur. to the ounce of solution increases its power and efficacy. 
Part xii., p. 302. 
Treatment of Pneumonia.—[The indications to be fulfilled in treating 
inflammation of the lungs, are, 1st, To subdue inflammatory action; 2d, 
To prevent deposition ; and, 3d, To guard against relapse. With the first 
intention, moderate bleeding, at the commencement of the attack, will be 
useful, and if the crepitant rale remains after this, it will be a safer criterion 
for the repetition of the bleeding than the beef-fed appearance of the 
blood. Dr. A. T. Thomson considers that the use of tartar emetic, as a 
contra-stimulant, in full doses, is far more advantageous than repeated 
bleeding. He observes:] 
My practice, as soon as I have fully satisfied myself of the existence of 
the disease, and if the attack has not run on to the second stage, is to 
order one bleeding to the amount of sixteen or twenty ounces; to follow 
this, immediately, with three or four grains of calomel and one grain of 
opium, with the view of preventing that nervous irritability which often 
succeeds the use of the lancet, and of sustaining the beneficial impression 
made on the system by the bloodletting. 
In two hours afterward, I give one grain of potassio-tartrate of antimonv PNEUMONIA. 
361 
in a fluid ounce and a half of emulsion of bitter almonds, and repeat this 
dose every third or fourth hour, until a decided diminution of inflamma- 
tory action takes place—that is, until the crepitation has nearly disap- 
peared, and the sputa are no longer rusty and tenacious. The intervals 
between the doses of the tartar emetic are then extended to six hours, 
and afterward to eight hours, and so continued until convalescence is con- 
firmed. I prefer the bitter almond emulsion, on account of its containing 
hydrocyanic acid, which has a sedative quality, and a more decided 
influence in quieting the nervous system, and abating the cough, than small 
doses of opium. When the pneumonia is uncomplicated, this plan, with 
the occasional aid of some mild aperient, has, in my hands, seldom failed 
to carry the case to a successful termination. When the attack has passed 
beyond the first stage, when dullness on percussion indicates hepatization, 
then the object of the second indication—namely, to excite the capillaries 
and prevent further depositions—requires attention; and, in order to fulfill 
this indication, I order four or five grains of mercury with chalk, or one 
grain of calomel, to be given in each interval of the administration of the 
tartar emetic. Part xiv., p. 71. 
Treatment of Pneumonia in Children.—According to Dr. West, in 
idiopathic pneumonia occurring in previously healthy children, depletion 
is as important as in the adult; and is to be followed up by tartar emetic, 
given in doses of one-eighth of a grain every ten minutes (to a child two 
years old), till vomiting is produced, and continued every hour or two 
afterward for twenty-four or thirty-six hours. Then if the physical condi- 
tion of the luftgs, and the general state of the patient, are found greatly 
improved, persevere with the medicine at longer intervals; but if the signs of 
inflammation are advancing, give mercury with small doses of antimony, and 
use larger doses of the latter to combat any sudden increase of fever or dysp- 
noea. If under any circumstances bronchial breathing is distinctly audible, the 
mercurial treatment is indicated; give, to a child two years old, a grain of 
calomel every three or four hours, and a little tartar emetic, except contra- 
indicated by sickness or debility; if the stomach and bowels are very irritable, 
use mercurial inunction. Do not blister, but employ stimulating liniments, by 
which there is no risk of those unhealthy sores which often follow a breach 
of the surface. If at the outset, large doses of antimony do not seem to 
be required, give two-thirds of a grain or a grain of calomel with two or 
three of James’ powders every six hours. It is difficult to know when to 
give stimulants ; but they are plainly indicated when there is much 
diarrhoea, the pulse becoming more frequent, and above all smaller and 
smaller, and the respiration, though slower, more labored, and irregular. 
Then give wine, even to a child at the breast, and ammonia in decoction 
of senega, or dissolved in milk, which conceals its pungency. If there is 
diarrhoea, let the nutriment be arrow root, or the decoction blanche of the 
French; otherwise give strong beef tea, or veal broth. In secondary 
pneumonia, especially if preceded by well marked bronchitic symptoms, 
antimony may sometimes be given at once, without bleeding. 
General Management.—It is desirable, in all cases of pneumonia at all 
severe, that infants should be taken from the breast, and that the mother’s 
milk should for a time be given them from a spoon. This is of importance 
on two accounts—partly because the thirst they experience induces them 
to suck overmuch (hence it is well that barley-water or some other diluent 362 
PNEUMONIA, 
be given them frequently instead of the milk, in order that they may 
quench thirst without overloading their stomach); partly because the act 
of sucking is in itself mischievous, since, as must at once be perceived, it 
taxes the respiratory functions to the utmost. A second important point is 
never to allow the children to lie flat in bed or in the nurse’s arms, but 
to place them in a semi-recumbent posture in the arms, or propped up in 
bed. 
When pneumonia has reached an advanced stage, or has involved a 
considerable extent of the lungs, the children should be moved only with 
the greatest care and gentleness, lest convulsions should be brought on. 
Part xvii., p. 88. 
Treatment of Pneumonia.—Dr. Todd asserts that all cases of pneu- 
monia have, independently of this or that mode of treatment, a decided 
tendency to depress the general powers of life—some more, some less ; 
and that, with all, a very decided direct antiphlogistic treatment is hazard- 
ous—with some, extremely so—and that in none is it absolutely necessary; 
but, with others, there is no safety for the patient, unless the treatment 
from the beginning be of a decidedly supporting and stimulating nature. 
Apply flannels soaked in‘warm spirits of turpentine over the regions of 
the dullness, and keep them on for half an hour. Let these be applied 
three times a day for three or four days. Give the liq. amnion, acetatis as 
a diaphoretic, in doses of six drachms every three or four hours. An 
occasional dose of a mild aperient may be given, and the patient allowed a 
pint of beef tea, with a little milk and bread, daily. Part xxvi., p. 52. 
Lungs, Inflammatory Affections of.—In a paper upon the different 
sounds of the respiratory apparatus, Dr. T. Thompson observes, that in 
proportion as sounds are confined to inspiration, they afford reason for 
depletion; in proportion as the rhonchi become bubbling they indicate 
secretion, and suggest a discontinuance of antiphlogistic treatment. 
Part xxviii., p. 79. 
Typhoid Pneumonia.—Take care how you confound pneumonia occur- 
ring in the course of typhus, with a pure inflammatory attack. The symp- 
toms may easily lead you astray, but to treat a case of typhoid pneumonia 
on the antiphlogistic plan would probably be destructive. Too great 
weight is placed on physical signs in typhoid pneumonia. The successive 
signs of crepitus, dullness, cessation of vesicular breathing, and its replace- 
ment by bronchial respiration, are too often mistaken for the effects of 
inflammation, whereas the same signs are seen in typhus. They are, in 
fact, often symptoms of typhus, and of all other forms of fever, whether 
these be variola, erysipelas, purulent poisoning of the blood, glanders, 
scarlatina, or measles. One of the greatest modern improvements of 
medical practice consists in treating these cases on the plan recommended 
by Dr. Stokes. Look attentively to the antecedents of a case of this kind 
when called upon to treat it; examine its history. The editor has been 
guided by one simple index in most of these cases—viz., the brown tongue. 
If the tongue be ever so slightly brown U the back, take care how you 
deplete ; on the contrary, begin in good time with broth, ammonia, and 
wine or good brandy. Don’t be afraid of the physical signs of pneumonia, 
if the history of the case and the tongue indicate coming typhus. It is 
truly surprising how these physical signs vanish by the timely exhibition 
of stimulants. The blood is decomposing, the coloring matter is acting on PNEUMONIA. 
363 
the tongue, the stimulating properties are disappearing, and the functions 
of life will soon cease, unless you compensate for a time for this loss of 
stimulation, by an artificial one, till the poison has been exhausted or 
eliminated. These views are also fully supported in some of Dr. Todd’s 
late lectures. Part xxxi., p. 17. 
Pneumonia, Chronic.—Dr. Cotton, of Brompton Hospital, for con- 
sumption, etc., believes that counter-irritation is of the greatest benefit. 
Apply one or two blisters, and follow these by Croton oil liniment, or 
iodine, or a combination of both. If there be no tubercular tendency, you 
may employ mercury carefully combined with a more tonic plan of treat- 
ment. Part xxx., p. 72. 
Absence of Chlorides from the Urine as Diagnostic of the onward 
Progress of Pneumonia.—Dr. Bennett states that in several cases of 
pneumonia, the absence of chlorides from the urine marked precisely the 
onward march of the pneumonia, whilst their presence indicated its cessa- 
tion, and was generally accompanied by the returning crepitation and com- 
mencing absorption of the exudation. It still remains to be determined 
whether the absence of these salts is a cause or a result of exudation into 
the lungs—whether the interference to the respiratory function, by dimin- 
ishing the amount of oxygen absorbed, gives rise to those chemical changes 
in the blood which react on the urinary secretion. 
Dr. Bennett looks upon this chemical fact as an important diagnostic 
sign. Therefore, in cases of pleurisy and pneumonia always test the urine 
for chlorides, as follows: Add a few drops of nitric acid to a portion of 
urine in a test-tube, and then a few drops • of a solution of nitrate of silver. 
If chlorides be present, a dense white precipitate of chloride of silver, which 
is insoluble in acids, will fall. If chloride of sodium be altogether absent, 
no precipitate will occur. Part xxxi.,/). 78. 
Treatment of Pneumonia.—[There are but few diseases which are 
treated more differently by different practitioners, than pneumonia. The 
methods and remedies vary from the most simple to the most heroic. In 
the General Hospital in Vienna, the treatment is almost entirely dietetic, 
they are simply left to nature. Dr. Todd, of King’s College Hospital, dis- 
courages blood-letting and even tartar-emetic; he gives large doses of liq. 
ammon. acet. or citrat., and supports the patient from the first with animal 
broths, given frequently in small quantities, with a small amount of stimulus. 
From the statistics which we have been able to collect, we find that the 
treatment by blood-letting, conjoined with tartar-emetic, is in the present 
type of disease, the worst, and the dietetic the best, especially in severe 
cases. The indications to be fulfilled are: 
1. To diminish the general fever. 
2. To relieve the local symptoms. 
3. To check the tendency to death by depression.] 
Dr. Routh says: The surest remedy to reduce the frequency of the pulse is 
aconite. The tincture of the P. L. should be avoided as uncertain. It is most 
to be depended upon when made from the alcoholic extract of the root, say 
one grain of the extract to twenty drops of alcohol; the dose of this tincture 
i would be from half a drop to three minims (one.drop is about equivalent to 
' one grain of opium). For children one or two drops may be added to 
I eight ounces of water, and half an ounce given every two hours; for an 
adult, half a drop every two hours will very soon reduce the feverish 364 
PNEUMONIA. 
excitement. Its action must be carefully watched lest an overdose be 
given. To relieve local symptoms the patient may be placed in water as 
warm as can possibly be borne, until the patient faints, which will usually 
be in about twenty minutes ; or instead of this, Junod’s exhausting appa- 
ratus may be used, which will draw the blood from the affected part to the 
extremity. As a counter-irritant, the acetum lyttoe with chloroform 
vesicates very speedily, especially if covered with cotton-wadding immedi- 
ately after the application. This produces comparatively little discomfort 
to the patient, and, if repeated occasionally, a vast quantity of serum may 
be got rid off'. The next best application to the chest is flannel dipped in 
turpentine. At the commencement, promote expectoration by small doses 
of emetic tartar, and afterward support your patient by mild emollient diet, 
broths, and gentle stimulants. Part xxxii., p. 80. 
Treatment of Consolidated Lungs from Pneumonia.—One of the most 
interesting features we have recently noticed in Dr. Todd’s practice at the 
King’s College Hospital is a plan of treating solidified lungs and strumous 
pneumonia by turpentine—a mode not new possibly, but eminently valu- 
able, and one in which Dr. Todd seems to gain greater confidence at 
every session. 
J. B., aged 21, was admitted into King’s College Hospital, October 2d, 
suffering under various symptoms of chest disease, the result of a severe 
attack of pneumonia. Dr. Todd pointed out to his class that the entire 
lung of one side was completely solidified. This lung had, in all probability, 
gone through the three stages of pneumonia so familiar in practice, but 
often so very unmanageable in their results, the first and second stages of 
pneumonic inflammation usually merging into one another, and leaving the 
lung quite solid. 
The chief practical point, to Dr. Todd, being, that the consolidation 
of pneumonia does not necessarily destroy the vesicular structure of 
the lung, any more than effusion into the iris, in iritis, removable by 
mercury, destroys the structure of that delicate part; the inflammatory 
effusion, in pneumonia, occurring almost universally through the lung- 
tissue, as well as into the air-cells and in ter-vesicular tissue. In a very 
advanced stage of pneumonia, it is true, Ave may have pulmonary abscess. 
This was evidently not the case in the present instance. The treatment 
adopted by Dr. Todd, and which he finds the most effectual,- was the fol- 
lowing : Wine, six ounces, daily; a draught every third hour, composed 
of julep of acetate of ammonia, with aromatic spirits of ammonia in excess ; 
and strong turpentine stupes, carefully aj)plied, every night and morning, 
over the back of the chest and site of the consolidated lung. Diet 
moderately stimulating. 
25th. This man is quite well. The right lung, as will have been observed, 
is most usually that affected. Dr. Todd has great faith in the stimulant 
action of turpentine—a remedy not often used, but which in this and 
numerous other cases has proved almost specific in its action. In phthisical 
cases also it may be used combined with strong acetic acid, when its action 
becomes even still more beneficial. * Part xxxiii., p. 99. 
Asthenic Pneumonia—Treatment by Quinine.—In the first stage of an 
attack in a healthy constitution, says Dr. Corrigan, the capillaries of the 
lungs become distended, but they preserve their sthenic condition ; in such 
a case, of course, you would bleed and give tartar emetic to act upon the poisoning. 
365 
whole vascular system. But if the capillaries have passed from this sthenic 
condition, or if from the state of the constitution, the type of the disease, 
or long-continued depressing influences, they have lost their sthenic power 
from the very commencement of the attack, then we have to deal with a 
contrary state of things, in which bleeding would be injurious and dan- 
gerous. You must meet these cases by large doses of quinine, five grains 
every three hours. Quinine appears to possess the same power in giving 
contractile action to the capillaries of the lungs which we know it possesses 
in so marked a degree over the capillaries and venous radicles in the spleen. 
The large proportion of venous capillaries in both the lungs and spleen 
seems to support this view. Part xxxiv., p. 33. 
Pneumonia—Bleeding.—What are the comparative effects of practising 
or abstaining from bleeding in a case of pneumonia ? Is one or the other 
practice indiscriminately to be adopted ? The answer to these questions, 
abstracted from the evidence of Profs. Alison, Bennett, Drs. Watson, 
Gairdner, Jos. Bell, etc., may be given thus: The non-bleeding plan has a 
demonstrable advantage over that of indiscriminate and repeated bleedings. 
The judicious practice of moderate early bleedings, general or local, in 
cases of more or less sthenic pneumonia, and of refraining from it altogether 
in asthenic pneumonia, whether as regards the character of the disease or 
the constitution of the patient, is pressed upon us both by experience and 
science. Part xxxviii., p. 69. 
Pneumonia, Secondary, of Rheumatism.—Opium and ammonia, says 
Dr. E. L. Ormerod, are preferable to wine for the support of the exhausted 
nervous system, when this demands especial attention in rheumatic 
pneumonia. Depletion done judiciously may be borne, but it requires 
great judgment—if done wrongly it will tend to produce or increase 
the secondary inflammation. As a general rule you may use blisters, 
slight cupping, and watery evacuations from the bowels and kidneys. 
Part xxxix., p. 88. 
Syphilitic Pneumonia.—There is an inflammatory consolidation of the 
lung which owes its origin to the poison of syphilis. A case is recorded, 
under the care of Dr. O’Connor, at the Royal Free Hospital, in which it 
was associated with a papular eruption, and enlargement of one of the 
testicles. The treatment consisted of bhsterings all over the chest, five 
grain doses of iodide of potassium, and four grains mercury with chalk, 
and conium, twice a week. Subsequently the iodide of mercury with 
chalk, were given, till the gums became tender. Part xl., p. 54. 
POISONING. 
Poisoning by Aconite.—[Mr. Sayle relates the case of a man who died 
in. consequence of taking decoction of aconite. He saw him an hour after 
he had taken it, when he was quite insensible, pupils widely dilated, and 
pulse scarcely perceptible; he was foaming at the mouth, and throwing 
his arms about. A teacupful of brandy was administered, which, for a 
time revived him, but while the contents of the stomach were being evac- 
uated by means of the pump, he suddenly expired.] 366 
POISONING 
The plant was the aconitum napellus, stalks and leaves quite fresh. Of 
these, six were cut up and boiled in half a pint of beer down to a quarter, 
half of which he drank. 
Remarks.—The case in itself presents nothing remarkable ; but as they 
are rarely met with, I think it behooves the medical man to publish these 
symptoms carefully for the information of others. Dr. Fleming, in his 
prize dissertation, speaks of four degrees of operation in man, and finishes 
his remarks on the fourth degree with these words : “When the-action 
of the drug is carried to a fatal extent, the individual becomes entirely 
blind, deaf, and speechless. He either retains his consciousness to the 
last, or is affected with slight wandering delirium; the pupils are dilated; 
general muscular tremors, or even slight convulsions supervene ; the pulse 
becomes imperceptible both at the wrist and heart; the temperature of the 
surface sinks still lower than before, and at length, after a few hurried 
gasps, death by syncope takes place.” It will be seen that this case and 
Dr. Fleming’s description admirably agree, and that death takes place by 
syncope is proved by all the organs examined post-mortem being enor- 
mously distended with blood. 
The stimulating plan of treatment will probably succeed, when employed 
early after the evacuation of the poison from the stomach. 
Part xiii., p. 149. 
Poisoning by Aconite Root.—This has not unfrequently been mistaken 
and eaten for horse-radish; it may be known by the acid taste of the 
aconite parings, and the pinkish color which they assume when exposed to 
the air. 
With regard to the treatment of such cases of poisoning, Dr. Headland 
recommended the immediate and free administration of animal charcoal, 
mixed with water. This to be followed by a zinc emetic, then by brandy 
and ammonia. The charcoal has the power of retaining and separating the 
poisonous alkaloid, and if we have rendered help in time, the patient may 
perhaps be saved. Part xxxiii., p. 308. 
ACONITINE. 
Recovery from a Large Dose of Aconitina.—[No case of poisoning by 
this deadly alkaloid has hitherto been published, and consequently the 
description given by Dr. Bird is highly important. The patient was ? 
highly educated gentleman, and obtained the aconitina by means of a pre- 
scription of his own writing. It is supposed that almost immediately after 
taking the poison he fell, and struck his head a severe blow against a piece 
of furniture, and that the poison, or the blow, or both, produced immediate 
and violent vomiting; but how long it may have been before he was dis- 
covered, cannot be stated.] 
An excellent surgeon, and shortly after, a physician, were called to him; 
and about two o’clock in the afternoon, which must at least have been 
eight hours after taking the poison, Dr. G. Bird met these gentlemen. 
The patient was then fearfully collapsed ; the surface cold and sweating; 
quite pale ; the heart’s action scarcely perceptible; pupils acting to light; 
no paralysis whatever, either of sensation or motion. Notwithstanding the 
intense exhaustion, the intellect was unimpaired. The most prominent 
symptom was the repeated and terrific vomiting of a brownish fluid. This 
vomiting was, however, peculiar, and perhaps hardly deserved that title POISONING, 
367 
the patient really being seized with a kind of general spasm, during which 
he convulsively turned on his abdomen, and with an intense contraction of 
the abdominal muscles, he jerked out, as it were, the contents of his 
stomach, with a loud shout, depending, apparently, on the sudden contrac- 
tion of the diaphragm. These exhausting and distressing symptoms had 
occurred every minute or two. On attempting to make him swallow any 
fluid, a fearful spasm of the throat took place, producing the distressing 
effects so well known in the hydrophobia from the bites of rabid animals: 
this was not produced by the sight of water, but the convulsive movements 
of the body, and the emptying of the stomach, were excited by abruptly 
touching him. He was placed in a hot bath, afterward removed to bed, 
covered with blankets, a large mustard poultice applied to the scrobiculus 
cordis, and an enema of turpentine administered. He remained in much 
the same state, the sedative effects of the poison on the heart gradually 
lessening, so that at nine o’clock the pulse was easily perceptible, although 
weak ; the hydrophobic spasms were, however, then produced by every 
attempt to swallow, so that none of the medicines suggested for him could 
be made use of. It was therefore determined merely to administer enemata 
of beef-tea, with the yolk of an egg, and ten grains of laudanum, chiefly 
with the intention of procuring rest and giving support. He had a fearful 
night of exhaustion and spasm; intellect perfect, and even vivid, so as to 
enable him, whenever he recovered a little from his exhaustion, to carry on 
a conversation. 
After this hard struggle with death, this man emerged from the 
effects of the poison; and at two o’clock on the following day, when 
another consultation was held, he was regarded as convalescent. Dr. 
Golding Bird drew attention to the fact, that although at least tico grains 
and a half of aconitina had been swallowed, yet'that the majority of the 
poison must haVe been got rid of during the vomiting which followed the 
injury to the head, resulting from the fall. He also pointed out the re- 
markable train of symptoms developed, especially the convulsive vomiting 
and imperfect hydrophobia, as possibly being characteristic of the effects 
of the poison. For although they differed importantly from the effects of 
aconite root, with the exception of the sedative influence on the heart, still 
such a difference becomes intelligible when it is recollected that a pure 
alkaloid often differs materially in its physiological action from that of the 
plant from which it is an extract, as shown remarkably ip the case of the 
alkaloid conia. Part xvii., p. 290. 
Action of the Hydrated Sesqui-oxide of Iron on Arsenic.—Dr. Maclagan 
concludes: 
That the hydrated oxide of iron is a real chemical antidote to arsenious 
acid, and that when it removes arsenic from solution and soluble combina 
tions it acts by chemically uniting with it. 
That it appears much better fitted for removing arsenic, when it has been 
precipitated by ammonia than when precipitated by potash ; and that it an- 
swers better when in the state of a moist magma, than when dried at 180°, 
even though, when thus dried, it still retains a considerable per centage of 
combined water. 
That thus there appears to be good grounds for believing that in the ex- 
ARSENIC. 368 
POISONING, 
periments on animals, and the cases in the human subject, in which it has 
been found to arrest the action of the poison, that it acted as a chemical 
antidote and not as a mechanical protection to the stomach; that the large 
quantities which have been found necessary are required not to protect the 
stomach mechanically, but to render the poison chemically inert. That, as 
far as chemical evidence goes, at least twelve parts of oxide prepared by 
ammonia, and moist, are required for each part of arsenic, and that when 
the oxide has either been precipitated by potash, or been dried even at a 
low temperature, that about three or four times larger quantities are requi- 
site. Part ii., p. 43. 
Antidote to Arsenic.—Dr. G. Bird recommends the following ready 
preparation of the hydrosesqui-oxide of iron as one of the best antidotes to 
arsenic : Half an ounce of the tincture of the sesqui-oxide of iron ; one oz. 
of liquor potassa. Mix. Part vi., p. 149. 
By White Arsenic—Liq. Kali Carhonici.—D. Emsmann, of Eckarts- 
berge, was called to a young woman who had been poisoned by means of 
white arsenic. She was in great pain, was vomiting, purging, and suffering 
great thirst, etc. He gave, every half hour, a spoonful of a mixture com- 
posed of half an ounce of the liq. kali carb. in two ounces of sir. althese. 
The effect was immediate, the vomiting ceased, the pain was relieved, and 
the other symptoms gradually disappeared. Part vi., p. 149. 
Arsenic as a Poison—Its Tests and Antidotes.—In order to prove the 
existence of arsenic, in a court of justice, says Dr. Shearman, we should be 
enabled to show the following facts so satisfactorily, that a jury may not 
only see, but perfectly understand them. 
1st. The metal should be produced either from the contents of the stom- 
ach, intestines, or urine, if the patient should survive; or, if dead, from 
these and some part of the body. 
2d. We should be able to prove that the animal substances experimented 
upon were the excretions and parts of the patient’s body only, unmixed 
with any other matter. 
3d. We must also prove that the tests we use to show the existence of 
arsenic have not a particle of arsenic in themselves. And this requires 
great caution, because a skillful advocate might make a guilty prisoner ap- 
pear innocent, owing to this omission. 
4th. As antimony, bismuth, tin, zinc, lead, tellurium, cadmium, selenium, 
and potassium, sublime in a somewhat similar manner to arsenic, and 
may be mistaken for it, it is absolutely necessary to guard against such a 
mistake. 
The most common mode of obtaining arsenic from an organic solution, 
is that of Dr. Chi'istison, in which he gets rid of the animal matter by 
boiling for half an hour in distilled water with strong acetic acid, which 
often precipitates the casein, and renders it sufficiently pure; if not, the 
solution should be neutralized by potash or ammonia, slowly evaporated to 
dryness, redissolved in distilled water, filtered when cold, and then evapo- 
rated several times again. This eventually produces a solution free from 
animal matter. With the ammoniacal nitrate of silver this gives a lively 
yellow precipitate, the arsenite of silver; with the ammoniacal sulphate of 
copper, an apple, or grass-green precipitate, the arsenite of copper; and 
with sulphureted hydrogen gas (previously acidulated with acetic acid), 
it throws down an abundant sulphur yellow precipitate, the sulplmret of POISONING. 
369 
arsenic. This sulphuret should be collected on a filter, dried, mixed with 
black flux, or freshly ignited charcoal, introduced into a bulbed tube, and 
properly heated by a spirit lamp, when a brilliant polished metallic ring of 
metallic arsenic will be sublimed all round the tube. This is called the re- 
duction test. This metallic ring of arsenic should then be oxidized by ex- 
posure to the heat of a spirit-lamp in atmospheric air, when octohedral 
crystals of arsenious acid, with triangular facettes, will be deposited on the 
upper part of the tube, which may be easily seen with a tolerably good 
microscope. 
In Marsh’s test, where hydrogen gas is generated from zinc, sulphuric 
acid and water, and the suspected substance is added in solution, arsenic 
having such an affinity for hydrogen quickly combines what that gas and 
forms arsenietted hydrogen, which being ignited, metallic arsenic is de- 
posited on porcelain or glass, and may be seen in rhomboidal crystals with 
a powerful microscope. The objection to the test is, that we are obliged 
to use zinc, which often contains arsenic ; and although it shows the most 
minute quantity, how can we swear, after the first layer of zinc is oxidized, 
that there may not be arsenic in the next ? for arsenic runs in the veins 
of the ore. 
In Professor Reinsch’s test, modified by Christison, we mix the sus- 
pected matter with distilled water, add 5ij- of pure hydrochloric acid to 
every eight ounces of fluid, immerse a very thin and bright copper plate, 
and boil for half an our, when the whole of the copper plate will be coated 
with arsenic. By cutting these plates into chips, and exposing them in a 
tube at a low red heat over a spirit lamp, arsenious acid will be sublimed in 
octohedral crystals with triangular facettes, which may be rendered more 
distinct by turning out the chips, covering the tube with the finger, and 
chasing the oxide up and down the tube over the lamp. 
A most ingenious, scientific, and elegant method of obtaining arsensic 
has been introduced by Robert Ellis, of University College. He has dis- 
covered that the oxides of copper have such an affinity for arsenic, that by 
merely passing arsenietted hydrogen over them, a double decomposition 
takes place : caloric is given out; the oxygen of the copper uniting with 
part of the hydrogen forms water, which is seen in the process; the arse- 
nic of the arsenietted hydrogen uniting with the copper forms arseniuret 
of copper—the remaining hydrogen being set free. This arseniuret of 
copper may be easily sublimed in a glass tube, when the whole of the arse- 
nious acid will be deposited in thick brilliant clusters of octohedral crys- 
tals on the tube. The objection urged against Marsh’s apparatus will 
equally apply to this—that of being obliged to use zinc for the generation 
of hydrogen. The cleanest and safest mode of detecting arsenic is by de- 
composing distilled water by galvanism, to which is added the suspected 
solution, and pure sulphuric acid : collecting the hydrogen from the nega- 
tive pole or zincode of Smee’s battery, igniting it, and examining the stain 
left in a glass tube, open at both ends. If there is the smallest particle of 
arsenic, the hydrogen will unite with it; and you then have a stain of me- 
tallic arsenic with rhomboidal crystals which you may then oxidize into 
octohedral crystals; collect, dissolve in water, go through the fluid tests, 
reduce the sulphuret in a tube, and sublime into arsenious acid again. 
This is the most delicate test known, and perfectly free from the charge 
of using any substance in which arsenic can exist. 
The most likely substance to be mistaken for arsenic by any of these 
vol. ii.—24 370 
tests is antimony, because antimony sublimes into tbe same kind of crys- 
tals as arsenic. But by attending to the following rules the two substances 
may easily be distinguished. Metallic arsenic sublimes into rhomboidal 
crystals at a heat of 356° without liquefying. Arsenious acid sublimes at 
380° into octohedral crystals. Metallic antimony sublimes not under 
810°, and on cooling, acquires a highly lamellated texture, and yields octo- 
hedral crystals like arsenic, which are insoluble in water / whereas the 
octohedral crystals of arsenious acid are very soluble, and which solution 
may be tested by the three fluid tests. In the reduction tests with sul- 
phureted hydrogen gas, it should be carefully remembered that the sul- 
phurets of antimony, tin, selenium, cadmium, and tellurium, have nearly 
the same yellow color, and are deposited in the same manner as arsenic, 
and when reduced to their metallic state with black flux, they not only 
give an appearance so much like arsenic, that it requires a very practised 
eye to distinguish each, if even that be possible; and tellurium and cad- 
mium also exhale a garlic odor like arsenic. 
The question then comes—how can a witness swear most positively, that 
a substance is arsenic and nothing else ; and how can he convince an un- 
scientific jury of that fact ? I think only in the following manner: 
1st. By producing the metal, and showing its crystals. 
2nd. Reducing it to oxide, and showing its crystals. 
3rd. From these crystals going through all the fluid tests. 
4th. Reducing the sulplmret again to its metallic state, then to the oxide 
and again going through the fluid tests. 
If this be shown clearly with all the before-mentioned tests, it will be 
impossible for any advocate to mislead a jury. The only antidotes which 
have been discovered for arsenic are the moist hydrated peroxide of iron, 
and the moist hydrated persulphuret of iron. I have lately given dogs 
and rabbits large doses of arsenious acid in solution and powder, and imme- 
diately afterward large doses of the moist hydrated peroxide of iron, and 
then killed them within a short time. The stomachs have shown minute 
patches of inflammation, but no arsenious acid could be detected by 
Reinsch’s method, the copper plates having merely a scaly deposit of iron 
upon them; nor could arsenious acid be detected in any other way. This 
is a strong presumption that the whole of the arsenic was reduced to its 
metallic state. 
Dr. Golding Bird suggests that hydrated per-oxide of iron may be ex- 
temporaneously prepared by adding one ounce of liquor potassae to half an 
ounce of tincture of sesquichloride of iron. Part ix., p. 55. 
POISONING. 
Magnesia in the Treatment of Poison by Arsenic. — Magnesia, not 
strongly calcined, is recommended by M. Bussy as an excellent antidote to 
arsenious acid ; it removes it entirely from a state of solution in water, and 
forms an insoluble compound. Magnesia in a gelatinous state answers 
best. Magnesia decomposes emetic tartar, the salts of copper, and corro- 
sive sublimate, also the organic alkalies, morphia and strychnia. 
Dr. Christison recommends the light pure magnesia, which may be ob- 
tained in a gelatinous pulpy state, by adding a solution of caustic potash to 
a cold saturated solution of sulphate of magnesia, and washed afterward 
with cold water. The dense magnesia has very little action on arsenic in 
solution. When the gelatinous cannot be obtained, then use the light cal- 
cined, in proportion of between thirty and fifty parts to one of arsenic taken. poisoning. 
371 
As in the hurry of these cases it is frequently difficult to know what 
quantity of arsenic has been taken, it must be left to the discretion of each 
practitioner to judge what quantity of the magnesia he shall administer as 
the antidote. Part xiv., p. 117. 
Poisoning by King's Yellow.—King’s Yellow, according to Dr. Chris- 
tison, contains sulphuret of arsenic, caustic lime, and free sulphur, and in 
all probability, the lime exists in the form of a triple sulphuret of lime and 
arsenic. 
The hydrated peroxide of iron acts as the best chemical antidote, com- 
bining with the arsenic in the stomach to form an arsenite of iron which 
has little solubility, and therefore little energy as a poison. As the 
arsenic may be again set free by the secretions of the stomach, take care 
to give the peroxide in excess, and repeatedly until all effects subside. 
Part xiv., p. 119. 
Poisoning by Arsenic.—[In a paper read before Guy’s Hospital Phy- 
sical Society, Mr. Odling states it as his opinion that the only plan of treat- 
ment to be depended upon is the removal of the poison physically from the 
stomach, and that this is best effected by using the double-action stomach- 
pump. He next considers the remedies to be used in cases of arsenical 
poisoning, and first, of the hydrated ferric oxide, or sesqui-oxide of iron. 
This, by being administered in the state of a moist magma, suspends the 
poison, but its power is extremely weak, and the compound formed with it 
is perfectly soluble in the gastric juice, and has been found to possess poi- 
sonous properties. Magnesia, so much vaunted at one time, is even less 
fitted to act as a chemical antidote.] 
Mr. O. would at once wash out the stomach by means of the double ac- 
tion stomach-pump, with a solution of chromate of iron or alumina, or a 
mixture of permanganate of potassa solution, or with hydrate and acetate 
of ferric oxide, or with hydrate and acetate of alumina. By these com- 
pounds the soluble arsenious acid is immediately converted into insoluble 
arsenic acid or into the insoluble sesqui-arseniate of alumina, iron, or 
chrome. Ten grains of the permanganate of potassa may be mixed with 
half a pint of the aluminous emulsion, under which circumstances, its 
irritant action would be very trifling, not more than that of an ordinary sul- 
phate of zinc emetic. Part xxiii., p. 317. 
Arsenic—Test for.—Give magnesia mixed to the consistence of cream, 
in doses of two or three tablespoonfuls. In a case reported by Dr. Mac- 
lagan, the patient took four ounces in three quarters of an hour, and, no 
doubt, vomited it nearly all up again. Reinsch’s test is a most valuable 
and convenient one in cases of poisoning by arsenic. All that is required 
is a little muriatic acid, a bit of copper wire, and some vessel as a test tube, 
in which they can be heated together. These articles are so common that 
it must be rare when they cannot be supplied. If the piece of copper be 
crusted black during the boiling, and when heated in a candle-flame loses 
its crust, and gives off alliaceous fumes, the evidence will be sufficiently 
precise. " Part xxv., p. 322, 
Electro-Chemical Mode of Testing for Arsenic.—Dr. Davy’s process is 
adapted to detect arsenic in all its states of combination, and in various 
organic mixtures ; and it is a strong recommendation of it, that it obviates 
in many instances, any troublesome or tedious manipulations. It essentially 
consists in depositing the arsenic in a metallic state upon a surface of pla- 372 
POISONING. 
tinmn (as a platinum capsule or a sheet of that metal), by touching the spot 
with a rod or thin slip of zinc, and maintaining the contact for a few 
seconds, when the metal arsenic falls as a film, more or less thick in pro- 
portion to its amount, and adhering firmly to the platinum, whence it can 
be removed by heat or acids, and subjected to any further tests that are 
desirable. 
To prepare the solution for testing, some pure muriatic acid must be 
previously added ; and when the fluid is very dilute it is then concentrated 
by boiling before using the electro-chemical test. After the concentration, 
which may be carried to a considerable extent with advantage, it is well to 
add some more muriatic acid before testing. Sulphuric acid appears, from 
some experiments, not to interfere with the result, but nitric acid did. 
“ There was some difficulty in exhibiting the arsenic.” 
In testing such arsenical compounds as realgar and orpiment, arsenical 
pyrites, etc., they require first to be acted on by nitric acid to dissolve 
them, and then all excess of this acid, either exhaled by heat or neutralized 
previous to adding muriatic acid and testing, as a minute quantity of nitric 
acid retards the reduction of the arsenic or redissolves it. 
Part xxxiv., p. 299. 
• BELLADONNA. 
Belladonna Poisoning.—Dr. Jenner, of University Col. Hospital, re- 
commends to apply a blister to the back of the neck, and give an aperient 
with live grains of the sesquicarbonate of ammonia every hour or half-hour, 
according to the severity of the symptoms. Part xxxv., p. 279. 
Animal Charcoal an Antidote to Vegetable Alkaloids.—Dr. Garrod, of 
University Col. Hospital, says that if to the solutions of the poisons of hen- 
bane, belladonna, stramonium, or morphia, a little animal charcoal be 
added, the poison is completely neutralized. This property makes animal 
charcoal of the greatest use as an antidote to these substances ; common 
black bone will do very well; vegetable charcoal does not possess these 
properties. Part xxxvii., p. 259. 
Poisoning by Belladonna. —Use of Opium recommended. Vide 
“ Poisoning by Opium.” 
COLCIICUM. 
Poisoning by— Case.—The subject of the following case was ordered 
in a public institution six drachms of tincture of colchicum in a half pint 
mixture of Epsom salts, of which he took one ounce every six hours. It 
was ascertained that a larger quantity (six ounces) of the colchicum had 
been put into the bottle than was prescribed. Vomiting soon commenced 
after the first dose, and after the third the nose began to bleed profusely, 
accompanied with violent purging. Notwithstanding these violent symp- 
toms, the medicine was continued. His medical attendant found him 
sitting up in bed, with his back reclined against the wall, his arms hanging 
listlessly beside him, his head bent forward upon his breast, and his shirt 
drenched with blood from his nostrils. His mouth was open, his eyes 
were staring, full, and turgid; the vessels of the adnata congested and 
the pupils dilated ; pulse 170, full, bounding, and incompressible, and respi- 
ration short and hurried. Thirty ounces of blood were taken from the POISONING. 
373 
arm, and a mixture containing potass, carb. and liq. opii sed. was prescribed, 
followed by port wine and cinchona bark. This treatment seemed to rally 
the patient, but he ultimately relapsed and died. 
Dr. Thompson makes the following practical remarks : 
On reviewing the treatment of this important case, I have little to re- 
mark, except that it is probable, had my assistance been sooner demanded, 
I should have opened the tempox*al artery, instead of bleeding from the arm. 
I am of opinion, that in the early stage of poisoning by an acrid, or a 
narcotico-acrid poison, the poison is circulating in the brain, and that 
much benefit would result from rapidly abstracting a large portion of it 
from the vicinity of that organ, upon which much of its energy is exerted. 
By such a practice, also, the sympathetic irritation would have been 
greatly lessened, and time would have been thus afforded for providing 
against the collapse, which, in all these cases, is the result to be dreaded. 
Part viii., p. 48. 
COPPER. 
Jig the salts of Copper— Treatment by Solution of Carbonate of 
Soda.—Liquid albumen is generally administered as an antidote in cases 
of poisoning with the salts of copper, but it has this disadvantage, that 
as we are unacquainted with the exact quantity necessary to neutralize the 
copper, if we employ too great a quantity, the poison is dissolved in the 
excess of albumen. To remedy this inconvenience M. Benoist proposes 
to substitute for albumen, a solution of carbonate of soda, which forms 
with the salts of copper an insoluble carbonate, having no deleterious 
action on the economy. Part, v., p. 84. 
Hydrated Proto sulphur et of Iron—Suggested as an antidote in poi- 
soning by the Salts of Copper. Vide Art. “Poisoning by Corrosive 
Sublimate.” 
CORROSIVE SUBLIMATE. 
Gold Leaf and Iron-filings, as a Galvanic Antidote to Corrosive Sub- 
limate.—All the compounds of mercury are more or less poisonous, but 
none more likely to be so than the corrosive sublimate or bichloride, on 
account of its being introduced so much in the process of tanning and to 
prevent the decay of timber, as well as in the destruction of insects ; thus 
exposing individuals to the danger of introducing it accidentally into the 
stomach. Gluten and albumen have hitherto been our chief antidotes, 
especially albumen, which changes the corrosive sublimate into calomel, 
and thus renders the patient liable to very severe salivation, which, of 
itself, is attended with inconvenience and even danger. Dr. Buckler, 
amongst other experiments, found, “ that by throwing gold dust into a 
solution of mercury, no action took place till iron-filings were added, when 
the metallic mercury was at once revived, and was seen to precipitate in 
a state of amalgam with the gold ; at the same time, the oxygen from the 
corrosive sublimate goes over to the iron, and forms an oxide of that 
metal with which the chlorine combines, leaving a hydrochlorate of iron 
in solution.” 
The result is a complete decomposition of the poison. Two grains of 
gold and two of iron are sufficient to decompose five grains of corrosive 
sublimate. 374 
POISONING. 
The proposed antidote should be kept by the druggists in papers con- 
taining each, 
Finely-divided gold, ditto iron, aa. 9ij; gum acacia, 3ss. M. 
free from dampness, to prevent oxidation to the iron. In poisoning with 
any compound of mercury, one powder is to be stirred in a tumbler of 
water, and swallowed; if any of it is rejected, another powder should be 
given. If a solution of mercury were swallowed, we could not expect 
much benefit to arise from the use of gold and iron, in any other state than 
that of dust. In case of poisoning with the insoluble compounds of mer- 
cury, if the dust cannot be obtained, then use the metals in the form ot 
beads, fine chains, or any other shape in which they can be swallowed. 
Dr. B believes that they would decompose the soluble salt with as much 
rapidity, at least, as it could be formed in the stomach. 
Mr. Barry thinks that Dr. Buckler’s discovery may prove exceedingly 
important; but seems to disagree with him on some parts of the question. 
He is of opinion that the decomposition is owing “ to the thin stratum of 
fluid immediately enveloping the two contiguous particles of iron and 
gold; ” and, therefore, that “ it is essential that these metals should be in 
a state of division so exceedingly minute, as to remain a short time in 
suspension throughout the whole fluid of the stomach. Every drop of 
that fluid must be made to contain a multitude of these particles, and yet 
the entire weight administered be very small.” The chief difficulty in this 
case will be, not in the minute division of the gold, but in that of the iron.. 
It is probable, however, that in this combination of gold and iron, we shall 
possess, when properly managed, a complete antidote to one of our com- 
monest and strongest poisons. Part, v., p. 34. 
Hydrated Protosulphuret of Iron as an Antidote to Corrosive Sublimate. 
—M. Mialhe has discovered that hydrated protosulphuret of iron, a perfectly 
inert substance, instantly decomjmses corrosive sublimate ; protochloride of 
iron and bisulphuret of mercury, two inert substances are formed. This 
preparation will probably also be found equally efficacious as an antidote 
to other poisonous salts, as those of copper and lead. 
The following is the mode of preparing the hydrated protosulphuret of 
iron: Dissolve any quantity of pure protosulphate of iron in at least 
twenty times its weight of distilled water, deprived of air by boiling, and 
precipitate the iron with a sufficient quantity of sulphuret of sodium, dis- 
solved also in distilled water, deprived of air. Wash the protosulphuret 
thus obtained, with distilled water, and preserve it in stoppered bottles, 
filled with boiled distilled water. 
Although the preparation of this sulphuret of iron is very simple, and 
may be effected in a few minutes, yet it would be desirable to keep it 
always prepared, that no time may be unnecessarily lost in any case of 
poisoning. 
The precaution of preserving this sulphuret out of contact of the air, 
must be strictly observed, as it has a great tendency to pass into the state 
of sulphate. Part, vii., p. 83. 
Antidotes of Corrosive Sublimate, Copper, Lead and Arsenic.—By 
means of numerous experiments, first made in the laboratory and then 
repeated on dogs, MM. Bouchardat and Sandras have arrived at many inte- 
resting results relative to the antidotes of corrosive sublimate, copper, 
lead and arsenic. POISONING. 
375 
Their conclusions were, that the following substances may be regarded 
as antidotes, and employed as such in medicine: 
As Antidotes for Corrosive Sublimate—A mixture of zinc and iron fil- 
ings ; or powder of iron reduced by hydrogen ; or the moist persulphuret 
of the hydrated peroxide of iron. 
As Antidotes for Copper.—A mixture of zinc and iron filings; iron re- 
duced by hydrogen ; porphyrized iron ; zinc filings ; or the persulphuret of 
the hydrated peroxide of iron. 
As an Antidote for Lead.—The moist persulphuret of the hydrated per- 
oxide of iron. 
As Antidotes for Arsenic.—The moist hydrated peroxide of iron; the 
dry hydrated peroxide of iron; and the moist persulphuret of the hydrated 
peroxide of iron. 
These experienced chemists add the following reflections: This last 
preparation, the persulphuret of the hydrated peroxide of iron, possesses 
this superior advantage over all the rest, that it changes the nature of all 
the four poisons above noticed, and is especially applicable in those cases 
where we have not had time to find which of the poisons has been taken. 
As to the manner of administering these antidotes, and the doses which 
it is necessary to administer, the simplest means appear the best. The 
powders of zinc and iron may be suspended in any electuary, or they may 
be swallowed in wafer paper. The magma of the hydrated preparations 
of iron may be swallowed in the form of jelly, in which they are procured 
from the druggists. Several draughts of lukewarm water ought to follow 
the antidote, and the fauces be tickled with a feather, to excite vomiting 
and the expulsion of the poison. The efforts at vomiting scatter more 
effectually over the stomach the antidote which is administered. As to 
dose, the experiments proved that 100 grains of the powder of iron or of 
zinc sufficed to prevent any bad effects from 15 grains of the acetate of 
copper. Fifteen drachms of the moist magma of the persulphuret were 
required to produce the same effect with the same dose (15 grains) of the 
acetate of copper. To act as an antidote to 4i grains of arsenious acid, 
15 drachms of the moist magma of the persulphuret, or 30 drachms of the 
moist hydrated peroxide of iron, or 20 drachms of the dry hydrated per- 
oxide of iron, were required. With regard to the time when these anti- 
dotes can be administered with advantage, in so far as the acetate of cop- 
per is concerned, the lapse of 40 minutes from the time of swallowing the 
poison ought not to be regarded as a sufficient reason for not administering 
the antidote; but arsenic is more quickly absorbed. Nevertheless, the 
antidote should always be administered, because, though it will not neu- 
tralize what is absorbed, it will prevent its further absorption, by decom- 
posing what remains in the stomach. Part ix., £>. 78. 
Mineral Poisons.—MM. Sandras and Bouchardat recommend a uni- 
versal antidote for the mineral poisons, the persulphuret of iron in such 
quantities as to be always in excess in the intestines, to prevent the reab- 
sorption of the poisonous matter. They administer first a purgative, and 
order a soap-bath, then give the patient a mixture of sirup and persulphu- 
ret of iron night and morning. Opium, strychnia, or belladonna may be 
employed at the same time. Two cases only proved fatal out of 122 with 
lead colic thus treated, and the others were rapidly cured. 
Part xiv., p. 324. 376 
POISONING. 
New Process for the Detection of Metals in Medico-Legal Researches.— 
M. H. Gaultier de Claubry gives the following: “ Process by which all 
Metals can be obtained by a single operation, in chemico-legal researches.” 
His objects are,—1, to obtain in all cases a solution of the metal; 2, to 
collect the metal from the solution ; and 3, to present it in solution, in as 
concentrated a form as possible, to the action of chemical reagents. He 
says: 
With this intention (that of obtaining a perfect solution of the metallic 
substances), hydrochloric acid or chlorine have been employed, with more 
or less advantage. Without stopping to discuss the advantages or incon- 
veniences arising from their employment, we may say, that the alteration 
desired to be affected by them is always more or less difficult, and that a 
great proportion of the organic matter resists their action. We know, 
from numerous facts, how much more readily a body enters into a new 
combination when in a nascent state, than when in the form under which 
we see it; and it is precisely in this state that chlorine may be made avail- 
able for the object which occupies our attention. If we introduce any 
organic matter into fuming hydrochloric acid, and, after having removed 
the fatty matters, which are altered with difficulty, gradually add concen- 
trated nitric acid to the fluid, either cold or slightly warmed, a complete 
solution is obtained of everything, with the exception of fatty matters. 
The solution is almost colorless, transparent, and can be afterward tested 
with the greatest facility. 
The stomach, intestines, liver, products of vomiting, excrements, blood, 
urine, wine, milk, earth from burying-grounds, etc., can all be treated after 
this method, which requires no particular care, so that the operation is 
performed as easily as the solution of a metal in an acid. Where the poi- 
sonous agent is arsenic, if the operation be conducted slowly, the metal 
does not pass oft’ by evaporation; however, as a portion of chloride of 
arsenic may be volatilized, and as the chlorine and acid require some 
means to prevent them from passing off, and incommoding the operator 
by Ailing the laboratory with their vapors, it is always best to use a retort 
furnished with a tubular receiver. When the operation is finished, the 
condensed liquor is to be treated in the manner to be presently described. 
A tubular retort, into which are introduced in succession, first, the hydro- 
chloric acid, then the suspected materials, and finally the nitric acid, is 
thus sufficient for the operation. If it be known that arsenic do not exist, 
and there be no necessity for guarding against the escape of acid vapors 
and of chlorine, the operation may be performed in a matrass. By this 
process the difficulties are prevented which arise from the employment of 
sulphuric acid for the destruction of the organic materials, and a perfectly 
liquid product is obtained. 
When the materials are much disorganized, the nitric acid is to be intro- 
duced gradually, and gentle heat is to be applied. When, after successive 
additions of the acid, the organic matters have disappeared, leaving only 
fatty matters, the liquor is to be decanted, and the residuum washed several 
times in distilled water. This is to be poured off, and mixed with the acid 
solution. After this, the detection of the metals becomes extremely easy, 
and may be effected in various ways. 
If it be desired to use hydrosulphuric acid, the nitric acid must be 
driven off, by boiling the liquor with an excess of hydrochloric acid, until 
chlorine ceases to escape; after this, the liquor will only have to be tested 377 
POISONING. 
for zinc, which may he present accidentally, or for those metals which are 
not precipitable by hydrosulphuric acid. If Marsh’s test is to be em- 
ployed, the liquor must be saturated with pure potash; and, after decom- 
position has taken place, sulphuric acid must be added, till the last traces 
of nitric acid are removed. The operation may then proceed in the ordi- 
nary manner. 
I have employed another process, which seems to olfer important advan- 
tages, and is easy to be performed; it depends on the precipitation, by a 
galvanic current, of the metals in solution. After having concentrated the 
liquors, as far as experience may determine to be necessary for di'iving ofi* 
an excess of acid, there are to be placed in the solution two plates of pla- 
tinum, or a single plate of that metal, forming the cathode of a permanent 
battery; and another of zinc (if that metal be not sought for), of tin, or 
platinum, forming the anode. After an interval of greater or less dura- 
tion, according to circumstances, but never exceeding, in the most unfa- 
vorable conditions, eight or ten hours, the platinum is covered by a de- 
posit of the metal, or metals, which were in solution. This deposit is to 
be washed, and treated with hot or cold nitric acid; a solution of the 
metal or metals is thus obtained, which, from the small quantity of liquid, 
can be operated on with the greatest facility. In this way, almost infini- 
tesimal quantities of the various .metals may be detected, and it is obvious 
that the same proceeding is applicable to all, with the exception of silver, 
which is rarely to be tested for in cases of poisoning, and zinc, which 
necessitates the employment of tin or platinum, as the anode of the pile. 
Although sparingly soluble, chloride of lead dissolves in an excess of 
hydrochloric acid easily enough for all the lead to be detected in the liquor. 
If the presence of arsenic be suspected in the matters to be examined, 
the liquid procured by the treatment with nitric acid, must be saturated 
with potash and after the solution has been conveniently concentrated, it 
must be mixed with the solution of the organic products. In no other 
case have volatile products to be dealt with. 
It is well known that bakers have sometimes fraudulently introduced 
extremely small proportions of sulphate of copper into paste. The com- 
bustion of the charcoal from bread is very tedious, but an examination is 
performed with ease and rapidity by the process which I have described. 
It permits a large quantity of bread to be operated on, and a repetition of 
the experiments, with a degree of exactitude, which leaves nothing to be 
desired. 
When, in testing for zinc in bread, or in other organic matters, recourse 
Is had to carbonization, there is always danger of a portion of the metal 
Deing volatilized; by treating it with aqua regia, the operation is rendered 
easy, and no part of the metal is lost. It is not necessary to mention all 
the other circumstances to which this new method may be applied. I 
have met with no case in which I have not been able to employ it; and 
hence I may consider its adoption will render great services to chemists, 
when called on to make researches of the kind under consideration. 
It may be objected to this method, as to many others in which hydro- 
chloric acid has been used, that this acid may contain arsenic. There is 
but one answer to this objection, viz., that as hydrochloric acid can be 
obtained free from arsenic, such must be procured, and alone employed. 
Sulphuric acid, also, often contains a greater or less quantity of this metal; 
that only which is free from it is to be used. Part xix., p. 215. 378 
POISONING. 
Animal Charcoal an Antidote to Poisons.—Fresh animal charcoal, 
when used in sufficient quantity, has the property of withdrawing from 
their solutions most, if not all, known vegetable and animal poisonous 
principles, and some mineral poisons. It should therefore be immediately 
administered in all cases; whilst, in the case of mineral poisons, the usual 
should also be given. Part xx., p. 298. 
CUBEBS. 
Use of Electro-Magnetism.—Dr. Page, of Valparaiso, has used this 
means in a case of poisoning by a large dose of powdered cubebs. The 
patient took half an ounce of this drug on going to bed, and was found 
next morning with his face red and swollen, lips dark purple, veins of the 
forehead and temples turgid, eyes rolling upward and injected, with the 
pupils contracted to a point, respiration very slow, short, and gasping, 
and with all the other symptoms of comatose sleep. Every method that 
could be thought of to rouse him was tried in vain; he soon returned to 
the same state of insensibility, and death seemed to be inevitable. In this 
case, Dr. Page tried the electro-magnetic battery with success. With an 
assistant rapidly rotating the wheel, he applied the balls at first to each 
side of the neck, and ran them down behind the clavicles. The arms and 
body now moved convulsively, but the patient lay as unconsciously as 
before: but on applying one ball over the region of the heart, and the 
other to a corresponding point on the right side, the patient opened his 
eyes widely, his head and body were thrown convulsively forward, and he 
groaned. He again sank back into his former state ; but on applying the 
balls to the same regions, he became conscious, and ultimately recovered. 
Dr. Page in this case used a large horse-shoe magnet mounted upon a 
stand, in a vertical position, with an armature, fixed upon an axis between 
the poles, so as to revolve in front by means of a wheel; but a much more 
portable machine is now made by most surgical-instrument makers, and 
which ought to be in the possession of every general pi’actitioner. 
Part vii., p. 32. 
PRUSSIC ACID. 
The Liquor Oxysulphatis Ferri—Thought to he an antidote to poison- 
ing by prussic (hydrocyanic) acid. Part v., p. 68. 
Cold Douche.—In cases where prussic acid has been administered, and 
the frame is influenced by that deadly poison, a valuable auxiliary will be 
found in cold affusion, to chlorine, ammonia, artificial respiration, etc. 
Ilerbst, Orfila, and others, speak highly of its powers. It occasionally 
happens that a sudden alternation from cold to hot applications, and from 
hot to cold, will be more beneficial than a continuance in the one or the 
other, exemplifying what Dr. Marshall Hall says, “ that it is not the mere 
application of cold, but the sudden application of cold to a warm surface, 
which is the effectual means of exciting respiration. It is the sudden 
alternation.” In the cases of persons to all appearance dead, heat and 
cold are powerful measures in arousing the respiratory system ; but they 
are not to be regarded as substitutes for other methods of resuscitation, 
so much as allies to them. The value of temperature in congenital asphyxia 
is admitted universally: one dash of cold water will suffice sometimes to 
excite breathing where it is delayed. Part viii., p. 45, Sulphate of Iron, xoith an Alkaline Carbonate, an Antidote for Prussic 
Acid.—[Messrs. Smith recommend, that in cases of poisoning by prussic 
acid, the first thing to be done should be to give a large dose of either 
caustic or carbonated magnesia, in order to neutralize the effects of the 
free acid, which is almost invariably to be found in the stomach, and 
which interferes with the action of the remedy they propose. This con- 
sists of two substances: the first, a salt of iron, of the same constitution as 
Prussian blue, and which is readily prepared by the following process:] 
Seven parts of proto-sulphate of iron, say seven half-draclnns are re- 
quired, four of which are to be formed into persulphate. This is done by 
adding to the solution a quantity of sulphuric acid equal to the half of 
what it already contains ; which, for two drachms, would be twenty-three 
grains of acid of the density of 1.845, and at a boiling heat; adding, at 
short intervals, small quantities of nitric acid, till red nitrous fumes cease 
to be given off. The liquid is then to be evaporated in a porcelain basin 
of perfect dryness, by the heat of a water-bath, stirring constantly with a 
glass rod, till the excess of acid is thoroughly driven off. The operations 
will be more quickly finished in a bath of a saturated solution of salt. 
The perfectly dry salt is then to be dissolved in distilled water, along with 
one and a half drachms of proto-sulphate of iron, so that the solution may 
amount to two ounces. This solution will not of itself precipitate prussic 
acid, but if a solution of an alkaline carbonate be previously added, con- 
taining a quantity just sufficient to take all the sulphuric acid from the 
iron salt, the prussic acid combines instantaneously with the iron, forming 
the very permanent and insoluble compound Prussian blue. As the solu- 
tion of the sulphate of iron contains in all nine equivalents of sulphuric 
acid, the same number of equivalents of carbonate of potash—the alkaline 
carbonate we use—will be required to seize upon these and produce com- 
plete decomposition. The relative quantities are 910 grains of proto- 
sulphate of iron, and 623.43 grains of carbonate of potash. Now, as the 
quantity of sulphate of iron given in our formula was seven half drachms, 
or 210 grains, the correct quantity of carbonated alkali can be found 
by the following proportion—910 : 622.43 : : 210 : : 144. There- 
fore 144 grains is the proper quantity for the exact decomposition of the 
iron salt; and for the sake of simplicity, we dissolve this in the same 
quantity of water as the sulphate of iron. As each of the solutions contains 
exactly 961 minims, which, by calculation, should throw down 56.8 grains 
of red prussic acid, between 17 and 18 minims of each should separate the 
grain ; and as the hydrocyanic acid of the London Pharmacopoeia contains 
two per cent, of real acid, 35 minims of each would be required to pre- 
cipitate 100 grains of such an acid. The acid of the Edinburgh Pharma- 
copoeia, on the other hand, containing about three per cent., a third more, 
or about 52 minims of each of the solutions, would be necessary to sepa- 
rate all the prussic acid from 100 grains. It is probably unnecessary to 
carry the calculation higher, as we suspect, that if a larger quantity than 
100 grains should be taken, the fatal effect would be so rapid, as com- 
pletely to exclude the possibility of rendering any available assistance. 
These are the quantities theoretically necessary, and, when pure materials 
are used, will be found very nearly correct, as tested in an open vessel; 
but when given as an antidote for the poison, Ave would recommend not 
less than three times the theoretical quantity to be given, as from the 
jjresence of food, mucus, etc., in the stomach, it is improbable that the 
POISONING. 
379 380 
antidote would mix immediately with the poison at every point, so that, 
to render the action more certain, a large excess is advisable, more espe- 
cially as this can be attended with no evil consequences, as the only effect 
that could follow an excess would be the formation of sulphate of potash 
and an insoluble mixture of proto-carbonate and peroxide of iron, which, 
if active in any way, would, by producing sickness and vomiting, be really 
in the direction most to be desired. Part xi., p. 99, 
Poisoning by Prussic Acid.— What ought a practitioner to do in $ 
fearf ul an emergency ? 
According to Dr. Christison, he ought, in the first place, to dash cold 
water on the face, the naked anterior part of the chest, and dorsal spine. 
Care must be taken not to soak the clothes of the patient. The object is 
not to chill the patient, but to produce a sudden shock on the external 
respiratory nerves, for the purpose of inducing a sudden expansion of the 
thoracic walls, and the full inflation of the lungs as a consequence thereof: 
and further, by getting the lungs thus expanded, we enable the right side 
of the heart to unload itself. 2. Diffusible stimuli may be given. 3. A 
small, but sudden abstraction of blood, pleno rivo, from the jugular vein, 
must be practised if the heart has ceased to beat, or beats very feebly, 
4. If the cold affusion, diffusible stimuli, and bleeding from the jugular, 
are not sufficient to restore the action of the heart and lungs, then artificial 
respiration must be resorted to. We need say nothing in favor of the 
cold affusion, as every one believes its employment in poisoning with 
prussic acid to be orthodox. The same remark will apply to the exhibi- 
tion of diffusible stimuli and trying artificial respiration. 
Part xii., p. J1S. 
Poisoning by Prussic Acid—Treatment.—Of all remedies, says Mr. 
Hicks, chlorine, ammonia, and the cold effusion, appear to be most 
generally relied on; and as ammonia is most readily to be obtained, this is 
resorted to in the greater number of instances. Should I be called to a 
case, I would on no account lose time by endeavoring to pour fluids into 
the stomach, but would at once put in practice a suggestion, for which I 
have to thank Mr. Taylor, which, he states, is of much service in many 
cases of asphyxia. It is merely to saturate a handkerchief with the liquid 
ammonia, and then to wave it over the face of the patient, by which means 
the individual being as it were enveloped in an atmosphere of ammonia, 
there is every chance of its vapor passing into the lungs ; and this has been 
found even of more service than where the ammonia has been given inter- 
jially. There is, however, another remedy mentioned by authors, but 
which I think has been spoken of too lightly; I allude to venesection. I 
would by no means neglect to adopt venesection in any future case, in 
combination with cold affusion, ammonia and artificial respiration. I 
would, however, observe, that in advocating bleeding, I do not mean to 
say that it is to be performed indiscriminately, but merely in those cases 
where congestion of the brain and lungs is evident from the bloated and 
livid appearance of the face. With respect to the treatment, I cannot do 
better than conclude with the words of Dr. Christison, who says, it is right 
to remember that on account of the dreadful rapidity of this poison, it will 
rarely be in the physician’s power to resort to any treatment soon enough 
for success; and further, that his chance of success must generally be 
feeble, even when the case is taken in time, because, when hydrocyanic 
POISONING. acid is swallowed by man, the dose is generally so large as not to be 
counteracted by any remedies. Part xii., p. 121. 
Poisoning by Prussic Acid.—[Mr. Bishop was sent for to a man who 
was stated to have taken poison. He found him in bed, senseless, with 
ghastly pale countenance ; face swollen and covered with perspiration ; 
breathing slow, labored, and accompanied by a hissing sound ; the corner 
of the sheet was between his teeth; along the sides of which quantities 
of thick white foam issued at each expiration ; the eyes were wide open, 
fixed and glazed, and the pupils widely dilated; the pulse slow and 
scarcely perceptible, heart’s action weak, and the whole body in a rigid 
state, with the respiration becoming at each instant more laborious. Ilis 
wife thought he had taken prussic acid, from finding a bottle so labelled, 
and Mr. B. accordingly decided on instantly trying the effects of cold 
water dashed on the body.] 
I then prepared him for the cold douche, by tearing away his shirt and 
flannel waistcoat, and directing two assistants to hold him off the side of 
the bed. A bucket of cold water was soon brought, and with a vessel 
holding about a quart, I commenced pouring the water upon him, so that 
it might flow over his face, chest, and abdomen. It produced a decided 
shock; he gave a start, after which the muscular system became relaxed ; 
the sheet dropped from his teeth, and the hands opened ; respiration was 
more quickly performed, and he sobbed violently. I applied it a second 
time; he again started, sobbed, began to roll his eyes about and utter the 
most agonizing cries. He evidently knew me, and in a second or two 
begged of me not to douche him again ; but as respiration was still slow, 
and the pulse weak, I continued, and found that after each application of the 
water he breathed quicker, and the pulse also became quicker and stronger. 
I now dissolved two scruples of the sulphate of zinc in a tea-cupful of warm 
water, and asked him to drink it, which he did very well. As soon as he 
had swallowed the emetic, ammonia, which I had sent for, on ascertaining 
that hydrocyanic acid had been taken, was brought to me; it was very 
strong, and I applied it to the nostrils, and rubbed the temples and the 
palms of the hands with it. The pulse rose, and the face became red, and 
at each inspiration of the ammonia, the patient said, “ Oh, I am better 
now; this has done me goodindeed, he became very loquacious, and it 
was with difficulty he could be restrained. In about ten minutes, vomiting 
took place, and the ejected matter smelt so strongly of prussic acid, that it 
was almost impossible to remain near it. The pulse was now 90, and full; 
the countenance bloated, with redness of face; and he occasionally com- 
plained with crampy pain in his arms and legs, and said, “ It is coming on 
again.” I continued the application of the ammonia, and every minute or 
two caused him to inhale it. A vein wras next opened in the arm, and sixteen 
or eighteen ounces of blood extracted, pleno rivo. It was of a dark color, 
and I thought at the time emitted the odor of prussic acid. Afterward I 
was convinced that it was an error, and that it arose from the room being 
so impregnate with the smell from the vomited matter. He occasionally 
complained of cramp in different parts of his body, but no other unfa- 
vorable symptoms followed. The patient had taken about 40 minims of 
prussic acid. Part xii., p. 124 
Poisoning by Prussic Acid.—[From an account of a case of poisoning 
by prussic acid, we extract the following, as being most interesting to the 
FOISONING. 
381 382 
POISONING. 
toxicologist.] A Jewess, aged 22, of generally good health, was ordered 
a mixture, to take a fourth part twice a day, for a pain in her side: and a 
lotion for chilblains was also given to her at the same time, which con- 
tained nearly four grains of anhydrous prussic acid. By mistake the labels 
were reversed, and a quarter of the lotion, containing little less than one 
grain of the pure poison, was taken. Death ensued in from fifteen to 
twenty minutes. Mr. Letheby obtained from the remainder of the lotion, 
amounting to about two ounces, 9.2 grains of cyanide of silver ; this would 
indicate 1.85 grains of anhydrous prussic acid ; and as half this quantity 
was taken, a dose equal to 45 or 50 drops of the medicinal acid, or 23 to 
25 drops of Scheele’s strength, were swallowed. 
The principal points for consideration are the following: The Dose.— 
Here a little less than one grain of absolute hydrocyanic acid, diluted with 
one ounce of water, occasioned death in from fifteen to twenty minutes. 
It is the smallest fatal dose upon record; for although the Parisian 
epileptics are reported, in most of our works upon medical jurisprudence, 
to have been killed by about two-thirds of a grain of prussic acid, yet it 
is now proved beyond all doubt that they are in error, and that the quantity 
of anhydrous acid which each patient took was five and a half troy grains. 
We learn this from a letter recently received from Professor Guibort, and 
published in the “Pharmaceutical Journal” for May. How so egregious 
an error could have crept into our English works is past my comprehen- 
sion. In reasoning, however, upon the present case, it does not appear to 
me that we are warranted in supposing that one grain of pure hydrocyanic 
acid would, under all circumstances, be sufficient to cause djeath ; on the 
contrary, the experience of almost every one, to say nothing of the cases 
which are upon record against this conclusion, would suggest that, in this 
instance, it was an unusually small dose for such a fatal event; and I am 
led to think that its potency was increased by the empty condition of 
deceased’s stomach. All that we can say, therefore, upon this case, is, 
that one grain of hydrocyanic acid may occasion death ; we go beyond our 
warrant when we say it will. 
[The immediate cause of death seems to be stoppage of respiration by 
the spasmodic condition of the muscles concerned in that act. The slow, 
laborious breathing, turgescence of the face and venous system generally, 
as well as the foaming at the mouth, support this opinion; and these 
symptoms so simulated epilepsy in the above that it was at first supposed 
she was laboring under such an attack.] Part xii., p. 125. 
Poisoning by Hydrocyanic Acid.—Dash cold water on the patient; 
apply ammonia to the nostrils, and heat to the spine and feet; give an in- 
jection containing tincture of assafcetida, use friction with a flesh-brush to 
the skin; and as soon as the jaws become relaxed, and the patient can 
swallow, give an emetic, and afterward some weak brandy and water, and 
strong coffee. Mr. Gray would also cause the patient to inhale the fumes 
of ammonia, when he has ceased to be able to swallow. 
Part xiii., p. 145. 
Poisoning by Prussic Acid.—The rapidity of death does not always ap- 
pear to be in pi’oportion to the largeness of the dose, but modified by cir- 
cumstances, such as idiosyncrasy, bodily strength, and the quantity of food 
in the stomach. There are some grounds even for thinking that beyond a 
ceffain dose the effects are not increased, that is to say, a dose far greater 383 
POISONING. 
than a merely fatal dose does not produce more violent symptoms or 
speedy death than the exact poisonous dose. The medico-legal question 
of how long a person, after a poisonous dose, may have power and con- 
sciousness to perform acts of volition and motion, is of the highest import- 
ance, as from these acts principally can it be inferred whether death has 
been the result of suicide or murder. In the case of the trial of Belany for 
the murder of his wife, the medical opinions were strong that all volition 
would cease after the scream which has been considered as characteristic 
of poisoning by this substance. This may be quite correct where a scream 
does take place, but it is by no means so frequent a symptom as is com- 
monly supposed. It does not appear to have been heard in the case of 
Sarah Hart; it did not occur in two cases reported by Mr. Hicks (Med. 
Gaz., 1845); nor in a case given by Mr. Nunneley (Prov. Med. and Surg. 
Jour., 1845). 
A sufficient number of cases, however, are now on record, to prove that 
after large doses, viz.: from two drachms to four ounces of the medicinal 
acid of different countries, and consequently of a variety of strengths, re- 
levant remarks may be made, and acts of volition and motion deliberately 
performed. 
A gentleman at Bristol (1843), after swallowing half an ounce (Lon. 
Phar.)=tive grains anhydrous acid, walked about sixty yards, articulated 
to an acquaintance several words distinctly and relevantly, and did not 
die for ten or twelve minutes. He gave no scream. A case is reported 
by Sobernheim of a young gentleman who took four ounces from two 
vials. He was found dead in bed, the clothes drawn up to his breast, 
his arms beneath the clothes, and on each side an empty two-ounce vial. 
In Mr. Nunneley’s case, already referred to, a gentleman, after taking an 
ounce, appears to have walked or rather ran up a stair, was quite sensible, 
and spoke rationally for about five minutes, and lived three quarters of an 
hour. 
There are no post-mortem appearances universally found after poisoning 
with prussic acid. The odor of the acid should be sought for both exter- 
nally and internally ; but it is not always appreciable externally as is 
shown by Sarah Hart’s case. Internally, however, it can generally be de- 
tected within three or four days; occasionally it is altogether wanting, 
but these cases are rare. Among the most characteristic signs of poison- 
ing by this drug should also be noticed, the calm and life-like appearance 
of the countenance, and the bright state of the eyes. There is also ex- 
treme fluidity of the blood, the veins being full and the arteries empty. 
The left auricle and ventricle of the heart are generally found empty, and 
sometimes all its cavities; but, in cases recorded by Mr. 1STunneley, of 
Leeds, the heart was completely distended with dark fluid blood. The 
action of this powerful poison seems now generally acknowledged to be 
directly on the nervous system, to what tissue soever it be applied. 
I)r. Lonsdale’s experiments haye led him to conclude that, the imme- 
diate effects of the poison are exerted on the brain and spinal cord, 
and that the contractility of the heart is indirectly enfeebled, according 
to the dose, or whether the acid be in a pure or diluted state. 
Part xiv., p. 115. 
New Test for Prussic Acid.—The following method of testing for hy- 
drocyanic acid is proposed by Mr. Austin, of Dublin. The precipitate cf 384 
cyanide of silver, say half a grain, obtained in the usual manner, is mixed 
with a small quantity of oxide of iron and carbonate of potash, and the 
whole fused together in an iron or plantinum capsule. The fused mass is 
then dissolved in half an ounce of distilled water, filtered, and rendered 
slightly acid by the addition of a few drops of hydrochloric acid. The 
liquid thus treated is next divided into two portions, to one of which a 
few drops of a solution of sulphate of copper is added, which immediately 
causes the evolution of the chocolate-brown color, so characteristic of the 
ferrocyanide of copper; and to the other a few drops of the muriate tinc- 
ture of iron, or any persalt of iron, when the solution becomes intensely 
blue by the formation of the ferrocyanide of iron, the ordinary prussian 
blue. 
In Mr. Austin’s opinion, “ these two tests, with the well-known odor of 
prussic acid, are, independent of all others, sufficient to convince the medi- 
cal jurist of the presence of free prussic acid.” 
The precipitates above mentioned are very distinctly obtained with half 
a grain of cyanide of silver. Part xiv., p. 117. 
POISONING. 
LEAD. 
By Salts of Lead.—Ilydrated Proto-Sulphuret of Iron—suggested as 
an antidote in poisoning by the salts of lead. Vide Art. “ Poisoning by 
Corrosive Sublimate.” 
Lead Poisoning.—In addition to the acid, sulph. aromat., mercury is 
exceedingly valuable in controlling the effects of, or removing this and 
other latent poisons from the body. Part xxvi., p. 348. 
Poisoning by Lead.—Dr. Goolden states that iodide of potassium in doses 
of 10 grains acts as a curative agent in lead poisoning, by converting the 
lead into a more soluble form, which can be readily taken up by the blood. 
It acts more rapidly in conjunction with galvanism. 
In a case of aggravated paralysis from lead poisoning, but in which there 
was absence of colic, the following prescription was completely successful; 
Iodide of potassium, 5 grains; liquor of i drachm ; peppermint 
water, ounces; three times a day. As the recovery progressed, it was 
observed that the blue margin of the gums gradually disappeared. 
Part xxix., p. 326. 
Poisoning by Lead, Mercury, Gold, Silver, 'r any other Metal—MM. 
Poey and Vergnes’ Electro-Chemical Bath.—Place the patient on a 
wooden bench, in a metallic bathing-tub, isolated from the ground, and 
filled with water up to his neck. The water is made slightly acid with 
nitric or hydrochloric acid, if mercury, silver, or gold is in the system; and 
with sulphuric acid, if lead is suspected. The negative pole of a pile is 
then brought into contact with the sides of the bathing-tub, and the posi- 
tive pole placed in the hands of the patient. The work of purification is 
now in full activity. The electrical current precipitates itself through the 
body of the sufferer, penetrates into the depth of his bones, pursues in all 
the tissues every particle of metal, seizes it, restores its primitive form, and 
chasing it out of the organism, deposits it on the sides of the tub, where 
it becomes apparent to the naked eye. Part xxxi., p. 227. 
Lead Poisoning.—Dr. Tunstall states, that when we have loss of power 
of the superior extremities, with corresponding loss of substance, without POISONING, 
385 
diminished sensation, if there be no evidence of cerebral mischief, we should 
suspect lead as the cause of the disease. The term paralysis should be re- 
stricted to those cases which have their origin in the brain or spinal cord; 
in lead atrophy the loss of power is dependent on loss of muscular sub- 
stance, and differs from true paralysis in being gradual instead of sudden 
in its invasion. The treatment should consist of warm baths, electricity 
and friction. Part xxxiv., p. 298. 
Drop- Wrist from Lead-Poisoning.—A case lately occurred at Charing- 
Cross Hospital, of a printer who had been the subject of this affection for 
only two days, resulting from absorption of lead, owing to the tips of the 
fingers being denuded by constantly handling new type. This case was 
cured completely in a week, by the patient sitting with his hand in a solution 
of sulphuret of potassium (§j. to gx.) for three hours three times a day. 
This acted from the great chemical affinities of sulphur and lead. 
Part xxxvi., p. 46. 
Lead Poisoning—Disease of the Sheffield File-Cutters.—During the 
process of cutlery, the file is placed upon a bed of lead, which rests upon 
an anvil. This lead is gradually worn away, and may be collected in con- 
siderable quantities in the form of fine black powder. The file-cutters’ 
disease results from the absorption of a portion of this lead, as is common to 
file-cutters, painters, lead smelters, shot manufacturers, sheet-lead rollers, 
sugar-of-lead, red-lead, white-lead and litharge workers, compositors, 
plumbers, potters, sealing-wax makers, enamellers of German cards, color 
grinders, lead miners, etc. 
Dr. J. C. Hall, says, that persons who work much in lead should use the 
bath daily, or if this be not obtainable, they should wash thoroughly the 
whole of the upper part of the body. The addition of about four ounces 
of sulphide of potassium to thirty gallons of water much increases the effi- 
ciency of the warm bath, causing a formation of sulphuret of lead. The 
habitual costiveness must be overcome by attention to diet, by the frequent 
use of injections, and by the administration of doses of sulphate of mag- 
nesia in infusion of roses. Iorfide of potassium exerts a most powerful 
influence on the poison of lead ; 'it should be taken fasting, that it may not 
be decomposed by acids, and it should be largely diluted. There is no 
evidence to show that sulphuric acid is an antidote to slow lead poisoning. 
The best means of purifying water from the contamination of lead, is by 
filtering it through sand ai d animal charcoal. Part xxxvi., p. 56. 
OPIUM. 
Poisoning by Laudanum—Novel Treatment.—A young female, aged 
22, swallowed an ounce of laudanum. The ordinary symptoms soon suc- 
ceeded. There was a state of almost perfect insensibility, the face livid 
and swollen, pulse slow, not exceeding 45 in a minute, and the jaws firmly 
shut. Dr. Buck saw her in about half an hour, and prying the mouth 
open, put into it 40 grains of ipecac., and as much of sulphate of zinc, in 
half a gill of water. He repeated this dose at intervals of ten or fifteen 
minutes, five times, using 200 grains of ipecac., and as much sulphate of 
zinc. It is doubtful, however, whether any was swallowed. In half an 
hour, as no change had occurred, he injected into the stomach, through an 
elastic catheter, twelve grains of tartar emetic dissolved in half a gill of 
VOL. II.—25 386 
POISONING. 
water. After waiting half an hour, and perceiving no symptoms of an 
operation, he threw down 24 grains of tartar emetic. This in a short time 
induced a very feeble effort to vomit, and about half a gill of fluid was 
thrown up. But the symptoms became more alarming; the pulse was 
slower, and the face extremely livid, while respiration was nearly extinct. 
He noAV threw down sixty grains of sulphate of zinc dissolved in half a pint 
of water, but without any sensible effect. 
“Under these circumstances, seeing that there was no prospect of mak- 
ing her vomit by any ordinary means, I was resolved to make an experi- 
ment. I injected a pint of vinegar into the stomach, and immediately after 
it, a large teaspoon four times heaped full of salaeratus, dissolved in half a 
pint of warm water. The effect was instantaneous. It broke forth foam- 
ing from the mouth in a stream of the full size of that orifice, with such a 
force as to be projected a yard or more. The quantity thrown up I judged 
to be at least a quart, in a state of complete effervescence. In about fifteen 
minutes, as there was no further vomiting, I repeated the operation, using 
but half the quantity of vinegar with the same quantity of salasratus and 
water, with the same immediate effect, and then left her for the night, with 
directions to give her freely strong green tea, if she should recover suffi- 
ciently to drink. 
“Next morning found her much prostrated, had vomited several times 
during the night, but was perfectly rational. She gradually recovered.” 
Part v., p. 75. 
Poisoning by Morphia.— Coffee as an Antidote.—To relieve himself 
of a severe attack of toothache, Dr. Fosgate swallowed in solution one and 
a quarter grain of the sulphate of morphia, equal to about seven and a 
half grains of solid opium. In about half an hour, a sensation of thicken- 
ing and rigidity of the muscles of the back of the neck came on, and 
gradually extended itself to all the flexors of the limbs. In about five 
hours severe nausea succeeded, accompanied by efforts to vomit. Tea and 
sour cider increased the efforts to vomit so much that the stomach rejected 
fluids the moment they reached it, so that the second mouthful could not 
be swallowed before the first was rejected. Prostration of strength and 
apathy, with full slow pulse, and pricking sensation of the skin, were added 
to the other symptoms which were continually increasing in severity, when 
coffee was proposed. One gill of cold strong infusion of coffee was swal- 
lowed, and was retained about five minutes; the distressing symptoms, 
however, were by it abated, the nausea in part subdued, as was also the 
sensation of rigidity of the muscles; and the occasional repetition of this 
simple remedy during the course of the night completely removed all the 
distressing symptoms. Dr. Fosgate states, that whilst suffering from the 
severe nausea, but previous to the exhibition of the coffee, his mind was 
depressed, and he felt considerable anxiety, no pleasurable sensations or 
reveries having been felt. But after the draughts of coffee, the depression 
of mind and all anxiety vanished, and there succeeded that exquisite 
revelling of the imagination so much sought after by the opium eater. 
This state continued for five or six hours, and was succeeded by sound 
sleep, on awaking from which he experienced a few hours of lassitude. 
The morphia had been taken after eighteen hours’ fasting. Part v., p. 62. 
Poisoning by Opium or Belladonna.—Opium and belladonna are mu- 
tually remedial, when either has entered the circulation in a poisonous POISONING. 
387 
dose. From this cause, if both be prescribed together, as with a view to 
lull cerebral excitement, the effect desired will not be produced, whilst if 
either be given separately it will. In cases of poisoning by opium, give a 
solution of belladonna—say a drachm of the tincture every half-hour, or, 
if it cannot be swallowed, inject it subcutaneously. Conversely, in a case 
of poisoning by belladonna, opium may be used. Several cases are 
recorded in a paper by Benjamin Bell, illustrating this subject. 
Part xxxviii., p. 244. 
Narcotic Poisoning—Cold Douche.—In narcotic.poisoning, this appli- 
cation is indicated urgently, but here it must be perseveringly repeated, 
not relinquished on a little trial. The great source of danger clearly con- 
sists in the blood being no longer duly oxygenated, through deficient or 
temporarily suspended breathing. The brain, therefore, becomes doubly 
influenced—primarily, by the narcotic, secondly, by venous blood. In an 
instance witnessed under the care of Mr. West, of Turnbridge, occurring 
in an infant who had accidentally swallowed a large quantity of opium, and 
was so affected by it that there was the completest coma, a pallid counte- 
nance, livid lips, and fearful pauses in the respiration and circulation, this 
remedy was given a fair trial. No sooner was it used than inspiration 
followed, and scarcely was it desisted from ere it became needful to resort 
to it again. Friction was had recourse to at intervals, that the warmth 
of the surface might be preserved. A sort of artificial respiration was 
kept up until natural breathing returned, and the cerebrum awoke from its 
lethargy. The nerves of the skin were made to play that part, which 
under ordinary circumstances the vagi nerves perform (through the stimulus 
of carbonic acid), and so life was continued, and a perfect recovery ensued. 
Part viii., p. 45. 
Electricity in Poisoning by Laudanum.—A case of this description is 
recorded by Mr. Corfe. The patient had taken an ounce and a half of 
laudanum the preceding evening, and on his admittance into the Middlesex 
Hospital, was to all appearance a lifeless corpse; and after all the more 
ordinary remedies had been tried in vain, Mr. Corfe thought of the electro- 
magnetic battery, conjointly with electricity. After this had been acting 
upon him for a time the pulse became more steady, firm, and frequent, and 
the respirations more indicative of resuscitation. A powerful electrical 
machine was also got into full play before a large fire : brilliant sparks and 
strong shocks were occasionally passed through the head, spine, thorax, 
and abdomen. By these means the whole body was thrown into violent 
and convulsive succussions and muscular contortions. The patient recovered. 
Part ix., p. 78. 
Py Opium.—Dr. Lancaster advises, after the use of the stomach-pump, 
to give coffee, and pass currents from the electro-magnetic apparatus 
through the shoulders, chest, abdomen, arms, and legs. In some cases, 
cold affusion will be beneficial. Such remedies as ammonia should not be 
given but under the most urgent circumstances. Part xix., p. 218. 
Laudanum, Poisoning by.—In a case of poisoning by laudanum, in an 
infant, Dr. Ilerapath excited respiration by galvanism, by placing the zinc or 
positive wire on the mucous membrane of the mouth, and the negative or 
copper wire just below the ensiform cartilage. The current seemed to enter 
by the fifth nerve, from this to the medulla oblongata, then along the phrenic 
and external respiratory and spinal nerves to the diaphragm, and the inter- 388 
POISONING. 
costal and other accessory muscles of the respiratory apparatus. If the posi- 
tive or zinc Avire slipped from the cheek to the tongue, the movements be- 
came more gasping and convulsive—another set of nerves becoming 
influenced. Part xxv., p. 317. 
Poisoning by Laudanum.—To evacuate the stomach speedily and 
effectually, introduce into it a quantity of carbonate of soda, followed by 
vinegar. The effervescence is so powerful that all the contents of the 
viscus are discharged. If emetics have before been taken ineffectually, they 
begin noAvto act. Part xxvi., p. 348. 
Poisoning by Opium— Use of Belladonna.—Belladonna has been found 
useful in poisoning by opium. When the patient is comatose and other 
remedies fail, try the following: tincture of belladonna, six drachms in five 
and a half ounces of Avater. Take an ounce of this every half hour, till 
the coma begins to disappear, or till the pupils dilate. In another severe 
case, one ounce of the tincture of belladonna was gi\Ten at once, in three 
ounces of water ; in half an hour two drachms more Avere given. 
Part xxix., p. 326. 
Use of Belladonna in Poisoning by Opium.—Dr. Graves first sug- 
gested, that in continued feA'er, with contracted pupils and coma, if an 
agent administered internally would occasion dilatation of the pupils, it 
might also relieve the other symptoms of cerebral derangement. 
For cases of Poisoning by Opium.—Always have ready the following 
preparation of belladonna: take four ounces of the leaves of belladonna, 
and two pints of rectified spirit, and percolate. Of this give six drachms 
in doses of about one drachm every half hour. 
In one case, ten drachms of the above tincture of belladonna were given 
in the course of one hour Avith success. Part xxx.,p. 301. 
Narcotic Poisoning.—Dr. Marshall Mali's “ Beady Method.”—When 
from the degree of narcotism all ordinary remedies fail in inducing vomit- 
ing, and the stomach pump is not at hand, place the patient on a table, 
with the head projecting beyond its edge, if possible ; if not, on the floor ; 
and being placed on the side, the finger of one person is to be introduced 
into the fauces, whilst the body is briskly and repeatedly rolled into the 
prone position by another ; thus mechanical vomiting Avill be produced, 
and the poison expelled. But supposing the narcotism is too deep for the 
success of this manoeuvre, \rolition has ceased, and that the patient can no 
longer be made to moAre or AA'alk about—that all physiological respiration 
has ceased—Ave must long and perseveringly employ the “ Ready Method ” 
to continue respiratory movements till the poison is eliminated from the 
blood.— Vide Art. “Drowning.” Part xxxv., p. 49. 
(ENANTIIE CROCATA. 
[Several melancholy cases of poisoning by this plant (hemlock dropwort) 
are related by Mr. Bossey. Several convicts were at work in the Royal Ar- 
senal at Woolwich, and mistook the plant for celery. They ate a considerable 
quantity, and were soon attacked with the most violent symptoms, strong con- 
vulsions in paroxysms, with insensibility. In the more violent cases the face 
was bloated and livid, the foam about the mouth was sanguineous, the breath- 
ing stertorous and convulsive, pupils dilated and insensible, with most of 
the other symptoms of apoplexy. These cases died. In others, the symp- POISONING. 
389 
toms were milder, and recovery took place. These were able to swallow 
emetics of salt and mustard with warm water, by means of which they 
vomited freely and ejected a large quantity of imperfectly masticated root, 
and were thereby greatly relieved. The convulsions ceased, sensation and 
reason were restored, but there remained giddiness, pallor of the face, 
dilated pupils, coldness of the extremities, much weakness, severe rigors, 
and a slow feeble pulse.] 
Further vomiting was promoted, and more of the root discharged. 
Friction and warmth were applied to the extremities, whilst ammonia and 
rum, with thin gruel and other drinks, were administered internally, till 
reaction was more fully established. 
Emetic doses of the sulphate of zinc and copper, and also mustard and 
water, were given without effect to the patients lying on the deck of the 
vessel. They were also bled very largely both from the arms and jugular 
veins. The introduction into and removal of warm water from the stomach 
by the pump, brought away small portions of the noxious roots. Cold 
affusions upon the head being perseveringly used, lessened the struggling, 
and produced some exhaustion. In three cases the subsequent fits became 
less violent; they passed into a state of maniacal delirium, with much 
jactitation of the limbs, and after some hours were removed into the hos- 
pital. But in one more patient all these remedies were ineffectual: he 
died convulsed, at a quarter before one o’clock. As a last effort, the 
trachea was carefully opened by an incision, and artificial respiration kept 
up, but life was quite extinct. 
Several of the men who had eaten the root, seeing the others suffer, took 
the salt water emetic with success, and had no symptoms of being poisoned. 
The first indication of treatment was doubtless to evacuate the stomach; 
but, as its sensibility was destroyed, and the poison was taken in the solid 
form, this could not readily be accomplished. Large and immediate de- 
pletion seemed to be essentially useful, by removing the imminent danger 
of extravasation from over-distention of the vessels; the cold affusion 
was also beneficial in rousing the patient, so as to make him sensible to 
the emetics, and so were purgatives during the after-treatment. 
Called thus in a moment to so many urgent cases of poisoning, it be- 
came needful to use such remedies as were at hand; but, upon reflection, 
it seems to me proper, in similar circumstances, to rely chiefly on emetics 
given early, on large blood-letting immediately employed, and the cold 
affusion. Part x., p. 90. 
STRYCHNIA. 
Tannin, as an Antidote. — In a case where strychnia had been in- 
cautiously taken by the patient to the amount of half a grain in six 
hours, and where the symptoms were becoming exceedingly dan- 
gerous, Dr. Ludicke ordered ice to be applied to the head, and half a grain 
of tannic acid to be given every hour, either in an effervescing draught or 
in distilled water. After twelve grains had been taken, he substituted for 
it a decoction of two ounces of oak bark in six ounces of water, with an 
ounce of sirup of cinnamon and a scruple of sulphuric ether. The symp- 
toms of poisoning entirely disappeared. Mesner, in Dresden, recommends 
as an antidote for strychnine, decoction of galls or of oak bark; five ounces 
of which precipitate two grains of nitrate of strychnine. Part vi., p. 85 390 
POISONING. 
Electricity in Poisoning by Strychnine.—The following statement is 
deserving of further investigation: M. Duclos has instituted a series of 
experiments on rabbits, dogs, and guinea-pigs. He poisoned these animals 
with strychnine and brucine, and then electrified them, and found that, on 
application of the negative electricity excited by means of an electrical 
machine, the symptoms of poisoning subsided, and the animals were saved ; 
the positive electricity, on the contrary, increased the muscular contraction 
produced by the poison, and hastened death. Animals which had been 
poisoned with arsenious acid could not only not be saved by electrifying 
them, but were killed sooner, whether positive or negative electricity was 
employed. Part ix., p. 83. , 
Purified Animal Charcoal as an Antidote to all Vegetable and some 
Mineral Poisons.—This substance, says Dr. Garrod, may be used as an 
antidote to opium and its active principles, morphia, etc.; nux vomica and 
its active principles, strychnia and brucia; henbane, deadly nightshade, 
bitter sweet, thorn apple, tobacco, hemlock, bitter almonds, prussic acid, 
the aconites, etc.; in fact, to all vegetable poisons—to animal also, as can- 
tharides. The carbo animalis purificatus of the pharmacopoeia should be 
used, and in the proportion of half an ounce to a grain of morphia, strych- 
nia, etc. It combines with and renders inert vegetable and animal sub- 
stances, and absorbs some mineral poisons, especially arsenic, and renders 
them harmless, and exerts no injurious effects on the body. 
It should be rubbed in lukewarm water, so as to form a fluid of slight 
consistency, and thus given in quantities of from one to four ounces. 
Emetics also should be given : ipecacuanha, however, will not do, as the 
charcoal renders it inert. Give sulphate of zinc in scruple or half drachm 
doses, or use the stomach-pump, and then give more of the charcoal. 
Might not this substance be tried to prevent the injurious effects of 
animal poisons, such as rabies, syphilis, poison of serpents, etc., applied 
in the form of poultice to the parts? Part xiii., p. 142. 
Chloroform in Poisoning by Strychnine.—A case, under the care of 
Dr. Munson, in which all the symptoms of poisoning by strychnine were 
present, was very successfully treated by the inhalation of chloroform. 
Part xxii., p. 329. 
Poisoning by Strychnine.—In a case of poisonous symptoms being in- 
duced from an over-dose of strychnine given in mistake, the following 
prescription gave immediate relief: Twenty-four grains of camphor were 
dissolved in six ounces of almond mixture, one-fourth to be taken every 
two hours. Part xxvi., p. 348. 
Test for Strychnia.—Mr. Maxwell Simpson, in a note to the editor of 
the “ Dublin Hospital Gazette,” says: I think it right to make it publicly 
known that strychnia is not the only substance that will produce a purple 
color when brought into contact with a mixture of bichromate of potash 
and oil of vitriol, the test usually relied on for the detection of this poison. 
I have found that naplithalidam, an organic base derived from naphthalin, 
will produce, as might have been expected, an exactly similar color when 
tested with the same mixture. The color is best brought out by making 
a mixture of equal volumes of oil of vitriol and a cold saturated solution 
of bichromate of potash, and bringing it, while still warm, into momentary 
contact with a particle of the naphthalidaiu. Part xxxiii.. p. 309. POISONING, 
391 
Strychnia and 'Woorali.—These two poisons, according to Dr. Pavy, 
of Guy’s Hospital, have the effect of reciprocally neutralizing the action of 
each other, according as the one or the other is in excess. Frogs poisoned 
with woorali, when flaccid and insensible, very soon become tetanic if 
strychnia be injected; and on the other hand, if poisoned with strychnia 
and afterward punctured with woorali, the tetanus speedily disappears. 
When treated in this way, they wfill recover from a larger dose of each 
than Avould be sufficient to destroy life, if either were given alone. Thus 
it would appear that the one might be used as an antidote for the other. 
Part xxxiv., p. 301. 
Strychnia, Tests for.—Dr. Harley, of University College, London, says: 
The physiological test is the most reliable. If l-8000th of a grain be 
injected into the thoracic cavity of a frog, it will become tetanic in ten or 
fifteen minutes. In order to apply any of the tests, we must first have the 
strychnia in a pure state. Suppose an animal has been poisoned with the 
smallest possible quantity, take the blood fromfthe heart and large vessels, 
mix it with twice its bulk of water, coagulate by boiling, acidify with 
acetic acid, decolorize by filtering through crystals of sulphate of soda or 
animal charcoal, concentrate the filtrate, add potash to precipitate the 
strychnia, purify and apply the tests. Strychnia seems to produce death 
by destroying muscular irritability, and rendering the tissues unable to 
absorb oxygen and exhale carbonic acid One part of bi- 
chromate of potash dissolved in fourteen parts of water, to which two 
parts of sulphuric acid are afterward added, is the most delicate and 
certain test for strychnia. When added to a suspected solution, if 
strychnia be present, it will be precipitated in the form of a beautiful 
golden-colored insoluble chromate. The crystals are immediately formed. 
A single half grain of strychnia, although divided into millions of atoms 
of crystals each, will demonstrate the presence of strychnia as well as if a 
pound weight of it were operated upon. (Mr. Horsley.) 
To do away with all possible sources of fallacy from the action of ex- 
ternal re-agents, you must put a little strychnia, with sulphuric acid, on a 
piece of platinum foil, and then connect the foil with the positive pole of 
a single cell of a Grove’s or Smee’s battery, and, by touching the acid 
with the negative pole terminating in a piece of platinum wire, the char- 
acteristic violet color is instantly produced. In operating on the contents 
of the stomach, acidify them with acetic acid, dilute if necessary with 
water, and filter ; evaporate this on a water-bath to the consistence of a 
thin paste, add eight or ten times its bulk of cold alcohol, filter and distill 
so that the spirit may not be lost. The residue, after the evaporation of 
all the spirit, must be diluted with water, filtered again, and super-saturated 
with liq. potassae. Shake this with its own bulk of ether, and allow the 
two solutions to separate, decant the clear ethereal solution, and treat the 
aqueous residue with a fresh quantity of ether, and so a third time, if 
necessary. The ethereal solution must be distilled to remove the ether, 
and the residue dissolved out of the retort with a small quantity of diluted 
acetic acid and filtered; treat again with potash and ether, and after the 
spontaneous evaporation of the ether, the alkaloid will be sufficiently pure 
to be identified. (Prof. Letheby.) Part xxxiv. p. 305-315. 
Poisoning by Strychnine.—Professor Haughton of Dublin, is of opinion 
that nicotine and are mutually antidotes to each other’s action. 392 
POISONING. 
He has performed some very interesting experiments on this subject. The 
nicotine is always easily procurable in the form of tobacco leaf infusion. 
Part xxxv., p. 277. 
Tests for Strychnine.—It is known that peroxide of lead, peroxide of 
manganese and chromate of potassa will each of them produce a red color 
when added to a mixture of strychnine and sulphuric acid. 
Mr. Lindo considers the red color produced by these three tests is in 
every instance referable to the same cause—namely, the separation of the 
hydrogen from the strychnine; that, when the metallic peroxides are used, 
they are converted into protoxides, which combine with sulphuric acid 
when the chromate of potassa is employed; that the chromic acid is 
converted into oxide of chrome, which combines with sulphuric acid; and 
that the oxygen liberated in each case takes hydrogen from the strychnine, 
forming water, the reaction being partly induced by the affinity of sul- 
phuric acid for water. Part xxxv., p. 280. 
Camphor, in poisoning by Strychnine.—Give two grains of powdered 
camphor, with half a teaspoonful of tincture of camphor, every quarter of 
an hour, if necessary, a little morphia may be added. Two cases are re- 
ported by Dr. Rochester, which were successfully treated in this way. 
A case of poisoning by strychnia, is related by Dr. Pritchard of Filey, 
Yorkshire, in which from three to five grain lumps of camphor were suc- 
cessfully administered. Emetics and the stomach pump were employed, 
and artificial respiration by Dr. Marshall Hall’s ready method was necessary 
at one part of the tetanic spasms. Toward the decline of the tetanic 
movements, which lasted about twenty minutes, the camphor was continued 
with opium. Part xxxv., p. 342. 
Strychnine— Dectection of.—Messrs. Rodgers and Girdwood, from a 
carefully conducted series of experiments, have come to the following 
conclusions: That strychnine can be detected even when it has not been 
given in excess ; that it is not decomposed in the body ; that it is found 
unchanged in the urine ; and can be detected in the blood, organs, and 
tissues of the body, quite independently of the contents of the stomach. 
It is more easily detected than any other poison, from the delicacy of its 
reactions, and from its extraordinary stable qualities. 
The process itself is as follows: The substance to be operated upon is 
digested with dilute hydrochloric acid, 1 to 10, until it is apparently fluid ; 
the liquid is then filtered and evaporated to dryness over a water-bath ; 
what remains, treated with spirit as long as anything can be dissolved, and 
the filtered tincture evaporated as before. The residue must now be dis- 
solved in water and filtered. 
This aqueous solution is to be rendered alkaline by ammonia and agitated 
in a bottle, or long tube, with about \ an ounce of chloroform. After 
subsidence, the chloroform is drawn off by means of a pipette, transferred 
to an evaporating basin, and expelled over a water-bath; the residue left 
on the basin must then be moistened with concentrated sulphuric acid, 
and exposed for some hours to the temperature of a water-bath, by which 
proceeding, all organic matter except the strychnine is destroyed. The 
charred mass is then treated with water, and the solution filtered to sepa- 
rate the carbon; excess of ammonia is added and the solution again 
agitated with about 1 drachm of chloroform. If, on evaporating a small POISONING. 
393 
portion of this chloroform solution, and acting upon the residue with 
concentrated sulphuric acid, any charring takes place, the foregoing process 
must be repeated. 
The chloroform solution will afford strychnine sufficiently pure for con- 
clusive testing. For this purpose, a small quantity is taken up in a capillary 
tube, and evaporated by adding successive drops, on the smallest possible 
space of a warm porcelain capsule. If the quantity of strychnine in the 
solution is large, say the 1-2000th of a grain or more, the method pursued 
in using the reagent is similar to that adopted by others, viz. moistening 
the spot, when the capsule is quite cold, with concentrated sulphuric acid, 
and then adding a minute fragment of bichromate of potash. When, 
however, the quantity is very small, no color will be perceived by this 
mode of testing. Under such circumstances, sulphuric acid, rendered 
slightly yellow by chromic acid, is said to be found successful. 
We may, in conclusion, enjoin a caution against two sources of failure 
in conducting this test. The common recommendation to stir the spot 
moistened with sulphuric acid, with a glass rod before the addition of 
bichromate is to be avoided, because the acid sulphate of strychnine may 
so be removed altogether ; and the operator must be careful not to expose 
the matter under examination to an intense light, as in his anxiety to watch 
the color changes he is too apt to do, the effect of light, in more than 
moderate amount, being to suspend the chemical reactions. 
Part xxxvi., p. 282. 
Poisoning by Strychnia—Inhalation of Chloroform.—A case occurred 
lately in Boston in which violent tetanic spasms, produced by swallowing 
two grains of strychnia, were completely subdued in ten minutes by Dr. 
Jewett, by the administration of chloroform. The patient recovered 
rapidly. Part xxxvii., p. 257. 
Poisoning by Strychnia.—The poison of strychnia is completely neu- 
tralized by nicotine. In a case of poisoning by the former, Dr. O’Reilly 
of St. Louis, U. S. recommends to take a cigar and infuse it in half a pint of 
water, which give in doses of one tablespoonful every five minutes. Pro- 
bably, when half the quantity is taken a favorable change will be noticed 
the muscles will have become relaxed, the spasms less severe, and the 
intervals between them longer. The infusion may then be given less fre- 
quently. Of course, in a healthy person, such quantities of tobacco internally 
administered would produce serious effects; but in this case its effects are 
antagonized. Part xxxviii., p. 238. 
Antidote to.—Dr. Bewley, wishing to kill a mangy cur, and having 
read in Magendie’s “ Report on Strychnia,” that the sixteenth of a grain 
will kill the largest dog, determined to make sure of this very little animal 
by giving it about half a grain. But either Magendie’s statement was in- 
correct, or the drug was adulterated, for at the end of ten minutes the dog, 
though suffering frightfully, was not dead. Dr. Bewley resolved to put 
him out of his misery at once, and accordingly mixed half a drachm of 
prussic acid with a little milk, and put it under the dog’s snout. He lapped 
the milk with avidity, and in less than a minute vomited, got upon his legs, 
ran away, and recovered. Part xl.,p. 278. 
Poisoning by Strychnine.—Action of wourali poison. Vide Art. 
“ Tetanus.” 394 
Poisoning, 
Poisoning by Strychnine.—A case of poisoning by strychnine is related 
by Dr. Bennett, of Sydney, in which apparently iodine conduced toward 
recovery. He explains its action by its forming an insoluble hydriodate 
of strychnine. Part xl., p. 315. 
UPAS ANTIAR. 
Poison of the.—[This energetic poison has not been examined since the 
beginning of the present century. It is obtained from Borneo and Java.] 
The following are the principal results obtained by Professor Albert 
Kolliker, in his experiments with frogs. 
1. That antiar is a paralyzing poison. 
2. It acts in the first instance and with great rapidity (in 5 to 10 minutes) 
upon the heart, and stops its action. 
3. The consequences of this paralysis of the heart are the cessation of 
the voluntary and reflex movements in the first and second hour after the 
introduction of the poison. 
4. The antiar paralyzes in the second place the voluntary muscles. 
5. In the third place it causes the loss of excitability of the great nervous 
trunks. 
6. The heart and muscles of frogs poisoned with urali may be paralyzed 
by antiar. 
7. From all this it may be deduced, that the antiar principally acts upon 
the muscular fibre and causes paralysis of it. Part xxxvii., p. 256. 
YEW-BERRIES. 
Poisoning by.—[As cases of poisoning by the berries of the yew (taxus 
baccata) are rare, and as some writers have denied the poisonous nature 
of the tree altogether, the following ease by Dr. James Taylor, of Castle 
Cary, becomes interesting.] 
October 28th, 1838. 5lary Baker, a fine healthy child, between five and 
six years of age, ate freely of yew-berries just before going into church. 
About an hour after, during divine service, she fell from her seat and was 
instantly removed in an insensible state to her home. I saw her immedi- 
ately ; the surface of the body was cold ; the countenance pale ; breathing 
laborious and frequent; pupils very dilated; pulse feeble ; convulsions and 
vomiting. Having carefully examined the head, and finding that it was 
not injured by the fall, I gave an emetic, and from what was ejected it was 
evident she had eaten a considerable quantity of the berries; not the 
mucous part only, but the seeds, wherein I believe is the most active prin- 
ciple of the berry, for the mucous or fleshy part of the berry has been fre- 
quently eaten with impunity. As soon as it appeared the stomach had 
been freed of its contents, a purgative was given, and had the desired 
effect, but the child never rallied from the first. She continued in a coma- 
tose state, and died in four hours after eating the berries. An inquest was 
held, but no post-mortem examination allowed. I stated, in my evidence, 
I considered yew-berries poisonous, and that the child’s death had been oc- 
casioned by them, but I remember several of the jury were very skeptical 
on the point. Part xix., p. 218. POLYPI. 
395 
ZINC. 
Poisoning with Chloride of.—Dr. Thomas Stratton relates two cases of 
poisoning with chloride of zinc. In both cases a wine-glassful of solution 
was swallowed, containing in one case about twelve grains of the salt, and 
in *the other about two hundred grains. In the latter case, burning pain 
in the gullet, burning and griping pain in the stomach, great nausea, and 
sense of coldness were instantly felt. Vomiting followed in a few minutes. 
Dr. Stratton saw this patient twenty minutes after the accident, and in- 
stantly made a strong solution of home-made brownish soap, of which he 
made the patient swallow at intervals, three or four pints. Afterward olive 
oil was given, and the patient recovered. The other case was not seen by 
any medical man ; but it also terminated favorably. Dr. Stratton suggests 
either soap or carbonate of soda or of potash, as antidotes to chloride of 
zinc. Part xix.,p. 218. 
P OLYP I. 
OF THE EAR. 
Mr. Wilde, in his treatise on the “ Causes and Treatment of Otor- 
rhoea,” observes: 
The last cause and complication of otorrhoea is what I have through- 
out this paper denominated polypus. Fleshy, pedunculated, morbid 
growths in the ear, nearly colorless, having a thin cuticular covering, unat- 
tended by pain, not appearing as the result of inflammation, and unaccom- 
panied by discharge, I have seen, but such cases, in comparison with 
those to which I have so frequently alluded, and now refer, are ex- 
tremely rare. Throughout this essay I have constantly employed the 
terms fungus and polypus as indicative of these morbid growths, 
the product of inflammatory action, and long-continued otorrhoea. By 
fungus, however, I particularly allude to those vascular and granular 
masses which generally grow either from diseased bone, or upon the de- 
struction, in the whole or in part, of the membrana tympani, and whose 
attachments are to be found principally in the very bottom of the auditory 
passage; while polypi are, for the most part, confined to the glandulo- 
ceruminous portion of the tube, and are attached by narrower roots than 
the fungi. It is stated in books that polypi are smooth on their surface, 
while fungi are lobulated. Here, however, is a very good specimen of a 
polypus removed from the posterior wall of the glandular portion of the 
meatus, presenting such characters. In many instances polypi may be 
coexisting with granular tympani or fungous masses proceeding from the 
middle ear. Generally the polypus grows more externally, that is, appears 
at the external orifice, while the fungus is mostly confined to the bottom 
of the tube. The latter may, however, appear externally. 
The instrument of greatest value for the removal of aural polypus from 
any portion of the meatus, is the small snare-like apparatus consisting of a 
fine steel stem, five inches in length, with a movable bar sliding on tin 396 
POLYPI. 
square portion toward the handle; in a properly-constructed instrument 
the small upper extremity, flattened out and perforated with holes running 
parallel with the stem, should not exceed the fourteenth of an inch in its 
greatest diameter. A fine silver, or what is much better, from its greater 
flexibility and strength, a fine platina wire, with its extremities fastened to 
the cross bar at the handle, passes through the holes in the flattened end 
of the small extremity of the instrument, and allowed to be of such a length 
as, that when the bar is drawn back close to the handle, this ligature is put 
fully on the stretch, and drawn tight through the holes at the small extre- 
mity. In using it, the cross bar is pushed forward and a noose made of 
the wire at the small extremity, of sufficient size to include the morbid 
growth, Avhich it is then made to surround, and toward the root of which it 
is pressed by means of the stem; the cross bar is then drawn up smartly 
to the handle, and it never fails of either cutting across, or of drawing with 
it whatever was included in the noose. Some bleeding generally follows, 
which should be allowed to subside, then syringe the parts with slightly 
tepid water, and again examine the ear, and if possible discover what por- 
tion of the polypus may remain, which, whether it may be the mere point 
of attachment, or a portion unaccessible to instruments, should be invari- 
ably touched with the armed port-caustic, and the same application applied 
from day to day, until all traces of the morbid growth are vanished. Unless 
this latter point of practice be strictly and perseveringly adhered to, it is 
in vain that we can expect a total eradication of the disease; no more, 
however, of the auditory apparatus should be submitted to the action of 
the caustic than the actually vascular, granulating, or fungous surface. I 
have frequently Avitnessed the Avhole canal in a state of ulceration, and an 
erysipelatous inflammation extending over the entire auricle, from a large 
stick of lunar caustic having been inserted into, and rolled round in the 
meatus to remove a polypus or fungus growth, the eradication of which 
had already been frequently attemped by instruments; a practice as cruel 
as it AATas ineffectual. Part ix., p. 162. 
Ear Polypi.—For the remoA'al of these growths Mr. Toynbee uses a 
kind of ringed forceps, each blade of the forceps having a ring at the 
extremity instead of teeth. By this the structure is not broken up, and 
the groAvth has a better chance of being removed by the roots. 
Part xxix., p. 257 
Polypus of the External Meatus.—In all cases of discharge occurring 
from the external meatus, says Dr. Toynbee, the first step is to use a 
syringe so as thoroughly to cleanse the meatus. When this has been done, 
there is no difficulty in determining Avliether a polypus be present, 
although it may be situated close to the membrana tympani. Polypi 
occurring in the external meatus may be divided into three classes. 
1. The one of most frequent occurrence, wrhich may be called the 
raspberry polypus. 
2. That which has been termed the gelatinous polypus. 
3. The globular polypus. 
The cellular raspberry polypus is most frequently met with, and con- 
sists of numbers of round beads, somewhat similar in appearance to the 
free surface of the raspberry. These beads are attached by means of small 
filaments, to a central stem, which forms the root. It is frequently POLYPI. 
397 
covered by ciliated epithelium, and when examined microscopically its 
interior is found to be composed of small rounded cells. It is usually so 
soft that, upon being taken hold of by the ordinary dressing forceps, it 
breaks up and bleeds freely. The raspberry polypus varies much in size ; 
sometimes it is not larger than a grain or two of mustard seed, at others 
it fjlls the whole of the meatus and projects from the orifice. The parts of 
the meatus to which this kind of polypus is attached are very various; as 
a general rule they are attached to the inner half of the tube, and fre- 
quently close to the membrana tympani. When small, their color is 
usually a deep red ; but when they increase in size they become more pale, 
and the rounded masses considerably increase in size. The formation of 
these polypi is often attended with considerable pain and by a discharge 
of blood. It is not uncommon for this polypus to remain undisturbed 
during several years, the whole of which time it throws off a most offensive 
secretion without producing symptoms sufficiently urgent to induce the 
patient to apply for relief; in other cases the head symptoms are so dis- 
tressing as to cause serious alarm. These polypi are usually the result of 
irritation in the tympanic cavity and they are frequently symptomatic ot 
obstruction of the eustachian tube. 
The treatment of polypi by astringent applications, has no beneficial 
effect; the same remark applies to the use of the nitrate of silver, whether 
solid or in solution. The potassa cum calce answers the best of anything, 
and if made to contain a small quantity of iron, it is firmer, much less de- 
liquescent, and may be more readily applied than the usual form. The 
first step in the proceeding is, to syringe out the meatus with tepid water, 
and dry it with cotton wool; then place the patient in a strong light, pass 
a glass tube down to the polypus to protect the meatus, and press the end 
gently against the polypus, so that it may fully occupy the distal part of 
the tube, the potass cum calce must then be introduced and kept in con- 
tact with the polypus for half a minute; this will scarcely give any pain, 
but if it should happen to touch the surface of the meatus, the pain will be 
very acute, the tube must therefore be allowed to remain for a few min- 
utes, the meatus must then be syringed out, to wash away the little oozing 
of blood, etc. On inspecting the polypus, it will be seen to present a 
pulpy, uneven mass of a dark livid color. As a general rule, the potass 
may be applied daily in the same manner until the whole of the mass is 
destroyed. Part xxxv., p. 147. 
OF THE NOSE. 
Gelatinous Polypus.—If Dr. Lewis Shaw’s method of removing the 
gelatinous polypus from the nose be found efficacious, it will certainly be 
an improvement on the more ordinary methods of excision, extraction, 
ligature and caustics. He powders very finely the sanguinaria canadensis, 
and causes it to be snuffed up the nostril, and the throat to be gargled 
with a strong infusion. In one case, by repeatedly using these means, the 
polypus broke in twenty-four hours, and discharged a considerable quantity 
of gelatinous fluid. The remedy was continued till the whole inner surface of 
the nose was made raw, and occasionally afterward. As the case, however, 
has not been watched a sufficient time, we could not depend upon the 
treatment. The sanguinaria canadensis is one of the best known acro- 
narcotics of the poppy tribe. Part vii., p. 215. 398 
POLYPI. 
Polypus of the Nose.—In the higher classes of society polypus of the 
nose is not an uncommon affection. It is frequently nothing more than a 
peculiar excrescence of the Schneiderian membrane, which is not malignant. 
It is a tumor connected generally by a thin neck to this membrane, or by 
a narrow pedicle, or a long thin membrane continuous with Schneiderian, 
but less vascular. 
The polypus is very smooth, and but little vascular, though sometimes 
vessels burrow into it. It is gelatinous in density, and appears to consist 
of coagulated albumen. In a few instances there is but one polypus ; but 
commonly there are two or three, and frequently clusters, so that we can 
scarcely count them. The color, which it is essential to notice, is pearl-like or 
white, mixed with brown, of an opal appearance. Soft polypi of this kind, 
Sir B. Brodie has never seen attached to the septum nasi, the inferior 
turbinated bone, or any part of the nostril, but almost always to the cells 
of the ethmoid bone, though occasionally to the superior turbinated bone. 
There is at first merely an unnatural secretion of mucus, often without 
pain—the smell is affected or even disappears, and even the taste may be- 
come considerably impaired. The symptoms may goon for years, while 
the polypus may go on increasing and become more solid, the base being 
at last almost cartilaginous. It may increase even to come down outside 
the nostril, or may descend down to the pharynx, behind the soft palate, 
of the size of the fist. 
What is the best way of removing a polypus from the nose ? A ligature 
can seldom be applied properly ; neither can the operation be safely done 
with the knife, and seldom with the scissors. The forceps, made for this 
purpose, is no doubt the best instrument. The whole of the opposite 
surfaces of the blades ought to be quite rough, convex above, concave be- 
low, opening laterally; sometimes opening from above downward. The 
forceps should be oiled and warmed, the polypus caught by the base, and 
the instrument cautiously closed. The part should then be not only pulled 
forward, but twisted a little to each side and then pushed backward— 
again twisted a few times, first in one direction and then another, and at 
last it should be pulled forward with some force, when it will generally 
come away entire. It is too often the case that when the neck of the 
polypus is laid hold of by the forceps, the surgeon suddenly extracts, 
without the repeated twistings in all directions so strongly recommended 
by Sir B. Brodie. It is owing to the neglect of this simple procedure that 
a great portion of the polypus is often left behind. When the diseased 
part has been removed, Sir B. Brodie recommends that the parts should be 
painted over every day, by means of a camel’s hair brush, with white 
precipitate ointment. The unguent, hydrarg. nitrat. diluted may also be 
used, but this causes more irritation than the white precipitate, and does 
not answer so well. The white precipitate ointment should be applied 
regularly, not for a few days or weeks, but for years. This should be 
done effectually; not by just brushing over the parts which are most 
external, but by smearing the whole surface of the nostril both upward 
and backward, even as far as the pharynx. Astringent lotions may also 
be used, as zinc or alum. Sometimes the polypus is of a more fleshy 
nature and attached to the nose by a narrow neck, like those of the uterus 
and rectum. When this is the case it may be snipped off with a pair of 
probe-pointed scissors, slightly curved. Nitrate of silver may be applied 
to the part, and it is probable that it may never reappear. Some polypi, POLYPI. 
399 
however, it is absolutely necessary to remove by ligature; as in a case 
related by Sir B. Brodie, in which there was an enormous tumor projecting 
the velum pendulum palati forward to the mouth, so that the finger could 
only just reach its lower margin. 
In such a case there would be great difficulty in applying a ligature, and 
it would be evident at once that it would be almost impossible to remove 
the mass either by the forceps or the scissors. Sir Benjamin Brodie re- 
commends that a bougie be passed into that nostril from which the 
polypus is supposed to rise, and .pushed forward into the pharynx. The 
finger is then to be passed to the back of the throat, and the bougie bent 
so as to bring one end out at the mouth, to which is to be fastened a 
double ligature. The bougie is then withdrawn from the nose, and of 
course the ligature follows its course. The ligature is then cut off from 
the bougie, and the tw'o cut ends hang out of the anterior nostril over the 
upper lip, the loop at the opposite end hanging out of the mouth. The 
next step is to get the ligature over the tumor. “ For this purpose you 
cut through the loop hanging from the mouth, so that there are now two 
single ligatures. One end of the single ligature is to be passed through 
a silver tube, and putting the tube into the mouth and pharynx, you carry 
one end of the ligature under the base of the tumor on one side of it. 
You leave that out of the mouth, and your assistant holds both ends of the 
ligature, to prevent it from slipping ; then with the same silver tube you 
are to take hold of the other loose ligature at the mouth, and carry that on 
the other side of the polypus, and there your assistant is to hold it. A 
knot that will not slip must then be made of the two ends of the ligature 
that hang from the mouth. You have now a ligature on each side of the 
polypus, and then, by carefully drawing the ligatures out at the end of the 
nose, you have got hold of the polypus at its base. A silver tube is then 
to be introduced into the nostril, and you tighten the ligature upon the 
shoulder of the tube in the same manner as you tighten a ligature on 
the polypus of the uterus. It must be tightened every day till you have 
completely cut through the polypus.5’ The polypus, however, should be 
secured by a ligature, so that when loose, the patient may draw it out, 
instead of being in danger of choking. But the method adopted by 
Dessault is perhaps still more convenient. “ You require a silver tube by 
which the ligature is to be directed into the mouth, a short silver tube to be 
introduced into the nostril for tightening the ligature, and two pretty long 
ligatures. You introduce a bougie into the nostril, and bring out one end 
at the mouth. To this you fasten a single and a double ligature; the 
single one must be very long. This being done, the bougie is to be 
drawn out at the nose, and of course the ligatures follow it. You then cut 
ofif the bougie, and you have the two ends of the double ligature hanging 
out of the nose, and the loop hanging out of the mouth ; one end of the 
single ligature also hangs out of the nose and one end out of the mouth. 
The single and the double ligature ahvays pass on one side of the polypus ; 
but by means of a silver canula you draw the single ligature to the other 
side of the polypus. The ligature being held in its place by an assistant, 
the end of the single ligature projecting from the mouth is passed through 
the loop of the double ligature, and the ends of the double ligature being 
drawn out of the nose, the single end follows, and you make a ligature 
which you fasten by means of a canula introduced into the nose.” This 
method of Dessault is certainly preferable to the one first described. 400 
POLYPI. 
Other tumors of a malignant nature may grow from the nostrils 
which may be confounded with the two kinds of polypus just referred to. 
No good has hitherto resulted from interfering with them, and there- 
fore Sir B. Brodie thinks it better to let them alone, as “ they have 
generally so broad a base that any operation for their removal is out of the 
cpiestion.” 
There are some non-malignant affections which are sometimes mistaken 
for polypi: for example, a scrofulous child may have difficulty of breathing 
through the nostrils, and on examination the membrane is found turgid 
and vascular, with an excrescence upon it. This, however, will fre- 
quently be nothing more than a thickening of the mucous membrane 
of the nostril at the anterior extremity of the inferior turbinated bone. 
The mucous membrane may not be more thickened than elsewhere, but 
it is more apparent in that situation on account of the projection of the 
bone. 
In some cases in which the mucous membrane has been sufficiently 
thickened to obstruct the respiration through the nostril, I have introduced 
a pair of probe-pointed scissors, slightly curved, and snipped off a portion 
of the projecting mucous membrane. There is no harm whatever in its 
excision. You may suppose this to be a very simple operation ; and so it 
is, for it is done in an instant, but yet it requires some care in order that it 
may be done properly. In the dead body you might snip off a bit, and if 
you had not completed it by one incision you could make another. But 
in the living subject the mucous membrane is full of vessels, and the part 
must be snipped off at once; for the moment one division is made with 
the scissors, the hemorrhage is so great that you cannot see a bit of the 
remaining part which requires to be divided. 
Delicate children who are liable to this disease of the Schneiderian 
membrane are always benefited by the exhibition of steel; it should, how- 
ever, be given not in large doses, for a short time, but in small ones long 
continued. Where the constitution is weak, you may sometimes cure the 
disease in three weeks, but the rectifying of the constitution is a work of 
years. Some good may be done by local treatment. Dissolve two grains 
of sulphate of zinc in an ounce of rose-water, and inject a portion into the 
nostrils two or three times a day; or paint the inside of the nostril with 
diluted ung. hydrarg. nitratis by means of a camel-hair brush. 
I have seen some cases in which a small abscess had formed in the tumor 
that I have just described. Suppuration has taken place in the substance 
of the Schneiderian membrane, just where it projects in front of the inferior 
turbinated bone, and the best plan to adopt is to cut off, with a pair of 
scissors, membrane and abscess altogether. When an abscess forms in a 
pile, that is best relieved, not by laying open the abscess, but by snipping 
off the pile. Part ix., p. 93. 
jRemoval of Nasal Polypi.—Dr. D. McRuer has been in the habit, for 
some years, of employing the following method for the removal of the 
gelatinous and soft polypi of the nasal passages. 
A piece of catgut is passed from the nostrils to the mouth, to Which is 
fastened a piece of soft and dry sponge, corresponding in size, when firmly 
compressed, to the narrowest part of the nasal passage; it is then gently 
drawn forward by the posterior fauces through the nose, and inDr. McRuer’s 
experience of at least ten cases it has never failed to bring with it all 401 
POLYPI. 
the morbid growths much more effectually and easily than could possibly be 
accomplished by the old methods of forceps, ligature, etc. Part xxiii., p. 15 V. 
Polypus of the Nose.—In a clinical lecture on this subject, Mr. Syme 
remarks as follows : When you are going to remove a polypus remember 
that non-malignant diseases of this description are generally very limited 
in the seat of their origin from within the nose. They never proceed from 
the floor, septum, or external icall, but always from the roof or that part 
which is formed by the turbinated plates of the ethmoid bone, so that the 
growth always descends and fills up the lower parts of the nose, even 
extending into the throat. Never, therefore, attempt to extract it low 
down, but high up. Select forceps of a very small size; introduce the 
instrument gently along the upper passage of the nose, with the blades 
separated as much as possible, till you come to the neck of the polypus— 
then compress the handles, and by combination of traction and torsion in 
one uniform direction, break through the connecting textures. If the 
growth does not follow the instrument, try again and again. The mucous 
polypus, always originating from the small extent of surface that has been 
thus defined, whether it does so singly or, as more frequently happens, in 
groups, descends so as to occupy first the higher and then the lower 
channel of the nose, but cannot attain any great size so long as it is limited 
to these situations; and not possessing sufficient vigor of expansion to 
enlarge the osseous space, in order to attain any considerable bulk, must 
therefore proceed backward toward the pharynx. Keeping these things in 
mind, you will at once perceive that the plan of removing polypus by 
means of a thread or wire, whether simply put up the nose, or passed 
through it into the throat, cannot possibly extirpate the growrth, or do more 
than remove a portion of its substance. You will also require no argu- 
ments to prove the inutility and inexpediency of trying to accomplish the 
object in view by scissors, knives, or caustic; so that our choice is thus 
limited to evulsion by forceps. 
[Mr. Syme then proceeded in the way that has been described, and after 
several introductions of the forceps, succeeded in removing a large round 
polypus quite entire, immediately after which the patient breathed with 
perfect freedom through both nostrils.] 
It seems not unworthy of notice that in this case there are some points of 
resemblance to that remarkable tumor named the fibrous polypus, of which 
the characters are unity of growth, ligamentous toughness of consistence, 
extreme firmness of attachment, and disposition to bleed. Several cases 
have occurred here in which the patients had nearly died of hemorrhage, 
and all the strength that I could exert was hardly sufficient to effect 
extraction, while blood streamed in torrents from the nose and mouth. 
But as this disease is not malignant, the operation, however formidable, 
proves satisfactory in its result. Now, you may have remarked, that the 
tumor which has just been removed was solitary, and confined to one 
nostril, instead of occurring in both, as the mucous polypus almost always 
does ; also that its connections ivere very firm, and that the bleeding was 
considerable. It would seem as if there may be conditions intermediate 
between the two sorts of growth, in which the respective characters more 
or less closely approach those of each other. For instance, some years 
ago, a nobleman returned from public service in one of the colonies, on 
account of complete obstruction to breathing through his nose, with a 
VOL. II.—26 402 
POLYPI. 
constant discharge of watery fluid from it, and occasionally alarming 
hemorrhage, of which the amount was estimated not by ounces but by pints. 
He remained in London for two months under the care of several practi- 
tioners, who regarded the disease as incurable; and finding himself thus 
given up as hopeless, he applied to me, bringing with him a letter from the 
late Mr. Bransby Cooper, which stated that the result of repeated consul- 
tations with Sir B. Brodie, Mr. Travers, Mr. Csesar Hawkins, and himself, 
was a decision against interfering with the disease, which they seemed to 
regard as a tumor of the throat. Seeing no sign of malignant disposition 
in the aspect of the patient, who was about thirty-four years of age, and 
recognizing in the tumor the characters which were familiar to me as those 
of a nasal growth stretching backward into the pharynx, I at once under- 
took to remove the source of complaint. The patient and his friends at 
a distance having given their consent, I introduced the forceps, and at the 
very first pull extracted the whole growth, with immediate, complete, and 
permanent relief. Four years have now elapsed, and there has not been the 
slightest symptom of relapse to interfere with the enjoyment of perfect 
health, or the vigorous exertion of an active life. ParZxxxi., p. 223. 
Nasal Polypus—New Forceps.—Mr. Gant has recently invented a pair 
of forceps for the removal of nasal polypi which cut and hold at the same 
time. “ One edge of either blade is finished oflf somewhat like that of an 
ordinary pair of scissors; the other edge is broad and rasped. This combina- 
tion of scissors and rasped forceps is a modification of the grape or flower 
scissors of the conseiwatorics.” Part xxxviii., p. 148. 
RECTUM. 
Polypus of.—[In his lectures on Surgery, Sir A. Cooper stated that he 
had only met with ten cases of polypus of the rectum. Mr. Syme states 
that lie once saw five in the course of a fortnight, and thinks it not so 
rare as is generally supposed. Mr. Syme says:] 
It presents itself in three different forms, of which one usually occurs in 
childhood, and does not appear much beyond puberty. It is extremely 
soft and vascular, of a florid red color, and assumes the form either of a 
worm from two to four inches in length, or of a strawberry with a connect- 
ing foot stalk two or three inches long. The tumor seldom protrudes ex- 
cept when the bowels are evacuated, and then admits of ready replacement, 
though not without occasional hemorrhage, which may be of considerable 
amount. The vascularity of this growth, and its attachment above the 
sphincter, made me averse from removing it by incision ;'and Sir A. Cooper 
has mentioned the alarm that was on one occasion excited in his practice 
by doing so. I have always employed the ligature; and though the soft 
texture readily gives way when the thread is drawn, bleeding lias never 
•occurred in a single instance, or any other symptom in the least degree dis- 
agreeable resulted from this mode of removal. I am therefore induced to 
regard it as the best that can be employed. 
The disease appears in adults in two very distinct forms. In one of 
these, the growth is soft, vascular, prone to bleed, lobulated or shreddy, and 
malignant-looking, so as on the whole to resemble very much the cauli- 
flower excrescence of the os uteri, but possesses a peduncle or foot-stalk of 
firm texture, capable of sound cicatrization after being divided. The pro- 
fuse, frequent, and protracted bleeding which proceeds from this sort of POLYPI. 
403 
growth, renders its removal an object of great consequence; and this may 
be effected very easily, with perfect safety, by transfixing the radical cord of 
connection with a double ligature, tying the threads so as to include a half 
of it in each, and then cutting it across a little below the constricted part. 
In a patient of Mr. Craig, of Ratho (who detected the disease from the 
great hemorrhage it occasioned), I could not accomplish protrusion of the 
tumor, but guided a ligature on my finger, and tied it on the neck within 
the rectum. It is more satisfactory to force or draw the swelling beyond 
the sphincter, so that the sound and morbid parts may be distinguished with 
certainty, and this can usually be done with great facility, although the 
growth has attained a large size. In a hospital case recommended by Mr. 
Anderson, of Castle-Douglas, I brought into view and removed a tumor not 
less than an orange, which had a most malignant aspect, and had nearly 
exhausted the patient by hemorrhage. 
In the other form which polypus of the rectum assumes in adults, the 
tumor is of a firmer consistence, smoother surface, and more regularly 
spherical or oval form, so as to resemble the growth which in general con- 
stitutes polypus uteri. The symptoms resulting from this simple swelling 
are rather annoying than seriously alarming ; and the patient, therefore, is 
apt to delay requiring assistance for a long while. In the case of an old 
lady, whom I saw with Mr. Ilillson, of Jedburgh, the tumor was about the 
size of a cherry, with a long stalk, and we were assured had protruded 
every time the bowels moved for twenty years. In another case, a gentle- 
man whom I saw with Dr. Johnson, of Cumnock, the tumor was nearly as 
large as an egg, had a cuticular covering, and appeared to have existed 
for a period equally long. I have always removed these growths in the 
way that has been already described, and never met with the slightest con- 
sequence of a disagreeable kind. Part xii., p. 207. 
Polypus of the Pectum.—[A little girl, five years old, had been subject 
for two or three years to great distress in defecation, accompanied by the 
protrusion of a polypus. She was considerably reduced by sanguineous 
discharge. Dr. Burns says :] 
On examination of the anus, I found a polypus protruding as large as a 
small seckel pear, being considerably diminished at the time from frequenb- 
bleedings. On dilating the anus as much as possible, by traction in oppo- 
site directions, I found the pedicle to be somewhat elongated from the mu- 
cous membrane of the rectum above the sphincter; to this I immediately 
applied a ligature of silk thread, allowing the ends to remain long, which 
were secured externally by a strip of adhesive plaster; about twenty-four 
hours after its application the polypus separated, and two days after, the 
ligature came away. She suffered some pain while the ligature remained, 
which did not demand special attention. Since its removal about eight 
months have passed away, and there has been no return of the disease; no 
hemorrhage, the function of the part is normal, and the child’s health and 
appearance very much improved. Part xvi., p. 194. 
Polypus of the Pectum.— Vide “Use of the Ecraseur.” 
Polypus of , expelled by the Action of Secede Gornutum.—[Mr. Moyle 
was requested to attend without delay a Mrs. W., who had suddenly lost 
UTERUS. 404 
POLYPI. 
a large quantity of blood from the womb, and bad just recovered from a 
long state of syncope. The blood was lost in about two or three minutes. 
She had frequently had small hemorrhages previously, and was becoming 
weaker in consequence. Her legs and thighs were swollen almost to 
bursting, her countenance pallid, respiration difficult, and general health de- 
clining. After she had recovered greatly from her fainting, and after Mr. 
Moyle had satisfied himself that the Hooding was owing to polypus of the 
uterus, he proceeded as follows :] 
A fresh appearance of hemorrhage induced me to give her at once two 
drachms of the tincture of secale cornutum. I also applied a bandage 
firmly round the abdomen, and applied cloths, wrntted with cold vinegar and 
water, to the pudendum. The discharge proved to be little, and no faint- 
ness followed. In twenty minutes after the first dose, the tincture was re- 
peated, and in a few minutes she complained of being griped. Suspecting 
this griping to be a slight contraction of the uterus, I ventured an exami- 
nation by the vagina. The vagina was full of coagula; the os uteri was 
flabby and dilated to the size of half-a-crown piece, immediately within 
which I found a substance of somewhat firmer texture than the coagula, 
and around which my finger passed freely. During the examination there 
was a pain of sufficient force of the os uteri to embrace the finger firmly, 
and I now felt confident of being able to subdue the hemorrhage for the 
present, and was not without hopes that I might, by a perseverance of the 
remedy, enable the uterus to throw off the extraneous substance within it. 
A third dose was now administered, which kept up the pains at short in- 
tervals, but they were weak and feeble. Finding this the case, the suppo- 
sition was, that she was too much reduced from the disease and the recent 
loss of blood for the medicine to have its full effect. A cup of gruel, with 
a small quantity of brandy in it, Avas given her, and in half an hour after, 
another similar potion, Avhich had the effect-of reviving her to a great de- 
gree. I noAV took my leave about eight o’clock p.m., giving directions for 
a repetition of the food, together with some beef-tea, at intervals of an 
hour or every second hour, leaving with her four doses of the secale, to be 
•taken at intervals of half an hour; in case there should be the slightest ap- 
pearance of flooding, I Avas to be sent for immediately. 
Early on the folloAving morning, I found her laboring under sharp con- 
tractile pains of the uterus, from having taken, two hours previously, tAvo 
doses of the secale. Examination discovered the mass of polypus filling the 
vagina. The patient Avas very cheerful, and expressing herself convinced 
that the mass Avas coming away. The pains Avere by this time not so se- 
\rere as they had been, and consequently I now gave her three drachms of 
the tincture in a little brandy. This had the effect, in about tAventy minutes, 
of producing a severe pain, Avhich brought the mass to the os externum. It 
Avas uoav grasped Avith the hand, and, on the recurrence of the pain, the Avhole 
Avas discharged. Slight hemorrhage only followed the expulsion of the po- 
lypus, Avhich equalled in size tAvo large placentae. From this moment she 
recovered Avith great rapidity. There Avas a slight appearance of the men- 
ses at the end of six Aveeks, succeeded by a more abundant appearance at 
the termination of another similar period. She daily improved in health, 
the cedema gradually subsided, and although she Avas for many months un- 
able to put the Avhole weight of her body on her right leg, yet from ban- 
daging, the use of tonics, etc., she is now, in all respects, a perfectly healthy, 
robust woman. POLYPI. 
405 
The successful result of this case induced Mr. Moyle to try the use of 
the ergot in another patient who had previously been under his care. He 
gave her four doses of the tincture of secale cornutum, 3ij. in each dose. 
Two or three slight pains were now experienced, nausea and vomiting fol- 
lowed. Shortly afterward she had a severe labor pain. She then took 
3iij. more of the tincture, and the pains increasing, the polypus mass was 
felt at the os uteri. By the further use of the medicine the substance was 
completely expelled. It was about the size of an average placenta. 
Part iv., p. 120. 
Polypus of Womb.—A polypus descending from the womb is said to 
be insensible, whilst an inverted uterus is very sensible. If, however, a 
polypus descend with a covering from the inner surface of the womb, it is 
evident that its sensibility will be more or less retained. 
In partial inversion of the uterus, M. Lisfranc thinks favorably of the 
mode of examination proposed by M. Malgaigne, which we shall describe. 
In this affection the bladder and a portion of the intestines are lodged in 
the concavity formed by the depression of the fundus of the uterus; if, 
then, a curved catheter is passed into the bladder with its concavity down- 
ward, and the beak of the instrument is directed to the most depending 
part of the bladder, its extremity will be readily felt by the finger in the 
vagina, if the case is one of inversion, unless, indeed, the intestines have 
become adherent to the womb in such a way as to prevent the catheter 
penetrating into the depression formed by the inverted organ, a circum- 
stance of very rare occurrence. But M. Lisfranc thinks that the best 
way of discriminating between polypus and inversion of the uterus, is by 
a mode of examination similar to that above recommended, in the case of 
an intra-uterine polypus or of a commencing inversion. If we seize and 
depress the tumor with two fingers passed into the vagina, and then intro- 
duce the index-finger of the other hand into the rectum, no tumor can be 
felt through the gut above the one which is grasped in the vagina, if the 
case is one of inverted uterus. But if, on the contrary, we feel through 
the rectum, a second tumor similar in shape to the uterus, above the vagi- 
nal tumor, then this latter tumor is a polypus. In one instance, indeed, 
M. Lisfranc was misled by this inode of examination; he diagnosticated 
inversion of the uterus, but the patient having died, a small fibrous tumor 
was discovered implanted on the uterus, which was flattened and reduced 
to the tenth part of its natural size. 
M. Lisfranc has on several occasions removed by enucleation both polypi 
and fibrous tumors which were not pedunculated, whether situated com- 
pletely within the cavity of the uterus, or having partly (or in the case of 
polypi entirely) made their way into the vagina. 
In one case having drawn a fibrous polypus almost entirely through the 
vulva, he perceived that its envelope, which consisted of a thin layer of the 
tissue of the uterus, was lacerated, and passing the index finger through 
the rent, enucleated the tumor with the greatest facility. In another case 
enucleation was effected almost accidentally : M. Lisfranc, while examining 
a polypus, found the envelope give way beneath the nail of the index- 
finger, and by an easy manipulation enucleated the tumor in a few seconds. 
On examining the uterus immediately afterward, he found that the part 
of that organ to which the polypus had been attached, had singularly con- 
tracted, that the depression caused by the tumor had diminished greatly 406 
POLYPI. 
in depth, and at least two-thirds in breadth, it seemed to be diminishing 
while the finger was in contact with it, and in ten hours the uterus had 
regained its natural size, and the cervix would not admit the finger. We 
mention these latter facts, as we conceive they have an important bearing 
on the question of hemorrhage after excision of polypi. M. Lisfranc has 
also frequently enucleated, with the nail of the index-finger, small cellulo- 
vascular polypi occupying the neck of the womb. In a case where a fibrous 
tumor as large as the clenched hand projected into the vagina, its envelope 
was lacerated with the nails, and the contained tumor turned out. But 
enucleation must generally be preceded by an exploratory incision: and 
by this combination of means, JVL Lisfranc has removed fibrous tumors 
while still completely included within the cavity of the uterus. A lady 
was reduced almost to extremity, by protracted uterine hemorrhage 
caused by a fibrous tumor, which could be felt through the dilated cervix 
uteri. The neck of the uterus was seized with Museaux’s hook, depressed 
almost to the vulva, and a more perfect examination being then practica- 
ble, the tumor was found to extend from the middle of the body of the 
uterus almost to its lower extremity, and to be lodged in its posterioi 
wall, from which it was commencing to disengage itself. A straight, 
blunt-pointed bistoury was jiassed along the fore-finger, a vertical incision 
slowly and cautiously made over the tumor until the finger was enabled 
to be insinuated beneath the envelope and complete the enucleation, which 
was not accomplished without some difficulty. Occasionally, enucleation 
may be more easily achieved by substituting a spatula for the finger. If 
it is necessary to enlarge the incision in order to effect the removal of the 
tumor, a grooved director will often guide the knife more conveniently 
and safely than the finger. In some cases where the cervix uteri was in- 
sufficiently dilated, M. Lisfranc divided it anteriorly. Whenever the 
peduncle of a polypus is very broad, we should incise the envelope, and 
endeavor to enucleate the tumor ; in this, however, we cannot always 
succeed. If the tumor is removed, the envelope sometimes contracts and 
cicatrizes, sometimes sloughs in whole or in part. 
Lisfranc, in common with many other French writers, disapproves alto- 
gether of removing polypi by the ligature; and the Reviewer agrees with 
this opinion in general, although there may be cases in which it is neces- 
sary to use the ligature: “ Thus, if a polypus of moderate size is com- 
pletely included within the uterus, and is imjfianted high up, especially at 
the summit of the organ, and if the symptoms imperatively demand an 
operation, a ligature should be applied, if its application is possible, as 
it occasionally is when a sufficiently small peduncle can be detected; or if 
a patient is so exsanguine that the smallest loss of blood is to be dreaded, 
we should employ the ligature, unless the peduncle is too thick, or unless 
we are unable to bring it, when bulky, fairly within our reach, and pierce 
it with several needles, each armed with a double ligature and thus tie it 
in two or more separate portions.” 
How should we proceed if we felt an artery pulsating in the peduncle? 
Dupuytren recommended excision, having previously placed a ligature of 
reserve in case of hemorrhage: Lisfranc disapproves of this, inasmuch as 
it would certainly lose its place; and instead he would at once place a 
ligature on the peduncle, and then excise the tumor at once, leaving the 
ligature on the peduncle for about eight or tin hours, and then removing 
it. If hemorrhage should come on, he is convinced that plugging would 407 
POLYPI. 
be sufficient. If the artery felt in the peduncle was only a small one, he 
would not even apply a ligature, hut excise the polypus at once, trusting 
to plugging, if required. Part x., p. 151. 
Uterine Polypi and Ulceration.—Dr. Montgomery directs if small, to 
remove them by twisting with a forceps, consisting of a straight stem, 
eight inches long, having two short spring blades, with serrated tips, upon 
which slide a brace movable from the handle, by which they are easily 
pressed firmly together, and made to grasp very securely, any object 
caught between them. Apply nitrate of silver to restrain bleeding. Where 
it is necessary, in a larger pedunculated polypus, apply a ligature; Uiessen’s 
double canula is recommended, and with it, silk salmon fishing-line soaked 
in linseed oil, which combines strength, perfect pliability, and softness, 
and is unaffected by moisture. U.B. In persons of a high habit, and 
who are subject to indulgences in dietary, be careful not suddenly to sup- 
press menorrhagic discharges, because of the dangers of determination to 
cerebral congestion. Part xiv., p. 301. 
Polypus Uteri.—Very small polypi situated high up in the cervix, says Dr. 
Locock, may be removed by an instrument made for the purpose, consist- 
ing of a very small, sharp scoop, like a carpenter’s gouge, inclosed in a 
canula from which it is made to protrude by turning a screw. Larger 
polypi should be excised ; but should first be twisted round several times 
so as to produce torsion of the arteries; or, if they are very large, a liga- 
ture should be applied for two or three days, and when the circulation 
has become well strangulated, the neck of the polypus should be o 
through above the noose. Part xvii., p. 277. 
Polypus Uteri, Intra-uterine—When the symptoms afford reason to 
suspect the existence of a polypus concealed within the uterus, says Prof. 
Simpson, the diagnosis may be rendered certain by the dilatation of the os 
and cervix uteri, by means of sponge-tents. The tents recommended are 
of a conical form, and are introduced by the aid of a director resembling 
the uterine sound. Usually a single tent, applied for twenty or thirty 
hours, opens the os and cavity of the cervix sufficiently to allow an 
examination of this part by the finger. In order to examine the cavity 
of the body of the uterus, it is necessary to employ a series of tents for 
several days, taking care to pass them within the os internum. When 
the presence of a polypus is ascertained, if it be gradually but certainly 
making its way downward, and the hemorrhage and other symptoms 
are not urgent, wait for its descent through the os, before attempting its 
removal; facilitating its passage by the dilatation of the os and cervix with 
sponge-tents, and by the internal use of ergot. But if there is too much 
hemorrhage to wait, or if there is no likelihood of the tumor’s descent, 
proceed forthwith to remove it. With this object, first dilate the os uteri 
further; then if the polypus is large, divide the pedicle with very curved 
blunt-pointed scissors, or with a silver wire passed around it and tightened 
by means of a screw; or if these means are inapplicable, contuse and 
crush the tumor by a pair of lithotomy forceps, or similar instrument. 
Or, if the polypi are small and vesicular (in which case they are generally 
numerous, and situated in the cavity of the cervix), remove those that 
are fully formed and pedunculated, by the scissors, or by scratching them 
off with the nail; and destroy those that are not completely developed, but 408 
POLYPI. 
are imbedded like peas in the mucous membrane of the cervix, by the 
application of potassa fusa. Part xxi., p. 275. 
Polypus Uteri—Intra- Uterine.—When the womb remains large and 
bulky after delivery, says Dr. Oldham, and when we are satisfied there is 
not another ovum, although we may suspect the presence of a polypus, 
we are decidedly not justified, so long as no alarming symptoms occur, in 
endeavoring to make out exactly by manual interference, whether such is 
the case or not, or in arousing the uterus to contraction by the exhibition 
of the ergot of rye. The system of non-interference must be pursued ; the 
safety of the patient consists in the quiescence of the uterus. To insure 
this, strict rest, mild sedatives, and the avoidance of all local irritation 
should be enforced. But if, in spite of all endeavors, it be necessary to 
remove the polypus, the best plan is, if the pedicle is small, to twist it off. 
If, however, it occur at a time when physical injury to the uterus may be 
hazardous, the ligature should be applied to the pedicle to prevent hemor- 
rhage, and then the body of the polypus removed with the knife. 
Part xxvi.,/>. 316. 
Polypus Uteri— Varieties.—The term “ polypus uteri,” says Dr. Rams- 
botham, has been given at different times to organic diseases of the uterine 
structure, as well as to formations, within the uterine cavity, of very various 
and dissimilar kinds; and even now, though it is restricted to tumors 
attached by vascular connection to the uterine substance, the phrase is 
applied to more than one variety of morbid growths. Some are dense, 
firm, and compact, in their structure ; some soft and cellular; some of a 
florid scarlet; some of a deep peony color; and some, when removed, 
almost white. They take their origin also from different parts of the 
organ,—the fundus, the body, the internal channel of the neck, or the 
outer circle of the mouth itself. 
Dr. Lee has noted four distinct species of polypus uteri, none of them 
malignant in their nature:—the fibrous;—the follicular or glandular, 
which he describes as a morbid enlargement of the Glandulce JVabothi ; 
and which, consequently, are situated only at the mouth or neck;—the 
cystic or cellular, made up of a congeries of small vesicles or cysts, con- 
taining a fluid more or less transparent, and yellowish in color. This 
variety is formed just beneath the lining membrane of the uterus, and 
springs from every part of the cavity. The tumor is highly vascular; 
and the cysts composing its chief bulk are bound together by fine fibrous 
tissues ;—and, lastly, the mucus, which does not grow to so large a size 
as either of the others, and which seems to be produced by a morbid 
change in the mucous membrane itself, and to be analogous to the poly- 
pous tumors sometimes formed within the nose and other mucous 
cavities. Part 201. 
Ligature in Polypus Uteri—In applying a ligature upon a polypus of 
the uterus, says Dr. Ramsbotham, we might grasp some of the structure 
of the uterus itself. To obviate this, the neck of the polypus must be tied 
some distance below its attachment; for that portion of the stem left in 
connection with the uterus will wither and come away in shreds, or be 
absorbed after the main bulk has been removed. The sensation of pain 
must, to a great extent, be our guide. If the patient complains much, the 
noose should be relaxed and again drawn tight over the lower portion of 
the neck or body of the tumor. Part xxvii., p. 203. 409 
POLYPI, 
Polypus Uteri.—Galvanism applied to the uterus has brought these 
growths into view where ergot had failed. Part xxix.,y>. 266. 
Extraction of Polyi from the Uterus.—Mr. Canney recommends 
excision rather than the ligature when the polypi are not large. Dr. 
Tyler Smith prefers ligature ; Mr. Hodgson says the torsion is sometimes 
both better and safer than either excision or the ligature. Dr. Copland 
gives us an interesting case to show the effects of biborate of soda. 
He says: 
Polypi, or fibrous tumors, on the inner surface of the uterus, were 
occasionally thrown off without resorting to the ligature, or any other 
operation. Some years ago he had been called in consultation to the case 
of a lady suffering from constantly recurring uterine hemorrhage. A 
tumor was protruding from the os uteri. The question of removal was 
discussed, and it was decided that biborate of soda should be given, with 
a view of producing the contraction of the uterus, by which the growth 
might be thrown off. The medicine was given in large doses, and con- 
tinued for two or three days. The uterus contracted powerfully, and the 
tumor was expelled. All the symptoms abated for three or four days, 
when a second tumor presented itself. Dr. R. Lee then joined the con- 
sultation, and it was determined that the use of the soda should be per- 
severed in. The result wTas that this second tumor, like the first, was 
thrown off, and the patient recovered. He could speak from his own 
knowledge, that she was alive and well 13 or 14 years afterward. This 
might not have been a case, strictly speaking, of polypus of the uterus, 
but it was certainly one of a tumor under the villous coat of that organ, 
which wras thrown off by the contractions of the uterus. 
Part xxix., p. 304. 
Polypus Uteri—Detection of.—The polypus will be best detected 
during the relaxation and forcing down, attendant on an attack of flooding. 
The bi-valved speculum assists by expanding and opening the os. Dr. 
Locock particularly points out that the tumor is always best found out 
during hemorrhage, and indeed it cannot be detected at all when very 
small, and only in the cervix, in the intervals of the attacks of hemorrhage. 
For bringing a polypus into view, the ergot of rye may sometimes suc- 
ceed, but galvanism is more safe and more efficacious. The os and cervix 
uteri may be dilated by means of sponge-tents—use two or three gradu- 
ated sponge-tents in succession so as to open the canal for inspection. M. 
Jobert de Lamballe has recently contrived an intra-uterine speculum. 
In those cases wffiich indicate the necessity of exploration beyond the 
uterus, first bring the polypus in view, if you can, by dilating the os uteri 
by sponge-tents, and giving repeated doses of ergot of rye, assisted by 
the application of galvanism. 11‘ you cannot get hold of the tumor so as 
to encircle the neck, pull it lower down by the aid of a tenaculum, if this 
operation be not particularly resisted—and now try again to ligature the 
neck of the tumor. Part xxx., p. 212. 
Excision of Large Pedunculated Uterine Polypi.—Prof. Simpson 
prefers to remove large uterine polypi by excision, rather than by ligature. 
You can always arrest hemorrhage by well plugging the vagina. For 
excision use a polypus-knife (called apolyptome). First reach the pedun- 
cle by the apex of the fore-finger of the right hand introduced along the 
pubic surface of the vagina. Then push the instrument along this finger, 410 
rKEGSTANCY. 
and by hooking down the peduncle it is divided by the knife, which is 
placed in the concavity of the instrument, something like the lately im- 
proved hernia-knife. Part xxxi., p. 210. 
Waterproof Ligatures.—In cases of polypus, etc., the ligature some- 
times breaks abruptly from the corrosive effects of the dischai’ges. If the 
ligature be previously rendered waterproof by a solution of caoutchouc it 
answers beautifully, and comes away as sound as when applied. 
Part xxxii. p. 318. 
Uterine Polypi.—These, when pendent from within the os uteri by a 
narrow peduncle, may be readily removed without any hemorrhage by 
the ecraseur. Slip the loop of the chain around it, and by tightening 
slowly and steadily, the stem will easily be cut through. 
Part xxxv., p. 253. 
Uterine Polypi.—For the removal of these tumors an instrument lately 
invented by Dr. Aveling, of Sheffield, will be found very useful. It con- 
sists of a long curved stem, at one end of which is a hook, and fitting into 
the concavity of this is a plate of metal, which by a screw in the handle is 
capable of being withdrawn lower down the stem. When used the plate 
is screwed half way down the stem, and the instrument is passed up so 
that the hook may be round the peduncle of the tumor : by means of the 
screw the plate of metal is now forced up into the concavity of the hook. 
Thus the tumor is removed, without the disadvantages of either the knife 
or the ligature ; viz. of the former, hemorrhage, which is here aAmided, as 
the peduncle is not divided by a cutting but by a crushing action, and of 
the latter, the fetid discharge caused by the putrefaction of the polypus. 
Part xxxvi., p. 240. 
Removal of Large Uterine Polypus, by the Curved Ecraseur.—Dr. 
Savage of the Samaritan Hospital, lately removed a vascular uterine poly- 
pus, Avithout pain or hemorrhage, by means of an ecraseur the curve of 
Avhich can be made to fall into the hollow of the sacrum and the point to 
pass up into the uterus. When removed by this instrument, the polypus 
is first seized by a pair of ring forceps, and the chain is passed over these, 
and draAvn tight, precisely as the cord in the ordinary operation by 
ligature. Part xxxvii., p. 214. 
Polypus Uteri.—Mr. I. B. BroAvn is of the opinion that the best mode 
of removing these groAvths, is to seize them with a pair of long Amlsellum 
forceps, and having dragged them into sight to pass a needle armed Avith 
a strong double ligature through the base, which can noAV be tied in two 
parts, then cut off the polypus just anterior to the ligature, and plug the 
vagina with oiled lint. This plan is infinitely preferable to that of either 
simply cutting off the polypus, or the more tedious process Avith Gooch’s 
apparatus, where the sloughing of the polypus within the vagina generally 
causes serious constitutional disturbance, not unfrequently pyaemia, and 
sometimes death. Part xxxvii., p 217. 
Nux Vomica, in the Vomiting of Pregnant Women.—Dr. Croyher, 
of Presburg, assures us that minute doses of the nux vomica, given in 
PREGNANCY. 411 
PEEGNANCY. 
some aromatic or in cherry-laurel water, are a specific, remedy against the 
troublesome vomiting to which many women are subject during the early 
months of pregnancy. In order to insure success, the bowels must be 
kept in a gently open condition, but neither purged nor constipated. The 
author says, that the effects of this remedy are certain, provided the 
vomiting is the result of pregnancy alone, and is not dependent on any 
morbid state, either of the stomach or of any other organ. The dose 
recommended is from two to four drops of the tincture—the strength of 
this is not stated—to be gradually increased to ten, twelve, or eighteen 
drops every morning in bed, and again in the evening. In many cases it 
proves quite successful within a week or even a shorter time ; in other 
cases its use must be continued longer. Part iii., p. 125. 
Gravidine as a sign of Pregnancy.—The fluid portion of the urine 
of pregnant women being drawn off, there appears a “ natural sedi- 
ment,” which, whether held in solution, or separated by ether, has a 
striking resemblance to the serous globule, but, when in a sedimentary 
state, bears an equally strong resemblance to the milk globule in recent 
milk. This substance differs from albumen and caseum, the two animal 
substances most analogous to it: from the former, in being soluble in 
water by means of heat; from the latter, in being soluble by sulphuric and 
nitric acids. From gelatine it also differs : first, in being precipitated from 
its solution in water on cooling ; secondly, though partially precipitated 
by tannin, the precipitate was soluble in water on boiling. The author 
calls it “ gravidine,” both from gravidas, big with young, occurring as it 
does in pregnant women ; and also from gravis, heavy, seeing that it falls 
to the bottom of the vessel. Kiestein is but the pellicle which results from 
the decomposition of gravidine. As the globules forming the latter 
substance are decomposed, urates and purpurates are developed in the 
urine ; and when these have broken up and assumed new combinations, 
the triple phosphates appear, with that beautiful crystalline appearance 
described by Dr. Bird as one of the characteristics of kiestein. 
Part v., p. 1G2. 
Severe Gastric Irritation in Pregnancy.—Whenever in a pregnant 
woman, in any stage of her gestation, severe vomiting, wearing away the 
strength of the patient, and preventing proper nutrition, shall have for 
several days resisted all the usual remedies, whilst the fever continues una- 
bated, and the vital forces are failing, we ought not to delay a moment, 
says Dr. Edwards, in procuring the expulsion of the foetus. 
Part xiv., p. 284^ 
Diagnostic Sign.—A good diagnostic is the enlargement of the anterior 
wall of the womb, its ordinary flatness becoming effaced by the fourth or 
fifth week. In congestion of the womb, it is the posterior wall which is 
chiefly enlarged. Part xv., p. 315. 
Appearance of the Os Uteri during Pregnancy.—Dr. Whitehead says : 
In order to ascertain the existence of pregnancy from a few days after 
conception to the middle or end of the fourth month, examine the os uteri 
with the speculum. Immediately after the conception, as during menstru- 
ation, the labia uteri are in a state of great vascular turgescence, and the 
os closed and linear. In from ten to twenty days the whole uterus is found 
enlarged, and the circulation in it augmented ; the labia are thickened and 
apparently elongated, the commissures less distinct, and the os apparently 412 
PREGNANCY. 
sunk in or dimpled. In the fourth week the os tineas, which was before a 
mere chink with parallel boundaries, now an elliptical or rounded aperture, 
separating the labia to the extent of a line or two, and occupied by a plug 
of mucus. At six or eight weeks it becomes decidedly oval or 
Avith a puckered or indented boundary. Part xvi., p. 239. 
Menstruation in Pelation to Pregnancy. — Conception, says Prof. 
Dubois, may take place in a woman not yet arrived at the age at which she 
ought to menstruate. There are, in fact, many women who do not mens- 
truate till the seventeenth, eighteenth, or nineteenth year. Such women 
may become pregnant at that time of life, although they have never 
menstruated. M. Dubois has known a Avoman become pregnant two years 
after the cessation of the menses. The woman finding her abdomen en- 
larging, entered the medical department of an hospital. The physician 
under whose charge she Avas, had so little idea of the Avoman’s being preg- 
nant, that he delivered a clinical lecture on the case, as one of ovarian 
dropsy. On making an examination of the case, M. Dubois easily made 
out the pulsation of the foetal heart. In fact, labor very soon supervened. 
The menses may be suppressed physiologically, and yet pregnancy take 
place. Thus, it is not rare to see nurses become pregnant before mens- 
truation has reappeared. We find also, that women who are extremely 
irregular, who, for example, menstruate only once or tAvice a year, become 
pregnant; although, in general, this state is one very unfavorable for 
conception. 
Various diseases and changes in habits may derange the menstruation, 
and give rise to the idea of pregnancy. This error occurs frequently, 
chiefly to persons anxious to become in the family way. Nothing is more 
common than to find the menses suppressed for some time after marriage. 
It is also very frequently observed, that Avomen leaving the country to 
reside in the tOAvn suffer from suppression. This may be said to occur 
habitually in young Avomen coming from the country into domestic service 
in Paris. 
In other cases, the menses, after having been suppressed for three or 
four months, re-appear suddenly, with some profuseness. This is some- 
times taken for the occurrence of abortion, Avhen it is merely the recur- 
rence of the menses after they have been suppressed, in consequence of 
some change in the habits of the female. Part xxii.,/>. 272 
Nausea and Vomiting of Pregnancy.—You must first try to get the 
secretions into a healthy state. One of the most serviceable remedies in 
these cases, according to Dr. Tyler Smith, is the infusion of calumba Avith 
soda and hydrocyanic acid, or you may give this in an effervescing form 
Avith citric acid—in some patients opium ansAvers better, and perhaps the 
solution of the bimeconate of morphia is the best form in Avliich an opiate 
can be given. Salicine, in doses of three to five grains, three times a day, 
is a valuable medicine. Creasote, in one or tAvo drop doses made into pills 
with bread, is an efficient remedy. Professor Simpson particularly recom- 
mends the nitrate of cerium in doses of one to tAvo grains in Avater, and 
also the inhalation of the vapor of laudanum. Part xxxiii., p. 251. 
Molar Pregnancy.—If the life of the mother should be threatened, the 
ovum should be detached by the catheter or the uterine sound Avithout 
hesitation. Ergot of rye must also be given to excite contractions, but in 
ordinary cases, as in simple abortions, Ave must wait until the ovum can be 413 
PREGNANCY. 
reached with the finger before we attempt to remove it. In hydatid 
degeneration, the treatment may be more positive—give ergot, and if the 
os uteri be dilatable, introduce the hand to detach and remove the hydatid 
mass. Part xxxiii., p. 270. 
Pregnancy—Diagnosis of,\ from Abdominal Tumors.—Dr. Oldham 
says: By applying the hand, the tumor at first feels soft and ill-defined, 
but by pressure it rapidly assumes a tense rounded form, becoming firm 
and resisting. This may be taken as a trustworthy characteristic of a 
pregnant uterus, since there is no other tumor which possesses any power 
of altering its form when irritated by palpation. Part xxxiii.,/). 270. 
Pregnancy—Duration of—To ascertain the most probable day of a 
woman’s confinement, add 278 days to the last menstruation. 
Part xxxv., p. 209. 
Vomiting of Pregnancy.—In a case which occurred to Dr. Clay, of 
Manchester, where the induction of premature labor seemed absolutely 
necessary, from the failure of all other means, for relieving the incessant 
vomiting—on introducing the finger to guide an instrument for this pur- 
pose, the os and cervix uteri were found very tender and painful when 
touched, and violent eiforts of vomiting caused. Considering this state to 
be produced by pressure on the os uteri, instead of proceeding Avith the 
operation, he caused the patient to be laid quite prostrate on the back, 
with the head very low and hips considerably raised. In about 24 hours 
the tendency to vomit was considerably less, and small portions of food 
could be retained: she continued to improve, and ultimately safely com- 
pleted the period of utero-gestation, but at any time the slightest attempt 
to resume the upright position was followed by violent retching and dis- 
tressing vomiting. Dr. Clay was convinced that there is pretty generally, 
if not always, considerable congestive inflammation and great tenderness 
about the os and cervix uteri which are best treated by local bleeding at 
the seat of mischief. That the irritable state of the stomach is purely 
symptomatic of that condition of the os and cervix uteri (that is) in these 
obstinate cases of the latter months. That these cases differ widely from, 
and must not be confounded with, those of nausea and sickness of the 
early months, however severe; and where the stomach itself particularly, 
and in some measure the entire digestive functions are much deranged ; 
and attention to the condition of the stomach will, in most, if not in all 
cases, be remedied by medicine and diet. That diet or medicine have 
little or no effect in the severer cases above described, in the latter 
months ; but that a position of the body calculated to relieve the os and 
cervix from pressure against the pelvic viscera, is best accomplished by 
lying on the back with the hips raised and head low, with food in very 
small quantities given at long intervals. Lastly, and mainly, Dr. Clay 
places much reliance on the application of a few leeches, by means of the 
speculum, directly to the os and cervix uteri—the seat of congestive 
inflammation, and consequently the cause of general irritation and sympa- 
thetic action of the stomach and its consequences. The leeches are to be 
repeated if any tenderness remains, and the position strictly observed 
until the symptoms are entirely conquered. Part xxxvii., p. 202. 
Pseudocyesis.—Diagnosis.—There is a form of spurious pregnancy, 
says Prof. Simpson, in which there is a firm unyielding swelling of the 
abdomen, often supposed to be due to the enlargement of a gravid uterus, 414 
PROLAPSIONS. 
but which is in reality due to a tympanitic state of the bowels and a 
peculiarly tonic condition of the abdominal muscles; and the abdominal 
Avails are so firm and tense, and resis: the pressure of the hand so effect- 
ually as to render an adequate examination utterly impossible. In such 
cases as this give chloroform; under its influence, if deep enough, the 
abdominal muscles will become perfectly relaxed, and on Dressing on the 
abdomen the Avails will give Avay before your hand, and sink backward 
until you can feel the spinal column quite distinctly. This curious affection 
is probably OAving to some affection of the diaphragm, Avhich is throAvn 
into a state of contraction, and pushes the boAvels dowmvard in the abdo- 
minal cavity. Part xl., p. 180. 
PROLAPSIONS. 
PROLAPSUS ANI. 
Prolapsus Ani.—Bransby Cooper makes the following remarks on pro- 
lapsus ani, which so frequently accompanies piles: Under ordinary cir- 
cumstances, you will cure the prolapsus by palliative means, and by curing 
the piles which have caused it, but if the mucous membrane and the mus- 
cles have been so much relaxed as to render a large prolapsus permanent, 
you must take up two or three folds of the mucous membrane which covers 
it, and surround each fold with a ligature, then return the prolapsed gut 
into the pelvis. The patient will be disappointed at first as he is not re- 
lieved ; it is the case that there will be no great relief till the ligatures come 
away, but after that the cure is permanent, at least so it has proved in three 
or four cases in which I have employed this method. Part iii., p. 88. 
Prolapsus Ani — New Mode of Treating.— Dupuytren’s method of 
curing a prolapsus ani in the adult was at first by excising a portion of the 
mucous membrane of the bowel, and afterward by cutting away only the 
folds of the skin at the margin of the anus. The anus in these cases being 
immoderately dilatable, this process causes a degree of consolidation and 
contraction. It is seldom that this is required in the child. Sir Benjamin 
Brodie’s plan will generally succeed by injecting every morning 2 or 3 
ounces of a lotion composed of 3j. of tinct. ferri muriatis and a pint of 
water: at the same time giving occasional gentle aperients, and not too 
much vegetable food. Dr. McCormac, reflecting on the method of Du- 
puytren, applies the same principle to cases of children in the following 
simple way : When the child goes to stool, the skin anterior to the anus is 
to be drawn to one side by means of the fingers extended around. At first 
the child may not be able to evacuate its bowel, but when encouraged to 
persevere it will do so, and wall often, in this simple way, be entirely cured. 
Part viii.,jt>. 162. 
Prolapsus Ani.—Five different means of treating this affection are men- 
tioned by M. Dieffenbach in his operative surgery. 1st. By diminishing 
the anal opening by excision of folds around it. 2d. By excision of wredge- 
shaped pieces from the anus. 3d. By excision of parts of the anal ring, 
and of the callous prolapsus. 4th. By extirpation of the spongy prolapsus. 
And 5thly. By cauterization. Part xxii., p. 218. PROLAPSIONS. 
415 
Pelvic, Viscera, Prolapsus of.—In these cases, Avith lacerated perineum, 
the object must be to remove the actions of the sphincter ani and the leva- 
tores ani, by-removing their points of attachment to the coccyx. Mr. Hilton 
describes his plan of operating in these cases as folloAVS : A narrow, sharp- 
pointed knife was introduced through the skin on one side of the point or 
free extremity of the coccyx, about half or three quarters of an inch from 
its end ; it was then passed into the pelvis between the concave surface of 
the coccyx and the rectum, special care being taken not to puncture the 
intestine. The cutting edge of the knife Avas uoav made to SAveep over the 
sides and ends of the coccyx, so as to separate from it the coccygeal at- 
tachments of the sphincter and levatores ani. The knife Avas then Avith- 
draAvn through the same small opening by Avhich it had been introduced, 
scarcely any blood escaped at the Avound, but a compress of lint, supported 
by adhesive plaster, Avas applied over it to keep the parts quiet, and to in- 
tercept the floAV of blood. Part xxix., p. 277. 
Nitric Acid.—Apply nitric acid as folloAvs : Wipe the acid down the 
protruded part in separate streaks or tracts vertically from the sphincter 
do\vrn to the lowest portion of the gut; then replace the protrusion and 
alloAV no motion for tAVO days. Dr. M‘DoAvel says : You may re-apply the 
acid at intervals of seven or ten days if necessary. Part xxx., p. 154. 
Strychnine.—Dupuytren’s method of treating prolapsus ani, Avas by ex- 
cising radiating folds of the skin round the anus, while Guersant used the 
actual cautery. Duchaussay thinks these acted only by stimulating the 
sphincter muscle, and therefore he applies strychnine. Apply one-sixth to 
one third of a grain of strychnine to a blistered surface in the neighborhood 
of the anus, Repeat this occasionally according to its effects. 
Part xxx., p. 155. 
Treatment of Prolapsus Ani by Strychnia and by the Actual Cautery. 
—Dr. A. Johnson says: If the child be about two years old, apply a blis- 
ter to the cleft between the nates, and dress the blistered surface with one- 
tAventieth of a grain of strychnia—on the fourth day one-sixteenth of a 
grain may be applied on a second blistered surface, the cuticle, of course, 
being removed. Five or six days aftenvard this may be repeated if neces- 
sary. In a child of four years old, one-eighth of a grain may be used each 
time. If this fail, apply the actual cautery in three or four places at the 
junction of the skin with the mucous membrane. This may be repeated in 
a few weeks, if necessary, but less extensively. Strychnia may do for very 
mild cases, but the actual cautery is the most certain remedy. 
Part xxxi., p. 156. 
Prolapsus Ani treated with Nitrate of Silver.—Dr. Lloyd says: Smear 
the whole surface of the protruded boAvel with solid nitrate of silver, and 
then return it. Repeat this once a Aveek or fortnight. This need not be 
confined to simple prolapsion, but may be used in cases of hemorrhoidal 
congestion and thickening of the mucous membrane about the verge of the 
anus. • Part xxxi., p. 158. 
Prolapsus Ani and Hemorrhoids—The Ecraseur.—The ecraseur is not 
so frequently used in these cases as it deserves. Two cases are related by 
Dr. R. Davies, in which a speedy and safe cure Avas effected, and that after 
the nitric acid plan had failed. Part xl.,p. ill. 416 
PKOLAPSIONS. 
PROLAPSUS UTERI. 
Use of Nitric Acid.—Mr. Benj. Phillips, in one case of prolapsus uteri, 
treated by him at the St. Marylebone Infirmary, succeeded in effecting a 
cure, or, at least, in affording complete relief by destroying a portion of the 
mucous lining of the vagina by means of nitric acid. The contraction con- 
sequent on the separation of the sloughs reduced the size of the vagina so 
much as effectually to retain the uterus in situ. Part i., p. 95. 
Use of the Actual Cautery in Procidentia Uteri.—Almost every remedy 
has been in vain tried in many of these cases. The actual cautery, though 
a severe remedy, will often be successful when all other applications have 
failed. Cases where this was successfully applied are brought forward by 
Dr. Lowrie, of the Glasgow infirmary. 
The following case shows the efficacy of this valuable remedy in proci- 
dentia uteri. C. M‘L., aged 18, a servant, while carrying a heavy tub, felt 
something give way in the pelvis, and as if the vagina immediately after- 
ward was unusually distended. Some days after this, the uterus distended 
the vagina, and rapidly descended so as completely to prolapse. It could 
easily be returned by pressure, but again descended almost immediately. 
She derived no benefit from the free application of the nitrate of silver, 
astringent injections, pessaries, bandages, and the ordinary treatment. 
Strips of the mucous membrane of the vagina were dissected off from the 
lateral and posterior parts of the vagina, without any benefit. Weiss’s 
three-pronged speculum was introduced and dilated, and the actual cautery 
freely applied to both lateral surfaces of the vagina, nearly as high as the 
uterus. Great pain was of course experienced, followed by other severe 
symptoms ; the patient Avas kept recumbent for about six weeks. 
Nine Aveeks after the operation the following report Avas entered in the 
journal: “Not the slightest tendency to reneAval of the procidentia; she 
has no feeling of prolapsus. Uterus felt nearly in its natural position, Avith 
a circular contraction of the vagina a little beloAV os uteri. The contrac- 
tion firm, but quite elastic.” We need hardly mention that the contrac- 
tion of the vagina is here made to support the womb ; and this must occa- 
sionally give Avay, especially Avhen previously over-distended by the use of 
large pessaries; and therefore in all cases of procidentia it will be well to 
make use of some kind of support, such as that recommended by Mr. Clay, 
previously noticed, ( Vide Article “ Pessaries,”) which Avill not produce this 
relaxation of the vaginal parietes. Part iv., p. 129. 
Prolapsus Uteri.—[Mr. Whitehead says that prolapsus is most fre- 
quently a consequence of inflammation and ulceration of the lower part of 
the uterus. He thinks that pessaries only aggravate the disease, and re- 
marks, that in addition to attention of the general health,] 
The local treatment should consist in applications of nitrate of silver, or 
other suitable remedies to the diseased surface, and in the insertion of 
medicated tents by the aid of the prolapsus tube. This latter procedure 
may be practised immediately after the nitrate has been employed, although 
the remedy Avith which the tent is charged be of a very different nature 
from that of the caustic. The manner of using the prolapsus tube — which 
Avill be found of equal service in the management of prolapsed displacement 
of the uterus, as in most other forms of uterine disease, and enables the 417 
PROLAPSIONS. 
patient safely and efficiently to apply the remedies herself, without the in- 
terference of the practitioner—is extremely simple. The charged tent, to 
which a length of thread has been previously attached, must be placed in 
the tube, the upper orifice of which is to be applied against the protruded 
portion of the uterus, in such a manner as to receive the os uteri within it. 
The instrument, previously smeared with some unctuous material, and 
having its curved arm placed anteriorly, in a direction toward the abdo- 
men, is now to be forced gently and steadily backward, until the Avhole, or 
greater portion of it, has passed within the canal, or until a moderate de- 
gree of resistance is felt to oppose its further ingress. 
The uterus being thus restored to its natural position, the tent or pledget 
must be passed upward against the cervix, and held in that situation by 
means of a skewer or other suitable instrument, the tube at the same time 
being gently withdrawn. The recumbent posture should be strictly main- 
tained for several days, and very little exercise taken for some weeks after- 
ward. The lotions, used for moistening the lint-tent, are strong solutions 
of nitrate of silver, sulphate of zinc, sulphate of copper, matico, opium, and 
tannin. The metallic preparations should not be employed oftener than 
every third or fourth day, the vegetable applications being used interme- 
diately. An emollient injection should be made use of after the removal 
of each tent. Part xvi., p. 277. 
Prolapsus Uteri—Galvanic Cautery.—In a case of long continued pro- 
lapsus, and in which the vagina was very lax and distensible, Mr. Marshall 
determined to apply the galvanic cautery to produce a series of eschars upon 
the Avails of the vagina. A peculiar speculum made for the purpose, con- 
sisting of tAvo large blades, and inclosing double rows of fenestrae about an 
inch in length and half an inch in breadth, having been introduced and 
the blades separated, the mucous membrane was seen to bulge through the 
apertures. The coil of heated Avire was now applied, and eight eschars 
rapidly made on each side of the vagina. For the first fortnight the pa- 
tient Avas confined to bed, and detergent injections used tAvice daily; as the 
sloughs separated, mildly stimulating ones Avere applied. The capacity of 
the vagina Avas considerably diminished, and on moving about no prolap- 
sion Avas found to take place. It is important to observe that if the vagina 
is protruded, it must be first returned, as, although under these circum- 
stances, it may be easier to apply the cautery, yet it is most difficult and 
dangerous to return the mass afterward. Part xxviii., p. 273. 
Prolapsus Uteri.—Having made the usual horse-shoe denudation in the 
operation for the cure of this disease, Mr. Fergusson applies the common 
interrupted suture instead of the quill suture, which is generally used. 
Mr. Fergusson believes that the quill suture sometimes causes tendency to 
sloughing from over pressure. Part xxxvi., p. 238. 
Prolapsus Uteri—Plastic operation.—In this operation, says Hr. Hut- 
chinson, the great element of success is to denude a sufficient portion of 
the back part of the vagina, to get contraction of at least the loAver two 
inches. To this end do not denude tAvo narrow slips, but a portion ex- 
tending from an inch to two inches on each side, commencing at the anal 
commissure, and extending an inch and a half upward into the vagina. 
VOL. II.—27 
Part xxxvii., p. 221. 418 
PKOLAPSIONS. 
PROLAPSUS VESICLE. 
Cured by Operation.—[This patient first observed a small tumor to pro- 
trude from the vagina, which gradually increased to the size of an orange, 
and then to the size of the fist, hanging between the thighs: the greater 
part was formed by the bladder and anterior paries of the vagina. After 
remaining in bed twrenty-four hours, the tumor could be easily reduced, 
but owing to the capacity of the vagina it soon prolapsed again in the 
erect posture, and was then accompanied, on making exertion, with an in- 
voluntary dribbling of urine. Mr. Lightfoot performed the operation for 
episeorraphie, as recommended by Dr. Fricke, of Hamburg, in the follow- 
ing way:] 
The bowels having been previously evacuated, and the hair removed 
from the parts, the patient was placed on a table, in the same position as 
for lithotomy, without, however, tying the hands and feet. The thighs 
being vrell separated by two assistants, I took hold of the left labium and 
transfixed it obliquely about the middle with a narrow bistoury three 
quarters of an inch from the edge, and in such a manner as to include more 
of the skin than of the mucous membrane; the knife was then carried 
rapidly downward in the same direction to the raphe, half an inch or so 
in front of the anus: the superior attachment of this flap wTas next divided, 
by carrying the incision upward as high as on a level with the meatus uri- 
narius. The same was repeated on the opposite side, after which the fre- 
nulum, and other parts included within the angle formed by the union of 
the two incisions in front of the anus, were carefully dissected oft'. The 
two surfaces thus formed extended from opposite the urethra to within 
half an inch of the anus, each being about two inches long, and varying in 
breadth from an inch posteriorly to half an inch anteriorly. The hemor- 
rhage was so trifling, as merely to require the torsion of one small vessel: 
the oozing having ceased, six strong hempen sutures 'were passed through 
the entire thickness of the denuded surfaces, and tied moderately firm. 
The first one was applied a few lines in front of the anus, and the last one 
immediately below the meatus urinarius. 
A gum elastic catheter was introduced into the bladder, and the knees 
were bound together, after which the patient was placed in bed on her left 
side. The antiphlogistic regimen vras strictly adhered to for four or five 
days, during which cold was constantly applied to the parts, and the 
vagina occasionally washed out and cleared of coagulated blood, by means 
of cold water injections. An anodyne was given at bed-time, and repeated 
for three or four nights, to allay irritation and confine the bowels. Two 
of the sutures were removed on the fourth day, and the other four on 
the sixth; at the expiration of which, union by the first intention had 
taken place throughout the whole extent. The bowels were moved on 
the eighth day, and an occasional dose of aperient medicine was afterward 
given. 
In the course of three weeks she was allowed to leave her bed, and walk 
about a little. The bond of union is very firm, and appears like an elon- 
gated perineum, extending from the anus to within a quarter of an inch of 
the urethra. 
In performing this operation, I think it would be better not to attempt 
the union of the posterior part of the labia, but to leave an opening into 
the vagina between the bond of union and the frenulum sufficiently large PKOSTATIC AFFECTIONS. 
419 
to allow of the discharge of the vaginal, mucous and menstrual secretion. 
By adopting this method the operation would be much facilitated; the 
most troublesome part of it, and, at the same time, the most painful to the 
patient, being the dissection required for the removal of the frenulum and 
the parts in front of the anus. During the treatment, likewise, coagulated 
blood, and the secretions from the vagina and wounds, could be more 
easily removed; and in case of considerable inflammation occurring after 
the operation, cold water could be more readily and continuously applied 
by means of a syringe. By this modification of the operation, the union 
of the labia would form a kind of bridge, with two communications into 
the vagina; care, however, must be taken to make the bond of union of 
sufficient extent, so as to allow for the subsequent contraction of the 
cicatrix, otherwise one or other of the openings might become so large as 
to allow the inverted mucous membrane gradually to be insinuated through 
it, and any unusual effort would expose the patient to a return of the com- 
plaint. Party., p. 125. 
PR.OSTATIC AFFECTIONS. 
Iodine as applied to reduce Enlargement of the third Lobe of the Pros- 
tate Gland.—After alluding to the difficulty he had in applying the iodine 
on the third lobe of the prostate, without touching any other part of the 
urethra, Mr. Stafford proceeds: 
“I at length thought of a very simple mode of applying it, which is by 
charging a bougie at its point with the iodine, iodide of potassium, or 
any other substance you may wish, and then dipping it into melted tallow 
so that a coating may be formed upon it. By such method I have been 
enabled to introduce any application I might desire up to the prostate 
gland, without touching the surface of any other part of the urethra. The 
bougie having reached the desired spot, its point is allowed to rest upon 
the diseased part, when the tallow gradually melts and brings the iodine 
or iodide of potassium into contact with it, and by drawing the bougie 
gently backward and forward the necessary friction is produced. I have 
found it advisable to be very cautious as to the strength of the application, 
for the prostate gland will not bear a strong preparation either of the 
iodine or iodide of potassium at first. It is usually in an irritable or in- 
flamed state; consequently, even the mechanical pressure of the bougie 
will give pain. The preparations I have used, therefore, have been very 
mild. At first I have found it necessary to employ even anodynes, such 
as belladonna, opium, hyoscyamus, etc., to quiet irritation and pain. When 
these have subsided, I have begun carefully by introducing the iodide of 
potassium in the proportion of one grain to the drachm of unguentum 
cetacei, and increasing it as the patient could bear it. I have then gone 
on with two, three, four, five, and even as far as ten grains, or a scruple to 
the drachm, according as the case required it. After this I have added 
iodine to it; half a grain, one, two, three, four, or even more grains in the 
same manner. The surgeon who applies it can alone judge of its effects. 
When the swelling is so great that the neck of the bladder is completely 
blocked up, and no catheter can be passed onward into the interior, the 
patient must be relieved at all hazards, else the bladder will slough or uri- 
nary coma will succeed. Under these circumstances the surgeon is reduced 420 
PEOSTATIC AFFECTIONS. 
to the alternative of either puncturing the distended organ, or carrying an 
instrument through the seat of obstruction.” 
By the use of a small elastic catheter without a stilette, we have suc- 
ceeded in relieving retention of urine under the most urgent circumstances. 
We should say, as a general rule, that the greater the swelling, the less 
chance there is of passing a stiff, curved instrument. If, after the trial of 
all ordinary expedients, the bladder still remains unrelieved, then the best 
and safest plan unquestionably is to perforate the obstruction. The perfo- 
ration is easily accomplished, and is never follow ed by disagreeable effects. 
Part ii., p. 128. 
Hemorrhage from Diseased Prostate Gland—PuspinVs Stypt c.—Sir 
B. Brodie, speaking of hematuria dependent upon disease of the prostate 
gland, says: 
“Those medicines which operate as styptics when taken internally, and 
wdiich are useful in cases of hemorrhage from the lungs, are also useful in 
hemorrhage from the prostate. I had a patient with very diseased pros- 
tate. A frightful hemorrhage took place. The usual methods of treat- 
ment were adopted, but wrere of no avail. The skin became pale, the 
pulse became weak, and the patient was exhausted; yet the bleeding con- 
tinued. Large quantities of blood, were drawn off with the catheter: 
nevertheless, the bladder continued to become more and more distended 
wdth blood, and was felt prominent in the belly as high as the navel. All 
other remedies having failed, I gave the patient a dose of the nostrum 
knowm by the name of Ruspini’s styptic, and repeated the dose twro or 
three times in the course of the next twrelve hours. In about half an hour 
after the first dose was taken the hemorrhage ceased, and it never re- 
turned. The patient lived a year and half afterward, and there w as no 
reason to believe that any ultimate harm arose from the bleeding.” 
Part vi., p. 53. 
Treatment of Diseased Prostate—There is a description of enlarged 
prostate, says Mr. Colles, in which surgery can render essential benefit to 
the sufferer, and that by a very simple operation. When wre find a patient 
in advanced life, complaining of unusual frequency of micturition, with 
more than ordinary straining, his urine depositing a good deal of muco- 
purulent sediment, and possibly a muco-purulent discharge from the 
urethra, wre should make a very careful examination of the state of the 
prostate. If, under these circumstances, wre introduce the finger into the 
rectum, and find the gland enlarged in either lobe, and upon pressing on 
one particular spot, we feel the point of the finger sink, as into a cavity; 
and particularly if we find this pressure to cause the discharge, per 
urethram, of a quantity of thin purulent fluid, to the amount, varying from 
a few drops to a teaspoonful; here wTe may hope to render an essential 
service. The operation to wdiich I allude, is simply that of striking a 
lancet into this hollo wq soft spot, which will generally be found to contain 
some matter. Now, as such an operation cannot be conveniently or 
securely performed by the common lancet, I have employed the pharyng* - 
tome, having previously adjusted the instrument, so as to allow' the lance; 
to project only to a length, varying from one-eiglith to one-half an inch, 
according to the apparent thickness of this soft part, our object being to 
open into this cavity. The operation will be found to cause very slight 
pain indeed, and that confined to the region of the wound ; not even PROSTATIC AFFECTIONS, 
421 
extending (as we might have anticipated) to the glans penis. So trifling 
and so momentary is the pain, that I have at different times performed 
the operation, and the patient merely imagined I had pressed a little 
more rudely on the gland. We are guided to the spot where the punc- 
ture is to be made, by holding the point of the forefinger of the left hand 
gently pressed on the soft part, and introducing the instrument on this 
as on a director. 
In some of these operations I have had incontestable proof that some 
pus had been contained in the cavity, for I have found it on the blade, and 
in the sheath of the instrument, yet in no instance have I been able to 
discover, afterward, any trace of matter discharged by stool, so small 
has been the collection of this fluid; in some of the patients a few drops 
of blood have passed afterward through the urethra. In one or two, 
some urine has passed for a time by the rectum ; the quantity, however, 
was, in general, very inconsiderable, but often sufficient, by its presence 
in, and irritation of, the rectum, to cause the patient to go to stool, though 
no faeces were in the rectum. This occasional watery stool was at once the 
only proof and inconvenience attending on such cases. This escape of 
urine, however, gradually ceases in the course of a week or two, never to 
return. 
In one instance only have I seen hemorrhage follow this operation, and 
in that it was easily commanded by laying on the orifice a small compress 
of lint, and retaining it for some minutes, firmly pressed against it by the 
forefinger introduced into the rectum. Part xii., p. 214. 
Senile Enlargement of the Prostate.—The symptoms in enlargement of 
the prostate gland depend with respect to their urgency upon the size 
it has acquired ; they are, sense of weight in the perineum, intolerance of 
pressure from the hardness of a seat; difficulty in passing the urine, and 
also in voiding the faeces, which will be found flattened by the encroach- 
ment of the hypertrophied gland on the rectum. Mr. Cooper says : 
At this stage of the complaint, the retention of urine occasionally super 
venes, rendering the introduction of a catheter necessary. This operation 
should be performed with the utmost gentleness, as the slightest flow 
of blood would cause decomposition of the urine, and consequent aggrava- 
tion of all the symptoms. An elastic gum catheter should always be used 
for drawing off the water, and, if possible, it should be introduced without 
a stilette ; leeches should be applied to the perineum ; the rectum emptied 
by means of enemata; and suppositories, recumbent position, and soothing 
remedies employed. I have also found colchicum of great use in such 
cases, and I believe that its beneficial influenceN arises from the circum- 
stance that this disease frequently attacks subjects of a gouty diathesis. I 
usually prescribe the colchicum in the following form. 
R Ext. colchici acet., gr. j.; pil. hydrarg., gr. j.; pulv. Doveri, gr. v.; 
ext. colocynth. co., gr. iij. M. Ft. pil. bis quotidie sumenda. 
It does not always happen that the whole of the prostate gland becomes 
hypertrophied in old age; but very frequently the third lobe only is 
affected, or perhaps it may more properly be said that a new development 
arises; for in a state of health, at the adult period, the third lobe is 
scarcely perceptible. When this third lobe enlarges, it presses the 
inferior region of the bladder or “ trigone ” upward above the commence- 
ment of the urethra in the bladder, preventing the evacuation of the urine, 422 
PROSTATIC AFFECTIONS. 
and consequently producing retention. Nor is this the only inconvenience; 
for by the raising of the bladder immediately behind the prostate, a kind 
of reservoir is established below the entrance to the urethra; and, in the 
effort to empty the bladder, a portion of its contents is always left; this 
becomes specifically heavier than the newly-secreted urine, which does not 
intermix with it; and, after a time, the retained urine undergoes decom- 
position, which gives rise to very urgent symptoms—such as frequent 
desire to make water, tenesmus, deep-seated pain in the perineum, and 
liability to positive retention. It is quite clear that these symptoms can- 
not be removed while the exciting cause remains ; the fetid urine must 
therefore be immediately drawn off by means of the catheter. 
The mode of introducing the catheter in such cases is similar to that in 
ordinary practice, until it arrives at the point of obstruction, when the 
penis and instrument are both to be drawn forward for the purpose of 
straightening the urethra ; the handle of the catheter is then to be con- 
siderably depressed, so as to tilt up the point, and it is then pressed 
onward into the bladder. 
The cleansing of the bladder may be effected by injecting it with tepid 
water by means of a syringe; and an improved instrument has been 
invented for this purpose, by which a continuous current is kept, the 
same stroke of the piston removing one quantity and supplying a fresh 
one. Constitutional remedies must not be neglected; and when an 
alkaline state of the urine exists, medicines of an acid character are 
generally indicated. Among the most efficacious of these is the following: 
R Nitro-hydrochlor. acid. gtt. iij.; sir. papav., 5hj-; inf. colom., £iss. 
M. Ft. haustus ter quotidie sumendus. 
In addition to this an opiate suppository at bed-time will often be found 
of great advantage; but if an acid condition of the urine be not thus 
restored, liq. potassa? will frequently be found capable of reestablishing 
the normal acid state; this anomaly has been accounted for by Dr. G. O. 
Rees, on the supposition that the alkali renders the secreted urine less 
irritating to the mucous membrane of the bladder, and prevents the 
secretion of alkaline mucus, from which the urine had acquired its abundant 
preponderance of alkali. 
I must again direct your attention to the propriety of employing the 
prostatic catheter in cases of enlarged prostate; for I have frequently 
known great mischief arise from a perseverance in the attempt to relieve 
a patient by the ordinary instrument. Part xix., p. 183. 
Prostate, Enlarged.—M. Vanoye recommends the administration of sal 
ammoniac in large doses, commencing with 15 grains every two hours ; 
we may double or treble this quantity, so that §ss. is taken per diem. 
Mucilaginous vehicles, bitter extracts or aromatics, and a good animal 
diet, should be employed at the same time. This plan should not be fol- 
lowed in hemorrhagic dispositions, or in affections due to poverty of the 
blood. Part xxvi.,p. 111. 
Fibrous Tumors connected with the Prostate.—Prof. Fergusson states 
that an important circumstance connected with lithotomy is, that not 
unfrequently, in extracting the stone, and without any undue violence 
having been used, a portion of prostate gland would protrude before it. 
Formerly he had been in the habit of attempting to avoid the removal of 
such portions, but finding that no inconvenience resulted from the prac- PUERPERAL AFFECTIONS, 
423 
fcice, he had latterly adopted the plan of always removing them. He 
thought they were probably tumors connected with the prostate, and 
not parts of the gland itself. Part xxxiii. p. 283. 
Enlarged Prostate.—Amongst other means of treatment the following, 
by Dr. H. Thompson, are particularly worthy of note. Let the patient sit 
every morning for about twenty minutes in a tepid hip bath (90° or 94°, 
or warmer), to which the bittern or mother lye of the Kreuznach 
springs has been added in varied proportions, beginning with half a pint, 
or pound, according to the form in which it is obtained, to four gallons of 
plain water. 
Local application may be made either by enema or suppository; if by 
the former method the following formula may be depended upon as not 
too irritating to the rectum. It should be retained there as long as the 
patient can conveniently do so. The best instrument for injecting it is an 
india-rubber bottle with ivory tube, as the constituents of the Kreuznach 
water will rapidly injure metallic apparatus. 
R Potass, iodidi, gr. v. Kreuznacher bittern, 5ij.; dec. hordei vel lini, 
§iij. Misce pro enema, quotidie utendum. 
To this a little opium may be added if necessary, in order to enable the 
bowel to retain it. 
The suppository, which, on the whole, is perhaps more easily adminis- 
tered and borne than the enema, may be used after the following- 
form : 
R Potass, iodidi, gr. ii.-v., vel, potass, iodidi, potass, bromidi, aa. gr. ii.- 
iij.; cerati, gr. viij. Misce, fiat suppositorium. 
This should be employed at the time of going to bed, and may be 
repeated every night for a considerable period. 
The iodide and bromide of potassium may also be given internally, three 
to ten grains of the former, to one of the latter, twice a day. 
The bromide of potassium given internally in these cases, has a very 
beneficial effect on the enlarged organ, it may be given week by week 
alternately with the muriated tincture of iron, for a period of several 
months. Part xxxvii., p. 163. 
PUERPERAL AFFECTIONS. 
Treatment of Puerperal Convulsions.—According to the views of Dr. 
W. Tyler Smith, the spinal system is chiefly concerned in the production 
of this form of convulsion, and therefore all our remedies must be such 
as affect the nervous system. “ Remedies affecting the spinal system,” 
says Dr. S., “ very naturally divide themselves into those which act on 
the central organ, the spinal marrow, and those which affect the extremi- 
ties of incident spinal nerves.” 
The action of bloodletting on the spinal marrow, is greatly modified by 
the condition of the circulation. In fullness of the vascular system, it 
is the most powerful sedative of spinal action we possess. Hence, vene- 
section is the grand remedy in the simpler form of puerperal convulsion, 
where the disease chiefly depends on stimulation of the spinal marrow by 
excess of blood, on the mechanical pressure exerted by the blood on that 
organ, together with the counter-pressure of the distended brain on the 424 
PUERPERAL AFFECTIONS. 
medulla oblongata. In such cases, bleeding should be performed with a 
view to its sedative action on the spinal marrow, and to avert the mechani- 
cal effects of vascular pressure upon this organ. Alone, it will be sufficient 
to subdue the disease, particularly when the fits come on before the be- 
ginning of the labor, or after delivery. But another most important inten- 
tion of bloodletting should never be lost sight of—namely, that of preserv- 
ing the brain from injury during the convulsion. Besides the primary 
cerebral congestion, which has been the cause of the attack by its counter- 
pressure on the medulla, the convulsive action itself, with the glottis 
closed, exerting great muscular pressure on the whole vascular system, 
and causing, as it does, the great turgidity of the vessels of the head, is a 
dangerous source of fatal cerebral congestion, or of serous or sanguineous 
effusion. As in the case of epileptics, women in puerperal convulsions 
frequently die of apoplexy, produced by the immense pressure exerted on 
the cerebral column of blood during the fits. It is in a great measure the 
effect of bloodletting in warding off the accident from the brain that bleed- 
ing is so universal in this disease. The due recognition of distinct opera- 
tion of bloodletting on the cerebral and spinal systems is of the utmost 
consequence. In plethoric states of the circulation, it is in this disease, 
curative in its action on the spinal marrow, preventive in its action on the 
brain. 
In the absence of definite ideas regarding the effects of bloodletting in 
this malady, it has been often pushed to excess, or practised where it 
should have been altogether avoided. In the numerous cases where, be- 
sides vascular excitement of the spinal marrow, some irritation of spinal ex- 
citor nerves exists as a conjoined cause of convulsion, repeated bleedings 
will often fail to subdue the disease, unless the eccentric irritation be at the 
same time removed. When irritation of the uterus, the rectum, or the 
stomach, is in part excitor of the convulsion, bleeding alone cannot be re- 
lied on. It may at first diminish the impressibility of the central organ, 
rendering it less susceptible of the incident irritation, but if persisted in 
to a large extent without the removal of the eccentric irritation, it be- 
comes in the end positively injurious, by increasing instead of diminishing 
the excitability of the spinal marrow. 
[The propriety and extent of venesection are to be estimated, not by the 
violence of the disease, but by the state of the circulation in the intervals 
of the fits. After noticing that patients not rightly bled at first are fre- 
quently subjected to successive depletion till the loss of blood itself be- 
comes the cause of the final seizure, he says :] 
Similar remarks would apply with almost equal force to the other parts 
of the common antiphlogistic regimen. Nearly allied to the modus ope- 
randi of bleeding are the effects of nauseating doses of emetic tartar, 
which have been found so serviceable in the treatment of puerperal con- 
vulsions by Dr. Collins. It is extremely probable that this remedy acts 
on the spinal system through the medium of its effects on the circuit 
tion. 
[During the attack of convulsion the glottis is in great part, or wholly, 
closed, and Dr. M. Hall questions if a true convulsion ever occurs without 
this symptom, and the cerebral and spinal congestion it occasions. Cold 
water must be dashed over the face or chest, to excite sudden inspiration 
and dilatation of the glottis. Excitation of the incident nerves in this way 
has been known to prevent a convulsion. PUERPERAL AFFECTIONS. 
425 
Harvey mentions the case of a woman who became comatose during 
labor, and was recovered by stimulation of the trifacial nerve in the nos- 
trils. Denman also relates a case, where a woman had a convulsion at 
every labor pain, but he kept off the attacks, till delivery was completed, 
by sprinkling cold water over the face on every accession of pain. Cold 
applied to the head by napkins, iced water, ice itself, and cold water 
poured from a height, are approved remedies in puerperal convulsions. 
Does the cold act as a sedative on the cerebral portion of the spinal mar- 
row, or does it lessen the distended state of the cerebral circulation ? It 
probably acts in both these ways. When used in the form of continuous 
douche it would tend to excite acts of inspiration, and thus dilate the 
glottis.] 
The application of cold to the spine as well as to the head may here- 
after be found beneficial in puerperal convulsions. Whenever cold in any 
form is resorted to, its use, except for the purpose of exciting the respira- 
tion, must be continuous, as the intermittent application of cold, locally or 
generally, would excite instead of allay the spinal system. The benefit 
derivable from cold must arise from its local action on the nervous 
centres, because in tetanus, the purest form of increased morbid spinal 
action, cold applied to the spine is serviceable, whereas when applied to the 
whole surface of the body, it is extremely dangerous, and even fatal. 
[It is important that we should learn precisely the true action of opium 
on the spinal system. Thus, some give opium to allay after-pains ; others 
say, you increase their energy ; some say it excites contraction in uterine 
hemorrhage ; others maintain that it produces inertia, etc. There is a 
great discrepancy of opinion with regard to the propriety of its adminis- 
tration in puerperal convulsions. AYhen a frog is narcotized by opium, 
a slight touch produces universal convulsions. Reasoning from this 
fact, we should judge opium to be an excitor of the spinal system; its ab- 
solute failure of arresting spasms in tetanus confirms this. Belladonna, 
on the contrary, acts as a sedative to the spinal marrow. Mr. Bonny sug- 
gests that it stimulates indirectly the refiex actions. Besides this, Mr. 
Smith thinks there are good reasons for believing it to be a direct excitant 
of the spinal system.] 
Some striking distinctions may be made respecting the administration 
of opium under ditferent circumstances, particularly in puerperal convul- 
sions. If a dose of opium be given in this disease in a full state of the 
circulation, before bleeding, there is an aggravation of the disorder ; while 
if it be given in puerperal convulsions in an anaemic subject, or after ex- 
cessive depletion, it is of great service. If in a case of convulsions opium 
be given at the commencement, it is dangerous in its effects; but the 
same medicine is frequently valuable in the advanced stage of the same, 
when the vascular system has been powerfully depleted. Thus it would 
appear evident, that in convulsions with a full state of the circulation, 
opium is a stimulant to the s )inal marrow, while in convulsions, with 
anaemia, it is distinctly sedative. It is certainly an important point in 
practice, that the effects of opium in puerperal convulsions depend on the 
state of the circulation ; that in plethoric or inflammatory conditions it is 
always dangerous, while in ana3inia and debility it may always be used 
beneficially. 
[A case is related by Mr. Charles Vines, of Reading, winch illustrates 
some important points in the pathology of puerperal convulsions, and 426 
PUEKPEEAL AFFECTIONS. 
seems to confinn the above views on their nature. The patient, twenty 
years of age, when eight months advanced in her first pregnancy, was 
suddenly seized with convulsions. When Mr. Vines first saw her, the 
symptoms were: Face and whole body livid, features distorted, frothy 
mucus about the mouth, oedema of the upper extremities, frequent and 
violent convulsions, and perfect unconsciousness ; there was also inordinate 
and tumultuous action of the heart, and a quick, feeble fluttering pulse. On 
examining the abdomen, the lower part was found greatly distended, 
and retention of urine was suspected. The catheter was passed, and five 
and a half pints of urine withdrawn. Great improvement of the symp- 
toms followed. There was no return of the convulsions after this evacu- 
ation of the bladder. The patient had had for some weeks, oedema of the 
hands and feet, which, when recurring in these cases, has lately been 
shown to indicate albuminuria. The cause of the fits seems to have been 
the continual irritation of the vesical nerves ; at all events they were kept 
up by it.] 
It appears clear that the irritation of the vesical nerves was conveyed to 
the spinal centre, and reflected upon the motor nerves and the muscular 
system in the form of convulsions ; how, otherwise, can we account for 
the cessation of the fits, and the speedy return of consciousness, when the 
local irritation was removed. Part xii., p. 293. 
Puerperal Convulsions—Use of Galvanism.—In those cases where 
there is a cold skin, congested countenance, and slow pulse, galvanism, 
Dr. Wardell says, will be useful. One wire should he placed behind the 
neck, and the other over the last lumbar vertebra. Part xviii., p. 286. 
Puerperal Convulsions.—Puerperal convulsions may seize the patient 
either before, in the progress of labor, or after it has concluded. Those 
that occur before or in the commencement of labor generally depend upon 
the irritation of some other organ than the- uterus, and hence are much 
more fatal than those which are the result of labor; you have in fact two 
sources of irritation acting upon the spinal system in place of one. Dr. 
R. Lee relates the case of a lady who “ returned home after midnight from 
a large dinner party, at which she had partaken of a variety of dishes and 
wines, and had been seated before a large fire.” Labor came on soon 
after, and with it violent convulsions. Another patient “ being in the 
eighth month of her pregnancy, dined on curry and rice, and ate bacon 
and eggs at tea;”- the following day she had convulsions and premature 
labor. Both these were fatal cases, and in both the stomach was a pri- 
mary, the uterus a secondary source of nervous irritation. Violent men- 
tal emotions act precisely in the same manner. More commonly, however, 
these are not the cases that induce the paroxysm; on the contrary, labor 
proceeds to a certain point without interruption ; the action of the uterus 
is perhaps powerful, the head large, and the resistance to its advance 
great. A severe struggle arises, congestion takes place in the uterus, the 
pains are interrupted, a morbid irritability is excited in the uterus, which 
is communicated to the spinal centre, and thence reflected over all the 
muscles in violent convulsions. The uterus alone is the source of irrita- 
tion here, and therefore the cause of the attack is more easily removed. 
Dr. Murphy sums up his remarks upon the nature and causes of puer- 
peral convulsions, as follows: 
1st. Puerperal convulsions should not be confounded with epilepsy, nor PUERPERAL AFFECTIONS. 
427 
with apoplexy. They agree with the epileptic attack in their physiologi- 
cal, but not in their pathological characters. Apoplexy is an effect of the 
paroxysms, which may or may not follow from them. 
2cl. The predisposing causes of puerperal convulsions, are either an 
excess of blood (hypersemia), a deficiency of blood (anaemia), or impure 
blood. 
3d. The proximate causes of convulsions are chiefly eccentric causes, 
being the morbid irritation of the afferent nerves supplying the different 
vital organs. 
4th. Morbid irritation of the uterus is the most common proximate 
cause of puerperal convulsions, the result either of hypersemia or anaemia. 
Hence the division into sthenic or hyperaemic convulsions, and asthenic or 
anaemic convulsions. Under the latter head we include not merely loss of 
blood, but poverty of blood, and impure blood, because the efieet seems 
to be similar, only differing in degree. 
5 th. Morbid irritation of other organs also causes puerperal convulsions, 
because, during pregnancy, and at the time of labor, the nervous system 
is more excitable than at any other time ; and hence any organ may easily 
be rendered morbidly irritable. Puerperal convulsions so caused are much 
more fatal than the former, because the nervous centre is exposed to a 
two-fold source of irritation—the organ primarily affected, and the uterus 
that is secondarily excited. 
6th. In the whole of these phenomena we must perceive a beautiful il- 
lustration of the reflex nervous function ; the peripheral nerves that supply 
the affected organ rapidly communicating their irritation to the spinal 
system, which, as an excito-motor centre, radiates the irritation over the 
whole of the voluntary muscles, and the muscles of respiration, in violent 
convulsive paroxysms. Even the involuntary muscles, as the uterus and 
heart, do not escape, but give every evidence of greatly increased muscular 
contractions. 
In cases of liyperoemic convulsions, bleed largely and promptly, at the 
very commencement of the paroxysm, or indeed as soon as the premoni- 
tory symptoms are sufficiently well marked. Give also a terebinthinate 
enema, and if the stomach is loaded, an emetic; or ten grains of calomel, 
followed by a saline senna draught containing a little tartarized antimony. 
And keep up the good effect of the depletion by repeated doses of tarta- 
rized antimony. Keep cloths wrung out of iced water applied to the head, 
and especially to the back of the neck ; being careful, at the same time, to 
keep the lower extremities warm. When the paroxysm comes on, dash a 
basin of cold water rapidly in the face ; and if this does not arrest it, take 
care that the patient does not injure herself during the fit, but do not hold 
her down, as if with the expectation of stopping the convulsion. Some 
recommend immediate delivery of the child, but it is not right to adopt 
this practice indiscriminately. If the head has descended within reach of 
the forceps, apply them ; but do not use the forceps if the paroxysms have 
subsided, for fear of again inducing them. If the head is impacted, and 
the child is dead, remove it by the crotchet. In other cases trust to the 
uterine action for effecting the delivery. Never turn, except the turning 
be otherwise necessary, as for a preternatural presentation. 
Asthenic, or Anaemic convulsions require a different mode of treatment. 
Get the bowels freely evacuated by the use of warm stimulating cathartics, 
such as aloes with assafcetida, turpentine, etc.; arid then give opium, stirn- 428 
PUERPERAL AFFECTIONS. 
ulants, as camphor, ammonia, wine, and brandy, and nutritious food. 
During the paroxysm, dasli cold water in the face. If venous congestion 
of the head results from the convulsions, cup from the back of the neck, 
and then apply a sinapism ; taking care at the same time to support the 
patient’s strength, and to keep the surface warm. 
The treatment of hysterical convulsions consists in the use of stinrn- 
lating purgative enemata, followed by diffusible stimulants with opium, 
and in dashing cold water in the face during the paroxysm. 
Part xix., p. 264. 
Puerperal Convulsions, Anaemic.—While stimulants are given, and the 
contraction of the uterus is secured, give opium, which Dr. Lever says, 
will act like a charm. 
Hysterical.—In this form of convulsions, which occurs chiefly during 
pregnancy, great benefit will result from the administration of a mild 
opiate as soon as the paroxysm is over. Part xxi., p. 305. 
Puerperal Convulsions.—In fullness of the vascular system, says Dr. 
Steele, blood-letting is the most powerful sedative of spinal action. Hence, 
when the convulsions depend on the stimulation of the spinal marrow, by 
excess of blood, or on mechanical pressure exerted by the blood on that 
organ, or on the medulla-oblongata, we must bleed. Remove, also, if 
possible, the eccentric cause of irritation, whether it exists in the womb, 
the rectum, or the stomach. The blood-letting must be regulated, not by 
the violence of the disease, but by the state of the circulation in the inter- 
val of the fits. Evacuate the liquor amnii, which, by relieving the disten- 
tion, diminishes the size of the womb, and the quantity of blood circulating 
in it, and also makes the organ less irritating to the general system. 
Evacuating the liquor amnii, is to the womb what an emetic or an enema 
may be to the stomach or bowels. Do not trust to chloroform, as, “ when 
the fund ion of the true cerebral or sentient portion of the nervous system 
are diminished or abolished, as is the case in amesthesia, the irritability of 
the excito-motory, or true spinal system of nerves, is increased.” 
Part xxx., p. 196. 
Puerperal Convulsions.—After the more common remedies have failed, 
the administration of turpentine conjoined with castor oil by the mouth 
has been found by Dr. Woodhouse, of the Royal Berkshire Hospital, tc 
be very eflicacious. Part xxxiv., p. 236. 
Puerperal Coma.—A middle aged, stout multipara was seized suddenly 
after her last confinement with loss of consciousness ; the labor was natural 
and had not been preceded nor followed by convulsions. The friends, 
imagining the case to be one of apoplexy, were much alarmed. Dr. Winn 
being called to the case, says : “ I found her in a condition closely resem- 
bling that induced by pressure on the brain. She was in a perfectly 
unconscious state, from which no impression made on the senses could 
rouse her. As the breathing, however, was not stertorous, the heart not 
much depressed, and the countenance tranquil, I was induced to refer the 
affection to a class of phenomena which I have termed puerperal coma, to 
prevent its being confounded with puerperal apoplexy, a disease of infi- 
nitely graver importance, and for which a totally different treatment is 
required. In the above instance, I was glad to have it in my power to 
assure the relatives of my patient that the complaint would in all probabi- 1‘UERPERAL AFFECTIONS. 
429 
lity terminate safely. The only remedies employed were a mercurial 
aperient, an ammonia draught every four hours, and the frequent adminis- 
tration of small quantities of fluid nourishment. The result justified my 
diagnosis: on the following day the comatose state had passed away, and 
the patient was free from any alarming symptoms. 
This affection, in most cases, appears to owe its origin to one or more of 
the following causes; nervous shock, a loaded portal system, uterine 
hemorrhage, and the too frequent administration of cordials and narcotics. 
A variety of this disorder frequently ensues after convulsions, and requires 
equally mild treatment. Part xxxAui., p. 205. 
PUERPERAL FEVER. 
Contagiousness of.—Mr. Storrs thinks that medical men do not go far 
enough in considering this disease to be propagated by medical men and 
nurses from one puerperal patient to another. He thinks that it is quite as 
frequently carried by the medical attendant to each fresh labor-case from 
some original infectious case, whether of gangrenous erysipelas, or typhus 
fever, or of whatever animal poison besides may hereafter be found to pro- 
duce it. In some cases which occurred in his own practice, he has no doubt 
that he took it to each patient from a case of gangrenous erysipelas with 
subsequent abscess, which he was attending at the time of these unfortunate 
occurrences. And such may be the case of other practitioners. They think 
that they convey the contagion from one puerperal patient to another, 
instead of from one common source. They probably lose a puerperal case 
and immediately take every precaution to prevent a similar occurrence, by 
careful ablution, and a complete change of dress. Nevertheless, the next case 
of labor is attended with the same fatal result; simply because the practition- 
er is still in attendance on the case which originally gave rise to the mischief. 
Mr. Storrs enumerates cases recorded by different practitioners, all of 
which prove that each disease had a common origin from some case of erysi- 
pelas or sloughing ulcer. He concludes his paper with the following advice. 
As it is well to be always guarded against such a misfortune, I think it 
desirable for midwifery practitioners to avoid attending labors in the same 
dress in which they attend their ordinary patients, especially the coat, as this 
garment must be the one most likely to be the means of conveying fomities ; 
and at any suspicious period, when typhus or erysipelas are prevailing, to 
carry out the same carefulness even in the after-attendance on labor cases. 
I should also, after a post-mortem of any kind, or after any operation upon 
any case of erysipelas, or of typhus, recommend the most careful ablutions 
of the hands, and for the sui’geon to avoid attending on a labor in any 
part of the dress in which such operations have been performed, not for- 
getting the gloves, as the hand and arm are the chief instruments of con- 
tact. Where, however, the disease has been unfortunately once set up in a 
practice, an absence from home for a fortnight or three weeks, a total 
change of raiment, the most; careful ablutions, and a perfect avoidance of 
every case likely to have been the source of animal poison, should alike be 
adopted by the practitioner. Part ix., p. 195. 
Malignant Puerperal Fever.—[Dr. G. B. Clark had two fatal cases of 
puerperal fever in quick succession; a post-mortem was refused in both 
cases, and therefore he was unable to ascertain the exact pathology of the 430 
PUERPERAL AFFECTIONS. 
disease; but on the occurrence of the second case, he ascertained what 
was supposed to be its cause. He says:] 
On revolving these cases in my mind, and remembering the connection 
of erysipelas with this direful disease, it immediately flashed across me 
that I had been treating, and had then under my care, a most severe case 
of phlegmonous erysipelas in a sailor, who was brought into the hospital. 
The disease extended from the hand to the axilla, and was treated bv 
free incisions, aided by nitrate of silver. The man recovered from oiie of 
the most severe cases I ever witnessed. The day that I made the 
incisions, on that afternoon I attended Mrs. F., and I think, however pain- 
ful for me to feel and relate, there can be little doubt that if no noxious 
matter was carried, at all events the effluvia remained, and thereby arose 
this malignant fever. 
[Dr. Clark very prudently desisted from midwifery, and as soon as 
possible from all practice whatever, and took a sea voyage.] 
Part xvi., p. 284. 
Puerperal Fever.—Any fluid matter in a state of putrefaction, commu- 
nicated by linen, a sponge, small particles of placenta, or by the ambient 
atmosphere, may induce puerperal fever. To remove such matter from 
the hands, wash them in a solution of chloride of lime. Part xxiv., p. 292 
Puerperal Fever.—Dr. Tyler Smith places great confidence in the 
chlorate of potash as a prophylactic against this fatal disease. It appears 
to act by liberating in the economy the oxygen and chlorine it contains. 
It should be given in doses from five to ten grains three times a day. The 
hands should be washed, and if necessary, in a solution of chloride of 
lime after touching any wound, purulent surface or pathological specimen; 
for, as Dr. Simpson remarks, the fingers may sometimes be compared to 
the armed points used in vaccination. Under suspicious circumstances the 
hands should even be washed before and after every vaginal examination. 
The nails of the practitioner should be kept closely cut, and some have 
even recommended that gloves should not be worn at all, as they have 
been known to become infected, and so keep up the mischief in spite of all 
precautions. The mucous surfaces are in the most favorable state conceiv- 
able for inoculation, and the surface of the os uteri is almost universally 
partly denuded of epithelium during labor. Students should not be allowed 
to attend labor except at certain seasons set apart for the purpose, during 
which time they must neither dissect, nor attend the wards of the hospital 
or the deadhouse. Part xxxv., p. 216. 
Puerperal Fever.—In this disease Dr. Copeland says: “ There is no 
remedy so efficacious as a decided and judicious use of spirits of turpentine.” 
The same author also recommends camphor in doses from eight to sixteen 
grains •, but by far the most important question is the prophylaxis of this 
disease. All bad or imperfect drainage must be avoided, and no medical 
man should attend a case of midwifery after making a P-M-examination 
without first washing his hands, and especially his nails, in a solution of 
chlorine. We must recollect that inflammation is owing to a poison, and 
our treatment must be directed rather to destroy or remove this poison, 
than to combat the inflammation. Part xxxvi., p. 232. 
Secondary Affections of the Joints in Puerperal Women.—Mr. Coul- 
son, surgeon to St. Mary’s Ilosnital, gives the following : PUEEPEEAL AFFECTIONS. 
431 
Puerperal women are occasionally attacked by a severe form of disease 
attended by low fever, with effusion of pus into the joints, and almost 
always terminating in death. 
The local affection occurs under two circumstances; viz., after delivery, 
at the full period of gestation: or after abortion in the earlier months. 
It is important to include the latter kind of cases, which have not been 
sufficiently noticed, as they throw great light on the true nature of the 
disease, and dispose of the theory which would attribute the secondary 
affections to child-bed fever. 
The articular disease is merely one of the effects of pyaemia, but it re- 
ceives certain modifications from the puerperal condition with which it is 
associated. Even in puerperal women these secondary joint affections may 
occur under several states which may be distinguished from each other. 
They are most commonly developed during the course of puerperal fever, 
from the third to the sixth day of the complaint. In other cases, they 
occur after convalescence from an attack of puerperal fever. Lastly, in 
some other cases they set in after parturition, without the patient having 
presented any symptoms of puerperal fever. 
When the articular affection occurs during the course of puerperal fever, 
the following train of events is generally observed. For the first three or 
four days, the ordinary signs of puerperal fever are alone recognized; then 
some symptoms of phlebitis may present themselves ; or these symptoms 
may be so slight as to be overlooked. They are soon followed by a change 
in the condition of the patient. Severe rigors often usher in this change ; 
the fever increases ; the countenance is anxious and sallow ; the respiration 
becomes more hurried; there is irregular delirium; and the patient 
sinks. 
In these cases, there are two dangerous maladies; viz., puerperal fever, 
and purulent infection, running their course at the same time; and it is not 
to be wondered at, if the general condition of the patient presents an ano- 
malous appearance, or if it be rendered obscure by the predominance of one 
set of symptoms over the other. 
In another set of cases, this obscurity does not exist. The patient has 
completely recovered from an attack of puerperal fever, or has not had any 
attack of that complaint; all the dangers of the puerperal state having ap- 
parently passed over. She goes on well for the first week or two; there is 
no fever; no abdominal pain ; no apparent danger of any kind. Suddenly, 
a severe rigor sets in; this is followed by febrile symptoms, small, quick 
pulse, etc.; or the attack may commence with local symptoms, the general 
disturbance being scarcely perceptible. These latter cases are very re- 
markable, and not long ago were mistaken for rheumatism. 
The disease with its local effects and constitutional symptoms, may occur 
after abortion in the early months. Here there are no symptoms of puer- 
peral fever, properly so called ; but there may be some slight symptoms of 
uterine phlebitis. These are often chronic and obscure cases; yet they 
proceed and terminate like the former series. 
The secondary joint affections are the same under all these different cir- 
cumstances. They may be either purulent or non-purulent; articular or 
periarticular; acute or chronic. These different conditions are found to 
exist in various cases; but the most common form of attack is acute, of a 
purulent nature, and occupies the interior of the joint. At other times, 
though extremely acute, the attack is non-purulent, and confined to the ex- 432 
PUERPERAL AFFECTIONS. 
terior of the joint; while in several cases, there is pus in the cavity of the 
joint, without any lesion of the articular tissues. 
It is also worthy of remark, that in several cases some of the joints are 
attacked by purulent inflammation, while other joints in the same subject 
suffer from simple inflammation with effusion of serum. 
The period at which the articular affection sets in is various. In a few 
cases, it has happened on the second day after delivery: in many other 
cases it does not appear until a few days before death, viz., from the 23d 
to the 25th day. Generally, however, the joints are attacked between the 
third and fourteenth days. The knee joint is most frequently the seat of 
the disease. I have found that it is attacked in one-third of the cases in 
which the joints have suffered ; next comes the wrist joint; then the ankle, 
the shoulder, elbow, hip; and lastly, the smaller joints. In a few cases, 
the purulent effusion has been confined to the symphysis pubis ; but I am 
inclined to think, from the history of these rare cases, that the suppuration 
of the pubic joint was primary, not secondary—the inflammatory action 
having extended from the cellular tissue of the pelvis. 
The duration of the joint-disease necessarily depends on the duration of 
the primary affection with which it is connected as an effect. It is not 
often prolonged beyond a week, but it may last from one to three weeks. 
In chronic cases the duration may extend to three months. 
I am quite unable to determine the circumstances which give rise to 
these differences, to explain why the effusion is purulent in some cases, 
serous in others ; why it takes place now in the joint, at another time out- 
side it. Moreover, the kind and seat of the effusion bear no relation to the 
gravity of the case, or to the intensity of the local symptoms. 
The joint-affections are frequently accompanied by abscesses in the mus- 
cles of the legs and arms, preceded by pain and attended by doughy 
swellings. When these occur in puerperal women they should always ex- 
cite attention, for they are too often the forerunner of purulent infection 
of the blood. The changes discovered after death are purulent effusion 
into the articular cavity without any alteration of tissue; frequently, signs 
of synovial inflammation with erosion and ulceration of the cartilages; more 
frequently still, purulent or serous infiltrations outside the joints, with ab- 
scesses in the neighboring muscles. In no cases have the bones been found 
diseased; in no case, likewise, are the lesions confined to the joints; yet in 
a few cases the joints and intermuscular tissue have only been affected. 
The other lesions are those of purulent infection ; viz., secondary deposits 
in the lungs, liver, etc. The brain has not been found affected, as far as I 
am aware. Pus is always found either in the veins or lymphatics of the 
uterus; or there is primary abscess in the walls of the uterus, in the cellu- 
lar tissue of the pelvis, in the symphysis pubis, or elsewhere. 
Practitioners are now agreed that the puerperal disease of the joints de- 
pends on blood-poisoning. The only question on which differences of opinion 
exists is, as to the nature of the poison. Is it pus ? Is it some morbid 
secretion or putrid element introduced into the blood ? My own opinion 
is that these secondary joint-affections, as well as many others, are caused 
by purulent poisoning of the blood. Part xxxvii., p. 227. 
Puerperal Fever.—When the fluids passing from the vagina are putrid 
and offensive, says Dr. T. P. Heslop, of Queen’s College (which of itself, 
if it cause not the disease, will at any rate greatly aggravate the symptoms 433 
PUERPERAL AFFECTIONS. 
from absorption of the poisonous matter), inject weak solutions of hydro- 
chloric acid at frequent intervals. A competent person must be found to 
do this or it will not be done effectually. Part xxxviii., p. 74. 
Use of Turpentine and Opium.—The use of turpentine and opium in 
puerperal affections, though a treatment by no means new, does not seem 
to be sufficiently known or valued by the profession. The opium may be 
given in the form of pills, and the turpentine in that of enemata. Trousseau 
prescribed the opium at first in doses of 5 centigrammes during the day, 
gradually increasing to double the dose (centigramme =0,15432 grain); 
the turpentine may be administered, if given by the mouth, in the form of 
capsules. Part xxxviii., p. 215. 
Puerperal Convulsions—Chloroform.—Two interesting cases of puer- 
peral convulsions are related by Dr. R. T. Tracy, in which subsidence of 
the paroxysms and tranquil sleep followed the use of chloroform. In the 
first case the chloroform was given at each return of the fit, and about two 
minutes at each inhalation. The patient being of a very plethoric habit, 
ten ounces of blood were taken away prior to the administration of the 
chloroform. Part xxxviii., p. 227. 
PUERPERAL MANIA. 
2lusJc in Delirium of.—Pills composed of musk or assafcetida and cam- 
phor, to which may be added a few grains of calomel, and also some ex- 
tract of henbane, if considered judicious, are recommended by Recamier 
in puerperal mania. Part ix., p. 77. 
Puerperal Insanity.—The treatment generally proper for anaemia, says 
Dr. Mackenzie, of Paddington Dispensary for Women and Children, will 
be found, upon the whole, to be most appropriate for puerperal insanity. 
Special indications will require to be fulfilled by special means ; and slight 
forms of the disease will often yield to the unassisted efforts of nature. But 
when the attack is severe, and resists the natural efforts, as well as specific 
treatment, it will generally be found that this obstinacy is connected with 
an aggravated form of angemia, and that in proportion as the condition of the- 
blood is improved, will the cerebral disorder disappear. Part xxiv., p. 286. 
Treatment of Puerperal Mania.—Speaking of the treatment of a case 
of puerperal convulsions, Dr. Mawer appends the following observations : 
In the first place, it serves to confirm the imperative necessity of large 
and adequate depletion in the congestive variety of this formidable dis- 
ease, affording at the same time ample proof of its undoubted safety and 
success. It also furnishes a remarkable example of the tolerance of tartar 
emetic—a fact long well established in reference to its use in pneumonia 
and some other pulmonary affections, but not that I am aware of to the 
same extent in cerebral disorders, as this case so strongly illustrates, a grain 
and a half having been taken every hour for eight consecutive hours with- 
out the least nausea resulting from it. While speaking of this valuable- 
medicine in connection with this class of affections, it may not be out of 
place to add, that I have employed it with marked benefit in combination 
with camphor and morphia (aided by cold applications to the head, and 
preceded by active purgation and leeches to the temples), in two very 
severe cases of puerperal mania. General blood-letting being for the most 
part inadmissible, it is very desirable to possess a remedy so available as 
VOL. II.—28 434 
PULSE, 
this proved in both the instances referred to, in controlling the excited state 
of the circulation, and in tranquillizing the extreme irritability of the nerv- 
ous system, both which conditions are so constantly present in the more 
active forms of the distressing malady. Part xxvii., p. 213. 
The Pulse.—[In a clinical lecture on this subject, Dr. Todd says:] 
The frequency of the pulse is affected by various morbid influences, of 
which the following are the most potent: 
The Condition of the Blood.—A poor blood is almost always associated 
with a rapid pulse; in animals bled to death the pulse attains an increasing 
frequency as the blood flows ; this occurs in men who have been very 
largely bled, and in cases of excessive hemorrhage, whether hemoptysis, 
epistaxis, or hematemesis, or after surgical operations, the pulse attains 
great rapidity. 
The Existence of a Poison in the Blood.—This tends generally to in- 
crease the frequency of the pulse, and so you find the pulse quick in the 
early periods of the exanthemata of typhus. The administration of alco- 
hol to a healthy man affords a good illustration of this; as soon as he has 
taken a certain quantity of it, acceleration of the pulse takes place. But 
some poisons will produce a contrary effect, by depressing and weakening 
the heart’s action, as you well know in the administration of digitalis, or 
of hydrocyanic acid. So also, some of the animal poisons, if taken in large 
doses, will cause depression of the heart’s action and a slow pulse. We 
have now a case of scarlet fever, in a man named Boon, in Bose Ward, 
with whom the pulse was as slow as 60 before the eruption had come out 
fully ; a state which seemed to me to indicate the use of stimulants, and 
under their administration the heart’s action increased in force and fre- 
quency, and the patient did well. 
The state of the Nervous System exercises a very remarkable influence 
upon the rate of f requency of the Pulse.—It is one of the features of the 
hysterical diathesis, that the pulse always quick, becomes accelerated under 
the slightest disturbance, physical or mental. Cerebral lesion sometimes 
causes a very depressed state of pulse ; as, for example, inflammation of 
the brain, vomiting, pain in the head, and sluggishness of pulse, are 
symptoms which should always awaken the anxiety of the practitioner, 
as regards the state of the brain. In many instances of injury to the 
head, concussion, fracture with depression, the pulse becomes notably 
retarded until the compression of the brain has been removed. So also, 
in many cases of apoplexy, the pulse is sluggish, and the heart seems op- 
pressed. 
Of intermitting Pulse. — Among the most interesting modifications 
of pulse, which we meet with in practice, is that which arises from im- 
pairment of the rhythm of the pulse, or what is called the intermitting 
pulse. 
The most common form of intermitting pulse, is that in which the phe- 
nomenon of intermission results from the prolongation of the natural 
period of rest in the series of changes which constitute the heart’s rhythm. 
The heart’s rhythm consists of a regular succession of first sound, second 
PULSE. PULSE. 
435 
sound, rest—first sound, second sound, rest—and so on. Now in an 
intermittent pulse this rest is unnaturally long—the first sound of one beat 
succeeds t|he second of the previous beat, but after too long a pause. 
Sometimes the intermissions are very regular, occurring after every fourth 
or every third beat; sometimes perfectly irregular, at one time after 
every one or two beats, at another every thirty or forty. 
Now what are the indications of this form of intermittent pulse? Is it 
indicative of organic disease ? I think I may state positively that an in- 
termittent pulse of itself affords no indications of organic disease of the 
heart. 
Nor are we justified in pronouncing unfavorably of a patient because 
he has an intermittent pulse. You will meet with many persons who will 
tell you that they have had intermitting pulse nearly all their lives. 
But undoubtedly this form of intermitting pulse denotes a derangement 
of the heart’s action of a sympathetic nature, and almost invariably m 
sympathy with the state of digestion. This kind of pulse is of very com- 
mon occurrence in men who work hard, neglect exercise, are irregular as 
to meals, and sit up late at night. It is also very common, and doubtless 
from the same cause, in gouty men. Intermittent pulse is not uncom- 
monly a precursor of a paroxysm of gout. Certain ingesta are very apt 
in some people to cause intermission of the pulse. Tea, for example, 
especially green tea, is one of these; ices, more particularly cream ices, 
wiil do the same. So, also, certain medicines—as digitalis and colchicum. 
I have stated that the intermittent pulse is not a necessary indication 
of organic disease of the heart. It is a curious fact, which is in some 
measure confirmatory of this remark,-that of the various forms of disease 
to which the heart is subject, intermitting pulse is not of very frequent 
occurrence with any, nor is it constant to any particular form. 
The intermittent pulse depends upon some interference with the healthy 
nutrition of the muscular system of the heart; and hence you get it so 
frequently in bad states of the blood—as in dyspepsia, gout, rheumatism. 
You may gather, from what I have stated more than once in the pre- 
ceding part of this lecture, that there is another form of intermitting 
pulse besides that to which I have alluded. The characteristic feature of 
this form is, that the intermission of the pulse does not result from the 
intermission of the heart’s rhythm, but from irregularity in the strength 
of the heart’s systolic contractions. The heart may never intermit, and 
yet the pulse may ; or, in other words, the intervals between the beats 
of the pulse may vary considerable in duration. This form of inter- 
mitting pulse sometimes occurs alone, sometimes simultaneously with 
that in which the heart’s rhythm is deranged. When it occurs in the 
progress of an acute disease, as of fever, erysipelas, etc., it must be looked 
upon as a sign foreboding the worst results. I apprehend that it is this 
form of intermitting pulse which most commonly accompanies fatty disease 
of the heart; and, on the whole, in all states of disease, both acute and 
chronic, it is that form from which we may augur least favorably for the 
patient. 
Posture influences these two forms of intermittent pulse differently. 
The first form, or that which depends on a prolongation of the natural 
period of rest in the heart’s rhythm, is diminished by the erect posture, 
and the heart becomes more regular in its rhythm. On the other hand, 
the erect posture increases the number of intermissions in the second 436 
PURGATIVES. 
form by embarrassing the heart’s action in the way which I have already 
described. 
[ In considering the means best adapted to keep down the frequency of 
the pulse, we may employ either direct means acting at once upon the 
heart, or indirect or general means.] 
Of the direct means the administration of digitalis, or of opium, is the 
most important. You may give digitalis as a diuretic, or with a view to 
obtain its specific action in reducing the frequency of the heart’s action. 
Given with this latter view it must be administered with due regard to a 
correct diagosis, for while it is a very valuable remedy in one case it is a 
dangerous one in another. I would lay it down as a rule, that in all cases 
where there is regurgitative valvular disease, but especially aortic, dig- 
italis given in doses which will depress the heart’s action is a dangerous 
medicine; it weakens the heart, and thereby increases the embarrassment 
under which it already labors. 
Now, opium operates upon the heart through its tranquillizing influence 
upon the nervous system, and so quiets the heart without weakening it, 
and therefore it is more generally applicable to heart affections than digi- 
talis. The diuretic properties of digitalis may be often called into play in 
cases of cardiac disease ; and for that purpose you may often combine it 
with a stimulant, as ammonia, or with some preparation of iron, so as to 
counteract the depressing effects. But the best combination, for a diuretic 
purpose, is with blue pill and squill, after a formula attributed to the 
late Dr. Baillie. I have seen, under the use of this combination, consid- 
erable dropsy disappear, and the heart become diseihbarrassed in its action 
in the most remarkable manner. 
But then there are certain other indirect means of acting on the heart, 
as purgatives, which diminish the quantity of the blood without impo- 
verishing it; or steel, which improves the condition of the blood already 
poor ; rest, the recumbent position, a nutritious and moderate diet, mental 
quiet. It is generally from the efficacy of some of these remedies, espe- 
cially the three or four last, that heart cases often experience a marked 
alleviation of all their symptoms on their first entering the hospital. 
Part xxiii., p. 100. 
PURGATIVES. 
Remarks on Drastic Purgatives.—Veratria, the alkaline principle which 
is supposed to give activity to colchicum, and white and black hellebore, is 
a powerful, and it may even be said intractable and dangerous, hydra- 
gogue-purgative. In arthritic cases, says Dr. R. Dick, attended with 
plethora and distinct constitutional fever, with morbid and loaded bowels, 
scanty and high-colored urine, and tumultuous action of the heart, veratria 
is indicated. Veratria, one grain ; powder of acacia, two scruples and a 
half; sirup, a sufficient quantity. 
The dose may be carried to three pills daily. This is the formula re- 
commended by Majendie. We have seen no good effect from it in 
paralysis, for which some recommend it. Veratria may also be used in 
tincture and ointment. 
Platerium is somewhat analogous in its properties to veratrum. Its 
action, which is that of a hvdragogue-purgative, is extremely violent. It PURGATIVES. 
437 
is useful in the inflammatory anasarca of robust or young subjects ; but its 
use is to be deprecated in chronic dropsies, and in the cases of persons feeble 
or aged. I have seen it powerfully check rheumatic fever, and wonderfully 
relieve rheumatic metastasis to the heart. I have also seen it rapidly 
reduce the effusion into the cavity of the large joints, consequent on acute 
articular rheumatism. Some degree of its febrifuge power no doubt de- 
pends on the extreme nausea which it usually induces. From ten grains of 
the extract of elaterium, one grain of an alkaline principle called elateria, or 
elaterin, may be obtained. A tincture of this is more manageable than the 
extract. Elaterine, one grain ; spirits of wine, eight drachms ; nitric acid, 
two minims. Dose, thirty or forty drops. This dose, I may remark, will, 
with many persons, act drastically. Where it does not operate sufficiently, 
it may be repeated, in a full or half dose, after three or four hours. In 
suspected scirrhus of the pylorus, neither veratrumnor elaterium should be 
ordered, unless in very particular exigencies, and then with very particular 
precaution. 
Croton oil is another of our drastic purgatives. In torpid states of the 
bowels, and when the vena portae is in a state of congestion and distention, 
constituting what is called abdominal plethora, which some German writers 
consider a very important pathological condition, croton oil. often brings 
sudden and marked relief. It also decidedly eases cerebral congestion and 
plethora, promptly dissipating the most intense and alarming headaches. 
Unless cautiously administered, however, it is a debilitating cathai’tic, and 
its use is not to be thought of in irritable states of the gastric or intestinal 
mucous membrane. 
The half of the following combination will be found to be nearly corres- 
ponding in strength to a similar dose of castor oil: Croton oil, one minim ; 
oil of almonds, two ounces. 
We may here observe that oil of turpentine has almost all the advantages, 
without any of the disadvantages, of croton oil, while the former jmssesses 
some good properties which the latter wants. In sluggish and flatulent 
states of the bowels, in tumid states of the intestinal mucous membrane, 
with a congested and distended condition of the rectum, oil of turpentine 
often gives surprising relief. Its nauseating taste and smell, and its ten- 
dency for some time after it is taken, to rise in eructations from the 
stomach, are its drawbacks. But this is compensated by the singularly 
warm and invigorating influence it has on the abdominal organs. In 
gouty, rheumatic, and paralytic cases, it is a most valuable means. It may 
be used with great benefit, in injection as well as in draught. 
Part 114. 
Oil of Anda, a new Purgative.—[The Anda Gomesii is a Brazilian 
plant, belonging to the class and order Monoesia Monadelphia, N. O. 
Euphorbiaceae. Its seeds are used as a cathartic by the inhabitants of the 
Brazils; and the oil expressed from them has been used in North 
America. Mr. Ure having administered this oil in several cases, gives the 
following account of its effect. He says:] 
It may be observed, that the average dose of oil of anda administered 
was 20 drops, and to secure its entrance into the stomach it was swallowed 
on sugar. It offered nothing unpleasant to the taste, produced none of 
that heat in the throat which croton oil creates, seldom occasioned nausea 
or griping; it rarely operated within a period of two hours, although in 438 
PTEOSIS 
one or two instances I have known it act within half an hour after its 
ingestion. Dart xx., p. 290. 
Best Means of Obtaining the Dargative Operation of Calomel.—[For 
the purpose of obtaining the best purgative effect of calomel, Dr. Hall 
recommends it to be mixed with a little table salt, and placed dry upon 
the tongue; no other purgative being combined with it, and the patient 
abstaining for some time from taking water or other fluids. Dr. Hall 
observes:] 
This is a point of practical importance, and well worthy the attention of 
the practising surgeon and physician. It is a well known fact that the in- 
habitants of maritime localities, and sailors, after a long voyage, in which 
they have been deprived of the use of fresh provisions, and kept upon salt 
meat, are more liable than others not so circumstanced to the influence of 
mercurial preparations ; which arises in the opinion of Mialhe, from the 
bodies of such men containing large quantities of the alkaline chlorides—• 
so that there is more complete conversion of calomel into corrosive subli- 
mate than under the usual state of the body. 
Children, and patients confined to a milk diet, support large doses 
of calomel, because the fluids in their alimentary canals are destitute, 
or contain only very small quantities of the alkaline chlorides. Pa- 
tients, also, who have lived for a long time on broth, or low diet, the fluids 
of whose bodies are also exhausted of chlorides, consequently bear larger 
doses of calomel without the system becoming aflected. 
Dart xxi., p. 151. 
PYROSIS. 
Ioduret of Silver.—In about one-quarter of a grain dose, three times a 
day, recommended, by Dr. Patterson, in pyrosis and gastric affections. 
R Ioduret of silver, nitrate of potassa, each ten grains. Pulverize 
thoroughly and add pulv. liquorice ext., half a drachm ; white sugar, 
twenty grains; mucilage of gum arabic, sufficient to mix. Divide into 
forty pills. Dose, one three times a day. Part vi., p. 13. 
Oxide of Silver in certain Diseases of Debility.—Sir James Eyre says, 
he has found half a grain of the oxide of silver, three times a day, uni- 
formly succeed in curing pyrosis ; he administers at the same time two of 
Dr. Hamilton’s pills (composed of ext. colcynth, c. 3ij.; ext. hyosciam, 3j.; 
in pil. xij.) every night. He gives numerous cases illustrative of his 
success. He next advances instances of similar successful results in 
hematemesis and hemoptysis, but he does not exclusively confine himself 
to the oxide of silver alone, but assists its administration by bleeding, 
blistering, and other means. 
From having found this remedy much superior to all other means em- 
ployed during an active professional life of upward of thirty years, Sir 
James feels fully justified in inviting a trial of the medicine. That it is a 
tonic and sedative there can be no doubt, and there is also good evidence to 
prove that it is a safe and efficient astringent. In the cases enumerated, 
the dose never exceeded three grains a day, instead of six, as recommended 
when first introduced ; and its employment where febrile action exists is 
not recommended. PYBOSIS. 
439 
In addition to its value in gastrodynia, in pyrosis, in hemoptysis, in 
hematemesis, and in the first and second classes of menorrhagia in Dr. F. 
Churchill, it will be found to be productive of infinite benefit in restrain- 
ing, when absolutely necessary, hemorrhage proceeding from the intestinal 
canal, obstinate chronic diarrhoea, colliquative perspirations, leucorrhcea, 
and other maladies. Part xi., p. 107. 
Treatment of Pyrosis.—The mineral acids, being astringent tonics, are 
especially suited to relieve obstinate pyrosis in feeble individuals. Some- 
times the sulphuric, sometimes the nitro-muriatic acid succeeds best; 
nor can the one best adapted for each particular case be always deter- 
mined beforehand. If there be much debility, however, the former should 
be first tried, and the latter if bilious disorder be conjoined with indiges- 
tion. It is perfectly consistent practice, according to Dr. Child, to pre- 
scxdbe regular doses of acids and occasional doses of alkalies for the same 
patient, each medicine fulfilling a separate purpose. Alkalies are merely 
palliative, and relieve only when the irritating fluid that has been poured 
out is of an acid nature ; on the other hand, the mineral acids strike at the 
root of the pyrosis, and produce a radical cure by checking the secretion 
of the fluid itself, in consequence of their tonic and astringent effects upon 
the vessels of the mucous membrane. The mineral acids, therefore, 
should be given, like other tonics, when the stomach is empty; while 
alkalies are of little use unless administered toward the end of digestion, at 
the moment when the acid fluids are irritating the gastric nerves. If 
taken with care in this manner, the one does not interfere with the action 
of the other. When pyrosis is obstinate, counter-irritation to the epigas- 
trium, as by means of a blister, is often highly useful: it operates by re- 
lieving congestion of the mucous membrane, and imparting tone to the 
secreting vessels. 
Medicines can palliate, even in the worst cases; but in order to effect a 
lasting cure, careful rules of diet must be enforced. In particular, fat, 
fried, or cured meat, pastry, nuts, cucumbers, pickles, and malt liquors, are 
to be eschewed. Moreover, all articles of food which, although generally 
wholesome and digestible, are yet found by patients to “ turn to acid or 
water, or to ferment,” as they express it, are to be avoided. Among the 
things in common use most apt to excite pyrosis, may be mentioned oat- 
meal, potatoes, fish and tea. As a general rule, a vegetable diet is more 
acid-producing than one chiefly composed of the easily digested kinds of 
animal foods ; hence many patients remark that they are more troubled 
with acidity when they live on slops—farinaceous articles—than when they 
make use of a full meat diet. When bilious pyrosis occurs the first thing 
in the morning, it is often prevented by taking a little food before getting 
out of bed. Many patients find that exercise or constrained postures are 
sure to bring on an attack: hence clerks are extremely apt to suffer there- 
from when closely confined to the desk. Part xvi., p. 318. 
Treatment of Pyrosis.—If the disorder should seem to be caused mainly 
by a diet not sufficiently nutritious or consisting too much of farinaceous 
substances, the most effectual remedy will be a wholesome nourishing diet, 
containing a proper quantity of animal food in its most digestible form. 
Little permanent benefit can, indeed, be expected from medicine unless the 
diet is improved. 
If the disorder should seem to have been induced, or to be kept up, 440 
QUININE, 
wholly or in part, by fatigue, it is very essential that the patient should 
rest; if by constipation, that this condition should be removed by purga- 
tives, such as aloes or colocynth, that do not offend the stomach. 
After these points have been attended to, much further good may be 
done by medicines. Give a combination of astringent and sedative reme- 
dies, as five grains of bismuth with 1-12th of a grain of the muriate of 
morphia, or five grains cf the compound kino powder, or an etficient dose 
of catechu, krameria, or logwood, with opium, two or three times a day. 
Astringents are useful sometimes, as half a grain of argent, nit. three times 
a day; or three to five grains of nux vomica three times a day; or quinine, 
or the mineral acids. If there be anaemia present, steel should be given. 
The medicines of which Dr. Budd has had most experience in disorders 
of this class, and which are probably as efficacious as any, are bismuth, with 
morphia; krameria, and logwood, with opium ; and steel. 
Part xxix., p. 107. 
Gallic Acid in Pyrosis.—Dr. Bayes says that in pyrosis, where this 
disease is unaccompanied by extensive ulceration, or organic malignant 
diseases of the stomach, or by disease of the liver, the most marked benefit 
will follow the use of the remedy. Gallic acid, here, not only checks the 
secretion with a certainty and rapidity he has never seen follow the admin- 
istration of any other remedy, but it gives general tone to the stomach, in- 
creases the appetite, and (what I very little expected when I first used it) 
in many cases removes constipation. This I can only account for on the 
supposition that the relaxed atonic state of the stomach which favors pyro- 
sis is continued throughout the alimentary canal, the constipation in these 
cases arising from want of power in the muscular coats of the intestines to 
expel the faeces. This want of tonicity is remedied by gallic acid. 
Part xxxv., p. 94. 
QUININE. 
To disguise the Taste of Quinine.—Administer it in coffee. 
Part xvi., p. 67. 
New Preparation of Quinine.—Dr. Ivingdon introduced a new prepa- 
ration of quinine which he had lately succeeded in preparing. It is the 
di-arsenite—that is, it consists of one part of arsenious acid, and two of 
quinine; it is a powerful medicine, and one which he has found of great 
benefit, especially in chronic cutaneous affections, and has no doubt it 
would be equally beneficial in ague, tic douloureux, and neuralgia. It pos- 
sesses both the qualities of a mineral and vegetable tonic, and when the 
system has become habituated to either the one or the other (which we 
frequently find the case from long-continued use), by the administration 
of this medicine you will keep up the former action, while at the same 
time a new one is introduced into the system. He related a case Avhich 
demonstrates this very satisfactorily. A young woman who had been af- 
fected with lepra six years, was admitted a patient at the Exeter Dispen- 
sary, under his care, and was ordered the liq. potassse arsenitis, with de- 
coct. dulcamarse, three times a day. For a time the disease appeared to 
be improving, but it gradually got back to its former state, although the 
quantity of arsenical solution was increased to the full extent; he then or- 441 
KECTUM. 
dered one-third of a grain of di-arsenite of quinine to be taken twice a day, 
and the following week the eruption Avas much improved. It has been 
gradually increased to four times a day, and notv she is nearly well. 
Part xvi., p. 297. 
Quinine, w ithout its Bitterness.—To deprive quinine of its bitterness, com- 
bine ten grains of it with two grains of tannic acid. Part xxiii., p. 336. 
Disguising the Taste of Quinine.—A piece of chocolate should be half 
masticated, and retained between the cheeks and the teeth. The quinine 
draught is to be rapidly SAvallotved; and then the mastication of the cho- 
colate is to be completed, so that it may be swallowed also. The taste of 
the quinine is thus hardly perceived. Part xxvi., p. 326. 
Action of Quinine.—The following are the general rules, established by 
M. Briquet, for giving quinine in fever : 1st. Give each hour or second 
hour the sixth or twelfth part of the quantity to be taken daily, and leave 
ten hours’interval without any quinine. 2d. Gradually increase the dose, 
until head symptoms, vertigo, and pain are produced. In ague, give the 
quinine so as to produce the maximum elfect at the commencement of the 
febrile action. In typhoid fever, give quinine during the night, for the ac- 
cess comes on in the afternoon, and it requires some hours after adminis- 
tration before it produces its full effect. Ahvays give it in solution: when 
given in the form of pills it is only one-sixth as active in three hours. 
Part xxxii., jp. 277. 
Quinine.—As a prophylactic, quinine is especially valuable Avhile in un- 
healthy localities. It should be given in three or four grain doses tAvice a 
day in a glass of sherry, and its use should be continued for fourteen days 
after leaving an unhealthy district. Its effects in tropical climates are very 
manifest, producing a refreshing and exhilarating elfect on the system, 
which nothing can equal. Part xxxv., p. 17. 
SEOTUM. 
Relaxed Rectum.—Dr. Hunt describes this as a malady of not unfre- 
quent occurrence, and productive of much inconvenience and distress. 
The most prominent symptoms are obstinate constipation, a frequent 
desire to evacuate the bowels, a constant sensation of load in the rectum 
—which is not relieved by an evacuation—and the discharge, after much 
forcing, of mucous streaked with blood. The bladder, urethra, and other 
adjacent organs, often participate in the irritation. On examination, the 
rectum will be found preternaturally enlarged, and more or less tilled with 
large folds of mucous membrane pressing down on the anus, which impede 
the evacuation of the faeces, introduction of instruments, and injection of 
enemata. This morbid condition of mucous membrane, the author attri- 
butes to a neglected state of the bowels, and repeated great distention of 
the rectum by faeces, which causes the mucous membrane, when the bowel 
is empty, to hang in loose folds. This disease, if neglected or mismanaged, 
gives rise to prolapsus ani, an irritable and painful state of the sphincter, 
and an intro-susception of the upper and undilated portion of the intes- 
tine, into the lower and dilated part. The treatment recommended for 
the simple relaxed rectum is, the avoidance of all aperient medicines, and 442 
the injection of a pint of cold water into the bowel every night previous 
to going to bed, the removal of the prolapsus, and the application of bella- 
donna ointment to the irritable sphincter. In the case of intro-susception 
of the rectum, in addition to the use of the cold water injection, the exhi- 
bition of some mild aperient, taking care that whilst a costive and hardened 
state of the faeces is prevented, purging is avoided, and a course of the 
hyd. cum creta, with hyoscyamus or conium, or the iodide of potash and 
sarsaparilla. 
[Dr. James Johnson disagrees with Dr. Hunt with respect to the use of 
mild aperients. He considers them to be essential to the successful treat- 
ment of the affection. He says:] 
In cases of constipation, it is essential, to effect a cure, that the colon as 
well as the rectum should be acted upon. Faeces often collect above the 
rectum, and cannot be reached by small injections of cold water. These 
injections are, moreover, not so harmless as people seem to imagine; at all 
events, he has seen them productive of violent tormina and great pain; 
in some instances, producing faintness. He would, in this class of cases, 
administer some mild aperient, which would act on the colon, and soften 
the faeces in that tube—such, for instance, as the tartrate of potash or the 
confection of senna. These medicines produce no irritation or unavailing 
efforts to evacuate the rectum ; on the contrary, they soften the faeces 
above, and soothe rather than irritate. In the second class ot cases men- 
tioned, in which there was intro-susception of the rectum, he has found 
Ward’s paste corrugate the folds and give tone to the part. In this class 
of cases, when the bowels have protruded, and have not been carefully 
returned, it was liable to become inflamed, and be productive of great 
suffering. 
Mr. Barnsby Cooper agreed with Dr. Johnson in reference to the expe- 
diency of applying remedies that would act on the colon in the first class 
of cases described by Dr. Hunt. 
He recommended evacuating the bowels at night, just before retiring to 
bed. In diseases of the rectum, this rule was one of the greatest impor- 
tance. When evacuated just before bed-time, the patient remained in the 
recumbent position for many hours, and the affected bowel was, during 
the whole of that time, in the pelvis. By this simple plan a cure was 
effected without the use of instruments or of medicine, both of which 
combined would only alleviate and not cure. 
[For the support of the rectum in these cases mechanical means may 
be resorted to similar to those applicable in prolapsus uteri.] 
In cases of constipation from relaxation, aloes in combination with 
sulphate of quinine was a favorite prescription of Dr. Abercrombie, and 
often succeeds remarbably well, especially in persons advanced in life. In 
cases of great dilatation, might not injections of nitrate of silver be of 
service, administered as recommended by Trousseau in the diarrhoea of 
children ? 
It has a great effect in producing contraction of the calibre of the 
vagina. In the habitual constipation which so often produces this affec- 
tion, Dr. Graves, after objecting strongly to the use of mercurial purgatives, 
recommends the following combination : 
R Electuarii sennse, §ij.; pulv. supertart, potass., §ss.; carb. ferri, 5ij.; 
sirupi zingib. q. s.—Ft. electuarium. 
The dose must be regulated by its effects, but in general a small tea- 
RECTUM, RECTUM. 
443 
spoonful in the middle of the day and at bed-time will be sufficient. Dr. 
Graves says, that the value of carbonate of iron as a tonic aperient has not 
been appreciated. Part xi., p. 160. 
Irritable Ulcer of the Rectum.—Mr. B. Cooper describes this painful 
form of disease—painful to the patient, and sometimes not less so by its 
obstinacy to the practitioner. Speaking of irritable ulcer, he says: Such 
a condition of ulcer not unfrequently attacks the rectum, under the form 
of a narrow elongated fissure, running along one of the folds of the mucous 
membrane, near to the orifice of the anus. The edges of the fissure are free 
from any callosity, and it bears a strong resemblance to the cracks which 
frequently affect the lips. The most usual situation for the ulcer, as far as 
my experience goes, is at the posterior aspect of the rectum in the 
mesial line, although I have sometimes found it on the side of the bowel. 
The symptoms of the disease are highly characteristic; a burning pain 
is experienced during the act of defecation, which continues for a consid- 
erable time after each evacuation. During the intervals the patient enjoys 
comparative ease, but still occasionally suffers from heat and lacinating 
pain about the anus, but nothing to be compared to the agony produced 
by the passage of the faeces over the ulcerated surface and through the 
sphincter, and which is commonly more or less in a state of spasmodic 
contraction. The bowels are in these cases generally constipated. 
The ulcer may involve merely the edge of the verge of the anus, or 
extend a considerable way up the intestine, but may always be detected 
by passing the finger into the rectum, when the nature of the sore is 
readily appreciated by the extreme pain which the patient experiences 
directly the finger comes in contact with the fissure. 
The finger on being withdrawn, will be marked with a streak of blood, 
and lead to the discovery of the size and position of the ulcer. 
Pass the forefinger of the left hand up the rectum, and direct a straight 
probe-pointed bistoury along it, beyond the very extremity of the fissure ; 
then divide the ulcerated surface, and the fibres of the sphincter which 
are connected with it. In the after-treatment, advise the patient to get 
the habit of evacuating the bowels at bed-time, instead of in the morning. 
Part xvii., p. 172. 
Stricture of the Rectum.—The rectum is sometimes, Mr. Cooper ob- 
serves, the seat of spasmodic stricture, resembling the stricture of the 
oesophagus which occurs in hysterical females. But permanent stricture 
is a frequent occurrence, and one of the prominent symptoms of this state 
is constipation, partly due to the obstruction, and partly occasioned by the 
avoidance of defecation by the patient, who dreads the acute pains which 
it occasions. 
The egesta, Mr. Cooper observes, in stricture of the rectum are passed 
in small rounded portions, or if “ figured,” of very small diameter, from 
being forced through the contracted part; the patient usually complains 
of distention of the abdomen, interference with the function of respiration, 
and loss of appetite. With these symptoms an examination should be 
made per anum, at first with the finger alone, and this will probably lead 
to the detection of the obstruction, which is often very firm, and resists 
the entrance of the finger into the bowel. This excessive hardness may be 
produced either by scirrhus, or by a mere attack of inflammation, and 
therefore, the hardness alone is not to determine the judgment of the 444 
EECTUM, 
surgeon as to the disease being malignant, as that question will be best 
decided by the age of the patient, the length of time the disease has ex- 
isted, and by the nature of the pain. If, for instance, the patient be old, 
the pain constant, severe, and of a lancinating character, and he has great 
dread of exciting the muscular action necessary to the evacuation of the 
bowels, and if at the same time there is an appearance of wrhat is termed 
malignant diathesis, the prognosis would be unfavorable. But, if the ob- 
struction results from simple inflammation in a youthful patient, it will be 
indicated by the suddenness of its appearance, by the febrile symptoms 
attendant upon it, and by the peculiar sensation conveyed to the finger; 
for although there is considerable hardness, it is not of the stony character 
that marks scirrhus, but gives the idea of its being a dense projection of 
the natural structures into the bowel, rather than an adventitious deposit. 
When the disease is malignant, bleeding is frequent, particularly upon 
examination either by the finger or instrument, and the pain lasts for a 
considerable time after, which is not the case with common stricture. The 
treatment in the non-malignant disease consists in the occasional applica- 
tion of leeches around the anus, the patient being kept in the recumbent 
posture, and I believe that enemata will be generally found better than 
bougies, as a mechanical means of overcoming the obstruction, unless they 
act, indeed, too much upon the bowels, in which case bcugies must of 
course be employed. 
The introduction of the bougie is a matter requiring considerable skill 
and anatomical knowledge. From want of this knowdedge, indeed, 
unskillful practitioners often do great mischief, sometimes wounding the 
rectum, from which accident extravasation of faeces, peritonitis, and death, 
may be produced. The bougie should, therefore, only be employed by 
scientific surgeons. Leeches, the recumbent posture,' injections, and in 
some cases the use of the bougies, and cupping in the loins when the pain 
is severe, are the means to be had recourse to in non-malignant obstruc- 
tion. And often, by such measures, a disease which at first appeared to 
be of an alarming character, is quickly removed. In malignant disease but 
little can be done: the adventitious matter indefinitely increases, so as at 
length completely to obliterate the bowel, and the patient dies from the 
insuperable barrier opposed to the escape of the excretions, unless an arti- 
ficial anus be made in the colon, or as some surgeons have recommended, 
a cutting gorget, or some instrument of the kind be forced through the 
obstruction; but this, if it afford any relief, can only do so temporarily. 
Scirrhus stricture generally destroys the patient, however, by the propa- 
gation of the malignant disease through the medium of the absorbents to 
some distant part: thus, perhaps, transplanting it to important vital 
organs, in which case the reaction on the constitutional powers is very 
rapid, and the patient soon sinks beneath its influence. 
Part xviii., p. 105. 
Stricture of the JRectum.—An operation for this disease was performed 
at St. Thomas’s Hospital, as follows : The patient being placed upon her 
face, the stricture soon reached, the mere point of the finger getting into 
it, a grooved director wras passed up to it, together with a bistoury. The 
director was next let fall out, and the knife carried through all the parts 
up to the coccyx. The intestine above the point of the stricture seemed 
quite free. The rectum was laid open, and two vessels, probably branches 445 
of the superior hemorrhoidal, spouted out pretty freely, and were tied ; the 
tibres of the upper and lower sphincter were also visible. The thick 
mucous membrane with the stricture, and the various veins and nerves 
were all divided. After the hemorrhage had ceased, a large plug of lint 
was put into the wound, and secured by a T bandage. The operation was 
quite successful. Part xxii., p. 216. 
Fungous Tumor of the Rectum in Children attended with Bloody 
Discharges.—M. Martin has already directed attention to the affection as 
it occurs in the adult, producing discharges which are mistaken for those 
from hemorrhoids. The first case occurred in a child, aged 5, about whom 
the author was consulted in consequence of hemorrhages which occurred 
during a prolapsus ani, and which arose from an excrescence that he at first 
mistook for hemorrhoids. Examining it more closely, he found it was a 
spongy vegetation, not unlike a portion of the placenta, which protruded 
from beyond the sphincter when the child went to stool, and was quite in- 
sensible to the touch. As the hemorrhage had been considerable, the fun- 
gus was touched with the nitrate of silver, whenever it protruded ; and, 
owing to its softness, four or five applications, at intervals of several hours, 
sufficed for its destruction. In a second case, a girl, aged 8, had become 
much reduced by the quantity of blood she had lost during several weeks; 
and a fungous tumor, about the size of an almond, was easily removed in 
the same way. A- third case occurred in an infant six months old, in 
whom efforts at stool protruded a tumor the size of a pea, which bled. 
The author believing it to be the germ of the fungous tumor, also treated 
it with caustic. 
M. Leclayse believes that this affection is often mistaken for hemorr- 
hoids ; and especially when the bleedings are said to be due to internal 
piles. The caustic could not be applied very high up, but as the bleeding 
lias only occurred on the protrusion of the tumor, this has been easily 
reached, the application being successful even when the base of the tumor 
could not be attained. Part xxii., p. 218. 
Irritable Fleer of the Rectum.—Give chloroform, and divide the fissure 
by a longitudinal incision through the centre of the ulcer, including the 
sphincter muscle. The great source of mischief is now set at rest, and the 
ulcer heals ; but the healing process is promoted by applying a plug of lint, 
coated with the following application: Liq. plumb, diacet., 3j-; confect, 
rosse, fj. This plug, dipped in sweet oil, is to be applied to the part. In 
sensitive ulcers of the rectum, and in painful affections generally, Mr. 
Curling uses the following ointment: Chloroformyli, 3j. to 3ij ; zinci oxydi, 
3ss.; olivse, 3j ; cerat. cetacei, 3iv. M. ft. ung. Part xxiv., p. 215. 
Inflammation and ’Ulceration of the Rectum.—At a meeting of the 
Medical Society of London, Mr. Coulson said, that he saw a patient, aged 
thirty-four, who passed a semi-solid feculent motion once in twenty-four 
hours, tinged with mucus and blood, and in addition to this, within the 
same time, four or five evacuations consisting solely of small quantities of 
mucus and blood. On examining the bowel with the speculum, it W'as found 
that the mucous membrane was destroyed to the extent of two inches from 
the anus, and pus and blood were seen exuding from the ulcerated surface. 
Various local and constitutional remedies were employed with little relief 
except a slight diminution of the discharge. It was then suggested that 
the decoction of tormentilla should be tried; three ounces of this root in a 
RECTUM. 446 
KECTUM. 
pint and a half of boiling water were boiled down to a pint, and four 
ounces of the decoction were thrown up the rectum twice a day, and 
retained each time a quarter of an hour. Under the use of this remedy 
the pus and mucus gradually diminished, and within five weeks the ulcera- 
tion had completely healed ; the only medicine taken during this time was 
a little castor oil, to keep the bowels loose. Mr. Coulson believed the 
rectum to be occasionally the seat of inflammation, attended with muco- 
purulent discharge, which, if unchecked, proceeds to the destruction of 
the mucous membrane of the bowel, and to the formation of abscesses in 
tbe neighborhood of the anus. A frequent desire to go to stool exists in 
these cases; and unless this be yielded to at once, the motions come away 
of their own accord, loose, and mixed Avith blood and mucus; at last the 
patient’s health gives way, and he is worn out by continued suffering. 
Mr. Coulson showed a preparation taken from a patient who had died of 
this complaint: the cellular tissue round the anus was hardened, the 
mucous membrane of the rectum completely destroyed, and the internal 
surface of this bowel presented elevated hypertrophied muscular fibres, 
between which there were several openings communicating with external 
abscesses, so that these in fact were the result of the disease of the interior 
of the gut—-the diseased action without being continuous with that within. 
The ulceration of which he had been speaking, W’as not to be confounded 
with the fissured rectum which often occurs from mechanical causes, or the 
ulcerated rectum which is sometimes found in persons laboring under a 
syphilitic taint. These conditions of the bowel very painful, and the 
source of great distress to the sufferer, but they easily yielded to remedies 
—as the black oxide of mercury ointment (one drachm of the black oxide 
to an ounce of lard) or if this failed, to a division of the surface of the 
ulcers—and when left to themselves did not destroy the patient. Mr. 
Coulson said it wras most desirable, in all diseases of the rectum, to make 
an examination of the bowel with the speculum. Part xxv.,p. 213. 
Rectum—Ulceration and Excoriation of.—Keep the bowels free by 
the management of diet after the confection of senna has been used. 
Touch the small surface of ulceration with the point of a piece of sulphate 
of copper morning and evening, and after the bowels have been opened, 
apply hot water with a sponge for a few minutes, and then an ointment 
consisting of hyd. c. creta and ceratum cetacei, 5ss to §j. 
****** ** 
Place the forefinger of the left hand upon the sore, and with a probe- 
pointed bistoury fairly divide the ulcer longitudinally by passing through 
it into the subjacent tissue. If the ulcer is extensive, or complicated with 
other diseases, some addition is necessary to the treatment by simple 
incision according to the complication. Sir B. Brodie and Mr. Copeland 
agree in the above method of treatment. Part xxvi., p. 187. 
Irritable Rectum.—In a case of this disease, under the care of Dr. 
Harlow, attended with constipation, in which repeated clysters and large 
doses of castor oil had failed in giving any relief, perfect success followed 
the administration of five grains of pil. saponis c. opio, given three times a 
day; wdth 5ij. of castor oil on alternate mornings. The opium did not in 
any Avay interfere wyith the powrers of digestion. Part xxvi., p. 196. 
Affections of the Rectum caused by certain conditions of the Womb.— 
Mr. I. B. Brown says: Displacement forward or backward, and enlarge- 447 
RESPIRATION. 
ment of the uterus, from whatever cause, whether pregnancy, hypertrophy, 
inflammatory engorgement, distention by fluid or by hydatids, polypi, or 
scirrhus, or any other disease, alike tend to injuriously affect the rectum. 
As displacement may occur without enlargement of the uterus, it may 
operate singly in inducing rectal disease; but more often the two con- 
ditions concur, and it is then chiefly that the mischief is so considerable. 
The evils, too, will be greater when, with retroversion, engorgement of 
the body of the uterus, and with anteversion, that of its neck, go together. 
On the other hand, enlargement, without deviation of the womb forward 
or backward, may, and oftener does, act singly in provoking disease of the 
rectum, than either of these displacements does without it. 
The conditions of the uterus under consideration act on the rectum 
injuriously in two -ways; first, by mechanical pressure ; and, second, by 
inducing vascular disturbance like that present in themselves. An enlarged 
uterus drags on its lateral ligaments, elongates them, subsides lower down 
in the pelvis, and so comes to press on the lower bowel, to interfere with 
its muscular action, and the circulation through its blood-vessels, and to 
irritate its mucous lining. At the same time any hypersemic state of the 
uterine vessels causes an increased fullness of the hemorrhoidal, and a 
determination of blood to them. Thus, by reflecting on the anatomy of 
the parts, it will easily be understood why and how diseases of the rectum, 
such as hemorrhoids, prolapsus, fissure, stricture, fistula, as well as dis- 
ordered functions of the bowel, as constipation, dysenteric irritation, etc., 
do sometimes result directly, either from the mechanical pressure of an 
enlarged uterus, or simply from the derangement of the hemorrhoidal cir- 
culation, resulting from uterine disease. Part xxx., p. 217. 
Ulcerated Cancer of the Rectum.—For the relief of the dreadful pain 
caused by defecation in this disease, and which alone is a principal cause 
of the great exhaustion, Prof. Erichsen recommends Amussat’s operation. 
You relieve the pain, and remove the cause which would stimulate the 
disease to make more rapid and extensive ravages than it otherwise would. 
Part xxxv., p. 106. 
Rectum, Hemorrhage from.—After operations on the rectum, instead 
of using lint to restrain the hemorrhage, Mr. Salmon would introduce into 
the return a large plug of the finest jeweller’s wool, and pi-ess it gently 
into the whole length of the wound. The wool must on no account be 
oiled, as it is by its loose absorbing texture, that it is so valuable. Styptics 
are never necessary, continued pressure is almost invariably found efficient. 
Part xxxv., p. 114. 
RESPIRATION. 
Respiration.—The ingestion of fats and pure starch decrease respiration; 
sugar largely increases respiration; albumen, gelatin, milk, and all ordi- 
nary nitrogenous diet, increase it to a moderate degree only. Whilst 
brandy, wine, and kirchenwasser greatly decrease respiration, rum largely 
increases it. Ether, tea, and sugar are the most powerful respiratory 
excitants: ammonia, opium, morphia, tartarized antimony, kirchenwasser, 
and sleep, are the most powerful depressants. Part xxxv.,p. 309. 448 
.RHEUMATISM. 
Artificial Pespiration—May be carried on by alternately squeezing the 
chest with the hands, so as to induce a forced condition of expiration, and 
removing the hands, when the elasticity of the parietes will restore them 
to a medium state and cause the entrance of air. Mr. Humphry has more 
than once saved life by resorting to this simple process. 
Part xxxix., p. 95. 
Artificial Respiration. Vide Art “Drowning.” 
RHEUMATISM. 
Abstracts from the best writings on Pheumatism—Colchicum.—Mr. 
L. Wigan, of Brighton, confidently asserts the following mode of using this 
remedy to be heroic, in proportion as the case is violent and recent. Eight 
grains of the powdered colchicum root (preserved by being kept ground 
to an impalpable powder with twice or thrice its weight of white sugar), 
are given every hour, in water, or ginger, or apple tea, until vomiting, 
purging, or profuse perspiration take place, or at least till the stomach can 
bear no more. If nausea is felt after three or four doses, he stops a quarter 
of an hour, and gives brandy on sugar or soda water, when the medicine 
is again continued. The usual quantity supported is eight or ten doses; 
the maximum fourteen ; the minimum five. After six or seven doses a 
slight nausea comes on ; but by keeping quiet, with something in the 
mouth, three or four doses might be received, when perhaps the disgust 
becomes unconquerable. After this there is generally sound sleep, with 
occasional nausea on waking. The pain ceases, but the more active effects 
of colchicum do not take place for some hours after the last dose, and after 
a few hours more is succeeded by “ Elysium.” The inflammation of the 
joints subsides, and they resume their size with miraculous rapidity. The 
acidity of the perspiration ceases as wrell as the peculiar odor. As soon as 
a cup of souchong tea can be obtained, a sound sleep comes on, from 
which the patient awrnkes perfectly WTell. When enabled to do so, Mr. 
W. prefers giving a breakfast of bread and butter and tea only, very early 
in the morning, and two hours afterward to commence the colchicum. 
Nothing more but tea, and bread sopped in it during that day. It is well 
to indulge the returning appetite very sparingly on the day following, on 
which we may allow a small snap of devilled meat and rice, with a little 
curry, if desired. Afterward the patient may resume his ordinary diet 
as soon as his appetite indicates it. Mr. W. has never known a relapse, 
and strongly urges the practice. We confess to have some doubts of the 
safety of this plan, unless in robust subjects and in a very acute form of 
the disease. 
Emetics, Purgatives, Peruvian Park, etc.—Dr. Davis says that the 
duration of the disease, under the following plan does not exceed a wreek 
in the majority of cases : Bleeding from the arm to faintness, succeeded 
by an emetic of ipecacuanha and tartar emetic, and in five or six hours by 
a purge of calomel and jalap; after this he gives a scruple to half a 
drachm of powdered bark, every three or four hours. This is 
similar to Haygarth’s plan, and has the sanction of very varied experience. 
Pleeding, Calomel, Opium, etc.—The late, and much-to-be-lamented 
Dr. Hope, after six years’ experience upon 200 cases, gives decided pre- RHEUMATISM. 
449 
ference to the following plan : After one, or even two full bleedings in the 
robust, he gave seven t'o ten grains of calomel, with one or two of opium, 
at night, a draught with fifteen to twenty minims of colchicum wine, and 
five grains of Dover’s powder in saline mixture, three times a day. It was 
seldom necessary to repeat the calomel more than from two to four times, 
after which he continued the opium at night, with the colchicum draught 
and a senna laxative every morning. The patient was almost always 
well in a 'week, and able to commence his work in seven to ten days after 
pains had ceased. Ptyalism was avoided unless the heart was involved. 
In chronic cases he gave five grains of calomel, and one of opium, at 
night, for five or six times, with the senna and colchicum draught as be- 
fore. Local depletion with some form of counter-irritation were usually 
employed. 
Tart. Emetic, Nitre, Colchicum, etc.—In the acute stage Dr. Graves 
principally relies on bleeding, with large doses of tartar emetic and nitre, 
and in less urgent cases, particularly if complicated with bronchitis, he has 
derived much benefit from the following mixture: 
R Almond emulsion, eight ounces ; vinegar of colchicum, half an ounce ; 
acetate of morphia, one grain; nitrate of potash, half a drachm. Mix. 
Half an ounce every hour or every two hours. 
If colchicum does not relieve in two or three days -we must have re- 
course to mercury. 
Peroxide of Mercury, Opium.—Dr. Pitschaft has for twenty years em- 
ployed mercury, preferring the red precipitate, in doses of one-eighth to 
one quarter of a grain twice a day, combined with opium if the system be 
irritable. 
Bleeding and Dover's Powder.—Dr. Christison, after premising bleed- 
ing, thinks that keeping up perspiration by frequent doses of Dover’s 
powder for 36 to 48 hours is an admirable plan. Purging must be 
avoided till the sweating is over, nor is the plan so successful if com- 
menced later than the fourth day. 
Bleeding, Purging, Guaiacum, etc.—Dr. Macleod advises bleeding from 
twelve to thirty ounces during the first week, giving three to five grains 
of calomel at night, and a senna purge in the morning. Opium to the 
extent of two grains in the twenty-four hours is often useful, and the 
guaiacum is recommended as the best after-treatment. In lumbago, Dr. 
M. thinks well of a brisk calomel purge once or twice a week as above, 
and considers half a drachm to two drachms of the compound tincture 
of guaiacum three times a day, with a grain of opium at night, the best 
plan. 
Tinct. Guaiacum, etc., in Lumbago.—Dr. Marryatt’s principal remedy 
against lumbago was half an ounce of the compound tincture given at bed- 
time, with other means adapted to promote diaphoresis. 
Diet—Hydriod. Potass—Liq. Potas.—Mr. Henry Rees says, “ In all 
cases of acute rheumatism, the diet should be strictly regulated; avoid 
rigidly, beer, wine, spirits, and animal food. Milk, beef-tea, butter, eggs, 
fish, etc., are all pernicious. His theory is that the disease depends on an 
excess of nitrogen. 
In very urgent cases bleeding and mercury may be necessary, but he 
regards the hydriodate of potass as certain an antidote to the rheumatic 
diathesis as mercury is to that of syphilis. Its combination with liquor 
potassse acts, he says, like a charm in rheumatic iritis. 
VOL. II.—29 450 
RHEUMATISM. 
Colchicum Mag. Sulph. Decoct. Baric, Soda.—Dr. Hughes never found 
it necessary to bleed. He gave a pill of opium and antimony at night, 
repeating it two or three times daily, if the pain was urgent. Calomel 
was only used when the inflammatory symptoms were severe. Half a 
drachm of the colchicum wine, with a drachm of the sulphate of mag- 
nesia, was given three or four times a day, producing, after two or three 
days, copious liquid, yellow evacuations, with evident relief, when he im- 
mediately ordered decoction of bark with soda. In a few days the patient 
was well. 
Emetics of Tart. Antimony.—In the report of the Worcester Infirmary 
it is stated “ that emetics of tartarized antimony, administered at the com- 
mencement, have cut short the disease in acute cases.” 
Mixture of Nitre—Lotion Iod. Potassium.—Mr. Horne speaks very 
favorably of the following mixture : 
R Nitrate of potash, half an ounce; potassio-tartrate of antimony, two 
grains; spirits of nitric ether, one ounce ; water twelve ounces. Mix. A 
wineglassful three times a day. 
He also strongly recommends the external use of a strong solution of 
the hydriodate of potass when the joints are implicated—a hint worthy 
of trial. The same lotion he has found serviceable in neuralgic pains. 
Nitrate of Potash.—Dr. Brocklesby, in 1764, first directed attention to 
the value of nitre in large doses, giving as much as ten drachms in the 
day and night. Mr. W. White, in 1774, confirmed its value, carrying the 
maximum dose to twelve drachms. In 1833, the same practice has been 
revived by Messrs. Gendrin and Solon. Sixteen cases are recorded, of 
which the average period of treatment was eight days. The mean quan- 
tity of the salt given in one day was one ounce in three quarts of water; 
the total average quantity, eleven ounces. They advise commencing 
with two drachms and a half in a quart of fluid. 
Twelve successful cases are recorded by M. Arran, where the mean 
dose was thirty-six grains in three pints of fluid, and the average total 
quantity 374 grains. The mean duration was eight days. 
We suspect the above doses to be excessive, and believe M. Arran’s 
practice the most reasonable and prudent. Such evidence is illustrative 
of the differences prevalent among practical men as to the necessary 
doses of medicine. There are enthusiastic givers as well as takers of 
physic. 
Opium, Quinine, Warm Embrocations.—Dr. Corrigan, in a very 
interesting paper in the “Dublin Journal,” asserts that the treatment of 
rheumatism by large doses of opium shortens the duration, diminishes 
suffering, husbands strength and lessens the tendency to complications. 
It is important that full and sufficient doses are employed, increasing them 
in amount and frequency, until the patient feels decided relief, and then 
continuing the same dose until the disease has steadily declined. The 
mean quantity given in twenty-four hours was from ten to twelve grains, 
but it often amounted to more than double. It does not affect the cere- 
bral function, and, as wTe have more than once observed, in some cases 
excites diarrhoea. The average duration of treatment was nine days. The 
plan is not adapted to gouty subjects. Warm embrocations, with turpen- 
tine, or camphorated spirits, were employed. Against the consequent 
stiffness he advises frictions, with half an ounce of camphorated oil and 
turpentine, and a drachm of sulphur. In cases with sweating, erratic 451 
RHEUMATISM. 
pains, and quick small pulse, the combination of quinine and opium is 
admirable. Other practitioners have confirmed Dr. C.’s experience ; and 
his suggestions, though not absolutely novel, possess great practical in- 
terest. 
Aconite. —Dr. Busse, of Berlin, in a monograph upon the subject, advo- 
cates the value of Richter’s treatment both of acute and chronic rheuma- 
tism. lie gives from fifteen to sixty drops every two hours, of the follow- 
ing solution: 
R Extract of aconite, four scruples; antimonial wine, three ounces two 
drachms. Mix. 
It excites diaphoresis without distress, and relieves pain. The evidence 
in its favor is very strong. 
Dr. J. B. Watkins of Philadelphia also speaks in favor of extract of 
aconite. It may be given in doses of one-fourth of a grain three times a 
day, to six grains, or even more, daily. 
Mr. Curtis recommends an aconite plaster, made by evaporating four 
ounces of the tincture to the consistence of oil; this quantity to be spread 
with a brush on half a yard of adhesive plaster. 
Belladonna.—Dr. Osborne (“Dublin Journal,” June 1, 1840), remarks 
that belladonna causes an immediate cessation of the migratory pains, 
without benefiting those which are fixed. The dose is one-third of a grain 
three times a day, increased to one-half every three hours. Its effects 
seem limited to muscular pains. 
Pills of Guaiacum, Camphor etc.—Dr. Ilassack “ Practice of Physic,” 
(p. 672) considers the following pill a good diaphoretic stimulant in chro- 
nic cases: 
Guaiacum, six drachms; camphor, one drachm; opium, two drachms ; 
potassio-tartrate of antimony, one drachm. Mix. To be divided into 120 
pills, two three times a day. 
Alkalies, Laxatives.—Cases occur, says Dr. Watson, which are not ab- 
solutely acute or chronic. There is some fever, the joints are affected, the 
skin dry, thirst, the urine loaded with lithic deposits, and strongly acid. 
In this state alkalies are of great use. A drachm of the liquor potassre 
daily for several days together, keeping the bowels free, has done more 
than any other treatment. 
Rheumatic Headache—Treatment.—Against rheumatic headache Dr. 
Johnson has found no treatment so successful as the following: Eight 
grains of Dover’s powder and two of calomel at bed-time on alternate 
nights for two or three times, followed by a third part of the following 
mixture the next morning, to be repeated in two hours, if necessary : 
Infusion of rhubarb, three ounces ; tartrate of soda, three drachms ; 
powder of rhubarb, half a drachm ; tincture of senna, half an ounce ; wine 
of colchicum, a drachm and a half. Mix. 
The same observer remarks that many of the most stubborn cases will 
yield to a course of blue or Plummer’s pill, taken at bed-time, and followed 
by a warm saline colchicum draught in the morning. Flannel clothing, 
and an occasional warm bath, are valuable adjuvants. 
Muscular Atony—Ammonia.—Dr. Paris asserts that against the mus- 
cular atony succeeding to acute disease, ammonia in large doses is the best 
remedy. 
Treatment of an Obstinate Case.—In a very obstinate case, characterized 
by severe pains, relieved by heat, and unaccompanied by much swelling, oo» 452 
EHEUMATISM. 
curring in the practice of Mr. John Brady, of London, the following means 
proved very successful: 
Compound extract of sarsaparilla, six drachms ; iodine, half a grain; hy- 
driodate of potash, half a drachm ; boiling water, six ounces. Mix. A 
fourth part three times a day, with one of the subjoined pills. 
Hydrochlorate of morphia, one grain; disulphate of quinine, nine 
grains; blue pill, ten grains; rhubarb pill, twelve grains. Divide into 
twelve pills. 
Quinine.—M. Briquet has recently addressed a letter to the Academy 
of Medicine of Paris, stating that large doses of quinine were as successful 
in rheumatism as in ague. All will not coincide with M. B., and some late 
experience has proved that an excessive use of this agent is not without 
inconvenience and danger. 
Sulphur.—We shall now adduce some evidence in favor of sulphur, 
which entitles it to the practitioner’s serious attention. It is an old but 
very partially employed remedy, and has now almost descended from the 
profession to the people. 
Dr. Munk states that he employed it successfully in 300 cases. It seemed 
more effective when combined with the carbonate of soda, in the proportion 
of two drachms to an ounce of sulphur. Half an ounce of the latter was 
the maximum quantity in twenty-four hours. 
The celebrated nostrum, well known as the “ Chelsea pensioner,” owes 
its efficacy to sulphur. 
Dr. Law states that in subacute rheumatism there is no one means he 
he has found so generally useful. 
R Sulphur, one ounce ; bitartrate of potash, half an ounce; powder 
of rhubarb, two drachms; powder of guaiacum, one drachm; powder of 
musk, one drachm; honey, four ounces. Mix. A dessertspoonful three 
times a day. 
If it purge too much, a drachm of Dover’s powder to be added. Dr. 
Graves also praises it, and substitutes the following electuary: 
R Powdered bark, one drachm; powdered guaiacum, one drachm; 
cream of tartar, one ounce; flour of sulphur, half an ounce; powdered 
ginger, one drachm. To be made into an electuary with sirup. A tea- 
spoonful three times a day. 
If it purge too much, we diminish the dose ; if constipation exists, we 
increase it. A teaspoonful of sulphur, with half the quantity of ginger, 
taken every morning in a glass of milk, has proved very useful. We know 
a lady liable to severe rheumatic pains in the scalp, who considers she can 
at any time cure them by a dose of sulphur at bed-time. 
Professor Otto, of Copenhagen, treated four cases, three of which were 
chronic, with four drops every two hours of tincture made of two drachms 
of the carburet of sulphur in half an ounce of rectified spirits. The same 
quantity, rubbed up with half an ounce of olive oil, was employed as an 
external embrocation. 
External Applications.—In chronic, obstinate affections of the joints, 
rubbing them with castor oil every night, and wrapping the limbs in 
warm flannels, is extensively employed in the East, and is said to be very 
successful. 
The external application of colchicum has been strongly recommended, 
and we have ourselves found it useful in cases where the sensibility was great, 
the pains diffused and recurrent, and the temperature of the part raised. 453 
RHEUMATISM. 
Painting the surface with tincture of iodine has been found useful. Equal 
parts of the compound camphor and soap liniments, with laudanum, is a 
good form of embrocation; and in case of severe local suffering, the fol- 
lowing ointment has succeeded in allaying pain. 
R Yeratria, half a drachm; opium, one drachm; lard, one ounce and a 
half. Mix. 
The endermic application of morphine is also worth remembering. 
Part viii., p. 24. 
Rheumatic Fever, General Treatment of.—Dr. R. B. Todd, in his 
article on the “ Dietetic and Medicinal Treatment of Gout and Rheuma- 
tism,” proceeds to say: 
Those channels which are obviously the most favorable for the elimina- 
tion of the rheumatic matter, are the skin, the bowels, and the kidneys ; 
hence the use of sudorifics, purgatives, and diuretics is indicated. Of su- 
dorifics, Dover’s powder is among the best, and is sanctioned by the expe- 
rience of many years; pure opium answers the double end of promoting 
diaphoresis while it procures rest and relieves pain ; or the nitrate of potash 
may be given either in combination with opium and ipecacuanha (a nearer 
approach to the original formula for Dover’s powder), or in solution along 
with minute doses of tartarized antimony. I am not in the habit of exceed- 
ing five or six grains of the nitrate of potass with one-eighth of a grain of 
the tartar emetic (to which, if there be nausea, a few drops of tincture of 
opium may be added), every four or six hours. The practice of giving 
very large doses of nitre, tried formerly in this country, and lately revived 
in France, does not appear to have any decided influence upon the mean 
duration of the disease. The administration of opium, however, is of 
great importance: it must be given in large doses, and is borne well by the 
patient. A good opiate should always be administered at night, and when 
there is much suffering, two or three doses should be given throughout the 
day. The irritative character of rheumatic fever is strongly in favor of 
this medicine. 
The purgatives which seem most applicable are those which produce co- 
pious watery evacuations. The combination of sulphate and carbonate of 
magnesia answers very well, the addition of the alkaline earth serving to 
neutralize some of the free acid which is so abundantly secreted. Colchi- 
cum is useful as a purgative, and if employed in large doses, exerts a pow- 
erful action on the intestinal canal, but the employment of it is not devoid 
of serious objection. The tartate of potass is also a useful purgative. The 
best mode of promoting diuresis in this disease is to allow the patient to 
use simple diluents freely; to these no other limits need be put than those 
which his own sensations will dictate. Any more direct stimulants to the 
kidneys would probably excite those organs too much. The saline effer- 
vescing draughts are agreeable and cooling, and have the additional recom- 
mendation of serving for the neutralization of the free acid, in its passage 
through the kidneys. 
The objection which has been urged against local applications to the 
affected joint during a paroxysm of gout, does not apply to rheumatic fe-ver. 
In the latter disease the morbid element is escaping at many places, in the 
former at a single joint; if we disturb its attraction to this one joint in 
gout, it may fly to a new one, or to some internal viscus. These risks are 
obviously wanting in rheumatic fever, as the disease is more generalized in 454 
KIIEUMATISM. 
its effects. And experience teaches ns that the greatest relief may be 
obtained by local bleeding in this malady. 
As, however, local bleeding does not prevent a joint from being revisited 
by the rheumatic irritation, the employment of it in ordinary cases, and as a 
general practice, is not to be recommended. You may apply leeches to- 
day to a joint, to-morrow it will be free from pain, and the next day it 
may be swollen and painful again. If the pain and swelling, both or either, 
be great, and such as to excite apprehension for the ultimate integrity of 
the textures, then the application of leeches will be really useful, and 
should not be deferred. 
When the articular affection is disposed to be chronic, and the rheu- 
matic matter appears to linger about a joint, local bleeding may be of 
essential service. Its timely use, in such instances, may save the patient 
from a tedious convalescence, if not from a chronic rheumatism. Local 
bleeding, in the earlier stages of the rheumatic paroxysm, has the addi- 
tional advantage of contributing to relieve the general fever in a manner 
not likely to inj ure the constitution. Warm fomentations or poultices often 
give considerable relief, and if agreeable to the patients, they may be used 
with safety. It has been proposed to foment the joints with a solution 
of an alkaline salt, as of soda or potass. I have seen this practice tried, 
but did not perceive any superiority of the alkaline fomentation over that 
of plain water. 
I am strongly inclined to believe that counter-irritation by blisters to the 
affected joints will be found a very useful practice in the severer cases of 
rheumatic fever, even in the acute stages. It will generally, however, be 
advisable to precede the application of blisters by that of leeches. 
Part ix., p. 46. 
Rheumatic Diathesis.—In his article on the “ Dietetic and Medicinal 
Treatment of Gout and Rheumatism,” Dr. li. B. Todd remarks as fol- 
lows : 
In the Rheumatic Diathesis, if the joints suffer much, they may be 
best treated by local stimulation, or counter-irritation. A strongly stimu- 
lating terebinthinate liniment is often beneficial; but, on .the whole, no- 
thing is so useful in chronic rheumatic states of the joints as blisters applied 
in rapid succession. In some instances where there have been much pain 
and swelling, the application of a few leeches will almost always do good. 
I learn from Mr. Busk, who has had great experience in the treatment of 
those painful articular affections connected with gonorrhoea (gonorrhoeal 
rheumatism), that blisters are an invaluable remedy in them, even from the 
first, and this accords with my own more limited experience. Doubtless in 
the case of rheumatic joints, blisters act in a similar way, by attracting the 
morbid element from the articular textures. I have lately employed 
pretty extensively, and with unquestionable benefit, the local application 
of iodine to the affected joints, for which purpose we may employ either 
the tincture of iodine, or a stronger compound, which is used at the 
King’s College Hospital, and is called iodine paint, the formula of which 
is as follows: 
R Iodinii, gr. lxiv; potassii iodidi, gr. xxx ; alcohol, 5j. M 
The mode of application is by painting the part freely with a camel-hair 
pencil. More or less smarting is produced, and frequently vesication, or 
a herpetic eruption may come on. The painting may be repeated as RHEUMATISM. 
455 
often as circumstances may demand. It is extremely useful where any effu- 
sion has taken place into synovial membranes or sheaths. Part 45. 
Chronic—Anodyne Pomade.—Take of Galen’s cerate, 31 parts; 
extract of belladonna, 8; acetate of morphia (previously dissolved), 3. 
Mix well together. 
This pomade is exceedingly useful in cases of muscular pains, chronic 
rheumatism, etc., when rubbed on the affected parts. Part ix., p. 192. 
Quinine in Articular Rheumatism.—In France, M. Briquet, M. Guerard, 
and Professor Fouquier, have employed sulphate of quinine for the treatment 
of acute articular rheumatism, with the most satisfactory results, the dose 
varying from 9j. to 3j- daily. Sulphate of quinine can be deprived of its 
bitterness by being taken in coffee. Part xvi., p. 67. 
Oil of Turpentine Externally in Rheumatism.—When the essence of 
turpentine is poured over a surface, its volatilization is not attended with 
any pain, or with the production of heat; but, when a compress imbued 
Avith the oil is applied to the skin and covered Avith waterproof cloth, the 
result is far different; violent pain folioavs in a quarter of an hour, and 
doubtless, if the application Avas prolonged, vesication might ensue. It is 
this revulsive action of the essence of turpentine, that M. HerATieux has 
endeavored to produce, and Avhich he has found extremely useful for the 
purpose of dispelling rheumatic pain. In cases of paralysis due to disease 
of the spinal cord, muscular Aveakness and pain Avere also relieved. 
Part xvi., p. 68. 
Phosphate of Ammonia.—After subduing the more inflammatory symp- 
toms by antiphlogistic treatment, Dr. EdAvards gives ten grains of phos- 
phate of ammonia e\Tery eight hours. This medicine acts beneficially by 
decomposing the uric acid or urate of soda, which is formed in excess in 
gout and rheumatism. Instead of urate of soda, a very insoluble, Ave have 
thus formed phosphate of soda, a most soluble salt. Part xvii., p. 26. 
Rheumatism—Acute.—The treatment of rheumatic fever is a subject 
upon Avhich much difference of opinion exists among practitioners. Dr. 
Todd insists very strongly upon the importance of curing, the disease with 
as little impairment of the power of the constitution as possible; and re- 
marks that Avhile Ave should aim at securing for the patient a short conva- 
lescence, we must guard equally against the danger of relapse, which the 
so-called speedy cures by the heroic treatment are too apt to leave behind. 
The indications are to relieve pain, to promote the action of the skin, 
kidneys and bowels, to use antacids, and to give large quantities of diluent 
fluids. For these purposes give a grain of opium, a grain of ipecacuanha, 
and five grains of nitre, every tAVO, three, or four hours; and a mixture 
with sulphate and carbonate of magnesia. Envelop the joints in a large 
quantity of cotton avooI, and cover Avith oiled silk ; changing it every 
tAvelve or tAventy-four hours. Give plenty of simple diluents, and from the 
first, let the patient have a little good beef tea frequently through the day. 
And Avhen the patient begins to pass pale urine, Avith or Avithout pale lith- 
ates, he Avill be the better for generous diet, Avith wine, ammonia, or qui- 
nine, even though the articular affection persists. Too much sweating, 
too much purging, or too much opium, are equally unadvisable. If the 
patient cannot bear opium, extract of hyoscyamus, hop or lettuce may be 
substituted. If the state of the joints does not yield to the application of 456 
cotton wool, apply a small sinapism for half an hour to redden the skin, 
then wash and dry the skin, and apply a blister the size of a crown-piece ; 
the blistered surface maybe allowed to heal, or maybe dressed with stimu- 
lating ointment; or a succession of small blisters may be used. Watch the 
state of the heart from the first; and on the first indication of pericardial 
or endocardial affection, apply a large sinapism over the region of the 
heart, and when it comes off, a large blister; but do not bleed either locally 
or generally. Give calomel and opium to affect the gums ; and, if needed, 
rub in mercurial ointment, or use it to dress the blistered surface. When 
delirium, resembling delirium-tremens, occurs as a complication of rheu- 
matic cardiac affections, it is “ a signal of distress,” and must be responded 
to by an immediate alteration in the treatment. All too free evacuations, 
whether from the skin or bowels, must be checked; nourishment must be 
given frequently in small quantities ; and even wine, brandy, or porter, 
may be administered. If the patient is wakeful, give opium. And take 
care that all exertion is avoided, lest fatal syncope be induced. If, how- 
ever, there is coma, do not give opium, but apply sinapisms or blisters. 
Part xviii., p. 36. 
Anaemia as a consequence of Rheumatism.—Dr. O’Ferrall, of St. Vin- 
cent’s Hospital, believes an anaemic condition may supervene in the course 
of acute rheumatism, resulting, apparently, rather from the natural course 
of the disease than from the remedies employed. Chalybeates should be 
given in this condition. Part xx., p. 34. 
Acute Rheumatism.—Dr. Watson says that “ the younger the patient 
is who suffers from acute rheumatism, the more likely will he be to suffer 
from rheumatic carditis.” 
This patient had the various symptoms of rheumatic fever. The heart’s 
action, being examined, was found natural, with the exception of a slight 
systolic murmur heard over the interval between the fourth and fifth ribs, 
about an inch below the nipple. 
The patient was ordered six drachms of lemon-juice, to be taken in sugar- 
water, three times daily. He was, however, in a couple of days much 
worse ; the pains were very acute, and the joints along the arms and hands 
became involved; the pulse rose to 120, full; the systolic murmur was 
more distinct; the perspiration profuse, very acid, and the urine high-col- 
ored. Dr. Barlow, after giving a purgative draught, with wine of col- 
chicum, prescribed a pill, composed of a quarter of a grain of tartar-emetic, 
half a grain of opium, and one grain of calomel, to be taken every fourth 
hour. These measures contributed to lessen the pains, and the patient was 
desired to take the pills only three times a day, with the following draught: 
-—half a drachm of acetate of potash, and ten grains of nitre, in camphor mix- 
ture. The improvement was very great on the next day; the pills were 
discontinued, but the mixture persevered in. The favorable impression 
produced by the salts of potash increased during the next few days; all 
the symptoms gradually gave way, and ten days after the draughts had 
been first taken, and regularly continued, the patient was convalescent. 
He took, before being finally discharged, small doses of iodide of potassium 
and carbonate of potash, and left the hospital quite well about three weeks 
after admission. Part xxii., p. 38. 
Treatment of Acute Rheumatism by Local Anaesthetics.—The applica- 
RHEUMATISM. 457 
tion, locally, of the Dutch liquid to the joints in this disease is highly re* 
commended. A moist compress sprinkled with the agent, is applied and 
renewed once in twenty-four hours, being inclosed in impervious bandages 
so as to prevent its evaporation. It is to be applied to each joint in suc- 
cession as it becomes inflamed. The complications of rheumatism may be 
treated on general principles at the same time. Part xxiii., p. 54. 
Rheumatism—Lemon-juice.—Dr. Babington had generally ordered 
three ounces of lemon-juice to be taken three times a day, but he has re- 
cently ordered as much as six ounces. He states that there is no remedy 
with which he is acquainted to be compared in value to lemon-juice in the 
treatment of rheumatism. In gout and chronic rheumatism its effects are 
far less obvious and uniform. He believes it will be found a valuable agent 
in inflammatory diseases generally. Part xxv., p. 32. 
Acute Rheumatism—Colchicum.—In all cases where albumen and urea 
are vicarious, and where coma supervenes, evidently from the accumulation 
of the latter principle in the blood, colchicum will prove of great value. 
Part xxv., p. 38. 
Articular Rheumatism.—In proportion as this disease approaches in its 
characters to gout we may expect to be successful with colchicum. Give 
twmnty minims of the tincture of wine every six hour3 until some relief is 
obtained, or a grain of the inspissated juice or of the acetic extract of col- 
chium every four hours. Part xxv., p. 41. 
Collodion.—In gout and articular rheumatism cover the part with a 
layer of collodion, so as to preserve it from the atmosphere. 
Part xxv.,p. 325. 
Pathology of Rheumatism and Gout.—The present theory with regard 
to these affections is, that they are both connected with an incfease of 
lithic acid in the blood. In rheumatism, this is dependent on excess of the 
secondary, and in gout on excess of the primary, digestion. In rheuma- 
tism, however, there is considerable excretion of lactic acid by the 
skin (Todd), whilst in gout there is an excess of soda, w’hich, uniting with 
the lithic acid, produces a compound of lithate of soda, that may be de- 
tected as such in the blood (Garrod), wThile sometimes it exudes into the 
cellular tissue of the skin, constituting tophaceous deposits. In both 
diseases there is an undue balance between the excess of lithic acid and 
the power of excretion—in rheumatism by the skin, and in gout by the 
kidney. This pathology serves to explain the similitudes and differences 
existing between the two affections. In both there is a certain constitu- 
tional state, dependent on deranged digestion, during which exciting 
causes occasion local effects. These exciting causes in rheumatism are bad 
diet, hard work, exposure to cold and wet, and its subjects generally are 
the poor and laboring population. In gout the causes are good diet, 
indolence, repletion, or indigest ion, and its subjects are for the most part 
the rich and sedentary. The h eal manifestations in both are acute wan- 
dering pains, with pain and swe lling—in rheumatism of the large, and in 
gout of the small joints, constituting the acute attack in the one, and the 
so-called regular attack in the other. These are combined with a tendency 
to various complications of the internal viscera, which are more or less 
dangerous to life. 
The general indications of treatment are, in both diseases—1st. So to 
RHEUMATISM. 458 
RHEUMATISM. 
regulate the nutritive functions as to insure a due balance between the 
amount of matters entering the blood as the result of digestion, primary or 
secondary, and the amount of matters discharged from the economy by the 
excretory organs. 2d. To conduct the acute attack to a favorable ter- 
mination, carefully watching the internal viscera and being prepared to act 
with vigor should these become affected. Hence the treatment of these 
diseases resolves itself into what may be called curative and preventive 
—the first having reference to the acute attack, the second to the means 
most likely to hinder its return ; the one must be carried out by remedies 
which act upon the blood and execretory organs, the other by the man- 
agement of diet and exercise. Part xxvii., p. 45. 
Treatment by Ash-leaves and Guaci.—Give an infusion of ash-leaves 
(Fraxinus excelsior). It possesses the advantages without the inconve- 
niences of colchicum. Generally, under its use, at the end of four or five 
days, or sometimes sooner, the pain, redness, and swelling visibly diminish 
in intensity, or even disappear. Each dose of the powdered leaves ought 
to be infused for three hours in boiling water, and before taken should be 
strained through a linen cloth, and sweetened to taste. Dr. Otterbourg 
says that 32 grammes, infused in a sufficient quantity of water, may be 
taken several times during the day. There is no need to change the mode 
of living. 
As a tonic, guaco (Mikania guaeo) is a most valuable drug after the 
fever has passed off; its effects were magical, where quinine produced 
restlessness, thirst and headache. Part xxvii., p. 249. 
Rheumatism.—One of the exceptional cases in which lemon-juice is of 
no avail, is that of a gonorrhoeal character. A woman, aged 30, was 
admitted into Guy’s hospital with rheumatism and a copious yellow dis- 
charge from the vagina. All ordinary remedies failed to relieve, until 
the purulent discharge had been removed by 5j. doses of cubebs. 
Part xxviii.,p. 34. 
Treatment of Acute Rheumatism by Acetate of Potash.—Dr. Golding 
Bird seems to depend on this remedy more than any other in the treat- 
ment of acute rheumatism. But, after all, it appears that the efficacy of 
lemon-juice itself depends not so much on the acid as upon the supercitrate 
of soda which it contains. It seems that all these kinds of salts are useful 
when they act powerfully on the kidney, and eliminate poisonous matter 
from the system. Thus citrate of potash, citrate of ammonia, acetate of 
ammonia, nitrate of potash, as well as the acetate of potash, all act very 
beneficially in rheumatism. 
Dr. Bird gives half an ounce, largely diluted, in divided doses every 
twenty-four hours. Part xxix., p. 43. 
Chronic Periosteal.—Dr. Basham has observed that in cases of chronic 
periosteal rheumatism, where the patient has been benefited by iodide of 
potassium, at some antecedent period he has been salivated by mercury; 
whereas if no salivation has previously occurred, he has found the iodide 
of potassium of little or no effect. This disease may depend upon the 
impregnation of the system by mercury, or from the syphilitic virus. If 
the former, iodide of potassium is the remedy; if the latter, alterative 
doses of some mild preparation of mercury. Part xxix., p. 45. 
Occurrence of Delirium Acute Rheumatism.—When delirium occurs 459 
RHEUMATISM. 
in acute rheumatism, says Dr. Durrant, it is of grave import. Examine 
the heart carefully—there is very likely to be pericarditis upon which the 
delirium depends. Bleed generally or locally according to circumstances, 
give calomel and opium, with salines and colchicum. Blister the cardiac 
region well, both in front and back. At the same time support the patient 
with broth, and even wine if necessary; always remembering that many 
of these apparently inflammatory diseases are asthenic and not sthenic. 
Part xxx., p. 222. 
Alkaline Treatment.—During the attendance of Dr. Swett, at the New 
York Hospital, all the patients admitted with acute articular rheumatism, 
were put under the “ alkaline treatment.” 
The salt chosen was the tartrate of soda and potassa, a neutral salt, 
possessing the property of rendering the urine alkaline. 
“ The plan of treatment usually pursued was, if the patient presented 
himself with unusual excitement of the skin and pulse, to administer a 
mixture of sulphate of magnesia and tartarized antimony, until the skin 
was relaxed, and the pulse reduced to a more natural standard. The 
Rochelle salt was then directed, in drachm doses, every two or three hours 
during the day-time, till the urine was rendered alkaline, when it was 
gradually suspended. A lotion of carb. potassa §j. with opium 3ij-, to the 
pint of water, was directed as an external application. The administra- 
tion of the salt was not attended with disagreeable consequences, with the 
exception occasionally of some ulceration about the fauces ; in no case was 
its action so severe upon the bowels as to require its entire suspension. 
The persons attacked were in full vigor of health, and the character of the 
disease acute in its form. The frequency of administration of the remedy 
was governed very much by the reaction of the urine. 
On the admission of the patient, the urine was tested, and in all cases 
was found to be of acid reaction, and the secretion of the skin presented 
the usual acid odor. The treatment was generally commenced the 
second or third day after admission, and the urine was rendered of 
decided alkaline reaction in an average of five days after its commence- 
ment ; the longest period it resisted the alkaline reaction having been 
twenty days, and the shortest two. 
In one case, attended with profuse perspiration, which yielded readily 
to treatment, the colored shirt the patient wore entirely lost its color ; and 
it was suggested whether the same change did not take place in the per- 
spiration, as in the urine. The average amount of the salt administered 
was from five to seven ounces. 
The average date of commencing improvement was seven days after 
commencement of treatment, coinciding, in the large majority of the cases, 
Avith the commencing alkalinity of the urine. The impro\rement Avas 
invariably permanent, and, after the mine Avas rendered alkaline, no neAV 
articulations were affected, as a general rule. 
The average period of convalescence Avas twelve days after admission; 
and the.Avhole duration of the disease, including the period previous to 
admission, was tAventy-two days. One of the most gratifying results 
of the alkaline treatment Avas the diminished frequency of cardiac com- 
plications. 
Not one patient was attacked with any heart complication during the 
treatment of the disease. Part xxxi.,p. 43. 460 
RHEUMATISM. 
Treatment of Acute Rheumatism.— Lemon-juice is still relied upon 
extensively, but since it became known that it contained some of the salts 
of potash, these have been largely prescribed in the acetate, tartrate, or 
nitrate of potash. Give half a drachm of acetate of potash, ten grains of 
the nitrate of potash, and ten minims of vinum opii diluted with barley- 
waiter, two or three times a day. Part xxxi., p. 46. 
Treatment of Acute.—You must be guided entirely by the specialties 
of the case; there are no specifics ; some preparation of iron wTith liquor 
potassae may be given. When the liver is much deranged, calomel and 
rhubarb; when the urine is scanty, colchicum. As tonics, quinine and 
iron, alone or combined, may be given. Quassia, with an alkali, suits remark- 
ably well. Wine is the best and most efficacious tonic in iveakly habits ; 
an opiate at bed-time is sometimes necessary. Warm fomentations are the 
best local applications. Part xxxiii., p. 40. 
Sulphur externally in the cure of Rheumatism.—Dr. Fuller orders the 
whole of the affected limb to be incased in flannel, thickly sprinkled with 
precipitated sulphur; a bandage is applied over this, and the whole covered 
with oiled silk or gutta percha, which has the effect of increasing the 
warmth and confining the vapor of the sulphur, and also obviating the 
disagreeable odor. This bandage should be constantly applied—absorption 
takes place, the breath, urine, cutaneous exhalations, unmistakably attest 
its presence. If the pain be situated where the above cannot be readily 
applied, substitute the compound sulphur ointment, which must be rubbed 
in for twenty minutes night and morning. When there is feverishness, 
acute pain, even when the limb is at rest, and the skin dry and inactive, 
no relief results from this treatment; but where there are no symptoms of 
active disease, and the pain is of a dull aching character, felt chiefly when 
the limb is in motion, and the skin acts freely, no external application 
proves so serviceable. Part xxxv., p. 23. 
Treatment of Gout and Rheumatism by the Silicate and Renzoate of 
Soda—combined with the Preparations of Aconite and Colchicum.— 
MM. Socquet and Bonjeau have proposed, in gouty and rheumatic affec- 
tions, the employment of the silicate of soda and benzoate of soda. Sili- 
cate of soda facilitates the elimination of uric acid, and its influence maybe 
extended so far as to render the urine alkaline. This salt, moreover, by it 
tonic action upon the digestive functions and its diuretic properties, is saiu 
to be far superior to the carbonates of soda or potash, which are so con- 
stantly employed in the rectification of the uric acid diathesis. The 
benzoate of soda transforms uric acid into hippuric acid, the combinations 
of which are extremely soluble, while those of uric acid are hardly soluble 
at all. This medicine, in thus modifying the part of the acid which may 
have escaped the action of the silicate of soda, will thus contribute also to 
diminish its quantity. Colchicum will rapidly carry away, by the urinary 
passages, the remains of the uric acid which the blood may still contain. 
Aconite is used to act specially upon the painful part. Part xxxv., p. 25. 
Treatment of Acute Rheumatism.—The treatment of acute rheumatism 
by one or other of the salts of potash has now become the established 
practice of the leading London physicians. Dr. Barlow has lately been 
trying the bicarbonate, but does not find it so effectual as the acetate 
which he had previously been in the habit of using. A combination of tne 461 
RHEUMATISM. 
nitrate, bitartrate, and acetate, given well diluted, is a good form of admi- 
nistration. 
Lemon-juice and Acetate of Potash.—If the portal system is congested, 
as shown by arrest of the biliary and urinary secretions, exhibit a brisk 
mercurial alterative and purgative, repeating this if necessary during the 
attack. Then prescribe lemon-juice in proportion of a teaspoonful or 
dessertspoonful, according to the age and size of the patient, every second 
hour. This of itself tends also to keep the bowels free. A little morphia, 
the dose being carefuly regulated, may be given at bed-time. Dr. Sand- 
with, of the Hull Infirmary, has recently treated ten cases with acetate of 
potash, with unusual success. It should be well diluted, and may be com- 
bined with lemon-juice. Part xxxvi., p. 30. 
Chronic Rheumatism and Gout.—Apply thin sheets of gutta percha 
over the parts; this produces great local transpiration, and the pain is 
generally considerably relieved. Part xxxvi., p. 31. 
Rheumatic Pericarditis.— Dr. Todd treats this and other forms of 
rheumatic inflammation on a stimulant plan throughout, not Avith a view 
of cutting short the disease, but of supporting the patient under it, and 
rendering conAmlescence more rapid. In a case lately under treatment, 
alkalies were given alone, till the appearance of the pericarditis, Avhen 
opium in grain doses, every four hours, and eight ounces of brandy daily, 
Avere administered. Pneumonia of both lungs came on, and the brandy 
Avas ultimately increased to thirty-five ounces daily. No leeches or blisters 
Avere throughout employed. He left the hospital to all appearance quite 
Avell at the end of a month. Part xxxvi.,p. 50. 
Acute Rheumatism.—After having procured free evacuation by means 
of senna and salts, begin the administration of equal parts of vin. colch. 
and spt. tereb., in doses of ten drops every tAvo or three hours. After a 
day or tAvo, give in connection Avith these (only at different intervals, say 
of five hours each), tr. ferri chlor. ten drops, using as much opium as may 
be necessary to quiet pain. Allow a free use of coffee of average strength. 
If the patient’s appetite remain, alloAv a moderate use of his usual food at 
the customary inteiwals. (Dr. Gordon.) 
Tfe sfc 5fc If; 5)« 5(e 
In acute articular rheumatism give large doses of iodide of potassium 
in conjunction with morphia. When more than one joint is affected do 
not use local means. (Dr. Hauschka.) Part xxxvii., p. 22. 
Rheumatism, Chronic.—A case of most obstinate chronic rheumatism, 
for years resisting every form of treatment adopted, yielded to the use of 
the sulphurous vapor-bath. A bath Avas given every other day, the 
patient being Avell steamed for tAventy minutes, and then, before leaving 
the bath, shoAvered Avith cold salt water, to prevent a too relaxing action 
of the vapor. In the course of six Aveeks, the man stated himself to be 
“ perfectly cured.” Artificial sulphurous water may be made by adding 
a drachm and a half or two drachms of sulphuret of potassium to a gallon 
of common Avater. Part xxxviii., p. 22. 
Rheumatism and Chorea.— Probably there is no fact in pathology 
better established by experience than the connection between rheumatism 
and chorea ; the former being the cause, the disease in fact, the latter only 462 
RICKETS. 
a symptom. Always carefully examine whether there be a rheumatic 
history ; in some cases, of all symptoms there may be only one leading to 
this suspicion, viz., urine highly loaded with lithates. If there be no 
febrile state to account for this state of urine, though not in itself actual 
evidence, it is in most cases highly presumptive of the existence of the 
rheumatic state. In one case we have seen chorea and loaded urine the 
only symptoms leading to the detection of acute pericarditis. (Ed. of 
Retrospect.) Rart xxxix., p. 72. 
Hypodermic Injections.— In many cases of rheumatism, says Mr. Hun- 
ter of St. George’s Hospital, great relief will be obtained by the use of 
narcotic injections, to relieve the pains when severe. Of course the usual 
constitutional treatment must be employed. In one case a man could not 
move his arm after acute rheumatism, on account of pain in the shoulder. 
The pain was removed by a single injection. Part xl,,p. 279. 
RICKETS. 
Rickets—Treatment of.—Mr. A. W. Close states that the softened state 
of the bones in this affection is owing originally to a deficiency in the 
supply of the nutritive nitrogenized substances. The affection is seldom 
seen during suckling, because the milk contains those elements which are 
exactly suited to the wants of the system. After weaning, the diet often 
adopted among the poor consists chiefly of potatoes, oatmeal, gruel, tea, 
coffee, and rice. Now proteine is only found in the two first in small 
quantities, and none in the rest. Among the middle and upper classes 
the diet after weaning is often sago, rice, or arrowroot, which certainly 
fatten the little children, but do not convey a sufficient quantity of nitrogen 
to the system. The diet ought to consist more of the nitrogenized 
substances when there is this disposition in the system, such as beef-tea, 
eggs and wheat ground and made into bread without the separation of 
the cuticle of the grain, in Avhich is contained the phosphate of lime, to 
whose absence the softened condition of the bones is usually attributed. 
Rart viii., p. 78. 
Mollities Ossium.— [This disease, depending immediately upon the 
want of the mineral constitutents of bone, may arise either from a want 
of power in the organs of assimilation and absorption to take up the 
phosphate of lime contained in the food, or from the food itself not con- 
taining enough phosphate of lime to furnish the required supply. It is 
well known that when common fowls are prevented from getting lime, 
their eggs will be without shells, but on restoring the lime, the eggs regain 
their earthy covering. On the same principle Mr. Cooper proposes to 
treat mollities ossium. lie says:] 
I have on two or three occasions certainly had reason to believe that 
great benefit was derived from giving bone powered and mixed with bread, 
and at the same time draughts containing phosphoric acid, which converts 
phosphate of lime into a biphosphate, a more soluble salt than the phos- 
phate, and probably much more readily assimilated. The result of this 
treatment was certainly such as would warrant the just expectation of 
facilitating the nutrition of bone. KICKETS. 
463 
I have demonstratively proved to you, I think I may say, over and over 
again, the advantages of applying phosphoric acid to exfoliating hone, to 
produce its rapid removal upon a principle precisely similar. 
Part xvii., p. 124. 
Treatment of,\ by Proteine.— Vide Art. “ Caries.” 
Pickets.—In diseases arising from insufficiency of earthy phosphates in 
the food, give calcined hones in powder ; and when there is too rapid 
elimination of phosphates by the urine, combine with the calcined bones a 
large proportion of sugar, or add the latter to the food. The sugar will 
diminish the activity of the nutritive changes which take place in the 
tissues, and so lessen the amount of matter excreted. But “when a child 
at the breast is affected wdth this disease, owing to the poverty of the 
milk, the mother should take the calcined bones, but without the sugar, 
in order that the elimination of the phosjffiates through the milk may not 
be interfered with. (Dr. Bocker.) Part xxi., p. 147. 
Observations on Pickets.—The indications are, not to cram the patients 
with preparations of earthy salts, for these are not deficient in the blood, 
but to correct disorder of the digestive system, and to invigorate the body 
by light nutritive diet, fresh air, cold ablutions, and the use of some 
medicinal tonic, such as quinine or iron. In some cases steel supports are 
proper. (Dr. Humphry.) Part xxi., p. 184. 
Use of Tannic Acid.—Give tannic acid in doses of half a grain or a 
grain, night and morning, in sweetened water or any simple vehicle, and 
continue its use for a long time. It acts, in all probability, rather as a 
tonic and “ histogenetic,” than by arresting the excretion of lime by an 
astringent action on the kidney. (Dr. Alison.) Part xxi., p. 326. 
Use of Phosphate and Oxalate of Lime.—In all chronic diseases which 
are distinguished by wasting, emaciation, ulcerations of the skin, etc. (as 
scrofula, especially rickets), a much larger quantity of phosphates is 
removed from the economy by the urine than ought to be in the normal 
state; indeed, in some cases, to an almost incredible extent. The phos- 
phates of lime and magnesia are held in solution in the urine by its acidity, 
and directly precipitated by the addition of alkalies, or when the urine 
becomes ammoniacal by putrescence. This precipitation is more complete 
by heating or boiling the urine, and by adding a solution of soda to boil- 
ing urine the whole may be precipitated; and by always using the same 
solution of carbonate of soda, say, one to twelve ounces of distilled water, 
the degrees of turbidity may be readily recognized, and the quantity of 
phosphates ascertained. There is scarcely any disease in which at one 
time or another an increase in the quantity of phosphates does not take 
place ; but as the times are quite uncertain, there is necessity for almost 
daily examination. The increase, however, does not depend so much upon 
the nature of the disease as upon the individual affected. (Dr. Beneke.) 
Part xxiv., p. 310. 
Superphosphate of Iron.—A sirup of superphosphate of iron is par- 
ticularly applicable to rickety and weak children ; it is very pleasant to 
take. It contains five grains of iron and five of phosphate of lime to an 
ounce of the sirup. (Dr. Routh.) Part xxxvii., p. 242, 464 
SALIVATION. 
SALIVATION. 
Salivation by Small Doses of Mercury.—In a discussion respecting the 
salivation of patients by minute doses of mercury, in the Westminster 
Medical Society, Mr. Snow offered an ingenious explanation. He said: 
He did not believe that the salivation which was occasionally produced by 
a very small dose of mercury depended on any idiosyncrasy of constitu- 
tion, which continued during the patient’s life, but was the result of the 
presence of an excess of acid, in the first passages. He had been led to 
this conclusion by having frequently seen patients salivated by a very 
small quantity of calomel or blue pill, taken at the same time with mixtures 
containing dilute sulphuric acid. Very lately, a man who was taking 
sulphuric acid freely for epistaxis, was severely salivated by two grains of 
calomel in a dose of cathartic pills. The acids naturally contained in the 
stomach Avere the muriatic and the acetic, and the mercury contained in a 
grain or tAVO of calomel, or a feAV grains of the blue pill, would, of course, 
be sufficient to produce the most serious consequences, if changed into 
the bi-chloride. If the vieAV he had suggested Avas correct, the means 
of preventing untOAvard effects Avould be to give corrosive sublimate at 
once, Avhere a course of mercury Avas indicated, and to give it in suitable 
minute doses. Dart i., p. 45. 
Leeches—Poultices—Gargles.—Dr. Watson, in his lectures on the 
Treatment of Inflammation, makes the folloAving remarks respecting the 
Treatment of Salivation : There are tAvo expedients which I am confident 
are often of very great use in checking the violence of the salivation, and 
in removing the most distressing of its accompaniments. If there be much 
external SAvelling, treat the case as being, what it really is, a case of local 
inflammation: apply eight or ten leeches beneath the edges of the jaw 
bones, and Avrap a soft poultice round the neck, into which the orifices 
made by the leeches may bleed; and I can promise you that, in nine cases 
out of ten, you will receive the thanks of your patient for the great com- 
fort this measure has afforded him. When the Aoav of saliva, and the 
soreness of the gums, form the chief part of the grievance, I have found 
nothing so generally useful as a gargle made of brandy and water ; in the 
proportion of one part of brandy to four or five of Avater. Part iii., p. 33. 
Use of Tannin.—Mr. Druitt considers it the best of all local means of 
making the mouth coihfortable in cases of severe salivation, and for all cases 
of relaxed sore throat attended Avith superabundance of mucus. It coagulates 
the mucus, and enables the patient to get rid of it easily. Part x., p. 139. 
New Demedy for Ptyalism.—Dr. Robertson has discovered that one of 
the commonest plants of his district, the Ambrosia trifida, has more 
prompt remedial powers in cases of excessive ptyalism, than anything he 
had previously tried. The patients are described as being generally 
relieved in six or eight hours of the more urgent symptoms, and com- 
pletely cured in tAvo days. The preparation employed is an infusion of the 
green leaves used as a gargle. Dr. Robertson suggests that the plant may 
also be found useful in other profluAaae, as leucorrhoea. The plant is known 
under the popular term of horseAveed—horsemint. Dr. Robertson Avas 
induced to try it from observing that it completely cured a horse affected 
with slabbering. The effect is simply local. Part x\\, p. 252. 465 
Treatment of Salivation by Sulphur.—Dr. II. Smith says a good prepara- 
tion in these cases is a mixture of alum and chlorinated soda; 5ij- of 
the former with Sj. of the solution of the latter to gviij. of water; but the 
strength must vary according to circumstances ; if there is much ulceration, 
a strong solution will give unnecessary pain. Oak-bark, nutgalls, and 
tannin are also serviceable remedies, and particularly the latter, as it is a 
powerful astringent. If there is inability to open the jaws, and the mouth 
is clogged with a viscid secretion, the lotion should be injected with a 
syringe, and warm water should be frequently thrown in, in the same 
manner to clean this away. But local measures alone will not suffice: the 
constitutional symptoms, which are severe and in some cases alarming, 
should be attended to, and we must endeavor to get the poison excreted 
from the system by the various depurative organs. 
[Mr. Smith, after just referring to the use of tartar emetic, acetate of 
lead, and opium, which he thinks may sometimes be useful, observes :] 
There is one remedy, however, which appears to possess considerable 
influence in removing salivation, and one which I think is not universally 
known ; I mean sulphur; by referring to Mr. Colles’ works I find that he 
recommended it several years ago. In what manner it acts we are not 
able exactly to tell, but it is highly probable that it enters into combina- 
tion with the mineral, and forms a sulphuret, ivhich is an inert preparation ; 
moreover, it acts as a purgative, and also goes off by the other secretions, 
particularly the skin. I have had opportunities of using sulphur for 
ptyalism, and I have seen it used by others, and certainly, in the majority 
of cases, decided benefit occurred. The only objection I have noticed, is 
the fact that it sometimes irritates the bowels very much. I used it in a 
case lately, when I was obliged to suspend it for this reason. I would 
strenuously recommend it to those who may meet with a troublesome case 
of salivation. Mr. Allison has found out that chlorate of potash has a 
most beneficial influence over mercurial salivation, and he has tried it in 
numerous cases. Part xvi., p. 218. 
Use of Greasote in Salivation.—Dr. Faulcon relates a case of profuse 
mercurial salivation, in which, after the unsuccessful employment of the 
usual remedies, he employed with great advantage a gargle composed of 
icreasote 3ss., sage tea a pint,—the affection quickly yielding. 
Part xx., p. 93- 
Salivation treated by Nitrate of Silver.—Dr. Ivirby applies a solution 
of nitrate of silver (3j. in an ounce), to the gums, three or four times daily 
with a hair-pencil. The teeth will be discolored, but the stain may be 
removed by a few applications of a solution of cyanide of potassium (one 
part of the salt to two of distilled water.) Part xx.,p. 147. 
Pella donna in Salivation.—A woman treated by mercury, internally 
and externally, for diarrhoea, was affected with profuse salivation. Dr. 
Erpenbeck treated this latter complaint with belladonna in divided doses, 
of two grains and a half, taken in emulsion every twenty-four hours. 
Next day the salivation had subsided, and the mouth was quite dry. On 
stopping the belladonna, the salivation returned, and again ceased when it 
was resumed. The author believes that after this fact and some similar 
ones, belladonna is the best treatment for salivation. Part xxx., p. 301. 
Chlorate of Potass in Mercurial Salivation.—Encouraged by the success 
SALIVATION. 
VOL. II.—30 466 
SARSAPARILLA. 
of Hunt, and others, in the employment of the chlorate of potass in the 
treatment of gangrenous affections of the mouth, M. Herpin has repeatedly 
employed it with the best effect in mercurial salivation, giving it in the 
dose of 3ss. to 3j. per diem—the cure, W’hen the case is taken early, being 
completed by the fourth day. He has long been accustomed to the employ- 
ment of this substance, as recommended by Odier, in jaundice, whether 
simple or complicated, with engorgement of the liver. Odier carried the 
daily dose as high as 150 grains. Part xxxi., p. 235. 
Mercurial Fetor and Salivation.—The best remedy for instantaneously 
and safely removing fetor of the breath, in the opinion of Dr. Nunn, of 
the Middlesex Hospital, is a strong solution of the chloride of zinc, made 
by mixing one drachm of Burnett’s solution with seven drachms of dis- 
tilled water. This must be applied by the medical attendant with a soft 
brush to the gums, and between the teeth, the mouth being frequently 
washed with water. The solution acts by immediately entering into com- 
bination with the rotting epithelium and forming an inodorous product, 
which the brush removes, at the same time it powerfully constringes the 
enlarged vessels, and tends to restore a healthy state of the local circula- 
tion. Part xxxv., p. 190. 
Quinine in the Salivation of Pregnancy.—Dr. Mauthner relates that he 
has found sulphate of quinine, given in two grain doses, prove completely 
efficacious in cases in w’hicli various other means had been tried without 
success. • Part xxxvii., p. 233. 
SARSAPARILLA. 
Powder of Sarsaparilla.—[Sir Francis Smith, speaking of this medicine 
says:] 
I have long been engaged in observing the effects of different prepara- 
tions of sarsaparilla, and I am persuaded that of all the forms in which it 
can be given, that of powder is in most instances the most valuable. The 
advantages which it possesses, in my opinion, may be stated as follows, 
viz.: 1, we can make use of it in many conditions of the stomach where 
a large quantity of fluid would prove inconvenient or injurious; 2, it may 
be taken in more certain and definite quantities; 3, its effects are, so far 
as I have observed, more durable. Of course certain conditions of the 
skin will occur, where the use of the domestic decoction will be more ser- 
viceable, especially if it be taken warm; and in a slimy or foul condition 
of the primae vise the infusion in lime water (recommended by Dr. O’Beirne 
of Dublin, not as made in the Pharmacopoeia) will present special advan- 
tages. 
Mode of Preparation and Administration of the Powder.—The mode 
made use of in one establishment where I have superintended its prepara- 
tion is as follows: A quantity of the roots of sarsaparilla, either split or 
not, but not cut into short portions, is either subjected to the vapor of 
steam for a few minutes, or if time admit, left in a damp cellar for twenty- 
four or thirty-six hours, and subsequently introduced for an hour into a 
stove or oven, moderately heated, which processes have the effect of 
loosening the connection between the bark and the ligneous portion, 
when the former may be easily stripped off, and powdered finely in a SCALP. 
467 
mortal*, and the powder may afterward be taken simply in a spoonful of 
any bland fluid, or may, in cases where quinine is indicated, be united 
with a suitable proportion, and the flavor be covered with a little oil of 
cinnamon—or the powder either simply, or combined with S. of quinine, 
or in gouty habits, with capsicum or ginger, may be made into pills, and 
administered in the proportion of from two to four scruples daily. 
Part ii., p. 68. 
Wounds of the Scalp— Contusion of the Hones.—[Severe cases of this 
kind, where the scalp is extensively separated and the bone denuded, some- 
times run a very rapid course to a fatal termination; but whenever this 
does occur, it is much more o wing to the contusion of the bone than the 
denudation. Prof. Hewett says :J 
In the flat bone of the skull, with its compact tables and intervening 
cancellous tissue, the contusion seldom reveals itself on the surface ; it is 
in the diplod that the blow produces its effects. • Examined as to its com- 
pact tables, such a bone, externally, may be to all appearance perfectly 
healthy ; but the contusion manifests itself in the diploe by an extravasa- 
tion of blood within its cells or in breaking down of the delicate fibres of 
their walls. In such a condition, the bone has hidden within itself all the 
seeds of the future mischief, if inflammation should arise in the bone—and 
arise, in all probability, it will, if the diploe has been much injured ; and 
the great tendency will be, in certain habits of the body, to produce sup- 
purative inflammation, and suppuration in such a situation is fraught with 
the utmost danger. 
The intimate connection of the bone to the membranes of the brain : the 
large and numerous venous channels in its cancellous tissue, render diffuse 
suppuration in the diploe not only one of the most formidable complaints 
the surgeon can have to deal with, but one which but too often sets at 
naught all his resources. 
Let us look to the train of evils Avhich may arise in the membranes of 
the brain, after a contusion of the bone, followed by mischief in the 
diploe. 
For days, for weeks even, there may be no appearance whatsoever of 
the mischief which is smoldering. Soon recovering from the effects of 
the accident, if it was a slight one, the patient appears to be in perfect 
health. For a time, all wears a favorable aspect; but generally, within a 
fortnight or three weeks, the first symptoms begin to show themselves— 
pain in the head, feverishness, and soon an unhealthy aspect in the wound, 
it there be one; a spontaneous secession of the periosteum from the bone, 
which, if denuded, becomes dry, and may be seen gradually to lose its 
natural color, being first of a dead white, then of an opaque yellow, a 
greenish, or it may be of a brownish hue. Matters go on thus for a longer 
or shorter period, that is, as long as the inflammation does not spread to 
the inner table of the bone; but, as soon as this is reached, the dura mater 
becomes involved ; inflamed in its turn, and it may be in a sloughy state, 
this membrane secedes from the bone, lymph or pus is poured out on its 
external surface, and as long as the inflammation is limited to the dura- 
mater itself, generally only that portion of the membrane corresponding 
SCALP. 468 
exactly to the inflamed hone is diseased; hut when the inflammation has 
once passed on to the parietal arachnoid, matter is thrown out into the 
cavity of this membrane, and then the visceral arachnoid, the pia mater, 
and the brain itself, soon present all the appearances of severe inflamma- 
tory action. The symptoms are in keeping with the progressive stages of 
the disease. As long as the inflammation is confined to the hone they are 
few, and not strongly marked; hut as soon as the dura-mater is reached, 
then decided symptoms of the cerebral mischief soon manifest themselves; 
increased feverishness, repeated rigors, intense pain in the head, sickness, 
drowsiness, occasional wandering, coma, and sometimes paralysis. 
Such cases as these strongly resemble those which, of late years, have 
so much occupied the attention of the profession. I allude to the diseases 
of the ear, where the bone is affected, and where the inflammation mani- 
festly spreads from the bone to the membranes of the brain. In these 
cases the disease may lay smoldering for years. I have known it to do 
so for upward of twenty; and as long as the mischief is confined to the 
bone, the symptoms are trifling ones; but suddenly, without any apparent 
cause, it spreads to the dura-mater, and then follows the train of cerebral 
symptoms. 
[Mischief so insidious in its course, and so constantly and rapidly fatal, 
when once fully developed, naturally led surgeons to bleed largely and 
repeatedly as a preventive; but we may fairly question whether we 
ought to bleed patients without a symptom of serious disease. We are 
told to do so to prevent inflammation of the dura-mater, but it is only 
one case in seventy where we find mischief in the dura-mater after death. 
As a general rule, blood ought never to be drawn without a clear indication 
of its necessity. In the majority of cases of severe wounds and contusions, 
patients recover, if kept perfectly quiet, and with an occasional saline pur- 
gative ; but whenever inflammatory symptoms begin to make their appear- 
ance, then is the time to have recourse to antiphlogistic treatment, which 
must be more or less strict according to the nature of the case.] 
Failing in our antiphlogistic remedies, have we any other means of re- 
lieving the patient ? The only chance left is in the trephine. But are we 
to trephine all cases of blows on the head, with bare bone and symptoms 
of suppuration ? 
A close examination of cases, under such circumstances, will show that, 
in many instances, wre really have no indications which could lehd us to ap- 
ply the trephine. 
The dura-mater, when laid bare by the trephine, is so often found to be 
perfectly healthy, that its use has of late years been abandoned, although 
the symptoms of suppuration may have been very evident. 
Fart xxxiii., p. 234. 
Scalp— Wounds of.—In spite of any treatment, erysipelas too commonly 
comes on about the third or fourth day; w henever such does happen, says 
Mr. F. C. Skey, the tonic treatment by quinine, steel and wrine is the best. 
Fart xxxiii., p. 235. 
SCARLATINA. 
SCARLATINA. 
Chlorine in Scarlet Fever.—[In scarlatina maligna, every practitioner 
is aware that frequently all his efforts are vain to check the disease. There SCARLATINA. 
469 
seem to be two sources of danger—one arising from the primary impression 
of the contagious poison upon the body, and especially upon the nervous 
system, which is overwhelmed by its influence. In this case, the patient 
often sinks without any affection of the throat, and our chief dependence 
will be upon wine and bark to sustain the powers of the system till the 
deadly agency of the poison has exhausted itself. Another source of dan- 
ger arises from the gangrenous ulceration of the throat—the system seems 
to be re-inoculated with the poisonous secretion from the throat. Wine 
and bark will here also be of great benefit; gargles composed of chloride 
of soda will be found efficacious, and if the child is too young to gargle, it 
may be injected into the nostrils and against the throat by means of a 
syringe. This will be found superior to capsicum gargles. But we think 
one of the most efficacious methods is that recommended so strongly by 
Velpeau, of blowing powdered alum up the parts by means of any tube 
long enough for the purpose, as two or three quills inserted into each 
other, so as to make one continuous tube. Dr. Watson seems to think 
highly of chlorine. He says:] 
From several distinct and highly respectable sources, chlorine has been 
strongly pressed upon my notice, as a most valuable remedy in the severest 
forms of scarlet fever. I will give you the formula for its prepara- 
tion. 
Two drachms of the chlorate of potass are to be dissolved in two 
ounces of hydrochloric acid, previously diluted with two ounces of distilled 
water. The solution must be put immediately into a stoppered bottle, and 
kept in a dark place. 
Two drachms of this solution, mixed with a pint of distilled water, con- 
stitute the chlorine mixture ; of which a tablespoonful, or two, according 
to the age of the patient, may be given for a dose, frequently. 
Part vi., p. 36. 
Belladonna.—On the Protective Influence of Belladonna in Scarlet 
Fever, Dr. Watson says : 
You are probably aware that belladonna is believed by many to exert a 
preventive and protecting influence upon the body against the contagion 
of scarlet fever. I know nothing, by my own experience, of the alleged 
conservative property of this vegetable, but in the small quantities, recom- 
mended, there can be no harm in trying it, provided that its employment 
does not lead to a neglect of other precautions. Three grains of the 
extract of belladonna are dissolved in an ounce of distilled water; and 
three drops of the solution are given twice daily to a child under twelve 
months old, and one drop more for every year above that age. It is 
affirmed that if this remedy does not prevent the disease, it will render it 
mild; and that if it be taken four or five days before exposure to 
the contagion, the resulting scarlatina never proves fatal. PartYi., p. 37. 
Carbonate of Ammonia in Scarlatina.—The value of carbonate of 
ammonia in scarlet fever has been attested by several observers, by Dr. 
Picken, of Dublin, and Dr. Ilieken, of Belgium ; while at St. Petersburgh 
it is said to have been employed by the German physicians without any 
evident advantage. Mr. H. Freke suggests that it may act by taking the 
place of urea, and thus supply the natural stimulus to the renal functions; 
and Messrs. Herdenreich and Heim have observed, that in cases of scarla- 
tina an ammoniacal alkali is deposited on the skin, and hence offer another 470 
explanation of its efficacy. Whatever the theory, the amount of practical 
evidence preponderates in favor of the administration of ammonia in scarlet 
fever. Part xii., p. 27. 
Treatment of Malignant Scarlatina.—Since bleeding was abandoned 
tn the treatment of this disease, stimulants have formed the usual reme- 
dies. They were employed by Dr. Coley, in connection with proper local 
applications, at the commencement of the epidemic in Dec., 1847 ; but 
finding that he lost the first four patients in succession, and observing that 
the state of the fauces was identical with that which was found in 
the late epidemical diphtherite, he was induced to try the effects of small 
repeated doses of calomel, at the very commencement of the disease. 
It should be given in doses of one or two grains every four hours ; and 
thus given does not affect the mouth. Acetate of ammonia may be given 
in conjuction with it; or in the latter stages, if there are hemorrhages 
from the mucous membrane, or petechial spots, quina with sulphuric acid 
may be exhibited. The best local application is a lotion with nitrate of 
silver, a scruple to the ounce, applied twice or thrice a day to all the parts 
which are ulcerated, or covered with diphtherite. If abscesses form in 
the glands of the neck, they are to be opened freely as soon as there is 
fluctuation or external redness. Part xviii., p. 34. 
Scarlatina—Some Points in the Treatment of—The state of the throat, 
says Dr. West, must be carefully wat ched in every case of scarlet fever ; 
and when there is much swelling of the tonsils, if the child be too young 
to gargle, a slightly acidulated lotion should be injected into the back of 
the throat, by means of a syringe, every few hours, in order to free it 
from the mucus which is so apt to collect there, and to be the source of 
much discomfort. If there be much deposit of lymph upon the tonsils, 
it is generally desirable to apply the strong hydrochloric acid, mixed 
with honey, in the proportion of about one part of the former to six of the 
latter, by means of a dossil of lint, or a camel’s-hair pencil, two or three 
times in the twenty-four hours; but the strength of the application must 
be increased if the tonsils be ulcerated, or if any disposition to sloughing 
should appear. The coryza, which is so distressing and so ill-omened a 
symptom in cases of severe scarlatina, is best treated by throwing a 
small quantity of a solution of gr. j. or gr. ij., of nitrate of silver in gj. of 
distilled water up the nostrils every four or six hours. The glandular 
swellings are very difficult to relieve. When considerable, they do not 
seem to be benefited by leeches ; the employment of which is also, in many 
cases, contra-indicated by the feeble state of the patient’s powers; while 
they show very little disposition to suppurate, and consequently are not 
relieved by lancing ; so that the constant application of a warm poultice is 
often all that can be done to afford ease to the patient. Children, in 
whom the local affection is severe, or in whom the disease assumes a 
malignant character, require all those stimulants, and that nutritious 
diet, which we are accustomed to give to patients in certain stages of 
typhus fever ; though, unfortunately, the best devised means will, in many 
such cases, prove ineffectual. 
[A still more easy and efficacious application in some of these cases is a 
solution of crystallized nitrate of silver, (3ss. or Bij. to the gj.) applied to 
the diseased parts by means of a sponge tied to the end of a bit of whale- 
bone, as described by Dr. Horace Green.] Part xviii., p. 35. 
SCARLATINA. SCARLATINA. 
471 
Treatment of Scarlatina by Hot Water Applications.—Mr. Bulley, 
surgeon to Berkshire Hospital, directs to apply a thick flannel pad, wrung 
out of hot water till almost dry, upon the pit of the stomach and oyer the 
region of the heart, and then wrap the patient carefully in several blankets. 
At the same time wrap another flannel, wrung out of hot vinegar and 
water, round the throat. After the patient has perspired profusely for 
three or four hours, remove the flannels carefully, and give Stevens’s saline 
powder (to an adult half a drachm) every four hours: and let him use a 
gargle containing 9ij. of burnt alum, 9ij. of Armenian bole, and 3j. of 
brown sugar in gviij. of water. Part xx., p. 30. 
Use of Acetic Acid in Scarlatina.—Dr. Webster, consulting physician 
to St. George’s and St. James’ Dispensary, has great faith in the use of 
frequent sponging with tepid vinegar and water, especially in the early 
stages, -when the skin is hot and the pulse accelerated. This measure is 
very eflicacious in preventing the spread of the disease. Part xxi.,p. 350. 
Yeast in the Treatment of Malignant Scarlet Fever.—Mr. Bennett 
states that he has found the administration of fresh yeast of the most inva- 
luable advantage when the symptoms are of a malignant character. He 
says: _ • t 
After ammonia, the mineral acids, chlorate of potash, etc., have failed, 
and the application of nitrate of silver besides, one or two table- 
spoonfuls of fresh yeast f requently given (according to the age and malig- 
nancy of the case) has, in my practice at least, been quickly eflicacious as 
an antiseptic and stimulant. Part xxiii., p. 29. 
Scarlatina—Delirium and Coma of.—Prof. Bennett gives the following 
case: A boy, aged 14, entered the clinical ward on the third day after 
experiencing distinct rigors. There was restless delirium, and constant 
moving of the head from side to side upon the pillow. He was apparently 
conscious when spoken to, but could not answer questions—the tongue was 
protruded with difliculty, dry, and of bright red color, studded 'with florid 
elevations—deglutition was much impeded—bowels open—pulse 130, 
weak—urine voided with difliculty, and diminished in quantity—sp. gr. 
1025—not acted on by heat and nitric acid—skin hot and dry, covered 
with the bright red scarlatinal eruptions.— Ordered salines and slight 
diuretics. He continued in the same condition, the angina, coma, and 
alternating delirium, however, being more pronounced until the sixth day. 
R. Sp. aether, nit., 3hj ; pot. acet., 3ij ; tr. colchici, §ss : aqum, §iij. Ft. 
mist. A teaspoonful to be taken every four hours. 
On the following day all coma and delirium had disappeared. He an- 
swers questions when put to him—skin cool—eruption laded—pulse 96, 
weak—passed 30 oz. of urine, which is turbid, with small flakes of a mem- 
braneous character floating in it. On the 8th day the quantity of urine 
excreted was 50 oz., and it was still more loaded with sediments which 
being analyzed were found to consist of urate of ammonia. Hext day the 
urine was only slightly turbid, and on the following one, wTas perfectly 
clear. From this time the boy gradually recovered. 
Commentary.—This was a very severe case of scarlatina. The angina 
was intense, occasionally rendering deglutition impossible. There was 
delirium on the third day, alternating at night with coma, which was often 
profound. The worst result was apprehended. It recurred to me that 472 
SCARLATINA 
the head symptoms in this as in several cases of typhus, might probably 
depend not so much upon inflammation of the brain, as is generally sup 
posed, as upon absorption of, and poisoning by urea, an idea that appeared 
to me supported by the diminished quantity of the renal excretion, as well 
as its freedom from all deposit. Remembering the alleged virtues of col- 
chicum in increasing the elimination of this excretion, I ordered it, in com- 
bination with diuretics, and the result was remarkable. For on the next 
day, not only had the fever diminished, but the urine was increased in 
amount and loaded wTith urates to an extent and in a form I had never pre- 
viously seen. Part xxiv., p. 31. 
Scarlatina.—Dr. Bennett remarks, that great watchfulness is required 
on the part of the practitioner, especially when the crisis is expected, that 
if the pulse at all falters, and prostration comes on rapidly, he may be pre- 
pared to meet it. When death does occur in a primary attack of scarlatina, 
it is from the same cause as in death from typhus—it is from congestion 
of the brain, as indicated by delirium, passing into coma, and followed by 
prostration of the vital powers. 
All the eruptive fevers, strictly so called, invariably run a natural course, 
and cannot be cut short. It follows that— 
The treatment of febrile eruptions has for its object conducting these 
cases to a favorable termination. To this end exactly the same general 
rules are to be followed as in continued fever, and the same indications 
exist for the use of salines and laxatives, cold to the head, wine and stimu- 
lants, and regulation of the diet. 
Dr. Andrew Wood, physician to Ileriot’s Hospital, Edinburg, recom- 
mends the production of diaphoresis. He considers that the most efiicient 
and safe method of treatment consists in acting powerfully on the skin, 
with a view of thereby assisting nature to eliminate the scarlatinal poison 
from the system. As ordinary diaphoretics frequently fail, he has recourse 
to the following method: Several common beer bottles, containing very 
hot water, are placed in long worsted stockings, or long narrow flannel 
bags, wrung out of water as hot as can be borne. These are to be laid 
alongside the patient, but not in contact with the skin. One on each side, 
and one between the legs, will generally be sufficient; but more may be 
used if deemed necessary. The patient is to lie between the blankets (the 
head of course being outside) during the application of the bottles, and 
for several hours afterward. In the course of from ten minutes to half 
an hour, the patient is thrown into a most profuse perspiration, when the 
stockings may be removed. In mild cases, the effect is easily kept up by 
means of draughts of cold water, and if necessary, the use of two drachm 
doses of sp. mindereri every two hours. In severe cases, where the pulse 
is very rapid—the beats running into each other—where the eruption is 
either absent or only partial, or of a dusky purplish hue—where the sur- 
face is cold—where there is sickness or tendency to diarrhoea—where the 
throat is aphthous or ulcerated, and the cervical glands swollen, then he 
follows up the use of the vapor-bath by four or five grain doses of carbo- 
nate of ammonia, repeated every three or four hours. Should this be 
vomited, then brandy may be given in doses proportionate to the age of 
the patients. Carbonate of ammonia he considers to act beneficially : 1st, 
by supporting the powers of life ; 2d, by assisting the development of the 
eruption ; and 3d, by acting on the skin and kidneys. Where the vapor 473 
SCARLATINA. 
bath was used early in the disease, and its use continued daily, or even twice 
or thrice a day, according to circumstances, he has found that the chance 
of severe sore throat was greatly obviated. In regard to supervening 
dropsy, he considers that, by the use of the vapor bath, with the other 
necessary precautions as to exposure, diet, etc., its recurrence is rendered 
much more rare. In the treatment of the dropsical cases, it was also very 
useful, and even might be trusted to entirely in some cases. Dr. Wood 
also condemns all depleting treatment, and even purgatives, during the 
first ten days, as not only not required, but positively dangerous, as tending 
to interfere with the development of the eruption. In the later stages, as 
well as in the dropsy, however, he thinks purgatives are often beneficial. 
Part xxvi., p. 22. 
Treatment of Coma, attending.—Dr. Murphy says that when coma 
exists after or during an attack of scarlatina, the electro-galvanic battery 
has been found successful, the same as in cases of poisoning by opium. At 
the same time a flexible tube may be passed into the stomach, and port 
wine and ether introduced. Part xxix., p. 314. 
Treatment of Scarlatina Anginosa.—[Mr. P. II. Chavasse has had great 
experience of practice among children. The result of his treatment of 
scarlet fever has been so uniformly successful that he has not lost a single 
case for upward of seven years. He says:] 
The system I adopt, in a case of scarlet fever, is to keep the bedroom 
cool—I may say cold—and to have a thorough ventilation through it; I, 
therefore, throw open the windows, be it winter or summer, and have the 
curtains and valances of the bed removed. If it be winter time, I allow the 
patient to have one blanket and a sheet; if it be summer time a sheet only 
to cover him. If the throat be not seriously affected, I merely order a 
narrow strip of flannel once around the throat. If the tonsils be much 
enlarged, I apply a barm and oatmeal poultice to the throat, changing it 
night and morning. I prescribe an acidulated infusion of roses mixture, 
that is to say, infusion of roses, with an excess of acid, made palatable with 
an additional quantity of sirup, to be taken every three or four hours. This 
is the only medicine I give. Where the child is old enough, I find roasted 
apples, mixed with raw sugar, very grateful to the patient. 
Here let me pause, to advise my medical brethren always to make medi- 
cines for children pleasant. I avoid purgatives in scarlet fever. I never, 
on any account whatever, give a particle of opening medicine for the first 
ten days at least. It is my firm conviction, that the administration of pur- 
gatives in scarlet fever is a fruitful source of dropsy, disease and death. 
When we take into consideration the sympathy that there is between the 
skin and mucous membrane, I think that we should pause before giving 
irritating medicines. The irritation of purgatives on the mucous membrane 
may cause the poison of the skin disease to be driven internally to the 
kidneys, throat, pericardium, or brain. You may say, Do you not 
purge if the bowels be not opened for a week ? I say emphatically, 
Ho 1 
Now with regard to food. If the infant be at the breast, keep him 
entirely to it. If he be weaned, and under two years old, give him milk 
and water, and cold water to drink. If he be older, give him toast and 
water, and plain water from the pump, as much as he chooses; let it be 
quite cold—the colder the better. Weak black tea, or thin gruel, maybe 474 
SCARLATINA, 
given, but caring little if he take nothing but cold water, unless he be an 
infant at the breast. Avoid broths and stimulants of every kind. 
Now, you must warily watch for a change of temperature of the 
skin. As long as the skin is hot, the above plan I steadily follow ; but the 
moment the skin of the patient becomes cool, which it will do probably in 
five or seven days, instantly close the window, and immediately put more 
clothes on the bed. But still do not purge. 
You will find the acidulated infusion of roses most grateful to the little 
patient; it will abate the fever, it will cleanse his tongue, it will clear his 
throat of mucus, it will, as soon as the fever is abated, give him an appe- 
tite. I believe, too, the acid treatment has some peculiar properties of 
neutralizing the scarlatinal poison. 
When the appetite returns, you may consider the patient to be safe. 
The diet must now be gradually improved. 
Within the last few years, I have had some fearful cases of scarlet fever; 
but, relying on this plan of treatment, I have given, even in very bad cases, 
a favorable diagnosis. I have had cases where there have been violent 
headache and delirium ; where there have been immense swellings of the 
parotid and submaxillary glands; where there have been enormous 
enlargement and ulceration of the tonsils ; where a great portion of the 
fluid that has been taken by the mouth has escaped down the nostrils; 
where there has been a purulent discharge down the nose, which discharge 
has in many instances quite excoriated the skin over which it has travelled 
—and yet in such cases the patients have invariable recovered. 
Another very important regulation is never to allow the patient to leave 
the house under a month in the summer, and under six weeks in winter. 
Part xxxiii., p. 29. 
Hematuria after Scarlet Fever.—In those cases where we have con- 
vulsions, coma, and death, there is r.o hesitation in attributing the symp- 
toms to uraemic poisoning, any more than if the mischief were limited to 
renal disturbance. The congestion of the kidneys, the hematuria, which 
form the incipient stage of the disorder leading to this uraemia, arise unde- 
niably from the imperfect elimination of the original virus. 
According to Dr. Basham, we must endeavof to bring into activity and 
act upon those functions and emunctories which are not, or only in a 
moderate degree, implicated in the morbid disturbance, and by their 
agency relieve, if possible, the ojDpressed and impeded organs. Thus, 
though the surface of the body is anasarcous, we must endeavor to promote 
its exhaling power; and as the intestinal mucous surface gives no Indica- 
tion of sharing in the morbid state of the kidneys, we must bring its se- 
cretions into activity to purge the system of the accumulated fluid, and 
vicariously, for a time, relieve the kidneys of their office. The intimate 
sympathy between the kidneys and skin, and between the latter and the 
bronchial mucous membrane, when the latter is the seat of inflammation, 
would entitle us to expect the most beneficial results by vigorously pro- 
moting the cutaneous function ; but unhappily, in these cases, the dropsical 
state of the surface of the skin precludes our obtaining much efficient aid 
in this direction. Warm baths efiect oftentimes great temporary relief to 
the lungs; the breathing becomes less oppressed, and the secretion from 
the bronchial tubes more free; but the hot-air bath appears to be the most 
efficacious; there is not that exhaustion which is induced by a succession SCARLATINA. 
475 
of warm baths, and, to my observation, the amount oi relie felt by the 
patient is greater. To aid these external appliances, ammoniacal salines 
may be given internally with advantage. Active purging, however, yields 
the best results. It is, however, of importance to select appropriate means 
to obtain the greatest amount of relief, for it is not every purgative of the 
Pharmacopoeia which answers the purpose equally well. That purgative 
which acts most directly as a hydragogue is the best adapted, but which, 
at the same time, is not followed by any disproportioned exhaustion, or by 
any torpid reaction. The combination of jalap and cream of tartar is most 
admirably suited to these ends. It acts quickly, without depressing the 
system, is not followed by inactivity, and induces copious watery dejec- 
tions. 
The appearance in the urine, revealed by the microscope, of that peculiar 
pigmentary condition observed in combination with albumen, indicates an 
advancing stage of degeneration, and if spread through both kidneys, must 
be quickly followed by an imperfect elimination of the chief urinary con- 
stituents ; and this was evident by the singularly watery state of the 
urine, its specific gravity not exceeding 1.005, but containing abundance 
of albumen, and this latter, associated with a peculiar pigmentary matter, 
rendered visible after boiling by the addition of nitric acid. 
It would be out of place here to enter into an investigation of the nature 
of the pigments that are occasionally met with in the urine, cyanurin, 
melanurin, etc. Experience tells me that the development of this pigmen- 
tary condition, in combination with albumen in the mine, is of the greatest 
import. It is always associated with the most advanced stage of renal 
degeneration, and in every instance in which I have seen it, it has been 
quickly followed by fatal results. Lehman, in his “ Physiological Che- 
mistry ” (vol. ii., p. 428), says, as far as his experience goes, it is only when 
uraemic symptoms have manifested themselves, that this peculiarity of the 
urine is generally observable, and this entirely coincides with my own. 
We should not, then, be unprepared for the development of unfavorable 
symptoms whenever this peculiarity of the urine is observed. Hence the 
value and importance of frequent examinations of the urine in such cases. 
You may learn an important point here—namely, the suddenness and 
abruptness with which the symptoms of ura3mic poisoning oftentimes com- 
mence. In some cases, particularly in adults, the indications are progres- 
sive; but here all other things being promising, convulsions suddenly 
supervene ; they intermit, but coma characterizes their remission, and the 
patient dies forty hours after the first indication of the urinous poison 
acting on the nervous centre. You may very properly ask, Can nothing 
be done in this crisis ? Are there no remedies available for such a state ? 
These cases of convulsion are not always fatal; sometimes in the intervals 
consciousness returns. Such cases ofter a better prospect for remedial 
agents than when the patient remains comatose. In either state, however, 
an effort should be made to excite the bowels to active excretion. Enemata 
containing, according to the age of the patient, half a drop, or a drop, of 
croton oil, should be administered, and where the ability to swallow is un- 
impaired, you may expect some benefit from the chlorine mixture, the 
agency of which, according to the hypothesis of Frerichs, depends on its 
union with the carbonate of ammonia, into which the urea in the blood is 
converted, and which he considers to be the poisonous agent in these cases 
of fatal uraemia. Part xxxvi., p. 25 476 
SCIATICA, 
Scarlatina.—Some pathologists think that there is a most intimate con- 
nection between the materies morbi of erysipelas and that of scarlatina, as 
well as other acute diseases. During a late epidemic of scarlatina at Brad- 
ford, Dr. Meade being much struck with the analogy between the symp- 
toms of this disease and erysipelas, very successfully applied the tincture 
of iron treatment, so useful in the latter, to the former disease, giving five 
to fifteen minims, according to the age of the patient, every three or four 
hours. He has only lost one case during the whole of last spring and 
winter, and almost all the cases in which he employed this treatment re- 
covered with unusual rapidity. 
Scarlatina and Measles.—Mr. Witt looks upon the treatment of scarla- 
tina and measles by ammonia as a specific. The dose given is from three to 
seven grains of the hydrochlorate every hour, for the first twenty-four 
hours, and every second hour for the next day. All acid drinks are care- 
fully avoided. This is a matter of interest, now that the power of ammonia 
in retarding the coagulation of the blood has been established. 
Part xxxviii., p. 17. 
Scarlatina.—Dr. E. Bishop says that the use of tonics, either the citrate 
of iron, or the tincture of the sesquichloride, not varying the plan of treat- 
ment, even when serious complications present, will be found very success- 
ful in the treatment of scarlatina. One gratifying result is, that with few 
exceptions the children escape that serious and frequent sequel—anasarca. 
Part xxxix., p. 19. 
Scarlatina.—Dr. Fountain says that chlorate of potash must not be given 
in scarlatina, with the idea that in chlorine something like a specific has 
been found for the disease—if so given it will fall into disrepute. It is a 
very valuable remedy for meeting particular indications in the treatment 
of disease, by arresting the ulcerative inflammation of the fauces, and by 
its arterializing properties, supporting the restorative powers of nature, 
when aided by other appropriate treatment. It may be combined with car- 
bonate of ammonia, with the best effects. Part 29G. 
Scarlatina.—In the early stage, if attended with high fever, burning 
heat of skin, thirst, etc., try full doses of nitrate of potash with mucilages. 
SCIATICA. 
Treatment of Sciatica and Lumbago.—[Dr. Graves justly remarks that 
in acute sciatica and lumbago, one of the most powerful remedies consists 
of morphia, calomel, and James’ powder, given in the following way: 
Three grains of acetate of morphia, six grains of calomel, and two grains 
of James’ powder, divided into eight portions, and one to be taken every 
third hour till the gums become affected. This is to be assisted by anti- 
phlogistic measures, as blood-letting, general and local, etc., but when the 
case becomes chronic, and the patient must of necessity continue his occu- 
pation, if possible, he strongly recommends, from personal experience, the 
hydriodate of potass. He experienced, in liis own person, a severe attack 
of this disease; against which he struggled for some time, obtaining relief, 
lie states as follows :] SCIATICA. 
477 
Mr. Ferguson recommended me to try hydriodate of potash, of which he 
was good enough to send me a drachm dissolved in a pint.of decoction of 
sarsaparilla. I took a quarter of this daily, and may literally apply here 
the common phrase, that I felt each dose do me good ; in four days all 
traces of the lumbago were gone, and my lameness had quite ceased. I did 
not take more than one bottle, i. e. one drachm of the hydriodate, but the 
good effect continued after I had ceased taking it, and in less than a week 
I was perfectly well. Subsequent experience enables me to recommend 
this medicine strongly, in subacute and chronic lumbago and sciatica. 
In spite of the best-directed means, sciatica is very apt to become chro- 
nic, and then spirit of turpentine, carbonate of iron, arsenic, extract of 
stramonium, corrosive sublimate, blue pill, and iodine internally, blisters to 
the loins, thigh, and calf of the leg, acupuncture, croton oil frictions, and 
other stimulating applications must be successively tried. On a former oc- 
casion I recommended a combination of opium, with spirit of turpentine 
internally, and when that fails, Dover’s powder, combined with sulphate 
of quinine. I am sorry not to have it in my power to lay down any gene- 
ral principle, wThich would enable us to judge in what cases each of these 
remedies is peculiarly indicated, for experience has not confirmed any of 
the rules generally relied on, and therefore we must content ourselves with 
treating these diseases empirically. * Part ii., p. 70. 
Treatment of Sciatica by Irritation of the Foot.—This consists in apply- 
ing an olive-shaped cautery, heated to a white heat, between the little toe 
of the diseased limb and the one next to it. This cautery ought to be ap- 
plied to that part where the nerve bifurcates to furnish its collateral 
branches to the last two toes; and ought to be kept there for five or six 
seconds. The wound should then be dressed with simple cerate, and al- 
lowed to cicatrize. A Capuchin monk, affected with sciatica, carried with 
him in his travels through various towns, an instrument for this purpose. 
Professor Quadri has often repeated this operation at Prati, in Tuscany, 
with great success. These circumstances were brought to M. Caffe’s 
memory, by reading an article on the treatment of sciatica, in which men- 
tion was made of a woman ofCassano who had a great reputation for her 
success in its cure. The means which she employed consisted in the appli- 
cation of a certain herb to the foot, which produced a sore. Various phy- 
sicians, astonished at the results produced, took the trouble to find out that 
the remedy in question was the leaves of the ranunculus sceleratus, which, 
as every one knows, is a powerful vesicant. Dr. Fioravante has employed 
common blistering plaster to the same part, with the happiest results. 
Fart ix., p. 85. 
Sciatica, treated by Blisters and Morphia.—This patient was under Dr. 
Taylor’s care in University College Hospital. It appears that in lifting a 
heavy weight, he had strained his back, and that a few months afterward 
he was suddenly seized with pain in the right hip—striking into the loins, 
and down the leg. On his admission he had still this pain, but there was 
no increased heat of skin; he was ordered to take, three times a day, 
two ounces of guaiacum mixture, wTith forty minims of am. tr. of guaiacum, 
and have a good diet; three days afterward he was to increase the dose 
of the tincture of guaiacum to one di-achm three times daily; a blister to 
be applied to the right hip, and the blistered surface to be dressed twice a 478 
SCIATICA. 
day with one grain of the hydrochlorate of morphia. Repeat the blister 
and morphia when necessary. 
Whether sciatica be rheumatic or not in its nature, it is certain that the 
seat of the disease is in the sciatic nerve. In the treatment of this case, Dr. 
Taylor attributes the cure to the blistering and morphia. M. Yalleix has 
published an excellent work on neuralgia. He also recommends the appli- 
cation of blisters, but Dr. Taylor remarks that:] 
The plan of blistering advocated by M. Yalleix is the application of flying 
blisters, as the French term them. This consists in having the blisters 
very small, allowing them to heal immediately, and in applying fresh ones 
as the seat of pain changes. This is the treatment which he has himself 
put in practice, and which he finds more efricacious than any other. After 
the application of blisters, the next best remedy in the treatment of this 
disease seems to be the internal administration of the oil of turpentine. 
Opium given internally generally has very little effect on the disease. 
Part xiii., p. 61. 
Moxas.—Dr. Thomson gives a case of sciatica wThich was treated with 
moxas. Tincture of guaiacum and. aconite was prescribed and the dose 
increased. Aconite plaster over the seat of pain. Cupping over the part 
and afterward two grains calomel and one grain opium; then a mixture of 
vin. colchici and tinct. aconite; lastly, six moxas; since which the case has 
done well. 
The best moxas are prepared by dipping a piece of bibulous paper in a 
solution of diacetate of lead, drying it, and rolling it up in the form of a 
cylinder. It burns well and steadily, leaving an ash of yellow oxide of lead. 
Part xiv., p. 59. 
Pisulphuret of Carbon in Sciatica.—A patient, who, for five years, had 
suffered at times under a very painful sciatica, with commencing emacia- 
tion of the limb, loss of appetite and sleep, and against which a great 
variety of remedies had been employed, was at last put under alcohol of 
sulphur (the bisulphuret of carbon), used both internally and externally, 
after the method of Wutzer. At the end of five days, there Avas complete 
removal. 
From the Memoir of Lampadius, it appears to have been internally em- 
ployed Avith adArantage in rheumatism, chronic gout, ] alsy, and cutaneous 
eruptions, and externally against burns: the latter use being dependent 
on its energetic property of producing cold. Part x\r., p. 07. 
Diagnosis of Sciatica from Morbus Coxarius.—[Mr. Corfe states 
that the following simple method enables us readily to distinguish 
betAveen sciatica and inflamed or diseased hip joint, in those cases Avhere 
difficulty arises.] 
Place the thumb of the right hand firmly on the great trochanter, and 
the third finger on the tuberosity of the ischium ; then drive the forefinger 
into the space that exists midway, and a little above, these tAvo points, and 
if sciatica is present, the patient will certainly wince. The fingers here 
describe a triangle, the apex of which, whilst it points toAvard the sacro- 
illiac symphysis, also rests upon the precise exit of the nerve from the 
pelvis, and the base is formed by the line from the trochanter to the 
ischiatie tuberosity. But in order to ascertain if disease of the hip-joint is 
present, reverse this triangle, and place the thumb of the left hand upon 
the great trochanter, and the third finger upon the tuber ischii, and let SCIATICA. 
479 
the forefinger be driven into the apex of that triangle, of which the two 
former fingers describe the base, and it will be found to be immediately 
over the articular surface of the hip-joint, and which will certainly cause 
pain if inflammation exists in it. It will be observed that the apex of this 
triangle looks downward toward the lesser trochanter. These directions 
apply to the detection of the seat of pain on the left side; but when the 
right hip is examined, the hands of the operator should be reversed to the 
above description. Part xviii., p. 104. 
Sciatica Cured by Cauterizing the Ear.—[However singular it may 
appear, M. Malgaigne did actually apply the red-hot iron to the anterior 
part of the right helix in a case of sciatica, and his patient was cured 
forthwith. Similar success is stated to have resulted on more recent occa- 
sions at the Hospital St. Louis, and] 
Dr. Lucciana of Bastia relates in the “ Journal des Connaissances Medico- 
Chirurgicales,” 1st May, 1850, a radical mode of curing sciatica, popularly 
practised in Corsica, and consisting in the application of a red hot iron to 
the ear, and exactly on its helix. The cauterization cures the sciatica in- 
stantaneously, or at least effects immediate improvement. The operation 
is in Corsica uniformly performed by the farrier, and the inhabitants, when 
affected with sciatica, lose no time in applying for his assistance. In confir- 
mation Lucciana adduces some cases of sciatica which he had in vain attempt- 
ed to cure in the hospital of Bastia by other therapeutical methods, and 
which yielded to the farrier’s cautery, as if to a charm. Part xxii., p. 86. 
Sciatica.—Sciatica, not connected with mechanical causes, as tumors, 
accumulation of faeces, etc., may be cured in fourteen days by rubbing 
along the affected nerve, from above downward, 3ss. of veratria ointment 
(gr. v. to gss.), every night at bed-time. The friction to be performed 
with a horse-hair glove until severe tingling is produced. 
Sciatica and Neuralgia.—Some cases recorded by Dr. Belcombe were 
entirely cured by the insertion of a needle just at the seat of pain, to some 
depth, and another two inches lower in the same direction. These were 
kept in for two hours, and then withdrawn. In cases of sciatic lumbago, 
give acetate of potash in compound infusion of senna, the patients finding 
much relief from the movement of the lower bowels, and pressure being 
taken oft'the kidneys. In the neuralgia of the upper extremity, carbonate 
of iron in full doses was given. Part xxv.,p. 74. 
Use of Croton Oil.—[Mr. Hancock is of opinion that mechanical irri- 
tation of the nerve within the pelvis is the most frequent cause of sciatica. 
This may be from loaded colon or caecum, or from tumors formed within 
that cavity.] 
In cases where sciatica depends on local irritation of the nerve within 
the pelvis from accumulation of faeces in the colon or caecum, the follow- 
ing pills generally produce a good effect-; the patient, however, should be 
warned of the activity of the remedy. Croton oil, one minim; blue pill, 
extract of hyoscyamus, each four grains; compound extract of colocynth, 
eight grains; to be divided into four pills, two to be taken at night, and 
repeated as the case may be. Part xxix., p. 71. 480 
SCOEBUTIC AFFECTIONS. 
SCORBUTIC AFFECTIONS. 
Extract of Monesia.—Suggested in tlie form of pills, in scurvy. Dose, 
from 12 to 36 grains during the day. Part ii., p. 77. 
Tincture of Cantharides.—Mr. Irven has introduced a new remedy for 
the cure of this disease. He administers tincture of cantharides ; at first, 
in doses of from ten to twenty drops, three times a day, increasing the 
quantity taken in the twenty-four hours, according to circumstances, to 
about eighty drops. At the same time that an improvement in the gene- 
ral health becomes perceptible, the urine becomes clear, and is found to 
contain albumen, which is said to be uniformly absent from the urine of 
scorbutic patients. Part vii., p. 13. 
Purpura, or Land Scurvy.—Scurvy is the old name for purpura hemor- 
rhagica, and land scurvy for purpura without hemorrhages: the two dis- 
eases are allied; they are only varieties of the same disease. 
[It consists in a lesion of the capillary system and of the blood, which is 
deficient in fibrin. Dr. Laycock observes that if not checked, the disease 
will assume as formidable an appearance as marine scurvy; there will be 
spreading ulcers, the gelatinous fungus on the skin and gums termed by 
sailors “ bullock’s liver,” and finally death. He says :] 
The explanation of the symptoms is not difficult. The morbid condition 
of the blood has impaired the contractility of the vascular system. In 
the depending portions of the body the capillaries give way from the 
mere gravitation of their contents; thus giving rise to the vibices in the 
legs, and in the under surfaces of the thighs. The petechias are really 
small inflamed or congested papillae, or the mouths of sebaceous glands. 
The muscular pains are those of fatigue; there is not enough fibrin in 
the blood for the nutrition of the muscles and the maintenance of their 
action. 
Let the diet be varied, and consist partly of vegetables, which contain 
acids : rhubarb, cabbage, potatoes, sorrel, water cresses, nettle tops, lemons, 
oranges, etc. Give citric acid four grains every four hours; or give 
nitrate of potash. Part xv., p. 39. 
Deficiency of Potash in the Blood, a Cause of—Dr. Garrod points out 
many objections to the opinion that a deficiency of any of the organic cow- 
stituents of the food produces scurvy; and states that from minute re- 
searches into the composition of scorbutic or antiscorbutic articles of diet, 
and into the state of the blood in scorbutic patients, he has been led to the 
following conclusions: 
1st. That in all scorbutic diets, potash exists in much smaller quantities 
than in those which are capable of maintaining health. 2d. That all 
substances proved to act as anti-scorbutics contain a large amount of 
potash. 3d. That in scurvy the blood is deficient in potash, and the 
amount of that substance thrown but by the kidneys less than that which 
occurs in health. 4th. That scorbutic patients will recover when potash is 
added to their food, the other constituents remaining as before, both in 
quantity and quality, and without the use of succulent vegetables or milk. 
5th. That the theory which ascribes the cause of scurvy to a deficiency of 
potash in the food, is also capable of rationally explaining many symptoms 
of that disease. SCOEBUTIC AFFECTIONS, 
481 
If medicine is to be prescribed, give 10 or 15 grains of the phosphate, 
chloride, or tartrate of potash twice or three times a day either in water 
or with food. Part xvii., p. 23. 
Treatment of Sea Scurvy.—The whole treatment of sea scurvy may be 
summed up in a few words. Supply the system freely with protein, by 
giving patients freely those vegetables in which it most abounds. Many 
English naval surgeons maintain that vegetable acids alone are not suf- 
ficient to cure scurvy, and that a portion of fresh animal food is necessary 
for a cure. Part xviii., jt>. 53. 
Scurvy.—It would appear from experiments made on board convict 
ships by Dr. Bryson, R. N., that the remedial powers of citric acid and 
lime-juice, in scurvy, are about on a par; and that the good effects of both 
of them are probably increased by the addition of sugar. As a prophylac- 
tic, citric acid has not been fairly tried, but lime-juice, with sugar, is un- 
questionably of the greatest advantage. Nitrate of potash would appear 
not to possess antiscorbutic properties, and not to be adapted either for a 
prophylactic or a curative agent. Part xxi., p. 33. 
Purpura Hemorrhagica.—Mr. Budd, physician to Bristol Infirmary, 
says: 
Although purpura is certainly a disease connected with a dissolved and 
thin condition of the blood, yet it is also more than probable that weakness 
of the vessels themselves, from defective nutrition of their walls, has a still 
larger share in the result; the symmetrical distribution of the ecchymoses, 
proving the correctness of this supposition. On this ground, the very valu- 
able properties of turpentine as a styptic, both applied locally and adminis- 
tered internally, is strongly recommended, great benefit having been pro- 
duced by it, when all other measures had failed. Twenty minims of the 
oil may be given in emulsion every six hours. A similar testimony of the 
styptic properties of turpentine is quoted from the illustrious Hunter, and 
also from Mr. Vincent, late surgeon to St. Bartholomew’s Hospital. 
Part xxii., p. 118. 
Case of Purpura Hemorrhagica treated by Turpentine.—A gentleman, 
aged 22, while coughing, expectorated a large quantity of dark colored 
blood. The respiratory sounds were natural, but the limbs were found 
covered with the peculiar eruption of purpura. He was an excessive 
smoker, and was generally from this cause in a state of salivation. 
The treatment consisted in an acid mixture, and a dose of aperient pills ; 
the bowels being sluggish. For the following three days this treatment 
was continued without change, except that a grain of ipecacuan was added 
to the pills. The hemoptysis subsided. A few days afterward, the patient 
suffered severe pain in the testicle, and on voiding his urine, it was mixed 
with a large quantity of blood. No material improvement following upon 
the administration of the acid mixture, aperients, and gallic acid, the treat- 
ment was changed and replaced by turpentine in the following form: 
R Spiritus terebinthinse, 5ij.; sacchari albi, pulveris acacise, aa. 5ij-; tinc- 
tur. lavandulse comp., 5j.; aquse menthse piper, ad gviij. M. Fiat mistura. 
Of this he took an ounce three times a day. The turpentine has been 
continued with the best effects. The urine has acquired its healthy cha- 
racter, and the patient expresses himself as feeling quite well. In about a 
week the turpentine was stopped, and a few drops of the tincture of the 
VOL. II.—31 482 
SCROFULA, 
muriate of iron, twice daily, prescribed in its place, with a compound 
rhubarb pill as an occasional aperient. There has been no return of the 
symptoms. 
As to the cause of the diseased blood, Dr. Willis ascribes it to excessive 
smoking. He says: 
I believe that the fumes of tobacco, if long inhaled, possessing as they do 
narcotico-irritant properties, are quite as capable of reducing the consist- 
ency of the blood as some other agents of the same character; and that 
the essence of purpuric symptoms is a fluid or defibrinated condition of the 
blood. Part xxix., p. 49. 
Chlorate of Potash in Scurvy.—[Mr. Corner, the resident medical offi- 
cer on board the Dreadnought Hospital Ship, always relies upon the chlo- 
rate of potash in scurvy.] 
Chlorate of potash has the effect of curing the spongy state of the gums 
in this disease much more rapidly than any other treatment. It should be 
combined with lime-juice. This salt appears to be curative in all inflam- 
mations of the mouth and gums whatever their cause, syphilitic and can- 
cerous affections alone excepted. Part xxxvii., p. 29. 
Purpura Hemorrhagica.—The use of the tincture of larch bark is recom- 
mended in the treatment of purpura hemorrhagica. Four cases are related 
in which improvement certainly seemed to date from its use. Dr. Moore 
remarks that the tincture is one of the most elegant forms at our disposal 
of prescribing a terebinthinate, either as an addition to a compatible ex- 
pectorant, or other fluid mixture, or to be given per se. The dose is from 
3ss. to 3hj.; of the extract, from gr. j. to grs. v. The value of terebinthi- 
nates in the treatment of purpura has been long acknowledged, the diffi- 
culty of their exhibition having alone restricted their employment in many 
instances; whereas in the preparations of larch bark, whilst all the valu- 
able styptic qualities of the turpentine are retained, its exhibition is not 
attended with disagreeable results. Part xxxix., p. 87. 
Leaves 6f the Walnut in Scrofula.—M. Negrier published a memoir 
on the use of walnut leaves in scrofula, which he regards, after 
numerous experiments, as one of the best antiscrofulous remedies that we 
possess. 
M. Negrier concludes his memoir with the following directions for the 
preparations of walnut. The infusion is made with an ounce of the leaves 
in twelve ounces of boiling water ; it may be sweetened with sugar or the 
sirup presently to be noticed. Two or three cupfuls may be given daily, 
or even five. The decoction is made with a handful of the leaves, boiled 
for fifteen minutes in a quart of water. The extract may be made in the 
usual manner from the dried leaves. For the sirup, eight grains of the 
extract are mixed with thirty-two scruples of common sirup; infants and 
young children may take two or three teaspoonfuls in the day; adults 
three drachms. The pills may be made of the extract, four grains in 
each; from two to four in the day. Part iv., p. 60. 
Medicinal effect of Manganese in Glandidar Swellings and Cutaneous 
SCROFULA. SCROFULA. 
483 
Diseases.—Dr. Krigeler, an Austrian practitioner, haying remarked that 
many workmen who were previously affected with glandular swellings and 
cutaneous diseases, had by degrees got rid of those affections while em- 
ployed in a bleaching factory in which oxide of manganese was used, has 
since employed the latter substance for the cure of such complaints with 
the happiest results. Its administration to children with scrofulous 
enlargements of the glands, in doses of one to five centigrammes (one- 
seventh to three quarters of a grain), has been found in a very short 
time to be attended by a diminution of the swellings, which have 
eventually disappeared altogether under the use of the medicine. 
Part vii., p. 90. 
Treatment of.—The basis of a very rational plan of treating scrofula 
consists in the administration of alkalies, and the continued use of highly 
animalized diet. Chemistry has lately shown in an interesting manner the 
reason of this fact, which is, that phosphates are passed in the urine of 
scrofulous patients to an extent many times greater than natural. The 
reason for the avoidance therefore of vegetable diet, which, by forming 
lactic acid, tends to dissolve the earthy phosphates, and the persistence in 
the use of alkalies, which neutralize the acid in the system, is clearly shown. 
Part xii., p. 301. 
Treatment of.—Dr. Wiltshire, physician to the infirmary for children, says 
iron is very valuable in the treatment of scrofula; to children at the 
breast give the vinum ferri, but for older children, nothing is better than 
the sesqui-oxide, from one to three teaspoonfuls daily, mixed with treacle. 
Quinine is also useful; but especially iodine. To the youngest children 
we may give a grain of iodide of potassium in distilled water, sweetened 
immediately before administration, thrice a day. If the child is above a 
year old, from one-tenth to one-eighth of a grain of iodine may be added ; 
and the dose increased according to age. For external use the compound 
ointment, or the compound tincture of the pharmacopoeia, will do ; or a 
lotion with from gr. v. to 3ij. of iodide of potassium to an ounce of 
distilled water. Or when more counter-irritation is needed, paint on the 
skin near the affected part, a solution of a drachm of iodine and a drachm 
and a half of iodide of potassium to half an ounce of alcohol. 
Part xvi., p. 60. 
Scrofula.—Dr. Graves recommends cod-liver oil; enlargements of 
the tonsils and of the cervical glands will disappear under its use. 
Part xvi., p. 62. 
Scrofula.—In addition to the usual hygienic treatment, Mr. Bulley recom- 
mends small doses of the purest sulphur, which has the effect of accelerat- 
ing the capillary circulation, and restoring the defective animal heat. The 
following formula maybe used : R. Sulphur, purif. gr. v. ad x.; sirup simp. 
3j-; aquae 3vij.; bene terendo ft. haust. To be taken once or twice a day 
in a tumblerful of new milk. A slight chalybeate may sometimes be 
advantageously added. Part xviii., p. 152. 
Treatment of Scrofula as it affects the External Lymphatic Glands.— 
Mr. Balman says, the best application for almost every kind of scrofulous 
sore is certainly the iodide of lead ointment: the ung. hyd. nit. oxid. is 
more stimulating for some very indolent and flabby sores; but the former 
has generally succeeded with me so well that I now seldom use any other. 484 
SCEOFULA, 
The disposition to scab seems very remarkable in all these kind of sores ; 
and however beneficial this process may be in other wounds, it very nearly 
always tends to impede, rather than otherwise, the healing of scrofulous 
ulcers, not only by preventing granulation from forming, but, by allowing 
the ill-conditioned materials to accumulate and fester under it, causes 
further destruction to the subjacent tissues. I have generally, therefore, 
directed a poultice to be applied until the sore becomes clean, and then 
endeavor to prevent their reproduction by some of the stimulating 
applications already alluded to. I have used a cataplasm composed of bran, 
linseed, and common yellow soap, with very good effect in these cases. 
We have observed, that these glandular swellings are met with under a 
great variety of circumstances. The patient may, for example, present 
the fine, delicate, white skin, the tumid lip, and crimson hue of cheek, and 
the languid, listless, and enfeebled gait so familiar to us in persons pos- 
sessing the well-marked lymphatic temperament; or all these signs of the 
strumous constitution may be for the most part wanting, and we have the 
outward characters of a sound and vigorous constitution ; or there may be 
evidences of a previously acquired syphilitic taint sufficient to justify our 
pronouncing this to have been the primary exciting cause of the disease. 
A disease, therefore, occurring under so many and varied aspects must of 
necessity require different modes of treatment. If, for instance, the swel- 
lings appeared for the first time after an attack of primary syphilis, 
the iodide of potassium and sarsaparilla will be found the best remedy, 
all other remedies, as far as my experience goes, being perfectly useless. 
I have made trial of most of the reputed antiscrofulous remedies, and 
must confess with very different results. The following, however, deserve 
some notice : mercury, barium, iodine, alkalies, cod-liver oil, etc. 
The hyd. bichloride may be given in doses of from 1-] Cth to l-20th of a 
grain dissolved in distilled water, or in the form of pill, with the ext. of 
sarsa. twice or thrice a day. In cachectic chlorotic, and other cases 
attended by a languid circulation and much general debility, barium may 
be used as follows : R. Baryta chlorid., gr. x.; tinct. ferri mur., 5ij- to §ss.; 
sir. aurantii, gss.; aq. dest., §x. Mix ; of this §ss. to §j. may be given two 
or three times a day. Cod-liver oil has little or no influence in the great ma- 
jority of glandular tumors; but in some forms it is a potent remedy, as 
when associated with caries of the bones or phthisis. Phosphoric acid, as 
a medicine, is also most valuable. It may be given in the infusion of ca- 
lumbo, beginning with five grains of the dilute acid of the pharmacopoeia, 
gradually increasing it to twenty or more. 
As regards the treatment of scrofulous swellings, I believe that much 
harm is sometimes done by the indiscriminate use of frictions with the 
iodine ointment and other compounds, by inducing a low form of inflam- 
matory action in the skin and integuments, and the chance of bringing on 
suppuration which it is desirable in many cases, for reasons before stated, 
to prevent. On this account, and also from the fact that the action of all 
such applications is very feeble in dispersing the tumor under any circum- 
stances, I seldom now have recourse to them. 
In the absence of all signs of inflammatory action after a trial of some 
of the foregoing internal medicines, I prefer, as a counter-irritant, penciling 
the part with the solid nitrate of silver a few times, at intervals of a week 
or ten days. This, I think, is a milder and safer proceeding than the 
use of blisters, the action of which is more diffusive and irritating. 485 
SEA-SICKNESS. 
It is hardly necessary to insist upon the utmost attention being paid to 
a variety of circumstances regarding the general management of scrofula ; 
such as good and wholesome food, good air, sea-bathing, exercise, and 
various other hygienic means, which are known to exercise the happiest 
effects in every form and variety of this disease. Part xxiv., p. 40. 
Use of Proteine in Scrofula.—In the case of a boy, proteine, given in 
three-grain doses, three times a day, the dose being afterward increased 
to five grains, produced the most remarkable effects—iron and other tonics 
having been previously given without any improvement. 
In another patient, aged two years, an emaciated, strumous child, with 
tumid abdomen and enlarged cervical glands, and numerous ill-conditioned 
ulcers on the loins, nates, thighs, legs, and arms, with symptoms of mesen- 
teric disease. Dr. Taylor ordered zinc ointment, and occasionally a poultice 
of equal parts of linseed-meal and wheaten flour, to be applied to the 
ulcerated parts; and to take, proteine, two grains, soda exsiccata, one 
grain, three times a day, in sugar and water. 
First week.—The skin has become cleaner and more healthy, and some 
of the ulcers have healed; several that are now open display in a very 
remarkable manner the appearance of softened tubercles ; the child looks 
more lively; bowels regular; appetite better ; takes beef-tea twice a day, 
and milk night and morning. To have mutton for dinner. 
Second week.—Greatly improved in every respect; has begun to run 
about again, which she has been incapable of doing for the last six weeks; 
nearly all the ulcers have healed; abdomen smaller; has gained flesh ; 
appetite excellent; bowels regular; sleeps well. Ordered the proteine to 
be continued in doses of three grains, soda exsiccata, one grain. A month 
afterward, the little patient was running about in excellent health and 
spirits. Part xxviii., p. 38. 
Scrofula—Anaemia—Polls.—Dr. Christophers considers the liquor cin- 
chonse hydriodatus cum ferro a very valuable preparation of iodine. It 
may be given in doses varying from fifteen minims to tAVO drachms. It 
does not produce the evil effects which arise from small doses of the other 
preparations of iodine. Another neAV preparation, the liquor cinehonje 
hydriodatus, in doses varying from one to three drachms, is equally 
valuable in secondary syphilis when the usual treatment has failed. 
Part xxxiv., p. 217. 
SEA-SICKNESS. 
Sear Sickness.—As preventives, Dr. D. F. W. Fisher recommends active 
exercise and a tonic regimen for some days before embarkation; and when 
on board, keep on deck in the breeze, make large inspirations, wear a 
girdle, walk quickly till perspiration or fatigue is caused, or engage in 
some hard work, such as helping the sailors, hard work being the surest 
prophylactic; and take warm and exciting drinks, as tea or coffee with a 
little brandy, or diaphoretic medicines, opium, saffron, or acetate of 
ammonia. When the sickness has come on, nothing will do except pal- 
liatives : lie down with the head low, in a hammock or a suspended bed, 
and take stimulant aromatics, lemons, etc. Part xvii., p. 293. 486 
SENSATION—SILYEE. 
Sea-Sickness.—We may often succeed in preventing an attack of this 
by creasote, and the best and most convenient form is to have it made up 
in lozenges, about one drop in each, one or two of which can be taken 
when necessary. Part xxxiii., p. 321. 
Sea-Sickness.—Give from ten to twTelve drops of chloroform in water, 
and if necessary repeat it. It is said by Dr. Landerer, of Athens, to be a 
“ sovereign remedy.” The patient soon becomes able to stand up, and 
gets accustomed to the movements of the vessel. Part xxxv., p. 306. 
SENSATION. 
Reflex Sensations.—Dr. R. B. Todd says : The irritation of a calculus in 
the bladder will give rise to pain at the end of the penis, or to pains in the 
thighs. Irritation of the ovary will cause pain under the right or left 
mamma; stimulation of the nipple, whether in male or female, gives rise 
to peculiar sensations referred to the genital organs ; ice suddenly intro- 
duced into the stomach will cause intense pjain in either supra-orbital 
nerve ; acid in the stomach is apt to cause a similar pain, which may be 
very quickly relieved by the neutralization of the acid. Phenomena of 
this kind imply some closeness of connection between the nerves of the 
sympatliazing parts in the centre, probably by means of commissural fibres 
connecting the respective points of implantation of the nerves with each 
other. jPart xx., p. 51. 
Sensation—Ross of.\ from Hysteria.—Dr. Rowland cites a case of this 
kind in a young woman, aged 25, which various remedies failed to relieve, 
who was gradually cured by the patient persevering in taking the follow- 
ing, in the form of a draught, three times a day. Tinct. ferri sesq., ntxv.; 
tinct. cantharid., ntiv.; and tincture of aloes, mxx. Part xxix., p. 68. 
SILVER. 
Nitrate of Silver—Use of in Stricture of the Urethra—In Fissured or 
Excoriated Nipples—Skin Diseases—Affections of the Mucous Membrane 
of the Throat, etc.—One of the most useful remedies in medicine is the 
nitrate of silver; whether we regard its use externally or internally, we 
must look upon all improvements in its mode of application as very desir- 
able ; the form of nitrate as an external application has not been improved, 
neither is it necessary, as its qualities in the present form are such as we 
require. As an external application, however, nitrate of silver has been 
greatly extended of late, and especially since some able publications on its 
use in dilferent diseases. In stricture of the urethra it has long been used, 
acting, not as is commonly supposed, by destroying the stricture, but “ by 
inducing some change in the vital actions of the part, which is followed by 
relaxation of the narrowed portion.” In fissured or excoriated nipples, it 
is occasionally very useful, and certainly superior in many cases to the 
tincture of catechu, which has lately been so praised in these affections. 
In porrigo, the solid nitrate of silver, by being well rubbed on the part, SILVER 
487 
will seldom fail in either curing the affection or considerably improving it 
—the cauterization should be repeated at intervals of a few days. In 
psoriasis and impetigo, it has also been found useful; but more especially 
in erysipelas, both when rubbed on the sound skin round the inflamed 
portion so as to separate the latter from the former, and also when rubbed 
all over the inflamed surface. In affections of the mucous membrane of 
the mouth and fauces, it is occasionally an invaluable application. “ When 
'the fibrinous exudation of croup commences on the surface of the tonsils 
and arches of the palate, its further progress may be stopped by the appli- 
cation of a solution composed of a scruple of nitrate of silver and an ounce 
of distilled water. The solid nitrate has been introduced through an 
aperture in the trachea and applied to ulcers on the inner surface of the 
larynx, in a case of phthisis laryngea with apparent benefit. (See Dr. 
Pereira’s work on Materia Medica, p. 696.) A case of diphtherite illus- 
trating its good effect on the mucous membrane of the throat is related in 
the “American Journal” of Medical Sciences, in which Dr. Gibbes applied a 
saturated solution with benefit, to an ulcer half an inch in diameter, over 
the left tonsil and to the fauces, by means of a small sponge, which was 
thrust far back into the pharynx. Every application was attended with 
relief, and it was repeated every two or three hours when the albuminous 
accumulation was present. Part vi., p. 178. 
Chloride of Silver—Therapeutic Properties of.—The chloride of silver, 
which was formerly recommended by Poterius, as an anthelmintic and 
hydragogue ; by Hoffmann, as an evacuant of phlegm in dropsy and 
melancholy ; by Tachenius, as an excellent remedy combined with the sul- 
phuret of antimony, for mania, melancholy, and epilepsy; and lastly, in 
modern times, by Professor Serres, for syphilis—has been employed in 
various cases by Dr. Perry. 
He declares that he has found it preferable to the nitrate of the same 
metal, inasmuch as its effects are more certain, its application easier, is less 
disposed to decompose, and free from any disagreeable taste. The 
chloride of silver acts best in the form of pills; nevertheless, for young 
children, it can be prescribed in the form of powders, or suspended in 
some appropriate sirup. The use of this salt inwardly is not attended 
with the risk of the green or brown discoloration of the skin, as with 
nitrate of silver. Dr. Perry has prescribed the chloride for epilepsy; he 
has also given it in chronic dysentery; under its influence the number of 
stools and other symptoms have diminished; he has used it also in sup- 
pressed menstruation ; and lastly, in the secondary form of syphilis. 
Part ix., p. 84. 
Oxide of Silver.—There are certain diseases of the mucous surfaces of 
the alimentary canal, bladder, uterus, vagina, etc., which often baffle our 
best attempts at relief, for example, pyrosis, menorrhagia, and leucorrhoea ; 
and there are endless which probably depend upon some irrita- 
tion in the nervous centre, either immediate or distant, which equally 
baffle our efforts at relief. Sir James Eyre has published a little work, in 
which he extols very highly the oxide of silver as a powerful tonic, seda- 
tive, and astringent, and states that in these tiresome cases it will be found 
very valuable. Part xi., p. 107. 
Stains from Nitrate of Silver, to remove.—Moisten the spots several 
times with a solution of hydriodate of potash, and expose the part to the 488 
SILVER. 
direct rays of the sun. The hydriodate converts the black stain of the 
nitrate into the white ioduret of silver. A trial of its use internally is also 
recommended in those cases where the skin has been tinted by the internal 
use of the nitrate. Part xiv., p. 254. 
Oxide of Silver.—Dr. Lane says that the conjunction of oxide of silver 
with confection of roses is injudicious, as a salt of silver is liable to be 
formed, though certainly the tendency of metallic oxides to be acted on 
by the vegetable acids (gallic, malic, or citric) varies much. The com- 
bination of essential oils with the oxide of silver is exceedingly objection- 
able, for the chemical union of the oxygen with the silver is not very 
powerful; neither is that of the hydrogen and carbon in the essential oils ; 
the substance in question, therefore, being intimately commixed, silent or 
explosive composition will inevitably ensue, the oxygen and hydrogen, 
forming water, while the silver remains in a metallic state, or is converted 
into a carburet. An analogous, though more complicated action, I think, 
takes place where the vegetable acids are concerned. I should not recom- 
mend any druggist to dispense a prescription wherein the oxide of silver 
and an essential oil are conjoined, without communicating with the pre- 
scriber, if possible. 
The combinations of the oxide of silver which I chiefly employ, and 
should recommend, are as follows: 1. With extract of gentian or chamomile. 
2. With extract of hyoscyamus or conium, to which I often add a small 
proportion of ipecac. 3. With inspissated ox-gall. 4. With the aqueous 
extract of opium. 5. With compound cinnamon powder. The pills never 
should be rolled or kept in carbonate of magnesia. Part xvi., p. 296. 
Nitrate of Silver Stains.—Messrs. Smith have advised a process, 
already suggested by others, which is remarkable for its simplicity. The 
stained portion of linen is well saturated with a strong solution of chloride 
of lime. This converts the silver to a white chloride, which is then 
removed by ammonia, or by a solution of liyposulphate of soda. If the 
stain be deep in the fibre and of old standing, this process must be 
repeated several times before it is effectually removed. 
A solution of the cyanide of potassium is also useful in the removal of 
these stains. The plan of converting them to iodide of silver by tincture 
of iodine, and washing out the iodide by hyposulphate of soda, is not 
always successful. Part xvi., p. 299. 
To Pemedy the Fragility of Nitrate of Silver Crayons.—The brittle- 
ness of nitrate of silver is the source not only of considerable loss of the 
material itself, but frequently of danger to the patient, as when the fauces, 
oesophagus, urethra, bladder, and cavity of the uterus are being cauterized. 
M. Chassaignac has succeeded in remedying this evil, by having in the 
centre of the stick of caustic a thread of platinum wife. M. Blatin secures 
the same object by a wick of cotton, which is placed in the mold before 
the fluid nitrate is poured into it. The crayon thus prepared is rendered 
more solid, and, when broken, the fragments remain attached to one 
another. Part xix., p. 324. 
To remove Nitrate of Silver Stains.—Mr. Collins, in a number of the 
“ Dublin Med. Press,” recommends to brush over the stains on the linen, 
skin, nails, or teeth, with a solution of cyanide of potassium, eight or ten 489 
SINUSES SKIN. 
grains to 9j. of distilled water. If the stains are superficial, one or two 
applications will suffice; if deep, several will be required. 
Fart xx., p. 148. 
Nitrate of Silver Stains.— Accident first led M. Martinenq to the 
observation, which he has since repeatedly confirmed, that the stains 
produced by nitrate of silver on linen, etc., may be readily removed by 
wetting the linen in a solution of bichloride of mercury ( 1 part to 31), 
rubbing it well, and then washing it well in cold water. 
Part xx., p. 294. 
Nitrate of Silver.—Mr. Ward recommends instead of dissolving this 
salt in water, to dissolve it in common nitric ether. The ether acts as a 
solvent of greasy matter on the skin, and from its volatility, quickly di*ies, 
enabling us to apply several coatings of the solution in a short time. The 
strength may vary, but about eight grains to the ounce will generally be 
sufficient. In erysipelas, this will be found an improvement. 
Part xxxi., p. 236. 
SINUSES. 
Treatment of Chronic Sinuses by strong Nitric Acid.—Mr. Skey says, 
whenever inflammation, or even redness, has attended them, the application 
has generally failed; but the large majority of these canals are not 
inflammatory, but chronic. 
The mode of applying the escharotic is by means of a fine glass tube of 
length sufficient to reach the full extent of the sinus. At one end of the 
tube is a small glass bulb. The air is sufficiently exhausted by the hand, 
when warm, to draw up sufficient acid to fill the tube, and partly so the 
bulb. The instrument, thus, armed, is passed into the sinus, and the acid 
discharged, either by the hand, or by the aid of a lucifer match, while the 
tube is slowly withdrawn, pouring out its contents along the entire track. 
Part xxxiii., p. 239. 
Functions of the Skin.—1st. The sldn is an external lung, an aerating 
mechanism spread out over the body’s entire surface. Both lungs and 
skin abstract oxygen from the atmosphere, which they replace by carbonic 
acid and watery vapor. A healthy cuticle, then, must be freely permeable 
by elastic fluids (gases and vapors). 2d. The cuticle is very profusely 
perforated by minute valvular orifices, openings of the sweat-ducts; the 
skin is the grand drainage pipe of the body; and when, on indubitable 
authority, we learn that, computing 2,506 square inches as the body’s 
superficial contents, its linear amount of drainage pipe is about twenty- 
eight miles—an hour’s railway ride forsooth! (Wilson)—we shall arrive 
at something like an appreciation of the importance of keeping this pipe- 
age pervious. 
Now, from the two just named properties, the skin is manifestly comple- 
mentary or vicarious in its functions to those two vital organs, the lungs 
and kidneys; therefore an obstructed skin throws the whole onus of elabo- 
SKIN. 490 
SKIN—SKIN DISEASE. 
ration upon these latter organs, which consequently become overworked 
and diseased. 3d. This is not all. The skin is a decarbonizing organ ; 
opening into the cuticle, in common with the hair follicles, are the orifices 
‘of the “fat glands,” which secern an oily matter (for the skin’s lubrica- 
tion) from the blood; if allowed to collect, this fatty matter checks the 
“ transpirability ” of the skin, by glazing it over with a sort of natural var- 
nish, thus throwing the whole work of decarbonization upon the liver; its 
fat cells become gorged, and thus arises that most grave malady “ fatty 
liver,” good enough in a pasty, that is, if there be any virtue in pate de fois 
gras, but no trivial calamity to any unfortunate human possessor. Carbon 
is retained, moreover, in the blood, depriving the sentient lining of the ar- 
teries and left heart of their proper stimulus; and carbon thus, with saline 
and other impure matters circulating through the brain, deranges that organ 
of organs. The connection, then, between a clear head and a clear skin is 
closer than the unlearned might suppose. 4th. Many years back, Drs. 
Blackall and Osborne discovered that dirtiness was a great source of dropsy. 
To understand this, it must be recollected, that in an impure obstructed 
skin are checked two of the skin’s main functions—evaporation and exha- 
lation. (Dr. J. Coventry.) Part xiv., p. 258. 
Pathology of Skin Diseases.—According to Dr. Burgess, eruptions of 
constitutional origin, by long standing may sometimes assume a local char- 
acter. Erysipelas and acne frequently supervene in cases of derangement 
of the uterine function. Strophulus is associated with the process of den- 
tition. Urticaria, lichen urticatus, and several varieties of herpes, are often 
the results of a disordered condition of the digestive organs. Psoriasis and 
lichen agrius frequently occur during the process of gout and urinary dis- 
eases ; and the hereditary nature of certain eruptions, as lepra, psoriasis, 
lichen, etc., is beyond all doubt. Unless we bear in mind, in our treatment 
of these eruptions, their intimate relation with the organic function, we are 
constantly liable to serious error. If, for example, we were to look upon 
these critical eruptions or discharges which occur at certain period of life 
as local diseases, and attempt to suppress them by topical applications, it 
is unnecessary to add that serious consequences would result; whereas, if 
they are not interfered with, they will get well as soon as the equilibrium 
of the system is restored. The impetiginous eczema of infants, and those 
eruptions which occur at the periods of puberty and the turn of life, are 
examples of this kind. Part xix., p. 197. 
SKIN DISEASE. 
ACNE. 
[Medical writers, of all ages, have found some difficulty in curing this 
peculiar form of eruption. Mr. Startin has been more successful; he first 
ascertains the exciting cause, and then applies those local and general means 
which increase the cutaneous circulation, viz., hot air bath, with or without 
sulphur; chalybeates combined with mineral acids, vegetable bitters, or 
iodine. He considers arsenic and mercury unnecessary, unless the state of SKIN DISEASE. 
491 
the liver or other viscera indicate their use; he recommends a mild nutri- 
tive dietary, with such alcoholic stimulants as the stomach may require for 
producing healthful digestion ; he considers vegetable acids, antiscorbutics, 
so called, and the common diet drink, worse than useless, nearly excepting 
even sarsaparilla.] 
The external local treatment of acne is not the least important, and 
must be regulated entirely by the stage and condition of the disease. In 
its commencement, when a loaded state ol the sebaceous follicles is the 
most prominent symptom, moderate frictions with the flesh-brush so as to 
keep open the pores, and the extraction, by pressure, of the larger collec- 
tion of sebaceous matter (the outlet of the follicle being dilated with some 
pointed but not too sharp instrument), will be required; whilst a weak spirit 
lotion and the use of oatmeal, instead of soap, may be enjoined; as the 
disease advances, and the suppurating points are numerous, large and pain- 
ful, the vapor douche on the face, mercurial ointment with camphor, white 
precipitate with camphor, or the Topique contre acne of the Hopital St. 
Louis may be recommended : the latter is composed of slaked lime, 3j.; zinc 
ointment, §j.; and camphor, Bj. From fifteen to thirty grains of the iodu- 
ret of sulphur to an ounce of lard, is also a useful application, as is a weak 
solution of bichloride of mercury in milk of bitter almonds, or thin quince- 
seed mucilage. The following lotion, not to be found in books, you will 
find occasionally very efficient: hyposulphite of soda, 3j- to 5ij-; sulphate 
of alumnia, 5j. to 3ij-; rose water, gviiss.; cologne water, §ss. for a lotion, to 
be used by washing the part with a linen rag twice or thrice daily. Of 
course these proportions are not applicable in every case, but the composi- 
tion is very useful in removing the unpleasant yellow stains of the cuticle 
as the acne declines, and it is perhaps more applicable to acne rosacea and 
pustulosa, than to the other varieties of the disease, as it always relieves 
the attendant itching. 
It sometimes happens that we may have succeeded in the removal of 
acne, particularly acne rosacea, but that a degree of redness remains on the 
end of the nose, or on one or two spots on the cheeks, which, on examina- 
tion, is not found to be inflammation, but a dilated state of the minute cu- 
ticular vessels; there are two ways of getting rid of this disfigurement, 
both of which I have constantly found successful; when the vessels are 
very small and numerous, not appearing to be nourished by conspicuously 
large trunks, the best plan is to paint them over very lightly with nitric 
acid, of the pharmacopoeia strength, which is to be immediately blotted off 
with bibulous paper; by this means a blister is raised, and the cuticle de- 
tached after a few days, when it will be found that the morbid state of the 
capillaries has disappeared, or that they have so much contracted, that a 
second application at the end of a fortnight is all that is required. 
The acetum cantharidis may also be used in a similar manner, though it 
is not so effectual. The second method has the same object in view, though 
the mode of its accomplishment is rather different, and it is only applicable 
when the red portions of the integument appear to be maintained by the 
influx of several larger capillary trunks—a morbid condition, which at the 
end of the nose, is exceedingly common. The plan I adopt in such instances 
is to divide each trunk in succession with the point of a fine lancet, and as 
the blood flows very freely, I restrain it by means of a small ring of steel 
or silver, which is mounted on a stem an inch or two in length, and fixed 
into a handle at right angles; by this means, I can, as it were, insulate the 492 
SKIN DISEASE. 
little wounded point, and arrest the hemorrhage, whilst the blood can be 
sponged away and the incision exposed, so that a piece of lunar caustic, the 
size of a grain of sand, can be introduced into it, by means of a probe with 
a flattened extremity, on which it has been previously made to adhere; this 
at once stops the bleeding, and obliterates the vessel, whilst it produces no 
disfigurement, beyond a temporary black spot that may be covered with 
court-plaster, or the blackness may be removed by wetting it with a solu- 
tion of iodide of potassium; I can assure you I have cured numerous red 
noses by this simple procedure—which I may mention is applicable to the 
removal of small nyevi and the congenital red marks called araneae (from 
their resemblance to a red spider, with its legs outstretched). 
The small mounted ring alluded to, you will find a most useful agent in 
arresting bleeding from leech-bites, until a grain of caustic can be accurately 
applied as already mentioned. I have also used it with advantage in re- 
moving cutaneous tumors of various kinds, for surrounding a troublesome 
bleeding artery till it could be secured ; the size of the ring may be varied, 
but I prefer it not larger than a quarter of an inch in diameter, for general 
purposes; but I can imagine such a contrivance useful under a variety of 
circumstances requiring surgical interference, which it would be quite out 
of order to discuss at this moment—amongst such are deep wounds of ar- 
teries, whether the result of accident, injury, or surgical operation. 
Part 240. 
This disease, says Dr. Burgess, arises from so many causes, the treat- 
ment can only be successfully conducted by taking these into account. 
Exclusively local, or exclusively general treatment, are equally erroneous. 
Part xx., p. 170. 
Acne of the Face.—Apply a saturated solution of gutta percha in chlo- 
roform over the spots, enjoining the patient not to rub off the pellicle by 
washing. (Dr. R. J. Graves.) Part xxvi., p. 287. 
Acne and Boils.—These, depending on similar states of the constitution, 
may be treated alike. Great success has been obtained at the Hospital for 
Disease of the Skin, by the combination of ferruginous salts with saline 
aperients. In acne simplex and punctata, Mr. Startin prescribes ferri 
sulphat., gr. ij.; magnes. sulphat., 5j-; ter die sumend.: an ointment of 
ammonio-chloride ot mercury gr. x. ad §j.; to be applied every night. 
I or acne indurata, the iodide ot iron in doses of gr. iij., three times daily. 
For the furunculous epidemic, so ripe of late years, full doses of iron with 
saline purgatives—mist, ferri acid., 3nj- ter die. Part xxvii., p. 161. 
Acne Posacea.—Smear the following over the face with the finger 
every night; camphor, a drachm ; milk of sulphur, twice as much, or the 
sulphur sublimatum. Afterward as much water as will render it suffi- 
ciently liquid. The camphor must be powdered by the usual addition of 
a little spirits of wine. (Dr. E. Wilson.) " Part xxxi., p. 195. 
Use of the Acid Nitrate of Mercury in Acne.—A very minute drop of 
the acid is placed, by means of a finely-pointed glass brush, on the apex of 
any indolent tubercles, whether suppurated or otherwise. It has the effect 
of opening the pustule, if matter have formed, and if not, induces the dis- 
appearance of the induration. The application is followed only by a little 
smarting pain, and if it have been carefully made, leaves no scar. 
(Dr. J. b tar tin.) Part xxxi.,p. 240. SKIN DISEASE. 
493 
Treatment of Acne.—After arsenic has been given for a long time with- 
out improvement, try cod-liver oil in teaspoonful doses three times a day ; 
it will often have a marked beneficial effect both upon the health and the 
disease. Lupus is equally benefited by the same treatment, but there is 
no cutaneous affection in which cod-liver oil has proved more effectual than 
in sycosis menti, or mentagra. (Dr. T. Hunt.) Part xxxii., p. J 84. 
Acne.—Cazenave has recently recommended ammoniacal lotions, which 
form with the fatty matter of the follicles a soluble soap with an ammonia- 
cal base ; the hydrochlorate or acetate of ammonia answers equally well. 
Part xxxii., p. 187. 
Treatment of the Different Forms of Acne.—In acne rosacea, and acne 
simplex, the acid solution of iron in half ounce doses is usually ordered, 
while for the tubercular form Mr. Startin places more confidence in the 
iodide of iron. The latter is generally given in from one to two grain 
doses. Malt liquors are strictly prohibited in all cases. In almost all the 
local use of the red lotion is directed, and any larger pustules or tubercles, 
which may be observed from time to time, are touched on their apices 
with the acid nitrate of mercury solution. In addition to these remedies 
the direction is mostly given to be particulcr in squeezing out the contents 
of the distended follicles as soon as they become perceptible. 
The “ acid solution of iron” is made by dissolving three ounces of Ep- 
som salts, and two drachms of sulphate of iron, in half an ounce of dilute 
sulphuric acid, and a pint of infusion of quassia. The “ red lotion” con- 
sists of two scruples of the bichloride of merdury, one of the bisulphuret, 
and ten minims of creasote, in a pint of water; each ounce containing two 
grains of the bichloride. Part xxxviii., p. 174. 
ECZEMA. 
Some Local Forms of Chronic Eczema.—Chronic eczema assumes dif- 
ferent forms as it attacks different parts of the body, as the scalp, face, 
ears, tongue, anus, etc. Chronic eczema of the face usually is of an im- 
petiginous character ; it is generally met with in children, rarely in adults, 
and when it does occur in the latter, it is in consequence of extension from 
the scalp. 
Chronic Eczema of the Face.—Mr. Erichsen mentions the case of a 
lady’s maid, who caught cold whilst travelling outside of the carriage; 
her face became stiff and inflamed, and pimples with watery heads came 
out on the forehead and cheeks. The disease continued for three months, 
without interruption, in spite of treatment, when she was admitted under 
Mr. Erichsen’s care, into the Westminster Hospital. 
Mr. Erichsen commenced by ordering three drops of the liquor arseni- 
calis three times a day, and directed that the affected parts should be 
preserved day and night from the action of the atmosphere, by covering 
them up with lint spread well with zinc ointment. 
Feb. 13.—Much better. The skin is softer, not so glazed, and the feel- 
ing of tension is less. The liquor arsenicalis was now increased to four 
minims for a dose, and ungent. hydrarg. precipitat. albi was substituted 
for the zinc ointment, it being thought that a light stimulant might be of 
service. Febrile symptoms arising, the arsenic was omitted for six days, 
when it was again resumed, and on the 25th of March, the disease was 
perfectly cured. 494 
SKIN DISEASE. 
When the disease depends on irritation of the skin and mucous surfaces, 
it can he soonest relieved by carefully regulating the diet, avoiding all 
stimuli, and using one of the most efficient remedies that we possess in 
affections of this class—the Harrowgate waters. Where the temperament 
of the patient is irritable, arsenic, cantharides, etc., would decidedly ag- 
gravate the disease. Chronic eczema of the ears, which usually proceeds 
by extension from the scalp, is a very painful as well as obstinate affection. 
Mr. Erichsen observes that : 
The ears, when attacked by the eczema, become exceedingly red, tense, 
hot, and shining; a number of small vesicles then appear, which contain a 
clear transparent serum, of a reddish or pale yellow color ; when these 
give way, the fluid that is effused forms thin scabs or scales, which are 
usually cracked in all directions, and which are frequently curled up or 
project from the surface of the skin. If the disease continue, the pinna at- 
tains a very large size, becoming hypertrophied, and often fissured ; some- 
times, indeed, the swelling goes on to such an extent as to block up the 
external meatus, giving rise to temporary deafness. 
When it occurs in young children, it can easily be cured : it is generally 
in females from fifteen to twenty-five, or in women about the change of 
life, where it proves so obstinate. It is generally associated with irregular 
menstruation, or may be noticed from the fact, that it is aggravated at 
those periods when the uterus ought to act. Mr. E. describes a case which 
came under his care, a female, twenty-one years of age ; menstruation was 
irregular. 
Both ears were found, on examination, to be affected nearly to an equal 
degree. They were red, glazed, much swollen, and chapped, covered with 
thin, flimsy, scaly incrustations, from under which a serous fluid occasion- 
ally oozes, and are very hot and tense. The integuments of the mastoid, 
temporal and parotidean regions are likewise involved, being inflamed and 
covered with thin furfuraceous lamina?. 
She was ordered to apply bread-and-water poultices to the ears every 
night, to cover them up in rags spread with zinc ointment during the day; 
to take ten grains of the pil. aloes c. myrrha every second night at bed- 
time, to abstain from all stimulants, and to adhere as strictly as possible to 
a milk diet. The ordinary means, such as mustard-and-water to the feet, 
etc., were likewise directed to be adopted for reestablishing the menstrual 
function, and were attended with success in the course of a week. At the 
end of a fortnight she was much better, the ears were less tense, and not 
so red or swollen. She was now ordered to apply an ointment composed 
of equal parts of a ceratum plumbi comp, and zinc ointment, and to take 
five minims of tincture of cantharides, and thirty of liquor potassoe twice a 
day. This plan of treatment was continued until the end of April, when 
she wras perfectly cured, the ears presenting their normal appearance, and 
having lost entirely their hypertrophied condition. 
Eczema of the Scrotum, Penis, and Anus.—Eczema of the scrotum and 
of the inside of the thighs of young children is of a more active character, 
and is by no means so troublesome as that which occurs in more advanced 
life. In many cases it appears to be owing to the urine being allowed to 
dribble over the thin and delicate skin of these parts. 
The appearance presented by chronic eczema of these parts in children 
is very remarkable. The scrotum and integuments covering the pubes, 
the inside of the thighs and penis, are of a vivid, red color, inflamed and SKIN DISEASE. 
495 
oozing ; occasionally covered with soft, moist, greyish, or yellowish scabs, 
from under and between which a serous fluid exudes in tolerable abun- 
dance. At other times they are dry, glazed, and chapped in all directions, 
being merely covered here and there with thin flimsy scales. These two 
conditions, the moist and the dry, alternate with one another, being evi- 
dences of the greater or less activity of the disease. 
Some local forms of Chronic Eczema.—When occurring in individuals 
past the middle period of life, eczema attacking the scrotum usually 
presents the ordinary characters of that disease in its chronic furfuraceous 
or squamous condition. The scrotum is much wrinkled, red, dry, rough, 
and glazed, or covered with thin, peeling, curled, laminated, and dry 
furfuraceous incrustations of a whitish or greyish color, which rub off in 
considerable abundance, exposing cracks and fissures, from which a thin, 
ichorous, or bloody discharge, oozes. The itching, which is intolerable, 
and is more complained of than anything else, is much aggravated by any 
excess in diet, or when the patient is warm in bed. Every now and then, 
under the influence of some exciting cause, the disease assumes a more 
active condition, revealing its vesicular elementary character, and thus 
enabling it to be readily distinguished from prurigo of the region afiected. 
Eczema involving the anus is always a most troublesome affection. It 
may be either an extension of the disease from the scrotum and perineum, 
or it may be confined exclusively to the anus and lower part of the rectum. 
It is occasionally seen in young children accompanied by intertrigo, or in 
consequence of the extension of the disease from the neighboring parts, 
when occurring in adults. It is characterized by occasional vesicular 
eruption, excoriation, fissures, and chaps, which bleed, and are excessively 
painful on the passage of the faeces, more particularly if these be hard or 
lumpy. There is always excessive pruritus; more especially, when the 
patient is warm in bed, or after standing for any length of time. 
Eczema of the anus is more commonly a disease of individuals who 
have passed the middle period of life, and is not uncommonly connected 
with piles. 
Treatment.—Cover the parts with lint, wet with lead lotion, and inclose 
them with oil-silk, in order to keep off the air, and to prevent urine get- 
ting upon the part. Give a small dose of hydr. c. creta at night, and a 
dose of castor oil in the morning : in a few days substitute zinc ointment 
for the lotion, and give small doses of liq. potassse, and five grains each of 
calomel and magnesia, twice a day. If it be of long standing, enjoin a 
strict diet, abstinence from fermented liquors, salted and heating articles 
of food, and give 20 minims of liq. arsenici et hydrarg. iodidi twice a day, 
with 5 grains of Plummer’s pill at bed-time, and apply a mixture of zinc 
ointment and the ung. plumbi acetat. to the parts by means of a piece of 
lint cut to the proper shape. The treatment must be persisted in for a 
length of time. A little extract of belladonna rubbed down with the 
ointment, often succeeds in allaying the irritation. 
Eczema of the Scalp.—[ Eczema of the scalp, however, appears to be 
the most commonly met with; for of all cutaneous diseases seated in this 
locality, as many as forty-three per cent, are cases of eczema. It is 
exceedingly difficult to remove : it occurs mostly in children, very rarely 
in adults. Mr. E. observes that,] 
Chronic eczema of the scalp, although presenting considerable variety in its 
characters, seems to resolve itself naturally into the three following species. 496 
SKIN DISEASE. 
1. Simple chronic eczema, which may assume either a moist or a dry 
form. 2. Eczema furfuracea, corresponding to the porrigo furfurosa of 
Willan. 3. Eczema amiantacea, which is an extreme condition of the 
last variety. 
Simple chronic eczema of the scalp may, as has just been stated, assume 
either a moist or a dry form. In the moist variety of the disease there 
is always a very copious discharge of a thin serous fluid from a number of 
small openings, the remains of former vesicles, that lie closely scattered 
on the inflamed and tender surface of the scalp ; this discharge, which is 
of an acrid and irritating nature, is apt to increase the inflammation in that 
part of the skin over which it flows. If it be very abundant the hair looks 
as if it had been soaked in a thin solution of gum arabic, being matted to- 
gether in locks, which have a dirty yellowish grey moist appearance, and 
between and under which the inflamed scalp may be seen pouring forth the 
discharge. As this lessens in quantity, soft yellowish-grey scabs will be 
formed, which gradually losing their moist appearance will be found to 
resemble those that characterize the dry variety of the disease. In the 
midst of this, acute attacks of eczema, attended by a great evolution of 
vesicles, by increased heat and redness of the scalp, frequently occur, 
adding very greatly to the severity and obstinacy of the disease; and the 
distress of the patient is very often greatly increased by a chronic inflam- 
mation of the eyes and ears, which is a common complication of this 
form of eczema. As the discharge lessens, and the inflammatory action 
subsides, the moist passes, in many cases, into the dry variety of chronic 
eczema. 
Treatment.—If occurring to a child, otherwise healthy, about the period 
of dentition, be careful how you check the eruption. Cut the hair, apply 
bread-and-water poultices, and subdue irritation by the application of rags 
dipped in olive oil, or smeared with zinc ointment; or sprinkle the part 
with the nurse’s milk. Give small doses of hydrarg. c. creta and castor 
oil, and lance the gums, if necessary. Fluid magnesia is often useful. If 
it becomes inveterate, wean the child on beef-tea, broth, and a nutritious 
diet, and give mild tonics, a few drops of tincture of ammon-chloride of 
iron, or iodide of iron, twice a day (from half a grain to two grains of the 
latter) ; a great part of the treatment consists in keeping the scalp so 
covered as to prevent the access of air. 
When it becomes chronic and inactive, and presents a furfuraceous ap- 
pearance, have recourse to gentle stimulants ; a lotion composed of from 
one to two drachms of sulphuret of potass, either alone or combined with 
an equal quantity of the carbonate of the same alkali, in a pint of plain, 
or of lime water ; wash the head with this lotion three times a day ; at the 
same time, every night after the last application of the lotion, apply an 
ointment composed of from a scruple to half a drachm of carbonate of 
potass to an ounce of lard, or of creasote in the same proportion, or of 
white precipitate; or use the ung. hydr. nit. dil., or the sulphur ointment, 
or a mixture of this and tar or of creasote ointment. Do not use the oiled- 
silk cap; it confines the perspiration and soddens the skin, producing a 
state of passive congestion which we wish to get rid of. 
Chronic Eczema of the Hands.—[ This generally arises from the direct 
application of irritating substances to the parts, as lime in bricklayers, 
sugar in grocers, potass or soda in washerwomen, mordants in dyers, or 
minute particles of steel in smiths, weelwrights, etc.] SKIN DISEASE. 
497 
The characters that this disease presents when attacking the hands are 
those assumed by chronic eczema in its worst and most inveterate forms. 
There is, in the first instance, an eruption of vesicles, which are most gen- 
erally small and pointed, projecting but slightly above the level of the skin, 
and which are at first confined to a small spot, usually on one of the 
knuckles, or on the back of one of the fingers, whence the disease gradually 
creeps on until the greater portion of the back of the hand may be involved. 
In some rare cases, however, these vesicles are large and prominent. 
[ The diagnosis is of importance, particularly if there has been no local 
irritant, as it leads to suspicion, more especially in the better classes of 
society ; it may be confounded with scabies and psoriasis.] 
From scabies the diagnosis is not always easy, though in the majority 
of cases it is not attended with any difficulty. In eczema the vesicles are 
usually small, agglomerated, and collected in clusters on the back of one 
or two knuckles, or in patches about the dorsal aspect of the hand; and 
occasionally we see a raw, excoriated, oozing surface, which is never met 
with in scabies. In scabies, on the contrary, the vesicles are generally 
large, more distinct, not clustered; and situated chiefly between the 
fingers at their roots, and not on the knuckles or back of the hand. In 
scabies also there is a peculiar pruritus, giving rise to an irresistible 
propensity in the patient to scratch himself. In eczema this is not the 
case, and the morbid sensation is of a smarting or burning character. 
The vesicular character of the disease is a sufficient guide in diagnosis, 
and when it becomes chronic, and assumes a furfuraceous appearance, it is 
of little practical importance, as the treatment is directed by the condition 
of the part, and the causes of the disease. The treatment is the same as 
when occurring in other parts, only the hand must be kept perfectly at 
rest. 
Treatment.—In the early stages apply water-dressing by means of oiled- 
silk gloves or finger stalls, and at a more advanced period, a solution of 
nitrate of silver (grain j. to the ounce), instead of the water-dressing; or 
a solution of carbonate of soda (grain ij. to iv. to the ounce) ; or the fol- 
lowing lotion: acid, hydrocyan., 5ss.; zinci oxidi, 3j.; aquae rosae, gviij.; 
or cover the hand with the ung. hydrarg. precip. alb., either alone or mixed 
with citrine ointment. 
If the disease only occupy a small patch, cover it with a slice of lemon. 
Its spreading may be checked by applying the solid nitrate of silver around 
the part. Constitutional treatment must also be adopted: remove any gas- 
tric, intestinal, or uterine disturbance, and give vegetable bitters, nitric 
acid diluted, or small doses of bichloride of mercury; the two latter may 
be given in infusion of bark. If the disease be of very long standing, give 
Fowler’s or Donovan’s solution. The hands should be kept at rest. 
Part xiii., p. 297. 
Chemical lleaction of Discharges in Eruptive Diseases.—In eczema 
and all eruptive diseases attended with more or less exudation, ascertain 
the reaction of the discharge upon test paper. If it is alkaline, apply 
nitric acid lotion (5ss. ad aquae Oj.) and give small doses of the same acid, 
in the compound infusion of orange, internally. If the discharge has 
an acid reaction, adopt the reverse of the above treatment. (Dr. J. Corfe.) 
Part xviii., p. 222. 
Eczema.—Apply a lotion containing bichloride of mercury, three grains 
voi\ ii.—32 498 
SKIN DISEASE. 
to the pint, five or six times a day. Or, apply water as warm as it can be 
borne. I'M. Trousseau.) Part xviii.,p. 223. 
Eczema.—In acute cases, says Dr. J. H. Bennett, the constitutional treat- 
ment is most important, and must depend upon the kind of constitutional 
affection; the disease being usually associated with either the oxalic, 
lithic, or phosphatic diathesis, or with a scrofulous taint. The local treat- 
ment here is of very subordinate importance. But in chronic cases, the 
local treatment is by far the most important, and should consist in the ap- 
plication of a solution of 5ij. of the subcarbonate of soda in a pint and a 
half of water; lint saturated with this solution being applied over the 
affected parts, and the whole covered with oil-silk. 
Dr. Burgess would direct the treatment chiefly to the constitution, giv- 
ing mild tonics and alteratives. Keep the parts cleanly, and when it is 
thought the discharge may be safely arrested, apply mild lotions contain- 
ing carbonate or bicarbonate of potash, and let the bath be frequently 
used. If these remedies are not sufficient, give active purgatives if the pa- 
tient is strong; or where these are not indicated, give sarsaparilla and 
hydriodate of potash; and employ lotions of nitrate of silver or bichlo- 
ride of mercury. If there is inflammatory tendency in the parts, apply 
a few leeches behind the ears. If there is much smarting, with abundant 
serous exudation, give sulphuric acid internally, beginning with a small 
quantity, administered in barley water, and a little cold water after each 
dose. 
Chronic of the Legs.—This disease, according to Dr. Burgess, is very 
difficult to manage, but is best treated by the application of the vapors of 
iodine and sulphur, assisted during the interim of the application by ban- 
daging from the foot upward. The best way to apply the vapor is the 
following: get a tin case or a common jar, large enough to hold the limb, 
and place a heated iron at the bottom of the apparatus, and a grating above 
it, to protect the limb. Place one of the powders, about to be mentioned, 
on the heated iron, put the limb instantly into the bath, and cover the 
mouth over to prevent the vapor from escaping; and continue the bath 
fifteen or twenty minutes. The powders consist of, sulphur, 5iij-; hydr. 
sulpli. rub., Bij.; iodin. gr. x.; divided into six powders. In a few days 
the proportion of iodine may be increased. 
When this affection is connected with a scrofulous constitution, give 
col-liver oil. Part xx., p. 168 
Acetate of Potash.—Recommended by Dr. Easton in half-drachm doses, 
three times a day, in eczema. Part xxi., p. 245. 
Local use of Alkalies in Treatment of Eczema.—A remedy which has 
been found more extensively applicable and more uniformly serviceable 
than any other, says Prof. Bennett, is a solution of two drachms of the 
sesquicarbonate of soda in a pint and a half of water; but it is necessary 
to place lint saturated with the solution over the affected part, and to cover 
the whole with oil-silk, in order to prevent evaporation. In these cases there 
is an increased exudation from the skin, both of sebaceous and purulent 
matters; and alkalies, we know, have the property of dissolving these, and of 
acting as a calmative and emollient to the irritated parts. Part xxii., p. 243. 
r 499 
SKIN DISEASE. 
Empyreumatic Coal Oil used in Eczema.—M. Lafont-Gouzi highly 
extols the virtues of the oil obtained by the distillation of pit-coal in the 
manufacture of gas, as a remedy in certain eczematous affections, and in 
itch. He has used the oil in the treatment of eczema impetiginodes, of 
itch, of prurigo, of psoriasis, of purulent ophthalmia, of keratitis, and 
of otorrhcea dependent on cutaneous eruption (otorrliees cle nature dar- 
treuse). M. Lafont mixes eight parts of empyreumatic oil with thirty parts 
of axunge, and spreads the ointment over the parts affected with eczema; 
he asserts that it is the most active of siccatives. In cases of prurigo and 
of psoriasis, he replaces the axunge with an oil of henbane containing 
opium (huile de jusquiaume opiaciee). If the disease proves obstinate, he 
uses the undiluted empyreumatic oil. Part xxiv., p. 257. 
Eczema.—Make an ointment as follows : Oil of juniper, giss.; suet, gss.; 
lard, giss. It should be applied locally to the part. Part xxxii., p. 186. 
Eczema, etc.—According to Dr. Godfrey, internal remedies are most 
useful, ointments are injurious. The tincture of the muriate of iron given 
three times a day he has never known fail. The parts should be daily 
washed with oatmeal gruel. Occasionally a little powdered starch with 
oxide of zinc will aid the cure. 
Professor Malmsten, of Stockholm, has used cod-liver oil externally very 
successfully in intractable skin diseases. If the whole skin be affected 
the patient must lie in bed, all the body and bed linen being saturated 
with oil; an alkaline bath may be allowed once a week, but no other 
washing or change of clothes until the skin is restored to health. 
Part xxxii., p. 186. 
Eczema.—The value of cod-liver oil in this obstinate disease is now 
almost universally conceded; it should be used in conjunction with other 
remedies. Part xxxii:., p. 236. 
Eczema Infantile.—[The great, the urgent symptom of this disease is 
the teasing, the intense itching, especially during the night; the child is 
often frantic with itching, it scratches with all its force, digging its little 
nails into the flesh, while the blood and ichor run down in streams.] 
For elimination, says Erasmus Wilson, you may give one grain of calomel 
with a little white sugar to the youngest infant; when older, give it in such 
a dose as will produce an efficient relief to the alimentary canal; this may 
be repeated once, twice, or three times a week, but generally once is suf- 
ficient. To alleviate the local distress, apply freely night and morning the 
benzoated oxide of zinc ointment over the whole of the inflamed skin ; this 
should be allowed to remain as a permanent coating until the skin is en- 
tirely healed; it will prevent the formation of crusts by the exclusion of 
atmospheric air. It is very important not to disturb the ointment, but at 
the same time it must not be allowed to accumulate too thickly. Washing 
is quite unnecessary, indeed it is injurious, and must be avoided. In 
chronic eczema infantile, that is, pityriasis capitis, the nitric oxide and 
nitrate of mercury ointment of various strengths are almost specifics. For 
the restoration of 'power the great remedy is arsenic. As an effective, 
harmless tonic, it stands alone and without its peer in this vexatious disease; 
indeed, it is specific, it cures rapidly, perfectly and unfailingly. Two 
minims of Fowler’s solution may be given three times a day to an infant 500 
SKIN DISEASE. 
from two months to a year old. It is very useful combined with iron as 
follows: 
R Vini ferri, sirup, tolutan, aa. §ss.; liq. potass® arsenitis, mxxxij.; 
aquae anethi, §j. M. Give one drachm three times a day after meals; if 
it appears to disagree it should be given less frequently or suspended. 
Cod-liver oil, in conjunction with arsenic, is a valuable addition. 
The following formula will be found convenient : 
R Olei jecoris aselli, §ij.; vitelli ovi, j.; liq. potass® arsenitis, mlxiv.; 
sirupi simplicis, 5ij.; aqu® fontan. q.s. ad §iv. M. ft. mist. A drachm 
three times a day. Part xxxiv., p. 199. 
Chronic Eczema in Children.—Dr. Behrend directs, first to get the 
scabs or crusts separated, by means of poultices, if the spots are limited, 
and are not settled on the head, face, and neck, where these applications 
are not suitable. Before applying them, it is a good plan to moisten the 
surface with a solution of carb. of soda (3ij. to gviii.) When the surface 
is large, a water dressing is to be preferred; a little sub-carbonate of pot- 
ash being added to the water. If situated on the head, face, or neck, 
paint the scabs over with a mixture of carb. of soda and cod-liver oil, re- 
moving the crusts carefully next morning, and moistening the surface with 
the alkaline lotion. This must be repeated as often as necessary, till crusts 
cease to be formed, and a red, inflamed, but painless surface is left. Next, 
we must remove this condition of the skin. One of the best means to this 
end, is the application of a solution of 3j. of acetate of zinc, and the same 
of acetate of lead, in gviij. of distilled water, adding to this, at the time of 
using it, an equal quantity of strong chamomile infusion. The last indica- 
tion is to restore the activity and healthy tone of the skin, by such hygienic 
measures as fresh country air, free exercise, a well regulated and whole- 
some diet, and such local applications as weak solutions of alum and sul- 
phate of zinc. Part xxxvi., p. 187. 
Eczema of the Face in Children.—Dr. Behrend recommends the fol- 
lowing application for the crusts which frequently cover the faces of 
children : Cod-liver oil, fifteen, and bicarbonate of soda, two parts. 
Part xxxvii., p. 182. 
Eczema—Acute.—Mr. Startin says, that the irritation of acute eczema 
wifi frequently subside most rapidly on slight ptyalism being induced. 
The bichloride of mercury is a good form for administration, and five 
or ten minims of colchicum may be given with each dose. 
Part xxxviii., p. 174. 
Eczema of the Scalp and Face in Children.—A fair-haired, blue-eyed 
child, aged two years, was admitted with that so common and so trouble- 
some form of eczema in which the whole face and scalp are involved, but 
the rest of the surface free. It had suffered since the age of six months, 
but excepting the irritation of the eruption its general health was not in- 
terfered with. Mr. Startin ordered as follows: 
Mistur® potasii iodid. §j., aq. §v. capt. 5j. ter die. 
The surface to be washed with the yolk of egg and water, and smeared 
with the nitric oxide of mercury ointment. Rapid improvement ensued 
in this individual case; and it may be taken as a fair illustration of the 
treatment usually adopted. In obstinate cases the compound iodide mix- 
ture, which contains arsenic, is often employed. 501 
SKIN" DISEASE. 
The formulae for the above-mentioned preparation are: of the mixture 
—a drachm of iodine, an ounce of liquor potassae, and a pint of distilled 
water, each drachm containing half a grain of iodine. Of the liniment— 
olive oil, two ounces; lard, two ounces; powdered nitric oxide of mer- 
cury, a drachm ; oil of bitter aknonds, half a scruple ; and glycerine, 5j- 
Part xxxviii., p. 174. 
HERPES. 
Dartres of the Perineum.—Dr. Barosh, of Lemberg, was consulted by 
a young man, about twenty-eight years of age, for a dartrous eruption 
affecting the perineum and scrotum, with which he had been afflicted from 
his sixteenth year, and the irritation from which was such as to cause him 
to be continually applying his hands there, so that he was obliged to avoid 
society. He had consulted the most famous physicians in Hungary, but 
the only thing that seemed at all to relieve him was the cold water hip- 
bath. When he consulted Dr. Barosch, he was exhausted by suffering, 
insomnia, loss of appetite, and despair; the skin was dry ; the entire 
perineum, scrotum, and internal surface of the thigh, were covered with 
deep brown, hard crusts, surrounded by bleeding fissures, caused by the 
nails of the patient. Below these crusts the skin was hard and thickened. 
The fall of the crusts alternated with an acrid discharge. Kcechlin’s 
liquor having failed, Dr. Barosch prescribed the external application of 
iodine as follows : Fifteen grains of iodine and two scruples of hydriodate 
of potass dissolved in five ounces of distilled water and one ounce of 
spirits of wine ; make a lotion. The topical application of this solution 
continued for several hours, caused at first a burning sensation, which 
was, however, very tolerable, and was soon followed by a relief such as 
the patient had not experienced for two years. The use of this lotion 
was continued for three weeks, the patient taking baths frequently during 
that period, at the end of which time the cure was complete. 
Part viii., p. 73. 
Herpes Squamosus.—The cyanuret and deuto-phosphate of mercury are 
occasionally employed. The former is said to be preferable to the bichlo- 
ride, being less apt to disagree, and less readily decomposed. It is a use- 
ffll external application in some skin affections, allaying the violent itching 
and irritation of what M. Alibert terms herpes squamosus. 
Part ix., p. 21. 
Treatment of Herpes Zostera.—The most soothing application, according 
to Dr. Corfe is freshly made ungt. hydr. ammonio-chlorid., smeared on 
the whole crop of vesicles, twice or thrice a day. Part xviii., p. 222. 
Arseniate of Iron in Herpetic and Squamous Eruptions.—Numerous 
facts accurately observed authorize M. Dupare in concluding that a daily 
dose of one-fifth of a grain of arseniate of iron, uninterruptedly repeated 
during the necessary time, is competent in the adult to effect the cure of 
an herpetic or squamous affection, however extensive or long-established. 
An anti-herpetic treatment by arseniate of iron in no degree excludes 
the employment of topical remedies of acknowledged utility, and it is 
materially assisted by the internal or external use of certain non-sulphu- 
reted mineral waters. Part xxx., p. 175, 502 
SKIN DISEASE, 
IMPETIGO. 
Devergie’s Solution of Arsenic.—Is composed of arsenious acid, ten 
grains; carbonate of potash, ten grains; distilled water, six pints and a 
half; alcohol, fifty minims: tincture of cochineal, as much as is required 
to color the mixture sufficiently. Each drachm of this solution is said 
to be equivalent to four drops of Fowler’s liquor arsenicalis. M. Devergie 
employs this remedy with advantage in long standing cutaneous erup- 
tions, particularly those of a squamous and impetiginous nature. IIo 
indicates, as a constant result and symptom of cure, the appearance of 
dark brown spots on all parts of the skin previously diseased, which per- 
sist for some months afterward. Part ix., p. 86. 
Impetigo.—In acute cases, says I)r. II. Bennett, treat the particular con- 
stitutional state wThich may accompany the eruption ; the local treatment 
being unimportant. In chronic cases, on the other hand, be particular 
about the local treatment. Apply lint saturated with the solution of sub- 
carbonate of soda (3ij. to Oiss. of water), and cover it with oiled silk. 
"When this affection seems connected with the scrofulous diathesis, give 
cod-liver oil. Partxx.,p. 286. 
Impetigo.—Apply the saturated solution of gutta percha in chloroform, 
by means of a camel’s-hair pencil, over the patches daily. 
Part xxvi., p. 128. 
Impetigo and Eczema.—Dr. Hughes Bennett keeps the parts moist 
with lint saturated with a solution of half a drachm of carbonate of soda to 
one pint of water, covering this with oil silk. For favus, first remove 
the crusts by poulticing, then apply oil to exclude the atmosphere and 
prevent the growth of the parasitic fungi. These remedies should be con- 
joined with cod-liver oil and generous diet. Part xxxiv., p. 197. 
Ichthyosis Fortuita.—Dr. Thomson considers that in the treatment of 
these cases, there are three indications to be fulfilled: 1st. Augment the 
action of the capillaries of the skin, by giving small doses of blue pill and 
emetic tartar; liquor arsenicalis; cantharides in decoction of rumex 
obtusifolius, made by boiling an ounce of the sliced root of the common 
dock in a pint of soft water; dose gij. 2d. Improve the secretions 
generally, by generous diet, as milk, vigorous exercise in the open air, etc. 
3d. Aid the action of the two former by topical means which stimulate 
the skin, and assist the separation of the diseased papillae by warm baths, 
friction, etc. Bart xiv., p. 254. 
ICHTHYOSIS. 
ITCH. 
Treatment of the Itch in Belgium.—The following circular was addressed 
to military surgeons by the Inspector-General of the Belgian army: 
Each patient is to be supplied with an ounce or an ounce and a half of 
liquid sulphuret of lime in a small pot; this quantity he is to rub carefully 
and slowly with his hands on every part that is covered with papulae. If 
there be any papulae on the back, another patient is to rub the liquid upon 503 
SKIN DISEASE. 
that part. The operation is to be repeated three times in the twenty-four 
hours, so that each patient consumes three or four ounces of the sulphuret 
daily. A bath is to be taken every alternate day; the frictions are to be 
suspended on that day. Fifteen frictions (or ten days’ use) are usually 
sufficient for the cure of the disease, if the medical officer in charge sees 
that the remedy is properly used. Part x.,p. 9f 
Treatment of Itch.—Immerse the hands of the patient in an alcoholic 
solution of stavesacre for half an hour together, two or three times, and 
the acarus scabiei will be destroyed. (Dr. Burgess.) Use a lotion made 
of an ounce of sulphate of copper to a pint of water: wash off the scabs 
before using it. It is an almost certain cure. (Mr. Lloyd.) Use a lotion 
of iodide of potassium in the day, and sulphur ointment at night; a cure 
may be expected in seven days. The lotion should be 5j. of iodide 
to §viij., or §xvj. of fluid. (Dr. Ward.) Part xiii., p. 307. 
Treatment of Scabies.—[Mr. Corfe states that he rigorously pursues the 
following plan with a patient affected with itch:] 
We provide him with old soiled linen and a worn out sheet; and each 
morning and evening he is ordered to make a good lather of yellow soap 
in his hands, and thus dip them wet into a basin of sifted or fine sand, 
and assiduously rub every part of the body on which the slightest trace 
of a vesicle exists. Having performed this ablution until the skin tingles 
smartly, he wipes himself dry, and then rubs the common ung. sulphuris 
firmly into the itchy parts. He is then enveloped in the winding sheet, 
and has a pair of old gloves on his hands, and he is left till night, when 
the same operation is pursued, and repeated daily until the fourth day, 
when he is ordered to indulge (and a great indulgence it is) in a warm 
bath, where he again lathers his body in plain soap and water, puts on fresh 
linen, and is provided with clean sheets, and the cure is from thence 
invariably effected. The vesicle of course is broken by the friction 
of the sand and soap; the acarus is exposed, and this ectozoon receives 
its death-blow by the inunction of the sulphur, which is oftentimes not 
accomplished by the mere application of sulphur ointment alone. The 
use of sand-soap balls is more elegant, though not more efficacious. 
Part xviii., p. 223. 
Treatment of Itch.—Use a sulpho-alkaline ointment. If there is a great 
abundance of pustules, and this excites too much pain, use frictions of lard 
and oil. Another ointment recently tried cures in three frictions, soothes 
the itching instantly, and does not give rise to any secondary eruption. 
It is composed of equal parts of fresh chamomiles, olive oil, and lard. M. 
Bourgignon makes an ointment by mixing 300 parts of the powder of 
staphysagria to 500 of lard, keeping it at a temperature of 100° C. for 
twenty-four hours. The frictions to be made four times a day, the cure 
being complete by the fourth day. Part xxiii., p. 291. 
Itch— Cured in Two Hours.—In the Hospital of St. Louis, Paris, the itch 
is cured in two hours. The patient is first put into a warm bath, and 
rubbed for an hour with yellow soap. He then passes into a clean bath, 
w'here he continues to cleanse his skin for another hour. After leaving 
this, one of his fellow-sufferers rubs him over for half an hour with the 
following ointment: Axunge eight parts, flowers of sulphur two parts, 
and carbonate of potash one part. The patient is then examined, and sent 504 
SKIN DISEASE. 
away cured, though sometimes pretty numerous vesicles on the hands and 
elsewhere remain unaltered. Part xxv., p. 265. 
Scabies, and other Parasitical Piseases of the Human Skin.—The vapor 
of benzoin, or benzole, which is prepared by the decomposition of benzoic 
acid, destroys parasites, says M. lieynal, more surely than almost any 
other application. It may therefore be used in pityriasis and scabies most 
effectually. Part xxxi., p. 196. 
Itch— Curedin Half an Hour.—Sulphur applied in a liquid form, says Dr. 
E. Smith, is more readily absorbed, and consequently more certainly de- 
structive to the insect than when used in the form of ointment. To pre- 
pare a solution, boil one part of quick lime with two parts of sublimed 
sulphur in two parts of water, until dissolved. The body should be pre- 
viously washed with warm water, and then this solution rubbed in for half 
an hour. By this time the cure will be complete, and it will only be 
necessary to wash and use clean clothes. Part xxxiv., p. 195. 
Treatment of Scabies by Sulphuret of Calcium.—A much more speedy 
and cleanly method of treating this loathsome disease than the filthy pro- 
ceeding of inunction, says Dr. Ivesteven, is to wash the parts affected with 
a solution of the sulphuret of calcium for half an hour night and morning. 
It is rarely that a third application is necessary, but it should be enforced 
to make security doubly sure. Part xxxiv., p. 196. 
Itch.—Instead of the sulphur ointment, Dr. Fischer recommends a lotion 
of caustic potass, 1 part; distilled water, 12 parts. Part xxxv.,p. 158. 
Bourgignori’s Treatment of Itch.—After the trial and comparison of 
the various modes of treatment, M. Bourgignon accords the preference to 
the following formula: Glycerine, 50 drachms ; finely-powdered sulphur, 
25 drachms ; 2 yolks of eggs; and tragacanth powder, q. s.; adding 
essences to mask the smell. Part xxxv., p. 331. 
Scabies.—The diagnosis of this disease is occasionally difficult; it will be 
much facilitated by the knowledge of the fact, that the ova of the acarus 
may be readily found with the microscope, attached to the roughened and 
undermined cuticle in the neighborhood of the vesicles. 
Part xxxvi., p. 191. 
Parasticides.—The following is the formula of the Hospital for Diseases 
of the Skin for the “ compound sulphur ointment ” which is in general 
use against scabies, favus and true ringworm, diseases which depend upon 
parasites, which it is necessary to kill: R Of sublimed sulphur, half a 
pound; of the ammonia chloride of mercury, half an ounce; and of the 
sulphuret of mercury, half an ounce; to these, well rubbed together, add 
four ounces of olive-oil, sixteen ounces of fresh lard, and twenty minims 
of creasote. It will be seen that we have here in combination three 
different drugs, each possessing great efficiency in the destruction of 
insect and fungus life. The object in view, that of obtaining a vigorous 
compound, which at the same time shall not be irritating to the skin, is, we 
believe, exceedingly well attained. Part xxxvii., p. 315. 
LEPRA. 
Bark of the TJlmus Campestris (or Elm).—Dr. Sigmond thinks favor- 
ably of the use of the decoction of elm-bark, both internally and externally, SKIN DISEASE. 
505 
in all varieties of lepra, and in other scaly affections of the skin. Four 
ounces of fresh elm-bark, bruised, boiled in four pints of water, form a 
thick decoction. 
The best time to gather it is in the spring, and the most desirable parts 
are the smaller branches and twigs. The inner bark abounds with a 
mucilaginous principle (which disappears on boiling too much). Dose of 
the decoction, from two to four ounces, three times a day. 
Dr. S. says : I have likewise found it very serviceable in tinea capitis, 
and more especially when it has been used as a wash externally. In those 
extensive papulous eruptions, known by the name of lichen, which usually 
terminate in scurf, the lichen simplex, which attacks the face and skin 
sometimes periodically, very quickly yields to the remedy; and in the 
milder cases of erysipelas, when the constitution has not in any way par- 
ticipated, I have been in the habit of using this remedy with a success 
that has now enabled me to lay the result of my observations before you. 
In those affections of the skin where the papulae are in a state of high 
irritation, amounting to inflammation, I have uniformly found lotions or 
applications of mercurials, such as the unguentum hydrargyri nitratis, or 
ointments of lead, to be rather injurioiis than beneficial; in such cases it is 
that I have observed so much benefit from the bark of the elm, internally 
taken, and externally applied, and in almost every stage of cutaneous dis- 
ease. There are likewise some states of the skin in which papulous erup- 
tions and erythematic blushes are indicative of diseased states of the internal 
mucous membranes, and likewise of various dyspeptic symptoms. Thus 
we observe where leucorrhoea exists, or where disease has been induced 
by dram-drinking, that redness of the skin, and disordered functions of 
the skin are visible ; in such instances the use of the elm-bark for some 
weeks, with attention to diet has been productive of the best consequences, 
and I have had the satisfaction of seeing some of those eruptions, which 
have for years baffled every attempt of the medical men, yield to a deter- 
mined course of the elm-bark. It is of importance to continue it for some 
time, and to attend to the state of the bowels during the period in which 
it is taken. The state of the urine should be carefully observed; and it 
will be found that, after some little time, much acid will become developed, 
which most probably is determined from the blood, and would have been 
deposited in the skin and have produced some of the disordered states 
which the elm-bark appears destined to avert. Part i., p. 61. 
Lepra.—Dr. Ross says: The iodide of potassium has been used exter- 
nally in almost all cutaneous diseases. From some experiments lately 
made with regard to its destructive power over the itch insect, it has been 
recommended for the cure of scabies. M. Schedel states, that the speediest 
cure of this complaint is effected by an ointment containing 5ss. to §j. of 
axunge. 
Dr. A. T. Thomson recommends an ointment composed of hyd. potass. 
5iss., to axunge giss., with tinct. opii 5j-, in lepra; this, conjoined with 
appropriate internal treatment, has a very good effect; but, from a com- 
parative trial, I think it inferior to another ointment recommended by the 
same author, viz.: 
R Calomelanos, 5j- ; unguent picis, 3iv.; unguent cetacei, 3j. M. 
Part vi., p. 122. 
Lepra, Psoriasis, Lupus, Acne, Eczema Chronica, Impetigo, Prurigo, 506 
SKIN DISEASE. 
Lichen.—In the treatment of these and all chronic affections of the skin, 
which are not venereal, nor dependent on local causes, Mr. Hunt advises 
to first, reduce inflammatory action by depletion and antiphlogistic regi- 
men ; then administer arsenic, beginning with five minims of the liquor 
potassjc arsenitis thrice a day, -with the meals, until the conjunctiva is 
inflamed ; afterward reduce the dose to four minims, keeping the eyelids 
slightly sore and weeping. The whole success of this treatment (which 
seldom or never fails in any of the above diseases), depends upon the con- 
tinued and persevering use of the medicine, which is perfectly harmless, 
when administered with vigilance under these restrictions. 
Part xiv., p. 247. 
Lepra—Treatment of.—In obstinate cases of lepra, use fumigation with 
sulphur and iodine vapors. 
When the functions have all been got into a healthy state, and the sys- 
tem is free from inflammatory action, begin with Fowler’s solution of 
arsenic, in four or five minim doses, taken thrice a day upon a full stomach ; 
and, without increasing the dose, continue this plan steadily till the 
system is brought under the influence of the remedy. Continue the me- 
dicine for some time after the disappearance of the eruption. (Dr. Griffith.) 
Let sti’ong tar ointment (£ to i of tar) be rubbed in gently thrice a day; 
while a tepid bath is used once or twice a week. And give Fowler’s solu- 
tion of arsenic, beginning'with five drops daily and increasing a drop every 
other day, until twelve or fifteen are reached. (M. Emery.) 
Part xx., p. 174. 
Syphilitic Lepra.—Dr. R. B. Todd would give five grains of blue pill 
night and morning, thus affecting the system slowly and gradually by a 
mild and unirritating preparation of the mineral. Iodide of potassium 
favors the mercurial influence, at the same time exercising some specific 
antidotal power of its own. Hyper-salivation, violent iodism, irritation of 
the boAvels and of the skin, and peculiar nervous affections are produced 
when too much of these minerals is thrown into the system, with a desire 
to produce a rapid effect. We may -withhold them lor a time, renewing 
them again as occasion may suggest. It is sometimes much more desirable 
to introduce mercury also by the skin than by the stomach. Tar is also 
one of the safest remedies—the pix liquida. It may be given internally in 
capsules, or applied externally, or both. Fifteen or twenty minims may 
be taken three or four times a day, at the same time the patient may be 
tarred over the surface, and lie in tarred sheets. This is exceedingly 
useful, though scarcely available in private practice. Part xxiii., p. 322. 
Lepra and Psoriasis—Sesquicarbonate of Ammonia in.—M. Cazenave, 
so well known as a very successful dermatologist, has published experi- 
ments tending to show that sesquicarbonate of ammonia may advan- 
tageously be used as a succedaneum of arsenical preparations, in lepra and 
psoriasis. 
Give the sesquicarbonate of ammonia in the following manner: Sesqui- 
carbonate of ammonia, 3ss. ; diaphoretic sirup, §vij.; take one to three 
tablespoonfuls per diem. If diarrhoea, lassitude, cephalalgia, and rapid 
alternations of heat and cold were to occur, the remedy must be suspended. 
Part xxv., p. 205. 507 
SKIN DISEASE. 
Lepra Vulgaris.—Dr. J. S. Taylor directs an alkaline bath once a week, 
and thin oatmeal gruel instead of soup. Give half-grain doses of iodide of 
potassium, and three minims of Fowler’s solution three times a day, and 
apply night and morning, an ointment composed of the nitric oxide of 
mercury and lard, with a few drops of creasote added. 
Part xxvi., p. 284. 
Scaly Disease of the Shin.—In these and scrofulous and cancerous dis- 
eases the galium aparine is proving very valuable. Mr. Hooper prepares 
an inspissated juice, a tea spoonful equalling half a pint of the decoction : 
3j. of this juice may be taken three times a day. Part xxix.,p. 47. 
Lepra Inveterata.—In the treatment of this most obstinate affection, 
says Dr. Willshire, much will be gained by a proper regulation of the diet. 
Bread, milk, eggs, and vegetables, as potatoes, water cresses, etc., should 
alone be allowed, and all alcoholic drinks avoided. A warm bath twice a 
week is of the greatest use. The medicinal means principally of use are, 
arsenic, bichloride of mercury, and iodine, for which the decoction of elm 
bark forms a good vehicle. An ointment containing calomel and pitch is 
one of the best local applications. Part xxxix., p. 230. 
PEMPHIGUS. 
Dr. Bennett, Mr. Skey and Mr. Startin believe that arsenic is almost a 
specific remedy in the worst cases of this disease, as it -remedies the 
unknown constitutional cause upon which the disease depends. It does 
not prevent the liability to return, but it renders the attacks less severe 
than the original one. Part xxix., p. 249. 
PITYRIASIS. 
Treatment of.—Dr. Startin recommends external applications of a 
soothing nature ; baths medicated with mucilage of linseed, milk, yolk of 
egg, etc.; at the same time give demulcents, diuretics, etc., to increase the 
renal secretion. Cover the parts over with glycerine ; it remains fluid, 
and resists evaporation under any temperature to which the body is 
exposed. Part xiii., p. 306. 
Pityriasis, Herpes, Eczema.—M. Cazenave uses a lotion composed of 
one part of alum, and sixty-two parts of water. In the slighter forms of 
acne, lichen, pityriasis, herpes, and even in eczema, a simple acidulated 
lotion. In impetigo, after the crusts have fallen off, the following appli- 
cation of alumina : Alum, eight grammes; infusion of Provence roses, live 
hundred grammes. Gowland’s solution, or Bateman’s mercurial emulsion, 
however, answer very well. M. Cazenave uses the following : Bichloride 
of mercury, ten centigrammes ; hydrochlorate of ammonia, ten centi- 
grammes ; almond emulsion 250 grammes ; make a solution. In really 
chronic eczema he uses the following lotion: Acid nitric, twenty-five 
drops; acid muriatic, twenty-five drops; distilled water, three hundred 
grammes. Mix by shaking. Part xiv., p. 253. 
Pityriasis.—Pityriasis is closely allied to psoriasis. Dr. Wright says: 
Psoriasis is prone to affect the muscular parts of the body; pityriasis 
chiefly shows itself upon the scalp, forehead, and face. You saw a very 
good case of both diseases in the person of a man named Hines, who came 508 
SKIN DISEASE. 
into the top ward of tlie hospital on the 28th of November last year. His 
arms, and hands, and legs were extensively covered with patches of pso- 
riasis : the upper part of his face, his forehead, and scalp were completely 
dusted with the peculiar dandriff of pityriasis. Both, here, occurred in 
the same individual, and merely different in their relative intensity. The 
man was a brass-founder, and had lately been out of work, and indifferently 
fed. The disease was of five weeks’ duration. He was ordered generous 
diet, and half-a-pint of ale daily. 
R. Decoct, dulcamarse, gviij.; potassa?, liq. arsenicalis, aa. §j.; misce fiat 
mist, cujus cap. coch. ampla duo ter die. 
R. Pil. coloc. c., Bij.; extr. hyoscy., Bj. Misce et divide in pil. xij. qua- 
rum cap. ij. omni nocte. 
This was all the general treatment the man had, and on the 23rd of 
December he left the hospital well. Five days less than a month, he was 
under medical management, and at the time of his departure there was not 
a trace of skin disease about him. It is probable that the medicines ad- 
ministered to this patient rendered him some service ; but perhaps the 
greater service was due to his improved mode of living. 
Part xvi., p. 221. 
Pityriasis Capitis.—Dr. Winsar recommends the following lotion: 
Fresh sulphuret of potash, 5j., distilled water, giij. It may be used once a 
day. Part xxviii., p. 330. 
Pityriasis Versicolor Curable by Local Applications.—This common 
disease known vulgarly as “ Liver spots,” and in the Nosology of Wilson 
as Chloasma, is one generally acknowledged to be of extreme intracta- 
bility. Mr. Paget, we notice, among his out-patients at St. Bartholomew’s, 
does not adopt any constitutional treatment whatever, but simply orders a 
wash of the bichloride of mercury (gr. j. ad §j.) He informs us that he 
has never known a case long resist the influence of this remedy regularly 
applied to the whole affected surface once in the day. At the Skin Hos- 
pital, although an arsenical course of internal medication is always pre- 
scribed at the same time, yet a mercurial lotion is also used, and may 
possibly be the chief curative agent. In the hands of Dr. Jenner, at the 
University College Hospital, the sulphuric acid has, we understand, suc- 
ceeded very well. There can be little doubt but that the disease is almost 
invariably curable by local applications solely (parasiticides ?) In relation 
to this mode of cure, it is important to connect the observation of Eich- 
stedt and others, as to the eruption depending on the presence of a crypto- 
gamic plant. Another interesting link in the same chain of evidence has 
recently been made out at the Skin Hospital, namely, that it is not 
unfrequently contagious. Part xxix., p. 250. 
Cocoa-Nut Oil Ointments.—Use of, in Pityriasis. Vide Art. “Medi- 
cines.” 
PRURIGO. 
Prurigo Senilis.—[This disease is well known to be very intractable, and 
is indeed set down by many authors as incurable; hence the treatment 
usually recommended is merely palliative, and consists in the use of simple 
salt or sulphur baths, lotions containing sulphuret of potash, or corrosive 509 
SKIN DISEASE, 
sublimate, cinnabar fumigations, etc. Dr. Bellingham thinks that a good 
deal may be done by treatment. He says :] 
Constitutional remedies appear to have little effect upon purigo; our 
principal reliance therefore must be upon local measures. The local appli- 
cation which I have found most generally useful, both in relieving the in- 
tolerable itching, and in curing the disease, is creasote, either in form of 
ointment or of lotion, usually the former. The ointment may be made 
with from ten to twenty drops of creasote to the ounce of lard, the lotion 
with from twenty to thirty drops of creasote to the half-pint of water, a 
little spirit of wine or acetic being added in order to render it more 
soluble. The ointment to be useful should be well rubbed into the parts 
every night, and a very few applications will in general relieve the itching, 
prevent the development of fresh papula1, while the old ones will gradu- 
ally desquamate. If the application of the ointment is premised by the 
warm bath, and if the patient attends to personal cleanliness, the remedy 
will be more likely to prove quickly successful. Part xvi., p. 223. 
Treatment of Prurigo Pudendi.—Dr. Corfe says: Prurigo, where it 
attacks the pudendum or scrotum, is oftentimes more effectually soothed 
by a lotion composed of two or four drachms of the terchloride of carbon 
or chloric ether, in a pint of distilled or elder-flower water, than any other 
application that I am acquainted with ; at the same time a warm bath 
administered every evening affords a calm and refeshing night’s rest. 
Part xviii., p. 222. 
Treatment of Prurigo—Prurigo Pudendi (and other Species).—In those 
severe cases which are not benefited by our treatment, Dr. Burgess gives 
strychnia, beginning with one-sixth of a grain twice a day, and increasing 
the dose to one-fourth of a grain. Occasional doses of tincture of henbane 
may also be given. 
Senilis.—Give phosphorus internally, in the form of phosphorated ether, 
having preceded it, for a day or two, by repeated doses of tincture of 
hyoscyamus. [The dose is not stated; but the dose of the tinct. aether, c. 
phosphoro of the French, is, according to Pereira, from 5 to 10 drops.—• 
Part xix., p. 199. 
Prurigo of the Genital Organs.—This affection (which often assumes 
the form of lichen or eczema) is well known to be very painful, distressing, 
and difficult to remove. M. Tournie has lately proposed calomel ointment, 
and a powder of camphor and starch, which topical applications he has 
used with much success. When the parts (genital organs, anal region, or 
axilla) are covered with scabs, tepid baths, and emollient applications are 
to be used first. When the indurated particles are removed, the affected 
spot is to be rubbed twice a day with the calomel ointment (one or two 
drachms of the calomel to one ounce of axunge), and after each application 
dredged with the powder (four parts of starch to one of finely powdered 
camphor). We mention M. Tournie’s treatment as this kind of prurigo so 
often baffles the remedies usually employed. Part xxy.,p. 247. 
Colchicum in Prurigo.—Dr. Elliotson gives the case of a man, laboring 
under this disease in its most inveterate form, to whom half a drachm of 
vinum colchici was administered thrice daily. This the patient took for 
three weeks; at the end of which time he was completely cured. 510 
Colchicum would thus seem to answer well in some cases of skin diseases 
where the urine is of low specific gravity. Part xxv.,p. 264. 
Prurigo—Starch in Skin Diseases.—M. Cazenave substitutes powdered 
starch for poultices, especially in pruriginous affections, either simply 
dusted over the part, or applied after the latter has been well cleansed by 
an alkaline solution and thoroughly dried. The starch may be used sim- 
ply, or mixed with oxide of zinc, camphor, etc. M. Cazenave treats acute 
eczema, acne rosacea, impetigo, and herpes, by dusting the affected 
regions, night and morning, Avith the following poAvder—White oxide of 
zinc, tAvo drachms; powdered starch, four ounces. Very good results 
have been obtained in prurigo of the genital organs, the groin, or the axilla, 
Avith the following powder : White oxide of zinc, tAvo drachms; camphor, 
half a drachm ; poAvdered starch, four ounces. 
Prurigo Ani et Vaginae.—Dr. Richart recommends the folloAA’ing: Take 
equal parts of sulphate of zinc and of alum, roughly powder them, and 
put them into a glazed earthenware vessel; put it on a slow fire and leave 
it there till bubbles of air are no longer disengaged, and till the mixture 
acquires a stony hardness ; then powder it, and throAv it by small portions 
at a time into boiling water. Filter, and apply to the parts Avith a sponge 
and on linen. Part xxx., p. 228. 
PSORIASIS. 
Psoriasis—Liquor Ilydriodatis Arsenici et Ilydrargyri.—[In a pre- 
A'ious number of the “Dublin Journal,” Mr. Donovan gave some account 
of a new chemical compound, consisting of iodine, arsenic, and mercury, 
and the diseases in which it would be found beneficial, namely, psoriasis, 
iepra, and lupus. He noAV presents to us the experience of some of the 
most eminent men in Dublin. Mr. Carmichael states that:] 
I have tried the liquor hydriodatis arsenici et hydrargyri, in five or six 
cases of lupus, and in one case of psoriasis, AA’ith decided benefit in all. 
In one case of lupus, of ten years’ standing, in Avhich great deformity had 
been occasioned by the disease on the features of a young lady, on Avhom 
all the usual remedies had been tried, it produced most decided benefit, 
and seemed to put an immediate check to the progress of the malady. She 
is not yet perfectly well, but sufficient advantages have ensued to promise 
recovery. In one of my lectures I stated the case of a man who had lost 
a great part of the vomer, and in whom much deformity had consequently 
ensued from an obstinate attack of lupus, Avho in the course of a feAV weeks 
so far recovered, as to be discharged from the hospital apparently well. 
I perceive there has been no relapse of the disease, as he Avas told to return 
to the hospital should any suspicious symptoms make their appearance. 
In the case of Mr. , affected with psoriasis, although the disease had 
existed for years, most decided benefit generally folloAA ed the use of the 
preparation in question, so that nothing but discoloration of the skin re- 
mains where scaly spots Avere formerly manifested. 
[Dr. Lwing’s case is the most interesting, not only on account of the 
virulence of the disease, but also because he had tried in different cases the 
separate ingredients of the liquor hydriodatis arsenici et hydrargyri Avith- 
out their having gained his confidence. In relating this case he says :] 
On examination, I found his legs and arms thickly covered with large 
spots of psoriasis, much inflamed, and itchy. He said they Avere in- 
creasing rapidly in number, and that some had made their appearance on 
bis body and forehead during the last few days. 
SKIN DISEASE. SKIN DISEASE. 
511 
I directed that he should be blooded to twelve ounces, and ordered him 
some aperient medicine which he was to continue for a week. These means 
afforded him some relief; the eruption was less itchy and less inflamed. I 
directed him to continue the aperient medicine, and to take twelve drops 
of liquor potassae three times daily. 
It would be tedious to relate the entire history of this case ; it is suffi- 
cient to say, that he took various remedies, Dulcamara and Plummers’s 
pill among the number, without any benefit unless temporary relief from 
itching. 
From the experience of many cases which I had treated without perma- 
nent benefit at the Maison de Sante, with Fowler’s solution of arsenic, 
iodine, and mercury, separately administered, I was inclined to doubt 
their efficacy; I therefore determined to try the compound of these three. 
On the 11th of February we commenced the solution. 
He took a draught containing 3ss. of liquor hydrioclatis arsenici et liy- 
drargyri three times a day from this date to the 28th of April. Twice 
during that period I found it necessary to stop the medicine for two or 
three days, and to give an opening draught, from his having complained of 
headache and sickness of stomach. 
On the 28th of April the disease was quite cured, nothing remaining but 
a stained appearance of the skin. 
Venereal Eruptions.—Mr. Cusack states a new and different application 
of the arsenico-mercurial compound, which he employed with considerable 
success. He found that venereal eruptions rapidly yielded to scruple or 
half drachm doses three times a day, that is to one-quarter of a grain of 
protoxide of mercury, and one-eighth of a grain of arsenic, or thereabouts, 
in the twenty-four hours. This indeed is a very small quantity of mercury 
to effect a rapid cure with : no one will deny that the less of it that will 
answer the purpose the better for the patient: and here again we perceive 
the effect of chemical combination, assisted no doubt by solubility. Mr. 
Cusack writes: 
“ I have unfortunately omitted to make notes of the cases in which your 
valuable remedy, the liquor hydriodatis arsenici et hydrargyri, was admi- 
nistered, and am only able to state generally, that I have used it freely in 
secondary venereal eruptions, both papular and scaly. I found the erup- 
tions yield rapidly to its administration in the dose of one scruple to two, 
three times each day. In two instances the mouth became tender, and a 
slight salivation followed; but in no case have I observed any unpleasant 
consequences, even when taken in larger doses.” Part ii., p. 50. 
Uses of some of the Combinations of Iodine.—In the paper before us, 
by Mr. Osbrey, the effects of some of the combinations of iodine are inter- 
esting. He begins with the liquor hydriodatis arsenici et hydrargyri, in a 
case of inveterate psoriasis. The patient, Susan A., aet. 9, was affected 
with diffuse psoriasis which engaged almost her whole body, the scales on 
the extremities being continuous and remarkably thick. The following 
mixture was given : 
R Aquae destillat., §viij.; liq. hydriodat. arsen. et hydr., gtt. 80; tinct. 
zingiber., §ss. 
• Sumat unciam misturae omni tertia hora. 
Sickness of the stomach was at first produced, which soon subsided on 
desisting from the medicine for a few days. In ten days the eruption 
began rapidly to decline upon the trunk, and the thick scales to loosen upon 512 
SKIN DISEASE. 
the extremities. The separation of the scales on the head was accelerated 
by applying an ointment consisting of equal parts of tar and dilute citrine 
ointments. “ In five weeks from the commencement of the use of these 
remedies she improved in health, but after that period her appetite de- 
clined ; she fell away in flesh, and her countenance became pallid. The 
use of the mixture was of course discontinued. All traces of the eruption 
had then disappeared from the surface of the trunk, and only a few patches 
remained on the extremities.” She then went into the country, took tonic 
medicines, and soon recovered her health. The mixture was again com- 
menced, and in three weeks no trace of the disease remained. 
The iodide of potassium, Fowler’s solution of arsenic, mercurial altera- 
tives, sarsaparilla, guaiacum, and other medicines had been previously tried 
in vain. At the same time we think that every practitioner ought to exer- 
cise the greatest caution in every case where he is using the above mixture, 
as in the case here related we perceive that the patient’s health was at first 
materially injured for a time. Three other cases of scaly eruptions were 
treated in the same way. One was affected with several thick scaly 
patches on the extremities for twelve months previously. These disap- 
peared when she had used the medicine about three weeks. The separa- 
tion of the scales was here also assisted by the tar and citrine ointments. 
Twenty-five drops of the mixture were given three times a day without 
producing sickness. Part vi.,p. G3. 
* 
Concrete Naphthaline in Psoriasis.—Dr. Emery, of the Hospital St. 
Louis, had his attention turned to the investigation of the different pro- 
ducts of tar as remedial agents in the treatment of skin diseases, on ac- 
count of the successful results he obtained from the use of tar, and because 
of the unpleasant odor it gave forth. Various preparations were had re- 
course to, the most valuable of which proved to be the concrete naphthaline 
which Dr. Emery tried in fourteen cases. In two cases, one of psoriasis 
gyrata, and the other lepra vulgaris, it failed in effecting any good ; in the 
remaining twelve it proved more serviceable. In two of the cases, lepra 
vulgaris of from fifteen months to two years’ duration, arsenical and iodic 
preparations had been previously tried ; in the younger patient the arsenic 
at first seemed to do good, but the improvement soon ceased. An ointment 
prepared with two scruples of concrete naphthaline to thirty of lard was 
applied, causing the scales to fall off, leaving the skin of a violet color, with 
white circles around. A perfect cure was effected in six weeks, and 
although three months have passed since, there has not been any relapse. 
In four other cases the men were laboring under inveterate psoriasis; in 
one of them it had existed sixteen years, and had resisted arsenical, iodic and 
mercurial treatment. The tar ointment was had recourse to, and with de- 
cided advantage, but the man becoming impatient on account of his busi- 
ness, an ointment of naphthaline, twice the strength of that used in the 
preceding cases, was spread on compresses, and applied over the diseased 
parts night and morning. The man was cured in six weeks. When the 
ointment was applied too strong, it caused a burning heat, which was soon 
removed by emollient baths and poultices. The other six cases were also 
instances of psoriasis cured by the naphthaline ointment. Dr. Emery states 
that this remedy has an unpleasant odor, which passes off, and it is apt to 
irritate the skin and cause erysipelas if it be not carefully watched. 
Part vii., p. 171. SKIN DISEASE. 
513 
Psoriasis: 
If dependent on strumous diathesis, Dr. Graves uses cod-liver oil, made 
into an emulsion with sirup, mucilage and orange-flower water. Insert one 
or more issues at a distance from the part affected; and let the patient use 
warm baths with two gallons of size added to the water, or an equivalent 
quantity of isinglass, or calf’s foot jelly. 
Of the /Scalp.—Use hot-air sulphur baths for fifteen or twenty minutes 
daily, and apply the following ointment at night: R Hydrarg. biniod., 9j.; 
adip. ppt. §j.; ol. limon., gtt., v. M. 
Or, give hydrarg. bichlor. gr. one-sixteenth dissolved in sp. vin. rect., 
3ss., thrice a day with decoction of bark and sarza, and apply dilute citrine 
ointment, with a third part of ung. cerse alb. Part xv., p. 256. 
Acetate of Potash in Psoriasis.—Give acetate of potash in doses of 
half-a-drachm three times a day. It acts (as described by Dr. Golding 
Bird) by increasing the metamorphosis of tissue in the system, by which 
means all products of low vitality are likely to become decomposed and 
eliminated from the system in the urine. Part xxi., p. 245. 
Use of Phosphorus.—Dr. Burgess recommends phosphorus as one of 
the most valuable medicinal agents wTe possess in those inveterate cuta- 
neous diseases—leprosy, psoriasis, lupus—in which the skin seems to adapt 
itself to the morbid condition, which it retains with singular tenacity 
against all the usual methods of treatment. 
The phosphorus treatment of these maladies may be either internal or 
external. The best method of administering the remedy internally is dis- 
solved in oil or ether, and the phosphorated oil or ether then mixed up 
with powdered gum arabic and mint water. Camphorated lard is the 
most appropriate vehicle for applying phosphorus externally. Its energetic 
revulsive properties may likewise be turned to account in certain diseased 
conditions of the skin. Phosphorus, the iodide of arsenic, cantharides, 
and the biniodide of mercury, are the most powerful internal remedies for 
the skin diseases, we possess. Part xxi., p. 250. 
Psoriasis.—“ Psoriasis, so-called, lepra vulgaris, psoriasis diffusa, psori- 
asis gyrata, psoriasis guttata, and psoriasis inveterata, are one disease more 
or less chronic.” The real nature of psoriasis is altogether unknown. 
There is no exudation, properly so called; there is considerable redness 
and an increased growffh, or a hypertrophy of the epidermis. As there is 
generally a deranged state of the digestive organs, with sometimes constitu- 
tional disorder in this affection, we must correct these by suitable combina- 
tions. For the constitutional treatment, Professor Bennett advises equal 
parts of Fowler’s solution and tincture of cantharides, in doses commenc- 
ing with ten drops, gradually increased to fifteen or twenty. Most der- 
matologists are agreed that the best local application is the pitch oint- 
ment (ung. picis); if it causes considerable irritation it may be diluted 
with an equal part of lard. Some cases require only the arsenic, others 
the pitch ointment alone, and a third class of cases require the action of 
both. Part xxii., p. 244. 
Treatment of Psoriasis and Lepra- Vulgaris.—According to M. Emery, 
the arsenical preparations, and especially Fowler’s solution, are the best 
internal remedies. Tar takes the first place as an external application. 
VOL. II.—33 514 
SKIN DISEASE, 
The combination of these is the best treatment for psoriasis. The iodide 
of mercury ointment is occasionally useful when judiciously applied, and 
next to it the iodide of sulphur. The tar ointment is made by mixing a 
third or a fourth of a part of tar to two or three parts of axunge. The 
ointment of iodide of mercury is made by mixing one part of proto-iodide 
of mercury with eight of axunge; and that of the iodide of sulphur by 
mixing from one part in thirty-two to one part in eight of lard. Besides 
these, dietetical and hygienic measures must be adopted. Diet mild, and 
not too substantial, avoiding all aliments difficult of digestion, regular ex- 
ercise, frequent use of baths, and having recourse again to the treatment 
which had benefited them before, on the least appearance of the disease. 
Part xxii., p. 245. 
Psoriasis, Chronic.—M. Cazenave has for many years past employed 
carbonate of ammonia in squamous diseases of the skin. He prescribes 
ten parts of ammonia to two hundred and forty of simple sirup, the patient 
taking from six to twenty-four grains of the salt daily. Part xxii., p. 259. 
Psoriasis—Dr. Graves applies a saturated solution of gutta percha in 
chloroform; no woollen stockings or rough garments of any kind should 
be allowed next the skin, lest the application should be disturbed. 
Part xxvi., p. 288. 
Psoriasis.—Dr. Crawford says the diet should be nourishing. R Po- 
tass. acet., 3ij-; aquse, §iij. Of this one drachm to be given in a little 
water three times a day. Locally, the limbs to be placed for five minutes 
in the morning into a tepid bath, containing one drachm of bicarbonate of 
soda. The scales to be gently removed with a soft flesh brush, and then 
the following applied : R Plumbi diacet. sol., §j. 5vj.; sol. mur. morph., 5ij.; 
a teaspoonful to be mixed with a tablespoonful of cream, and applied to 
the limbs. Part xxviii., p. 233. 
Psoriasis Diffusa.—When in large patches over the flexures of joints, 
forehead, neck, chest, etc., says Dr. Bullar, give a quarter of a pint daily 
of the decoction of the urtica dioica (common stinging nettle), made by 
boiling an ounce of the leaves and stems in a quart of water, down to a 
pint. An extract may be made from this—dose, five grains three times a 
day. The same medicine is efficacious in inveterate chronic papular erup- 
tions (lichen), and in various forms of vesicular and scaly diseases (eczema, 
lepra, and psoriasis), especially in cachectic states of the system. 
Part xxxi., p. 172. 
Scaly Cutaneous Diseases.—Mr. Thomas Hunt believes that if there be 
any medicine more safe and manageable in these cases, in careful hands, 
than another, it is arsenic united with chlorate of potass; but if there be 
any medicine more dangerous and unmanageable than another, it is the 
compound of arsenic, iodine, and mercury, known as Donovan’s solution. 
Part xxxii., p. 182. 
Psoriasis—Syphilitic.—Iodide of potassium and sarsaparilla, says Mr. 
Stanley, will generally cure the disease for a time; but, as a matter of cer- 
tainty and safety, 5 grains of Plummer’s pill should be given night and 
morning, though not necessarily to touch the mouth. 
Part xxxiii., p. 236. 
Psoriasis of the Matrices of the Nails.—In cases under the care of Dr. SKIN DISEASE. 
515 
Hare, at the University College Hospital, he put them upon the plan of 
treatment which he has found to answer very well in cases of psoriasis— 
viz., liq. potass® in half-drachm doses, and liq. arsenicalis in five-minim 
doses, three times daily, in water. Part xxxvii., p. 308. 
SYCOSIS MENTI, OR BARBER’S ITCH. 
Iodide of Sulphur.—Dr. Ross says he made use of the iodide of sulphur 
very successfully in a bad case of sycosis menti. After soothing the irri- 
tation by extracting the hairs from the pustules, by poultices, prussic acid 
lotions, and warm poppy-head fomentations, an ointment of gr. xv. to the 
ounce was used by gentle friction morning and evening. In ten days the 
tuberculated indurations covering the chin were much smaller, and ulti- 
mately a complete cure was effected. Part vi., p. 123. 
The Liquor Potassce.—Given in doses of from 15 to 30 drops, three times 
a day—is an admirable remedy in many cases of inveterate skin diseases. 
According to our observations, it is far more efficacious, and perhaps, too, 
less injurious, than the potash in combination with iodine. The liquor 
potass® may be given in milk, beer, decoction of Sarsaparilla, etc. With 
respect to the sulphate of iron as an external application, in sycosis, men- 
tagra, etc., we cannot believe that it possesses any curative virtues above 
those of the sulphate of zinc, or of the sulphate of copper, that are in daily 
use. The white vitriol is our favorite, and the best way of applying it is by 
dipping rags of soft linen in a tepid solution of the salt, and covering these 
with a piece of oil-skin. If used thus, the lotion will not require renewal 
oftener than night and morning. In some cases, a little hydrocyanic acid 
may be conveniently added to the solution with advantage. (Ed. Med. 
Chir. Rev.) Part ix., p. 189. 
Sycosis.—Sycosis, says Mr. Startin, has its site in the sebaceous fol- 
licles of the face and head, which are perforated by the hair of the beard, 
whiskers, eyebrows, or scalp, and unattended with any necessary derange- 
ment of the general health. 
The treatment consists of plucking out the hairs with a pair of forceps, 
and the application of a mildly stimulating ointment composed as follows: 
White precipitate of mercury, gr. xv.; strong mercurial ointment, 5j. ; 
liquor of acetate of lead, 3ss.; recent pure palm oil, 3yj. This made a 
smooth, creamlike application, which suited the parts very well. To com- 
bat the general disorder, brisk acidulated saline purgatives were admin- 
istered, which, when the desired effect was produced, were combined with 
a chalybeate. 
Also daily ablutions with the yolk of an egg and water, until the cure 
is effected. 
In one very severe case the disease had extended to the forehead, and 
all the hairy parts of the face, and so much hypertrophy existed in many 
of the diseased parts that the disfigurement was hideously great; the 
upper lip was quite lobulated, and a stiff yellow beard grew out of the 
surface, covered with fungoid-looking granulations that oozed a muco- 
purulent secretion. I had more leisure at that period than now falls to 
my share, and I spent many hours at different times in removing the hairs 
from this diseased mass, and in opening the tubercles when suppuration 
could be detected, anointing him with my own hands; in short, in carry- 516 
SKIN DISEASE. 
ing out the principles I have detailed. He took iron in various forms, but 
received the most marked benefit from the iodide internally administered, 
and iodide of sulphur externally, in the form of ointment (15 grains to the 
ounce of lard), by which conjoined means in two or three months he was 
perfectly freed from his disease, save that a few of the eyelashes seemed 
to have been permanently destroyed. 
Mr. S. states, that as the implication of the hairs constitute the only dif- 
ference between acne and sycosis, it becomes a rule, as conclusive as it is 
practically useful, that they should be extracted by a forceps from all 
the inflamed vari as fast as they appear; and thus the maladies will be 
rendered identical, and require only a similar treatment. 
Fomentations of decoction of mallows or poppies, of linseed, or of warm 
water, in which a little sulphur and bran have been boiled (in an earthen 
vessel), are very serviceable, both before and after this operation, and I 
would recommend the sulphur-vapor douche as a most valuable accessory. 
This bath can be readily applied by means of any contrivance, at the 
end of the steam-pipe which will exclude the nose, or as is the preferable 
mode, the whole face may be subjected to the sulphurous vapor, if the nose 
be provided with a tube for inspiration. 
By paying attention to the extraction of the hairs, to the use of the 
scissors instead of the razor, and to washing and anointing the parts, after 
the manner recommended for acne in my last lecture (the use of the lancet 
and cauterization being also occasionally required), and the internal 
treatment directed as then advised, I have often succeeded in curing 
sycosis of twenty or thirty years’ duration in as many weeks. 
Part xiv., p. 238. 
Treatment of Sycosis.—[The patient was directed to clip the beard 
carefully, to use no soap in washing, but to dab the face with a soft 
towel. Regular diet and abstinence from stimulants were enjoined; 
and,] 
Dr. Wright ordered the following to be applied three times a day : 
R Hydrarg. bichloridi, gr. ij.; acidi muriatici ndj.; mist, camphors?, 
gviij. M. ft. lotio. 
Additionally he had these medicines : 
R Inf. gentianse, gviij.; liq. potassas, liq. arsenicalis, aa. 5j- M. ft. mist, 
cujus cap. coch. larg. duo ter die. 
R Pil. coloc. c. 9ij.; extr. hyoscy., 9ij.; pil. hydrarg., gr. x. Misce et 
divide in pil. xiv. quarum cap. ij. omni nocte. 
In less than a fortnight, we had some satisfactory evidences of improve- 
ment. The congestive and inflammatory tendency was less, as shown 
by the external appearance, and the patient’s own remark, that he had less 
heat, pricking and pain in his chin, than previously. Further, there were 
fewer spots of suppuration, and in one or two places a little furfuraceous 
material had collected. You remember my dwelling upon this, as one of 
the best features in the manifestations of amendment, and saying that the 
fact of epidermal desquamation being successive of suppuration, was proof 
that the local inflammatory action was subsiding. Such proved to be the 
fact. In this case we had not a solitary drawback. The patient sys- 
tematically improved from the commencement, and before two months 
had elapsed he was able to shave the lower part of his face without incon- 
venience. 517 
SKIN DISEASE. 
[In these cases of psoriasis, pityriasis, and sycosis, alluded to by Dr. 
Wright, glycerine will prove a valuable application.] Part xvi.,p. 222. 
Treatment of Sycosis.—In regard to the treatment of this most 
troublesome complaint, Mr. Wilson mentions that he has found the strong- 
citrine ointment, the iodide of sulphur ointment, and the tar ointment, to 
be the most useful local applications ; but that it is difficult to predict in 
any individual case, which of these will be most serviceable, one fre- 
quently succeeding where another has failed, or even proved highly inju- 
rious. At the same time he gives Fowler’s or Donovan’s solution inter- 
nally ; but he mentions a case in which a gentleman was nearly poisoned 
by two drops of the former. Part xxiv., p. 258. 
Mentagra or Sycosis.—Sycosis is often very troublesome and obstinate. 
The object of treatment is to destroy the vegetable parasite which causes 
or is the disease. An ointment of corrosive sublimate, one grain, and lard, 
two dr’s, is often very useful, or the white precipitate ointment of the 
Pharmacopoeia. An ointment composed of a scruple of iodide of sulphur 
to an ounce of lard is strongly recommended by Dr. Thompson. Warm 
fomentations and poultices are very useful. Epilation is sometimes abso- 
lutely necessary to effect a cure. The condition of the digestive organs 
must be attended to, and purgatives, tonics, and antacids exhibited as 
required. Part xxxvii.,y>. 179. 
Treatment of Sycosis.—Dr. W. Cooke says: Poultice with linseed until 
the scabs are removed, and then apply constantly a lotion composed of 
two drachms of manganese, with potassa or permanganate of potash and a 
pint of water. After the ulcers are healed apply red precipitate ointment 
every night for several weeks. Part xxxvii., p. 182. 
SYPHILITIC ERUPTIONS. 
M. Cazenave considers the best remedies to be the iodides of mercury. 
Biett gave R hydrarg. biniod., gr. x.; pulv. glycyrrh., 5j* M. ft. pilul. lx. 
Dose two or three daily. But the protiodide is better ; R hydr. protiodid. 
gr. x., pulv. glycyrrhiz. 3ss. M. ft. pilul. lx. Begin with one, and afterward 
give two, three, or four, daily. In the more inveterate forms, as the 
tubercular, give twice the above quantity. Do not combine with opium, 
which neutralizes the elfect. If the bowels become deranged, suspend its 
use for a few days. 
Next in value to iodide of mercury is that of potassium, in doses of six 
grains daily, increased to ten, or in obstinate cases, and where the consti- 
tution is not irritable, to half a drachm in the day. Topical remedies are 
not of much use. To dress an ulcerated surface use hydrarg. protiod. 9j. 
to an ounce of lard. Part xv., p. 242. 
Syphilitic Cutaneous Eruptions.—In the treatment of these eruptions, 
which may come on as exanthematous affections, vesicular, papular, tuber- 
cular, pustular, and as ulcerations, Mr. Acton strongly recommends mer- 
curial fumigations. 
He does not believe the condylomata to be inoculable. As local treat- 
ment he recommends the parts to be washed with a solution of chloride 
of soda twice a day, the parts to be well dried, and calomel sprinkled upon 
them, and dry lint kept between the excoriated surfaces. 518 
SKIN DISEASE. 
Under the head of pustulae, he includes rupia, Lulhe, and impetigo of 
the scalp. He finds the emplastrum ammoniaci cum mercurio an admirable 
local application. 
In the local treatment of alopecia, Mr. Acton recommends stimulating 
washes, as, equal j)arts of rectified spirits, eau de cologne, and castor oil, 
or, if a stronger one be required, equal parts of vermy water and tinctura 
lyttse, some pomade being used also. 
The throat is very frequently the seat of secondary symptoms. Patches 
of erythema appear, which become prominent, and then pale in the centre, 
extending in size. They are often of a circular shape, or like the figure 
8; they frequently ulcerate ; their most common situation is on the 
tonsils, the sides of the tongue, or near the framum; they are met with 
less frequently at the corner of the mouth, and on the dorsum of the 
tongue. Generally the patient has other secondary symptoms at the same 
time. 
Mercurial Fumigation.—“The patient, having undressed, is seated naked 
on a chair in a large box, his head being the only part exposed to the air. 
This box is heated by a furnace, on which the bisulphuret of mercury is 
placed, in the proportion of three drachms for each vapor-bath. The 
intense heat applied soon volatilizes the mercury, which quickly fills the 
well-closed chamber or box with a leaden-colored vapor that condenses on 
the body of the patient, who is exposed to its influence for twenty 
minutes, during the last ten of which he perspires profusely. The box is 
then opened, and the surface of the bod/ is gently wiped, so as only to 
remove the drops of perspiration ; a gown is now thrown over the body, 
and towels twisted round his legs, and the patient laid on a bed, thus 
swaddled up, between two blankets, which are tucked carefully round him, 
and additional covering added. The patient is now left for half an hour, 
during which he jjerspires freely, and a glass of toast and water may be 
given. At the end of this time, the wet clothes should be removed, and 
the patient thoroughly rubbed down ; after dressing he should not at 
once expose himself to the open air, but remain a short time in a cool 
room. The vapor, thus administered, may be repeated two or three times 
a week, for a month or five weeks, and a cure of some of the most rebel- 
lious forms of secondary symptoms may be attained. It may be readily 
assumed that this treatment is one that cannot be easily carried into 
effect in the country, as the necessary conveniences are not at hand. In 
these instances, the vapor-bath may be had recourse to, and the cinnabar 
may be placed on a inetal plate over a little charcoal furnace ; but, from 
some experiments which I have instituted, I find that the mercurial vapor 
is so heavy, that it will not usually rise more than a foot, and the good 
effects of the fumigation will be slight, as compared with those arising 
from the real fumigating apparatus. The body should be covered with a 
dark powder when the apparatus is well applied, and gold leaf will detect 
the presence of mercury on every part of the body. The above remarks, 
perhaps, explain why fumigations have fallen into disrepute, as the proper 
means of application are not always at hand.” Part xxiv., p. 266. 
Treatment of the Syphilides—Formulae.—The following is the prescrip- 
tion for the mistura hydrargyri bichloridi of the Pharmacopoeia of the 
Hospital for Diseases of the Skin: R Of the bichloride of mercury, two 
draclnns ; of strong hydrochloric acid, one drachm; of spirits of camphor, SKIN DISEASE. 
519 
two drachms; of burnt sugar, half a drachm; of water, a gallon. The 
dose is from a drachm to two drachms, each drachm containing a twelfth 
of a grain of the bichloride. An extemporaneous biniodide of mercury is 
also much used, the formula for the mixture being as follows: R Of the 
bichloride of mercury, two drachms ; of the iodide of potassium, six 
ounces; of the tincture of cardamoms, two ounces; and of water, a 
gallon. Of this, the dose, a drachm, contains a tenth of a grain of the 
bichloride, and two grains of the iodide. Simultaneously with the use of 
either of these mixtures, Mr. Startin almost always orders the “red 
ointment ” to be rubbed into the patches of eruption, or applied to any 
ulcers which may exist. The formula for this “ unguentum rubrum,” the 
prime favorite of the institution, is : of the bisulphuret of mercury, half an 
ounce; of the nitric oxide of mercury, half an ounce; of creasote, twenty 
minims ; and of fresh lard, sixteen ounces. Part xxxvii., p. 316. 
TINEA CAPITIS OR PORRIGO. 
Treatment.—Dr. Graves directs attention to the following points : 
When the disease is of long standing, always insert an issue in the arm 
before you attempt its cure. I have seen water on the brain and other 
fatal consequences, from neglect of this precaution. 
If this disease has clearly originated tfom contagion and no other evi- 
dence of derangement of the general health can be detected, we must not, 
from the mere presence of the cutaneous affection, infer a constitutional 
taint, and must avoid the common error, of making the poor children 
undergo a course of alterative medicines. 
This affection originating in contagious matter directly applied to the 
skin, cannot, like some varieties of lepra and psoriasis (to which it often 
bears a great resemblance), be cured by internal medicines, such as mer- 
cury, arsenic, and iodine, given separately or in combination. 
When it occupies the hairy scalp, the common procedure of shaving the 
head is injudicious, for it adds to the irritation of the skin ; and the scalp 
can be sufficiently exposed by cutting the hair as close as possible with a 
sharp scissors. 
The cure must be accomplished by removing the scales as far as that 
can be done by diligent ablution, without using any irritating degree of 
friction : and when the diseased portion of the skin has been thus exposed, 
we must next have recourse to some application which will destroy the 
morbid secreting surface. Formerly this was attempted by means of an 
endless variety of complicated formulae, each of which had its advocates; 
the list may, however, be now reduced to a few simple remedies, and in 
truth, wTith nitrate of silver, sulphate of copper, or strong tincture of iodine, 
every case of this disease may be cured. 
I never use the solid lunar caustic, or sulphate, but prefer a solution of 
ten, fifteen, or twenty grains to the ounce, as the case may require. As 
to the application of this solution, it will not do to apply it, as is generally 
done, with a camel’s-liair pencil, for it must be strongly rubbed into each 
spot, for which purpose a small bit of sponge, covered with fine linen, and 
tied to the end of a quill or slender stick, should be employed. When a 
large portion of the scalp is affected, it will require some perseverance to 
apply this lotion in an effectual manner. 520 
SKIN DISEASE. 
An application of this nature, when effectually done, must not be re- 
peated oftener than once a week. 
Immediately after it the whole scalp must be covered with a spermaceti 
dressing, and the spermaceti must be renewed at least four times daily, so 
as to keep the head constantly moistened with it. The head is not to be 
washed for three days after the application of the caustic, or of the 
tincture of iodine, but then it may be well but very gently washed with 
yellow soap and water twice a day, taking care to cover, as before, with a 
spermaceti dressing after each washing. 
In scaly diseases of the skin, it is quite surprising how much the cure is 
facilitated by keeping the affected parts constantly smeared with sperma- 
ceti, oil, melted suet, or even candle-grease. Without this aid, the use of 
caustics will often disappoint the practitioner. 
When the above precautions have been taken, the cure will advance 
rapidly, and each succeeding application of the caustic solution, or if the 
tincture, may be less severe. Part ii., p. 69. 
Tinea Capitis, or JPorrigo. — Dr. Davidson makes some valuable 
remarks on the use of ioduret of sulphur in porrigo, and other cutaneous 
affections. The following are among the cases given: 
C. B., aged 10, was admitted to the Glasgow Royal Infirmary, on the 
1st Feb. Scattered over the whole of the head were numerous thick 
greyish patches of scabs, which, when removed, left the surface under- 
neath perfectly bare and shining, but in a day or two, numerous small 
pustules made their appearance, accompanied with considerable itching. 
The eruption appeared in the form of small pustules four years ago. In 
this case, the scabs were first softened by the constant application of poul- 
tices for two days; the head was then shaved. An ointment, composed 
of five grains of the bichloride of mercury to one ounce of axunge, was 
tried from the 5th of February to the 12th, without any improvement. 
The following was then employed : 
R. Iodur. sulphur. Bij.; axungiae, §ij. misce. 
This ointment was applied daily to the head ; and in a few days a decided 
amendment was remarked. 
On the 5th of March, the following report was taken.—Pustules and 
scales are now completely gone, but there are some bald patches on head 
in situation of eruption; no itching; surface of skin pretty natural; general 
health good. 
He was dismissed in a few days afterward. 
James R., aged 12, was admitted on the 10th Feb. The whole of the 
head and neck was covered with thick laminated yellowish scabs, which were 
easily removed. Some yellowish pretty large pustules were situated behind 
the ears, but on the scalp they were not distinct, the hair being matted 
together. A fetid ichorous matter was discharged, and numerous pediculi 
nestled everywhere on the head. He had had the eruption for two and a 
half years, but the general health was pretty good. 
A poultice was applied for a day, after which the following ointment 
was applied, even before the shaving of the head, in order to extinguish 
the pediculi, which it effectually did in twenty-four hours. 
R. Iodur. sulphur., Bij.; axungiae, §ij. Misce. 
He was-dismissed perfectly cured on the 29th February, or in about a 
fortnight after the commencement of the ointment, the skin being quite SKIJST DISEASE. 
521 
natural in appearance, without itching, and the hair growing naturally over 
the whole head. 
D. M’l., aged 10, admitted 30th December. The whole head, particularly 
the forehead, 'was covered with a thick, dry, greyish white crust, accom- 
panied with itching, but without discharge. The disease was of four years’ 
duration, and was represented to be of a very inveterate kind. General 
health good; bowrels regular; tongue clean; pulse 80. 
R. Iodur. sulphur., Bij.; axungiae, §j. Misce. 
A fortnight after the use of the ointment, the eruption is reported 
to be quite gone, and the skin covering the scalp natural in appearance. 
As a precautionary measure, it was continued till the 22d, when he wras 
dismissed. 
Observations.—Porrigo, in all its forms, is often a very unmanageable 
disease, and even when cured is very liable to return. In the treatment 
of porriginous affections, the following is a more particular account than 
what is given in the short history of the cases. The head is first well 
washed with soap and water, the hair is then cut as short as possible with 
the scissors, a poultice is applied, and continued for a day or two if necessary, 
to soften the crusts, which being removed as thoroughly as possible, the hair 
is closely shaved. In general, the ointment is not applied until the head 
has been shaved ; but if pediculi be present, it is employed from the com- 
mencement, in order speedily to extinguish these vermin. The proportion 
of ioduret of sulphur employed has varied from 20 to 40 grains to one 
ounce of axunge. 
As a general rule, the daily application of the ointment will be sufficient; 
but, in some cases, it is advisable to use it twice a day, in order to facilitate 
the cure. 
Alteratives, or any particular internal treatment, have rarely been 
resorted to, 'when the general health was tolerably good. Laxatives have 
occasionally been prescribed, and a mild farinaceous or milk diet. 
Part v.,y>. 115. 
Tinea Capitis or JPorrigo.—Topical Application of Iodine and its 
Compounds.—Dr. James J.Koss remarks as follows, regarding the topical- 
use of tincture of iodine in cases of porrigo: 
The next instance we shall bring forward of the external use of tincture 
of iodine is in porrigo, or, more generally speaking, ringworm of the scalp, 
comprising all those affections, described as tinea, porrigo, eczema, impeti- 
go, etc. The diagnosis of these various forms, which run one into another, 
is often exceedingly doubtful, and, what is of more consequence, their 
cure is often difficult, and frequently exhausts the patience both of patient 
and surgeon. Hundreds of applications have been used in the treatment 
of ringworm, and their very number proclaims their inefficiency; while in 
many cases, there can be no doubt, that the cure ultimately effected, 
ought rather to be referred to the natural dying-out, as it were, of the 
disease in course of time, than to the particular remedy in use at the mo- 
ment. In such circumstances, then, we are all much indebted to Dr. Graves, 
who has laid down certainly the most successful plan of treatment I have 
yet had an opportunity of trying. He recommends as a precautionary 
measure, that, if the disease has been of long standing, an issue should be 
inserted in the arm, before attempting its cure. He condemns shaving 
the head, for it adds to the irritation of the skin, and the scalp can be 522 
SKIN DISEASE. 
sufficiently exposed by cutting the hair as closely as possible with a sharp 
scissors. The next object is to remove the concreted scales, which lie over 
and conceal the diseased skin: this is to be accomplished by diligent ablu- 
tion, without using any irritating degree of friction. We must next have 
recourse to some application, which will destroy the morbid secreting sur- 
face, or those vegetable fungi, which, according to some late observers, 
constitute the true pathology of the disease. For this purpose, Dr. Graves 
recommends either the tincture of iodine, or a solution of lunar caustic, or 
blue-stone, 10, 15, or 20 grains to the ounce, as the case may require. 
Since reading Dr. Graves’ paper, I have in several instances used the tinc- 
ture of iodine, and have since been far more successful than before. “ As 
to the application of this solution, or the tincture,” continues Dr. G., “ it 
will not do to apply it, as is generally done, with a camel’s-hair brush, for 
it must be strongly rubbed into each spot, for wrhich purpose a small bit of 
sponge, covered with fine linen, and tied to the end of a quill or slender 
stick, should be employed. When a large portion of the scalp is affected, 
it will require some perseverance to apply the lotion, or tincture, in an 
effectual manner. An application of this nature, when effectually done, 
must not be repeated oftener than once a week. Immediately after it, the 
scalp must be covered with a spermaceti dressing, and the spermaceti must 
be renewed at least four times daily, so as to keep the head constantly 
moistened with it. The head is not to be washed for three days after the 
application of the caustic, or the tincture of iodine, but then it may be 
well, but very gently, washed with yellow soap and water twice a day ; 
taking care to cover, as before, with a spermaceti dressing after each wash- 
ing.” The doctor adds, “ when the above precautions have been taken, 
the cure will advance rapidly, and each succeeding application of the 
caustic solution, or of the tincture, may be less severe.” I have been thus 
particular in transcribing Dr. Graves’ directions, as there is no disease 
more troublesome to the practitioner, and as, from experience, I can bear 
testimony to the efficacy of his mode of treatment, as above explained. 
The surgeon, when applying the iodine or caustic, should have his hands 
protected by gloves. Part vi., p. 120. 
Tinea Favosa—Treatment.—The mode of treatment of this obstinate 
disease, employed by the frbres Mahon, although kept secret by them, has 
for a long time been followed with unquestionable benefit in the Parisian 
hospitals. 
The hair is first cut short, and the crusts then removed by emolient poul- 
tices. The head is now frequently washed with soap and water, and the 
inunctions and lotions continued until the scalp is completely cleaned. 
When this has been effected, the second stage of the treatment commences, 
the object of which is to remove the hair slowly and without pain, from 
all the points of the scalp, occupied by the favus. Every second day the 
ointment (No. 1) is applied, and its use continued according to the obsti- 
nacy of the case. On the intervening days the hair is combed with a fine 
comb, to remove the loose hairs. This mode of treatment having been 
continued for about a fortnight, a depilatory powder (No. 2) is sprinkled 
through the hair once a week ; on the following day the hair is combed, 
and the depilatory ointment applied as before. At the end of a month or 
six weeks a more active ointment is applied every day ; and as the disease 
gives way the frictions are made only once a week, until the redness of 523 
8KIX DISEASE. 
the skin has entirely disappeared. Although the formulae of the remedies 
employed by the frtires Mahon have been kept secret, yet their composi- 
tion has been very nearly ascertained by experiment and are supposed to 
be as follows: 
No. 1.—Slaked lime, eight scruples ; soda of commerce, twelve scruples; 
lard, sixty-four scruples. 
No. 2.—Wood-ashes, sixty-four parts; pulverized charcoal, thirty-two 
parts. 
Lotion.—Lime-water, five hundred parts; sulphate of soda, one hundred 
and eighty-five parts; alcohol, twenty-four parts; white soap, ten parts. 
Part viii., p. 159. 
Scald Head, Ringworm of Scalp, etc.—In one of the meetings of the 
Westminster Medical Society, Mr. Fisher refers to the practice of treating 
scald head, ringworm, etc., in Brussels. This is by an ointment chiefly 
composed of wood soot. The common soot of the chimney is collected, 
placed in a quantity of water, and macerated by a gentle heat for four 
days ; the fluid is then strained and evaporated in an open vessel to the 
consistence of treacle. An equal portion of this and common lard are 
mixed together and applied to the part affected night and morning. The 
head is shaved occasionally and thoroughly washed every third day. It is 
supposed that the efficacy of this ointment depends upon the creasote and 
pyroligneous acid which it contains : 
Dr. Sayer observes, that the ointment used in Brussels years ago, with 
so much efficacy, consisted of equal parts of charcoal, so burnt as to retain 
its pyroligneous acid, nitrate of potash and common brimstone, worked up 
with hog’s lard into an unguent, and applied night and morning. The 
head was, moreover, washed daily with soft soap containing a great 
quantity of alkali, and shaved every fourth day. Part ix., p. 172, 
Treatment of Porrigo.—Dr. Corrigan states that nothing is easier than 
to give the appearance of having cured the disease. It is merely neces- 
sary to poultice the head, or part it is on, when the scab all comes off, leav- 
ing a shining red surface, then to wash it, when it looks clean, and thus 
make it look as if cured. After many applications, a week, fortnight, or 
month, may pass over, but in all those instances where I had the opportu- 
nity of afterward observing the case, the small favi began again to show 
themselves, and the disease then rapidly shot up again, and spread ; indeed, 
so certainly was this the case, that I at last began to think the disease was 
incurable. To reflecting on the nature of the disease, I owe the thought 
of a remedy on which I place considerable reliance—it is the local applica- 
tion of oxymuriate of mercury, which has much power in destroying the 
sporula of cryptogamic plants. I have used it in the form of ointment in 
the proportion of five grains in very fine powder to §j. of ung. cetacei; I 
have used it in the proportion of 10 grains to gj., but it sometimes gives 
pain in this larger proportion. A small portion of the ointment is rubbed 
in on the part affected every day. It has not salivated in any instance in 
which I have employed it. Part xii., p. 255. 
Porrigo.—Mr. Startin submits the following: The first procedure I 
would dwell upon as most necessary to success (I speak of course from my 
own experience) is to avoid all unnecessary irritation ; do not use soap or 
apply cold lotions, or poultices, or narcotics that by their absorption may 524 
SKIN DISEASE. 
occasion fatal effects, as tobacco, etc. Do not shave the head, but use scis- 
sors, cutting the hair as close as possible, and use all applications without 
force or friction, following the grain of the hair, and extract with the for- 
ceps those hairs only which are loose, and can be removed without pain. 
The directions I am in the habit of giving are as follows: Soften the crusts, 
if necessary, by applying flannel wrung out of water as steaming hot as 
possible, without scalding or injury to the head, till the hair can be cut 
short with scissors, so that the root of every hair may be visible without 
touching the parts; wash the head with half* of the yolk of a fresh egg 
and tepid water; dry it with a soft cloth, and anoint with an ointment 
adapted to the case, which in porrigo should be a sulphureous application; 
in impetigo the iodides of mercury or of sulphur; in pityriasis calomel, 
white or red precipitate of mercury; and in eczema the bisulphuret of 
mercury, and sometimes the black oxide of manganese ; all these ingre- 
dients may be combined with creasote, w ith camphor, etc., as well as va- 
riously intermingled, bearing in mind that the proportions of each article 
must not exceed 9j. to §j.of lard, wdiich is better than any oleaginous sub- 
stance of which I have made trial. Of course the internal treatment must 
correspond to the nature of the particular affection, its stage, and the con- 
stitutional symptoms manifested. It will also be advantageous that the 
patient wreaf a light linen or silk cap, which is by no means to be rendered 
impervious to perspiration, but to be of a kind that can be vrashed daily; 
the lining of hats, bonnets, etc., must also be frequently cleansed and re- 
newed. If these recommendations be attended to, I can assure you from 
my own experience, that a complaint which ordinarily lasts for years may 
be subdued in as many vTeeks or months. Part xiv., p. 236. 
Porrigo Scutulata ( Wittan)—Herpes Tonsurans (Gazenave)—(Ring- 
worm.)—Mr. Erichsen advises to shave the head, and apply one of the 
stronger acids to the part. The strong acetic answers best. It may be 
applied by means of a piece of sponge tied to a stick, and should only be 
used for a few minutes. Nothing more should be done for a week or ten 
days, when the crust produced by the acid should be separated writh a 
pair of scissors, and if there be any appearance of the disease remaining, 
the acetic acid should be applied again ; but if it present a healthy appear- 
ance, let it be wrell washed with soap and water, and a little olive oil ap- 
plied every night. When all the vegetable organisms constituting the dis- 
ease have been destroyed, then use a stimulating ointment, as the ung. 
creasote, 3ss. to 5j. to the ounce of lard; or apply tincture of iodine by 
means of a camel’s-hair brush; or the ung. hyd. bmiodid., diluted with six 
parts of the ung. picis liquid.; or a mixture of equal parts of sulphur and 
pitch ointment; or the carb. of potass ointment, 5ss. to 5j- to the ounce of 
lard. It is often useful to alternate some of these remedies; the head 
should also be wTashed three or four times a day with a lotion of the sul- 
phuret of potass dissolved in lime water, or wdth carbonate of potass dis- 
solved in water, or with soft soap and water. Attend to the general 
health ; if the child be of a delicate habit or scrofulous, give iron and ton- 
ics, quinine with infus. quassiae, and a nutritious diet. All heating articles 
of diet are improper, also salted food; the diet should be plain, but nu- 
tritious. Part xiv., p. 243. 
Porrigo Dedavans.—According to Dr. Coley, wre should not remove 525 
SKIN DISEASE. 
the hairs ; but rub solution of sulphate of copper upon the bald patches for 
several minutes, three times a day; and give a purgative occasionally. 
And in Porrigo Favosa apply twice a-day the ung. hydr. amnion, chlo- 
rid., and give a calomel and jalap powder every three days. Treat P. lu- 
pinosa in the same manner. Part xv., p. 254. 
Oil of Juniper in Scald Head.—The direct application of the oil of the 
juniperus communis has been already proved to be successful in scrofulous 
ophthalmia, scabies, and eczema. Dr. Sully has found besides, that it is 
efficacious in the most inveterate forms of scald head. His formula is, oil 
ofjuniper, one ounce and a half; axunge, two ounces; essence of aniseed, 
six drops. The oil may also be applied unmixed; but in either case it 
should be applied freely over the whole affected surface. 
Part xv., p. 255. 
Creasote in Porrigo.—Speaking of the treatment of Porrigo Senilis, Dr. 
Bellingham says: Before concluding, I may observe that the efficacy of 
creasote, as a local application in cutaneous disease, is not limited to cases 
of prurigo. In that comparatively rare, but very intractable form of dis- 
ease of the scalp, the favus confertus of Erichsen, which is known under 
a great variety of names, as the porrigo scutulata, tinea annularis, scald 
head and ringworm of the scalp, which constitutes one of the few conta- 
gious diseases of the scalp, and is one of the few which occasions the de- 
struction of the bulbs of the hair, and for the cure of which that most 
painful application, the pitch cap, was in former times supposed to be es- 
sential, creasote in the form of ointment and lotion will be found a most 
effectual remedy, provided its use is persevered in for a sufficient length of 
time, and attention is at the same time paid to cleanliness. On the other 
hand, in the vesicular and pustular diseases of the scalp, in which the erup- 
tion is usually preceded or accompanied by more or less inflammation, evi- 
denced by the heat, redness, soreness, and discharge, creasote as a local 
application will be found to disagree, and will rather aggravate than re- 
lieve the disease. Part xvi.,p. 223. 
Ointment for Scald Head.—No rway pitch, 30 parts ; turpeth mineral, 
15 parts; red oxide of mercury, 15 parts; lard, 100 parts. Mix. The 
ointment to be applied night and morning. Part xvii., p. 196. 
Favus.—By those not well accustomed to the diagnosis of skin diseases, 
favus has often been confounded with other eruptions of the scalp, more 
especially eczema and impetigo, or the combinations of these diseases known 
as the eczema impetiginodes ; but in none of these do the yellow crusts or 
scales present, when examined microscopically, traces of vegetation. This 
furnishes the real diagnostic and pathognomonic character of the disease. 
There can be no doubt the disease is inoculable, and capable of being 
communicated by contagion. The pathology of favus is best understood 
by considering it essentially to be a form of anormal nutrition, with exuda- 
tion of a matter analogous to, if not identical with, that of tubercle, which 
constitutes a soil for the germination of cryptogamic plants, the presence 
of wffiich, as stated, is pathognomonic of the disease. As favus is in many 
cases a constitutional disease, and dependent upon the causes inducing 
scrofulous diseases in general, the treatment must be constitutional, and 
directed to remove the tendency to tubercular exudation. The internal 
and external exhibition of cod-liver oil with appropriate diet and exercise, 526 
SKIN DISEASE, 
has been attended by most marked advantage. As to the local treatment, 
Professor Bennett directs the affected scalp to be poulticed for several 
days, until the favus crusts are thoroughly softened and fall off, then the 
head to be carefully shaved, and lastly, cod-liver oil to be applied with a 
soft brush, night and morning, and the head covered with an oil-skin cap 
to prevent evaporation, and further exclude the atmospheric air. 
Every now and then the accumulated and inspissated oil should be re- 
moved by gently washing it with soap and water. Whenever favus is re- 
cent, and of limited extent, it may be at once destroyed by cauterization 
with nitrate of silver. Part xxii., p. 238. 
Apparatus for Fumigating the Scalp, in some Chronic Diseases of that 
Region.—Dr. Burgess has recommended fumigation of the scalp in cer- 
tain of its diseases. He thus describes the apparatus he uses for that pur- 
pose : 
The vapor apparatus is extremely simple. It consists of a tin jar, about 
ten inches by four, with a conducting tube, on which is placed a stop- 
cock, for the purpose of diluting the vapor, or turning it off, and an 
elastic cap of vulcanized india-rubber, which fits closely to the head, so 
as to prevent the vapor from escaping. The great majority of diseases of 
the skin are constitutional, and those of the scalp are not an exception to 
the rule. 
Favus (tliq porrigo favosa of Wilan), for example, which is one of the 
most unsightly, as well as the most inveterate of the eruptions of that 
region, may be temporarily relieved by tonics and fomentations, and the 
skin even made to appear clean and healthy ; but the virus still remains, 
and, consequently, the “ cure ” will be but of short duration. In this, as in 
other inveterate diseases of the scalp, the application of vapor, simple or 
medicated, as the case may require, to the diseased scalp, will be found a 
very efficient remedy. Where the object is, to alter the vitality of the 
parts, it can be done more effectually by the repeated application of stimu- 
lating vapor (the skin being previously cleansed with any detergent wash) 
than by the employment of caustic lotions or ointments. Indeed, greasy 
applications of every kind may be advantageously dispensed with in the 
treatment of diseases of the scalp. 
That variety of baldness, which is the result of atony, or disordered nu- 
trition of the hair-follicles and bulbs, will be materially benefited by the 
use of the vapor apparatus. Part xxi., p. 259. 
Cachexia Fczematosa in Children. — This disease is very common 
amongst the ill-fed and neglected children of the lower classes. There is 
a pale and sickly aspect, and on different parts of the scalp the hair is mat- 
ted together with filthy scabs of eczematous secretion, from which exudes 
a thin and irritating discharge. There are also weak ulcerations behind 
the ears, and about the angles of the mouth, and on the nares, etc. 
There is no eruptive disease more easily got rid of than this, says Dr. 
W. S. Oke, provided the treatment be carefully carried out. The whole 
of the scalp having been closely clipped, and the scabs removed by poultice 
or fomentation, the eczematous parts are to be smeared by the ointment, 
1, twice a day, and well fomented before each application. The alterative 
dose, 2, is to be given twice a week, and the strength supported by 3. By 
these means the removal of the disease will be at once accomplished. 
1.—R Unguenti hydrarg. nit. oxidi, oz. ss. Bis die applicandum digito. 527 
SKIN DISEASE. 
2. —R Hydrarg. cum creta, gr. iij. ; pulv. rhei, gr., iv.; pulv. cinnamo- 
mi, gr. j. Misce ; fiat pulvis bis hebdoinada sumendus in theriaca. 
3. —R Quime disulphatis, gr. ij.—iij.; acidi sulphurici dil., gtt. vj.; tinct. 
aurantii, co. syrupi zingib. sing, dr. ij.; aquae destillatse, ad oz. iij. Misce 
capiat cochleare largum bis quotidie. Part xxvi., p. 292. 
Treatment of Favus.—After removing the crusts of favus by poulticing 
and shaving the head, keep the surface moist with cod-liver oil, or use Dr. 
Jenner’s lotion, composed of one part of sulphurous acid mixed with three 
parts of water, in the following way : Saturate lint with this lotion and 
apply it all over the scalp night and morning, keeping it moist by an oil-silk 
cap. Part xxix.,y>. 248. 
Treatment of Favus.—From the observation of about a dozen cases of 
severe favus (diagnosis by the microscope in all) recently treated by Mr. 
Startin at the 'Hospital for skin diseases, we can speak with great confi- 
dence of the efficiency of the following ointment. It is the ung. sulph. 
comp, of the pharmacopoeia of that institution: 
R Sulph. sublimati, Ibss.; hydrarg. ammonio-cldorid., §ss.; liydr. sulphu- 
reti cum sulph., §ss.; leviga simul, dein adde olivae olei, §iv.; adipis recen- 
tis, §xvj.; creasoti, mxx. Misce. 
To correct the state of general health, Mr. Startin commonly orders 
simultaneously a mild course of the iodide of potassium, but this, we sus- 
pect, has but a small share, if any, in the local result. 
In a most disgusting disease for which as yet no real cure is known, it is 
much to be in possession of an almost certain means of insuring its absence. 
The ointment no doubt acts as a parasiticide. Before its first application 
it is desirable to clear away the crust as much as possible, either by fomen- 
tation or a poultice. 
We may remark, that the ointment mentioned is used by Mr. Startin in 
the treatment of scabies, and also in that of the contagious form of porrigo. 
Part xxx., p. 177. 
* * 
Porrigo.—The treatment now in vogue for this affection in Guy’s Hospi- 
tal is the iodide of lead ointment and alkaline lotions, with the internal use 
of the iodide of arsenic. Part xxxiii., p. 236. 
URTICARIA. 
In a case of this disease, says Dr. Maclagan, where the urine was of low 
specific gravity (1010), and was found on examination to be much deficient 
in urea and uric acid, colchicum was employed with complete success. The 
urine before taking colchicum was of a pale straw color, transparent, and 
left no deposit on standing. 
Colchicum was then administered, and a fortnight after the urine was again 
examined. The urea was more than triple in his amount, and raised above 
the normal standard. The increase of uric acid was in a tenfold ratio, whilst 
the other organic constituents and water suffered a corresponding diminu- 
tion, the inorganic salts remaining nearly as before. Part xxv., p. 264. 
Treatment of Urticaria.—It sometimes happens, says Dr. G. Budd, that 
a nettle-rash resulting from defective digestion is brought on not merely 
by some one substance, but by several substances in common use; and it 
is then very difficult to detect the offending substances or to prevent the 
disorder by any restriction of diet to which the patient will submit. 528 
SKIN DISEASE. 
Where it arises from defective digestion, give a dinner pill, containing 
three or four grains of rhubarb, and from half to one and a half grains of 
ipecacuanha. This remedy is a very valuable one in slowness of digestion. 
It sometimes happens, especially in women, that the nettle-rash, though 
depending immediately on the stomach, occurs only wdien digestion is 
weakened by over-fatigue, or by anxiety or some other mental emotion, 
or by profuse monthly discharges, and that remedies of a different class are 
availing. 
In some such cases, where all the means spoken of failed, the eruption 
■was known to disappear under the use of carbonate of ammonia, alone or 
in conjunction with tincture of gentian. 
Serpentaria is another remedy that has obtained some repute in the treat 
ment of this disorder. An excellent application for allaying the irritation 
of nettle-rash, whatever be its cause, is a lotion made by mixing 3ss. of 
acetate of lead and §ss. of tincture of opium with §viij. of water. 
Part xxix., p. 106. 
Treatment of, by Quinine.—A severe case, in 'which the eruption had 
come out daily for the last six months, presented itself a few days ago. 
The patient was a married woman, of middle age, and of nervous tempera- 
ment. The following was the prescription ordered : 
R Quin, disulph., gr. xij.; am. sesquicarb., 3j-; magnes. carbon., §ss.; aq. 
pur., gviij. Ft. mist. §ss. ter. die sumend. 
The quinine in this formula is of course undissolved, and the magnesia is 
added in order to suspend it. To relieve the itching of the eruption, a 
lotion containing the dilute nitric acid was ordered to be used. With 
regard to the latter, it may be worth remarking, that Mr. Startin believes 
it quite as useful as the hydrocyanic acid for the relief of tingling, etc., 
while it is very much less expensive. Part xxx., p. 236. 
Urticaria.—This, says Prof. Budd, is generally caused by the imperfect 
digestion of particular articles of food, such as crabs, muscles, pork-pie, fish, 
honey, mushrooms, cucumbers, almonds, and oatmeal. Our main object 
of treatment must therefore be to exj)el the offending matter as soon as 
possible ; this is best done by an emetic, followed by a warm quick purga- 
tive. If it seems rather to be referable to several articles in common use, 
it may be kept off by the administration of a few grains of rhubarb before 
dinner; it may occur from weak digestion, attended with general debility; 
in such cases the carbonate of ammonia, with the tincture of gentian, will 
succeed when other means fail. To allay the cutaneous irritation use a 
lotion composed of half a drachm of acetate of lead, half an ounce of tinc- 
ture of opium and half a pound of water. Part xxxiv., p. 197. 
MISCELLANEOUS. 
Arsenic in Chronic Scaly Eruptions.—Mr. Erichsen lays great stress 
upon the necessity of attending particularly to the constitution and tempe- 
rament of the patient before commencing the xise of the medicine. It will 
be badly borne by individuals of a plethoric habit of body, or of a highly 
sanguine or sanguineo-nervous temperamant—this arises from the stimu- 
lating properties of the metal. In such cases, the digestive organs become 
so irritated, and the nervous system so excited under the use of the arsenic, 
that it is impossible to employ it in any such dose as can be expected to SKIN DISEASE. 
529 
produce a beneficial effect upon the cutaneous affection. There are other 
circumstances which contra-indicate the use of this remedy, namely, “ the 
complication of the cutaneous affection with other diseases,” and especially 
with irritative or inflammatory gastric dyspepsia, accompanied with a 
sensation of heat and oppression at the epigastrium, increased by food, so 
well described by Dr. Todd. When this form of dyspepsia is present, the 
smallest doses of arsenic will do harm, as the usual effect of the remedy, 
when continued too long, is to produce these very symptoms. Besides 
this form of indigestion, any other local inflammatory condition of the 
system, or the supervention of phthisis, will contra-indicate the use of so 
powerfully stimulating a tonic as arsenic. Another important circum- 
stance to attend to is the kind of disease, and the stage in which to use it. 
The indiscriminate use of this article in certain diseases of the skin, has 
no doubt frequently brought discredit upon it. 
One great principle to be held in view in its use is never to administer 
it in the early, acute, and inflammatory stages of the affection. The solu- 
tion of the arsenite of potassa (Fowler’s solution), and the solution of the 
iodide of arsenic and mercury (Donovan’s solution), are the two prepara- 
tions which are most frequently prescribed in this country ; and the former 
is by far the most popular of the two. Different authors vary a little as 
to the dose of Fowler’s solution which ought to be given; but most of 
them agree that we ought not to exceed 15, or at most 18 drops in the 
course of the day. Mr. Erichsen, however, begins with two minims of 
the solution twice a-day, and increases the dose to 5, 6, or 7% minims three 
times a-day, beyond which, he says, it ought not to be carried, as its good 
effects will be more evident from small doses continued for some time, 
than from larger doses which have to be sooner relinquished. Some 
patients, however, are so excitable, that the smallest doses are inadmis- 
sible. Another good preparation is the iodide of arsenic introduced by 
Dr. A. T. Thompson. The dose is the twelfth of a grain twice a day, to 
be increased to the sixth or fourth of a grain three times a-day, although 
these doses are seldom necessary. It is well to combine the extract of 
conium with iodide of arsenic, in order to sheath its irritating qualities, 
and prevent it from exciting too powerfully the mucous membrane of the 
stomach. By the addition of the biniodide of mercury, a compound pill 
may be formed, which resembles in its effects the liquor of the hydriodate 
of arsenic and mercury, and which has been found by Dr. A. T. Thompson 
very efficacious in lupus, and by Mr. Erichsen in some syphilitic eruptions, 
more particularly when of a squamous kind. A pill may be made contain- 
ing one-twelfth of a grain of the biniodide of mercury, and two grains of 
the extract of conium; to be given twice a-day. The iodide of arsenic 
may be gradually increased to one-sixth of a grain, and the biniodide of 
mercury omitted at the end of a fortnight, or sooner, as it might affect the 
gums. The diluted biniodide of mercury ointment may in some cases, as 
in syphilitic psoriasis, be also applied externally at the same time. Arsenic 
seems to be an excitant or stimulating tonic, acting chiefly on the digestive, 
nervous, and integumentary systems ; and when the dose has been pushed 
so as to irritate any one of these parts, the medicine ought to be imme- 
diately suspended, or greatly reduced in strength. The time for pre- 
scribing arsenic in a cutaneous affection requires, perhaps, as nice a dis- 
crimination as can be exercised. Mr. Erichsen points out a mode of 
practice which will be generally serviceable in these cases. As it is in the 
YOL. II.—34 530 
SKIN DISEASE. 
chronic stages that the remedy is to be used, he first ascertains whether 
the affection will bear the topical application of mild stimulants, such as 
the ointment of the white precipitate, or the nitrate of mercury diluted 
with equal parts of the spermaceti ointment, or a solution of the sulphuret 
of potassium in the proportion of about a drachm to the pint; and if any 
of these applications can be borne without increasing permanently the 
severity of the disease, the internal administration of arsenic may likewise 
be beneficial. In illustration of this opinion he adduces as an example that 
very common disease, eczema, which, when in its acute stage, in which it 
will bear no other topical application that the most soothing poultices and 
fomentations, will infallibly be greatly increased in severity by the employ- 
ment of arsenic, even in its most minute doses; but at a more advanced 
period, when it can bear topical stimulants, the same disease will be greatly 
benefited by the internal administration of this medicine. The diseases 
of the skin for which arsenic is recommended, may be of very different 
kinds, but they all agree in this, that they are characterized by the pre- 
sence of scales or scurf; and even when they do not belong to the order 
squamae they are usually but little benefited until they arrive at that 
stage in which they assume a furfuraceous or scaly condition. 
Part viii., p. 10. 
Selection from the Formulary of Biett on Diseases of the Skin— 
Internal Bemedies.—Subcarbonate of soda, half, to one drachm ; barley- 
water, one pint. Dose, four glasses daily. Use: Lichen; prurigo; 
chronic diseases with itching. 
Decoction of Dulcamara.—Dulcamara, half an ounce; water, a pint and 
a half. Boil down to two-thirds. The quantity of the remedy may be 
increased to one ounce, or an ounce and a half. Dose, half a glass at 
first; then a glass, morning and evening. Use, lepra vulgaris; chronic 
diseases. 
Decoction of Orma.—Orma pyramidalis, four ounces ; water, four pints; 
boil down to a half. Dose, two to four glasses a day. Use: Scaly 
diseases. 
Sirup of fumaria, twelve ounces ; sirup of viola tricolor, four ounces ; 
bisulphate of soda, two drachms. Mix. [M. Biett often employed this 
mixture in cases of eczema, lichen, and several chronic diseases of the skin.] 
Dose, two spoonfuls a day. 
Sirup of fumaria, a pint; bicarbonate of soda, three drachms. Dose, 
two teaspoonfuls; one before breakfast; the other at bedtime. Use: 
eczema; lichen; prurigo. 
Pearson’s Solution.—Arsenite of soda, four grains; water, four ounces. 
Dose, from twelve drops to a drachm or more. Use: most chronic dis- 
eases of the skin; eczema, impetigo, lichen; but chiefly in squamous dis- 
eases, lepra, psoriasis, etc. 
Fowler’s Solution.—Arsenious acid, and cai’bonate of potass, of each 
seventy-eight grains ; distilled water a pint; alcohol, half an ounce. Use: 
the same as Pearson’s solution. Dose, three or four drops, gradually 
increased to twelve or fifteen. 
M. Biett’s Solution.—Arsenite of ammonia, four grains; water, four 
•ounces. Use : same as above. Dose, same as Pearson’s solution. 
Larrey’s Sirup.—Sudorific sirup, one pint; bichloride of mercury, hydro- 
chlorate of ammonia, and extract of opium, of each five grains ; Hoflman’s SKIN DISEASE. 
531 
liquor, half a drachm. Dose, half an ounce to two ounces. Use : syphi- 
litic eruptions. Sirup of mezereon, two ounces; balsam of tolu, four 
ounces ; subcarbonate of ammonia, half an ounce. Dose, a spoonful morn- 
ing and evening. Use : constitutional syphilis. 
Van Svneteti’s Liquor.—Bichloride of mercury, eighteen grains ; water, 
twenty-nine ounces; alcohol, three ounces. Dose, a teaspoonful daily, in 
a glass of decoction of sarsaparilla. Each ounce contains a little more than 
half a grain. Use: secondary syphilis. 
Powders—Pills.—sublimed sulphur, magnesia, of each half an ounce. 
Make eighteen packets. Dose, one daily. Use: chronic eczema; scaly 
diseases. 
Proto-ioduret of mercury, twelve grains; extract of lettuce, two scruples. 
Make forty-eight pills. Dose, one to four. Use : syphilis. Or, 
Proto-ioduret of mercury, half a drachm; extract of guaiacum, one 
drachm; extract of lettuce, two scruples; sirup of sarsaparilla, q. s. 
Divide into seventy-two pills. Dose, one, and then two daily. Use : 
syphilis. 
Bichloride of Mercury.—Extract of aconite, six grains; bichloride of 
mercury, tAVO grains ; marshmallows poAvder, eight grains. Make eight 
pills. Dose, one to four. Use : syphilis. 
JDeuto-ioduret of Mercury.—Deuto-ioduret of mercury, six grains; 
marshmallows poAvder, half a drachm. Make thirty-six pills. Use: the 
same. Dose, tAVO or three a day. 
M. SedilloPs Pills.—Strong mercurial ointment, one drachm; soap, two 
scruples; malloAvs poAvder, one scruple. Make thirty-six pills. Dose, two 
or three daily. Use: the same. 
M. BietPs Pills.—Mercurial ointment, poAvdered sarsaparilla, of each a 
drachm. Make forty-eight pills. Use: the same. Dose, one to four 
daily. Or, 
Phosphate of mercury, half a drachm ; extract of fumaria, one drachm. 
Make forty-eight pills. Dose, one to tAVO a day. Use : as before. 
Aconite Pills.—Extract of aconite, half a drachm; mallows powder, two 
scruples. Make forty-eight pills. Dose, one or tAvo morning and evening- 
Use : syphilitic eruptions ; nocturnal pains. 
Arsenic Pills.—Arsenious acid, one grain; black pepper powdered, 
twelve grains; gum arabic, two grains; water, q. s. Make twelve pills. 
Dose, one or two a day. 
Arsenite of Iron—M. Biett.—Arsenite of iron, three grains; extract of 
hop, one drachm ; malloAvs poAvder, half a drachm ; orange flower sirup, q. s. 
Make forty-eight pills; each contains the one-sixteenth of a grain. 
Dose, one daily. Use: the tA\ro preceding formulae are chiefly used in 
cases of chronic eczema and lichen ; in the scaly diseases, lepra, lupus, and 
psoriasis. 
Arsenite of Soda—M. Biett.—Extract of aconite, one scruple; arsenite 
of soda, tAvo grains. Make tAventy-four pills. Dose, one or tAvo daily. 
Use: as above. 
Hydrochlorate of Iron.—Hydro chlorate of iron, twelve grains; gentian, 
in poAvder, tAventy-four grains. Make twelve pills. Dose, one to four 
daily. Use: employed Avith success by M. Biett in scrofulous eruptions. 
Sulphate of Iron—M. Biett.—Sulphate of iron, one scruple ; powdered 
malloAvs, tAvelve grains; sirup, q. s. Make twelve pills. Use and dose 
the same. Part ix., p. 73. 532 
SKIN DISEASE. 
Use_ of Tar in Cutaneous Diseases.—[Mr. Wetlierfield published, iu 
1845, an account of several intractable cases of skin disease which were 
cured by the use of tar, after arsenic and other favorite remedies had been 
tried in vain. As he still finds the remedy a valuable one, Mr. W. again 
calls the attention of the profession to the subject. He says:] 
Tar was administered in these cases in capsules, each containing ten 
‘minims of simple Stockholm tar, and was first prescribed in this form by 
Dr. Sutro, of the German Hospital. This mode of administering the tar 
removes every objection on the score of taste to the use of this valuable 
remedy, which doubtless would still have enjoyed all the credit it obtained 
at the time its virtues were so much extolled in the works of Bishop 
Berkeley, but for its nauseous flavor in the then mode of administering, 
viz., tar water. 
Acne.—Two obstinate cases of this disease, of several years’ standing, 
were published in the report. The face, neck, and shoulders were much 
covered and disfigured by the eruption, which had withstood all kinds of 
treatment. One capsule wras given three times a day, and continued for 
three months. The disease entirely disappeared. 
Eczema Impetiginodes and Eczema Capillitii.—Both diseases nearly the 
same in character, the former attacking adults, the latter children. Two 
cases of the former disease, one of eight years’, another one year’s dura- 
tion. Both cases were treated by the internal use of the capsule, and 
externally the ung. picis. liquid, continued between two and three months, 
with perfect success. 
Eczema capillitii is most common in young persons, beginning on the 
scalp behind the ears ; from thence extending to the body and limbs. 
Several obstinate cases, of from five to seven years’ duration, have been 
treated with the capsules of tar and ung. picis liq. very successfully. In 
one case a bath of tar water was employed instead of the ung. picis, the 
child being but three years of age. Four ounces of tar, added to a suffi- 
cient quantity of water to cover the child’s body and limbs, is the mode in 
which the tar bath may be made, and a very efficient remedy it is, free 
from the objection which might be raised against the ointment, of soiling 
the linen. This child took the capsules with perfect ease, and together 
with the warm tar bath used every other night, recovered hi five weeks. 
Cases of this disease often run a course of five or seven years, resisting 
every, even the most potent remedies. 
Lepra.—A case of this disease came under treatment. The patient was 
covered with leprous patches. He took the capsules about a month, and 
the disease decidedly diminished. He was unsteady in conduct, and irregu- 
lar in his habits, and did not pursue the plan so as to derive all the benefit 
he might have done. The odor of tar was perceptible in his clothes worn 
next the skin. 
Psoriasis Palmaris et Nasi.—In this disease, in addition to the internal 
use of the capsules, which should be persevered with a considerable time, 
the hands should be immersed in a bath of tar water every night for a 
quarter of an hour, then dried, and powdered with starch powder. In a 
case of psoriasis nasi, the cracks which form at the junction of the mucous 
membrane and true skin should be anointed with ung. picis liq. very 
slightly at bed-time, and washed off in the morning with warm water. In 
a case of this kind which annoyed the patient, who was a great snuff-taker, 
the disease was thus removed in a few days. SKIN DISEASE. 
533 
Prurigo Senilis.—Two cases in men, one of 85, and the other of 90 
years of age. These gentlemen were subject to attacks of prurigo, attended 
as usual with desperate itching and irritation. Various remedies had been 
employed in vain ; lotions of hydrocyanic acid. hydr. bichlorid., etc., etc., 
The ung. picis liq. was applied freely on the legs, and over it an elastic 
roller, occasionally bathing the legs" in bran water, to remove the deposit 
of tar from the skin. Fresh applications were made in this manner 
every second or third day. This plan soon allayed the itching. Both 
patients suffered repeatedly from this disease, but always found relief 
from this mode of treatment, and were often quite free from it for months 
together. 
Sycosis.—A case of this disease, which had resisted a multitude of reme- 
dies, amongst others carbonate of iron in large doses, sarsaparilla and lime 
water, arsenic, mercury, etc., was cured by the internal use of tar in cap- 
sules, taken one morning and evening, which removed not only the mealy 
eruption, but pimples, which were a source of great annoyance and much 
pain in shaving. 
Tar acts as a diuretic and diaphoretic. The odor of tar is distinctly 
perceptible in the urine of those who take it in capsules. The quantity is 
somewhat increased, and it is rendered clear and free from all deposits. 
A physician who took it for acne, and wffio had studied the analysis of 
mine long and carefully, told me he had found it entirely remove a de- 
posit of phosphates to which he had been long subject. Increased per- 
spiration, and the strong odor of tar on the linen of those who have taken 
it, clearly prove its action on the skin. In moderate doses it improves the 
digestive organs, and invigorates the general health. 
Tar certainly deserves a trial in all chronic intractable and senile erup- 
tions, where, owing to peculiar idiosyncrasy, arsenic cannot be adminis- 
tered. Part 223. 
Treatment of the more Common Forms of Skin Diseases.—According to 
Prof. Bennett, of Edinburgh, Eczema is by far the most common disease 
met with, both in its acute and chronic forms. 
Prof. B. says: The local treatment I have found most efficacious, con- 
sists in keeping the affected part moist, with lint or linen saturated in a very 
weak alkaline solution, consisting of soda subcarb. 3ss. to a pint of water. 
For this purpose it is necessary to cover the moistened lint with oil-silk, 
or gutta percha sheeting, which should well overlap the lint below, so as 
to prevent evaporation. The usual effect is soon to remove all local irrita- 
tion, and especially the itching or smarting so distressing to the patient; 
to keep the surface clean, and prevent the accumulation of those scabs 
and crusts, which in themselves often tend to keep up the disease. After 
a time, even the indurated parts begin to soften, the margins of the erup- 
tion lose their fiery red color, and merge into that of the healthy skin, and, 
finally, the whole surface assumes its normal character. 
Herpes.—This disease generally runs its course in about fourteen days, 
and requires no treatment whatever, further than an acetate of lead lotion 
to allay the smarting. It is not very common. 
Scabies occurs very frequently, and is cu?ed by a host of remedies. A 
strong lather of common soft soap and warm water, twice a day, answers 
very well. The question with scabies, is not what remedy is useful, but 
which will cure it in the shortest period. The most extensive experience 534 
SKIN DISEASE. 
at St. Louis has shown, that the smphur and alkaline, or Helmerinch’s 
ointment, cures itch, on an average, in seven days. That sulphur, how- 
ever, is not the active remedy, I have satisfied myself of by experiment. 
Soft soap, as we have seen, which contains alkali, and even simple lard, if 
pains be taken to keep the parts constantly covered with it, will cure the 
disease as soon as suljohur ointment. I have tried the Stavesacre oint- 
ment, recommended by M. Bourguignon, in only a few cases, but found it 
to answer very well. 
Pemphigus.—This is rather a rare disease, and when chronic, coming 
out in successive crops, is very rebellious. Two cases which entered the 
infirmary last winter were cured in a few weeks by the weak alkaline 
wash, applied as in the case of eczema, combined with generous diet. 
Impetigo.—This affection in all its forms is very common, and is best 
treated by the weak alkaline wash, exactly the same as in eczema. In the 
chronic forms which attack the chin of men, constituting one of the varie- 
ties of mentagra, the same treatment cures the most rebellious cases if the 
moisture be constantly preserved. For this purpose the hair must be 
cautiously cut short with sharp scissors, and the razor carefully avoided. 
If the side of the cheek covered with the whisker is attacked removal of 
the hair from thence also is essential to the treatment. A bag or covering 
accurately adapted to the part affected must be made of gutta percha 
sheeting, and tied on with strings. This may be covered with black silk, 
to allow the individual to go about and carry on his usual occupations. 
In this way I have frequently seen chronic impetigo of the chin, of from 
eight to ten years’ standing, completely removed in a few weeks. But 
then the surface must be kept constantly moist, a circumstance requiring 
very great care and determination on the part of the patient. AVhen it 
becomes necessary to shave, flour and warm water, or paste should be 
used, and not soap. Alkalies applied from time to time only, as in the 
form of wash or soap, always irritate, although, when employed continu- 
ously, they are soothing. 
Ecthyma is not a common disease, and usually presents itself, as the 
E. cacheticum, requiring in addition to the alkaline wash locally, a gene- 
rous diet. 
Acne is a disease always requiring constitutional rather than local reme- 
dies. Although not uncommon in private, it is rare in hospital practice. 
Careful regulation of the diet, abstinence from wine and stimulating 
articles of food, watering-places, baths, etc., etc., constitute the appro- 
priate treatment. 
Pupia.—This disease I have never seen occur but in individuals who 
have been subjected to the influence of mercurial poisoning. Hydriodate 
of potassium and tonic remedies, with careful avoidance of mercury in all 
its forms, is the treatment I have found most successful. 
Lichen and Prurigo.—In both these affections constant inunction with 
lard is as beneficial as constant moisture in the eczematous and impetigin- 
ous disorders. In the prurigo of aged persons, the ung. hyd. precip. 
alb. is a useful application, although the disease is not unfrequently so 
rebellious as only to admit of palliation. The chronic papular diseases 
often constitute the despair of the physician. 
Psoriasis, and that modification of it known as lepra, are very common 
diseases, and are uniformly treated by me externally with pitch ointment. 
I have satisfied myself by careful trials, that it is the pitch applied to the 535 
SKIN DISEASE, 
part that is the beneficial agent, as I have given pitch pills, and infusion of 
pitch, largely internally without benefit. With the hope of obtaining a 
less disagreeable remedy, I have frequently tried creasote, and naphtha 
ointment and washes, but also without benefit. Lastly, I have caused 
simple lard to be rubbed in for a lengthened time, but without doing the 
slightest good. The oil of cade is also very useful, especially in psoriasis 
of the scalp. Internally, I give five drops each of Fowler’s solution, and 
of the tr. cantharidis. It is rare that the internal treatment alone pro- 
duces any effect on a case of psoriasis of any standing. If a case resists 
this conjoined external and internal treatment, I have always found it 
incurable. About a year ago I carefully treated a series of cases inter- 
nally with Donovan’s solution, without producing the slightest benefit. 
Lupus is a constitutional disease, and must be treated by cod-liver oil, 
and all those remedies useful in scrofula, of which it is a local manifesta- 
tion. The external treatment is surgical, consisting of the occasional 
application of caustics, red lotion, ointments, etc., according to the appear- 
ance of the sore. 
Favus is a very common disease in Edinburgh, and is most readily 
removed, first, by poulticing the crusts till they fall off, and the skin pre- 
sents a smooth, clean surface; secondly, by shaving the hair; and thirdly, 
by keeping the scalp continually covered with oil, so as to exclude the 
atmosphere, and prevent the growth of the parasitic fungi, which consti- 
tutes the disease. For this purpose, a gutta percha or oil silk cap must be 
constantly worn. A continuance of this treatment for six weeks produces 
a cure in young persons if combined Avith cod-lrcer oil, generous diet, and 
auti-scrofuious remedies internally. I have tried the lotion of sulphurous 
acid, recommended by Dr. Jenner, and found it successful in a few cases, 
but the treatment by oil is so easy, to be far preferable to it. Very 
chronic cases are cured Avith difficulty, but so long as the oil is applied the 
disease never returns, and mere freedom from the disgusting crusts is a 
great gain. 
Scalp diseases must be treated according as it depends on eczema, 
impetigo, psoriasis, or favus, in all cases first removing the crusts Avith 
poultices, then keeping the head shaved, and lastly, applying alkaline 
Avashes, pitch ointment, or oil, according to the directions formerly given. 
Ringworm is a disease I have never seen in Edinburgh, and of what it con- 
sists I am ignorant. Some writers apparently consider it to be favus, and 
others a form of herpes. On two or three occasions I have seen a scaly 
disease of the scalp, in the form of a ring—that is lepra, which I have 
cured by pitch ointment, or oil of cade. My friend, Dr. AndreAV Wood, 
informed me some time ago, that he banished it from the ITeriot’s Hospital 
school by condensing on the eruption the fumes of coarse brown paper, 
and thus causing an empyreumatie oil, or kind of tar, to fall upon the part. 
This has led me to suppose that it is a scaly disease, and a form of lepra 
or psoriasis. 
So-called syphilitic diseases of the skin are, in my opinion, the various 
disorders already alluded to, modified by occurring in individuals who have 
suffered for periods more or less long from the poisonous action of mercu- 
ry. A longer time will be required for their cure, but the same remedies 
locally, conjoined with hydriodate of potassium, in smaller doses, with 
bitter infusions, tonics, and a regulated diet, offer the best chance of 
success. 536 
SKIN DISEASE. 
The great difficulty in the treatment of skin diseases generally consists 
in their having been mismanaged in the early stages—a circumstance I 
attribute to their not having, until a recent period, been much studied by 
clinical students. Many chronic cases of eczema are continually coming 
under my notice, which, in their acute forms, have been treated by citrine 
ointment, or other irritating applications, which invariably exasperate the 
disorder. I shall not easily forget the case of one gentleman, covered all 
over with acute eczema, who had suffered excessive torture from its having 
been mistaken for psoriasis, and rubbed for some time with pitch ointment. 
In the same way I have seen a simple herpes, which would have readily 
got well if left to itself, converted into an ulcerated sore, by the use of 
mercurial ointment. Nothing is more common than to confound chronic 
eczema of the scalp with the favus, although the microscope furnishes us 
with the most exact means of diagnosis. I need scarcely say that the cor- 
rect application of the remedies I have spoken of can only be secured by 
an accurate discrimination, in the first instance, of the diseases to which 
they are applicable. 
The general constitutional treatment in all these cases seldom demands 
aperient or lowering remedies except in young and robust individuals with 
febrile symptoms. In the great majority of cases, cod-liver oil, good diet, 
and tonics are required. In a few instances, sedatives, both locally and 
internally, are necessary to overcome excessive itching and irritation. 
These the judicious practitioner will readily understand how to apply 
according to circumstances. Part xxxi., p. 178. 
Use of Collodion in Slcin Diseases.—Mr. Wilson says: the diseases of 
the skin in which I have hitherto used the collodion with advantage are, 
chronic erythema of the face; intertrigo ; chapped nipples and chapped 
hands ; herpes labialis, preputialis, and herpes zoster; lichen agrius ; lupus 
non exedens and exedens; acne vulgaris; and several affections of the 
sebiparous organs. In chronic erythema of the face, its contracting 
power was most usefully evinced, as it was also in lupus non exedens, and 
acne. 
In a troublesome case of chapped hands and fingers, resulting from 
chronic lichen agrius, the collodion acted not merely as a protective cover- 
ing, but also promoted the healing of the cracks. In chapped nipples, it 
was even more efficient in its protective and curative action. The gaping 
cracks were instantly drawn together and almost obliterated by the con- 
tracting power of the remedy, and were effectually shielded from the 
influence of moisture and the pressure of the gums of the infant, and all 
this, in consequence of the rapid evaporation of the ether, in an instant of 
time. In another point of view the remedy is invaluable as an application 
to chapped nipples—namely, as being in nowise injurious to the infant, 
from offering nothing which can be removed by the lips during the act of 
sucking, and in this particular, therefore, possessing a vast superiority over 
the various forms of ointments, astringent lotions, eto. As it is usually 
prepared, it has the consistence of sirup, and in this state is best suited for 
those cases in which its adhesive properties are principally needed. 
Where, however, it is intended to be applied to the surface of an ulcer or 
abrasion, or to chaps of the skin, I find it convenient to dilute it with 
ether, and render it almost as limpid as water. Part xviii., p. 227. 
Borax in Efflorescence of the Face.—Mr. Vanoye, in these cases of red 537 
SLEEPLESSNESS, 
spots, or efflorescence of the face, so often seen in the young otherwise in 
good health, states he has found washing them several times a day with 
Hufeland’s formula a most excellent remedy. It consists of borax two 
parts, orange-flower and rose-waters of each fifteen pai'ts. 
Fart xxiv., p. 258. 
Grease in Man—Inoculation of.—In a case in Guy’s Hospital, three 
grains of quinine were ordered three times a day; also a lotion of nitrate 
of silver, 5ss. to §j. of distilled water, applied by a sponge pushed up the 
nostrils ; with full diet, ten ounces of port wine, and two pints of porter 
daily. The solution of caustic seemed decidedly to have killed the disease. 
The parts around the nose, cheeks, and eyes, were much swollen, and were 
punctured. The streams and jets which flowed from the wounds showed 
the state of congestion the parts were in. Fart xxiv., p. 349. 
Balms for Diseases of the Skin.—Baume Chiron ou de Lausanne, em- 
ployed to promote the Cicatrization of chapped Nipples and Broken 
Chilblains.—Take of olive oil, ten ounces; Venice turpentine, two ounces; 
yellow wax, one ounce ; alkanet root, half an ounce ; boil together, sti’ain 
and add of balsam of Peru, two and a half drachms; camphor, nine and a 
quarter grains; stir constantly until cold. 
Balm for Chilblains.—Take of rectified spirit of turpentine, one drachm; 
sulphuric acid, fifteen grains ; olive oil, two and a half drachms ; mix. To 
be rubbed night and morning on unbroken chilblains. 
Goulard’s Balm (Oil of Saturn).—Take of essential oil of turpentine 
any quantity; heat it secundem artem / decant, etc. Used for dressing 
phagedenic ulcers, ecthyma, some chronic eczemas, and rupia. 
Flench's Mercurial Balm.—Take of mercury, one ounce ; Venice tur- 
pentine, half an ounce ; lard, three ounces ; calomel, seventeen grains and 
three-quarters; elemi ointment, three ounces: mix. Used for dressing 
venereal ulcers. Part xxvii., p. 161. 
Cutaneous Affections.—When associated with the cancerous diathesis, 
are best treated at the London Hospitals, by creasote made into pills with 
liquorice powder. Part xxxiii., p. 236. 
Disuse of Soap in Skin Diseases.—Mr. Startin is very emphatic in his 
directions to patients suffering from cutaneous eruptions, to avoid the appli- 
cation of soap to the irritated part. In the general directions appended to 
the pharmacopoeia is the following : “Avoid using soap of any kind to the 
affected part; substitute to cleanse the skin, instead of soap, a paste or gruel 
made of bran, oatmeal, linseed-meal, arrowroot, or starch and warm water, 
or warm milk and water; and yolk of egg and warm water to cleanse the 
scalp.” The last named application is exceedingly useful in cases of porrigo 
and eczema of the scalp in children. Both of these affections are often ag- 
gravated and kept up by the persevering use of soap. Part xxxviii.,p. 176. 
SLEEPLESSNESS. 
Sleeplessness.— Vide Selections from Favorite Prescriptions, Article 
“ Medicines.” 
Wakefulness—Hypodermic Injections.—Opium, morphia, and other 538 
SMALLPOX, 
sedatives, Mr. Hunter observes, will, in some cases, entirely fail in pro 
curing sleep, or even cause a little delirium, whilst a little morphia (a third 
or half a grain of the acetate) injected into the cellular tissue of any part 
of the body, will act rapidly and effectually, procuring sleep and allaying 
irritation. Part xxxix., p. 53. 
Sulphur.—It would appear from the experiments of Dr. Midaveine, 
that sulphur possesses the same efficacy as mercury in arresting the 
development of the small pox pustule. Dr. M. employs an ointment 
composed of two to two and a half drachms of flowers of sulphur to an 
ounce of lard, and with this ruhs lightly, thrice a day, all parts of the 
body on which pustules exist. The nearer the pustules are to the period 
of their first appearance, the greater the chances of success ; the papulae 
then contract, become dry, and fade away. Even in confluent smallpox 
the patient quickly recovers his appetite, and asks for food. 
Dr. Midaveine employed the sulphur ointment in sixteen cases only, and 
of these twelve had been vaccinated. 
Gold-leaf.—Gold-leaf is used for the same purpose by the Egyptians 
and Arabs as related by Baron Larrey. They cover the parts with gold- 
leaf as soon as the eruption makes its appearance. 
M. Legrand bears testimony to the efficacy of the practice, having tried 
it in one case, which he relates. The patient was a beautiful English girl, 
who had a copious eruption of confluent smallpox. On the first day of 
the eruption the whole of the face was covered with the gold leaves, 
which were made to adhere by means of gum water. The application was 
renewed morning and evening so long as the suppurative fever continued; 
and when the cure was complete, net a pit or scar was left on the face 
where the gold-leaf had been applied. The hands, and the rest of the 
body which had not been thus protected, were deeply marked with the 
scars of the pustules. 
Almond Oil.—Barron Larrey says that he has found nearly the same 
beneficial results to follow from the repeated anointing of the face of the 
person laboring under smallpox with almond oil; a practice which 
recommends itself from its cheapness and the facility of its application. 
Part iii., p. 51. 
Aphorism of Practical Surgery.— It is a well-known fact that all 
abcesses caused by smallpox exist between the periosteum and the bone, 
with tumefaction of the latter, and subsequent formation of a sequestrum ; 
but in the majority of cases, this cause produces only a swelling of the 
bone with denudation. It is important to distinguish these two sets of 
cases. (Dupytren.) Part iii., p. 116. 
Iodine a Preservative against Variola.—Dr. Schreiber states that he 
has found the administration of iodine useful in preventing the members 
of the family of a person laboring under smallpox from being infected 
with the same disease. The formula he used was as follows : 
# Hydriod. potass., gr. viij.; tinct. iod., gtt. xyj.; aquas font., gij. S. A. 
teaspoonful morning and evening. Part x., p. 187. 
Blisters in confluent Smallpox.—M. Piorry has for some time past 
SMALLPOX. 539 
SMALLPOX. 
derived great assistance from the use of blisters as a means of preventing 
the scarring of the face by the cicatrices of confluent smallpox. The pus, 
retained so long in contact with the tissues, and altered in character 
through the agency of the air which passes through the pustules by 
endosmosis, operates extensive local destruction, and proves very injurious 
to the system when re-absorbed. Various practitioners have proposed mea- 
sures for obviating this inconvenience, as by cauterization of each pustule 
(impossible in the confluent disease), the opening them by scissors, nee- 
dles, etc. Experience, however, shows that over such means the blister 
has the advantage of—1, opening at one time the whole of the pustules 
over which it is applied; 2, evacuating their entire contents, and 
preventing the consequences of the sojourn, or resorption of pus; 3, 
counteracting the attendant erysipelas, by diminishing the swelling: and 
5, causing the scabs to fall much sooner from the face than from other 
parts of the body. It has an advantage over mercurial plasters in not 
risking the excitement of salivation, the extent of evil which results from 
its use being a slight ischuria. The various plasters applied as abortives 
in this disease, have been reproached with exerting a repellent action, 
and directing the morbid action upon the brain and its membranes. A 
blister, on the contrary, rather acts as a derivative. Part xv., p. 261. 
Smallpox—To prevent Pitting from.—Professor Bennett recommends 
mercurial ointment thickened with starch (ung. hydrag., §j.; pulv. amyli., 
§ij.) to the forehead and face, night and morning. The ointment forms a 
thick hard crust, which, as it cracks and peels off, is renewed by a fresh 
application. Part xxi., p. 262. 
Abortive Power of Collodion on Smallpox.—A case occurred in the 
wards of M. Aran, at the Bon Secours, in which the good effects of collo- 
dion was proved to be as decisive in confluent smallpox as it had been 
found before in the more simple form. It occurred in the person of an 
unvaccinated young man, and the collodion was applied to all parts of the 
face but the lips and ears. Through this transparent covering the progress 
of the pustules was observed to become at once arrested, while those un- 
covered continued enlarging. Moreover, a part of the covering having 
been destroyed without being observed for some hours, the pustules thus 
exposed immediately began to develop themselves until again arrested by 
a reapplication. The ears, too, were now covered, and the progress of the 
pustules stopped there. In a few days the collodion peeled off, the skin 
looking as if after erysipelas, but no cicatrices were to be observed, though 
in other parts of the body they existed in abundance, the eruption having 
been very confluent. Part xxiii., p. 292. 
Treatment of Smallpox.—After mature deliberation upon the treat- 
ment of smallpox, Mr. Pasquin arrived at the conclusion that the pitting 
and disfigurement of the face was dependent upon the confinement of the 
matter too long in the pocks, causing a slough thereby to form in the cel- 
lular tissue lying between the cuticle and the fascia of the face. This is 
not regenerated, hence the cuticle falls into the space where the cellular 
tissue is then wanting, and thus follows the pitting. To obviate this, Mr. 
Pasquin determined to puncture each pock previous to its arriving at per- 
fection, and apply a common poultice. This treatment succeeded to his 
utmost satisfaction. As the pustules are liable to form on the tongue, 
fauces, pharynx, and larynx, apply a few leeches over these regions, exter- 540 
SMALLPOX. 
nally, so as to diminish the circulation and to reduce the size of the pocks. 
Part xxiv., p. 42. 
Smallpox.—In a case of smallpox, under the care of Dr. George, at- 
tended by great swelling of the throat, and painful and difficult degluti- 
tion, great relief followed the application to the throat of jeweller’s cotton, 
well sprinkled with powdered camphor. Part xxvi., p. 290. 
Smallpox—Abortive Treatment.—Professor Bennett recommends to the 
face the following plaster : Carbonate of zinc, three parts ; oxide of zinc, 
one part; rubbed in a mortar with olive oil to a proper consistence. This 
may be used throughout the case, and renewed from time to time. 
Part xxix., p. 50. 
Smallpox—To prevent Pitting in.—Dr. Crawford uses a saturated solu- 
tion of iodine in spirits of wine. Brush this tincture freely over the face 
once or twice daily, from the earliest period of the eruption, and continue it 
during the maturation of the pustules. Part xxx., p. 175. 
Abortion of the Variola Pustule.—Many are the remedies which have 
been recommended for the prevention of the pits left in the place of the 
pustule. Mercurial ointment has, perhaps, been most useful, though it is 
very objectionable. Trousseau’s Elastic Collodion is much more useful 
and agreeable; it is formed of collodion 30 parts, Venice turpentine and 
castor oil part. It must be applied over the whole face three or four 
times a day. The result has been highly satisfactory. 
In the Paris hospitals from 30 to 40 centigrammes of corrosive sublimate 
are added to every 30 grammes of the elastic collodion, and it is said with 
excellent results; but of this mixture M. Delioux has had no experience. 
Part xxxii., p. 188. 
Prevention of Pitting in.—Dr. Stokes and Dr. Graves, of Dublin, have 
recommended painting the face with a solution of gutta percha in cliloro- 
form. It should be applied immediately before complete maturation. 
The increase of swelling after this time is moderate, and not such as to 
give rise to much pain, tension, or inconvenience. Part xxxiii., p. 228. 
Smallpox.—In confluent variola, as soon as the eruption is complete, 
the greatest benefit may be derived from a few grains of Dover’s powder, 
given every night. Part xxxiii., p. 308, 
Smallpox—Prevention of Pitting in.—If the eruption be distinct, the 
solid stick of nitrate of silver should be applied to each pustule, previously 
moistened with a little water. If confluent, the concentrated solution of 
8 scruples to an ounce of distilled water, must be applied over the whole 
surface. (If necessary to apply it to the scalp, the hair should be pre- 
viously removed.) The application should be used on the second or third 
day of the eruption. Mr. Higginbottom relates a case of confluent small- 
pox, where no punctures were made, in which the strong solution was ap- 
plied to the whole of the face and ears, the pustules were immediately ar- 
rested, and in nine days the eschar had come away from the face, without 
leaving pits. Part xxxv., jo. 159. 
Treatment of Smallpox.—During the spring of 1858, smallpox was 
very prevalent in the Chatham garrison, and only one case out of thirty 
proved fatal under the treatment pursued by the author. The patient, 
under the care of Mr. Mandeville, surgeon 3d Indian Depot Battalion, was SNAKE BITES. 
541 
directed to take a mixture composed of 2 drachms of compound rhubarb 
powder, 2 drachms of tincture of hyoscyamus, and ounces of camphor 
mixture, in doses of two tablespoonfuls three or four times a day; but if 
the attendant fever was very high, there were added two ounces of the 
solution of acetate of ammonia to the above. This mixture was generally 
continued as long as the fever lasted, which was usually about the time 
when the pustules had fully maturated and the scabs had formed, the fever 
seldom extending beyond that period. It was then omitted, and bark or- 
dered, if there had been great prostration, after a serious attack. A 
draught containing one drachm of tincture of hyoscyamus, in an ounce of 
camphor mixture, was given at night, as soon as the patient complained of 
any restlessness or itching, which was about the second or third day of the 
eruption in the confluent form; but they sometimes complained of it on 
the first day, when the eruption appeared to be retarded, as if struggling 
to force its way through the cutis vera. This was continued every night 
as long as the sleeplessness from the pruritus continued, and at the same 
time the following liniment or ointment was laid on with a large-sized 
camel-hair brush three or four times a day over the face and any other 
part of the body of which the patient complained of being itchy—viz., 
half a drachm of extract of belladonna, rubbed up with half a drachm of 
spermaceti ointment, to which were added 3£ ounces of olive oil and 21- 
drachms of chloroform. The cerate was added to give it consistence and 
hold the chloroform in suspension, but the bottle must, notwithstanding, 
be well shaken before using, as the chloroform will subside after standing 
for any time. Part xxxviii., p. 28. 
SNAKE BITES. 
Ipecacuanha in the Bites of Venomous Animals.—[A little girl was 
bitten by a centipede; after the usual remedies, oil, spirits, laudanum, am- 
monia, had been exhausted without relief to the pain.] 
Mr. Collett says: I fetched a bottle of wine of ipecacuanha from the 
chest, and gave it to the mother to apply locally. To my surprise and de- 
light she came out of her cabin in two minutes, to tell me it had stopped 
the pain instantly. I requested her to re-apply it if necessary. The pain 
returned once, when it again immediately and entirely relieved it. If so 
minute a quantity as is contained in the wine, could be attended with such 
good effects, I think much more might be expected from its use in the 
concentrated form of emetine. Part xvi., p. 331. 
SnaTce Bite.—Dr. Bland recommends a ligature, whenever practicable, 
above the bite; include the bitten part between the blades of a pair of 
tenaculum forceps, raise it from the subjacent tissues, and cut it com- 
pletely out with a scalpel; apply a cupping-glass to the wound, or use 
suction ; give stimulants, as brandy, wine, ammonia, or oil of turpentine ; 
bleed to relieve constriction of the chest, or pain about the heart or head; 
wash the head, face, and hands, occasionally in cold water; and prevent 
sound sleep for some time after the injury. Part xvii., p. 296. 
Snake Bite.—Dr. Whitmire paints the part bitten, and the whole ex- 
tent of the swelling, with three or four coats of tincture of iodine, twice 
daily. Part xx., p. 180. 542 
SNAKE BITES, 
Pite from an Adder.— Vide Art. “Bites.” 
Pite from a Cobra de Capello.—Give a teaspoonful of sp. ammoniae 
aromaticus in a little water every five minutes. Dr. Mac Rae, when bit- 
ten by this snake, took 13 teaspoonfuls in this manner; every dose 
seemed to give some relief. In three hours he was out of danger. 
D. Cole adds his testimony to the great value of ammonia administered 
internally in the cases of bite from this snake. He prefers the liq. ammon. 
fort., (P. L.) in doses of ten to twenty drops. He also states his belief 
that it is exceedingly dangerous to suck the poison from the wound, as, 
in his opinion, the deleterious principle of the poison is not neutralized by 
the gastric juice. 
In twenty cases of this nature, hot brandy and water was immediately 
administered along with peppermint and laudanum. Not one case was 
lost. 
The late M. Lisfranc spoke in the most unqualified manner of the suc- 
cess following the free application of ammonia to the wound, and its free 
administration internally. 
Suction from the wound, or the actual cautery, or if possible, a tight 
ligature, combined with every means to combat torpor, ought to form 
the bases of the treatment. Part xxvi., p. 334. 
Pites from Serpents.—Rub the parts with the tincture of guaco, and 
give 3j. doses every ten minutes. This remedy is said by Dr. Pritchard 
to be unerring in its efficacy. Part xxvii., p. 250. 
Arsenical Treatment of cases of Snake Pite.—Arsenic has been re- 
cently employed for the treatment of these cases, and it is singular that 
persons having been bitten by snakes recovered completely by this treat- 
ment, without any of the poisonous symptoms of arsenic being manifested. 
Mr. Ireland prescribed liquor arsenicalis, 3ij.; tinct. opii, gtt. x.; aquas 
menthas pip., giss. To this quantity half an ounce of lime juice was added, 
and the medicine taken in an effervescent form. A grain of arsenic every 
half hour looks formidable treatment, but it was certainly successful in 
snake bite, and may be so in hydrophobia. Arsenic would seem to stimu- 
late specially the semilunar ganglion and its tributaries, presiding over 
the organic life of our bodies. Its “ evacuant ” operation is an incident 
of prime importance in cases of poison. It should always be given on 
these occasions until the patient vomits and purges abundantly. 
Part xxviii., p. 317. 
Snalce Pite.—Dr. Loundes recommends 5 grains of bicarbonate of am- 
monia every five minutes, and to administer an enema of mustard and 
water, with two drachms of tinct. of valerian, which may be repeated if 
returned. Apply a mustard cataplasm over the cardiac region and then 
give the following : Chloroform, 3j.; spirit, gij.; mist, camph., giij.; M. ft. 
m. gj. every ten minutes. Part xxix., p. 326. 
Snake Pite.—A decoction or broth of the leaves near the root of the 
common male fern, polypodium filix mas, has been used as a secret re- 
medy in Australia, as a specific for snake bites. Though the experiments SOAPS SORES. 
543 
hitherto made cannot be said to be satisfactory, it might be tried by me- 
dical men in the army, if nothing better is at hand. Probably a tincture 
would be more powerful. Part xl., p. 278. 
Alcoholic /Stimuli in Snake Bites.— Vide Art. “Bites.” 
Medicated Soaps for the Treatment of Skin Diseases.—Sir II. Marsh 
recommends the following in the more chronic forms of skin disease, as 
chronic eczema, psoriasis, et<?.: 
Sulphur Soap.—Take of white Windsor soap, two ounces ; spirit of 
wine, colored with alkanet root, one fluid drachm. Pound the soap well 
in a marble mortar, so as effectually to get rid of all lumps ; add the 
spi rit and beat into a uniform paste; then add sublimed sulphur two 
drachms, otto of roses, ten drops—beat all well together. 
White Precipitate Soap is made precisely as the sulphur soap, substi- 
tuting ammoniated submuriate of mercury for the sulphur. 
Red Precipitate Soap.—Take of white Windsor soap, two ounces ; rec- 
tified spirit of wine one fluid drachm; pound the soap well in a marble 
mortar, until all lumps have disappeared; add the spirit and beat into 
a uniform paste; then add precipitated red oxide of mercury, one drachm; 
otto of roses, six drops; beat all well together. 
Corrosive Sublimate Soap.—Take of white Windsor soap, two ounces; 
spirit of wine, one fluid drachm; corrosive sublimate, one scruple ; pound 
the soap well in a marble mortar until all lumps have disappeared; add 
the corrosive sublimate, previously reduced to a fine powder, and rubbed 
in a separate mortar, with the spirit. Beat all into a uniform paste, 
adding six drops of otto of rose. 
Sir II. Marsh states that the only forms of cutaneous disease that 
admit of the application of these soaps are those which either have passed 
from the acute into the chronic stage, or have not been at any period 
peculiarly irritable and tender ; at the same time, he has met with several 
cases in which the tender surfaces, at first intolerant, became subsequently 
inured to them; and, after a little perseverance, the patients began to 
speak highly of their soothing and beneficial effects. Part xxii., p. 260. 
SOAPS. 
SORES. 
So7'es and Wounds—Sloughing.—Dr. T. S. Fletcher advises the use 
of chlorine. It is a powerful antiseptic, and prevents sloughing. Make a 
solution of chloride of lime, two drachms of the powder to a pint of cold 
water. Cover the wound with pads of tow dipped in this solution, and 
renew them about twice a day. Part xxxi., p. 191. 
Chloride of Potash in Scrofulous Sores.—M. Bouchut employs with 
great success, a solution of this substance (5j. ad §iij. aquae) as a local 
application to external sores in scrofulous children. He has also found it 
highly useful in arresting the progress of ulcers supervening upon the em- 
ployment of blisters, as also in ulcerated chilblains. Part xxxviii., p. 175. 544 
SPASMODIC AFFECTIONS. 
Spasmodic Affections of the Larynx—Veratria.—Dr. Bushnan lias 
strongly recommended the ointment of veratria in the treatment of dys- 
menorrhoea. Dr. Bushnan supposes that dysmenorrhoea may frequently be 
owing to perversion of the nervous action of the lower portion of the spinal 
nerves, and found good effects from the external application of the oint- 
ment of veratria. Dr. Tunstall suggests that if the ointment of veratria 
has this effect on the lower portion of the spinal marrow, why may it not 
have a similar effect on the portion ? and in this latter case it 
would be supposed to be useful in spasmodic affections of the larynx and 
appendages. Dr. T. accordingly tried it in the case of a schoolmistress: 
she was usually seized with a sense of suffocation, the whole of the muscles 
employed in respiration were put into violent and convulsive action, the 
lower extremities became cold, the face purple, the whole surface was be- 
dewed with cold perspiration ; she was perfectly sensible during the whole 
attack; the fit usually terminated in ordinary dyspnoea, which lasted for 
hours, or even days.. Every variety of depletion and counter-irritation 
had been employed; also, opiates and antispasmodics, without the least 
advantage. Dr. T. says :] 
I therefore prescribed a scruple of veratria to one ounce of simple cerate, 
and directed that a small portion should be applied on each side of the cer- 
vical vertebrae, and rubbed well into neck, throughout its whole extent, 
twice a day. Although the attacks were previously rather frequent, she 
had not a single attack of consequence during its use. Part iv., p. 29. 
Opium Smoking as a Remedial Agent.—Dr. James Johnson suggests 
that the Chinese mode of smoking opium may be made useful “ in certain 
dangerous and painful maladies, where the common mode is found to be 
inefficient, and attended with great derangement of the digestive organs.” 
The Chinese method induces a profound sleep and insensibility to all mental 
misery and corporeal pain, which cannot be induced by opium taken into 
the stomach, and may, therefore, at some period, be used in cases of teta- 
nus, hydrophobia, tic-douloureux, and violent spasms, where the com- 
mon mode of giving opium by the stomach so frequently fails. Dr. 
Johnson adds, that “ the various preparations of opium might be easily 
smoked by means of a common pipe, and the powerful effects induced in a 
very short space of time without the possibility of their being rejected by 
the stomach, or prevented from acting energetically on the sensorium, and 
throughout the whole nervous system.” Part v., p. 56. 
Division of the Muscles of the Face when affected icith Chronic Spasms. 
Dieffenbach performed this operation in four cases in which the disease 
had existed for a considerable time. The orbicularis palpebrarum was 
divided, also the muscles of the*cheek, from the ala of the nose to the an- 
terior border of the masseter, and lastly, the muscles at the angle of the 
mouth. The result of the operation was, that the spasmodic affections 
were cured. . Part v., p. 142. 
SPASMODIC AFFECTIONS. SPERMATOCELE. 
545 
SPERMATOCELE. 
Spermatocele and Hydrocele.—[In a clinical lecture upon a case of liy 
drocele which had been operated upon,] 
Mr. Syme stated, that he had long ceased to employ port wine for injec- 
tion into the tunica vaginalis, on account of its effect proving very uncer- 
tain ; and that having subsequently used a mixture of the tincture of 
iodine with three parts of water for this purpose, he had, during the last 
five years, always injected the tincture alone, and without a single case of 
failure or unpleasant effect, either in public or private practice. The quan- 
tity required was about a teaspoonful, or as much as filled a common six- 
penny pewter syringe, which was the most convenient instrument for the 
operation, as the substance composing it allowed the nozzle to be readily 
adapted to the canula of the trocar. The fluid when injected was allowed 
to remain, and while producing the effect desired with absolute cer- 
tainty, seemed to occasion less pain than any other agent in past or present 
use. 
When the tumor was punctured, the fluid which issued through the 
tube, to the amount of a pint or more, appeared somewhat turbid, and this 
was attributed to its probably containing the scales of cholesterine, which 
are frequently met with in albuminous fluid long pent up in close cavities. 
The tincture of iodine, therefore, was injected as usual. But when a little 
of the fluid was poured from the basin, in which it had been received, 
into a glass vessel, in order that the gentlemen present might more readily 
examine it, the absence of scales, and the peculiar opalescence observed, 
at once suggested the idea of spermatocele, and an appeal to the micro- 
scope confirmed this suspicion, by bringing myriads of spermatozoa into 
view. 
Had the true nature of the case been ascertained in the first instance, in- 
jection would not have appeared expedient, since spermatocele has not only 
resisted the means of treatment which have proved sufficient for the remedy 
of hydrocele, but has also shown a disposition to resent with violence even 
liberties of a much slighter kind. 
The result of this case was, therefore, watched with interest; and when,, 
after passing through the usual course of a simple hydrocele, under the 
same circumstances, the swelling quickly subsided, with complete restora- 
tion of the testicle to its healthy state, it naturally suggested another trial 
of the same kind. For this an occasion happened at the time to present 
itself, in the case of a gentleman, who had had a hydrocele tapped about 
twenty years ago, by Sir Astley Cooper, and afterward injected with port 
wine by another surgeon in London, but still suffered from it. The tumor 
was in every respect very similar to that just mentioned; and when punc- 
tured, was found to contain the same sort of turbid opalescent fluid. The 
suspicion of spermatocele was confirmed by the microscope, which detected 
abundance of spermatozoa ; but everything went on satisfactorily after the 
iodine was injected, so that before the end of three weeks the testicle had 
very nearly regained its proper size and consistence. 
The two cases just related afford encouragement to attempt the radical 
cure of spermatocele by the injection of tincture of iodine, although other 
means have been found to fail. Pctrt xxi., p. 236. 
VOL. II.—35 546 
SPERMATORRHOEA. 
SPERMATORRHCEA. 
Causes and Treatment of.—[A number of years ago, Mr. Phillips, at the 
suggestion of M. Lallemand, first applied lunar caustic to the mucous 
membrane of the urethra to check involuntary seminal discharges. Mr. P. 
says:] 
Involuntary discharges are, for the most part, if not altogether, caused 
by irritation set up in or about the ducts connected with the testicle. 
There are particular modes in which the urethral irritation is commonly 
excited; among these, masturbation holds a prominent place: by this prac- 
tice the constant excitement of the seminal ducts ends by establishing a 
permanent irritation there : it may likewise happen from excess in sexual 
intercourse. Next to this cause we arrange gonorrhoea or gleety dis- 
charges, which, from time to time, establish chronic inflammation in the 
vicinity of the orifices of the ejaculatory ducts. Then follows stricture, 
which, by opposing an obstacle to the free passage of urine, ultimately 
causes the development of a morbid condition of the mucous membrane 
between the stricture and the bladder. The same state of these organs 
may result from irritation within the rectum ; that irritation may be caused, 
by fissures of piles, or by the presence of ascarides. 
The mode in which the irritation, once set up around the orifices of the 
ejaculatory ducts, acts, is very much the same as obtains upon the applica- 
tion of irritation to the mouths of other ducts; it solicits increased action 
in the organ with which they communicate. Irritate the bladder, and the 
kidneys are stimulated to increased action ; irritate the conjunctiva, and 
the lachrymal secretion increases ; irritate the duodenum, and it is said 
bile will be supplied in increased quantity; it is unnecessary to carry the 
illustration further. 
In most cases the evidence of involuntary spermatic discharges is clear 
enough, but the time comes when the ejaculation is unaccompanied by the 
■ordinary sensations, and the patient may then be unaware of the extent of 
the evil. I have again and again known cases where the spermatic fluid 
passed out with the urine; others, in which the efforts at stool caused a 
pressure to be made upon the distended seminal vesicles, and thus their 
contents were squeezed out; but the fluid may not pass until the process 
of buttoning up is going on, and the evil may be undiscovered. Still, un- 
less the disorder be very advanced, in most cases the person himself is 
aware of it when it passes with the urine, because it almost always passes 
with the last drops, and can then be detected, and because a certain sensa- 
tion is experienced about the neck of the bladder. But when the medical 
man is consulted, he calls for the recently passed urine, or requests that it 
may be passed in his presence, and at the bottom of the vessel he perceives 
small granular diaphanous particles ; and they are seen floating even before 
the urine cools; if the evil be, however, very advanced, no peculiar sensa- 
tion is experienced, and the granular matter may be undetected, and 
may assume a more uniform cloudy appearance. In cases where uncer- 
tainty remains with regard to the deposit, we may advantageously have 
recourse to the microscope, by means of which the little long-tailed ani- 
malcules of the spermatic fluid can readily be perceived. Under any debi- 
litating causes, whether those causes be found in frequent spermatic 
discharges, disease, or old age, the fluid becomes much thinner, and the 547 
SPERMATORRHOEA. 
animalcules much less numerous, and they maybe almost, if not altogether, 
wanting. 
One of the general symptoms resulting from too frequent spermatic dis- 
charges, which is most distressing to the sufferer, is a state approaching to, 
if not at the time, actual impotency. It is not that the seminal fluid, 
though deteriorated, is incapable of determining fecundation, but it is that 
the organs are wanting in the energy necessary for projecting the fluid into 
the uterus ; the erection of the penis, if it exist at all, being only momen- 
tary. The digestive functions become deranged ; the bowels constipated ; 
nutrition languishes ; respiration is troubled; the voice fails; the heart’s ac- 
tion is interfered with, even to such an extent as to induce the belief of 
actual disease in that organ, and hypochondriasis becomes complete. These 
things do not advance far without causing trouble in the nervous system, 
manifested by some perturbation of the senses, by headache, with great 
sense of weight or pressure, and they are accompanied by loss of memory; 
a timidity and apprehension which are very painful. It must be evident 
that as the causes of these discharges are many, the treatment must also 
be variable. When the irritation is in the rectum, the case will require a 
very different course of treatment to one proceeding from stricture of the 
urethra. We will therefore make such general remarks as are proper with 
reference to the treatment of the several varieties of the affection which we 
have considered. First, when the cause is masturbation or sexual excess : 
the causes here are voluntary, the cure must also be voluntary. Lunar 
caustic will be powerless, unless the patient has sufficient determination to 
abstain from the practice. But in many cases perfect abstinence will not 
suffice to put an end to the mischief; the voluntary discharges are got rid 
of, but they were persisted in so long that a permanent irritation has been 
set up in the verumontanum, and that irritation may, as we have already 
explained, excite equally injurious involuntary discharges: and here a 
remedy must be found by the surgeon. The first thing we have to do is 
to introduce cautiously a bougie, to pass it down toward the bladder ; but 
before it arrives there, the patient will complain of pain which is sometimes 
very acute; and the point at which the bougie has then arrived is usually 
a little in front of the prostate. The surgeon must then carefully observe 
how far the penis has been extended, and a mark must be made upon the 
bougie to indicate the depth to which the instrument has penetrated, be- 
cause that is the point upon which the lunar caustic must be applied. The 
depth to which we must penetrate must be marked upon the caustic instru- 
ment, which is then introduced and gently passed to the proper point, 
when the caustic is uncovered, and the membrane brushed over: as soon 
as that has been done, the caustic is again covered, and the instrument is 
withdrawn. 
The point upon which the caustic is to be applied is, as near as practica- 
ble, about the region of the orifices of the ejaculatory ducts. It often hap- 
pens, however, that the whole or several parts of the urethra are very sen- 
sitive, and it becomes difficult to know, from this circumstance, which is 
the most tender and irritable ; but when, for example, it is found that it is 
seven and a half inches from the orifice of the urethra to the bladder, which 
is known by the urine passing along the catheter, and when it is further 
seen that an acute pain is felt at a little more than six inches, we may con- 
fidently cauterize the space between the sixth and seventh inches, satisfied 
that the orifices of the ejaculatory ducts will not escape. 548 
SPERMATORRHOEA. 
In some cases the patient complains of a little heat when the caustic is 
applied; in others, the sensation spoken of is a coldness. I have more than 
once known some discomfort almost amounting to spasms at the anus, but 
altogether it is astonishing how rarely any complaint is made. At the next 
time of passing the urine, more smarting is usually experienced; it may 
continue through the day, but it is very bearable. In all cases it occasions 
a discharge, which is sometimes considerable, and at first is thin and watery, 
but gradually becomes thicker, and in the course of a few days ceases. In 
a few cases the discharge is at first streaked with blood; and in a few rare 
instances there may be trifling hemorrhage. 
It is always necessary to guard the patient against impatience, because 
four or five weeks will, in some cases, pass, before the beneficial effects of 
the remedy become clearly evident; and this is the more necessary, because 
he looks with intense anxiety to the result; and sometimes it happens that 
a single discharge, after the application of the caustic, will dash the cup of 
hope from his lips, and induce the most gloomy forebodings. I may again 
repeat what I have said before, that I have never applied too much caustic, 
but I have more than once failed by using too little ; and much experience 
is necessary to apply the proper dose. However, it is better to err on the 
safe side, until experience shall have given confidence in the use of the 
remedy. I have scarcely ever had recourse to a second application until 
five or six weeks have passed, and given the assurance that the first has 
been insufficient. 
If the affection has been caused by a gonorrhoeal or gleety discharge, the 
treatment must be the same as in the former instance. 
If it has been caused by stricture, we must first restore the canal to its 
natural diameter; the obstacle to the passage of the urine maybe removed, 
but the morbid condition of the posterior part of the canal, which has re- 
sulted from it, may persist; so may the specific discharges. Then the effi- 
cacy of the lunar caustic can be at once demonstrated; and a single proper 
and sufficient application of the remedy, with the precautions already indi- 
cated, will, in most cases, promptly cure the disease of the urethra as well 
as that of the spermatic organs. 
If the discharge be determined by irritation of the anus, or the rectum, 
appropriate means must be used to cure the intestinal disorder; and it may 
be that when that has ceased the spermatic disorder will also cease. Bm 
it may persist, because a distinct irritation may have been determined in 
the urethra by the long-continued action of that of the intestinal canal; and 
to dissipate that, recourse must be had to the lunar caustic, under the same 
restrictions as have been already pointed out. 
The space which M. Lallemand usually, cauterizes, is from the neck of 
the bladder to the membranous part of the urethra; but sometimes he 
brushes over the internal surface of the bladder itself to a greater or less 
extent. He cautions us strongly against repeating the operation too soon ; 
and advises us to wait two or three weeks before we re-apply the caustic. 
Many of his cases appear to have been cured by a single application. Pain 
and a slight discharge of blood, but never amounting to hemorrhage, seem 
to have followed some of his operations ; but these consequences disappear 
at the end of from twelve to forty-eight hours. In one case they are de- 
scribed as lasting three weeks, but this is mentioned as a rare exception. 
"W hen the emissions have been diurnal, M. Lallemand regards the conver- 
sion of them into nocturnal, and the fact of the emissions being once more 549 
SPEKMATOKRHCEA. 
accompanied with erections and with pleasurable sensations, as a sign of 
the favorable effects of treatment and prospect of cure. 
We shall now, with great brevity, advert to other modes than cauter- 
ization, of treating involuntary seminal discharges, depending solely on 
chronic inflammation of the prostatic portion of the urethra and of the 
vesiculse seminales. The daily introduction of a bougie, and the retaining 
it for a longer or shorter time in the urethra, may first be mentioned. 
This, as onr own observation enables us to testify, is often useful. Leech- 
ing of and blisters to the perineum are by no means of slight efficacy, es- 
pecially where th.e prostate is tender and enlarged. We have also pre- 
scribed tartar emetic frictions of the perineum with excellent effects. A 
total abandonment of masturbation, and a moderate use, or even an entire 
though temporary disuse of coition, are, of course, indispensable measures. 
One of our correspondents states that he has found opiates extremely use- 
ful. They are so in most cases, though not in all; since they sometimes 
seem to augment the disease. Conium is safer : and both it and opium 
may be used both constitutionally and as a suppository. Cold clysters are 
often of benefit. As regards general means, alcoholic and malt liquors 
must be abandoned. M. Lallemand’s opinion of these is exceedingly hos- 
tile ; and we believe he is right in this. The food should be nourishing, 
light, and unstimulant; the bowels should be of coui-se attended to, and, as 
a general rule, country air and exercise prescribed. Among medicines and 
articles of diet, tea and coffee in excess, tobacco, camphor, nitrate of potass, 
aloes, must be abstained from. Part vii., p. 119. 
Involuntary Seminal Discharges. — Since the publication of Mr. B. 
Phillips’ paper on this subject, in which the application of the nitrate of 
silver to the prostatic portion of the urethra, as first recommended by 
Lallemand, is shown to be very efficacious, the subject has been taken up 
by other writers. 
Mr. James Douglas, of Glasgow, publishes a case in which the cauteri- 
zation of the urethra, though very beneficial, did not cure the affection, 
and for which an injection composed of one grain of opium, three grains 
of acetate of lead, and one ounce of mucilage, used three times a day, and 
doubled in strength in ten days, Avas remarkably efficacious. 
Another paper on the same subject is published by Mr. Allnatt, in which 
he hesitates to believe that these discharges are always seminal. He thinks 
that they are often more of a mucous character, and unattended with the 
pleasurable sensation accompanying the emission of semen. An abundant 
secretion of mucus may be afforded by the prostate, the glands of Cowper, 
and by the internal coat of the bladder when diseased. Mr. Allnatt has before 
directed the attention of the profession to the effect of creasote on the 
mucous membrane in fluor albus, gonorrhoea, and purulent otorrhoea, and 
thinks that it may be useful in these mucous discharges resembling semen. 
In the case of otorrhoea he used an injection composed of a drachm of crea- 
sote, the same quantity of liquor potassae, and six ounces of water; to be 
frequently thrown into the tube. Mr. Allnatt accidentally discovered thoc 
value of the same remedy to restrain the bleeding from piles. 
Part viii., p. 163. 
Spermatorrhoea.—In the treatment of this affection, M. Lallemand ob- 
serves, it is more important that our attention should be directed to the 
present condition of the spermatic organs, than to the original cause pro- 550 
SPERMATORRIKEA. 
ducing this; and there can be no question that, in many cases, until this 
great source of irritation be removed, all the efforts of the practitioner and 
resolutions of the patient will be in vain. To the chapter which directs the 
suitable treatment, when this diseased condition arises from irritation oc- 
curring in the vicinity, we need not advert; seeing the remedies employed 
against ascarides, eruptions, or fissures at the margin of the anus, diseased 
conditions of the prepuce, stricture of the urethra, constipation, etc., are 
those in ordinary use. 
When arising simply from debility, as it may do in persons of lymphatic 
temperament, and who have suffered in childhood from incontinence of 
urine, give tonics, as the ferruginous waters, use the local douche followed 
by friction, or transmit galvanic shocks through the penis and perineum; 
warm aromatic baths, ergot of rye, 4 to 20 grains night and morning, ox- 
small doses of copaiba or turpentine are sometimes useful. When from 
great nervous susceptibility of the organs, give narcotics and sedatives, as 
camphor in 5 or 6 grain doses, and introduce every few days a medium- 
sized gum cathetei', and allow it to remain for an hour or more, or practice 
acupuncture of the perineum. When dependent upon sub-inflammatory con- 
dition of the orifices of the ducts, use tepid baths, give milk diet and light 
regimen, apply nitrate of silver to the parts, sec. art., and let all exercise 
of the organs be abandoned. Part xvii., p. 181. 
Spermatorrhoea and Impotence.—Let the patient sit in the hip-bath of 
Priessnitz for five minutes three times a day, the water being brought to 
the temperature of 65°. The time may be increased and the temperature 
lowered, until the patient sits for twenty minutes, three times a day, in 
water at 50°. In some cases the spine may be sponged for three or four 
minutes before leaving the bath. A shower-bath may be used after the 
first daily sitting-bath, the head being protected by a conical cap.—(Rev.) 
Part xxiv., p. 248. 
Treatment of.—Mr. Adams, surgeon to the London Hospital, recommends 
the application, locally, of caustic, and the internal exhibition of conium 
and soda in the infusion of gentian, cold-bathing, fresh air, and the almost 
entire abstinence from alcoholic fluids. After the secretions of the patient 
have been got into good order, give small doses of tinct. cantharides and 
the sesquichloride of iron in a bitter infusion. Part xxv., p. 216. 
Spermatorrhoea.—[Mr. Milton offers the following observations on the 
treatment of this disease. He says :] 
It consists— 
1. Of Quinine in Solution, in the following form : 
ll Quin, disulpli., gr. vj.; acid sulph. dil., 5j. ; tinct. cardam. co., 5iij.; aq. 
cinnam., §vss. M. Sumat cochl. duo arnpl. bis die. 
Used in this way, one grain seems to have much more effect than larger 
doses with less acid. 
2. Of Local Paths of Cold Salt Water.—I generally direct the patient 
to buy a pound of common salt, break a piece oft' as large as a walnut, and 
dissolve it in half a basin of water. The scrotum and perineum are then 
bathed with this by the aid of a sponge for five minutes evei*y morning, 
and the water thrown away, so that nothing remains to excite suspicion; 
those patients who are under no restraint may use a hip bath of cold solu- 
tion of salt water with the greatest advantage. 
3. Some' Gymnastic Exercise every JJay.—^The application of this S PERMATORKHCE A. 
551 
remedy must naturally be modified by the patient’s position in life ; but 
even those most restricted can take a walk early in the morning and last 
thing at night. When this trenches on the hours of sleep it may be re- 
garded rather as an advantage than otherwise ; the less sleep the patient 
has the sounder it will be ; the earlier he rises the better, the erections 
being generally most forcible and recurring most regularly in the morning. 
When the weather does not admit of out-of-door exercise, I advise read- 
ing for a fixed time, as an hour or so every night; and if the patient be 
restless and unsettled, reading aloud, even when he is obliged to walk to 
and fro" to accomplish his task, will often soothe down this excitement and 
dispose him to sleep. 
4. Of Checking the Erections.—It will often be remarked, that the pa- 
tient has erections two or three nights successively. When these awaken 
him, I find it best to treat the case like one of chordee, and direct him to 
rise, take a teaspoonful of spirit of camphor in water. This will generally allay 
the priapism, and prevent its recurrence. On those nights when he ex- 
pects the emissions, a dose may be taken last thing at night. 
The bowels should be kept loose; and, for this purpose, five grains of 
blue pill may be taken occasionally, in conjunction with rhubarb. When 
this does not act, the sulphate of magnesia may be added to the mixture. 
5. If these measures do not suffice to cure the disease, I would advise 
blistering. If applied on the perineum, it acts most efficiently; but, in 
some instances, I have seen this followed by a troublesome crop of boils ; 
this I have never seen from a blister on the penis, where it can be applied 
and dressed much more easily, and where it occasions much less soreness 
and difficulty in walking. If the patient objects to this, it may be laid on 
the groin. 
Those cases in which I tried steel failed. In place of acting beneficially, 
it seemed to heat and over-stimulate the patient, and even to dispose more 
to erections. In that shattered state of the frame in which the semen 
passes away involuntarily, and almost without an erection, it may be 
useful, but I am inclined to rely more on the measures I have laid down. 
Some sui'geons, considering this disorder, in many instances, as merely 
au effort of nature to throw off an accumulated secretion, recommend con- 
nection. I would neither recommend nor forbid it, unless I found it 
acting injuriously. In some cases the patient takes it for granted that if 
this be the remedy, medicines, gymnastics, etc., can do him no good, and 
shaking off all restraint, gives way to the worst excesses. This plan, too, 
is not free from danger to the surgeon’s reputation. Only very recently, 
a patient placed himself under my care for seminal emissions. He had 
suffered under them for a long time, and hau consulted a surgeon, who 
advised him to have connection. The result was a gonorrhoea, which took 
two months to cure ; and this mistake unsettled all his former confidence 
in his medical adviser. 
When self-pollution or excessive connection is indulged in, I only know 
of one remedy, and that is, the employment of some irritative ointment to 
the penis, such as that of bichloride of mercury, 5ss. to §j.; deutiodide of 
mercury, 9j. to Sj.; or of the ung. ant. pot.-tart. 
The only way to break him of it, is to make the penis so sore, that he is 
at once awakened by the smarting as soon as he commences any attempts 
at friction. When once the habit is fairly broken off, he rarely recurs 
to it. 552 
SPERMATORRHOEA. 
The despondency of spirits, the loss of appetite, flatulence, weakness, 
pain in the back, etc., under which many of these patients labor, are 
generally removed by adopting a plain diet, as weak coflee, toast, and 
bacon, for breakfast, an early dinner, consisting of a chop or two and 
bread, strictly excluding all porter, vegetables, cheese, pickles, or pastry ; 
as little tea as possible ; and in the evening, instead of supper, a basin of 
tapioca, ground barley, or arrow-root, with a biscuit. 
A persevering use for a few weeks of this treatment will, I think, effect 
a cure even in the most inveterate cases. Part xxv.,p. 241. 
.Lupulin (the Alhaloid of Hops) as an Anaphrodisiac.—M. Debout, of 
Paris, editor of the “ Bulletin de Therapeutique,” has found lupulin ex- 
tremely useful in chordee, priapism, traumatic orgasm, and spermatorrhoea. 
The lupulin should be used in powder, and triturated with lump sugar. 
The dose is from fifteen to thirty grains. M. Ricord and M. Puche have 
carried the dose from one to three drachms without any unpleasant effect. 
Part xxviii., p. 320. 
Spermatorrhoea.—According to Mr. Milton, where physical weakness is 
a prominent symptom, quinine has an undoubted efficacy in controlling the 
•light discharges of spermatorrhoea. Spirit of camphor is the best remedy 
for relieving the obstinate erections which sometimes remain after gonor- 
rhoea, a teaspoonful for a dose. Gymnastic exercise is an excellent means 
of controlling spermatorrhoea. The best plan is to rise at six in the morn- 
ing, sponge with cold salt water, use the dumb-bells for half an hour, and 
follow this up with a brisk walk. For both the night and day discharges, 
opium is a most valuable remedy. If the costiveness is obstinate, let the 
patient take a pill of gentian with 1-12th of a grain of strychnia, with a 
tumbler of unsweetened gin and water at night, and one of cold water in 
the morning. If the urine scalds, and the patient complains of spasmodic 
pain at the neck of the bladder, and the urine be loaded with lithates, or 
clouded with mucus, we may give the nitro-muriatic acid with laudanum, 
in the decoction of pareira brava or chimaphila. In cases of extreme 
uneasy sensation or creeping along the vas deferens or urethra, veratria 
ointment, or some mild counter-irritant, are the most useful applications. 
The caustic holder is not to be regarded as the remedy, because, in truth, 
it is not often called for. In cases complicated with gleet, where the 
cautery has failed, blistering is the best remedy. A good instrument for 
applying the caustic is a platinum canula with stilette. After introduc- 
tion, the stilette is withdrawn, and a bougie passed down prepared thus : 
the tip being scraped rough, it is rolled in fused caustic, and this again in 
melted tallow, by which means a thin film of caustic is secured. 
The indigestion in this disease is best relieved by aromatic confection, 
with sulphate of soda and mint water. Before resorting to the caustic 
bougie, the sensitiveness of the urethra must be diminished by occasional 
blisters and injections. In prostatic gleet, a blister repeated two or 
three times has cured the patient after all other treatment had failed. 
The same in night discharges. Quinine may be given subsequently. 
Part xxix., p. 233. 
Nocturnal Seminal Emissions treated by Pigitaline.—Digitaline, of 
late much extolled and employed with success, according to many practi- 
tioners, in cases of nocturnal seminal losses, has yielded, in the hands of 
Dr. Laroche, a result which deserves to be mentioned. A young man, 553 
SPINA BIFIDA, 
aged 18, presented himself some months ago to be treated for nocturnal 
seminal losses. The disease had come upon him about two months pre- 
viously. For twenty days, the pollutions had not omitted a single night; 
his strength was gone, the appetite had left him, and his sleep was troubled 
by unpleasant dreams. M. Laroche prescribed three granules of digitaline 
(equal to a grain of the powder of the plant). The night following the 
administration of the medicine, the pollutions intermitted for the first 
time. In three weeks he was cured. Part xxxi., p. 167# 
Bromide of Potassium— Use of in Spermatorrhoea.— Vide Art. 
“ Chordee.” 
SPINA BIFIDA. 
Spina Bifida.—Mr. Hewitt makes the following remarks regarding the 
treatment of spina-bifida: The dissections of the cases of spina bifida 
wThich have been published, and the preparations which are to be found in 
our museums, at once point out the rashness of attempting to remove 
these tumors either by ligature or by the knife. I do not consider this 
remark to be in the least invalidated by the success which is said to have 
attended the practice of M. Hubourg, who has published in the Gazette 
Medicale de Paris, 1841, a paper upon the radical cure of spina bifida. 
M. Dubourg operated upon three cases: in one, a ligature was applied to 
the tumor—the patient died two days after the operation; in the other 
two, which terminated successfully, the sac was removed by the knife, and 
the lips of the wound were brought together by hare-lip pins and sutures. 
The successful termination of these two cases was, it must be confessed, 
very fortunate; but this success ought not, in my opinion, to lead any 
surgeon to adopt so rash a practice; for, laying aside the question of thus 
opening the theca vertebralis, there still remains the fact that, in the 
majority of cases, some nerves are connected with the sac, and that, when 
the sac corresponds to the sacrum, the chord itself is generally connected 
with the tumor. In one of M. Dubourg’s cases the tumor was in the loins: 
in the other it was in the lower part of the cervical region. The sacs 
were examined after the operation, but no nerves were connected with 
them. 
Several cases in which the plan of treatment adopted by Sir A. Cooper 
has completely succeeded, have been placed upon record by various authors; 
but in these cases two points of importance have not, I think, been suffi- 
ciently considered, and I would, therefore, lay down the following general 
rules: 
1st. The tumor ought never to be punctured along the mesial line, 
especially in the sacral region; for it is generally at this part that, the 
chord and its nerves are connected with the sac. The puncture is to be 
made at one side of the sac, an 1 at the lowest part, so as to diminish the 
risk of wounding any of the nervous branches. 
2d. The instrument ought to be a grooved needle, or a small trocar; for 
if a lancet is used there will be a greater risk of wounding some important 
part contained in the cavity of the tumor. - Part x.,p. 180. 
Spina Bifida successfully treated by Ligature and Puncture.—In a 554 
SPINE. 
case where the tumor is pedunculated, owing to the defect in the bony 
canal being very slight, and the neck of the tumor covered with ordinary 
integument, it is possible, safely and with success, to remove the pro- 
jecting membranous bag by the application of ligatures. The ligature 
must be gradually tightened so as not completely to constrict the part for 
some days, and if great tension of the tumor come on, it may be relieved 
by puncturing with a fine needle. A case, the text of the above, is related 
by Dr. Wilson, of Glasgow, in which a firm cicatrix, and consequent cure, 
resulted. Part xxxviii., p. 144. 
SPINE. 
Lateral Curvature of tlie /Spine.— Wry-neck depending on Contraction 
of the Sterno-Mastoid Muscle.—[The object of this paper of Mr. Syme’s 
is to point out the kind of case in which an operation for spinal curvature 
may be useful, and to discourage the operations which are recommended 
for all other kinds of spinal distortion. We cannot always be sure 
whether the hones or muscles are the first cause of lateral curvature. The 
muscles may he so weak as to allow the spine to bend, and the hones may 
at the same time he so unhealthy that an undue pressure may cause a 
premature distortion. All the operations which have been recommended 
for these lateral curvatures are at least very doubtful in their efficacy, if 
not positively injurious, and there is only one kind of spinal distortion 
which it is proper to attempt to remedy by subcutaneous incisions, and 
that is spinal curvature depending upon wry-neck caused by contraction of 
the sterno-mastoid, which muscle is liable to contraction both spasmodic 
and permanent. Although spasmodic contraction does not generally 
affect the shape of the spine, the permanent contraction may do so very 
materially.] 
Wry-neck, like club-foot, is sometimes congenital, but much more 
frequently, like squinting, and theses equinus, occurs during childhood, in 
connection with some inflammatory or feverish state of the system. It 
depends upon a contracted state of the sterno-mastoid muscle, which has 
usually the feeling and appearance of a tense cord stretching from the 
clavicle to the ear. The head is bent toward the side affected, the face 
being turned to the opposite direction. Until the introduction of subcu- 
taneous incision, the treatment of this complaint was very defective, since 
it consisted either in the use of mechanical support, which did little, if 
any good, or in cutting across the contracted muscle, together with its 
superjacent integuments, which was a painful and bloody operation, 
leaving a large sore, slow to heal, and apt to renew the evil during cica- 
trization. The subcutaneous process requires merely a puncture of the 
skin, is not attended with pain or bleeding, needs no dressing or after- 
treatment, and at once affords the relief desired. 
There is still another condition of the complaint, of which I may mention 
an instance that came within my notice last summer, in the case of a boy 
who was brought from the country on account of lateral curvature. 
Observing that his head inclined to one side, I examined the sterno-mastoid, 
and found it, not tense and rigid as I expected, but soft and yielding. 
I perceived, however, that when an attempt was made to raise the head, 555 
SPINE. 
the muscle resisted and became tense, and therefore concluded that it was 
the seat of the evil. Under this impression I proceeded to divide it, and 
succeeded in doing so, though with more difficulty than usual, from the 
want of tension, for which it was necessary to compensate by stretching 
the neck. A good effect was immediately perceptible, and the following 
day the patient’s back was comparatively straight, which it has since, I 
am informed, become completely. 
In concluding these remarks, it may be well to warn against mistaking 
for wry-neck depending upon musclar contraction, the distorted position 
of the head which proceeds from caries between the occiput and atlas. 
The latter disease, like the former, usually occurs in young persons, 
presents to a careless observer similar symptoms, and if confounded with 
it, leads to treatment not only useless, but extremely injurious. A young 
gentleman had for twelve months used friction and exercise under the 
instruction of a distinguished member of the profession, who supposed 
that he labored under wry-neck from the contraction of the sterno-mastoid. 
No benefit having been experienced, it was thought that an operation 
might be serviceable, and with this view I was asked to see the patient. 
He presented all the characters and well marked symptoms of spondy 
larthrocace, or caries at the occipito-vertebral articulation, in a stage so 
advanced, that there was nothing left for me but to explain the nature of the 
case and predict the fatal termination, which soon afterward happened. 
Part vii., p. 143. 
Treatment of Lateral Curvature of the Spine.—For many cases of this 
affection Mr. Stafford recommends lateral exercise; and for this purpose 
he has devised a machine, which consists of a semicircular wooden frame, 
resembling the platform or rocker of a hobby-horse. This frame lies on 
its convex surface, and the ends of a rope, which passes through two 
pulleys fixed in the ceiling, at a distance from each other equal to the 
length of the rocking frame, are attached respectively to a bar at each 
end of the frame. “The patient stands upon this machine, taking hold 
of the rope by each hand, and then rocks himself or herself backward 
and forward (from side to side, rather), by which both the lumbar and 
dorsal curve are acted on laterally.” Mr. Stafford has “ hardly known an 
instance when it (lateral exercise) has not been of the greatest service.” 
But “ lateral exercise, however, will not always recover a lateral curvature. 
The spine is sometimes so completely distorted and the vertebral column 
so entirely thrown out of the centre of gravity, that the muscles have lost 
their power. They are so stretched on the convex, and so contracted on 
the concave side of the curve, that they cannot act. In such cases lateral 
exercise will not alone be sufficient. More must be done—the spine itself 
must be elongated; and the best method of accomplishing this is by 
gravitation of the body. “To effect this object I have invented a machine 
by which the patient can be raised up from the ground by the upper part 
of the body, while the lower part hangs suspended. Hence the lower 
pait, by its own gravitation, and by additional weights being hung round 
the hips, gradually elongates the spinal column, until it becomes nearly if 
not quite, for the time being, straight. In this manner the muscles on the 
concave side are lengthened, while those on the convex are shortened, 
and allowed to contract, whereby they are both put into a more favorable 
position to pull back and retain the vertebra? in their situation. After the 556 
SPINE, 
machine has been used I usually recommend the lateral exercise, as the 
muscles and ligaments are then in the best state to be strengthened.’’ 
Part x, p. 161. 
Spinal Irritation.—Dr. Tfirck, of Vienna, says : “ If we carefully analyze 
the symptoms observed in well-marked cases of spinal irritation, we shall 
find that they can all he elucidated on the supposition, that there is a cen- 
tric change so operating as to exalt the functions of the cerebro-spinal axis. 
This change can scarcely be considered strictly structural, because we 
know that structural changes are marked by anaesthesia, or paralysis; on 
the other hand, we know that the circulation may be the medium through 
which the actual change is induced. Opium renders frogs tetanic, as 
strychnine acts on man and lower animals; the slightest touch of the sur- 
face in poisoning by strychnine is sufficient to excite convulsions. The 
poison of the rabid dog so exalts the functions of the incident excitor and 
reflex motor nerves of the respiratory and spinal ganglia, that a breath of 
air on the face will excite a convulsive gasp and general spasms. In ‘ spfinal 
irritation ’ the change is probably in the capillary circulation : 1, of the 
cerebro-spinal axis ; 2, of the ganglia of the sympathetic, or ganglia of 
the posterior spinal nerves; and 3, of the fibrils of the nerves them- 
selves. This purely functional derangement of the nervous system 
has been termed neursemia by Dr. Laycock, one of the recent English 
writers on this subject, and the class of diseases to which it gives origin, 
neursemic. 
“ If we were to attempt an illustration of our remarks as to the diagnosis, 
we could not take a more apt instance than that of abdominal tenderness. 
Where it depends on spinal irritation, it will be found that the history of 
the patient presents instances of her having previously suffered from 
neursemic affections. The affectible stat6 of the cutaneous nerves of the 
abdomen is never observed to occur alone, the nerves of the abdominal 
viscera suffer also. The kidneys, for example, secrete less or more 
urine than natural: if less, the deficiency amounts occasionally to complete 
ischuria; if more, the urine is pale and diabetic. And so there is one or 
other of the two opposite states of constipation and diarrhoea, but more 
usually constipation, with spasm of the colon, giving rise to colic. In the 
more aggravated cases, the motor nerves of the large intestines, bladder, 
abdominal parietes, and lower extremities are also affected; and tympa- 
nites, vesical paralysis, constipation, and paraplegia ensue. The tender- 
ness experienced is not simply tenderness on pressure, but it is a tender- 
ness to the slightest touch, and when there is sninal tenderness, for it is not 
always present in these cases, the tenderness is of the same kind. The 
abdominal tenderness of peritoneal or visceral inflammation differs 
altogether from the preceding, both in its history and concomitant symp- 
toms. It is rarely seen in neursemic females, except when the case is quite 
manifest, as for example, when there is chronic structural disease of the 
peritoneum or abdominal viscera, accompanied by inflammation, or when 
it appears in parturient females as a symptom of metritis. We believe 
the neursemic state is rarely coincident with structural disease within the 
abdomen, or terminates in it. 
“ The accompanying phenomena differ widely; in the tenderness from 
peritoneal inflammation it is impossible not to be struck by the peculiarly 
haggard expression of countenance of the patient ; in neursemic tender- SPINE. 
557 
ness, the expression is rather that of peevishness and pain than of mortal 
suffering. In the latter, there is rarely or never, the grass-green vomit 
observed in peritonitis; the pulse, too, is fuller, rounder, and larger, nor 
are the knees of the patient drawn up as in peritoneal inflammation: in 
the latter, tenderness on pressure, and not tenderness to the touch, is the 
distinguishing characteristic. 
“ The diagnosis of ail neursemic affections, whether their seat lies in the 
head, thorax, or abdomen, is, mutatis mutandis, precisely similar. The 
previous history of the patient, and the physiological character of the 
symptoms themselves, will almost always enable the practitioner to 
decide. Inflammatory diseases of the heart, lungs, and brain, are pecu- 
liarly liable to be confounded with neursemic affections of those organs. 
“ With respect to the treatment of cases of cerebro-spinal irritation, we 
would above all observe that it must be constitutional. They principally 
occur, idiopathically, in females whose parents are gouty, and of the nerv- 
ous temperament, or at least who have themselves suffered from affections 
of the nervous system. Neimemia of the cerebral and spinal ganglia is 
not unfrequently seen in females, one or other of whose parents has been 
insane. This we believe is extremely usual, and the fact is of importance, 
both in the diagnosis and treatment of the affections of all the viscera in 
connection with the spinal cord. While remedies suitable to the constitu- 
tional peculiarities of the case are administered, endermic medication, on 
the principle of incident excitor action, will be found of singular benefit; 
even the metallic neurines, as arsenic, may be thus employed with safety 
and efficiency. We would conclude this short sketch of the treatment, by 
the observation that no plan whatever will be successful unless the hygienic 
condition of the patient—namely, the condition as to mental occupation, 
sleep, diet, pure air, sufficient light, and exercise be strictly attended to.” 
Part xi., p. 13. 
Rheumatic Caries of the Spine.—It is of great importance in practice 
to distinguish between strumous caries of the spine, and the rheumatic 
caries described by Sir B. Brodie, as the two diseases are quite different 
in their origin, progress and termination, and the treatment required is 
also different in each case. In the former, pain is frequently, though not 
invariably met with; in the latter it is a constant symptom, whilst in para- 
plegia from disease of the chord alone, there is entire absence of pain. 
We may also be assisted in our diagnosis by the moral history of our 
patient, as well as by the presence of a strumous or rheumatic diathesis. 
But in females we meet with the most anomalous symptoms, which, if 
there be no rheumatic diathesis, no increase of pain on pressure, the pain 
shifting from one part of the spine to the other, may pretty safely be 
referred to hysteria. 
With respect to the patholgy of the disease, Mr. Solly believes that it is 
local; the mollities ossiuin rubra et frag ills; and renders this view pro- 
bable by instancing the softening of the bones of the pelvis occasionally 
met with, which is an entirely local disease, and from which recovery not 
unfrequently takes place. A medical friend of Mr. Solly’s, who had suf- 
fered under this rheumatic caries, broaches the very pertinent idea that 
nervous exhaustion may be a cause of diminished supply of phosphatic salts 
to the bone, seeing that the phosphorus is an essential constituent of the 
brain, and, therefore, that, from the superior importance of the latter to 558 
the system, the principal portion secreted would be supplied to it in pre- 
ference to the bones. On this supposition, Mr. S. would give phosphoric 
acid freely, for he says that, even if it does not act specifically, it is a good 
tonic, often agreeing better than sulphuric acid with the system. The 
dose lie would commence with is ten minims of the dilute acid. lie men- 
tions another important fact which should be strongly impressed on the 
mind in the treatment of all spinal affections, namely, the necessity for 
absolute quiet of the mental system, on account of the close connection 
existent between the spinal cord and the brain. 
In treating this disease as inflammatory, it is necessary to be extremely 
careful in our antiphlogistic measures, on account of the general depression 
of the vital powers attendant upon inflammation of their structure. It will 
scarcely ever bear active treatment, and the blood-letting should be almost 
invariably merely local. Part xi., p. 146. 
Alkaline Urine, consequent upon Injuries of the Spine.—Dr. Snow says 
that the urine is alkaline, because the bladder, being paralyzed, cannot ex- 
pel the whole of its contents, and a little is constantly retained. Wash 
the bladder out with warm water every day or two. Part xv., p. 144, 
Spine—Lateral Curvature from Relaxed Ligaments.—Sir B. Brodie 
says that if the patient is 19 or 20, treatment is of no avail; it must be 
begun if possible at 13 or 14, and patiently continued. Improve the gene- 
ral health by country and seaside residence, open-air exercise, tonics, etc. 
Strengthen the muscles of the back by climbing and other exercises; for 
which in delicate girls friction and shampooing for an hour or two daily 
may be substituted. And let the patient lie down either a part or the 
Avhole of the time that she is not engaged in exercise. 
In inveterate cases, as where one scapula is three times as far from the 
spinous processes as the other, it is necessary to use artificial support. The 
patient may walk on crutches, so high, that only the toe can be placed on 
the ground, or wear a machine to take the weight of the shoulders off the 
spine, and to make pressure on the projecting ribs. Some of the best are 
those made by Bigg, of Leicester Square, Laurie, of Bartholomew Close, 
and that known as Tavernier’s lever belt. 
From Rickets.—The general treatment is the same as that for rickets 
generally. Instruments are worse than useless. Part xv., p. 155. 
Angular Curvature of the Spine.—Dr. Pirrie recommends the following 
as the most judicious plan of treatment to pursue : Any attempt to remove 
the curvature would be most injudicious. Anchylosis is the only favorable 
termination to be hoped for, and therefore the object aimed at in treatment 
should be to place the patient under the circumstances most likely to con- 
duce to that result. With that view it is indispensable, first, to keep the 
patient in a recumbent position, so as to remove from the diseased parts 
the pressure of the superimposed weight, and to preserve the parts as 
much as possible in a state of perfect quietude in that position ; and, sec- 
ondly, to use all means, judicious and available in the circumstances of the 
case, for maintaining the general health. In some cases, local remedies are 
highly beneficial. 
One particular advantage which results from preserving the parts at 
perfect rest in the horizontal position, is that the removal of the irritation 
caused by the superincumbent weight from the diseased parts, diminishes 
SPINE, SPINE. 
559 
the danger of the formation of abscess, which is a most unpromising occur- 
rence, and must induce the gloomiest apprehensions as to the ultimate re- 
sults. One of the best means for fulfilling the above indication is to place 
the patient in the supine position on Earle’s bed, which, beside other ad- 
vantages rendering it very convenient for this part of the treatment, al- 
lows the relative position of the trunk and limbs with regard to each other 
to be slightly changed, without any risk of moving the diseased parts on 
each other. The slight change thus allowed renders the confinement to 
the recumbent position much less irksome than it otherwise would be. As 
an additional precaution for preserving the diseased parts from any move- 
ment, it is in many instances advisable to apply splints on each side of 
the spine. The splints in such cases must suit the shape of the parts to 
which they are applied. 
Rest of the diseased parts, and the recumbent position, whether the 
body be prone or supine, are of the utmost importance from the very com- 
mencement of the disease until a cure is effected by anchylosis. When 
it is believed that anchylosis has taken place, and the patient is allowed to 
resume the erect attitude, it is a judicious precaution to employ for some 
time an apparatus such as that, generally known by the name of the spine 
supporter, for removing the superincumbent weight. 
[The maintenance of the general health is another important indication, 
but, unfortunately, some of the best means for fulfilling it are incompatible 
with the essential points of judicious treatment. In individuals of a scrofu- 
lous diathesis, insufficient clothing and food, or any causes acting perma- 
nently or habitually, have doubtless an influence in exciting caseous depo- 
sits in bone as well as in other textures. Hence the necessity of a generous 
digestible diet, pure air, and exposure to the light of the sun. As to the 
tonic remedies, that of iron is the most useful, but the class of medicines 
more immediately called for Dr. P. thinks are those which are calculated 
to preserve a healthy condition of the digestive organs. In cases where 
the disease depends upon scrofulous caries of the vertebne, or upon soft- 
ening with absorption without ulceration or caries, the surgeon should not 
deplete, but advise the recumbent position, quietude, and the preservation 
of the general health.] 
In scrofulous caries, benefit will often be found to accrue from the early 
and very cautious employment of counter-irritation along with the treat- 
ment here alluded to. If the curve arise from inflammation of the bodies 
of the vertebrae, of their investing membrane, or of the intervertebral car- 
tilages, slight local depletion by leeching or cupping at the commencement 
of the disease, and afterward counter-irritation, are known to be highly 
beneficial. The repeated application of small pieces of blister to each side 
of the vertebral column at the seat of the disease has been found well 
suited for children, and caustic issues for adults. Of the various means 
for producing counter-irritation, Mr. Pott gave the preference to caustic 
issues. It is improper to produce a great discharge, which would tend to 
weaken the patient, and besides, the long continuance of a profuse dis- 
charge and irritation might induce hectic fever. If abscesses form, the 
issues should be discontinued. Mr. Pott, whose valuable works contain 
many cases of disease of the spine, attended with paralysis, successfully 
treated by the application of counter-irritants, was the first who pointed 
out to the profession the results of such practice, and many have since 
followed it with equal success. Part xv., p. 161. 560 
SPINE. 
Distortions of the Spine.—Bransby Cooper says that we should endea- 
vor to improve the nutrition of the bones, by the use of articles of diet con- 
taining a good deal of phosphate of lime, as beef and mutton, giving at the 
same time phosphoric acid, to render the salt of lime more soluble. Bottled 
porter will also do good, if it do not relax the bowels. Support the 
weight of the trunk by the simplest possible mechanical means, and put 
into gentle action such muscles as may counteract the unnatural direction 
the bones have acquired. Let such exercise in the open air be taken as 
causes the least fatigue, as riding in an open carriage, or sailing on the sea. 
Dart xvii., p. 125. 
Spine—Curvature of the.—Dr. Bishop says that when the spine becomes 
curved from previous curvature of the legs in weak children, support 
should be given by the use of leg irons, made with joints corresponding to 
those of the hip, knee, and ankle. Many object to the use of leg irons, 
but their objections are refuted both by sound theory and by the results 
of practice. Dart xviii., p. 148. 
Functional Affection of the Spine, liable to be mistaken for Organic 
Disease.—The alfection alluded to was essentially a disease of the young, 
being seen most frequently between twelve and twenty years of age. Dr. 
Kennedy had, however, met with it as early as nine years, and as late as 
twenty-five. He had only seen it in private practice, and it was more 
common amongst males than females, in the proportion of at least two to 
one. It consisted in a pain in the back, combined with weakness, and 
this wras always referred to the lumbar region; at least he had never seen 
it higher up. This pain commenced gradually, and might or might not be 
attended with the feeling of weakness; and occasionally only the latter 
was complained of. On examining the spine, the patient was nearly always 
able to refer the suffering to a particular part; but Dr. Kennedy had seen 
cases where the feeling was more diffused. It was worthy of notice, that 
a rough examination of the part might be made—the spine might be 
twisted, or percussion strongly used, and yet the patient would not com- 
plain. When left to their own feelings, they invariably preferred the 
recumbent posture. Walking was much less irksome than sitting, and 
particularly when they had no support for the back. In addition to an 
ordinary chair, they would use a cushion, so that it might press on the 
spine where they complained ; and even when reclining at full length, they 
often placed a cushion in the hollow of the back, so as to cause direct 
pressure. Those whose business led them to stand or work at a desk, 
seemed peculiarly liable to the affection. 
On the subject of treatment, Dr. Kennedy had nothing very definite to 
offer. A considerable variety of means had been used, both local and 
constitutional. The former included local bleedings, dry cupping, blisters, 
frictions, the cold douche, and galvanism; and the latter, aperients, tonics, 
change of air, and relaxation from business. Of these two, the latter had 
in his experience proved by much the most useful. He had also seen 
benefit follow the application of small and repeated blisters, as also the use 
of a weak stream of galvanism, applied daily, or every second day, accord- 
ing to circumstances. The patient, too, often got great relief from wear- 
ing a stiff belt. Still the general measures were the most important. 
Dart xxiv., p. 64. SPLEEN, 
561 
Spinal Exhaustion.—In remarking upon the beneficial effects of strych- 
nine in cases of impaired spinal energy, Dr. Marshall Hall says: 
Such cases occur from causes of nervous exhaustion, such as excessive 
study, muscular effort, sexual indulgence, etc.; and in such cases strychnia 
has appeared to me the appropriate and useful remedy. 
This agent acts distinctly on the spinal marrow. In excess it induces 
spasmodic affection. It is therefore contra-indicated in cases of irritation 
of this nervous centre of spasm. Its appropriate use is in spinal exhaustion. 
It constitutes one of our best tonics, improving the general health, and 
conducing to the recovery of strength and flesh. 
I have given it in minute doses thrice a day, in the midst of meals, for 
many months. The following is the formula which I have adopted: R 
Strychnine acetatis, gr. j.; acidi acetosi, ntxx.; alcoholis, 3ij-; aquae destillatae, 
3vj.M. 
Of this, ten drops, containing one-fiftieth part of a grain, may be 
given thrice a day ; but I have generally begun with five, and gone on to 
fifteen. 
In two cases only have I known it to disagree. It seemed to affect the 
head. In many the patient has improved in looks, as in general health and 
strength, without experiencing anything but good from it. 
I am giving the strychnia a cautious trial in the epilepsy attended by 
pallor, thinness, and nervous exhaustion; in the paraplegia the result of 
sexual excesses, and in which neither pain nor spasm has occurred ; and in 
the paralysis agitans. Part xxvii., p. 58. 
Spinal Curvature.—M. Piorry gives one ounce of fine filings of fresh 
bones daily, either in milk, or better still, in rice milk, which entirely dis- 
guises all disagreeable taste. At the same tune the patient must be freely 
exposed to fresh air and sunlight. Part xxxv., p. 75. 
SPLEEN. 
Uses of the Spleen.—Dr. O’Beirne offers an ingenious theory respecting 
the uses of the spleen, which is much the same as the one entertained by 
Professor Hargrave. 
He arrives at the conclusion that this viscus in the healthy state is con- 
tracted and at rest, that it contains no more blood than is poured into its 
cells, after becoming venous, by its nutritious arteries; and that it per- 
forms no function but that of a reservoir for the relief of overloaded states 
of the vena cava inferior and the whole portal system. This is easily seen 
to be probable when we remember that the venae cavae hepaticae enter the 
vena cava inferior just as it is passing through the tendinous opening of 
the diaphragm, that their mouths are large and always wide open, having 
no valves and consequently admitting of reflux, and that the powers which 
propel the blood of the portal system are very feeble compared with those 
which propel that in the inferior cava, all which circumstances seem to 
show that the venae cavae hepaticae, as well as the rest of the portal system, 
instead of offering resistance, are constructed not only to facilitate but to 
provide for determination toward them: the blood of course would easily 
And its way along the splenic vein into the spleen, and this organ would 
thus act as an immense and most important reservoir to relieve venous 
YOL. II.—36 562 
SPONGE TENTS SPRAINS. 
obstructions almost throughout the whole system, either immediately or 
collaterally. Part vi., p. 54. 
Engorgement of the Spleen—German Treatment of.—Dr. Schwabe has 
employed the following in engorgement of the liver and spleen: 
R Belladonna root, powdered, a grain and a half; muriate of quinine, 
four grains ; powdered rhubarb, fifteen grains; mix. Divide into ten 
powders. One to be taken morning, noon, and night, in any convenient 
vehicle. Part viii., p. 78. 
Improved Method of Making.—Mr. Coates says : The plan I adopt is to 
select a piece of the best cupped sponge, of the required form and size, 
and, after beating and washing it well to free it from any sand or gritty 
particles it may contain, to squeeze it almost to dryness in a towel. A 
piece of tape about ten inches long is then passed through the sponge at 
about one-third from its base, making a shallow groove on each side from 
the apertures to the base for the tape to rest in, both ends of which are 
tied together for the withdrawal of the tent when necessary. Having 
fixed one end of a piece of whipcord (say two or three yards long) to 
some firm object, I commence winding the other end on the sponge 
gradually, from apex to base, as firmly as possible. The tent is then 
well dried before the fire, or in an oven, previous to the removal of 
the cord. When it is thoroughly dry, a small hole about half an inch 
deep should be made in the base, with a joiner’s pricker or a heated wire, 
for the introduction by the director. The whole surface of the tent is 
then slightly coated by dipping it into equal parts of melted lard and 
beeswax. The expansion of the tents is gradual, and never requires the 
aid of “ tepid water injections,” the moisture of the surrounding parts 
being quite sufficient. 
No possible good can accrue from steeping the sponge in a solution of 
gum, which not only renders the operation most disagreeable and un- 
cleanly, but prevents the close contraction by the retention of the 
glutinous partfctes in the interstices of the sponge. Part xxii., p. 306. 
SPONGE TENTS. 
SPRAINS. 
Application of Cold to Sprains.—Many different opinions have been 
entertained as to whether recent sprains should be treated by warm or 
cold applications. We find that Mr. Cock, of Guy’s Hospital, entertains, 
as the result of his large experience, a very strong preference for cold. 
He states that the consequences of a sprain may be very much limited, 
both in duration and severity, by the early and efficient employment of 
cold. It should either be done by iced water, or by irrigation. Mr. Cock 
is accustomed to quote by way of illustration of the powers of cold, the 
certainty with which the application of ice will induce the absorption of 
effused blood in an ordinary ecchymosis, a power which, by the way, in 
certain cases of “ black eye ” may be turned to good account. 
Part xxxii.,j9.138, 563 
SQUILL—STAMMERING. 
SQUILL. 
Squill.—According to the “Northern Journal of Medicine,” squill obvi- 
ates some of the ill effects of opium. If an aperient be added besides, the 
good effects of opium may often be obtained when it would otherwise be 
inadmissible. 
R Pulv. opii; pul. scilke, aa. gr. iij.; aloes; conserve rosse, aa. gr. ix. 
Fiat mass, divid. in pil. vj. aequales. Sign, opiate pills, two at bed-time. 
We have remarked very beneficial results in cases of chronic ill health 
with tendency to dryness of the skin, from the continued use of such com- 
binations as the following. Besides its diaphoretic effects, it should be 
regarded as alterative. 
R Resinge guaiaci; extract, gentianse, aa. 5j-; pulv. ipecacuanhse, gr. xv. 
Ft. mass, divid. in pil. xxx. aequales. Sign, tonic alterative pills, two 
twice a day. 
Or, if an aperient be required, aloes may be substituted for the gentian, 
and then the combination will somewhat resemble the pulv. aloes comp, of 
the London Pharmacopoeia. Part x., p. 187. 
STAMMERING. 
M. ColombaVs Treatment.—M. Colombat has recommended a most 
judicious method of treatment, which if rightly pursued is always sure to 
effect a cure. It consists in the adoption of the following three means: 
1. Giving the tongue such a position that its apex is directed upward and 
backward. 2. Taking in a deep breath at the commencement of each phrase, 
and repeating this more or less frequently. 3. Marking the time in speak- 
ing by the movements of the thumb upon the forefinger. Part ii., p. 79 
Operative Treatment.—Various operations have been proposed for the 
cure of stuttering, which may be classed as follows : 
1st. Simple transverse division of the muscular structure of the base of 
the tongue, performed by M. Dieffenbach by two separate methods. 
2d. Transverse division, with excision of a portion of the base of the 
tongue, performed by the same surgeon. 
3d. Mr. Lucas’ method, consisting of excision of a triangular portion of 
the bodies of the genio-glossi muscles. 
4th. A simple incision in the bodies of the genio-glossi muscles, common 
to MM. Amussat, Phillips, and Velpeau, though performed in a different 
manner by each. 
5th. Division of the attachment of the tendons of the genio-glosso mus- 
cles (and occasionally of the hyo-glossi muscles also) to the lower jaw, 
performed, in different ways, by MM. Baudens and Bonnet. 
6th. Simple division of the mucous and subjacent tissue of the floor of 
the mouth, occasionally found sufficient, by M. Amussat. 
7th. Excision of a portion of the apex of the tongue, performed in one 
case by M. Velpeau. 
8th. Mr. Yearsley’s method of snipping off a portion of the uvula. 
Part iii., p. 74. 
Auxiliary Treatment.—Dr. Abercrombie has observed a few facts which 564 
STERILITY. 
may lead to a material improvement in the treatment of stammering : 
Stammerers never stammer in singing; nor when the voice is elevated to 
a particular pitch, as during conversation in a crowd or in a carriage on a 
rough road ; on the contrary, they stammer when endeavoring to speak 
when the lungs have become emptied of ail* or nearly so. Among other 
indications of treatment therefore, the patient should accustom himself 
never to speak except with a full and. continuous current of air proceeding 
outward from the luugs. The aflection is not perceived to be owing to 
any defect in the organs of speech, and if he would speak in that tone of 
voice as if he were calling to a person at a distance, or in a tone resem- 
bling singing or chanting, he would probably find himself considerably 
imjwoved : and for this purpose, Dr. Abercrombie recommends that the 
person should read aloud several times a day from an author whose style 
is somewhat declamatory. “ In doing so he should be made to read in a 
high-pitched tone, and to stop frequently and take a full breath, so as to 
have the voice thrown out with a force beyond what is required for ordi- 
nary reading or ordinary conversation. With this view, it is necessary to 
make him stop and take a full inspiration much more frequently than would 
be required by any other person. In particular whenever he feels the 
tendency to hesitate at a word, he is to be taught to stop instantly, take a 
full breath, and then try it again.” Part vii., p. 78. 
Carbonic Acid Gas, as a Counter-irritant.—In a discussion in tlie 
London Medical Society respecting the nature and value of counter-irri- 
tation, Dr. Janies Johnson alluded to carbonic acid gas, applied either as a 
local or a general external remedy. In the first mode of its application, the 
gas was admitted into the vessel from beneath, and slowly ascended until 
it filled the bath. The patient’s body was entirely immersed, his head 
being protected by a covering fitting close to the upper part of the bath, 
admitting the head only through an aperture in its centre. When the gas 
was locally applied, it was conducted in tubes of various diameters, and 
with such variety of force as the case might require. He had tried the 
remedy both locally and generally; it acted in both cases as a powerful 
stimulant. Its first action was the production of a momentary sensation of 
cold which was followed by a feeling of heat, which when the gas was 
applied locally, was sometimes so intense as to be scarcely tolerable. 
Perspiration succeeded to these phenomena. The application of carbonic 
acid in this manner was stated to be of great benefit in a variety of chronic 
diseases, in which there was no trace of inflammatory action. It was 
beneficial in tic-doloureux, atonic gout, and rheumatism, and similar dis- 
eases. If the reports were to be credited, it also exerted a remarkably 
powerful influence upon the reproductive organs. Females who for years 
had sighed in vain for progeny, became fertile in a very short space of 
time after this gas had been applied in douches to the uterus, by means of 
a pipe introduced into contact with that organ into the vagina. Cases in 
which this beneficial result had followed its use were so numerous, that 
the subject merited consideration. 
Dr. Clutterbuck relates a case “ of great irritation and some prolapsus 
STERILITY. 565 
of the uterus” in which Dr. Rossi, of Turin, used carbonic acid gas with 
the greatest advantage. There was “ no organic disease of the uterus, 
but a preternatural irritation of the genital organs altogether, and the 
general health was suffering from sympathy with the local disease.” It 
was treated by the repeated local application of carbonic acid gas to 
the uterus, in the manner described by Dr. Johnson. The quantity of 
gas applied was thirty cubic inches on each occasion. Nine hundred 
and thirty cubic inches were applied altogether. The local disease was 
removed, both the irritation and the prolapsus altogether ceasing, and 
the health became restored. Part ii., p. 64. 
Sterility—Proposed Remedy for.—Dr. Marshall Hall throws out a 
suggestion on the treatment of sterility, which may be tried under some 
circumstances. There is an extraordinary sympathy between the mammae 
and the uterus, so that the functional condition of the former influences 
that of the latter. “ This sympathy is partly nervous in its character, 
partly vascular. As a reflex action the uterus is made to contract after 
parturition, by applying the newly-born infant to the mammae. As a 
vascular sympathy, uterine hemorrhage and leucorrhoea occur from undue 
lactation.” Many cases of sterility, of course, arise from organic defect, 
but when the cause is of a functional and less permanent nature, it becomes 
a question whether or not the uterus can be stimulated so as to assume a 
healthy functional action in the way suggested by Dr. M. Hall, who says : 
My suggestion, then, is, that when the mamma is excited at the return of 
the catamenial period, a robust infant be repeatedly and perseveringly 
applied, in the hope that the secretion of milk may be excited, and that 
the uterine blood may be diverted from the uterus and directed into the 
mammary vessels, and that a change in the uterine system and a proneness 
to conception may be induced. I would propose that the patient should 
sleep, for one week before, and during each catamenial period, with an 
infant on her bosom. Part ix.,p. 202. 
Sterility.—Dr. Oldham believes that the greatest discrimination is 
required in the use of mechanical treatment; both because it is not easy to 
distinguish cases in which there is really mechanical obstruction, from per- 
fectly natural conditions, and also because the operations for the relief of 
such obstructions are not without danger. Strictures of the os or cervix 
sufficient to prevent impregnation are very rarely met with; and the at- 
tempt at mechanical dilatation has been followed by a fatal result. The 
treatment of mal-position of the uterus supposed to be the cause of 
sterility, has also caused death. Lastly, obstructions in the fallopian tubes 
are probably never, when they do occur, of a kind which could be over- 
come by catheterism ; and as this operation will be always extremely diffi- 
cult, and never without danger, its performance appears to be altogether 
indefensible. 217. 
Japanese Remedy for Sterility.—Dr. E. Williams has described a Ja- 
panese remedy for sterility. The tree is one of the order of Ternstromacete 
of Jessieu, with leaves somewhat larger than those of the congou tea, 
emitting an odor when bruised resembling pulegium and sabina. The 
mode of preparation is to take a quantity of the leaves, macerate them in 
as much rice spirit as will just moisten them, for six hours ; then express, 
and give about a teaspoonful every hour, and two or three doses will 
STERILITY. 566 
STOMACH, 
invariably bring on the menstrual secretion, which can be maintained by a 
dose or two daily, for any length of time. Part xxii., p. 320. 
Sterility.—In those cases which cannot be accounted for by any disease, 
but which seem to depend on defective ovarian action, apply Professor 
Recamier’s galvanic poultices. Part xxiv., p. 348. 
Sterility from Pysmenorrhoea, etc.—When the cervix uteri is very much 
contracted, says Dr. I. B. Brown, introduce through the speculum a long 
stilette into the uterus, then over this pass the smallest sized elastic tube, 
and allow it to remain for a short time. Gradually pass on from this to 
larger tubes, until Simpson’s dilators can be introduced. The best time 
for introducing the instrument is immediately after the cessation of the 
catamenia. Diseases of the rectum will also produce sterility. The rectum 
and uterus are both supplied by vessels and nerves from the same source, 
and therefore disease in the one organ must interfere with the other. 
When a female is suffering from bleeding hemorrhoids, duiing the mens- 
trual period a diminished supply of blood is sent to the uterus, and its 
mucous membrane will not undergo those normal changes necessary for the 
reception of the impregnated ovum. The same observations apply to pro- 
lapsus ani with loss of blood at every defecation : when this is the cause, 
apply two or three ligatures to the prolapsed mucous membrane, and 
return them within the sphincter. Give opiates to keep the bowels quiet, 
and give good diet. After the usual operation for fissure of the rectum, 
you must give opium regularly and freely to relieve pain and secure 
perfect rest for the bowel. After a week or ten days they may be moved 
by injections. Part xxxv., p. 251. 
Atony of the Stomach.—Dr. Debreyne believes this disease is not of 
unfrequent occurrence, especially in women affected with leucorrhoea, 
chlorosis, anaemia, etc. 
One important characteristic is, that the distress of the stomach is 
usually increased by the use of vegetable and farinaceous food, and 
relieved, more or less, by a generous diet of animal meat, wine, etc. 
Neither opiates nor antiphlogistics are suited to such a case; tonics 
alone constitute the most approved treatment, such as the use of some 
mild ferruginous preparation, quinine, or of some other vegetable bitter, 
as gentian, calumba, aloes, etc., in the form either of infusion or wine. 
In a variety of gastro-atony, characterized by frequent returns of vomit- 
ing, from 5 to 10 grains of powdered calumba, recommended 3 or 4 times 
a day. 
If the epigastric uneasiness should be troublesome, advised to combine 
with the calumba a mild opiate. Part i., p. 23. 
Nitrate of Silver in Gastric Affections.—[A good case of this kind is 
related by Dr. Dick, in which this remedy was useful.] 
A young gentleman had stomach ailments almost from infancy. The 
most distressing symptom, however, was eructation of an acid and burning 
fluid and gas from the stomach, which often commenced even during 
STOMACH. STOMACH, 
567 
meals, and continued for hours afterward. Yet his bowels were regular, 
urine natural, and the functions of the skin normal, with sound sleep—and 
no apparent disorder or disease of any other organ in the body. 
The case of this young gentleman appearing to me to betray a union of 
morbid secretions and morbid sensibility, I commenced the treatment with 
small doses of blue pill and ipecacuanha, from which no immediate benefit 
appeared to result. I then put him upon a month’s course of nitrate of 
silver, with a view to allay the morbid sensibility of the mucous membrane. 
The effect in this, as in almost every other case in which I have tried it, 
was surprising and gratifying in the extreme. This patient, in common 
with many others who had taken this medicine, warmly expressed the 
great relief from irritation, flatulence, cutaneous chillness, discomfort, 
which it promptly procured. Part 61. 
Chronic Diseases of the Stomach—Atony of the Stomach.—This kind 
of gastric affection, says Dr. Strange, so common among the crowded 
population of manufacturing towns, presents the following symptoms and 
physical signs : The tongue is large, flat and flabby, filling the whole width 
of the mouth, its surface almost uniformly pale and without scurf, present- 
ing the appearance of boiled veal or muscular fibre which has been 
macerated in cold water; the face pale and flaccid, corresponding re- 
markably with the tongue ; the epigastrium distended, not painful, but 
uneasy on pressure; the abdomen in women often pendulous and flabby, 
sometimes hard and tender; the pulse is generally unaffected, or it is 
weak and small. 
Patients affected with this form of disease complain that they have no 
appetite, or that they crave for things which are to them indigestible. 
There is not often very acute pain in the region of the stomach or along 
any part of the digestive canal; but sometimes to the sense of fullness 
succeeds a constriction about the lower part of the epigastrium, accom- 
panied by eructations of gas sometimes mixed with acidity. There is 
flatulence, with irregularity of the bowels, a general state of costiveness 
being occasionally interrupted by a painful diarrhcea. A feeling of con- 
striction, with pain extending through the back, coming on two or three 
hours after meals, may be owing, as is supposed by Dr. Abercrombie, to 
irritation created in the duodenum by the passage of insufficiently digested 
food into the bowel; and I have remarked that this pain very frequently 
coexists with a relaxed state of the bowels and painful emotions. On the 
whole, however, a feeling of acute pain coming on periodically some hours 
after a meal is much more frequently met with in another well-marked 
form of gastric disorder, viz., where the tongue exhibits a degree of red- 
ness round the edges, with furred centre; and where there is pain on 
pressing the epigastrium, denoting an irritable state of the mucous and 
muscular coats of the stomach. 
With the view of reducing the irritation, if any, and of gently stimulat- 
ing the stomach, I have for a length of time mainly depended upon one 
substance, viz., the oxide of bismuth, which has also been highly extolled 
by Dr. Paris and other authorities. When cases to which it is applicable 
are selected, I believe that not one in ten cases will occur in which much 
benefit will not be procured from its use. The manner in which I prescribe 
is as follows: • 
R Bismuth, trisnitrat., 3j.; morphise muriat., gr. ss.-j.; acacise mucil., 568 
STOMACH, 
§ij.; sirup, zingiber.; tinct. cardam. com., aa. 5iij. * infus. cascarill., §v. 
M.—§j. ter die. 
This formula retains its appearance for a length of time; the mucilage 
suspending the bismuth in such a manner as to give to the mixture the 
consistence of cream. In pyrosis, taken at the period of attack, and in 
that form of gastrodynia previously described, taken half an hour after 
meals, it immediately assuages the pain and promotes digestion. In those 
cases particularly where there is considerable derangement of the 
duodenum, this medicine acts like a charm. 
All kinds of fermented and spirituous liquors, as they debilitate as well 
as stimulate, are injurious in this affection. Purgatives must not be re- 
sorted to for the relief of the costiveness which so often accompanies this 
form of dyspepsia as by over-exciting they afterward debilitate the intes- 
tines. Gentle laxatives with tonics, such as small doses of aloes or colocynth 
with sulphate of iron, as recommended by Dr. Abercrombie, or with sul- 
phate of zinc, are the most beneficial. # 
Atonic Morbid Irritability of the Stomach.—I look upon this second 
form of dyspepsia as the natural consequence of a long continuance of the 
former atonic variety. 
The symptoms indicating this affection differ considerably from those 
characteristic of mere want of tone. The tongue is generally slightly red 
at the tip or round the edges; there is a thin whitish fur all over the 
centre which cannot be scraped off; a sense of heat in the throat, oesoph- 
agus, and sometimes in the stomach. The sleep is often disturbed, and 
muscular efforts are weakened. The appetite is always uncertain in this 
affection, following the remissions and exacerbations of the attacks. There 
is a general desire for savory and solid food, although this almost invari- 
ably aggravates the symptoms. There is pain in the stomach during the 
whole time the food remains there, which is sometimes relieved by vomiting 
coming on from half an hour to three or four hours after a meal. 
Substances in small quantities are seldom returned. In some cases there 
is a sense of weight only at the stomach until about two hours after taking 
food, when a sense of pain and constriction ensues, which lasts frequently 
until relieved by a relaxed but unsatisfactory motion. In these cases it 
has been no doubt rightly supposed that the irritable stomach pushes 
onward the partially digested food into the duodenum, whence it is either 
forced back by vomiting, or passes out of the bowels, after giving pain in 
its whole course, in a partially relaxed and often scalding motion. This 
morbid irritation of the stomach is sometimes accompanied by a degree of 
pyrosis, but not by any means in a constant manner. The regurgitations 
are more frequently composed of the mucus of the stomach mixed with 
acidity, gas, and the aroma of the food. 
When the disorder has not arrived at any very troublesome height a 
similar treatment to that recommended for atony of the stomach, will be 
found to answer very well. In more exaggerated cases, however, and 
especially if there be much pain and heat at the epigastrium, it will be 
well to begin with moderate counter-irritation, as a blister, two or three 
mustard poultices, or the ung. antim. tart. All drastic purgatives, particu- 
larly mercurial ones, should be avoided, as they increase the irritation. 
The oxide of bismuth, with infusion of rhubarb and magnesia, will be 
found to answer the double purpose of maintaining a steady action upon 
the bowels, and of correcting the acidity and heat of the stomach. 569 
STOMACH. 
The following is a good formula : 
R Bismuth trisnitrat., 3j-; magnes. carb., 3ss.; tinct. hyoscyami, 5ij.; 
Infus. rhei, gviii. M. 
One ounce of this mixture to be taken three or four times a day. After 
the more acute symptoms have been reduced, the mixture of bismuth with 
gentle stimulants and tonics, as prescribed for the atonic state, will answer 
well; and, finally, we may have recourse to quinine, iron, zinc, and other 
direct tonics. 
Should there be much acidity with regurgitation some time after taking 
food, accompanied with a costive and unsatisfactory state of the bowels, 
the following pill, taken regularly after the principal meal, will be found 
very useful: 
R Aloes in pulv. gr. iss.; ferri sulpli., gr. ij.; sapon. dur., gr. vj. M.—• 
Div. in pil. ij. simul sumend. 
The soap is a great addition to the aloes and iron pill in common use, as 
it unites chemically with the free acid of the stomach. Part x., p. 68. 
Vegetable Acids in Acidity of the Stomach.—Dr. Tracy, of Ohio, 
makes the following remarks on vegetable acids as correctives of acidity 
of the stomach: During the summer of 1841, I was myself the subject of 
repeated and severe attacks of catarrhal inflammation of the eyelids, 
which uniformly yielded to the usual treatment in the course of from three 
to six days. I observed that they always succeeded to irregularities of 
diet and regimen, or to anxiety of mind, and were accompanied by acidity 
of stomach. This I attempted to correct by the early and free use of 
soda, but in vain ; it had but a very slight and temporary effect. As these 
attacks became more and more frequent, I observed that they were pre- 
ceded by a sense of fullness and oppression in the prsecordia. I had for 
months abstained from the use of acids, under the impression that they 
were not suited to my state of health; but having received no benefit 
from soda, I was induced to take a glass of lemonade, at the first com- 
mencement of the attack, and almost instantly I experienced very copious 
eructations of gas, together with much alleviation of my feelings of dis- 
tress. The remedy was again and repeated, and the threatened ophthalmic 
attack effectually prevented. I have since resorted to my bottle of lemon 
sirup, whenever threatened with a recurrence of the complaint, and uni- 
formly with complete success; all the symptoms being removed in the 
course of a short time. I have from the time above mentioned to the pre- 
sent (June, 1843), made a free use of acids, and have not experienced a 
single recurrence of ophthalmia, and very few, indeed, of pyrosis. 
I have found vegetable acids uniformly and entirely successful in remov- 
ing the disposition to attacks of acidity of stomach, in persons who, dur- 
ing the intervals of such attacks, were free from all such symptoms; and 
my impression is, that in all such cases they can be relied upon with more 
confidence than any other remedy. In cases of acidity, arising from preg- 
nancy, I have found the sub-acid fruits of great service, while those that 
were tart could not be borne, and mineral acids were decidedly injurious, 
and where alkalies or absorbents were of little or no avail. 
Part x.,p. 73. 
Use of Acids in some Affections of the Stomach.—It seems to be a 
contradiction to cure acidity of the stomach by the administration of vege- 
table acids; but such seems to be the case in some peculiar and obstinate 570 
STOMACH. 
affections of this organ. Dr. Chapman, of Philadelphia, refers to the 
same thing in his late work on the diseases of the thoracic and abdominal 
viscera. lie has found occasionally the most discrepant sorts of nourish- 
ment agreeing with dyspeptics. One patient was cured of his dyspepsia 
by drinking sour beer, another by living exclusively on raw turnips; other 
cases are related in which sour pie-clierries and vinegar were ttsed. Dr. 
Tracy states that the vegetable acids will be successful when the alkalies 
have failed, and for general use he recommends lemonade or lemon-juice. 
Part xi., p. 61. 
Digestion of the Mucous Membrane by the Gastric Juice following 
simple Ulcer of the Stomach.—In that gastric disorder which often occurs 
in the advanced stages of phthisis, says Professor Budd, and is attended 
with increased secretion of the gastric juice, such as may produce ulcera- 
tion, give liq. potassae, fifteen drops, or bicarb, potassae, a scruple, thrice 
a day, or give infusion of logwood, §j. thrice a day, which will also arrest 
diarrhoea. Part xvi., y>. 149. 
Simple Ulceration of the Stomach going on to Perforation.—[The 
symptoms of this disease, in its early stage, are not yet defined. Dr. Sey- 
mour has found, that before the fatal seizure, the patient has long felt pain 
after eating, unaccompanied with symptoms of acidity; and aggravated 
sometimes by one kind of food, and sometimes by another, but most com- 
monly by solid meat. As to treatment, Dr. S. observes]: 
In the treatment of such cases, when there is real reason to suspect so 
serious a disease, soothing remedies seem to be indicated. The bowels 
should be carefully kept open by enemata, so as to prevent any acrid medi- 
cine coming in contact with the ulcer ; and occasional blisters to the epi- 
gastrium may be expected to be useful. Where the existence of the com- 
plaint is more clear, from the preceding pain and the subsequent vomiting 
of blood, a case which I have frequently seen, I know of no remedy so 
uniformly successful as the oil of tuspentine taken internally. 
Part xvi., p. 150. 
Observations on Disorder of the Stomach.—Dr. Seymour observes, that 
pain dependent on excess of acid in the stomach, often becomes attended 
with great irritability of the heart and pulsation in the epigastrium, so 
that the patient is led to believe that he is suffering from disease of the 
heart, or aneurism of the aorta. These alarming symptoms are cured by 
the regular administration of antacid medicines with sedatives, or alkalies 
with rhubarb and calumba root. His formula is rhubarb, six grains; bi- 
carbonate of soda, fifteen grains ; calumba powder, three grains; compound 
cinnamon powder, two grains; to be taken in a glass of water, before din- 
ner or at bed-time, and continued regularly during at least a fortnight. 
Pain without heartburn or vomiting, is most likely to be the result of ir- 
regular contraction of the stomach, in which case he relies on bismuth 
with magnesia, in the following formula—trisnitrate of bismuth, calcined 
magnesia, compound tragacanth powder, of each a scruple: rub together, 
and add water an ounce and a half; sirup half a drachm : this draught to 
be taken every four hours. He says bismuth is highly useful in all painful 
spasm arising from disorder in the intestinal canal, and states from his own 
knowledge that it was used with much effect at Moscow in the spasms of 
the Asiatic cholera in 1831. 
When the pain of the stomach resists this treatment, he trusts to a grain 571 
of opium administered thrice daily; the bowels being in the meantime 
kept open by injections. In simple pyrosis he employs the compound 
powder of kino (Pli. Lond.)—namely, kino and opium with cinnamon, in 
doses of five grains a day, the bowels being kept free by aloes, rhubarb, or 
enemata. A blister over the epigastrium is sometimes useful at first. 
When under the idea that the liver is diseased, “ calomel and purgatives 
are prescribed, such cases become greatly aggravated, both as to time and 
severity.” Pyrosis is often, however, the forerunner of an incurable dis- 
ease—namely, the fungoid disease of the stomach. Part xvi., p. 150. 
Sarcina Ventriculi.—In a case of this disease under the care of Mr. 
Amyot, attended by frequent and most violent acid vomiting, after alkalies, 
hydrocyanic acid, creasote, nitrate of silver, and opium, had been tried, 
without permanent effect, §ss. of the concentrated essence of calumba, to 
the gviij. of water, and given every two or three hours during the attack, 
gave the most decided relief. Part xxvi., p. 87. 
Sarcina Ventriculi.—One indication necessary to be fulfilled in the 
treatment of this disease is to destroy the fungus by a regular and syste- 
matic exhibition of alkalies, thereby removing the acidity so essential to its 
formation and development, and then to employ some remedy capable of 
destroying its growth. This may be done, says Dr. Hassall, by giving 
bicarbonate of potash and infusion of quassia, and afterward the sulphite 
of soda. The operation of this salt seems to be that the sulphite being 
decomposed in the stomach by the acids therein generated, sulphurous 
acid gas is liberated, the destructive effects of which upon parasitic forma- 
tions like the sarcina is well known. Part xxvii., p. 83. 
Sarcince Ventriculce.—In a case of this disease, of many years’ stand- 
ing, under the care of Dr. Neale, "University Col. Hospital, the following 
was the successful treatment: At first the diet was the same as that 
ordered commonly in diabetes mellitus. Three grains of sesquicarbonate 
of ammonia were given three times a day in one ounce of infusion of 
quassia, with one to two drachms of sulph. sublim., to open the bowels. 
Afterward the same diet was continued, but the medicine was sod® 
hyposulph., 5vj.; infus. quassise, §xij.-§ss. ter die. The only variation 
made was, that precipitated sulphur was preferred to sublimed sulphur; 
and one ounce of cod-liver oil was given three times a day. 
Part xxviii., p. 109. 
Sarcince Ventricular.—This disease is easily recognized, saVs Prof. 
Budd, by the vomited matter fermenting, both the foam on its surface and 
the sediment thrown down containing abundance of sarcina) and torulae. 
The fermentative process may be checked by giving half a minim of crea- 
sote in a pill at each meal. Common salt has the same effect. Bisulphite 
of soda from the liberation of sulphurous acid, has the same power. It 
may be given in doses of 3ss. to 5j. in water, two or three times a 
day. 
In chronic cases of the disorder, the drain from the coats of the stomach, 
and the frequent throwing up of part of its contents, causes constipation; 
and it is requisite to obviate this condition, since any undue accumulation 
in the bowels aggravates the stomach-disorder. The best aperients are 
probably aloetic or colocynth pills. 
"When the disorder is severe, and the patient reduced in flesh, opiates, 
STOMACH, 572 
STOMACH. 
timely administered, are of much service in lessening the uneasiness at the 
stomach, and promoting sleep. 
It now and then happens, that the disorder coexists with chronic ulcer 
of the stomach, and that eating solid food causes pain in the stomach, 
which is different from the uneasiness that results from distention of the 
stomaeh, and pain also in the corresponding part of the back. In such 
cases, as in ordinary cases of simple ulcer, the diet should be of the least 
irritating kind. 
By the various means enumerated, the disorder may be greatly miti- 
gated, the strength of the patient kept up, and his life prolonged ; which 
is as much as can be promised for any disorder which originates, as this 
usually does, in irremovable organic changes. Part xxix., p. 108. 
Epigastric Neuralgia.—[On the slightest pressure in the epigastric 
region great pain is felt in these cases—not occupying a space above the 
size of a five-shilling piece. The following illustrates this kind of case, 
which might easily be mistaken by the young practitioner. Dr. Lees 
proceeds:] 
He says that he never experiences pain in the stomach, but that, after 
eating, he has been often obliged to lift his shirt from contact with the 
epigastrium, as the tenderness caused by even its apposition was intoler- 
able, although it was not aggravated by increasing the pressure. The 
state of his general health and appetite is good ; functions natural; tongue 
clean ; bowels regular ; no thirst, nausea, or vomiting. He does not suffer 
from flatulence, has no headache, but is very low spirited. The circula- 
tion is languid, pulse 56 ; heart’s action feeble, but regular, and without any 
murmur; the abdominal muscles are in a state of constant tension, hard 
and rigid; there is no evidence of any tumor, nor abnormal pulsation in 
the epigastric region ; neither pain nor tenderness in the back, nor in the 
course of the intercostal nerves. His easiest posture is on liis left side, 
with the right leg drawn up. When he lies on his back with the right 
leg extended, the spine is arched, so that the hand can be passed freely 
under it, but it becomes quite flat and in contact with the bed, on the leg 
being flexed. The urine is of natural appearance, sp. gr., and reaction ; 
no visible sediment, but on microscopic examination there are seen 
numerous very minute crystals of oxalate of lime aggregated in long 
masses. 
He could not assign any cause for his complaint, except that he has been 
constantly employed in a very dusty meal-room, but he has neither 
suffered from cough, nor from any difficulty of respiration. 
Tincture of aconite was applied over the tender part, but without any 
relief. Ordered: 
R Infusi valerianae, infusi cinchonae, aa. §iij. 
Sumat §j. ter in die; a small blister over the part, and to be dressed 
with acetate of morphia ointment, gr. j. ad §j. 
He was allowed meat every day, and advised to walk about and amuse 
himself. Under this treatment he was cured. Part xxx., p. 57. 
Remedies for Stomach Disorders.—Prof. Budd remarks : Quinine, and 
the bitters generally, are especially grateful to persons who have injured 
their stomachs by hard drinking. With such persons they improve the 
appetite and strengthen digestion, and have a bracing effect upon the sys- 
tem at large. 573 
STOMACH. 
Iii persons exhausted by over-work, or wherever weakness of the 
stomach is the result of general debility from other causes, they often do 
much good in the same way—by improving the appetite and strengthen- 
ing the digestion. 
They do harm in the organic diseases of the stomach ; in plethoric states 
of the system; and generally where there is a furred tongue, or where 
the urine throws down a sediment of lithic acid, or of lithate of ammonia. 
Their most striking effect is to improve the appetite, when this has been 
impaired from hard drinking or from over-work, or from nervous exhaus- 
tion from other causes ; and the best time for giving them is from half 
an hour before meals. 
The different hitters have not precisely the same effect. Calumba has 
a sedative influence not possessed by the others, and probably on this ac- 
count has had a wider reputation as a remedy for mere indigestion. Gen- 
tian and chiretta (which is of the gentian tribe, and is much employed by 
practitioners in India) tend to increase the secretion of the liver, or, at 
any rate, do not impede the secretion of the liver, which quinine and 
quassia seem often to do. They are, therefore, better suited to bilious 
persons, and to those cases of indigestion where the secretions of the liver 
are defective. 
The different preparations of steel are especially useful in the indigestion 
that occurs in chlorosis, and generally where weakness of the stomach 
results from anemia. 
They do harm in plethoric states of the system, and generally where 
there is a furred tongue, or where the urine throws down a sediment of 
lithate of ammonia or of lithic acid. 
The citrate, or ammonio-citrate is the most agreeable preparation to the 
taste, and generally the most grateful to the stomach. If there be any 
disposition to sickness or nausea, or any tendency to furring on the tongue, 
it may be given in conjunction with the bicarbonate of soda or potash. 
makes a mixture having much the same effect as Griffith’s mixture— 
the mistura ferri composita—and far more agreeable. 
The muriated tincture of iron is more astringent than the other prepa- 
rations, and may be given in conjunction with dilute muriatic acid, in the 
forms of indigestion suited to this latter medicine, when these exist in 
states of anaemia. 
The sulphate of iron, like other metallic sulphates, has a tendency to 
cause sickness, and should not be given in cases where a disposition to sick- 
ness exists. 
Steel medicines do good by improving the quality of the blood rather 
than by their immediate action on the coats of the stomach, and are best 
given at meal-times. They then are mixed with the food, and gradually 
absorbed with the products of digestion, and are less apt to offend the 
stomach and to cause headache than at other times. 
Whenever steel medicines are given, it is essential that a regular action 
of the bowels be kept up. These medicines tend to confine the bowels and 
to cause evolution of sulphureted hydrogen in them : and unless this ten- 
dency be counteracted, they are apt to fur the tongue and cause headache. 
The choice of purgatives is a very important matter in stomach dis- 
orders. The different purgatives exert their chief action on different 
portions of the intestinal canal: some excite the secretion or the peri- 
staltic movement of one part, some of another. In disorders of the sto* 574 
STOMACH. 
mach and bowels, where a purgative is required, care should, therefore, 
be taken to select those which are least prone to irritate the injured or dis- 
ordered part. 
Castor oil, for example, offends the stomach, but acts very mildly on the 
large intestine. It should not be used in stomach disorders, or where, 
from any cause, a, tendency to vomiting exists; but is better than any 
other purgative in dysentery, or during convalescence from typhoid fever, 
when the intestines are ulcerated, and in various other conditions where 
a speedy and sure purgative, and one not apt to irritate the large intes- 
tine, is required. 
Senna acts chiefly on the small intestine, and, besides exciting its 
peristaltic action, increases the secretion from its mucous membrane. 
It acts, also, on the liver, increasing the secretion of bile. In conjunction 
with a few grains of calomel or blue-pill, it is, as every one knows, one of 
the best purgatives in bilious states of the system, or where an evacuant 
is required; but in mere disorders of the stomach it is often objectionable, 
from the tendency it has to cause sickness. 
The best purgatives in stomach disorders are aloes and colocynth, which 
exert their chief action on the large intestine. These medicines may do 
much harm when the large intestine is ulcerated or inflamed; but in simple 
ulcer of the stomach, and in the most severe functional disorders of the 
stomach, they may generally be given without causing either pain of the 
stomach or sickness. In some kinds of functional disorder of the stomach, 
aloes seem indeed, like other bitters, to improve the appetite and 
strengthen digestion. 
Aloes appear to act more exclusively on the large intestine, and irritate 
the stomach much less than colocynth, and hence, in stomach disorders 
are generally preferable to it. 
Where, from the existence of piles, or from pregnancy, or some other 
condition, these medicines are objectionable, the best substitutes for them 
in stomach disorders are the saline purgatives, which exert their 
action on the small intestine, and have little tendency to cause pain in the 
stomach, or sickness. Part xxx., p. 58. 
Stomach—Dilatation of, with Obstructions at the Pylorus.—A good 
diagnostic symptom of disease of the pylorus, says Dr. R. B. Todd, is the 
vomiting of sarcince with a peculiar yeast-like substance. Give half 
a drachm of sulphite of soda in an ounce and a half of water every four 
hours. If necessary increase the dose to a drachm. The sulphite of soda 
will destroy the sarcince, but it will not act upon a diseased pylorus. 
Where the disease, therefore, is simply from sarcince, give the sulphite, but 
otherwise, it is not to be depended upon. Part xxx., p. 59. 
Sarcince Ventriculi.—Chloride of calcium, says Dr. A. Beared, is per- 
haps a better remedy to restrain the vomiting than hyposulphite of soda. 
Give the following draught: R Liquoris calcii chloridi, 5j.; aquce 5vij.; 
sumat haustum talem ter quotidie. Part xxxi., p. 92. 
Gastric Affections.— Vide Selections from Favorite Prescriptions, Art. 
“ Medicines.” 
Gastric Ulcer.—Dr. Ilandfield Jones thinks there are many who cannot 
dissever in their minds the idea of inflammation from that of ulceration, 
but he believes that the perforating gastric ulcer is essentially the result STOMACH. 
575 
of a local failure of nutrition, and not in any degree necessarily connected 
with inflammation. Our chief object in treatment must be to improve the 
general condition of the system, by good nutritious diet, allowing five or 
six hours’ rest between the meals; we must attend to the general mucous 
surface, and invigorate the organ as much as possible. For this purpose, 
counter-irritation, with sedatives and astringents, may be necessary at 
first; and, as soon as they can be borne, tonics, as acids, bitters, quinine, 
iron, and cod-liver oil. If there be much vomiting and pain, which the 
ordinary remedies fail to relieve, order strychnine, one-sixteenth of a 
grain ; muriatic acid, one minim ; water, one ounce; three times a day. 
Part xxxiii., p. 111. 
Affections of the Stomach—Excessive Secretion of Mucus and Gastric 
Juice.—Prof. Budd gives the following: Bismuth, combined with aro- 
matics or alkalies, may be administered before meals with advantage. 
When there are fetid eructations, you may give creasote pills (containing 
from a quarter to half a minim) or a few grains of bisulphite of soda; or 
some finely powdered wood charcoal. To alleviate pain, and allay general 
nervous irritabiltiy, the best medicines probably are conium and bella- 
donna, which do not confine the bowels or check the secretions as opium 
does. 
Deficient Secretion of the Gastric Juice.—Take care that the albu- 
minoid food be as liquid as possible; let the quantity requisite for the 
day’s consumption be taken at frequent short intervals; and if likely to 
turn sour, guard it with alkalies. We often find a draught of cold water, 
an hour or two after meals, will remove the discomfort arising from difficult 
solution of meat meals ; in part by replacing the gastric juice, and also by 
favoring the absorption of the delayed nutrimentary mass. In the way of 
medicines, a pill containing a grain of ipecacuanha, or capsicum, with three 
grains of rhubarb, maybe taken before dinner. For slowness of digestion, 
ipecacuanha is more effectual than any of the other stimulants. When 
digestion is habitually slow and feeble, much lasting benefit will be de- 
rived from nitro-muriatic acid, taken half an hour before the principal 
meals. 
Sympathetic Vomiting.—The most effectual remedies for this are, seda- 
tives, to lessen the irritation from which it springs ; alkalies, to neutralize 
the acids which the stomach contains; astringents, to restrain the undue 
and untimely secretion. The insoluble antacids, magnesia and chalk, are 
very suitable ; bismuth has a remarkable effect in restraining undue secre- 
tion, especially when combined with magnesia or chalk. If there are any 
symptoms indicating inflammatory action, apply a blister to the epigas- 
trium, and attend carefully to the diet, which should consist chiefly of milk 
and farinaceous food. 
Pyrosis.—The classes of remedies which have been found most useful 
are astringents and sedatives. We might advantageously combine five 
grains of bismuth with a twelfth of the grain of the muriate of morphia; 
or five grains of the compound kino powder, or logwood, catechu, kra- 
meria, with opium, given two or three times daily before meals. 
Indigestion of Drunkards.—The most efficient remedies are bitters, 
opium, and solid food. Gentian, quassia, and calumba, may be taken 
singly or combined, in the form of tincture, an hour before the principal 
meals; with these, small doses of opium or morphia may be advan- 576 
STOMACH. 
tageously combined, to tranquillize the nervous system, but in all these 
cases it is essential that the patient should eat as soon as possible some 
solid, nourishing food. 
Employment of Vegetable and Mineral Tonics.—Quinine and the bitters 
generally do much good in persons exhausted by overwork, hard drinking, 
or other causes; they improve the appetite and strengthen digestion. 
The best time for giving them is about half an hour or an hour before 
meals. The different bitters have not precisely the same effect; calumba 
has a sedative influence not possessed by others; gentian and ehiretta 
tend to increase the secretion of the liver; quinine and quassia seem to 
impede secretion. Tonics do harm in organic diseases of the stomach, in 
plethoric states of the system, and generally where there is a furred 
tongue, or when the urine throws down a sediment of the lithates. 
When there is any disposition to sickness or nausea, the amonio-citrate of 
iron, in conjunction with the bicarbonate of soda or potash, is the most 
pleasant preparation, and will have the same effect as Griffith’s mixture, 
the sulphate of iron, like other metallic sulphates, has a tendency to cause 
sickness. Steel medicines act generally instead of locally, and are there- 
fore, best given at meal-times, so as to be absorbed with the food. 
Part xxxiv., p. 11. 
Ulcer of the Stomach.—If there be a constant gnawing pain at the epi- 
gastrium, says Dr. Brinton, apply some counter-irritant, as a blister, mus- 
tard poultice, etc.; if the powers are exhausted, dry cupping is the best 
means of mitigating it. A still more valuable remedy, in some cases of 
obstinate vomiting and severe pain, may be found in frequently swallow- 
ing small bits of pure ice. In cases of severe hemorrhage its use is almost 
indispensable. When severe pain is accompanied by very frequent vomiting, 
a very small opium pill is retained better than any other sedative. If diar- 
rhoea be present, the compound kino powder, combined with the trisnitrate 
of bismuth, is an excellent remedy. Ten or tAventy grains of the trisnitrate 
of bismuth, with five to ten grains of the compound kino powder, has a 
very remarkable effect in relieving pain, vomiting, and diarrhoea. If flatu- 
lence be very troublesome the alkaline carbonates with bitter infusion are 
the best remedies. We can recommend the following combination : 
potass, iodid., gr. j.; potass, bicarb., gr. xv.; tinct. aurant., 3ss.; inf. 
calumb., 5viiss. To be taken an hour after food. Part xxxiv., p. *76. 
Syncope Senilis, arising from Gastric Irritation.—This complaint, ac- 
cording to Dr. Higginbottom, is common to all ages, but more particularly 
to infancy and old age. It is generally observed in persons above sixty, 
and takes place Avithout any organic disease, although both the Arascular 
and nervous system must be inactive and in an impaired condition. 
Gastric irritation from the food remaining undigested in the stomach, 
appears to be the sole cause of the attack; this gAes rise to syncope and 
convulsions which may be fatal. Vomiting at an early period is the most 
effectual remedy. Half a drachm of the poAvder of ipecacuanha, with ten 
or fifteen grains of bicarbonate of potash to neutralize any acidity, Avill 
produce full vomiting and raise the system to its normal condition. The 
nausea and ineffectual natural attempts at vomiting produce debility and 
exhaustion. If the first half drachm of ipecacuanha does not operate, a 
second dose may be given Avith perfect safety. In adAranced age the body 
does not require the same amount of solid food. It has been erroneously STOMACH. 
577 
said that “ wine is the milk of old agethe truth is that milk is the wine 
of old age; second childhood should be treated as directed by the late Dr. 
Janies Hamilton, of Edinburgh, “Plenty of milk, plenty of flannel, and 
plenty of rest.” Part xxxiv., p. 99. 
Treatment of Ulcer of the Stomach.—When hemorrhage from a chronic 
ulcer amounts to a considerable quantity, says Dr. Brinton, although it be 
only a symptom of the disease, yet we must direct special attention to it, 
and we may remark that the astringents we introduce are much more effi- 
cacious than in the case of bleeding into the lungs. If there is reason to 
believe that the bleeding is from a large vessel, the stomach must be kept in 
the state of perfect rest, the supine position must be rigidly observed, and 
the minimum of food that will support life, taken lest the clot which alone 
intervenes between life and death be disturbed. 
In many cases of hematemesis, if there be no great tendency to vomiting, 
turpentine, or the sesquichloride of iron act admirably; but what is pre- 
ferable, because it is not so apt to excite vomiting, is ten grains of gallic 
acid, dissolved in an ounce of distilled water by the aid of about ten min- 
ims of the dilute sulphuric acid. Among tonics, the preparations of iron 
claim the foremost rank. When vomiting and pain have ceased, begin 
with the very mildest preparations, such as the ammonio-citrate, which 
should always be given immediately after food. The insoluble oxide 
should generally be avoided. As a combination of the vegetable and 
mineral tonics, none is so elegant and so generally useful as a mixture of 
sulphate of quina and iron, kept in solution by a few drops of sulphuric or 
hydrochloric acid. 
It is impossible to cure ulcers of the stomach by any remedies in the ab- 
sence of proper regimen ; drugs, although invaluable as aids to a strict diet, 
are powerless as substitutes for it. Milk diet, given in small quantities at 
frequent intervals, is the best that can be given under such circumstances; 
if the stomach be excessively irritable, it may be diluted with lime water. 
During convalescence the diet must be kept up as much as prudence will 
allow; ground rice with milk forms an excellent food, wkeaten flour is best 
given as bread steeped in boiling water, and pressed through a muslin sieve 
while still hot (bread jelly) and boiled with milk. With respect to alco- 
holic stimulants we may say that it is advisable they should be studiously 
avoided : in cases of extreme exhaustion, where alcohol seems necessary, it 
must be given as an enema. But we may ask, are there no stimulants 
which may afford us the advantages of alcohol without its disadvantages ? 
In such cases the peculiar stimulant effects of opium make it by far the 
most valuable of them all. Part xxxv., p. 55. 
Cardialgia.—Dr. Tilt says, that if this does not depend upon foul secre- 
tions, requiring purgatives, give a sedative mixture before meals ; an alkali 
after meals ; three grains of blue-pill and two of extract of hyocyamus every, 
or every other, night; a mustard or hot linseed poultice, sprinkled with 
coarsely-powdered camphor, every other night. If the pains continue, 
prescribe a pitch, belladonna, or opium plaster : the two last may be alter- 
nated every fourth day. Often much benefit is derived from the applica- 
tion to the pit of the stomach of a piece of lint steeped in chloroform and 
covered with oil-silk. In some of the worst cases, in which the pain is 
agonizing, relief will sometimes be obtained by about thirty to sixty drops 
vol. ii.—37 578 
STOMACH. 
of aromatic spirit of ammonia, in the smallest possible quantity of water, or 
by the same quantity of chloroform, on a lump of white sugar. 
The following liniment, recommended by Dr. Oldham, may be tried with 
advantage: Extract of belladonna, half a drachm; tincture of aconite 
(Fleming’s), four drachms ; for an ounce and a half of soap liniment. Dr. 
Shearman gives nitrate of silver and opium, with quinine and potash water, 
in one drachm doses; Mr. J. Frank recommends oxide of bismuth; and 
Hufeland writes favorably of nitrate of bismuth, in ten or twenty-grain 
doses. Partxxxv.,p. 58. 
Liquor Pepsinoe in Dyspepsia from Ulceration of the Stomach.—Prof. 
Nelson gives the following case: 
Miss S. J., aged 18 or 20, was brought by her mother to me from Chel- 
tenham, laboring under pain and fullness of the epigastrium and right side, 
vomiting of blood, and sometimes of purulent matter. She was excessively 
anaemic, her skin being nearly white, and the legs oedematous. There had 
been no catamenia for a considerable time, and her father, as reported, had 
died of cancer of the stomach. She became worse after the journey. I 
saw her in bed, and detected a rounded swelling to the right of the epigas- 
trium, which I inferred might be a hepatic abscess, complicated with 
stomach ulceration. At this time she lay faint and helpless, vomiting 
everything she ate, sometimes intermixed with blood, and occasionally 
being composed entirely of muco-purulent matter combined with bile. She 
was afraid to speak above a whisper, her tongue and mouth were parched, 
and her legs pitted deeply under pressure; the pulse was small, frequent, 
and thready, about 140 per minute. Soothing poultices were applied over 
the swelling, large masses of hard round fecal matter were removed by 
injections, nitrate of silver was administered before food, and the alkalized 
liquor pepsinse, with hydrocyanic acid, was given after food, at intervals 
of one hour. At the same time the food was entirely pultaceous or liquid, 
and consisted of the smallest quantities at a time, seldom more than one 
teaspoonful. After several fluctuations, and occasional severe attacks of 
purulent vomiting, she gradually began to amend. So soon as the above 
symptoms abated, she went through a course of quinine and steel; and, 
after a tedious treatment of about ten months, she recovered plumpness, 
color, and strength, contrary to the expectations of all her friends and ac- 
quaintances. The remedy could have little power over hepatic abscess ; 
but I can scarcely see how, in her utterly reduced condition, she could 
have gone through the treatment without the support derived from the 
solvent action of the pepsine upon the food—oysters, arrowroot, and milk 
and wine, having all been previously rejected. Part xxxv., p. 294. 
Heartburn.—In anaemic feeble persons, Dr. T. R. Chambers believes this 
arises generally from over-sensibility of the nerves to the natural acidity 
of the stomach. This is relieved by alkalies, but alkalies prevent perfect 
digestion by neutralizing the acidity necessary to a proper performance of 
the digestive function. The treatment must therefore be directed to alle- 
viate the over-sensibility of the nerves, temporarily, by hydrocyanic acid 
and bismuth; permanently, by strengthening the general nervous system 
by quinine and iron, combined with sea-bathing, or the shower-bath. In 
other cases heartburn depends on too large an amount of acid being pre- 
sent in the stomach, resulting from chemical decomposition of the sugar in 
the chyme, owing to decreased vital power. The treatment here is to STEANGUR Y—STRICTURE. 
579 
increase the power and vigor of the stomach. The activity of the pepsine 
may be much augmented by neutralizing the saliva collected in the 
stomach and oesophagus just before the meal, by a little hydrochloric or 
lactic acid; for the saliva arrests the solvent action of the gastric juice in a 
close proportion to its amount. The quantity of gastric juice maybe further 
increased by supplying one of its most important constituents, water, which 
is best taken as cold as possible about half an hour after the meal. 
Part xxxvi., p. 65. 
Eructation and Vomiting.—When from simple relaxation of the oesopha- 
gus, Dr. Chambers gives astringents, as gallic acid combined with a little 
rhubarb. When from excess of air, swallowed from irregular nervous ac- 
tion, as in hysteria and chorea, valerian, either in infusion of the herb or 
combined with ammonia. When these fail, strychnine or creasote. The 
shower-bath is a very powerful remedy. When from the formation of 
foreign gases from chemical decomposition, no agent is so useful as sulphu- 
rous acid, which may be given as hyposulphite of soda; if this chance to 
disagree, charcoal will scarcely foil to arrest gastric fermentation. When 
chronic vomiting is sympathetic, i. e., from some disease or condition else- 
where, as in peritonitis, pregnancy, etc., give hydrocyanic acid. When 
from gastric mucous flux, with copious formation of acid, give carbonate 
of magnesia. When the vomiting is accompanied by much local pain, as 
from gastric ulcer, malignant tumor, peritonitis, hernia, perforation of the 
gut, opium is the remedy of most value. When at the commencement of 
fevers and in cholera, apply chloroform on cloth to the epigastrium. Milk 
and lime-water, as a sole diet, will often alone stop chronic vomiting; com- 
plete rest and absence from excitement must accompany it. Chloroform 
does not arrest the nausea of sea-sickness, but it controls the violence of 
the straining. Part xxxvi., p. VO. 
STRANGURY. 
From Administration of Cantharides.—Dr. Seymour relies chiefly 
upon starch injections containing twenty or thirty drops of tinct. of opium. 
Cantharides should not be given to patients with stricture of urethra. 
Dr. S. believes that cantharides should not be given to women, from its 
peculiar effects upon the uterine system. Camphor is recommended in 
some books, but is very slow in its operation. Hyoscyamus, however, in- 
creases its efficacy—especially in chronic irritation of the neck of the blad- 
der. Part viii., p. 68. 
STRICTURE. 
RECTUM—(ESOPHAGUS—URETHRA. 
Of Iiectum:—Dr. O’Beirne considers that it is our duty, if possible, 
to avoid making an opening into any part of the colon, and that in cases 
of stricture it might be avoided. The failure in the use of the instruments 
in cases of spasmodic stricture, he attributes to want of sufficient boldness 580 
STRICTURE. 
in their use, and mentions a few facts to embolden practitioners, and to 
show the impunity with which the most obstinate constriction of the bowel 
in question might be overcome. 
The facts were as follows : Of all the diseases in which constipation is most 
obstinate, tetanus is certainly the one. In some cases of this disease which 
had terminated fatally, he succeeded in passing the instrument to a consi- 
derable height, but only by means of long-continued, gradually increasing, 
and determined pressure against the point of resistance; when first he 
used this force, he remembered the instrument passed rapidly upward, as 
if through a narrow ring, giving to his hand a sensation as if he had per- 
forated the walls of the intestine; accordingly he withdrew the tube, and 
was much pleased to see its extremity coated with fasces, and bearing no 
marks of blood. This circumstance had occurred to him not once, but 
twenty times in the treatment of those fatal cases to which he alluded. In 
those cases it was found, after death, that the whole of the colon was so 
enormously distended as to conceal the other intestines, and to equal in 
size the thighs of a very large man, while the uppermost part of the rectum 
was contracted to the diameter of the barrel of a quill, but felt much 
firmer. On cutting into the intestine at this point, neither the serous nor 
the mucous coat was found in the least thickened, neither did the muscular 
coat exhibit any signs of thickening other than that caused by the power- 
ful contraction of its fibres upon themselves. It was quite evident in these 
cases that even this firm structure was forced at each introduction of the 
instrument, so as to enable the bowels to be freed. Why, then, should 
we be deterred from employing a sutficient degree of force in another case 
when the degree of resistance is infinitely less ? When the difficulty of 
introducing the tube is great, the application of a blister over the sacrum, 
extending up a little on the spinous processes of the lumbar vertebrae, 
would be found a considerable assistance; and in order to effect this 
rapidly, if the case be very urgent, a sponge should be impacted into a 
tumbler, boiling water poured upon this, throwing it off repeatedly in 
order to produce the necessary degree of heat, and then the tumbler could 
be inverted over the part to be blistered. Having thus disposed of spas- 
modic stricture, he would now say that, in cases of the organic kind, every 
success might be obtained by the same means, with this difference— 
namely, the use of small tubes gradually increased in size. With respect 
to malignant stricture of the rectum, he was of opinion that this might be 
a legitimate case for the lumbar operation. 
[Dr. Williams says that the great difficulty in the formation of an artifi- 
cial anus in the lumbar colon consists in the difficulty of distinguishing the 
colon from the small intestine; for the signs mentioned by M. Amussat, 
whether taken separately or collectively, are not diagnostic, consequently 
there is always a risk of opening the peritoneum, and thus sacrificing the 
entire principle and chief advantage of the operation. M. Amussat has, 
however, discovered a sign which bids fair to do much toward removing 
the difficulty in question]. 
The sign rested on the fact that the small intestines sustained a motion 
of alternate ascent and descent corresponding to expiration and inspira- 
tion, in which the lumbar colon did not participate; if, therefore, the 
exposed intestine presented this oscillation, it was small intestine—if it did 
not, it might be presumed to be the colon. As M. Amussat made no 
mention whatever of this distinctive sign in any of his publications on the 581 
subject, it was very satisfactory that it had now been made known and 
recorded. Part xi., p. 110. 
Stricture of the Ilectum and (Esophagus.—If nonmialignant, these may 
be treated effectually with instruments, invented by Mr. Wakley; consist- 
ing of a flexible guide and four dilating tubes about ten inches in length 
for the rectum, and twenty for the oesophagus; the guide being also longer 
for the latter tube. The guide is first introduced, and over this, the direc- 
tors, which fit accurately, and must be used of progressively larger size. 
Mr. Wakley also xises instruments for the dilatation of the os uteri, con- 
structed on similar principles, but the dilators are shorter, and have an 
inverted cup-shaped rim to fit the os uteri. Part xxxv.,p. 130. 
Dilatation of the Urethra in Stricture.—Dr. Arnott makes use of “ a tube 
of oiled silk lined with the thin gut of some small animal, as the cat, to 
make it air-tight, and attached to the extremity of a small canula, by 
which it is distended with the air or water from a bag or syringe at the 
outer end with a stopcock or valve to keep the air in when received.” 
The canula may be of elastic gum, or of the flexible metal used to make 
the metallic bougies, or of silver. The instrument is easily passed, and as 
soon as the bag is sufficiently within the stricture as much air is to be injected 
as the patient can easily bear. Part iii., p. 94. 
Aphorisms of Practical Surgery.—Few diseases are more difficult to 
cure radically than a very tight (tres grand) stricture of the urethra. 
For, after the canal has been widened by the prolonged use of bougies, 
there is always a great tendency to a relapse of the disease. It is then 
that cauterization becomes useful, because we thus obtain a cicatrix molded 
upon the bougie. 
There are cases of stricture, etc., in which the keeping of an instrument 
in the urethra, instead of being a means of cure, becomes actually an ob- 
stacle to it: Dupuytren used to cite several instances of urinary fxstulae 
cured by the mere withdrawal of the sound. Part iii., p. 115. 
Use of Alum in the Treatment of Stricture of the Urethra.—M. Jobert 
regards alum as possessing many advantages in the treatment of this dis- 
ease. He uses it as follows: 
A bougie is selected, the finer at the extremity the narrower the stric- 
ture. By placing its extremity for a moment in a candle, it is so far soft- 
ened, that on immersing the instrument in pulverized alum, it adheres to 
the entire heated surface ; the point is then rounded off between the fingers, 
so as to communicate to it a suitable shape. The bougie, when thus armed, 
is passed into the stricture and left there for twenty minutes or an hour, 
according to the period of the treatment, the sensibility of the patient, etc. 
After a few minutes a slight smarting is felt, but no other apparent effect 
is perceived. On withdrawing the bougie, a few drops of whitish mucus 
escape, which M. Jobert considers as tending to liberate the canal of the 
urethra. Not unfrequently, on the day following the application, bougies 
of a considerable size can be passed into the bladder. 
M. Jobert also uses large bougies armed with alum, in the treatment of 
stricture of the urethra. Part v., p. 145. 
Stricture of the Male Urethra—Urinary Abscess.—SirB. Brodie thus 
describes the ordinary course of the affection. The patient, he says, com- 
plains of more than usual difficulty in voiding his urine; but the difficulty 
STRICTURE. 582 
STRICTURE, 
does not amount, at least it tlie first instance, to an absolute retention. 
Perhaps he has a shivering. There is a sense of fullness in the perineum, 
and some degree of deep-seated induration is perceptible in one part. This 
gradually increases, and a tumor presents itself under the skin of the peri- 
neum, surrounded with more or less of cedematous effusion, especially into 
the scrotum. The skin becomes inflamed, and the fluctuation of fluid is 
perceptible underneath. An abscess bursts or is opened with a lancet, and 
a considerable quantity of putrid pus is discharged. Here the oedema of 
the neighboring part subsides. Pus continues to flow through the orifice 
of the abscess, and after some time it is observed that urine flows through 
it also. The discharge of pus diminishes, but the urine flows in larger 
quantity; and whenever the patient makes water, part escapes through the 
natural channel and part by the new opening. The abscess has evidently 
a communication with the urethra, behind the stricture. If you have an 
opportunity of dissecting the diseased parts while the abscess is recent, you 
find it to open into the urethra by a ragged, irregular orifice. If you ex- 
amine them at a later period, the orifice in the urethra is found to be 
smooth, regular, and rounded at the margin; the external orifice in the 
perineum is reduced to a narrow diameter, and is seen in the centre of a 
button-like projection of the skin ; and the abscess itself is contracted, per- 
haps reduced to a narrow passage, with a smooth surface, which presents 
somewhat of the appearance of its being lined by a mucous membrane. We 
now say that the case is one of fistula in perinceo. The whole of these 
phenomena are easily explained. The urethra, constantly teased by the 
pressure of the urine against it, ulcerates behind the stricture. If the stric- 
ture had been completely closed, as in the case of retention of urine, an 
extensive extravasation of urine would have immediately taken place ; but 
under the existing circumstances, this does not happen, and only a mode- 
rate quantity, perhaps not more than a few drops, dribbles into the cellular 
membrane, sufficient to induce inflammation and suppuration and no fur- 
ther local mischief. A fistula in ano is formed in the same manner, by ul- 
ceration of the rectum allowing the escape of a minute quantity of feculent 
matter into the neighboring textures. 
Sir Benjamin goes on to remark, that sometimes the abscess of the peri- 
neum is accompanied by typhoid symptoms. If the abscess is opened, the 
matter that issues is putrid and urinous—if the opening is deferred the 
patient may die. 
“ I have described,” continues our author, “ the simplest form of the uri- 
nary abscess. But it is often more complicated. It is not always confined 
to the perineum; sometimes it makes its way forward through the upper 
part of the scrotum, and presents itself on the lower part of the penis, be- 
tween the scrotum and the glans. At other times it burrows in the opposite 
direction, forming a large collection of matter in the nates, or it may burst 
in the groin, or in the scrotum. In one case, in which I had an opportu- 
nity of examining the body after death, I found a large abscess in front of 
the pubes, extending half-way toward the navel; another among the adduc- 
tor muscles of the left thigh ; and a third among the muscles at the upper 
part of the right thigh, as far outward as the foramen ovale of the ischium; 
the periosteum having been destroyed, and the bone itself rendered carious 
to a considerable extent: and all these abscesses could be traced into an 
abscess in the perineum, communicating with the urethra behind a stricture 
by a small orifice. In another case which I attended with Mr. Samuel STRICTURE. 
583 
Cooper, there was a, fistula in perinceo, communicating with a large abscess 
of the pelvis on one side of the bladder. 
“ I have seen a few cases in which an abscess of this kind had made its way 
into the rectum, forming a fistulous communication between it and the 
urethra. If such communication be of a large size it is a source of great 
distress, as feculent matter occasionally passes through it from the rectum 
into the urethra. If it be small, hoAvever, the absolute inconvenience is but 
trilling, and the patient is rendered sensible of its existence only in conse- 
quence of a small quantity of air escaping occasionally by the urethra; and 
this may continue, without any further symptoms supervening, for many 
years.” 
Bougie.—“The best kind of bougie,” he observes, “is that in common 
use, made of plaster spread on linen, and rolled up. It should be smooth 
on the surface and neatly rounded at the extremity. The plaster bougie 
should be rubbed until it becomes warm, so that it may be molded by the 
hand, and bent into the form of the urethra. Thus bent, it is much to be 
preferred to the elastic bougie, which is made of elastic gum on the outside 
and of catgut within. The latter may, it is true, be bent into any form; 
but it is elastic, and however you may bend it, it always regains its straight 
figure ; and hence it is not well constructed for being passed along the 
curved canal of the urethra. The bougie which is used for the purpose 
of examining the urethra should be of full size, that is, large enough to fill 
the urethra without stretching it. A small bougie may deceive you in two 
Avays : it may pass through a stricture, and thus lead you to believe that 
there is no stricture, Avhen there really is one; or it may have its point en- 
tangled in the orifice of one of the mucous follicles of the urethra, or in 
some accidental irregularity of the canal, and lead you into the opposite 
mistake of supposing that there is a stricture where none exists. If you 
use a bougie of the size of the urethra, you are not at all liable to the first 
error, and you are much less liable to the second than you would be other- 
wise. The bougie should be cylindrical. There is no advantage in any 
bougie, except a \rery small one, being conical. A conical bougie, 
becoming larger toward the point which is held in the hand, is likely to 
extend forcibly the orifice of the urethra, and to excite inflammation in it.” 
Retention from Spasmodic Stricture.—Sir Benjamin recommends the 
immediate and direct recourse to mechanical means. 
“ Begin,” he says, “ by taking one of the smallest gum catheters, which 
has been kept for a considerable time on a curA'ed iron wire, and which re- 
tains the curved form after the Avire is withdraAvn. Introduce it without 
the wire; and as it approaches the stricture, turn the concavity of the ca- 
theter tOAvard the pubes, elongating the penis at the same time by drawing 
it out as much as possible. It is not very improbable that it Avill pass 
through the stricture, and enter the bladder. The urine will then flow 
through it in a fine stream, and the patient will obtain immediate and com- 
plete relief. 
“ If you fail Avith the small gum catheter, try, not a plaster, but a small 
catgut bougie. Let this be well made; that is firmly twisted, nicely 
rounded at the extremity, and everyAvhere well polished. Observe the 
same rule of elongating the urethra, and it Avill probably enter the stricture. 
It is not necessary that the catgut bougie should pass on to the bladder ; it 
is sufficient if the stricture grasps or holds it. Let it remain in the stric- 
ture until there is a violent impulse to make water. Then withdraw the 584 
STRICTURE. 
bougie, and the urine will follow it in a small stream. If the patient empties 
the bladder, the object is attained; but, otherwise, re-introduce the catgut 
bougie, or rather introduce another of the same size (for a catgut bougie 
which has been once used is not fit to be employed a second time) ; and 
let the patient retain this second bougie as long as he can. If the straight 
catgut bougie cannot be passed, you will often succeed in effecting its in- 
troduction by bending the point of it. This contrivance enables you to 
keep the point sliding against the upper surface of the urethra, avoiding 
the lower part, in which the obstruction is always most perceptible, and 
in which the bougie is most likely to become, as it were, entangled. 
“ Even where you have failed to relieve the patient by means of the catgut 
bougie, you will often succeed in introducing a silver catheter, or an elas- 
tic gum catheter mounted on a firm iron stilet, into the bladder. The ca- 
theter employed on this occasion, if the stricture be of recent formation, 
should be nearly of the full size of the urethra; but if the stricture has been 
of long duration, it should be considerably smaller. The common silver 
catheter is not so well adapted for the purpose as that which I now show 
you. You will observe that it is shorter and less curved than usual, and 
that it is fixed in a wooden handle, which renders the instrument more 
manageable than it would be otherwise. If you use an elastic gum cathe- 
ter, the iron stilet should have a flattened handle, resembling that of a com- 
mon sound. You should pass it as far as the obstruction, and having as- 
certained where it is situated, withdraw the catheter a little, a quarter of 
an inch for example, and then, as you pass it on again toward the bladder, 
keep the point sliding against the upper part of the urethra, which is toward 
the pubes, avoiding the lower part, which is, of course, toward the peri- 
neum. Be careful to employ no violence. If you lacerate the urethra, so 
as to cause hemorrhage, you will be defeated in your object. Press the 
catheter firmly, but gently and steadily, against the stricture, keeping in 
your mind the anatomical position of the parts, and being careful to give 
the point of the instrument aright direction. When the pressure has been 
thus carefully continued for some time, the stricture will begin to relax. 
It will allow the point of the catheter to enter, and, at last, to pass com- 
pletely through it into the bladder. In some instances this will be accom- 
plished in the space of one or two minutes; while in others it may be ne- 
cessary to persevere for a quarter of an hour. As soon as the catheter has 
reached the bladder, the patient’s sufferings are at an end, as the bladder 
becomes completely emptied. If you have used the elastic gum catheter, 
it may be prudent to allow it to remain in the urethra and bladder for one 
or two days, or even for a longer period; and this will go far toward ac- 
complishing the cure of the stricture.” 
Use of Opium.—“ The remedy on which you are most to rely, where 
these mechanical means fail, is opium. From half a drachm to a drachm 
of laudanum may be given as a clyster in two or three ounces of thin 
starch. If this should not succeed, give opium by the mouth, and repeat 
the dose, if necessary, every hour until the patient can make water. 
According to my experience, the cases in which the stricture does not 
become relaxed under the use of opium, if administered freely, are very 
rare. The first effect of the opium, is to diminish the distress which the 
patient experiences from the distention of the bladder. Then the impulse 
to make water becomes less urgent; the paroxysms of straining are less 
severe and less frequent; and after the patient has been in this state of 585 
STRICTURE. 
comparative ease for a short time, he begins to void his urine, at first in 
small, but afterward in larger quantities.” 
Warm Bath.—“ It is customary in these cases to employ the warm bath. 
It is, indeed, sometimes useful, but you can place no dependence on it as 
compared with opium. It is not sufficient that your patient should sit in a 
hip-bath: the bath, to be at all efficient, must be complete; his whole 
person ought, therefore, to be immersed, and he should remain in it for 
half an hour, or an hour, or Jonger, unless he previously becomes faint. 
Bleeding from the arm is seldom required in cases of retention of urine 
from stricture ; but in sorry? instances, even where other means have failed, 
taking blood from the perineum by cupping gives immediate relief.” 
Purgatives, when induced by Spirituous Liquors.—“ Purgatives require 
some time to produce their effect, and in most cases, at the period of your 
being called in, the symptoms are too urgent to admit of this delay. 
Where, however, a stricture is chiefly spasmodic, and the retention follows 
the too great use of fermented liquor or spirits, I would advise you, if you 
are sent for on the commencement of the attack, to prescribe a draught of 
infusion of senna with the tartrate of potass and tincture of jalap. As 
soon as this has fully operated, and the bowels are emptied, give thirty or 
forty drops of tincture of opium by the mouth, or order an opiate clyster 
to be administered, and, in all probability, the attack will subside.” 
“ After all, there is no absolute rule as to the treatment of retention of 
urine from stricture. One person is relieved in one way, another in another; 
and you will do well in each case to bear in mind the particular mode of 
treatment which has proved of service, in order that you may at once 
resort to it, if you are called a second time to the same patient, under the 
same circumstances. In one instance, you will be able to pass a catgut 
bougie, and not a catheter; in another you will be able to pass a catheter, 
and not a catgut bougie. One individual is relieved by opium, another by 
the warm bath. A gentleman of my acquaintance, who was subject to 
attacks of this description for a considerable time, almost always began to 
make water after a pint of warm water had been thrown up as a clyster.” 
Sir B. Brodie relates a case of old stricture of the urethra, in which the 
attack of retention of urine came on periodically, and was cured like other 
intermittent diseases, by prescribing sulphate of quinine. 
When an operation becomes indispensable, which Sir Benjamin thinks it 
must rarely be, he is of opinion that puncturing the bladder from the 
rectum is applicable to the greatest number of cases. But those who 
operate frequently must often operate unnecessarily. 
Stricture in the Anterior Part of the Urethra.—Sir Benjamin observes 
that a stricture at the orifice of the urethra may be dilated by means of a 
common bougie, or a short metallic instrument; the size of the bougie 
being gradually increased, and t lie introduction being repeated daily or on 
alternate days, according to circumstances. The process of dilatation 
is, however, in many instances, attended with much inconvenience to the 
patient. In those cases, especially, in which the contraction began in 
early life, every introduction of the bougie causes considerable pain; at 
the same time that the disposition to contract is so great that the opera- 
tion requires to be repeated almost daily. The consequence is that the 
part is kept in a constant state of inflammation, and, between the disease 
and the remedy, is a source of incessant annoyance to the patient. In a 
case of this sort, which was extremely troublesome, Sir Benjamin deter- 586 
STRICTURE, 
mined at once to divide the contracted part of the urethra. This was 
easily accomplished by means of a pair of knife-edged scissors, one blade 
with a blunt point being introduced into the urethra, and the division 
being made in the situation of the fraenum. No hemorrhage followed the 
operation. A piece of lint was kept between the cut surfaces to prevent 
their reunion, and in about ten days they were cicatrized, being covered 
by what had already assumed a good deal of the appearance of a mucous 
membrane. 
Strictures in the anterior part of the urethra, but behind the orifice, 
require to be mechanically dilated, by the introduction of bougies or 
metallic instruments. Sometimes the patient 'obtains relief on very easy 
terms, the dilatation being readily accomplished, and the use of the bougie 
once in three or four days being sufficient to prevent a recurrence of the 
contraction. At other times, however, the disposition to contract is so 
great, that it becomes necessary to introduce the bougie once or twice 
daily; and, indeed, Sir Benjamin has known cases in which the patient 
was seldom able to expel his urine until the bougie had been em- 
ployed. 
Caustic Bougie.—Sir Benjamin conceives that the caustic bougie is 
applicable to the following cases: 1st. Those of spasmodic stricture, where 
two or three applications of the caustic may be sufficient to relieve all the 
urgent symptoms. 2dly. Some cases of old stricture, in which there is 
still a considerable disposition to spasm. In these last cases apply the 
caustic two or three times, and no oftener. It will probably relieve the 
contraction as far as it is spasmodic, and thus enable you to proceed more 
advantageously, with the use of the bougie or metallic sound. 3rdly. The 
caustic may be used very properly in some cases of stricture which are 
endowed with peculiar irritability, in which every application of the com- 
mon bougie induces severe pain, or brings on spasm, preventing it entering 
the stricture. Two or three applications of the caustic may be sufficient 
to deprive the stricture of that unnatural sensibility which otherwise would 
have foiled your efforts to effect a cure. Yet our author seldom employs 
caustic for these reasons: 1st. Although the caustic often relieves spasm, 
it also very often induces it. It is true, that in many instances it enables 
a patient to make water with more facility; but in many instances also, it 
brings on retention of urine. 2dly. Hemorrhage is a more frequent cqpse- 
quence of the use of the caustic than of the common bougie, and it some- 
times takes place to a very great and to an almost dangerous extent. 
3dly. Where there is a disposition to rigors, the application of caustic is 
almost certain to produce them; and frequently the application of caustic 
induces rigors where there had been no manifest disposition to them pre- 
viously. 4thly. Unless used with caution, the application of caustic may 
induce inflammation of the parts situated behind the stricture, terminating 
in the formation of abscess. Part vi., p. 92. 
Stafford's Treatment of Stricture—The Lanceted Stilette.—Mr. W. 
Coulson arranges those cases of stricture in which the ordinary plans of 
treatment fail to relieve or cure under three or more classes : the first, 
in which there is simple stricture of the urethra, so complete, however, 
as sometimes to cause retention of urine ; the second, in which two, three, 
or more inches of the urethra, are thickened and contracted, and often 
complicated with fistulous openings in the perineum; the third, in which one or more bad strictures exist in an extremely irritable urethra, which 
is frequently combined with an irritable state of the whole system. 
Three cases are produced to elucidate the above varieties, and to show 
that, after every other method had failed, Mr. Stafford’s mode of dividing 
the part with his instrument was successful. After which Mr. Coulson 
goes on to say: 
My object in publishing these cases is to assist in removing the feeling 
which too generally prevails against Mr. Stafford’s treatment in cases of 
impermeable stricture : for nearly all who have written on the complaint 
more or less condemn the use of his instrument. In alluding to it, Sir 
Benjamin Brodie says : “ Mr. Stafford has invented an ingenious machine, 
which is intended to divide a stricture by means of a cutting instrument. 
If any cases occur in which this method may be useful, they are undoubtedly 
very few in number; and great caution must be required to avoid making 
false passages, which might be followed by effusion of urine and purulent 
deposits.” These were the fears which unfortunately influenced me in 
rejecting for years this most valuable instrument. I say unfortunately, 
for I now recall to my recollection numerous cases in which I failed to 
afford relief for want of this or a similar instrument. I believe that there 
is much less danger of making a false passage with the lanceted stilette, 
carefully directed against an impermeable stricture, than in the use of the 
common catheter or sound. As to the effusion of urine and purulent 
deposits, how rarely do they occur, in cases where great violence has 
been used, and lesion of structure has taken place in the attempts to 
introduce instruments into the bladder. In the use of Mr. Stafford’s 
instrument, admitting that the division is not made in the direction of the 
canal, it is certain to be made anterior to the obstruction, and consequently 
not likely to be attended with infiltration of urine. In lieu of Mr. Staf- 
ford’s operation, Sir. Benjamin Brodie proposes the following modification, 
which he adopted in the patient, viz.: “I then make an incision in the 
perineum, dilating the fistulous sinus, and laying open the membranous 
part of the urethra as far forward as the stricture, the exact situation of 
which was marked by the bougie. The bougie was then withdrawn ; an 
instrument was then introduced in its place, consisting of a straight silver 
tube, closed at its extremity, except a narrow slit, through which a small 
lancet could be made to project, by pressing on a stilt which projected on 
the handle of the instrument; the round extremity of the tube being pressed 
against the anterior part of the left hand, introduced through the wound 
in the perineum and urethra to its posterior surface. The pressure of the 
instrument being distinctly communicated to the finger through the sub- 
stance of the stricture, the lancet was protruded, and the stricture was 
divided. A silver catheter was then easily introduced through the urethra 
and divided stricture into the bladder, and allowed to remain there. The 
urine, of course, flowed through the catheter. At the end of two days 
the silver catheter was removed, and replaced by one of elastic gum. 
The wound in the perineum gradually healed, and the patient ultimately 
recovered, making water in a full stream, and being able to introduce 
a sound of a full size into the bladder, so as to prevent a recurrence of 
the contraction.” 
Now the following is Mr. Stafford’s plan. The single lanceted stilette, 
or urethral perforator, is passed down to the stricture, the exact distance 
of which from the extremity of the urethra is first ascertained. When 
STRICTFJRE. 
587 588 
STRICTURE. 
the point of the instrument is arrived at, and rests upon the contraction 
(which is known by means of its graduation), and is in an exact line with 
the natural course of the canal, the instrument is held and maintained in 
that position by the left hand, the fore-finger of which being passed through 
the ring on the under part of its handle, the thumb of the right hand is 
passed through the ring on the handle of the stilette. The stilette is then 
pressed gently and gradually forward, when the lancet is protruded out 
at its point, and is thus made to incise the stricture. The lancet must be 
immediately drawn back, or allowed to retire into the sheath, by the 
action of the spring. 
In the operation which is proposed by Sir Benjamin Brodie, as a modifi- 
cation of Mr. Stafford’s, and as a substitute for it, an external wound is 
made in the perineum for the purpose of preventing infiltration of urine, 
and next for the purpose of guiding the lancet. 
I have already alluded to the little chance of infiltration of urine, and 
I know of no case in which it has occurred. As to guiding the lancet, I 
really think the instrument may be as safely guided when passed down 
the urethra, and held properly against the stricture, as by the finger 
introduced through the wound in the perinseum. The principle of the 
operation is Mr. Stafford’s ; the modification is the opening in the perineum, 
which complicates the operation, inflicts additional pain, and prevents the 
patient, for a time at least, from following his usual avocations. 
I am not wishing to urge this plan of treatment in cases where there is 
any passage, however small, through the stricture; but in every case 
where the contraction is so great as not to admit of the introduction of 
an instrument, Mr. Stafford’s plan, in my opinion, offers a safe, speedy, and 
effectual mode of cure. Part vi., p. 115. 
Stricture of the Urethra.— Dr. Leroy d’Etiolles, advises when the 
stricture produces complete retention of urine, to endeavor to pass bougies 
in conjunction with bleeding, baths, etc.; try the application of tobacco 
smoke; should these fail, press a small catheter against the obstacle for an 
hour. Cut down upon the urethra posterior to the obstacle, but should a 
calculus be there detained, cut through the rectum. If necessary to 
puncture the bladder, do it through the rectum. M. Lallemand cuts down 
on the strictured part itself. Part xiii., p. 286. 
Opium in Stricture of the Urethra.—There is a case related in the 
reports of the Ipswich Medical Society, of an old man with obstinate 
stricture, and who had passed no urine from the Saturday to the Tuesday, 
when it was determined to puncture the bladder. But having taken two 
grains of opium, and repeated the dose in an hour, the spasms relaxed and 
the operation was not required. Part xv., p. 229. 
Instrument for Dividing Strictures.— M. Civiale has invented a new 
instrument for the division of indurated strictures of the urethra. The 
principle of the improvement consists in the division of the strictures from 
behind forward, instead of cutting in the reverse directions, as hitherto 
practised by surgeons. The new instrument, according to M. Civiale, 
has the advantage over the old method in the fact, that the extent of 
the incision can be precisely ascertained, and controlled by the operator, 
and a division of all the tissues can be performed with safety. 
Part xix., p. 184 589 
STRICTURE, 
Stricture of the Urethra.—There is a form of stricture, marked by the 
“ tightness of the contraction, the resilient disposition displayed after 
dilatation, and the great degree of irritation induced by attempts to effect 
this,” in wdiioh Mr. Syme has advised the free division of the contracted 
part upon the director. 
The best plan is to introduce a grooved director into the tight portion, 
to cut down upon it, and freely divide the stricture, and introduce a 
catheter into the urethra. This plan must not be confounded with that of 
introducing a catheter as far as the stricture, cutting down upon its point, 
and then with the knife cutting a way for the catheter to the bladder. 
Part xix., p. 187. 
JB. Cooper’s Treatment of.—[Mr. Cooper would substitute the name of 
“ irritable ” for that of “ spasmodic,” as applied to stricture, since the 
latter term involves the idea of the disease being caused by muscular 
action : while this is not really the case, except in the membraneous and 
bulbous portions of the urethra.] 
Irritable or Spasmodic.—Give a dose of opium with tartarized antimony, 
a hot bath, and warm purgative enema. These measures should always 
precede the employment of the catheter, and will generally be found 
sufficient to afford relief without resorting to its use. In obstinate cases 
of mixed stricture, cup in the perineum, give two grains of calomel and a 
grain of opium at night, and, during the day, small doses of the tincture 
of muriate of iron. At the same time employ the bougie very gently. If 
it produces pain and bleeding, apply caustic to the stricture to diminish its 
irritability and introduce into the rectum, at bedtime, a suppository con- 
taining a grain and a half of opium, and five grains of extract of henbane, 
mixed with soap. 
Permanent.—In the first place, explore the urethra. Making the patient 
lie down on a sofa, introduce a bougie or silver catheter (No. 6), and press 
it gently, for a minute or more, against the stricture. If it should pass 
the stricture, do not seek to introduce it further. After the use of the 
bougie, let the patient keep quiet and on low diet for the rest of the day, 
and take a draught containing liq. potass., gtts. xx.; tinct. opii, gtts. x.; 
mist, camph. giss., at bedtime, and an aperient in the morning. In about 
forty-eight hours, introduce the bougie again, and this time it may be 
passed into the bladder, and allowed to remain for ten minutes or a 
quarter of an hour. If No. 6 cannot be introduced, carefully try a smaller 
one. If no instrument can be passed, be guided as to the treatment, by 
the urgency of the symptoms. When there is retention of urine, and the 
pain complained of is very severe, put the patient in a hot bath, give a 
grain and a half or two grains of opium, and a purgative enema; and 
when the bowels are opened, introduce into the rectum a suppository, con- 
taining opium, and a quarter of a grain of belladonna. These means will 
generally relieve the urgent symptoms. Then proceed with the treat- 
ment, introducing a bougie gently every other day; and while this is 
being done, insist on the patient living very carefully, and give such 
medicines as blue pill with tartarized antimony, followed by aperients. If 
the stricture becomes irritable, give sedatives, and apply the caustic 
bougie carefully. If the attempts at dilatation by the bougie fail, try the 
repeated injections of tepid water into the urethra. If by all these means 
relief is not obtained, and the patient is suffering from retention, or is 590 
STRICTURE. 
threatened with ulceration of the urethra behind the stricture, the bladder 
must be punctured. Under very urgent circumstances we may puncture 
by the rectum (provided that the prostate is not enlarged) ; but as a 
general rule it is much better to cut down upon the urethra, and divide the 
stricture in the perineum. 
The operation of dividing the stricture in perineo is performed with the 
patient in the same position as in lithotomy : an instrument is passed 
down to the stricture, the grooved staff being perhaps the most appropriate 
to the purpose. An incision is next made in the perineum, commencing 
at the point where the end of the instrument can be felt resting on the 
stricture ; the groove is then to be cut into, and the knife carried down- 
ward with great caution, cutting the way for the point of the staff, which 
should be made to follow it as it gradually divides the stricture, and the 
staff, being pushed on, passes into the bladder. The staff should then be 
withdrawn, and an elastic gum catheter put in its place, and retained there 
for several days. 
In cases of fistulous opening in the perineum being concomitant with the 
stricture, Mr. Cooper adopts another plan for performing this operation. 
He says : 
Having made the incision into the perineum, instead of opening the 
urethra at the groove of the staff as before described, I have first opened 
the membranous parts of the urethra behind the stricture, and then passed 
a female catheter into the bladder, and drawn off the urine ; thus relieving 
the patient of the retention, but having still to divide the stricture ; this 
Is effected by feeling within the wound for the point of the grooved staff 
above the stricture; and, proceeding to cut through the obstruction, 
carrying forward the staff as before described (first, however, having 
withdrawn the female catheter), the staff enters the bladder through the 
opening originally made for that instrument. The staff should then bo 
withdrawn, and an elastic gum catheter inserted in its stead; this should be 
left in for a week, when it must be removed, and substituted by a new one. 
At first, some urine will escape by the wound through the perineum, as in the 
operation for lithotomy; but generally in the course of a week or ten days 
it passes entirely through the catheter. About a fortnight after it has 
entirely ceased to flow from the perineum, the catheter should be removed, 
but still for some time the patient should regularly have the water drawn 
off, and this, if performed with gentleness, produces much less irritation than 
would be excited by the constant presence of an instrument in the bladder. 
When a permanent stricture occurs in the urethra anterior to the bulb, 
and especially in that part of the canal covered by scrotum, it is not 
advisable to cut down upon the stricture from without, owing to the 
liability to infiltration of urine if the incision be made through the scrotum, 
and of the difficulty of healing the wound when the opening is made 
anterior to it. The cure of such stricture must, therefore, be assiduously 
attempted by the use of bougies or caustic, or should they resist this 
treatment, perhaps the instrument, furnished with a cutting stilette, 
employed by M. Stafford, may be used; as this part of the urethra may be 
rendered straight, the instrument may be directed with much more certainty 
than when the stricture is seated in the curved portion of the canal. I 
should myself, however, prefer opening the urethra behind the stricture, if 
retention demand it, rather than to puncture the stricture itself. 
Part xix., p. 189 STRICTURE. 
591 
Use of the Bougie in Stricture.—Mr. Solly, of St. Thomas’ Hospital, 
says: 
When the catgut bougie is used, the great secret is to handle it with 
the utmost delicacy, and twirl it gently between the thumb and finger 
when it meets with obstruction. When it is introduced it should be 
allowed to remain for an hour. Part xix., p. 194. 
Case of Stricture attended by Profuse Discharge.—[In this case there 
was such profuse discharge, that gonorrhoea was suspected. The patient 
had previously had stricture, and as he completely negatived the idea that 
it was gonorrhoea, Mr. Smith suspected that he might have stricture 
remaining. He says:] 
I requested permission to examine the urethra, and, on doing so, I dis- 
covered two irritable strictures. I told him that this was the cause of the 
discharge persisting, and that it was necessary for him to come to London 
every week to have the bougie passed. I, at the same time, desired him 
to refrain as much as possible from sexual connection, and from all other 
species of excitement. 
I need not enumerate the pai'ticulars of this case, which was trouble- 
some to treat—for the urethra was so excessively irritable that about three 
weeks after this, I could only introduce, with some trouble, a No. 4 bougie. 
In a short time, however, a good-sized instrument could be introduced, the 
discharge diminished, and, at the end of two months, I passed No. 12 
bougie ; all discharge had ceased. He had latterly used a weak solution 
of acetate of zinc, in order to diminish the irritability of the urethra, and 
hasten the cure. I advised him to return to me in another month, in order 
that I might ascertain if the cure was satisfactory. He visited me last 
week. The urethra admitted No. 12 bougie, and the discharge had never 
returned. Part xx., p. 159. 
Strictures—Mr. Guthrie's Conclusions Respecting.—1. That a hard and 
elastic, or an intractable stricture is never permanently cured by dilatation, 
or by the application of caustic, although it may be materially relieved by 
the regular periodical use of a dilating instrument. 
2. That the division of an old, hardened, or elastic stricture through the 
perineum is not usually followed by a permanent cure, although it is always 
attended by immediate relief. The disease being apt to return unless a 
solid sound or catheter is occasionally passed to prevent it. 
3. That the operation of dividing the perineum and urethra in such 
cases is sometimes attended by severe hemorrhages, by fever, and is 
occasionally followed by fistulous openings, giving rise to much incon- 
venience. 
4. That such division does, in some instances, effect a permanent cure. 
5. That the division of the urethra through the external parts should 
never be attempted in any portion of it anterior to the bulb, such opera- 
tion not being necessary; for the narrowest stricture of the pendulous or 
movable part may always be divided internally with much less comparative 
danger than by the external incision, inasmuch as the instrument can be 
guided through this part by the finger and thumb of the left hand of the 
surgeon with a certainty almost unerring. 
6. That the stricture considered by all surgeons as the most important 
and difficult of cure—viz., at the termination of the bulbous portion of the 
urethra—may always be divided, when impassable, by a straight instru- 592 
STRICTURE, 
ment, and in general more easily than "by a curved one; the use of which 
is founded on the erroneous belief that the stricture is situated in the 
membranous part of the urethra, instead of being, as it is, anterior to it. 
7. That the division of a stricture should, if possible, be effected by an 
instrument passed through it, and cutting from behind forward, rather 
than from before backward, although a combination of both methods will 
frequently be necessary to insure success. 
8. That the division of a stricture by these means will not always insure 
a permanent cure if more than the mucous membrane is implicated, unless 
such parts be divided also. 
9. That in cases of intractable stricture, the mucous membrane, the inner 
layer of involuntary muscle, and the elastic tissue external to it, should be 
divided when the operation is done from within, but not the outer layer 
of muscular fibres, which should remain as a barrier between the stream 
of urine and the common integuments of the external parts—an accuracy 
of division not always to be attained; whence, perhaps, the difficulty of 
effecting a permanent cure. 
10. That when a permanent cure is effected in these cases, the divided 
elastic wall of the urethra is not re-united by a structure exactly similar to 
itself, but by common areolar tissue, rendering the part more dilatable 
under the pressure of the stream of urine; the formation of which dilata- 
tion can be aided during the progress of the cure by pressing on the 
divided part with the point of a solid instrument passed daily for the pur- 
pose of preventing, if possible, that contraction which always takes place 
during the process of cicatrization ; a proceeding which cannot be advan- 
tageously adopted when the parts are divided through the perineum, lest 
it should encourage the formation of a fistulous opening, to which there is 
always a tendency. 
11. That in cases of intractable stricture accompanied by one or more 
fistulous openings in the perineum, in young persons, or of middle age, 
the operation through the external parts, or along the urethra, may 
be resorted to at the pleasure of the surgeon with an equal chance of 
success, provided the portion of the obstruction or bank preventing the 
free passage of the urine be effectually divided, the sine qua non of the 
operation. 
12. That the operation within the urethra should always be preferred in 
elderly persons, particularly if somewhat stout or fat, as less likely to 
create severe constitutional disturbance, and if this operation should fail 
from any cause, it by no means interferes with the due performance of 
the other through the perineum, which in serious cases then becomes 
imperative, as the last resource capable of giving relief. 
Part xxiv., p. 227. 
Prof. Byrne's Operation for Urethral Stricture.—The patient having 
been placed under the influence of chloroform, is “ brought to the edge of 
his bed, and his limbs are supported by two assistants, one on each side. 
A grooved director, slightly curved, and small enough to pass readily 
through the stricture, is next introduced, and confided to one of the as- 
sistants. The surgeon sitting, or kneeling on one knee, now makes an 
incision in the middle line of the perineum or penis, wherever the stricture 
is seated. It should be an inch or an inch and a half in length, and extend 
through the integuments, together with the subjacent textures exterior to STRICTURE. 
593 
the urethra. The operator then taking the handle of the director in his 
left hand, and a small straight bistoury in his right, feels, with his fore- 
finger guarding the blade, for the director, and pushes the point into the 
groove behind, or on the bladder side of the stricture, runs the knife for- 
ward, so as to divide the whole of the thickened texture at the contracted 
part of the canal, and withdraws the director.” A silver catheter is now 
allowed to remain in the bladder for forty-eight hours, after which it is to 
be withdrawn. After eight or ten days a moderate-sized bougie should be 
passed, and its introduction repeated once every week or fortnight for 
two months. Mr. Syme makes it an indispensable condition of his opera- 
tion, that the stricture should be permeable; in other words, should admit 
the passage of an extremely small director at least; and in order appa- 
rently not to limit the usefulness of his operation, he asserts that there is 
no truly impermeable stricture. He also condemns, in measured terms, 
the old operation of cutting into the perineum in search of the obstructed 
canal without any further guide than the point of a catheter, introduced, 
not through, but merely down to the contracted point. An imperfect di- 
vision of the contracted part—want of care to pass instruments while the 
urethra is healing, as all injuries of the canal are apt to occasion strictures 
when this precaution is neglected—and subsequent exposure to a repetition 
of the causes which give rise to the disease—may prevent the advantage 
gained from lasting so long as could be desired. The first of these cir- 
cumstances tending to cause relapse did not originally occur to me, but 
was suggested by facts falling under my observation, which led to the per- 
suasion that as a stricture gives the canal a sand-glass form at the part 
affected, it is not sufficient to cut merely the narrowest portion—the coni- 
cal-shaped contraction on each side of it also requiring division; so that, 
instead of being limited to a quarter or half, the incision should extend a 
whole inch through the coats of the urethra. In regard to the after-treat- 
ment, as wounds and bruises of the urethra are apt to induce strictures, 
unless a full-sized bougie be passed occasionally until the part affected 
recover from the injury which it has sustained, there can be no doubt that 
if this precaution is neglected after the operation for stricture, there must 
be a risk of relapse. And it is no less obvious, that however perfectly the 
patient may be relieved from an existing stricture, he cannot reasonably 
claim exemption from the production of another, if he exposes himself to 
the exciting causes. It will, therefore, be prudent to enjoin sach a mode 
of life as may, as far as possible, afford' protection from the influence of 
circumstances calculated to act in this way. With due attention to all 
these points, it is reasonable to expect that the obstinate forms of stricture 
in question may be effectually remedied by an operation of the utmost sim- 
plicity and most perfect safety; and that the relief will generally, if not 
always, prove permanent. Part xxvi., p. 199. 
Traumatic Stricture of the Urethra.—Mr. Coulson asks the question, 
where great damage has been done to the urethra from injury, whether it 
would not be better to contrive some artificial outlet for the renal secre- 
tion, than to make repeated attempts to rectify the state of the natural 
canal when they are not likely to be attended by success. He thinks rather 
than risk repeated attacks of retention, the best plan w'ould be to make 
an opening into the bladder above the pubes, or through the rectum, and 
by allowing the urethra perfect rest for a few days, favor its return to a 
YOL. II.—38 594 
STRICTURE, 
normal state, and then, if after several weeks’ rest, the urethra is found so 
mutilated as not to be amenable to the treatment by dilatation, to make 
such temporary opening permanent. Part xxvi., p. 213. 
New form of Director for the remedy of Stricture by External Inci- 
sions.—In his operation by external incision, Mr. Syme has frequently 
found the inconvenience of not being able by ordinary instruments to tho- 
roughly divide the contracted portion of the urethra. To this fact, Mr. 
Syme believes, are owing the relapses said sometimes to take place. He 
has had a solid director recently made, but with a long slender portion, 
which is grooved, and this latter part being much smaller than that usually 
employed, passes with more readiness completely through the stricture. 
The operator now cuts through the integuments above the stricture into 
the groove, runs the knife down until the contraction is completely divided, 
as is readily seen by the thicker portion of the director passing easily 
through the whole length of the canal. Part xxviii., p. 215. 
Stricture of the Urethra.—Dr. Dick operated in a case of stricture as 
follows: Making a very small opening above the stricture through the 
integuments into the urethra, he introduced a curved tenotome and divided 
the stricture from before backward. The ready passage of the sound 
proved that the stricture was completely divided. Part xxviii., p. 215. 
Stricture of the Urethra.—If we wish to know whether the bougie is 
pressing against the walls of the urethra, or has entered the stricture, we 
must draw it gently back; if the latter, we shall meet with some degree of 
resistance, as if it had been grasped by some contracted orifice. If the 
stricture be long and callous, the bougie may cease to advance, and in this 
case it should be withdrawn and a larger one introduced. Catgut bougies 
are going out of use; the common plaster ones are not very convenient, 
but they must be employed where the contracted parts are tortuous and 
of small calibre. Mr. Liston, however, rejected them altogether, and if 
the stricture was moderate, used a plated metal bougie, and if very tight, 
a small silver catheter. Mr. Lawrence is another high authority in favor 
of metallic sounds. Having been passed, the instrument should remain in 
the urethra a short time, and then be withdrawn, introducing it again on 
the third day, and if it is well borne, introducing it daily, and allowing it 
to remain a longer time, so as gradually to dilate the strictured part. 
This is a good but a tedious plan, and some surgeons prefer introducing a 
small instrument first, and then immediately passing in rapid succession 
two or three of a larger size, until the patient complains of weariness or 
pain. Permanent dilatation is effected by passing an instrument and allow- 
ing it to remain forty eight-hours or longer, according to the case, then this 
is withdrawn and a gum-elastic catheter substituted. This may be left for 
from two to six days ; it is then withdrawn and a larger instrument passed, 
and so on until the dilatation is complete. For this purpose Mr. Wakley’s 
instruments are very useful, consisting of silver and flexible tubes of gradu- 
ated sizes. Part xxix., 226. 
Stricture of the Urethra.—Prof. Syme says : Stricture never occurs in 
the membranous portion of the urethra. If you divide the urethra into 
three portions, the prostatic, membranous, and the remaining part which 
is covered by the corpus spongiosum, it is in the last portion that all stric- 
tures exist. It is never necessary, therefore, to cut beyond the bulbous 595 
STRICTURE. 
part of the urethra, as no strictures are beyond the bulb. If you bear these 
facts in mind, you need not dilate sinuses, which are sure to close when 
the stricture is removed. A catheter should be introduced into the blad- 
der after the operation, and retained for 48 hours—not less, on account of 
the risk of extravasation of urine, anti not longer, because it is unnecessary 
and apt to do harm. 
Mr. Syme’s set of bougies are exceedingly small in size. No. 1 is per- 
haps smaller than those made anywhere else. The tightest and worst stric- 
tures are anterior to the scrotum. A stricture in this place is felt like a 
small pea, somewhat elongated. This is the kind most unmanageable by 
dilatation, and most successfully and easily treated by division. Pass a very 
small director (which is here comparatively easily done, but would be very 
difficult at the bulb). Introduce the point of the knife into the groove of 
the director anterior to the stricture, and push it backward through it, 
while the end of the penis is held firmly. Cut baclcward in stricture ante- 
rior to the scrotum, and forward when the stricture is at the bulb. You 
will never meet with a tight stricture behind the scrotum along with an 
extreme contraction in front of it. Part xxxi., p. 159. 
Stricture of the Urethra.—As a rule, Mr. Syme, in common with sur- 
geons generally in this country, treats stricture by simple dilatation, es- 
chewing the use of caustics and internal incisions. So firmly persuaded is he 
of the efficiency of the catheter, that he believes there is no stricture, how- 
ever narrow, which will not admit an instrument, provided it be sufficiently 
small, and be employed with care and patience. He therefore believes 
that it is wholly unnecessary to resort to the operation of dissecting 
through what have been termed impermeable strictures, preferring to 
insinuate a catheter rather than to employ a knife in these circumstances. 
Hence he disapproves of that operation usually termed “the perineal 
section,” which has been frequently resorted to in this coimtry for the last 
thirty-six years. Having proceeded to employ dilatation, if he finds that the 
stricture rapidly reappears in spite of it, or that the process involves much 
constitutional disturbance, he prefers to divide freely the stricture from 
the perineum, upon a grooved director, performing the incisions in the 
median line, tying in a catheter for forty-eight hours, and subsequently 
passing it a few times at about weekly intervals. This proceeding, to 
which he gives the name of “ external division,” is stated by him, on the 
ground of an extensive experience, to be devoid of danger, and generally 
to be attended with a successful result, a conclusion with which our own 
experience of it leads us, without any hesitation, to coincide. 
Part xxxii., p. 109. 
Stricture of the Urethra.—Mr. Lawrence, surgeon to Northern Dispen- 
sary, says : The following method of applying caustic in these cases is free 
from the ordinary objections to the practice. Coat the end of a catgut 
bougie very evenly with a fine layer of caustic, by immersing it in fused 
nitrate of silver, to which a little water has been added. Pass a full-sized 
straight catheter with one terminal aperture completely down to the stric- 
ture, then pass the armed bougie through the catheter into the stricture, 
and by gently rotating the bougie, the whole tract of the stricture may 
be freely and equally cauterized. Part xxxii., p. 175. 
Stricture of the Urethra.—In the employment of dilatation, says the 
“ Lancet,” the golden rule which must guide us, both in regard to the 596 
STRICTURE, 
extent it may be carried at the time, and the length of interval which is 
to elapse between each repetition of it, is to exercise just so much pressure 
and dilating power as can be exerted without producing pain or uneasi- 
ness, or more than slight irritation, and not to repeat the process until any 
excitement produced by the previous catheterism has completely subsided. 
The fulfillment of these indications will conduce in the long run the most 
quickly and safely to a successful result. Part xxxiii., p. 194. 
Maisonneuve's Method.—The method which M. Maisonneuve adopts 
for their radical and instantaneous cure is that by internal division. When 
very contracted, he commences by passing a very fine thread-like bougie 
into the bladder—this will require great tact and perseverance : another 
larger bougie is then articulated to the end of this, and pushed forward, 
so that the first bougie becomes coiled up in the bladder; when this is 
thoroughly in the stricture it must be withdrawn, and another filiform 
bougie passed, to which is attached the cutting instrument ofFrere Come. 
When this is fairly in the stricture, you must unsheathe the bistoury and 
withdraw the instrument, cutting through all resistance. The patient 
generally gets well in fourteen days. As to the possibility of relapses, 
nothing at present can be affirmed—it is a question to be judged of here- 
after. This method of treatment has been the subject of much discussion 
before the Surgical Society of Paris ; the result of this shows that dilata- 
tion is still the best and safest plan, and that the cases are very few requir- 
ing incision. If a patient can bear with tolerable ease a moderate stric- 
ture, he had better do so than be operated on, for experience shows it is 
not free from danger, however practised. Part xxxiii., p. 206. 
Stricture of the Urethra.—Mr. Solly, of St. Thomas’ Hospital, believes 
that the knife ought never to be employed in any case when you can 
introduce the thread catgut bougie, that is, in any stricture which is 
pervious. When you can once introduce a bougie into the bladder you 
can cure that stricture 'without cutting. There is not one case in two 
hundred, of even bad strictures, -where the knife need be used at all. 
Mechanical means must be combined with medical treatment; if you can- 
not pass a bougie, give one grain of the iodide of mercury three times a 
day to promote absorption, and the buchu mixture to relieve irritation. 
To pass the bougie as far as the stricture, and allow it to remain half an 
hour wdth gentle pressure, will excite the absorbents. If you can pass a 
fine catgut bougie, pass over it a No. 5 elastic tube, and withdraw the 
bougie. As a general rule, the bougie should be passed every other day 
for the first week or fortnight, afterward the p&iods to be lengthened to 
once a week, then once a fortnight, but the use of the instrument must 
never be abandoned altogether. Part xxxiv., j?. 167. 
Stricture of the Urethra.—In Syme’s operation for stricture, one element 
essential to its success has by many been entirely overlooked, and that is, 
the necessity of passing a full-sized bougie at intervals, gradually increas- 
ing, and for a considerable time after the cicatrization of the opening made 
in the urethra. In the treatment of stricture of the urethra great advan- 
tage will be gained by passing a No. 8 catheter as far as possible, and 
keeping its point pressing with moderate firmness against the obstruction 
for twelve or twenty-four hours : systematic attempts should then be made 
to overcome the impediment, first, with the No. 8, and then, if necessary, 
others of smaller calibre. This is a powerful adjunct to the ordinary mode 597 
STRICTURE. 
of treatment with the bougie, and should be employed in certain cases, 
which may be classified as follows: 1. Those in which the contracted 
portion is longer than usual. 2. Those which afford but little time for 
treatment. 3. Those 'which are likely to resist the passage of an instru- 
ment for a considerable time. 4. Those which would yield if the patient 
would rest, but when he cannot. Part xxxiv., p. 169. 
Syme’s Operation for.—Prof. Syme states that there can hardly be any 
serious hemorrhage in urethrotomy by external incision unless the artery 
of the bulb has been wounded, which may certainly be avoided by cutting 
in the middle line upon a grooved director. Extravasation of urine may 
take place if the stricture be not freely divided, or, still worse, if the stric- 
ture be undivided and the urethra be opened behind it. The urethra 
should be freely exposed before opening it, so that the incision of its coats 
may not be subcellular, which would expose the patient to the same 
dangers which attend internal incision. There can be no safety unless a 
free drain be provided for the urine through a full-sized catheter ; this 
will require very careful management: the external extremity should be 
curved downward, so that the urine may fall into a vessel without wetting 
the bedclothes; stopcocks are productive of much danger, the person in 
charge gets confounded, so as not to know wdiether the catheter is open 
or shut, and if the patient makes any expulsive efforts he may do himself 
much injury. It will be much better to keep the catheter constantly open, 
so that the urine may not pass along its outer surface. The patient should 
remain quiet on his back, wTith a pillow under his knees, for forty-eight 
hours, no change of position being allowed. It is not desirable that the 
wound should heal by the first intention; if there be any tendency to this, 
the finger must be occasionally introduced so as to feel the instrument, or 
the patient will be exposed to a relapse of the disease. Strictures do not 
occur behind the bulb, except in cases of extreme rarity, so that incisions 
into the membraneous portion of the canal are unwarrantable. The danger 
of extravasation will be especially serious when the deep facia of the peri- 
neum has been divided ; in such cases the introduction of a straight tube, 
as after lithotomy, will effectually prevent the risk of serious consequences. 
Part xxxiv., p. 181. 
Petention of Urine from Stricture—Syme's Operation.—When there 
is repeated retention of urine, says Mr. Lane, it will be necessary to open 
the membranous portion of the urethra behind the stricture. To do this 
it is necessary to hit off, with microscopic accuracy, the delicate line of the 
raphe, for, if we cut sidewise through the muscles, the wound will be 
found to gape, there will be hemorrhage and extravasation of urine. This 
operation is much more easy and successful than puncturing the bladder 
through the rectum, for, while the recent wound is healing the previous 
stricture will be found to give way very much, so that an instrument may 
readily be passed. Part xxxiv., p. 183. 
Remedy of Stricture by External Incision.—Prof. Syme says, with 
regard to the use of external incision in the treatment of stricture, that it 
is not true that wounds of the urethra, like those of the skin, must heal 
either by adhesion or granulation, and so the old contraction be restored 
with greater firmness than before. It has been repeatedly shown that the 
most tightly contracted urethra may remain perfectly patent after division 
of the stricture, and in the bodies of some persons who have died several 598 
STEICTTJKE. 
years after the operation, the canal has been found actually wider than 
natural, and the surface of the previously deranged mucous membrane not 
distinguishable from the neighboring portion. Part xxxvi., p. 173. 
Source of Danger in Division of Stricture.—Out of the great number 
of cases operated upon by Mr. Syme, he has met with two in which during 
the act of micturition, acute pain in the perineum Avas followed by quick 
pulse, delirium, and death. In neither were there any signs of local mis- 
chief, but in one the kidneys were gorged with blood to an extreme 
degree; besides these two cases, slighter symptoms of disturbance oc- 
curred in many others. It was noticed that these symptoms were always 
connected with micturition after withdrawal of the catheter, therefore 
probably proceeding from the action of the urine upon a raw surface, pro- 
duced by tearing of the imperfectly united wound in the urethra, and 
being of the nature of a sudden shock to the nervous system. To obviate 
this he introduces a short catheter by the wound in the perineum, about 
nine inches in length, and slightly curved in opposite directions at the 
extremities. By thus keeping the wound open a little longer perfect 
security is obtained. Part xxxviii., p. 154. 
Stricture of the Urethra.— Urethrotomy.—Prof. Syme’s practice is to 
cut from behind forward, and not backward, as is the London practice. 
The risk of cutting the deep perineal fascia is much lessened. 
Part xxxviii., p. 157. 
Sensitive and Contractile Stricture.—In cases of stricture so exquisitely 
sensitive that the passage of a catheter is followed by severe constitutional 
and local disturbance; also in cases in wrhich immediately upon omission 
of treatment contraction begins to return, the operation of external 
division is most valuable. The above opinion of Mr. Bryant upon this 
subject is valuable, from the large amount of experience necessarily ob- 
tained at so large a hospital as Guy’s. Part xxxviii., p. 158. 
Stricture of the Urethra.—Syme’s Operation.—Mr. Lee, surgeon to 
Lock Hospital, observes : It is singular that the success wrhich has attended 
Mr. Syme’s operation should have varied so considerably in different hands. 
This can be accounted for in a great measure by the kind of stricture for 
which the operation had been undertaken by different surgeons. An 
incision through the bulb is a safe proceeding, but an incision through the 
membranous part, involving, as it necessarily does, a division of the deep 
perineal fascia, is a very unsafe proceeding, and not to be undertaken 
except in cases of perineal fistuloe, where the parts are often so condensed 
by adhesive inflammation, that incisions may be made with instruments: 
otherwise the operation is adapted only to cases of stricture confined to 
the bulb of the urethra. Part xxxix., p. 207. 
Internal Urethrotomy.—Mr. Thompson, of University College Hospital, 
considers the best instrument for ordinary use to be that designed some 
fifteen years ago, by Civiale, of Paris. The shaft is almost equal in size 
to an ordinary No. 3, the bulb to No. 5. By means of the bulb the extent 
of the narrovdng can be accurately told. When the instrument is used, 
the bulb having been passed about half an inch beyond the obstruction, 
the cutting side must be directed downward, and directly in the middle 
line ; the blade is made to project to the required extent, by means of ail 
apparatus in the handle, which accurately controls it, and the instrument 599 
STYPTIC SUPPOSITORIES. 
is firmly pressed on the floor of the urethra, and slowly and steadily drawn 
outward, about an inch or an inch and a half, so as fairly to divide the 
obstructing portion. For smaller strictures than Civiale’s instrument is 
applicable to, Mr. T. has invented a smaller instrument on essentially the 
same plan. Part xl., p. 130. 
STYPTIC. 
Aid of Turpentine as a Styptic.— Vide Art. “ Turpentine.” 
Styptic (M. Pagliar'ds).—This styptic liquor, which seems to have 
abundant testimony in its favor, is composed as follows: Eight ounces of 
tincture of benzoin, one pound of alum, and ten pounds of "water, are 
boiled together for six hours in a glazed earthen vessel, the vaporized 
water being constantly replaced by hot water, so as not to interrupt the 
ebullition. The resinous mass is to be kept stirred round. 
Part xxvi., p. 349. 
Styptic.—Solid Perchloride of Iron.—The perchloride of iron is manu- 
factured in a solid form in which state it is particularly manageable as a 
styptic. Another, and perhaps superior way of using it is to apply, by 
means of a spun-glass brush, a small quantity of the thick brown fluid, into 
which the solid perchloride kept in a bottle always deliquesces. It is par- 
ticularly useful, according to Mr. Lawrence, in such cases as excision of 
the tonsils, bleeding from the deeper-seated gums, etc. No inflammatory 
action follows the use of this drug. Part xl., p. 298. 
SUPPOSITORIES. 
Dr. Simpson's Morphia Suppositories.—Mr. Spencer Wells lias intro- 
duced into use at the Samaritan Hospital, a form of morphia suppository, 
used with great advantage by Dr. Simpson of Edinburgh. Mr. Wells has 
found it a most convenient form of suppository after operations on the 
vagina, rectum, uterus or perineum of women, both in hospital and private 
practice, and especially so after operations made on the genito-urinary 
organs, as lithotrity, in cases of retention of urine, irritable stricture, etc., 
and after division of fistula in ano, or the removal of piles or prolapsed 
mucous membrane of the rectum by the ecraseur. They act much more 
efficiently than the soap and opium in common pill use as a suppository, 
and are seldom or never expelled from the rectum after their introduction 
above the sphincter. The following is for the hall' grain suppository: Take 
of acetate of morphia, 6 grains; sugar of milk, 1 drachm; simple cerate, 
half a drachm, or as much as may be sufficient to make a proper consistence, 
and divide the mass into twelve suppositories. Then dip each suppository 
into the following mixture, to form a coating: Take of white wax one part, 
lard plaster two parts; melt together. The best way is to insert a needle 
into the apex of the suppository, dip it into the melted wax and lard, and 
immediately afterward into cold water to harden it before it loses its shape. 
The shape is conical, like a pastille. It is easily introduced by the finger, 
or more neatly by the ordinary ivory suppository syringe. Mr. Coulson 600 
SUTUKES—SYNOVITIS. 
has also used these suppositories lately in several lithotrity cases, and has 
found them of the greatest benefit in allaying the irritation which often 
attends the passage of the fragments of calculi through the urethra. 
Part xxxv., p. 255. 
SUTURES. 
Employment of Threads of Caoutchouc for Sutures.—Mr. Nunn el y, 
of Leeds, recommends the use of caoutchouc sutures. 
“ There are many cases where the unelastic ligature in common use is 
even prejudicial, and where a more elastic thread might be advantageously 
substituted. It produces less irritation, and holds the divided parts to- 
gether with much less stretching than the common ligature, and at the 
same time it keeps up an equal degree of tension, ‘ for if the parts swell, 
the ligature gives way in proportion to the pressure; on the contrary, do 
they contract, so also does the ligature, and an equable approximation is 
maintained.’ In hare-lip this kind of ligature might supersede the use of 
pins.” Part iii., p. 78. 
Pead Suture.— Vide Art. “ Palate.” 
Suture—New form of.—This form of suture was used by its inventor, 
Mr. Spencer Wells, in an operation for the cure of vesico-vaginal fistula. 
It is applicable in most cases in which the quilled suture is employed, and 
is more easily applied. Pass a pin, armed with a shot and perforated bar, 
through one edge, and then through the opposite edge of the wound, then 
pass a secohd bar over the point of the pin, and then a shot, which must 
be pressed by forceps on to the pin, so as to fix this bar in its place, then 
cut the pin off close to the shot. Part xxxv., p. 171. 
Lead- Wire Suture.—In cases where it is desirable to place a suture to 
any part not easily reached, take a curved needle, and a piece of lead-wire 
which is very soft and flexible—the end of the needle must be so made 
that the wire may be screwed into it. Pass the needle through the edges 
of the wound, cut off the needle, and with a pair of forceps twist the two 
ends of the wire together, and double up the ends to prevent scratching. 
Part xxxvi., p. 273. 
Aluminium Sutures.—When union by the first intention is required, 
few will deny that silver sutures possess great advantages over ordinary 
thread or silk ones. Their great drawback is their great cost. Dr. Frod- 
sham, surgeon to Cumberland Infirmary, says that aluminium possesses all 
the pliability and other properties of silver, and is only half the price. 
Sutures may with great advantage be made of this metal, and will be 
found to answer quite as well as silver. Part xxxviii., p. 163. 
Gonorrhoeal Synovitis.—Mr. B. Cooper says: Patients suffering from 
gonorrhoea are subject to the attacks of a peculiar form of synovitis, 
which so closely resembles the rheumatic affection, that it is sometimes ex- 
tremely difficult to distinguish between them; and, indeed, it is only from 
SYNOVITIS. SYPHILIS. 
601 
a history of the case that a just diagnosis can be formed. It usually 
happens in such cases that the gonorrhoeal discharge ceases simultaneously 
with the accession of the disease to the joint; and it is of the highest im- 
portance that the former should be reestablished as quickly as possible, 
the best means being the application of warm fomentations over the organs 
of generation. I have never knowrn an attack of the above kind to occur 
unless the patient has taken copaiva, and am inclined to think that this 
medicine acts specifically on the synovial membranes; for I have invariably 
found the symptoms of inflammation greatly aggravated by its adminis- 
tration. Bark and alkalies, combined with opium, seem to be the most 
appropriate remedies, as colchicum does not afford relief. In these cases 
the latter circumstance constitutes a further distinction between gonor- 
rhoeal and rheumatic affections. Part xvii., p>. 160. 
SYPHILIS. 
Inoculation as a Test—M. Picord’s Process.—In all doubtful cases, the 
patient is inoculated from his own sore, and if a syphilitic ulcer is pro- 
duced, similar to the one from which the matter is taken, it is considered 
to be genuine syphilis, and treated accordingly. But instead of allowing 
this second sore to proceed, M. Ricord destroys the part inoculated, on 
the third or fourth day, before it has proceeded far enough to produce 
bad effects. By long experience, M. Ricord knows, even on the second or 
third day, what would be the effects of his inoculation, and thus destroys 
the part in time, as unpleasant effects might take place were the second 
sore to become intractable, as has occasionally happened. Part i., p. 123. 
Employment of Platinum—Therapeutic Action.—The perchloride is to 
be regarded as an efficacious remedy in syphilis, especially of a chronic 
form. The chloride of platinum and sodium is more applicable to the 
recent forms of the disease. It is equally efficacious in rheumatic affections. 
Platinum must be ranked amongst the alteratives along with gold, arsenic, and 
iodine. It differs from mercury in producing previous excitement of the 
system; and it does not cause the same serious accidents which often follow 
the use of that drug. Part iii., p. 61. 
Treatment of Chancre—Vide Preparations of Antimony and Mer- 
cury, Art. “ Antimony.” 
Aphorism of Practical Surgery.—Syphilitic exostoses do not always 
disappear, although their primary cause has been entirely removed. 
Part iii., p. 116. 
Gangrenous Syphilitic Uleers.—Nitrous acid saturated with nitrate of 
silver, recommended topically to arrest gangrenous inflammation and pha- 
gedenic ulceration, resulting from syphilis. Part v., p>. 115. 
Inoculation as a Test of Syphilis.—[Several objections have been re- 
peatedly urged against the process of inoculating a patient to ascertain 
with certainty whether or not the chancre is really syphilitic. It has been 
urged, that by producing another sore, we increase the chance of affecting 
the constitution; but most surgeons now believe that one sore will pro- 
duce as much mischief as two. It has been also asserted, that matter 602 
SYPHILIS, 
from any angry sore, introduced below the skin, is likely to cause the 
point to fester. This, however, is denied by Mr. Mayo. He makes the 
following remarks on the way in which the inoculation is to be performed :] 
Before arming the lancet, the suspected sore should not have been 
wiped, or dressed with any chemical application, for two or three hours 
at least. The most convenient part for inoculation is the back of the fore- 
arm immediately above the wrist. 
The point inoculated should be covered with a patch of sticking plaster, 
and not disturbed for three days. 
At the expiration of that period, on examining it, either the punctured 
jjoint is found to be scarcely distinguishable, having healed, and having no 
redness about it; or it has ulcerated, and the skin around it is inflamed, 
and, if the epidermis is not broken in raising the sticking plaster, there is 
seen a small flat vesicle containing lymph or pus, surrounded by an inflam- 
matory zone. Occasionally, but very rarely, the inoculated point does not 
become inflamed during the first three days, but on the fourth or fifth a 
pustule suddenly forms. 
When the inoculation has taken to this extent, the evidence required is 
obtained. The suspected sore is certainly of syphilitic origin. And, if 
circumstances are not present to contra-indicate the use of mercury, a 
mercurial course should be immediately commenced. 
In order to get rid of the artificial sore, we must freely apply the nitrate 
of silver, so that the texture may be destroyed to the depth of half a line, 
which will almost certainly destroy it, and cause the sore to heal. 
Part v.,p. 145. 
Chronic Venereal Ulcers— Creasote.—In chronic venereal ulcers, Dr. R. 
Cormack of Edinburgh has repeatedly used creasote with advantage. It 
answers very well to apply it pure once, when there is great deficiency of 
action, and subsequently to employ an ointment of from four drops to 
thirty, to the ounce of lard. The lotion is also a very excellent form of 
application. In phagedenic ulcers, ulcerated chilblains, and sores yielding 
a sanious discharge, Dr. C. has often used creasote with great benefit. 
In the application of creasote to ulcers and other solutions of continuity, 
there are several facts which the practitioner should bear in mind. It is 
important to remember that water only dissolves one-eightieth part. If an 
excess of creasote be present, it will float on the surface in small globules, 
and can therefore very easily be removed; but if this is not done, when 
the lint is dipped in the lotion, these globules will adhere, and in this way 
a very different wash from what was intended, is placed upon the sore. 
In very few cases, where the raw surface is extensive, pure creasote ought 
to be applied to the whole of it, as severe irritation is generally the result. 
Part vi., p. '74. 
Syphilitic Sore Throat—Iodine Gargle.—Dr. James J. Ross says : 
Another case in which the local use of the tincture of iodine is of signal 
efficacy, is that of ulcers of the tonsils and fauces—specific or non-specific. 
I have seen the ugliest sores in this situation put on quite a healthy ap- 
pearance in a few days under its use. It is highly recommended by 
Ricord, and certainly 1 do not know anything equal to it in such cases. 
It is best in the form of gargle; thus : 
R Tinct. iodin., 3j.-ij.; tinct. opii, 3j-; aquae, gvj. M. Fiat. garg. ter 
quaterve in die utenda. 603 
It may be made weaker or stronger, with or without the laudanum. It 
requires to be well shaken when used. 
The first case in which I used it, was one of irregular phagedenic ulce- 
ration near the base of the uvula, Avith patches of a white exudation on the 
back of the pharynx ; the voice, respiration, and deglutition being all 
affected. The general aspect of the patient was cachectic, but he denied ever 
having had syphilis. The above gargle was ordered. An improvement 
tvas observable on the third day of its use, which went on steadily and rapidly 
to a perfect cure. In another bad case of syphilis, with sloughing, irregu- 
lar ulcers on the velum and fauces, the local use of the same gargle (made 
first with 5j. to §vj. and afterward increased to 5iss), arrested the phage- 
denic ulceration, and reduced it to a healing sore, which soon cicatrized. 
Patients do not complain of the gargle being disagreeable. 
Part vi., p. 118. 
Chronic, Indolent Bubo and Ulcers.—Dr. James J. Ross recommends 
the iodide of mercury as follows : 
1. An ointment of iodid. hydrarg., 9j. to giss of lard, is extremely ser- 
viceable in various syphilitic ulcers, particularly those indolent greyish 
regular sores, which are seen on the arms and legs of venereal patients, 
and those which are left on the separation of the concreted scurvy cuta- 
neous tubercles, which are met with on the face in bad cases. The above 
ointment is one of the most effectual applications for such sores that I have 
seen used. It is applied in the usual manner—spread on lint. 
2. An ointment of this substance may be used like other preparations 
of iodine, with the view of causing the absorption of various tumors. 
Ricord uses it in this way for chronic indolent bubo. Part vi., p. 123. 
Treatment of Syphilis by Tartarized Antimony.—Mr. Smee recom- 
mends the use of tartarized antimony for the cure of syphilis. Mr. Smee 
says that by giving very small doses of this medicine frequently repeated, 
we charge the system with it; thus irritating the capillary system, and in- 
citing it to action throughout the whole body, causing it to throw off the 
antimony and with it the syphilitic poison. 
He goes on to say: 
As a general rule, most patients laboring under syphilis, except, in- 
deed, if it be a sloughing phagedena, violent inflammation, or some such 
analogous case, no. matter what form or duration, primary or secondary, 
provided the party be otherwise robust, or at any rate, not in very ill 
health, will be benefited by the antimonial treatment. The medical man 
begins, if necessary, by ordering an aperient of colocynth, jalap, black 
draught, or similar purgative, and then directs the patient to take from 20 
to 60 drops (30 medium) of antimonial wine, or the solution of antimony, 
every two or three hours regularly, and in every case where pus or a puri- 
form discharge exists, use at the same time a lotion of chloride of soda, 
the strength of which should be regulated to the sensitiveness and delicacy 
of the part of the body affected. 
Simple Sores.—In simple sores, either of the prepuce or glands, the 
treatment is extremely efficacious, and here had better be conjoined 
with a solution of chloride of soda, containing about an ounce of the latter 
to a pint of water, which should be applied two or three times the first 
day. In many cases, in twenty-four hours the character of the sore be- 
comes changed; the surface is no longer covered with white pus, a heal- 
SYPHILIS, 604 
SYPHILIS. 
ing edge begins to show itself, and the sores, perhaps three, four or more, 
are speedily healed. As soon as the character of the sore is changed, the 
part had better only be dabbed once or twice a day with the lotion, and 
at other times simply covered with a piece of dry lint; for we may be sure 
that here, as in all other cases, too much disturbance of a healing part only 
interferes with the natural healing process. Superficial sores will fre- 
quently, although of three weeks’ or a month’s standing, be healed in four 
or five days; but it is prudent to continue the antimony till not only the 
surface of the skin is not in the slightest degree raised, but even till the 
part affected assumes its natural color. 
Indurated Sores.—The treatment of indurated sores is similar in all 
respects to that of superficial sores, and indeed that slight puffiness always 
to be seen round the most superficial sore is perhaps to be considered as a 
slight induration, and the dense cartilaginous hardness which occasionally 
presents itself is nothing but the same thing differing in degree rather 
than in kind ; and we have the authority of some most eminent surgeons, 
in confirmation of universal experience, that either produce indifferently 
secondary symptoms. The rapidity with which the cure is effected in 
these cases is proportionate to the degree of hardness. If the induration 
is moderate, the sore may heal, but the induration will remain ; in which 
case the person is by no means to be considered as cured, for the anti- 
mony must be continued not only till the sore is cured but till the indura- 
tion is removed. If the induration is very intense and hard, the sore, 
although healthy, will not heal till that is absorbed. In all these cases 
the antimony should be given very frequently at the commencement, 
and with the utmost regularity: for the remedy always produces the 
greatest effect on its first administration, and seems rather to lose its 
power after many days, for which reason it should be gradually increased 
in quantity. 
Phagedenic Sores.—Phagedenic sores generally occur in poor, weakly 
constitutions, and require peculiar treatment on that account. The 
employment of antimony in these cases acts decidedly as a mild tonic ; 
but still, as its excreting effects seem to exceed its tonic powers, we find 
it advisable in these cases to conjoin the use of the remedy with that of 
other more potent tonics. If, indeed, the skin is cold and clammy, we 
should use such remedies as experience has taught us determine the blood 
to the surface, for a few days previous to the employment of the antimony. 
A grain of sulphate of quinine may be given twice or thrice a day. A 
grain of proto-sulphate of iron, or a grain of sulphate of zinc, may be used 
with great advantage for the same purpose; and the antimonial drops 
exhibited as before. If the patient is but slightly feeble we may begin at 
once with the following mixture :— 
R Zinci sulphatis, gr. v.; aquas desk, gss.; vin. ant. pot. tart., gss.; quaque 
5ss. vel 5j. pro dose 2da vel tertia hora sumenda. 
Proto-sulphate of iron may be substituted for the zinc with similar suc- 
cess. If the patient is restless or sleepless, or the nervous system much 
affected, the addition of about twenty or thirty minims of sirup of poppies, 
or a few drops of laudanum to each dose, is of much service. A little 
Dover’s powder may be given at bed-time. Whenever iron is employed it 
appears to be essential that the metal should be in the state of the pro- 
toxide ; for probably the persalts have but very little action on the system, 
and even that little action maybe dependent upon a portion of the salt giving 605 
SYPHILIS 
up one equivalent of oxygen. The nature of the salt of iron, provided it 
he a protosalt, does not seem to influence the result. 
In all cases where the patient is feeble, he should be desired, immediately 
on leaving his bed in the morning, to rub his entire body with a coarse 
towel till the skin is red, which will further help to promote a proper flow 
of blood to that important organ. 
Buboes.—Buboes give way to antimony perhaps more rapidly than they 
do to mercury, and a more favorable prognosis may be given if this treat- 
ment be adopted. It would, however, be vain to attempt the removal 
of an inflamed bubo containing a large quantity of pus, by any general 
means. 
Eruptions of the SJcin.—Various eruptions of the skin, the sequelae of 
syphilis, as a general rule, yield favorably and rapidly to antimony. 
Ulcerations of the Throat.—Ulcerations of the pharynx, uvula, and roof 
of the mouth, yield rapidly to this line of treatment. It is a good plan to 
use a gargle containing from 5j. to §j. of chloride of soda to the pint of 
water, as that much facilitates the favorable termination of the disease. 
The ulceration, in these cases, rapidly loses its white layer of pus, fre- 
quently mistaken for lymph or sloughs ; and as soon as a perfectly healthy 
surface is established the ulcer heals as rapidly as a common sore. 
Ulcerations of the Mouth, etc.—Ulcerations of the corners of the mouth 
and tongue, and a peculiar growth of the papilke of that organ, yield 
rapidly to this line of treatment. 
Syphilitic affections of the testicle, rhagides digitorum, etc., yield rapidly 
to this plan. 
Of the value of antimony in syphilitic iritis and nodes I do not happen 
to have had any experience. Part vi., p. 125. 
Syphilitic Ulcerations of the Throat.—The inhalation of ammonia gas 
recommended. Vide Art. “ Hoarseness.” 
Buboes.—The ferruginated pill of mercury recommended as a superior 
resolvent, especially with respect to buboes. Vide Art. “ Pills.” 
Treatment of Chancre.—Mr. Langston Parker, of Birmingham, recom- 
mends the following mode of treating a chancre: A chancre when first 
presented to the notice of the surgeon, is generally in one of two states— 
either in that of a small pustule with its contents yet undischarged, or a 
minute ulcer. In whatever state it may be, our first duty is to endeavor, 
by the use of escharotics, to convert the specific sore into a simple one. 
For this purpose you will find most authors recommending either a strong 
solution of the nitrate of silver, or the application of this caustic in sub- 
stance. When the nitrate of silver is used, if the disease be pustular, it 
will be necessary to open the pustule with the point of a lancet, to discharge 
its contents, and rub the whole surface and edges of the ulcer thus pro- 
duced with the nitrate of silver, previously cut to a sharp point; if the 
disease be an open ulcer, it is to be treated in the same way. The nitrate 
of silver thus applied will sometimes have the effect of producing a simple 
sore, but it will more commonly give rise to considerable irritation and 
inflammation, while the specific character of the sore is not destroyed. 
The great evil in the use of the nitrate of silver in these cases is, that it 
is powerful enough to irritate, but not sufficiently powerful to destroy. 
We want a remedy that will at once disorganize the tissue to a depth co- 606 
SYPHILIS, 
equal with that of the chancre. For this purpose I now employ several 
remedies : highly concentrated nitric acid, the acid nitrate of mercury, 
the acid nitrate of silver, or the potassa cum calce of the London Pharma- 
copoeia. The second of these remedies is made by dissolving a drachm of 
the subnitrate of mercury in an ounce of nitric acid; the third by dis- 
solving the same quantity of the nitrate of silver in the like quantity 
of acid. 
When it is determined to destroy a primary venereal ulcer with any of 
the three first caustics, a camel’s-hair pencil must be dipped in them, and 
the surface and edges of the sore pencilled thickly over; if the acid be 
sufficiently concentrated, the whole surfaces touched are at once destroyed, 
and converted into a yellow eschar, which, on separating, generally leaves 
a clean simple sore underneath. When the potassa cum calce is employed, 
which is the most certain of all the remedies I have mentioned, it must be 
made into a paste of moderate consistency, with spirits of wine, at the 
time it is wanted for use, and the sore and its edges covered with it. 
When it has been on a few seconds, a smart burning pain is felt, which 
continues to increase as long as the caustic is suffered to remain on, which 
it should be from half a minute to a minute, or even longer, according to 
the effects produced. After this the caustic must be all removed by means 
of a fine bone spatula, and the black eschar left may be covered with a 
poultice, a cold saturnine lotion, or fine, soft, dry lint. The pain soon sub- 
sides after the caustic has been removed. The parts touched by it are at 
once destroyed, and on the separation of the eschar, we have a clear granu- 
lating sore left, which commonly heals with great rapidity, particularly if 
the ulcer be a recent one. A poultice is the most convenient and best 
application during the time the eschar is separating, if the patient can rest, 
which should always be urged upon him as an essential point, if it can 
possibly be managed. The moment the eschar begins to be detached, and 
a secreting surface is exposed, the poultice must be done away with, and 
other remedies employed. Of these, weak lotions are the best. I employ 
weak solutions of the nitrate of silver, acetate or sulphate of copper, alum, 
or zinc, or tannin in port wine, in the proportion of about two drachms of 
the former to six ounces of the latter. 
There are certain conditions of primary venereal ulcer, which contra- 
indicate the use of the caustic in the first instance. If an ulcer of this kind 
produce violent inflammation of the penis, this must be reduced by a pro- 
per general treatment before we have recourse to these remedies, which 
may be used after the inflammation has been subdued, if the sore be foul, 
and stationary, and show no disposition to heal. 
Preliminary Cautions.—Whenever a patient consults you with a pri- 
mary venereal ulcer, particularly if it is the first from which he has ever 
suffered, point out to him in as strong tex-ms as you can the necessity of 
his adhering rigidly to a very abstemious diet till the ulcer assumes a 
granulating condition; it is well, also, at this period, to administer re- 
peatedly, for some few days, aperient medicine, and to insist on a total 
abstinence from malt liquor, wine, or spirits. If your patient, from cir- 
cumstances, cannot lie by and rest altogether, press upon him the advan- 
tage of retiring early to bed, rest in bed being a most important auxiliary 
in the treatment of all forms of primary syphilis. 
Mercurial Courses.—Whether it be your intention to submit your pa- 
tient ultimately to mercurial treatment or not, these preliminary cautions SYPHILIS, 
607 
should never be omitted. Many of the evils attendant on mercurial courses 
are to be attributed to not preparing the patient by diet, rest, and appe- 
rients, for the administration of this medicine. 
If you administer mercury for the cure of a primary venereal ulcer, do 
not have recourse to it till your patient has been prepared to receive it by 
adopting, for some days, the regimen laid down, and till all inflammation 
produced by the action of the escharotics has subsided ; you may then use 
it with every hope of realizing its most beneficial effects. 
Mr. Parker’s method of treating a bubo is equally judicious. When, as 
a consequence of a primary venereal ulcer not yet healed, or just healed, 
we perceive enlargement with tenderness in the groin producing stiffness 
when the patient walks, we may be sure that a bubo is about to form. I 
would not recommend you at this period to follow the old-fashioned prac- 
tice of applying leeches; it is a practice generally very unsatisfactory, ren- 
dering your cure long, uncertain, and tedious ; you must insist upon a strict 
regimen on the part of your patient, and absolute rest, if possible. You 
may smear the part thickly over with mercurial ointment, over this a lin- 
seed or a bread poultice, cold, and a piece of oiled silk to keep it moist, 
confining all by a bandage. Pressure may also be made by the emp. am- 
moniaci c. hydrarg. spread on thick wash leather, the plaster to be placed 
lengthwise parallel to the thigh, and not at right angles with it; this pre- 
vents the plaster getting displaced when the patient walks. The best 
means of all, however, is to paint over the enlarged gland night and morn- 
ing with a strong solution of iodine in hydriodate of potass. (Iodide, one 
scruple ; hydriodate of potass, two scruples; water, one ounce.) The effect 
of this is almost magical. In the intervals of the dressings pressure should 
be made by a pad and bandage. If the patient has not used mercury for 
the treatment of the primary sore, the dispersion of the bubo will be has- 
tened by now administering it so as gently to affect the system—always 
presupposing that the patient is in a condition to bear mercury. Should 
these means not succeed (which in a majority of instances they will), and 
suppuration appears inevitable, hasten it by all means in your power by 
warm poultices and fomentations. When matter is ready to be discharged 
a question of very great importance suggests itself—viz., how should this 
be done ? Many surgeons open the abscess freely with the bistoury or 
lancet, whilst some prefer the potassa fusa for this purpose. I would not, 
under ordinary circumstances, recommend either of these methods. 
When a bubo is ready to puncture, I would not advise you to open it 
by a free incision; for, almost under every circumstance where this is prac- 
tised, there is a quantity of integument in the edges, which will not unite 
with the granulating surface of the sore thus produced. By opening an 
abscess in this way the whole anterior wall of it is destroyed, and your 
cure must be performed by the cicatrization of a granulating surface which 
springs from the floor or posterior wall of the abscess. Your great object 
is to evacuate the matter first, then to diminish the disposition to its refor- 
mation, and lastly, to procure union of the two sides of the cavity. This 
may generally be done in the way I have adopted in the treatment of 
chronic abscesses in the Queen’s Hospital. 
When a bubo is ready to be opened, you should not suffer the skin to 
become too thin ; when you practise this method, with a fine lancet make 
several very small punctures over the thinnest part, perhaps, six, eight, or 
ten; through these the matter will ooze out till the cavity of the abscess is 
empty. Through one of the punctures the point of a very small glass 608 
SYPHILIS 
syringe may be introduced, and a very weak solution of the sulphate of 
zinc injected, in the proportions of two or three grains to the half pint of 
water. When the abscess is quite empty, place over it a large compress of 
lint, and use moderately tight pressure by means of a roller. In many in- 
stances, if you can keep your patient quiet for twenty-four hours, you will 
get either partial or total adhesion of the sides of the bubo, and a speedy 
cure will be the result; in other instances this may not be the case, but by 
the daily use of the injection througli one of the punctures, which should 
be kept open for that purpose, you will succeed in a few days, in ahnost 
every case, in effecting a cure. 
I generally employ for an injection in these cases the weak solution of 
sulphate of zinc. I have used also a weak solution of iodine in hydriodate 
of potass. 
Iodine, four grains; hydriodate of potass, eight grains; water, eight 
ounces. An injection. 
The injections must be varied in strength to suit the feelings of the pa- 
tient, or a gentle warmth and slight irritation should be experienced, but 
violent pain on no account produced. Solutions of the sulphate, or acetate 
of copper, alum, port wine, wine with tannin, may all be used ; and if one 
does not succeed quickly, have recourse to another. This is the best way of 
treating a suppurating bubo with which I am acquainted. Part vii., p. 140. 
Local Treatment of Chancres.—Dr. Strohl assures us that his local 
treatment of chancre is one of the most successful yet practised. It con- 
sists in cauterizing the sore if it is not much inllamed nor extensive. If it 
is so, he employs sulphate of copper instead, and dresses the part five or 
six times a-day with charpie soaked in a solution of about a grain and a 
half of sulphate of copper to an ounce of water. The sores will generally 
heal in about twelve days. At other times he uses an ointment composed 
of two grains of cyanuret of mercury to an ounce of axunge. This ointment 
is spread upon a piece of linen corresponding to the size of the sore. When 
this is too painful, it must be taken off for a time and replaced in a weaker 
form. When it has been on from four to ten hours, it is dressed with 
mercurial ointment, or opium cerate. Part vii., p. 167. 
Syphilitic Affections of Throat—Mercurial Cigars.—M. Paul Barnard 
proposed to the Acad, de la Medecine, the use of cigars impregnated with 
a weak solution of bichloride of mercury for persons affected with syphi- 
litic affections of the throat and palate, as a mode of conveying mercurial 
fumigation. It has been proposed first to deprive the tobacco of its nar- 
3otine by frequent washings. Part viii., p. 80. 
Success of Arsenic in Syphilis.—Dr. Sicherer, of Heilbrunn, cites the 
following case : A lady having become affected through her husband with 
the virus of syphilis, had at length passed through the various stages of 
that disease until about to sink under final marasmus. The palate and the 
organs of deglutition were destroyed to such an extent that scarcely any 
liquid could lie swallowed, and then only in a recumbent position. As a forlorn 
hope (for other remedies had been unsuccessfully employed), Sicherer had 
recourse to arsenic, ordering Fowler’s solution to betaken, at first in doses 
of two drops, but gradually increased to thirty drops, three times a day. 
The remedy was continued until about two ounces of the arsenical solution 
had been taken, by which time a considerable portion of the impaired struc- 
tures had been restored, and the faculty of deglutition regained; and after a 
period of ten years no relapse had been experienced. Part viii., p. 164. 609 
SYPHILIS, 
Proto-Ioduret of Mercury.—MM. Cullerier, Biett, Ricord and others 
employ this remedy in many forms of constitutional syphilis, especially 
where secondary and tertiary symptoms are combined, and in primary 
sores in strumous habits. Cullerier says that it is chiefly in constitutional 
syphilis that the proto-ioduret of mercury is administered with success. 
Its effects are principally evident in secondary ulcerations of the mucous 
membrane, cutaneous tubercles, exostoses, and chronic affections of the 
joints, where the other preparations of mercury have had little effect. It 
should always be guarded by opium, and given in half grain doses twice or 
thrice a day. The deuto-ioduret is more stimulating, and consequently its 
dose is smaller. Either of these may be employed in friction upon tumors 
and indolent buboes, after the removal of all acute inflammatory symptoms. 
Part ix., p. 21. 
Use of Mercury—Inunction preferred.—It is, perhaps, easier to know 
when we ought to administer mercury, than when we ought not. In per- 
sons of a scrofulous disposition, for example, who are disposed to phthisis, 
it requires the greatest discrimination: in such a case, however, we may 
be obliged to give it, knowing how frequently tubercles are developed 
in the lungs after any morbid poison has been circulating. This result 
may consequently follow an attack of syphilis as well as an attack of 
measles, scarlatina, or small pox. Sir B. Brodie prefers mercurializing a 
patient by inunction, to any other way, when the case is severe, and when 
the process is not inconvenient to the patient. It gripes and purges less 
than any other form, and is said to cure the disease a great deal better. 
Sir Benjamin even expresses his opinion of this method as follows : “ It 
does not damage the constitution half so much as mercury taken by the 
mouth; nay, I will go so far as to say that, except in very slight cases, you 
really cannot depend upon any mercurial treatment effecting a certain cure, 
or even giving a good chance of it, by any other means than inunction. 
You may very often patch up the disease by giving mercury internally, 
but it will return again and again and you may cure it at last by a good 
course of mercurial ointment.” In such a case, he recommends that the 
ointment be rubbed in at first before the fire, for three-quarters of an hour 
at a time, and afterward for a shorter time; the patient taking great care 
not to expose himself* to cold. Sir Benjamin further states, that we ought 
not to leave off the mercury as soon as the sore has healed, but to persevere 
in it till the hard cicatrix has disappeared. In short, he recommends us 
rather to recur to the old practice of using mercury in abundance, and 
warns us against using it too slightly, according to some modern notions. 
He says: “ You must not suppose that we have made an advance in all de- 
partments of surgery; on the contrary, I am sure that in some we have 
gone back. I am satisfied that the mercurial treatment of syphilis, as em- 
ployed by the late Mr. Pearson, during a great part of his life, was as 
nearly perfect as possible, and it was much more successful than the less 
careful treatment of modern practitioners.” Sir Benjamin’s method of 
using mercury in children, is, in our opinion, very judicious, as it prevents 
most of the griping and purging which follow the internal use. 
“ Children, when born, sometimes labor under syphilis, the father or 
mother having been affected with it—perhaps the father and not the mother. 
The child at birth looks thin, and is of small size, and instead of thriving 
it becomes still thinner. At the end of three weeks it is covered by a nasty,, 
VOL. ii.—39 610 
SYPHILIS. 
scaly eruption; there is a sort of aphthae in the mouth, and chaps about 
the lips and anus. I have tried different ways of treating such cases. I 
have given the child grey powder internally, and given mercury to the wet 
nurse. But mercury exhibited to a child by the mouth generally gripes 
and purges, seldom doing any good; and given to the wet nurse it does 
not answer very well, and certainly is a very cruel practice. The mode in 
which I have treated such cases for some years past has been this—I have 
spread mercurial ointment, made in the proportion of a drachm to an ounce, 
over a flannel roller, and bound it round the child once a day. The child 
kicks about, and the cuticle being thin the mercury is absorbed. It does 
not either gripe or purge, nor does it make the gums sore, but cures the 
disease. I have adopted this practice in a great many cases with the most 
signal success. Very few children recover in whom mercury is given in- 
ternally, but I have not seen a case where this method of treatment has 
failed. 
“ Mercurial inunction may be used in certain cases in which were mercury 
taken internally it would do absolute harm. For example, a gentleman 
had a nasty phagedenic sore upon the penis; it could not be said that he 
was in ill health before, and therefore there was some reason to believe 
that the disease was spreading from the intensity of the venereal poison. 
He had taken calomel and opium until the gums were sore, and he was 
decidedly worse under it. The disease destroyed a great part of the 
glans, and evinced no disposition whatever to stop. It resisted all 
modes of treatment until he was put on a course of mercurial inunc- 
tion ; its progress was then arrested directly, and the sore healed with 
great rapidity. I have seen several instances of the same character.” 
jPart ix.,p. 111. 
Prevention of the Contagion of Syphilis.—The problem of the means 
of extinguishing syphilitic contagion, appears to have been solved at the 
hospitals at St. Petersburg. In principle, it appears simple enough, the 
point to be effected being merely to prevent the absorption of mueo-puru- 
lent matter, either by means of washings, which remove it directly, or by 
liquids, such as the chloride of lime, which have the property either of de- 
composing it, or of preventing otherwise its inoculation. In practice, 
however, it proves a matter of great difficulty, especially in the female. In 
St. Petersburg, the most satisfactory results are said to have followed the 
use of the prophylactic soap of Dr. Pfeffer. The active ingredients of this 
soap appear to be—in 500 grains of the substance, six grains of bichloride 
of mercury, four of tannin, and forty-five of chloride of lime, incorporated 
into a soap with soda. Part ix., p. 180. 
Treatment for Buboes.—In commenting on the process adopted by M. 
Regnaud of treating buboes, by first blistering, then applying a corrosive 
stimulant, etc., Dr. Johnson states that the plan is needlessly complicated, 
and that the application of the caustic potash so as to form an eschar of 
sufficient depth is sufficient. He further says : 
Unquestionably the best method, as a general rule at least, of opening 
buboes is with caustic—in preference to the use of the knife—and we are 
therefore glad to find that Mr. Regnaud is in the habit of adopting it; the 
only objection we make to his practice is as to the mode of effecting this 
purpose. When the abscess is once fairly open, and its surface and edges 
are in an unhealthy condition, few applications are so good as the tinct. 611 
SYPHILIS. 
benzoini comp. (Friar’s Balsam), applied with lint; it is an admirable de- 
tergent to foul ulcers in general. Besides its stimulating and antiseptic 
properties, the balsam seems to act beneficially by totally excluding the 
admission of the air to the sore, in consequence of the varnished coating 
which it forms. When the ulcer is tolerably clean, but very tardy in heal- 
ing, we have seen excellent effects from covering it daily with a layer of 
powdered rhubarb. As a matter of course, bark and other tonics are 
generally required to be administered internally at the same time. 
Part x.,p. 161. 
Treatment of Secondary and Tertiary Syphilis.—M. Devergie, one of 
the physicians of the St. Louis Hospital, which receives a much larger 
number of syphilitic patients than any of the other hospitals in Paris—has 
met with great success in the treatment of the secondary and tertiary affec- 
tions by adopting the following remedies. The patient is to drink every 
day about a quart of a sudorific ptisan, in which from five to twenty grains 
of the ioduret of potash have been dissolved, and also to take every morn- 
ing, fasting, a pill composed of guiac, opium and a minute quantity of the 
corrosive sublimate. In the course of a week or so, a second pill is to be 
taken at night also. These medicines are to be persevered with for two or 
even three months, without intermission. A tepid bath is to be taken once 
a week. No wine is allowed; but milk is given freely instead. If the 
patient’s constitution has been much damaged by irregularity or want, 
M. Devergie recommends the use of some ferruginous preparation, or 
of bark, or of both together; at the same time diminishing the dose of 
the sublimate, if the state of the symptoms should still require its continu- 
ance. 
When, after six or seven weeks’ use of these remedies, the local symptoms 
still exhibit an unhealthy character, the application of the crystallized acid 
nitrate of mercury—dissolved in water, to which a few drops of nitric acid 
have been added—will be found most convenient. The ointment of the 
proto-ioduret of mercury is also a valuable application, to promote the heal- 
ing of certain ulcers. Part x.,p. 172. 
Treatment.—[With regard to the use of mercury, Mr. Carmichael 
says:] 
Primary Ulcer.—1st. I do not think it necessary in the treatment of the 
simple primary ulcer without induration, nor for the papular eruption, and 
other constitutional symptoms it produces; but should the eruption 
linger into the fourth or fifth week after it has desquamated into scaly 
spots or blotches, mercury in alterative doses, either in the form of 
Plummer’s pill or the proto-ioduret of mercury, will be of service in clear- 
ing the skin of the eruption, and in removing the pains of the joints* 
which are constantly present in this form of venereal. But I protest most 
strongly against the use of mercury at the period when the eruption first 
appears in its papular form, at a time that it is usually preceded and 
accompanied by considerable fever, like all the other exanthemata, to 
which class of Cullen it obviously belongs. If we should exhibit mercury 
prematurely during the eruptive stages of this as well as the other forms of 
disease, the scaly excepted, we may possibly clear the skin of the eruption, 
but in all probability it will return again to the great disappointment of the 
patient and perplexity of the medical attendant. 
Iritis.—2d. For iritis I would give mercury, so as to excite its full 612 
SYPHILIS. 
effect upon the system, and at the same time not neglect the usual anti- 
phlogistic measures to remove this dangerous inflammation. 
Nodes.—3d. For nodes I would exhibit mercury, and I think the 
iodide of that mineral for their removal is superior to any other prepara- 
tion. 
Phagedemic Ulceration.—4th. For phagedenic primary ulcers I have 
always found mercury most injurious. 
Use of Nitric Acid.—They are most successfully treated by the applica- 
tion of strong nitric acid, immediately followed by a douche of cold water. 
The same application is also the most efficient for phagedenic ulceration of 
the throat, which if not checked will soon extend over the velum, uvula, and 
back of the pharynx, from whence it will spread upward into the nares, 
and downward into the larynx. In either of which situations I need not 
state the difficulty and danger of the case. Instead of the douche of cold 
water, in this situation inadmissible, I employ a probang, the sponge 
moistened in a solution of soda or potash will neutralize any superabun- 
dant acid applied to the ulcers. 
Scaly Eruption.—During the eruption of pustules or tubercles which 
cause those crusts termed rupia, I have found mercury injurious, although 
its exhibition may at first flatter both patient and surgeon that the disease 
is yielding to this remedy. But the natural tendency of this eruption is 
also to become scaly after it has existed several weeks or months. This 
scaliness is a sign that the disease is on the decline, and indicates that 
mercury in alterative doses may then be employed with safety and 
advantage. Should any of the constitutional ulcers on the skin spread 
after the rupia crusts fall off, their progress may also be effectually checked 
by the application of nitric acid to their phagedenic margins. They of 
themselves first show signs of healthy reparation in their centres, which 
need not therefore be meddled with. Mercury in this stage of the disease 
should not be exhibited. Hydriodate of potash, sarsaparilla, country air, 
and the tranquillizing effects of opium, should the patient be harassed by 
extensive ulceration, are the constitutional means most to be relied upon. 
Hunterian Chancre. — 5th. For the true Hunterian chancre with 
hardened edge and base, and for the scaly eruptions which attend it, as 
well as the deep excavated ulcer of the tonsil, nodes, and other symptoms 
belonging to this form of disease, mercury may be esteemed a certain and 
expeditious remedy. Part xi., p. 174. 
Infantile Syphilis.—[In the treatment of congenital syphilis, marked by 
copper-colored blotches over various parts of the body, Dr. Bird has 
found that two grains of hyd. cu. creta, continued for a fortnight or so. by 
which time the eruption has usually faded very much, and then the admin- 
istration of pot. iodid. gr. j. in 5ij. sir. sarzae, ter die, will soon effect a 
cure. Dr. Bird remarks that syphilitic eruptions are exceedingly frequent 
among the infants of the lower classes, and that the simple treatment just 
mentioned is very effective in their cure. There are few affections among 
children, the treatment of which is more satisfactory than that of syphilitic 
eruptions ; indeed they seem to fatten upon their medicine. If the mercury 
.cause diarrhoea, it is sufficient to suspend its use for a time. The diagnosis 
of this disease is frequently mistaken, though of great importance, as while 
it readily yields to proper treatment, it is extremely obstinate when mis- 
managed.] 613 
SYPHILIS. 
There is seldom any real difficulty in the diagnosis of these cases when 
once the practitioner has learnt to recognize them. The characteristic 
snuffling will often enable him to recognize the existence of disease, even 
before he has confirmed his opinion by visual examination. The puckered 
mouth, the position of the very characteristic eruption round the lips and 
anus, in addition to the peculiar varnished and fissured appearance of the 
parts from which the scales have faded, will seldom if ever fail to convert a 
suspicion of the true nature of the disease into positive certainty. Condy- 
lomatous excrescences from the margin of the anus have never, in any of 
the cases, accompanied the earliest development of the syphilitic affection, 
but were always secondary, being observed in those children only whose 
primary affection was neglected or incompletely eradicated. When the 
eruption occurring on the nates and face in the first few weeks of life had 
been promptly treated, no condylomata appeared on the anal margin, at 
least so long as the children were kept in sight. But on the contrary, 
when the eruptions Avere neglected, condylomata were the almost certain 
results. I have not treated any case by the iodide of potassium alone, 
although this drug appeared to be of peculiar service after the mercury had 
produced a decided effect on the disease. Part xi., p. 175. 
Mr. Acton employs the subjoined treatment: 
Syphilitic Alopoecia.—Cut the hair close, and use warm baths; and 
then apply the following liniment: Equal parts of rectified spirit, eau de 
cologne, and castor oil; or equal parts of honey-water and tinct. can- 
tharides. Should little red spots or blisters be produced, cease the appli- 
cation for a short time. 
Lichen, Lepra, Psoriasis, Impetigo, etc.—Frequent warm baths, taking 
care to soak the head well; and cover the spots nighty and morning with 
olive oil, §ss. ; citrine oint., 3j.; M. Make a liniment. Or use the fol- 
lowing ointment: purified beef marrow, sixteen parts ; sulphur ointment, 
sixteen parts; turpeth mineral, two to four parts; essence of lemons 
sufficient to scent it. (Ricord.) 
Mucous Tubercles.—Use a dilute solution of chloride of sodium; dry the 
parts and sprinkle them over with calomel. Great cleanliness is necessary; 
do pot use ointments. 
Eczema Impetiginoides.—Cut the hair close, and apply water dressing, 
or lint dipped in an aqueous solution of opium; do not apply ointments. 
It should be a rule never to apply greasy substances to any eruption 
attended with oozing of fluid, since it mixes with the secretion, becomes 
rancid, forms a crust, the edges of which become excoriated, and what 
was an effect becomes a cause of irritation. Paint gummata and nodes 
with tinct. of iodine; it may also be applied to unhealthy tertiary ulcers. 
Give internally, in secondary forms of syphilis, iodide of potassium or 
mercury: some prefer the former, as Dr. Williams, others the latter, as Sir 
B. Brodie. The following should be our guide in giving the iodide of 
mercury: Secondary symptoms occurring after a course of mercury, will 
be benefited by a course of iodide of potassium. Secondary symptoms 
occurring where mercury has not been used, will not yield to the iodide, 
but will to mercury. In order to prevent the iodide from causing pain at 
the pit of the stomach, or heat at the back of the throat soon after swal- 
lowing it, dissolve two drachms in three ounces of water, and let the 
patient take a teaspoonfnl of this solution night and morning in a large cup 614 
SYPHILI8 
of tea, and the same quantity in half a pint of beer, or other fluid, at mid- 
day ; the dose to be continued and increased according to circumstances. 
It is of no use increasing the dose, or indeed of continuing this remedy 
beyond a week or ten days, if no amendment is visible. If mercury has 
not been given for the primary symptoms, begin with it immediately when 
secondary symptoms appear. Ricord gives the pure mineral, but the 
hydr. c. creta will answer best. If the organs of digestion be impaired, 
use friction ; direct the size of a horse bean of ung. hydr. to be smeared on 
the inside of each calf of the leg every night; do not rub it in, as you 
irritate the hair bulbs by doing so, and you produce subsequent tenderness. 
Direct your patient to sleep in old drawers, so as to keep the bed clean. 
Do not use the ointment to the thighs, as is usually recommended; it gets 
between the thigh and the scrotum, producing eczema ; it also dirties the 
patient’s linen, and excites the attention of the washerwoman. Get the 
patient firmly under its influence before you discontinue the use of mer- 
cury. 
Chancre.—Wash the part well with warm water, and then apply the 
solid nitrate of silver; it will completely destroy the affection, if not more 
than of three days’ standing. If it be a pustule, evacuate its contents, 
and the walls of the pustule are to be well cauterized. When there is a 
chancre of the frenum, it is more readily healed by dividing it, and caute- 
rizing the whole of the divided surface. To check discharge, apply a 
solution of pure tannin—two grs. to the ounce of water ; or sulphate of 
zinc solution, in private practice, as the former tells tales.by staining the 
linen. The caustic should be reapplied as soon as the eschar is removed, 
or about once in twenty-four hours. If lint have been applied after the 
caustic, take care to soak it well before you remove it, or the eschar may 
be detached, and the part made to bleed. If the case be seen early, one or 
two burnings will suffice; if at a more advanced period, it must be 
repeated at intervals of twenty-four hours—for a week or ten days, or as 
long as we consider any virus is secreted by the sore, which is known by 
the ulcers remaining stationary, and the surface being covered with a yellow 
pellicle; when becoming healthy, granulations spring up and the sore 
heals. Caustic is not so efficacious when the chancre is situated on the 
frenum, orifice of the urethra, around the prepuce, or on the fourchettfe in 
the female—enjoin rest and strict attention to cleanliness, and avoid 
rupturing the cicatrix. Fart xiii., p. 274. 
Treatment of Secondary and Tertiary—Secondary form of Syphilis.— 
M. Ricord advises, to give the proto-iodide of mercury, and should it 
occasion irritation in the bowels with diarrhoea, combine it with opium. 
Let the diet be simple, avoiding all stimulants whether solid or fluid; the 
diet, however, should not be debilitating but nutritious. Cold and damp 
air is very injurious ; fresh air is highly necessary. 
Tertiary form of Syphilis.—The characteristic of these symptoms, is 
their not being transmissible hereditarily. They are manifested chiefly in 
the subcutaneous or submucous cellular tissue, in the fibrous, osseous, 
cartilaginous, muscular or nervous tissues, and organs in their locality. 
The remedy most to be depended upon is mercury. Part xiii., p. 280. 
Repellent treatment of Buboes.—The method pursued by M. Malapert 
is to apply a blister the size of a crown for twenty-four hours, then raise 
the cuticle, and apply a pledget of lint of corresponding size, well saturated 615 
SYPHILIS. 
with a solution of bichloride of mercury (a scruple of the salt to one ounce 
of spt. vini rectif.); keep it in situ from two to four hours, and then apply 
cold applications for some hours; an eschar is formed, which will be 
thrown off, and the tumor will be dispersed. Part xiii., p. 283. 
Chancre.—If seen within three days, says Mr. Acton, apply nitrate of 
silver freely, and secondary symptoms need not be feared, and even after 
this time, in nine cases out of ten, the same results will take place. There 
are some indications, however, against the use of caustic, and these are 
inflammation, or great irritation of the part; but, perhaps, the most 
important indication, against its use, is induration of the sore ; the consti- 
tution is sure to be affected when this occurs, and mercury must be given. 
Part xiv., p. 222. 
Secondary Syphilis—Pains in the Pong Bones, etc.—Mr. Ormerod 
directs us to give hydriodate of potash, five to eight, or to fifteen grains 
three times a day, and, if not successful in a few days, then mercury may 
be had recourse to. Where the secondary symptoms are scaly eruption, 
excavated ulcer of the tonsil, swelling of the testicle, excavated ulcer of 
the tongue, acute ulcers of the edges of the eyelids, iritis, purulent dis- 
charge of the meatus auditorius externus, papular eruption without fever, 
desquamating tubercular and pustular eruption, secondary ulcers, fissured 
tongue, ulceration round the nail, phagedenic ulcers of the skin, and foul 
sloughy ulcerations of the pharynx, they will be benefited by mercurial 
fumigations* Part xiv., p. 227. 
Bromide of Potassium in Secondary Syphilis.—The low price of the 
bromide compared with that of the iodide of potassium, lias induced 
M. Ricord to substitute that salt for the iodide in the treatment of 
secondary syphilitic affections. The dose of the bromide is the same as 
that of the iodide of potassium. It has produced the same therapeutical 
effects, but more slowly. Part xiv., p. 229. 
Bubo.—Prof. Porter advises to open it as soon as matter can be de- 
tected, and by a very free incision, so as to prevent the lodgment of a 
drop of matter. Part xv., p. 236. 
Treatment of Chancre.—Mr. Ormerod directs the use of the black wash 
to the sore, and when it is healed, and induration remains, rub on a little 
strong mercurial ointment, and keep constantly applied a piece of leather 
smeared with it. 
Give in old cases small doses of hydr. c. creta, perseveringly, for a long 
time. If a quick action is desired give mercury by friction; but usually 
blue-pill is the best preparation. In phagedenic ulcers give calomel and 
opium so as rapidly to induce mercurial action, and when the phagedena 
is checked give a milder preparation. Some phagedenic sores, however, 
require depletion and purgatives : others wine and opium. To unhealthy 
and exhausted subjects give hydriodate of potash and sarsaparilla. 
Part xv., p. 246. 
Secondary Syphilis—Treatment of at St. Bartholomew's Hospital—- 
Papular Eruptions.— Treat antiphlogistically at first, then give mild 
mercurials, with tonics and the warm bath. 
Scaly.—Give mercury, or, Avhen slight, iodine will do. 
Tubercular.—Iodine is the best remedy. 616 
SYPHILIS, 
Pustular.— Give mercury cautiously, and apply yellow wash to the 
ulcers into which the pustules degenerate: if, hovever, these are large and 
shallow, give iodine : or if round and excavated, give opium with iodine, 
and nutritious diet, and apply black wash. 
Ulceration of the Throat.—Give mild mercurials; or, if sloughy, iodine 
with wine and good diet. Use cinnabar fumigations, especially to the ex- 
cavated ulcer, but with caution. 
Ulceration of the Larynx, Tongue, etc.—Give mercury or iodine, or 
both, according to the accompanying symptoms. 
Pains in the Pones.—Iodine is the best remedy; but in some cases re- 
quire mercury, others incisions. 
Nodes.—Give iodine; if recent and soft, apply mercurial ointment on a 
piece of leather. Part xv.,p. 247. 
Treatment of Syphilis.—[Mr. Christophers has been in the habit of 
recording his experience of syphilitic cases for some years; and he has 
been able to observe a considerable number of cases for years after their 
treatment. He has come to the conclusion that syphilis, in the present 
day, is a disease which, even without treatment, produces few symptoms 
of severity; and which, itself tending to its own cure, is very amenable 
to rational treatment. In a case of real chancre, unless destroyed by 
excision or caustic before the fourth day, secondary symptoms will certainly 
supervene, whether the treatment have been “mercurial,” cr “simple: ” and 
the severity of the secondary symptoms is in proportion, not to the number 
nor to the severity of the primary sores, but to their duration. If this 
be true, the best treatment is that by which the primary sore is most 
rapidly healed. Mr. Christophers says respecting treatment:] 
It has been observed that some sores are very slow to heal under simple 
treatment, but that immediately the system is brought (though ever so 
slightly) under the influence of mercury, they rapidly progress toward a 
cure. Now here I believe the advantageous use of mercury stops; pushed 
beyond this, it becomes a positive evil. 
I have treated cases of syphilis on a plan differing from both the mer- 
curial and simple systems, and in every case it has succeeded well. Having 
first convinced myself, by the aid of inoculation (I am speaking of cases 
in which the sore has existed beyond the period assigned it as a local 
disease,) that it is a genuine chancre I have to treat, I prescribe calomel, 
in one or two grain doses, till the gums give the slightest evidence of its 
effect. This accomplished, I suspend it at once, and begin with small 
doses of the hydriodate of potass, with sarsaparilla; and it is a curious 
fact, that if the gums are made slightly sore with mercury, that action 
will be maintained in them by very small doses of the hydriodate, though 
it does not produce that effect generally, if mercury have not been given. 
The object in giving the mercury is speedily to heal the primary sore; the 
object of the iodine and sarsaparilla, to put the system in the most favor- 
able condition to encounter the secondary affection that must (in some 
shape) inevitably ensue. Part xvi., p. 213. 
Comparative effects of Bromide and Iodide af Potassium in the 
treatment of Secondary Syphilis.—Some time ago, Dr. Egan’s attention 
was directed to preparations of bromine as a substitute for those of iodine, 
which had attained a very high price. His experiments led him to the 
conclusion that the bromide of potassium is comparatively inert. 
To detect the Adulteration of the Iodide with the Bromide of Potas- 617 
SYPHILIS. 
slum.—Take of the suspected salt one drachm, dissolve in two ounces of 
distilled water, of sulphate of copper two drachms, dissolved in the same 
quantity of distilled water, mix, and put both into a clean oil flask, and 
boil till the vapor from the flask will not produce any effect upon a piece 
of paper, to whose surface a solution of starch has been applied, the fluid 
remaining in the flask, if impure, will immediately, on the addition of a 
few drops of a solution of chloride of lime, give the usual orange color of 
bromine which will be rendered more apparent by the addition of a little 
starch. Bromide of potassium is not precipitated by sulphate of copper, 
in which it differs from the iodide. Part xvi., p. 214. 
Urethral Chancre.—When secondary symptoms appear to follow blen- 
norrhagia, this virulent blennorrhagia as it is called, is the result of a ure- 
thral chancre; this M. Ricord has proved by observation both on the living 
and the dead. 49 
During the first few days, employ the abortive treatment. The patient 
having passed water, M. Ricord injects into the urethra a little of a solu- 
tion of nitrate of silver, fifteen grains to the ounce, from a glass syringe ; 
the only precautions needed are to press the lips of the meatus so as to 
bring them in close contact with the pipe of the syringe, and to make the 
injection pass suddenly, so as to take the urethra by surprise. Repeat the 
injection at the end of two days ; but if the first application does not cause 
pain and sero-sanguineous discharge, followed by creamy suppuration, re- 
peat it on the same day. At the same time give copaiba and cubebs. 
Part xvii., p. 183. 
Treatment of Chancre.—M. Sisovics, chief surgeon to the general hos- 
pital of Vienna, directs at first, to use local emollients and baths; and 
when the syphilitic character of the ulcer is manifest, give diaphoretic 
drinks of decoction of sarsaparilla, or guaiacum, and then give the prepa- 
rations of iodine, and use them externally in the form of local baths and 
fomentations. Part xvii., p. 186. 
Treatment of Venereal Disease Generally.—[At the end of this course 
of lectures on venereal disease, published in the “ Lancet,” M. Ricord 
gives the following recapitulation of the doctrine he inculcates :] 
The great class of venereal diseases comprises two very distinct orders— 
first, the non-virulent diseases, the type of which is blennorrhagia; the 
second, the virulent diseases, the type of which is chancre. 
First Order.—The blennorrhagic affections do not taint the constitution, 
are not transmissible by hereditary, and never yield any positive results by 
inoculation either on the skin or mucous membranes : they are contagious 
in the manner of irritants, the simple catarrho-phlegmonous discharge be- 
ing the most common form. 
Second Order.—The virulent affections owe their origin to a peculiar 
principle, to an ulceration which can be reproduced at will, and inoculable 
within a certain period. The ulceration always springs up at the very spot 
where the virulent matter has been implanted, and its evolution takes 
place in a variable space of time. The virulent effect may remain strictly 
local, and merely give rise to consecutive phenomena, of which the most 
oommon is the suppuration of the inguinal glands ; but it may penetrate 
into the economy, and determine in the same a set of characteristic symp- 
toms. The general infection of the system is the result of an idiosyncrasy 
which does not invariably exist in every individual. The most tangible 618 
SYPHILIS. 
phenomenon of this infection is the specific induration of the chancre. 
There is no such thing as a specifically indurated chancre, without subse- 
quent symptoms of constitutional syphilis. Once or twice in a hundred 
cases the induration may be ill-defined, and pass unnoticed ; but if the at- 
tention be directed to the inguinal glands (which inevitably suffer by the 
infection), the existence of an indurated chancre may, by their state, be 
inferred; for a bubo, consecutive to such a chancre, never suppurates spe- 
cifically. There is no constitutional syphilis without a primary local acci- 
dent. When the infection has taken place, we may look for the secondary 
manifestations within a twelvemonth. But if a mercurial treatment be 
used, these manifestations may be prevented or retarded for more or. less 
time, or perhaps forever. When no treatment, however, has intervened, 
there is an admirable order in the succession of the manifestations, which 
is denied only by those people who will not be convinced. Primary, con- 
secutive, secondary, transitory, and ternary accidents follow each other 
with the most perfect regularity. But I repeat it—a treatment breaks up 
the order altogether. If a mercurial course has been gone through, the 
secondary manifestations may, under its influence, be retarded for a varia- 
ble time; but it does not destroy the diathesis, and merely postpones the 
secondary symptoms. On the other hand, you will remember that the 
mercurial treatment does not prevent tertiary accidents, and these may 
even appear whilst the secondary symptoms are being kept off by mercury; 
the latter may then make their appearance after the tertiary accidents have 
disappeared, and thus the order of the manifestations may be totally in- 
verted. Constitutional syphilis can be contracted but once—the diathesis 
can never be doubled. The diathesis persists, but the manifestations are 
not certain or inevitable. This diathesis is not incompatible with health. 
Syphilitic cachexia is very rare. The non-virulent affections require no 
specific medication, neither do the virulent primary accidents ; mercury is 
used for the latter only in exceptional cases; namely, where the chancre 
is indurated. 
Constitutional syphilis demands a mercurial treatment; but when the 
later secondary symptoms and the tertiary have come on, mercury should 
be abandoned, and iodide of potassium be taken up. The latter is then the 
medication par excellence. Whenever we have to treat any peculiar disor- 
der or affection of the viscera, along with syphilis, we should never lose 
sight of the indications which belong to that intercurrent disease, and 
should even delay the specific medication, if found necessary. 
[Dr. de Meric, the reporter of these lectures, subjoins the following list 
of formulae used by M. Ricord at the Hospital du Midi:] 
Non- Virulent Diseases.—1. Injection for Balano-posthitis.—Make three 
injections a day between the glans and prepuce with the following fluid: 
distilled water, three ounces ; nitrate of silver, two scruples. 
2. Abortive Treatment of Blennorrhagia.—Make one injection only with 
the following liquid: distilled water, one ounce; nitrate of silver, fifteen 
grains. And take every day, in three doses, the following powder : 
cubebs, one ounce; alum, thirty grains. 
3. Injection for Blennorrhagia when the period for the Abortive Treat- 
ment is passed.—Make three injections daily with the following liquid: 
rose water, six ounces and a half; sulphate of zinc, and acetate of lead, of 
each, fifteen grains. 
4. Internal Treatment of Blennorrhagia.—Take one tablespoonful of SYPHILIS. 
619 
the following emulsion three times a day: copaiba, sirup of tolu, and sirup 
of poppies, of each, one ounce; peppermint water, two ounces; gum 
arabic, a sufficient quantity; orange flower water, two drachms. 
5. Acute stage of JBlennorrhagia.—Twenty leeches to the perineum; 
bath after the leeches; refreshing drinks; rest in bed; low diet; suspen- 
sory bandage. Take one of the following pills four times a day; expressed 
and inspissated juice of lettuce (lactuca sativa) and camphor, of each, forty- 
five grains : make twenty pills. 
6. Gleet.—Make every day three injections with the following liquid : 
rose water, and Roussillon wine, of each, six ounces ; alum and tannin, of 
each, ten grains. 
7. Subacute Epididymitis.—Rub the testis twice a day with the follow- 
ing ointment: stronger mercurial ointment, and extract of belladonna, equal 
parts of each ; a poultice to the part after the ointment, and rest. 
8. Acute Epididymitis.—Fifteen leeches to the perineum, and the 
same number in the groin corresponding to the affected epididymis; bath 
after the leeches; barley-water for common drink; low diet, rest, and 
poultice. 
9. Chronic Epididymitis.—Apply Vigo’s plaster to the testes, and wear 
a suspensory bandage. (Simple plaster, yellow wax, pitch, ammoniacum, 
bdellium, ohbanum, mercury, turpentine, liquid styrax, and volatile oil of 
lavender, are the component parts of Vigo’s plaster.) 
'Virulent Diseases—Primary Symptoms.—10. Abortive Treatment of 
Chancre.—Within the first five days of the contagion, destroy the chancre 
with potassa fusa cum calce (pate de Vienne.) 
11. Regular non-indurated Chancre.—Frequent dressing with the aro- 
matic wine, extreme cleanliness, occasional light cauterization with the 
nitrate of silver. Rest, demulcent drinks; when there is inflammation, 
antiphlogistics, purgatives, and emollient applications. (N.B.—No mer- 
cury.) Ji 
12. Phagedenic Chancre.—Complete cauterization with the nitrate of 
silver, the liquid nitrate of mercury, the potassa cum calce, or the hot iron, 
according to circumstances. Afterward lotions with aromatic wine, three 
ounces; extract of opium, three grains; or, aromatic wine, eight ounces; 
tannin, thirty grains; or, distilled water, three ounces; tartrate of iron 
and potash, four drachms ; or, in the scrofulous diathesis, distilled water, 
three ounces ; tincture of iodine, one drachm ; or, sulphur ointments, and 
sulphureous baths. Internally: tartrate of iron and potash, one ounce; dis- 
tilled water, eight ounces. One ounce three times a day. 
13. Indurated Chancre.—Three dressings a day with the following 
ointment: calomel, one drachm; axunge, one ounce. (N.B.—Mercury is 
used internally for the indurated chancre : as to the mode of administra- 
tion, see secondary syphilis, No. 21, aS the metal is given in the same man- 
ner in both cases.) 
14. Acute, non-Specific Adenitis, vel Inflamed Bubo.—Twenty leeches 
on the tumor, emollient cataplasms, barley-water as ordinary drink, rest, 
broths. If fluctuation be detected, let out the purulent matter by a free 
incision. 
15. Abortive Treatment of the Bubo consecutive, by absorption of the 
Virus, to the Non-indurated Chancre.—Deep cauterization of ten minutes’ 
duration, with the potassa fusa cum calce, and await the fall of the eschar. 
(N.B.—Analogous to the early destruction of chancre.) 620 
SYPHILIS, 
16. Bubo consecutive to the Non-indurated Chancre, which inevitably 
Suppurates.—Use antiphlogistics according to circumstances, and then free 
the purulent matter by cauterization with potassa fusa; gradually destroy 
afterward, by the use of caustics, the glandular mass which lies at the bot- 
tom of the open bubo. To the poultices used after cauterization may be 
added an ointment, of equal parts of extract of belladonna and mercurial 
ointment. 
17. Ilorse-shoe Bubo and Gangrene.—Horse-shoe and phagedenic ul- 
cers in the groin, resulting from a suppurating bubo, require the dressing 
mentioned in No. 12. Gangrene: chloride of lime, one ounce; distilled 
water, three ounces. This lotion is to be used several times a day. Or, 
powdered charcoal, powdered Peruvian bark, equal parts of each, to be 
thickly applied to the sore. 
18. Phimosis.—Inject between the glans and prepuce the aromatic wine 
with opium, as mentioned in No. 12, and use emollient and sedative appli- 
cations ; if gangrene be imminent, operate. 
19. Paraphimosis.—Keep the organ raised, and surround it with cold 
compresses. Bland diet, refreshing drinks ; endeavor to reduce or free 
the constriction by an incision, according to circumstances. After the 
strangulation is relieved, use emollient and antiseptic applications combined 
with opium. 
20. Scrofulous Complications.—Order every day the following emulsion 
in three equal doses : iodine, three grains; oil of sweet almonds, one 
ounce ; gum arabic, a sufficiency; almond emulsion, three ounces. 
21. Secondary Symptoms.—Order every day three tumblers of decoc- 
tion of saponaria leaves, and put into each tumbler one tablespoonful of 
sirop de cuisinier (N.B. Sirop de cuisinier: sarsaparilla, borage and white 
rose leaves, senna, aniseed, honey, and sugar;) and take every day one 
of the following pills : proto-iodide of mercury, inspissated juice of lactuca 
sativa, of each, forty-five grains; extract of opium, fifteenigrains; extract 
of hemlock, one drachm and a half. Mix, and make sixty pills. 
22. Slight Stomatitis.—To gargle three times a day with the following 
liquid: decoction of lactuca sativa, five ounces; honey, one ounce and a 
half; alum, one drachm and a half. 
23. Mercurial Stomatitis.—To gargle three times a day with the follow- 
ing liquid : decoction of lactuca satita, five ounces; honey, four drachms ; 
hydrochloric acid, fifteen drops. 
24. Salivation.—Order every day one drachm of flowers of sulphur in- 
corporated with honey. As a common beverage, the nitric acid lemonade. 
Gargle three times a day with decoction of lactuca sativa, five ounces; 
honey, four drachms ; hydrochloric acid, fifteen drops. 
25. Mucous Patches in the Mouth.—Gargle three times a day with 
decoction of hemlock, six ounces and a half; bichloride of mercury, three 
grains. 
26. Mucous Tubercles around the Anus (Condylomata.)—Put twenty 
leeches to the perineum. Take every evening a small enema of a decoc- 
tion of poppyheads, cold, and mixed with twenty drops of laudanum. As 
a habitual beverage, take linseed tea, sweetened with sugar and almond 
emulsion. 
27. Vegetations.—Put twice a day on the vegetations the following 
powder: powdered savine, oxide of iron, calcined alum, of each one 
drachm. Part xviii., p. 205. 621 
SYPHILIS. 
Treatment of Tertiary Symptoms.—[Tertiary symptoms, M. Ricord 
observes, will not inevitably occur in the course of syphilis, but they are 
very likely to do so if the treatment of the primary and secondary symp- 
toms be not conducted with the greatest care. As soon as ever the 
tertiary period has set in, mercury must be abandoned, and iodide of 
potassium given. Ray, further, as mercury, taken in time, may prevent or 
retard secondary symptoms, and so may be regarded as a prophylactic 
against them, so may iodide of potassium be regarded as a prophylactic 
against tertiary symptoms; and therefore M. Ricord observes:] 
To render the treatment of secondary syphilis complete and rational, it 
should always be followed by the exhibition of iodide of potassium. This 
substance is, however, not only useless, when employed against secondary 
symptoms and those of transition, but very often hurtful; yet, when 
secondaries have been of long standing, it may produce beneficial effects; 
it is also useful as an adjuvant of mercury, in those affections which in 
some degree lie between the secondary and strictly tertiary manifestations; 
and, finally, it is indispensable for combating the symptoms of a decided 
tertiary nature. In order to become well acquainted with the proper 
manner of administering the iodide of potassium, we should take the 
trouble of studying its effects, independently of its curative action. First 
let us see how it acts on the skin. It may produce on the cutaneous sur- 
face diverse psydracious and acnoid eruptions. The pustules are generally 
surrounded by a vividly red areola, and the usual seat of these eruptions 
is below the umbilical region, as the nates, thighs, etc., whereas the com- 
mon acne (not to mention its other characters) is mostly situated in the 
upper half of the body. To these peculiarities, it may be added, that the 
pustules will fall in immediately the administration of the iodide is inter- 
rupted. Exanthemata, impetigo, and lichen, are very apt to be produced 
by the use of this salt; and what you ought especially to keep in mind is, 
that ecchymosis, and purpura in the inferior extremities, are sometimes 
caused by the action of the iodide of potassium. The effects of the latter 
on mucous membranes should also be carefully observed. It may cause 
inflammation of the conjunctiva, the sub-mucous cellular tissue lying under 
which gets then infiltrated and puffed up; the eyelids turn red and 
cedematous, and when the inflammation and effusion are not arrested, the 
internal parts of the eye become involved in the affection, and photophobia 
is the result of this state of things. The normal mucous secretion is 
always a little increased, but it does not take the muco-purulent character, 
as in the case of catarrhal ophthalmia. Coryza, of a more or less severe 
nature, often exists at the same time: it is preceded and accompanied by 
headache, and a pretty abundant mucous secretion; but this coryza never 
reaches the suppurative state; it never produces more than a catarrho- 
serous flux. These affections never give rise to any fever, and they disap- 
pear as soon as the iodide is given up. This coryza is an accident which 
we should not overlook, for it is of importance to avoid it when we have 
to treat a tertiary affection of the nasal fossae. As for the effect of the 
iodide on the intestinal canal, I have to state that persons enjoying good 
health can bear very large doses of it; I have given as much as fifteen 
drachms a day. M. Puche has often given ten drachms per diem, after 
commencing with six; and it has been noticed that it improves the appetite 
of the persons who use it. With some patients a certain pleurodynic sen- 
sation, corresponding to the cardiac extremity of the stomach, is felt after 622 
SYPHILIS, 
its ingestion, but it never causes vomiting. The sub-mucous cellular tissue 
of the stomach may, by the use of this iodide, undergo the same modifica- 
tions which we have noticed the conjunctiva to be subject to—a sort of 
hyper-secretion and intestinal ptyalism takes place, and much of the fluid 
which ought to have been secreted by the skin is rejected by the mouth. 
This liquid has a slight taste of iodine; it is not fetid in the least: the 
gums are not swollen, and there is no fetor in the breath, as happens in 
mercurial ptyalism. The same effect may be produced on the other por- 
tions of the intestinal canal; the patients are then seized with abundant 
serous diarrhoea. The iodine is eliminated from the system by the kid- 
neys ; half an hour after the ingestion of it, its presence may be ascer- 
tained in the urine, and it should be remembered, that the presence of 
iodine in the blood increases the renal secretion. I have even observed a 
case of polydipsia which went on as long as the iodide was used, but dis- 
appeared when the latter was discontinued, and gradually sprang up again 
as the use of the salt was resumed. 
The effects of the iodide of potassium on the circulation are of a seda- 
tive kind ; it diminishes the number of arterial pulsations and lowers their 
force, but they may regain their normal standard if the remedy act bene- 
ficially on the system; the same arterial energy may also reappear when 
the iodide causes a slight phlegmasia. This salt is somewhat antiplastic, 
for it has rather a tendency to liquefy the blood, and may even produce 
the peculiar hemorrhages of purpura. When the effect of the iodide on 
the nervous system is carefully watched, it is found to cause a certain 
excitement of the nervous centres, followed by a little uncertainty in the 
movements and in the intelligence. 
Doses and Forms.—If the efficacy of the iodide of potassium has ever 
been doubted, it is because no one would venture to give it in doses suffi- 
ciently large to test it fairly. Most practitioners confined themselves to 
three or four grains a day—no wonder that no effects were produced. The 
daily dose ought to be fifteen grains to begin with; two or three days 
afterward, forty-five grains may be given every day in three distinct doses. 
If the remedy has no pathogenic effect we must be guided by the thera- 
peutic action, so that if the curative effect be not apparent at all in three 
or four days, the dose should be augmented. The influence produced on 
the osteoscopes may very well serve as a criterion of the action of the 
remedy, provided these osseous pains do not arise from suppuration, and 
they be strictly a result of the diathesis. I have had patients in whom 
the removal of these pains required as much as one drachm and a half, two 
drachms, and even three drachms per diem. 
Forms.—The iodide of potassium has been given in capsules, in solution, 
in sirup, etc.; rarely in the form of pill, for this salt is very deliquescent; 
I generally give it in sirup, and I have found bitters to be the best adju- 
vants—viz., sirup of gentian, of saponaria, of quassia, de cuisinier, of 
sarsaparilla, etc. One pint of sirup is to be used for one ounce of the 
iodide, which will give about twelve grains to the spoonful; the same 
quantity may also be given in the sweetened mistura acacise, or in the sirup 
of poppies, or of lactucarium. As to the diet, it ought to be of a tonic 
and regenerating nature—chops, steaks, wine, porter, etc. You see, 
therefore, that we know pretty well what ought to be the daily dose 
of the iodide, but we are not so well informed as regards the absolute 
quantity which can be given with safety; it is impossible to fix this 623 
syphilis. 
beforehand. Neither do we know exactly how much time this medication 
may be continued in order to free the patient from the possibility of a 
relapse. 
You must be careful to modify the treatment just described, accord- 
ing to certain peculiar manifestations. For instance, when you have 
to contend against syphilitic sarcocele, and the same is exempt from 
complications, it will be sufficient to use the general treatment. 
But when there is much inflammation, you must have recourse to 
antiphlogistics and emollient applications; and if it were noticed that the 
testicle is suffering both from syphilis and struma, anti-scrofulous remedies 
should be added to the usual treatment of such cases. The plastic 
effusion will be efficiently controlled by rubbing the part with the mercu- 
rial ointment, and covering the whole with a soothing cataplasm; and 
much benefit will likewise be derived in these cases by/the methodical 
compression with strips of plaster, which was spoken of when I considered 
epididymitis. If you have elastic tumors of the testis to treat, the best 
practice is to open them as soon as fluctuation is detected, and you should 
have recourse to sedative applications when you perceive that they are 
surrounded by an inflammatory areola. But when the ulceration presents 
no redness, nor any symptoms of irritation, a very good wash may be 
made with a solution of iodine in the proportion of one half or a* whole 
drachm to 12 ounces of distilled water; and when this solution is being 
prepared, a certain quantity of iodide of potassium should be added, to 
prevent the precipitation of the iodine. If the granulations of the tertiary 
ulcerations are too prominent, they should be destroyed with the pate de 
Vienne, or any other caustic. 
When elastic tumors are not situated in the scrotum or testicle, they 
may be attacked by very energetic means—viz., mercurial frictions, 
Vigo’s plaster, bliss's followed by irritative dressings, as advised by Vfcala- 
pert, etc.; and where suppuration has occurred, the matter should be' 
freed without delay. As for the elastic tumors situated on the mucous 
membrane of the nasal fossae or mouth, they may be very beneficially acted 
upon by lotions containing a solution of iodine, in the proportion of two to 
six parts of this substance to one hundred of distilled water; in fact, the 
proportion of the iodine may be increased as long as no pain is produced 
by the application. 
The muscular retraction, or plastic degeneration of the muscles, requires 
local' applications besides the internal remedies. Topically, I use circular 
compression, carefully applied with strips of Vigo’s plaster. 
Part xviii., p. 206. 
Proto-Sulphate of Iron in Chancre and Gonorrhoea.—[An anonymous 
correspondent of the “ Lancet ” says:] 
The whole class of caustic agents, when applied to the Hunterian 
chancre (though the potassa fusa cum calce be used till the ulcer 
be “ punched out,” as recommended by M. Ricord) form an eschar with 
pus still secreting; in fact, the morbid cells have not been destroyed. 
The alkaloids and hydrocarbons are equally inefficacious. 
If a chancre be perfectly freed from its eschar and the inclosed pus, at 
the bottom of the excavation may be observed minute white points or 
germs, secreting, slowly, the morbid virus. If, now, the proto-sulphate of 
iron, minutely pulverized, be dropped into this excavation, the parts will 624 
SYPHILIS. 
instantly assume a charred appearance, the metal is absorbed into the tissue, 
the morbid cells or germs will instantly cease to secrete pus, the cleared 
cavity will shortly granulate, and a smooth surface, without induration, 
will be the result of the use of the proto-sulphate of iron. The chancre is 
destroyed. 
The proto-sulphate of iron, I have observed to be the most powerful 
agent for arresting decomposition in animal and vegetable substances. 
Inflammation and decomposition in the living tissue is likewise arrested 
by it. 
In gonorrhoea, we have now an agent arresting the morbid cellular 
action in the salts which should be used in solution super-saturated. 
In leucorrhoea, and in simple ulcers, the morbid action is arrested or 
peroxidized by this metallic salt. 
Large doses of this salt have been exhibited in obstinate diarrhoea, with 
great benefit. Part xix., p. 186. 
Creeping Pubo.—[Mr. Solly observes that there is a form of venereal 
affection which has not received an exact name from systematic writers, 
and which he designates “ creeping bubo.” It is that intractable sore 
which arises when chronic syphilitic bubo proceeds to ulceration, unstayed 
by mercury. Mr. Solly says:] 
Its most striking feature is the manner in which it burrows under the 
skin, creeping onward from place to place. This creeping character has 
induced me, for some time past, to designate it in my clinical observa- 
tions, as creeping bubo. It often creeps upward on the abdominal parietes, 
as high as the umbilicus; down the thigh, as low as the knee ; round the 
thigh, to the anus; and over the buttock, nearly to the spinous process of 
the ilium. 
'Jlie formidable nature of this ulcer is best seen in tkose cases where no 
• mercury has been administered; for, in these, there is scarcely any attempt 
at the healing process. Some years ago, I had an opportunity of witnessing 
several cases of this kind occurring about the same time. Their extreme 
obstinacy astonished me. *1 saw every local application in the Pharma- 
copoeia tried, but in vain. Mercury was not made use of and they con- 
tinued to extend. One case sank under the disease, apparently exhausted 
by its depressing effects. 
The appearance which creeping bubo exhibits in its early stage, presents 
some peculiarities by which it may be distinguished. The surface of creep- 
ing bubo is of a yellowish color, the discharge is thin and ichorous, the 
edges are everted, overlapping, corrugated, in dotted points, white, hard, 
and very irregular. In its early stage it is most like the strumous or 
scrofulous bubo, with its overlapping edges; but it differs, inasmuch as 
the edges of the strumous bubo are inverted, not everted, and soft, not 
hard and corrugated. The distinguishing marks, however, are not so 
easily described by the pen as by the pencil. 
In this form of bubo, a mercurial treatment is almost invariably required. 
We must give mercury steadily, until it disagrees with the system ; then 
abstain from it, and give tonics; and after waiting a few weeks, or even 
months, again return to the use of the mercurial preparations. 
Part xix., p. 195. 
Pransby P. Cooper's Treatment of Chancre—Simple.—When called to 
Bee a venereal sore, of only three or four days’ duration, apply concentrated SYPHILIS. 
625 
nitric acid. But if a sore has all the appearances of true chancre, begin by 
using constitutional treatment—giving five grains of blue pill and a quarter 
of a grain of opium night and morning. So long as the patient is taking 
mercury, apply no local remedy whatever, and then the sore will furnish, 
by its appearance, the best possible indication of the effect which the 
medicine is producing. 
Irritable.—Apply nitrate of silver to the sore, and give repeated doses 
of opium. If when the irritability is subdued, induration remains, give 
mercury, as in a simple case. In some instances of irritable chancre, 
calomel and opium will answer as well or better than opium alone. 
Phagedenic.—First evacuate the bowels, and then give repeated doses 
of opium, and apply soothing fomentations. If the vital powers are 
depressed, give bark, ammonia, and even wine ; but if there is a plethoric 
condition, adopt antiphlogistic measures. If the progress of the ulceration 
is not checked, apply concentrated nitric acid. 
Gangrenous.—Keep the patient in the recumbent posture, and after 
evacuating the bowels, give ammonia, bark, or serpentaria, with wine or 
porter; and apply black wash, nitric acid lotion, stale beer grounds, or 
stimulating poultices. 
When the healing of chancres on the penis is interfered with by the 
occurrence of erections, give five or ten grains of lupulin at bedtime, and 
repeat it if necessary. * Part xxi., p. 269. 
Diagnosis and Treatment of Bubo.—[Mr. Cooper lays especial stress; 
upon the importance of distinguishing between a bubo arising from a 
virulent and one from a non-virulent disease. He says :] 
Non-virulent bubo is that which attends simple gonorrhoea, and may be- 
considered as arising from common inflammatory action, extending in the 
course of the absorbent vessels of the penis to the glands of the groin ; this 
disorder is to be treated as phlegmonous swellings in other parts of the 
body, either by repellents for the purpose of preventing the formation of 
matter, or by fomentations or poultices to produce suppuration, when that 
termination seems to be threatened by nature. 
By repellent remedies, I mean those which have a tendency to repress 
the formation of matter, such as leeches and evaporating lotions ; by means 
of these we may succeed in preventing suppuration, but there sometimes 
yet remains a permanent indurated condition of the swelling, which may 
excite apprehension in the mind of the surgeon as to its having been pro- 
duced by a specific virus, a chancre existing within the urethra. A bubo 
of this kind may, however, result from a mere strumous habit; and if so,, 
the hardness readily yields to the exhibition of iodine and iodide of potas- 
sium, and such dietetic rules as generally improve strumous constitutions ; 
while, on the contrary, if the hardness depends upon the action of a spe- 
cific poison, a mercurial course is, in my opinion, the only safe mode of 
treatment. 
A virulent bubo is marked by the same characteristic induration as a 
chancre itself, and the presence of this induration must inevitably give rise 
to the question of the virulent or non-virulent nature of the disease. The 
mere phlegmonous bubo has always a tendency to suppurate; while the 
virulent bubo, on the contrary, seldom manifests this disposition ; and, 
therefore, its permanent hardness, uncombined with any symptom of sup- 
puration, is a further proof of a virus having been the origin of a bubo. 
vol. ii.—40 626 
SYPHILIS. 
The virulent bubo goes on to ulceration; but even this is not conclusive, 
for strumous ulceration not unfrequently occurs in persons of a scrofulous 
diathesis; therefore, as Ricord observes, there is as much difficulty in 
forming a diagnosis between the virulent and non-virulent bubo as between 
the virulent and non-virulent sore. In my own practice when the bubo 
puts on all the characters of a virulent or specific action, I commence at 
once with the cautious administration of mercury, not unfrequently com- 
bining with it small doses of iodide of potassium, abstaining at the same 
time from the use of any local application to the ulcerated bubo, which 
might tend to conceal the characteristic appearance of the sore. If the 
mercury be producing the desired effect, the ulcerated surface of the 
swelling acquires a healthy appearance, indicated by the growth of soft,, 
red granulations, by the absence of any tendency to eversion of the edges 
of the sore, and by a general softness of the whole base of the tumor ; in- 
deed, the characteristics of the healing sore are as strongly marked as 
were the peculiarities which had before indicated its virulence. And until 
the induration has completely disappeared, the mercury should be perse- 
veringly continued. Part xxip. 269. 
Venereal Warts and Gondylomata.—In long standing cases of gonor- 
rhoea you will sometimes observe condylomatous growths about the 
scrotum, perineum, and verge of the anus ; these, Bransby B. Cooper 
states, can generally be cured by an application of the yellow wash. Warts 
often follow also upon a gonorrhoea, in cases where the disease commences 
externally—that is to say, in balanitis. In the first instance they are found 
in points where the mucous membrane has been abraded; warty granula- 
tions spring up from these points. Whenever these warts are present Avith 
phimosis, the prepuce must be laid open immediately; this is always 
necessary. Sometimes these warts are \rerv difficult to When they 
have narrow peduncular necks, a ligature may be used to remove them; in 
other cases caustic should be applied to them, and savine poAvder may also 
be employed as an escharotic. Sometimes, hoAvever, neither caustic nor 
savine powder will remove these Avarty excrescences; they must then be 
excised, and caustic applied to the surface from Avliich they are removed. 
Part xxi., p. 270. 
Treatment of Secondary Constitutional Syphilis.—Surround the patient 
with an atmosphere of mercurial vapor, in a moist state, by the folloAving 
method, recommended by Langston Parker: Place the patient on a chair, 
covering him Avith oil-cloth lined Avith flannel, then fumigate him Avith the 
bisulpliuret of mercury, or the grey oxide, or binoxide. The patient may 
remain in this mercurial atmosphere for ten minutes or half an hour. Let 
the patient then repose in an arm chair for a short time, and let him drink 
a cup of warm decoction of guaiacum, sweetened with sirup of sarsaparilla. 
Part xxii., p. 261. 
Phagedenic Chancre.—Iron is the remedy, its effects are almost magical. 
It is much used by M. Ricord. The following is the best mode of giving 
it. Potassio-tartrate of iron, one ounce ; Avater, six ounces. Mix. Two 
tablespoonfuls three times a dav. 
Tertiary Symptoms.—Give the iodide of potash in large doses, which 
will benefit when small ones are of no avail. Tart xxii., p. 262. 627 
SYPHILIS, 
Treatment of Syphilis.-—[Speaking of the definition of the stages of this 
disease, Mr. Cooper remarks :] 
If I might be allowed to express my own opinion on the subject, I would 
give the following definition of the three stages or forms of syphilis: Pri- 
mary symptoms—the chancre or local affection; secondary syphilis—the 
sore throat and the various cutaneous eruptions; and tertiary—the ulcers 
and sores which succeed the eruptions, and which, like them, are the 
result of the constitutional manifestation of the disease. 
The diagnosis of a primary syphilitic sore or chancre is sometimes exceed- 
ingly difficult; in fact, taking the physical characters of the ulcer alone, it 
is frequently impossible to distinguish it from one of a non-specific nature, 
frequently out of the surgeon’s power to say with decision and confidence 
•this is venereal, or that is not. There is but one true poison of syphilis, 
which poison produces different effects, depending on the nature of the 
tissue affected,, and on the peculiarity of the constitution; and I believe, 
that all the different effects, and all the varieties of sores, depend on one 
and the same morbific cause, the action of which is modified by the par- 
ticular state or disposition of the individual in which the symptoms are 
developed. 
With regard to the treatment of primary symptoms we possess, happily, 
a remedial agent—mercury, which might be considered to have almost a 
specific influence over the disease, and I believe that syphilis cannot be 
thoroughly eradicated from the system by any other medicine, after 
absorption has taken place and it has become a constitutional affection. 
If, however, you have a patient come to you within four days after the 
appearance of a chancre—that is, before the syphilitic poison has had time 
to become absorbed, and implanted in the system, no matter if the sore be 
of the callous or true Hunterian description, or however ambiguous 
its characters, by the application of concentrated nitric acid you would 
effectually decompose or destroy, and render inert the specific poison. 
The healing of a chancre, by the application of local means, is no proof 
of the constitutional subsidence of the disease. I therefore depend solely 
on the constitutional employment of mercury, and object to the use of 
black wash and similar applications, which are in themselves capable of 
removing the sore, and thus destroy the index which its appearance forms 
when its reparation is effected, only as a result of the constitutional eradi- 
cation of the disease. The healing of the sore under these indications is an 
evidence that the system lias been sufficiently mercurialized; and that its 
use may now be confidently abandoned. Acting under this principle and 
conviction, the plan I in almost all cases pursue, is to apply a simple piece 
of moist linen—not lint, for I have seen it (whether from the chlorine used 
in bleaching it, or what I do not know) excite such irritation round a 
chancre, as almost to produce balanitis, which all quickly subsided on the 
use of linen instead of lint to the sore, and administer internally gr. v. of 
blue pill with 1-4 gr. opium at bedtime, and v. gr. of blue pill alone in the 
morning ; directing these pills to be. made up separately, and labelled 
respectively “ night ” and “ morning ” pills. I tell the patient, if his 
bowels become constipated, to take only the morning pills both night and 
morning ; if, on the contrary, relaxed, to take only the night pills. With this 
variation in treatment, according to the circumstances of the case, I con- 
tinue the mercury until the sore has disappeared, and the hardness of its 
base subsided, i learned this treatment from my uncle, Sir Astley Cooper, 628 
SYPHILIS 
and have adopted it in almost every case that has come before me during 
the last thirty years; and I have never yet once got into a difficulty with 
it, from the reappearance of the disease under secondary symptoms. 
Trust to mercury, but give it cautiously, give it judiciously, watching your 
patient during its administration, and seeing that he avoid all possible 
exposure to cold, and if possible keep him within doors. 
Secondary symptoms are manifested in various morbid phenomena of 
different parts, more especially of the skin, mucous membranes, and bones. 
Affections of the latter, I believe, are not the result of syphilis alone, as a 
specific disease, but of its action, modified by the influence of mercury, 
which, as far as I can learn, in such cases, has always been previously ad- 
ministered ; and I consider syphilis of itself, I will not go so far as to say 
incapable, but certainly not as yet proved to have the power of producing * 
such direful morbid conditions of the osseous system. 
With regard to the treatment of secondary syphilis, the iodide of potas- 
sium is the remedy held in most repute, and the one that in general pro- 
duces the most immediate beneficial and successful results. But, according 
to my experience, iodide of potassium and iodine, although they have the 
power of arresting or suspending the disease pro tem., are incapable of eradi- 
cating or eliminating it in toto from the system, and securing the individual 
from subsequent attacks. Sir Astley used almost invariably to prescribe 
the bichloride of mercury, in doses of 1-16 gr., taken in bark or sarsapa- 
rilla, two or three times a day; and I myself prefer and recommend mer- 
cury to be given. It is true, its remedial effects are not so speedy as those 
of iodide of potassium ; but this is more than compensated for by their 
being of a more permanent character. Cases sometimes occur where 
iodide of potassium has been administered for some time, and the further 
continuance of its use increases instead of diminishes the symptoms it 
was intended to relieve. In such instances, I have sometimes seen the 
most marked effects accrue from small doses of arsenic, especially when 
combined with mercury and iodine, in the form of the liquor arsenici et 
hydrargyri hydriodatis, or Donovan’s solution. 
[It was clear in the case before them that the mercurial treatment was 
abandoned before the symptoms thoroughly yielded. After this he was 
iodized and mercurialized frequently, but with no ultimate benefit. Had 
he been a strong man, Mr. Cooper said he would have given him mercury 
and used every precaution. But being of a depraved constitution, and 
Aveak, he ordered him:] 
R lodinii, gr. ss.; potassii iodidi, 5ss.; sirupi papaveris, gss.; infusi 
gentians} co., gx. Misce, ut fiat mistura, cujus sumantur cochl. ij. magna 
ter die, cum morphiae acet.j gr. ss. omni nocte. 
I pursued this for a few weeks, and at the same time enjoined perfect 
rest in bed, but found little or no improvement in the sore; which, as is 
the character of the specific kind, healed in one part, but extended itself 
in another. At the same time, a number of tubercles appeared over his 
head and face, which are anything but a favorable indication of the condi- 
tion of his system. Tubercles and blotches—the difference between the 
two being, that the former are elevated, but the latter even with the sur- 
face of the skin—may depend on other causes than syphilis; but, as a 
result of this disease, they are always unmistakable from their coppery hue, 
their smutty or dirty appearance, the skin in fact conveying the impression 
of its wanting to be washed. SYPHILIS. 
629 
Seeing that he made no progress under the influence of the medicines 
prescribed, I altered them, and gave him: 
R Liq. hydriodatis arsenici et hydr., 3iss.; extracti sarzte, 5j-; dec. sarzse 
co., gviij.; cochl. ij. amp. ter die sum.; pulv. opii, gr. ss. omni nocte. 
And since then, I must say, he has been slightly improving. 
In concluding these remarks on syphilis, I may observe, that in sloughing 
phagedena, mercury has the effect of aggravating rather than mitigating 
the symptoms, and is consequently decidedly prejudicial; the remedies are 
the topical application of nitric acid, and the internal administration of 
opium. Nitric acid not only destroys the part in contact with it, but at 
the same time induces a more healthy action in those beneath. 
Part xxiii., p. 203. 
Prophylaxis of Syphilis.—This preservative consists of a strong alco- 
holic solution of soap, having an excess of alkali. Dr. Langlebert had 
performed several experiments by inoculating with the poison of chancres, 
and then employing his antidote within about five minute afterward. The 
effects of the virus had in every case disappeared. Part xxiv., p. 262. 
Borax as an Application to Gangrenous Buboes.—Dr. Effenberger ap- 
plied a solution of borax, in the proportion of from one to two drachms in 
a pint of water, to a large number of patients who suffered from gangrenous 
bubo, with great success. He had fifty cases in one year; not one had 
died, although there were several very severe cases, and in one the femoral 
vessels were laid bare. The solution was applied by means of charpie, so 
as to cover the edges of the sore. It was very essential that the charpie 
should be very frequently renewed by night and day; and to the neglect 
of this precaution, he attributed the failure of this practice in the hands of 
other surgeons. Part xxiii., p. 212. 
Phagedenic Chancre.—Give iron. M. Acton trusts chiefly in the tar- 
trate, probably any other form would do as well. If there is sloughing 
phagedena, give opium in large doses. Destroying the surface of the 
ulcer with nitric acid is useful in some cases. 
Bubo.—Give one grain closes of tartar emetic every second hour, until 
a marked effect is produced upon the inflammatory swelling. 
Part xxiv., p. 268. 
Mercury—Substitute for, in Syphilis.—M. Robin, of Paris, substitutes 
15 grains of the bichromate of potash divided into 80 pills, with extract of 
gentian; one to be taken night and morning. Part xxv.,p. 268. 
Bubo— Ope7iing of by Multiple Punctures.—M. Vidal strongly recom- 
mends that venereal buboes should not be allowed to open of themselves; 
for when they are left to nature, the skin becomes detached and thinned, a 
great loss of substance ensues, a tedious recovery takes place, and an un- 
sightly deformity is left. Opening by caustic, too, leaves disfiguring 
scars; and the same inconvenience results from large incisions, and cutting 
away, by the bistoury, portions of skin that are too much changed to unite. 
Still the bistoury is much more easily managed than is the caustic, and M. 
Vidal much prefers removing by it a portion of half dead, detached skin, 
or a gland which is an obstacle to reparation, to attacking such parts by 
caustic. By its aid the cicatrix may be rendered more regular, and cause 
less deformity. But cases requiring large incisions and excision are rare, 630 
SYPHILIS 
especially if the bubo be early treated, and punctures are made as soon as 
matter is formed. The bubo should be shaved. If the abscess is recent, 
and suppuration not extensive, one puncture may be made at the fluctuat- 
ing point. If other glands suppurate, they must be punctured in the same 
manner. If the collection is extensive and superficial, several punctures 
are required, not in the fluctuating centre, but at the circumference, by a 
straight bistoury passing subcutaneously to the centre ; thus the skin is 
divided where it is adherent, intact, and possessed of its vitality. The 
bubo must not be pressed for two days, wdien it will gradually discharge 
itself. Sometimes the punctures close before the matter is evacuated ; this 
may be prevented by gently pressing the abscess once a day. If they all 
close, it is better to allow them to do so than introduce tents, making one 
or two new punctures if required. By this plan not the slightest mark, or 
only a very slight one indeed, is left. Part xxv., p. 269. 
Treatment of Syphilis.—Prof. Bennett enters into a comparison of the 
simple treatment of syphilis with the mercurial treatment, and gives statis- 
tics to prove the great superiority of the former plan. Prof B. says: 
The simple treatment is divided into internal or medical, and external 
or surgical. The first consists in the observation of certain hygienic rules, 
and the employment of general therapeutic means. The diet must be light 
and mild, meat and all stimulating viands retarding the cure; even with 
the lightest diet the hunger should never be quite appeased. The regimen 
must be the more diminished and rigid in proportion to the youth- and 
vigor of the patient. Diluent beverages, decoctions of barley, liquorice, 
and linseed, alone or mixed with milk, shovdd be taken freely, to the 
amount, indeed, of several pints a day. Perfect repose must be secured by 
confinement to bed. Constipation must be obviated by the use of emol- 
lient clysters or mild laxatives. The air should be maintained at the same 
temperature ; this is an indispensable precaution in chronic, consecutive, 
and mercurial affections. Exercise is only useful in the convalescent stage. 
In chronic syphilis, however, it may often be carried to fatigue with ad- 
vantage. Tepid baths, repeated three or four times a day, are always 
attended with advantage. General blood-letting is often required when 
the primary disease is intense, or the system excited and the patient ple- 
thoric, but should not be used indiscriminately. 
In the external or surgical treatment, strict attention to cleanliness and 
the position of the diseased parts should never be lost sight of. Emollient 
decoctions .or fomentations, or dressings of simple cerate, are the best 
applications, and the dressings should not be .too frequently renewed. 
Leeches are generally necessary. The greatest benefit is derived from the 
external use of a concentrated solution of opium (in the proportion of 
about two drachms to one ounce of water) ; it soothes excessive irrita- 
bility in all cases. "When the suppuration is moderated and the surface of 
the ulcer cleansed, stimulating dressings, consisting of solutions of the 
sulphates of alum and copper, the nitrate of silver, and subacetate of lead, 
favor cicatrization. 
In inveterate cases, more especially those laboring under tertiary symp- 
toms, the iodide of potassium has been used with benefit, in doses of five 
grains, three times a day, conjoined with emollient applications to the 
affected parts. 
The Mercurial Treatment consists in keeping up slight salivation, by SYPHILIS, 
631 
means of the internal administration of blue-pills or some form of mercury, 
sometimes conjoined with mercurial frictions or fumigations, at leftst for 
the space of a month. This physiological action of the drug may be pro- 
duced by administering any of its preparations continuously in small doses. 
If combined with opium, they act less on the bowels and more on the sys- 
tem generally. 
It is necessary during its action, that the patient do not expose himself 
to cold. A certain irritability is produced, and the constant soreness 
of the gums, the metallic taste in the mouth, not to speak of the incon- 
veniences of profuse salivation which occasionally occur, render this 
species of treatment anything but agreeable to the patient. 
Part xxvi., p. 278. 
Venereal Ulcers.—The following is the composition of Plenck’s Mercu- 
rial Balm for dressing venereal ulcers : Mercury, 1 oz.; Yenice turpen- 
tine, £ oz.; lard, 3 oz.; calomel, 17f grains; elemi ointment, 3 oz. Mix. 
Part xxvii., p. 162. 
Seton for Suppurating Bubo.—M. Bonnafont, chief surgeon of one of 
the military hospitals of Paris, has lately proposed to supersede the ordi- 
nary modes of opening buboes by the following method: A seton of a 
very few threads, is passed through the bubo in the direction of its long 
axis, and left for several days, until a kind of fistulous tract is established, 
The thread is then removed, and the purulent matter escapes by the small 
apertures, either spontaneously or by pressure. The advantages of this 
practice are, according to the author, the avoidance of the unsightly 
puckered cicatrix generally left when incisions are made, and the more 
rapid healing of the bubo. 
Bubo.—Dr. Clairborne applies collodion over a bubo when there is not 
much local inflammation; the collodion is applied layer after layer, until 
considerable compression is produced. If there be any amount of inflam- 
mation, leeches are previously applied. Part xxviii., p. 221. 
Syphilid Congenital.—Mr. Wormald, of St. Bartholomew’s, says: The 
mildest preparations of mercury given to children are apt to run off by 
the bowels; to obviate this, let a piece of flannel smeared with mercurial 
ointment be worn constantly over the child’s belly. If the child be at 
the breast, mercury should be administered to the mother also. 
Part xxix., p. 241. 
Syphilis.—There is a great difference, Mr. Acton believes, between 
what is called the infecting chancre which is an indurated sore, and 
the unindurated sore. The former communicates constitutional syphilis, 
the latter does not. The infecting indurated sore ought to be treated by 
mercury, the unindurated form need not be so treated. Hence the diffe- 
rence of opinion amongst medical men is often founded on a misappre- 
hension. 
In treating the former, in Paris, the proto-iodide of mercury is used, 
but this does not answer so well in this country as mercurial friction, blue 
pill, or the grey powder. 
Phagedenic Chancre is treated by Bicord, by first destroying the 
whole of the unhealthy surface with a red-hot iron, previously placing the 
patient under the influence of chloroform. After the sloughs have sepa- 632 
SYPHILIS. 
rated, the surface is covered with strips of ammoniacum and mercurial 
plaster, and doses of tartrate of iron are given with great success, in the 
less obstinate cases. The most frequent variety of sore in London is the 
phagedenic with induration. In this the actual cautery does no good; 
mercury must here be given, and the system supported by bark, wrine, or 
steel. jPart xxx., p. 172. 
Bubo.—To prevent a bubo from suppurating, Dr. Thompson, at the 
Marylebone Infirmary employs counter irritation by means of a strong 
solution of nitrate of silver, three drachms to the ounce of distilled water, 
with twenty minims of strong nitric acid. It may be applied with a glass 
rod or stick, or a glass brush. The black eschar will peel off in a few 
days, and then it should be reapplied. Part xxxl\.,p. 229. 
Preservative Means Against the Syphilitic 'Virus.—It is stated that a 
neutralizing liquid has been discovered for this poison, composed as fol- 
lows : Distilled water, Sixss.; perchloride of iron, citric acid, hydrochloric 
acid, of each 5j- Let a drop of this fall upon the part inoculated, and 
allow it to remain fifteen minutes, or apply a bit of lint soaked in the 
fluid. If the lint be applied for an hour the antidote is complete. 
Part xxxi., p. 236. 
Plurality of Poisons in Syphilitic Diseases.—Mr. Skey, surgeon to 
St. Bartholomew’s Hospital, believes that there are a plurality of poisons 
in this disease depending upon the constitution of the person affected, and 
not on the source of the infection. For the treatment of venereal sores, 
mercury, in ninety-nine cases out of one hundred, is unnecessary. We may 
say that there are three different kinds of venereal sores : first, the com- 
mon venereal sore, where mercury is quite inadmissible; second, the pha- 
gedenic sore, wrhere mercury is positively injurious; third, the true syphi- 
litic sore, dusky, cartilaginous, indurated; here mercury is useful, and it is 
the only case in which it is admissible, but it is very rare comparatively. 
M. Ricord, of Paris, entirely and fully coincides with these views. In the 
exhibition of mercury, it is a bad plan to push it where it seems to have 
little or no effect. It urould be much better to intermit its use for a few 
days, and when resumed it will be far more likely to produce a beneficial 
impression. When pushed to salivation, it too often produces a long train 
of complaints, which last as long as life. Part xxxiii., p. 239. 
Tincture of Iodine in Bubo.—M. Joliclerc states, as the result of much 
observation, that tincture of iodine is the best application in bubo, prevent- 
ing, or dissipating fluctuation, and facilitating healing if the bubo be 
already open. lie applies it by gentle friction, so as to avoid vesication. 
Part xxxiii., p. 242. 
Common Sore or Venerola.—Mr. Skey, of St. Bartholomew’s says, 
There, are three stages through which we may trace this sore: the first is 
ulcerative, the pimple which comes out on the third or fourth day in- 
creases until it is about the size of a pea; in the second stage, the sore 
thrown up a border or elevated edge, granulations also spring up to the 
edge of the mound; in the third stage, these granulations are absorbed 
and cicatrize. This is the ulcer of gonorrhoea inoculation, and is never 
followed by secondary symptoms. Mind, now, that about these sores 
there is no thickening, tumefaction, induration. Indurated sores, that is, 
with edges like cartilages, are very rare indeed. If your patient has true SYPHILIS, 
633 
syphilis bubo, you feel a distinct gland inflamed under your finger. It is 
not like common bubo, but inflamed tissue like an abscess, running along 
the line of Poupart’s ligament. There is no suppurative action in true 
bubo. None of these common complications are at all bettered by mer- 
cury. The chief and abiding principle of treatment in venerola is, to keep 
the parts scrupulously clean. The sore will take a certain time to heal, 
and you cannot stop the ulcerative process either by mercury or caustics. 
Above all things the parts must be kept clean, or your patient will have a 
“ crop of sores.” Simple spermaceti ointment and morphia is the nicest 
application. In the second stage give bark or quinine, and an extra 
allowance of good wine. At the end of four months you may look out for 
secondary symptoms, but you will never find them. In this special sore, 
which produces no sore throat, no eruptions, etc., mercury is never 
required. In fact, mercury is not more required for what are called syphi- 
litic diseases, than for any other class of diseases. Mercury, as regards 
syphilis, is the greatest cftrse of a cure, and about the most useless thing 
as a remedy ever discovered. Part xxxiv., p. 211. 
Obstinate Chancre.—Opium, says M. Rodet, acts most efficaciously in 
those cases in which mercury is of the least use, and vice versd. Thus in 
constitutional syphilis it acts as a mere corrective, and should only be given 
in very small doses. When, however, the chancre manifests any tendency 
to phagedena, mercury should be rigidly forbidden, while opium is espe- 
cially valuable in diminishing the irritability, pain, and suppuration. It is 
in the phagedenic serpiginous ulcers that large doses of opium act almost 
as a specific. It should not be given too frequently, for if the stomach be 
kept too constantly under its action digestion will be interfered with ; the 
entire daily quantity should be taken at two doses, morning and evening. 
Wine should also be given freely with the opium as a corrective to the 
stomach ; to prevent its constipating effect on the bowels, and to obviate 
the tendency to sleep. Part xxxiv., p. 215. 
Secondary Syphilis.—[We sometimes meet with cases of secondary sy- 
philis which resist the usual preparations of iodine. The object of this 
paper is to bring before the notice of the profession a new compound, which 
combines all the advantages to be derived from iodine, while it is devoid 
of its bad effects, and has proved very valuable when other combinations 
have failed.] 
Dr. Christophers’ experience of the action of this remedy is limited to 
cases of secondary syphilis ; but in the hands of some other surgeons, it 
has been found efficacious in cases of scrofula, anemia, and in the furuncu- 
loid plague. 
There are two preparations: the one found so useful in treating cases of 
secondary syphilis) he names “ liquor cinchonce hydriodatusthe other 
(that which has been found useful in treating boils, anemia, and scrofula), 
“ liquor cinchonae hydriodatus cum ferro.” The former contains in one fluid 
drachm of liquor, twelve grains of cinchona flav., and one grain and a half 
of iodine, in the form of hydriodic acid. The latter contains, in addition 
to the former ingredients, one grain of protoxide of iron in each fluid 
drachm of the liquor. These preparations are pi’oduced by exhausting the 
powdered bark with an aqueous solution of hydriodic acid; then with 
water, and the liquor is subsequently evaporated to the above bulk. 
The dose varies from one drachm to three drachms of “ the liquor cin- 634 
SYPHILIS. 
chonae hydriodatus,” and from fifteen minims to two draclims of “ the liquor 
cinchona} hydriodatus cum ferrothe use of the hot-air hath in order to 
produce profuse sweating, is a potent remedy for intractable and inveterate 
cases of secondary syphilis. Part xxxiv., p. 217. 
Primary Syphilis—Ferruginous Treatment of.—Mr. Behrend, of Liver- 
pool, instead of the old mercurial treatment, uses the potassio-tartrate of 
iron, to cure every type of primary sore: of course this does not exclude 
the use of caustics. He prescribes the salt in form of solution, in the pro- 
portion of one part to six of water, of which two tablespoonfuls are to be 
taken three times a day, and a solution of the same strength as a local ap- 
plication to the part. The patient must be instructed, lest he remove the 
lint roughly, and so destroy an incipient cicatrice or healthy granulations. 
In the phagedenic form, generous diet, wine, and fruit, may be allowed, 
but no pastry or cheese. He has not had a single case of secondary or 
constitutional syphilis after treatment with the, potassio-tartrate of iron 
alone, either in hospital or private practice, except in two cases in which he 
combined the iron with mercurial treatment. Part xxxv., p. 171. 
Secondary Syphilis.—Of the different forms of eruptions, we may men- 
tion, first, among the rashes, the annular form of roseola: this very soon 
yields to the iodide of potassium, if it be given before desquamation has 
taken place, and the copper-colored stain has formed. Purpura must be 
treated by generous diet, iodide of potassium, and decoction of bark. Of 
papular eruptions, syphilitic lichen may be very obstinate, but it will always 
yield to a strong lotion of the bichloride of mercury, ten grains to the 
ounce. In the ulcerating form of lichen, the iodide of mercury, one grain 
every night, with two or three grains of the extract of coniurn, in the form 
of a pill, is the best treatment. Syphilitic prurigo yields more readily to 
sarsaparilla than to any other remedy. In the scaly forms, such as lepra 
and psoriasis, Donovan’s solution, in doses of ten minims to half a drachm 
three times a day, is the most efficacious internal remedy. The best local 
remedies are, the bichloride of mercury lotion, and in some cases, the mer- 
curial vapor bath, by surrounding the patient, seated on a cane-bottomed 
chair, with blankets, and applying a spirit-lamp to the mercurial prepara- 
tion ; but the simplest plan is to heat half a brick in the fire, put it in a 
chamber-pot beneath the chair, and throw the mercurial preparation upon 
it. If you use the bisulphuret of mercury, one or two drachms will be ne- 
cessary ; if the iodide, ten grains or a scruple ; but perhaps a combination 
of the two is better, say ten grains of the iodide with a drachm of the bi- 
sulphuret, increasing the dose to double this quantity. At the Lock Hos- 
pital, ten grains of calomel is preferred. The patient should be kept ex- 
posed to the vapor for ten or fifteen minutes ; and when the blankets are 
removed, he should be rubbed dry, and a wet sheet wrung out of cold 
water thrown over him, to diminish the sensitiveness of the skin and the 
relaxing effects of the vapor bath. The only vesicidar form of disease is 
rupia: here mercury is most dangerous, while iodide of potassium inter- 
nally, with the red precipitate ointment locally, is almost sure to cure. 
Among pustular diseases, we may mention ecthyma; this again is aggra- 
vated by mercury, but sarsaparilla often cures it. The tubercular erup- 
tions are always obstinate, but the mercurial vapor bath is the best treat- 
ment. Cutaneous excrescences may be easily destroyed by strong acetic 
acid or the tine, ferri mur.; but liicord’s plan of using a chloride of soda SYPHILIS. 
635 
lotion for a few days, and then sprinkling the growths with calomel, is the 
best treatment. With respect to the syphilitic diseases of bones, it is in 
the hard periosteal node that the iodide of potassium, in eight grain doses, 
three times a day, is the specific remedy. The soft or gummy node gra- 
dually yields to repeated blistering. In chronic syphilitic diseases of the 
joints, the iodide of mercury is more generally useful than the iodide of 
potassium; these cases are very obstinate, and it may be well to alternate 
the remedies, at the same time giving good diet. In syphilitic angina, if 
not very severe, mercurial fumigation may be used, or the vapor of the 
grey oxide may be inhaled ; but in very severe cases, the iodide of potassium 
internally,with the red precipitate ointment externally, acts like a charm. In 
the treatment of syphilitic iritis, commence at once with calomel and 
opium, say one grain of calomel with a sixth of a grain of opium every 
three hours, until the gums are slightly touched, but do not carry it to 
salivation. Part xxxv., p. 174. 
Bubo.—Instead of opening these by the knife, which is the plan ordina- 
rily employed, Mr. Turner, military surgeon at Bombay, uses caustic 
potass. The slough soon separates, and the result is much more satisfac- 
tory to the surgeon, as you avoid the constant opening and reopening, 
causing drain to the system and disgust to the patient. Part xxxv.,p. 186. 
Venereal Inoculation.—Prof. Porter, of Dublin, believes that secondary 
symptoms may be produced in the female ‘by the seminal fluid of a man 
who may have had syphilis previously, and who may seem to have been 
perfectly cured. Thus the woman may be affected either primarily, or by 
a foetus, or by the semen : were we not aware of the last mode of commu- 
nication, we should be sometimes quite puzzled to account for the symp- 
toms. Part xxxv., p. 200. 
Calomel Fumigation in Syphilis.—Xo mode of mercurial treatment, 
according to Dr. Lee, removes the symptoms of syphilis so readily as fumi- 
gation ; none is attended with so little mischief to the patient’s constitu- 
tion, and after none is a relapse so seldom experienced. Calomel is the 
best preparation to use for the purposes of fumigation; it is readily sub- 
limed—is not decomposed thereby—and but a comparatively small quan- 
tity is required. It is found to answer the purpose better if combined with 
vapor of water ; therefore, in any lamp used for this purpose, provision 
must be made not only for volatilizing the calomel, but a small amount of 
water likewise. Part xxxvi., p. 195. 
Cure of Syphilis icithout Mercury.—Dr. Marsden believes that secondary 
syphilis may be treated entirely without mercury, and on the following 
simple plan : and not one in a hundred instances will return with constitu- 
tional symptoms. Stomachic and tonic remedies must be administered, con- 
joined with a good diet and the following formula, viz.:—Sulphur, one 
drachm ; sulphuret of antimony and nit'rate of potash, of each five grains; 
mixed into a powdei’, half of which must be given night and morning, and 
persevered in until a cure is established. Part xxxvi., p. 199. 
Chancre.—Dr. Collman applies pure acetic acid by means of a glass tube, 
thoroughly to the part, preventing its diffusing itself around by means of 
charpie. On the third day a whitish eschar separates, and a clean, healthy 
sore is left, which will rapidly heal by common dressing. On the first and 
third day an active purgative is administered. Part xxxvi., p. 200. 636 
TABES MESENTERICA. 
Secondary Syphilis— Communication of.—A case is recorded by Dr. 
Elliotson, in which secondary syphilis was communicated from a lady’s 
maid (having cracks in the palms of the hands and other syphilitic symp- 
toms), to her mistress, in whom it showed itself as an eruption at the fore- 
part of the scalp where the hair is thinnest. There had been no breach of 
surface to account for this. The poison had probably been communicated 
from the maid applying pomatums and rubbing them in with the palms of 
her hands. 
The third or cachectic stage of syphilis does not require mercury, and 
yields generally to hydriodate of potass or sarsaparilla ; the hydriodate is 
incapable of curing true syphilis in either its primary or secondary stage. 
Part xxxviii., p. 171. 
Primary Syphilis. — Dr. Thompson, of University College Hospital, 
says: There are two entirely distinct forms of primary sores—distinct 
alike in course, results, and treatment. First, the true Hunterian, or indu- 
rated chancre with hard indurated edges, feeling like a cup of cartilage 
imbedded in healthy tissues, and moving freely over the underlying parts ; 
if followed by enlarged inguinal glands, these never inflame and suppurate, 
and the important point is, that this form is always followed by constitu- 
tional symptoms, unless destroyed before the induration appears, which 
happens generally in about from six to eight days. Secondly, the soft, or 
non-indurated chancre, with sharply-cut, even, slightly-undermined edges, 
much inclination to spread from the highly contagious nature of the secre- 
tion, not necessarily, though generally followed by suppurating bubo ; and 
lastly, there is no constitutional affection. Both chancres should be de- 
stroyed with caustic, as early as possible, the soft to destroy its specific 
character, and hence its aversion to heal; the hard, for the same reason, on 
account of its tendency to infect the system. If induration, however, have 
occurred, no cauterization will avail. Thus, at the time when cauterization 
is of use, it cannot be determined to which variety the sore belongs. The 
best caustic is the Vienna paste or potassa c. calce made into small sticks. 
Ricord uses strong sulphuric acid made into a paste with charcoal; some 
astringent lotion, as a solution of tannic acid in water, should be used to 
restrain the abundant secretion of the soft variety, and thus prevent the 
spreading of the sore by infection of neighboring parts. Nothing hastens 
cicatrization so much as a mild form of iron given internally. Now, in 
this soft variety, mercury is wholly out of place and must not be employed. 
In the indurated variety, mercury should be commenced at once (the iodide 
in doses of half a grain to a grain and a half twice a day, is one of the best 
forms for administration), and it is undesirable to exceed very slight mer- 
curialism ; a little opium may be combined with it to prevent relaxation 
of the bowels, and if the stomach is irritable, inunction may be substituted. 
Part xxxix., p. 222. 
TABES MESENTERICA. 
Tabes 3fesenterica, and Chronic Peritonitis in Children.—Dr. West 
says : Chronic peritonitis, so often a fatal disease in children, differs from 
acute inflammation of the peritoneum, not only in its tardy progress, but 
in being almost invariably associated with the tuberculous cachexia. 637 
TABES ME8ENTEKICA. 
The occasional attacks of pain in the abdomen which form a prominent 
symptom of this disease, may or may not be preceded by vague indications 
of decaying health. But, however this may be, it is not long before the 
appetite fails or becomes capricious, the bowels become irregular, and the 
motions unnatural, and thirst and feverishness set in. Occasionally the 
stomach is irritable, but the tongue is usually clean throughout the disease. 
The abdomen soon becomes large, tense, and tympanitic, and manipula- 
tion of it occasions uneasiness, or severe pain. As the disease proceeds, 
though pauses seem to take place in progress, the symptoms increase in 
severity. 
The child loses flesh ; the face grows pale and sallow, and anxious; the 
skin becomes habitually dry, and hotter than natural, and the pulse is per- 
manently accelerated. The abdomen does not grow progressively larger, 
but it becomes more and more tense, although its tension varies without 
any evident cause, and sometimes disappears for a day or two, to return 
again as causelessly as it disappeared. When the tension is diminished, 
the abdomen yields a solid and doughy sensation, and the union between 
the contents of the abdomen and the abdominal walls become very percep- 
tible. The superficial abdominal veins now become enlarged in many 
instances, and the skin grows rough, and looks as if it were dirty. The 
pain in the bowels retains the same colicky character as before, but it 
returns very frequently, and sometimes exceedingly severe, while the child 
is never free from a sense of uneasiness. The tenderness of the abdomen, 
however, but seldom increases in proportion to the increase of pain. The 
bowels are in general habitually relaxed, though the degree of the diarrhoea, 
as well as the severity of the abdominal pain, vary much in different cases. 
As the disease advances, the child becomes confined to bed, and is at 
length reduced to a state of extreme weakness and emaciation. Death is 
often hastened by the concomitant affection of the lungs; but should this 
not be the case, the patient may continue for many weeks in the same con- 
dition, till life is destroyed, after a day or two of increased suffering, by 
some renewed attack of peritoneal inflammation. 
In the first stage, rely chiefly upon dietetic and hygienicmeans. In the 
second, relieve pain by the application of a large poultice, frequently re- 
newed, to the abdomen, avoiding if possible, the application of leeches. 
As mild mercurials continued for a long time are of service, as soon as the 
abdominal tenderness is sufficiently relieved to allow of it, let the belly be 
rubbed twice a day with a liniment consisting of equal parts of lin. hy- 
drarg., lin. snpon., and ol. olivje ; and give hydrarg. c. creta, with an equal 
quantity of Dover’s powder once or twice a day. The abdomen may be 
advantageously supported by a well-adapted flannel bandage, with a piece 
of whalebone at either side. If there is diarrhoea, give a mixture with 
logwood and catechu. If diarrhoea is slight, or is absent, and there is 
much feverishness, use the tepid bath, and give small doses of liquor po- 
tassce and ipecacuanha, with extract of dandelion, and the mercurial with 
Dover’s powder. If a mild tonic seems likely to be borne, give a mixture 
with extract of dandelion, extract of sarsaparilla, and carbonate of soda; 
or give infusion of calumba, or liquor cinchonse. Chalybeates will not often 
be borne ; citrate of iron, or the ferro-citrate of quinine are the best, but 
must be given with great caution. Change of air, however, and especially 
removal to the sea-sicle, is the best tonic. The diet must, • of course, be 
light and unstiinulating throughout. Part xviii., p. 125. 638 
TANNIN, 
Oily Frictions in Mesenteric Disease.—In this paper Dr. Baur reports 
the great success that has attended the friction of the whole surface of the 
body, night and morning, with a sponge imbued with tepid oil, the patient 
being kept in bed, wrapped in a blanket, for two hours after. The first 
effect produced is abundant general sweating; the skin, losing its dry 
aspect, becomes supple, turgescent, and of a fresh color, a rubeloid erup- 
tion sometimes occurring. A secondary and highly benefical calming effect 
is produced, which is manifested in the jwoduction of tranquil sleep. As 
a third, there is increased secretion, especially of the kidneys and liver. It 
is evident that many affections may be rendered tractable by such an agent, 
and Dr. Baur regards it as almost possessed of specific properties in the 
diseases of scrofulous origin, as tabes mesenterica, or glandular tumors. 
He believes the frictions are powerfhl adjuvants in scrofulous hydrocephalus, 
and may even prove curative in phthisis, when steadily persevered in. 
Part xxxii., p. 90. 
Tuberculosis and Tabes Mesenterica of Infants.—Prof. Nelson, in his 
“ Clinical Observations on the Special Application of the liquor Pepsince 
in certain Diseases,” says : The number of these cases that have presented 
themselves precludes my entering upon them individually. Let it suffice 
to picture them generally, and according to their broad features: to wit, 
the wrinkled, discontented, fretful faces of the young children, rather re- 
sembling those of old men and women in the most unhappy humor possi- 
ble ; the small shrunken chests ; the large toad-like bellies ; shrivelled ex- 
tremities ; and bloodless, wax-like fingers. Such patients often have vora- 
cious appetites, without any good results ; the food passing off in diarrhoea, 
without having been digested. By means of hydrargyrum cum creta and 
Dover’s powder, and the liquor pepsiniae by itself alter food, the changes in 
such children have been very extraordinary, especially when the diet has 
been consistent with the other treatment, and goats’ or asses’ milk used, 
along with raw egg. The same results will accompany its use amongst 
the pot-bellied young of the lower animals. Part xxxv., p. 298. 
Vide Art. “ Marasmus.” 
Use of Pure Tannin—The use of tannin, or tannic acid, externally, will he 
found especially valuable hi sore nipples, excoriations about the anus and 
scrotum, piles, leucorrhoea, aphthous sores in the mouth, toothache, severe 
salivation, and relaxed sore throat. For sore nipples, Mr. Druitt, uses it in the 
strength of five grains to the ounce, on lint, and the part to be covered 
with oil silk. For that troublesome itching about the anus and scrotum, 
so teasing to some people, he prefers lemon juice. In leucorrhoea, tannin 
will be found useful as a suppository, ten grains being mixed with a little 
tragacanth, and introduced up the vagina sufficiently high that during its 
solution and passage downward, it may be smeared over the whole surface. 
It is also one of the best applications for severe salivation and for relaxed 
sore throat, attended with an increased secretion of mucus. But Mr. Druitt, 
seems to think, also, that it is the best application for toothache ; a piece 
of information which he received from Mr. Tomes. “ Let the patient 
thoroughly wash out the mouth with a solution of carbonate of soda in 
TANNIN. TEETH. 
639 
warm water ; let the gum around the tooth or between it and its neigh- 
bors, be scarified with a fine lancet; then let a little bit of cotton-wool, 
imbued with a solution of a scruple of tannin and five grains of mastic in 
two drachms of ether, be put into the cavity, and if the ache is to be cured 
at all, this plan will put an end to it in nine cases out of ten.” 
Part x.,p. 139. 
Tannin—Employment of—Dr. Cummings states, as the result of several 
years’ experience, that he has found tannin the most valuable of astrin- 
gents. Thus, whenever, in dysentery, medicines of this class are indicated, 
it acts admirably, either given alone or combined with opium. lie says, 
he could refer to more than a thousand cases of dysentery, diarrhoea, 
cholera infantum, etc., in which he has employed it, never with regret, and 
almost always with advantage ; while other practitioners, with whom he 
has communicated concerning it, express similar opinions. In the sweat- 
ing, or last stage of phthisis or low continued typhus, and even in the worst 
cases, this accompaniment of diseases of debility has been entirely or in 
part relieved. It is useful in almost all forms of hemorrhage, and most 
remarkably so in hemoptysis; and when combined with opium and ipecac, 
it forms a medicament very preferable to acetate of lead and other similar 
substances. Among other forms of hemorrhage, over which it exerts great 
power, is that from the bowels resulting from dysentery, and that which 
occurs in threatened abortion. In hemorrhoids, it is of great use as an 
outward wash. In epistaxis, it may be snuffed up or blown through a 
quill, and will almost always arrest the bleeding. No article in the whole 
class of astringents acts like it in severe salivation. In aphthae and other 
diseases of the mouth, in which there are spongy or bleeding gums, it 
possesses no equal. Used as a gargle in relaxed uvula and tonsils, its 
efficacy is great. As an antiseptic, for cleaning old foul ulcers, the author 
has extensively used it in the form of a powder, especially when there is 
disposition to hemorrhage. As an astringent collyrium, it is, in his opinion, 
preferable to all other substances in the purulent ophthalmia of infants. 
He administers it internally in two-grain doses. Part xxiv., p. 350. 
TEETH. 
Hemorrhage from the Socket of a Tooth— Use of Plaster of Paris — Some 
interesting cases of bleeding after extraction of a tooth have been related 
in the Journals, several of which have terminated fatally. Mr. Roberts, 
of Edinburgh, relates a case in which a friend of his completely succeeded 
in stopping the hemorrhage by filling the bleeding cavity with plaster of 
Paris. From the plastic nature of this substance when moistened, we may 
conceive how readily and completely it may be pressed into every part of 
the bleeding cavity, and by its rapid consolidation how it may form the 
most perfect plug. Part vi., p. 114. 
Transplantation of a sheep’s Tooth into the Socket of a Child.—Mr. R. 
Twiss, after having extracted the remainder of a broken front tooth from 
a young lady, aged twelve years, put in its place the front tooth of a year- 
ling sheep, reeking from the jaw of the living animal, having previously 
shortened its root about a quarter of an inch. After the first week, during 
which there was little promised success (the tooth being much too small 640 
TEETH. 
for the space, and the child not attending to directions), it became more 
and more firm, with every indication of its having taken root. 
Mr. Twiss was led to select the sheep, on account of the extreme clean- 
liness of this animal, and the beauty and aptitude of the teeth for the pur- 
pose. He recommends that teeth be taken only from sheep two or three 
years old, as at that age they are about the size of adult human teeth, and 
they are more likely to grow when transplanted. The root, he observes, 
may be shortened or pared, if necessary, to fit its new situation. The new 
tooth may be kept in situ by waxed silk ligatures. Part vi154. 
Different Cements to stuff decayed Teeth.—1. Ordinary Tooth Cement. 
—Is generally formed of a very concentrated etherial, or alcholic solution 
of gum sandarac, mastic, dammar, colophony, etc., in the proportion of 
one-third of the solvent to two-tliirds of the resins by weight. A very 
usual-formula is: sandarac, twelve parts; mastic, six parts; amber pow- 
der, one part, to six parts of ether. This preparation is a balsam of the 
consistence of copaiba; it readily dries on exposure to the atmosphere, 
but remains for some time soft and compressible. The mass yields, with 
alcohol, a milk-white solution, the turbidity depending on the masticine 
which is precipitated. 
2. Gauger’s Tooth Balsam (Balsamum Odontalgicum).—Is chiefly 
in use in St. Petersburg. The recipe is as follows: Dissolve §ij. of picked 
mastic in §iij. of absolute alcohol. Pour the solution into a bottle capable 
of containing two pounds, and add of dried balsam of tolu §ix. Promote 
the solution by a gentle heat, and frequently shake the stoppered bottle. 
When the latter substance is dissolved, place the whole in a warm situation, 
to allow the undissolved particles to deposit. This balsam is viscid, and 
forms, when exposed to the air, a firm mass, which is neither acted upon 
by the saliva nor by other watery liquids. To prevent tooth-ache arising 
from exposure of the nerve, the decayed tooth should be well dried by 
means of cotton or blotting-paper, and a piece of cotton or wool imbued 
with the balsam is to be carefully inserted into the cavity. 
3. Vienna Tooth Cement.—Herr Y. Wirth, apothecary of Vienna, first 
conceived the idea of mixing with a viscid alcoholic solution of the resins 
powdered asbestos, which perfectly supplies the place of the pledget of 
cotton. His preparation is generally sold along with a tincture for cleans- 
ing the hollow teeth, and allaying tooth-ache.. The latter tincture consists 
of an alcoholic solution of guaiacum and myrrh with acetic ether. Oster- 
maier, an apothecary at Munich, analyzed this nostrum, and has perfectly 
succeeded in preparing it, but we are not at liberty to publish his recipe. 
It will, however, be a sufficient hint to the scientific man to be reminded 
that powdered West Indian copal gains considerably in solubility in 
spirit by exposure to moderately warm air, and that pure alcohol, to 
which a few drops of any essential oil -are added, greatly augments its 
solubility. 
4. Ostermaief s Tooth Cement.—The principle of this preparation is the 
formation of phosphate of lime in the cavity of the hollow tooth. For 
this purpose anhydrous phosphoric acid must first be formed by burning 
phosphorus under a large basin, fifty-eight parts of pure unslacked lime 
in powder, are to be mixed with forty-eight parts of this flocculent anhy- 
drous phosphoric acid, and the necessary quantity is to be pressed into the 
cavity of the tooth, after the tooth has been Avell dried ; for, if the latter TEETH, 
641 
proceeding be not observed, the mass will become heated, and, in expand- 
ing, fall out of its place. The application should be quickly elfected, for 
the substance becomes quite hard and useless in the course of one or two 
minutes. Part x., p. 176. 
Treatment of Caries of the Teeth.—Scrape out the entire of the soft- 
ened carious part of the tooth, and rub its interior with a saturated solu- 
tion of nitrate of silver, or with pulverized nitrate of silver barely wet. 
In this way the progress of caries may be effectually stopped; and a tooth 
thus treated will often remain for years, though without any stuffing, and 
exposed to all the variations of food and drink, without giving any trou- 
ble or pain, and without any reappearance of the caries. 
. Part xiv., p. 197. 
Hew Amalgam for stopping Teeth.—[Mr. Evans states that he has em- 
ployed this amalgam successfully for a length of time. He says:] 
It is composed of chemically pure tin, prepared with much care, to in- 
sure its being free from any other metallic substance, and combined with 
prepared cadmium, in small quantities, and mercury. In using it so much 
mercury should be employed as may be required to make it more or less 
plastic. 
The cavity of the tooth being previously thoroughly freed from carious 
matter, can be carefully filled with paste thus formed. In the course of a 
few minutes it hardens into a solid, and gradually acquires a still firmer 
consistence and toughness, exhibiting a whitish color, or, if cut or bur- 
nished, a metallic lustre, like that of pure tin. 
It retains its color perfectly, neither oxidizing on the external surface, 
nor on that applied to the cavity, and, of course, it does not discolor the 
tooth itself. It fills each crevice of the cavity, and by effectually excluding 
moisture and all kinds of deleterious matters, prevents the occurrence of 
caries, and becomes sufficiently hard to withstand the friction of mastica- 
tion. To these most important advantages may be added others—e. g. it 
is easily and quickly prepared, without the trouble of beating it, as is the 
case with some of the amalgams hitherto used. It will not amalgamate 
with, or injure any gold clasps or plate bearing artificial teeth, which may 
be placed in contact with it; and, in case of its removal being necessary, it 
can be cut out as easily as gold filling, as it forms a tough, almost ductile 
substance, and not a hard, brittle one, like the ordinary amalgams. 
Part xix.,p. 322. 
Hemorrhage after Extraction of Teeth.—In severe cases use the 
actual cautery. It is best applied by means of a small rod of polished 
iron, furnished with a sheath ; the end of the sheath is applied to the 
bleeding part, and the heated iron then inserted, and passed along the 
sheath until it reaches the part. ♦ Part xx., p. 119. 
Material for Arresting Alveolar Hemorrhage.—The difficulty that 
sometimes occurs in arresting hemorrhage after the extraction of teeth, 
especially in a person of hemorrhagic diathesis, is well known. Mr. 
Beardsley describes a composition which he found useful as a plug in such, 
cases, and also for other purposes. 
The proportions of the ingredients used, are, gutta percha, one ounce; 
Stockhohn tar, ounce and a half to two ounces; creasote, one drachm; 
shell lac, one ounce, or more, to harden it. To be boiled together in a 
VOL. II.—41 642 
small crucible, and constantly stirred or beaten, till it becomes thoroughly 
blended into a stiff’ homogeneous mass. 
He has found the above composition a very ready and easy application 
for leech-bites, when the hemorrhage is at all troublesome. It is very 
adhesive when warmed, and firmly adheres all over the wounds when the 
part is wiped dry, and a small portion pressed on, just wetting the finger 
before doing so, to prevent it adhering to it also. Part xxi., p. 196. 
Teeth—Loosening of the.—Use a gargle of tannic acid, three or four 
grains to the ounce of water. Part xxi., p. 326. 
New Preparation for Stopping Teeth.—[Mr. Davenport gives the fol- 
lowing recipe :] 
Pour a small quantity of collodion on a plate or glazed surface; allow 
it to evaporate till it acquires the consistence of a thick paste, or, in more 
familiar language, a pill consistence ; let the cavity of the tooth be well 
dried, and quickly filled wTith the paste; in the course of a few minutes it 
will be hard and fit for mastication. Very slight pressure is required, and, 
being of a vegetable nature, somewhat analogous to the tooth itself, will 
resist the action of vegetable juices, and remain colorless. 
[Mr. Davenport prepares his collodion in a manner different from that 
usually adopted. He tells us:] 
The chemical manipulation is extremely disagreeable; the nitrous acid 
fumes are very abundant, consequently highly irritating to the respiratory 
organs. Great care is necessary in well washing the cotton; also, a 
moderate heat in drying it. The process is as under : 
Take nitrate of potash, 4 lbs.; sulphuric acid, 8 lbs.; carded cotton 
wool, 8 oz.; mix the nitrate and acid in a glazed vessel, add the cotton, 
and constantly agitate with a glass rod for half an hour; then wash the 
cotton thoroughly in cold water, so that no trace of acid should be per- 
ceptible to test paper; then dry carefully, and the result will be a very 
soluble gun-cotton; then take 1 oz. of the cotton; rectified sulphuric 
ether, 16 oz. fluid ; when dissolved, add 1 oz. absolute alcohol. Allow the 
solution to stand twenty-four hours, and the collodion will be ready for 
use. Part xxi., p. 358. 
Teeth—Vegetable and Animal Parasites of.—From microscopic ob- 
servations made by Dr. Bowditch, he has, in a large majority of instances, 
found these parasites between the teeth, or at the juncture of the gums, 
in persons from different classes of the community, but without any disease 
of the mouth. He attributes their presence to a want of cleanliness ; and 
recommends thoroughly brushing the teeth after each meal. M. Foy, a 
French dentist, recommends tinct. kino, tinct. catechu, aa.; a teaspoonful 
to be added to cold or tepid water, and used every morning. 
Part xxii., p. 366. 
Materials the best Adapted for Filling the Teeth.—Dr. Robertson 
says: 
Pure and well-preserved gold leaf is undoubtedly the best and the most 
durable material which has yet been discovered for filling the teeth, and 
particularly so when the operation is performed in the early stages of 
decay, and before the slightest tenderness has been felt in the tooth. I 
should therefore recommend gold to be used in all cases where it is prac- 
ticable, in preference to any other filling. But we have numerous cases 
TEETH. TEETH. 
643 
which present themselves where gold cannot he used, and where an 
amalgam becomes a necessary substitute. The consideration then is, 
what materials are the best to form this amalgam ? 
I have given much time and labor to the investigation of this subject, 
and after numerous experiments with the various metals, have come to 
the conclnsion that gold, silver, platina, and tin, in their pure state, are 
the best; because I have found in using them, either separately or com- 
bined, that they resist the acids of the mouth better than any of the other 
metals. 
An amalgam of these, however, cannot be formed without mercury, 
but the smaller the portion the better, so that there shall be just sufficient 
to unite and hold in permanent combination the purer metals above spe- 
cified. 
The amalgams in general use, even those of the better class, which are 
composed of metals above mentioned, contain a great deal too much 
mercury; and I shall presently show that the cause for this superabun- 
dance of mercury arises from the incorrect proportioning of the metals, 
and the improper mode of mixing them. The method generally adopted 
in preparing an amalgam is to combine the mercury at once with the other 
metals, so that the compound may be ready for using, and when a* portion 
is required it has to undergo a process of heating and rubbing, to bring it 
back from its crystallized form to a pasty state before putting it into the 
tooth. Instead of adopting this method, the mercury ought to be kept 
separate from the other metals, and only mixed with them at the time of 
using. This mode of mixing, with the metals rightly proportioned, will 
produce a hauler and more durable filling, and .the metals will combine 
with one-third of the mercury required in the former mode of preparing 
the amalgam. 
Some dentists use an amalgam of palladium and mercury, which makes 
a firm and durable filling, but it becomes black in the tooth. A few years 
ago cadmium was introduced as a filling, and for a short time it promised 
well, and appeared to be an improvement upon former amalgams, but 
after a few months’ trial it showed its defects, and has very properly been 
discarded. It neither retained its color nor its hardness, for when acted 
upon by the friction of the opposing teeth it soon wore away, and when not 
acted upon became, in parts, yellow as saffron,' with the disadvantage also 
of having a strange tendency to produce galvanic action in the mouth. 
Objectionable as this compound is, it still continues to be used by a certain 
class of practitioners, under the title of “ Parisian filling.” 
There are various kinds of amalgams used by the same class of indi- 
viduals, which contain copper, lead, bismuth, zinc, and antimony, all of 
which are injurious. 
The amalgam which I am about to desoribe contains nothing novel so 
far as the materials are concerned; but it is in the proportioning of 
them, and by a different mode of preparing the compound, that I have 
been enabled, of late years, to get rid of two parts out of the three of 
the mercury formerly required j and this I consider to be an important 
advantage. 
The amalgam consists of gold, one part ; silver, three parts; and tin, 
two parts ; and it is of the utmost importance that the metals should be 
pure, free from the smallest particle of alloy. 
The mode of uniting the metals, is, first, to put the gold and silver into 644 
TEETH. 
the crucible, and just as they are on the point of melting, add the tin, 
which requires less heat than the former metals. When they become 
melted, but not over-lieated, pour them from the crucible, melt them a 
second time, for the purpose of having them properly mixed, and then pour 
them into an ingot of a shape adapted for reducing the compound into the 
tinest powder. 
The mercury is to be kept apart from the powder, and mixed with it 
at the moment the amalgam is to be put into the tooth. The mercury 
must be perfectly pure, and the quantity required will be equal in weight 
to the powder. 
In mixing the powder with the mercury, the exact proportions of each 
can be ascertained to the greatest nicety, and by a very simple process, 
which will save time and materials, and which makes a harder compound, 
than by using a larger portion of mercury, and squeezing part of it out 
again. 
A measure for the mercury maybe made from a square portion of ivory, 
by drilling in it three holes ; one may be made to contain four grains, the 
second eight grains and the third twelve grains. The mercury to be poured 
into any one of these, as more or less may be required to fill the cavity 
of the tooth, and by drawing the finger across, so as to bring the mercury 
on a level with the surface of the ivory, the portion wanted may be 
accurately obtained. 
The measure for the powTder is equally simple and convenient. It is a 
metal tube, with a handle attached, calculated to hold four grains, which 
is also got to a nicety by filling, and then drawing the finger across the 
mouth of the tube, so as to make level measure. 4> 
The mercury should be kept in a small bottle, with an india-rubber tube 
attached to its neck, and the mercury is readily passed through the tube 
into the measure. In this way the exact quantity of each of the metals is 
readily obtained. 
The powder and mercury to be emptied from the measures into a glass 
mortar, and rubbed till they become mixed. The compound is then to be 
rubbed firmly with the finger in the hollow of the hand, till converted into 
a paste, which, before hardening, allows plenty of time for insertion into 
the cavity of the tooth. 
I have found this compound to be far superior to the former class of 
amalgams. It does not, like palladium, and some of the other metals that 
have been used, become black in the mouth, It retains its hardness and 
firmness, and is not, like cadmium, liable to be wmrn away by friction of 
the teeth. 
Formerly, in fixing artificial teeth upon a gold plate, it was necessary 
to avoid bringing the gold in contact with a tooth filled with amalgam, 
because a portion of the mercury united with the gold and injured it. 
This evil is now remedied by the compound containing so small a quan- 
tity of mercury, which is held in permanent combination with the other 
metals, so that not a particle of it is abstracted by the embrace of a gold 
clasp. With these important improvements upon former amalgams 
another advantage is, that it is used with much greater facility. 
Part xxvi., p. 172. 
Cauterizing the Dental Nerve.—[Dr. W. A. Roberts, before the Edin- 
burgh Medico-Chirurgical Society, described the following method of TEETH. 
645 
applying the actual cautery by means of wire brought to a white heat by 
electricity. He says:] 
After several experiments, I found that “ Grove’s ” battery answered 
best, being moje convenient than “ Smee’sit is much smaller, and con- 
sequently and more easily kept out of sight. By this one 
pair of plates I can produce a more decided result than I could arrive at 
with six pair of “ Smee’s.” In the porous jar I have a mixture composed 
of two parts of nitric, to one part of sulphuric acid. In the glass jar there 
is a mixture of four parts of water to one part of concentrated sulphuric 
acid. At the end of each of the conducting wires, you will observe a fine 
platina wire brought to a point. This wire is fine enough to enter the 
foramen of any tooth, and if required merely to cauterize the large cavity 
of a decayed tooth, it can be easily rolled up to act as a small ball. When 
the wire is to be heated, the communication is made by gently pressing 
upon the ivory knob while pressing down the spring; the contact is made 
instantaneously; by taking off the pressure, the current is broken off as 
quickly. I found some difficulty at first in operating, from the want of 
elasticity in the wires, as the thickness necessary to convey sufficient 
quantity of the electric fluid to heat the platina wire to a white heat, ren- 
dered them very unwieldy. This has been got over very ingeniously and 
satisfactorily by a plan of my son’s, which consists in filling two small 
india-rubber tubes with quicksilver, the ends of the copper wires being 
inserted into the mercury at both ends, and tightly tied ; by this means 
the communication is rendered complete, and allows of free motion. 
Since this was done, we find now full freedom can be obtained by having 
a bundle of very fine wires tied together instead of a single thick one. 
The advantages, then, to be obtained by this instrument are, its easy 
application to the desired spot in the mouth, and that perfectly cold, 
instead of alarming the patient by holding a red-hot iron before his face; 
its being at once raised to the requisite heat, and no more than the mere 
point of the wire used being hot; its being at once cooled on simply 
removing the finger from the ivory knob; and lastly, there being no ap- 
pearance of heat to alarm the patient. 
When to be applied for the purpose of arresting hemorrhage, or the 
deadening of the dental nerve, the cavity should be first wrell wiped out 
with a piece of lint, and then the desired spot should be rapidly touched, 
so as not to come into contact with other parts. This can be repeated if 
necessary. The platina must be at least red hot, as it then acts instan- 
taneously, and wdth little or no pain, otherwise it would cause much pain, 
and subsequent inflammation. I need not say, with timid persons, the in- 
halation of chloroform should be resorted to. I have used this form of 
the actual cautery with and without chloroform in many cases. 
Part xxvi., p. 175. 
Teeth—Cement for making them Insensible to Pain.—Previous to 
stopping teeth permanently with any metal, use a cement composed of 
Canada balsam and slaked lime, which is introduced into the hollow tooth 
like a pill. The most sensitive tooth, says Dr. I. P. Clark, of London, 
may, by repeating this application, be made quite insensible to the most 
severe operative proceedings. Part xxx., p. 137. 
Some of the Effects Produced by Carious Teeth.—[The following lec- 
ture by Mr. Smith contains many interesting facts.] 646 
On the present occasion it is nay intention to describe to you some of 
the effects produced by carious teeth, the causes of which are occasion- 
ally overlooked by practitioners; and I am induced to do this by the occur- 
rence of a case which came under consideration on mmjast admission- 
day. 
Elizabeth H., aged 40, was sent from some distance in the country to 
this infirmary, Dec. 12th, 1856, to be treated for what she was told by a 
medical practitioner, was a cancerous tumor in the cheek. On examina- 
tion, a tumor, the size of a small chestnut, was found, with an ulceration 
of the mucous membrane, just fitting the sharp edge of one fang of a cari- 
ous molar tooth of the lower jaw, which was making its way from the 
gum. Being fully assured, from former experience of many cases of a 
similar kind, that this was the sole cause of the tumor and ulceration, I re- 
moved the tooth, and in your presence promised her it should be well in a 
few days. A little lotion was ordered for the mouth. She appeared 
again on the next out-patient day, Dec. 17th. The ulceration was healed, 
the tumor gone, and she was discharged cured. 
Now, I tell you, that if the cause of that tumor had been overlooked, 
no treatment of any kind would have been of the least use; it would have 
continued, it would have increased, and gone on from bad to worse for 
months, and possibly for years, unless the tooth had been removed by the 
efforts of nature. I could tell you of scores of cases like the above. 
Sometimes instead of the cheek, the tongue suffers from the same cause. 
I have detected many cases of this kind. One interesting example shall 
be sufficient to explain such cases to you. 
' More than thirty years ago, one out-patient’s day, my senior colleague 
(Mr. Hey) informed me that a few days previously he had excised a malig- 
nant-looking tumor from the tongue of a young country-woman, who was 
a private patient of his; that, to his surprise, in a few days the tumor had 
sprouted out as large or larger than before the operation ; that, as she was 
not in circumstances to pay consultation fees, he had requested her to be 
in the house-surgeon’s room at twelve o’clock, in order that he might ask 
Mr. Chorley’s opinion, along with my own, on the case. On that day Mr. 
Chorley did not come to the infirmary, and I went with Mr. Iley to see 
his patient. There was a foul, dark, fungoid tumor, which occasionally 
bled, and from which she suffered much pain during every attempt to 
speak or masticate food ; it was the size of a small walnut. On examining 
it with the finger, I detected two broken incisors (the middle and left late- 
ral of the lower jaw) leaning inward, and with sharp-pointed edges fitting 
into the centre of the tumor. I was immediately convinced that these 
two teeth were the cause of all the mischief, and stated that opinion to 
Mr. Hey, who appeared doubtful. I said that he would not be justified 
in applying the ligature or using any other means, without first waiting 
to see the effect of the removal of the two broken carious teeth. I never 
saw the young woman again, but I was informed by Mr. Richard Hey 
that the teeth were drawn, and soon afterward the tumor entirely dis- 
appeared, without any other means being resorted to. 
Sometimes carious teeth produce abscesses in the cheek, neck, and throat; 
these burst or are opened, and form fistulous sores, which will remain 
unhealed for months and years unless the cause be removed, just in the 
same manner as you see fistulous openings in the leg in cases of necrosis, 
and which remain open for years until the sequestrum is removed. 
TEETH. TEETH. 
647 
A few years ago a middle-aged man asked my opinion about a fistulous 
sore which opened on the middle of his whisker on the right cheek. I 
introduced a probe, and it came in contact with the fang of the last molar 
tooth of the upper jaw. I persuaded him to allow me to draw it, on the 
promise that, he should be well in a few days. I requested him to write 
by post on the tenth day, and let me know the result. He wrote to say 
the discharge ceased the day the tooth was drawn, and that it was per- 
fectly well. 
Seven or ten years ago a young woman came under my care at the in- 
firmary with a fistulous sore in the fore part of the throat, within an inch 
of the sternum. It had been discharging upwards of a year. I probed 
it; the instrument could be passed in the direction of the molar of the 
lower jaw on the left side. On inquiry, she said that eighteen months 
before she had had a tooth drawn at the dispensary, but the fangs of the 
tooth were left in the jaw. Afterward an abscess formed, which descended 
lower and lower till it burst midway between the sternum and pomum 
Adami. I drew the stumps ; it still discharged for a week or ten days, 
when it got well without any other treatment. I mention the above 
case to impress on your minds the possibility of the fistulous orifice 
being at a considerable distance from the offending tooth. The fistulous 
sores proceeding from carious teeth are generally in the cheek or at the 
angles of the jaw. On the application of the probe you will often find 
the instrument pass readily to the interior of the mouth; you have then 
only to select the proper victim for sacrifice, and you will rarely err in 
this respect. Where the sinus from the sore to the tooth is short, the 
discharge from the external sore will generally cease in a day or two after 
the extraction of the tooth, but where it is long, as in the above case, it 
may be a week or two. 
As abscess in these cases always precedes the formation of a fistulous 
sore, it should be your endeavor to detect these cases at this particular 
period. 
A long time ago a near relative consulted me about an abscess at the 
angle of the jaw, on the right side. I suspected its cause, for on pressure 
I could make pus appear at the edge of one of the molars. He refused to 
have the tooth drawn until I assured him the abscess would burst ex- 
ternally, and continue discharging till the tooth was removed, and that an 
ugly looking scrofulous cicatrix would remain for life. The tooth was 
drawn ; the abscess discharged itself into the mouth, was soon well, and 
left no mark. 
How, if the cause had not been detected when it was, in ten or twelve 
days the abscess would have burst externally, and a fistulous sore would 
have been the consequence, which would have continued discharging until 
the teeth had been removed either by nature or art. 
Whenever you extract a tooth in these cases, always examine it care- 
fully ; you will invariably find a fang deprived of its periosteum, and some- 
times a little sac attached to its root, containing pus. 
Sometimes, where abscess forms from a carious molar of the upper jaw, 
the matter, instead of making its way to the cheek, gets into the antrum. 
Remove the tooth, and if this does not give sufficient outlet for the 
matter, perforate the antrum Avith a joiner’s gimlet. There has been a 
very interesting case of this kind recorded in the journals during the pre-' 
sent month. 648 
TEETH. 
A horse was condemned to the knacker’s yard as being afflicted with 
glanders, having a foul offensive discharge of purulent matter from the 
nostrils, and being in the last stage of emaciation. A veterinary surgeon 
finding that it could not masticate its food, examined its mouth, and de- 
tecting a carious tooth in the upper jaw, extracted it. The discharge 
ceased; the horse soon began to thrive, and got well. Here was a case in 
which there was as much professional credit due to the surgeon as if 
instead of saving a horse from the knacker’s yard he had saved the life of 
an alderman. 
Mr. Louis Oxley, the dentist, related to me a case of such interest, that 
I requested him to write it out for me. Here you have it in his own 
words: 
A young woman, of rather strumous habit, complained of a dull, aching 
pain under the orbit. The pain lasted from three to four months, attended 
by a gradual elevation of the orbital surface of the maxillary. The eye 
above this surface became at length so affected as entirely to lose its func- 
tions. At this stage of the case the young woman, who was attended by 
a general practitioner, who ignored dental surgery and pathology, resorted 
to leeches, blisters behind the ears, and drastic purges: I need not say in- 
effectually. After two or three months’ loss of the sight the young woman 
first perceived a discharge from the right nasal fossa of a thick purulent 
fluid. This discharge had existed for eighteen months Avhen I first saw 
her, even in spite of the aforesaid remedies ! An examination of the mouth 
at once revealed the cause of so much misery, and the removal of three . 
roots in a state of periostitis was the simple means by which two most im- 
portant organs regained their proper functions. 
There is another case in which swelling, inflammation, and ulceration at 
the sides of the tongue take place, and which does not appear, as far as my 
experience goes, except in individuals approaching to or upward of sixty 
years of age; but I have seen several cases of it, and shall proceed to 
describe the cause. If you will examine the form of the molai’s of the 
lower jaw where they come in contact with the sides of the tongue, you 
will find the line from the neck to the top of the crown gives a convex out- 
line, so that for thirty or forty years during the act of speaking or mastica- 
tion, the sides of the tongue come in contact with a smooth rounded sur- 
face ; but the constant grinding of hard food, such as biscuits, etc., for two 
score years, where all the teeth have remained sound, wears away one-third 
of the upper part of the teeth, the bony part is worn away deeper by one- 
eighth of an inch than the enamel, leaving a sharp edge projecting into 
the mouth, so sharp that, by firmly pressing the finger and drawing it 
along the edge, you might cut it to the bone. The friction of the tongue 
against this sharp edge produces the effect I have described. It is only 
necessary to round oif the edges by the use of a fine file, and the tongue 
will soon heal. The operation will require to be repeated in a few years. 
, Part xxxv., p. 95. 
Cements for Stopping the Teeth.—M. Vagner recommends the follow- 
ing : A drachm of gutta percha, softened by hot water, is to be worked 
np with catechu powder and tannic acid, of each half a drachm, and with 
a drop of essential oil. For use, a morsel is to be softened over the flame 
of a spirit lamp, introduced while warm into the cavity of the tooth, and 
adapted properly. The mass becomes hardened, and even after several TENDONS. 
649 
months exhibits no traces of decomposition. M. Pouton states, that we 
may also obtain an excellent cement by dissolving one part of mastic in two 
of collodion. Having well dried out the cavity, a small ball of cotton 
soaked in some drops of the solution is to be introduced. It soon solidifies, 
and may remain in situ, seeming also to exert an influence on the further 
progress of the caries. Part xxxv.,p. 99. 
Application of the Electric Cautery to Dental Surgery.—The Electric 
Cautery is a very safe, rapid, and effectual means of destroying the ex- 
posed pulps of decayed teeth. The cavity of the tooth having been well 
dried out and cleaned, and the mouth protected by a soft napkin* the pla- 
tinum point is introduced into the cavity of the tooth, and then heated, 
which is preferable to heating it before introduction. The part is distinctly 
illuminated, and the pulp may be destroyed almost instantaneously. In the 
great majority of instances there is little or no pain beyond a momentary 
twinge. As a rule, the tooth should not be stopped on the same day as 
the electric cautery has been employed, but the cavity should be filled with 
a combination of morphine and mastic for a day or two. If the tooth 
should remain tender after the use of the cautery, it is better to wait till 
this has entirely subsided. Part xxxvi., p. 291. 
Exposed and Diseased Dental Pulp.—Mr. Underwood says: The nerve 
may be either removed by means of some instrument to withdraw it, as a 
straightened fishhook, or by destroying it entirely, or by rendering its 
exposed surface insensible; for the latter purpose a strong spirit solution 
of tannin may be applied, and the nerve becomes coated and protected by 
an insoluble compound formed by the albumen and tannin. As an escharo- 
tic for these purposes, nothing is better than four or five grains of recently 
burned quick-lime fnixed with a grain of morphia; this should be taken 
upon a piece of wool, and placed on the pulp, and the cavity closed with 
wax. Next day the application may be removed, and if any tenderness 
remains the dressing may be applied again. A strong, saturated solution of 
camphor is a good anodyne application. The actual cautery may often be 
used with great success to instantly destroy the dental pulp. 
Part xxxvi., p. 295. 
Carious Teeth—Stopping for.—A very good and easily applied cement 
for stopping teeth, says M. Henriot, is soft sulphur; it is not acted on by 
any of the alimentary substances or dentifrices. Put some washed flowers 
of sulphur in a test tube, heat it over a spirit lamp to over 350° Fahr., and 
pour it into cold water, when it will be a spongy mass, brown, soft, and 
elastic. A little ball of this should be pressed into the decayed tooth. 
Part xxxvii., p. 142. 
Dislocation of the Long Head of the Biceps.—Mr. Hancock, surgeon 
to the Charing Cross Hospital, says: 
There are probably few accidents so little noticed or understood as dis- 
placement of the tendons. The subject is scarcely mentioned in any of the 
numerous works on dislocations, although the consequence, when unre- 
duced, is great inconvenience to the patient, and in the case of displace- 
ment of the tendon of the long head of the biceps, which happens more 
TENDONS. 650 
TENDONS. 
frequently than any other kind, the patient is deprived in a great degree 
of the use of the limb. 
The principal signs of this accident are pain and tenderness in front of 
the joint, corresponding to the bicipital groove; acute pain in the course 
of the biceps when it is thrown into action, the pain being referred more 
particularly to its two extremities; the patient is unable to raise his hand 
to his head, or his arm beyond an acute angle from his body; the appear- 
ance of the shoulder is somewhat altered, the head of the humerus being 
drawn upward, and more forward than natural, lying close beneath the 
acromion.process, while the posterior and external part of the joint is some- 
what flattened. When we consider how much in appearance these acci- 
dents resemble partial dislocations of the head of the humerus upward and 
forward, we can entertain but little doubt that they have frequently been 
mistaken for them. 
In the treatment of these cases you have three principal objects in view: 
to overcome the action of the capsular muscles, to reduce the tendon, and 
to keep the tendon in its groove when you have reduced it. I am not 
aware of any particular symptom by which we can be guided with any 
certainty as to when the tendon is dislocated inward, or when outward ; 
but, as a result of my experiments, I should imagine that it is more fre- 
quently dislocated inward than outward, the inclination of the head of the 
humerus, and the greater projection of the large tubercle, being unfavor- 
able to the latter displacement. Place your patient on a low chair, and let 
an assistant fix his scapula by pressing upon the superior angle and costa; 
then separate the patient’s arm from his side, as far as you can; keep his 
hand in the prone position, and make extension doAvnward and outward 
from the wrist, until you have somewhat withdrawn tlte head of the bone 
from the acromion process. Now let an assistant sit down on the floor, 
underneath the injured arm, and, clasping both his hands over the deltoid 
muscle, draw the head and neck of the bone downward and a little back- 
ward, while you rotate the head of the bone inward and backward in the 
glenoid cavity, by making the patient’s arm describe a circle, carrying it 
backward, upward, forward and inward, across the chest. Should you 
have reason to suppose that the tendon is displaced outward, separate the 
arm as far as you can from the body, and let an assistant make extension 
in that direction best calculated to remove the head of the humerus from 
the acromial process, that is, downward and outward. -Unless this be 
done, in either form of the dislocation, the bicipital tendon remains pressed 
up by the head of the humerus against the acromial process, and is oUvi- 
ously prevented from returning into its natural position. Next place your 
left hand well up in the axilla, and direct your assistant, while he keeps up 
the extension, to rotate the arm strongly outward, and at the same time 
to bring it to the patient’s side. Having reduced it, gently separate the 
arm from the patient’s side; keep it steadily rotated outward, and the 
hand supine; place a long splint, which extends from the shoulder to the 
fingers, along the back of the arm and hand, and also a pad or compress in 
front, over the bicipital groove. Fix the whole with a roller evenly and 
carefully applied, and place your patient on his back in bed, where he had 
better remain until you consider that the parts have become sufficiently 
firm to prevent a recurrence of the accident. 
The reason why I recommend you to separate the arm from the side 
after reduction, is, that by so doing you place the pectoralis major muscle TENDONS, 
651 
upon the stretch, and consequently make its broad tendinous insertion 
press more closely and directly over the bicipital groove. In my experi- 
ments, the difficulty was not so great in reducing, as in keeping the tendon 
in its place when reduced, and certainly the plan which I am now advocat- 
ing appeared to be the most efficacious. Part 157. 
Rupture of the Tendon of the Long Head of the Biceps.—This accident, 
says Air. Hancock, may be occasioned by falling upon the arm, by violent 
twists of the limb, without external violence referred to the part, or by the 
sudden and violent extension of the limb, as when we put out our arms to 
save ourselves in filling. The patient experiences at the moment, a sensa- 
tion of snapping in the shoulder, soon succeeded by inability to raise the 
hand to the head; acute pain is caused by even slight pressure in the 
course of the bicipital groove, or lower down, on the muscle itself; the 
latter becomes flabby, and the movement of the arm backward and forward 
produces acute suffering, mostly referred to the situation of the biceps, 
where it passes over the head of the humerus. 
Treatment.—Your object in these cases should be to approximate the 
two portions of the tendon, to obtain union if possible, or otherwise to 
favor the attachment of the lower portion to the head of the. humerus, as 
Air. Stanley has pointed out. To do this effectually, place the hand in the 
semi-supine position, that is, with the thumb upward, making your patient 
grasp the opposite shoulder; thus you effectually relax the biceps muscle, 
as you will at once perceive, upon recollecting that the biceps is inserted 
into the back of the tubercle of the radius, and that the first action of the 
muscle, when the hand prone, is to render it supine before it can effect 
flexion of the elbow. Now apply a roller carefully, beginning from below, 
carrying it up to*the axilla, and fixing a compress over the course of the 
biceps tendon, by which means you will keep the muscle quiet and prevent 
spasms; and, lastly, secure the arm in this position by bandages. 
Part xi., p. 159. 
Painful Crepitation of the Tendons.—AI. Velpeau gives the following 
account of his patient: A week since he endeavored to raise a load, having 
his left hand applied to his hip. He felt a violent pain in his arm, and now 
we may perceive a slight swelling at the lower and external part of the 
forearm, unaccompanied by any change of color or fluctuation. Of a re- 
gular and elongated shape, it is only painful during motion, while on 
applying the hand over it we may perceive a fine characteristic crepitation; 
and it is an example of the painful crepitation of the tendons which was 
vaguely indicated by Boyer and Desault. I first met with it in a case in the 
hospital of Tours, where it-was suspected to be a fracture of the radius. The 
affection is especially observed among washerwomen, mowers, blacksmiths, 
locksmiths, and joiners, and when it is seated in the foot, among soldiers 
huntsmen, etc. Excessive friction is the condition necessary for its pro- 
duction. In the forearm and wrist, where it is especially met with, its 
recognition is very easy, the crepitation it gives rise to being quite pa- 
thognomonic, being neither like that felt in fractures, that of cartilage or 
emphysema: but which has been compared to the crepitation of starch or 
of hoar-frost—such as is produced by walking on the snow. Its seat is 
evidently the sheath of the tendons, and it is probably due to a slight in- 
flammation, first causing too great dryness of the membrane, and after- 
ward giving rise to effusion, it is generally in no-wise serious,-disappear- 652 
TE8TE8. 
ing in a few days by rest alone ; but it must not be absolutely neglected, 
for I have seen it in some cases give rise to a fungous transformation of 
the sheaths; and indeed there is no reason why all the changes which 
occur in diseases of the joints should not take place here. If there is 
much pain we apply leeches and poultices, and the resolvent lotions and 
compression ; but rest is indispensable. Part xvi., p. 330. 
Tendons, Reunion of.—Mr. Adams, surgeon to the Royal Orthopedic 
Hospital, states that the newly-formed connective tissue, or new tendon, 
gradually assumes the character of the old tendon, so perfectly that no dif- 
ference can be perceived; it may be formed to the extent of two inches, and 
it is through the agency of this that the required elongation is maintained. 
Tenotomy.—To perform this operation cleanly and readily, you must 
use a knife with a cutting edge considerably longer than the breadth of the 
tendon. You must place the patient on the stomach, and let an assistant 
put the tendon on the stretch, by endeavoring to flex the foot, then intro- 
duce the tenotomy knife with its flat surface parallel with the tendon and 
close to its edge, but rather toward the posterior surface, pass it obliquely 
downward, keeping the point close to the tendon, and then by depress- 
ing the handle you carry it beneath the tendon; this done, turn the 
cutting edge toward the tendon, and divide it transversely; the division 
is indicated by a sudden audible snap and the yielding of the joint. In 
infants direct pressure of a sharp knife is often sufficient; but in adults 
a little cutting manipulation is required. On withdrawing the knife apply 
instantly a compress of lint plaster and bandage. Some surgeons recom- 
mend the tendo Achillis to be divided by passing the knife flatwise poste- 
riorly between the tendon and the skin, and then cutting from behind 
forward ; but the other method described is perhaps the better. 
Part xxxiii., p. 156. 
Scrofulous Diseases of the Testis.—The following is Mr. Curling’s ac- 
count of the symptoms of scrofulous disease of the testis: 
“ The disease commences insidiously, and is insidious in its progress. The 
patient’s attention is usually first attracted by a slight uneasiness in some 
part of the gland, generally the epididymis, which on examination is found 
to be Somewhat enlarged, prominent, and hardened. Sometimes the whole 
organ feels slightly enlarged and indurated, though it more frequently forms 
a tumor with an unequal and irregular surface. The state of the testis, 
however, is often marked by small local effusions of fluid in the tunica 
vaginalis, the surfaces of this membrane being partially adherent. Very 
little pain is experienced in the part, and there is but slight tenderness on 
pressure. After the disease has lasted for some time, many months, or 
even a year and more, making little progress, and often remaining station- 
ary, one of the prominences begins to increase so as to be observed exter- 
nally, and to feel painful and tender; the skin over it becomes adherent, 
changes to a livid hue, ulcerates and bursts, giving vent to a soft caseous 
matter mixed with pus. This is followed by the formation of a fistulous 
sinus, which discharges a scanty, thin, serous pus, mixed with particles of 
TESTES. TESTES. 
653 
tubercular matter and often with semen, particularly after venereal excite- 
ment. Similar changes may take place in other parts of the testis, occa- 
sioning two or more sinuses leading to the interior of the gland. These 
sinuses sometimes communicate, and they may continue open and discharg- 
ing for a great length of time. After the deposit has all come away, if the 
original disease be arrested, and no more tubercular matter formed, repa- 
rative changes sometimes take place; the discharge ceases, the fistula} 
close up, leaving the organ more or less diminished in size, or entirely 
wasted, according to the extent to Avhich it had been disorganized by the 
tubercular deposit. The bursting of the abscess and escape of the tuber- 
cular matter are sometimes followed by a hernial protrusion of the testis, 
as after chronic inflammation of the gland.” 
The administration of liquor potassce gradually increased to sixty or 
eighty drops, three times a day, in combination with iodide of potassium 
suggested. Fart ix.,p. 1*79. 
Fungus of the Testicle.—This disease was ably treated on by Mr. Law- 
rence in 1808. The testicle, from a variety of causes, as a blow, or gonor- 
rhoea, enlarges and inflames—the skin at last ulcerates, and a fungoid 
excrescence sprouts from the part. This growth has its origin from the 
glandular substance of the part, a protrusion of the tubuli seminiferi often 
taking place. Mr. Lawrence recommends the removal of this substance by 
escharotics, the ligature, or the knife. Still, as Mr. Syrne says, this could 
not be considered as a very satisfactory operation, although a great im- 
provement on the old one of castration, for it was plain that a portion of 
the gland must be sacrified in order to preserve the remainder. In order 
to remedy this evil, Mr. Syme proposes an improvement in the treatment. 
He says: 
When the fungous growth is divided longitudinally, that is from the 
base toward the circumference, it may be seen to consist of two textures 
distinguished by their color and arrangement. One is brown and disposed 
in straight lines, radiating from the base, where they are nearly, or quite 
close together, toward the circumference, where they are more or less 
apart, according to the size of the excrescence. The other is white and 
glandular, lying in the spaces which are afforded by the diverging rays. 
The former is composed of the tubuli seminiferi, altered in situation but 
not in structure, while the latter is simply organizable lymph that has been 
effused into the interstices. The relative proportion of these textures may 
be seen best by making successive sections of the fungus, parallel with its 
base. Here the substance of the testicle appears little if at all altered, and 
presents a mass of uniform brownish color. But in proceeding toward the 
circumference, each slice shows more and more of the white interstitial 
substance, until it seems to be the sole constituent. In addition to these 
facts, which are within reach of the naked eye, Mr. John Goodsir detected 
in a fungus which I gave him for examination, by the microscope, that it 
was covered externally by a thin layer of substance possessing the charac- 
ters of a granulating surface. So that the excrescence might be regarded 
as merely an extreme degree of exuberant granulation, or what in vulgar 
language is called “ proud flesh.” 
This observation suggested to me the idea, that by the use of proper 
means the fungus might be made to retrace its steps, through absorption 
of the white substance and gradual approximation of the brown, and that 654 
TESTES, 
the granulating materials of the surface might thus be enabled to com- 
pete the healing process. Pressure was obviously the agent on which 
reliance should be chiefly placed for producing the effect desired with this 
view, and the most convenient mode of compressing the growth, seemed 
to be inclosing it within its proper covering of the scrotum. There is no 
Joss of substance in this part, as the fungus issuing through a small ulcer- 
ated orifice, merely presses the integuments aside, so that they are found 
lying in loose folds above the dense ring that encircles the neck of the 
protruded mass. It must therefore be easy to obtain from this source, an 
abundant supply of materials for the purpose. 
Case.—Admitted on account of sores upon his legs, and a fungous ex- 
crescence from the testicle, about the size of a filbert. I cut round the 
fungus, and extended the incision upward as well as downward, so as to give 
it an elliptical form. The integuments were then separated on each side, 
and brought over the growth, where they were retained by three stitches. 
The scrotum was supported by plasters and a bandage. It appeared at 
first as if union by the first intention had taken place completely; but part 
of the wound suppurated, without, however, showing the slightest dispo- 
sition to protrude. The patient might have been allowed to go home soon 
after the operation, but was retained until the wound had fairly cicatrized. 
Part xi., p. 122. 
Fungus of the Testiele, treated by Professor Symes’ Method.—Dr. 
Cormack says: When in Glasgow, we saw, in the Royal Infirmary of that 
city, under the care of Dr. Lawrie, a case in which this operation had been 
performed with complete success. The patient, a lad, had been 
kicked on the scrotum twelve months before. Suppuration, ulceration, 
and protusion of the whole anterior and inferior portion of the left testicle 
followed; the surface and a great part of the substance of the fungus 
appearing to consist of yellow strumous deposit. On the 12th May, Mr. 
Symes’ operation was performed; and on the 25th, the patient was so 
well as to be anxious to return home, but was prevailed on to remain a 
few days longer, that the cicatrization might be more secure. Dr. Lawrie 
remarked to us, that where the skin was most deficient, and with the 
greatest difficulty made to cover the protrusion, there the cure was soonest, 
and apparently most securely effected. The case was altogether a most 
satisfactory testimony in favor of the new method of treating fungus of 
the testicle. Part xii., p. 213. 
Syphilitic Affection of the Testis.—[Syphilitic affection of the testis, 
says M. Helot, may be distinguished from gonorrhoeal affection by the 
following circumstances:] 
In the gonorrhoeal epididymitis, the attack comes on suddenly with the 
attendant train of inflammatory symptoms ; it shows itself during the 
course of gonorrhoea, or at the moment of its disappearance. On the con- 
trary, the commencement of the syphilitic testicle is essentially chronic ; 
it appears, as we have above remarked, long after the primary symptoms, 
constituting a consecutive affection. The gonorrhoeal and syphilitic affec- 
tions are thus two distinct complaints, except where the one terminates in 
the other ; but the course, lesions, and terminations of these two affections 
show no further relation between them. 
In the syphilitic affection of the testis, the organ is, even at tho com- 
mencement, hypertrophied; in the gonorrhoeal form, the testis, n the TESTES, 
655 
contrary, commonly preserves its elasticity and its size; the epididymis is 
principally affected, and if, in exceptional cases, the testis itself participates 
in the inflammation, an inflammatory swelling follows, quite at variance 
with the chronic enlargement of the syphilitic complaint. In the gonor- 
rhoeal orchitis, the tumor is painful, the skin of the scrotum red, tense, and 
shining ; the cord, when it is affected, becomes painful to the touch. In 
the syphilitic testicle, the enlargement is most commonly indolent from the 
commencement to its termination, and pressure with the hand on the testis 
and cord is unattended with pain. The anatomical characters - of the two 
affbctions are equally opposed; thus, in the gonorrhoeal affection, it is 
always the epididymis in which the complaint commences, and in the 
majority of cases, the body of the testis remains .free from disease; the 
contrary happens in the syphilitic affection of the organ. 
.[Simple hydrocele can scarcely be mistaken for the syphilitic testicle; it 
is not, however, so easy to distinguish what has been called by Pott, Boyer, 
Velpeau, etc., “hematocele.” M. Helot observes:] 
The scrofulous affection of the testicle may, under certain circumstances, 
be mistaken for syphilitic affection of the testis, and the diagnosis may 
present great difficulties. Thus, for example, a.patient having had syphilis, 
may be attacked with a scrofulous affection of the testis; what then are 
the characters drawn from tumor which may tend to clear up the case, and 
decide whether we have to treat one or the other affection ? First of all, 
in the scrofulous testicle there are two varieties of swelling, one formed 
by the tuberculous infiltration of the whole organ, the other formed by the 
development of encysted tubercles, either in the epididymis or in the body 
of the testis. We have remarked, that in the syphilitic affection of the 
testis the epididymis is rarely diseased ; in the scrofulous affection, on the 
contrary, the complaint commences usually in that organ, and extends only 
to the body of the testis at a subsequent period. The scrofulous testicle 
commences by isolated enlargements ; but these nodules become chesnut- 
shaped, very prominent, standing out in relief, as if attached to the epidi- 
dymis or testicle. We have seen, in the syphilitic affection of the testis, 
the cord generally remaining in a healthy condition, or if it enlarges, it 
does so in a gradual and uniform way, presenting no inequalities or promi- 
nences ; whereas, in the scrofulous affection, particularly in the advanced 
stages, it is not uncommon to find the cord studded with tubercles, re- 
sembling a bead necklace. Although the course of one or the other 
affection is similarly Chronic, nevertheless it presents differences which may 
be useful in forming a diagnosis. Thus the syphilitic affection of the 
testicle is more indolent than the scrofulous, which presents, from time to 
time, inflammatory accessions, characterized by a sense of tension of pain, 
which is augmented by the touch. The ordinary termination, by resolu- 
tion, of the syphilitic affection of the organ, opposed as it is to the sup- 
puration of the scrofulous disease of the organ, is likewise very important 
in differential diagnosis. 
The syphilitic is often difficult to be distinguished from the cancerous 
affection of the organ. How many tumors of the testis have been removed 
by the knife, which might have been cured had the true nature of the 
complaint been suspected. The rapid development in the encephalic tumor 
of the testis, the considerable size it will attain, its softness, which may 
often impose on the surgeon, leading him to believe it fluctuative; the 
unequal resistance it presents, the darting pains which occasionally come 656 
TESTES, 
on, mark a striking contrast with that uniform hardness, indolent cha- 
racter, and moderate size of the syphilitic enlargement of the organ. The 
cord in the cancerous affection is often knotted, hard, and unequal, and we 
know how uncommon the uniform hypertrophy of the cord is in the 
syphilitic affection. The engorgement of the glands in the iliac fossa is 
observed sometimes in the cancerous affection of the testis, but never 
happens in the complaint we are treating of. Authors, and, among others, 
Sir Astley Cooper, have described, under the name oTsciri-hus of the testis, 
a variety of cancer which might be more easily confounded with syphilitic 
affections of the testicle, as its development is slower than in encephaloid 
disease, and presents, from its commencement, hard nodules ; but these 
are hard from their formation, and become more and more so in scirrhous 
affections, which we do not observe in the venereal testicle. Notwith- 
standing the characters above given, the surgeon, amid all his doubts, has 
no other proof than a rational treatment to follow, in extricating himself 
from his uncertainty. 
[The syphilitic testicle is one of the consecutive secondary symptoms of 
syphilis; it may be said to border on the tertiary, hence it will require the 
treatment applicable to these periods.] 
Combine the mercurial treatment with iodide of potassium. Give three 
quarters of a grain of iodide of mercury in a pill every night, and one or 
two grains of iodide of potassium twice or thrice during the day. Continue 
this treatment for some time after a cure is effected. When effusion into 
the tunica vaginalis occurs, the fluid is generally absorbed; occasionally, 
however, it remains, and it is necessary to tap and inject the sac ; before 
doing this we should endeavor to procure its absorption, by mercurial 
frictions on the scrotum, or the application of bego plaster with mercury. 
We should also try compression. Part xiv.5jp. 229. 
Treatment of Swelled Testicle by Narcotics.—Mr. Jackson relates 
several cases in the practice of Mr. Gay; cases of gonorrhoeal orchitis, 
some of them very acute with febrile symptoms. The treatment consisted 
in low diet, a purgative dose, and the administration of tincture of henbane 
in the dose of one drachm three times a day. The treatment was in all 
speedily successful. Part xviii.,jp. 214. 
Testicle, Enlarged.—When compression is wanted, use Hutchinson’s air 
compressor. A kind of double nightcap, made of impermeable material, 
such as Macintosh, or oil-silk, is folded over the testicle, and then, by 
means of a stop-cock and force-pump, air is forced into the bag, by which 
almost any degree of compression can be produced. Some forms of hydro- 
cele may be treated in this way. Part xxxi., p. 169. 
Swelled Testicle.—Dissolve gutta percha in bisulphuret of carbon, and 
spread the substance over the part affected. (Recommended by M. 
Ellefson.) It immediately becomes dry and stiff, and forms a thin, tight, 
and adhesive covering, which loosens at the edges after three or four days, 
when it must be repeated. Part xxxii., p. 180. 
Belladonna in Orchitis.—M. de Larue recommends the following appli- 
cation, which, he says, promptly relieves the pain, and leads to a cure in a 
mean period of eight days. Lard, 60 parts; aqueous ext. of belladonna, 
16 parts. It should be applied generally every two hours in considerable 
quantity, the parts being afterward covered with a linen compress, which 
is to remain unchanged. Part xxxvii., p. 311. TETANUS. 
657 
TETANUS. 
Opium Smoking—By means of the common pipe, suggested by Dr. 
James Johnson, as a remedial agent in tetanus, hydrophobia, tic douloureux, 
etc. Part v., p. 56. 
Belladonna in Tetanus.—The value of belladonna in cases of tetanus 
has been repeatedly pointed out. It is surprising what large doses of the 
different sedatives may be given in this disease. Dr. Hutchinson, of Not- 
tingham, publishes some cases of this description, in one of which five grains 
of the extract were successfully administered, and in another the dose was 
ultimately four grains every two hours, until the disease was completely 
subdued. 
From the success of this treatment in tetanus, Dr. Hutchinson recom- 
mends that large doses of belladonna be given in cases of hydrophobia, so 
as to relieve the spasms affecting the muscles of the glottis and larynx. 
Part x., p. 29. 
Treatment of Tetanus—Use of Indian Hemp, Croton Oil, Opium, 
Emetics, etc.—In the first case recorded, Mr. Miller used the tincture of 
the hemp and the resinous extract. It was in a girl seven years of age, la- 
boring under traumatic tetanus. She took three grains of the resinous 
extract every half hour—a full dose for an adult, under ordinary circum- 
stances, without repetition. Narcotism was usually pi’oduced by a few 
doses, but only continued a short time, when the doses were recom- 
menced. 
Under ordinary circumstances, Mr. Miller doubts the efficacy of this me- 
dicine as an anodyne and hypnotic, and considers that its chief value rests 
in its power to subdue inordinate muscular spasm. We suspect that if the 
experiments of Mr. Donovan had been known to Mr. Miller at the time, he 
would have preferred the tincture of the resin instead of the resin itself, not 
only on account of its more certain effects, but also for its easier mode of 
administration. In a case of idiopathic tetanus in Guy’s Hospital, Dr.Bab- 
ington prescribed the tincture of the extract in the proportions of three 
grains to half a drachm of rectified spirit, to be given every half hour. The 
effects were variable, but upon the whole beneficial. This patient took in 
the space of five days 248 grains of the extract, although a single grain 
produced powerful effects in a healthy individual. Five doses of three 
grains each were given before any good effects were produced, and after 
that five-grain doses were administered every two hours for some time. 
This case shows that in cases of tetanus we must not be deterred from ad- 
ministering very large doses if smaller ones fail. Another authority on the 
use of this drug is Dr. Clendinning. He disagrees with Mr. Miller, and 
asserts that he has found it to be a valuable hypnotic and anodyne, both 
conciliating sleep and lulling pain; and another valuable quality is its power 
of allaying cough without the pernicious effects of opium. We protest 
most seriously against the baneful practice of giving opium in one form or 
another in bronchial affections, with the view of allaying cough. It may, 
indeed, allay this symptom, but it acts most prejudicially upon the mucous 
membrane, producing a stoppage of secretion and an increase of conges- 
tion. We hope, however, that the resinous extract of Indian hemp may 
afford considerable relief in a most troublesome class of bronchial disorders, 
in which the practitioner is incessantly called upon by his patient to give 
YOL. II.—42 658 
TETANUS, 
relief, which, by opium, he can only do by protracting the disease. In ar- 
ticular rheumatism, or severe bronchitis, we may be able, by means of 
hemp, to put the patient at once under the double influence of a diuretic 
laxative, and an anodyne antispasmodic; a saline solution, with or without 
colchicum, correcting the blood and secretions, unimpeded by the narcotic, 
whose whole influence appears to be expended on the tissues, seats of pain 
and irritation. . Another class of cases in which we may find this medicine 
useful is that of low fever, by securing the enjoyment of that great restora- 
tive—tranquil sleep—without any neutralizing inconvenience. In the 
treatment of another case of tetanus, by Mr. Stapleton, the effect of ail re- 
medies seemed perfectly useless; and this gentleman had recourse to pro- 
found intoxication. Under any other circumstances we should say that 
this remedy was improper, but in the case alluded to it was successful. Mr. 
Stapleton provided himself with a mixture of alcohol and water in equal 
parts. He gave six ounces of this mixture at once, and four ounces more 
in a quarter of an hour. In twenty-five minutes the patient laid on his side 
and fell into a profound sleep—every muscle was in a state of quiet relax- 
ation, and the sense of pain had vanished as if by a charm. For seventy- 
two hours he was kept under the influence of the remedy ; when it was 
withdrawn the tetanic symptoms returned and were as quickly relieved, 
when the alcohol was again resorted to. The relief, however, was only 
temporary, as the patient eventually died. 
[The following case of idiopathic tetanus is given by Dr. Newbigging: 
The patient Avas a baker, who, while perspiring profusely, went out to chop 
Avood, at a time of intense cold. In the evening of the same day he com- 
plained of tetanic symptoms, Avhich gradually increased. Dr. N. saAV him 
first a Aveek after the attack. The pulse Avas natural; boAvels constipated; 
urine scanty. He Avas bled to 12 oz.; a drop of croton oil was adminis- 
tered, and a large blister Avas applied to the upper part of the spine. The 
bowels Avere opened by the oil, and he felt altogether Three days 
after he Avas again bled to 14 oz.; and a strong dose of morphia Avith 30 
drops of tinct. cannabis ind. Avere given at bed-time. Three days after this, 
spasmodic action had commenced in the limbs ; the dose of morphia was 
then increased, and ordered to be given four times a day, and elaterium to 
be used as a purgative. Next day croton oil was again had recourse to, 
the elaterium having pro\Ted ineffectual. Dr. Abercrombie, at the same 
time, recommended the use of arsenic, AArhich was given Avith the morphia. 
He continued to improAre for a Aveek, Avrhen he was suddenly seized with 
great dysphagia and tremors, Avhich Avere soon remoAred by placing him in 
the erect position. His medicines having been discontinued for two or 
three days, were renewed. About five weeks after the commencement of 
the attack, he expectorated a quantity of pus mixed Avitfi mucus, which 
expectoration continued three Aveeks. He had aftenvard thickening of the 
spinous process of the cervical vertebras, and Avas attacked Avith anasarca, 
Avhich was subdued by diuretics, actively administered, and in about three 
months he Avas able to return to business.] 
The principal features of interest in this case of what is considered a rare 
disease in this country, are the gradual affection of the different muscles 
of the body, commencing Avith those of the jaw, and the successful issue 
of the treatment Avhich, hoAvever varied, may be considered to have resulted 
from the persevering employment of croton oil and opium : for although 
arsenic, Indian hemp, colchicum, etc., Avere administered to him at different TETANUS, 
659 
periods, I believe to none of these was so much benefit attributed by us— 
and he was occasionally visited by Dr. Abercrombie, Sir George Ballingal, 
and Dr. Duncan—as from the exhibition of opium in full doses, with the 
occasional use of croton oil; for, whether we consider this medicine to be 
endowed with any specific effect or not, as reasoning from somewhat ana- 
logous cases of nervous affections, I feel disposed to do, it certainly seemed 
to be followed by greater relief to the tetanic symptoms than when an or- 
dinary purgative, such as scammony, gamboge, etc., was exhibited. I have 
occasionally observed benefit from the Indian hemp in allaying irritation 
and causing sleep, particularly when opium was contra-indicated ; but I am 
somewhat doubtful of the value of this remedy in tetanus, and am disposed 
to think, that no case where opium is so decidedly indicated can be bene- 
fited by the administration of hemp, if the former powerful remedy has 
failed to be of service. 
[It seems probable that in this case some degree of inflammation at the 
upper part of the spine produced the complaint, followed by formation 
of matter which subsequently became connected with the organs of respi- 
ration.] 
A case of traumatic tetanus, which was cured by the use of emetics, is 
published by M. Allut. The patient was treated first by opium and musk, 
turpentine liniment along the spine, and leeches to the neck, but hourly 
grew worse. It occurred to M. Allut that he had seen the use of emetics 
proposed, and in despair he administered a strong dose. On returning 
four hours after, he found his patient decidedly better, and the urine, 
which had been suppressed for 24 hours, had returned. The treatment 
was continued for eight days, without any vomiting being produced, or 
more than one stool per diem, and the man made a rapid and perfect re- 
covery. Part xi., p. 22. 
Acupuncture, in Protracted Loch-Jaw.— Vide Art. “Lock-Jaw.” 
Treatment of Tetanus.—With regard to the treatment of tetanus— 
opium has been given in nervous cases, as much as twenty grains every 
three hours. In other cases, stupor has ensued if the tetanic spasm had 
not relaxed. A case is recorded of a patient taking 110 bottles of port 
wine in forty-two days, and he was cured. Cold affusion has been said to 
have cured a few cases. Blood-letting is not curative, but it appears to be 
palliative in the acute cases. Hydrocyanic acid, mercury, digitalis, and am- 
monia, have been tried without effect. Dr. Elliotson gave cax*bonate of iron, 
in enormous quantities successfully. Hamilton and Abernethy have re- 
commended purgatives, and each one recommends his own hobby. Tur- 
pentine has been considered one of the most effectual purgatives in this 
disease; but this, like others, cannot effect a cure. Indeed, very few of 
the remedies that have been tried have had any effect toward a cure. 
Looking rationally at the thing, says Dr. J. C. B. Williams, I should at- 
tempt to cure idiopathic tetanus on the same principles as rheumatic in- 
flammation, using the strongest counter-irritants, liquor ammoniae, and 
calomel and opium in very large doses, with colchicum, my favorite anti- 
rheumatic remedy. In traumatic tetanus I cannot say much about the 
expectation of curing this form of the disease, but there are some cases re- 
corded of cures having been effected by Indian hemp. Part xii., p. 47. 
Mitigation of the Symptoms in Fatal Cases of Tetanus.—Prof. Colles 660 
TETANUS, 
asserts, that when cases of common tetanus are to become fatal we do not 
find the paroxysms grow less frequent, but they become apparently milder, 
and on the contrary, when the patient is recovering the intervals between 
the paroxysms are lengthened; but the violence of the last paroxysm that 
man may have may be as great as that of any of the preceding ones. 
Sometimes on visiting a patient he tells you he is better—he is now able 
to put two fingers between his teeth, whereas a little while ago he was 
only able to put one; he feels himself better, his jaw can be opened more, 
and his limbs are more flexible; his friends meet you with a smiling coun- 
tenance, and everything is congratulation. Now, what are you to expect ? 
Why, that the next paroxysm the patient gets will carry him olf—the 
very next paroxysm will certainly be the fatal one. Part xii., p. 47. 
Idiopathic Tetanus.—The patient, aged thirty years, had felt for some 
days unpleasant sensations, as stiffness and pain, in different parts of his 
body, but on his admission to the hospital the muscles of the jaws, neck, 
both extremities, back, and abdomen were in a state of rigidity; the body 
was curved forward in consequence of the head and loins being drawn 
backward; every two or three minutes the pain and muscular contractions 
were increased, the paroxysms lasting about five or six seconds. He had 
not received a wound, but had been much exposed to cold and wet. In 
the treatment of this case, Dr. Watson, under the impression that the 
spinal cord or its coverings were inflamed, ordered local bleeding and 
counter-irritation. The pain in the loins was relieved, but there was no 
alleviation of the tetanic convulsions. This led him to infer that the affec- 
tion of the nervous centres was functional and not organic, consequently 
care should be used, lest, by too active treatment, the patient’s strength 
be worn out. Do not depend so much on stimulants, but support the 
strength on nutritious diet, such as animal jellies. Give opium in large 
doses with hydrocyanic acid ; also a well-sustained course of purgatives, as 
colocynth pills with castor-oil, cupping over the spine, turpentine glysters. 
A colocynth pill, with a drop of croton-oil, and occasionally an ounce of 
castor-oil, and on two occasions ten grains of calomel with the aid of pur- 
gative enemata sufficed. The character of the fecal evacuations in relation 
to the spasms is interesting: whilst they were natural there was no relief 
of the symptoms; but when, by the use of purgatives, they became thin 
and offensive, there was a very marked alleviation of the man’s sufferings, 
and from the stools becoming again more natural, the spasms, both per- 
manent and convulsive, speedily gave way. This case, therefore, is one 
corroborative of the opinion, that whatever else may be judged necessary 
for the relief of the patient, much reliance must be placed in respect of a 
cure on a decided and well-sustained course of purgatives ; and this, not- 
withstanding the at first ordinary character of the evacuations. We all 
know what a difficult thing it is, in many instances, thoroughly to unload 
the bo-wels, and when this is at last effected, what a wonderful ameliora- 
tion is produced in many convulsive diseases not very dissimilar in some 
of their characters to the present. No doubt, it must be acknowledged, 
that this is more likely to occur in idiopathic than traumatic tetanus, where 
we have another and obvious source of irritation. Part xiii., p. 57. 
Traumatic Tetanus—Recovery.—In the earlier stage of this case, under 
care of Dr. Greenhow, calomel and opium carried to ptyalism nearly re- 
moved the symptoms: not so, however, in the more advanced stage, and TETANUS. 
661 
from the success which frequently results from the use of opium and tartar- 
ized antimony, a trial was made, which produced a most tranquillizing 
effect, causing sleep, the relief of spasms, and the general soothing of the 
system. Patient took half a grain of tartarized antimony, with one of 
opium and three of calomel, every three hours, having a double dose every 
night, and an enema in the morning. Part xiv., p. 54. 
Electricity in Tetanus. — Try electricity. Use a continued current, 
passed down the nerves in the direction of their ramifications. According 
to Prof. Matteucci, the tendency of this direct continued current, when its 
application is sufficiently prolonged, is to diminish the excitability of the 
nerves, and thereby to produce a temporary paralysis. Part xvi., p. 100. 
Traumatic Tetanus cured by the Destruction of the Cicatrix by a Red- 
hot Iron.—A robust youth, aged twenty-two years, was seized with tris- 
mus on the ninth day after the receipt of a wound on the temple, when it 
had almost healed. He experienced a painful constriction of the chest, 
followed by reiterated convulsions and opisthotonos. Suppression of 
urine, delirium, dysphagia, and unconsciousness followed. 
All other means having failed to abate the severity of the disease, M. 
Remy, on the seventh day of the attack, determined to have recourse to 
the mode of treatment advised by Larrey, viz., cauterizing the cicatrix in 
its whole extent with an iron heated to a white heat. The symptoms im- 
mediately underwent a great improvement: the convulsive movements 
became less frequent, and soon ceased entirely; consciousness returned, 
and the urinary excretion reappeared; but the muscular rigidity con- 
tinued, the slightest movement or attempt at the deglutition of fluids pro- 
duced a sense of suffocation; the recumbent posture had become impos- 
sible, and the patient exclaimed against a breath of air. This condition, 
which lasted from four to five days, disappeared under the use of digitalis 
in large doses. In fifteen days more convalescence was complete. 
Part xx., p. 62. 
Tetanus—Traumatic.—Bransby B. Cooper advises, when tetanus is 
threatened in consequence of a punctured wound, to convert the latter 
into an incised wound by laying it freely open to the same depth as the 
original puncture ; and if it is then found that a branch of nerve had been 
punctured or partially divided, cut it completely through. The plan of 
cauterizing the wound, with a view to promote suppuration, is unadvisable. 
Amputation is not generally advisable after tetanic symptoms have set in ; 
there are cases, however, in which it may be resorted to, especially when 
the injury is so severe that the limb is not likely ever to be a useful one. 
Part xx., p. 114. 
Idiopathic Tetanus treated by Galvanism.—A case of idiopathic tetanus 
successfully treated by galvanism, applied in the form of shocks from an 
electro-magnetic apparatus, along the spine, over the masseter muscles, 
and in the course of the great sciatic nerves, is related by Mr. H. Hailey. 
Part xxi., p. 91. 
Case of Traumatic Tetanus treated by strong Voluntary Action of the 
Respiratory Muscles.—[The following case is from Cruveilhier’s work on 
Pathological Anatomy. 
The case was one of a peasant who labored under tetanus produced by 
the forcible separation of the thumb from the hand.] 662 
TETANUS, 
The patient was young, and full of life and courage, and 1 ventured to 
assure him of being cured if he submitted to my orders. I placed myself 
before him, and instructed him to respire in a measured time, making as deep 
inspirations as possible. To direct him in this fatiguing exercise I beat be- 
fore him the measure d deux temps. During an hour there was an attack 
of suffocation or strangulation. My place was taken by assistants, who 
relieved each other, and at the end of four hours the patient fell into a 
profound sleep. On his waking, the same system was recommenced, which 
was again followed by sleep. After the suspension of this treatment, there 
were slight exacerbations, but they speedily gave way, and he was com- 
pletely cured. • Part xxi., p. 96. 
Treatment of Traumatic Tetanis.—Mr. De Ricci thinks we are justified, 
with the view of removing the exciting cause, in amputating the entire 
part, or dividing the nerves leading to it. In tetanus the energies of the 
brain are minus, and those of the spinal marrow plus ; therefore we must 
increase the first by stimulants, wine, brandy, and Indian hemp, and reduce 
the latter by the careful use of tobacco enemata and fomentations (fifteen 
grs. of tobacco to eight ounces of boiling water) every half hour, so as to 
keep up a state of nausea. The spine should also be well rubbed with a 
liniment of croton oil and turpentine. It is right to say that idiosyncrasy 
in some instances renders the use of tobacco extremely dangerous. The 
Symptoms in this case, are, the countenance assuming a deadly hue and ghast- 
ly appearance, and the pulse becoming quivering and intermittent. When 
these occur the administration should be stopped, and stimulants imme- 
diately resorted to. These means, with paying attention to the state of 
the bowels by croton oil or other strong purgative, and bringing the 
patient under the influence of tobacco, as rapidly as possible, are the 
principal means upon which we have to rely. Part xxii.,/>. 88. 
Treatment of Tetanus—Traumatic.—M. Bresse, surgeon at the Military 
Hospital at Rennes, has cured cases by the use of frictions with the tinc- 
ture of belladonna, composed of five parts of extract to eleven of alcohol, 
applied all over the body, more particularly over the rigid parts. 
Part xxii., p. 90. 
Indian Hemp in Tetanus.—In three cases of this dreadful disease the 
cannabis indica seemed to Prof. Miller to answer effectually. In other 
cases of the disease, although it failed to cure, it never failed to relieve. 
The dose was three grains of the extract, or thirty drops of the tincture, 
to be repeated every half hour, hour, or two hours, the object being to 
produce and maintain narcotism. There is a very marked tolerance of 
the remedy. Part xxiii., p. 287. 
Traumatic Tetanus.—A case of this disease was treated locally by 
Mr. Eddows, and with the best success. It was traumatic, arising from 
injury to the ball of the thumb. The jaws became closed with slight 
general tetanic symptoms, a blister was applied over the back of the hand, 
and acetate of morphia, and afterward the tincture of aconite were 
applied until ntxv. of the last were applied at one time. There remained a 
contraction of the flexors for some time, but this was removed by a splint. 
Part xxiii., p. 323. 
Treatment of Tetanus.—Use frictions of chloroform all over the body. 
Recovery was thus brought on in a case in four days. TETANUS. 
663 
In a case under Mr. Cock, that gentleman pursued the tonic plan of 
treatment. Three grains of disulphate of quina were given every fourth 
hour, and twelve ounces of wine allowed per day. Recovery gradually 
took place. 
In the Hotel Dieu of Marseilles, a case of tetanus from wound of the 
toes was arrested by large doses of disulphate of quinine, maximum forty- 
live grains in one day. The cure was completed in about a fortnight. 
Part xxiv., p. 67. 
I 
Worrara Poison as a last resort in Tetanus.—Mr. Campbell, surgeon of 
the 55th regiment, India, says he thinks the Worrara poison has been 
proposed justly as a last resort in tetanus, by inserting the poison in the 
linger, and tying a ligature above the wound, so as to regulate its action 
and effect in the system. Part xxiv., p. 336. 
Tetanus and Hydrophobia.—From the experiments of Dr. Marshall 
Hall, he arrives at the two following practical conclusions : 1st. That the 
tetanic patient be preserved from all external excitement absolutely. 
2nd. The hydrophobic patient, wdiilst equally preserved from excitement, 
should be submitted to efficient tracheotomy. Part xxvii., p. 59. 
Tetanus folloicing Lesions of the Uterus, Abortion and Parturition.— 
[From a series of twenty-four cases, Dr. Simpson proves that traumatic 
tetanus does occasionally supervene as a secondary obstetrical disease. He 
then, enters upon the] 
Nature of Puerperal Tetanus.—It will be granted, I believe, by all 
pathologists that the existence of an injury or a wound upon the external 
parts of the body, is by far the most common cause of tetanus. After 
abortion and parturition we have the existence, upon the interior of the 
uterus, of a similar state of lesion. All authorities seem now generally 
agreed as to the facts (1) that the human decidua is, as was maintained in 
the last century by Krummacher, the thickened and hypertrophied mucous 
membrane, of the uterus, (2) that the epithelial or superficial layer of it 
separates from its basement or outer layer in abortion and after delivery ; 
and (3) that this separation or solution of continuity of tissue, as well as 
the rupture of the organic attachments of the placenta from the uterus, 
leaves the interior of this organ so far in the condition of an external 
wound, or with a new or raw surface for the time-being exposed. Obste- 
trical tetanus has, in this respect, an exciting cause essentially similar to 
surgical tetanus. And perhaps the great reason why this state of lesion of 
the interior of the uterus does not more frequently give rise to tetanus is, 
simply this, that the uterus is itself principally, or indeed almost entirely, 
supplied by nerves from the sympathetic system, while apparently, as 
stated by Mr. Curling and other pathologists, tetanus is an affection far 
more easily excited by lesions of parts supplied by nerves from the cerebro- 
spinal system, than by lesions of parts supplied by nerves from the 
sympathetic system. 
Tetanus is known to follow wounds very various in their degree and 
severity. u Whether (says Professor Wood) the wound is trifling or severe 
seems to be of little consequence,” as far as regards the supervention of 
secondary tetanus. By what pathological mechanism a wound or lesion of 
a part can, under any circumstances, lead on to an attack of tetanic disease, 
is an inquiry regarding which we as yet possess little information; and in 664 
TETANUS, 
this respect, the production of obstetrical tetanus is not more obscure than 
the production of surgical tetanus. 
The disease, when developed, essentially consists of an exalted or super- 
excited state of the reflex spinal system, or of some segment or portion 
of that system. 
Treatment of Puerperal Tetanus.—In obstetrical tetanus, no kind of 
local treatment to the seat of the original uterine lesion could be well 
applied, or would probably be of any avail, if applied. And, as to consti- 
tutional means, perhaps the most important are— 
1st. The greatest possible quietude and isolation of the patient from all 
irritation, corporeal or mental, during the course, and for some time even 
after the resolution of the disease. 
2nd. The special avoidance of painful and generally impracticable attempts 
at opening the mouth in order to swallow ; but sustaining the strength of 
the patient, and allaying the thirst by enemata, or by fluids applied to the 
general surface of the body. 
3rd. If there is any well-grounded hope of irritating matters lodged in the 
bowels, acting as an exciting or aggravating cause, to sweep out the intes- 
tinal canal at the commencement of the disease with an appropriate enema. 
4th. To relax the tonic spasms of the affected muscles, and diminish the 
exalted reflex excitability of the spinal system by sedatives, or antispas- 
modics; with the prospect of either directly subduing this morbid reflex 
excitability, or of warding off the immediate dangers of the disease, and 
allowing the case to pass on, from an acute and dangerous attack,-to a 
sub-acute, and far more hopeful and tractable form of the malady. 
Various sedatives and antispasmodics have been recommended to 
fulfill this last most vital and important indication in the treatment of 
tetanus— as belladonna, stramonium, hemlock, henbane, musk, camphor, 
indian hemp, hydrocyanic acid, valerian, etc. Perhaps the two drugs of 
this class that have hitherto been most used, and relied upon, are opium 
by the mouth, and tobacco by enema. 
Latterly the antispasmodic action of sulphuric ether and chloroform has 
been repeatedly employed to allay that exalted state of the reflex nervous 
system, and to relax that resulting tonic contraction of the maxillary and 
other muscles, which constitute the essence of tetanus. 
Chloroform in sufiicient doses acts as a direct sedative upon the 
reflex nervous system, and upon exalted muscular contractility. In conse- 
quence of this action, it affords us one of our surest and most manageable 
means of allaying common convulsive attacks ; if used in tetanus its action 
will require to be sustained for many hours, or oftener perhaps for many 
days. And there is abundant proof of the safety with which its continuous 
action may be kept up under proper care and watching. For instance, a 
few months ago I saw, with Dr. Combe, a case of convulsions of the most 
severe and apparently hopeless kind in an infant of six weeks. The disease 
at once yielded, and ultimately altogether disappeared under the action of 
chloroform, which required to be used almost continuously for thirteen 
days; as much as 100 ounces of the drug being used during the period. 
Part xxix., p. 65. 
Tetanus.—Dr. Hodges, of Somerset, recommends to apply a solution of 
morphia to the wound instead of giving it internally. The following is a 
good formula : Hydrochloride of morphia, one scruple; tincture of hyos- TETANU8. 
665 
cyamus, two drachms; water, three ounces. Moisten a piece of lint with 
this solution and keep it on the wound. Part xxx., p. 39. 
Tetanus.—Dr. Hobart, of the Cork Dispensary, recommends, on the first 
appearance of this disease, to try to remove the source of irritation, by 
dividing the nerves going to the part; or, if the wound be in the skin and 
very trifling, either make deep incisions around it or excise it altogether; 
but if the wound be such as would materially injure the limb independently 
of the tetanic complication, it is better to amputate at once. If this does 
not suffice, we must use some agent to render the nervous system less 
sensitive to the irritating cause, its effect being long kept up—such agents 
we have in chloroform, nicotine, and wourali. Chloroform causes conges- 
tion of the bronchial tubes, and nicotine has an extreme depressing influ- 
ence on the circulation. Now wourali does not act on the heart or other 
involuntary muscles at all, and preference should be given to it. Artificial 
respiration will be necessary, if that function become seriously embar- 
rassed. Part xxxvi., p. 40. 
Traumatic Tetanus.—A case of traumatic tetanus was lately treated at 
St. Thomas’s, Avith some degree of success by the administration of nico- 
tine. At first, one-twelfth of a minim Avas given hourly, continued Avith a 
little brandy and Avater ; this dose Avas gradually increased. The effects 
were found to be very transitory. It produced, at first, giddiness, profuse 
perspiration and nausea, together with a slower and feebler pulse, and 
marked alleviation of the muscular spasms. In about a quarter of an hour 
the pulse became fuller and stronger, the face flushed, and the tetanic 
symptoms as severe as ever. When given too'freely, it produces faintness 
and sickness, even an intermittent pulse, Avithout alleviating the symptoms. 
Part xxxviii., p. 46. 
Tetanus.—In acute tetanus, Prof. Erichsen says that all drugs are utterly 
useless in retarding, mitigating, suspending, or arresting its progress. 
Division of the nerve, leading to the Avound when it can be found and 
isolated, has been done with success, and it is better to do this pretty high 
up in the limb, beyond the sphere of the local irritation. The occasional 
inhalation of chloroform will alleviate, though it Avill not cure, acute 
tetanus. We must remember that Ave have an exhausting disease to deal 
with, and the patient will soon sink unless supported. If the case, however, 
assume the subacute or chronic form, calomel and opium, and even bella- 
donna may be employed Avith advantage. Keep the patient quiet and 
support his strength. Part xxxix., p. 62. 
Hypodermic Injections.—In very violent cases the injection of a third 
of a grain of acetate of morphia beneath the skin, says Mr. Hunter, AviU 
procure sleep and cessation of the movements for some hours. It is only a 
palliative, but in this manner may be used to procure the rest, the absence 
of which causes so much exhaustion. Part xxxix., p. 51. 
Tetanus—Poisoning by Strychnia.—Wourali poison is a direct sedative 
to the muscular system, causing complete relaxation to the fibre. It is a 
direct antidote to strychnine. It does not appear to have been used in 
poisoning cases in the human subject, but Dr. Harley has succeeded in 
saving the lives of animals to Avhich strychnine had been administered in 
poisonous doses. M. Vella, of Turin, has successfully used woorara in 
cases of tetanus at the French Military Hospital during the late war. In 666 
THROAT, 
one case, which proved successful, two grains of woorara were dissolved 
in nine drachms of water, and compresses moistened with the solution 
were applied to the wound, the strength being gradually increased to fif- 
teen grains in fourteen drachms of W'ater, and the compresses renewed 
every third or fifth hour. This mode of treatment requires and deserves 
extensive trial. Part xl., p. 42. 
THROAT. 
Treatment of Sore Throat, or Angina, by Alum.— Vide Art. “Alum.” 
Phagedenic Ulceration of the Throat.—Dr. J. J. Ross observes as 
follows on the topical use of iodine : Another case, in which the local use 
of the tincture of iodine is of signal efficacy, is that of ulcers of the tonsils 
and fauces—specific or non-specific. I have seen the ugliest sores in this 
situation put on quite a healthy appearance in a few days under its use. 
It is highly recommended by Ricord, and cei'tainly I do not know any 
thing equal to it in such cases. It is best used in the form of a gargle ; 
thus : R Tinct. iodini, 3j* to 3ij*; tinct. opii, 3j.; aquae, §vj. Mix. Use 
three or four times a day. Part vi., p. 119. 
Treatment of Malignant Sore Throat by Emetics.—In a paper “ On the 
present state of Therapeutical Inquiry,” Dr. Arnott mentions a remedy for 
malignant sore throat, which, like the invaluable discovery of Jenner, was 
found out by accident at a time when an endemic and supposed contagious 
species of malignant sore throat (diphtherite ?) was very prevalent at St. 
Helena. A sergeant’s wife had four children laboring under this affection, 
at the same time that she was suffering from some illness for which an 
emetic mixture had been prescribed.] 
It consisted of a strong solution of tartrate of antimony, a certain quan- 
tity of which was to be taken at intervals until vomiting should be excited. 
The woman, supposing that this mixture had been sent for one of her 
children, the last attacked with sore throat, not only administered it in the 
large doses intended for herself, but continued to exhibit it during the day 
so as to keep up a frequent and severe vomiting. I accompanied her me- 
dical attendant in his evening visit, when we found the child in a state of 
extreme exhaustion, but in all other respects much relieved. It rapidly 
recovered; and the practice of severe and continued vomiting was 
adopted during my stay on the island in many subsequent cases of the 
same disease, with equal success. I have learned also that severe and 
continued vomiting was employed by the medical officers of our army in 
Egypt to arrest the rapidly disorganizing ophthalmia which then prevailed ; 
and it is manifestly applicable to other diseases of the same character, 
requiring the adoption of prompt and decided measures. Part xi., p. 59. 
Wound of the Throat.—[Remarking upon the difference of opinion 
which exists as to the treatment of cut-throat, Mr. Park relates a successful 
case which he lately attended. He found his patient, a woman aged 54, 
of melancholy temperament, lying on the floor in a state of syncope. The 
wound of the throat was four inches in length and gaping ; and the larynx 
was opened to such an extent, as to admit the point of the finger between 
the thyroid cartilage and the os hyoides. Mr. Park’s account of the 
treatment is as follows:] THROAT. 
667 
Having cleansed the wound, and adjusted its mangled parts, I proceeded 
at once to stitch it up, and to strap it closely with adhesive plaster. I ap- 
plied a layer of lint and a bandage, and placed the head elevated upon the 
pillow, so as to keep the divided parts in juxtaposition. The pulse was so 
feeble, that I administered a little brandy-and-water, which revived her ; 
and after giving the necessary instructions to the attendants, I left, anu 
sent the following mixture : Tincture of opium, forty minims; tincture of 
henbane, a drachm : camphor mixture, four ounces ; mix : to take a fourth 
part every four hours. The wound was dressed daily, the general health 
attended to; and it was surprising to witness how speedily the wound 
healed. On the first day, she could not speak at all; on the second and 
third, she could, but in a low, husky whisper: and on the fourth, she 
articulated very well. I was careful in requesting the attendants to 
watch and keep her perfectly quiet; and thus the case pi-oceeded most 
favorably for fourteen days, when I pronounced her convalescent, and 
ceased to attend. 
In the account of the preceding case, I trust the question, whether union 
by the first intention in these cases can take place, will be completely set 
at rest; for, notwithstanding the magnitude of the wound, there was very 
little suppuration, and that merely superficial; and the short space of time 
ere the wound had perfectly cicatrized bears out the assertion, and con- 
firms the opinions of Sir Charles Bell and Mr. Fergusson. Of course, m 
all cases of this description, it will be essentially necessary for the surgeon 
carefully to watch the effect of closing the wound on the organs of respi- 
ration, whether the epiglottis be injured. Part xv.,p. 203. 
Treatment of Cut-Throat.—[Speaking of suicidal cut-throat, as discussed 
in Mr. Ellis’s lectures on clinical surgery, the reviewer in the “ Monthly 
Journal ” says:] 
Now, if (as we are led to infer from the manner in which the cases are 
detailed) Mr. E. advocates immediate closure of the wound, we consider 
the practice as at once dangerous and useless. Dangerous, because under 
any circumstances there is risk to be apprehended from swelling of the 
divided parts from infiltration, and this is necessarily increased by stitch- 
ing the wound closely. Besides, after the active hemorrhage has been 
arrested, there is always more or less oozing of blood, which, if it does not 
escape readily by the wound, is apt to trickle down, the air-passages, and 
may prove fatal by suffocation. Mr. Liston relates a case in his work on 
Practical Surgery, where the patient, except for his timely aid, would have 
been suffocated from the pressure caused by confined coagula, although 
the air-passages had not been opened into. The addition of compresses 
and plasters must of course add to the danger, on the interruption they 
cause to the breathing and circulation. And the practice is useless, 
because the constant separation of the deeper seated parts of the wound, 
caused by the slightest motion of the head, by attempts to swallow or 
cough, together with the passage of air and mucus between the divided 
surfaces, all render immediate union of such wounds impossible. Sewing 
up the wound, then, can only serve to render the appearance of the 
unfortunate patient less frightful, whilst it greatly increases his real 
danger. The insertion of a single point of suture near each end of the 
incision, in extensive transverse wounds, for the purpose of diminishing the 
exposed surface, is not liable, of course, to these objections. Part xv.rp. 203. 668 
THROAT. 
Foreign Bodies in the 3fucous Canals.—A portion of an ear of barley 
slips into the nostrils, with the stalk end foremost. The least touch of a 
body so formed, in such a situation, thrusts it further inward. For one 
or two days it produces considerable irritation, which, however, at length 
subsides ; and the foreign body, coated with thick mucus, is ejected 
without effort. A small piece of leaf of a vegetable gets into the ventricle 
of the glottis; and causes great irritation and coughing for some hours. 
It is soon enveloped in mucus, and comes quietly away next day. 
These facts show what the surgeon should do under similar circum- 
stances. He should not 'with his forceps irritate still more parts already 
too much irritated. He is not to allow even any effort of sneezing, in the 
one case, or unnecessary hawking in the other. He is to require the 
patient to be kept quiet, that the body may continue in one situation, so 
as to acquire as soon as possible the coating which facilitates the ejection. 
Part xix., p. 157. 
Treatment of Wounds of the Larynx or Trachea.—It has been a sub- 
ject of much discussion, whether, in cases of free transverse division of 
the larynx or trachea, we ought to bring the wound together by sutures, 
or to leave it open. If the wound is closed by sutures there is danger of 
asphyxia from accumulation of blood and mucus in the tubes ; and if, on 
the other hand, the -wound is not healed at an early period, the patient 
will seldom recover. Mr. Eves says : 
The treatment which I should adopt in a case in which the larynx or 
trachea has been freely divided, would be, after all hemorrhage Avas per- 
fectly stopped, and after waiting a short period to be assured on that 
point, to bring the parts accurately together by sutures, introduced even 
through the cartilages, if necessary ; then, if great difficulty of breathing 
should arise, so as to threaten immediate asphyxia, either from derange- 
ment of the rima glottidis, or from accumulation of fluid in the bronchial 
tubes and cells, I should immediately adopt the suggestion thrown out by 
Mr. Porter, of Dublin, and open the trachea by a longitudinal incision ; 
of course, this must not be thought of, except there appears an absolute 
necessity for such a step; but it is satisfactory to know, that we have the 
means in our poAver of rendering that line of treatment, Avhich is certainly 
the best, free from the dangers Avhich have hitherto been apparently con- 
nected with it. I would also strongly insist upon the necessity of pre- 
venting a drop of nourishment from passing by the mouth for a feAv days, 
and the necessity of nourishing the patient by enemata. To prove the 
sufficiency of this mode of conveying nourishment, I would refer to a case 
treated in the Meath Hospital, in which Mr. Porter states, the patient Avas 
thus supported for several months, positively refusing all food by the 
mouth. Part xx., p. 275. 
Throat—Relaxed.—Employ a gargle made Avith three or four grains of 
tannin to the ounce of Avater. Part xxi., p. 326. 
Inflamjnation and ulceration of the Throat and Tongue—Nitrate of 
Copper.—Dr. Moore reports a case in Avhich the uvula and soft palate, with 
the structures posterior to these, had been removed by the ulcerative 
process, extending deeply also at the base of the tongue, partially destroy- 
ing the epiglottis. The mucous meipbrane presented an ulcerated and 
abraded appearance. A trace of tonsil remained; but from pain affecting THYKOIDAL AFFECTIONS. 
669 
the right ear, it is natural to suppose the ulcerative process had extended 
along the Eustachian tube. 
A variety of means having been used, the patient was eventually cured 
by the administration of the mistura ferri composita, with iodine, and 
locally, the use of a gargle of dilute hydrochloric acid and tinct. catechu. 
The ulcerations were touched with nitrate of copper. 
Precaution in Use of Nitrate of Copper.—Dry the ulcer or part to 
be cauterized before applying the nitrate, and afterward smear it with oil. 
Part xxv.,p. 110. 
Throat—Erysipelatous Affection of.—Dr. Todd has related several 
cases of this affection, which is characterized on its first approach by symp- 
toms somewhat resembling lockjaw ; in one case the patient was not able 
to open his mouth by the most violent effort. Then follows great difficulty 
of swallowing any fluids, even a little water. The best treatment seems 
to be, the application of the solid nitrate of silver to the fauces, and 
enemata of strong beef-tea, with ten grains of quinine in each, to be 
administered every four hours. Part xxvi., p. 77. 
THYROIDAL AFFECTIONS. 
Biniodide of Mercury in.—Dr. Maj’sisovics, having long enjoyed a large 
share of practice in Vienna, where scrofulous and other diseases requiring 
the use of iodine are very prevalent, has had ample opportunities of 
administering this remedy in various forms and with variable success. 
The effects of saturation with the remedy are described as the exanthema 
iodicum, which shows itself in dark red definite spots of various sizes, 
spreading over the whole body, remaining without the formation of scales, 
and disappearing only after a long time. 
[Iodide of mercury, from the facility with which it undergoes decompo- 
sition, and its liability to produce inflammation of the stomach and bowels, 
is seldom used internally, but] 
In the form of ointment, it is exceedingly useful in promoting absorp- 
tion ; the strength recommended by the author is, gr. x. to 3ij. (that of 
the London Pharmacopoeia is, gr. xv. to 3ij.), which quantity is to be daily 
rubbed into the part affected. The biniodide of mercury is also but little 
used internally, it is, however, an excellent external application, in the 
strength of3j. to half an ounce of simple ointment, rubbed in three times 
a day. (The strength of the preparation in the London Pharmacopoeia is, 
3j. to |j.) ... 
The action of this ointment, applied as a plaster spread upon leather, is 
the following: In the space of half an hour, varying according to the 
spot where it is applied, or according to the individual constitution, burn- 
ing pain comes on, which in some persons lasts two or three hours, but in 
very sensitive subjects even longer. In the third hour the cuticle begins 
to shrivel, and then rises in little vesicles filled with transparent fluid. 
They increase in size, and form at length a single bladder, and the fluid 
becomes opaque. On the second day, the raised epidermis is thicker, the 
quantity of fluid lessened, and upon the third day the thick and solid 670 
THYROIDAL AFFECTIONS. 
epidermis separates in the form of a yellowish white crust. When this 
has fallen off, the part underneath is seen to be already covered with new 
epidermis, and entirely healed, but slightly red and sensible. This is the 
course when the bladder is not opened ; when it has been torn, the part 
becomes painful, and discharges pus for a long time. After three days 
have elapsed, the application may be made again. The patient may be 
allowed to walk about during the painful stage, if it be not applied upon 
the perineum or the lower extremities. In bronchocele its powerful effect 
may be mathematically shown, if the tumor is measured before the appli- 
cation of the plaster; for upon the falling off of the dried cuticle the size 
is found to have diminished sensibly. In this disease no preparation of 
iodine is comparable with the biniodide of mercury. It performs in one 
month what the other forms will scarcely do in three or four. I have 
treated goitres of enormous size with this medicine, and at the first appli- 
cation all the threatenings of suffocation or apoplexy (when they existed) 
ceased. Soft or so-called lymphatic tumors of the thyroid body can be 
entirely cured, whatever is their size. Those which are indurated, as well 
as endemic goitres, are harder to cure than those which are soft, and those 
which occur sporadically. Condylomata about the anus and perineum, or 
even within the rectum or vagina, are cured by this ointment; and unless 
they are exceedingly extensive and indurated, a single application, al- 
though very painful, combined with the internal use of iodine, has been 
found sufficient. Partxi.,jo. 176. 
Bronchocele.—Mr. R. Hey, of York, says that in some cases, where 
surgical interference seems called for, the seton will be a legitimate and 
proper mode of treatment. In performing the operation, do not use a 
common seton needle, but get a curved trocar made, fixed in a handle, and 
grooved like a lithotomy staff, and having an eye behind the shoulder. 
Having threaded this eye with a single silk, which has a skein attached, 
enter the trocar at the upper part of the tumor in the median line, carry 
it on in a semicircular direction, so as to embrace a good deal of the 
tumor, and bring out the point in the median line below. Get hold of 
the silk thread, then withdraw the trocar, and pull the skein through. 
Part xx., p. 274. 
Bronchocele.—A case is recorded by Dr. Terzi which was successfully 
treated by electro-acupuncture. The number of plates used was from six- 
teen to twenty, and upon the intervening discs of cloth, dipped in an acid 
or saline solution, a little tincture of iodine was dropped. 
Part xxi., p. 85. 
Diseases of, and Operations on, the Thyroid Gland.—[In describing 
the post-mortem appearance of the gland after inflammation, Dr. Handheld 
Jones remarks :] 
“ I have more than once found the veins issuing from the gland, and 
passing its inferior margin, implicated in the inflammation and full of pus, 
or obstructed by a clot. In one case the coagulum completely obliterated 
all the principal venous trunks ; even the lymphatic vessels, in cases of 
thyroiditis, often appeared inflamed, varicose, tinged with rosy lymph, or 
puriform matter, and with opaque pari'etes. The glands to which they 
pass are swollen, red, sanguineous, and buried in masses of plastic lymph. 
The ramifications of the thyroid nerves are interlaced on the surface of the 
injected capillary vessels.” 671 
THYROIDAL AFFECTIONS. 
[The medical and surgical modes of treatment of simple organic pro- 
ductions of the thyroid gland are next considered. Of the first we must 
first ascertain the cause, and, if possible, avoid or remove it. The second 
is to resolve the tumor. As a local application, the author prefers the 
protiodide of mercury. Four or five grains, with a scruple of lard, are 
rubbed in at each friction ; or a saturated solution of iodide of potassium 
in water mixed with lard may be used. From ten to twenty of these 
frictions will be quite sufficient to judge of the effect of the application. 
The absorption by the cuticle is perfect. Professor Porta generally now 
gives the iodide of potassium, commencing with eight grains daily, and 
increasing the dose to a scruple, half a drachm, or even a drachm daily. It 
is to be preferred to the tincture of iodine. 
Extirpation of bronchocele has often been mistaken for mere enlarge- 
ment of the gland or tumors upon it and external to it. Still eighteen or 
twenty cases are reported of it during the last century; the result in 
about half successful. Professor Porta has performed it four times, every 
time with a fatal result. The danger arises from the hemorrhage, denu- 
dation of vessels, and nerves of neck, or trachea and larynx, and diffusive 
suppuration ; or from acute inflammation of the air apparatus; or from 
nervous exhaustion. The operation of extirpation of the whole, or part 
of the gland, should be discarded from surgical practice. Small isolated 
tumors may be easily and safely removed. Small accessory lobes, or 
isolated appendices, may increase and form tumors, the gland itself 
remaining normal. Professor Porta has repeatedly excised such tumors 
with perfect safety and success, a simple linear cicatrix remaining.] 
Method of the Author.—Convinced of the difficulty and danger of 
isolating the thyroid gland from the part surrounding it, Professor 
Porta has followed a plan which he strongly recommends as safe and 
efficacious. 
“ In studying the thyroid gland, my attention has been directed to two 
facts which have especially interested me. First, that the arteries are 
inserted at the extremities of each lobe, and that their trunks run toward 
the superior, inferior, and external margins of the lobes ; also that the 
large branches before penetrating the parenchyma, generally subdivide 
into a digitation of smaller branches. Thus, although the thyroids are 
externally four considerable arteries, within the tissue of the gland, they 
are merely branches and anastomoses of small calibre, and the embarrass- 
ment and danger of severe hemorrhage from injury to large vessels, are 
scarcely met with when we isolate the external portion of the tumor. In 
the second place, that the greater number of bronchoceles, as I have fully 
explained before, do not arise from degeneration of the proper glandular 
tissue, but from the generation of one or more non-malignant sarcomatous 
or encysted tumors in the midst of the parenchyma of the gland itself; 
that these tumors increasing, at last invade the whole space, and reduce 
the organ to a simple envelope or matrix, on dividing which the new pro- 
ducts are exposed, and may be extracted with the greatest ease, injuring 
only small vessels, and leaving behind a fleshy sac, which, when so evacu- 
ated, falls together, and no trace of the tumor remains The 
result of these observations was the following reflection : If the extirpation 
of the thyroid gland, and even one lobe of it, is so difficult and dangerous, 
would it not be better to invert the plan of operation, and evacuate the 
contents of the tumor, without touching its external portion, without 672 
THYEOIDAL AFFECTIONS. 
lacerating the surrounding cellular tissue, without injuring the arterial 
trunks, and without dividing the principal organs of the neck ? On these 
grounds the new plan of operation consists in the simple incision of the 
external envelopes, and of the anterior surface of the tumor, at some dis- 
tance from the direction of the arterial trunks; in the evacuation of the 
tumor by means of separation and extraction, or by excision of the cysts 
and nodules contained in it, without separation of the outer surface.” 
We are not told in how many cases the author has performed his opera- 
tion, but he has selected six as illustrations, stating that in these, and in 
all his other cases, it succeeded perfectly in removing the tumor, and 
curing the patient. In only two cases did inflammatory symptoms require 
prompt antiphlogistic treatment. In one case a coriaceous cyst, and two 
sarcomatous tumors were removed from the substance of the gland. In 
another, the gland did not contain new products, but the enlargement 
was owing to simple hypertrophy. In this patient, the whole fleshy inter- 
nal part of the tumor was cut away, leaving a sort of surrounding bark, 
about two lines in thickness. The bleeding was very slight. Cysts and 
sarcomatous tumors were extracted in all the other cases recorded. 
The instruments for this operation are merely scalpels, blunt-hooks, dis- 
section and torsion forceps, scissors, etc. There are three steps in the 
proceeding. First: division of the integuments of the neck and of the 
second belly of the omo-hyoid muscle, which is almost always necessary. 
Secondly: incision of the tumor parallel to the external incision, avoiding 
the branches of the thyroid arteries, or on division, at once applying the 
ligature or torsion, which is very easy, because the branches are mere 
secondary ones, running along and adhering for some distance to the sur- 
face of the tumor. Thirdly : by means of the forceps, and the back or 
handle of the knife, cysts or tumors are removed. When very deep and 
adherent, they are excised on the base. In case of simple hypertrophy, 
the whole internal texture of the gland may be removed. Should any 
arteries be injured in this last step of the operation, torsion should be 
employed. 
Sometimes the wound heals by the first intention, but more frequently 
it suppurates, and cicatrizes in a few weeks. Occasionally it becomes 
sacculated, and requires dilatation, or becomes converted into a fistula, 
which does not close for a considerable time. The great object of after- 
treatment is to moderate inflammation which may arise, adopting active 
antiphlogistic measures, should its extension to the chest or head be 
threatened. Part xxiii., p. 290. 
Use of Iodine.—Instead of applying iodine by means of friction, in the 
form of ointment, to the neck in the case of goitre, M. Ilannon recom- 
mends it to be tied over the part, between two layers of cotton wool in a 
bag. To prevent its staining the linen, a small piece of gummed silk may 
be placed over the bag. Part xxvi., p. 348. 
Goitre.—Dr. Mouat, of Bengal, states that upward of 60,000 cases of 
goitre have been treated in that country on the following plan, which 
generally effects a cure at once, if not, a second repetition next year 
suffices : Melt 3 lbs. of lard or mutton suet, strain and clean ; when nearly 
cool, add 9 drachms of biniodide of mercury, taking care to make the pow- 
der fine by trituration in a mortar. Work in a mortar until no grains of 
red are apparent in the ointment, and put in pots for use, taking care TIBIA TOBACCO. 
673 
always to keep both powder and ointment fr<3m the rays of light. Use 
as follows: About an hour after sunrise apply the ointment to the goitre 
with a spatula made of ivory, or thin, broad, smooth bamboo, quantity 
according to size of tumor—rub it well in for at least ten minutes. Let the 
patient then sit with his goitre held well up to the sun, and let him remain 
so as long as he can endure it. It is probable that about noon he will suf- 
fer severe pain from the blistering effect of the ointment, although no pus- 
tules are raised on the skin. About 2 p. m., the ointment should again be 
applied with a very careful and tender hand, and the patient should be 
dispatched to his home with orders not to touch the ointment on any 
account with the hand, but to allow it to be gradually absorbed, which 
absorption will be complete on the third day. Part xxxvii., p. 264. 
TIBIA. 
Nodes on the Tibia—Actual Cautery.—We are disposed to agree with 
Mr. Fergusson, that as a means of producing counter-irritation, the actual 
cautery is too much neglected; people are too much afraid of a heated 
iron approaching them to allow of the popular objection to this remedy 
being very easily overcome. The operation resembles too much that of 
firing horses, to become fashionable, but when properly managed, it is an 
equally efficient, more manageable, and less painful counter-irritation than 
either the caustic, potash, or the moxa. It is also of the greatest service 
in arresting hemorrhage. Mr. Fergusson has found it of use in some 
obstinate cases of nodes on the tibia. He brings a large extent of sur- 
face under the influence of the heated iron in these cases, not so as to 
cause a slough, but somewhat in the way Which is adopted in firing horses, 
by which means a sudden excitement is produced over a large surface, 
while at the same time the skin is not destroyed, or converted into a 
slough. Part vii.,y>. 215. 
TOBACCO. 
Tobacco taken ModeratelyTobacco taken moderately, says M. Raspad,, 
is a condiment to which some people inure themselves. In whatever form 
it is employed, the tobacco acts evidently by property, the base of which 
is formed by ammonia. In fact, if we moisten common tobacco with a1 
little ammonia, we give to it a flavor which increases its value. Pound 
some walnut leaves with potass in a heated mortar, and then place them 
in a drying stove, and you will have a powder very similar to tobacco, for 
the purpose of smoking, and which has even a stronger flavor, especially 
if a few drops of ammonia be added to it; and there is every reason to 
believe that common tobacco is thus adulterated to a great extent. The 
walnut leaves may be replaced by those of the potato, henbane, helle- 
bore, aconite, by the grains of elaterium and of colocynth, etc. 
Part ix., p. 81. 
Use of Inf usion of Tobacco.—The infusion of tobacco has been used 
with much success in many cases of prurigo. In purulent ophthalmia, 
also, and the scrofulous conjunctivitis of infants, it has been used with de- 
VOL. II.-—43 674 
TOBACCO, 
cided success, and may be resorted to with confidence, when other reme- 
dies have failed. The strength of the infusion for these purposes is double 
that used for enemata—viz., 3j. to Oss. of boiling wrnter, and shag tobacco 
proves more efficacious than pig-tail. Part xii., p. 301. 
Injurious Influence of Tobacco in Insanity.—[Dr. Woodward’s expe- 
rience is quite at variance with that of the physicians to our asylums. It 
must be questioned, however, whether depriving some patients of the en- 
joyment of this luxury may not lead to a good deal of irritation, and thus 
aggravate the disease. Dr. W. observes:] 
Alcohol is not the only narcotic which thus affects the brain and ner- 
vous system. Opium produces delirium tremens, and probably insanity. 
Tobacco is a powerful narcotic agent, and its use is very deleterious to 
the nervous system, producing tremors, vertigo, faintness, palpitation of 
the heart, and other serious diseases. That tobacco certainly produces 
insanity I am not able positively to observe; but that it produces a pre- 
disposition to it I am fully confident. Its influence upofi. the brain and 
nervous system generally, is hardly less obvious than that of alcohol, and, 
if excessively used, is equally injurious. In our experience in this hospi- 
tal, tobacco, in all its forms, is injurious to the insane. It increases excite- 
ment of the nervous system in many cases, deranges the stomach, and 
produces vertigo, tremors, and stupor in others. Part xiv., p. 65. 
Tobacco /Smoking—Effects of.—From a few experiments instituted by 
M. Malapert, it was found that, in the smoke of tobacco extracted by in- 
spiration, there is 10 per cent, of nicotine. Thus a man who smokes a 
cigar of the weight of seventy grains, receives in his mouth seven grains 
•of nicotine mixed with a little watery vapor, tar, empyreumatic oil, etc. 
Although a large portion of this- nicotine is rejected, both by the smoke 
puffed from the mouth, and by the saliva, a portion of it is nevertheless 
taken up by the vessels of the buccal and laryngeal mucous membrane, cir- 
culated with the blood, and acts upon the brain. With those unaccus- 
tomed to the use of tobacco, the nicotine, when in contact with the latter 
organ, produces vertigo, nausea, headache, and somnolence; whilst habitual 
smokers are merely thrown into a state of excitement, similar to that pro- 
duced by moderate quantities of wine or tea. 
From further investigation it was found that the drier the tobacco the 
less nicotine reaches the mouth. A very dry cigar, whilst burning, yields 
a very small amount of watery vapor; the smoke cools rapidly, and 
allows the condensation of the nicotine before it reaches the mouth. 
Hence it comes that the first half of a cigar smokes more mildly than the 
second, in which a certain amount of condensed watery vapor and nicotine, 
freed by the first half, are deposited. The same remark applies to smok- 
ing tobacco in pipes, and if smokers were prudent, they would never con- 
sume but half a cigar or pipe, and throw away the other. Smoking 
through water, or with long tubes and small bowls, is also a precaution 
which should not be neglected. Part xxxii., p. 283. 
Tobacco.—The use of tobacco should be forbidden during the preva- 
lence of an epidemic of typhoid fever; it has the effect of relaxing the 
mucous membranes, and diminishing the vital force, and is very apt to pro- 
duce or predispose to diarrhoea and intestinal lesion. Catechu is the best 
remedy for diarrhoea arising from this cause. Part xxxv., p. 342. TOE NAIL. 
675 
TOE NAIL 
Inverted Toe Nail.—In many, though by no means in the majority of 
cases, the cutting the nail too short, is the primary cause of the affection. 
The soft parts, being no longer kept down by the projecting free edge of 
the nail, are forced, by the pressure of the boot or shoe in walking, against 
and even over the truncated end of the nail, and, as this again increases in 
length, it may be made to even penetrate into them—giving rise thus to 
inflammation, swelling, ulceration, and fungous granulations, with a degree 
of suffering which often renders the slightest motion of the foot, un- 
bearable. 
[Many of the operations hitherto proposed are extremely painful, and 
while few of them afford more than temporary relief, some even tend to 
increase the evil. Dr. Zeis has had frequent opportunities of seeing pa- 
tients operated on by Dupuytren’s method of extraction of the offending 
portion of the nail, and he found that in every case it -was ineffectual, the 
free edge of the nail expanding laterally, and keeping up a constant irrita- 
tion. The new modes of treatment constantly met with in the medical 
journals are mostly mere modifications of the older plans. The most pain- 
ful is that of N’eret, who directs a spatula to be forced down beneath the 
nail'to its roots, and then for the nail to be torn out. Larrey’s operation 
differs from the former only that the third of the nail is thus treated. 
Baudens removes the whole of the inverted edge, together with the spongy 
flesh in which it is imbedded. Others advise the destruction of the nail, 
or a portion of it, by caustics, for which caustic potass and lime, and burnt 
alum have been used. Labat destroyed the root of the nail at once by the 
actual cautery. Donzel dissected back the skin from the root of the nail, 
filled the wound with charpie, and the next day with pate caustique; re- 
moving the edge of the nail when the slough separated. Others, objecting 
to the destruction of any portion of the nail, propose various plans by 
which it may be kept from contact with the inflamed portion of the soft- 
parts until these are completely healed. Martin recommends a triangular 
portion to be cut out of the middle of the nail, the base being at the free 
edge, and then the cut edges of the nail to be drawn together by a suture 
of brass-wire. This, however, from the constant growth of the nail, cati 
only afford temporary relief. Others propose to give the nail a flatter 
form, by thinning the centre, and applying compresses of different kinds, 
whilst Bressy, after shaving the nail as thin as possible, touches it six or 
eight times with lunar caustic, until it shrivels up, and its edges are in 
consequence drawn out of the soft parts; this, however, infallibly produces 
entire destruction of the nail.] 
Dr. Zeis considers it all-important to attend to the general health, which 
will usually be found more or less deranged. So soon as the nail acquires 
the slightest projection, he is in the habit of introducing beneath it, by 
means of a fine probe, a small portion of charpie, and to prevent the fall- 
ing out of this, he covers the end of the toe with adhesive plaster, spread 
upon gold-beater’s skin, which adapts itself better to the parts, and pro- 
duces a less amount of pressure than when it is spread on silk or linen. 
The toe is then to be bathed frequently, during the day, in warm water. 
If the soft parts at the point of the toe, are in so swollen a condition as to 
interfere with the dressing just directed, or completely to cover and con- 676 
TOE NAIL. 
ceal the edge of the nail, Dr. Zeis is in the habit of removing them by the 
knife. 
“Much more obstinate, hotvever, are those cases in which the disease 
affects, at the same time, or is entirely confined to, the side of the nail. 
These are, especially, the cases in which the destruction of the whole, or a 
part of the nail, has been considered indispensable to the cure. I have, 
however, in such, seldom failed to secure the entire and permanent relief 
of the patient by rest, the frequent use of the foot-bath, and the removal, 
by the knife, of the fungous granulations or spongy and morbidly sensible 
flesh, by which the edge of the nail becomes covered. I will not, how- 
ever, pretend to deny,” he adds, “ that cases of a very aggravated charac- 
ter may occur, in which the unhealthy condition of the ulceration, seated 
beneath the nail, will require the loosened edge of the nail to be cut away, 
that our applications may be applied directly to the ulcerated surface, and 
also to prevent the constant irritation which is kept up in it by the de- 
tached portion of the nail. It is never necessary to destroy the whole, 
or any part of the nail, even under such circumstances.” 
Part xi., p. 163. 
Toe Nail—Ingrowing of the.—In order to heal the troublesome ulcer 
arising from this cause, says Dr. Newman, separate the soft parts from the 
nail so as to expose the whole surface of the ulcer, and sprinkle it freely 
with powdered charcoal, mixed with a little acetate of lead or oxide of 
zinc; bind a piece of lint over it, and let the patient wear a wide shoe, and 
keep quiet. Every day bathe the toe with tepid water, and sprinkle fresh 
charcoal over it, without disturbing that previously applied. 
Part xxi., p. 260. 
Onychia.—The late Mr. Colies, of Dublin, in a paper on some morbid 
affections of the great toe nail, divides them into three kinds : 1. The com- 
mon onychia, or nail growing into the flesh, on its external edge. 2. The 
inner angle of the nail resting on a hard white mass of laminated horny 
cuticle, which may be picked out in bran-like scales, exposing a small cup- 
shaped cavity, without ulceration. 3. Onychia maligna depending on a 
morbid condition of the secreting matrix of the nail. In the first disease, 
only so much of the nail as is separated from the matrix, and imbedded in 
the fungus, is to be removed. This is done by pressing on the fungus 
with a spatula, raising the nail from it by a pair of strong forceps, and then 
by means of curved scissors passed underneath it, cutting it completely 
out. In the second it is to pick away the laminated scales and remove 
the bulbous end of the nail. In the third, the treatment is to keep the 
patient in bed, poultice the part for two or three days, then cleanse the 
ulcer thoroughly by means of a syringe and a stream of* tepid water, and 
afterward cutting away as much of the loose nail as can be done without 
irritating the surrounding sensitive surface. Lastly, fumigate, night and 
morning, by means of a funnel, with the mercurial candle, which contains 
5j. hyd. sulph. rubrum to §ij. of wax. After each fumigation, the toe to 
be enveloped in a piece of lint spread with spermaceti ointment. 
Part xxvi., p. 328. 
Onychia.—If you see this disease early, Dr. Hamilton, of Dublin, ad- 
vises to poultice until you can insinuate a small shred of lint under the 
angle and side of the nail, by means of a small probe ; you must then vet 
this with a solution of nitrate of silver (5j. ad §j.). Keep the lint in for TONGUE, 
677 
forty-eight hours, and by renewing two or three times the disease will be 
cured. To prevent a return, caution the patient against rounding off the 
angles when cutting the nails, and direct him to cut them straight across. 
Part xxxii., p. 191. 
Ingrowing Toe-Nail.—The chief pain in the operation for the cure of 
this affection is caused by the necessity of forcing away a portion of the 
nail from attachments rendered excessively tender by inflammation. It is 
not generally known, says Dr. Long, surgeon to Liverpool Royal Infir- 
mary, that by rubbing the nail well with nitrate of silver along the line of 
intended division, about two days before the operation, this tenderness is 
done away with, and the operation rendered nearly painless, as the caustic 
causes the nail to loose its attachment to the parts beneath. The best 
plan of doing this is to gently introduce a bit of cotton wool along the 
edge of the nail, thus separating it from, the overgrowing granulations, 
and along the edge of this to apply the nitrate of silver. If the nail be 
very thick, it may be necessary to scrape off* the blackened parts, and 
apply the caustic a second time There is no such thing as 
ingrowing toe-nail; it is the upgrowing of the quick through exposing the 
same, and taking away the natural protection and support of the nail itself. 
Therefore do not remove the nail, but soak the part well in hot water, and 
delicately remove all discharge, pass in plenty of very finely powdered 
burnt alum, cover all the fungus with the same, and on the next and every 
day do the same until no longer sensitive, then strap down the alum, first 
putting on the top, not under, a piece of lint. Part xxxvii., p. 176. 
Ingrowing Toe-Nail.—After fomentation, Dr. Alcantara interposes be- 
neath the nail a small piece of lint, upon which some ointment of per- 
chloride of iron has been spread; all the surface of the excrescence, de- 
prived of its epidermis, is covered over with this, and the dressing is 
renewed twice a day. At the end of four days the excrescence becomes 
dry and mummified, and is easily detached. The wound then assumes a 
regular aspect, and the cure is completed at the end of a week. 
Part xxxix.) p. 233. 
TONGUE. 
Diseases of the Tongue.—On diseases of this organ we find very little 
attention has been paid by authors, except on those which are malignant. 
The tongue is sometimes swollen in dyspeptic persons, or it becomes 
cracked on the surface. These cracks or fissures are sometimes very deep, 
and will generally be durable. They often arise from profuse salivation 
at some former period of life, but, when slight, may be owing to dyspepsia. 
If owing to mercury, the best remedy, perhaps, is sarsaparilla, or nitric 
acid. We sometimes find little ulcers on the tongue, often the consequence 
of syphilis, and accompanied, pei’haps, with little spots of syphilitic pso- 
riasis, on the body or on the scalp. They soon disappear by means of 
small doses of mercury; and in one case, mentioned by Sir B. Brodie, the 
hyd. c. creta was given in small doses for nearly two months before a 
radical cure could be effected. Small doses are much to be preferred to 
large ones. Sir Benjamin prefers five grains of the hyd. c. creta with one 
or two grains of Dover’s powder; and where this fails, he gives the iodide 678 
TONGUE, 
of potassium, two or three grains given twice daily, dissolved in plenty of 
water. If these ulcers arise from dyspepsia, which is frequently the case, 
one or two applications of the nitrate of silver will be sufficient to cure 
them. Sir Benjamin continues: “There is a disease of the tongue which 
I have seen every now and then, and which I am sure is very often mis- 
taken for cancer, though it is of a different nature. It is a curable disease, 
although it looks like a malignant one in many respects. The first thing 
of which the patient complains is enlargement of the tongue, with some 
pain. On examination you find a tumor in one part of it, not very well 
defined, nor with any distinct margin. It is a softish tumor, and increases 
in size, and perhaps another tumor appears in a different part of the tongue, 
and that increases also. There may be three or four of these soft elastic 
tumors, with no very defined margins, in various parts of the tongue. This 
is the first stage of the disease. 
“ In the second stage there is a small formation of matter in one of these 
tumors—a little abscess, which breaks externally, discharging two or three 
drops of pus. When the abscess has burst it does not heal, but another 
forms in one of the other tumors. These abscesses may assume the form 
of ulcers, and the ulcer has a particular appearance. In the first instance 
it is a very narrow streak of ulceration, but on introducing a probe you 
find that the ulcer is the external orifice to a sort of fissure in the tongue. 
The probe passes in obliquely; the tongue is, as it were, undermined by 
the ulcer, a flap of the substance of the tongue being over it. 
“ The disease now becomes more painful, and at last these ulcers may 
spread externally. In some instances they occupy a very considerable 
portion of the surface of the tongue, but generally they burrow internally, 
and do not spread much toward the surface. This is a very distressing 
state of things, and a man may remain in this state for a long time. The 
glands of the neck do not become affected, nor does the general health 
suffer, except from the difficulty of swallowing food. This is one incon- 
venience experienced by the patient, and he also labors under a difficulty 
of articulation. The tongue, from its enlarged state, may become stiff, not 
sufficiently pliable for the purposes of speech, and the patient either speaks 
thick or lisps. . 
“ In some instances the disease may be relieved by a course of sarsaparilla, 
with small doses of bichloride of mercury. A strong decoction of sar- 
saparilla, with from a quarter to half a grain of bichloride of mercury, may 
be taken in the course of the day. Of course, if there be anything wrong 
in the general health, you should endeavor to get that corrected, and 
attend especially to the state of the bowels and the secretion of the liver. 
If the secretions of the digestive organs be unhealthy, a dose of senna and 
salts may be given every other morning, and blue pill every other night. 
When the patient is brought into this state, one remedy, as I have said, is 
sarsaparilla with bichloride of mercury, but, according to my experience, 
this is not the best remedy. The remedy best adapted for these cases is a 
solution of ai’senic. Give the patient five minims three times daily, in a 
draught, gradually increasing the dose to ten minims. It should be taken 
in full doses, so that it may begin to produce some of its poisonous effects 
on the system. When it begins to act as a poison, it will show itself in 
various ways. Sometimes there is a sense of heat, a burning pain in the 
rectum; sometimes griping, purging, and sickness, and nervous tremblings. 
A patient who is taking arsenic, especially in pretty large doses, ought to TONGUE, 
679 
be carefully watched. At first you may see him every two or three days, 
and then every day: and as soon as the arsenic begins to operate as a 
poison, leave it off. When this effect is produced the disease of the tongue 
generally gets well, but at any rate leave off the arsenic, and the poisoning 
will not go too far; it will do no harm. If, after a time, you find that the 
disease is relieved, but not entirely cured, you may try another course of 
arsenic. Perhaps it may take a considerable time to get the tongue quite 
well. Sarsaparilla, with the bichloride of mercury, may be given at one 
time; and at anothei', arsenic. You cannot give either of these remedies 
forever, and indeed the arsenic can only be given for a very limited 
period; but it is astonishing what bad tongues of this description I have 
seen get well under these modes of treatment, especially under the use of 
arsenic.” 
[Sir Benjamin thinks that many of these affections, which at first are not 
malignant, may ultimately prove so; and when they assume the malignant 
character, or when a disease is of a malignant nature from the first, he 
thinks it is the best plan to let it have its own course. As in a cancer of 
the breast it would be of no use to remove the small portion where malig- 
nancy first shows itself, or part of a tibia affected with fungus liaematodes, 
so in cancer of the tongue the whole organ is more or less diseased from 
the first, and to remove the piece which first shows symptoms of malig- 
nancy, would be of little avail.] 
“ There is one other disease of the tongue, or rather a disease under it, 
which remains to be mentioned. A patient comes with a sore mouth, and 
you see the tongue pushed up to the soft palate. It looks as if the tongue 
were enlarged, but that is not the case, it is lifted up. Yon tell the patient 
to put his tongue against the incisor teeth, and on looking beneath you see 
a tumor. By feeling it you find fluctuation, you puncture it, and let out 
a quantity of transparent fluid, sometimes a teaspoonful or more. The 
fluid is a little glutinous, and consists of saliva. There has been an 
obstruction to the orifice of the submaxillary gland ; the saliva has been 
secreted by the gland, but could not get out by the duct, and hence it has 
remained till it has formed a large tumor. This is what is called ranula. 
“ You puncture the tumor with a lancet; the fluid comes out, and imme- 
diately the patient is well. You see him a week afterward; he is quite 
well, and there is no saliva flowing out of the orifice you have made with 
the lancet. But you see him a month afterward, and the tumor has 
reappeared, the orifice has healed, and the tumor becomes as large as 
ever. All you want is, to get a permanent orifice from the bag into which 
the duct has been converted; but that is a very difficult matter. I have 
tried to effect it in various ways. I have punctured the bag, and then 
touched the edge with caustic potassa to prevent its healing. The patient 
has gone on very well so long as it did not heal, but as soon as I have left 
off applying the caustic the orifice has closed. I have introduced a tena- 
culum into the bag of the ranula, and cut away a piece sufficiently large to 
admit the finger ; the patient has then continued well for a longer time, 
because the part takes longer to heal, but contraction takes places, and 
the patient is bad again. I have run a seton through, and the patient has 
then gone on well for a considerable time. I have introduced a gold or 
silver ring, and kept that in as a seton. If the seton be kept in a conside- 
rable time it seems to effect a permanent cure, but even that fails, and 
you have to perform the operation two or three times. I know of nothing 680 
TONGUE. 
better than the use of a seton, and I believe that it is better made of 
metallic substance than of silk. It does not so soon ulcerate its way out, 
and if it remain in for a long time, the edges of the orifice through which 
the seton is introduced may become covered with mucous membrane. If 
you introduce a silk or india-rubber seton in the back of the neck, after a 
great length of time a sort of skin forms on the inner surface of the canal; 
there is a discharge of matter; and when you take away the seton the 
part in which it lay remains pervious. So if you keep a seton in a ranula 
for a very long time the opening may remain pervious. The advantage of a 
metallic over a silk seton is, that it does not ulcerate its way out so soon, does 
not get putrid in the mouth, and therefore may be' kept in for a long time.” 
[Sometimes the tongue is affected with a tumor, which, if it occurred 
in the female breast, would perhaps be mistaken for scirrhus ; but still it 
has not the character of scirrhus of the tongue—it is hard and circum- 
scribed, and rather deeper than common scirrhus. Sir Benj. Brodie would 
ascertain the effects of iodine upon such a tumor, before he pronounced 
a decided opinion. In one case he gave eight or ten drops of the tincture 
of iodine three times a day, and gradually increased the dose to 20 drops. 
The tumor ultimately disappeared. In relating this case he cautions us 
against the too long continuance of iodine, without keeping our eyes on 
the patient. After continuing its use too long he was seized with 
paralysis, but on leaving off the medicine he recovered—thus showing 
how powerfully iodine may affect the nervous system, if used for too long 
a time.] Part ix., p. 98. 
Diseases of the Tongue.—[As actual disease of the tongue is often 
obscure, and seldom met with in private practice, attention to the follow- 
ing remarks taken from a lecture by Mr. Lawrence on the subject, will be 
of service when such do occur. Ulceration, swelling, and thickening of 
the mucous membrane, and hypertrophy with induration of the whole 
organ, are the forms most frequently met with. With the two latter 
ulceration is a frequent concomitant. Syphilis and cancer are the more 
formidable diseases, the first being by far the most frequent. Serious 
affections too, occasionally depend upon disorder of the digestive organs.] 
Syphilitic disease of the tongue occurs most frequently in conjunction 
with other venereal symptoms, such as ulcerations of the fauces or mouth, 
and eruptions, particularly of the scaly kind. Here the nature of the 
malady is too obvious to be mistaken. A gentleman who had a primary 
syphilitic sore some weeks previously, showed me an ulcer on the right 
edge of the tongue, very similar to those frequently accompanying the use 
of mercury. The surface was raised and irregular, excoriated and par- 
tially ulcerated. There were two small superficial ulcerations of the palate, 
and no other symptoms. These appearances were entirely removed in 
three weeks under the mild use of mercury with sarsaparilla. A female, 
at present in the hospital, has the mucous membrane at the edge of the 
tongue thickened, and considerably raised, for a length of three quarters 
of an inch, with alteration of the epithelium, giving it a white color. It 
has been in this state, with considerable soreness, for three months. I 
lately saw a young person with thickening of the mucous membrane on 
both sides of the tongue, occupying nearly the whole length of the organ. 
It was reddened, slightly fissured, but not greatly enlarged. There was a 
superficial ulcer, of elongated form, on each side, about the middle of the TONGUE, 
681 
diseased portion of the membrane. This affection, which had followed a 
primary sore, and was not attended with any other secondary symptom, 
was said to have existed in a more or less troublesome state for more than 
a year. I prescribed the hydrarg. c. creta, and conclude that it had the 
desired effect, as I have not seen the patient since. A gentleman 26 years 
of age consulted me on account of an affection of the tongue. There was 
a thickening of the mucous membrane on the middle line and at the back 
of the organ, constituting a flattened projection of circular form larger 
than a sixpence. It was redder than the rest of the mucous membrane, 
and had a slightly broken surface, like that of a wart. It was painful, 
and smarted when acids, strong liquids, or stimulating condiments were 
taken into the mouth. As he mentioned that he had felt some uneasiness 
about the throat, I inspected the fauces, and found a superficial ulcer, the 
size of a sixpence, on the side of the pharynx, behind the root of the 
tongue. I asked whether he had contracted any syphilitic complaint; he 
was surprised at the inquiry, but informed me that he had had a chancre 
several weeks previously, which had healed in ten days under the use of 
mercury. The tongue and throat soon became well under the use of that 
remedy. 
Sometimes the dorsum of the tongue presents red patches, in which the 
mucous membrane is denuded of its epithelium, and perfectly smooth, but 
not ulcerated. These are sore when hot or strong things are taken into 
the mouth. They may last for a considerable time, particularly if they are 
neglected, getting better and worse. There is sometimes a combination 
of diseased appearances in the same case. A gentleman consulted me on 
July 1st. There had been a primary sore ten months ago; then an erup- 
tion, which did not last long. He had been plagued with a bad tongue for 
the last four or five months : it had been so swelled and painful that he ate 
with difficulty. The surface of the organ, in its middle portion, and over 
more than half its extent, the dorsum and edges being included, was 
smooth, the epithelium being white and opaque, as if this part had been 
ulcerated, and partly having a raw appearance. There were three or four 
small superficial ulcers with grey surfaces at the edges and tip, and small 
superficial ulcerations of the lips, with chaps at the angles of the mouth. 
In both palms there were scaly eruptions in a slight form, but not else- 
where. This patient had frequently taken the iodide of potassium in rather 
large doses ; the tongue would get better, but the mischief would return 
on leaving off the remedy. I prescribed the hydrarg. c. creta, gr. iiss. 
three times a day. The patient did not visit me again for a week, at the 
end of which time severe ptyalism had been produced, with more than the 
usual degree of suffering. He expressed his belief, however, that the 
original complaint of the tongue was better. Now (August) that the 
mercurial affection has subsided, the tongue is quite well, though having 
marks on its surface of the previous disease. The beneficial influence of 
mercury on ulcers of the tongue, mouth, and throat, has always appeared 
to me to afford the most unequivocal evidence of its peculiar antisyphilitic 
virtues ; for while the sound mucous membrane is inflamed and ulcerated 
by the action of the remedy, we see the contiguous venereal ulcerations 
altered in character and healing rapidly. 
Venereal enlargement and induration of the tongue may be confounded 
with cancer, in which the substance of the organ is also more or less har- 
dened. There are several and sufficient points of distinction, so that if the 682 
TONGUE, 
history be investigated, and the symptoms carefully examined, there will 
be no risk of mistaking the comparatively mild and manageable venereal 
affection for the very painful, and, I fear, inevitably fatal cancerous disease. 
I have always seen the latter begin on the edge of the tongue, generally at 
the middle or back part. It extends slowly into the substance, and may 
ultimately embrace the greater portion, or the whole oi’gan. The hardi- 
ness which, as in the scirrhous breast, is in the highest degree, renders the 
part incompressible; it is accurately circumscribed, so' that we imme- 
diately feel the boundary of the disease. The hardness is less marked in 
syphilis, more diffused, and not confined in its origin to the margin of the 
tongue. Scirrhous induration does not last long, nor become considerable 
in extent, without the occurrence of ulceration ; while syphilitic enlarge- 
ment may occupy one-half, or nearly the whole organ, without breach of 
surface. The cancerous ulcer is deep, often with an ash-colored or par- 
tially disorganized and bleeding surface. Sometimes profuse and alarming 
hemorrhage occurs. The margin is hard, raised, and everted, or ragged 
and excavated. The induration is considerable in.proportion to the ulcera- 
tion, especially at the commencement. The secretion from the sore is thin 
and offensive. The induration, in syphilitic ulcerations, is comparatively 
inconsiderable; the surface is of better character, and the ulcer seldom 
penetrates deeply. Cancer of the tongue is a hardened mass, which be- 
comes ulcerated; syphilitic disease is an ulceration of which the base and 
edge are sometimes thickened, moderately indurated, and raised. The 
pain of cancerous ulceration is most severe, and so much aggravated by 
motion of the organ, that articulation, mastication, and swallowing, are 
attended with the greatest suffering. The aid of opium is absolutely neces- 
sary to procure temporary ease. The uneasiness in syphilitic cases is com- 
paratively inconsiderable. The absorbent glands soon become enlarged 
and indurated in 'cancer of the tongue, while they seldom suffer in syphilitic 
ulceration; if they do, it is simple enlargement. Part xii., p. 188. 
Morbid States of the Tongue.—Dr. Wright says : As a rule the tongue 
is a very faithful indicator of the condition of the alimentary organs ; but 
its evidences are not unexceptionable. A furred tongue, for instance, is a 
common indication of dyspepsia, but it is not a constant one. You some- 
times meet with irritable, nervous subjects, whose tongues are habitually 
furred, yet without any signs or symptoms whatever of gastric derange- 
ment. Others, again, will have clean tongues, and of natural redness, 
whilst they are suffering from severe stomach disorder. I called your 
attention to a case of this sort the other morning, in the person of a female, 
the subject of very severe pyrosis. During the three weeks that she has 
been under my care, the tongue has never lost its cleanliness or good color. 
I once had a dispensary patient affected with scirrhus of the pylorus, of 
which he died, yet up to the time of his death the tongue was scarcely ever 
furred or dry. Various circumstances exert a remarkable influence upon 
this organ. Some people, otherwise healthy, get a furred, clammy tongue 
if their stomachs are empty a little longer than usual; others have their 
tongues furred always when their stomachs are full; the coating continues 
only during digestion, and passes off as this function ceases. Mental and 
moral embtions affect the condition of the tongue in a singular manner. 
It may happen, that in dyspepsia, the disorder the brain suffers, sympa- 
thetically with the stomach, lias as much share as this organ itself in giving TONGUE. 
683 
the tongue its characteristic coating. Certain it is, as I have said, that 
the feelings of the mind will, in a very few minutes, render a clean tongue 
a foul one. Among the profoundly studious, among those terrified by sud- 
den apprehensions, or shocked by the sudden advent of ill news ; among 
the hypochondriacal, hysterical, gloomy, and desponding, you will find 
many examples of the mind’s influence, in this particular, upon the body. 
A few days ago, in calling upon a patient, one of the first things I did 
was to look a*t his tongue. I found it, as usual, very pale, flabby, and 
moist, but without any coating. After having made other necessary in- 
quiries, I was informed by my patient that his heart, which has long been 
disturbed by mental emotion, the other night beat with unusual vehemence 
and irregularity. On my asking if he could account for it, he told me that 
he had just then received the distressing intelligence that an uncle, from 
whom he expected a competency, had not left him with a shilling! This 
pitiable tale, told with much earnestness and visible feeling, occupied little 
more than twenty minutes; at the end of that time I again looked at his 
tongue, and found it coated with a thick white fur ! 
I mention these things, thus generally, to you, not only as items in pa- 
thology with which you ought to be made familiar, but also suggestive of 
a discreet rule of practice, viz., to let the examination of a patient’s tongue 
be one of your first duties at his bed-side. 
Besides moral and mental states, there are certain physical ones, of 
which the tongue is an occasional, though not an invariable evidence. Our 
hospital opportunities have lately given me the occasion of showing you 
these pathognomonic facts somewhat strikingly. I have dwelt with parti- 
cularity upon them at the bed-side, and have no doubt that they are still 
fresh in you remembrance. You have seen in several varieties the dark, 
dry tongue of typhoid fever; the glassy, bright red tongue, with its 
elevated papillae, in sub-acute gastro-enteritis; the brown furred tongue 
of dyspepsia, with bilious derangement; the pale, flabby, furred, sodden, 
tongue of chlorosis, habitual drunkenness, debility of the gastric apparatus, 
etc.; the pale or patched, trembling tongue of the hypochondriac, the dis- 
sipated, the excessively weakened, from whatever cause; the dry, con- 
tracted, dusky-red tongue of gastric irritation, etc. 
A morbid state of the tongue not only indicates (with rare exceptions) 
the condition of the gastric apparatus, and of the system in general, but 
an improvement of its appearance denotes, also, that the patient is advanc 
ing toward recovery. This change sometimes occurs with singular sud- 
denness, and the patient as suddenly gets well. You remember the girl 
Scandret, in the middle ward, 'whom we had some difficulty of relieving of 
fever that had supervened upon dyspepsia. Her tongue was broad, flabby, 
indented at the edges, very trembling, and completely covered with dense 
white fur. She complained of a feeling of hollowness or sinking of the 
epigastrium, with frequent darting pains there, and occasional fits of 
nausea ; her food always lay like a load in her stomach, and oppressed it 
with flatulence. She was ordered the twelfth of a grain of strychnine, 
three times a day. She had only taken five doses up to the time of our 
next visit, and you remembered how altered she then was. Iler tongue 
had no indentation on it: scarcely any fur ; its trembling was almost im- 
perceptible, and its size diminished. She had no gastric pain or flatulence 
after the first dose of strychnine. In four days afterward she left the hos- 
pital, apparently quite well. I told you that the appearance of her tongue, 684 
TONGUE. 
and her expressed symptoms, indicated that her stomach was suffering from 
irritability, the result of local nervous debility: the manner in which she 
improved under the strychnine confirms me in that opinion. 
There was another case to which I called your particular attention, a 
short time back, in the person of a girl. When convalescent from fever, 
she one day begged to be allowed some beef for dinner. Her tongue was 
very furred, but there was nothing else to prohibit the gratification of her 
appetite; and she asked so imploringly that I ordered her some roast beef, at 
the same time remarking to you that it was not improbable her anticipated 
meal would clean her tongue. The' next day confirmed what I had said ; 
we found her with neithei*fur nor fetor in her mouth, and she required no 
more medicine during the few remaining days that she was in the hospital. 
It is not always safe to gratify the inclination of patients’ appetites, for they 
are sometimes disposed to crave for very strange things. Inclination and 
appetite have frequently a great share in promoting good digestion. I have 
known oysters, lobsters, pork, pastry, and such like allowed almost ad 
libitum,, for once, to patients, not only with impunity but with advantage. 
I mention these as curiosities of experience, not as examples for imitation. 
Part xv., p. 106. 
Tongue—Inflammatory and other Affections of.—Dr. Fleming says, that 
sudden and alarming swelling sometimes takes place in the tongue, which 
seems to be merely an unaccountable and active hyperajmia, readily yield- 
ing before inflammation has had time to be lighted up, by incision, by 
leeching copiously, both locally and under the chin. Another affection is 
“ an inflammation, circumscribed or diffused, originating in the loose cellular 
tissue between the genio-liyo-glossi muscles,” the treatment for which is 
antiphlogistic, but if it does not readily yield, Dr. Fleming recommends a 
free incision to be made under the chin in the median line, through the 
integuments and fascia, and through the raphe of those muscles, delaying 
the advancement of the suppurating process. Dr. Fleming says, the best 
treatment for the abraded surface of the tongue, sometimes met with, and 
for a peculiar kind of ulcer, which is accompanied by a small tumor about 
the size of a pea, and which he states may occur without the slightest 
suspicion of a syphilitic taint, is the iodide of iron, with hemlock, and the 
local application of the nitrate of copper. Dr. Fleming thinks it a tuber- 
culous disease, and says it is by no means uncommonly met with. The 
nitrate of copper, he says, is almost invaluable also as an application to the 
small excoriated ulcers, of a semi-phagedenic character, occurring in the 
genitals of both male and female. It is very deliquescent, and can be ap- 
plied only in its liquid state. The surface of the ulcer should be well 
dried previously, and afterward covered with oil. Part xxii., p. 367. 
Tongue—Tumors of.—For the removal of these tumors, the surgeon has 
choice of three methods. Amputation by the knife gets rid of the mass at 
once ; strangulation by means of ligature prevents any loss of blood ; and 
excision performed carefully by a wire heated by galvanism accomplishes 
both these objects at the same time. Part xxvi., p. 340. 
Percyanide of Mercury in Syphilitic Ulceration of the Tongue.—Mr. 
Wormald, at St'. Bartholomew’s Hospital, has recently been employing a 
saturated solution of the bicyanide of mercury, as an application to syphi- 
litic ulcerations, abrasions, etc., on the tongue. Without speaking very 
enthusiastically respecting it, he states that he has obtained more satisfac- TONSILS, 
685 
tory results from it than from any remedy he had previously employed. 
The solution is painted over the affected part, care of course being taken 
that the patient do not swallow any quantity of it. The extremely intract- 
able nature of this form of syphilis is matter of general remark. 
Part xxxii., p. 181. 
Tongue, Deep Fissures of.—Dr. Fleming, surgeon, Richmond Hospital, 
Dublin, uses locally the nitrate of copper to the ulcerated surfaces, and 
gives chlorate of potash in from five to fifteen grain doses, with bark and 
sarsaparilla. The nitrate of copper is almost invaluable in this class of 
ulcers, and it will be found equally valuable in small excavated semi-phage- 
denic ulcers which occur on the genitals. It is a very deliquescent salt, 
and can only be applied in the liquid state, by means of a small piece of 
cedar. Part xxxiii., p. IV8. 
Glycerine and Borax in Cracked Tongue.—Dr. Brinton advises to apply 
a lotion composed of two scruples of borax, one ounce of glycerine, and 
four ounces of water; at the same time give the iodide of potassium and 
bark. Part xxxv.,p. 59. 
TONSILS. 
Pulvis Aluminis et Capsid.—R Alum, three parts; concentrated tinc- 
ture of capsicum, one part. Mix and dry. 
Dr. Turnbull has found a very small quantity of this powder applied to 
the tonsils, more efficacious, in some cases, than an alum and capsicum 
gargle. Part v., p. 84. 
Chronic Enlargement of Tonsils—Iodide of Zinc.—Dr. J. Doss says: 
The first notice I saw of the medical use of this compound was in the 
review of Dr. Cogswill’s essay on iodine in “ Johnson’s Journal” (Jan. 
1839, p. 118). It is there stated, “During the two last years we have 
been in the habit of employing a strong solution of the iodide of zinc, as 
an application to the tonsillary glands, when affected with chronic enlarge- 
ment, and we can recommend it to our readers as the best local remedy we 
know for that most obstinate complaint.” To this statement I fully sub- 
scribe. In those cases of hypertrophied tonsils where I have used it, the 
diminution in their size was most marked and speedily produced. In two 
patients in whom these glands were so much enlarged as almost to fill up 
the isthmus of the fauces, and interfere materially with deglutition, they 
were quickly reduced to nearly theii natural size, and gave no further in- 
convenience. A solution may be made of 10,15, or 30 grains to the ounce 
of water, and applied to the tonsils daily, by a piece of sponge tied to a 
quill or thin piece of wood. After using this for some time, I employ the 
substance itself, undiluted; a little of it is exposed to the air till it deli- 
quesces, and then applied in this state to the tonsil, by means of a camel’s- 
hair brush. This is a much more effectual plan than Dr. Cusack’s mode of 
applying the nit. argenti point by point; indeed, it is superior to every 
local application I know of being used in such cases, always, of course, 
excepting the knife. Part vi., p>. 124. 
Chronic Congestion of the Tonsils.—Dr. Becker has found extract of 
green walnut shells of great efficacy in congestion of the tonsils. The 686 
TONSILS. 
mode in which he uses it is in the form of a solution of the extract of one 
part to fifteen of distilled water, to J>e applied externally with a brush. 
Part xi., p. 59. 
Excision of the Tonsils—Follicular Disease of.—Extirpate (as also the 
uvula) if much hypertrophied and indurated, and apply strong solution of 
nitrate of silver. (Dr. If. Green.) 
Hypertrophy and induration of the tonsils occur frequently in young 
persons and children, independent of follicular disease of the throat. In 
some instances, the affection appears to he congenital, or is hereditary; in 
others, it is the result of repeated attacks of chronic inflammation of the 
tonsillary glands. When the hypertrophy is accompanied by induration, 
whether this condition coexists with follicular disease, or is the effect of 
chronic tonsilitis, excision of the enlarged gland is almost the only method 
of treatment by which permanent and effectual relief can be obtained. 
This fact ought to be better understood by the profession than it seems to 
be, for the practice of painting these morbid growths with the tincture of 
iodine, or of cauterizing them with the solid nitrate, is still continued, and 
patients are daily being subjected to this still annoying and useless practice, 
often month after month, with the apparent expectation on the joart of 
their attendants that enlarged and indurated tonsils may be discussed by 
these applications.—(Rev.) Part xvi., p. 126. 
Tonsils—Chronic Enlargement of.—Apply nitrate of silver, either the 
solid caustic, or a solution gradually increased from three grains to two 
drachms to the ounce of water ; paint the tonsils twice or thrice at one sit- 
ting, and then let the mouth be well washed with water. Dr. Naudin 
makes the application every two or three weeks. Part xvii., p. 94. 
Evils attending Excision of the Tonsils.—With respect to enlargement 
of the tonsils affecting the permeability of the Eustachian tube, Mr. Har- 
vey said that he considered it to exist much less frequently than had been 
supposed; and in cases where this occlusion did exist, it was not from 
the enlarged tonsils pressing upon the mouth of the tube, but from thick- 
ening, the result of inflammation of the lining membrane. 
Excision of the tonsils was not, therefore, expedient; indeed, in many 
cases which he had examined, that proceeding had been attended with 
enlargement of the follicles of the pharynx, continued heat and thirst, con- 
stant desire for deglutition, disturbance of the general health, and impair- 
ment of the voice. Enlarged tonsils were more frequently found in 
females than males; and when enlarged in childhood, generally assumed 
their natural size at puberty. They appeared to the author to have some 
intimate sympathy with the sexual organization. The treatment of enlarge- 
ment of the tonsils consisted of small doses of the bichloride of mercury 
and colcliicum; the latter, with guaiacum, was most efficacious. 
Part xix., p. 160. 
Tonsils—Enlarged.—Do not remove them by the knife in children, as 
the operation is troublesome, and sometimes serious; and, besides, they 
often diminish in size spontaneously after puberty. When the patient is 
old enough to exercise self-control, the operation is safe enough. 
Part xxi., p. 25. 
Tonsil—Enlarged.—The excision of enlarged tonsils is recommended, TOOTHACHE. 
687 
as performed by M. Lisfranc, of Paris, by grasping the tonsil with the 
forceps, pulling it inward from the side of the fauces, or merely held 
steady in its natural position, and then passing a straight narrow blunt- 
pointed bistoury, the blade being sheathed except rather more than an 
inch from the point, through its base. It may be clone with perfect safety, 
with immediate relief, and with little hemorrhage succeeding. 
Mr. Harvey recommends the bichloride of mercury, in small and divided 
doses, with tincture of rhubarb and of bark, to be taken at bedtime; also 
the tincture of colchicum, to be taken internally, and applied externally 
with lin. saponis. When the scrofulous character predominates, he uses 
the cod-liver oil. Of all the remedies advised to be used in the chronic 
state, Mr. Harvey thinks colchicum is the best. He was led to this con- 
clusion from investigating the history of this affection, and the contents of 
the tonsils, resembling very much those concretions found in the joints of 
gouty and rheumatic patients. Part xxii., p. 215. 
Angina Tonsillaris.—Dr. Flange states that the employment of the 
zincum aceticum in this disease, and especially in thirty cases occurring 
during an epidemic of' scarlatina, where it was exhibited in very different 
degrees of the affection, has been followed by almost immediate relief. 
He prescribes from E)j. to 5j. in from §vj. to gviij. of water, giving a table- 
spoonful in some mucilage every two hours, in severe cases, and frequently 
gargling the throat also with the same. Part xxii., p. 365. 
TOOTHACHE. 
Oil of Ergot.—Suggested to relieve the pain ; applied on a small piece 
of cotton, within the cavity of the tooth. Part ii., p. 42. 
Oil of Valerian.—Suggested in cases of pain arising from carious teeth, 
unaccompanied by inflammation of the fang. Part ii., p. 56. 
Creasote, generally gives relief from pain; applied directly within the 
cavity, but is thought to hasten the destruction of the teeth. 
Part vi., p. 73. 
Gregorian Paste.—Currie powder, made into a paste with brandy, is 
an excellent remedy for toothache, and forms the celebrated Gregorian 
paste. 
Augustura Park.—"When purely nervous, fifteen grains of Augustura 
bark every four hours has often cured it in a few hours. 
Odontalgic Pill.—Dr. Handel, of Mentz, strongly recommends the 
following: 
R Opium, half a drachm; extract of hyoscyamus, camphor, of each six 
grains ; oil of hyoscyamus, one drachm ; cajeput oil, tincture of lytta, of 
each eight minims. Mix. Insert a little into the tooth as a pill, or on lint. 
Part viii., p. 29. 
Aqua, or liquor Ammonice.—Recommended in odontalgia, in doses 
of 20 to 40 drops, thoroughly blended with a cupful of thick gruel, and 
taken whenever the paroxysm of pain supervenes. Part ix., p. 33. 
Chloride of Zinc in Toothache.—According to Dr. Stanelli, the chlo- 
ride of zinc, liquefied by exposure to the air possesses the property of 688 
TOOTHACHE. 
calming dental pains. His mode of application is most simple. By 
means of a small hair pencil, a small quantity of it is applied to the cavity 
of the painful tooth, and in the space of a few minutes it appeases the 
most acute sufferings, without causing any irritation. Before proceeding 
to the application, it is indispensable carefully to surround the tooth with 
cotton wadding, and, when the chloride has been applied, to well fill the 
cavity with this same cotton. The mouth is finally washed with a little 
warm water. The author affirms that he has obtained uniform success 
from this means in more than fifty cases, and that he has never observed 
the progress of the caries rendered more active by it. Part ix., p. 178. 
Use of Pure Tannin.—Prof. Druitt considers tannin the best remedy 
for toothache : 
“It will often be found that the gum around a carious tooth is in a 
spongy, flabby condition; a little piece of it, perhaps, growing into the 
cavity. The ache, too, is often quite as much in the gum as in the tooth 
itself. But, be this as it may, when the tooth aches, let the patient wash 
out the mouth thoroughly with a solution of carbonate of soda in warm 
water ; let the gum around the tooth, or between it and its neighbors, be 
scarified with a fine lancet; then let a little bit of cotton wool, imbued 
with a solution of a scruple of tannin, and five grains of mastic, in two 
drachms of ether, be put into the cavity, and if the ache is to be cured at 
all, this plan will put an end to it in nine cases out of ten. I think that 
practitioners are to blame in not paying more attention to the cure of 
toothache ; I am convinced that in most cases .it is as curable as a colic or 
a pleurisy; the chief point being to open the bowels, and put the secre- 
tions of the mouth in a healthy state, and to apply some gentle astringent 
and defensative to the diseased tooth till it is capable of being stopped 
by some metallic substance. I say emphatically a fine lancet, be- 
cause the coarse, round, blunted tools that are generally sold under the 
name of gum-lancets, only bruise the gum, and cause horrible pain. The 
lancet which I use is sickle-shaped, cutting on both edges, and finely 
ground ; and if guarded with the middle finger of the right hand, it may 
be used in the case of the most unruly children without any possible ill 
result.” Part x., p. 139. 
Mew Remedy for Toothache.—Sulphuric ether, saturated in the cold 
with camphor, and then a few drops of liq. ammonias added. It acts as a 
cautery. M. Cottereavi, who has employed it for four years, says it is 
always attended with success. The rapid evaporation of the ether causes 
a slight deposit of camphor in the dental cavity, and this protects the 
nerve from the air. The ammonia cauterizes. Part xiv., p. 324. 
Toothache—Morphine Locally to the Gum.—Three hours after the last 
meal in the evening, rub a quarter of a grain of muriate of morphia gently 
upon the gum, for about three minutes; then incline the head to the 
affected side, and keep in that position for ten minutes, taking care neither 
to spit out nor swallow the saliva. Repeat it in two hours if relief is not 
obtained, except there is headache or sleepiness. Part xvi., p. 89. 
Carvacrol, a Mew Remedy for Toothache.—Carvacrol, according to 
Professor Schweitzer, is formed by the action of potassa, iodine, or 
hydrated phosphoric acid, upon oleum carui, ol. thy mi: and according to 
Claus, by the action of iodine upon camphor. TOOTHACHE. 
689 
Carvacrol is an oily liquid, very similar to creasote, with a very unplea- 
sant smell and strong taste. Applied on a piece of cotton to a decayed 
and painful tooth, it gives immediate relief. 
[The following has also been used with success:] 
A mixture of two parts of liquid ammonia of commerce with one of 
some simple tincture is recommended as a remedy for toothache, so often 
uncontrollable. A piece of lint is dipped into this mixture, and then 
introduced into the carious tooth, when the nerve is immediately cauter- 
ized, and pain stopped. It is stated to be eminently successful, and in 
some cases is supposed to act by neutralizing an acid product in the de- 
caying tooth. Part xvii., p. 58. 
Toothache.—Having dissolved some gum copal in chloroform, clean out 
the hole, moisten a little cotton with the solution, and introduce it into the 
decayed part. Part xviii., p. 105. 
Toothache.—Dissolve a little gum mastic in chloroform, so as to thicken 
the fluid, and then apply it to the tooth on a little cotton wool. 
Part xix., p. 67. 
Toothache.—Apply a minute portion of arsenic, not exceeding the twen- 
tieth part of a grain, in combination with creasote and muriate of morphia, 
on a little cotton wool, to the sensitive portion of the tooth, and retain it 
in situ for twenty-four hours, by softened wax. Then clear away the dead 
dentine, lay open the pulp cavity, and remove the pulp ; if the operation 
gives any pain, desist from it, and renew the arsenical application until the 
following day. When the pulp and carious dentine have been removed, 
plug the tooth in the usual way. If there is a discharge from the pulp 
cavity, after subduing the tenderness by the arsenical application, and be- 
fore proceeding to plug the tooth, get the condition of the pulp cavity 
which gives rise to this secretion, relieved by the daily injection of a solu- 
tion of alum or of nitrate of silver. In the still more advanced stages of 
toothache, hardly anything but extraction will do good. 
Part xix., p. 323. 
Toothache.—Let the mouth be first cleansed with warm water contain- 
ing a little carbonate of soda; then remove any foreign body from the 
cavity, dry it, and drop into it from a point, collodion in which morphia 
has been dissolved, fill the cavity Avith asbestos, and saturate this Avith col- 
lodion ; lastly, place over it a pledget of bibulous paper. By occasionally 
reneAving this application, a more durable stopping Avith gold may at last 
be effected. Part xix., p. 324. 
Toothache.—Apply a bit of cotton saturated with a drop or tAVO of 
strong tincture of capsicum (capsic. bacc., §iv.; sp. vin. rect., gxij). 
Part xxi., p. 262. 
Toothache.—The most intense toothache connected Avith decayed teeth, 
is relieved in a moment by the magic touch of the membrana tympani Avith 
a blunt probe. Agonizing neuralgia of the face is relieved in the same 
way. These effects are supposed to be obtained by the influence of the 
chorda tympani nerve. Part xxiv., p. 336. 
Emetics in Toothache.—Sometimes this is owing to the stomach, and is 
not relieved by any remedy, not even by the extraction of the tooth. In 
this case try an emetic of ipecacuanha. Part xxX., p. 137. 
vol. ii.—44 690 
TOURNIQUET. 
Toothache.—A few drops of chloroform on a bit of cotton, applied to the 
commencement of the meatus auditorius, often gives great relief. The 
chloroform must not be dropped directly into the ear. Part xxxv., p. 32. 
Toothache.—For the last thirty years, Mr. Hoarder, of Plymouth, has 
been in the habit of using galvanism for the relief of toothache; those cases 
yield most easily in which the pain originates in the tooth itself. A metal 
disc covered w'ith moistened cloth and connected with the positive pole, is 
placed on the back of the neck, a similar disc connected with the negative 
pole being placed either on the tooth itself or gum; the degree of power 
necessary is very feeble. Most cases are relieved permanently, many for 
a considerable period, and very few not at all. Of course, in cases of ab- 
scess at the root of the tooth, the symptoms, as might be expected, are 
aggravated. Part xxxviii., p. 253. 
Proper Mode of Applying the Tourniquet.—When you first put on the 
tourniquet, says Prof. Liston, no pressure must be made on the vessels ; the 
surgeon must be ready to make his incision before it is screwed up ; for if 
you allow it to remain on a minute or two, the whole limb is gorged with 
'blood. If you are desirous that the patient should not lose blood, it is of 
the utmost moment to attend to this point. Put on the tourniquet; you 
may even allow the surgeon to transfix the limb with his knife; the instant 
the principal vessel is about to be divided, screw it up quickly, and again, 
as soon as the larger arteries are secured, take it off. If you go on screw- 
ing it up, look at the end of the vessels, then unscrew it; if you see some- 
thing bleeding, try to catch the vessels, and then screw" again ; there is an 
immense quantity of blood lost, the veins pour it out as fast as the arteries, 
you do not know' w'hat you are tying, and you are almost certain to tie a 
great many vessels unnecessarily. Part xi., p. 185. 
Arch-Tourniquet.—[Dr. Oke, of Southampton, has caused to be con- 
structed an arch-tourniquet on a somewhat novel plan.] 
It consists of an arch, a pad, and screw'. The flanks of the arch are per- 
forated w'ith holes for the action of the external screw, which is w'orked 
by a short handle, as in the common tourniquet. The pad is of the ordi- 
nary size, flat on one side and convex on the other. Upon its flat surface 
there is a smooth cavity for the reception and working of the point of the 
screw. Mode of application : Let the arch embrace the limb, so that one 
of the perforations of the flank may be exactly opposite the cavity on the 
flat side of the pad, previously applied over the trunk of the artery to be 
compressed. Then fit the external into the internal screw', and work it 
upon the pad till sufficient pressure be made to stop the circulation of the 
artery. Part ix., p. 174. 
Military Tourniquet.—This consists of an ordinary straight stay busk, 
of sufficient length to embrace the largest limb, and by a series of notches 
at both extremities, may be so reduced as to fit the smallest. The limb 
being surrounded by this, all that remains is to direct the pressure upon 
the artery, by means of a screw. The pads are made of box-wood, and the 
TOURNIQUET. TRACHEA. 
691 
busk is covered with a sheathing of india-rubber, so as not to absorb mois- 
ture. Part xxxv.,/). 87. 
Vide Mr. Guthrie’s remarks on, Art. “ Amputation.” 
TRACHEA. 
Removal of Foreign Bodies from the Trachea.—The case of Mr. Bru- 
nei, in whose windpipe a half-sovereign Avas accidentally lodged, has given 
rise to one or two practical suggestions which on future occasions will be 
found valuable. Although the symptoms in such case may not be imme- 
diately dangerous, disease of the lungs would very probably take place 
sooner or later, and, therefore, it would be always wise to take the neces- 
sary steps for the removal of such a foreign body without loss of time. 
The opening of the trachea in Mr. Brunei’s case answered one important 
end, viz., it enabled the patient to be inverted without giving rise to vio- 
lent symptoms of suffocation, which took place on this change of position 
before this orifice was made. From this circumstance Sir B. Brodie comes 
to the conclusion that in all similar cases where it is necessary to invert 
the body for the sake of dislodging a foreign substance from the lower part 
of the windpipe, or its bifurcations, tracheotomy ought always to be pre- 
viously performed. This will always act like a safety-valve to prevent suf- 
focation, and will also enable the practitioner to manipulate with the forceps 
or any other instrument that he may wish to use. At the same time it 
will be seen from the experience of Mr. Erichsen that such an opening in 
the trachea does not materially diminish the irritability and contractility 
of the glottis ; and for this reason he has suggested an instrument which 
will answer the double purpose of intercepting any foreign body which 
might fall downward toward the larynx during the inverted position of the 
body, and of a scoop, so as to extract the substance when it is caught in its 
net. “ It consists of a pair of cross-action forceps, the blades of which ter- 
minate in branches inches in length, and slightly bowed at the extremi- 
ties ; within the bowed part is inserted a piece of delicate but strong net; 
the forceps open to the extent of three quarters of an inch, which will be 
sufficient to obstruct all passage through the windpipe in the ordinary situ- 
ations for tracheotomy.” When the patient is inverted it is evident that 
any foreign body would be very likely to fall into this net, and might then 
be removed at once, or by a pair of common forceps. Part viii.,p. 124. 
Cases of Spontaneous Expulsion of Foreign Bodies from the Air- 
Passages.—A case of spontaneous expulsion and subsequent recovery is 
given by Mr. Plant, in the Dublin Hospital Reports. A piece of Avood 
had been passed into the trachea, and at first had lodged in the right 
bronchus. At the end of four weeks, during which time the boy had suf- 
fex*ed much from troublesome cough, it was thrown up from the bronchus 
into the trachea, where it could be detected moving up and down. As 
there appeared to be no particular danger, Mr. Plant, trusting that, as it 
had been thrown up from its first situation, it might also be ejected from 
the trachea, deferred operating. At the end of the fifth week it was so, 
and the boy recovered. Another case of this nature is given by Stalpart 
Yander W'iel. A small piece of bone passed into the trachea of a girl 692 
TRACHEA, 
while she was engaged in supping bouillon. The symptoms were constant 
cough, fever, and ultimately hemoptysis, with purulent expectoration. 
At the end of four months the bone was coughed up, and the girl re- 
covered. Mr. Howship relates a case in which a nail had passed into the 
trachea of a man aged 65. The accident occurred on the 15th of August: 
severe pulmonary symptoms followed, and the man was given up by the 
faculty, but the nail was discharged on the 12th November, the patient 
recovered, and was alive twelve years afterward, though subject to fre- 
quent pulmonary affections. In a case given by Dr. Lettesom, the cover- 
ing of a button remained in the air-passages for eight months, when it 
was coughed up, and the pulmonary symptoms subsided. The admission 
of an ear of grass into the air-passages appears not to be an uncommon 
accident, and almost invariably gives rise to very distressing symptoms. 
Dr. Donaldson, of Ayr, relates one of this description, in which the grass 
remained in the right bronchus for seven weeks, giving rise to intense 
bronchitis; it was then expectorated, and the patient recovered. 
Part xii., p. 186. 
Case in which the Larynx of a Goose was Impacted in the Trachea of 
a Child.—The children in Dr. Burow’s vicinity are very fond of blowing 
through the larynx of a recently-killed goose, in order to produce some 
imitation of the sound emitted by this animal. When given to them for 
that purpose, it has usually ten or twelve rings of the trachea connected 
with it. 
A boy, aged 12, while so engaged (Nov. 1, 1848), wras seized with a 
cough, and swallowed the instrument; a sense of suffocation immediately 
ensued, which was, after a while, replaced by great dyspnoea. Dr. Burow 
found him laboring under this eighteen hours after, his face swollen, of a 
bluish-red color, and covered with perspiration. At every inspiration, the 
muscles of the neck contracted spasmodically, and a clear whistling sound 
was heard ; and at each inspiration, a hoarse sound, not very unlike that of 
a goose, was emitted. As, on passing the finger down to the rima glottidis, 
it was found closed, Dr. Burowr felt convinced (improbable as, from the 
relative size of the two bodies, it seemed) that the larynx of the goose had 
passed through it. Tracheotomy was at once performed ; but owing to 
the hornogeneousness of structures of the foreign body and of the part it 
was in contact with, the greatest difficulty existed in distinguishing it by 
the forceps. Moreover, so sensitive was the mucous membrane, that the 
instant an instrument touched it, violent efforts at vomiting were pro- 
duced, and the entire larynx was drawn up behind the root of the tongue. 
At last, after repeated attempts, Dr. Burow having fixed the larynx in 
the neck by his forefinger, so that it could no longer be drawn up on these 
occasions, he contrived to remove the entire larynx of the animal. The 
child was quite well by the ninth day. Part xxi., p. 203. 
Improved Mode of Applying Nitrate of Silver to the Interior of the 
Larynx and Trachea.—To apply nitrate of silver to the trachea, use an 
instrument having a small grindstone, five or six inches in diameter, 
which, being caused to be rapidly revolved by means of a pulley and 
strap, and the salt being placed upon it, a fine dust is thrown from it, 
which, by the mouth being opened and the breath drawn in, is placed in 
direct contact with the diseased surface of the trachea or larynx. 
Part xxii., p. 150. TEACHEOTOMY. 
693 
TRACHEOTOMY. 
Tracheotomy.—[The larynx occasionally requires to be opened during 
the existence of ulceration on some of its upper portions. When this has 
been accomplished, Mr. Liston recommends that the surgeon should touch 
the parts with a solution of nitrate of silver, by means of a piece of sponge 
at the end of a bent probe, carried upward through the wound in the throat. 
It may happen that it is not necessary to open the trachea, but only to 
make an orifice in the crico-thyroid membrane.] 
In cases where there is obstruction at the rima glottidis, as where 
swelling has followed a scald of the glottis, the high operation might 
answer, and in cases where a foreign body, not of large size, is lodged in 
the ventricle of the larynx, an opening in the crico-thyroid membrane 
might suffice, and it is much simpler than tracheotomy. It can be done 
at once with any pointed instrument that comes readiest to hand, as a 
penknife, and without any great incision. You feel for the space between 
the cricoid and thyroid cartilages, and there make a longitudinal incision, 
right into the tube. This might be resorted to where a person is suffering 
from the lodgment of a foreign body in the oesophagus, and in such cases 
it has been done successfully too. A patient may labor under serious and 
alarming obstruction of breathing in consequence of some large body 
pressing on the back of the trachea, and you may have nothing at hand to 
displace or extract it, but you may save the patient, in the meantime, by 
performing laryngotomy, and allowing him to breathe until you can examine 
what the foreign body is, and take proper means for its removal. In the 
majority of cases the operation of tracheotomy is to be preferred, as for 
the extraction of loose foreign bodies, or of those lodged in the lower part 
of the canal. In all diseases of the larynx and glottis you will also act 
more wisely by opening the windpipe. You thus get a lai*ge opening, and 
in apart of the canal which you are certain is quite pervious and clear; you 
thus insure the free breathing of the patient. 
This operation, as I said before, is one not attended with great difficulty 
or danger. The wound can be made down upon the windpipe without 
involving any vessel of importance. There are sometimes arterial branches 
running across the windpipe ; but this is very rare. 
There is no muscular substance to divide; but there are a few veins, 
lying over the windpipe and the thyroid body, to be avoided. The wound 
heals immediately; everything is in favor of it, and it is, therefore, very 
different from a wound across the windpipe. 
If you make an opening to extract a foreign body, and succeed, the 
wound will heal as far as you wish it to do ; you must, in fact, try to keep 
it open for some time ; you must not dream of sewing it up, because blood, 
even in a small quantity, might insinuate itself into the windpipe, or be- 
come infiltrated in the cellular tissue, or collect in the cavity of the wound, 
and cause injurious or fatal pressure: you put a bit of lint betwixt its 
edges, and cover the surface of the wound with a pledget dipped in cold 
water, which is to be frequently renewed. After the incision lias been 
made six or eight hours, you may then bring it together, or apply some 
strips of plaster : it will generally heal with great rapidity. You find 
in cases where a foreign body has been lodged in the wound for many 
days or for many weeks, or even months, that, upon its withdrawal, the 694 
TRACHEOTOMY. 
parts contract so much that, in twenty-four hours, if it were necessary 
to introduce an instrument again, you will find it very difficult to accom- 
plish. 
There is no difficulty in getting down to the windpipe in an adult pa- 
tient, if he is at all steady and willing, as most patients who have suffered 
from difficulty of breathing are, to submit to the operation. You place 
the patient on a chair (this is better than the recumbent position), turn 
his head back, and have an assistant to support it. You make an incision 
from the top of the sternum upward, toward the cricoid cartilage, fully an 
inch in length, through the skin and the subjacent tissue. You expose, at 
once, the sternohyoid muscles, and cut between them, push the veins out 
of their place downward, clear the windpipe upward, by pushing the 
isthmus of the thyroid body out of the way, if it is there, and then you are 
quite prepared to exit into the passage. You desire the patient to swallow 
his saliva, and, taking advantage of the windpipe being pulled downward, 
you push the knife into it at once, with the back toward the top of the 
sternum, and, by a little sawing motion, divide three or four of the rings. 
There is generally no difficulty in doing this, and no bleeding; but if any 
vessel be wounded you may tie it, or wait a little before you open the 
windpipe. If yon operate for the extraction of a foreign body, the proba- 
bility is that it will slip out of itself at once ; by the relief of the respiration, 
and the cessation of struggling and exertion on the part of the patient, the 
bleeding, principally venous, will cease immediately. If there is any 
arterial bleeding, you will take care to arrest it; you then dress the wound, 
and allow it to come together in due time. If you operate for an ob- 
struction at the top of the windpipe, you must keep the opening in the 
tube pervious ; and for this purpose you introduce a properly-formed 
canula. Veterinary surgeons do not hesitate to cut a large square hole in 
the trachea, and some surgeons, practising on the human body, have pro- 
posed to cut out an oval piece of the rings and their connecting mem- 
brane ; but that is, at least, quite unnecessary, and, indeed, it may be 
hurtful, by leading to an after contraction of the windpipe. 
In children you may sometimes find difficulty in performing the opera- 
tion. The neck is short, and often very fat. The space in which you cut 
is very limited; the windpipe also is exceedingly small, and in all cases 
where the operation is required, the breathing is embarrassed, and the 
parts are in constant motion. You must have the patient well secured ; 
you cut down upon the fore part of the neck, right in the median line, 
expose the sternohyoid muscles, separate the connecting cellular tissue, 
and clear the trachea. You cannot make a young subject elevate the 
windpipe well or certainly, by swallowing his saliva ; you must therefore 
stretch and fix the tube before cutting into it; you do this by putting a 
sharp hook in it. You then pull the larynx upward, push in your knife, and 
make a sufficient opening. 
In some individuals, when the operation is performed for disease at 
the rima glottidis, the canula may soon be removed safely, and the 
wound permitted to heal; but sometimes it must be worn for several 
weeks. 
The same precautions are to be observed here as in wounds after the 
1>atient has attempted suicide; the wound must have a covering of 
oose texture to prevent cold air getting into the passages. 
Part xi., p. 171. TRACHEOTOMY. 
695 
Tracheotomy.—When the operation of tracheotomy is to be performed, 
says Professor Colles, you will find things in a different condition from 
what you might suppose from performing it on the dead subject. It is all 
very well to say, throw the head back, and give yourself room, but you 
cannot put your patient into the position you would wish, on account of 
the difficulty of breathing; it is so great that he cannot bear such a position 
an instant, and that in which you find him is generally a bad one, for he is 
leaning forward; and you must put up with the inconvenience. 
Part xii., p. 186. 
Tracheotomy in Acute Diseases of the Larynx or Trachea.—M. Trous- 
seau nas recorded the results of his experience in 121 cases of croup, in 
which tracheotomy was performed. He advocates the rather early per- 
formance of the operation. 
If you cannot avoid the thyroid veins, cut straight through them; the 
hemorrhage ceases on the introduction of the canula. If the case be not 
very urgent, keep the edges of the wound apart by some instrument, for 
a short time before introducing the canula, in order to allow of false mem- 
branes being expelled. You may expedite this by dropping water into 
the bronchi, and sponging the trachea. If the canula become obstructed, 
remove it immediately and empty it, and when the canula is withdrawn 
introduce the dilator. After the fourth or fifth day, diminish the size of 
the canula, and by the thirtieth day, it maybe dispensed with. Drop into 
the air-passages, fifteen or twenty drops of a solution of nitrate of silver 
(gr. v. to §j.), and cleanse the trachea with a sponge dipped in the same 
solution. Part xiii., p. 237. 
T'aclieotomy.—Dr. Marshall Hall qbservcs as follows: In every case 
the first thing to be done is to make an incision of appropriate length 
through the integuments merely. All the other tissues down to the 
trachea are to be pushed aside without further incision, which may be done 
without the slightest hemorrhage. For this purpose either an eye-probe 
may be used, or the double-acting forceps closed. Either of these being 
introduced, and gently moved in different directions, the trachea is at 
length laid bare, and this part is kept exposed by applying and expanding 
the forceps. 
At this moment, either an incision may be made into the trachea, by 
means of a minute scalpel, such as is used in operations on the eye, and 
this incision may be kept open, by means of the double-acting forceps, 
whilst a silver tube is introduced; or the tenaculum canula may be applied, 
and a portion of the trachea removed, and the tube maybe inserted, or not, 
according to the views of the operator. Part xix., p. 151. 
Indication for the Performance of Tracheotomy.—Dr. G. H. Rees 
says: Do not operate for croup or laryngitis in children if the ribs are 
motionless during inspiration, as this indicates that effusion has taken place 
into the pulmonary tissues. If the lungs were free, the ribs would be 
pressed inward or backward by the external atmospheric pressure, when 
attempts were made at inspiration while there was some serious obstruction 
to the air-passages. 
If the altered movement be considerable, the lungs are yet free, and 
incision may afford relief. Part xx., p. 83. 
Tracheotomy.—[If there is a necessity for enlarging the wound in the 696 
TRACHEOTOMY. 
tracheotomy to introduce the canula, the knife should be carried upward, 
and not below. The reason of this, says Prof. Fergusson, is, that] 
There is always much less danger in carrying your incisions upward, in 
this operation, than in cutting at the lower part of the wound ; tor, if you 
happen to get very low down, you might come in contact with important 
blood-vessels; the arteria innominata, in some cases, rises very high, and 
that might be wounded ; but more especially might the vena innominata 
be in the way. At the upper part of the wound you may cut without 
much fear; it is true, there is the isthmus of the thyroid body in the way ; 
but this does not matter much, so that you keep exactly in the median 
line. You must not misunderstand me, and fancy that I would wish you 
to cut through the isthmus. You ought, if possible, in opening the trachea, 
to get below this process on all occasions ; but it is not easy or judicious 
to do so in many instances. In the case under notice, the neck was very 
short, and I was obliged to divide the isthmus of the thyroid body. It is 
most important to recollect these two points in performing the operation 
of tracheotomy : in the first place, not to use your knife freely at the lower 
part of the wound; and to take especial care not to deviate from the mid- 
dle line. Part xxv., p)> 197. 
Tracheotomy.—Dr. Gerson, of Hamburg, has invented an instrument 
which is similar to a three branched speculum in principle, for the 
purpose of opening the trachea without risk of hemorrhage. 
Part xxvi., p. 336. 
Tracheotomy.—Recommended by Dr. Marshall Hall, in cases of hydro- 
phobia. Part xxvii., p. 59. 
Impromptu Tracheotomy.—If you are called suddenly to a case requir- 
ing tracheotomy, without proper instruments, take a pair of pointed 
scissors, and, the integuments having been divided with a lancet or sharp 
penknife, pierce the trachea with the scissors, and separate the blades. You 
may then insert the handle of a teaspoon and turn it one quarter or half 
way round. Part xxx., p. 132. 
Tracheotomy.—When the trachea has to be opened to extract a foreign 
body, don’t be satisfied with making a mere slit, but make a sufficiently 
large valve-like aperture, larger than the size of the body which has passed. 
Part xxx., p. ] 33. 
Pr. Marshall Jlall's Tracheotomy Scissors.—To facilitate this operation 
both in epilepsy, hydrophobia, and other cases, Dr. Ii. invented a pair of 
scissors, made so as first to divide the skin over the trachea, and then being 
pushed into the tube and the blade opened, as large an aperture may be 
made as required. An instrument called a cage is then introduced so as 
to keep the orifice open. Part xxx.,p. 271. 
Tracheotomy.—Before opening the windpipe, always introduce a hook 
into one side, so as to keep the part steady. The opening is then made 
much more easily, and the orifice kept open and prominent for the intro- 
duction of the canula. Part xxxi., p. 226. 
Tracheotomy.—Mr. T. S. Wells, of Samaritan hospital, recommends to 
fix the trachea by passing a tenaculum, grooved on its convex surface, 
beneath the lower edge of the cricoid cartilage ; by this the trachea must 
be drawn upward and forward; then pass a knife along the groove, and TRACHEOTOMY. 
697 
divide three or four of the tracheal rings: nothing can be easier, simpler, 
or safer, if the hook be used to iix the trachea. Part xxxv., p. 93. 
Tracheotomy.—[We must admit that tracheotomy is a heroic remedy, 
and only appropriate to Herculean forms of disease. But Dr. Marshall 
Hall says:] 
I am persuaded that life may be saved, where imminently threatened, 
by a simple pair of pointed scissors. The integument, being taken up 
horizontally by the thumb and linger of the left hand, should be divided 
longitudinally by the scissors; these should then be promptly forced into 
the trachea, to the proper depth, and opened horizontally to the just ex- 
tent ; the scissors must be then turned, being kept in their place, and 
opened in the direction longitudinally; the operator has thus made, in a 
little more than a moment of time, an opening through which the patient 
may breathe until further appliances can be obtained. 
The scissors would be better if they were notched on the external edge, 
so as to prevent them passing too deeply. The opening made must be 
kept patent: a tracheotome made of silver wire, capable of being intro- 
duced readily and expanding within the edges of the opening, is undoubt- 
edly the best of any. Part xxxv., p. 94. 
Foreign Bodies in the Air Passages.—Tracheotomy.—An ingenious 
and advantageous plan of operating in these cases, is to lift up a piece of 
the trachea like a flap, with a common tenaculum, after the tube has been 
laid bare, and then, having allowed the foreign body to be expelled, to drop 
the flap down again into its original position. Part xxxvi., p. 170. 
Foreign Bodies in the Trachea—Tracheotomy.—In performing trache- 
otomy for a foreign body in the air tube, says Mr. J. Adams, if the offend- 
ing substance does not escape at the time of operation, or cannot be dis- 
covered, the tracheal tube is not adapted to maintain the patency of the 
opening made, as a foreign body could not readily escape through it. A 
strong metallic wire speculum, something like those used in operations on 
the eye, as invented by M. Luer, of Paris, could be easily modified so as to 
maintain the patency of the opening, and at the same time allow of the 
exit of any offending body. If such an instrument were used in case of 
croup, any false membrane making its appearance at the opening could be 
extracted. The complete arrest of all hemorrhage would be necessary 
before an opening was made into the trachea, as the passage of blood into 
that tube would not be prevented by the speculum. Part xxxviii., p. 147. 
Foreign Bodies in the Trachea.— Tracheotomy.—The opening required, 
says Mr. F. C. Skey, is large, in fact, sometimes as large as it can be made, 
if in a child of four or five years of age. There is no increase of danger or 
difficulty in making a large opening instead of a small one. It is little or 
no use employing forceps of any kind for the purpose of extracting the 
offending body, it is preferable to await the return of cough, which in the 
act of expiration, will inevitably carry the foreign body with the current 
of air through the larger and nearer orifice, in preference to the smaller 
and more remote one. Part lx., p. 275. 698 
TRANSFUSION. 
TRANSFUSION. 
Transfusion of Blood.—Dr. Prichard mentions the case of a gentleman 
who had been reduced to an exhausted and exsanguineous state by a 
long continued draining of the system through the kidneys. 
“ His early complaints had been of dyspeptic symptoms. These were 
followed by emaciation and loss of strength. His actual state was that of 
extreme inanition ; his pulse was feeble, jerking, very compressible, the cali- 
bre of the artery apparently not filled ; he had palpitation of the heart, in- 
creased by the slightest exertion, while any effort brought on an approach to 
syncope. No disease was discoverable by the sounds of the heart or res- 
piratory organs, though some suspicion was entertained of slight dilatation. 
“ The state of the urine alone threw some light on the nature of the disease. 
It had long deposited a very copious sediment, of a whitish color, slightly 
tinged with purple, which was redissolved by dilution, with the addition 
of an alkali. It appeared to consist of lithates, with some chyle; it was 
thought probable by the medical gentleman who had previously attended 
the patient, and by myself at our first meeting, that an exhausted and ex- 
sanguineous state, brought on by a long continued draining of the system, 
constituted the principal disease, or at least that which first required atten- 
tion. Under these circumstances, it was determined to try a restorative 
and repletive plan. A nourishing diet was ordered, with malt liquor and 
some other stimulants. His stomach would receive but little, and at length 
rejected food. His exhaustion increased to that degree that immediate 
fatal syncope was threatened. We determined, the patient being obviously 
in extremis, to try the effect of transfusion, and as patients under cholera 
had borne the injection of large quantities of fluid, there seemed to be no 
danger in injecting a considerable quantity of blood. Sixteen ounces were 
taken from the veins of a hale young man, a servant of the patient, and 
were injected most skillfully by Mr. Clark. The patient was immediately 
revived and roused. On the following day he appeared much stronger, 
but complained of some sense of fullness about his head, and a few drops 
of blood escaped several times from the nostrils. This subsided ; his ap- 
petite became good, and he ate plentiful meals of meat, and drank porter, 
etc. He gradually recovered his strength. The urine improved under the 
use of alkalies with lime-water, and these were nearly all the remedies used 
except a few bottles of an effervescing solution of citrate of iron. After 
two or three months he left his chamber, and then his house, and is now 
travelling on commercial business.” Part viii., p. 78. 
Case of Tranfusion.—[Mr. Brown relates a case of transfusion which 
he performed in November, 1837. His patient, who had been subject to 
epilepsy, was suddenly attacked, during labor, with most alarming prostra- 
tion. The child’s head was opened and delivery speedily effected, but she 
did not rally ; the lochial discharge was not more than usual. Stimulants 
were given, and friction along the spine made use of, with other means 
likely to restore her, but without effect. Mr. Brown then recommended 
transfusion, although he very much doubted its efficacy. He describes the 
operation and its effects as follows :] 
Maw’s instrument was the one employed ; the central cup, designed to 
hold the blood, was surrounded by hot water, intentionally made two de- 
grees above the temperature of the fluid. I took from the woman about TRANSFUSION, 
699 
§iv., which were received in the prepared vessel, and in the quickest man- 
ner I could, while my assistant was engaged in receiving the blood into the 
apparatus, I punctured the right basilic vein of the patient, and most 
readily (after sending a stream of blood through the instrument, to expel 
the atmospheric air which it contained) passed the extremity of the tube 
into the vein. The piston was slowly worked : after its second movement 
the patient expressed that she could feel the tranfused blood “ go along 
her arm into the heart, and quite warm it.” Before I had injected the 
remainder of the blood, she gradually improved both in color and in 
warmth, and avowed her delight that I was no longer of a “ green color, 
but quite right.” Her subsequent recovery took place without any unto- 
ward symptoms. Part xiii., p. 341. 
Operation of Transfusion of Blood.—Dr. Routh has collected together 
all the recorded cases in which transfusion was performed, and from these 
data has come to conclusions very favorable to the performance of the ope- 
ration. According to him it should be employed— 
Firstly. In all cases of collapse induced by hemorrhage, whether primary 
or secondary. 
Secondly. In that state of extreme exhaustion from dyspepsia, where 
collapse is imminent, it might be advantageously employed. There are 
many cases in which dyspepsia has persisted for a long time, and perhaps 
been neglected, and where, notwithstanding, no organic disease can be de- 
tected ; in which no food can be retained on the stomach, and the remedies 
employed are powerless. Here the patient will sink from inanition, if 
something is not done. In these cases it is highly probable, that were the 
operation more frequently resorted to, life might often be saved. Dr. 
Blundell kept a dog alive three weeks, by copsecutively transfusing the 
blood of another dog in his veins. 
Thirdly. In some cases of stricture of oesophagus, where no food can be 
taken, to give the patient time to rally, so as to admit the introduction of 
bougies subsequently. 
Fourthly. In the collapse which follows long-continued fevers, more espe- 
cially those of a typhoid character, produced frequently by supervening 
diarrhoea, or by the crisis of the disorder. It is exceedingly probable, 
transfusion here might be most advantageous. 
Fifthly. In the collapse, or great exhaustion following diarrhoea, dysen- 
tery, and cholera. 
As a rule, the quantity transfused should not be less than 6 oz., nor more 
than 16 oz. 
The operation may be executed in three ways: 1. By receiving the blood 
in a vessel, and allowing it to enter the body by gravitation. 2. By inter- 
posing a tube between the blood-vessels of the emittent and recipient per- 
sons, and trusting to the force of the circulation for the transmission. 
Both these methods have given place to the third or injecting process, 
which is effected by the stop-cock stomach pump; but, instead of the tube 
through which the pump would be filled, there is a funnel-shaped basin to 
receive the blood. Much nicety is required in its make. 
“ So little is the theory of transfusion understood by instrument makers 
in general, that instruments are made and sold for the purpose that are 
wholly inapplicable. The basin should be cased like a plate, that it might 
contain hot water. The piston should fit accurately, and at the same time 700 
TUBERCLES, 
work freely. I think that an interruption by some elastic material in the 
tube that is to convey the blood, is advisable, for then the pipe that is in- 
serted into the vein is less likely to be disturbed by any motions which may 
arise in the working of the syringe or movements of the patient. At least 
three persons are required for the safe and efficient performance of the ope- 
ration, and their attention should be Avholly given to it. Supposing every- 
thing ready, the instrument quite clean, air-tight, and thoroughly warmed, 
the basin filled with hot water, a vein in the patient’s arm should be punc- 
tured, and the finger applied to the orifice till the tube is ready to be in- 
serted. It is quite unnecessary to dissect out a vein, and place a probe 
under it before making the puncture, as has been recommended. A vein 
in the arm from which the blood is to be taken, is next to be opened by a 
fine cut, and the stream directed into the centre of the basin, the arm 
being held close to it. When sufficient has entered, the syringe should be 
filled, and the piston pushed in a little till blood flows at the end of the 
pipe, which is then to be introduced into the vein. The injector now 
works the syringe till the desired quantity has been thrown in. There 
should be no cessation to the stream of blood entering the basin till the 
operation is ended, so that after each occasion of the syringe being filled, 
there may be at least an ounce of blood at the bottom of the basin, or else 
air would probably be sucked in. The accident to guard against is the 
transmission of air. The greater facility with which this is likely to occur 
when transfusion is performed through the jugular vein, points out the im- 
propriety of selecting this vein for the operation. It would be worse than 
useless to attempt to transfuse unless an expert bleeder be procured. 
Much of the success of the operation depends on the dispatch, as well as 
the steady and uninterrupted course that is pursued ; for, with the disad- 
vantage of the blood travelling over dead surfaces, very little exposure of 
it to air must be apt to destroy vitality. Part xx., p. 130. 
M. Lombard's Conclusions regarding Tubercles.—1. Tubercle is a se- 
creted substance, deposited under the form of yellowish opaque grains. It 
grows by superposition. 2. There are two species of tubercles, the simple 
and the multiple; the latter forms by the aggregation of several simple 
tubercles. It contains organized parts within. 3. Granulations are a form 
of chronic pneumonia; they do not pass into tubercles. 4. The softening 
of a tubercle depends on the action of the surrounding living parts. 
5. Simple tubercle never softens from the centre to the circumference. 
6. The multiple tubercle often softens from the centre to the circumfer- 
ence. V. The most frequent seat of tubercle is the cellular tissue. Tuber- 
cle is sometimes to be seen in the lymphatic vessels. 'Tubercle does not 
occur on the free surface of mucous membrane so long as it is entire. 
8. Tubercles are often hereditary. 9. The lymphatic and sanguineo-ner- 
vous temperaments are predisposed to tubercles. 10. Infants and females 
are most subject to tubercular diseases. 11. Inflammation is an exciting 
cause of tubercles. 12. The same is to be said of passive congestions, of 
over-activity or deficient activity of an organ, and probably also of the 
alterations of the fluids. 13. No certain sign of the rise of tubercles is 
TUBERCLES. TUMOKS. 
701 
known. 14. The hectic fever which occurs in tubercular diseases results 
from the act of elimination. 15. To prevent the tendency to tubercles, we 
must counteract the influence of hereditary disposition, of temperament, 
of age, of sex. 16. In persons with predisposition to tubercles, inflamma- 
tions should be guarded against with the greatest care, or arrested as 
promptly as possible. 17. The same rules apply to passive congestions. 
18. The absorption of tubercles is very probable. 19. To obtain the cure 
of tuberculous ulcerations we must prevent the formation of new tuber- 
cles, and confine the work of elimination within certain limits. 20. Tuber- 
cles may remain long in the organs in a latent state ; to obtain this result 
we must seek to arrest the process of elimination by antiphlogistic means, 
and above all by revulsives. Part xi., jp. 52# 
TUMORS. 
Erectile Tumor Cured by Vaccination.—A, child thirteen months old 
(not vaccinated), had a small erectile tumor over the left eyebrow. M. 
Pigeaux inserted nine points of vaccine matter over its whole surface. 
The vaccine eruption was confluent on the tumor, but followed its usual 
course; on the 25th day the scabs fell olf, and nine-tenths of the tumor 
had disappeared. The surface of the tumor was now powdered with alum, 
and the scab was removed every four or five days, to permit a fresh appli- 
cation of the powder. At the end of three weeks the whole of the erec- 
tile tissue was destroyed; the bottom of the wound threw up healthy 
granulations, and in seven weeks it was completely healed. For the suc- 
cess of an operation of this kind, it is necessary that the points of insertion 
be sufficiently numerous to produce a confluent pock; and should any 
portion of erectile tissue remain after the removal of the scabs, it must be 
destroyed by some caustic like the powdered alum. Part vii., p. 168. 
Mode of Taking out a Fatty or Steatomatous Tumor from the Breast.— 
On this subject Sir B. Brodie says: We know of no internal medicine, 
nor of any local application that will disperse these tumors, and the only 
thing to be done is to remove them by the knife. This may be done when 
the tumor is quite small. I do not, however, generally recommend the 
operation at this period; first, because the tumor may never increase, and 
as long as it- is small it is of no consequence; and secondly, because the 
operation is really more easy when the tumor has attained a certain size. 
Still, it is better not to let the tumor go to any very large size; and for 
this reason, lest the pressure of the skin should cause it to contract ad- 
hesions to the neighboring parts. Where such adhesions have taken place 
the operation is rendered difficult, and you cannot be certain that you do 
not leave some small portion of it, which may be the nucleus of a future 
growth. As soon, then, as the tumor becomes large enough to be trouble- 
some from its bulk, you may dissect it out; and this is a simple operation 
if you know how to do it, and very difficult otherwise. Make a free in- 
cision of the skin, not upon the tumor, but into it, cutting fairly into its 
substance. Do not spare the incision through the skin, but let it extend 
from one end to the other. Then lay aside your knife, and you will find 
that with the fingers you can easily separate the cyst that contains the 
adipose matter fi’om the neighboring textures, pulling out one lobe after 702 
TUMORS. 
another, till at last the tumor remains attached only at one corner, that is, 
at the point at which the vessels run in and out. You have no bleeding in 
any other part of the operation, but in this last part of it you will generally 
find one or two arteries which you must secure by ligature. When the 
tumor is situated under a muscle, the operation is to be performed in the 
same way, with this exception, that besides laying open the skin, you must 
freely divide the muscle, cutting across the fibres. 
[Sir Benjamin gives a curious case, which illustrates the value of liquor 
potass® in some of these fatty deposits. It is as follows :] 
A man came to this hospital some seventeen or eighteen years ago, with 
a very odd appearance—an enormous double chin, hanging nearly down 
to the sternum, and an immense swelling at the back part of the neck— 
two great tumors as big as oranges sticking out, one behind each ear. 
The patient stated that these tumors had begun to form three or four years 
before, and had been gradually increasing in size. They gave him no 
pain, but they made him miserable, and in fact had ruined him. The poor 
fellow was a gentleman’s servant, and having such a strange, grotesque 
appearance, nobody would hire him. I gave him half a drachm of liquor 
potass® three times a day, and gradually increased the dose to a drachm. 
This was taken in small beer. About a month after he began to take it, 
the tumors were sensibly diminished in size. He went on taking the 
alkali a considerable time, and the tumors continued decreasing. It was 
just then that iodine began to have a sort of reputation, much beyond 
what it deserved, for the cure of morbid growths, and I gave him the 
tincture of iodine. It was curious that while he took the tincture of iodine 
he lost fiesh generally, but the tumors began to grow again. Finding this 
to be the case, I left off the iodine, and gave him the liquor potass® a 
second time. lie took an immense quantity altogether, and left the hos- 
pital very much improved, being directed to continue to take the medicine 
for some time longer, off and on. I had lost sight of him for some time, 
when I happened to be requested to visit a patient in Mortimer street. I 
did not observe the servant that opened the door, but as I came down he 
stopped me in the hall, and said that he wished to thank me for what I 
had done for him. To my surprise it was this very man. lie had gone 
on taking the caustic alkali for a considerable time, and you may suppose 
how much he was improved by his being able to get a situation as foot- 
man. There were some remains still of the tumors, but nothing that any 
one would have observed. Part ix., p. 117. 
Sanguineous Tumors on the Heads of Newborn Infants.—[Mr. Adams 
has met with several cases of a rare form of infantile pathology, which is 
scarcely mentioned by British authors. All obstetric practitioners are 
acquainted with the caput succedaneum, as it is usually termed—a soft 
tumor formed by effusion of the serum of the blood at the presenting part 
of the child’s head, and which, though usually requiring none but the 
simplest treatment, sometimes, though rarely, inflames and gives rise to 
abscess. There is, however, another class of tumors found under the same 
circumstances, which, on account of their rarity, have either attracted 
little attention, or have been mistaken for a totally different pathological 
state. For our knowledge of these we are indebted entirely to French 
and German writers. They applied various names to these tumors, for 
which Naegele has substituted Cephalhcematomata.] TUMORS. 
703 
Cephalksematomata may exist in three forms, viz., under the aponeurosis, 
under the pericranium, and under the bone. The first kind, viz., that 
wherein the blood is effused under the aponeurosis formed by the expan- 
sion of the occipito-frontalis muscle, is generally considered to be of a 
simply contusive character, as evidenced, by its mode of production as 
well as by its external and internal anatomical characters. This is the 
simplest, but at the same time the rarest form of the cephalhaematoma. In 
general it disappears rapidly, and requires only mild discutient treatment. 
The third variety in the above list, the subcranial cephalhaematoma, 
■which has its seat between the dura mater and the bone, has been but 
rarely observed, and very little of a satisfactory nature is known regarding 
it. The symptoms are those of cerebral compression, but it is impossible 
to diagnose its existence during life, and it can only be guessed at when it 
coexists with an external cephalhaematoma, which, according to M. Baron, 
frequently happens. The second variety, or that in which the tumor 
exists beneath the periosteum, although much more frequent than either 
of the two preceding, is on the whole a rare affection. I place it last, be- 
cause it is to it I mainly wish to direct attention, as being the most in- 
teresting in a practical point of view. 
Mr. Adams then relates two of the best mai-ked cases of the second 
variety. He was sent for to examine the head of a healthy male child, 
which he had delivered eight days before; the presentation was in the 
second position of natural labor, and the duration of labor six hours, of 
which the first stage occupied five. The mother and friends were alarmed 
at what they called “ a hole in the child’s skull.” There was a soft fluc- 
tuating tumor over the left parietal protuberance, which felt as if circum- 
scribed by a ridge of bone that seemed to mark the boundary of an open- 
ing into the skull. But, on more careful examination, the bone could be 
felt in the centre of the apparent hole, which, together with the absence 
of pulsation, etc., satisfied him that it was a case of cephalhaematoma. 
Evaporating lotions and slight pressure with a bandage were accordingly 
used, and in three weeks the tumor had entirely disappeared. 
Another case of exactly the same nature occurred in the practice of Dr. 
Menzies, which was left to the efforts of nature, and recovered without 
any treatment. The presence of a bony ridge, circumscribing the tumor, 
which gives the impression of an opening in the cranium, is the most strik- 
ing peculiarity, and of the greatest practical importance. The bone within 
the circle can generally be felt uninjured on pressing the finger firmly from 
the edge to the centre. The time the tumor takes to become fully deve- 
loped varies from a few hours to as many days, and it seldom disappears 
entirely within four or five weeks. Various are the opinions as to its 
causes, some holding that it is a consequence of severe labor or the use of 
instruments, while others say that when it occurs it is almost always after 
very easy labors. 
But the most important researches on this point have been made by M. 
Valleix. He considers that cephalhaematomata do not exist before the 
occurrence of labor, and that they are the consequence of force or pressure 
employed upon the child’s head during delivery. For a right understand- 
ing of his views it is necessary to advert to the anatomy of the parietal 
bones in the infant. At birth the pericranium adheres but slightly to the 
bone, with the exception of a few lines at the sutures and fontanel!es, and 
consequently a slight force is sufficient to strip it off. In doing so, nu- 704 
TUMOKS. 
merous vessels are seen to enter the fissures of the bone. The bone itself 
ossifies from one point in the centre, i. e., the parietal protuberance, and 
bony radii shoot from the centre to the circumference. These radii are 
best seen on a dried preparation. Haller noticed, that on compressing the 
head of an infant even slightly, after removing the pericranium, he saw 
springing from between these radiated fibres innumerable drops of blood, 
which, collecting together, formed a thin layer over the bone. M. P. Du- 
bois, after corroborating Haller’s experiment, suggested that the fact fur- 
nished a probable explanation of the formation of the bloody tumors of 
the head. M. Valleix, after numerous observations, confirms the theory 
of Dubois, and concludes that if pressure, and above all, if circular pressure, 
is made upon a point of the cranium, blood will spring from the surface of 
the bone, and by its upward pressure strip off the pericranium, which-is 
easily detached; that as the liquid blood accumulates under this membrane, 
new outlets will be opened up for the escape of more blood, and thus at 
length a tumor will arise. Assuming this as a settled point, he considers 
that the pressure of the child’s head against the mouth of the uterus causes, 
according to the degree of pressure, either the simple sero-sanguineous 
tumor, an ecchymosis, or a sub-pericranial cephalhaematoma. 
The contents of the tumor may vary in quantity from a scruple to 
nearly eight ounces. Dr. W. Campbell, in one case which he punctured, 
obtained a large teaspoonful, and in another half a teaspoonful of slimy 
sanguineous matter. 
There are but few diseased appearances occurring on the heads of new- 
born infants likely to confuse the diagnosis ; and it requires little more 
than a knowledge of the existence of such affections, and of their distin- 
guishing characters to prevent our falling into error. A favorable prog- 
nosis may in general be given. If, however, the cephalhematoma be of 
great size, or remain undiminished for several weeks, the bone is apt to 
become affected, when, from the excessive discharge, and the constitu- 
tional disturbance attendant upon the extension of the disease to the brain, 
death will almost inevitably result. 
Regarding the treatment of cephalhaematoma there needs not much be 
said. In many cases—I might almost say in most cases—no treatment is 
required, or at least the treatment adopted may be of the simplest descrip- 
tion, and used principally with the view of preventing the parents or 
friends from becoming anxious. When the tumor is small, causing no un- 
easiness, and not threatening to inflame, there may be used a simple eva- 
porating lotion, such as a solution of muriate of ammonia with alcohol, 
and this treatment may be conjoined with slight pressure. But when the 
tumor is large, and does not diminish at the end of a fortnight or three 
weeks, these means are likely to fail, and it may be necessary to adopt 
more active measures to procure absorption or evacuation of its contents. 
[Dr. Zorer, of the Foundling Hospital of Vienna, employs cold appli- 
cations of calomel when cerebral congestion is supposed to exist, and 
almost invariably opens the tumor, a most injudicious practice when has- 
tily adopted.] 
Lowenhardt recommends puncture with a trocar, and strapping; and to 
this plan I am inclined to give preference, using, however, the ordinary 
knife for subcutaneous puncture instead of the trocar. Where the con- 
tents of the tumor are fluid, it will be equally efficacious, and the wound 
will be more readily disposed to heal by the first intention. The wound TUMOKS 
705 
must afterward be treated on the ordinary px-inciples, and the simpler the 
dressing the better. In making the incision, care must be taken to avoid 
the arterial vessels; for, in a case operated on by M. Yalleix, death fol- 
lowed the division of a small branch, and Smellie records a similar unfor- 
tunate case which happened in the hands of one of his pupils. 
Part xi., y>. 207. 
Encysted Tumors—Cure for Encysted Tumors, or JVens of the Head, 
or other Parts of the Body, without Cutting them Out.—First make a 
longitudinal cut along the scalp. This is performed with little loss of 
blood. Next, press out the contents of the cyst, and apply freely, alcohol 
in the cavity, with a camel’s-hair brush. Then place in the cavity, also, 
from two to six grains of nitrate of silver, and bring the edges together 
Avith strappings, when inflammation takes place. Should it inflame too 
much, apply cold water dressings, and give a few doses of active purgative 
medicine. This plan, says Dr. Harvey, has ever been found to complete 
the cure in a few days. Part xi.,p. 156. 
Pulsating Tumors of Bone.—[Mr. Stanley remarks that there are three 
distinct sources of pulsation in the tumoi’S of bone: 1. The proximity of 
the tumor to a large artery ; 2. The development of blood-vessels and 
blood-cells, constituting a sort of erectile tissue within the tumor ; 3. The 
enlargement of the arteries of the bone in Avhich the tumor has arisen. 
Of these, the first is by far the most common. The tumor generally con- 
sists of soft, fibrous, and dense osseous tissue. Such cases have frequently 
been mistaken for aneurism, and the principal artery supplying the part 
has in consequence been tied. On the subject of pulsation in the tumors 
of the bone dependent on the development of blood-vessels and blood- 
cells, forming a sort of erectile tissue within the tumor, Mr. Stanley re- 
marks, that assuming these cells to be continuous Avith the surrounding 
arteries, the rush of blood into this structure might give to the Avhole mass 
a pulsation resembling that of aneurism. Several cases of the third variety 
are referred to. The density and resistance of the investments of the 
tumor are specially noticed by the author as appearing to have a material 
influence in causing pulsation in them, for it may be doubted Avhether any 
of these tumors would pulsate Avithout the resistance derived from the 
bone or its coverings.] 
After some observations tending to sIioav the little value to be attached 
to the presence of bellows-sound in the diagnosis between aneurism and 
the pulsating tumor of bone, Mr. S. proceeds to relate the case of pulsating 
tumor of the ilium which occurred in St. BartholomeAv’s Hospital, in Avhich 
a ligature was placed around the common iliac artery. The patient, a 
man, aged 42, had on the inner side of the right upper arm, a tumor about 
the size of a small orange, very loosely connected with the surrounding 
structures, free from pain, and Avithout pulsation. This tumor Avas first 
observed about ten years ago, and during the last three years it had ceased 
to grow. The pulsating tumor of the pelvis had its chief attachment to 
the left ilium, and projected from both surfaces of the bone. It reached 
dowmvard to Poupart’s ligament, and to the extent of about three inches 
into the abdomen. It felt moderately firm, and a little beloxv the crista, 
near the anterior superior spine, a small movable piece of bone Avas dis- 
covered apparently involved in the tumor. EveryAvhere Avithin reach of 
the fingers the tumor pulsated, not Avith a thrill of vibration, but Avith the 
VOL. II.—45 706 
TTJMORS. 
deep heavy beat of aneurism. By the ear resting against the abdominal 
parietes, a bellows-sound Avas plainly recognized. After a minute descrip- 
tion of the local features and constitutional phenomena of the disease, the 
author observes, that in deciding on the nature and treatment of the case, 
the following points Avere involved—Avas this pulsating tumor an aneurism ? 
and if so, from Avhat artery had it arisen ; or Avas it one of the pulsating 
tumors of bone ? He then states the argument Avhich, in consultation, led 
to a preponderance of opinion in favor of this tumor being an aneurism. 
In the uncertainty respecting the origin of the supposed aneurism from the 
external or internal iliac artery, the decision would obviously be that the 
common iliac should be tied, and the man having decidedly expressed his 
feeling in favor of submitting to the operation, the author considered it his 
duty to undertake it. 
The case proceeded favorably to the middle of the second day, when 
symptoms of peritonitis ensued, and he sunk on the morning of the third 
day from the operation. On examining the body, the effects of peritonitis 
were observed in the deeper parts and left side of the abdomen. In the 
Avail of the left ventricle of the heart there Avas a medullary tumor about 
the size of a filbert. Medullary matter was found in the bronchial glands, 
and a feAV deposits of the same kind in the lungs. A minute description 
is given of the tumor in the pelvis, Avhich Avas connected with the ilium, 
and composed of a spongy tissue Avith cells and convoluted ATessels dis- 
tributed through it. The tumor in the arm, Avhich had all the marks *of 
an innocent structure, Avas found to the surprise of the author, identical 
in structure Avith the tumor in the pelvis. 
NotAvithstanding its density, says M. Roux, the osseous structure may 
become the seat of a transformation similar to that which, in the soft 
parts, constitutes sanguineous (erectile) tumors. The capillary vessels, 
more especially those which depend on the arterial system, become extra- 
ordinarily developed. Perhaps when they are thus amplified, the network 
Avhich they form naturally may assume a different arrangement; perhaps 
the capillaries are differently interlaced, anastomosed. However this may- 
be, as these capillaries become dilated and filled with blood, the bone 
softens, SAvells, and probably there is destruction of the proper fibres of the 
thin lamellae which constitute its substance. At last, the disease pro- 
gresses to such an extent that the external lamellae of the bone, even those 
formed by the compact tissue, are reduced to a kind of thin, flexible en- 
velope, through which the pulsations of the tumor may be felt, and Avhich 
rupturing divides into little fragments, or disappears entirely. This state 
of the osseous substance may be compared to aneurism; it is indeed, an 
aneurismal state of the capillary system of the bone. The flat bones, 
Avhich have a Avell-marked diploic structure, such as those of the skull and 
pelvis, and the spongy portion of the long bones, are the most liable to the 
disease. The immediate cause is nearly always a bloAv. As is the case in 
the soft tissues, sanguineous fungus tumors of the bone are not ahvays be- 
nignant; they may be endoAved with a force of expansion and a rapidity 
of growth, Avhich alone Avould render them extremely formidable, and pre- 
sent, on anatomical inspection, the most heterogeneous structure; or the 
cancerous element may manifestly be superadded. When this is the case, 
these tumors approximate very closely to the degenerescences of the osse- 
ous structure, known under the name of spina ventosa or osteosarcoma. 
These latter appear to be merely different forms of cancer of bone, a dis- TUMORS. 
707 
ease which has been but imperfectly described hitherto, and which it will, 
perhaps, be ever impossible to delineate with precision, so great are the 
anomalies which it is susceptible of presenting. These tumors are so rare, 
that M. lloux has only seen a few well-marked cases during his long sur- 
gical career. The only methods of treatment which can be adopted with 
any chance of success are—the ablation of the tumor along with the part 
of the bone which is diseased : the amputation of the entire part or organ 
affected; and lastly, the ligature of the principal artery of the diseased 
region. 
M. Lallemand, of Montpellier, describes a sensation of crackling to be 
perceptible to the finger when pressure is made upon the tumor. This is 
due to the breaking down of minute osseous septa which exist in the sub- 
stance of the morbid mass. The noise produced has been compared to the 
“ crumpling ” of parchment. The above phenomenon also presented inself 
in a case treated by M. Roux. Part xi., p. 180. 
Adipose Tumor in the Spei'matic Cord—Unique Case.—The patient, 
43 years of age, in the autumn of 1S42, discovered an enlargement in the 
left side of the scrotum. This was at first supposed to be hernial, but by 
careful examination with an exploratory needle, the disease was considered 
to be confined to the spermatic cord. As the tumor increased in size, 
Mr. Edwards was consulted. 
He considered the tumor to be irreducible epiplocele, but advised the 
patient to consult Mr. Lawrence. By him endeavors were made, but 
without success, to reduce the supposed hernia, and a suspensory bandage 
was directed to be worn. In the spring of 1844 slight enlargement had 
taken place, and a change in form was perceptible. No effect resulted 
from the administration of iodine, which was used both internally and 
externally. At midsummer, 1844, there was a manifest increase in size, 
though slight, and the tumor had assumed a lobulated form. The lobules 
were very hard, not unlike scirrhus, and insensible. In April, 1845, the 
tumor had enlarged to the size of a melon; the left testicle lay in front, 
and both spermatic cords could be felt in a sound condition. Mr. Travers 
was now consulted, and he convinced himself that the mass was uncon- 
nected with either abdomen or testicle, and advised operation. Sir B. 
Brodie and Mr. Lawrence, on examination with a candle, were convinced 
that it was not hernia, and agreed in recommending excision of the 
tumor. 
Mr. Lawrence thus describes the symptoms : “ Upon first view it would 
be pronounced a scrotal rupture. It was a pyriform enlargement occupy- 
ing the whole left side of the scrotum, extending to the abdominal ring. 
The integuments and cellular tissue were perfectly natural. But a cir- 
cumstance was immediately perceived at variance with the supposition of 
a rupture; the left testicle lay on the front of the swelling; it was loose 
and movable on the mass ; the cord could be traced a little above it, and 
was then lost in the tumor. When firmly grasped, the mass was found to 
be of an unequal consistence ; portions were solid and firm, but the greater 
part was soft, so that I examined it with a candle, supposing- it might 
contain fluid ; there was no transmission of light. Judging from the mere 
manual examination, it might have been a large scrotal rupture, with 
various contents, principally omentum; or it might have been a tumor not 
of uniform consistence. It had the doughy feel belonging to omental 708 
TUMORS, 
rupture ; and the omentum, when long out of the abdomen, becomes some- 
times much enlarged by the deposit of fat in its texture, especially in 
corpulent persons, but this gentleman was thin. Although the swelling 
was continued upward, careful examination showed that it had no con- 
nection with the cavity of the abdomen ; the cord could be felt free above, 
close to the abdomen. The conclusion was obvious; the swelling could 
not be a rupture, but I could not make up my mind as to its real com- 
position. Although the nature of the disease was doubtful, there were no 
evidences of dangerous character, nothing to contra-indicate the operation 
of removal, which had become urgently necessary from the great bulk of 
the tumor, and its rapid rate of increase during the last few months.” 
Mr. Lawrence, assisted by Mr. Travers, removed the diseased mass. 
The first step was an incision into the swelling. Two elliptical incisions 
were now made, including a considerable portion of the skin of the scrotum. 
An attempt was made to save the testicle, but the different constituents of 
the spermatic cord were so entangled with the substance of the tumor, 
that after some loss of time, the entire contents of the left scrotal sac were 
turned out. Mr. Lawrence thus describes the tumor after excision : “ This 
mass, measuring about eight inches in length, by six in width, was taken 
from the scrotum. It presents the ordinary appearance of adipose swelling, 
the component masses of fat being larger, and the surface being partly 
tabulated. On a superficial view of its exterior, and of the cut surface 
after it had been divided, it might have been taken for a mass of beef suet. 
Swellings of the scrotum, in the great majority of instances, are ruptures 
or morbid conditions of the testis, its coats, or the spermatic cord. 
Diseases of the cellular structure, excepting inflammations and effusions of 
blood, serum, pus, or urine, are very uncommon. I do not remember to 
have met with a tumor in this situation ; and the fatty growths so common 
in the adipose tissue, are what we should have least expected in a part 
which naturally does not contain a particle of fat. I have never seen in 
the scrotum, the cellular tumor which is sometimes met with in the external 
organs of the female.” The ligatures came away kindly, and in three 
weeks the patient walked about his house. lie now walks from Islington 
to the city without inconvenience. Part xii., p. 225. 
Removal of Tumors by a Flap Operation.—[Every practical surgeon 
must have noticed the facility with which a tumor loosely connected with 
the parts on which it rests can be raised, and also that this facility is 
diminished when the skin is dissected off it. By the ordinary mode of 
incising, the operation becomes converted into a digging ; this is proposed 
to be remedied by using a flap. The mode in which Mr. Chippendale 
operated in a case of this sort, is best described in his own words, as 
follows:] 
Raising the tumor as far as I could from the body with one hand, I 
passed a long narrow knife under the skin near the border of it, in the 
direction of its long diameter; having cut through the connections at its 
base, and the edge of the knife having arrived at the opposite border, it 
was turned toward the surface of the body, and the skin severed. The 
whole was now turned out, and the tumor dissected from the flap thus 
formed, with the greatest facility. The few vessels which bled had liga- 
tures applied, which in a quarter of an hour, were again removed ; the 
flap was laid down on the wound wTith two points of suture in the long side, TUMORS. 
709 
and the edges secured with adhesive plaster; the whole was healed in a 
few days, leaving a scar representing three sides of a rectangular parallelo- 
gram as thus [. 
The skin when thus divided, so soon shrinks, that it can seldorit be ne- 
cessary to take any portion of it away ; but should a case occur where such 
a proceeding became necessary, a portion could be taken from the free 
border of the flap, so as to make it fit the exposed surface, as parts are 
brought to coincide in autoplastic operations. . Part xii., p. 251. 
Pulsating Tumors of Pone.—[These tumors so nearly resemble aneu- 
risms that they are liable to be mistaken, even by the most eminent sur- 
geons; they have, indeed, been named osseous aneurisms. M. Dupuytren 
regards them as accidental development of erectile tissue, generally impli- 
cated with the cancerous element. He has recorded many of these cases. 
Mr. Teale observes:] 
A case of pulsating tumor of the ilium, supposed to be aneurism, recently 
occurred at St. Bartholomew’s Hospital. Mr. Stanley describes the tumor 
as pulsating throughout its whole extent; not with a thrill or vibration, 
but with a deep heavy beat of aneurism; and a bellows sound was dis- 
tinctly audible. A ligature was applied to the common iliac artery. The 
patient died on the third day, from peritonitis. The tumor on dissection, 
was found to be composed of a spongy tissue, with cells and convoluted 
vessels distributed through it. In the wall of the left ventricle there was 
a medullary tumor, of the size of a filbert. After relating the case to the 
Medico-Chirurgical Society, Mr. Stanley alluded to several others, in which 
tumors originating in the bones had been mistaken for aneurism. Two 
such had occurred at St. Bartholomew’s Hospital: one was an encephaloid 
tumor of the humerus: the other a morbid growth, consisting Of a soft 
fibrous and dense osseous structure, originating in the femur, and supposed 
to be popliteal aneurism. Mr. Stanley also referred to a case of great 
interest, which had occurred to Mr. Guthrie. In this instance, a medullary 
tumor, situated in the gluteal region, presented so decidedly the characters 
of aneurism, that it was regarded as such by Sir Astley Cooper and other 
surgeons, and accordingly Mr. Guthrie applied a ligature to the common 
iliac artery. Part xiii., p. 235. 
Treatment of Pendulous Tumors.—[These tumors after remaining sta- 
tionary for years, often become the seat of morbid action : hence the 
general rule of practice is to remove them when first presented. The 
chief point of importance in their removal is a consideration of the proper 
part of the pedicle at which the division is to be effected. Dr. O’Ferrall 
observes :] 
If the section be made too near the bulb, an unsightly projection will 
remain after the operation ; if it be done too near the other extremity of 
the pedicle, the integument, on retracting, will leave a wound, and conse- 
quently a scar, much larger than could have been anticipated. Allowance, 
then, must be made for the elongation of the pedicle by the weight of the 
bulb, and for the contraction of the stalk, which always follows its division 
—the same process which renders it unnecessary to tie the neck of a 
uterine polypus close to the mucous surface from which it has grown. The 
best mode of proceeding is, to poise the tumor on the hand, and allow the 
surrounding skin to retract and recover its pristine position, and then to 
make the section of the pedicle a little below its origin. Should the nutri- 710 
TUMORS. 
tious artery be large enough to deserve attention, the jet of blood may be 
prevented by previously including the neck of the tumor in a provisional 
ligature, and, when the section is accomplished, tying the divided artery. 
The provisional ligature may then be removed altogether. A slight touch 
of the nitrate of silver, just sufficient to produce a delicate white coating, 
will not only shorten the duration of the subsequent smarting, but lessen 
the probability of any reaction, especially of an unhealthy kind. Simple 
water dressing will then complete the local treatment. 
In operating on the adipose pendulous tumor, the extent of interference 
with the pedicle will be regulated by the presence or absence of tatty mat- 
ter in its substance. If the growth extend through the neck into the sub- 
cutaneous cellular membrane beyond it, such an incision must be made as 
will allow of its complete extraction. In such a case, the small cavity then 
left should be tilled with lint dipped in olive oil, and the integument brought 
gently over it, to prevent an unnecessarily large cicatrix. The lint is with- 
drawn when suppuration is established, and the integuments bi’ought 
together by adhesive plaster. 
The proceeding in the case of pendulous nsevus is somewhat different, 
and must be adapted to the peculiar circumstances of the case. It is not 
usual for the pedicle, in such instances, to be entirely free from all traces 
of erectile tissue. Should the pedicle be implicated, or should the vessels 
of the cellular or dermoid tissues beyond it be hypertrophied, a simple 
section would be inadequate to the cure ; hemorrhage of a troublesome 
nature would be the immediate result, and reproduction of the disease the 
more remote consequence of such an imperfect procedure. The diseased 
part must be included in an elliptical incision, and thus freely and com- 
pletely removed. It may happen that the erectile formation may extend 
irregularly, for a considerable distance, beyond the origin of the pedicle. 
In such cases, the amputation of the pedicle alone would entail the conse- 
quences already alluded to, while the excision of the whole of the morbid 
structure might be forbidden by its extent, or by the importance of the 
parts in which it is found. The following is the mode I would recommend 
under such circumstances, and when the removal of the pendulous tumor 
is desired on account of the inconvenience it occasions. The tumor being 
held horizontally and on the stretch, the point of the style or nail cautery, 
described by Dr. Wilmot, should be passed through the cervix in several 
places, so as to insure the obliteration of the vessels contained in that 
place. The whole cervix may be traversed by these punctures at one or 
several successful operations, according to its breadth. When the vascular 
character of the cervix is thus changed, its section may be performed, 
without risk of hemorrhage. 
When a pendulous tumor is known, or suspected to be malignant, great 
care must L»e taken to remove the entire of the morbid parts. If the 
heterologous structure be confined to the bulb of the tumor, and the pedi- 
cle or surrounding skin be healthy, there can be no reason for doing more 
than simple section of the former; but the section should not, for obvious 
reasons, be made too near the bulb. But should the neck of the tumor be 
thickened, hardened, or irregular, a free elliptical incision should be made 
in the integument beyond it, and all suspicious parts satisfactorily removed. 
Part xvi., p. 313. 
Tumors of the Neck connected with Blood-vessels.—[Some years ago Mr. TUMOKS. 
711 
Liston punctured a tumor in the neck, from which considerable hemorr- 
hage occurred, and which the operator then supposed to be an abscess in 
communication with an artery. Professor Syme has published the account 
of a similar case in which he tied the artery, but after death the tumor 
was found not to communicate. Mr. Syme says :] 
About a month ago a young man called upon me to get my opinion of a 
swelling in his neck. It was seated on the right side, and occupied the 
upper triangular space. It was of an oval form, quite circumscribed, and 
obviously consisted of a bag containing fluid. Upon more particular ex- 
amination, I found a distinct pulsation of the kind which I had been accus- 
tomed to regard as characteristic of aneurism, being an expansive impulse, 
not limited to a portion of the tumor, but felt equally at every accessible 
point, even from the mouth, and more especially in a lateral direction. 
The patient stated that the swelling had commenced about nine months 
ago—and had progressively enlarged without any cause that had been as- 
certained. He also stated, that when he tvorked hard, or walked fast, the 
tumor increased in size, and had a strong beating in it. I felt satisfied 
that there was an aneurism of the carotid artery, but expressed no opinion 
at the time, and desired the patient to call again for further examination. 
When he did so, I varied the process by placing him in different positions 
—by trying the effect of pressure on the tumor and artery—and by listen- 
ing to the sounds of the tumor. There was no distinct aneurismal “ bruit,” 
but a very strong loud pulsation, that implied the action of the heart upon 
an extensive surface. Finding my impression thus confirmed, I informed 
the patient of my apprehension ; but before giving a decided opinion, re- 
quested that lie would call once more. He did so a few days afterward, 
and I then felt fully warranted in informing him that an operation would 
be requisite for his relief. Next day he placed himself in my hands for this 
purpose. After he had been confined to bed for a few days, I tied the ar- 
tery below the crossing of the omo-hyoideus, as the tumor prevented this 
from being done higher up. The textures of the neck were more than 
usually adherent, and the vessel was not exposed to view with nearly the 
same facility as upon the former occasions which have required me to per- 
form the operation. I nevertheless succeeded without any tearing, or 
undue disturbance of the parts, in passing and tying the ligature, so as to 
relieve me from the slightest apprehension of any bad consequences. The 
tumor immediately sustained a very distinct diminution of bulk, which was 
remarked not only by the gentlemen present, but by the patient. He 
went on most favorably after the operation until the fifth day, when 
hemorrhage took place from the wound, and notwithstanding every eftort 
to effect prevention, recurred from time to time until the evening of the 
twelfth day, until it proved fatal. 
The parts concerned tvere examined next day in the presence of 
Drs. Scott, Duncan, Mackenzie, Peddie, Brown, Gillespie, and Ballin- 
galh 
We found a tumor, extending from the ear to the extremity of the omo- 
hyoideus, and completely occupying the upper triangular space of the neck. 
At the lower part it seemed to terminate in the sheath of the vessels, 
which looked like a prolongation of it downward, but was found to be 
merely enveloped by the bag, which I dissected out entire from the 
coats of the vessels to which it had intimately adhered. The cyst, when 
opened, was found to possess a tough consistence, and to contain a fluid 712 
TUMORS. 
like thin gruel. At the posterior part, when viewed internally, it dis- 
played a sacculated or honeycomb-looking structure. 
[Another case has been reported in which a large abscess in the neck 
(treated by a quack) had not been opened, but allowed to go on till it 
burst by several openings. When the discharge had gone on for about a 
month, alarming and repeated hemorrhages took place from the openings. 
After death,] 
The blood-vessels were injected, and it was found that ulceration had 
occurred in the subclavian artery, as it lies upon the first rib. The rib 
Avas in a carious state, as well as the bodies of the contiguous vertebrae. 
The situation of the ulcerated opening in the artery was toward the 
bone, and occupied about one-fourth of the calibre of the vessel; the 
opening Avas of o\'al shape, and Avell defined. There was no enlargement 
of the capacity of the vessel at the point. Part xvii., p. 141. 
Treatment of Erectile Tumors.—M. Behrend, of Berlin, treats these 
tumors by the application of the concentrated acetic acid, followed by 
lint dipped in distilled vinegar. Under this treatment the tissue becomes 
pale and hard, diminishes in bulk, and is at length Completely thrown off. 
He also, in some cases, enjoins the repeated division of the dilated vessels, 
by puncturing them with a needle with double-cutting edges. 
Part xviii., p. 230. 
Tumors—Encysted.—In cases of small sebaceous tumors, instead of dis- 
secting out the cyst, puncture the tumor, squeeze out the contents, and 
apply nitrate of silver all over the internal surface of the cyst. The most 
convenient Avay of applying the nitrate, is, to have a probe coated with it. 
Part xix., p. 271. 
Neuroma, or Tumor of Nerve.—Uo measure is successful except that 
of excision. The tumor may either be dissected out of the mass of nerve- 
fibres among Avhich it has grown, or it may be cut away together Avith the 
piece of nerve to which it is attached. The latter measure is generally 
quite safe and practicable. Lastly, amputation may be resorted to [if the 
disease is situated in an extremity], Avhen other means fail, and the symp- 
toms are urgent. Part xx., p>. 59. 
Extirpation of Erectile Tumors by the Cautery.—Dr. Douglas Macla- 
gan makes the folloAving remarks : “ These erectile tumors, which consist 
essentially of a congeries of enlarged blood-vessels, are commonly treated 
by ligature; but this causes a good deal of suffering, and often much con- 
stitutional irritation, before the strangulated mass finally separates. The 
method of applying the cautery is to pass a large red-hot surgical needle, 
which may be readily heated by a gas-flame, once or tAvice through the 
base of the tumor; and the object is to cause effusion of lymph, and thus 
to alter the structure of the tumor, and to arrest its growth. 
Part xxiii., p. 154. 
Fibrous Tumors.—[According to Dr. G. M. Humphrey, with the excep- 
tion of the fatty, the fibrous are perhaps the most common of the simple 
groAVths. They resemble the natural fibrous tissue as found in areolar 
membrane, in ligaments, tendons, etc. Their miscroscopical examination 
is also distinctive. In some instances, the fibres are disposed more or less 
concentrically. These tumors generally do not attain to a very large size. 
In other instances, the component fibres interlace in a complicated irregu- TUMORS 
713 
lar manner. These kinds may attain to a very large size; they are com- 
monly round. In a third, but more rare class, the tumor consists of an 
aggregation of small nodules, or masses closely compressed together, hav- 
ing an uneven, knotty outline, and looks like a conglomorate gland.] 
When you examine fibrous tumors with the naked eye you may observe 
that many or most of them consist of two structures, viz., dense opaque 
fibres, or bands, coursing about and interlacing in the midst of a more clear, 
hyaline, softer substance; the latter being contained in the meshes formed 
by the interweaving of the former, much in the same way that the fatty is 
related to the fibrous element of an adipose tumor. The actual difference 
between these two components of fibrous tumors seems to depend upon 
the larger quantity of fluid—serous or aqueous fluid—which exists in the 
softer substance; and the proportion which this substance bears to the 
rest of the mass varies exceedingly. In some instances it is scarcely per- 
ceptible, the tumor appearing to consist almost entirely of the tough, 
opaque, fibrous element; in others the latter structure forms but an insigni- 
cant part, or may not even be distinguished at all in the soft, succulent, 
cellular mass of which the tumor consists. When a tumor of this latter 
kind is opened, and the fluid allowed to drain away, the mass shrinks, and 
soon loses a half or two-thirds of its weight. Now and then the fluid is 
contained in distinct cysts with smooth walls, lying in the interstices 
between the interlacing fibres; thus constituting one of the forms of 
“sero-cystie sarcoma,” and consist of a thickened condition of the 
cellular tissue excited, perhaps, by chronic inflammation, or some long- 
continued irritation, or they may take place without any obvious 
cause. 
Fibrous tumors vary so much in the' compactness of their structure, and 
the mode of arrangement of their fibres, that in the classifications of 
tumors made by Abernethy and succeeding pathologists, the several mem- 
bers of this class were arranged in separate divisions. The name “ cellular 
sarcoma,” or “ vascular sarcoma,” was given to those in which the struc- 
ture was soft and succulent, resembling the common cellular tissue, the 
chief bulk and weight of the mass being dependent on the larger quantity 
of fluid contained in the spaces between its solid elements. Tumors of 
this kind grow, as we might expect from their structure, more quickly than 
the other varieties of the class; they are found generally in parts where 
the cellular tissue is naturally lax and abundant—in the scrotum for 
instance, and in the labia pudendi, occasionally in the ovary, or in the 
cellular tissue surrounding the lower part of the uterus and the vagina. 
They are generally invested with a thin capsule, which separates them 
from the surrounding parts ; their connections are loose, and though they 
may attain very large size, they are easily dissected out. The capsule is 
not, however, always present: on the contrary, the tumor may be blended 
Avith the surrounding cellular tissue, so that it is not easy to define its 
limits very clearly. Those enormous tumors of the scrotum which are 
occasionally met Avith in this country, and are more common in Avarm 
climates, appear to be of this nature. 
The testicles and penis are commonly buried in these masses. Some- 
times the skin is affected in a similar manner, becoming greatly thickened 
and tuberculated, so as to present the usual appearance and characters of 
elephantiasis. When an incision is made into a scrotum thus diseased, a 
large quantity of serous fluid drains away, and the size of the mass soon 714 
TUMOKS. 
diminishes. I have occasionally met with ill-defined tumors under the 
skin of the face and in other parts of the body, which I could account for 
only on the supposition that they depended upon a hypertrophic condition 
of a small portion of the subcutaneous cellular tissue. You will perceive 
that there is a near relation between tumors of this kind and that thickened 
condition of the areolar and fibrous tissues which occurs in warts, polypus, 
pterygium, and the like; indeed, we cannot draw any clear line of distinc- 
tion between them. 
Another species of fibrous tumors has been called the “ mammary sar- 
coma,” from the resemblance of the tumors to udder ; their fibres being 
interwoven so as to form a toughish, doughy, pale mass, intermediate in 
consistence between the cellular sarcoma and the tumors next to be des- 
cribed. The specimens of mammary sarcoma are generally found in the 
neighborhood of the breast; they have been know to attain a very large 
size, and are usually capsulated. 
The third species of fibrous tumors, which is by far the most common, 
and in which the characters of the class are most strongly marked, was 
not distinguished by Mr. Abernethy with a particular name. These tumors 
are remarkable for their great hardness, and on this account are very often 
described under the name “ scirrhus,” a word which has been so indiscrimi- 
nately used in former times as to have retained hardly any definite meaning 
at all, but which is now by all accurate pathologists applied exclusively to 
one of the varieties of cancer; they are more frequently found in the uterus 
than in any other part of the body, and were described by Dr. Baillie 
under the name of the “ fleshy tubercle of the uterus the term “ fibro- 
calcareous ” has also been applied to them, because of their liability to un- 
dergo calcareous degeneration, a peculiarity which I believe is not shared 
by either of the other varieties of fibrous tumors. 
In each of these species there is a general correspondence to be remarked 
between the characters of the tumors and those of the tissues in which 
they grow. Thus the soft, succulent, “ cellular ” tumors are found in the 
loose cellular tissue of the scrotum; the “mammary” tumors are found 
in or near the breast; and the last variety, the “fibi'ous” tumors—strictly 
so-called—are found in the uterus, among tendinous structures, in the 
periosteum, and in the dura mater. 
The characters of these three species of fibrous tumors are so far distinct 
that I have thought it worth while to direct your attention to them ; at 
the same time you should know that the intervals between them are filled 
xxp by intermediate gradations, just as it is in natural structures with 
regard to the areolar and fibrous tissues. Here, for instance, is a round 
tumor growing in the tough cellular tissue which forms the soft, strong 
padding at the extremity of a finger: it is scarcely hard enough to belong 
properly to the third species just mentioned, yet it is too firm to be 
classed with either of the other two ; and you will find many specimens 
not strictly included in either of these species, but serving to connect them 
more closely together. 
A fibrous polypus consists of a fibrous tumor, which, projecting into 
the interior of the uterus, has become pedunculated. It corresponds in 
structure with the fibrous tumors growing in other parts of the uterus, 
though I think its structure is not generally quite so dense. It is covered 
by the mucous membrane of the uterus reflected over it, together perhaps 
with a thin layer of uterine tissue ; these converging at the upper part of TUMOKS. 
715 
the polypus, pass from it to the uterus, .and constitute the pedicle, which 
is generally narrowest at the middle, expanding below over the polypus, 
and again expanding above where it is connected with the uterus. The 
pedicle thus consists entirly of stretched uterine structure, forming, in 
reality, no part of the polypus, which explains the fact of its not being 
necessary to remove the entire pedicle in order to prevent a return of the 
disease after operation. The mucous membrane covering the polypus is 
sometimes very vascular, so as to bleed profusely when it is lacerated or 
superficially ulcerated. This was the case with a patient lately in the 
hospital, who had been greatly reduced by repeated hemorrhages and 
continual oozing of blood from the vagina; on examination I found a 
fibrous polypus presenting at the os uteri, and the lower end of the tumor 
rough from superficial ulceration. The os was sufficiently dilated to permit 
the introduction of the finger and Gooch’s canula, with the assistance of 
wdiich the tumor was tied at its upper end, and the patient quickly recovered. 
When the tumor is situated near the exterior of the uterus it projects 
into the abdominal cavity, carrying before it the peritoneum, together 
perhaps with a thin layer of uterine tissue. In process of time the tumor, 
gradually projecting more and more, may become pedunculated ; as in this 
instance, where a large fibrous tumor hangs from the left cornu of the uterus 
by a pedicle thinner than one’s little finger. Under such circumstances 
the tumor is likely to contract adhesions to the adjacent viscera, and in 
some instances it lias been known to be quite detached from the parent 
organ and transplanted as it were to a new soil. When this has taken 
place, I believe the tumor always ceases to grow and becomes calcified. 
In like manner, when the tumor is situated near the internal surface of 
the uterus it projects into the cavity of the organ, carrying before it the 
mucous membrane, with perhaps a thin layer of uterine tissue. As it 
increases it projects more and more into the uterine cavity, where the 
resistance is least, its basis of attachment to the uterus gradually narrows 
and at last forms a mere pedicle. In this manner is formed the fibrous 
polypus which differs from the mucous and uterine varieties of polypus 
described on a former occasion, inasmuch as it is the result of a fibrous 
tumor forcing its way into the cavity of’the uterus. 
Under ordinary circumstances fibrous tumors occur in considerable 
numbers in the same uterus; in some of these specimens there are five, six, 
or even more, indeed they are rarely single, except when they project into 
the cavity of the uterus, and distend its walls; there is then commonly 
only one tumor. This exception is a matter of some practical importance, 
inasmuch as it gives us greater confidence that we may be able to effect a 
permanent cure by our operations upon polypi, and that the patient will 
not be troubled with relapses from the presence of other tumors. I do 
not mean to say that such is invariably the case, for you will every now 
and then meet with an instance of fibrous polypus, associated with fibrous 
tumors in other parts of the uterus, and such a coincidence may be 
adduced as an argument in favor of the view which regards the polypus 
to be of the same nature with the tumors, but it is certainly not the 
general rule. 
In the greater number of cases the fibrous tumor in the uterus consists, 
as I have said, of a firm globular mass growing from one centre without 
any peripheral processes or lobes; this, however, is not their constant 
character. Sometimes there are several nuclei, forming distinct masses, 716 
TUMORS 
closely packed together. Here is a specimen of an uneven, granulated, or 
finely lobulated tumor in the fundus of the uterus, which appears to consist 
of a number of separate masses less closely packed; it looks something 
like a salivary gland, but is of firmer structure. 
Again, fibrous tumors are generally distinct from the surrounding 
uterine substance, and separated from it in their whole circumference by a 
well-marked capsule. Exceptional cases, however, do occur, in which the 
line of demarcation between the tumor and the uterine tissue is less 
marked. 
In this specimen the tumor consists of a thickened, coarse, hypertrophied 
state of one side of the fundus uteri. Rarely is the os uteri the seat of 
fibrous tumor at all, but when it is so the tumor, so far as I have been able to 
ascertain by the examination of specimens in different museums, consists 
of an enlargement of one or both lips of the os uteri, the posterior lip 
being most frequently affected. The tumor thus formed partakes of the 
usual characters of fibrous tumors, except in the continuity of its structure 
with the uterine tissue ; it may attain to a very large size, filling the 
vagina, or even projecting externally. 
All the changes to which fibrous tumors are liable may be observed in 
those affecting the uterus. They are : calcareous degeneration, softening, 
and the various effects of inflammation. 
Calcareous degeneration commences with the appearance in the substance 
of the tumor of one or more small grains of hard, straw-colored substance, 
consisting of carbonate, with some phosphate of lime. They are generally 
near the centre of the mass at first, and gradually extend toward the cir- 
cumference ; they increase at the expense of the fibrous structure, and are 
evidently the result of a transformation of it—a conversion of the fibrous 
into earthy matter. In course of time the earthy grains enlarge and coar 
lesce, forming very hard, branching, knotty masses, like coral, of straw- 
color. They are closely connected with the remaining substance of the 
tumor; indeed they are continuous with it, so that they cannot be cleaned 
without great difficulty, or the help of maceration. Such masses may attain 
to considerable size, involving the greater part of the tumor, but they ge- 
nerally contain enough of the fibrous structure in their interstices to dis- 
close their real nature. In a few instances the calcareous degeneration has 
commenced upon the surface of the tumor, and I have seen one casein which 
it had converted the outermost layers of the tumor into a hard shell, in- 
closing the central part like a kernel. It may take place in the tumors 
which project into the peritoneal cavity, or in those which hang polypose 
into the uterus ; but I have not met with an instance in which it affected a 
tumor formed by the hypertrophy of an appreciable portion of the uterus, 
such as those originating in the os uteri just mentioned. Neither have I 
known it to occur in the cellular tumors, in the mammary sarcoma, or in 
any of the softer varieties of fibrous tumors. 
Softening appears to take place in two ways: first, as a chronic process, 
affecting some circumscribed portion of the tumor, which is usually at or 
near the centre. The change is observed to commence with a slight disco- 
loration—a yellowish or dark tinge—which is followed by a loosening or 
incipient disintegration of the structure; at the same time a line of demar- 
cation is formed round the altered portion, which becomes separated like 
a sequestrum from the surrounding mass. Both the detached portion and 
the cavity are at first rough and shreddy on their opposed surfaces; the TUMORS. 
717 
former undergoes still further disintegration and solution, becoming broken 
up into a number of small fragments, which float about in a dark, dirty, 
turbid fluid, and which may, ultimately, quite disappear. 
The process of destruction may go on in the adjacent portion of the 
tumor, enlarging the central cavity, till the whole is reduced to a fluid or 
semifluid mass, walled in by the cellular capsule of the tumor, which now 
stands in the relation of a cyst-wall to the disorganized contents. Uterine 
tumors, which have undergone this change in a greater or less degree, have 
more than once been mistaken for ovarian cysts, and tapped accordingly. 
There is a specimen in the museum of the College of Surgeons, with a his- 
tory appended, to the effect that an encysted tumor formed in the uterus, 
and the patient was twice tapped and the cyst emptied, the disease having 
been supposed to be ovarian dropsy during life; it was, probably, a case 
of the kind I am now describing, if we may judge from the appearance of 
the sac, and from the knowledge that cysts are very rarely produced in the 
walls of the uterus. In some instances the softening process is completed 
at one spot without extending to the circumference; the ragged processes 
hanging into the interior of the cavity are removed, the latter acquires a 
smooth lining, and looks like a simple cyst lying in the substance of the 
tumor. You must not mistake for cavities thus formed, the vacancies oc- 
casioned by enucleation of portions of the tumor after death. It is neces- 
sary to give you this hint, because I have known such an error to have been 
made. 
The second mode in which softening takes place is more rapid and more 
diffused ; the whole or greater portion of the tumor being affected at once. 
The change commences with the infiltration into the mass of a serous fluid, 
whereby its texture is loosened, and its components separated ; at the same 
time the tissue of the tumor is softened, and interstitial absorption is set up 
in it. As the result of these processes combined, the tumor is soon broken 
up into detached fragments, and reduced to a diffluent pulp, or it may be, 
completely liquefied. It may even burst into the cavity of the uterus or 
the abdomen, and its contents be discharged. These changes are probably 
occasioned by some altered state of nutrition analogous to inflammation ; 
they may be induced by an accidental cause, an injury, or pregnancy, and 
purulent fluids are sometimes found mixed up with the softened substance 
of the tumor. Nevertheless, they are not necessarily attended with any 
constitutional disturbance at all corresponding with the extensive destruc- 
tion which is in progress. 
Suppuration has been now and then known to take place in a fibrous 
tumor, and ulceration sometimes extends into it after penetrating its cover- 
ings, as in the case of polypus. Here is a specimen of large fibrous tumor 
of the uterus, projecting into the peritoneal cavity, and covered with a 
coating of cancer, which was diffused over nearly the whole interior of the 
abdomen. At one part you may see that the cancerous disease has pene- 
trated the tumor, and destroyed its substance for about an inch. Dr. Lever, 
in his work on disease of the uterus, relates a case where melanosis was 
deposited in the structure of a fibrous tumor. 
We cannot say that these tumors are attended with any particular train 
of symptoms, they have hardly any nervous link connecting them with the 
rest of the body. The drain upon the vascular system, occasioned by them 
is scarcely appreciable, neither do they return to it any noxious element, or 
communicate an evil influence in any other way. The symptoms to which 718 
TUMORS. 
they do give rise are almost entirely dependent on their effects upon the 
neighboring organs and tissues, and therefore vary with their position. 
Thus, if they be placed near the lining membrane of the uterus, they occa- 
sion the several symptoms of chronic inflammation of that membrane, such 
as uneasiness, discharges of mucus or blood, with, perhaps, the pains of 
forced uterine contractions, sensations of weight, bearing down, etc. When 
situated more in the middle of the uterine wall, or nearer to its external 
surface, they may exist for a long time, and attain considerable size, with- 
out giving any indication of their presence. In some cases, by their pres- 
sure upon the rectum or bladder, they occasion an irritable disordered 
state of these organs, or difficulty in voiding the urine and faeces. These 
and other symptoms of the like kind are rather casual results of the 
tumor’s relation to certain external parts, than of any intrinsic quality of 
its own. 
The fibrous tumors of the uterus become the subject of treatment only 
when they grow from the os uteri, or when they project into the cavity of 
the uterus and the vagina, assuming the polypose form. In either case 
they may be removed by ligature, or if their pedicles be narrow, may be 
excised, as recommended and extensively practised by Dupuytren. In a 
few cases an incision has been carried through the coverings of a fibrous 
tumor, projecting into the cavity of the uterus or vagina, but not become 
polypose, and attempts have been made to turn the mass out of its bed by 
dissection, and by tearing the fine filaments which unite it to its capsule. 
This proceeding, though successful in a few instances, is for obvious rea- 
sons, seldom to be attempted. The application of iodine externally, and 
its internal administration, has been recommended with the view of pro- 
moting the absorption of these tumors, and is said to have been attended 
with success. I have seen it tried in a few instances, but the result has 
not been encouraging. 
Fibrous tumors affecting the bones are usually found upon those of a 
spongy nature, upon the ends of the long bones, the phalanges, pelvis, and 
lower jaw. So far as I have seen, they are confined to the exterior of the 
bones, growing from the periosteum, and creeping along the surface of the 
bone in such a manner as to prove almost to a certainty that they originate 
in some morbid condition of the periosteal fibres. The bones underneath 
these tumors may suffer absorption, in consequence of the pressure pro- 
duced, but do not seem to be affected in any other way. They appear 
upon the maxillary bones more frequently than upon any other part of the 
skeleton. On the lower jaw they spread along the ramus, encircling it 
beneath and on the sides; so that the bone is almost concealed by the 
tumor. In some instances they form within the substance of the jaw, pro- 
bably from periosteum lining the sockets of the teeth, and as they increase 
the walls of the bone become spread out over them. They grow up around 
the teeth, and where they project into the mouth, maybe soft and fungous. 
In the upper jaw they form now and then in the antrum, and gradually 
distend the walls of the cavity ; more frequently they commence on the 
outside, and grow along the surface of the bone, projecting into the mouth, 
nose, orbit, and toward the cheek, so that the natural outline of the 
maxilla can scarcely be recognized. 
In some instances these fibrous tumors of the jaws have exhibited a semi- 
cartilaginous structure ; and now and then fibres, or plates of bone, are 
formed in various parts of them. The progress of the disease is well TUMORS. 
719 
illustrated by the series of tumors of the jaws in the College of Surgeons, 
from the museum of the late Mr. Liston. These preparations furnish 
ample proof, if proof were needed, of the skill of that illustrious operator; 
they show also how necessary it is to bear in mind the mode of growth of 
these periosteal fibrous tumors of the jaw; because from their disposition 
to creep along the surface of the bones, they are liable to return after 
removal, unless the immediately adjacent as well as the affected part bo 
excised. The histories attached to the specimens teach us that very large 
fibrous tumors, both of the upper and lower jaw, together with the bones 
on which they grow, may be removed successfully. 
Nearly allied to these tumors of the periosteum, and forming a close 
connecting link in pathology between them and the common warts and 
polypi, are the tumors of the gum called “ epulis.” They are of two kinds ; 
one consisting of a red granulated or nodulated growth springing from the 
sockets of the teeth, originating apparently in a morbid condition of the 
membrane lining the sockets, and caused in many instances by a diseased 
state of the teeth. Such a growth requires to be extirpated, and it is not 
enough simply to slice off' the tumor, for it is deeply rooted and will most 
likely reappear unless the alveolus from which it springs, be removed with 
it, which may easily be done by cutting a notch in the jaw with the bone 
forceps or a small saw. The second kind of epulis is exemplified by this 
specimen of tumor of the gum on the outside of the upper jaw; it is a red, 
soft, pulpy growth, as large as a walnut, in appearance resembling swollen 
gum ; indeed it consists evidently of a growth of the gum. It is slightly 
lobulated on the surface, and tolerably defined at the circumference, where 
it is continuous with the surrounding gum. The patient was a healthy 
young woman, and the disease had been observed to follow the extraction 
of a tooth six months before she came to the hospital. The tumor was 
closely connected with the bone, so I removed the portion of the maxilla 
on which it rested, ■ including the sockets of the canine and first molar 
teeth. Seven yeai’s have now elapsed since the operation was performed, 
and the patient is still quite well. The tumor was very vascular, bled 
frequently and might have been mistaken for a malignant affection. 
Fibrous tumors are not uncommonly found in nerves. In some cases 
they form distinct round masses within the neurilemma. In others they 
appear to consist of an increase of that fibro-cellular tissue which unites 
the nervous filaments together. These tumors are in some cases attended 
with a good deal of pain, felt in the course of the nerves and easily excited 
by pressure, a slight blow, or a quick movement. Excision is the only 
remedy, and it must in each case be uncertain how far it will be possible 
to effect that without injuring the structure of the nerve. Not long ago 
I removed from within the sheath of the medium nerve near the wrist, 
from a woman aged forty-eight, this spherical tumor ; it is as large as an 
orange, presents a semi-opaque glistening appearance, not unlike brawn, 
with more opaque yellow spots interspersed here and there. It resembled 
some of the varieties of encephaloid disease so closely that I should have 
been apprehensive as to the result had it not been gradually forming many 
years, during which time the woman enjoyed good health. It was attended 
with a good deal of pain and a shrivelled state of the fore and middle 
fingers. Some filaments of the nerve were removed with the tumor, never- 
theless, the patient recovered completely, regaining the use of the hand ; 
the fingers were also in course of time restored to their natural condition. 720 
TUMORS. 
It has already been intimated that fibrous tumors occur in several other 
parts of the body besides the uterus, the periosteum, and the nerves. 
Here is one as large as a walnut and of spherical shape, growing from the 
inside of the dura mater, and causing an indentation in the surface of the 
brain. Sometimes they form in the substance of the testicle, the prostate 
gland, the ovary, and even the walls of the alimentary canal. Very rarely 
are they to be met with in any other of the internal organs. 
One point more requires to be specially mentioned in relation to these 
growths; viz., their occasional liability to return after they have been to 
all appearance completely extirpated. Where this has taken place the 
tumor has, I believe, generally grown quickly in the first instance, has 
been composed of several detached portions, of which one or more may 
have been left behind in the first operation, or has consisted in a thickened 
morbid condition of the tissue in which the growth occurs, affecting a con- 
siderable area and probably not having such definite limits as these growths 
usually present. To the latter circumstance I have already directed your 
attention in speaking of fibrous tumors of the periosteum, and have said 
that the same feature is to be observed in some of the adipose tumors, 
more particularly those under the skin. Part xxiii., p. 236. 
Diagnosis of Tumors in the Neck.— [This always presents great dif- 
culties when the tumors are of large size, only slightly painful and 
fluctuate indistinctly. If a complete and accurate history of the case 
cannot be obtained, more than a general diagnosis may be impossible ; but 
when the precise position of the tumor at its commencement can be made 
out, when its relations to the larynx and trachea, and its mobility in regard 
to them and the surrounding parts when it was of small size, can be ascer- 
tained, together with the rapidity and manner of its growth, Dr. Redfern 
thinks there will be little difficulty in arriving at a satisfactory conclusion.] 
A tumor developed in the substance of the thyroid body presents itself 
in the front of the neck, is usually larger on one side than the other, is firmly 
connected with the larynx and trachea, moves freely with the larynx in 
deglutition, and when it is displaced laterally by manipulation. The other 
features vary with the nature of the tumor. 
In ordinary bronchocele (hypertrophy) the swelling is soft, projecting, 
elastic; without fluctuation, pain or tenderness on pressure; it occurs 
usually in early life, in the female sex, and in particular districts of country; 
it is simple in its nature throughout, and presents no tendency to degene- 
ration or change of structure; it in no way interferes with respiration or 
deglutition, nor does it affect the patient’s health or comfort until it becomes 
of very large size, when difficulty of respiration and deglutition, with fre- 
quent headaches, occasion the greatest distress, and may end with the 
death of the sufferer. 
In cystic disease of the thyroid the nature of the tumor becomes mani- 
fest, sooner or later by the presence of fluctuation in one or more cysts, 
by a glairy, serous, or sero-sanguineous fluid escaping readily along a 
grooved needle when introduced, the fluid containing no cellular formations 
when examined microscopically, or having such a structure as is consis- 
tent with the idea of the existence of cancer—by the formation of the 
tumor taking place at or after the middle of life—by its slow and painless 
growth, and by the slight inconvenience it occasions as long as its size is 
not very great. TUMOKS, 
721 
In cancerous disease of the thyroid (usually scirrhus) the tumor ap- 
pears between forty-five and sixty-five years of age, is of great and uniform 
density, and generally painful; it is developed rapidly, and may attain a 
large size in the course of a few months; it accompanies the larynx in its 
movements, but shortly limits their extent by attaching the organ to the 
surrounding parts; it occasions great difficulty of deglutition and respiration 
from an early period ; hoarseness, cough, and spasmodic action of the mus- 
cles of the larynx and pharynx come on and increase in their intensity—the 
distress and anxiety of the patient, his sallow complexion and emaciation, 
marking him out as the subject of a steadily advancing and destructive 
malady. 
In medullary cancer of the thyroid the surface of the tumor may 
be even and- tense, or indistinct fluctuation may be perceived, the other 
characters depending on the steady infiltration of the surrounding textures, 
distinguishing the disease from other tumors of the same part. 
Enchondromatous tumors are to be recognized by their great density, 
the slowness of their growth, and the absence of any signs of the extension 
of the affection to the surrounding parts, and of general evidence of the 
existence of malignant disease. 
The diagnosis of tumors of the neck not connected with the thyroid body, 
is to be established by reference to the general characters which distin- 
guish them in other situations, every particular of their history and mode 
of growth being carefully ascertained as essential points, and sufficient 
care being exercised lest the presence of a quantity of coagulable fluid, in 
the interior of a cancerous tumor, lead to the belief that it is of a cystic 
character. Part xxiii., p. 279. 
Tumors, Encysted.—Evacuate the contents by making a small oblique 
opening on the cyst. Inject then an alcoholic solution of iodine, closing 
the aperture with diachylon or charpie. As soon as the inflammation has 
subsided, the cyst becomes detached, and may be extracted by means of 
the forceps. Usually, however, M. Borelli has found that two or three in- 
jections are necessary to promote a complete separation. 
Part xxiii., p. 295. 
The Gold Douche in Promoting Absorption.—Dr. Sloan submitted to 
its action, cases of an encysted tumor—a goitre and a scirrhous mamma— 
and in all there has been decided improvement. The water with which he 
has practised is supplied to the town from a basin 100 feet above the lowest 
street. He applies it by means of the gutta percha tubing fixed to one of 
the pipes, allowing the stream to strike the object at from six inches to 
two feet from the end of the tube ; at all events, before the column of 
water is broken. A pressure of less even than forty feet of water produces 
excellent effects. The application should be continued until a decided 
sense of pain is induced, or for something less than five minutes. 
Part xxiii., p. 306. 
Sanguineous Pelvic Tumor in Females.—M. Nelaton c.alls attention to 
a peculiar form of tumor, hitherto much neglected by authors. These 
tumors are usually preceded by some general symptoms, as malaise, dis- 
turbed menstruation, pains in the hypogastrium, and a feeling as if a heavy 
body were about to escape from the vagina. *The abdomen is sometimes 
enlarged, and a hard, very painful tumor is felt by the patients in the hy- 
pogastric region; in other cases they are not aware of its existence, and, 
vol. ii.—46 722 
TUMOES. 
■when it is pointed out to them, they cannot say how long they have had it. 
On examination, the abdomen is found to be inflated, tense, convex, and 
painful. The decubitus is dorsal, with the thighs flexed on the pelvis. By 
palpation in the hypogastrium, a tumor is felt in the cavity of the pelvis 
(petit bassin). This is sometimes confined within its inner border, and 
sometimes extends as high as the umbilicus; it is commonly inclined to- 
ward the right iliac fossa. The tumor is small, rounded, without knotty 
projections, and becomes gradually lost in the pelvic cavity ; it is scarcely 
movable, and is of pretty firm consistence, sometimes presenting fluctua- 
tion. On vaginal examination, there is found, between the uterus, a tumor, 
advancing toward the orifice of the vulva in proportion to its size. It is 
smooth, rounded, and fluctuating, varying from the size of a large goose- 
egg to that of a thumb, without pulsation or expansive movement; it may 
narrow the vaginal canal so as only to permit of the passage of the index 
finger. The uterus may be raised by the tumor, so that its body is felt 
above the pubes ; and its neck may be so much elevated, that the forefin- 
ger can only with great difficulty reach it. 
The treatment of these tumors consists in evacuating the liquid which 
they contain. M. Nelaton proposes to employ a large trocar, and then a 
simple lithotome to enlarge the opening. The patient is placed on her 
back, on a tolerably high bed, with her legs and thighs bent, as in the 
position for lithotomy. By introducing a speculum into the vagina, the 
tumor is discovered toward its base, at the posterior wall. The point 
where fluctuation is most apparent having been discovered, a long trocar 
is introduced, with a canula sufficiently long to allow the escape of the 
matter, which is liquid, black, and viscid, like treacle. The incision ought 
generally to be three centimetres in extent; it should be made in the axis 
* of the vagina, so as to avoid wounding the uterine arteries. It should 
also be carefully ascertained that there are no arteries on that part of the 
wall in which the incision is made. The incision should be neither too 
wide nor too deep, so that the rectum may be avoided. When some days 
after the operation, the liquid which escapes has become purulent and fetid, 
disinfectant injections should be employed. The strength of the patient 
should at the same time be supported by quinine and other tonics. The 
Avails of the tumor should also be explored with a scoop (curette), so as to 
remove any adherent clots, which may be in a state of commencing putre- 
faction. Part xxiv., p. 297. 
Calcification of Fibrous Tumor of the Uterus.—Mr. I. B. Brown ex- 
hibited a specimen of fibrous tumor, Avhich had been transformed by calci- 
fication into a solid, heavy body,weighing eight ounces. It Avas situated at 
the fundus of the uterus. The sides of the uterus were not adherent to this 
body, but Avere distended so as to form a sort of close-fitting bag to the 
tumor ; the neck of the uterus was drawn up and lost in the body, and the 
os Avas elongated and thin. This interesting specimen Avas found in a patient 
aged seventy. 
The calcareous crust of this tumor consists of semi-transparent plates, 
overlaying each other, having a glassy fracture ; these dissolved in dilute 
muriatic acid alloAved an abundant escape of carbonic acid, leaving a resi- 
due of an imperfect fibrous basic substance. Part xxv., p. 292. 
Fibrous Tumor of the Womb removed by Incision and Enucleation.— 
Mr. Teale recently removed a large fibrous groAvth from the interior of the TUMOKS. 
723 
uterus. The tumor had protruded through the mouth of the womb and 
filled the vagina. It was so large that the fingers could not be passed 
above it to determine its mode of attachment. The treatment adopted in 
this case, which Mr. Teale also recommends in similar ones, is, to pull down 
the tumor beyond the external parts, if necessary, by midwifery forceps or 
other means, and partially or completely invert the womb. The operator 
can then ascertain whether the tumor be pedunculated or imbedded in the 
wall of the womb. Should the latter mode of attachment be found, he re- 
commends the investing membrane of the tumor, a little below its attach- 
ment, to be carefully cut through in a transverse direction, by long curved 
probe-pointed scissors, to such an extent as to allow of the tips of two or 
three fingers to be insinuated between the investing membrane and the 
tumor, and the process of enucleation to be completed by detaching the 
upper part of the tumor from the wall of the uterus, after which the re- 
maining attachment of the investing membrane may be divided by the 
scissors, and the tumor removed. If the uterus should remain inverted, it 
must be immediately replaced by gentle but firm pressure, which may gene- 
rally be done without difficulty, as the os uteri has been so long subject to 
distention that it will offer but little resistance. Part xxviii., p. 289. 
Nerves—Excision of Tumors of {Neuroma).—When a tumor pressing 
upon, or in any way implicating a nerve, has to be excised or dissected 
out, make a clean incision of the nerve either above or below the tumor 
before the operation, as this will not only considerably lessen the pain, but 
also the subsequent inflammation. The consequent paralysis lasts only a short 
time, as the divided nervous extremities soon reunite. Part xxx., p. 309. 
Tumors of the Upper Jaw.—It is a common opinion that these tumors 
originate within the antrum of Highmore. Mr. Hancock does not agree 
with this opinion. Mr. Ormerod, of St. Bartholomew’s, has taken pains to 
classify these tumors, which he does as follows : 
1. Epulis. 
2. Cystic tumors, consisting of the walls of the bone expanded on or 
into a sac, with more or less of solid growth ; the walls in some parts being 
quite membranous and transparent, and the sac filled with glairy fluid, or 
a firm substance contained in cells, or accompanied with a granular fatty 
substance, partitioned by fibro-cellular substance; also consisting of a 
single bony cyst lined by a membrane, with a second canine tooth adherent 
to it, and having its cavity filled by a glairy fluid. 
3. Cartilaginous and osseous tumors from the upper jaw-bones, as round 
tumors growing on their outer surface here and there, but chiefly as a mass 
growing from their inner surface, so as to fill up the maxillary sinuses, the 
septum nasi and spongy bones being also affected. The thickening is 
dense, hard, and ivory-like. 
4. Fibrous tumors from the upper and lower jaw-bones, consisting of 
white or pale yellow, firm, and nearly homogeneous, with or without specks 
of bone, or of dense, more or less fibrous, or even obscurely fibrous, sub- 
stance, containing at times one or more small cavities filled with pus, with 
a glairy fluid, or with blood ; growing on a healthy bone and periosteum, 
or from the alveolar and outer surface of the bone, or originating in the 
cancelli, and being accompanied with a perfectly healthy condition, with 
absorption or consolidation of the surrounding bone. 
5. Medullary tumors from the upper or lower jaw, consisting of round 724 
TUMORS. 
lobed, or nodulated masses, with a smooth membraneous covering, or with 
a rough fungous or ulcerated shreddy surface; invested by a thick cap- 
sule, by a dense periosteum, or by partial thin laminae of bone; composed 
of round lobes, connected together by cellular tissue, or formed of an 
almost homogeneous mass ; made up of a structure of a soft medullary, 
brain-like, spleen-like, or firm fatty nature, with cells and bony spiculse, 
sometimes commencing in the neighboring glands, and extending to the 
jaws secondarily. 
In addition to these, Mr. Stanley enumerates fatty and erectile tumors of 
the jaw ; whilst Mr. Paget adds what he terms myeloid tumors of the 
part; but whilst the examples he quotes resemble so much, on the one 
hand, the fibrous, on the other medullary tumors, their true character, 
whether innocent or malignant, is so very doubtful, that I should hesitate 
in admitting them as a distinct class. 
I have never met with a fatty growth so invading the upper jaw as to 
require the removal of any portion of that bone, and therefore I do not 
presume to offer any opinion upon that form of disease. 
Mr. Stanley states that the erectile tumor is a very rare form of disease ; 
but that it occurred to M. Gensoul in one of his successful cases. The 
tumor was soft and vascular, and quicksilver, impelled- into the morbid 
structure, readily pervaded it throughout. I have not seen a similar case, 
nor have I been able to meet with any recorded elsewhere. It is occasion- 
ally very difficult to form a correct opinion of the exact point of origin of 
a fibrous tumor of the upper jaw. It will sometimes commence by a con- 
tracted pedicle, enlarge, and spread out, and not only fill the antrum, but 
extend into the nares ; by its peculiar and irregular appearance giving rise 
to the supposition of its being a polypus of the nostril, and leading to 
abortive attempts for its removal by the polypus forceps. Mr. Stanley, 
although not mentioning the disease, has the following observations bear- 
ing upon this point: “ A tumor gradually increasing within the antrum 
may occasion yielding of the walls equally in all directions; but in some cases, 
disease extends chiefly in one direction, and causes difficulty of diagnosis. 
In a case I saw, a morbid grotvth originating in the antrum had extended 
only in the direction of the nostril, and portions had been extracted by 
polypus forceps.” 
[Osseous tumors are the most frequently met with amongst the non-malig- 
nant growths of the upper jaw. Mr. Hancock has two specimens of this 
disease:] 
The first case is that of a young man, aged 22, a farmer, residing in Lin- 
colnshire, who was sent up to me on the 1st October, 1848, by Mr. Young, 
of Gosberton, whose patient he was. This case was a striking example of 
what has been affirmed elsewhere, that “ osseous growths are in some in- 
stances combined with hypei’trophy of the surrounding bones, producing 
general enlargement.” The whole of the bones on the right side of the 
head and face were very much enlarged and thickened, the bone at the 
fronto-malar suture presenting a surface of more than a square inch, and 
this, I believe, is the usual origin of the tumors in question. I believe that 
they should not be regarded as originating within the antrum, or from 
causes connected-With the teeth, but from excessive development or hyper- 
trophy of the bone itself, which, in its growth, extends in various direc- 
tions, invading the antrum of Highmore, and in some 'instances entirely 
obliterating that cavity. M. Paget, in his Lectures on Surgical Pathology, TUMOKS 
725 
in allusion to these tumors, says : “ More commonly, it is almost limited to 
the antrumbut he singularly disproves his assertion, and confirms my 
views, by his illustrative example. He says : “ In this case, it may exist 
with little deformity. In the museum of St. Bartholomew’s Hospital is a 
specimen, in which both the antra appear nearly filled by the thickening 
and in-growing of their walls; only small cavities remain at their centres. 
The new bone is hard, heavy, and nearly solid, yet it is porous or finely 
cancellous, and is neither so compact nor so smooth on its cut surface as 
that of ‘ ivory exostosis.’ The same disease is manifest in a less degree 
upon the outer surfaces of the maxillary bones, and on the septum and side 
walls of the nose.” 
I have operated upon three cases of this form of disease. One of these 
I have just related, and in the other two the antrum remained; in one of 
these there was general hypertrophy of the bone, causing great disfigure- 
ment, and necessitating its entire removal. The swelling did not arise 
from, and was not confined within, the cavity, but was, in truth, a portion 
of the general thickening and enlargement of the bone. I have a prepara- 
tion, which was taken from a child of six years of age, upon whom I ope- 
rated in April, 1852, and is a well-marked example of the fallacy of Mr. 
Stanley’s position, that “ morbid growths mostly arise from either of the 
lateral parts, not from the front of the jaw—a fact which might be explained 
by the consideration that irritation more frequently originates in a molar 
than in an incisor tooth,” as does the following case: 
A child was admitted, under my care, into the Charing Cross Hospital, 
in August, 1852, with tumor of the left upper maxilla. It appears that in 
December, 1851, she fell -and bruised her face. Soon afterward a tumor 
was observed on the left side, just below the orbit. This was unattended 
with pain, but it gradually increased in size until, at the time of admission, 
it was about the size of a walnut. Upon careful examination, I found the 
hard palate and gums perfectly healthy; the tumor was smooth and solid. 
Upon carrying my finger behind the soft palate, I could not detect any- 
thing wrong in that situation; but as I otherwise could not detect the ex- 
tent of the mischief, or what was the extent of operation required, I intro- 
duced a small exploring trocar into the tumor, and felt it enter a solid mass, 
which prevented my giving the instrument any lateral motion. I next per- 
forated the upper jaw above the alveolar process corresponding to the 
molar tooth, and found the instrument enter a cavity, in which I could 
freely move its point, and from which I decided the case was hypertrophy 
of the anterior portion of the maxillary bone, and I acted accordingly, 
confining the operation to the simple removal of the part affected, without 
interfering either Avith the floor of the orbit or the roof of the mouth. 
The last form of abnormal growth is the eneephaloid or medullary sar- 
coma ; and it is here that a correct idea of the origin of these growths 
becomes of so much importance. I have throughout this paper been at 
great pains to disprove the opinion so universally maintained, and so de- 
cidedly advocated by Mr. Stanley, that morbid groAvths commonly origi- 
nated within the antrum, not only because I felt, from what I had observed, 
that such opinion was wrong, or rather open to very many exceptions, but 
because the statement, backed by such an authority, gives rise to the sup- 
position that medullary sarcoma usually commences within the antrum; 
and that, if attacked sufficiently early, it may be eradicated by operation. 
At the risk of appearing tedious, I feel that the importance of the subject 726 
TUMORS. 
fully justifies my again quoting Mr. Stanley. He says: “ But even with 
the help of the most careful examination, whenever the disease fills the 
antrum and nostril, it will be uncertain whether or not it extends pos- 
teriorly beyond the front surface of the pterygoid processes of the sphe- 
noid bone. Whilst Mr. Liston has observed: ‘If anything is to be done, 
it ought to be undertaken with a thorough detei*mination to go beyond 
the limits of the morbid growth, to remove the cavity which holds it, and 
thus get quit, if possible, of all the tissues implicated, or which may have 
become disposed to assume a similar action.’ I know from experience, that 
this step, if adopted in time, may prove successful.” It may appear pre- 
sumption in me to differ from such authorities as these, and men of such 
experience, but my own experience leads me to an opposite conclusion. 
I entirely differ from the opinion that medullary sarcoma commences in 
the antrum of Highmore, and extends backward to the pterygoid pro- 
cesses ; but, on the contrary, from what I have observed, I firmly believe 
that the disease commences in the cancellated structure of the body of the 
sphenoid bone and bones at the base of the cranium; and that, however 
early we may perform the operation, we never succeed in eradicating the 
mischief, which is sure to return at a longer or shorter period, according to 
circumstances. 
I have performed, and assisted at many operations for the removal of 
the upper maxilla for this disease; and where the mischief, as far as ex- 
ternal examination and the introduction of the finger behind the soft palate 
went, appeared to hold out every reasonable prospect of its complete re- 
moval, but in no one instance was this satisfactorily accomplished, and in 
no one instance did the disease fail to reappear, whilst post-mortem ex- 
amination demonstrated its growth from the body of the sphenoid bone, 
the basilar process of the occipital bone, etc. This disease will sometimes 
extend into the orbit, in some instances causing the eyeball to protrude, 
in others presenting us a firm tumor on one side of the eyeball. But it 
should be borne in mind that, notwithstanding the absence of external 
swelling of the cheek, these growths rarely, if ever, originate in the orbit, 
or are confined to that cavity, but that the swelling in the orbit is almost 
invariably an extension of the disease in that direction, its origin being in 
the cancellated structure of the bones at the base of the cranium, and that 
it mostly, at the same time, invades the spheno-maxillary fossa and antrum 
of Highmore, so that it can never be entirely removed by dissection from 
the orbit. 
I have a lady at present under my care, who consulted me for protru- 
sion of the left eyeball, with apparent commencing chemosis of the con- 
junctiva and indistinctness of vision. The protrusion is not very great; 
but pressing the base of the eyelids near the margins of the orbit, gives 
the sensation of an elastic body between the orbit and the eyeball. There 
is no swelling of the cheek; but, upon examining the mouth, I find the 
gum is beginning to separate from the molar teeth, and the dental margin 
to become everted, whilst separation is also commencing between the hard 
palate and its covering, the bone appearing softer than natural when 
pressed upon. Carrying my finger behind the soft palate into the spheno- 
maxillary fossa, I can distinctly feel an irregular growth in that situa- 
tion. 
This case shows the impropriety of operating upon orbital growths of 
this description, the tumor in that situation being commonly but a local TUMORS. 
727 
manifestation of disease extending into the upper jaw and elsewhere, 
where the knife cannot penetrate. In some instances the tumor will be 
more isolated or partial, and equally, if not more malignant, if we may 
judge from the rapidity of its growth. It will not present the same 
elasticity to the touch, feeling more like an enchondroma, and when cut 
into, it has very much the appearance of a fibrous growth. 
A woman brought her child, aged two years, to me at the Ophthalmic 
Hospital with a conical tumor of the orbit, at the inner and upper part; it 
was very firm to the touch, and the mother said it caused the child great 
uneasiness. She had perceived the swelling about a month before. I 
eutertained some doubts as to the nature or the swelling, and expressed 
them to the mother, at the same time telling her that I could not recom- 
mend any operation. At this time the disease was apparently confined to 
the orbit, as by careful examination I could not detect any manifestations 
elsewhere. She pressed me to do something, and therefore I endeavored 
to remove it, and found it to consist of dense fibrous structure, invested by 
yellow, firm substance ; it penetrated so deeply, however, that I could not 
get the whole away, and the swelling rapidly reappeared, the disease 
seeming to be lighted up with fearful intensity. The child lived two 
months afterward, but had become a most frightful object. The tumor 
protruded from the orbit, extending upward toward the forehead, out- 
ward, invading the temple, and downward through the upper maxilla and 
mouth to the neck. 
These cases justify the opinion that fungoid or medullary growths of 
the orbit rarely exist as independent disease, but that they almost always 
coexist with the same disease in the antrum and spheno-maxillary fossa; 
at all events I do not recollect an instance where this was not the case, 
and I have seen many of them. 
Having endeavored to point out the inadvisability of performing opera- 
tions in cases of medullary sarcoma of the upper jaw, I will now advert to 
some of the most prominent means of diagnosis between this disease and 
other abnormal growths of that part. The diagnosis between fibrous 
tumors and medullary sarcoma is very obscure; some idea may be 
obtained from puncturing the tumor, and from the degree of resistance to 
the lateral motions of the instrument presented in the former disease, as* 
well as from the absence of spiculte of bone discernible in some forms of* 
the latter ; but the principal diagnostic signs which we posses are, the con- 
dition of the teeth, gums, and bones of the part. It is true that the bones, 
in certain conditions of health—as in the case to which I have alluded— 
may, from pressure, become carious, or even destroyed by necrosis; but 
they are never converted into that soft degeneration so characteristic of 
medullary sarcoma, or the malignant disease. Pressure on the hard palate 
is met with firm, hard resistance ; whereas in medullary sarcoma—in all 
cases where the tumor projects from the cheek, and in very many of those 
wherein the disease manifests itself in the orbit—the palate upon the 
affected side is elastic to pressure, usually more congested than natural, 
whilst the gums are congested and thickened, the dental margin is thick- 
ened and everted from the teeth, which become irregular, loosened, and 
projecting. When seen for the first time, this condition of the gums and 
teeth may be mistaken for abscess or disease connected with the teeth, 
with which, however, it has nothing to do, and from which it may be dis- 
tinguished by the comparative slight pain which accompanies it, by its 728 
TUMORS. 
gradual progress, by the absence of inflammatory swelling of the cheek, 
and by the character of the enlargement of the gums. 
In this affection the gums are spongy and elastic, and, when pressed 
upon, are found, in a great degree, to have lost the support of the alveolar 
process, which becomes softened by the disease : whereas in inflammation 
and abscess resulting from disease of the teeth, or alveolar sockets, of a 
simple character, the pain is very great, the swelling of the cheek is evi- 
dently of an inflammatory character, whilst the enlargement of the gums 
is smooth and firm, and the firm resistance of bone beneath may almost 
always be detected. In medullary sarcoma this state of the gums should 
be regarded as the result, not the cause, of the disease ; and for the 
reasons which I have already given in the early part of the.paper, the 
teeth, though loose and comparatively useless to the patient, had better 
not be meddled with. 
Bony tumors, though more easily distinguished from medullary sarcoma 
than fibrous growths, may, upon superficial examination, create doubts in 
the minds even of well-informed surgeons. As I was going down into the 
operating-theatre, to remove the upper jaw from a child aged six years, a 
surgeon of some standing, who had examined the child in the ward, said, 
“ Surely, Mr. Hancock, you will not meddle with that; it is malignant.” 
He was misled by a certain degree of elasticity presented at one point of 
the tumor, and which I have observed in all the cases which have fallen 
under my observation. They have not been of that form denominated 
ivory exostosis, but have all presented a certain degree of yielding to the 
touch ; but they have this marked distinction from the medullary sarcoma : 
in this latter disease the surface of the tumor is uneven and elastic, but the 
elasticity is superficial; whereas in osseous tumors the elasticity is deeper 
seated, and the yielding or elastic substance is evidently covered by a thin 
shell, which recedes when pressed upon, but appears to recover itself when 
the finger is removed. We have not the crepitation in these cases as in 
osseous cysts, but the elasticity is covered by a thin, smooth investment, 
and is not so immediately upon the surface as in osteo or medullary 
sarcoma. Puncturing these tumors with an exploring needle, or what I 
prefer, a small trocar, will also assist us in our diagnosis. In medullary 
sarcoma, the instrument appears to enter a soft mass, and with but little 
force a considerable degree of lateral motion may be given to the instru- 
ment ; but not so in osseous tumors. Here, though it may be introduced 
with difficulty, still it will appear to be clung to by the structure into 
which it penetrates, and lateral motion cannot be obtained except with 
that degree of violence which we should be unwilling to employ ; and, 
again, a3 in fibrous growdhs, the condition of the gums and teeth will 
pretty surely mark the non-existence of malignant disease. The teeth will, 
in many instances, be perfectly sound ; and though, in others, the patient 
may have lost some of those organs, the gums may have healed, and will 
not show any of that spongy appearance, or tendency to eversion, so cha- 
racteristic of the malignant disease. I never saw a tumor of the upper 
jaw7 of a malignant character unaccompanied by mischief about the palate 
and gums ; but an osseous tumor may have attained great size, and cause 
considerable deformity, without projecting into the mouth, or complicating 
the palate or gums at all; and this is an additional reason for employing 
an exploring needle or trocar, this instrument, in some cases, affording us 
the only means of ascertaining the extent of operation to be performed— TUHOKS. 
729 
whether the whole, or a portion only, of the upper maxilla is to be 
removed. Mr. Fergusson has laid down that rapidity of growth is a 
diagnostic sign of malignant tumor; this, however, is not entirely to be 
depended upon, as the growth of bony tumors will sometimes be extremely 
rapid, as in oue case wherein the tumor attained a great size in less than 
five months. Part xxxi.,/>. 136. 
Tumors of the Jaws.—[In a clinical lecture on tliis subject, Mr. Syme 
makes the following important general remarks which will apply to tumors 
affecting both upper and lower jaw.] 
There are some anatomical differences between them, which lead to 
pathological differences. In the upper jaw, the hollow of the maxillary 
antrum exposes to a condition which cannot exist in the lower jaw—viz., 
inflammation and suppuration of the cavity. The antrum also serves as a 
receptacle for polypus growths, which, however, are mere intruders from 
the nasal cavity, and not diseases of the jaw itself. In both jaws the bone 
is apt to die from the effects of inflammation. In the upper no reproduc- 
tion of bone takes place after removal of the exfoliation ; in the lower the 
bone is denser, and the periosteum more capable of reproduction, and 
there is no instance in the body of a more complete restoration of bone. 
I have repeatedly seen almost the whole lower jaw, including the condyle, 
thrown oif as an exfoliation, yet complete reproduction has taken place. 
These are all the differences which it is necessary for me to notice now. 
There has been a notion prevalent, that tumors of the upper jaw originate 
in the antrum. This is erroneous; their origin is in all cases similar to 
tumors of the lower jawT. 
Tumors of the jaws are chiefly of five different kinds—three solid and 
two fluid. Of the solid, you have one growing from the surface, and two 
in the interior of the bone. The one on the surface is denominated “ epulis,” 
or “epulotic tumor;” it appears on the gum, and increases in size without 
limit to its growth, and at last becomes inconvenient from its bulk ; it is also 
liable to bleed, and may become as serious, in this respect, as if it were 
malignant. Epulis grows from the surface of the bone, and requires for 
its remedy the removal of the part to which it is attached. The knife 
never cures the disease completely, and it is always requisite to take away 
more or less of the alveolar process, in order to do which you must extract 
one or more teeth. 
The other two forms of solid tumor originate in the osseous substance, 
and are divided into simple or local, and malignant, or those where there 
is some constitutional derangement connected with the local condition, 
which produces a tendency to a return of the disease after its removal. 
The first kind are generally of firm consistence, and slow growth, and 
accompanied by a healthy state of the constitution ; the second are of soft 
consistence, and rapid growth, and the patient’s constitution commonly 
unhealthy. But these kinds pass, by various degrees, insensibly into each 
other. The slower the growth, the firmer the consistence, and the more 
healthy the constitution, the greater will be the probability that the dis- 
ease is entirely local, and that the removal of the tumor will be followed 
by a permanent cure. But tumors of the most rapid growth and softest 
consistence have sometimes been taken away, without any return of the 
disease; and hence the general rule is, that if such tumors are distinctly 
limited to the jaw, they should be removed. You must bear in mind, 730 
TUMOKS, 
however, that a malignant growth is apt to extend its roots beyond the 
bone from which it originated, in this respect remarkably differing from 
the simple, local, or fibro-cartilaginous growths, to which your attention 
was lately directed. The other day, a lady, said to be laboring under 
polypus of the nose, consulted me. I found, however, that the soft mass 
which showed itself in the nostril wTas really a tumor proceeding from the 
superior maxillary bone; and further, a swelling at the inner canthus, 
showed that the disease was not limited to that bone, but extended up to 
the ethmoid, and probably to the base of the skull. I therefore advised 
her against any interference ; but had the disease appeared limited to the 
superior maxilla, I should have recommended excision of the bone. I 
could mention several cases, where the removal of soft tumors of the jaws 
of rapid growth has been followed by permanent recovery. 
The fluid tumors of the jaws are of two sorts, being collections either of 
serous or purulent fluid; the serous or cystic are not unfrequently mistaken 
for solid tumors ; they grow in the substance of the bone, and are gene- 
rally at some parts of their extent as hard and as unyielding as bone, so 
that if their examination be limited to these parts, the tumors will be 
supposed to be solid. Even so accomplished a surgeon as M. Gensoul, of 
Lyons, had once made his incision and exposed a tumor of the jaw, when 
all at once the knife entered a cavity, from which serous fluid escaped. I 
have myself met such cases, and seen them in the practice of others. It is 
therefore necessary to examine a tumor of the jaw over its whole surface; 
then, if it be cystic, you will be almost sure to find some yielding point 
where the bone gives way like pasteboard, and is perhaps felt to crackle 
under the finger. 
These cysts frequently exist independently of any other morbid condition, 
but sometimes, and especially in the upper jaw, they are connected with 
displaced teeth, one of the permanent set having taken a wrong direction, 
so that, when the cyst is opened, the tooth is found lying in its interior: I 
have, in this theatre, more than once found such a state of things present. 
Whether this be the case or not the treatment is the same—viz., to open 
the cavity freely and stuff it with lint. The prognosis is, however, more 
favorable if a tooth be found in the cyst; it is then almost certain that the 
cavity will contract and heal. This may occur in other cases, but it has 
also been noticed that cysts, after being opened, are not unfrequently fol- 
lowed by the formation of a solid tumor. I could mention to you cases 
where I have opened cysts containing nothing but serum, in the place of 
which solid tumors have afterward been formed. It is also possible that 
the cysts may be complex, and so extensive as to require removal. A 
patient left the hospital only a few weeks since who applied to me five 
years ago on account of a large cystic tumor of the lower jaw, which I 
opened, and gave exit to a large quantity of albuminous fluid, and stuffed 
the cavity with lint. The swelling afterward contracted to a considerable 
extent, but never entirely disappeared, and she returned two years later 
with the tumor as large as when I first saw her, and affecting the jaw 
more extensively. I again opened and stuffed it, and the tumor again 
contracted to a certain extent. It, however, again increased, and I 
repeated the process for the third time, but with the same result, the 
patient returning last autumn with the tumor larger than ever, and ex- 
tending now from the symphysis to the coronoid process. I removed half 
the jaw by disarticulation, and on examination we found that the cyst, TUMOKS, 
731 
instead of being simple, was complex, consisting of four chief cavities, the 
walls of which were studded with smaller cysts of various sizes. It was 
clear that in this case nothing short of excision of the portion of the bone 
affected could have produced a cure. 
Tumors depending on purulent collections are not at all uncommon. 
They are almost invariably in connection with the stump of a tooth. A 
portion of a stump may remain after the extraction of a tooth and be for- 
gotten, and the tumor may be supposed by the surgeon to be solid. 
Generally, however, the parietes, like those of serous collections, will be 
found to yield at one place, and you tind an additional guide to your diag- 
nosis in the presence of the diseased tooth. I lately saw a tumor of the 
lower jaw, which was removed under the supposition that it was solid 
throughout; but on being sawn through, it proved to be an abscess, the 
osseous wall of which had undergone immense thickening, except at one 
small point in immediate connection with a diseased tooth, which had 
never caused any pain. In that case, it may be doubted whether it would 
have been possible to afford relief otherwise, even if the real nature of the 
disease could have been made out, from the difficulty of affording a free 
outlet for the discharge. Part xxxi., p. 140. 
Fibrous Tumor of the ~\Vomb.—Give the liq. calcis chlor. from 30 to 50 
minims, twice a day for months, or give the Kreuznach-water (artificially 
prepared by Mr. Hooper) 3j. three times a day in warm water, at the same 
time using an injection for the vagina of 3ij- to the §j. of water. Dr. 
Preiger, however, chiefly depends on baths and fomentations composed of 
the Kreuznach-water, and some extraordinary effects have no doubt been 
produced by him, as we have seen. Part xxxi., p. 212. 
Iodine in Fibrous Tumors in the Uterus.—Dr. West almost invariably 
orders for those of his patients at St. Bartholomew’s who are the subjects 
of fibrous tumors of the uterus, a long course of one or other of the prepa- 
rations of iodine. The following is the prescription which was ordered for 
a middle aged woman, who applied with that disease. 
Potassii iodidi, gr. j.; sirup ferri iodidi, mxx.; aquae carui, gss. Ter die 
sumend. Part xxxi., p. 311. 
Atheromatous Tumors of the Scalp.—[These consist essentially of a 
diseased sebaceous follicle, lined inside by tessellated epithelium, and com- 
bining a cheesy-looking matter ; if they contain a darkish-colored matter, 
it is a sign of disintegration, not unfrequently followed by ulceration, 
which may readily be mistaken for a malignant growth. Mr. Erichson says:] 
The mode of removal of these tumors before ulcerating is very simple. 
A single incision is made across the wen or cyst, and then, with a strong 
drag of a forceps, a sort of evulsion is practised, the entire growth coming 
out "like an almond from its husk or shell. They are found also under the 
eyelids, and are made worse by any practice but one—namely passing a 
small probe through them on the conjunctival surface, and stirring up the 
contents with the probe dipped in nitric acid. Part xxxii., p. 196. 
Vascular Tumors.—Elastic ligatures are much superior to inelastic 
ones in the removal of vascular tumors, etc. To apply it the elastic 
thread must be stretched to its full extent, and tied in a single knot; it 
must then be slipped over the tumor and tied, by a double knot. Stran- 
gulation follows, and the tumor falls off in a few clays. Part xxxv., p. 93. 732 
TUMOKS. 
Sebaceous Tumors.—Pass through the centre of the tumor a needle 
carrying a thread, and tie the same as a seton; the tumor xvill inflame, 
pus will form and be evacuated through the apertures. The thread may 
be removed in a fortnight. This treatment is only applicable to those 
tumors which are more or less in a fluid state. The size of the thread 
must depend upon the size of the tumor. (M. Marchand.) Part xxxv.,p. 170. 
Uterine Fibroid Tumor—Enucleation of.—In making the opening 
through the uterine wall, the French and American surgeons prefer the 
use of the knife. In a case of Dr. Simpson’s, caustic potash was applied 
an inch behind the os uteri. Our own opinion is decidedly in favor of the 
knife, and to make the opening through the uterine structures from within 
the uterine cavity, rather than from the vagina. Then comes the question, 
ought we to enucleate at once by instruments, or wait for the expulsive 
action of the uterus ? Before we can answer this, we ought to be able to 
say whether the organ is, in such cases, always in a condition to exert it. 
Is it hypertrophied ? This is by no means invariable. Hence how hope- 
less it would be in certain cases to wait for any expulsive uterine action, 
for the uterus may be actually atrophied, although this is very rare. We 
may generally expect hypertrophy if the fibroid growths project into the 
cavity of the uterus and irritate the mucous membrane; or if the tumor 
be vascular ; also if it be developed during or shortly after the period of 
conceptivity. On the other hand, we should expect atrophy if the tumor 
occurred during the period of decrepitude. If the uterus be hypertro- 
phied, will it always exert its expulsive action ? In all the cases recorded 
it has not failed to occur, so that after making an artificial os, the cellular 
attachments of the tumor must be separated and expulsion waited for. 
If the pains do not come on, the operation of separation must be repeated, 
the uterus will be sure in time to expel the exposed and partially separated 
tumor. Ought the tumor to be enucleated at once, or the uterus be 
allowed to expel it, either partially or entirely ? In favor of the latter 
method we may say that it bears a more close relation to the natural pro- 
cess of effecting the same object; there is less risk of hemorrhage, and 
lastly, the cavity left is much smaller, and the uterus is more likely to con- 
tract on it. In the removal of these tumors, we should recommend, 1. 
That the incision through the uterine walls be made sufficiently large. 
2. That the separation of the cellular attachments be as extensive as pos- 
sible. 3. That the cyst of the tumor me not cut into. 4. That ergot be 
given. 5. That the hand be introduced as soon as the dilatation of the os 
will admit to remove the tumor. (Dr. Grimsdale.) Part xxxv., p. 234. 
“ Phantom Tumors ” of the Abdomen.—Dr. Greenhow relates the fol- 
lowing among other remarkable cases: 
Mrs. , aged forty-four, having borne a family, had suffered for seve- 
ral years from menorrhagia, alternating with profuse leucorrhcea. She 
had also suffered from a variety of other ailments referable to spinal irri- 
tation, itself due, I do not doubt, to the disarrangement of the uterine 
system. I was consulted by her, somewhat more than three years ago, 
for a tumor in the left hypochondrium, the appearance of which had been 
long preceded by occasional attacks of pain in that situation, of such in- 
tensity as to make her writhe about in bed, and for the relief of which 
opiates, even in large doses, were of little avail. This pain was of par- 
oxysmal character, often coming on very suddenly, and sometimes without 733 
TUMORS 
apparent cause, although more frequently as a consequence of over-ex- 
ertion. It sometimes lasted for many days without intermission, but with 
variable intensity. The employment of counter-irritation to the spine, 
and of tonic treatment calculated to improve the general health and lessen 
the uterine flux, were of essential service; and when, at a subsequent 
period, I sought for the tumor, it was not discoverable. After an interval 
of many months I was again consulted for the tumor, which, sure enough, 
had very evidently returned, and is described in my notes of the case as' 
“ an ovoid movable tumor, free from tenderness, and apparently floating 
loose in the left hypochondriac region; it is difficult to estimate its size, 
but it appears to be somewhat reniform, and at least twice the natural 
size of a kidney.” It is further added that the patient was in all other 
respects in good health; that no fullness, tenderness, or pain existed in 
the posterior lumbar region, and that the urine was normal. Notwith- 
standing that I believed the tumor to be of the same character with those 
already related, I thought it desirable that the patient should have the 
benefit of a second opinion, particularly as I had been unable to find it on 
a previous occasion. An eminent physician who was called to my assist- 
ance, devoted much pains to its elucidation, but without arriving at any 
more satisfactory conclusion as to its nature than myself. We agreed 
that it could not be ovarian, from its position; that it was too movable for 
an enlarged kidney, which was also discountenanced by the absence of 
any unusual fullness, resistance, or tenderness posteriorly ; and that it had 
not the character, neither had the patient the aspect, of malignant disease. 
Although in great doubt on the subject, we treated it on the supposition 
that it might eventually prove a hydatid growth. Some time afterward 
other symptoms of spinal irritation manifested themselves ; and although 
I had never seen an avowed case of Dr. Addison’s “ phantom tumors,” I 
began to suspect that this would prove an example of them, as it subse- 
quently did. The patient very shortly after the consultation, went from 
under my immediate observation, although she continued to act under my 
instructions. In the course of a few weeks she wrote me word that the 
tumor had dispersed ; and a few months ago, being again in town, she 
afforded me several opportunities of satisfying myself that the tumor really 
was gone. Part xxxv.,p. 247. 
Arterial Tumors — Aneurisms.—Mr. Cusack, of Steevens’ Hospital, 
Dublin, applies compression by means of conical weights, which, suspended 
to a frame arching over the limb, may be exactly applied to the artery ; 
five and a half to seven and a half or eight pounds, are generally required 
to arrest the pulse of the femoral artery completely. At first the circula- 
tion must only be partially arrested, and the weight must be applied every 
alternate hour. After the lapse of six or eight days the weight may be 
increased till the circulation is completely arrested, the pressure not being 
continued, however, more than an hour and a half at a time. This mode 
of applying pressure appears the best hitherto suggested, as it approaches 
the nearest to manual pressure. It is easily applied, and has proved very 
satisfactory in its results. Part xl., p. 307. 734 
TURPENTINE. 
TURPENTINE. 
To Prevent Nausea, from Administration of Turpentine.—It is stated 
that turpentine when made into an electuary with mucilage, honey, and a 
little magnesia, may be given without exciting the disgust and nausea, so 
frequently caused as ordinarily prescribed. Part xii., p. 301. 
Oil of Turpentine as a Styptic and Astringent.—As an astringent, in 
doses varying from 20 minims to a drachm, according to the urgency of 
the symptoms, and repeated every three or four hours, turpentine is one of 
the most efficacious remedies which we possess. The best vehicle for its 
administration, in the first place, is water, flavored with sirup of orange, or 
any other agreeable aromatic. It may afterward be advantageously com- 
bined with any other therapeutic agents, which the special nature of the 
case may require : thus, in epistaxis depending upon the rupture of one or 
more small vessels, and where much arterial blood has been lost, muriated 
tincture of iron will form a valuable adjunct. In hematemesis and other 
sanguineous discharges from the bowels, it may be united with compound 
infusion of roses, sulphate of magnesia, iced-water, and solutions of tannic 
or gallic acid. In some forms of hemoptysis, it may usefully be added to 
infusions of matico ; in hematuria, to the decoctions of uva ursi, chima- 
phila, pyrola, etc.; or to tincture of the sesquichloride of iron. In purpura 
hemorrhagica, the decoctions or infusions of the barks form with it an 
excellent adjuvant. In hemoptysis, it has speedily and effectually arrested 
the hemorrhage ; and is a much safer remedy than lead. 
Dr. Smith states that in his experience, there is no single medicine in the 
materia medica, that can be compared with it as a styptic, either as to cer- 
tainty of action, or to the safety of its effects. It is compatible alike with 
acids and alkalies. • Part xxi.,j!?. 116. 
Paths containing Oil of Turpentine.—[Dr. Smith recommends the em- 
ployment of alkaline camphene or turpentine baths, in chronic rheumatism, 
lumbago, sciatica, gout, and other affections. lie says :] 
I have employed camphene in the form of a bath, mixed with common 
soda ; or two pounds of the latter with from a quarter of a pint to half a 
pint of camphene, and half an ounce of oil of rosemary, will form an excel- 
lent bath. In delicate skinned patients, females and children, §ij. of 
camphene will be sufficient. I may remark, in limine, that the alkaline 
camphene bath possesses virtues peculiarly its own. In the coldest day in 
winter, as I have verified in more than one instance, it may be employed 
with the most perfect safety. Whilst the individual is in the bath, he 
experiences, to my knowledge, no disagreeable annoyance from the disen- 
gaged vapor; on the contrary, if we except the taste of the turpentine, 
which for some time remains in the mouth, a sense of calmness and tran- 
quillity very often follows a previously disturbed, irregular, or excited con- 
dition of the respiratory or sanguiferous systems. After five minutes 
recumbency in the bath, the pulse is found to become fuller, softer, and 
slower; I have seen it fall from 100 to 80. The respiration also becomes 
freer, deeper, and less labored. On coming out of the bath, the whole skin 
has a peculiar velvety, soft, and agreeable feeling; the breath is strongly 
tainted with the terebinthinaceous odor. If it have not been too hot, a 
pleasurable tingling warmth is experienced throughout the whole cutaneous ULCERS. 
735 
surface ; and this, with the preceding symptoms, may continue twenty-four 
hours. One great advantage of this bath will be found in the circumstance 
that it may be employed at a heat from 10° to 15° below the temperature 
of the ordinary warm one, without including that sensation of chill to which 
some delicate constitutions are so peculiarly obnoxious ; ten or fifteen min- 
utes is the length of time a patient ought to remain in a bath of this descrip- 
tion. In the first instance, it is well for patients to commence with a 
smaller quantity of the turpentine and soda, say a pound of the latter, with 
two or three ounces of the former, and gradually increase its strength on 
each repetition of the bath, to the first mentioned proportions. This bath 
may be taken every second or third day, according to the urgency of the 
symptoms and the nature of the affection for which it is prescribed. 
Part xxi.,p. 355. 
ULCERS. 
JBaynton’s Method of Treating Ulcers.—[Mr. Joseph Bell, brings for- 
ward cases to show the efficacy of this mode of treatment, which he justly 
supposes has fallen too much into disuse. There is no doubt that the 
practice is excellent; but the troublesome attention which it constantly 
requires must always be an impediment to its general and continued use, 
especially amongst the classes of poor people in whom the most trouble- 
some cases occur. Mr. Bell says :] 
To explain at any length the method of this celebrated surgeon, may 
seem to some superfluous. It is, however, my decided conviction that the 
majority of practitioners are either ignorant of it, or do not put it into 
practice. 
Baynton’s system consists of three parts: First, straps of adhesive 
plaster, from two to three inches broad, and of sufficient length to surround 
the limb, and to overlap a few inches. These straps are to be applied by 
placing the centre of the strap exactly opposite the ulcer, over which the 
free ends are to be crossed, pulling them as tight as the feelings of the patient 
will permit. The first strap is to be placed a little below the lower margin 
of the sore ; the second is to overlap it a little ; the third to overlap the 
second a little ; and so on till the ulcer is completely covered ; a soft piece 
of cloth is then to be placed over the ulcer; but I frequently dispense 
with this. Secondly, a bandage is to be applied, from the extremity of 
the limb to the articulation above the sore. Thirdly, this bandage is to 
be kept constantly wet with cold water. The dressing to be changed 
every day, or every second day, according to the quantity of discharge 
and irritability of the ulcer. Such then is the Bayntonian system, which 
when properly applied, is competent to cure, speedily and effectually, the 
irritable or inflamed, and the varicose, as well as the indolent or callous 
ulcer ; proper attention, of course, being paid to the improvement of the 
general health—a sine qua non in every plan of treatment. 
Part iii., p. 105. 
Ulceration of upper part of Rectum and Sigmoid Flexure—Case of— 
Cured by Lime Moxa.—Dr. Osborne of Dublin relates the case of a female 
who labored under the symptoms of ulceration of the upper part of the 
rectum and sigmoid flexure, for above a year, and had constantly most 
severe pain in those parts on passing her motions, which were accom- 736 
ULCERS. 
panied by discharges of purulent and sanious matter. On being examined, 
the rectum and lower part of the colon were free from contractions, and 
the fecal masses which occasionally passed, although productive of great 
suffering, yet showed that the passage was not considerably narrowed ; a 
lime moxa, which extended to about the size of a crown, w'as applied over 
the sigmoid flexure, and Avas immediately followed by a diminution of 
pain and an almost complete cessation of the discharge; and before the 
ulcer produced by the moxa had filled up by granulations, all the symp- 
toms of the internal ulceration had entirely disappeared. Part v., p. 129. 
Treatment of Old Ulcers by the use of Cor*rosive Sublimate and Tinc- 
ture of Iodine.—E. B., aged 43, was admitted into hospital with a large, 
foul, and painful ulcer on the lower part of the left leg; extending from 
the instep nearly six inches upward, across the whole front of the limb. 
Several useless attempts being made to effect a cure, Mr. Furgusson put 
her on a course of mercury, in the following way. “ Twelve grains of the 
bichloride of mercury were made up into 240 pills; two of these were 
taken for a dose immediately after dinner, the first day, four on the third, 
six on the fifth, and so on; increasing the dose by two every second day, 
until the patient should take thirty pills at a time. After this, if necessary, 
the dose was to be gradually diminished every second day by two pills, 
until the number decreased to two. The patient proceeded till she took 
eighteen pills for a dose, which affected the system, and she then desisted 
taking any more. Meantime, Mr. Partridge had recommended the sore to 
be lightly touched with a strong tincture of iodine, which had an excellent 
effect; and it was supposed, by the combination of the two remedies, a 
most obstinate case was cured. Part v., p. 144. 
Outward Applications to Ulcers—Chemically considered.—On examin- 
ing the composition of the more common medicinal applications to indolent 
ulcers, it would appear that, 1st, their energy on the animal tissue, and 
their caustic properties, are in direct ratio to the rapidity with which they 
part with their oxygen; and 2d, the bases of those compounds which ex- 
perience has taught us to prefer, are, when deprived of their oxygen, 
perfectly inert, and their affinity for oxygen is comparatively slight. 
Three qualifications, therefore, appear necessary to constitute a good out- 
ward application to an indolent ulcer. 1st. A substance containing a large 
proportion of oxygen, or of an electro-negative body. 2d. A compound 
that will part with its oxygen to the animal organism moderately slow. 
3d. A compound whose elements, when its oxygen is abstracted, possesses 
no chemical or solvent powers on the tissues, nor poisonous effects on the 
body generally. 
Guided by these views, Mr. Sankey is led to recommend the employment 
of various compounds to indolent ulcers, such as the iodate of the pro- 
toxide of mercury in the strength of Bss. to 3s«. to the ounce of lard; the 
iodide of starch ; the oxide of silver; pectic acid applied as a poultice ; the 
iodate of peroxide of mercury ; the preparations of periodic acid, the bro- 
mates ; succonates ; the precipitate formed by tr. opii on Goulard water ; 
mucic acid ; alloxan ; hydrated peroxide of iron, etc. In angry and in- 
flammatory ulcers, on the other hand, which are attended with increase ot 
circulation, and consequently, with excessive supply of oxygen, the oxy- 
genated compounds would be prejudicial. Cold lotions or poultices, for 
chemical reasons, would bo indicated; or, if ointments are used, thoso ULCERS 
737 
only containing a preponderance of electro-positive elements, as ung. 
cetacei, creasote, etc.; perhaps, also, the application of turpentine, or the 
non-oxygenated essential oils, as the ol. Union. Part vii., p. 168. 
Simple Ulcers of the Cervix Uteri—Cauterization of.—M. Lisfranc, 
greatly vaunts the mode of treating ulcers of the neck of the uterus, by 
the application of escharotics. That which he prefers greatly to all others, 
is the solution of mercury in an excess of nitric acid. The speculum uteri, 
he says, is indispensable. The escharotic is never to be applied otherwise 
than very lightly ; nor with a view to destroy the ulcerated or altered sur- 
faces, but to modify their vital state—to produce a new action in the parts. 
A soft brush, or dossil of lint, is the proper tool for making the appUcation, 
and the speculum is immediately afterward to be filled with tepid or cold 
water—the abraded surfaces are to be washed clear of all remains of the 
caustic, which is only felt as peculiarly painful, when it is suffered to come 
in contact with the sides of the vagina.- Part viii., p. 155. 
Phagedenic Ulcer of the Septum Nasi—Chloride of Zinc.—Dr. Zwerina 
gives the following case : A woman, aged 30, who had suffered from severe 
pain and enlargement of the right tibia, which was judged to be syphilitic 
in its nature, was at the same time affected with an ulcerous disease of the 
nose, which by and by perforated the septum, and threatened to destroy 
the whole member. The disease of the leg was arrested under the use of 
mercurial inunction, that of the nose resisted all the topical applications 
that were made to it—sublimate, arsenic, red precipitate, sulphuric acid, 
nitric acid, etc., until the chloride of zinc was called into requisition. One 
grain and a half of the salt was dissolved in one ounce of distilled water, 
and the scabs being removed, the sore was pencilled over several times a 
day with the solution. At the end of a fortnight, a healthy granulating 
surface was found underneath the thick crust which now covered the sore, 
and this being removed from time to time, and the solution re-applied, at 
the end of five weeks, the cicatrix was perfect, and the patient well. 
Part viii., p. 155. 
Use of Turpentine.—Mr. Hancock recommends turpentine in those 
ulcers which are prevented healing by deficient action, where the ulcer is 
sluggish, surface smooth, without granulation, or of a greenish foul appear- 
ance ; discharge serous, edges rounded, smooth, and callous, and the sur- 
rounding skiu is pink or blue. It should not be exhibited where the patient 
is plethoric, the ulcer inflammatory, and the pulse full and frequent, or 
where it produces nausea, or other unpleasant symptoms; in the last case 
substitute cajeput oil, three drops three times a day, or give capsules, each 
containing twenty to twenty-five drops of the turpentine. Continue the 
use of the turpentine until good healthy granulations appear, with the se- 
cretion of good pus. Part xiv., p. 32.1. 
The treatment of Ulcers.—With respect to ulcers with exuberant granu- 
lations, Bransby Cooper says: 
In such cases pressure is indicated, which is best effected by the applica- 
tion of bandages; but, should such means not succeed, escharotics maybe 
required to keep down the tendency to hypertrophy. Sulphate of copper 
I consider the best application for this purpose. Nitrate of silver, which 
is very frequently employed, tends, in my opinion, rather to increase their 
growth ; for, although when first applied, it removes them, yet they appear 
to return with increased vigor after its escharotic influence has ceased.. 
vol. ii.—47 738 
TTLCEES. 
[Indolent ulcers will generally require both constitutional treatment, and 
stimulating applications to the sore. Mr. Cooper says:] 
Bark and acids are indicated, having taken care first that the bowels are 
freely opened and the secretions generally natural. Stimulants should be 
applied to the ulcer, either the ung. nitrici oxidi, or the ung. zinci; or,, 
should lotions be preferred—and, indeed in some cases they seem more 
suitable than greasy applications—nitric acid lotion, or zinc or lead in solu- 
tion, may be substituted ; but at the same time, the patient should be kept 
during a large portion of the day in a recumbent posture, and much benefit 
is sometimes derived from the elevation of the affected limb. Porter and 
generous diet will also expedite the cure, by exciting the reparative pro- 
cess. The pressure and support of a bandage is occasionally useful, but in 
languid or indolent ulcers its utility is doubtful; for I have frequently 
observed that a tendency to slough follows its application, as if the granu- 
lations were too tender to sustain the slightest pressure. 
When these ulcers prove very stubborn, and resist all the consti- 
tutional and topical remedies, I have lately witnessed the best results 
from stimulating their surface by subjecting it to a stream of negative 
electricity. 
At a convenient distance from the indolent ulcer (not less than five or six 
inches) a portion of the cuticle is raised from the cutis by the application 
of a piece of emplast. lyttse of the size of a half-crown. The cuticle is de- 
tached by a pair of scissors, and on the exposed cutis a piece of zinc foil is 
placed, of the same size as the denuded spot. A plate of silver foil is 
laid on the original ulcer, and the two plates connected by means of a thin 
copper wire. The size of the silver plate is immaterial. Both zinc and 
silver are now covered with pieces of moistened lint and oil-skin, and the 
apparatus, as recommended by Dr. Bird, is complete. In a few hours the 
surface beneath the zinc becomes white, and a slough begins to form, which 
in a short time is thrown off, leaving a healthy ulcer behind. In the mean- 
while a great change has taken place in the original ulcer; it has thrown 
aside its indolence ; the granulations are sjjrouting and contracting; hew 
skin is forming at the margin, and the whole surface looks healthy and 
animated. Part xvi., p. 228. 
Callous Ulcers of the Leg.—Prof. Syme’s method of treating these tire- 
some cases was to apply a large blister over the sore and neighboring 
swelled part of the limb, which has the effect of speedily dispersing the sub- 
cutaneous induration and thickening, so as to relax the integuments, and 
thus remove the obstacle opposed to healing action. In the course of a 
short time, seldom exceeding a few days after the blister has been applied, 
the surface of the ulcer, however deep it may have been, is found to be 
on a level with that of the surrounding skin; not, of course, through any 
process of reproduction or filling up, but merely from the removal of 
interstitial effusion, allowing the integuments to descend from the position 
to which they had been elevated, as may be readily ascertained by mea- 
suring the circumference of the limb, before and after it has undergone the 
effect of blistering. But, along with this change of form, the ulcer in 
other respects no less speedily requires the characters of a healing sore, 
assuming a florid color, affording a moderate discharge of purulent matter, 
and presenting a granulating surface with surrounding margin of cicatris- 
ing pellicle. No subsequent treatment beyond the attention requisite for ULCERS, 
739 
insuring quiet and cleanliness is needed, and recovery is completed, not 
only more quickly, but with much less tendency to relapse, than when 
accomplished by other means. 
With regard to the varicose ulcer, the author states that his opinion is 
not in favor of aiming at what is called the “ radical cure,” by obstruction 
of the vein or veins concerned. He has frequently practised the method 
of Velpeau, who accomplishes the object of obliteration by passing a pin 
through the skin under the vessel, and then tying a thread lightly round 
the included part; and has never met with any bad consequences from 
doing so : but he is nearly satisfied, from what has fallen within his own 
observation, that the operation is barren of good effects in permanently 
remedying the tendency to ulceration. The black wash has long seemed 
to him the best application for promoting cicatrization of the ulcer. If the 
sore comes under treatment in an inflamed or irritated state, poultices 
should be employed in the first instance ; and if the depressed surface and 
thick edges denote a complication of the callous condition, blistering will 
be proper instead of such relaxing means. Part 188. 
Phagedenic Ulcers.—[Phagedenic ulcers may occur in other cases than 
syphilitic ones. The disease is very rapid in its progress, and is attended 
with severe pain preventing sleep, headache, fever, furred tongue, and 
tenderness of epigastrium.] 
“ In the local treatment,” Professor Cooper says, “ bleeding can rarely 
be resorted to with advantage; venesection exposes the patient to the 
risks of hemorrhage, on account of the natural tendency of this disease; and 
leech-bites assume a morbid action, as is j ust what we see in hospital gan- 
grene. Mr. Welbank found an application of strong nitric acid to the 
surface an excellent means of arresting the ravages of gangrenous pha- 
gedena. Ilis mode of applying it was, after protecting the surrounding 
skin with a thick coating of cerate, to dip lint in the acid and apply it to 
the part, the surface of which was thus converted into a firm and dry 
mass. Simple dressings were afterward employed, and an evaporating 
lotion. In France a solution of chloride of sodium, consisting of one part 
of the concentrated solution in eight of water, is employed, either mixed 
in a poultice or used with lint. The dressings most used are bread or 
carrot poultices, a watery solution of hyoscyamus, the liq. opii sed., with- 
a pledget or poultice over the lint. From a consideration of the predis- 
posing cau ou will infer the propriety of attending to diet and regimen ; 
when great debility exists, you are to employ bark, quinine, and wine, 
with a light nourishing diet. In St. Thomas’s Hospital it is customary to 
allow a mutton chop with eggs and milk.” Part xvii., p. 195. 
Treatment of., by Proteine.— Vide. Art. “Caries.” 
Treatment of Specific Ulcers—Strumous.—A weak solution of iodine, 
or the black wash, are useful stimuli to strumous ulcers. If there is a 
mass of strumous matter forming beneath the skin, paint it over with 
tincture of iodine, or solid nitrate of silver. 
Phagedenic.—In cases of phagedenic ulcer with extensively under- 
mined edges, in which, if an escharotic were used, a large quantity of skin 
would have to be destroyed, take small strips of lint thoroughly saturated 
with black wash, and thrust them with a probe to the very bottom of the 
sore, so as to bring the black powder into contact with its entire surface. 
Afterward apply strapping, sec. art. 740 
TTLCEKS, 
A suitable course of medicine and generous diet are accessories in the 
treatment which must not be omitted. 
Menstrual.—Mr. Critchett next proceeds to speak of the menstrual 
ulcer. He says: 
There are two or three modifications of this disease met with in prac- 
tice ; thus you have a class of cases, in which, the uterine function being 
entirely suspended, the system finds relief in a constant discharge from 
the surface of a sore, which discharge is altered in quality and increased in 
quantity at the usual monthly period. In other cases the uterine function 
is performed, but the sore becomes inflamed and painful, and increases its 
amount of discharge at that period ; thus giving evident signs of sympathy 
and co-operation with the uteras. There is, again, a peculiar and very 
formidable class of sores, which occur either at the period when, in the 
natural course of things, the menstrual function is about to cease ; or where, 
from some organic change in the menstrual organs, this discharge no 
longer takes place. 
The first form of this disease to which I have alluded, and which may 
be distinguished as “ the true menstrual ulcer,” occurs generally in young 
females, soon after the age of berty. It is often, in the first instance, 
of a strumous character ; or it may have arisen from some external injury. 
The uterne function not being very fully and regularly established, by 
degrees it ceases, and its place is supplied by the ulcer. 
I have invariably found that the breaking out of the sore has preceded 
the suspension of the menstrual dischai’ge, or has been first formed prior 
to that period of life when the function of the uterus commences. I note 
this especially, because it is an important element in the consideration of 
the treatment of these cases. The appearance of the ulcer is charac- 
teristic of its nature: it is generally rather large, its edges are ragged, its 
surface is irritable, dark-colored, and exhibits specks of blood; the 
surrounding parts are of a deep red-color, but not much swollen ; the 
discharge is thin, and often mixed with blood ; the pain and soreness 
are generally distressing and much aggravated at the period when the 
uterine function is due. When this vicarious dischai-ge is fully established, 
the disease becomes most intractable. I have met with cases that have 
existed above three years, having resisted all the ordinary methods of 
treatment adopted on these occasions. 
If we consult surgical authorities on this subject, we invariably find the 
matter rather briefly dismissed, somewhat in the following way : “ Restore 
the healthy functions of the uterus, and then the ulcer will heal.” This 
sounds very rational and very proper, and no doubt answers exceedingly 
well when it can be accomplished; but, according to my experience, it is 
always difficult, and very frequently impossible. 
I contend that it is scientifically more correct, and practically far more 
efficacious, to adopt a method the very converse of the one I have above 
stated—viz., “Heal the ulcer, and the uterine function will speedily be 
restored to health and regularity.” 
I commence, then, at once to attack the ulcer. Some stimulus is often use- 
ful in allaying the irritation ; a solution of the nitrate of silver is generally the 
best. I then apply strapping rather tightly; for I find in all those eases in 
which I have, as it were, to compel a cure in spite of the rebellion of the 
constitution, rather tight and very accurately applied support is necessary. 
As the discharge is copious, it should be applied frequently, either ULCEKS. 
741 
alternate days, or every day. The wound will soon take on a healthy 
action, and begin to heal, and you will naturally suppose the cure is at 
hand; but as the monthly period approaches, in spite of all your efforts, 
the aspect of the sore changes, the discharge again becomes thin and 
copious, and much of the improvement that has taken place during the 
previous month is lost. You must not be discouraged by this, but must 
start again, and each month you will find you gain more than you had 
previously lost, until, at last, you succeed in entirely closing the wound, 
and then you are safe; the ulcer being healed, the uterus spontaneously 
resumes its healthy and regular function—at least, such has been my 
experience. But even suppose such a result should not invariably occur, 
you have then a simple case of amenorrlioea to deal with, which is surely 
far more easily controlled when uncomplicated with a vicarious discharge 
from an ulcer in the leg. 
When sores occur about the time of the cessation of the catamenia, 
take care, before healing them, to get a freely-discharging issue made. 
Part xix., p. 200. 
Treatment of Indolent Ulcers.—Mr. Chapman’s plan is as follows : 
Dress the sore with a compress of lint dipped in cold water, and folded 
once, twice, or three times, according to the amount of compression 
deemed necessary; or, if the ulcer is very deep, cover it first with soft 
sponge torn up into very small shreds, and soaked in water, and over this 
apply the wetted lint in a single layer; then take three or more moistened 
strips of linen or calico, about two and a half inches wide, and apply them 
round the leg in the same manner as Baynton’s strapping. Cover the 
whole by a calico bandage, placing compresses of lint about the malleoli, 
so as to insure the bandage being evenly applied. Soak the bandage with 
cold water, and envelop the limb in oiled silk, reopening this from time to 
time, to renew the cold affusion. At first the ulcer may require dressing 
every day, but after a time, an interval of three, four, or even five days, 
may elapse between the dressings. Part xix., p. 203. 
Use of Chloride of Zinc.—Dr. Brookes states that the chloride of zinc 
exerts a good effect in stubborn ulcers, especially with callous, hard, 
everted edges, and will rapidly set up a healthier action when other 
remedial means have failed ; the surface will speedily granulate and heal. 
Take two parts of chloride of zinc, and three parts of gypsum; mix 
them, and spread the powder over the surface of the sore, protecting the 
edges of the healthy skin with vinegar. In about a quarter of an hour 
apply a poultice. Part xix., p. 205. 
• Foul and Flabby Ulcers.—Bi-sulphate of iron and alumina, is recom- 
mended as an excellent application. Vide Art, “ Iron.” 
Chronic—Use of Collodion.—Apply collodion, in the following man- 
ner : Dry the ulcer with bibulous paper; wash it over with ether, by 
means of a soft brush ; again dry with the paper; then apply the collodion 
with a brush in a circular manner, so as to cover the edges of the ulcer to 
a greater or less extent, as may be deemed necessary, and varnish over so 
much of the ulcer itself as to leave a small central opening for the escape 
of discharges. Any stimulus judged to be favorable to cicatrization may 
be applied in the dry form before beginning to paint with the collodion. 
Part xix., p. 318. 
Chronic Ulcers—Treatment.—Dr. T. II. Burgess recommends, to em- 742 
ULCERS, 
ploy fumigation in the following way. It Sulphuris, 3iij.; hydr. sulph. 
ruhr. 9ij.; iodinii, gr. x. M. Ft. pulv. sex. Put one of these powders 
upon a heated iron at the bottom of a large jar or tin case, the iron being 
covered by a grating. Immediately put the limb into the jar, and close it 
up to prevent the escape of vapor; and continue the bath for fifteen or 
twenty minutes. In a few days the proportion of iodine may be increased. 
Part xx., p. 168. 
Treatment of Ulcers by means of Opium.—Mr. Skey says : Mr. P., 
placed himself under my charge, with a large chronic ulcer on the calf of 
the right leg. Its margin was irregular and jagged, and was elevated to 
at least one-third of an inch above the base of the ulcer, which base was 
pale and bloodless. This wound was about the size of a man’s extended 
hand, including the fingers, or even larger. It had existed for, I think, 
seventeen years. All remedies had failed, and the cure had long been 
abandoned as hopeless. I gave Mr. P. half a grain of opium night and 
morning: In three days he himself noticed the singular red color of the 
entire margin of the ulcer, which in a week extended over the base. I 
rolled and strapped the limb; the entire sore consequent on its depressed 
surface being placed beyond the influence of the pressure. Within two 
months that sore was reduced to the size of half a crown, and the only 
remedy employed was half a grain of opium night and morning, which, 
by the by, had a very beneficial influence on his health. Part xx., p. 177. 
Treatment of the “ Warty Ulcers of Mar jolinf by means of the Chloride 
of Zinc.—[Dr. Fearnside proceeds to describe the case which fell under his 
care. His patient was a large unwieldy man, having the aspect of a man 
accustomed to indulge in malt liquor. About nine years previously^lie had 
sustained a severe injury in the front of his right leg. Inflammation and 
a swelling ensued, the size of a pullet’s egg, which underwent little change 
for some years. But 10 or 12 months prior to his coming under Dr. Fearn- 
side, pain was felt in the tumor, which acquired a dark red color, the skin 
covering it being indurated and uneven, and the discharge thin, fetid, and 
often bloody. Dr. Fearnside continues :] 
When I first saw him, the morbid growth presented the following cha- 
racters : From the centre of the front of the right leg, occupying a space 
of about three inches in diameter, there sprung a dark grey substance, 
which projected at least two-tliirds of an inch above the surrounding skin. 
Its surface had a granular appearance—at first view not unlike the head of 
a cauliflower ; on closer examination, it was seen that this was occasioned 
by the prominent extremities of coarse fibres which arose from the base of 
the ulcer, and were collected into masses, separated from each other by 
deep fissures. The mai'gin of the sore was thickened, elevated, and pos- 
sessed little or no connection with the fibrous structure above described : 
the surrounding integument had undergone considerable warty induration 
and discoloration. A thin ichorous discharge proceeded from the part; 
the pain experienced was not violent; there was no enlargement of the 
popliteal or inguinal glands. He complained of being Aveakened by re- 
peated loss of blood, but his health was otherwise good. He had been 
previously under the care of one or tAvo medical men, and had been advised 
to submit to amputation of the leg, on the supposition that the disease Avas 
fungus hematodes. The case Avas considered a favorable one for the em- 
ployment of the chloride of zinc. ULCERS, 
743 
On its first application, the remedy was mixed with flour. (Canquoin’s 
formula.) But little pain was occasioned by it, and the resulting slough 
was not deep. When it was next employed, it was blended with pure 
sulphate of lime, as proposed by Mr. Ure. The whole of the morbid 
growth was covered to the depth of a third of an inch with a paste com- 
posed of one part of chloride of zinc and two parts of sulphate of lime. The 
application gave rise to severe pain, which was only partially under the 
control of opium. At the expiration of four days an extensive and deep 
slough was produced, which separated in the course of the ensuing week 
or ten days. The greater part of the sore was then covered with healthy- 
looking granulations; but to get rid of two or three small masses of 
whitish semi-cartilaginous substance, as well as to overcome the indurated 
condition of the margin of the ulcer, it was requisite again to have recourse 
to the caustic paste. The subsequent progress of the case was, upon the 
whole, highly satisfactory. No hemorrhage ensued after the first complete 
application of the chloride of zinc. In the course of a month small florid 
granulations had arisen to the level of the adjoining surface, and cicatriza- 
tion commenced. Part xxii., p>. 249. 
Treatment of Varicose Ulcer at St. Thomas’s Hospital.—After all 
other measures have failed in the treatment of this affection, in cases at St. 
Thomas’s Hospital, perfect success has followed the application of a caustic 
issue, by rubbing potassa fusa along the chief vein between the ulcer and 
the heart. Part xxii., p. 256. 
Ulcers external to the Anal Aperture.—Mr. Hilton directs these to be 
treated by the recumbent position to relieve the hemorrhoidal veins, keep- 
ing the bowels open by castor oil, which acts on the entire course of the 
intestinal canal, and lubricates the hard exterior of the fecal mass as it 
passes through the rectum; and by applying the following ointment: 
ungent. opii, 3j-; ung. hydrarg. fort., 3hj., to be applied two or three times 
a day. Part xxiii.,y>. 176. 
Cicatrization of an Ulcer promoted by the Electric Moxa.—[The atten- 
tion of Mr. Cooper was formerly directed to this process for the promotion 
of the cicatrization of obstinate ulcers, by Dr. Hull, of the United States. 
Instead, however, of employing the galvanic battery which is cumbersome, 
he used one introduced by Dr. Golding Bird, merely using two plates, one 
of silver and the other of zinc, connected by a copper wire. The case in 
which the apparatus was used, was an ulcer originally produced from a 
gun-shot wound situated on the inner side of the right foot and below the 
ankle. The charge of shot passed obliquely through the soft part of the 
right instep, and injured the navicular bone. During the treatment several 
small pieces of bone came away, as often as two or three times a week. 
The wound never, however, completely healed, and previous to the appli- 
cation of the electric moxa, it was the size of the hand.] 
Carrot poultices were first used, and leeches were from time to time 
applied round the sore. W arm water dressing was subsequently employed, 
and the patient took sarsaparilla, but this treatment continued for about 
six weeks, proved unavailing as regarded the cicatrization of the ulcer. 
At this period Mr. Cooper ordered the electric moxa to be applied; this 
was done in the following manner : a small oval piece of blistering plaster, 
about the size of a crown piece, was placed six inches above the sore. On 744 
ULCEKS, 
the following day, a blister having formed, the cuticle was removed, and a 
plate of zinc, previously cut so as accurately to fit the vesicated surface, was 
applied on the same. A silver plate was then placed on the original sore, 
and the two metallic agents connected with a copper wire. This simple 
apparatus was secured on the limb by means of a few narrow strips of 
adhesive plaster, the whole being covered with wet lint, and a loose band- 
age, which latter was kept constantly moist. 
On the next day the silver plate was raised for the purpose of examining 
the sore, and a most decided improvement was observed, the granulations 
looking more healthy and active. On the second day, however (the moxa 
having remained in contact with the limb for forty-eight hours) there was 
pain and considerable redness over the whole leg, with enlargement of the 
inguinal glands. The moxa was therefore removed, the stimulating effects 
having evidently caused inflammation of the absorbents; yet the original 
sore had a more healthy appearance, and was evidently decreasing in size. 
On the fifth day the inflammatory symptoms had considerably subsided 
and the sore was improving fast. On the ninth all pain and redness in the 
leg had disappeared, and a slough separated from the blistered surface to 
which the zinc plate had been applied. The original ulcer was found much 
decreased in size, being now no larger than a crown piece ; the granula- 
tions assumed a healthy appearance ; they rose to the level of the margins, 
and were covered and protected toward the centre of the sore by a 
whitish layer of healthy pus. The borders were becoming flattened and 
regular, and the gradual extension of the cuticle could be distinguished 
within them. 
The cicatrizing process went on uninterruptedly. About four months 
after admission, the ulcer was quite healed up, and the patient left the hos- 
pital in good health. He was, however, recommended not to bear the whole 
weight of his body upon the leg for some time to come, and allow the soft 
parts about the ankle to gain tone before he used them freely. 
Part xxiii., p. 293. 
Phagedenic Ulceration.—Sarah II , aged 6, a strumous child of low 
powers, living in an unhealthy neighborhood, was admitted as an out- 
patient on July 18th, with acute phagedenic ulceration of the side of the 
tongue, gums, and lips; it was of one week’s duration, and was now 
spreading rapidly. 
Caustic was freely applied. Ten grains of chlorate of potash in water 
to be given three times a day ; and the sore to be sponged frequently in 
the course of the day with a solution of nitrate of silver (three grains to 
the ounce.) In a few days the phagedenic action was checked ; and at 
the end of a fortnight, healthy granulations were seen fast repairing the 
breach. Bark and soda were now substituted. On August 8th, the child 
was perfectly cured. 
Phagedenic Ulceration of Labia and Pend of Thigh—Pecovery.— 
Jane J , aged 20 months, a stout, healthy-looking child, brought up by 
hand, had been ailing one week, was brought to the surgery with exten- 
sive, spreading, superficial ulceration of both labia and bend of the thigh 
on the right side, almost running into gangrene. This was accompanied 
with great oedema, and excessive pain and difficulty in micturition. 
Ordered stale beer grounds poultice ; nutritious diet; and ten grains of 
chlorate of potash in barley-water three times a day. ULCERS. 
745 
This treatment was pursued with speedy success, subduing the phage- 
denic tendency, and causing a healthy action to be set up in the ulcerating 
surface. In a few days, a simple bread cataplasm was substituted; and at 
the end of three weeks the child was quite cured. 
The above cases fully prove the value of nitrate of silver in solution and 
stale-beer grounds as applications in phagedenic action ; at the same time 
the effects of chlorate of potash must not be forgotten as an important 
agent in checking acute ulcerative spreading. Part xxiv., p. 220. 
Granulating Surfaces.—To protect raw granulating surfaces from the 
atmosphere, lay a thick semifluid aqueous solution of gum tragacanth on 
the raw surface; if it is imperfect in any part repair such by another 
layer. This application, says Professor Miller, produces no irritation, and 
being translucent permits a complete surveillance. Vide “ Collodion.” 
Part xxiii., p. 288. 
Obstinate Ulcers—Tincture of Cantharides.—Mr. Tait gives the follow- 
ing mixture, which has been recommended as being of great utility in these 
affections: Tinct. of cantharides, 12 drops; iodide of potassium, 5ss.; com- 
pound tincture of cinchona bark, §j.; water, seven ounces. Mix. §j. ter 
die; and apply the following lotion: Tincture of cantharides, twelve 
minims ; diluted nitric acid, twenty drops; compound tincture of cinchona, 
two drachms; water, one ounce. The tincture of cantharides is of great 
utility in indolent ulceration, dependent either upon atony of the engaged 
parts, or system generally. It is useful—1st. Where the granulations are 
exuberant, but pale, weak, and flabby. 2d. Where there is deficiency, 
or total absence of granulations, the ulcers being deep and scooped out, 
with raised and indurated edges. 3d. Where the granulations are not 
defective, but cicatrizing irregularly, sometimes in the centre, at other 
times on one side, the lymph which is thrown out and organized on one 
day being absorbed the next. Part xxiii., p. 325. 
Chronic and Secondary— Use of Phosphate of Lime.—In chronic ulcers, 
resulting from scrofulous diathesis, Dr. Reneke recommends the use of 
phosphate of lime, in doses of from eight to twenty grains per diem. It 
should be ordered to be taken with the breakfast, dinner, and supper, so as 
to be thoroughly mixed with the food. These cases are accompanied 
always by a want of the proper cell growth, which the phosphate is said 
to increase in a remarkable manner. The phosphate, nevertheless, cannot 
be said really to cure the scrofulous dyscrasia, but we shall certainly pro- 
mote the cure in the most efficient manner by its administration. 
In persons who have suffered from secondary ulcers, ulcers of the bones, 
etc., and who have become exceedingly weak and emaciated, give (along 
with the preparations of mercury, of which the iodine may be preferred) 
the phosphate of lime in doses of fifteen to twenty grains during the day. 
Part xxiv., p. 303. 
Ulcers.—Mr. Holt, of Westminster Hospital, recommends to exclude 
the atmosphei'ic air by the following treatment, after the inflammation has 
subsided. From a piece of adhesive plaster somewhat larger than the 
sore, a portion, just the size of the sore itself, is cut out; the plaster is 
then applied to the part, and painted with collodion. Oiled silk is now 
placed over the ulcer, and made to adhere to the plaster by means of the 
collodion, by which process the air is completely excluded from the ulcer- 
ative surface. The whole is then secured by strips of adhesive plaster 746 
ULCERS. 
placed crosswise, and by a roller running from the toes to above the 
knee. Part xxv., p. 266. 
Treatment of Ulcers of the Leg.—The facilitation of the flow of blood 
toward the heart is the great object to be attained in treating ulcers of the 
leg. Many methods have been proposed whereby to effect this. That 
employed in the Middlesex Hospital, is the most easy and rational; the 
limb being raised high above the level of the body on an inclined plane. 
By such a plan ulcers commonly heal rapidly. 
The out-patients of the London Hospital are treated as recommended 
by Mr. Critchett, by strapping the whole leg from the toe to the knee 
with inch-wide strips of plaster, and applying a bandage as tight as can 
be borne. The plaster should be made of unirritating material, and spread 
on unglazed calico. In the London Hospital the emp. plumbi is used. At 
St. Bartholomew’s, Mr. Wormald directs the application of a folded com- 
press of lint over the trunk of the internal saphena, immediately below the 
knee, to be fixed with considerable tightness, by means of a broad strip of 
sticking-plaster. The same object is gained yet more effectually by Mr. 
Startin’s elastic spiral bandage, as used at the Hospital for Diseases of the 
Skin. These ulcers are essentially of an inflammatory character, and the 
blistering the edges by some blistering fluid (Bulleyn’s is the best) is often 
followed by remarkable benefit. At the Hospital for Diseases of the Skin 
the patient is put under a continued course of iodide of potassium, or binio- 
dide of mercury, and the following ointment is applied to the ulcer: Hyd. 
bisulpliuret, hydrarg. nitric, oxyd. aa. §ss.; creasote, mxx.; adipis recentis, 
3xvi. Misce. 
In an obstinate case of this disease, Mr. Gay, finding the skin imme- 
diately in the neighborhood of the ulcer very tense, and unable to yield 
further to the contracting power of the scar, divided that part of the skin 
where the tension existed in the greatest degree. Three weeks after, the 
ulcer was quite closed. Mr. Gay observed that it was only by altering the 
direction of the traction, and transferring it to more healthy and movable 
parts, that any advantage can be expected from measures similar to the 
above. Part xxvii., p. 159. 
Cancroid.—Dr. Roe, of Westminster Hospital, recommends from one 
eighth to one-fourth of a grain of ammonio-sulphate of copper three times 
a day. It may be continued for many months. Part xxvii., p. 248. 
Ulcers—Indolent and Callous.—Instead of employing the expensive 
and troublesome plan of strips of adhesive plaster, Professor Syme recom- 
mends to apply a large blister. This quickly relieves the hard swelling of 
the limb, and allows speedy healing and sound cicatrization without further 
trouble. 
Varicose.—Professor Syme recommends to apply simply the common 
black-wash lotion. Under this plan they generally readily heal. 
Part xxvii., p. 352. 
Venereal Ulcers.—Instead of the violent treatment which has been com- 
monly employed for this kind of nicer—such as rubbing over the surface 
with caustic potass, and pushing it into the several sinuosities—Prof. Syme 
recommends to apply a blister over the sore, and administer small doses ULCEKS. 
747 
of iodide of potassium to the extent of two grains twice or thrice a 
day. Part xxvii., p. 353. 
Treatment of Indolent TJlcers by Incisions.—The principle in Mr. Gay’s 
method of treating ulcers which have resisted all other modes, is to relieve 
the tension of the shin or other tissues, by making incisions at right angles 
with the line of tension; or where the tension is at the edge of the sore, 
to supply new skin altogether by a species of plastic operation. 
Mr. Chapman proposes a modification of Mr. Gay’s new operation, 
where the edges of the ulcer are adherent to the tissues beneath; this is, 
to glide a double-edged bistoury under the tense margins of the sore, so 
as to set them free, and allow of their edges being brought as near into 
contact as possible across the suppurating surface. Part xxviii. p. 240. 
Treatment of Callous Ulcer by Excision of the Margin.—Mr. Hain- 
worth thus describes the disease : The apparently sunken, nearly circular 
or oval ulcer, varying in diameter from one-third of an inch to three, four, 
or five inches, having a level, pale-red, glassy surface, void of granulations, 
excreting a thin, scanty, unirritating fluid, with a hard, precipitous, white 
or dusky edge, surrounded by integument, thickened and indurated by 
infiltration of lymph and serum, even now occupies too many a bed in our 
great hospitals, and too frequently exhausts the patience of sufferer and 
surgeon, dresser and nurse. 
From this description it wfill be seen, that those ulcers are purposely 
excluded from consideration which are either inflamed or irritable—which 
depend simply on a varicose state of the veins—which are complicated 
with diseased bone, or with any special local or constitutional cause. 
The primary obstacle to the successful treatment of this ulcer is the pre- 
sence of a compact and effete solid ring of cuticle. This must be excised 
by carefully shaving off the accumulated cuticle without wounding the 
cutis. Part xxix., p. 242. 
New Mode of Treating Ulcers from Irritation of the Nails.—[Mr. lire 
related the following case of a young woman, aged 23, who was under his 
care at St. Mary’s Hospital.] 
Four months before admission, the great toe of the right foot became 
uneasy and swollen, the patient having pared the nail the day preceding. 
Ere long, a painful and irritable sore made its appearance by the side of 
the nail, which discharged from time to time a quantity of thick, bloody, 
and sometimes black-looldng matter. 
As the sore was rather in an inflamed state on her admission, poultices 
were applied. On the third day, when all surrounding inflammation 
seemed to have subsided, Mr. Ure prescribed the use of-a salve composed 
of one grain of finely levigated arsenious acid, incorporated with an ounce 
of spermaceti ointment. He was led to try this remedy by the suggestion 
of Mr. Copeland, who deemed it almost a specific in ulcers of this nature. 
This was steadily employed for about ten days, without producing any 
marked change on the sore. Mr. Ure then ordered, instead, the contin- 
uous application of a hot saturated solution of alum. This induced rapid 
absorption of the thickened parts, and prompt cicatrization of the ulcerated 
surface, so that the patient was enabled to leave the hospital, cured, in the 
course of three days. 4 Mr. Ure observed that, while alum is soluble in five 
parts of water at 60° Fahr., it is soluble in little more than its own weight 748 
ULCEUS, 
of water at the Tboiling temperature. A hot saturated solution is, conse- 
quently, more energetic in its action than a cold one. Part xxix. p. 247. 
Extensive Phagedenic Ulceration, Successfully Treated by the Actual 
Cautery.—[This patient, 25 years of age, ten days after exposure to con- 
tagion, observed a small pimple near the frenum on the penis. Caustic was 
liberally applied, apparently with success. At the end of a fortnight, 
swelling in the groin came on, an abscess formed, which burst spontane- 
ously. The sore on the penis was nearly healed. Subsequently the oj)en- 
ing in the groin extended rapidly, and he soon labored under all the symp- 
toms of irritative fever.] 
Where the chancre had existed there was a slight depression, some dis- 
coloration, but no hardness of the base; it had been cicatrized for two or 
three weeks. In the groin was a foul ulcer of the size of the palm of the 
hand; its surface presented a yellowish dark aspect; the edges of the 
wound were ragged, uneven, and undermined, secreting a thin, fetid, 
sanguineous discharge; an areola of a livid tint surrounded the wound for 
a considerable extent. Ordered to be confined to bed, to live on broths, 
jellies, and farinaceous food. The compound decoction of sarsaparilla with 
nitric acid, twelve grains of Dover’s powder, at bed time. To the ulcer, 
the nitrate of silver, an opiate lotion, and poultice of linseed-meal. To 
give the symptoms and treatment of this protracted case in extenso would 
be tedious. Suffice it to say he took the compound decoction and extract 
of sarsaparilla, the mineral acids, quinine, opium, and various preparations 
of iodine; to the wound were applied the strong nitric acid, muriate of 
antimony, the balsam of Peru, different kinds of lotions, ointments, and 
poultices. The edges of the ulcer were cut away by means of curved 
scissors; a moderate allowance of stimulants and a suitable regimen en- 
joined ; still, however, the phagedena continued progressing, so that vffien 
all treatment to stay its progression had failed, it was determined to apply 
the actual cautery. It was done at once; and the parts covered with lint, 
spread with cerate composed of two parts of resin cerate, and one of oil 
of turpentine; forty drops of tincture of opium were given to procure 
sleep. The recovery of the patient thereafter was truly remarkable. 
Part xxix. p. 247. 
Cancerous Ulcers.—Mr. Weeden Cooke recommends a carrot poultice 
to be applied to cancerous sores Avhen offensive. It should be changed 
every few hours. Mr. Chatterley says that wood soot (not powdered 
charcoal) answers very Avell for the same purpose. The wood soot should 
be sprinkled from an ordinary tin pepper box, on the outside of the other 
dressings used. It may be obtained from chimneys of fire-places in which 
wood and nothing else is burned, or from the ovens of ham and bacon 
curers. * Part xxix., p. 321. 
Treatment of Phagedena.—For a considerable period past, a mild form 
of hospital phagedena has been prevalent in the various London insti- 
tutions. 
It has generally attacked superficial wounds, whether those resulting 
from accidents or operations, and, in a few instances, even stumps have 
been affected with it. The treatment which has certainly been found of 
most general benefit has been the application of pure nitric acid. In a 
case under the care of Mr. Coulson, a man in good admitted on 
account of a laceration on the dorsum of the right foot, had the wound ULCERS. 
749 
so severely affected by phagedena, that amputation was seriously pro- 
posed. The nitric acid was freely applied, by soaking a piece of lint, and 
then pressing it into the sore ; it was allowed to remain seven hours, and 
completely achieved its intention. The gangrene ceased to spread, the 
sore took on healthy action, and rapidly cicatrized. Neither in this nor 
in any one of several other cases in which the dorsum of the foot was the 
affected part did any sloughing of the tendons follow the use of the acid. 
It appears to be in cases of simple phagedena that the local use of nitric 
acid is most to be depended upon, since those of syphilitic origin not un- 
frequently resist its influence. A case of the latter character, occurring in 
a young and seemingly healthy woman, was lately under the care of 
Mr, Stanley, in St. Bartholomew’s Hospital, and, in spite of all measures, 
ultimately terminated in death. Nitric acid had more than once been 
freely applied, and opium, cinchona, chlorate of potash, etc., had been 
fairly tried. In the Middlesex Hospital, the favorite treatment for phage- 
dena is by opium pushed freely until its effects become apparent. Some 
very successful cases are accredited to this plan. It is observed, that 
there seems scarcely any limit to the quantity which may be borne, and 
that, generally, before any narcotic effects become apparent, the sore takes 
on a healthy action. Now and then the acid succeeds admirably in syphi- 
litic cases ; as a rule, however, they seem more amenable to constitutional 
than local measures. 
The most convenient mode of applying nitric acid is by means of a glass 
brush ; in the absence of which, however, a glass rod succeeds very well. 
Part xxx., p. 11*1. 
Ulcer of the Leg in Elderly People.—According to Mr. Skey, of St 
Bartholomew’s, opium has a wonderful effect as a stimulant in these cases. 
Give good diet, and a common opium and soap pill at bedtime. Assist 
by strapping and bandaging if necessary. The soap and opium pill may 
be given, once, twice, or three times a day if necessary, and if other 
symptoms do not forbid its exhibition. Sometimes the soap and opium 
purges; in this case leave off the soap, and give half a grain of extract of 
opium night and morning, or once a day; increase to one grain if necessary. 
Opium gives energy to the capillary system of arteries, promotes warmth, 
and thus secures an equable balance of the circulation.— Vide Art. 
“Opium.” Part xxxi.,/>. 192. 
Use of Acid Nitrate of Mercury—For Sloughing Ulcers.—The prac- 
tice of treating unhealthy ulcerations wherever situated, by means of 
caustics, is much pursued at this hospital, and with excellent results. The 
pain attending the application of nitric acid has been much overrated by 
the profession generally. 
Its powers in case of phagedena are now widely recognized. The pain 
spontaneously caused by an unhealthy sore during a single night is proba- 
bly much more than that produced by an application of caustic. In most 
cases of sloughing or unhealthy ulcers, Mr. Startin employs either the 
solution of the acid nitrate or the arsenical paste. The rapidity with 
which the surface granulates afterward is often surprising. 
Part xxxi., p. 240. 
Spender's Chalk Ointment in Ulcers of the Leg.—The following for- 
mula has been very successfully used in chronic non-specific cases of this 
kind: R Cretse prep., Ibiv.; adipis suilli, Ibj.; olei olivae, §iij. 750 
ULCERS. 
Having heated the oil and lard, add gradually the chalk, finely pow- 
dered. 
The ointment and a bandage being once applied, it is left until the 
cicatrix forms and becomes firm. Part xxxii.,£>. 196. 
Phagedenic Ulceration.—When situated upon an extremity, and the 
sore can be well exposed, Mr. Cock, of Guy’s Hospital, advises to try con- 
stant irrigation. You must have a reservoir above the bed filled with luke- 
warm water, to which a little* chloride of lime or soda has been added as a 
preventative of smell. Then by means of an elastic tube a stream must be 
kept continually flowing over the sore. By this means all particles of dis- 
charge, etc., are washed away as soon as formed, and a speedy arrest of 
morbid action is secured; of course this is based on a supposition that 
phagedenic action is a process of local contagion, the materies morbi by 
which the ulcer spreads being its own pus. Part xxxiii., p. 233. 
Astringent Lotion for Ulcers.—A lotion, consisting of half a drachm of 
the tincture of catechu, to a pint of the decoction of oak bark, is a favorite 
one at the Aldersgate-street Dispensary, as an application to foul and 
indolent ulcers on the leg. Mr. Savory, the surgeon to that institution, 
finds it superior in efficiency to most other astringents. It is applied freely, 
a piece of lint being well soaked in it and laid over the sore. 
Part xxxiii., y>. 238. 
Cancerous Ulcers.—From a trial of a great variety of applications, the 
following lotion seems to answer perhaps the best: RPlumbi acet., 9ij. ad 
3j.; creasoti ntxl. ad 3j-; aq. fluvial., §xij. M. Ft. lot. 
The acetate of lead and the creasote form a uniform mixture, and there 
is no separation of the latter ingredient. A piece of lint soaked in the 
lotion, and applied to the ulcer twice or three times a day, is Mr. Valen- 
tine’s mode of applying it. The whole is covered by an oiled silk. 
Part xxxiii., p. 239. 
Ulcers—Spreading and Sloughing.—Mr. Stanley, of Lock Hospital, says 
that the best of all the usual remedies for such affections is the external 
application of the “ Friar’s Balsam,” (tict. benzoin co.) 
Part xxxiii.,p. 237. 
Treatment of Ulcerated Legs.— The most important point, in the 
opinion of Dr. Thos. Westlake is to get rid of the superincumbent column 
of blood which impedes the circulation ; this is best done by means of a 
flannel bandage, from seven to eight yards long and three inches wide, 
applied very carefully, so as to give complete and uniform support to the 
affected limb. In indolent ulcers the compound tincture of iodine is the 
most safe and efficient stimulant. In irritable ulcers, the application of 
the following lotion—iodide of potassium, one scruple; hydrocyanic acid 
(Scheele’s) half a drachm; camphor mixture, one oz.—applied for four or 
five minutes with lint well saturated acts like a charm. The following 
ointment may be afterward employed; spermaceti ointment, half an 
ounce ; iodine, five grains; extract of belladonna, one drachm. 
Part xxxiv., p. 197. 
Ulcers of the Leg.—Dr. J. K. Spender says: we must endeavor to • 
preserve the purulent secretion which nature has provided as a protective 
covering; if this be deficient, the best ointment as a substitute will be one 
composed of two parts of lard and three of chalk mixed when heated and ULCERS. 
751 
fluid ; this must be applied spread on linen and over this a flannel or calico 
bandage. If the ulcer be extensive and the discharge great, it should be 
dressed every day, but generally ulcerated legs are disguised much too 
frequently; all interference should be postponed as long as possible. One 
great advantage of the chalk ointment is, that it neutralizes the acrid 
secretion, and allows the dressing to remain much longer than otherwise, 
without interfering with the healing process. When removing the dress- 
ing, be careful that you do not take away the ointment vThich may adhere 
to the ulcer, or you will very much hinder it's healing. 
General principles of treatment often require some modification in prac- 
tice. The instances in which the chalky incrustation and compression has 
answered best are superficial ulcerations, however extensive the surface, 
and whether dependent on varix or not. Deep and callous ulcers require 
a special treatment, which is best fulfilled by the addition of a stimulant to 
the chalk ointment, and the best is, the nitric oxide of mercury; ointments 
of tar and chalk, and iodine and chalk, are found to subdue many forms of 
irritable ulceration. Dr. Hughes Bennett and others confirm the value of 
tar in all dermal affections of a psoriasical character. The use of ban- 
daging is of equal importance, to afford a support to the veins. Poultices 
are generally injurious, and cannot be condemned in too emphatic terms ; 
they relax and weaken the structures and granulations, which rather require 
tonics and support. The application of a poultice is nothing less than a 
mischievous interference with the natural healing process. Lotions of 
every kind are equally prejudicial. The constant application of cold water 
is exceedingly injurious. To keep patients in bed is a useful element in 
the treatment of varicose ulcers of the leg, but compression answers 
every object to be gained by the assumption of the recumbent position; 
and whenever compression is resorted to, exercise confers the direct and 
positive benefit of assisting and sustaining those processes necessary for 
restoration, it sets up an additional energy in the process of reparation by 
its direct effects as a stimulus. Of the various measures which have been 
proposed for the treatment of varicose ulcers of the leg, we may notice 
Mr. Syme’s proposal for blistering the edges of the callous ulcer. Mr. Holt 
has proposed the exclusion of atmospheric air by the application of plaster, 
oiled silk, and collodion. M. Denonvilliers has recently brought glycerine 
into notice as a clean and useful application to ulcers. Dr. Neumann is an 
advocate for the application of charcoal. Mr. Gay maintains that the edge 
of the ulcer is not free to contract, being bound down to the tissues be- 
neath, and therefore recommends an incision to be made through the 
healthy skin and superficial facia, within a short distance of the edge of 
the ulcer, in a direction parallel to the direction of the axis of the limb. 
Mr. Chapman adopts a modification of this, but considers the cases very 
rare where it would be required. To Mr. Hainsworth is due the credit of 
reviving the ancient practice of excising the margin of the callous ulcer. 
The late Dr. Golding Bird and Mr. Spencer Wells have explained and 
illustrated the application of the electric moxa. Mr. Skey advocates the 
use of opium upon principles which are unquestionably authentic and 
sound. Part xxxiv., p. 202. 
TJlcers of the Leg.—If the ulcers are gangrenous, they may readily be 
made healthy by applying a powder made of equal parts of fine charcoal 
and chalk, and over this a poultice, or dry lint and bandage. If very pain- 752 
ULCERS. 
ful and irritable, apply a dossil of lint dipped in chloric ether, and over 
this the bandage. If sanious, or fungoid, apply freely the nitrate of silver, 
or sulphate of copper. If sluggish, they must be roused into action, by 
applying the nitric oxide of mercury ointment. If the edges are hard and 
cartilaginous, draw the edges tightly together by straps of plaster, and 
apply a flannel bandage as tightly as possible, to awaken the absorbents 
into activity. For simple sores, the simple ointment is best, with a band- 
age as tightly applied as it can be borne. If much matter is discharged, 
they should be dressed daily, and in all troublesome cases a flannel band- 
age is absolutely indispensable; it will be found to be very much superior 
to the usual calico bandage, if' properly applied. (Dr. Hunt.) 
Part xxxv., p. 166. 
Ulcers—Old Callous.—Dr. Watson, surgeon to the Royal Infirmary, 
Glasgow, says: If an ointment consisting of anhydrous sulphate of zinc, 
mixed with glycerine, spread upon bits of lint the size of the ulcers, be 
applied to them, and allowed to remain a few hours, most acute pain will 
be caused, and the ulcer will be corroded; but when the slough separates, 
the granulations will rapidly spring up to a level with the surrounding 
parts, and in most cases will soon become skinned over. The sulphate of 
zinc is as suitable, but not superior to the chloride for this purpose. 
Part xxxvi., p. 259. 
Powdered Chlorate of Potash as an Application to Ulcers, etc.—Mr. 
Hutchinson, of the Metropolitan Free Hospital, says that finely powdered 
chlorate of potash is an excellent application to cachectic ulcers ; it seems 
to speedily induce cicatrization, and is very convenient of use; it is of 
great use in cracked nipples and open buboes; it should be dusted into the 
sac with the finger, and it may also be prescribed internally at the same 
time. Part xxxvii., p. 175. 
Ulcers of the Leg.—At the Hospital for Skin Diseases, the patient is 
always directed to bandage the limb, though no very particular attention 
is paid to this part of the treatment. Internally the mistura hyd. com. is 
mostly ordered, and to the sore itself the unguentum rubrum is applied. 
If the ulcer is sloughy or very unhealthy looking, the acid nitrate of mer- 
cury is applied as a caustic previous to the use of the ointment. Confine- 
ment is not insisted on. From the rapid healing which often ensues, 
probably the mercurial induction, both internal and local, has usually a 
considerable share in the cure. Part xxxviii., p. 173. 
Caustic Lint.—Nitrate of silver is never applied to sores, except in the 
solid state or in solution. In the former case its action is often too severe; 
in the latter it is sometimes too transient. M. Riboli has conceived the 
idea of dissolving nitrate of silver in a small quantity of water, soaking 
pledgets of lint in the solution, and drying them. This caustic lint, applied 
to ill-conditioned ulcers, produces a more permanent effect than the remedy 
in a liquid state; and as the author proposes different degrees of concen- 
tration for the solution the activity of the treatment may be varied, accord- 
ing to the nature of the case, and the more or less advanced stage of the 
affection. Part xxxix., p. 232. UMBILICAL COED—UMBILICUS. 
753 
UMBILICAL CORD. 
Advantages of retaining Undivided for a Short Time after Birth.—In 
all cases where the infant is born weakly or in a state of asphyxia, M. Bau- 
delocque recommends not to cut the umbilical cord for some time at least 
after birth. He relates that since he has followed the opinions of Smellie, 
Levret, Chaussier, etc., on this subject, he has not lpst a single case, 
although when born the child might be in a state of pretty complete as- 
phyxia or apoplexy. He states that, though a child be born in an apoplectic 
or asphyxiated state, the circulation still continues through the umbilical 
vein, even though the umbilical arteries should have ceased to beat, and 
that premature section of the umbilical cord takes away one of the chief 
aids to its revival. Part iv., p. 135. 
Treatment of Hemorrhage from the Navel of New-born Children.— 
Ordinary remedies are insufficient to arrest the bleeding. Ivolophonian, 
alum, the various styptic fluids, turpentine, ice, amadou, compression, etc., 
have been employed in vain. Cauterization has been several times tried, 
both with the nitrate of silver ami the actual cautery. In fact, the use of 
the ligature appears to be the only means worth dependence upon as capa- 
ble of restraining the bleeding, and the mode of its application en masse, as 
advised by Dubois, is to be preferred. But in the best manuals and trea- 
tises we find no advice given as to the method of securing immediately 
the umbilical arteries, and, so far as we know, it has never been accom- 
plished, from the many difficulties attendant upon its performance. It has, 
therefore, been proposed to secure all the three vessels together, by pulling 
the navel-knot forward, and passing around it a ligature with the help of 
hare-lip pins. At first sight this operation seems to have much in its favor, 
though experience does not confirm it. Nevertheless, up to the present 
time, it has been of most service.—Roger, in Journ. f.*Kinderh. 
Part xxix., p. 311.. 
UMBILICUS. 
Treatment of Urinary Discharge from the Umbilicus, in Infants.—B* 
Cooper says that, in infancy it is not uncommon for a nrinary discharge to 
take place from the umbilicus, in consequence of the open state of the 
urachus; in such a case you should first ascertain that there is no obstruc- 
tion to the passage of the urine through its natural canal, and if that 
should be the case, as frequently happens from congenital pliymosis, the 
cause of the obstruction should be removed, and then, upon gentle pres- 
sure being applied to the umbilicus, the urachus generally closes, although 
there have been instances in which the defect was never remedied. 
Part xviii., p. 203. 
Hemorrhage from the Umbilicus after Separation of the Funis.—When 
a disposition to this hemorrhage is known or suspected, says Mr. Ray, 
apply collodion after the separation of the funis, and before the usual com- 
press is applied; and examine the part every day. When the bleeding 
actually occurs, it is necessary to adopt mechanical means to check it with- 
out the least delay. For this purpose, first pinch up the umbilicus between 
VOL. II.—48 754 
URETHRA. 
the finger and thumb, in the manner recommended for leech-bites; and if 
this is successful, fill the depression of the umbilicus with cotton wool, and 
coat it over with collodion, or apply plaster of Paris mixed up with water. 
If these means do not control it, make an eschar with a probe, director, or 
skewer, heated to whiteness, and afterward coat with collodion. Lastly, 
if other means fail, tie the vessel, first introducing a fine probe into it, to 
act as a guide for the incision. Ligature is not recommended except as 
a last resource, because in these cases there seems to be a hemorrhagic 
diathesis, and, consequently, it is undesirable to make incisions. 
Part xix., p. 256. 
URETHRA. 
Inflammation of Mucous Membrane of Urethra—New Mode of In- 
troducing the Catheter.—Dr. Patterson, of Rathkeale Infirmary, gives the 
following case: The patient labored under most distressing inflammation 
of the mucous membrane of the his bladder was greatly dis- 
tended with urine, which he could only pass in drops and in extreme 
agony; there was a most unbearable desire to empty the bladder, occa- 
sioned, in a great measure, it may be presumed, by that organ’s partaking 
of the inflammatory action. The morbid sensibility of the urethra was 
such as that no instrument of any kind could be introduced, and the 
patient’s impatience could not wait the abatement of the inflammation, 
under the employment of the most active means. In this case I attached 
an injecting apparatus to a curved elastic catheter, and, having inserted 
the extremity of the tube a little way within the orifice of the urethra, I, 
in the gentlest manner, injected, or rather insinuated a little warm decoc- 
tion of linseed, just so as to moderately distend the urethra; I then 
gradually urged tMe catheter onward, and succeeded in getting it into the 
bladder, with little or no pain or inconvenience to the patient. 
Part iii., p. 97. 
Mechanical Injury of.—Obstructions of the urethra may arise from 
mechanical injury to various parts of the urethra, as, from the violent 
pressure of some circular body, as a ring round the penis, or a blow upon 
the urethra as it passes under the pubes where the mucous membrane is 
especially liable to suffer from such a cause. Sir B. Brodie gives the fol- 
lowing directions with regard to the treatment: 
“ In all cases,” he says, “ in which there is reason to believe that the 
urethra has been divided or lacerated in consequence of an injury inflicted 
on the perinaeum, it is the duty of the surgeon not only to look at the 
great and immediate danger, but to guard against future ill consequences; 
and much may be done at this period toward preventing a most serious 
inconvenience, which would be relieved with difficulty afterward. If 
there be a penetrating wound, in which the urethra is probably implicated, 
an elastic gum catheter should be introduced with the least possible delay, 
and allowed to remain in the urethra and bladder until the healing of the 
wound is far advanced, or, at all events, until it is ascertained that the 
urethra has not suffered; the catheter being, however, occasionally re- 
moved for a limited time, if it seems to act as a source of irritation. 
In cases of contusion of the perinaeum, when the effusion of blood in the 
perinaeum and scrotum, and more especially the discharge of blood from URETHRA. 
755 
the urethra, or any other circumstances, lead to the suspicion that the 
urethra has been lacerated, the same treatment should be had recourse to, 
the gum catheter should be introduced as soon as possible, and allowed to 
remain for at least some days after the occurrence of the accident. The extra- 
vasation of blood does not in itself justify the making an incision in the 
perinaeum. ; and indeed, according to my experience, there can be no worse 
practice than that of making an incision in a case of simple ecchymosis, 
either in this or in any other situation. But where such extravasation exists, 
there is always reason to apprehend that there may be further mischief; 
the progress of the case, therefore, should be carefully watched, and, on 
the first appearance of any symptoms which might be supposed to indicate 
that urine had escaped into the cellular membrane, or that suppuration had 
begun to take place, a staff should be introduced into the urethra instead 
of the gum catheter, and a free incision should be made from the perinaeum 
into it, the gum catheter being' replaced afterward. 
But it may be that these measures of precaution have not been adopted 
in the first instance, and that you are not consulted until after the lapse of 
a considerable time, when the wound or laceration of the urethra is already 
healed, leaving the urethra contracted in the situation of the cicatrix. 
Here you may, perhaps, succeed in gradually dilating the urethra, as 
where there is an ordinary stricture. But in a case which I have already 
mentioned, I have stated that “ this was not accomplished without a great 
deal of local and constitutional disturbanceand so it has been in all 
cases of this kind which have fallen under my observation. Nor will the 
occurrence of such difficulties be a matter of surprise to any one who bears 
in mind that here the object is to dilate, not a genuine stricture, but a 
cicatrix, of the urethra, and who has not observed how the cicatrix of an 
old sore leg inflames and cracks when the subjacent muscles begin to 
increase in bulk from exercise, or how the endeavor to extend forcibly the 
contraction after an extensive burn produces the same result. It may be 
that these difficulties are insuperable under the method of treatment by 
simple dilatation ; and under these circumstances, a small staff having been 
introduced into the bladder, the cicatrix of the be divided 
by an incision from the perinaeum, a gum catheter being introduced after- 
ward, and allowed to remain until the wound is healed over it. But 
even then much remains to be accomplished. The cicatrix has still a 
greater disposition to contract than an ordinary stricture; the bougie or 
catheter must be had recourse to almost daily, and the patient must be 
contented if he can persevere in the use of instruments of a moderate 
diameter, as the urethra will invariably resent the attempt to keep it 
dilated by those of large dimensions.” 
The condition of the patient is improvable, where the injury of the 
urethra is limited. But where there has been actual loss of some portion 
of the canal, the patient must either be content to void the whole of his 
urine by the perinaeum, or submit to an operation for establishing a com- 
munication between the anterior and portions of the urethra. 
This operation is best explained by a case. 
“ A young man, in making a leap on horseback, received a violent blow 
on the perinaeum from the pummel of the saddle. The immediate conse- 
quence of the injury was hemorrhage from the urethra, and this was 
followed by extravasation of urine and sloughing of the perinaeum to a 
considerable extent. A catheter was at first introduced into the bladder, 756 
URETHRA, 
but it was afterward removed. The sloughs having separated, the sore 
in the perinaeum gradually closed, a small fistulous opening only being left 
immediately behind the scrotum, through which the whole of the urine 
was discharged. He was in this state seven months after the occurrence 
of the accident, when he arrived in London, and Mr. Baker advised him 
to have my opinion on the case. 
On introducing an instrument into the urethra, I found an obstruction 
of the canal immediately below the pubes. Several ineffectual attempts 
having been made to penetrate the obstruction in the usual manner by 
bougies and sounds of various sizes, I had recourse to the following opera- 
tion : The patient having been placed in the same position as in lithoto- 
my, a staff was introduced into the urethra, and held by Mr. Hilles, who, 
with Mr. Baker, assisted me in the operation, with the extremity of it 
resting against the obstruction. I then made an incision in the perinasum, 
extending backward from the part in which the staff was to be felt, in 
the direction of the prostate gland. It was now evident that not less 
than three-quarters of an inch of the urethra was deficient below the pubes, 
the place of it being occupied by a rigid cicatrix. This having been 
divided longitudinally by the point of the scalpel, I was enabled, though 
not without some difficulty, to pass the staff from the part at which the 
extremity of it rested, into the sound portion of the urethra toward the 
bladder, and then into the bladder itself. The staff' was then withdrawn, 
and an elastic gum catheter having been substituted for it, the latter was 
allowed to remain in the urethra and bladder. On the ninth day after the 
operation, there being some degree of irritation at the neck of the bladder, 
the catheter was removed, being reintroduced, however after two days 
more. From this time it was removed at intervals, which were sometimes 
longer, sometimes shorter, according to circumstances. The wound in 
the perimeum gradually healed, and in less than ten weeks from the time 
of the operation was reduced to the diameter of a small pea. The patient 
was now able to introduce a silver catheter of the size of his urethra into 
the bladder without difficulty, and he repeated this operation so as to draw 
off his urine three pr four times daily. When he voided his urine without 
the catheter, by placing the point of his finger on the opening in the 
perimeum, he was enabled to discharge the whole in a sufficient stream by 
the urethra. Part vi., p. 101. 
Importance of Discriminating Diseases of the TJretlira.—(M. Civiale 
mentions two mistakes which are often made in the treatment of diseases 
of the urethra.) One consists in regarding as a poisonous discharge 
produced by gonorrhoea, that which is innocuous, and caused by irritation 
merely in the passage; such, for instance, as the presence of a stricture; 
the former being a virulent poison capable of reproducing ad infinitum, 
while the latter is perfectly harmless. 
Want of due discrimination in this case not unfrequently inflicts an irre- 
parable injury on the patient. For example; when a stricture, attended 
with a discharge from the passage, is observed soon after an attack of 
gonorrhoea, the patient naturally considers that he is suffering from the 
gonorrhoea, which had not been properly cured ; and should the person 
who has the treatment of the case entertain the same opinion, the result 
will be that the patient will continue taking copaiba, cubebs, etc., off and 
on for months, perhaps years, to the great injury of his stomach and UEETHKA, 
757 
system in general, while the stricture all the time is gradually getting 
worse. There is a curious point in reference to the effect of copaiba on 
this kind of discharge, and it is this—the discharge is always relieved, but 
never removed by copaiba, unless in conjunction with the use of bougies. 
This fact again tends materially to perpetuate the erroneous treatment, as 
the inference at once suggests itself, that copaiba, etc., will cure this dis- 
•charge if persevered in, inasmuch as it always exerts a marked influence 
on it. But however good the argument, the practice is bad, for it will 
never cure such a discharge. The practitioner very commonly remains in 
ignorance of his error, by reason of the patient becoming dissatisfied with 
his treatment, on feeling no permanent benefit from it, and therefore, 
soliciting the assistance of various others for the relief of what he and they 
regard as an incurable clap. 
Occasionally, the discharge caused by the irritation of a stricture is 
attended with many of the symptoms of a regular gonorrhoea; but when 
it is generally known that it is so, there will be experienced but little 
difficulty in practice, in distinguishing these discharges, "which differ so 
materially in their effects on the system. 
The other mistake refers also to the presence of a stricture. It is the 
received opinion, being so laid down in all works on surgery, that the 
stream of urine through the urethra bears an exact ratio to its calibre. It 
would be so, were the urethra a dead body; but being endowed with 
vitality which is acted upon by muscles—whether in its substance or not 
is immaterial—the result is, that a person afflicted with a permanent 
stricture may pass his urine in a good stream, because when he feels a 
desire to evacuate, his urethra, obedient to his will, opens out, so to speak, 
at its strictured part, and discharges a larger-sized stream than would 
have passed through it, had it been an inanimate body. 
In practice this consideration is of high importance, for if a person 
afflicted with a permanent stricture passes his water in a fair stream, a 
surgeon in this particular, misled by his teachers, will pronounce the case 
not to be stricture, to the great injury of his patient. Indeed, no error 
that can be made in surgery is attended with more serious results than 
this, because the case, from being misunderstood, gradually gets worse, in 
spite of all treatment, bougies not being introduced, until some exciting 
cause having supervened, irritation comes on in the passage; no urine 
whatever can be passed; and the patient’s life will be in extreme danger, 
should he not then be efficiently treated. Part xix., p. 185. 
Vascular Tumors at the Orifice of the Urethra.—Mr.-Norman, Surgeon 
to the Marylebone General Dispensary, directs to remove them by excision 
or by the ligature, the latter being preferable in consequence of the serious 
hemorrhage which sometimes attends excision: in either case apply a 
powerful caustic afterward to prevent the growth being reproduced. 
For very small tumors it will be sufficient to use the actual cautery, or 
caustics, such -as potash, nitric acid, and pernitrate of mercury: nitrate of 
silver is less efficient and much more painful. Part xx.,p. 162. 
Vascularity of the Lining Membrane of the Female Urethra.—Under 
the name of “ Vascular Tumor of the Orifice of the Meatus Urinarius,” 
says Dr. Gream, of Queen Charlotte’s Lying-in-Hospital, this affection was 
first described by Sir Charles Clarke, in his valuable work on the “ Dis- 
eases of Women.” 758 
UliETHKA, 
I have ventured to refer to this affection under another name, because 
my own experience, confirmed by that of others, tends to show that it 
does not always appear as a tumor, but that it may be present under 
other forms, accompanied by the same general as well as local symptoms. 
Dr. Ashwell has correctly described the disease, but he speaks of it 
more especially as a tumor, and states that it is rarely seen after the 
cessation of the menses. I am led to think that he is mistaken in this 
respect, for I have witnessed the disease as often in elderly women as in 
the young. 
It may be present as a simple vascularity of the lining membrane of the 
urethra, without any elevation whatever, extending some little distance 
toward the bladder; the membrane itself being highly florid in color, 
and extremely tender when touched, or during the passage of the urine. 
This is the usual character of the disease, when it is confined within the 
canal; but Sir Charles Clarke relates the case of a patient in St. Bartho- 
lomew’s Hospital, in whose urethra there was a tumor of a scarlet color, 
nearly filling up the canal. The occurrence of a tumor, however, within 
the urethra is unusual. 
The second form in which the disease appears, is that of a flattened 
vascular spot, with but slight elevation, surrounding the orifice of the 
urethra, highly florid in color, and exquisitely tender when touched ; it is 
so little elevated that it can scarcely be called a tumor. The redness 
extends from it into the canal for some little distance, but the membrane 
within, although florid in appearance, is quite smooth on its surface ; 
whereas the external spot of vascularity is slighlly granulated, because it 
is not modified by pressure from the sides of the urethra. 
In the third stage, the disease consists of a distinct tumor, granulated, 
and attached, sometimes by a broad base, sometimes by a narrow one, 
and, in some instances, even by a slender pedicle, to the side of the 
urethra, or just externally to it; and, in almost all cases, some dilated 
vessels will be seen extending from its base to within the urethral canal. 
When there is an actual prominent tumor, the local pain and the consti- 
tutional symptoms are greatly increased in severity. 1n some cases, the 
peculiar scarlet color of the part has attracted the notice of the patient; 
but in many instances, particularly when the vascularity is within the 
urethra, not only has the actual seat of the disease escaped her observation, 
but it has also been overlooked by her medical attendant, who has referred 
to the uterus as the diseased organ, has stated that its cervix was inflamed 
or ulcerated, and caustic has sometimes for weeks, or months, been applied, 
without affording the least advantage to the patient. 
This vascular disease is not at all to be considered as similar to an affection 
situated in the same parts, having its origin in a varicose state of the veins. 
In the vascular disease in question, the blood contained in the vessels is 
arterial, while in the venous enlargement it is dark colored, and the dis- 
tended veins have the same appearance which veins have in other parts of 
the body when in a varicose condition. Attention is first called to the vascu- 
lar disease, by an uneasy sensation at the lower part of the body, and pain 
passing down the thighs; and pain when urine is voided, or when the part 
is touched; slight bleeding also occurs occasionally, owing to the rupture 
of some dilated vessel, whose covering is always much attenuated. There 
may be frequent desire to pass urine; and walking causes great suffering; 
while accompanying these symptoms, there is always copious mucous dis- UEETHKA, 
759 
charge, which is excessive when the disease appears in the form of a tumor. 
Owing to which, as well as to the constant uneasiness and frequent acute 
suffering, the patient becomes emaciated and weak, and it is surprising to 
find so many and such severe symptoms arising from a disease whose 
extent is confined within such limited bounds ; but there is clear evidence 
that it does produce them in the fact that, immediately upon the destruc- 
tion of the vascular spot, or even on its partial removal, a comparative 
freedom from the symptoms is at once enjoyed. 
The only mode of cure is the destruction of the entire congeries of 
vessels ; and if the smallest part of it is left, the disease will most certainly 
return. 
Having several times been called upon to treat cases which had been 
before apparently cured (by myself and others) it occurred to me that the 
application of strong nitric acid, in the manner adopted by Mr. Henry Lee 
for the destruction of hemorrhoids (and which proves so successful,) 
would be equally applicable to the vascularity of the female urethra. 
But there is a difficulty in exposing the part sufficiently, and in prevent- 
ing the sides of the vagina from collapsing too soon after the application 
of nitric acid; and this is overcome by the use of a speculum, invented, I 
believe, by Mr. Hilton, for the removal of hemorrhoidal excrescences. A 
portion of the side of the speculum, extending nearly to its internal 
extremity, can be removed after its introduction into the vagina, and if 
this part of it is just under the pubes, the spot of vascularity will project 
into the tube; but should only the lining membrane of the urethra be 
vascular, it wTill be readily exposed by pressing the speculum firmly toward 
the pubes against the surrounding part; and the acid can be applied while 
the pressure is kept up. 
A small rod of glass, or a piece of hard wood in the form of the stick of 
a camel’s hair pencil, is the best thing with which to apply the acid; and 
this should be held to the part for about a minute, care being taken that 
each enlarged portion of the vessels is completely destroyed, and in about 
three or four minutes the pain attending it ceases, and the speculum can 
be removed. It will be better to examine the part in about four days 
from the time of the application of the acid, and it often will be found 
healed with no trace of the complaint left. More frequently it presents an 
unhealed sore, but an absence of the disease. If, however, there be any 
vessel remaining having the peculiar scarlet color, it should be again 
touched with the nitric acid, otherwise the symptoms will rapidly return. 
Part xxv., p. 297. 
Impermeable Urethra.—In cases of complete obstruction from wounds, 
Prof. Syme would introduce an instrument like the common lithotomy 
staff, but grooved on the concave side, through the fistulous opening of the 
perinaeum into the bladder, then pass the guide director employed for the 
division of strictures by external incision, down to the seat of obstruction, 
and thrust it through the opposing structures (in the course which it ought 
to take were the canal free) forward into the bladder; the obstruction may 
then be divided in the same way as in the usual operation for stricture. 
It must be remembered that this is not the remedy for stricture, but for 
obliteration of the canal. Part xxxv., p. 125. 
Pilatation of the Female Urethra.—There are various means of dilating 
the female urethra, as sponge-tents and metallic dilators; but these cause 760 
URINE. 
great pain, and, worst of all, are very liable to be followed by permanent in- 
continence. Weiss’ dilator, though simple and easily applied, drags the ure- 
thra into a sort of triangle, the pressure falling entirely upon three points. 
What is wanted is a uniform pressure, and one capable of dilating quickly, 
as being less liable to be followed by incontinence. This desideratum is 
supplied by fluid pressure. The apparatus, used by Mr. Wells, surgeon to 
Samaritan hospital, is an elastic tube, having at one end a syringe and at the 
other a female catheter, the latter having a piece of India-rubber tubing 
closely fitting over it. The syringe must be furnished with a stop-cock. 
The catheter being introduced, the India-rubber tubing may be gradually 
distended with water by means of the syringe. The whole process will 
not occupy more than ten minutes, and, besides, the other advantages 
possessed by it, will not be accompanied by much pain. 
Part xxxviii., p. 223. 
Urethral Caruncles.—If these florid painful growths be removed by the 
knife alone, even if the piece of mucous membrane upon which they are 
seated be also removed, a permanent cure is seldom effected. The use of 
caustics is not attended with better results. The actual cautery alone, says 
Prof. Simpson, will destroy these growths effectually. An iron of pro- 
per size and shape, adequately heated, may be employed, or the requisite 
degree of heat may be applied through the galvano-caustic wire. The 
latter method is especially useful when the caruncles extend up the urethra 
higher than the orifice, because you can introduce and apply the wire, 
before heating it, by the transmission of the galvanic current. Apply im- 
mediately afterward cold water and cloths soaked in it; and subsequently 
treat the ulcerated surface, after the slough separates, with very frequent 
applications of black wash, zink lotion, or other surgical applications. 
Though this is the best mode of treating these growths, yet even this is not 
absolutely a certain method of cure, as cases now and then occur in which 
the growth will return in spite of all. Round the larger projecting tumor 
a number of small painful red spots of mucous membrane generally exist, 
and the removal of these is essential to the radical cure. The best local 
application to relieve the irritation and pain is an ointment made up of two 
drachms of the dilute hydrocyanic acid of the pharmacopoeia to an ounce 
of lard. A bit of this ointment, about the size of a pea, applied to the 
part three or four times a day, often relieves the pain more effectually than 
any quantity of opium administered internally, or than any other form 
of local anodyne. Part xl., p. 209. 
URINE. 
Retention of Urine— Case Relieved by the action of Cold.—The opera- 
tion of cold as an excitor of the expulsor fibres of the bladder, has been 
most interestingly illustrated by Dr. Currie, in his “ Medical Reports.” 
“ My friend, Dr. Ford, has mentioned to me the case of Mr. C , of Bris- 
tol, who was instantly relieved of an obstinate stricture of the bladder, 
of thirty hours duration (during all which time not a drop of water had 
been passed), by placing his feet on a marble slab, and dashing cold water 
over the thighs and legs. The effect was instantaneous; the urine burst 
from him in a full stream, and the stricture was permanently removed. URIXE. 
761 
The common remedies, particularly opium and bleeding, had been tried in 
vain.” Facts of this kind have been noticed by several other observers. 
Part viii., p. 47. 
Urine as a means of Establishing the Diagnosis and Treatment of 
Diseases.—Dr. F. Simon gives the following valuable communication: 
Among the earlier investigators who paid attention to the urine, though very 
partially, I may mention Brandt, Kunkel, Boyle, and Bellini; Boerhaave, 
however, attempted an analysis of the urine, which, considering the time, 
was extremely good. Scheele’s discovery of uric acid, and Cruikshanks’ of 
urea, contributed essentially to a more correct knowledge of this secretion. 
The latter surgeon had already examined the urine in several diseases, 
especially in diabetes and dropsies. At the commencement of the present 
century it was chiefly Berzelius and Prout who made the urine the subject 
of extended inquiries ; Berzelius demonstrated the existence of lactic acid, 
which, by the earlier chemists had been considered to be acetic acid ; the 
analysis communicated by Berzelius, in 1809, of the composition of the 
urine, has been till within the last few years the only correct examination 
of the same ; Prout has continued his inquiries up to the latest period. Of 
the more recent works on the constitution of the urine, those by Lecanu 
are the most prominent; within the last years, Becquerel, Lehmann, and 
Simon, have employed themselves with examinations of the urine in the 
healthy and morbid state. Several constituents of the urine, both in the 
state of health and disease, are very accurately known, as uric acid, urea, 
lactic acid, the salts and the sugar of the urine; of others, probably not 
less important, we have a very imperfect knowledge, as of extractive and 
coloring matters. Regarding the quantitative composition of the urine, 
which is rather changeable, numerous investigations have been made by 
the above-named chemists. Lecanu also investigated the varieties which 
may be shown in healthy urine, according to age and sex. 
The quantity of urine passed in the twenty-four hours, and its color, are 
frequently of importance. A diminished quantity of the urine passed in 
twenty-four hours, is under circumstances a sign particularly of acute dis- 
eases ; an excessive increase of the urine, if permanent, is oftentimes indi- 
cative of serious diseases. A dark-colored, flaming, or fiery red urine 
commouly indicates an inflammatory affection ; a dark brown red is gene- 
rally observed in typhus. But the urine may also be colored blood-red or 
brown-red by bile-pigment, which is easily detected by its reaction with 
nitric acid; the latter constantly indicates an affection of the liver; a 
blood-red urine commonly contains blood ; there is then for the most part 
found in it a sediment of blood-corpuscles, which are recognized with the 
microscope; but should a little blood be contained in the urine and this in 
a state of solution, it may be discovered by adding nitric acid, which occa- 
sions a precipitation of coagulated albumen colored red by hematine. This 
bloody urine indicates a bleeding in the kidneys, bladder, or, in the case 
of women, of the uterus. Blood flowing from the urethra comes in drops. 
If the blood is discharged in masses after clear urine, it comes from the 
bladder, and in that case it often stops up the passage from the bladder by 
coagulation; if the blood is distributed through the urine, partly dissolved, 
and not in very large quantity, it comes from the kidneys ; if i't be dark, 
and mixed with mucus and pus, it owes its origin to an ulcer. The pre- 
sence of stone-colic shows that the blood has been poured out during the 
descent of a renal calculus. 762 
HEINE, 
Blue urine has been observed, though not frequently; in the majority 
of cases it probably owes its origin to the use of certain medicines ; black 
urine has likewise been observed; the connection, however, is not yet 
known between the coloring matter and the morbid process ; greenish urine 
indicates, according to Prout, an oxalic acid diathesis ; sediments of oxalate 
of lime form, or mulberry calculi pass away; a urine, which is pale-colored, 
and has a bias to green, frequently indicates the presence of albumen, 
which is readily detected by heating to boiling or by nitric acid. In this 
case the urine is not perfectly clear, but slightly opalescent; its quantity 
may be increased, diminished, or natural. The oxalic acid diathesis of the 
urine indicates, according to Ptout, functional disturbances in the chylo- 
poietic system ; albuminuria ordinarily indicates dropsy and an affec- 
tion of the kidneys. The reaction of the urine is important for the 
physician. Natural urine, it is well known, has an acid reaction; the 
quantity of free acids in the urine and the intensity of the reaction may 
increase to an extraordinary degree in diseases, more particularly in rheu- 
matism, gout, in disturbances of the digestive organs, and in certain stages 
of typhus ; to judge correctly of the intensity of the acid reaction, reference 
must be had to the quantity of the urine ; the greater or less acid reaction 
is known by the effect of the urine on litmus paper of a weak blue color, 
which becomes colored so much the more rapidly and the more deeply 
reddened, the greater the acid contents of the urine are. Urine with a 
neutral reaction commonly forms the transition from the acid to the alka- 
line reaction, and vice versa. The alkaline reaction of the urine is of great 
importance to the physician ; it commonly depends on carbonate of am- 
monia, the presence of which is recognized by the odor, and the white 
cloud, which a glass rod develops wrhen moistened with an acid salt and 
brought near to it. The urine also may have an alkaline reaction through 
its containing carbonate of soda, which salt finds its wray into the urine by 
the long-continued use of carbonate or bicarbonate of soda with vegetable 
acids. The urine, alkaline by carbonate of ammonia, is but seldom evacu- 
ated in this state from the bladder; during its discharge it is commonly 
neutral, and becomes alkaline only in a shorter or longer time after ; badly- 
cleaned vessels may moreover contribute much to this, a circumstance 
which ought to be taken into account. Urine which already on voiding 
it has an ammoniacal reaction, and has also a very bad smell, indicates 
always a serious affection of the nervous system, and especially of the 
spinal cord. In certain unfavorable stages of tabes dorsalis, phthisis of the 
spinal cord, paralysis of the lower extremities and of the bladder, the void- 
ing ammoniacal urine is ever an unfavorable sign ; in other affections of 
the nervous system, also, as in typhus, ammoniacal urine is observed, Avhich, 
however, assumes this reaction in the majority of cases not till after it has 
stood for some time. In typhus the reaction of the urine may be of im- 
portance for the prognosis when the urine, after it was observed to have 
an acid reaction through one, two, or three periods of seven days, is finally 
found to be neutral, and then to have an ammoniacal odor and reaction ; 
when this reaction lasts for several days, probably during one entire period 
of seven days, and then again passes into the acid, this seems in most cases 
to indicate a favorable termination to the disease. The urine having an 
ammoniacal reaction in typhus has usually a dirty, turbid, yellow-brown 
or red-brown appearance, and forms sediments which disappear in a great 
measure on the addition of free acids; also in catarrhus vesicas, or in phthisis HEINE, 
763 
vesicse, the urine becomes ammoniacal in a very short time after being 
voided ; the large quantity of vesical mucus or pus indicates this affection ; 
finally, the formation of urinary concretions, consisting of earthy phosphates, 
is in part occasioned by the neutral or alkaline reaction of the urine ; the 
urine voided in this urinary affection, is not so dark as the urine in typhus, 
and commonly forms sediments of phosphate of lime, and of ammonio- 
magnesian phosphate. If the vesical calculus exercise an irritating influ- 
ence on the parietes of the bladder, a great quantity of vesical mucus is 
commonly mixed with the urine. 
The specific gravity of the urine, though by itself it possesses no great 
diagnostic value, as it depends on the variable quantity of water in the 
urine, may, however, claim the attention of the physician under certain 
circumstances ; the clearer and the more like water the urine appears, the 
less is its specific gravity ; the deeper and darker-colored, the higher the 
specific gravity. This general law may admit of an exception in one case, 
namely, in diabetes mellitus ; in this disease a urine is voided either normal 
or pale, seldom deeply-colored, the high specific gravity of which (1020- 
1060) is in contradiction to the color ; this high specific gravity imperative- 
ly requires a more strict examination of the urine. More than all other signs, 
the correct examination of the sediments is of importance to the physician. 
Healthy urine forms only after long standing a light, sinking cloud of vesical 
mucus; every other separation in the urine is of a pathological nature. The 
urinary sediment consists either nf organic formations, as mucous corpus- 
cles, purulent corpuscles, blood, etc., or of heavy, insoluble salts or acids, or 
lastly, of an admixture of both ; the microscope will throw light on this. 
The sediment consists of organic formations. If the urine has not a 
blood-red color, the sediment is white, grey, dirty-yelloW, and with the 
microscope can be seen mucus, or pus-corpuscles; here the sediment is 
constantly mucus, if the urine contain no albumen; it is probably pus, if 
the sediment is deposited rapidly after the urine is voided, and the urine 
contains albumen. It is not necessary now to state of what importance it 
is to discover and appreciate mucus and pus in the urine; in catarrhus 
vesicae the mucous sediment frequently assumes a very glutinous quality ; 
this, however, happens only when the urine begins to become ammoniacal, 
which, in urine containing mucus, often occurs in a very short time, as we 
have already mentioned; the same may be said of pus, and it is good in 
this case to test the presence of albumen not by boiling heat, but by nitric 
acid. If the sediment is blood, the blood-corpuscles are then seen with the 
microscope; the urine standing over this is also of a blood-red color. Of 
the import of blood in the urine I have no remark to make. If the urine 
contain albumen, and there exist at the bottom a mucous sediment, it is 
of great importance to examine this with the microscope. We may find 
therein, as I have observed, peculiar long prominences, partly filled, partly 
transparent, and round spheres, twice or thrice as large as mucus corpuscles, 
filled with dark, granular contents, which beyond a doubt have their origin 
in the kidneys, and denote a morbid state of this organ. These peculiar 
forms I have frequently, and at different times, found in the urine of a per- 
son laboring under morbus Brightii. 
The sediments which are not of an organic nature, may in like manner 
be easily recognized with the microscope and some few reagents; they 
are either crystalline or amorphous, present themselves either in acid, 
neutral or alkaline urine, and are readily distinguished; in acid urine 764 
UEINE, 
sediments of uric acid present themselves, urate of ammonia, urate of soda, 
oxalate of lime, cystin. The greatest number of sediments which present 
themselves in acid urine consist of urate of ammonia; less frequent are 
those consisting of uric acid, still rarer are those consisting of oxalate of 
lime, and the most uncommon of all are those consisting of cystin. Sedi- 
ments consisting of earthy phosphates do not occur in urine having a 
strong acid reaction. Every sediment occurring in acid urine from yellow 
to brown, from red to purple-red, appearing under the microscope as an 
amorphous precipitate, or as large and small globules aggregated together, 
which is dissolved entirely or almost entirely on warming the urine, is 
urate of ammonia; to this belong accordingly all the so-called critical sep- 
arations in the urine; the species of separation of the urate of ammonia is 
very various, and it appears sometimes as mere tui'bidness, without form- 
ing any sediment whatever, sometimes it lies at the bottom of the vessel 
as colored mucus or pus, at other times heavy, like an earthy precipitate. 
In the case of those diseases, which in the course of their development 
admit a termination by a critical separation in the urine, the kind of sepa- 
ration is of importance. The heavier the sediment lies at the bottom, and 
the clearer the urine is that stands over it, the more decided is the crisis 
allowed to be ; whilst the lighter the sediment floats, and the less disposi- 
tion there is to a perfect deposition, the more imperfect is Nature’s effort 
to break down the disease by a crisis. The various colorings of the sedi- 
ment are characteristic of some diseases; in acute rheumatism of the joints, 
in intermittent fevers, the critical sediment is observed to be colored red up 
to a brown red; in acute diseases of the liver the sediment is rose-red; in 
typhus it has a flirty-red color ; in some diseases the appearance of the sedi- 
ment appears to be of no constant critical import, as, for example, in typhus. 
A sediment in fthe acid urine, which is not dissolved on heating the 
urine, and which appears crystalline when observed either by the unarmed 
eye, or with the microscope, and is colored yelloAV up to vermilion-red, is 
uric acid. It ordinarily appears in the form of rhombic plates, and in the 
majority of cases mixed with urates of ammonia, where it then forms the 
undermost and dark-colored layer of the sediment. That the deposit of 
uric acid is of critical import, is scarcely to be doubted; in gout and in 
cases of renal calculi, where the deposits consist of uric acid, uric acid or the 
discharge of gravel form the most perfect crisis ; in many other diseases 
we still want the necessary observations concerning the critical value of 
uric acid secretions. The sediment of oxalate of lime presents itself more 
rarely than those before mentioned ; it usually forms a white precipitate ; 
observed with the microscope, it appears in the form of small octahedra, or 
of little spheres arranged one by the other; it is not soluble in acetic acid, 
but readily in hydrochloric acid; when sulphuric acid is poured on it, it 
disappears, and after some time long lancet-formed plates of sulphate of 
lime are seen. 
Respecting the diagnostic value of the oxalate of lime in the sediment, 
sufficient observations are still wanting ; it is probable that it is connected 
with serious disturbances in the chyiopoietic system; that we should be 
attentive to the possible formation of stone of oxalate of lime, where the 
sediment shows itself frequently and permanently in the urine, is of 
importance ; however, the physician, in order to judge of the phenomena 
more correctly, must also have reference to the diet, as oxalic acid may 
be conveyed into the body by various sorts of food. URINE, 
765 
The occurrence of cystin in the urinary sediment is very rare. It is 
easily recognized by its remarkable form; it forms faint yellow-colored 
hexahedral plates. According to Prout, the appearance of cystin in the 
urine is a very unfavorable sign, it indicates the formation of cystin calculi. 
In neutral urine, or that with an alkaline reaction, besides the sediments 
already mentioned, precipitates of earthy phosphates present themselves ; 
they are readily known by this; that they disappear on acidifying the 
urine with acetic acid or acid salts ; the phosphate of magnesia, commonly 
combined with ammonia, is distinguished by its crystalline form; it appears 
in colorless prisms obliquely tinctured, very frequently in the form of a 
roof; the calcareous phosphate appears almost always as an amorphous 
precipitate; as the earthy phosphates are constantly present in the normal 
urine, their precipitation is commonly to be looked on as a consequence of 
the formation of ammonia, the free acids by which the earthy phos- 
phates were previously dissolved being neutralized by this alkali; in some 
cases, on the contrary, the appearance of earthy phosphates in the sedi- 
ment is of diagnostic value. In affections of the spinal cord the phosphate 
of magnesia, more especially, appears to be secreted in great quantity; in 
affections of the mucous membrane of the bladder, the phosphate of lime 
appears in large quantity ; in three cases of inflammations of the respira- 
tory organs, at the time when resolution of the disease set in, I have seen 
the previously acid urine become neutral, and have observed, as a precipi- 
tate, the secretion of a considerable quantity of already formed crystals of 
ammonio-magnesian phosphate, perceptible to the naked eye, at the same 
time that in two of these cases the clear urine held so large a quantity of 
urate of ammonia in solution, that precipitates of uric acid were instantly 
produced by every acid. When calculi of the bladder are present, which 
consist of earthy phosphates, the urine frequently contains sediments of 
earthy phosphates, with which a greater or smaller quantity of mucus is 
mixed. In scarlatina the urine is observed to be turbid at the time of the 
desquamation, often also before, the occurrence of the same on the outer 
cuticle; when it is observed with the microscope, an extraordinarily 
quantity of the epithelium of the vesical mucous membrane is seen in it. 
It is, therefore, to be admitted, that the desquamation goes on also on the 
mucous membrane of the bladder; and if, as frequently appears to be the 
case, the scaling off takes place earlier on the mucous membrane of the 
bladder than on the external skin, one may determine the commencement 
of the scaling off by examining the urine. 
The knowledge of the chemical composition of the urine is of very great 
value for diagnosis and prognosis; especially as far as concerns the 
presence of matters which are not found in the normal state of the urine ; 
albumen is readily discovered in the urine by heat or by the addition of 
nitric acid; if the urine is acid, heat is preferred; if alkaline, nitric acid. 
The presence of albumen in the urine is always of great import, and the 
correct estimation of the same as a means of diagnosis not altogether easy; 
cases are known in which albumen was observed in the urine of healthy 
individuals, or set in in consequence of disturbance occurring in the diges- 
tive organs; in the great majority of cases, albuminuria is the attendant of 
dropsical phenomena, or the forerunner of them, the urine is then com- 
monly clear, evinces a tendency to green, and contains much albumen; 
but there are cases of dropsy krfown, which set in altogether without 
albuminuria. That the presence of albumen in the urine does not infer 766 
URINE. 
the presence of Bright’s degeneration of the kidneys, has been sufficiently 
proved; where degeneration of these organs is suspected, great attention 
must be directed to the mucous sediment of the urine. In violent inflam- 
mations, as well as in typhus, small quantities of albumen are sometimes 
found in the urine; the urine is then generally very dark, and has an acid 
reaction ; according to Becquerel, this appearance of albumen in cases of 
inflammation appears to be connected with a congested state of the 
kidney, and as this, unless the disease is itself an inflammation of the 
kidneys, seems to occur only in very violent and intense inflammations, 
the appearance of albumen in the urine accompanying inflammation might 
be a sign of the intensity of the inflammation. In consequence of inflam- 
matory exanthems, especially in the desquamatory stage of scarlatina, 
albumen sometimes is observed to exist in the dark-colored urine, and 
sometimes, though more seldom, blood. It is, therefore, a matter of 
importance for the physician carefully to examine the case, as this hetero- 
geneous mixture is not unfrequently the forerunner of dropsy; however, 
dropsy has been observed after scarlatina without albumen in the urine, 
and albumen in the urine without dropsy following thereon. At the com- 
mencement of diabetes mellitus, albuminuria is no rare phenomenon, and 
of great importance to the physician. The occurrence of albumen in this 
case is not constant, but alternating, it appears, before a trace of sugar 
can be observed, and when the sugar begins to form, it sometimes ceases 
again, and passing off, it gives way to the albuminuria. 
To demonstrate the presence of sugar in the urine is the principal means 
of satisfying oneself of the existence of diabetes mellitus. If the quantity 
of sugar is considerable, it is easily discovered in the alcoholic extract of 
the urine after evaporation; if only traces of sugar are present, the 
sulphate of copper is used to demonstrate its presence, as we shall see at 
another time. Gall pigment in the urine is constantly a sign of the 
liver being affected; we have already stated that this can be discovered 
by the addition of nitric acid ; but to infer* the presence of gall pigment 
from the color of the urine is sometimes fallacious. Part viii., p. 49. 
Changes produced in Urine by Disease.—Dr. Shearman gives the fol- 
lowing : 
Excessive indulgence in animal food, with too little bodily exercise, dys- 
pepsia, and want of perspiration, are always attended by increase in the 
quantity of uric acid and urates. Uric acid is frequently produced in great 
quantity in the bladder, by the hydrochloric acid formed in the stomach 
from disease of that organ ; which, being absorbed into the blood, and 
secreted by the kidneys, forms hydroclilorate of ammonia, and deposits the 
uric acid. In fever, and in all diseases accompanied by rapid emaciation, 
the urine is of a high specific gravity, a dark brown-red color from excess 
of urea, uric acid, urate of ammonia, and sometimes blood and purpurine. 
The lateritious sediment, is urate of ammonia. And in extreme cases of 
acute rheumatism and hypertrophy of the heart, very large quantities of 
uric acid and urate of ammonia are commonly found. In all acute diseases 
attended by great emaciation, inflammation, or disorganization, with un- 
healthy digestive organs, as long as the kidneys remain healthy, uric acid 
is secreted in abundance ; but if the kidneys become diseased, as in mor- 
bus Brightii, diabetes, etc., then the secretion from the kidneys is per- 
verted ; part of the nitrogen remaining in the circulation, and the carbon, URINE. 
767 
hydrogen, and oxygen, assuming the forms of albumen, sugar, hippuric and 
oxalic acids, etc. In diabetes inellitus, when starch, sugar, etc., do not 
undergo the changes required to be converted into carbon or fat the starch 
is converted into grape-sugar by oxygen, and the sugar is excreted by the 
kidneys. In gout and rheumatism, urate of soda is found both in the urine 
and deposited in the joints and sheaths of the tendons. When pressure 
on the renal veins exists to such an extent as to prevent the return of 
blood to the cavae, as from a tumor, pregnancy, or diseased viscera, the 
elements of the blood are often poured out by the kidneys ; and on exam- 
ination, we find albumen, blood-discs, and the coloring matter of the blood 
(hematosine). And in granular diseases of the kidneys, and anasarca after 
acute disease of the skin—as scarlatina and extensive burns—albumen in 
large quantities is detected, but when the kidneys and skin regain their 
natural functions, uric acid and urea are again secreted in the place of 
albumen. In all diseases of an ansemic or chlorotic nature, attended by 
languid circulation and extreme debility, independent of acute disease, 
deficiency of urea and uric acid is found, and no deposit takes place un- 
less there is a very small secretion of urine. In hysteria there is a large flow 
of limpid urine, of low specific gravity, and of a green color. In chlorosis, 
the urine is also of a Ioav specific gravity, and green ; and this green color 
is owing to the mixture of cystine with hemaphaein. When the functions 
of the skin are impaired only, an excess of urea and urate of ammonia is 
always the result; and if, in this case, profuse perspiration occurs, the fluid 
goes off by that process instead of the kidneys, the specific gravity of the 
urine becomes increased, and deposits frequently take place in the bladder 
in consequence, forming calculi, owing to deficiency of fluid; but, if the 
skin is imperspirative, then the kidneys carry off the extra quantity of water, 
and the urine becomes lighter ; but the animal acid (lactic or butyric), 
which ought to go off by the skin, is secreted by the kidneys, and com- 
bining with the ammonia or soda of the urates, produces uric acid. When 
the functions of the liver are deranged, carbon is eliminated with hydro- 
gen and cholesterine from the kidneys, which gives the peculiar color to 
the urine in all cases of jaundice. In organic mischief in the liver and 
spleen, or great congestion of the vena portae, the urine is very red, pur- 
ple, or copper-colored, owing to purpurine and urate of ammonia; but 
when bile is circulating in the system from disease of the gall-ducts, etc., 
the urine is very brown, and easily shows the bile by the proper tests. In 
contracted, hobnail, or cirrhosed fiver, the extent of the disease may gene- 
rally be measured by the quantity of purpurine in the urine ; and usually 
in ascites from diseased liver we find purpurine ; but in ascites from peri- 
toneal disease we find none. The purpurine appears to proceed from the 
altered condition in the portal circulation. When the fiver and lungs are 
both S9 diseased as to prevent the proper quantity of carbon being carried 
off by their functions, hippuric acid is sure to be found in the urine. 
In cases where organic mischief exists in the kidneys, the urine is fre- 
quently semi-solid when cold, and of a dark color, like a mass of black cur- 
rant jelly. And when hemorrhage from some part of the urinary organs 
takes place, the urine is red, and shows quantities of blood-discs under the 
microscope. In fungus hematodes of the kidney, the urine looks like 
infusion of roses while "warm, and like red currant jelly when cold, taking 
the form of the vessel. During the progress of pneumonia, less carbon will 
be eliminated from the lungs, and therefore more will be in the urine and 768 
TEESTE. 
liver; consequently hippuric acid is often found. And in confined situa- 
tions, where animals are obliged to breathe impure air, the globules of the 
blood are not sufficiently supplied with oxygen, carbon cannot be con- 
verted into carbonic acid in the lungs, and life could not go on unless the 
kidneys secreted more nitrogen and carbon in the forms of urate of ammo- 
nia and hippuric acid. In hepatitis, the carbon is not converted into bile ; 
and, as long as the other secretions are going on properly, the carbon which 
ought to form the bile is converted into fat and oil, and is found in the 
blood and urine. We often meet with melancholy, highly nervous, emaciated 
patients, simulating diabetes mellitus, but even more depressed in spirits, 
who merely complain of great debility and exhaustion, with some little 
pain in the back or loins, for which we find it very difficult to prescribe 
effectually. Dr. G. Bird has clearly shown that most of these cases are 
owing to imperfect assimilation in digestion, converting the urea of the 
nitrogenous part of the food into that state which is secreted by the kid- 
neys as oxalic acid and ammonia instead of sugar, which, combining with 
the lime of the phosphates, produces the oxalate of lime diathesis ; and it 
is to the derangement of the stomach, duodenum, and liver, that we must 
look for success in the treatment of these cases. 
Alkaline Urine.—When, from any cause, as the consequence of wear 
and tear in old age, excess of study, or gteat excitement of the brain, an 
injury to the spine, or stone in the bladder, the kidneys or bladder are 
deprived of their natural supply of nervous power, the elements of urea 
combine with the elements of water, and are converted into carbonate of 
ammonia, which, by irritating the mucous membrane, and neutralizing the 
solvent phosphoric acid, throws down the triple phosphates, and phosphate 
and carbonate of lime, and renders the urine alkaline. Thus we find in 
almost all cases of long-continued calculi in the bladder—let the calculus be 
composed of what it may—that the urine is strongly alkaline, ammoniacal, 
and deposits phosphate of lime, which sticks to the bottom of the vessel 
like birdlime. The fusible calculus is composed of ammonio-phosphate of 
magnesia and phosphate of lime. In persons who are confined to very 
sedentary habits, with great mental exertion, for a length of time, and then 
obliged to use violent muscular exercise for a few days, as clergymen with 
small livings, lawyers, and schoolmasters, alkaline urine, with abundance 
of earthy phosphates, is usually the consequence ; and this unnatural secre- 
tion brings on a degree of debility not easily accounted for in any other 
manner. In irritative dyspepsia in gouty habits, the urine often contains 
the phosphates in abundance ; and whenever the triple phosphates, with 
alkaline urine, are deposited for a length of time together, both in the 
night and morning urine, accompanied by emaciation, there will always be 
found organic disease, either in the digestive organs, kidneys, or bladder, 
if not in the spine. Dr. Golding Bird gives the following rule respecting 
the phosphates, whioh will be found very useful in practice : That Vhere 
the presence of phosphates is only found in the evening urine, organic dis- 
ease is rarely the cause of it; but where they are found equally in the morn- 
ing and evening urine, you may be sure organic disease exists. In bad cases 
of typhus fever, the#urine is frequently ammoniacal toward the close of 
the disease, the nervous system of the kidneys being too depressed to 
secrete urea, and its elements being converted into carbonate of ammonia, 
just as they would be in common chemical decomposition out of the body. 
During retention of urine from diseased prostate gland, stricture of the UKINE, 
769 
urethra, or where a catheter is obliged to be worn, the urine is always 
alkaline, owing to irritation in the mucous membrane. 
It is easy, after a few trials, to discover, in a few minutes, the contents of 
almost any ordinary specimen of urine; and, without this knowledge, it is 
quite impossible to become acquainted with the changes Avhich are con- 
stantly occurring in the urinary organs. For instance, you are called to a 
patient complaining of excruciating and deep-seated pain in the abdomen, 
shooting down the thigh, which resists the usual soothing mode of treat- 
ment. Examine the urine, and you may there find blood, pus, oxalate of 
lime, uric acid, or phosphates. This at once explains the nature of the 
malady, and you can confidently tell your patient that he has a small calcu- 
lus of a certain description in the ureter, and your treatment is no longer 
empirical. Or you may be consulted by a person with various anoma- 
lous symptoms of a cachectic nature, which you would find it impossible to 
give a name to unless you examine the urine chemically, when you discover 
either albumen, sugar, or oxalate of lime excreted ; and this at once ex- 
plains the case. A patient consults you, much reduced in strength, 
depressed in spirits, and emaciated, his appetite being good, and digestive 
organs healthy, as far as you can discover, there being no evident cause 
for such a state. Take the specific gravity and quantity of the urine. If 
it is high, without deposit, and the quantity not great, add nitric acid to 
it in a wTatch-glass, and you will most likely discover a large quantity of 
urea, sufficient at once to account for the symptoms ; or if the quantity of 
urine be large, you may discover sugar. During the course of febrile and 
inflammatory diseases, urate of ammonia is generally deposited. But if the 
symptoms increase, instead of diminish, under this deposit, examine it, and 
perhaps you may find the deposit to consist of phosphates and purpurine, 
and the urine alkaline. This will at once warn you to be watchful of your 
patient, and cautious in your prognosis. Suppose you have a surgical opera- 
tion to perform on a patient apparently out of health, but with no decided 
disease. If, on examining the urine, you find albumen, oxalate of lime, 
or the ammonio-phosphates of magnesia in abundance, you may feel assured 
the person is in an unfit state to bear any operation ; and by waiting, and 
attending to his general health, you will feel more confidence in the suc- 
cessful event of such an operation. Part xii., p. 96. 
Test for Sugar in TJrine.—Lowig recommends the following : Evapo- 
rate the urine to the consistency of sirup ; treat with alcohol \ then to the 
solution add an alcoholic solution of potash; if sugar be present, a white 
precipitate is formed, consisting of a compound of sugar and potash ; wash 
this with alcohol, and dissolve in water; thus a saccharine solution is 
formed, which may be examined in any way, and if required, the amount 
of sugar determined quantitatively. Part xii., p. 117. 
Alkaline Urine.—Use strychnia when the affection follows injury or 
lesion of the spine, as recommended by Dr. Golding Bird. 
Part xiv., p. 97. 
Influence of the Phubarb Plant in producing Oxalate of Lime in 
Urine.—[The oxalate of lime in urine, can only be considered diagnostic 
of disease, when the oxalic acid is known to have been generated within 
the economy, and not introduced from without, for, says Liebig, the ana- 
lysis of urine, when made without respect to the inorganic salts, acids, and 
bases of the aliment, teaches nothing. Are there any kinds of food which 
vol. ii.—49 770 
TRINE, 
may be the means of impregnating the urine with pxalate of lime ? Dr. 
Wilson says:] 
The young stalks of the rhubarb plant, which of late years have come 
into such general use in this country for tarts in the spring, and sorrel, of 
which our neighbors, the French, consume a good deal in salads, and in 
other ways, both contain oxalic acid ; and hard water contains lime. Dys- 
peptic persons who drink such water, and eat such articles of food, and 
are thus daily introducing, without suspecting it, the constituent ingredi- 
ents of the mulberry calculus, are very likely indeed to incur the pain and 
the exceeding peril of a renal concretion of that kind. You must see, 
therefore, the great importance of detecting the oxalic diathesis, and of 
forbidding, to those who have it, all such viands as contain the oxalic acid, 
and of recommending them to use pure water, even distilled water for 
drinking. Part xiv. p. 108. 
To Pender the Urine acid.—Dr. Bird states, that, the benzoic is the 
only acid, the exhibition of which will render the urine acid. 
Part xv., p. 143. 
Alkaline Urine.—Wash the bladder out every day or two with warm 
water ; the urine is rendered alkaline by retention of a few drops in the 
bladder. But Dr. Snow considers it important to distinguish those cases 
in which the urine is secreted alkaline. Partxv.,p. 144. 
Incontinence of Urine in Children.—[In the incontinence of urine oc- 
curring during sleep, in children, and unconnected with organic disease, 
Dr. Chambers advises the following treatment.] 
Let the patient abstain from drinks for three hours before bed-time; 
empty the bladder on going to bed, and awaken in three hours to make 
water again. Blister the sacrum occasionally, to prevent sleeping on the 
back, and to stimulate the bladder ; use cold shower bath or douche, and 
give ten drops each of tinct. cantharid. and tine, ferri mur. thrice a day. 
Sometimes cauterize the orifice of the urethra, that the passage of urine 
may excite pain. Part xv., p. 145. 
Incontinence of Urine in Young Persons.—M. Gerdy advises to give 
strychnine, gr. to gr. daily, and small enemata of quinae sulph.; or 
give ext. belladon. gr. iij. daily. Continue the remedies for some time 
after it is apparently cured. 
When the urine is catarrhal, inject into the bladder a solution of nitrate 
of silver; give ergot of rye and camphor, aa. gr. x. daily, and rub the 
perineum and pelvis with camphor ointment. Or give strychnine or qui- 
nine, or four grains of cantharides powder daily. Part xv., p. 146. 
Benzoic Acid in Incontinence of Urine.—Dr. Fraene recommends giv- 
ing six grains, night and morning, increasing the dose to twelve grains. 
He succeeded in curing a case with this after three weeks of unavailing 
treatment with other means. Part xv.,p. 146. 
jRetention of Urine from Spasmodic Stricture.—Dr. Lanyou recom- 
mends tine, secale cornutum; half a drachm infused in three ounces of 
boiling water, and strained when cold; one ounce to be given every 
six hours ; or two scruples of ergot of rye may be given twice a day, an 
hour < r two before the bladder is distended. Part xv. p. 147. UKINE, 
771 
Retention of Urine treated by Galvanism.—Mr. Donovan gives the case 
of a lady who, after delivery, could not evacuate her bladder. The cathe- 
ter had to be used thrice a day, and Drs. Radford and Goodwin employed 
all the usual remedies for a fortnight, when it was decided to try galva- 
nism ; the first application was successful. Part xv., p. 234. 
Dry Cupping in Retention of Urine.—M. Vandenbroeck, principal phy- 
sician at Mons, informs the Society of Medicine at Anvers, that for more 
than twenty years he has replaced the use of the catheter in both sexes by 
the application of large cupping glasses to the superior and internal part 
of the thigh. In nine cases out of every twelve, the emission of urine, 
he says, was made at the end of some seconds. He does not assert that 
this has any effect in mechanical retention of urine. Part xvii., p. 181. 
Ergot of Rye in Retention of.—In retention of urine from paralysis of 
the bladder, cerebral or otherwise, Dr. Allier, of Marcigny, recommends 
small and repeated doses of ergot, up to seventy-five grains a day, to be 
continued in decreasing doses, for eight or ten days after the cure. 
Part xviii., p. 143. 
Suppression of Urine.—Dr. J. C. Hall advises to give a drop of croton 
oil, with a full dose of calomel and colocynth ; follow this by a draught 
containing sulphate of magnesia, cream of tartar, and infusion of senna; 
and then give a large stimulating clyster; so that the bowels may be 
freely purged. Then cup over the loins, or bleed, if the state of the pulse 
admits ; and give warm baths. Afterward apply a blister to the loins, 
and give full doses of powdered cantharides,—a remedy, which, however 
inapplicable theoretically, has been followed by the best results. 
Part xx., p. 100. 
Uric Acid Diathesis.—Mr. B. B. Cooper would order low diet and 
vegetable food; employ the warm bath, and give carbonate of soda or 
potash, or liquor potassae, taking care not to give them till three or four 
hours after a meal, otherwise they may interfere with digestion. Some 
vegetable acids may be given, but everything liable to generate acid in 
the stomach must be scrupulously avoided. Part xx., p. 149. 
Use of Test Paper.—II. Bence J ones believes that the reaction of test 
paper on urine made at any one hour of the day should never determine 
the use of acid or alkaline medicines. The different deposits which take 
place in the urine are far better tests of the state of the urine, and of the 
necessity for these remedies. If you are guided by the reaction of test 
paper, the total quantity of urine made in twenty-four hours must be 
examined. Part xxi., p. 161. 
Relation of the Specific Gravity of the Urine to its Solid Contents.— 
Tables have been constructed professing to tell how much solid matter is 
contained in urine of any specific gravity. It is said, that by taking the 
specific gravity and referring to the table, the quantity of solid matter may 
be immediately determined. 
From experiments, Dr. H. B. Jones has come to the conclusion that the 
quantity of solid contents cannot be determined by taking the specific 
gravity. Part xxi., p. 162. 
Detection of Oxalate of Lime in the Urine.—Dr. II. B. Jones says: 
Oxalate of lime is so frequently found in the urine of those Avho are in a 772 
UKINE, 
good state of health, that I do not consider it as indicating any disease, 
but only a disorder of no serious importance. It scarcely indicates a more 
serious derangement of the general health than a deposit of urate of 
ammonia does. It may occasionally be found in the urine of all who lead 
sedentary lives, taking insufficient air and exercise, and more food than is 
requisite for the daily wants of the system. I have found it in the urine 
of those who are free from every complaint. Even in the urine of healthy 
children it may very frequently be seen. I have met with it in every kind 
and stage of disease. In the fracture wards of St. George’s Hospital, I 
have very frequently found it. The most severe case I ever saw, was an 
artist, aged thirty, dying of an abdominal aneurism. In cases of indiges- 
tion, especially where flatulence occurs; in cases where no indigestion ever 
was felt; in skin diseases ; in cases where the skin never was affected ; in 
cases of acute rheumatism, of acute gout, of fever ; in sciatica in a gentle- 
man, seventy-four years old, with spermatorrhoea; and in the diseases of 
women and children, octohedral crystals occur. So frequently is oxalate 
of lime mixed with urate of ammonia in sediments and calculi, that I have 
returned to the conclusion which Dr. Prout originally published in the 
second edition of his work. After giving some details of twelve cases of 
oxalic calculus, he says, “ We are authorized to draw the following conclu- 
sions : 6th. That from the dissection of calculi formerly mentioned, it 
appears that the oxalate of lime diathesis is preceded and followed by 
the lithic acid diathesis—a circumstance which seems to be peculiar to 
these two forms of deposit, and when taken in conjunction with the other 
circumstances already related, appears to show that they are of the same 
general nature, or, in other words, that the oxalic acid merely takes the 
place, as it were, of the lithic acid, and by combining with the lime natu- 
rally existing in the urine, forms the concretion in question. 7th. (Dr- 
Prout continues:) The diathesis being of a similar nature, the principles 
of treatment adapted for counteracting the original tendency to it must be 
also similar.” And, as a medicine, muriatic acid was used to change the 
diathesis from the oxalate of lime to the lithic acid. 
I find that the two deposits together may be met with daily on careful 
examination, by the microscope, of the urine in different cases of disease ; 
Thus at one hour we may find oxalate of lime alone; at another, oxalate 
of lime with urate of ammonia; and at a third examination, oxalate of 
lime and phosphate of lime, or phosphate of lime only; the variations in the 
acidity of the urine being the chief cause of the difference in the deposit. 
It requires no skill and no preparation of the urine to find the oxalate of 
lime. The urine should be left to stand for twenty-four hours in a bottle, 
or tall glass; the upper part of the fluid should be poured off, and the last 
few drops remaining in the glass or bottle should be examined. A magni- 
fying power of 320 times is generally sufficient, but the crystals are some- 
times so small, that twice this power is necessary to determine the form. 
Generally oxalate of lime octahedra are thus found without the least 
difficulty, sometimes in large single crystals, very frequently in aggregations 
of small octahedra, forming microscopic calculi. Dr. Golding Bird was 
the first observer who stated that these crystals, which had for some time 
previously been observed in urine, were oxalate of lime. The chemical 
proof is difficult, if not impossible, to obtain, for the octahedral crystals 
are rarely present in sufficient quantity to admit of perfect examination. 
Port xxi., p. 163. URINE. 
773 
Test for Sugar in Liquids.—Chlorine, M. E. Maumene, (of Rheims,) 
observes, contrary to the assertion of Liebig, acts on sugar at a tempera- 
ture of 212° Fah., and even in the cold, after a long period. A brown 
substance, partly soluble in water, is produced by its dehydrating power. 
The chlorides e. g. chloride of tin, bichloride of mercury, chloride of anti- 
mony, by their affinity for water, possess this property in a still greater 
degree. 
A strip of any kind of tissue that is not acted upon by chloride of tin— 
e. g. white merino—is to be saturated with a strong solution of this salt, 
and then dried. Thus prepared, the tissue forms a convenient test of the 
presence of sugar in any liquid. A few drops of a very dilute saccharine 
fluid placed on the merino, and exposed to a temperature of from 260° to 
300° Fall., will immediately produce a dark brown oj black spot. 
By the help of this test the presence of sugar in the urine can be readily 
detected. Ten drops of diabetic urine, the author stated, diffused in half 
a pint of water, would in this way yield a brownish black spot. Ordinary 
urine, urea, and uric acid, produce no results of this kind. 
Part xxi., p. 168. 
Incontinence of Urine in Children.—Examine the urine; and if, as will 
usually be found, it contains lithic acid, Mr. Simon recommends the follow- 
ing treatment: Give hydr. c. creta, or some mercurial, till the tongue is 
clean, and the intestinal secretions are healthy (for they will generally be 
found disordered). Then give a little quinine twice a day, before break- 
fast and before dinner ; and give daily, a single large dose of bicarbonate of 
potash in copious solution, five hours after dinner. Let the quantity and 
quality of the diet be also carefully regulated. If these measures are 
adopted, blistering, etc., will seldom be called for. Part xxi., p. 242. 
Retention of Urine.—When the bladder cannot be evacuated by the 
catheter, after leeching, aperients, warm baths, and opium, are we to 
puncture the urethra behind the strictured portion (Sir A. Cooper,)—or 
make a free opening in the perineum over the strictured part (Liston,)— 
or perforate the bladder through the rectum ? Mr. Gay, of the Royal 
Free Hospital, advocates the latter, and states that he has never met with 
one unfavorable result from the practice. Part xxii., p. 232. 
Retention of.—Mr. Tatum, of St. George’s Hospital, reports a case in 
which retention of urine had taken place from stricture. All means of 
passing the catheter both before and after the warm bath, and after the 
most patient and cautious manipulation in trying to accomplish this object 
had failed, and it was only after a large dose of laudanum had been twice 
given, and the warm bath repeated with a soothing enema, that the cathe- 
ter could be introduced. The symptoms again coming on after some time, 
the same means were again repeated, but it was not before a purgative 
draught had been given, eight leeches applied to the perineum, and the 
opium and warm bath again resorted to, that the stricture yielded so as to 
allow the instrument to be passed, and the bladder to be emptied. 
Part xxii., p. 234. 
Hints in Treating Urinary Affections.—[Dr. Bird concludes his work 
on the above subject by the three following rules.] 
1. Whenever it is desirable to impregnate the urine with a salt, or to 
excite diuresis by a saline combination, it must be exhibited in solution, so 774 
URINE 
diluted as to contain less than 5 per cent, of the remedy, or not more than 
25 grains in an ordinary draught. The absorption of the drug into the 
capillaries will be insured by a copious draught of water, or any diluent, 
immediately after each dose. 
2. When the urine contains purpurine, or presents other evidence of 
portal obstruction, the diuretics or other remedies employed should be 
preceded or accompanied by the administration of mild mercurials—tarax- 
icum, hydrochlorate of ammonia, or other cholitic remedies. By these 
means, or by local depletion, especially by leeches to the anus, the portal ves- 
sels will be unloaded, and a free passage obtained to the general circulation. 
3. In cases of valvular disease, or other obstructions existing in the heart 
and large vessels, it is next to useless to endeavor to excite diuretic action, 
or appeal to the kidneys by remedies intended to be excreted by them. 
The best diuretic will, in such cases, be found in whatever tends to dimin- 
ish the congested state of the vascular system, and to moderate the action 
of the heart; as digitalis, colchicum, and other sedatives, with mild mer- 
curials. Part xxiv., p. 155. 
Conditions of the Urine as Indicative of the State of Disease.—[The fol- 
lowing valuable remarks on the state of the urine are made by Dr. Dick, 
in considering the subject of dyspepsia.] 
Urine which immediately on being voided gives out a sensible smell of 
ammonia, generally indicates that the vital powers have suffered declen- 
sion ; that disease has become chronic ; that the patient is past middle life, 
or is prematurely aged, etc. 
In arthritic and rheumatic cases, the mineral and vegetable acids are 
carefully to be shunned. Among the latter the oxalic is the most objection- 
able ; next, the malic ; then, the tartaric, citric, and acetic. There can be 
little doubt that these acids act injuriously by their astringent effect on the 
cutaneous and mucous surfaces, by their thus interfering with their own 
elimination and that of the uric and lactic acids ; thereby loading the blood 
with acidulous principles; whence follows that peculiar irritative condition 
of the nerves, constituting local affections, such as sciatica, lumbago, gout, 
or the systemic disturbance of rheumatic fever. It is amazing how difficult 
it is to rid the blood of this acidulous diathesis (if the expression may be 
used) when once it has been formed. The excerments seem to find it a 
peculiarly hard task to eliminate acids. Years of rigid attention to the 
dietetic ingesta are necessary. Hence the rarity of radical cures of gout 
and rheumatism. Part xxiv., p. 160. 
Phosphatic Diathesis.—Dr. Beneke found the phosphates to be present 
in the urine in very different and nearly all sorts of diseases, varying on 
different days in one case, and always remaining of nearly the same amount 
in others; proving that it is not the disease itself which causes the excre- 
tion of phosphates, but that there must necessarily exist some other 
cause in the economy to account for the excretion alluded to. In all 
cases of rapid emaciation there was a large excretion of the phos- 
phates, and sores of blisters in these cases scarcely healed at all, or not 
until long after. We may provide persons in this condition with 
the largest quantities of albumen and fat, but Ave shall never produce 
thereby a remarkable increase of tissues or complexion—that is to say, of 
formation of cells, if avc do not diminish at once the excretion of phos- 
phates by the urine. A hypernormal excretion of earthy phosphates by 
the urine is independent of the nature of the disease. When avc observe HEINE. 
775 
such an excretion, we find a corresponding deficiency of formation of cells, 
emaciation, and loss of strength; but this deficiency is not always exclu- 
sively caused by a hypernormal loss of phosphates, it is often only the 
result of fever or suppuration, or of any other loss of material necessary 
for the regeneration of tissues and organs. It is to be observed we shall 
never be able to judge of the quantity of the earthy phosphates present in 
an ounce of urine, unless we examine the tvhole quantity which is passed 
during the twenty-four hours. Although albumen and fat are present, the 
phosphate of lime increases the produce of cells, and in this manner we may 
promote the cure of diseases showing a deficiency of formation of cells, 
especially in scrofula. On the other hand, in all wasting diseases, a hyper- 
normal quantity of phosphates is always excreted, especially hi those cases 
where the phosphate of lime proves most beneficial. This quantity, from 
Dr. Beneke’s investigations, is not increased by the administration of the 
phosphate of lime, but on the contrary, by its use the quantity in the urine 
often decreases considerably. Part xxiv., p. 312. 
Urine—Deficiency of Urea in.—In all cases where the renal secretion is 
deficient in urea and uric acid, these existing in the blood, Dr. Maclagan, 
of Edinburgh, recommends colchicum. Part xxv., p. 38. 
Causes of Albuminous Urine.—In the normal state the albumen is burnt 
in the blood, and the nitrogenized residue of this combustion, viz., urea and 
uric acid, is eliminated by the urine. The combustion is, however, not so 
complete as not to allow some little albumen to escape with the renal secre- 
tion ; but this albumen, besides being very small in amount, is somewhat 
different from the ordinary kind. M. Robin thinks that if during a suffi- 
ciently long time the albumen underwent in the circulation a much smaller, 
amount in the combustion than is habitually the case, it might pass unaltered 
into the urine, instead of being thrown off in the form of urea and uric acid. 
The urine becomes albuminous in croup, in complete ascites, and in cases 
of capillary bronchitis, with emphysema, accompanied by much dyspnoea ; in 
pulmonary phthisis, especially when complicated by pneumonia and marked 
with difficult breathing; in gestation, when sufficiently advanced to occasion 
a habitual congestion of the kidneys, owing to an impeded abdominal cir- 
culation ; and in such states of the system in which a very incomplete respi- 
ration causes a marked diminution of combustion. The urine is also albu- 
minous in cyanosis, of whichever nature it may be; in affections of the 
heart when they exist in such degree as to keep the patients in a state of 
semi-asphyxia; and, of course, in such cases where an obstacle to the circu- 
lation of the blood, or of malformation of the heart, prevents the hematosis 
from being as rapid as under ordinary circumstances. The urine is likewise 
albuminous in idiopathic or traumatic lesions of the nervous centres, which 
cause a lowering of temperature, and thereby a marked decrease of com- 
bustion ; in diabetes, a disease where very often a lesion of the nervous 
centre seems to be the origo mali; where the great abundance of sugar in 
the blood seems to be an obstacle to the combustion of albumen; and 
where finally the natural heat is lowered by one or tw'o degrees with 
patients who are severely affected. The urine is albuminous in that kind 
of nervous exhaustion which characterizes the state of frame called lum- 
bago, which exhaustion must be connected with a great diminution of 
calorification, and slow combustion. The urine is likewise albuminous in 
consequence of severe exposure to cold of a large surface of the body. 776 
URINE. 
Finally, Bright’s disease, where the urine is always albuminous and anaemic, 
is especially attributed to many of the causes Avhich have been above 
enumerated as capable of exciting the passage of albumen into the urine. 
When the activity of the combustion which takes place in the blood is 
too feeble to burn the whole of the albumen which, in the normal state, 
should be consumed in a given time, the general vitality is diminished, and 
thus more or less albumen is alloAved to pass unaltered into the urine, viz., 
just so much organic matter as escapes the transformation into urea or 
uric acid. The proportion of urea contained in albuminous urine should 
therefore be smaller than it is found in normal urine, and such is found to 
be the case in the following diseases, the only ones, according to the author, 
in Avhich experiments have been made, viz.: pulmonary phthisis, diseases 
of cerebro-spinal axis, extensive and acute bronchitis with intense dys- 
pnoea, and Bright’s disease. Part xxv., p. 134. 
Uraemia, or Uraemic Intoxication.—According to Frerichs, a train of 
symptoms frequently arises in Bright’s disease, due to the contamination of 
the blood Avith the excrementitious constituents of the urine. There are 
two forms of uraemia, acute and chronic. Early in Bright’s disease, patients 
often complain of headache or of a confused sensation in the head; their 
eyes groAV dull and expressionless ; they are forgetful and indifferent; and 
slow and inactive in their movements. If the urinary secretion becomes 
more abundant, these symptoms diminish, or they may disappear entirely. 
In other cases they increase in intensity, the drowziness passes into stupor; 
at first, the patient maybe aroused by loud calling and speaking, and then 
he gives rational answers; subsequently, the coma is complete, and the 
respiration becomes stertorous. Delirium is an infrequent symptom; when 
it does occur, the patient will repeat over and over again the same Avord 
or sentence. Convulsions frequently precede death. 
The acute form of uraemia commences suddenly, and manifests itself in 
the three following Avays: by depression of the functions of the brain, by 
irritation of the spinal cord, and by both sets of symptoms conjoined. In 
the first form, the patients sink suddenly into a state of deep stupor, out 
of which they are very soon unable to be aroused. The face is mostly 
pale, and the pupils immovable; in other cases there is circumscribed red- 
ness of the cheeks, the conjunctivas are then injected, and the pupils small. 
The pulse ranges betAveen 60 and 90 ; on the occurrence of coma, it usually 
increases in size and hardness. The respiration is sometimes stertorous, 
the character of the stertor differing, as Dr. Addison pointed out, from that 
in cerebral hemorrhage.—In the second form, convulsions occur suddenly, 
similar in character to those seen in eclampsia and epilepsy. The Avhole 
muscular system is usually affected. Consciousness is undestroyed.—In 
the third form, coma and convulsions are conjoined. 
These acute forms of uraemia are usually the result of sudden suppression 
of urine, particularly in Bright’s disease, from scarlet and typhus fevers. 
Acute uraemia may be readily confounded Avith cerebral hemorrhage, hys- 
terical convulsions, reflex spasms of various kinds, narcotic poisoning, 
typhus fever, etc. 
Closely allied to the foregoing disorders of the nervous system, as con- 
sequences of uraemia, are certain affections of the senses. The most strik- 
ing of these is loss of Arision ; Amaurosis urmmica.—Like coma and con- 
vulsions, this local nervous affection may be slowly developed, or it may URINE. 
777 
manifest itself in a few days or even hours. The patient complains of a 
sensation, as though a mist lay before his eyes, which from time to time 
becomes denser. The only change perceptible to the physician is some 
sluggishness of the pupil. Landouzy affirms that amaurosis is one of the 
most constant symptoms of Bright’s disease. 
The sense of hearing is affected by Bright’s disease about as frequently 
as that of vision. 
During the convulsions, the pulse, on account of the disturbance of the 
respiratory movements, is accelerated, and at the same time it is often 
irregular; in the intervals between the attacks of convulsions, it resumes 
its normal rate and regularity. 
A febrile disturbance (febris urinosa) closely resembling typhus fever in 
its general characters, is sometimes produced by uraemia. 
The cessation of the symptoms of uraemia is usually accompanied by a 
profuse secretion of urine. 
Vomiting is one of the most constant and early symptoms of uraemia. 
The vomited fluid is generally alkaline, and contains carbonate of ammo- 
nia ; when acid, the presence of ammonia in the egesta is proved by the 
addition of liquor potassae. Frerichs says, “I have frequently sought for 
undestroyed urea in the vomited matters, but always in vain.” Further, 
in uraemia produced by extirpation of the kidneys, and injection of urea 
into the blood, Frerichs always found a large quantity of carbonate of 
ammonia in the vomited matters, but not a trace of urea. 
It is doubtful in what relation the diarrhoea, which occurs in Bright’s 
disease, stands to the uraemia. 
The older physicians frequently asserted, that in cases of suppression of 
urine, the breath and perspiration had a fetid urinous-odor. Many mo- 
dern observers have denied this. Frerichs says, that 'whatever difference 
of opinion there may be as to the existence of this odor, it is a fact, that 
when the symptoms of uraemic intoxication, coma, convulsions, etc., com- 
mence, carbonate of ammonia is mixed in considerable quantity with the 
expired breath, and that the quantity of the ammonia is in proportion to 
the intensity of the uraemic phenomena. 
“I have,” he writes, “repeatedly demonstrated the ammonia contained 
in the expired air of sick men, and of animals into whose veins urea was 
injected after extirpation of the kidneys ; reddened litmus paper quickly 
turned blue in the air issuing from the mouth and nostrils; a rod moist- 
ened with hydrochloric acid produced, when held in the same air, a more 
or less thick cloud. Animals into the veins of rvhich urea was injected, 
continued quiet and awake so long as the expired air was free from ammo- 
nia, but as soon as a rod dipped in hydrochloric acid produced a white 
cloud when held in the expired air, the disorders of the nervous system 
characteristic of uraemic poisoning manifested themselves.” 
Frerichs’ own observations have not enabled him to say anything defi- 
nite as to the state of the sweat in uraemic intoxication. 
After death from uraemia, no lesion of structure of the central organs of 
the nervous system can be detected. The membranes of the brain and 
spinal cord are normal; the quantity of fluid in the ventricles rarely ex- 
ceeds an ounce—i. e., is within the range of health. In four cases of amau- 
rosis uraemica mentioned by Landouzy, in one recorded by Bright, and in 
one observed by Frerichs, the optic nerves and the visual apparatus 
appeared normal. The stomach, also, even when during life it has been 778 
UKINE. 
the seat of severe symptoms, is usually found after death unchanged in 
texture. So the intestinal mucous membrane may be normal in appear- 
ance, when during life there has been profuse diarrhoea. The kidneys 
exhibit the lesions characteristic of one of the three stages of Bright’s dis- 
ease. The blood is sometimes firmly, at others imperfectly coagulated; 
Frerichs thinks that in all the cases of uraemia he has seen occurring spon- 
taneously or produced artificially, it has exhibited a peculiar shade of vio- 
let. Christison, Jaksch, and Hamernjk, have observed cases in which the 
blood had an ammoniacal odor similar to that of decaying urine. Chem- 
ical analysis proves, Frerichs affirms, that the blood, in every case in which 
the symptoms of uraemia are present, contains carbonate of ammonia, and 
also, usually, traces of undestroyed urea. The quantity of carbonate of 
ammonia varies greatly. 
The above are, according to Frerichs’ researches, the most important 
facts known concerning uraemia. 
The cause of the symptoms of uraemia has been generally sought in the 
retention of the constituents of the urine in the blood. 
The following is Frerichs’ own theory of uraemia. The symptoms of 
uraemic intoxication, he says, arise in consequence of the urea accumu- 
lated in the blood being converted, by the agency of a suitable ferment, 
into carbonate of ammonia, while yet within the vessels. For the super- 
vention, then, he adds, of uraemic intoxication, two agents are necessary— 
1st, an accumulation of urea in the blood ; 2ndly, the presence of a fer- 
ment by the agency of which the decomposition of the urea may be 
effected. 
If the urea, after collecting in quantity in the blood, be suddenly decom- 
posed, then the symptoms are those of apoplexy ; if its decomposition is 
effected more gradually, then the symptoms resemble those of typhus ter- 
minating in coma and convulsions. 
With the causes which occasion the development of the ferment, we are, 
Frerichs says, but imperfectly acquainted. In the acute blood-disease— 
e. g., typhus, scarlet fever, and cholera—this agent is rarely absent. Slight 
febrile disturbance, as from exposure to cold, or trifling local inflammation, 
seems in some cases to give the impulse necessary for the destruction of 
the urea. In cases of Bright’s disease which arises during pregnancy, 
the ferment is usually developed. 
The presence of the ferment is manifested only by its effects. Frerichs 
offers no other proof of its existence. 
In order to demonstrate its truth, it must, he says, be proved— 
1st. That in every case of uraemic intoxication, a resolution of urea into 
carbonate of ammonia takes place. 
2nd. That the symptoms characteristic of uraemia can be produced by 
the introduction of carbonate of ammonia into the blood. 
Two series of experiments are described by Frerichs, as offering the re- 
quired proof. 
“ In the first series of experiments, a solution of from thirty to forty- 
six grains of urea was injected into the veins of animals, the kidneys of 
which had been previously removed. They remained for some hours per- 
fectly free from convulsions. . . . In from to 8 hours they became 
restless, vomited acid chyme, or a slimy yellow alkaline mass, according to 
the state of fullness of the stomach at the commencement of the experi- 
ment. At the same time that ammonia was perceptible in the expired air, URINE, 
779 
convulsions supervened, which occasionally ceased and returned again, and 
gradually passed into stupor with stertorous breathing. In some cases, 
convulsions were absent, and then sopor and coma were the lirst symp- 
toms. After death, which took place from 2% to 10 hours from the time 
of the injection of the urea, ammonia in largo quantity was found in the 
blood ; the contents of the stomach emitted, in most cases, a strongly 
ammoniacal (urinous) odor, and contained much carbonate of ammonia; 
in one case only was it somewhat acid, and even then it contained ammo- 
nia. This basis was detected in the bile and other secretions. The stom- 
ach was usually injected, and of a dusky-red color. The brain and its 
membranes were normal in appearance; and the quantity of fluid in the 
ventricles was not increased. 
“In the second series of experiments, a solution of carbonate of ammo- 
nia was injected into the veins of animals. Convulsions, often very violent 
in character, instantly ensued, and stupor quickly supervened. The res- 
piration was difficult, the expired breath was loaded with ammonia, and 
vomiting of bilious matters occurred. The stupor lasted for some hours, 
and ammonia was expired during the whole time. Gradually, however, 
the latter disappeared, and then by degrees, the animals recovered their 
senses. When more carbonate of ammonia was injected, while the animal 
lay in a state of stupor, the convulsions and vomiting recurred, and the 
urine and the stopls passed away involuntarily; after the lapse of five or 
six hours the ammonia again disappeared from the blood, and the animal 
again became lively.” 
Although death by uraemia is the natural termination, so to say, of 
Bright’s disease, yet the fatal result is sometimes caused by other lesions 
—e. (7., by inflammation of serous or parenchymatous structures, by sink- 
ing from vomiting, diarrhoea, dropsy, tubercular suppuration, asphyxia, etc. 
The diagnosis of uraemia from apoplexia cerebri, typhus, gastritis, con- 
vulsions of various kinds, and narcotic poisoning, is to be made by a care- 
ful examination of the quantity and quality of the urinary secretion, the 
presence of ammonia in the expired air, and the symptoms of disease de- 
rived from the organ the functions of which are disordered ; thus uraemic 
coma is distinguished from that dependent upon hemorrhage into the 
brain, by the absence of paralysis of the voluntary muscles, the more fre- 
quent and softer pulse, and the more rapid breathing. The character of 
the stertor, too, differs in the two. The early occurrence of delirium and 
coma, and the absence of the eruption and of enlargement of the spleen, 
aid in diagnosing uraemia from typhus fever. At the same time it must be 
borne in mind that an eruption closely resembling the mulberry rash of 
typhus is sometimes present in the uraemia which follows cholera. 
In the treatment of uraemic intoxication, the first object to be attained is 
the restoration of the urinary secretion. Mild diuretics are the best reme- 
dies for the accomplishment of the desired end. Should these fail, then 
hydragogues are to be employed. Little hope can be entertained of diu- 
retics acting, in the advanced stage of degeneration of the kidney. The 
second object is to prevent the injurious influence of the carbonate of 
ammonia developed in the blood on the nervous centres. When convul- 
sions have commenced, this indication requires our first attention. Hydro- 
chloric and the vegetable acids, Frerichs says, are the remedies which 
naturally suggest themselves ; they pass into the blood, and are excreted 
again, either in their primitive or an altered form, with the urine. At the 780 
URINE. 
same time the patient may be washed with vinegar, and enemata contain- 
ing acetic acid administered. If marked symptoms of cerebral congestion 
are present, purgatives and bloodletting may be required. 
Vomiting, consequent on irritation of the kidneys, is to be relieved only' 
by treating the local affection ; that from chronic dyspepsia, consequent 
on the abuse of spirituous liquors, or disease of the heart, by bitters, nar- 
cotics, and antacids. Uraemic vomiting is most obstinate. Christison 
recommends creasote. Narcotics, Frerichs says, are of no service. 
Diarrhoea, when it occurs during the latter stages of the disease, is 
very obstinate. Frerichs has generally found relief follow the use of liq. 
ferri muriatis. 
In bronchial catarrh, expectoration is to be favored, if deficient, by sen- 
ega, ammoniacum, etc.; if in excess, it is to be restrained by tannic acid, 
acetate of lead, muriate of iron, and other astringents. Alum is some- 
times extremely useful. 
"When the disease is the consequence of pregnancy, it is a question in 
some cases whether premature labor should not be induced. 
Part xxv., p. 135. 
Test for Sugar.—Dr. H. B. Jones gives the following: Test a portion 
of urine with a solution of sulphate copper and liq. potassas ; a blue solution 
is first produced, heat it, and the blue color becomes slightly yellow on the 
surface, and rapidly changes into that of a reddish yfellow precipitate, 
which is the mixture of the color of the urine and the color of the sub-oxide 
of copper. With this test, independent of sugar, a large quantity of ani- 
mal matter or of urea will produce a blue color, but when heated the 
reduction of the copper does not take place near so rapidly.—A salt of 
another metal may be used instead of the copper, as silver with a drop of 
ammonia. The sugar takes the oxygen from the silver, and it is deposited 
in a beautiful metallic form on the glass.—Another easy test is allowing a 
drop of diabetic urine to dry on the glass, and examining it by the micro- 
scope, when remarkable tufts of stellated crystals will be seen. 
Part xxv., p. 155. 
New Test for Sugar.—It is stated by Professor Bbttcher, that the least 
quantity of sugar in urine, or any other fluid, may be detected by adding 
a little carbonate of soda and a small quantity of magisterium bismuthi, 
and boiling briskly ; when the liquid cools, the bismuth, if sugar be present, 
is reduced, and forms a black powder. Part xxv., p. 1G0. 
Mode of Testing for Glucose or Diabetic Sugar.—The only tests on 
which Lehmann places any reliance are Trommer’s, the fermentation test 
and the development of the torula, and the application of Biot and Soleil’s 
polarizing apparatus. The following is the best method of applying Trom- 
mer’s test to an animal fluid suspected of containing sugar: 
The fluid to be examined is treated with caustic potash and filtered if 
necessary—that is to say, if there be too great a precipitate; an excess of 
caustic potash is productive of no harm, as it should be present in more 
than sufficient quantity to decompose the sulphate of copper; the latter, 
which must be added gradually, and in a diluted state, usually gives rise 
to a precipitate, which disappears when the fluid is stirred ; as the quantity 
of the oxide of copper which is soluble is proportional to the quantity of 
sugar which is present, very little sulphate of copper must be added at a 
time, if we suspect that only a little sugar is present in the fluid. On UKINE. 
781 
allowing the azure solution thus obtained to stand for some time, there is 
usually formed a more pure red or yellow powder than the precipitate, 
which is at once thrown down on boiling the fluid. Moreover, very pro- 
longed heating is improper, for there are several substances which by pro- 
longed boiling separate suboxide of copper from alkaline solutions of oxide 
of copper; amongst them we may especially name the albuminous sub- 
stances, which with oxide of copper and potash yield very beautiful azure- 
blue, or somewhat violet solutions, and by very prolonged boiling, separate 
a little suboxide of copper, although without the aid of heat they have not 
this property. 
If a specimen of urine contain very little sugar, or if we are searching 
for sugar in some other fluid, it is advisable to extract the solid residue 
with alcohol, to dissolve the alcoholic extract in water, and to apply the 
potash and sulphate of copper to this solution. By proceeding in this 
manner, we usually obtain the reaction in its most distinct manner. If, 
however, we are seeking for very small quantities of sugar, as, for instance, 
in chyle, blood, or in the egg, we must neutralize the aqueous fluid, pre- 
viously to its evaporation, with dilute acetic acid, in consequence of the 
solubility of albuminate of soda or of casein in alcohol, thus preventing any 
albuminous body from remaining in solution. If the reaction do not pro- 
perly manifest itself in the alcoholic extract thus obtained, or if we would 
carry the investigation further, we must precipitate the sugar from the 
alcoholic solution by an alcoholic solution of potash, dissolve the com- 
pound of sugar and potash in water, and now apply the sulphate of copper: 
if only a trace of sugar be present, we obtain a most distinct and beauti- 
ful reaction. Part xxv., p. 160. 
Operation for Retention of Urine occasioned by Inveterate Stricture.— 
Mr. Simon advocates a modified perineal operation in certain cases. He 
opens the urethra by puncturing a very small incision immediately in front 
of the prostate gland. He then runs a short, elastic catheter along this 
wound into the bladder. He then leaves the stricture untouched for ten 
days more or less, during which the urine flows through the perineal 
catheter; at the end of that time, the stricture is sufficiently relaxed to 
begin its dilatation with a middle-sized instrument. Part xxv., p. 222. 
Retention of—Puncture of Bladder through the Rectum.—Pass the 
index-finger of the left hand into the rectum until the prostate gland is 
felt; the finger must be pushed, if possible, behind this part; seek now for 
fluctuation, which, however, is not always easy to find. The anterior part 
of the bladder having been pressed upon, «nd the posterior part of the 
prostate gland recognized, glide the instrument along the palmar surface 
of the left index-finger until it is in contact with the distended bladder 
resting upon the rectum—take out the director—introduce the trocar—and 
push it upward and forward one or two inches into the bladder. The 
greatest care should be taken that the prostate gland be not transfixed; 
it might be a fatal mistake. 
After puncturing the bladder through the rectum, the patient should be 
kept in bed at least three weeks after the sinuses are securely cicatrized, 
as from its weak and feeble organization, the newly formed cicatrix is 
liable to give way. 
In this case, stricture of the urethra had been the root of the evil. This 
had been followed by abscess, fistula in perineo, and retention of urine; 782 
UELNE. 
for the relief of the last of which the bladder had been punctured through 
the rectum. Mr. Hilton believes the operation is free from danger if care- 
fully performed ; there is very little risk of hemorrhage ; the operation is 
by no means of a protracted kind ; it does not tax the patient’s strength ; 
is not exhausting, and entails no drain upon the system. As the lower 
part of the bladder is punctured, the accumulation of mucus, urine, pus, or 
other secretions, is not allowed, the viscus being completely emptied; you 
prevent the urine finding its way into the urethra, and give an opportunity 
to the false passages of healing, and the natural urethra of recovering 
itself. The seat of the stricture is kept in a state of rest; no local excita- 
tion is used, and all irritation, muscular contraction, or spasm is forestalled. 
There is, on the other hand, no chance of the bladder contracting away 
from the instrument; it contracts toward it. Part xxvi., p. 216. 
Retention of Urine—Puncturing the Pladcler through the Symphysis 
Pubis.—Dr. Brander recommends puncturing the bladder through the 
symphysis pubis. He performed the operation first on the dead subject, 
and then carefully dissected the parts and found that in all respects it had 
been a successful one. The operation has now been performed several 
times with complete success. He employs a flattened trocar. 
Part xxvi., p. 251. 
Presence of Pus in the Urine.—Dr. R. B. Todd says that when the 
urine contains pus it is muddy from the first; hence the difference between 
this and urine containing lithate of ammonia, the latter only becoming 
muddy after a certain time. Phosphatic urine is also muddy when passed, 
but in this case it is much paler ; and after standing some time there is a 
deposit as in the case of pus, but in phosphatic urine it is white instead of 
being yellow, and flocculent and light instead of being thick and heavy. 
A little acid renders phosphatic urine clear, while if pus be present it 
increases the turbidity. In cases of phosphatic deposits also the urine is 
generally alkaline ; in purulent, the urine is generally slightly acid. The 
pus is also rendered glairy and stringy by liq. potassae. Again, if the 
urine be rendered acid by applying heat, the pus coagulates. Lastly, 
examined by the microscope, it consists of two essential parts, liq. puris 
and pus globules, which are characteristic. Part xxvii., p. 89. 
Fetid, Phosphatic, Mucous Urine—Prolapsus of the Anterior Wall of 
the Vagina an Occasional Cause of.—Dr. Bird remarks that middle- 
aged females sometimes suffer great distress from symptoms similar to 
those occasioned by enlarged prostate in the male ; that is to say, there is 
great irritability of the bladder, the urine when passed being fetid, ropy, 
and containing much mucus. He endeavored to trace these symptoms to 
a similar cause, namely, a prevention of the complete emptying of the 
bladder, and the retention of a portion of urine, so as to produce in it 
decomposition. Such a cause, he considers a prolapsion of the anterior 
wall of the vagina. He says : Almost the first case in which I recognized 
the condition to which I am alluding, occurred in the person of a stout, 
tolerably healthy-looking woman. 
She complained of great sense of distress in the lower part of the abdo- 
men, with weight and bearing down. Walking was painful to her, and 
she was almost constantly tortured with a desire to empty the bladder. 
The urine was very offensive, and contained a large quantity of dense, URINE, 
783 
ropy mucus, mixed with phosphates. Suspecting the possible presence of 
a calculus, I introduced a catheter, but little urine escaped, and no concre- 
tion could be felt. But on examining the vagina, a large pink looking sac 
depended from its anterior wall, and almost separated the labia. She was, 
indeed, suffering from prolapsus of the bladder into a pouch formed in the 
anterior vaginal wall. By keeping the bladder emptied by the daily use 
of the catheter, the urine soon recovered its healthy appearance, and the 
mucus decreased considerably. The decomposition of the secretion in this 
vesical pouch had evolved ammonia, which had irritated the bladder, and 
caused a copious secretion of mucus, loaded with the earthy salts, from 
its lining membrane. I sent the patient to my brother, Dr. Frederick 
Bird, as I believed no permanent cure could be obtained while the pro- 
lapsus existed. lie applied the actual cautery to the anterior wall of the 
vagina, and the result was most satisfactory. After the slough came away, 
sufficient contraction occurred to prevent the formation of the vesical 
pouch, and the patient remained free from the ailment which had so long 
distressed her. 
In another case the condition of the patient was relieved by introducing 
an injection of infusion of galls three times a day into the vagina, wearing 
an abdominal support with a perineal pad, and the administration of quina 
and iron with dilute phosphoric acid. Part xxvii., p. 193. 
Characters of TJrine Depositing Oxalate of Lime.—The principal 
characters which have been noticed as belonging to urine containing 
oxalates, are the following: (1) A density somewhat higher than natu- 
ral, indicating an excessive elimination of urea, or of the indeterminate 
extractive matters of the urine. In the series of cases recorded by Dr. 
Golding Bird, one-half of the specimens ranged from 1015 to 1025. Some 
were as low as 1009; some as high as 1030. In the cases recorded by 
Dr. J. W. Begbie (Monthly Journal, March 1848,) the average density 
was 1028 ; the extremes being from below 1015 to above 1030, and in 
one case 1040. Dr. Prout states, in general terms, that the urine in such 
cases is of moderate density. (2.) A color, according to Dr. Prout, pale 
citron yellow, or greenish; according to Golding Bird, amber, never 
greenish; according to Dr. Begbie, amber, darker than in health. (3.) 
An odor generally natural, rarely aromatic, like mignonette (Golding 
Bird); on the other hand, aromatic, occasionally approaching to that of 
the sweet-brier, noticed in urine containing the cystic oxide (J. W. Beg- 
bie). (4.) A reaction almost always more or less acid, frequently power- 
fully so. Part xxix., jo. 137. 
Oxaluria.—The terms oxaluria and oxalic acid diathesis are now well 
understood to mean that morbid state of the digestive and assimilative 
functions in which oxalic acid is eliminated by the kidney in combination 
with urine. It is by no means an uncommon complaint. The prevailing 
forms of the crystals are the octahedral and the dumb-bell. It is at present 
believed that the former consists of the oxalate, and the latter of the 
oxalurate, of lime; and this is likely, because therapeutic agents do not 
act alike in both cases. In a case of this disease under the care of Dr. 
Gray, of Glasgow, marked by the presence of dumb-bell crystals, after 
other remedies had failed, one grain of nitrate of silver was given every 
six hours. In two days it was diminished to half a grain, and 3j. of the 
acidulated tincture of calumba was given night and morning. It should 
O O O 784 
UKINE. 
be observed, that where oxalate of lime appears in octahedral crystals, 
the nitromuriatic acid with a vegetable tonic will generally eflect a cure. 
If the dumb-bell form appears, nitrate of silver is very useful. Where 
both kinds of crystals are present, these medicines should be given alter- 
nately. Part xxix.,p. 142. 
Morbid Condition of the Urine connected with Chronic Disease.— 
Indigestion.—When alkalescent from fixed alkali, says Dr. II. B. Jones, 
it is from the stomach. Take more air and exercise, Avith mild nutritious 
food. Give Aregetable acids, as lemon-juice or citric acid, but not tartaric. 
Seventeen grains of dry citric acid are about equal to half an ounce of 
lemon-juice, and one lemon generally gives one ounce of juice. IVelve 
ounces of lemon-juice, equal to 408 grains of citric acid, may be given in 
one day if necessary. 
When alkalescent from volatile alkali, it arises from affection of the 
mucous membrane of the bladder. In this case bucliu, pareira brava, tur- 
pentine, cubebs, copaiba are used. Buchu is given when pus is present; 
pareira brava Avhen there is ropy mucus. Buchu is good when the urine 
is acid, pareira when it is alkaline; in short, when you Avant a stimulant 
give buchu; Avhen you Avant a demulcent give pareira brava; when you 
want an astringent give uva ursi. Part xxix., p. 145. 
Sulphuric Acid, versus Urine.—Mr. J. E. Huxley has pointed out that, 
in the wards of insane establishments which are wet and dirty, no scrubbing 
or scalding will effect more than a temporary improvement, as the floor 
becomes a reservoir for the perpetual exhalation of the volatile ammonia. 
But if dilute sulphuric acid be poured over such floors, in the proportion of 
one ounce of acid to tAventy-four of Avater, and allowed to remain tAventy- 
four hours, a Avhite film (sulphate of ammonia) will form, which may be re- 
moved by Avashing, and Avill leave the room sweet. The principle is that 
of converting a volatile into a fixed salt that may easily be got rid of. 
Part xxxi., p. 232. 
Test for Sugar.—Dr. Garrod considers that sugar in very small quanti- 
ties may be detected by treating the fluid Avith trisacetate of lead, filtering, 
removing the lead with bicarbonate of soda or potash, and again filtering, 
by Avhich means a colorless urine is produced, giving, on the addition of a 
few drops of concentrated solution of potash and heat, a bright orange 
color. Part xxx\.,p>. 277. 
Retention of Urine.—Dr. H. Thompson insists upon the principle, that 
Avhen perineal abscess is found co-existing with retention of urine, it is very 
rarely necessary to have recourse to any severer measures than the 
opening of the abscess, and the passing of the catheter ; and, further, that 
the sooner the necessary opening is made, the less likely is the patient to 
become the subject of extravasation at the time, or to suffer from urinary 
fistula afterward. Part xxxii., p., 169. 
Urine, Extravasation of, from Injury to the Perineum.—Dr. Fletcher 
says Ave may have extravasation of urine from a rupture of the urethra 
without any SAvelling in the perineum, and in all such cases, Avhere there 
are all the general symptoms of extravasation and you have reason to 
fear escape of urine, you must make a free and deep opening into the peri- 
neum, exactly in the medial line. Part xxxii., p. 179. URINE. 
785 
Purulent TJrine from Chronic Pyeletis.—Dr. Basham of Westminster 
Hospital says the value of the information to be derived by-examining the 
chemical and microscopic character of the urine depends much on the care 
and accuracy with which these chemical and microscopic facts are applied 
to the condition and symptoms of the patient. The special characters of 
these deposits, if correctly interpreted, become highly significant and 
instructive, great aids to diagnosis, and the eventual basis of treatment. 
The cause and nature of a dropsical condition of the system are at once 
recognized, when in albuminous urine there are found epithelial, fibrinous, 
or waxy casts of a tubular character, glandular epithelial cells loaded with 
fat, or blood discs with amorphous fibrin, stained with hematin. The 
pathology of dropsy with such concomitants differs materially from that in 
which the urine is free from such deposits. But, on the other hand, cases 
occur in which there is no dropsy—no anasarcous state, yet the urine con- 
tains albumen, to which is added the presence of pus corpuscles, minute 
membranous coagula entangling clots of blood, blood discs in abundance, 
and shreds of amorphous fibrin. If, in such cases, there is great irrita- 
bility of the urinary organs, frequent micturition with pain referred to the 
neck of the bladder, perineum, or penis, a suspicion at once exists of disease 
of the renal organs very different in character from that which we predicate 
on the first example. It is, however, only by a cautious comparison of the 
symptoms experienced by the patient with these morbid products in the 
urine that a correct and satisfactory diagnosis can be obtained. The pre- 
sence of pus corpuscles in the urine is not, alone, sufficient to induce sus- 
picion of renal disease. In gonorrhoea, or other inflammatory affections 
of the urethra, in catarrh of the bladder, or gouty inflammation of this 
viscus, pus would be present in the urine. In stricture, in chronic gleet, 
membranous debris, often entangling minute clots of blood, may be, and 
often are, present, and yet no suspicion of renal disease from any such 
appearances would be warranted. It is therefore by a careful comparison 
of the sedimentitious matters in the urine with the general symptoms of 
the patient, that we are enabled to arrive at a correct and intelligible diag- 
nosis. 
The symptoms most characteristic of pyeletis or inflammation of the 
pelvis of the kidney, are, rigors, with lumbar pains, sometimes dull and 
continuous, sometimes pungent and darting; often extending and becom- 
ing fixed at the crest of the ilium, or prolonged to the outside of the thigh, 
with numbness in the direction of the external crural nerve. Occasionally 
there is retraction of the testicle of the same side; there is frequent mictu- 
rition, and great irritability of the urinary organs. The patient complains 
of pain in the perineum, or in the neck of the bladder, or feels a darting 
pungent sensation along the urethra, fixing itself in the glans penis till 
temporarily relieved by passing urine ; the quantity passed rarely exceeds 
one or two ounces, and the urgency for passing this small quantity recurs 
at very short intervals of time. The pain in the bladder, perineum, or 
penis, is always relieved by micturition, and there is no difficulty or obstacle 
to the free passage of the urine. 
The urine when first passed is cloudy, or even milky, but when set at rest, 
separating into two portions, an upper, clear, natural-colored fluid, not 
ropy, but containing albumen ; a lower and distinct sediment of a yellowish 
color, consisting of pus corpuscles, amongst which oftentimes may be seen 
minute fibrinous shreds or membranous flocculi, with small coagula of blood 
YOL. II.—50 786 
URINE. 
attached. Earthy amorphous matter is also present in some cases. 
Hematuria, sufficient to cause discoloration of the urine, may or may not 
have occurred ; yet, in most cases, although the urine is not discolored, 
scattered blood discs may be detected by the microscope. 
If the disease be of a certain duration, there may be fullness and enlarge- 
ment of the kidney of the affected side ; for if a concretion becomes per- 
manently fixed in the pelvis of a kidney, a partial obstruction of the ureter 
follows, and the usual conditions of an encysted and sacculated kidney have 
commenced. If, on the other hand, the calculus descends into the bladder, 
a train of symptoms sufficiently characteristic follows, which clearly indi- 
cate its descent into that cavity. 
But we have to interpret from these symptoms the part of the urinary 
apparatus which is the seat of the disease, for these conditions, in some 
respects, are common to many different disorders; yet if they be carefully 
analyzed, and a just comparison established between the one and other, 
we shall ultimately arrive at a correct diagnosis of the disease. Turbid and 
troubled urine, with painful and frequent micturition, may occur in stric- 
ture, gleet, or gonorrhoea; but, in the two latter, the character of the pain 
during the passage of the urine, and the appearance of discharge at the 
orifice of the urethra, not to say the stains on the linen of the patient, 
would make the case sufficiently clear. In stricture, in addition to a tui’bid 
urine, when gleet is present, there may be membranous shreds, and even 
minute coagula, such as have been noticed in the urine of the patient under 
consideration. But, in such a case, the pain and distress are felt during 
micturition, not before; the urine passes with difficulty, or in drops, or in a 
diminished stream, and an exploration of the urethra proves the impedi- 
ment to the free excretion of the urine. In calculus of the bladder, similar 
conditions of the urine might exist, and much pain be experienced in the 
bladder, perineum, and penis ; but the pain in such cases is most aggra- 
vated after micturition; as the bladder fills the pain diminishes; just the 
reverse happens in the painful and irritable bladder of renal disease. 
Moreover, an exploration of the bladder establishes the presence of a stone. 
In the case before us, the patient refers the commencement of the pain to 
the region of the kidney, and describes the pain as if descending thence in 
the direction of the bladder, and becoming pungent and stabbing in the 
perineum, and occasionally extending itself to the extremity of the glans 
penis. These distressing sensations are always relieved by micturition, and 
there is a temporary lull till the urine collects again, even in small quantity. 
This fact is of much importance in the diagnosis of renal disease, and t aken 
in conjunction with the history of the case, with the albumen and amount 
of the purulent sediment in the urine, and the peculiar character of the 
lumbar and regional pain, constitutes very fair evidence of inflammatory 
action of the pelvis of the kidney. 
In cases of inflammation of the bladder, cystitis or catarrh of the blad- 
der, and limited to that cavity, the character and quality of the urine differ 
much from what is excreted in renal disease. The urine is contaminated 
by the inflammatory exudation from the vesical mucous membrane; pus 
cells, and the so-called exudation corpuscles, are present in abundance; but 
the pus corpuscles do not subside as a distinct and well-defined precipitate, 
they are entangled in a ropy magma, in which numerous crystals of the 
triple phosphate are visible ; this vicidity and these crystals being rapidly 
developed by the agency of the alkaline urine always voided in inflamma- HEINE. 
787 
tion of the bladder. This character of the urine will suffice to distinguish 
vesical from renal inflammation. 
The ready separation of a turbid or milky urine into two parts, a clear 
supernatant portion containing»albumen, derived from the liquor purus, and 
a sedimentary portion of pus corpuscles distinctly precipitated, voided by 
a patient who suffered from severe regional pain either in the kidney or 
bladder, perineum or penis; and if, in the first-named position, aggravated 
by pressure or motion, or when, in the latter parts, relieved temporarily 
by micturition, and in whose urine gravel, or blood, or both, had been 
previously, or at some antecedent period, present, to such a collection of 
symptoms there should be little hesitation in referring them to a chronic 
inflammation of the pelvis of the kidney. 
In the treatment of these cases our chief reliance must be placed on 
the palliative agency of opium. If it be a case of calculous pyeletis—that 
is, chronic inflammation of the pelvis of the kidney arising from the irrita- 
tion of the calculus impacted therein—it is quite obvious that so long as 
the irritating agent remains, so long will the symptoms of chronic inflam- 
mation continue. We have no remedies that can either dissolve or remove 
such a concretion, and the progress of the case must ultimately depend on 
the form and composition of the calculus, some of which escape into the 
bladder, with symptoms characteristic of their descent through the ureter; 
and, if their diameter be but small, may be excreted through the urethra; 
this is more likely to happen in the female. These are the most favorable 
terminations to renal calculus. In other cases the calculus having escaped 
the kidney, lodges in the bladder, and gives rise to the usual symptoms, 
relief from which can only be obtained by the assistance of a skillful 
surgeon. But in by far the more numerous cases of calculous pyeletis, the 
concretion grows by the apposition of fresh matter, becomes impacted in 
- the head of the ureter, does not completely occlude the outlet, but becomes 
branched and irregular in shape by the constant deposit of phosphatic 
matter derived from the action of alkaline purulent fluid on the urine, still 
secreted by the intact part of the kidney; the fluid retained in the pelvis 
of the kidney is constantly exerting a dilating influence, and in the progress 
of the case a renal tumor is felt, distinctly fluctuating, and if the history 
and symptoms of such a case be carefully collated, the diagnosis is not 
difficult. It must be clear that medicinal remedies can exert no curative 
influence in such a case. To palliate and relieve must be the limit of our aid. 
In the case which has formed the subject of these remarks, you have 
seen that perfect quietude, the warm-bath, cupping on the loins in the early 
period, and opiates, were the agents through which partial relief was 
obtained. The buchu, the sesquiehloride of iron, and the mtro-muriatic 
acid, although severally administered, cannot be said to have done any- 
thing for the relief of the patient. Part 123. 
Oxalate of Lime Deposit.—When examining urine, microscopically, 
which contains oxalate of lime, it is possible that the crystals may be 
obscured by opaque urates. When such is the case, says the editor of the 
“ Medical Times and Gazette,” they must first be dissolved out by liquor 
potassse, or they may very much deceive you, by leading you to suppose 
that there is very little oxalate of lime, when it is present in great abund- 
ance. ' Part xxxiii., p. 127. 
Tests for Sugar.—Kledzinslafs fluid, composed of potash, glycerine, 788 
UKINE, 
and saturated solution of sulphate of copper, when added to diabetic urine 
and boiled, turns it of an opaque amber color; with non-saccharine urine, 
there is a white flocculent deposit. Maumene's Test is made by soaking 
white merino, or any woollen fabric, in a solution of bichloride of tin, and 
drying in a water bath: when dipped in suspected urine and carefully 
dried, the cloth becomes of a darkish brown or almost black color. 
Part xxxiii.,y>. 128. 
Liebig's 3Iethod for the Rapid Detection of Sugar.—Dissolve a small 
quantity of ox-gall in the suspected fluid in a test tube; then add rapidly 
an equal quantity of strong sulphuric acid. If sugar is present, a beautiful 
purpurine is immediately produced. Part xxxiii., g>. 129. 
New Test for Sugar in Urine.—Krause advocates the use of the test- 
fluid, originally proposed by Luton, containing the bichromate of potash 
in solution. He proposes that the fluid should be made thus: Dissolve 3j- 
of bichromate of potash in 3ij. of aq. destill., with the addition of 5ij. of 
concentrated sulphuric acid. When glucose urine is treated with an equal 
bulk of this fluid, the reddish-yellow color changes, in a short time 
(instantly by the application of heat), into a beautiful bluish-green color, 
more or less dark, according to the degree of concenti’ation, and carbonic 
and formic acids escape during effervescence. A dirty brownish-red color 
(with occasionally a tinge of green) results if no sugar be present. Whilst 
Krause deprecates neglect of the well-known tests proposed by Trommer 
and others, he considers this one as more certain and less difficult than any 
other. Part xxxv., p. 64. 
Sugar in the Urine—Tests for.—Dr. Garrod, of University College, 
says: Moore’s test, or that by boiling the urine, to which an equal bulk of 
liquor potassse has previously been added, may be much increased in 
delicacy by first adding a drop or two of the potash solution to insure slight 
alkalinity, and then some good bone black or animal charcoal. This mix- 
ture must now be filtered, and we thus obtain a liquid perfectly color- 
less, and on adding a further excess of liq. potassae, and boiling, the yel- 
low or orange color is much more readily observed than in the urine 
before preparation. Should no change of color take place, we may safely 
conclude that no sugar exists, or, at any rate, such traces as may safely 
be disregarded. Part xxxv., p. 301. 
Retention of Urine.—If a catheter cannot be passed, Mr. Forster, of 
Guy’s Hospital, would place the patient under the influence of chloroform; 
if the stricture be spasmodic, it will be at once relaxed, and even if a per- 
manent one, will often be relaxed so far as to admit of the passage of an 
instrument. Part xxxvi.,jp. 182. 
Constituents of the Urine and their Sources.—The following, by Dr. 
A. H. Ilassall, of Koyal Free Hospital, are the sources from which the 
different constituents which come under the name of Essential Consti- 
tuents of the Urine are derived: 
Urea is a nitrogenous compound, derived from the disintegration of 
some of the nitrogenized tissues, according to Dr. Prout, the gelatinous 
tissue of the body. The principal part of the nitrogen of the disintegrated 
tissues is eliminated from the system through this compound. 
Creatine and Creatining are also nitrogenous bodies, derived, as appears 
from the researches of Liebig, from the disintegration of the muscular tissue. 789 
URINE, 
Uric acid, according to Dr. Prout, results from the disintegration of 
the albuminous tissues. But it is probable that uric acid is in some cases in 
part derived from elements of food rich in nitrogen, imperfectly assimilated, 
and the same, perhaps, is also true in some cases with urea. 
The coloring matter of the urine, which is a non-nitrogenous substance, 
and extremely rich in carbon, is supposed to be modified hematin, set free 
on the decay and breaking doAvn of the blood corpuscles, and to be the 
vehicle by which much of the excess of carbon contained in the system is 
eliminated. 
The sulphuric acid is formed in part by the oxydation of the sulphur 
contained in the proximate nitrogenized animal principles, as well as in 
taurine. 
The phosphoric acid present in the urine proceeds in part from the 
oxydation of the phosphorus which forms one of the constituents of the 
nervous tissue, and especially of the brain. 
The silica is set free by the disintegration of the osseous tissues. 
Lastly, the ammonia of the urine is in part derived from the decomposi- 
tion of the urea. 
On the other hand, the constituents termed Non-essential, as all the 
chlorine of the chlorides, and great part of the sulphuric, phosphoric, and 
silicic acids, are derived from the articles of drink and food consumed, 
together with the several bases, excepting part of the ammonia, as lime, 
magnesia, potash, and soda, with which the chlorides, sulphates, and 
phosphates, are in combination. Part, however, of these salts are, during 
assimilation, received into, and imbibed by the different tissues, and 
become set free again on their disintegration. 
The presence in the urine of either of the essential constituents in 
increased or diminished amount, signifies the extent of the decay and dis- 
integration of the particular tissues from which they are derived. 
Part xxxvii., p. 90. 
Discrimination of certain Organized and Disorganized Matters and 
Principles in the Urine.—Dr. A. H. Hassal gives the following: Dis- 
crimination of Epithelium.—Occasionally, deposits appear in the urine 
bearing considerable resemblance to mucus or pus, and which it is impos- 
sible to distinguish by the eye alone, but which, when examined under the 
microscope, are found to consist almost entirely of epithelium. These 
deposits occur especially in the urine of women, the epithelial scales being 
derived, for the most part, from the vagina. More rarely, however, the 
deposit consists of the epithelium of either the renal tubules or bladder. 
Each of these three varieties of epithelium possesses well-marked structural 
peculiarities, by which it may be distinguished, either as they occur 
separately or when mixed together. 
Discrimination of Pus.—A deposit of pus in urine is distinguished from 
one of mucus, first, by its appearance; it is more opaque and cream-like, 
and forms a more decided and equal sediment, and when the urine is 
shaken, it becomes equally diffused throughout, without any ropy or tena- 
cious shreddy substance being visible. 
If, however, the urine be very alkaline, the appearance presented by the 
purulent deposit is very different; it becomes acted upon by the alkalies 
of the urine, and is then converted into a semi-transparent, tenacious sub- 
stance, very closely resembling mucus, from which, by the eye alone, there 790 
URINE, 
is no means of distinguishing it. This change of appearance is often 
observed in urines which contain pus, and which have been kept for some 
days; the deposit, from being soft and opaque, gradually becomes trans- 
parent and ropy. The appearances presented to the naked eye by a deposit 
of pus in fresh urine are often quite decisive. 
The outward characters of the deposit having been carefully observed, 
a portion of the urine, after filtration, is to be boiled in a test-tube; if this 
prove albuminous, there will be stronger reason for regarding the deposit 
as one of pus, for, with a mucous deposit, as already stated, the urine is 
scarcely ever albuminous. 
When we come to examine a deposit of pus with a microscope, we find 
that the granular corpuscles are much more numerous than in mucus; that 
they are more readily acted upon by dilute acetic acid ; and that a large 
number of nuclei are disclosed in them; also, that there is an absence of 
the fibrous shreds as well as of epithelial scales. 
Thus, by the several characters, external and microscopical, now enume- 
rated, pus and mucus may in general be easily and satisfactorily distinguished 
when in a separate state; when, however, these deposits are mixed 
together, the distinction is much more difficult, and in some cases quite 
impossible. 
When pus has been acted upon by the alkalies of the urine, and con- 
verted into a substance resembling mucus, the distinction between the two 
may still, in general, be effected by means of the microscope, for in this 
case, while there will be an absence of epithelial scales, the pus corpuscles 
will be found to be considerably larger than tliey are under ordinary cir- 
cumstances. 
Another difference between mucus and pus is that the latter contains a 
rather larger propoi*tion of fatty matter ; this is seen under the microscope 
in the form of small, shining droplets or spherules, either free or contained in 
the granular corpuscles, or the fatty matter may be extracted by means of 
ether. The quantity of fatty matter in mucus is very small, and frequently 
it is almost entirely absent. When, therefore, fatty matter is left, on the 
evaporation of the etherial solution of a suspected deposit of pus, there is 
further reason for considering that the deposit really consists of that 
substance. 
We have noticed that pus acted upon by alkaline urine becomes con- 
verted into a ropy substance, similar to mucus ; this conversion is more 
marked, and is almost immediately effected, by the addition to the deposit 
of a solution of either ammonia or potash. 
Urine containing pus, is most commonly either neutral or slightly acid, 
and becomes alkaline only slowly, while mucous urine, on the contrary 
even if acid when first passed, very quickly becomes alkaline and ammo- 
niacal. 
The liquid portion of pus, liquor puris, differs essentially from that of 
mucus, and holds in solution the following substances : albumen, a peculiar 
compound, pyin, or tritoxide of protein, which is soluble in water and pre- 
cipitated by acetic acid, fat, and salts. The salts consist for the most part 
of chloride of sodium, with small quantities of phosphate, sulphate, and 
carbonate of soda, chlorides of potassium and calcium, earthy phosphates, 
and traces of iron, thus showing a resemblance in composition to the serum 
of blood. 
Deposits of triple phosphate, especially when the crystals are small, are UKINE, 
791 
very apt to be mistaken for pus—an error w Inch is at once rectified by 
the employment of the microscope. 
Discrimination of Albumen.—The detection of albumen in urine is very 
simple. A small quantity of the urine is to be heated until it boils, in a 
test-tube, over the flame of a spirit-lamp. As soon as the temperature of 
the liquid becomes raised to over 170° Fahr., the albumen will become 
coagulated ; and if the test-tube be set aside for a time, it will become de- 
posited, when it may be collected, dried, and weighed. The precipitated 
albumen is soluble in solution of potash, but insoluble in nitric acid. 
There are certain sources of failure and fallacy attending the detection 
of albumen in the urine : 
Thus, if earthy phosphates be present in excess, they will become preci- 
pitated as soon as the urine is boiled ; this precipitate’resembles somewhat, 
and might be mistaken for, albumen, from which it is, however, distin- 
guished by its solubility in nitric acid. 
Again, it has been noticed, that, when urates are in great excess in the 
urine, a white precipitate of uric acid is occasioned on the addition of nitric 
acid, which might also be mistaken for albumen. 
Dr. Owen Rees remarks, “ I have observed this in cases of typhus fever 
of low type, and also in several cases of smallpox. This precipitate is dis- 
tinguished from albumen by the fact that the addition of hydrochloric acid 
to a second portion of the urine will occasion a precipitate equally with the 
nitric acid, if it be owing to uric acid, but no precipitate will ensue if albu- 
men be present.” 
A precipitate likewise occurs when nitric acid is added to the urine of a 
patient who has taken either copaiba or cubebs, and which, at first, closely 
resembles albumen. This precipitate arises from the deposition of the 
resinous matter contained in the above-named medicines. It is distin- 
guished from albumen by its not subsiding as distinct deposit, and by its 
producing a permanent opacity of the urine. 
Another method of distinguishing albumen in such cases is by acidulat- 
ing the urine with acetic acid, and then adding a solution of ferrocyanuret 
of potassium. If albumen be present, it is thus immediately thrown down; 
whereas in the other case, if acetic acid produce a slight turbidity, this will 
not be increased by the addition of the ferrocyanuret of potassium. Lastly, 
no precipitate is occasioned by boiling, and the urine of persons taking 
copaiba or cubebs evolves, when first passed, the strong odor of those 
drugs. 
But it sometimes happens that albumen is present, and yet is not preci- 
pitated on boiling ; this happens whenever the urine is alkaline, the albu- 
men being kept in solution by the alkali. In this case it is necessary first 
to acidify the urine with nitric acid, and then to boil. But nitric acid in 
excess precipitates albumen from the urine as well as heat. It is, there- 
fore, best in most cases, to test both with nitric acid and heat, and it is 
always proper to ascertain whether the precipitate which appears on boil- 
ing is soluble in excess of nitric acid or not. 
In employing nitric acid, the reagent should be added in excess, as it 
sometimes happens that the albumen first thrown down is redissolved; but 
when an excess of the acid is used, the albumen is thrown down perma- 
nently, and is not redissolved. > 
Dr. Bence Jones has stated, that he has found a few drops of a mixture 
of one part of nitric to three of hydrochloric acid much more decided in 792 
its effects, and much more delicate in its indications, than pure nitric acid. 
This is explained in the evolution of chlorine gas by the extraction of the 
hydrogen of the hydrochloric acid, one of the most delicate precipitants of 
the protein compounds being thus set free. But this test, like the ferro- 
cyanide of potassium test, has the property of precipitating other protein 
compounds besides albumen, as mucus, etc. 
The quantity of albumen in urine varies greatly, from a mere trace to 
some grains to the ounce ; and according to the quantity present, so varies 
the appearance of the urine on the application of heat. If the quantity be 
very considerable, the urine will become almost white, and nearly solid ; 
whereas, if it be very small, the deposit may be so trifling as altogether 
to escape detection, until the test-tube be set aside for some hours so as to 
allow of the subsidence of the deposit. In this way the presence of a very 
minute quantity of albumen will be detected. When but little more than 
a trace of albumen exists in the urine, it is best to take a very large test- 
tube, and to boil some five or six drachms of the urine. 
Albumen is also precipitated by dilute hydrochloric acid, ferrocyanide 
of potassium, bichloride of mercury, alcohol, creasote, tannin, and many 
other substances. It is not precipitated, however, by phosphoric and acetic 
acids, which exert a solvent action upon it, nor by strong hydrochloric 
acid, with which, when warmed, it forms a purple-colored solution. 
A remarkable substance allied to albumen has been detected in urine, 
by Dr. Bence Jones, in case of rickets. It differed from albumen by not 
being precipitated by either heat or nitric acid ; but on boiling the urine, and 
allowing it to cool, a precipitate fell which redissolved on the application 
of heat. Alcohol added to the urine readily coagulated this substance. 
Determination of Chyle.—Urine containing chyle is usually more 
milky and opalescent than when it contains only oil. In chylous urine ex- 
amined microscopically and chemically, all the usual elements of chyle will 
ordinarily be detected, as oil, albumen, and granular organic corpuscles, 
resembling the white corpuscles of the blood. The albumen is to be de- 
tected after filtration of the urine by coagulation in the ordinary manner. 
The oil may, or may not, be visible under the mici’oscope in the form of 
droplets; but if present it may always be obtained by agitation with ether; 
lastly, the granular corpuscles are distinguished from the flat globules by 
their size,- granular texture, and by the action of acetic acid and ether 
upon them; by the first reagent, nuclei are disclosed in the corpuscles, 
while in ether they are insoluble, and thus distinguished from the fatty 
globules, for some of which they might be readily mistaken. 
The milky appearance presented by chylous urine is occasioned partly 
by the oily matter and the granular corpuscles present, and partly by pre- 
cipitated albuminous, or more probably fibrinous matter. Chylous urine 
when first passed, and while still warm, does not usually present the same 
degree of opacity and milkiness which it acquires when it becomes cold. 
This depends on the solidification both of the fatty and fibrinous matters 
present. If the quantity of chyle present be very considerable, the urine 
will sometimes acquire a gelatinous or semi-solid consistence, owing to the 
coagulation of the fibrinous element. 
In some of the cases of chylous urine which fell under the observation 
of Dr. Prout, the albumen did not coagulate on the application of heat, 
but it did when nitric acid was added, and hence he was led to consider 
that this albumen was in an imperfect state. 
URINE. URINE, 
793 
The proportion of fat present in chylous urine may be so great that it 
may interfere with the gelatinization of the spontaneously-coagulable albu- 
men or fibrin, but as soon as the fat has been removed by means of ether, 
the solidification will in some cases, take place. 
Determination of Fatty or Oily Matter.—Urine containing fatty or 
oily matter is usually, but not always, more or less turbid, and if the fat 
occur in connection with chylous matter, it will not only be turbid, but it 
will possess a whitish and milky appearance more or less marked. Usu- 
ally when a drop of such urine, especially if it has been allowed to stand 
at rest for some time, and it be taken from the surface, is examined under 
the microscope, droplets or spherules of oil will be seen, which are readily 
distinguished by their strongly refractive properties, as well as by their 
solubility in ether. 
Should the presence of fat be suspected, and no globules of oil be visible 
under the microscope, a portion of the urine should be agitated with ether, 
which will dissolve out any oily or fatty matter which may be present, and 
which may be obtained in a separate state on the evaporation of the ethe- 
real solution. 
That the substance thus contained consists really of fat is known by its 
greasy appearance, its insolubility in cold water, by its breaking up into 
droplets when agitated with hot water, and its solubility in ether. 
It is not very often that a urine is met with containing only fat, for when 
this is present, it is usually derived from chyle, some of the constituents 
of which are generally present in the urine with it. 
But minute quantities of fat may be present in urine, independent of 
chyle, as in certain forms of Bright’s disease, and also without occasioning 
the slightest turbidity. In this case, the fatty matter is found in the cells 
and renal casts thrown off", and whicn have become deposited from the 
urine after it has stood for some hours. 
The microscope affords the only means by which the presence of oily 
matter in connection with the renal cells and tubules can be ascertained. 
In the Mauritius, fatty urine is epidemic, and it accompanies a peculiar 
form of irritative fever. 
A peculiar kind of fatty matter, to which its discoverer, Dr. Florian 
Heller (Heller’s Arch., 1844 and 1845), gave the name of uro-stealith, has 
been detected in one instance in the urine. The patient, a weaver, twenty- 
four years of age, labored under all the symptoms of calculus, and passed 
some small concretions, which, on examination, were found to be com- 
posed of the peculiar fatty matter in question. These concretions pos- 
sessed the following characters: When fresh, they were soft, becoming 
when dry, hard, yellow, wax-like, brittle, and amorphous, and presenting 
by transmitted light a greenish-yellow color. On the application of heat, 
they puffed up, inflamed, emitted a peculiar pungent odor, between that 
of shellac and benzoin, and left a voluminous ash. In hot water they 
softened, but did not dissolve; they were readily soluble in ether; the 
residue, on the evaporation of the ethereal solution, assumed a violet color. 
On the application of a gentle heat, nitric acid dissolved them with a slight 
effervescence, forming a colorless substance. 
Determination of Fibrin.—Fibrin is distinguished from albumen by its 
undergoing solidification when effused from the blood-vessels. It usually 
occurs in the urine in connection with blood, but not always so. Some- 
times it exudes from the blood-vessels of the kidneys, and solidifies in the 794 
UKESTE, 
renal tubules, in the form of casts. In other, but very rare cases, the 
effused fibrin does not solidify until after the urine has been voided. 
When the fibrin solidifies in the kidneys, the casts are usually met with 
in the urine. Whenever, then, these casts are observed under the micro- 
scope, or the urine becomes at all gelatinous on cooling, and this whether 
it contain blood or not, fibrin is present. 
Now, almost constantly, albumen is voided at the same time with the 
fibrin ; whenever, therefore, the latter is present in the urine, the former is 
almost sure to be found. 
There is a form of deposit of frequent occurrence in the urine, and 
which, since it bears much resemblance to a renal cast, may here be no- 
ticed. It consists of long threads of very variable diameter but which are 
all more or less striated, showing that they are made up of fibrillae of fibrin. 
They are met with in abundance in urines depositing oxalate of lime; also 
in those containing excess of earthy phosphates and mucus, or which con- 
tain semen; besides, wherever irritation of the bladder from any cause 
exists, and as an evidence of which irritation they are to be regarded. 
They are found alike in the urine of men and women. 
Determination of Keistein.—Another substance of great interest, met 
with in the urine of pregnant women, and with the characters of which it 
is necessary to become acquainted, is that known by the names of keistein 
and gravidine. 
After the urine of a jwegnant woman has been exposed to the air in a 
cylindrical glass vessel for two or three days (and never later than the 
sixth day), a fatty looking pellicle forms upon the surface, which at the 
end of two or three days, when the urine is becoming alkaline, gradually 
breaks up, and falls to the bottom as a sediment, frequently evolving at 
this stage a powerful odor of cheese. 
This scum or pellicle, viewed under the microscope, is seen to be con- 
stituted of three distinct elements, and to consist of a granular base in 
which are imbedded well-defined crystals of the ammonio-magnesian phos- 
phate, and droplets of oil. The only essential and distinctive constituent 
of keistein is therefore the granular matrix. This is not acted upon by 
acetic acid, but is dissolved by ammonia, and this it is that evolves during 
decomposition the cheesy odor above referred to. When this scum is 
collected in any quantity, it presents a greasy and opaque appearance, re- 
sembling spermaceti, arising partly from the large quantity of triple phos- 
phate present. 
The triple phosphate may be dissolved out by means of acetic acid, and 
the Oil by ether ; the cheese-like substance being left behind. 
The scum of keistein is distinguished from the ordinary phosphatic crust 
or scum, not only by the presence of oil and the casein or cheesy substance, 
but also by its not remaining on the surface beyond three or four days 
from its complete formation. 
The urines on which keistein is formed rarely become turbid on boiling, 
or throw down any deposit on the addition of nitric or acetic acid, show- 
ing the absence of albumen but not necessarily that of casein, since this 
would not be precipitated by acetic acid unless it were present in large 
amount. 
Determination of Blood.—When blood is contained in urine in amount 
at all considerable, its presence is sufficiently indicated by the eye alone. 
The urine will be observed to possess a reddish color, and if it be set aside UBINE. 
795 
for some time, a reddish or rust-colored precipitate will subside, the pres- 
ence of* which is so peculiar that it cannot be confounded with any other 
colored deposits which occur in the urine, as uric acid and the urates. 
Moreover, if the quantity of blood be very considerable, the urine will 
become more or less gelatinous, and if a portion of it be boiled, it will be 
found to abound in albumen. 
When the quantity of blood is very minute, the microscope affords the 
only ready and certain means of determining its presence. By this instru- 
ment, if the urine *be fresh, the presence of the red and white corpuscles of 
the blood will be revealed in any sediment from urine which has been 
allowed to remain at rest a sufficient time. If the hemorrhage proceed 
from the kidneys, casts, containing blood corpuscles, are sometimes met 
with. 
Determination of Bile.—When bile is contained in urine in considerable 
quantity, its presence is sufficiently indicated by the color of the urine ; 
this is especially the case in jaundice, in which the urine usually possesses 
a dark-yellowish green or brown color, which is exceedingly characteristic. 
When the quantity of biliary matter in the urine is less, the tint of the 
urine is only deepened and rendered of a brown or reddish hue. When 
this is the case, it becomes necessary to seek for the presence of bile, for 
which there are several tests. 
One of these is Pettenkofer’s test, which consists of sulphuric acid, free 
from sulphurous acid, and sugar. It is used as follows : 
To a small quantity of the urine, in a test-tube, about two-thirds of the 
bulk of sulphuric acid is to be added, drop by drop, so 'that the tempera- 
ture of the mixture may not be raised above 144° Fahr., at which the color 
characteristic of bile is destroyed. 
To this mixture a grain or two of sugar or sirup is to be added, the 
whole shaken, and then allowed to stand at rest a few minutes. Should 
bile be present, the liquid will have assumed a more or less intense red color 
with a tinge of violet. This remarkable development of color is not 
due to any change effected in the coloring matter of the bile, since it takes 
place equally when the above reagents are added to a solution of decolor- 
ized bile. 
Should the suspected xirine contain albumen, this should be first removed 
by coagulation and filtration, because with albumen and sulphuric acid and 
sugar a nearly similar color is developed. 
If the quantity of bile present be very small, the urine should be evapo- 
rated to dryness on a water-bath before the test is tried, and the bile dis- 
solved out either by means of a little water or alcohol. 
Another test for bile is that commonly known as Heller’s test, which is 
thus employed: 
A little white of egg is added to a small quantity of the suspected urine, 
and after the mixture has been well shaken, a few drops of nitric acid; this 
causes the precipitation of the albumen, in combination Avith some of the 
coloring matter of the bile, the precipitated albumen thereby assuming a 
dull-green or bluish color. 
When the quantity of bile is very small, the urine should be evaporated 
as before, and the albumen added to the aqueous solution. 
A third test for bile in urine depends upon the action of nitric acid upon 
the brown coloring matter of the bile, called biliphoein. Two or three 
drops of nitric acid are to be allowed to fall upon a little of the urine 796 
UKINE. 
spread out in a thin layer on a white surface. When bile is present m 
amount at all considerable, the mixture assumes a variety of changing and 
evanescent tints, green, violet, yellow, and pink, the latter color usually 
predominating. As in the case of the previously described tests, should 
the quantity of bile present be very small, the urine must be evaporated 
before the nitric acid is added. 
According to the late Dr. Golding Bird, it occasionally happens that 
bile exists in urine in a modified, and, perhaps, oxydized state, in which it 
does not exhibit, with the tests above noticed, the characteristic reactions, 
the urine becoming merely imperfectly reddened. Ammonia, Dr. Bird 
states, then becomes a valuable test, it immediately producing a deep red 
color. There are certain fallacies attending the ammonia test, arising 
chiefly from the presence of vegetable coloring matters in the urine, as 
those of rhubarb and senna, and on which ammonia acts in a nearly simi- 
lar manner. 
Lastly, there is the microscopic test, which has already been described, 
for bile when present in urine in small quantities. 
Detection of Seminal Fluid.—In some cases a mucus-like deposit occurs 
in urine, which, on examination with the microscope, turns out to be 
semen; this is shown by the presence of the well-known seminal animal- 
cules and corpuscles. The animalcules are nearly always dead, owing, 
perhaps, partly to the length of time which usually elapses before the urine 
is examined, and partly to the injurious action exerted upon them by the 
urine itself. Spermatic animalcules are occasionally seen in urine in small 
number where there is no visible deposit. 
Mixed up with the spermatozoa, octahedral crystals of oxalate of lime 
are frequently noticed. Some observers have gone so far as to state that 
whenever these crystals occur in urine, spermatic fluid is always present, a 
statement which is certainly erroneous. Part xxxvii., p. 91. 
Mode of detecting Sugar in the TJrine.—-Dr. A. Becquerel, physician at 
the Hospital of La Pitie, in a series of lectures, pointed out the following- 
facts : “ First, that nearly all urines become discolored, impart a green 
color to, and even precipitate the cupro-potass solution of Barreswill, or 
that of Frommerz, if heated with these reagents. Second, that a great 
number of these same urines become brown, in like manner, on the addi- 
tion of caustic potass, however pure that may be.” 
He strongly insisted on the erroneous conclusions to which the reaction 
afforded by these tests might lead, and showed that nothing is more easy 
than to avoid this source of error, and that there is at our disposal a much 
more sure, expeditious, and certain method of detecting the presence of 
sugar in the urine than is usually employed. 
“We take a certain determinate quantity of urine, say 60 grs.; this Ave 
treat with a small quantity of solid and crystallized acetate of lead, say 4 
grs.; on heating this mixture, there is immediately fox-med a copious pre- 
cipitate of a dirty Avhite color; the liquor is then to be filtered, and the 
solution treated by sulphate of soda in excess. If, for example, we have 
added four grs. of acetate of lead, Ave add eight gi*s. of sulphate of soda. 
This being done, the mixture is again heated, and sulphate of lead is 
deposited ; Ave then filter once more, and there is afforded a clear transpa- 
rent liquid, which contains the sugar, when there is any, and some unim- 
portant salts. The liquid thus obtained is neither acted on by the UTEKINE HEMOEIillAGE. 
797 
cupro-potass reagents, nor browned by the caustic potass, unless sugar is 
present. These two re-agents are in this way perfectly reliable, very 
accurate, and afford no results when no sugar is contained. 
“ Should the urine under examination contain albumen, it is immediately 
coagulated by the acetate of lead at the same time as other organic matters, 
and gives no further trouble. 
“ Thus, in all cases where it is desired to ascertain the existence of sugar 
in the urine, whether along with albumen or not, we possess two excellent 
reagents in the cupro-potass solution, and in the caustic potass itself; only 
we require, in the first place, to treat the urine with the acetate of lead and 
the sulphate of soda, by which means we get rid of all such matters as decom- 
pose or discolor the cupro-potass or caustic potass tests.*’ Part xxxvii.,^.104. 
UTERINE HEMORRHAGE. 
Oil of Ergot of Eye.—Diffused through water, recommended by Dr. 
Samuel Wright to be injected into the uterus in severe cases of flooding. 
Part ii,,p. 42. 
Modes of Arresting Uterine Hemorrhage.—[Dr. W. Tyler Smith treats 
this subject under several heads. He speaks first of] 
The Different Modes of exciting Reflex Contraction of the Uterus in 
Uterine Hemorrhage.—Keflex contractions may be excited by stimuli 
applied to certain organs at a distance from the uterus; by stimuli applied 
to certain other organs and surfaces in the vicinity of the uterus; and lastly, 
by stimuli applied to the uterus itself. 
[Under the first division Dr. Smith mentions as excitors of contraction, 
the mammary nerves (called into exercise when the child is put to the 
breast,) thepneumogastric (when food, hot or cold drinks, or emetics are 
taken into the stomach,) and the abdominal intercostal nerves. Respecting 
the latter, he says:] 
The cutaneous nerves of the abdominal parietes are excitors of the 
uterus in an extraordinary degree. The sudden impression of cold or heat 
upon the abdominal surface will almost always excite the most energetic 
contraction of the uterus affected with inertia, and from which hemorrhage 
is taking place. We may contract the relaxed and diffuse uterus to a firm 
ball, by douching the abdomen with cold water from a height; or by 
plashing a towel, taken out of cold water, upon the naked abdomen ; or 
by suddenly placing the hand, taken out of iced water, upon the umbilicus. 
If the surface of the abdomen should be cold, the sudden impression of 
heat produces a similar contraction. 
About the true mode of action of irritation of the mammary and 
pneumogastric, arid the abdominal intercostal nerves, there can be no 
doubt whatever. These nerves are too remote from the uterus, in their 
peripheral extremities, to admit of any other explanation save that of the 
reflex function. 
[Under the second division, or organs and surfaces in the vicinity of the 
uterus, Dr. Smith refers to irritation of the vulval, vaginalvesical, and 
rectal nerves, induced by the application of cold to those parts. He says :] 
This group of organs, it will be observed, is in the immediate vicinity of 
the organ from which the blood flows, and they are in great measure 798 
UTERINE HEMORRHAGE. 
supplied by nerves having the same origin as the uterine nerves. But 
what I wish to insist upon is this, that all the actions I have been describ- 
ing are reflex in their nature. Physiology repudiates the idea of uterine 
contractions, excited by means of continuity or contiguity of the organs 
excited with the organ which contracts. The peripheries of the nerves of 
the bladder, rectum, vulva, and vagina, receive the impression, and the 
incident nerves, the spinal centre, and the motor nerves of the uterus 
distributed to its muscular structure, are all concerned in the muscular 
contraction which ensues. Though the organs excited are near the uterus, 
which contracts, the route of the nervous action is precisely the same as it 
was in the case of the stimuli applied to the'mammary or the pneumogas- 
tric nerve. 
1 now come to the consideration of the contraction of the uterus, and 
the arrest of hemorrhage by irritation of the uterus itself, through the 
medium of stimuli applied to 
The Uterine Nerves.—The power we possess over the uterus by this 
means is very great indeed, and the modes by which we can exert it are 
very various. We may excite the nerves of the external surface of the 
uterus, the nerves of the internal surface, or the nerves of the os uteri. 
When we produce uterine contractions by irritating the uterus through 
the abdominal surface, we act on the first series of nerves; when we inject 
cold water into the uterine cavity, we act on the second, and when we 
irritate the os uteri by digitation, we act on the third. These measures 
are of great importance in our attempts to rouse the uterus itself to action. 
We may excite the organ by introducing ice into the cavity, by injecting 
cold water into the cavity, or by injecting stimulating solutions. 
Besides digital irritation of the uterus through the abdominal parietes, 
there is another external mode of inducing uterine reflex action, in the 
‘use of the abdominal bandage. The compression of the uterus thus occa- 
sioned, increases uterine action, or evokes it when it has disappeared; it 
is certainly one of the best means we have of preventing that inertia of 
the uterus after delivery which so strongly tends to hemorrhage. 
The introduction of the hand into the uterus, or the irritation of the os 
uteri by the fingers, or the whole hand, excites the uterus very powerfully. 
Besides the mere introduction of the hand, irritation of the internal surface 
of the organ by the tips of the fingers is sometimes practised. 
The different modes of exciting direct or centric Spinal Contractions of the 
Uterus, in Uterine Hemorrhage.—If we administer a dose of the ergot of rye 
to a patient suffering from hemorrhage, we observe in many cases that 
uterine contraction will follow. I have no doubt that the true channel 
through which the ergot acts is the blood, and the organ it reaches and 
affects, through this channel, is the spinal centre. We may illustrate its 
modus operandi by referring to the action of emetic substances on the 
stomach. There are certain substances which, when taken into the stomach, 
immediately excite all the motor actions of vomiting. This happens, for 
instance, when sulphate of zinc comes into contact with the mucous mem- 
brane of the stomach. Sulphate of zinc, then, appears to excite the actions 
of vomiting in a reflex form. But again, in the case of the stomach, there 
are other medicines—the potassio-tartrate of antimony, for instance, which 
acts as an emetic only after it has been taken into the circulation, and which 
acts more promptly when injected into the blood itself. I believe the ac- 
tion of this medicine to be perfectly analogous to the action of the ergot UTERINE HEMORRHAGE. 
799 
of rye; that the one acts upon the medulla oblongata and the motor nerves 
of vomiting ; the other, upon the lower medulla spinalis, and the motor 
nerves of uterine action. The ergot, therefore, is a remedy of centric utero- 
spinal action. 
Ipecacuanha is another medicine which is sometimes given in uterine he- 
morrhage. This medicine, by its emetic action, excites contraction of the 
abdominal muscles, and compression of the uterus, which in turn may re- 
excite some amount of uterine reflex action, but over and beyond this it 
appears to have a special action upon the uterus, increasing its contractile 
power beyond what we could imagine to occur from the merely secondary 
effects of vomiting. Ipecacuanha, then, appears to influence both the me- 
dulla oblongata and the lower medulla spinalis. 
Opium is also, in hemorrhage, a remedy of direct spinal action. In mode- 
rate loss of blood it undoubtedly promotes uterine contraction, and arrests 
the flow of blood. Opium is an excitant of spinal action of the direct kind, 
and thus it is that its administration is beneficial in hemorrhage, with ute- 
rine inertia, and injurious in puerperal convulsion, of the active kind. As 
a minor remedy of the same spinal relations as the foregoing, the biborate 
of soda may be mentioned. It may be said, briefly, that all stimulants 
taken into the stomach and received into the blood have a centric spinal 
action in hemorrhage from the uterus. But one of the most important 
agencies of a centric kind, and one different in its nature from the forego- 
ing, consists in the influence of emotion. Where sensibility is present, the 
influence of emotion comes in aid of the reflex action. It is only the hope- 
ful and confident emotions which excite muscular contraction. The de- 
pressing passions paralyze the uterus as well as other muscles, and they 
are, in truth, not unimportant as causes of hemorx-hage. 
[Dr. Smith next speaks of “ the different modes of exciting uterine action 
by stimulating the muscular irritability of the organ,” as distinguished from 
the excitement of muscular action through the nerves. He mentions three 
methods by which this is performed: the application of cold, mechanical 
irritation with the hand, and the use of galvanism. With regard to the 
latter, he says:] 
In patients perfectly paraplegic, with entire loss of reflex uterine power, 
the uterus has been excited to contractions sufficient to expel the foetus by 
means of galvanism. Dr. Radford, of Manchester, applied this power to 
the arrest of uterine hemorrhage. One pole of a galvanic trough- being 
placed within the os uteri, and the other applied over the fundus, it has 
been found, that, on making and breaking the galvanic circle, powerful 
uterine contractions occur. 
The Different Modes of arresting Uterine Hemorrhage mechanically.—• 
There are various modes of compressing the uterus mechanically, which 
are resorted to in cases of hemorrhage. One mode is that of grasping the 
uterus through the abdominal parietes, and holding the organ so firmly as 
to prevent the further effusion of blood, while other means are being ap- 
plied to insure the permanent contraction of the organ. Another mode 
sometimes followed is that of introducing one hand into the uterus, and 
then exerting pressure with the other hand externally, so as to compress 
the bleeding portion of the organ between the two hands. A third mode 
of mechanical arrest, and one which is exceedingly useful, consists in the 
abdominal bandage, made to embrace the pelvis tightly, and having several 
towels or napkins folded into a conical shape placed underneath. 800 
UTERINE HEMORRHAGE. 
Compression of the aorta, so as to cut off the supply of blood to the 
uterus, and prevent arterial hemorrhage, has been insisted on by Baron 
Dubois, M. Chailly, and others. Several years ago, I pointed out that the 
directions given by obstetricians were wrong, and that we should make 
pressure upon the inferior cava instead of the aorta. The great hemor- 
rhages, those which kill, are from the veins, and not from the arteries, and 
further, not from the veins which are returning blood from the uterus, but 
from the vena cava and the heart itself. When the uterine veins are open, 
there is a great column of blood between the uterus and the right auricle, 
to the sudden escape of which there is no let or hindrance except uterine 
contraction. The compression of the great vessels is, however, at best 
palliative, not curative, but it may give time for the application of other 
remedies. 
The various forms of plugging the vagina and the uterus are a distinct 
class of obstetric remedies in hemorrhage. Mechanical plugging is ex- 
tremely useful in hemorrhage in many forms of abortion, in certain hemor- 
hages during delivery, and in cases of placenta praevia. The sponge oi- 
lmen plug is useful in moderate floodings of the impregnated, and also of 
the unimpregnated uterus. This form of plug, when it fills the Avhole of 
the vagina, acts by preventing the escape of blood externally; this favors 
the coagulation of the blood elfused behind the plug, and though the plug 
itself does not reach to the bleeding surface, the coagulated blood is con- 
verted into a secondary plug, which acts directly upon the mouths of the 
bleeding vessels. But beside the common form of tampon, we often con- 
vert the foetus itself into a plug, having precisely the same mechanical 
action. Thus when, in hemorrhage before delivery, we rupture the mem- 
branes, beside the other results, the body and limbs of the foetus come 
into direct contact with hemorrhagic tissue. So in placenta previa, when 
the presentation is allowed to remain, but the placenta is torn away, the 
foetal head becomes in effect a tampon to the os and cervix uteri of the 
most powerful kind. Again, when turning is performed in these cases, 
the feet are brought down, and engaged in the os uteri as a plug. These 
instances only differ from the plug of sponge or linen in their being more 
effective, and in being applied from within instead of from without. After 
delivery, no form of plugging can be of much service. 
The arrest of Uterine Hemorrhage by Astringents and lief rigerants.— 
These remedies, consisting of the acetate of lead, the mineral acids, alum 
given internally, and used in the form of injection, the sustained applica- 
tion of local cold, etc., are useful in all hemorrhages which do not proceed 
from patulous vessels sufficiently large to require the contraction of the 
muscular organ in order to close them, or wdien the uterus is so far unde- 
veloped as to render its muscular contraction impossible. Such are he- 
morrhages occurring in the course of uterine disease, or in menorrhagia; 
uterine floodings in the early months of pregnancy, and the profuse lochial 
discharges which sometimes occur a few- days after delivery, when the 
uterus has become perfectly contracted. Part xix., p. 237. 
Principle of Treatment by Cold in Uterine Hemorrhage.—Dr. Gooch 
mentions the case of a lady that he attended, in whom, both before and at 
the time of labor, the force of the circulation vras very great; “ she vras 
flushed and had a quick pulse.” After delivery, she had a most violent 
flooding; and Gooch remarks that, “after the violence of the hemorrhage UTERINE HEMORRHAGE. 
801 
was over, although the abdomen was covered with pounded ice, it returned 
again and again, slightly in degree, yet sufficiently, in the debilitated state 
of the patient, to produce alarming occurrences of faintness; the uterus, 
too, which had become firm and distinct, became so soft, it could no longer 
be felt. Finding the ice so inefficient, I swept it off, and taking a ewer of 
cold water, I let its contents fall from a height of several feet upon the 
belly ; the effect was instantaneous; the uterus, which, the moment before 
had been so soft and indistinct as not to be felt within the abdomen, 
became small and hard, the bleeding stopped, and the faintness ceased—a 
striking proof of this important principle, that cold applied with a shock 
is a more powerful means of producing contraction of the uterus than a 
greater degree of cold -without the shock.” Part xix., p. 246. 
Accidental Hemorrhage.—Prof. Murphy, of London University College, 
says : The treatment must be prompt and decisive. Accidental hemor- 
rhage usually occurs in the first stage of labor, Avhen the membranes are 
unbroken, and the liquor amnii prevents the uterus contracting about the 
body of the child. In order, therefore, to control flooding, the uterus 
should be made to contract as much as possible, and coagulation promoted 
in the spongy structure of the placenta; both objects are accomplished by 
rupturing the membranes, because the uterus contracts on the body of the 
child, and the placenta being compressed between both, the blood is pre- 
vented escaping so freely from its uterine surface. This effect may be ren- 
dered more perfect by using means to increase the tonic contraction of the 
uterus, which rupturing the membranes alone will not always accomplish. 
Therefore, ergot of rye, or the electric current, may be used; a drachm 
of the former infused in a wine-glass of water, may be given alone, or, 
what is better, in combination with opium. Thirty or forty minims of 
tincture of opium may be added to the infusion, and in proportion as ex- 
haustion increases, larger doses of opium may be repeated. When you wish 
the aid of the electric current, the electro-magnetic apparatus should be 
employed, and currents passed either transversely or in the longitudinal 
axis of the uterus; rods, holding sponges moistened in a saline solution, 
are connected by wires to the apparatus, and may be applied to any part 
of the abdomen ; a sponge may be introduced within the vagina, and con- 
nected in the same manner with the battery ; by these means currents may 
be made to pass in any direction. The only objection to this mode of 
exciting the uterus is the delay which might arise in preparing the 
instrument. 
Turning was formerly a universal practice in cases of accidental hemor- 
rhage. It is now very rarely resorted to, and Dr. Murphy thinks it will 
very seldom be found necessary. Stimulants must be given even largely, 
and if all means fail, transfusion may be cautiously resorted to. 
Part xix., p. 248. 
Post-partum Hemorrhage.—Post-partum hemorrhage may occur either 
before or after the expulsion of the placenta. In the former case, its causes 
are three, inertia of the uterus, irregular contractions of the uterine fibres, 
and morbid adhesion of the placenta. Professor Murphy observes : 
Inertia of the uterus is equally the cause and the effect of hemorrhage. 
You should be careful to recognize true inertia as soon as it presents 
itself; you may do so before any hemorrhage takes place, even when the 
child is being expelled. The fundus of the uterus has not its usual firm 
VOL. II. 51 802 
UTERINE HEMORRHAGE. 
feel under the hand ; it seems spongy or like dough, and is larger than it 
ought to be, because it very seldom contracts to its full extent. After the 
delivery of the child, when the uterus generally remains contracted, it will 
not do so. You may have followed the contracting uterus with the hand, 
moderately compressing it, and in a short time you find that it has eluded 
your grasp, and cannot be felt. Strong frictions over the lower part of 
the abdomen may again excite its action ; but it is only for a moment— 
again it is lost. While this want of tone may be observed in the uterus, 
a corresponding amount of constitutional irritation may be noticed in the 
patient. The pulse is increased in frequency, and assumes the jerking 
hemorrhagic character; the patient is watchful and restless ; complains of 
sinking, and does not experience that relief from the termination of her 
sufferings that is usual after delivery. All these symptoms may precede 
any hemorrhage, and should be most carefully watched ; they are the 
monitors of what is approaching. Hemorrhage generally begins with a 
slight draining from the vulva, just sufficient to soil the napkins that are 
applied, but in a short time, if no means for prevention are used, the stream 
rapidly increases to a torrent, deluging the bed, and forming a pool on the 
floor beneath. If the attendant is not on his guard, this may be the first 
notice of danger, because the patient is sometimes too much exhausted to 
give any intimation of her condition ; she lies on her side in a listless, dosy 
state ; syncope may follow, and hemorrhage for a moment cease, but it 
soon returns with the pulse, a violent gush of blood places the patient at 
once “ in extremisa more prolonged syncope returns, from which she 
may never recover. Sometimes a fit of convulsions precedes dissolution. 
The treatment of such cases must be direct: 1st. To restore the tonic 
contractile power of the uterus. 2d. To remove the placenta. 3d. To pre- 
vent, as far as possible, any subsequent relaxation of the uterus. 
In order to accomplish the first object, you must endeavor, by every 
means in your power, to support the general circulation, which every 
symptom points out to you is struggling to maintain itself. 
If there be great exhaustion, the patient should be given a drachm of 
tinct. of opium in brandy; this may be repeated in more moderate doses, 
until the pulse becomes steady. If the stomach be very irritable, and 
reject this, it will sometimes bear broth when taken cold, and morphia 
may be substituted for tincture of opium. Smellie used to give potable 
soups, dissolved in water. The patient should be kept in a perfectly hori- 
zontal position. The arms and legs should be wrapped in hot flannels, 
the curtains drawn back, the window raised, and a free circulation of air 
secured in the apartment. Locally, every means must be employed to re- 
tard the force of the circulation in the uterus. The most convenient mode, 
I think, is to have a bucket containing flannels, over which may be thrown 
lumps of ice, and a sufficient quantity of water poured over the whole. 
These flannels may be wrung out, and applied from time to time to the 
hips and vulva. At the same time that these means are being carried 
into effect, the strongest pressure should be maintained on the fundus uteri, 
to prevent its relaxation. The success of your treatment becomes evident 
when you feel the fundus first become distinct, and then more firm, 
under the hand. In many cases the pressure is sufficient to cause the 
expulsion of the afterbirth, but if not, it becomes your duty, in tins favor- 
able opportunity, 
2dly. To remove the placenta.—For this purpose, let one hand still UTERINE HEMORRHAGE. 
803 
compress the fundus, or assign this duty to an assistant, clearly explaining 
what is to be done, and then pass the hand into the vagina to the os uteri; 
sometimes, by drawing down the hand again slowly, the back of it being- 
pressed strongly against the posterior wall of the vagina and the perineum, 
the uterus is excited to contract and expel the placenta into the vagina, 
from whence it may be removed. 
If not, draw down the funis to its full extent, as far as it will go, and let 
the hand in the vagina, guided by it, press forward into the uterus. The 
fingers formed into a cone will readily dilate the os uteri sufficiently to 
admit the hand ; and here, again, it sometimes happens that the act of 
dilatation will excite a sufficient contraction to expel the placenta; if not, 
you must. proceed ; but, as a precaution, it would be well to give the 
patient a full dose of opium previous to entering the cavity of the uterus ; 
Avhen the placenta is reached, do not at once seize it in order to draw it 
down, rather seek to pass the hand above it, toward the surface of the 
cavity of the uterus. This portion of the uterus is now placed between 
the introduced hand and that which compresses it externally through the 
abdomen ; by increasing this pressure, the irritation very seldom fails in 
causing the uterus to contract; the moment this is observed, let the hand 
be slowly withdrawn, having the whole placenta within it, and let a strong 
pressure be made on the fundus uteri externally. Thus, the placenta may 
be safely withdrawn, and if the uterus be properly secured, no further 
hemorrhage will take place. Our next object is, therefore, to do this, and 
3dly. To prevent, as far as possible, any subsequent relaxation.—It is 
necessary to press very firmly with both hands on the fundus, and to con- 
tinue this pressure for some time; if fatigued, an assistant may continue 
it; but you must be particularly careful that he understands your object. 
In order to insure this effect, by the continuance of the pressure, the 
abdomen must be very carefully bandaged. 
Hemorrhage after the separation of the placenta may depend upon 
inertia of the uterus, an over-excited circulation in a plethoric patient, or 
upon mismanagement. The last is by far the most frequent cause; the 
patient may be too soon disturbed after her delivery, for the purpose of 
changing the dress or bed-clothes, or her friends may keep her in a con- 
stant state of excitement by their kind, but too officious, congratulations. 
The result is flooding. Again, if she escape these dangers immediately 
after delivery, your patient may be allowed perhaps on the third or fourth 
day to get out of bed ; the circulation is again excited in the uterus, still very 
large and easily distended, and hemorrhage is the consequence. You are 
not even safe on the tenth or fourteenth day. One of the most alarming 
hemorrhages I ever had to treat occurred on the tenth day after delivery. 
Tart xix., p. 254. 
Method of plugging the Vagina with a Caoutchouc Bladder.—M. Diday, 
having a case of metrorrhagia, in which the patient had become reduced 
to almost the lowest point of exhaustion, resolved to avail himself of one 
of Dr. Gariel’s ingenious applications of vulcanized caoutchouc. The 
apparatus consists of a small bladder of caoutchouc, to which is attached a 
long tube, Rolled up so as not to exceed the little finger in size, it was 
passed as deeply into the vagina as possible, and kept there by the end of 
the finger; it was then inflated through the tube, until the small body, 
which had been introduced almost imperceptibly, acquired a volume con- 804 
UTERINE HEMORRHAGE. 
stituting a sphere of about 33 centimetres in diameter. The air was 
retained by tying the tube. Xo means of retaining it in situ were 
required, and the hemorrhage entirely ceasing, it was removed sixty-four 
hours after, as easily as introduced, by allowing the air to escape through 
the tube. Part xxi., p. 202 
Uterine Hemorrhage.—In a most dangerous case of this nature, I/r. 
Sweeting gave five grains of acetate of lead every hour for forty-eight 
hours. As the hemorrhage returned on the suspension of the medicine, 
the same dose was given every four hours, and continued for a fortnight 
with complete recovery; the patient having taken in sixteen consecutive 
days 576 grains. Part xxiv., p. 114. 
Indian Hemp.—Dr. Christison considers Indian hemp exceedingly 
valuable in restraining uterine hemorrhage. The tincture of the hemp is 
the most efficacious preparation; it may be given in doses of five to fifteen 
or twenty minims, three times a day in water. Part xxiv., p>. 321. 
Post-partum Hemorrhage.—Dr. Thos. Elliott recommends the follow- 
ing plan of treatment with a view of inducing uterine contraction, it being, 
in his experience, an “ unfailing remedy.” 
Inject into the rectum 4 oz. of turpentine, 4 oz. of cold water, and a 
handful of common salt, forcibly retaining this by pressure from a folded 
napkin, until violent tenesmus is induced; this will invariably be attended 
with contraction of the womb. Turpentine is used because it is a power- 
ful stimulant and restorative to the whole system, and, moreover, possesses 
considerable anti-hemorrhagic properties. Part xxxvii., p. 205. 
Opium in Uterine Hemorrhage.—Dr. Gabb, of Bewdley, states that 
opium has a very different effect in large and in moderate doses on the uterus. 
In large doses it relaxes and favors hemorrhage; in small or moderate doses, 
as 25 minims, it stimulates and causes contraction. It is especially applica- 
ble in cases of deficient power from exhaustion or fatigue, being here, 
perhaps, the best remedy which can be employed. 
Utility of Galvanism in accidental Hemorrhage.—Dr. Stafford, of Bir- 
mingham Lying-in Hospital, recommends, if you have a case of accidental 
hemorrhage during labor, and the os be pretty well dilated, to apply gal- 
vanism to the abdomen, which will probably soon bring on uterine con- 
tractions, and the head of the child will descend low enough to 
admit of the forceps being applied. This is especially valuable, as in 
these cases ergot of rye often entirely fails to induce contraction. 
Part xxxvii., p. 208. 
Post-partum Hemorrhage.—Dr. W. Thomas, F. R. C. S., says: In these 
alarming and dangerous cases, where the countenance is blanched and the 
pulse imperceptible; do not, as is too often taught, hesitate to give stimu- 
lants freely; their revivifying influence once seen can hardly be forgotten. 
The great thing to stop the hemorrhage is to empty the uterus; introduce 
the hand at once and remove the placenta, keeping up the pressure 
externally with the other hand ; this should always be done half an hour 
after delivery, if the placenta be not then expelled. 
Part xxxviii., p. 210 
Hemorrhage from Carcinoma Uteri.—In cauliflower excrescence of 
the uterus, says Prof. Simpson, the hemorrhage is occasionally most vio- 
lent and alarming. Simply plugging the vagina does not suffice to cheek UTERUS 
805 
it, and the use of some powerful styptic means becomes necessary. Of 
these the simplest and surest is the perchloride of iron dissolved in 
glycerine. It may be applied by a sponge or piece of lint. Tannin also is 
very useful; it may be applied in the form of a medicated pessary; it 
rapidly coagulates the effused blood, and thus prevents the further flow. 
Part xl., p. 234. 
UTERUS. 
Diagnosis of Diseases of the Uterus—Simpson’s Uterine Sound.—To 
assist in the diagnosis of diseases of the womb and its appendages, Dr. 
Simpson has been in the habit of using a metallic uterine sound or bougie, 
of nearly the size and shape of a small male catheter, which is to be intro- 
duced into the womb and manipulated in the way which we will describe. 
In diseases of these parts, we have only been able hitherto to extend our 
physical examination to the neck and lower portion of the body. If the 
womb were very large, we might, perhaps, feel the fundus through the 
walls of the abdomen, but from its mobility and low situation, this would 
be of little service; in short, we are constantly in doubt when examining 
any tumor in this region, whether it be an enlargement of the "whole mass 
of the womb or a distention of its cavity, or a morbid growth ; and, if the 
latter, whether the growth be seated in the womb itself, or in one of the 
ovaries or other neighboring parts. 
It is particularly useful when we want to ascertain the state of the 
fundus, body, and cavity of the womb, and also when any particular solid 
tumor or fluid cyst is connected with that organ. It is provided, like the 
common male sound, with a flat handle, and terminates in a rounded knob 
or bulb. Its stem is thicker at its upper part, and tapers gradually from 
the knob to the handle. By being thin next the handle, it allows of more 
extensive movement in the mouth and neck of the womb, and its increased 
thickness at the other end gives it strength. The stem is about nine 
inches long, and graduated so as to enable us to measure the depth of the 
parts. In introducing this bougie, the patient may be placed on her back 
or left side, and having felt the os uteri, the practitioner can easily glide 
the instrument into the womb, the internal surface of which, when in a 
healthy state, is not more sensible than that of the vagina, so that when any 
severe pain is felt, it may be considered as indicative of some morbid con- 
dition. When the instrument is in the womb, the practitioner can give 
that organ sufficient resistance for its exploration by the fingers, and he 
can alter its position as he pleases. He can thus fix the fundus, and even 
move it about, so as to enable him, with his other hand on the abdomen, 
to examine its external surface and walls, and to ascertain what connections 
any other tumor may have with it. The great mobility of the uterus is 
well known. Its position is changed by many of the movements of the 
bladder and rectum; it may be drawn down by instruments till the cervix 
reach the external parts; and therefore the uterine sound will enable us 
to move it about in rather a startling manner. The instrument being 
metallic, can be bent to any shape, so that when we want to bring the 
fundus uteri more immediately under our fingers in our hypogastric 
examinations, the extremity should be bent upon its stem at as neai’ly a 
right angle as the conformation of the genital canals admit, and, after being 806 
UTEEUS, 
introduced, its handle should be well retracted toward the perineum. B, 
this proceeding, the body and fundus of the womb will be more easily and 
fully turned forward. 
This mode of examination will also be particularly valuable in the early 
stages of ovarian tumors. The ovary lies behind the womb, so that if the 
sound shows the tumor to lie on the anterior surface of the uterus, or, in 
other words, if the uterine cavity runs up the posterior surface of the mor- 
bid mass, the disease may be considered as certainly not ovarian. This 
remark will only apply to those cases in which the tumor is still not so 
large as to have passed out of the pelvic cavity and become abdominal. 
Part viii., p. 106. 
Excision of the Os Uteri.—[Excision of the os uteri was, on account of 
the marvellous cures said to have been frequently performed by it, in cases 
of cancer of the uterus, very slow in establishing itself as a legitimate prac- 
tice in this country. Cancer of the uterus is in reality of very rare occur- 
rence, and removal of the diseased part presents even less chance of 
recovery than of any other part in which this disease may exist. Cauli- 
flower excrescence, as Dr. Clarke named it, is, however, very much more 
common than was formerly supposed, and it has been ascertained that the re- 
moval of this by the knife or scissors, is an operation perfectly safe and effec- 
tual. Dr. Clarke, when he wrote, had little to offer as regards treatment.] 
Professor Syme says: A great step in advance has been made through 
the establishment of the important fact—for which we are chiefly indebted 
to the surgeons of France—that excision of the os uteri, executed either 
by knives or scissors, is an operation perfectly safe and effectual when 
employed for the removal of growths not possessing a malignant disposi- 
tion. In performing the operation, it is always desirable, and, in general, 
easily practicable, to draw the tumor fairly into view, so that the excision 
may be effected without taking away either more or less than what is 
requisite, and without injuring the neighboring parts. The most con- 
venient instrument for this purpose is that which Dupuytren employed— 
the hooked forceps of Muzeux, who invented it for facilitating the removal 
of enlarged tonsils—or “ vulsellum,” as it has been improperly named by 
some writers. 
By means of the double-hooked extremities of this instrument deeply 
inserted into the morbid growth toward its base, where the texture is of 
firmest consistence, the tumor may usually be induced by steady traction 
of moderate force, to descend and present itself to* view, when a bistoury 
or curved scissors may be used without any difficulty or danger. The 
assistance of a speculum should be taken to insert the forceps, and if it 
seems necessary, in order to obtain complete command over the excres- 
cence, additional instruments of the same kind are to be fixed into different 
parts of its substance. If the tumor cannot be made to protrude without 
resorting to an unsafe degree of violence, it may at all events be brought 
down in this way, so as to be within reach of the fingers, which will then 
form a safe guide for the scissors. The hemorrhage is seldom more than 
very trivial, and when at all considerable, may be suppressed by filling the 
vagina with lint. In a case which happened fourteen years ago, and was, 
I believe, the first of the kind subjected to operation in Edinburgh, I visited 
the patient about an hour after cutting off the excrescence, and to my no 
small alarm, found the blood dropping from her bed upon the floor. As 807 
there had been frequent and profuse hemorrhage from the disease, I con- 
sidered it necessary to use the most efficient means for preventing any 
further flow, and therefore pulled the bleeding surface into view, transfixed 
its base with a needle, conveying a double ligature, and tied both the threads 
firmly. Recovery was accomplished without any untoward symptom. 
In removing polypus of the uterus, evulsion, excision and ligature have 
been employed, and each of these modes of operation may be rendered the 
most eligible by peculiar circumstances of particular cases. But, in 
general, the combination of tying and cutting certainly seems to be the 
best plan of proceeding. It has the recommendation of facility, efficiency, 
and safety. It accurately determines the limit of destruction, prevents the 
possibility of hemorrhage, and relieves the patient from the fetor, and 
other unpleasant consequences, which attend the slow separation effected 
by ligature. Finally, it has the testimony of experience in its favor. 
Part xii., p. 286. 
UTERUS 
Uterus—Diseases of.—Dr. Kennedy, of the Dublin Lying-in Hospital, 
directs, in first examinations, to use the foar-bladed speculum. If the os 
is not readily caught, ascertain carefully its position with the finger, pass 
the instrument well up, and if, on withdrawing the plug, the os is not 
seen, withdraw the speculum slowly, expanding it at the same time. 
When making applications in the os or the vagina, use Ferguson’s glass 
speculum. 
Congestion.—Apply three to six leeches directly to the uterus, or scarify, 
injecting warm water through the speculum for some time after. Repeat 
this several times, and then make a caustic issue over the pelvis or sacrum. 
Inject cold or tepid water into the vagina thrice a day; also mild astrin- 
gent lotions. Give alteratives—Pullna water, sarza, iodine, pil. plum, and 
taraxacum. Be cautious about using tonics. If the menses are interrupted, 
use the hip-bath, and apply a few leeches to the uterus, at the period. 
Chronic Catarrh.-—Dilate the os internum by gutta percha bougies, 
and apply nitrate of silver by a porte-caustique, or nitrate of mercury by a 
camel-hair brush with a graduated handle introduced through a gum tube. 
After cauterizing three or four times, at intervals of eight or ten days, 
use, every three or four days, lotions of nitrate of silver or copper, ten 
grains to the ounce, and afterward milder lotions with lead or zinc. 
Apply leeches ; use counter-irritation by sinapisms, tartar-emetic ointment, 
or an issue ; and give cubebs, or mild tonics and alteratives. 
Inflammation.—Use general and local depletion, antiphlogistic regimen, 
mercury and counter-irritation, the warm bath and soothing injections, and 
perfect quiet. 
Ulceration—Mild.—If it is not easily detected, brush over with a ten 
grain solution of nitrate of silver, which will mark its outline ; then use, 
for ten days, a lotion with plumb, acet. gr. j. ad aq. dest. 5j- In applying 
lotions, lay the shoulders lower than the hips, and inject a continuous 
stream, for some minutes, by a “ gum-elastic siphon.” 
Granular.—Get rid of or relieve the inflammation by depletion, etc., 
then apply caustic, at intervals of seven or ten days, three or four times, 
using in the interim mild astringent or emollient lotions, according to the 
symptoms. 
Code’s Comb Ulcer.—Apply caustic more freely, using the nitrate of 
mercury, so as to form a slough. 808 
UTERUS. 
Bleeding Ulcer.—Lay a piece of lint carefully round tlie margin of the 
ulcers, then apply caustic f reely; apply it also to the interior of the uterus, 
if the lining membrane is diseased, taking care to have the caustic melted 
into a porte-caustique, to prevent its breaking; afterward wash out the 
vagina with a stream of water. Continue the application at intervals, till 
the muco-purulent discharge ceases, and the mucous membrane ceases to 
bleed on being touched. 
If aphtha appear when an ulcer is nearly healed, apply a stream of borax 
or weak nitrate of silver lotion. Bart xv.,p. 283. 
Ulceration of the Cervix Uteri in Virgins.—Dr. Henry Bennet has 
found that inflammatory affections of the os and cervix uteri do occur in 
the virgin, and that, too, not very unfrequently; being a cause of those 
cases of severe dysmenorrhcea, and leucorrhoea, which so inveterately resist 
treatment. 
[Dr. Bennet remarks that from what we know of the diseases of mucous 
membranes generally, we cannot suppose that a mere increase of secretion 
from the mucous membranes of the female genitals, should produce that 
excessive debility and ansemia which we frequently see accompanying it; 
but Ave can readily understand that the assimilating processes should be 
affected by ulcerative inflammation in an organ with such extensive sym- 
pathetic affections as the uterus. Very marked general debility (in the 
absence of any decided cachexia) should lead us to suspect lesion of the 
cervix or os uteri—in this case, palliatives, as rest, injections, etc., may 
be tried ; but if they fail, or the case do not admit of delay, we must at 
once resort to a digital examination. Dr. Bennet observes, that,] 
A satisfactorily digital examination of the uterus may be nearly always 
made in a virgin, without injury to the hymen, especially when the vagina 
and external genital organs have been relaxed by long continued conges- 
tion and inflammation. The hymen is nearly always sufficiently dilatable 
to admit the index, introduced slowly and with proper care. Generally 
speaking, the os and cervix are reached with ease, the Cervix not being 
retroverted, as it is when inflamed in most married females; and when 
once the finger has reached the os nearly all doubts may be solved. If the 
cervix is free from disease, it is soft, and the os is closed; if it is inflamed 
and ulcerated, the cervix is enlarged, swollen, and the os is more or less 
open and fungous. This open and soft state of the os may also exist from 
mere inflammation of the cavity of the cervix. 
If possible, we must introduce the speculum without dividing the hymen. 
The existence of the disease once ascertained, it is to be treated secundum 
artem. Part xvi., p. 278. 
Varicose Ulcer of the Os and Cervix Uteri.—Dr. Whitehead, of Man- 
chester and Salford Lying-in Hospital, treats such cases as follows : Bleed 
from the arm, and cup, or apply leeches; confine the patient strictly to 
the recumbent posture, and give three to five grains of calomel, with 
hyoscyamus or opium, followed by a saline aperient. Apply to the ulcer 
at first a strong solution of nitrate of silver, and afterward the solid caustic, 
and if there is much discharge of blood, apply strong solution of sulphate 
of zinc with vin. opii and tincture of matico. (Or gallic or tannic acid, in 
the form of solution or ointment.) Part xvii., p. 259. 
Preternatural Elongation of the Cervix Uteri.—Dr. Coley, of Pimlico 
Dispensary, says that at first, when consisting chiefly in passive congestion, 809 
it may be relieved by rest in the horizontal position, and the introduction of 
a soft sponge to support the parts, and the internal use of iodide of iron, 
or of mercury. But if permanent hypertrophy remains, excise the part; 
the operation is perfectly safe and easy, in the absence of specific disease. 
Part xvii., p. 260. 
Retroflexion of the Uterus.—In recent cases, replace the organ by the 
uterine sound, and let the woman lie for a length of time on the side or 
face: at the same time prevent accumulation in the rectum or bladder, and 
restore the tone of the parts by astringent injections. In more chronic 
cases, besides the above means, such treatment must be adopted as will 
relieve other co-existing disease, as congestion or chronic inflammation of 
the uterus or ovaries; and after the uterus has been restored to its posi- 
tion, it must be retained there by wearing one of Dr. Simpson’s wire 
pessaries.—(Drs. Simpson, Beattie and Hensley.) 
Dr. Braithwaite considers the best plan of proceeding, in the introduc- 
tion of the sound or uterine pessary for retroflexion, is to place the female 
on her knees and elbows, with her face on a pillow. Then placing the 
forefinger of the left hand upon the os uteri, the point of the sound is very 
easily passed into the cervix, and by gently depressing the handle, as with 
the male catheter, the sound passes to the fundus uteri. Part xvii., p. 265. 
Treatment of Ulceration of the Os and Cervix Uteri with Collodion.— 
Dr. Mitchell adopts the following method : The patient being placed up- 
on her left side, and the speculum introduced, the ulcerated surface is to 
be wiped dry with a succession of pieces of soft lint until the adherent mu- 
cus is removed; a camel’s-hair pencil dipped in the solution is then to be 
rapidly applied to the ulcerated surface, and allowed to dry, which will 
occupy a couple of minutes—a second, third, and fourth coating, if neces- 
sary, can thus be applied ; the first coating is followed by a slight burning 
sensation caused by the ether, followed by a sensation of coldness from 
its evaporation. The application requires to be renewed at the end of 
forty-eight hours, as the secretion collects underneath the varnish, and de- 
taches it. In cases of simple abrasion, three dressings have proved suc- 
cessful : in more obstinate cases, and where large granulations have been 
present, I have used nitrate of silver, acid nitrate of mercury, and potassa 
fusa first, and then applied a varnish of the gun cotton over the eschar, 
and have succeeded in curing extensive ulcers of the cock’s-comb variety in 
half the time I have been able to succeed without the solution. 
In cases of vaginitis without ulceration, I have found the painting of the 
walls of the vagina with the solution most beneficial. The difficulty, how- 
ever, is to dry it well, which requires time and trouble, but in my mind, 
the result amply repays both, the friction of the surfaces is prevented, and 
the amount of suffering, pain and inflammation consequently much dimi- 
nished. Part xviii., p. 2VO. 
Uterus—Hypertrophy and Induration of the.—Dr. Oldham advises to 
reduce the size of the uterus by the application of four or six leeches to 
the upper and back part of the vagina once or twice a week. Blister the 
sacrum or inguinal region, when these parts are the seat of continuous 
pain ; or rub them well with a liniment composed of tinct. aconit. (Flem- 
ing) 3iv.; ext. belladon. 5ss.; lin. sapon. co. §iss.; M. Internally give 
the solution of bichloride of mercury, in doses of one or two drachms twice 
in the day, combined wfith vegetable tonics, or chalybeates, and occasion- 
UTERUS. 810 
UTERUS. 
ally, if the bowels are torpid, with a little tinct. rhei. Let the colon and 
the rectum be cleared out daily by a tepid or cold milk-and-water injec- 
tion ; long continued exercise or standing to be avoided; and sexual inter- 
course abandoned or nearly so. The application of potassa fusa, and 
other escharotics, to the uterus, is much to be deprecated unless there be 
fungoid granulations about the os and cervix. But with a view of strength- 
ening the structures below the uterus, cold hip baths may be used, and 
astringent injections efficiently given, such as decoction of oak bark or 
tormentilla, solution of sulphate of zinc, etc., or vaginal suppositories, made 
of ten or twelve grains of tannin mixed up with honey. A mechanical sup- 
port should be afforded by means of a perineal pad, attached to a firm, 
elastic, abdominal belt. Part xviii., p. 293. 
Uterine Catarrh.—Prof. Strohl, of Strasbourg, recommends the use of 
injections of liq. plumbi acetatis, or of a solution of 3j- of iodide of iron in 
gxij. of distilled water. Inject the fluid very slowly, through a caoutchouc 
tube introduced about three lines into the os uteri, and of such diameter 
as not completely to fill the orifice of the uterus. Part xix., p. 270. 
Ulceration of Os Uteri.—The best way to apply Vienna paste to the os 
uteri, for the purpose of changing the morbid action which gives rise to 
congestion of that part, says Dr. Mitchell, is to use a glass rod, expanded 
at the end into a circular disc. The paste is spread upon this disc, and 
the rod introduced through the speculum, and pressed against the part we 
wish to act upon. Part xix., p. 270. 
Inversio Uteri.—When the organ is not affected with malignant disease, 
and no other special contra-indication exists, and the patient’s health is 
suffering, Dr. Higgins believes that extirpation of the womb is a proper 
proceeding. In performing the operation, tie a flat tape, half-an-inch wide, 
round the inverted vagina, as high up as possible. This, when tightened, 
acts as a tourniquet, without injuriously pressing on the parts—it allows 
sutures to be easily inserted—and, if retained on for some time after the 
operation, it keeps the parts closely in apposition, and prevents dragging 
upon the sutures. Part xx., p. 223. 
Climacteric Disease in Women.—Dr. W. Tyler Smith directs to remove 
any obvious cause of uterine irritation, by appropriate treatment. Use 
moderate depletion from the uterus, by incisions made into the os, or, 
still better, by the application of three or four leeches to the os. And 
use cold hip-baths, or cold injections into the vagina or rectum. If there 
are any dysmenorrheal symptoms, use injections with decoction of poppies 
and laudanum, into the rectum and vagina ; if there is menorrhagia, let 
alum baths (§xvj. of alum to each gallon of water, at temp. 98°) be used 
in the intervals between the periods. Keep the bowels lax, but avoid 
drastics, and especially aloes ; and promote the alvine, renal, hepatic, and 
cutaneous secretions. Let the diet be light and nutritious, with very little 
wine and no malt liquor or spirits. Let the clothing be warm, and in win- 
ter let flannel jackets and drawers be worn. And for the severe symptoms 
of nervous irritation, give moderate doses of sulphuric ether and valerian. 
Sulphuric ether is at this period a more decided sedative upon the female 
constitution, than either morphia, opium, or hyoscyamus. Part xx., p. 232. 
Caulifloicer Excrescence of the Os Uteri.—According to Dr. Watson of 
Glasgow, as this disease is, in all probability, not of a malignant nature, we 
may hope by its removal to effect a permanent cure. It is necessary, how- UTERUS. 
811 
ever, that the removal should be complete ; and the safest and most effi- 
cacious mode of accomplishing this end is by free excision of the affected 
lip, or, if necessary, of the entire neck of the uterus. Partxx.,p. 242. 
Rupture of the Uterus.—Dr. J. C. W. Lever recommends full doses of 
opium at intervals during several days. A case so treated has recovered, 
though the rupture was so extensive that the hand could be passed into 
the cavity of the abdomen. Part xxi., p. 305. 
Erectile Engorgement of the Cervix Uteri.—Dr. Tilt gives the follow- 
ing case: A few months since I was consulted by a lady, aged twenty- 
five, who had menstruated for the first time at the age- of fourteen years, 
and who did so regularly till she married, three years ago. Since then she 
had suffered from dysmenorrhoea, and latterly from backache and leucor- 
rhoea. After adopting the usually employed method of treatment by 
injections and tonics for three weeks, I made an examination, and found 
the vagina hotter and more irritable than usual; and on applying the specu- 
lum, its field was filled by a well circumscribed substance of a bright red 
color, and yielding to pressure. On enlarging the aperture of the specu- 
lum (Coxeter’s), it was easy to see that the whole mass was formed by a 
swollen lip of the os uteri, which on being carefully dilated, did not pre- 
sent any erosion or ulceration, either on its external portion or in its cavity. 
The internal mucous membrane was redder than usual, and there was an 
increased flow of the normal glutinous secretion. I scarified the swollen 
surface, and ordered tepid injections, mild purgatives, and rejjose. A few 
days after the tumor was smaller, more livid, less painful, less tense on 
pressure, and I whitened it by rapidly passing the nitrate of silver over its 
surface. I ordered injections with cold solution of alum. I repeated the ap- 
plication of the nitrate of silver every five days for a month; and finding 
that the swelling did but slowly decrease, I applied iodide of iron to it 
every four days with a large camel-hair pencil, and in three weeks the 
swelling disappeared. The patient was under treatment for three months ; 
and never during repeated speculum examinations could I find any other 
lesion of the neck of the womb, except an increased intensity of color. 
Sometimes both lips are swollen, but generally only one is so. Out of 
twenty well-marked cases of this description which I have observed, in 
two the swelling was general; in eight the posterior lip was swollen ; and 
in ten the interior. Most of my twenty patients were of a lymphatico- 
sanguine temperament; they were all married, and in five the complaint 
came on within the six months which followed marriage. In almost all 
the cases intercourse was painful. 
I never employ potassa fusa in this form of uterine disease; I principally 
make use of nitrate of silver, and I have with advantage alternated its use 
with that of the solid sulphate of copper, or a strong solution of diacetate 
of lead, or of the iodide of iron. Part xxii., p. 278. 
Uterine Neuralgia.—M. Valleix has pointed out a class of cases in which 
the cervix uteri, usually insensible, becomes the seat of the most acute 
suffering of a neuralgic nature, and has pointed out the diagnostic distinc- 
tions between these and cases of painful inflammatory congestion of that 
organ. 
In all the cases which have come under M. Valleix’s notice, the affection 
has been accompanied by pain following the course of the lumbo-abdomi- 
nal nerves. He therefore regards the neuralgia of the cervix as part of 812 
UTEEUS, 
the more extensive lumbo-abdominal neuralgia. This feature is of impor- 
tance in reference to the diagnosis of neuralgic from other pains of the 
cervix uteri. 
The subjects of this neuralgic affection present all the characters of 
sufferers from chronic uterine congestion, with which disease the former is 
almost always confounded. The pain is much augmented at the menstrual 
period producing dysmenorrhcea. The vaginal discharge which occurs in 
these cases is analogous to the increased secretion from the mucous mem- 
brane of the eyelids in certain affections of the trifacial nerve. They are 
both functional disturbances originating in disordered nervous influence. 
Careful exploration is of the first importance to its detection. The neck 
of the uterus will be found tender to the touch, often so to a great degree, 
the tenderness being most acute at the sides of the cervix, while the ante- 
rior and posterior surfaces are free. The cervix is of its ordinary form 
and size. 
On examining the abdomen and loins, a neuralgic pain will be detected 
in the hypogastrium a little beyond the middle line on one side, most fre- 
quently the left only. Along the course of the first pair of lumbar nerves 
will be discovered other points, more or less acutely painful, and more or 
less isolated. The painful point always corresponds with the seat of pain 
in the uterus. 
The chief diagnostic features are, the degree and isolation of the tender- 
ness, the intermittent character of the pain, and the occurrence of the neu- 
ralgia of the abdomen and loins. 
Apply blisters to the hypogastric region, cauterization of the cervix, 
narcotic injections, with absolute rest and general treatment. 
Part xxii., p. 307. 
Purulent Discharges from the Uterus.—Dr. Lloyd uses an injection of 
a solution of chloride of zinc, gr. j. to the §j. every eight hours. 
Part xxiii., 210. 
Inversion of the Uterus.—Drs. Denman, Burns, and Merriman advise 
the uterus with the attached placenta to be returned; but the latter men- 
tions an instance in which he first detached the placenta, and the patient 
did well. Part xxiv., p. 278. 
Carcinoma Uteri.—To relieve the excruciating pain, apply the vapor 
of chloroform to the os uteri by means of Dr. Hardy’s “ anaesthetic 
douche.” 
The apparatus for applying it consists of a small metallic chamber; to 
one end of this a gum-elastic bottle is attached, to the other, a pipe fur- 
nished with a valve. On the end of the chamber there is also a second 
valve to admit atmospheric air for the working of the instrument. In 
order to charge it with chloroform it is necessary to unscrew the stopper 
in the side of the chamber, within which a piece of sponge is placed for 
holding the fluid. 
The quantity poured in should not be more than the sponge will absorb, 
otherwise, instead of vapor, fluid chloroform will be thrown against the 
affected part. When charged, the vapor may be conveyed to the part re- 
quiring its application by any convenient pipe, if closely fitted to the one 
on the instrument, pressure being made on the elastic bag to produce 
expulsion of the vapor. Part xxix., p. 279. UTERUS. 
813 
Uterine Catarrh and Internal Metritis.—It may be stated with a great 
degree of confidence, that the general opinion of medical men with regard 
to the seat of leucorrhoeal discharges, is, that they depend upon organic 
lesions of the os uteri and its vicinity. In these cases the treatment is 
effective and satisfactory. But in some cases the lesions may be in the 
mucous membrane lining the womb, and it is in these cases especially that 
there is the greatest uncertainty, both as regards the diagnosis and treat- 
ment. 
A sound symptom to judge by in this disease, is, that lateral pressure 
all down to the neck of the womb gives considerable pain. Dr. E. J. Tilt 
recommends the application of the tincture of iodine to the inside and out- 
side of the neck of the womb in such case. The second application may 
take place ten days after the first, and then repeat it every four or five 
days, if necessary, for three months. The uterine mucus should be first 
cleared away. The best injection in such case is 5j. of the acetate of lead 
and one pint of decoction of poppy heads. As a remedy, five to ten grains 
of ergot of rye, given three or four times, proved as useful as any. 
Part xxix., p. 285. 
Intra-Uterine Speculum.—For the exploration of the cervix uteri and 
using various applications, an ingenious speculum is used by M. Jobert; a 
very small instrument with a long handle—sufficiently small to be passed 
up the common vaginal speculum. Part xxx.,p. 203. 
Uterine Affections.— Vide Selections from Favorite Prescriptions, Art. 
“ Medicine.” 
Inflammation of the Os and Cervix Uteri.—[Besides arising from 
general unhealthy conditions of the system, it may be induced by causes of a 
mere local nature, as exposure, violent horse exercise, improper irritation 
of the part, but especially by the too frequent application of caustic to the 
os uteri, with such short intervals that the eschar produced by one applica- 
tion could not have healed before the next was made, and this continued for 
such a length of time as to produce the most serious mischief, both local 
and constitutional. Dr. Rigby says:] 
This form of inflammation of the os and cervix presents features which 
distinguish it from the ordinary species I have been describing. It would, 
perhaps, be correct to call it a highly irritable condition of the uterus 
(which not only involves the ovaries, but frequently implicates the spinal 
cord to a serious extent), were it not for the actual alteration of structure 
and permanent injury of the part which has suffered more immediately 
from the treatment. 
The patient complains of constant pain in the uterine region, but generally 
more behind the symphysis pubis than is usually the case in ordinary 
inflammation of the cervix, extending from hip to hip, and in aggravated 
cases darting up the spine with neuralgic severity. It is increased by 
standing or by any exercise whatever. Sitting down upon a hard seat, or 
the passage down the rectum of solid faices, produces great suffering, inas- 
much as when once the pain is brought on, it will continue severely for 
some time after. The moment she assumes the erect posture she has a 
sensation of weight, bearing down, and burning heat in the pelvis, which 
are quickly followed by the pain itself. 
The catamenial periods usually follow each other too quickly; are 
almost always very profuse, and invariably attended with great suffering. 814 
UTERUS, 
If the ovaries are involved, the symptoms of ovarian dysmenorrhoea will 
also be present. She has a constant ichorous watery discharge, which 
is sometimes very profuse. The bowels are unhealthy; the urine thick; 
the tongue pale, dry, and rough, with red papillae; the face sallow and 
Avan; the spirits depressed ; the pulse feeble and very irritable; and she 
has lost strength and flesh. 
On examination, per vaginam, this canal is found soaked in the thin, 
watery discharge already mentioned. On gently touching the os and cer- 
vix uteri Avith the finger, the patient feels as if the parts Avere raw, from 
the aggraArated sensibility which noAV exists in them; firmer pressure with 
the finger brings on the neuralgic pain already described. The os uteri 
is usually swollen, uneven, and knobby—it is frequently dragged forward, 
or to one side, Avithout any corresponding displacement of the organ itself. 
Whether this alteration of shape is oAving to cicatrization in the part 
itself and surrounding ATagina ; or AAThether it depends on different portions 
being affected with different degrees of induration, it is not easy to deter- 
mine ; at any rate, the cervix usually has a strong degree of hardness, and 
the uterus above it feels large, hard, and very tender to the touch. 
Seen through the speculum, the os uteri does not present the dark red 
tinge, more or less mottled Avith patches of a brighter color, as in cases of 
ordinary inflammation, but has a pale ashy hue, much injected with Aressels, 
just as is occasionally seen in the irritable throat and tonsils of an unhealthy 
person who has been suffering from repeated attacks of quinsy. 
The discharge is evidently uterine, and is constantly oozing from the os 
uteri in considerable quantities. If the uterine sound be passed, it gene- 
rally penetrates half an inch, or a Avhole inch, beyond the usual dis- 
tance, showing that the uterine cavity is enlarged; and intense pain is 
produced the instant it touches the internal surface of the uterus, indicat- 
ing great irritability of that organ, and probably inflammation of its lining 
membrane. 
The treatment of this affection will necessarily differ a good deal from 
the ordinary forms of inflammation of the os and cervix ; the indications, it 
is true, Avill to a certain extent be the same, but the local as Avell as the 
general condition of the patient is Arery different. The inflammation of 
the os and cervix in these cases is seldom of such a nature as to require 
the application of leeches to the part itself, and the extreme irritation 
which they not unfrequently produce contra-indicates any local applications 
but those of a soothing character; while the enfeebled state of the patient’s 
health renders any depletion very questionable. 
The general treatment is by no means so simple or so easy as in the 
other case. The health has been so much deranged by the long-continued 
effects of severe uterine irritation, and the strength so broken down by 
frequent attacks of menorrhagia, and profuse leucorrhoea during the in- 
tervals, that it is difficult to adopt any distinct line of treatment at first 
starting, beyond the attempt to regulate the liver and boAvels, by the mild- 
est remedies, and soothe the irritable system by gentle sedatives. 
A course of taraxacum, with decoct, sarsa? comp, and liq. calcis, is Aralu- 
able in the early stages of treatment, as it obviates the necessity of mercu- 
rial alteratives, Avhich are usually contra-indicated by the mucous irritation 
of the intestinal canal. It is of great importance to allay this condition as 
quickly as possible, not only because Ave thereby remove a fruitful source 
of uterine irritation, but because it also enables us to employ remedies UTEKUS 
815 
which we could not otherwise do. When this has been arrested, we may 
generally pass at once to the use of mineral acids and tonics, and, if neces- 
sary, these will pave the way to a course of cod-liver oil. If the season of 
the year permit, a residence for some months at the sea-side will be most 
desirable. The patient should use sea-water in her morning ablutions, and 
if her health be sufficiently improved, and the Aveather warm enough, she 
may bathe in the sea Avith advantage. 
The local treatment, as I haA-e before stated, must be essentially of a 
soothing character. Liq. plumbi diacet. in decoct, papaveris forms one of 
the best injections Avhere there is any amount of heat, SAvelling, or dis- 
chai’ge ; in other cases, the plain poppy decoction appears to be the only 
local application which Avill give relief. As it is desirable she should retain 
injections of this sort for fifteen or twenty minutes, she ought to lie upon 
her back, Avith her heels drawn up to the nates, and thus give the vagina 
such a direction that the injection Avill remain in it as long as she preserves 
this position. The suppositories of diacetate of lead and extract of conium 
are also \Tery valuable in these cases, and by being in a more concentrated 
form, and capable of being retained much longer, produce a much greater 
effect. The Avarm hip-bath is very useful, and with some patients appears 
to be the only thing which gives relief. If, hoAvever, the Aveather be mild, 
the sooner she can gradually come to the use of coldAvater the better; and 
she may always be looked upon as having made good progress, Avhen, dur- 
ing her residence at the sea-side, she is able to bear cold sponging with sea- 
Avater, and bathing in the open sea. For those Avho are able to enjoy 
these advantages, the salt tOAvel which I have before recommended will be 
an excellent adjunct to the cold sponging. But it Avill be needless to enter 
into further details ; they will vary more or less Avith every patient, or 
Avith the same patient at different times, and Avill be naturally suggested 
by the peculiar features, etc., of each case. The indications of treatment 
are to allay irritation and restore tone, but the treatment itself must neces- 
sarily be modified by the circumstances of each particular case. 
Part xxxiii., p. 248. 
Uterine Neuralgia.—This is often conjoined with uterine deviations, 
says Dr. Tilt, and may be alleviated or removed by sedative injections into 
the bowels—say from fifteen to thirty minims of Battley’s solution, Avith 
a drachm of tincture of henbane in a teacupful of warm milk. No remedy 
is so valuable in neuralgia as heat (cauterization with a red-hot iron), but 
as this is so very objectionable, apply to the most painful part a hammer 
previously plunged in boiling Avater. Part xxxiv., p. 239. 
Carbonic Acid as a Local Anaesthetic in Uterine Disease.—Prof. 
Simpson has used carbonic acid gas applied as a local anaesthetic very suc- 
cessfully in neuralgia of the uterus and vagina, and in various morbid states 
of the pelvic organs, accompanied Avith pain and spasm. It may be very 
conveniently generated in a common wine bottle, by mixing six drachms 
of crystallized tartaric acid with a solution of eight drachms of bicarbonate 
of soda, in six or seven ounces of Avater. A long flexible caoutchouc tube 
tightly fixed to the cork, conducts the gas from the bottle into the vagina 
Part xxxiv., p. 251 
Uterus— Cancer of.—Dr. West remarked at St. BarthoJomeAv’s that hem- 
orrhage is an almost constant symptom of commencing cancer of the os 
uteri, quite as valuable as hemoptysis is in respect to tubercle in the lungs. 816 
UTERUS. 
It is peculiarly valuable when the subject of the affection has previously 
ceased to menstruate. Part xxxv., p. 254. 
Uterus and Pladder—Peciprocal Sympathies between.—Dr. Mont- 
gomery communicates as follows: in the human female, there is an intimate 
reciprocal sympathy between the. uterus and bladder, and other parts of 
the urinary apparatus; so that, under a variety of circumstances, when the 
former organ is the seat of any anomalous action, or brought into a state 
of exalted sensibility, whether from natural or morbid causes, the latter 
is not only liable, but very apt to sympathize, and suffer correspondingly. 
This is constantly exemplified in the increased urinary irritation so often 
accompanying ordinary healthy menstruation, and still more remarkably, 
when the latter function happens to be painfully performed. Again, in 
eai’ly pregnancy, the same thing is observed; and the remark is trite, that 
morbid actions in the uterus, whether benign or otherwise, often have the 
earliest announcement of their invasion in symptoms of disturbance first 
noticed in the functions of the bladder. 
Thus, congestion or slight ulceration of the cervix uteri, and still more 
strikingly, malignant affections of that part, frequently excite, in the first 
instance, in the patient’s mind, only apprehensions of gravel, or some vesi- 
cal disease, for which alone she is induced to seek advice; but woe betide 
us, in this and many other circumstances, if we let ourselves be beguiled 
into the belief that because a particular organ or locality is affected with 
certain anomalous symptoms, it is therefore the seat of some disease, of 
which these symptoms are to be taken as indications; and so prescribe. 
Could we, for instance, expect to cure the itching of the nose and angle of 
the eye which accompanies the presence of intestinal worms, by applications 
to the Schneiderian, or conjunctival membrane? 
Mrs. C. had, for a long time, intense, intolerable, distracting itching of 
the perineum and anus, which really rendered her life miserable, and for 
which she had consulted many, and used a multiplicity of remedies: many 
of them, no doubt, very appropriate for pruritus, but not for her. When 
she came under my care, I also, at first adopted the wrong course ; I jxre- 
scribed/or the symptom, and not for its cause. But fortunately, after see- 
ing her a few times, something led me to suspect the existence of intestinal 
worms. I gave her a dose of the Kousso, which caused the expulsion of 
some very large lumbrici, and all her troubles were forthwith at an end. 
Mrs. M. consulted me for pruritus of the pudendum, from which she 
suffered to such a degree, and it was accompanied with other symptoms 
of so distressing a kind, that she declared she loathed herself, and felt her 
life an intolerable burden to her. She had used gallons of lotions, and all 
sorts of ointments, without the slightest relief. Examination showed an 
intense congestion of the cervix uteri; this was made the object of treat- 
ment, and on its removal, the pruritus and all its miserable concomitants 
totally ceased. 
I have already called the consent between the uterus and bladder a re- 
ciprocal sympathy, because it equally acts in the reverse direction, irrita- 
tions of the bladder being frequently found to influence and disturb the 
functions of the uterus—a fact which should not be forgotten in practice, 
and especially in the treatment of the disease of pregnancy, when the ad- 
ministration of the more irritating diuretics should be avoided, lest they 
should excite contraction of the fibres of the uterus, and so induce prema- 
ture expulsion of its contents. UVULA—VACCINATION. 
817 
And again, we must remember that vesical disturbances may produce a 
group of symptoms so closely resembling those arising from disease of the 
uterus, as to be mistaken for them. 
Several years ago, the wife of a general officer, at that time holding the 
highest military command in this country, began to complain of distress- 
ing symptoms, having all the characters of those produced by uterine dis- 
ease. Such was her own conviction, and on her consulting an accoucheur, 
he pronounced the affection to be cancer uteri, and could only promise pallia- 
tion. But she had many friends, and some of them urged upon her the 
necessity of having another opinion; to this she at last consented, and the 
gentleman called in pronounced the case to be one of stone in the bladder; 
the stone was extracted, and the lady passed at once from a state of pain 
and misery to one of comfort and happiness. 
A few years since, a patient came to consult me, stating that, to gratify 
her friends, she had come to town for my advice, although quite aware she 
could not be cured. She also handed me a written statement of her case, 
which set forth that she had had seven labors of terrible severity, owing 
to contracted pelvis, always requiring instrumental delivery; that for some 
months she had exhibited unequivocal symptoms of the existence of cancer 
uteri; and I. confess, that from this account, and the woman’s own des- 
cription of her symptoms, I thought there was little room to doubt as to 
the nature of her malady. 
However, I instituted a careful examination ; on doing so, I could dis- 
cover no disease of the uterus, but the neck of the bladder was distended 
and felt very hard. I passed a sound into it, which at once struck against 
a stone of considerable size. Mr. Fleming now saw the case with me, the 
stone was removed, and the woman soou returned home well, and con- 
tinued so. Part xxxvii., p. 229. 
Uterine Excitement.—Bromide of potassium has a decidedly sedative 
effect upon the generative system. Dr. Simpson recommends its use in 
spurious pregnancy. Some time since, Dr. Locock advocated its use in 
cases of epilepsy in females apparently having a monthly return. 
Part xl., p. 181. 
Vide Arts. “Palate”—“Throat”—“Chronic Phthisis.” 
UVULA. 
VACCINATION. 
Vaccine Crusts, the most Effectual Packages for Vaccine Virus.—[The 
following is from Dr. Epps’ Medical Director of the Royal Jennerian and 
London Vaccine Institution, who states:] 
The indurated pock, the scab or crust of the vaccine pock, contains the 
dried matter in its cells, which, being broken down, and moistened with 
the wetted point of the lancet, has been found elfective in hot climates, 
when attempts to preserve the vaccine ichor in other forms have failed. 
The crusts or scabs we have been able to collect in this country, we learn 
by letters from the East and West Indies, have withstoood the heat of 
VOL. II.—52 818 
VACCIN ATION. 
their vertical sun, and spread protection through the plantations and the 
surrounding districts. 
N.B.—These crusts, Avhen levigated and moistened, and Avorked into a 
fine pulp, have been used by many practitioners in tropica) climates with 
the most signal success. Part iii., p. 54. 
Dr. Gregory's Lecture on.—The surgery of vaccination, simple as it may 
appear, has been a fruitful theme of controversy. Differences of opinion 
have existed with respect to the selection of lymph, the mode of making 
the incisions, and the number of incisions necessary to insure a full effect. 
Each of these points merits attention. 
Dr. Gregory observes, that one of the earliest and most important dis- 
putes which chequered the career of vaccination (inasmuch as it led to the 
secession of Jenner, in 1807, from the original Jennerian Institution) had 
reference to the mode of taking the lymph. Dr. Walker adopted the plan 
of detaching the epidermis from the vesicle, and vaccination with the 
lymph (or fluid) which exuded from the abraded floor of the vesicle. Jen- 
ner objected strongly to this, and employed only the superficial lymph. 
Dr. Walker persevered in his plan; and it is but fair to confess that his 
vaccinations have stood the test of time fully as well as those conducted 
according to the Jennerian method. 
The proper time at which lymph may be taken so as to obtain it in the 
most efficient state for propagating the disease, has also been a subject of 
discussion. Some have objected to the employment of very early lymph, 
others have scruples in taking lymph after the first appearance of areola, 
and all parties have concurred in condemning the use of lymph taken on, 
or after the tenth day. The facts bearing on this question are as follows : 
The younger the lymph is, the greater is its intensity. The lymph of a 
fifth-day vesicle, when it can be obtained, never fails. It is, however, 
equally powerful up to the eighth day, at which time also it is most abun- 
dant. After the formation of areola, the true specific matter of cowpox 
becomes mixed Avith variable proportions of serum, the result of common 
inflammation, and diluted lymph is always less efficacious than the concen- 
trated virus. After the tenth day the lymph becomes mucilaginous, and 
scarcely fluid, in which state it is not at all to be depended on. Out of a 
dozen incisions made AATith such viscid lymph, not more than one will prove 
effective. The scabs of coAvpox, ground to powder, and moistened with 
lukewarm water to the consistence of mucilage, will sometimes reproduce 
the disease in all its purity—a satisfactory proof that the alteration which 
the lymph undergoes in its progress to maturity is not of a specific kind, 
liable to influence the result of the subsequent vaccination, but simply 
dilution. 
Cowpox matter differs in intensity according to the source from which 
it has been obtained. Very pure lymph, of great intensity, will often prove 
efficacious when taken from the arm on the ninth and even on the tenth days. 
Experience teaches that all vesicles are not equally fitted to produce the 
disease in purity; but it requires a practised eye to detect these minutiae. 
Irritable sores are often produced by draining the vesicle too much. 
Infantile lymph is more to be depended upon than the lymph obtained 
from adults. The matter of primary vaccinations is more energetic than 
that of secondary vaccinations. These statements may serve as a guide in 
the selection of lymph wherewith to vaccinate. The number of incisions 819 
VACC [NATION. 
which it is requisite to make in order to produce a full constitutional effect, 
has been always a disputed point. At an early period of vaccination one 
vesicle was held to be sufficient. Then three, four, or six, were recom- 
mended. In Germany, great importance is attached to the raising of 
numerous vesicles, it being a received doctrine in that country that, unless 
some decided constitutional effect be produced, little reliance can be placed 
on the process as a security in after-life. Common sense dictates that the 
greater the number of vesicles, the greater will be the local inflammation, 
and, on this theory, the greater the probability of constitutional sympathy. 
Some of the German inoculators have been in the habit of raising from 
twenty to thirty vesicles in each subject. In forming a just judgment on 
this matter, the nature and quality of the lymph must always be taken 
into account. Lymph recently derived from the cow possesses so much 
intensity, and fixes itself with so much more of a poisonous character upon 
the skin of the arm than lymph long humanized or habituated to the human 
constitution, that a single incision made with it is equivalent to six or 
eight made with lymph of minor energy. 
Dr. Gregory recommends, that with lymph of ordinary intensity five 
vesicles should be raised, and that these should be at such distances from 
each other as not to become confluent in their advance to maturation. 
Vaccine lymph should always be used in a fluid state, and direct from the 
arm, wherever practicable, for it is a very delicate secretion, and very 
slight changes in it are capable of materially altering its qualities. Lymph 
which has been retained fluid for four or five days, is very apt to occasion 
that irritable vesicle described as the most frequent of all the anomalous 
appearances. 
When lymph fresh from the arm cannot be obtained, other means must 
be had recourse to. Vaccine virus may be preserved fluid and effective 
for two or three days in small bottles, with projecting ground stoppers, 
fitted to retain the matter. It may be preserved for a like time in small 
capillary tubes having a central bulb. This is the mode usually adopted 
in France for the transmission of vaccine lymph to the Provinces, and 
which proves very effectual; but if we attempt in this manner to transmit 
lymph to the East or West Indies, we fail utterly. Most surgeons have 
seen what are called ivory points. These, when well armed and carefully 
dried, are very effective. They will retain their activity in this climate for 
many months, and they are found to be'the most certain mode of sending 
lymph to our colonies. Some practitioners prefer glasses to points, but 
they are less certain. The employment of scabs for the propagation of 
cow pox was first recommended in 1802. It is a very excellent mode of 
transmitting vaccine matter to distant countries, but some nicety is required 
in operating with scabs, which experience alone can teach. 
Part viii., p. 204. 
Value of Vaccination and He- Vaccination. -IM. Sevres presented to 
the Academy of Sciences, in the name of the committee appointed to 
decide on the merits of a number of treatises on this subject, a report, from 
which the following is taken :] 
Vaccination preserves the human species from variola, but its preserva- 
tive power is not absolute. Variola itself, either spontaneous, or produced 
by inoculation, does not preserve absolutely from future attacks, therefore 
it is not extraordinary that vaccination should not. Thus Mead mentions 820 
VACCINATION. 
having seen three variolous eruptions take place successively on the same 
woman ; the son of Forestus Avas tAvice attacked Avith variola, and Dehaen 
states that one of his patients Avas attacked six times by variola with impu- 
nity, but died of a seventh invasion of the disease. Although, hoAve\-er 
vaccination is sometimes poAverless to preserve us from variola, it s 
diminishes the gravity of the malady. This property, which Jenner and 
his first successors did not even suspect, is thoroughly proved by the 
various facts Avhich have been recently accumulated. In one of the most 
terrible epidemics of variola that has taken place in Europe since the dis- 
covery of vaccination—that of Marseilles, in 1828—more than ten thousand 
persons Avere attacked. Of these, tAvo thousand only had been A’accinated, 
and of that number forty-five only died, Avhereas, one thousand five hundred 
of the eight thousand AArlio had not been vaccinated, Avere carried off by 
the pestilence. Vaccine matter evidently loses part of its efficacy in passing 
from arm to arm ; it is therefore desirable to renew it as often as possible. 
A remarkable fact mentioned by one of the competitors, supplies us with a 
means of reneAving it, as it Avere, at Avill. A coav Avas vaccinated with 
matter taken from a child. Not only did the pustules rise, but they Avere 
communicated to other coavs, so that coav pox Avas observed nearly in its 
natural state. The pustules Avere identical in both cases. The propriety 
of re-Araccination is iioav fully established. In Germany, the \Tarious govern- 
ments have been induced to pay great attention to re-vaccination, owing 
to the circumstance of epidemics of variola having latterly manifested 
themselves with a severity to which Ave had become quite unaccustomed, 
since the introduction of Auiccination. Re-vaccination has, consequently, 
been resorted to on a very extended scale, and has had the effect of arrest- 
ing the epidemics. Thus, in Wurtemburg, forty-two thousand persons 
Avho haATe been re-vaccinated, have only presented eight cases of varioloid, 
whereas, one-third of the cases of variola have latterly occurred on persons 
Avho have been vaccinated. It is principally between the ages of fourteen 
and thirty-five that vaccinated persons are exposed to be attacked by 
variola. When there is an epidemic, the danger commences earlier, and 
children of nine years of age may be seized. Prudence, therefore, requires 
that, under ordinary circumstances, re-vaccination should be performed at 
the age of fourteen or fifteen, and four years eai'lier if within the radius of 
an epidemic of variola. ‘ Part xii., p. 126. 
Instrument for Vaccinating.—[Dr. Weir introduced to the Edinburgh 
Obstetrical Society a neAV instrument for vaccinating.] 
It consists of a small handle of ivory, Avith four needle-points projecting 
from one extremity, and a small curved knife for collecting and separating 
the Araccine matter at the other. The skin is opened by a crucial scratch 
Avitli the needle-points, which are held vertically, and are lightly applied, 
so as merely to remove the cuticle. The advantages of this instrument 
over the lancet are, that the operation is done more speedily, and that it 
opposes a larger surface for the absorption of the lymph, Avhich is less lia- 
ble to be AArashed aAvay by too great an effusion of blood. 
Soak a piece of sugar Avith the lymph, pound it when dry, and keep it in 
a Avell-closed bottle. Apply this poAvder by sprinkling it on the exposed 
surface Avith a hair-pencil. Part xvi., p. 230. 
Vaccination.—Dr. W. S. Oke directs to make at least six punctures, each 
produced by carrying the point of a lancet, held flat to the arm, obliquely VAGINA. 
821 
downward through the cuticle into the surface of the cutis. If possible, 
use fresh lymph ; and never take lymph from a vesicle after the eighth 
day. Let the instrument used to apply the lymph remain inserted a few 
seconds, and then be wiped upon the orifice of the puncture. Lastly, if 
the development of the vesicle is not satisfactory, or if there is only one 
vesicle, use Bryce’s test to try the efficacy of the vaccination. It consists 
in inserting fresh lymph on the evening of the fifth, or morning of the sixth 
day; then, if the second vesicle progresses rapidly, and overtake the first, 
it will show that the vaccination has been successful. Part xxi., p. 36. 
Adhesions and Strictures in the Vagina during Pregnancy and Labor. 
—Adhesions and strictures of the vagina may, no doubt, frequently exist in 
the virgin subject, as well as in one who has been previously impregnated 
and undergone parturition. When it occurs in the latter subject, it will 
generally be the result of pressure or injury during labor. The walls of 
the vagina may become glued together either at one point or throughout 
the whole surface, or bridles of lymph may be found in different parts. 
The formation of these cicatrices somewhat resembles the same process 
from burns. 
“ The most usual complication is a falciform band encroaching on the 
area of the vagina, or one or more rings of cartilaginous hardness either 
traversing its whole circumference, or only contracting a segment of it; 
and with these there is too frequently found a vesical fistula.” If the con- 
striction is slight, it will not be necessary for the practitioner to interfere 
much during labor. 
The relaxation of the parts will almost invariably be sufficiently accom- 
plished by the judicious use of tartar emetic, given in nauseating doses. 
In most instances, this practice will entirely supersede the use of the lancet. 
Cases of the greatest rigidity, almost resembling a “ cylinder of iron” 
round the finger, have been relaxed by this medicine in less than six hours. 
Sometimes, however, a perfect occlusion exists, and in this case, we must 
have recourse to an operation, which must at all times be dangerous on 
account of the proximity of the bladder on one side, and the rectum on the 
other. 
“ The best instrument,” says Dr. Doherty, “ which we can employ, is a 
straight bistoury, covered throughout with sticking plaster, except over a 
small portion of its extent. It can be safely introduced by carrying its flat 
surface along the finger, passed into the vagina. In making our incisions 
we should never allow them to go beyond the sixteenth of an inch in depth 
at once, and we should frequently withdraw the knife and make a careful 
examination of the progress we have made. A pair of flat wooden spatu- 
las, introduced one on either side, will, by keeping the parts asunder, facili- 
tate the operation. It will also be found a useful precaution to pass the 
finger of the left hand up the rectum, in order that we may judge how far 
our incisions may be carried without endangering that intestine ; and it is 
a matter of prudence to avoid as much as possible, cutting toward the 
bladder, lest, from its close proximity and intimate connection with the 
vagina, we open into its cavity. Having thus, step by step, and with the 
utmost circumspection, separated the adhesions as far as wc think prudent, 
VAGINA. 822 
VAGINA. 
we should wait until the opening has had an opportunity of dilating under 
the pressure of the presenting part, when if the head he still prevented 
from descending, we may endeavor, in the same cautious manner, to enlarge 
the canal a little more.” 
[The next question is, how long are we to wait before operating, when 
only a severe constriction exists, and when the child’s head must of 
necessity tear through the parts, if those parts are not artificially liberated. 
We must remember that in all severe constrictions of the vagina, its 
parietes are not the only parts implicated. The neighboring viscera will 
frequently be too adherent, and therefore any laceration of the vagina will 
also lacerate those viscera ; hence the necessity of timely interference with 
the knife or other instrument, when we feel convinced that the head will 
not pass without this. The constriction should, therefore, be nicked in two 
or three places, the incisions never exceeding the sixteenth part of an inch 
in depth, and being directed laterally or backward rather than forward, 
and the finger of the left hand at the same time being kept in the rectum 
as a guide. Dr. Rigby recommends that this should be done during a 
pain, when the patient will probably be unconscious of the act; but the 
correctness of this practice is certainly questionable, as few patients can 
be sufficiently quiet on such an occasion for the surgeon to be particular 
in the depth and extent of his incisions ; and moreover the incisions might 
be very suddenly enlarged if made during a pain. On all these occasions 
we are not warranted in resorting to an operation, till we feel convinced 
that relaxation of the parts has been carried to the utmost, and that any 
further delay might produce laceration.] Part v., p. 148. 
Vagina and Urethra—Disease of.—The value of the speculum is incal- 
culable in all cases where there is reason to suspect disease of the neck of 
the uterus. 
Local Treatment.—In vulvular inflammation, Dr. Mitchell, of Dublin, 
recommends the hip-bath and poppy fomentations. For the itching, nitrate 
of silver 5j-, aq. dest. §j., applied three or four times a-day; or tincture of 
matico. Roth may be applied either with a camel-hair pencil or with a 
stick, to which a piece of sponge is tied. Lotions of the soluble salts of 
lead, zinc, mercury, narcotic preparations, borax, hydrocyanic acid, bread 
crumb soaked with liquor plumbi diaeet., gelatine and bran baths. 
General Treatment.—Mild saline purgatives, rest, sea-bathing, alterative 
doses of mercury, as Plummer’s pill, gr. v. nocte maneque. Brandishe’s 
alkaline solution, twenty drops in an ounce of any bitter infusion ; balsam 
copaiba. For pain in the back apply cautery to the sacrum. 
Part xiv., p. 300. 
Vaginitis.—Dr. Mitchell recommends to paint the walls of the vagina 
with several coats of collodion, taking care to allow the first coat to dry 
well (which requires two or three minutes at least) before the second is 
applied. Part xviii., p. 270. 
Vagina—Plugging the.—The vagina may be easily and efficiently 
plugged by means of a little bladder of caoutchouc, of suitable form, 
introduced in a collapsed state, as recommended by M. Diday, and then 
inflated by means of a long tube attached to it. Part xxi., p. 302. 
Vaginal Cystocele, or Prolapsus of the Anterior I Vail of the Vagina 
and Bladder—Operation for its cure.—[The case was so aggravated that VAGINA, 
823 
with the least exertion the anterior wall of the vagina became so prolapsed 
that a tumor was produced by it of the size of a man’s fist, producing 
several ulcerated patches from the friction of the parts. All means of 
relief wrhieh had been suggested, having done no good, Dr. I. B. Brown, 
of London, determined to try to effect this by means of operation.] 
The patient having been prepared for the operation, by emptying the 
bowels, was placed under the influence of chloroform, and then put in 
position for lithotomy, each leg being held by an assistant and well bent 
back on the abdomen, a third assistant holding up the tumor with Jobert’s 
bent speculum, and pressing it under the pubes in its natural position. A 
piece of mucous membrane, about one inch and a quarter long, and three 
quarters of an inch broad, was dissected off longitudinally, just within the 
lips of the vagina. The upper edge of the denuded part being on a level 
with the meatus urinarius, the edges wrere drawn together by three inter- 
rupted sutures, this being repeated on the other side of the vagina. The 
next stage of the operation consisted in dissecting off the mucous mem- 
brane laterally and posteriorly in the shape of a horse-shoe, the upper edge 
of the shoe commencing half an inch below the lateral points of denudation, 
taking care to remove all the mucous membrane up to the edge of the 
vagina, where the skin joins it. Two deep sutures of twine were then 
introduced about an inch from the margin of the left side of the vagina, 
and brought out at the inner edge of the denuded surfaces of one side, 
and introduced at the inner edge of the other denuded side, and brought 
out an inch from the margin of the right side of the vagina, thus bringing 
the two denuded surfaces together and keeping them so, by means of 
quills, as in the operation for ruptured perineum. The edges of this new 
perineum were then brought together by interrupted sutures, and the 
patient placed in bed on a water-cushion. Two grains of opium given 
directly, and one grain every six hours ; simple water-dressing applied to 
the parts; beef-tea and wrine for diet. A bent metallic catheter was 
introduced in the bladder, to which was attached an elastic bag to catch 
the urine ; by this means the bladder was constantly kept empty. This 
patient progressed satisfactorily from day to day, without a single unfa- 
vorable symptom. It is scarcely possible to imagine a more satisfactory 
result from any operative procedure. The benefits from this operation for 
vaginal cystocele will be equally, if not more, applicable to vaginal recto- 
cele, as well as to prolapsus of the entire vagina, and also, with some 
slight modifications as to denudation of the mucous membrane, to prolap- 
sus uteri. Part xxviii., p. 279. 
Vaginitis.—M. Demarquay has found a composition, consisting of 
eighty parts of glycerine and twenty of tannin, of great service. Copious 
injections of warm water should be previously used, and the part freed 
from mucus, etc., by lint; then a plug should be introduced, saturated with 
this composition, and allowed to remain to the next day. 
Part xxxiv., p. 254. 
Vaginitis, with Superficial Inflammation of the Cervix Uteri.—M. 
Boucher introduces every morning, with the assistance of the speculum, 
a good-sized pledget of cotton wool, well smeared over with tannin oint- 
ment, into the vagina, bringing the pledget in contact with the cervix. 
By means of a thread attached to it, this may be withdrawn by the 
patient, either in the evening or next morning, and the parts having been 824 
VAGITUS UTEEIXUS. 
well washed out with cold water or weak alum water, a fresh pledget may 
be introduced. By a little practice, patients soon learn to apply the cotton 
wool for themselves. Part xl„ p. 214 
Case of—Its Medico-Legal bearing.—Cases of vagitus uterinus are by 
no means common, and many alleged instances of this kind, reported in med- 
ico-legal works, are unworthy of credit. Any authentic or well-observed 
case is, therefore, acceptable. The following has been communicated to 
Dr. A. S. Taylor, by Dr. Crothers, who says : I was called upon to 
attend Mrs. W., in labor of her sixth child ; her former labors had been 
quick. On my arrival I found her suffering from very strong pains ; and 
on examination the membranes were tense, and protruding through the 
os uteri. 
The labor not progressing as rapidly I expected, I ruptured the 
membranes, found the face presenting, and apparently arrested 
at the brim. I endeavored to move it into a more favorable position, when 
happening to introduce a finger into the child’s mouth, I was very much 
surprised to hear a distinct erg, which was repeated two or three times, 
and so loud as to alarm the mother and attendants. The former was 
quite frightened, so that I had a good deal of trouble to compose her. I 
do not now remember if the child cried afterward, without the fingers 
being introduced ; but several times it did so, and so audibly that I think 
the lungs must have been pretty well filled with air. I was obliged to 
complete the delivery by the forceps. The child is now a fine healthy 
boy. 
Pemarks.—The possibility of a child in utero, having its lungs so filled 
with air, as to be able to utter an audible cry, has been doubted. The 
above case, with a few others of a similar kind, reported in medical peri- 
odicals, removes all doubt on the subject. 
In all the authentic instances that have been hitherto published, the 
uterine cry has been heard only where the face has presented, and the 
accoucheur has by any accident introduced his fingers into the mouth of 
the child. The air thus finds a passage to the lungs. 
The only case in legal medicine on which the production of a uterine 
cry has any bearing, is in the application of the lung-tests in cases of 
infanticide. The air found in the lungs of a child may have been received 
into them before birth. Thus the fact that these organs floated on water, 
either entire, or when divided into small portions, Avould not furnish con- 
clusive evidence, that the child had been born alive. It would merely prove 
the establishment of respiration, and not the fact of birth. The uterine 
cry has less interest, in a practical view, than vaginal respiration during 
the passage of the head; because in a case of unassisted labor, it is not 
easy to perceive how it could possibly occur ; and if an accoucheur were 
present, then the case would not be likely to come before a medical prac- 
titioner as one of infanticide. Part xxii., p. 315. 
VAGITUS UTERINUS. VARICOCELE. 
825 
VARICOCELE. 
Radical cure of Varicocele by Invagination and Shortening of the 
Scrotum.—The mode of operating here recommended by Dr. Lehman, is 
very similar to that which has been adopted successfully for the radical 
cure of hernia. A portion of the relaxed and elongated scrotum is to be 
pushed up on the forefinger of the left hand, and invaginated into the part 
above it, till the finger reaches the external abdominal ring. Holding the 
parts in this position, a broad curved needle, with a double thread passed 
through an eye near its point, is to be carried along the left finger, through 
the bottom of the inverted portion of the scrotum, and to be made to pene- 
trate it and the integuments immediately over the external ring. The thread 
is then to be removed from the eye, and the needle drawn back and again 
carried through the inverted portion of the scrotum and the integuments at 
a distance of about half an inch from the parts previously penetrated. The 
threads passed through the two apertures being now drawn, the invag- 
inated portion of scrotum may be pullecj. up to any desired height; in gen- 
eral, it must be drawn very nearly to the external ring ; for in the subse- 
quent progress of the cure, the relaxation of the parts is so great that the 
folds and wrinkles thus produced are almost entirely obliterated. The 
threads then having been drawn must be knotted, and the parts thus tied 
up must be left for eight or nine days, under a soothing and cooling regi- 
men, by Avhich time adhesion will have taken place between them at the 
cut edges, and, by the excoriation which the discharge produces between 
the opposed surfaces of the inverted portion of the scrotum and that into 
which it is pushed. Part iii., p. 108. 
Treatment of Varicocele.—[This disease, which consists in a dilatation 
of the veins of the chord, is treated in various ways by different surgeons, 
and very much according to the peculiar treatment of varix, which each 
surgeon adopts. Cumano employed the ligature and extirpation at the 
same time; Mr. Warren excised or tied the varicose veins of the 
scrotum ; M. Moulinie combined excision with ligature ; Delpech divided 
the scrotum, exposed the cord, and tied or incised the veins; in some 
cases, he passed a small bit of sponge under the dilated veins and fixed it 
with strips of sticking plaster—it is said he cured six out of seven patients 
in this way. Bell has tied the spermatic arteries for this affection. 
Within the last ten years several new methods of treating this disease 
have been tried, all based on the results obtained from M. Velpeau’s 
experiments on the acupuncture of vessels. This eminent surgeon adopts 
the following method:] 
The patient is placed on his back, the scrotum shaved, and the vas 
deferens held aside. I then seize the scrotum from behind, and with the 
thumb and index finger of the other hand I bring the mass of varicose 
veins forward toward the integuments, and fix them in a fold of skin ; an 
assistant holds one end of this fold, while I support the other. I then pass 
a needle under the veins, in the way described for varix, and bring a liga- 
ture round it; a second needle is passed within about an inch of the first 
one. You must avoid inserting the needles too low or too high, and sepa- 
rating them too far from each other. If the lower needle, for example, be 
placed too low down, you may wound the tunica vaginalis ; if the superior 
needle be inserted too high up, you will have difficulty in separating the 826 
VARICOCELE. 
veins of the coi-d ; finally, if the needles are placed too close to each other, 
the two wounds may unite and form one. The needles being placed, the 
ligatures are wound circularly round them, in the same way as for varix 
of the lower extremities. When the eschars are detached, the needles are 
withdrawn from the tenth to the twentieth day. Unless the inflammation 
which supervenes be severe, the patients are not confined, and a cure takes 
place in about a month. I have never seen phlebitis occur after this ope- 
ration ; in two cases, however, where the inferior needle was inserted too 
low down, inflammation of the tunica vaginalis came on. The whole of 
my patients, then, were cured in a short time; and, of those whom I have 
since met, not one has suffered a relapse. Part v., p. 136. 
Varicocele treated by the Needles and the Twisted Suture.—It seems 
pretty well understood that all cases of varicocele do not require ojmrative 
interference, proper and well-regulated support generally affording suffi- 
cient relief where the affection is not of a severe description. The dis- 
tended veins of the cord, however, may cause such painful dragging and 
disturbance of the general health, as to call for some remedial means. M. 
Boyer advises an incision to be made over the external ring, to lay open 
the fibrous sheath of the spermatic cord, and to tie everything contained in 
it but the vas deferens and the artery. Though hazardous, the author 
prefers this method to the ligature as advised by M. Rieord, cauterization, 
or to the rolling up of the varicose plexus, as advocated by M. Vidal. In 
one case, Mr. Fergusson passed three needles under the scrotal veins, and 
twisted strong silk round them, as in the hare-lip operation. After a few 
days the needles were removed, which were very nearly out, and in five 
days afterward the sores were rapidly healing, and the patient was soon dis- 
charged cured. Part xxiv., p. 242. 
Treatment of Varicocele by Gutta Percha dissolved in Chloroform.— 
Dr. Carey says: After having used gutta percha considerably for other 
purposes, a knowledge of its properties forcibly suggested it in solution, 
as admirably fitted to fulfill the desired objects sought in the treatment of 
varicocele. In order to apply it, the patient is placed upon his back, and 
by means of cold, the scrotum is corrugated until it is drawn firmly over 
the root of the penis, compressing the testes firmly in the upper portion 
of the inguinal pouches; then, by means of a camel-hair pencil, after the 
hair has been removed, apply the solution freely over the site of the 
scrotum, allowing it to extend on all sides some distance by a thin attach- 
ment ; but over the scrotum proper lay on a succession of coats, until a 
thickness of a line uniform throughout is obtained, which will be suffi- 
ciently strong to form an artificial pouch of the nature and character 
desired. This thickness will be so yielding and pliable as not to afford the 
wearer any considerable inconvenience. Soon after the solution is applied 
to this sensitive part, the patient will complain bitterly of the burning- 
sensation experienced, depending upon the presence of the chloroform ; 
but this temporary inconvenience will soon pass off. The constitutional 
indications, if there be any, must not, of course, be neglected. 
Part xxv., p. 245. 827 
VARICOSE VEINS. 
VARICOSE VEINS. 
Varicose Veins cured by the Formation of Small Fschars.—Mr. Skey, 
of St. Bartholomew’s Hospital, treats these cases by forming small eschars 
a little larger than the diameter of a split pea, the number being regulated 
by the extent and complication of the disease. This is effected by apply- 
ing a small portion of the caustic paste through an opening made in three 
or four thicknesses of adhesive piaster. A piece of plaster may be laid, 
then, over each quantity, and may be removed in from twenty minutes to 
half an hour. Rest in the horizontal position is desirable, but not essential. 
The healing of the ulcers, which are sometimes slow and tedious, should 
be pushed by bark, wine, good diet, and stimulants, if necessary. 
Fart xxiii., p. 151. 
Varicose Veins and Ulcers.—These obstinate and disagreeable affec- 
tions, have lately been treated by the application of a convoluted spiral 
strap of vulcanized india-rubber, instead of the ordinary uniform elastic 
apparatus used. If there are ulcers along with the varicose veins,—first 
wet with a solution of glycerine. 5ss. to 3viiss. medicated with a little nitric 
acid, a little common blotting paper, and apply it over the wound, and 
over this a pledget of lint or linen wet with the same solution. These 
may be secured by a turn or two of the calico roller, and over this is 
placed the convoluted spiral bandage. Mr. Startin, the author of this 
mode of treatment, states that great success has resulted from its employ- 
ment. Fart xxiii.,p. 276. 
Treatment of Varicose Veins by Needles and Sutures.—It is an estab- 
lished rule in surgery that as long as varicose veins of the lower extremity, 
or varicocele, do not create much inconvenience, this abnormal state of 
vessels should not be interfered with ; but when the dilated veins become 
very troublesome, or threaten to give way, it is urgent that relief should 
be afforded. 
Mr. Fergusson has operated with much success on various patients with 
the needles, and sutures, in cases of varicose veins of the lower extremity; and 
as some surgeons are rather timid on this subjeet, we mention the following 
case : The patient, twenty-six years of age, a servant, has always enjoyed 
good health, but having had much standing work in her situation, and many 
pairs of stairs to ascend in the day, has lately found the veins of her leg 
enlarging considerably. When admitted the pain and inconvenience had 
much increased, the left saphena vein being large, tense, and tortuous. 
Mr. Fergusson transfixed the vein with needles, and applied the twisted 
suture, as in hare-lip cases; the patient was enjoined perfect rest; some 
pain and tenderness arose in the vein ; this was, however, soon subdued 
by fomentations, and the patient was discharged in a few weeks with 
complete obliteration of the vessel. Fart xxv., p. 194. 
Varicose Veins—On the Obliteration of.—Mr. Henry Lee operates upon 
these cases in the following manner : He first introduces a needle under 
the vein to be obliterated, and leaves it there for a few days. 2nd, after 
that time, when the blood on either side of the needle has become coagu- 
lated, the operation is completed by dividing the vein by a subcutaneous 
incision. The vein must be blocked up before incision is performed, and 
then we know that no abnormal product, as pus, can pass into the current 
of the circulation from the division of the coats. Hence the blood must 828 
VARICOSE VEINS. 
be kept at rest for a certain time in the vein. By this plan we are assured 
that the coagulum so formed consists of blood alone, and no other vitiated 
fluid. Part xxvii.,/>. 124. 
Varicose Veins cured by Injection of the Perchloride of Iron.—In a case 
of large varicosity of the saphena vein, under the care of M. Follin, injection 
of the perchloride of iron produced coagulation and effected a cure. 
Part xxix., p. 208. 
Varicose Veins.—Compressing the vessel at various points, by passing 
a hare-lip pin beneath, and applying the twisted suture, is insufficient to 
cut off all channels of communication, excepting it excites subacute inflam- 
mation throughout the veins in the neighborhood, and this end is far more 
safely attained by the application of caustic issues, which Mr. Skey has 
shown to be superior to any other mode of treatment at present known. 
The caustic recommended is composed of three parts of quicklime and 
two of caustic potash, made into a paste with spirits of wine. In apply- 
ing it, cut a small hole about the size of a split-pea, or a fourpenny-piece, 
in adhesive plaster, put this exactly over the part, then apply the paste ; 
in from ten to twenty minutes the pain will have ceased, and the paste 
must be removed. The issues must not be applied too closely one to 
another, for they approximate afterward by the contraction of the skin. 
Part xxxv., p. 91. 
Varicose Veins treated by Needles and Subcutaneous Section.—Mr. 
Erichsen’s practice is to pass pins under these veins, generally in three 
places, for which purpose the vein must be lifted up, and the pins passed 
well under them, so as to avoid puncturing them ; over each of these a 
figure of 8 suture must be applied. In about three or four days, he with- 
draws the pins, and divides the veins subcutaneously. In no instance have 
any bad efiects followed this plan of treatment. Part xxxv., p. 91. 
Varicose Veins—ligature of in Pregnancy.—It has been shown by 
the results of a case of Mr. Erichsen’s at University College Hospital, that 
even during pregnancy (should such a procedure be necessary from danger- 
ous hemorrhage) varicose veins may be safely ligatured. Mr. Erichsen’s 
method, it will be recollected, consists of placing pins under the veins, 
and tying them over a piece of gum elastic bougie. Part xxxvi., p. 169. 
Varicose Veins.—A case presented to Prof. Erichsen, at University 
College Hospital, where a mass of enlarged veins, the size of half an 
orange, was situated in the popliteal space. A pin was passed under the 
upper extremity of the tumor, and tied in the usual way, and the parts 
below were injected with a solution of the perchloride of iron, by means 
of a small French syringe, the piston of which works with a regulating 
screw, and the point of which is made sharp, and intended to penetrate 
the integuments. The intention of this operation is to coagulate the blood 
in the large vessels, and thus cause their obliteration. Part xxxix., p. 162. 
Varicose Veins and Ulcers.—For some time past the following method 
has been followed at the Great Northern Hospital by Mr. Price, in the 
treatment of varicose veins of the legs, whether associated with ulceration 
or not. The leg is firmly incased in a bandage which is saturated with a 
mixture of starch and glue; a uniform support is thus afforded to the 
swollen vessels. This bandage, when well applied, can be worn for weeks 
or months ; but the rapid sxibsidence of the swelling of the leg, in some VEINS, 
829 
instances, may require a recasing of the limb at an earlier period. This 
plan of treatment, in many cases, has proved as effectual as obliteration 
of the vessels by the twisted suture, and it moreover possesses the advan- 
tage of being available in almost every instance of varicose enlargement 
of the superficial veins of the extremities. When there is also ulceration, 
a icincloic must be cut somewhat larger than the circumference of the sore 
or sores, to admit of the treatment of the sore without disturbing the case. 
Fart xxxix., p. 232. 
Treatment Required after the /Spontaneous Introduction of Air into 
the Veins.—[The possibility of the introduction of air into the veins 
during surgical operations is now generally acknowledged, as well as the 
situation in which only it can happen, accurately pointed out. Mr. 
Erichsen in this interesting paper confines his remarks to the spontaneous 
introduction of air into the system, that is to say, when it is not pur- 
posely injected into the heart, but when it gains admittance into that 
organ either in consequence of one of the large veins in its vicinity being 
opened at a point where the flux and reflux of blood are naturally ob- 
served, or, during operations, under such circumstances, whether of dis- 
ease of the coats of the vessel, of traction in the removal of tumors, or of 
contraction of surrounding muscles, that it forms an unyielding, uncollaps- 
ing tube, into which the air is apt to be sucked in to supply the vacuum, 
which the action of inspiration has a tendency to occasion within the thorax. 
Mr. Erichsen, before giving his own views of the cause of death in 
these cases, sums up those of previous writers on the subject, which lie 
arranges in four classes, viz.: 1st. That death ensues from over-disten- 
tion of the right cavities of the heart. Of this opinion are Nysten, Du- 
puytren, Cormack, Amussat, and Bouillaud (partly.) 2d. That death en- 
sues from the irritation occasioned by the passage of the air through the 
vessels of the brain.—Bichat. 3d. That the heart’s action is arrested in 
consequence of the deleterious influence of the carbonic acid which is 
eliminated from the venous blood.—Marshall de Calvi. 4th. That the cir- 
culation is arrested in the lungs, either, as Piedagnel and Leroy have sup- 
posed, in consequence of these organs becoming emphysematous, or, as 
Bouillaud and Mercier (partly) think from obstruction of their capillaries, 
or, as the reviewer in Dr. Forbes’ Journal is of opinion, in consequence 
of the respiratory changes being interfered with. 
Mr. Erichsen states his own opinion to be : 1st. That the primary 
arrest of the circulation that takes place in the capillaries of the lungs, or 
in the terminal branches of the pulmonary artery, in consequence of in- 
ability in the right ventricle to overcome the mechanical obstacle pre- 
sented by air-bubbles in the vessels of those organs. 2d. That respira- 
tion and animal life cease in consequence of a deficient supply of arterial 
blood to the central organs of the nervous system. Mr. Erichsen then 
proceeds to that part of the subject which is the most interesting to the 
practitioner, namely, the plan of treatment to be adopted.] 
And first of all, as most important, let us take into consideration the best 
way of preventing the occurrence of the accident in question. Before 
doing so, however, it may be better, in order to understand the principles on 
which we should act, to give a brief summary of those circumstances that 
VEINS. 830 
VEINS. 
are peculiarly apt to occasion the introduction of air into the circulating 
system during operations. Now it is well known that Avhat is called by 
the French writers the “ canalisation ” of a vein, or its conversion into a 
rigid uncollapsing tube, is the condition of all others which is most favor- 
able to the introduction of the air into it. Indeed, except in those situ- 
ations in which there is a natural movement of flux and reflux of the 
blood in the veins, this accident cannot occur unless these vessels be canal- 
ized, or, in other words, prevented from collapsing. This canalization of 
the vessel may be occasioned in a variety of ways. Either the cut vein 
may be surrounded by indurated cellular tissue, which will not allow it 
to retract upon itself, but keeps it open like the hepatic veins ; or the 
coats of the vessel may have acquired, as a consequence of inflammation 
or hypertrophy, such a degree of thickness as to prevent their falling to- 
gether when divided. Again, the principal veins at the root of the neck 
have, as Berard has pointed out, such intimate connections with the neigh- 
boring aponeurotic structures that they are constantly kept in a state of 
tension, so that their sides are held apart when they are cut across. The 
contractions of the platysma and other muscles of the neck may likewise, 
as Mr. Shaw has shown, have a similar effect. In removing a tumor also 
that is situated about the neck, the traction exerted upon its pedicle may, 
if this contain a vein, cause it to become temporarily canalized. 
The introduction of air into a vein will be favored by the vessel being 
divided in the angle of a wound, the vein being, when the flaps that form 
that angle are lifted up, rendered openmouthed and gaping. 
[In looking over all those cases in which the wounded vein is particu- 
larized, Mr. Erichsen found that the wounded vessels were always in 
one or other of the abovementioned conditions] and consequently, what 
the surgeon should peculiarly guard against in the removal of tumors 
about the neck and shoulders, viz., incomplete division of the veins and em- 
ployment of forcible traction on the diseased mass at the moment of using 
the scalpel. 
If this be necessary, the chest should, for reasons that will immediately 
be pointed out, be tightly compressed, that no deep inspirations may be 
made at the moment that the knife is being used, or before a divided or 
wounded vein can be effectually secured. 
But although it be necessary for the spontaneous introduction of air 
into the circulating system, that the vein be either canalized in one or 
other of the ways that has just been mentioned, or else that it be opened 
where the venous pulse exists, yet it is only during the act of inspiration 
that air can gain admittance into the vessel; aud it is the more ready to 
do this the deeper the inspiratory efforts arc. If a vein be opened at the 
root of a dog’s neck, it will be found that it is only during inspiration that 
air rushes in; that none gains admittance during expiration, and but 
little, if any, when the inspirations are shallow, as when the chest is 
forcibly compressed by the hands ; and that the rapidity of the spon- 
taneous introduction of air is, cceteris paribus in proportion to the depth 
of the inspirations. 
This depends upon the tendency that there is to the formation of a 
vacuum within the thorax, more particulary in the pericardium, during in- 
spiration ; at which time the blood is carried with increased velocity 
along the veins in the neighborhood of the heart; and when expiration 
takes place a temporary retardation occurs. This is particularly evident VEINS, 
831 
during excited respiration. Now, during operations the state of the 
breathing is such as to dispose the patient peculiarly to the entrance of air 
into the veins. When a patient is under the knife, the respirations are 
generally shallow and restrained, the breath being held, whilst every now 
and then there is a deep gasping inspiration, at which moment, if a vein 
be opened in which the pulse is perceptible, or that is canalized, air must 
necessarily be sucked in; and, as has already been said, in quantity and 
force proportioned to the depth of the inspiration. This, then, being the 
case, the mode of guarding against the introduction of air into the veins 
is obvious. The chest and abdomen should be so tightly bandaged with 
broad flannel rollers or laced napkins, as to prevent the deep gasping in- 
spirations, and to keep the breathing as shallow as possible, consistently 
with the comfort of the patient. 
The surgeon must be careful not to remove the compression until the 
operation be completed and the wound dressed, for if this precaution be 
not attended to, as the patient will most probably, on the bandage being 
loosened, make a deep inspiration, air may be sucked in at the very mo- 
ment that all appeared safe. 
It has been fully proved from the experiments of Nysten, Cormack, 
and Amussat, as well as from recorded cases of recovery in man, that it is 
necessary that a certain quantity of air be introduced before death can take 
place, in confirmation of the observations made long since by Nysten, 
that a few bubbles of air would not occasion death. Magendie states, that 
he has several times, whilst injecting medicinal saline solutions into the veins 
of patients, seen air introduced without any bad consequences ensuing. 
In order, then, that the accident prove fatal, it is necessary that a certain 
quantity of air be introduced into the venous system. This quantity it is 
impossible to determine accurately, for obvious reasons. 
What, then, are the measures that a surgeon should adopt in order to 
prevent the occurrence of a fatal termination in those cases in which air 
has accidentally been introduced into the veins during an operation ? 
Beyond a doubt, the first thing to be done is to prevent the further in- 
gress of air, by compressing the wounded vein with the finger, and, if 
practicable, securing it by ligature. At all events, compression with the 
finger should never be omitted, as it has been shown by Nysten, Amussat, 
Magendie and others, that it is only when the air that is introduced ex- 
ceeds a certain quantity that death ensues. All further entry of air hav- 
ing thus been prevented, our next object should be to keep up a due sup- 
ply of blood to the brain and nervous centres, and thus maintain the 
integrity of their actions. The most efficient means of accomplishing this 
would probably be the plan recommended by Mercier, who, as it has 
already been stated, believing that death ensues in these cases, as in pro- 
longed syncope, from a deficient supply of blood to the brain, recommends 
us to employ compression of the aorta and axillary arteries, so as to 
divert the whole of the blood that may be circulating in the arterial sys- 
tem to the encephalon. This appears to me to be a very valuable piece of 
advice, and to be the most effectual way of carrying out the first indica- 
tion, that of keeping up a due supply of blood to the brain and nervous 
centres. The patient should, at the same time that the compression is 
being exercised on his axillary arteries and aorta, oi', if it be preferred, 
as more convenient and easier than the last, on his femorals, be placed in 
a recumbent position, as in ordinary fainting, so as to facilitate the afflux 832 
VEINS, 
of blood to the head. The compression of the axillary and femoral arte- 
ries may readily be made by the fingers of two of those assistants that are 
present at every operation. 
For the fulfillment of the second indication, that of maintaining the 
action of the heart until the obstruction in the capillaries of the lungs can 
be overcome or removed, artificial respiration should be resorted to, as 
the most effectual means of keeping up the action of that organ. Thus 
Sir B. Brodie states that he has seen, in a dog that was beheaded, and 
whose cervioal vessels were tied, the contractions of the heart maintained 
by artificial respiration for two hours and a half, at which time there were 
thirty-two pulsations in a minute, and from my own observations, I can 
state that, by the same means, this organ may easily be kept in action in 
an animal that has been pithed for an hour and a half. For the purpose 
of keeping up artificial respiration, the Humane Society’s bellows, if they 
be at hand, might be used, or, if they cannot readily be procured, a split- 
sheet might advantageously be employed. Before inflating the lungs, it 
will be necessary to remove everything that can compress the chest or 
interfere in any way with the free exercise of the respiratory movements. 
Friction with the hand over the prsecordial region, and the stimulus of 
ammonia to the nostrils may at the same time be resorted to. 
The third indication—that of overcoming the obstruction in the pulmonic 
capillaries, would probably be best fulfilled by the means adapted for the 
accomplishment of the second, viz., artificial inflation of the lungs. That 
the action of respiration if kept up sufficiently long, would enable the capil- 
laries of the lungs to get rid of the air contained in them, appears to be the 
case, for I have several times observed that, if a certain quantity of air 
be spontaneously introduced into the jugular vein of a dog, and artificial 
respiration be then established and maintained for half or three quarters of 
an hour, but a very small quantity indeed, if any, will be found, on killing 
the animal, in the cavities of the heart, or in the branches of the pulmo- 
nary vessels. 
If by these means we should succeed in warding off an immediately fatal 
termination to the accidental introduction of air into the veins, we must 
watch carefully for the supervention of pneumonia or bronchitis, which 
disease Nysten has shown to be very apt to occur in those animals that 
recover the immediate effects of the accident. That the same danger exists 
in man is evident by the two cases that have occurred to MM. Roux and 
Malgaigne respectively. In Roux’s case the patient lived seven days after 
the accident, at the expiration of which period he died of pneumonia; whilst 
Malgaigne’s patient died on the fourth day of bronchitis. In recapitulation, 
then, the following are the principal points that it has been endeavored to 
establish in this paper: 
1st. That the primary arrest of the circulation takes place in the capillaries 
of the lungs, or in the terminal branches of the pulmonary artery, in con- 
sequence of inability in the right ventricle to overcome the mechanical ob- 
stacle presented by air-bubles in these vessels. 
2d. That respiration and animal life ceases in consequence of a deficient 
supply of arterial blood to the central organs of the nervous system. 
3d. That as air enters the veins in quantity, in force, and in rapidity, 
proportioned to the depth of the inspirations, the best mode of preventing 
the occurrence of the accident, or, at all events, of lessening its probable 
fatality, would be in all operations about the dangerous region—the root VENTILATION VERMIFUGES. 
833 
of the neck and summit of the thorax—to bandage the chest tightly with 
broad flannel rollers or laced napkins, so as to prevent deep gasping inspi- 
rations, and to keep the breathing as shallow as possible, consistently with 
the comfort of the patient. 
4th. If the air have already gained admission, prevent its further entry 
by compressing, or, if possible, ligaturing the wounded vein by which it 
entered. 
5th. Keep up a due supply of blood to the brain and central organs of 
the nervous system, by placing the patient in a recumbent position, and by 
compressing his axillary and femoral arteries. 
6th. Maintain the action of the heart, by artificial respiration and friction 
on the precordial region, until the obstruction in the capillaries can be over- 
come or removed. 
7th. Remove, if possible, the obstructions in the capillaries of the lungs 
by artificial respiration. 
8th. If the patient survive the immediate effects of the accident, guard 
against the supervention of pneumonia or bronchitis. .Part ix., p. 149. 
VENTILATION. 
Importance of Ventilation.—According to Mr. Squire, the usual argand 
gas-burner consumes above five cubic feet of gas per hour, producing rather 
more than five cubic feet of carbonic acid, and nearly half a pint of water. 
Shops using thirty of these lights, therefore, in an evening of four hours, pro- 
duce upward of nine gallons of water, holding in solution the noxious pro- 
ducts of the gas. An argand lamp, burning in a room twelve feet high and 
twelve feet square, containing 1728 cubic inches of air, with closed doors 
and windows, produces sufficient carbonic acid, in rather more than three 
hours, to exceed one per cent, which is considered unfit for respiration, 
and when it amounts to ten per cent, it is fatal to life. A man makes, on 
an average, twenty respirations per minute, and at each respiration inhales 
sixteen cubic inches of air; of these 320 cubic inches inhaled, thirty-two 
cubic inches of oxygen are consumed, and twenty-five cubic inches of car- 
bonic acid produced. Part xi., p. 108. 
VERMIFUGES. 
Observations on Vermifuge Medicines.—Dr. Cazin, of Boulogne-sur- 
Mer, states that he has frequently employed the common spigelia or worm- 
grass. He administers it in the form of decoction, prepared by boiling- 
two drachms of the herb in a quart of water to one-half. The decoction 
is then expressed, strained, and flavored with a little lemon juice and a 
sufficient quantity of sugar. The dose for an adult is two wine-glassfuls, 
followed by a wine-glassful every six hours until the desired effect is pro- 
duced. To children and delicate persons a smaller quantity is to be given. 
Wormwood (absinthium) is an excellent indigenous anthelmintic : it is 
also a powerful tonic and stimulant, the use of which, continued after the 
expulsion of the worms, prevents their reproduction. M. Cazin often uses 
YOL. II.—53. 834 
VERMIFUGES 
a wine prepared by digesting an ounce of wormwood, with an equal quan- 
tity of garlic, in a bottle of white wine, of which he gives from one to three 
ounces every morning. This wine is well adapted for poor lymphatic sub- 
jects, wasted by wretchedness, and suffering from the influence of a 
marshy soil. The absinthium maritimum is likewise a very good anthelmin- 
tic. M. Cazin gives it to the extent of one or two drachms boiled in four 
or five ounces of water, with the addition of some white sugar, or of any 
anthelmintic sirup. This is a quite popular remedy in the maritime dis- 
tricts, and almost always succeeds with children affected Avith Avorms. 
Assafoetida possesses acknoA\rledged anthelmintic properties, and is suit- 
able for cases of sympathetic nervous affections produced by the existence 
of worms. It thus, like valerian, fulfills a two-fold indication. In a case 
of nervous affection, which M. Cazin beliexred to be idiopathic, the admi- 
nistration of assafoetida both determined the disease and revealed its true 
cause, by effecting the expulsion of a number of lumbrici. This result has, 
in three cases of chorea and in tAvo of epilepsy, enabled him to recognize 
that sympathetic irritation, depending on the presence of intestinal worms, 
Avas the sole cause of disease in these instances. Under ordinary circum- 
stances, M. Cazin frequently combines assafoetida with calomel in pills’ 
This combination, of all those that he has employed, succeeds best in expel- 
ling lumbrici. He has also combined it with black oxide of iron, particu- 
larly in anaemic patients. Assafoetida may be given in powder, in doses of 
from four grains to half a drachm. 
The essential oil of turpentine is not merely useful in cases of taenia, but 
is also decidedly efficacious in expelling the lumbrici. M. Cazin has some- 
times, in cases of lumbrici and ascarides, administered with advantage tur- 
pentine enemata, prepared by suspending, by means of yolk of egg, from 
one drachm to half an ounce of the oil in decoction of tansy, absinthium, 
Avorm-seed (semen-contra), or Corsican moss. 
Common salt is \rery destructive to worms; it is given alone in large 
doses dissolved in Avater ; it should be taken on an empty stomach. M. 
Cazin also frequently administers it in the form of enema, with brown su- 
gar, linseed or poppy oil, and a sufficient quantity of Avater. With children 
it almost ahvays succeeds. 
Like all tonics, iron has the advantage of destroying worms, at the same 
time that, by imparting tone to the intestines, it prevents their repro- 
duction. From six to eight grains of iron filings, mixed with an equal 
quantity of rhubarb, and taken tAvo or three times a day, have often been 
sufficient to expel the Avorms contained in the intestines. 
M. Cazin succeeded in rapidly curing a boy nine years of age, emaciated 
and pale, Avhose sleep Avas disturbed, and Avho Avas suffering from spas- 
modic movements similar to those which characterize chorea, by the ex- 
hibition of pills of sulphate of iron, combined, according to Puller’s form- 
ula, with aloes, senna, etc., under Avhich treatment he voided tAventy-three 
lumbrici in four days. He has also used Avith remarkable success Bosen’s 
mixture, containing extract of black hellebore and sulphate of iron. But 
what he chiefly gives to children, as well as to adults, is the sirup of citrate 
of iron (four parts of citrate to sixty of simple sirup, and one of essence 
of lemon,) in doses of from two drachms to half an ounce to children, and 
from half an ounce to two ounces to adults. 
M. Cazin remarks that calomel, so efficacious as an anthelmintic, ought 
never to be combined Avith an alkaline chloride, as the formation of corro- VOMITING, 
835 
sive sublimate would probably ensue from their admixture. In like man- 
ner, the combination of calomel with cherry-laurel water, or emulsion of 
bitter almonds, would give rise to the development of two formidable poi- 
sons, corrosive sublimate and cyanide of mercury. 
The effects of the male fern, tin, pomegranate bark, hellebore, etc., re- 
quire merely to be noticed ; and the properties of the pomegranate root 
bark are so well known that they need not be dwelt upon. M. Cazin has 
remarked nothing particular respecting other anthelmintics. He merely 
says that cod-liver oil has succeeded with him in the cases of two females, 
one of whom passed twelve lumbrici the same day that she had taken in 
the morning three table-spoonfuls at intervals of an hour. 
But whatever be the medicine selected, we must not, like routine prac- 
titioners, be content when the worms are killed and dislodged, Avith this 
merely palliative cure. A very important indication remains to be fulfilled, 
viz. to prevent their reproduction. This object is attained, according to 
M. Cazin, by the adoption of a tonic and stimulant regimen, which must 
be long continued, and, above all, by the employment of bitter and chaly- 
beate preparations. He has found the ferruginous chocolate to be suffi- 
cient, in the case of children, to prevent the relapses which are for many 
years very apt to occur. Wine taken while fasting has succeeded Avith 
the poor inhabitants of the marshes, accustomed to live only on xregeta- 
bles and milk; and he has also remarked its efficacy as a preventive of 
worm affections in other instances. Part xxi., p. 154. 
VOMITING. 
Creosote and Acetate of Lead in Vomiting.—Dr. Cormack, of Edin- 
burgh, states that creasote, in medicinal doses, is almost immediately seda- 
tive and calming ; but these effects are of short duration; so that it is a 
drug which requires to be given in often repeated small doses. 
Creasote is one of the best medicines which we possess for stopping 
vomiting. In the vomiting of pregnancy, an affection so distressing to the 
patient, it seldom fails. If the sickness come on regularly after rising in 
the morning, Dr. C. prescribes two or three drops to be taken five or ten 
minutes before getting out of bed. This generally proves effectual; but 
if it does not, the patient ought to be directed to repeat the dose in two 
hours. In more troublesome cases, when the sickness occurs at intervals 
during the day, one or two drops should be given every two, three or 
four hours. 
[In a case communicated by Professor Simpson, the creasote failed to 
relieve the distressing sickness, while doses of acetate of lead proved suc- 
cessful. In the sickness and vomiting following a drinking debauch, crea- 
sote is sometimes very useful. In such a case a single dose of four drops 
was found to relieve speedily. In sea sickness it will often be found effica- 
cious ; but “ it is worthy of notice as a general remark that creasote, 
though excellent in allaying vomiting, often excites it when it does not 
exist.”] 
In vomiting connected with hysteria, creasote proves a very valuable 
remedy, and so far as Dr. C.’s experience goes, he is inclined to think, that 
Dr. Elliotson and others, who have recommended it very strongly in this 
class of cases, have not done so without sufficient cause. In at least ten 836 
VOMITING. 
cases of this kind, Dr. C. has tried it in doses varying from two to eight 
drops, and in all excepting one, it proved an admirable medicine, not only 
relieving the vomiting, but also apparently, in most instances, calming the 
nervous excitability. In the case in which it apparently did no good, the 
dose could not be increased beyond six drops thrice a day, on account of 
the vertigo w'hich it occasioned. The patient was ultimately much bene- 
fited by sponging with cold water, and taking four grains of the saccha- 
rine carbonate of iron three times a day. Part vi., p. 12. 
Atonic Vomiting.—Dr. Debregue gives the following: In the vomit- 
ing that may be considered, to be nervous or spasmodic in its nature—i. e., 
when it is not connected either with inflammation or any bilious dis- 
turbance of the stomach—he recommends very highly the use of eolumba 
powder: it possesses, he says, a sort of specific virtue in such cases nearly 
as great as bark does in agues. He gives it in doses of from 15 to 20 
grains in two or three spoonfuls of red (French) wine, before meals. The 
addition of a few grains of magnesia, or of a minute dose of opium, may 
be necessary, if much, acidity or gastralgia be present; and, should the 
patient be feeble and anaemic, the subcarbonate of iron may be very ad- 
vantageously combined with it. Opium is freely used by Dr. D. in vari- 
ous abdominal affections, after the state of the intestinal secretions has 
been ascertained to be tolerably healthy. Part x., p. 21. 
Vomiting of Pregnancy—Strychnia—Recommended in minute doses, 
by Dr. Golding Bird. Part xiv., p. 98. 
Observations on Vomiting.—For sympathetic vomiting occurring espe- 
cially in females, Dr. Seymour, of St. George’s Hospital, uses the following 
formula: Carbonate of ammonia, a scruple ; water, an ounce and a half; sirup, 
a drachm ; fresh lemon juice half an ounce ; draught to be taken every 4 
hours. The following draught, according to our author, answers the same 
purpose : Sulphate of magnesia, a scruple; carbonate of magnesia, 10 grains ; 
mint-water, 10 drachms; laudanum, 3 to 6 minims; this draught to be taken 
every four hours. The same means, he says, often afford relief for consi- 
derable periods of time, even when the vomiting is symptomatic of much 
more serious disease or injuries. In symptomatic vomiting, a blister or 
mustard poultices often put an end to the morbid sympathy. From half a 
grain to a grain of opium, made into the smallest size, and as fresh as can 
be procured, is often successful where all has failed. He has seen equal 
parts of milk and lime-water succeed where everything else had been tried 
in vain. In hysterical vomiting, he gives his testimony to the value of 
creasote, the dose being one or two minims thrice daily. Among other 
means of checking vomiting, he mentions the successful use of savory meat 
—the jelly of meat taken in very small quantity regularly thrice a day. 
Against the vomiting of phthisis he recommends four grains of the extract 
of conium, to be taken twice or thrice a day, followed by this draught: 
Lime-water, one ounce; cinnamon-water, half-an-ounce ; sirup, a drachm. 
Our author affirms that vomiting occurring almost always after cough in 
phthisis at an early period, marks a severe and rapid form of it; and at a 
late period that large collections of matter are locked up in the lungs. In 
the vomiting attending what was formerly termed the iliac passion in a young 
woman, after the case had become hopeless, he succeeded by administer- 
ing two grains of calomel, made up with a grain of the soft and recent extract VOMITING, 
837 
of opium ; and when the endeavor to vomit returned, by forcing the pa- 
tient to swallow half a bottle of soda-water in a state of effervescence ; “the 
expansibility of the gas, and the downward impression in swallowing, had 
the desired effect.” Such cases as this, marked by feculent vomiting, he 
regards as the idiopathic iliac passion, being plainly unconnected either with 
hernia or intus-susception. 
[In the vomiting of Asiatic cholera, one of the best remedies consisted 
of a scruple of Epsom salts, with five grains of magnesia, and two or three 
minims of laudanum in a tablespoonful of water every three or four hours, 
or oftener.] Part xvi., p. 151. 
Vomiting during Pregnancy.—According to Dr. Churchill, if all other 
means fail in its relief, premature labor must be induced. 
Part xvii., p. 208. 
Vomiting.—In obstinate vomiting, try Sir James Murray’s new salt, 
“ the bisulphate of iron and alumina,” given in doses of five or ten grains, 
every two or three hours. Part xix., p. 312. 
Use of Sub-nitrate of Bismuth.—Vomiting may depend upon a simple 
gastric neurosis, and then M. Monneret thinks the bismuth can be very 
usefully employed. It is also usefuf in the vomiting of pregnancy, and that 
accompanying dysmenorrhcea ; but its efficacy is less certain than in affec- 
tions of the gastro-intestinal tube, and is never so great as when diarrhoea, 
colic, and flatus are present. From whatever cause pain manifests itself 
during digestion, we may relieve it by mixing the sub-nitrate freely with 
the articles of food. Part xx., p. 92. 
Vomiting—Sympathetic.—Dr. Selkirk advises iodide of potassium in 
combination with infusion of quassia; a wineglassful of the infusion with 
three or four grains of the iodide three times a day. Part xxi., p. 152. 
Vomiting— Obstinate.—In a case treated by Dr. Heath of Newcastle-on- 
Tyne, where all the usual remedies had been tried in vain, a small quantity 
of chloroform was inhaled to quiet the stomach, but not to produce insen- 
sibility. Half a grain of morphia was then given and the inhalation 
renewed. The patient was kept fully under its influence for a few minutes, 
and when consciousness retixrned he was free from all feeling of sickness. 
The inhalation was kept up slightly for an hour and a quarter. He had 
no return of the sickness for twenty-four hours. A slight return was 
checked afterward in the same way. Part xxviii., p. 310. 
Treatment of Vomiting.—Dr. Lees, of Meath Hospital, says : If vomit- 
ing be caused by some structural disease of stomach, as ulcer, scirrhus, etc., 
give a drop of creasote, or five or ten drops of medicinal naphtha, or a com- 
bination of bismuth with gallic acid and opium, as recommended by Dr. 
Turnbull. If caused by a morbid state of the blood, as in scarlatina, ery- 
sipelas, cholera, etc., our treatment must be chiefly directed to eliminate 
the “ materies morbi” from the system by means of the skin and bowels. 
Vomiting may be from a mechanical cause, as from the violence of an 
habitual cough, or a stooping occupation. If vomiting be from a sympa- 
thetic cause, as disease in the womb or brain, or calculus in the gall duct, 
kidney, or ureter, we must endeavor to remove this, the origin of the 
vomiting. Thus it has been necessary in some cases to produce abortion, 
the life of the patient having been in danger from the long continuance of 
this distressing symptom. If caused by the passage of a calculus, either from 838 
VULVA, 
the gall-bladder or kidney, large doses of opium are required, the first dose 
combined Avith aloes and carbonate of soda. In some cases chloroform 
may be given Avith good effect. For the cure of nervous Amounting, that is, 
vomiting induced by some modification of innervation of the stomach, un- 
connected Avith any change of structure, a proper regulation of the mind 
is essential. A slight but continuous action must be kept up by some mild 
aperient medicine. In some cases, effervescing draughts, with prussic acid 
or laudanum, Avill succeed; and in hysterical cases, assafoetida, valerian, and 
creasote will be found useful. When the patients are anaemic, give iron 
with bitter tonics. External counter-irritation is often of much use. The 
diet must be very simple and easily digestible. Part xxxvi., p. 275. 
Vomiting of Pregnancy—Oxalate of Cerium.—Prof. Simpson states 
that cerium has a peculiar sedative and tonic action on the stomach, re- 
sembling in some degree the action of the salts of silver and bismuth. It 
is of all remedies the most generally useful in cases of obstinate vomit 
ing from pregnancy. It does not invariably nor certainly act thus in 
these cases, but it is more certain than any of the remedies previously in 
use. The oxalate is the salt most readily procured. It may be given in 
doses of one or tAvo grains three times a day, or oftener. Part xl., p. 185. 
Curdled Vomitings of Children.— Vide “ Marasmus.” 
Inflammation of the Mucous Follicles of the Vulva.—M. Robert 
believes this affection frequently accompanies Menorrhagia, or occurs in 
women liable to inflammatory affections in these parts, from pregnancy, 
abortion, etc. The chief seat of the inflammation is in those two large 
mucous follicles at the entrance of the vagina. Its cure consists in intro- 
ducing one of Anel’s stylets into the follicle, and then laying its cavity 
open by means of a pair of probe-pointed scissors, and cauterzing its inter- 
nal surface with nitrate of silver. Fart v., p. 143. 
Treatment of Pruritus Vulvce.—Having been a great many times con- 
sulted for the relief of pruritus vulva?, and most frequently in pregnant 
women, says Dr. Meigs, I have rarely had occasion to order anything more 
than the following formula, viz.: R Soda? borat., §ss.; morphia? sulphat., 
gr. vj.; aq. rosa destillat., §viij. M. F. sec. art. mist. I direct the person 
to apply it thrice a day to the affected parts by means of a bit of sponge, 
or a piece of linen, taking the precaution first to wash the surfaces with 
tepid water and soap, and to dry them before applying the lotion. I can 
confidently recommend the prescription as suitable in most cases of this 
most annoying malady. Part xii.,p. 297. 
Follicular Pisease of the Vulva.—Mr. Oldham has met with several 
cases of a form of disease attacking the follicles which are freely scattered 
over the mucous membrane of the vulva. It is a painful affection, very 
difficult of cure, and is attended with leucorrliceal discharge. In its treat- 
ment arg. nit. and nitric acid are of no use. Hydrocyanic acid lotion is 
serviceable, or an ointment made of two drachms of prussic acid and a 
scruple of diacetate of lead, with two ounces of cocoanut oil. The parts 
are to be first washed with infusion of roses, and the ointment applied tAvo 
or three tunes a day on lint. 
VULVA. Wr ARTS. 
839 
Or try a lotion of lime-water with opium ; or make a poultice of bread, 
saturated with decoction of conium leaves, to a pint of which add two 
drachms of the liq. plumbi diacet. 
When irritation is excessive, prescribe vapor-baths, either simple or 
medicated with sulphur. Attend to general health, order a nutritious but 
unstimulating diet; avoid wine and porter ; give milk with lime water; 
keep the patient at rest; forbid sexual intercourse. There should be 
change of air. Give the vegetable tonics, as cascarilla, columba, cinchona, 
sarsaparilla, etc.; keep the bowels open with small doses of magnes. sulph. 
in infusion of cascarilla or chamomile. When the symptoms are decidedly 
abating, give a mild mercurial course with sarsaparilla. Part xiv., p. 307. 
Vidva—Prurigo of the.—Prof. Simpson recommends in severe cases of 
prurigo of the vulva, vagina, or cervix uteri, to brush the affected parts 
over with hydrocyanic acid, the strength of that of the Edinburgh Phar- 
macopoeia. Part xxi., p. 289. 
Plenorrhagia of the Vulva.—Mr. Acton would enforce cleanliness. A 
soothing plan should be first employed, and separation of the surfaces at- 
tempted ; then lotions of nitrate of silver, 3j. to §ij. of distilled water, with 
the addition of warm baths. If the inflammation has gained the deeper 
structures, leeches may be employed in addition, to the groins ; and if 
abscess should form, it must be opened immediately, though we should 
pause when the inflammation occurs round an already-formed cyst. 
Part xxiv., p. 345. 
Prurigo of the Vulva.—Prof. Simpson believes this may be relieved, 
and generally cured by the assiduous and persevering application of a 
solution of borax, five or ten grains to the ounce of water, or in a little 
infusion of tobacco. An ointment of the iodide of lead, or of bismuth and 
morphia, is very useful. Chloroform, applied locally in the form of vapor, 
is one of the most certain means which can be employed. These remedies 
should be alternated. In the more obstinate cases astringents will be 
found of much use : alum, or aluminated iron, or tannin. Of course the 
general health of the patient must be attended to. Arsenic, aqua potassa, 
and other alterative medicines of that class may be required. 
Part xl., p. 214. 
Treatment of Venereal Warts.—If they are pedunculated, Bransby B. 
Cooper recommends the ligature; in other cases, caustic or powdered 
savine. If these means are insufficient, excise the warts with the knife, 
and apply caustic to the cut surfaces. When there is phimosis with warts, 
the prepuce must always be laid open immediately. Vide “ Condylomata.” 
Part xxi., p. 270. 
Warty Excrescences.—Mr. T. W. Nunn, acting on the principle of Dr. 
Arnott, of using congelation as an anaesthetic agent, has recently applied 
little wedged-shaped pieces of ice to the necks of large warty growths 
depending from the labia minora, till they became blanched and cold; and 
he then removed a great many of them with a single stroke of the knife, 
without causing the patient any but very slight pain. Part xxii., p. 314. 
WARTS. 840 
WATER—WIIEY. 
Non-Specific Affections.—These, which consist of warts, vegetations, 
herpes preputialis, eczema, and excoriations, may be treated with strong 
acetic acid. Mr. Acton recommends the powder of oxide of zinc in the 
more simple forms, and in the obstinate a powder composed of equal parts 
of ®rugo and pulvis sabin®. Part xxiv., p. 346. 
Unexpected Effects of the Employment of Carbonate of Magnesia in 
Case of Warts.—In the case of a girl affected with gastralgia, whose 
hands were covered with warts, Dr. Lambert gave carbonate of magnesia. 
Two months after, though the stomach affection was unaltered, the warts 
had disappeared. In another case, the same dose, a teaspoonful night and 
morning, produced a similar effect in five weeks. Part xxvii., p. 161. 
WATER. 
Artificial Harrogate Water.—Where the genuine Harrogate water 
cannot well be procured, the following will be found a good substitute : 
ARTIFICIAL HARROGATE WATER. 
R Sulphatis potassse cum sulphure, 3j-; potass® bitartratis, 3ss.; mag- 
nes. Sulphat., 3vj.; aqu® destillat. Ibij. 
Solve.—Capiat dimidium p. r. n 
The above is sufficient for a quart, and ought to be taken early in the 
morning before breakfast, and be followed by a walk, to produce the 
desired aperient effect. Party.,p. 85. 
Waters of Vichy and Carlsbad.-—Dr. Cahill considers the waters of 
Vichy and Carlsbad very valuable in gout, rheumatism, gravel, and affec- 
tions of the liver and spleen, owing to their strong alkaline character, 
which is principally due to the large quantity of bicarbonate of soda which 
they contain; they are very mild and gentle in their operation, and not 
like the waters of Ilomburg, Weisbaden, and Kissengen, which contain 
chloride of sodium, and are severely purgative. Part xxxiii., p. 295. 
Kreuznach Waters.—Dr. Prieger thinks there is no reason to believe 
that these waters, whether employed on the spot, or elsewhere, have any 
power in removing undoubted fibrous tumors of the womb, although we 
may speak with the greatest confidence of their efficacy in diminishing 
general hypertrophies of the uterus, not having an isolated form, or inde- 
pendent growth. Part xxxv., p. 308. 
Different Kinds of Whey.—The following is a translation of the direc- 
tions given in the “Pharmacopoeia Borussica” of 1829, for the preparation 
of five different kinds of whey : 
1. Serum lactis dulce, Sweet Whey.—Take an ounce of the dried 
stomach of a calf, infuse with six fluid ounces of cold water for teh or 
twelve hours, add an ounce of this liquor to nine pounds of fresh cow’s 
milk, warm gently, and after coagulation is effected, decant and strain the 
liquid. 
2. Serum lactis dulcificatum, Sweetened Whey.—Take three pounds of 
WHEY. WIXITLOW OK FELON. 
841 
cow’s milk, boil, and at the commencement of ebullition add one drachm 
of bitartrate of potash; when a coagulation is effected, and the whole lias 
become cool, strain, and boil with a sufficient quantity of white of egg 
beaten up into a froth, until the albumen is coagulated ; strain, and add 
as much prepared chalk (or shells) as is required to neutralize the acid, 
and filter. 
3. Serum lactis acidum, Sour Whey.—The former without addition of 
the chalk. 
4. Serum lactis aluminatum, Alum Whey.—5. Serum lactis tamarind- 
inatum, Tamarind Whey.—In these respectively a drachm of crude 
powdered alum, or one ounce of the pulp of tamarinds, is employed 
instead of the bitartrate of potash. Part xxviii., p. 321. 
WHITLOW OR FELON. 
Use of JPotassa Fusa.—Whitlow, paronychia, or felon, may be removed, 
according to Dr. Barnes, of St. Louis, U. S., in the early stages, and in 
the later stages may be much relieved, by applying potassa fusa. Slightly 
moisten the end of a stick of this caustic, and rub it over the surface of 
the diseased and adjacent parts for a few seconds, until the patient com- 
plains of much pain. If this pain or burning sensation lasts for a few 
minutes, the application has been sufficient; if it subsides more quickly, 
reapply the caustic for a short time. Be very careful not to destroy the 
skin. Part xvi., p. 32C. 
TVhitloic—Peep-seated.—Dr. Hamilton, of Richmond Hospital, Dublin, 
gives the case of a man forty years old, who Avas seized with a deep-seated 
whitlow. Deep incisions were made in the front of the first phalanx, out 
of which matter gushed, to the-man’s great relief. Incisions were after- 
ward made in the palm and dorsum of the hand, but still the finger was 
obliged to be removed at the metacarpal articulation. 
The symptoms are usually as follows: The affected finger becomes 
painful, the pain increasing to the greatest degree, so as to prevent sleep, 
and often to cause the patient to spend the night walking about his room 
in torture. This will be at first accompanied by little swelling, and little 
redness, more especially in front, although the greatest suffering is com- 
plained of there. The finger will be kept bent, any attempt to straighten 
it increasing the pain, as does also pressure over the affected part. By 
keeping the finger flexed, the skin in front is relaxed as well as the tendon, 
relieving the painful tension, and the pressure of the tendon on the inside 
of the inflamed sheath. The back of the finger next becomes red, swollen, 
and shining, pitting on pressure. You might be misled by this, and think 
it was the place to make your incisions in search of matter, but it will be 
found that pressure on this part can be borne, whereas in front, where 
Boyer says this whitlow always occurs, it cannot; and when the finger is 
attempted to be straightened, the suffering is at once referred to the front. 
After the third or fourth day, this part will be found swollen and prominent, 
particularly on a side view, but no fluctuation is discernible. If no treat- 
ment is adopted, the disease will often proceed from the finger to the palm, 
which becomes red, swollen, and tender, the back of the hand particularly 
swollen, and tender, the hack of the hand particularly 842 
WHITLOW OK FELON. 
so, of a deep shining red, pitting on pressure, and fluctuation is soon appa- 
rent either over the knuckle of the affected finger, or in the web between 
the fingers. In the palm of the hand we often observe that the matter, 
after having made its way out through a small opening in the skin, does 
not pierce through the cuticle, which in the laboring classes is excessively 
thick, but separates it extensively, and yoxi have a considerable collection 
of pus only covered by cuticle, before you come to real abscess ; as the 
palm becomes engaged, other fingers get flexed, and cannot bear exten- 
sion, and the pain shoots up the arm to the shoulder; in a woman, I knew 
it extend to the breast of the affected side. In most instances the inflam- 
mation with suppuration stops at the finger and palm, particularly when 
treatment has been resorted to; but if not, it may go up the front of the 
Avrist to the forearm, in which case the patient recovers after weeks of 
suffering, worn out by sleepless nights and profuse suppuration, with bent> 
emaciated fingers, and a stiff wrist, and a nearly useless hand. Should 
the disease not extend so high, or not be so violent, it may end with a 
stiff, bent finger. I should say when there has been suppuration the finger 
is invariably stiff, and usually bent, from adhesion of the integuments to 
the sheath of the tendons, and of the tendons to the inside of the sheath, 
while in the state of flexion. If the inflammation is very intense, the 
tendons die and protrude through the natural or artificial opening that 
has let out the matter, and throw off greyish white sloughs; where a 
portion of the flexor profundus is totally destroyed, the finger may be 
quite straight, being kept so by the extensor tendon. Such is the case in 
the man now in the house, who came to the hospital after having suffered 
from whitlow six weeks. I took away a dead portion of the flexor tendon, 
one and-a-half inch long, from the sheath. I am going to remove his 
finger, as he presents a further step in the disease, viz., the periosteum is 
stripped from the bone of the first phalanx by effusion of pus, and the bone 
is killed. 
The death of the bone is most common in the last phalanx, particularly 
of the thumb. In such a case you will find, though the matter has been 
let out by a free opening, the disease lingers, the part continues red and 
swollen, the opening discharges abundance of thin matter, they are large 
flabby granulations around it, and if you feci the end of 'the finger, there 
is a pseudo-fluctuating feel, as if it was extensively undermined; a probe 
passed in removes every doubt, by grating against the rough bone. It is 
best not to wait till it separates of itself, but enlarge the opening, and seiz- 
ing the dead bone with a forceps, divide any ligamentous connections at 
the joint, while they are on the stretch. The parts soon heal, the finger 
shortened, bent forward, and clubbed at the end, the nail irregular, but 
still a useful finger. 
The fever, in deep-seated whitlow, often runs high, and I have known 
delirium at night, but I never met with a fatal termination, except in one 
case, a man who crushed his thumb while intoxicated; deep-seated 
paronychia followed, inflammation of the veins up the arm, and death. 
On looking over the notes of many cases, I find the most frequent seat 
of deep-seated whitlows to be the middle finger, next the ring, and then 
the index finger, all before the thumb. This agrees with Boyer’s experi- 
ence ; it differs from what we perceive in the superficial paronychia, in 
which the index finger and the thumb are so much the oftenest affected, 
and at their extremities. The part of the finger in the deep-seated parony- WHITLOW OR FELON. 
843 
chia most commonly engaged is the sheath of the flexor tendon over the 
first phalanx; this sheath is not only the longest, but the strongest, and 
most complete. A few cases, when suppuration was threatened, subside 
and terminate by resolution. The majority run rapidly into suppuration, 
which is more or less extensive, according to the intensity of the inflam- 
mation. Such is an outline of the symptoms and pathology of deep-seated 
whitlow. You see that it is an inflammation of the inside of the sheath 
of the tendons, that nature makes vain efforts to get out the matter con- 
fined in the strong fibrous envelope ; you have witnessed the disastrous 
effects of the unrelieved diseased action, the periosteum, the tendon, the 
bone, all at last engaged, and the finger, or even the hand, permanently 
injured or even lost. You will at once naturally arrive at the conclusion, 
that a free incision into the sheath, early performed, is the ordy treatment. 
Yet how is it that so many come to the hospital, where this has never 
been done, and all the destructive consequences allowed without an inci- 
sion ever having been made ? 
I believe it arises from timidity, a fear of wounding blood-vessels, par- 
ticularly when the disease approaches the palm ; there the palmar arch 
becomes a kind of bugbear. Some years ago, I made careful dissections 
of the hand, with a view of furnishing myself with precise rules for making 
incisions in deep-seated whitlows. Permit me to call your attention to a 
few practical conclusions I arrived at: 
“There are two principal wrinkles or lines running across the palm of 
the hand ; one, nearly transverse, corresponds to the joints between the 
metacarpal bones and first phalanges, and is situated about an inch behind 
the first transverse lines on the fingers. The second begins from the first, 
at the articulation of the index phalanx with its corresponding metacarpal 
bone, and goes in an oblique direction across the palm toward the pisiform 
bone at the inside of the wrist; it answers pretty nearly to the course of 
the ulnar or superficial or palmar arch. These two lines, which are very 
regular, will be found to serve as excellent guides in making our incisions 
in paronychia with confidence. 
“ On the fingers there are three bundles of transverse lines; the two from 
the tip correspond to the articulations, that next the palm does not corres- 
pond to any joint, but is situated about the centre of the first phalanx end 
of the sheath of the flexor tendon. 
“The palmar fascia goes about as far as the transverse palmar line before 
it sends off its four processes which go between the fingers, and are 
attached to the sides along with the tendinous insertions of the extensor 
muscles and the lumbricales. 
“ The web between the fingers contains the digital artery from the pal- 
mar ach and its division, and is filled up with loose cellular tissue, allow'- 
ing matter easily to go from the palm to the back of the hand. As the 
superficial palmar arch, the only one likely to be wounded, corresponds to 
the oblique line which is behind the transverse line, the distance increas- 
ing as it approaches the inside of the wrist, you can, in all the fingers, 
safely make your incision as far as the transverse line ; nay, in all fingers 
but the middle, you can cut beyond this as far as the centre of the hand, 
and in the index finger even further. But it is worse than useless ever to 
carry your incision from the finger further than the transverse line, so as 
to endanger the arterial arch at all, as after going so far it is quite suffi- 
cient to pass a director under the palmar fascia, which alone confines the 844 
WORMS. 
matter, if it has gone into the hand. On the director, you could, if desira- 
ble, cut out through the fascia, and even the annular ligament. Whereas, 
if you cut down without a director to the palm, through all the parts to 
the bone (which in the palm is unnecessary, as there is nothing below the 
palmar fascia or annular ligament to confine matter), you could scarcely 
avoid wounding the arteries or large nerves. In the same way in the fin- 
gers after the sheaths of the tendons are divided, nothing remains to con- 
fine matter. These sheaths extend from the tip of the fingers to the 
transverse palmar line or metacarpal phalangeal articulation ; they are 
thick and strong, between the joints, thin opposite to them; you should 
avoid over the joints, and confine your incisions to the strong part of the 
sheaths between them, cutting to the bone if you choose, or what is gene- 
rally enough, down to the tendon, taking care to open the sheath well, 
and always keeping in the centre to avoid the digital arteries running 
along the sides of the fingers. In the thumb it is particularly necessary to 
observe this last rule, as otherwise, after cutting beyond the first joints, 
you would be very likely to wound the superficialis volae. 
“ Bearing these facts in mind, you will have no hesitation in making 
sufficiently free and deep incisions. I repeat, take care that your 
cut is long enough to. open the sheath freely ; a mere deep puncture 
through it may let out matter, and give ease for the time ; but not allow- 
ing free vent, will cause the pus to seek another outlet, and much mischief 
ensue.” 
In spite of free incisions the diseased action is not always stopped. In 
such cases, though there is at first much relief, the unpleasant sensations 
return ; the next night the patient will be kept awake by deep-seated, 
throbbing pain, and you may be sure that the matter is working its way 
out in some other direction, and is not getting free exit, and you will 
probably discover some swollen, tender spot, to repeat the incision. If 
the disease presents itself in a more advanced and aggravated form, not 
only engaging the finger, but extending to the palm, back of the hand, or 
even the wrist, which last is very rare, you will have to follow the matter, 
regulating your incisions by the rules I have mentioned. Some authors 
have made a separate division of paronychia, which they name paronychia 
periostei, from supposing the disease in this form to commence in the peri- 
osteum covering some part of the phalanges, with suppuration between 
the periosteum and bone, death of the bone, etc. I regard the affection 
of the periosteum rather as a secondary effect of the deep-seated parony- 
chia, whose seat we have seen to be the sheaths of the tendons, but 
when neglected, to engage finally all the tissues, the periosteum among 
the rest, and the bone. When the first or second phalanges are stripped 
of periosteum, and dead, it is best to remove the whole finger at the meta- 
carpal articulation. 
If it is the last phalanx, it can be removed alone, and as I have already 
said, a useful finger will remain after the opening is healed. 
Part xxxi., p. 183. 
WORMS. 
Tape-icorm—Treatment of.—In 206 cases of tape-worm, Dr. Wawruch 
found the following treatment the most efficacious: As a preparatory step, WORMS 
845 
all the patients took a laxative decoction with sal ammoniac, for three, four, 
or five days, and ate nothing but weak soup, thrice a-day. In 8 cases the 
worm was expelled by the mere effect of continued abstinence. The an- 
thelmintic remedies employed were castor oil and the powdered root of 
the male fern. From one to two tablespoonfuls of the oil were given as a 
dose, alternately with one or two drachms of the powder twice or thrice 
a day. 
Enemata of oil and milk were frequently thrown up, to attract the worm 
toward the large intestine, and it was observed, that the effect of the 
drastic was always most sure when given a certain time after the last dose 
of fern, than at once. The drastic purge employed was composed of equal 
parts of calomel, gamboge, and sugar, two to eight grains of each for a dose. 
In many cases a single dose brought the worm away, but in others three 
to six doses were required. The period at which the worm was discharged 
was very various. The taenia is not exclusively a solitary worm, for in 
nine cases there were two worms, of different ages and development; in 
two cases, three worms. In one very remarkable case, four worms were 
discharged, and this patient still suffers from the complaint. 
Generally speaking, the patient may expect to be entirely free from his 
disease, if he pass ten or twelve weeks without discharging any remnants 
of the worm. Part iv., p. 26. 
Tape-worm—Mode of giving Turpentine.—Dr. Bellingham does not 
think it necessary to administer this remedy in the large doses which were 
formerly given. He states that it will be equally effectual if the system be 
kept for some time under its influence by giving it in moderate doses, two 
or three times in the twenty-four hours, occasionally exhibiting a larger 
dose : and if no cathartic effect follows, he combines it or follows it up with 
castor oil. Partxi., p. 74. 
Oleum Santonicce, or Chenopodii as an Anthelmintic.—[Dr. Monsarret 
made use of this medicine when some obstinate cases, supposed to be owing 
to intestinal worms, came under his notice. He began with four to eight 
or ten drops on lump sugar or milk to a child, and so on in proportion. 
He says:] 
Its effects surprise me, not having had much previous faith. In almost 
every case, I could observe innumerable quantities of lumbrici were dis- 
charged. In adult cases I have used it to the extent of half a drachm, or 
more, for several days, with success; then, as a precaution, prescribing the 
following draught: 
R 01. ricini, 5vj.; ol. terebinth., 5ij.; spts. lavand., 3j.; ess. m. pip., gtt. 
xx. M. Ft. haust. Part ix., p. 13. 
Santonine—A Tasteless Worm Medicine.—This is now recommended 
on good authority as a remedy for worms, especially lumbricales, in this 
form. Take 
Santonine, one drachm ; sugar, five ounces ; gum tragacanth, half a 
drachm. Make into 144 lozenges; of these a child may take from five 
to ten daily, or santonine may be given in powder with sugar. 
Part x. _£>., 184. 
Lumbricoides—Pulmonary Disease arising from the Presence of.—Dr. 
Chapman gives the following case : I was called into consultation with Dr. 
Monges, to a boy who, with most of the symptoms of pthisis, particularly 846 
W>RMS, 
the copiousness of purulent expectoration, was so much reduced that 
the portions of the hones on which he rested, had protruded through the 
integuments in several places. Discovering that his abdomen was tumid, 
his tongue furred, his appetite capricious and depraved, and that he was 
subject occasionally to convulsions, I was led to suspect the existence of 
worms, and under such an impression, anthelmintics were administered. 
In less than one week, sixty-eight lumbricoides were evacuated, and from 
that moment he became convalescent and rapidly got well. Part xi., p. 55. 
Ascarides— Of the Rectum.—An anonymous correspondent of “ Amer. 
Jour, of Med. Sc.” recommends give an enema with five grains of Prus- 
sian blije, rubbed up in two ounces of rain water or mucilage, and let it be 
retained until the next regular stool. Repeat this daily, gradually increas- 
ing the qantity of the salt. Part xvi., p. 155. 
Ascarides.—Give camphor in three or five-grain doses ; a convenient 
form is Sir James Murray’s solution of camphor in his fluid magnesia. Or 
the same preparation maybe given in the form of enema. Part xvii., p. 18. 
Treatment of Worms in Children.—The symptoms said to indicate the 
presence of worms, are most of them, Dr. West remarks, of small value ; 
and nothing short of seeing the worms can be regarded as affording con- 
clusive evidence of their existence. The general treatment is, to regulate 
the diet, and, give alteratives and ferruginous preparations, with occasion- 
ally a brisk cathartic. The special treatment for ascarides consists in 
giving a lime-water enema, with or without two drachms of muriated 
tincture of iron ; if they have occasioned much diarrhoea and tenesmus, 
the lime-water injection should be given daily for two or three days 
together, and small doses of castor oil mixture given every six or eight 
hours. For taenia give decoction of the bark of pomegranate root, in 
doses of §j. thrice a day, to a child seven years old, interrupting its 
administration twice in the week, in order to give a purge of calomel and 
scammony. Part xviii.,y>. 128. 
Tape-icorm treated by “ Kousso A—The “kousso,” or brayera an- 
thelmintica (a plant of the natural order Rosaceae), was introduced into 
notice by a pharmacien of Paris, and its properties as an anthelmintic 
were investigated by the Academy of Medicine so long ago as 1847. The 
report of the above-named body, as also of the Academy of Sciences, was 
extremely favorable. 
The parts of the plants used are the flowers, which, being reduced to a 
fine powder, are macerated in lukewarm water for fifteen minutes. The 
infusion, with the powder suspended in it, is taken either in one, two, or 
three doses, quickly following each other. It is recommended that lemon 
juice should be taken freely before and after the kousso. The patient 
must be prepared by low diet for a day previously, and the medicine taken 
on an empty stomach before breakfast. The clear infusion has the color, 
and a somewhat similar taste, to very weak senna tea. It rarely causes 
any annoyance or uneasiness, except a slight nausea, and this but seldom. 
Part xxi., p. 153. 
Lumbrici.—A combination of assafoetida with calomel, in the form of 
pills, says Dr. Cazin, has succeeded better than anything in expelling 
lumbrici. The dose of assafoetida is from four grains to half a drachm. 
The administration of three tablespoonfuls of cod oil, at intervals of an hour, 
has also been followed by the expulsion of lumbrici. Part xxi., p. 154. WORMS 
847 
Schmidt's Remedy for Tape-worm.—By the process of Schmidt, the 
tape-worm is said to be expelled in from three to five days, without injury 
to the patient. A trial of it was made, under the authority of government, 
in the Berlin hospital, when the results were found to be so favorable, that 
the King of Prussia purchased the secret through a pension of several 
hundred dollars bestowed upon the originator. The plan substantiates 
the purely empirical fact, that vermifuge medicines, when exhibited sepa- 
rately, are less efficacious than when combined in complex formulae. The 
patient commences by taking, in the morning, the following mixture : 
R. Pulv. rad. valer. min., 3vj.; fol. senn., 3ij.; aq. ferv., gvj.; infunde et 
cola; adde sal. glauber. crystall., 3hj-; syr. mannae, §ij.; elaeosacch. tanaceti. 
5ij., M.S. Two tablespoonfuls every two hours, drinking freely at inter- 
vals of sweetened coffee. With this he perseveres till seven in the 
evening. At noon he takes a thin gruel; and in the afternoon one or two 
herrings with the milt. At eight in the evening tjie patient has a herring 
salad, with minced raw ham, and oil, sweetened with sugar, plentifully 
added. Frequently portions of the tape-worm begin now to be discharged. 
At six in the ensuing morning, he commences the following pills, every 
hour : R. Assafoetidae, extr. graminis, aa., 5iij.; gambog., pulv. rhei, jalap, 
aa., 3ij.; pulv. pecac., digit, purp., sulph. antim. aurat. aa., Bss.; sub. 
muriat. hydr., Bij. ; ol. tanaeet., aether, anisi, aa., gt. xv. M. Divide into 
pills of two grains each, which are to be placed in a well-stoppered bottle ; 
of these, six pills are to be administered every hour with a teaspoonful of 
common sirup. Half an hour after the first dose, a tablespoonful of 
castor oil is also given. Sweetened coffee is again to be taken freely at 
intervals during the day. At two in the afternoon, the worm is usually 
wholly expelled, when the pills are to be discontinued. Should only sepa- 
rate portions be voided, however, the-remedies are persisted with, and a 
second dose of castor oil becomes requisite. Meat soup is allowed at 
dinner, and in the evening. On the succeeding day, as an additional pre- 
caution, six pills are again exhibited at three different times—morning, 
noon, and evening. Part xxiii., p. 124. 
Vermicularis (maw-ioorm.)—Dr. Merel uses injections of an infusion of 
red onion, mixed with half a grain of extract of aloes. Part xxvi., p. 90. 
Tape-worm.—Prof. Osborne, of College of Physicians, Ireland, suggests 
tannic acid. This we might infer from analogy would be beneficial from its 
action on gelatine and albumen, both of which these parasites contain. 
The seeds of the pumpkin contain a fixed oil; Prof. Paterson, Philadel- 
phia, recommends half an ounce of this given twice a day, followed by an 
ounce of castor oil. Part xxix.,p. 120. 
Tcenifuge Medicines.—Prof. Strohl says : The fruits call tatze and zareh 
are the produce of a shrub of the family of the myrsinaceae, the “ myrsina 
Africana.” 
This plant is found in Abyssinia, in moist, rocky places at the Cape of 
Good Hope, in the Azores, in Algeria, and other parts of Africa. 
Tatze is a powerful taenifuge, which has succeeded in all the six cases in 
which it was administered. This number is too small to draw any con- 
clusion as regards the constancy of its action, but it is quite sufficient to 
assure us that it at least deserves to be placed among the resources of 
materia medica. Tatze is less gentle in its action than saoria. 848 
WORMS, 
As to its mode of administration, it should be given in doses of about 
half an ounce, reduced to powder, and blended in a ptisan or aromatic in- 
fusion ; if after three hours it has not caused a motion from the bowels, or 
if in stools which have followed no traces of the worm arc to be discovered, 
a dose of castor oil should be administered. Part xxx., p. 65. 
Tape-worm.—Professor Bennett has found this to be the best remedy 
for tape-worm. Give 9ij. of the ethereal extract of the male shield fern in 
the evening, and follow this in the morning by §j. of castor oil. If ne- 
cessary, give another scruple of the extract the next evening, and another 
dose of castor oil the following morning. These doses may be repeated 
according to circumstances. Part xxxi., p. 94. 
Santonin as an Anthelmintic.—For round and thread-worms, Dr. Perry 
gives to a child two years old, three grains of crystallized santonine, and 
about two hours after it a dose of calomel and jalap ; in the course of 
twelve or twenty-four hours the worms will be expelled. Santonine is a 
medicine which may be given with perfect safety, and its effects are cer- 
tain and satisfactory Part xxxiv., p. 103. 
Tape-worm.—The following mode of administration of male fern is re- 
commended by Dr. Jenner, University College Hospital. You must first pre- 
pare the patient by clearing out the bowels and keeping on low diet. For 
an adult give two calomel and colocynth pills at night, and a dose of castor 
oil in the morning; when the bowels have acted well give one drachm 
and a half of the oil of male fern on some aromatic water, and repeat in 
six hours if necessary. The dose of the oil must be the same for a child 
as an adult. No unpleasant results ever follow its use. Part xxxiv., p. 105. 
Use of Kameela as an Anthelmintic.—Kameela, a native plant of India, 
is said to be much more efficacious than kousso, and is certainly much 
cheaper. It produces only the ordinary effect of a purging medicine and 
little or no griping. Dr. Gordon (surgeon to the 10th foot regiment) has 
never known it fail. A drachm may be given mixed with a little water, 
and repeated in about three hours—from one to live doses may be neces- 
sary. A spirituous tincture is more convenient, §iv. of the powder to Oj. 
of alcohol, and filtered. Only about §vj. will be obtained in this way. 
The dose necessary will be from 5j. to 3iij.—3ij. being in most cases suffi- 
cient. Part xxxv., p. 263. 
Nitrate of Silver in Ascarides.—Dr. Schultz states that he has employed 
enemata of this substance with great success for the removal of the oxyu- 
ris vermicularis which so frequently infest the anus in such large numbers. 
The clyster is formed of argent, nitrat. gr. x. ad xv. to aq. dest. §iv. Two, 
or at most three, of these suffice to effect a complete cure. The first one 
does not usually remain up long, and worms, some living and others dead, 
are returned with it. The next clyster remains from six to twenty-four 
hours, and the great mass of the dead worms are discharged with it. 
Part xxxviii., p. 91. 
Tcenia.—Dr. Peacock, of St. Thomas’ Hospital, considers kameela more 
efficient than kousso, but prefers the oil of male fern to either. The res- 
inous principle of the oil is apt to be deposited from the ethereal solution, 
when the supernatant fluid is of course inefficacious. Part xxxviii., p. 334. WOUNDS 
849 
Hints on the Treatment of Wounds after Operations.—The following 
brief passages are extracted from a letter which M. Phillips, of Liege, ad- 
dressed to M. Baudens, the chief surgeon of the French army in Africa. 
After an amputation in a joint, the flaps should be brought and kept 
together by a few stitches, in order to promote union by the first intention; 
but as adhesion rarely, or perhaps never, takes place between the surface 
of a cartilage and the contiguous flesh, we should not only remove so 
much of it (the cartilage) before closing the wound, but also place a small 
portion of lint upon it, so as to encourage suppuration at this point, while 
the rest is retained in exact contact. The annals of surgery afford scarcely 
one instance of complete and perfect union, without suppuration of a 
wound, after a disarticulating amputation. We are of opinion that when- 
ever an amputation is performed at a joint, an issue or opening should 
always be left opposite to the cartilage, while the rest of the wound is 
retained together by sutures. 
Even after ordinary amputation, where a bone has been sawn across, 
some surgeons have recommended that the same practice be pur- 
sued ; but without positively admitting the propriety of so general a rule, 
it is worthy of remark that when the two ends of a bone are sawn off in 
cases of ununited fractures, not only is there a better chance of a union 
taking place, but this union is always much firmer and more solid, when 
suppuration has been established at the point of junction, than when imme- 
diate adhesion of the wound has occurred. Such was the opinion of M. 
Delpech; a high authority certainly on all subjects of practical surgery. 
The success of M. Percy, after the battle of Neubourg, deserves to be 
alluded to, in consequence of certain circumstances. There was such a 
want of many of the most necessary articles, as lint, ointment, and ban- 
dages, in the French camp, that all the patients wrere dressed indiscrimi- 
nately with merely cold water. It is probably to this very circumstance 
that the great success of the surgeons, in the results of their operations, 
was attributable on that occasion. For some years past, the same practice 
has been adopted by Mr. Liston at the London University Hospital, and 
M. Phillips has of late universally followed it with very marked benefit, 
after almost all his operations. In all severe injuries of, as well as after 
operations of the eye, M. P. always subjects the part to the action of the 
cold water for several days. Also after the extirpation of tumors, when 
the lips of the -wound have been brought and kept together by several 
stitches, compresses wretted frequently with cold water, are laid invariably 
upon the part. M. Phillips mentions that in such cases he generally unties 
the ligature at the lower angle of the wound on the day after the opera- 
tion, for the purpose of giving exit to any bloody or other kind of dis- 
charge, and after removing this, he again secures it. On the third or 
fourth day he removes one ligature, and another on each day successively; 
continuing the use of the cold application all the time. M. P. trusts to 
torsion of the arteries to arrest the hemorrhage, after many such operations. 
There is very little doubt that this simple expedient, if really sufficient as 
a hemostatic means, must contribute very materially to the speedy union 
of wounds, as each ligature on a blood-vessel must necessarily give rise to 
a point of suppuration and to a minute sinus or fistula extending from the 
tied vessel to the surface of the wound. Part i.,p. 88. 
WOUNDS. 
vol. n.—54 850 
WOUNDS. 
Wounds after Amputation—Primary and Secondary Union of.—Baron 
Larrey Avas a surgeon eminently practical. In his work on the sui'gical 
cases of the campaigns of 1815, he takes the opportunity of noticing the 
mode of performing amputation in London, and whilst he admires the 
coolness and dexterity of the surgeons, he condemns their mode of dressing 
the stumps. This condemnation, however, is only applicable to those 
surgeons Avhose operations he Avitnessed, and not to many others AArho do 
not make a practice, as he supposes, of forcibly approximating the divided 
surfaces for the purpose of promoting union by the first intention. Larrey 
denies that the surgeon abridges the labor of nature by this process. He 
states that as the tissues or organs of the limb are divided more or less 
perpendicularly to the axis of the bone, there must necessarily remain at 
the bottom of the Avound a cavity Avhen the superficial parts are forcibly 
approximated. This will be especially the case A\Then Ave remember the 
conical way in Avhich the muscles are generally divided so as to produce 
a good flap to protect the extremity of the bone. In this cavity there Avill 
continue to accumulate the fluids that for some time are poured out of the 
contiguous surfaces, Avhich Avill necessarily cause distention, and perhaps 
separation of the flaps or absorption of pus. The presence of pus in the 
veins is no proof of these vessels being inflamed; they may only be con- 
veying this secretion from the wounded surfaces. In all amputations for 
chronic diseases of the extremities, he strongly recommends, as indeed is 
noAV adopted by many surgeons in this country, that the divided surfaces 
be not immediately united and kept together. 
“ When the tissues of an injured part are in a state of inflammation, they 
are not at all in an apt condition to unite; and the only way, in Avhich 
they can become degorged, is by the process of suppuration being estab- 
lished. When the operation is performed for any chronic disease of the 
extremity, as for caries of the bones, white-swelling of the joints, or can- 
cerous or other malignant degeneration of the soft parts, I consider it to 
be quite indispensable, if we hope to prevent local engorgement and 
purulent infection, that the divided surfaces be not immediately united and 
kept together; so that the effused fluids may not be retained or forced 
back upon the system, but may ooze but from the wound as they are 
formed.” 
He recommends nearly the same practice in those cases where amputa- 
tion is adopted in consequence of recent injuries; and confirms his opinion 
by relating the Avant of success Avhich folloAved many of the amputations 
at the siege of AntAverp, in consequence of attempting to heal the parts 
by the first intention, and the greater success of his oavii practice. In the 
former cases, the limbs Avere frequently not healed before the fiftieth or 
fifty-fifth day, Avhereas this Avas accomplished three weeks earlier by adopt- 
ing his OAvn method. 
Most of our leading surgeons uoav adopt this practice to a greater or 
less extent—Liston, for example, says, “ Surfaces are not disposed to unite 
for many hours after the division and separation have occurred. So long 
as oozing continues, there is no good end to be achieved by their close 
apposition. It is only when reaction has occurred, when vascular excite- 
ment around the solution of continuity has taken place, when the whole 
circulation has been roused, and when plastic matter begins to be secreted 
and thrown out, that the process can be expected to commence. The 
edges of a large Avound, as that resulting from amputation of the extremi- WOUNDS 
851 
ties, may be approximated in part so soon as bleeding from the principal 
vessels and larger branches has been arrested. But the close apposition, 
and the application of all the retentive means, had better be delayed fox- 
six or eight hours at least. In the interval, extreme sensibility of the 
injured parts may be abated, the oozing moderated, and the chance of 
secondary hemorrhage much diminished, by covering the parts with lint 
dipped in cold water, and frequently renewed; or a piece of lint may be 
placed on the wound, and a constant irrigation of the exposed surface kept 
for some time by threads passing from a vessel containing cold water. 
This plan is very useful when the whole surface of a wound is exposed. 
In cases where there is a deep cavity, where coagulated blood may collect, 
as at the bottom of the wound after amputation of the thigh, where the 
flaps, as they always should be, are very long, it is much better to change 
the lint frequently.” 
Mr. Fergusson, on the other hand, is an advocate for dressing the stump 
early. On this subject he says, “ Whether an amputation is done by flap 
or circular incision, it is almost the invariable practice among British sur- 
geons of the present day to promote union by the first intention; and for 
this purpose, as soon as the bleeding has been arrested by the application 
of ligatures and otherwise, the sui*faces of the wound are brought into 
apposition, and retained thus by means of stitches, straps, and bandages. 
It is the custom of some to allow several hours to pass ere the edges or 
sux-faces are finally adjusted ; and this is done with the intention of mak- 
ing sure that all bleeding has actually ceased, and also under the convic- 
tion that union is not retarded by keeping the sui-faces so long from each 
other. If the edges of such a wound are brought together immediately 
after the operation, and probably whilst the patient is faint from the shock, 
there is a chance of some vessel beginning to bleed after he has got warm 
in bed; and on this account it may be necessary to undo all the dressings. 
In general, however, if proper care be taken to apply a sufficient number 
of ligatures at the time of the operation, there will be no further trouble; 
and I do not hesitate to recommend that, as a common rule, the wound 
of an amputation should be dressed whilst the patient is on the operating 
table. I have tried both ways, and have always remai-ked the additional 
disti-ess which any interference with the wound, foxxi-, six or eight hours 
afterward, has occasioned.” 
Larrey is a great enemy to the frequent dressing of all recent wounds, 
whether these be simple or complicated with fracture of bones. In the 
case of gun-shot wounds, the frequent renewal of the dressings is, we need 
scarcely say, often quite impracticable; it is therefore a matter of serious 
importance to know the best mode of pi-oceeding under such cii-cumstances. 
The authority of so experienced a writer will very propei-ly command 
no ordinary attention. The main object of his instructions seems to 
be, to place the wound in such a position that nature is interfered with as 
little as possible in the repai*ation of the injury that has been inflicted. 
With this view he seeks to maintain the pai't in perfect quietude, guard- 
ing it from exposure to the outward air, and maintaining a proper tempe- 
rature around it; and effecting these ends, without confining the patient 
to bed, or even to the house. He found by experience that in cold sea- 
sons wounds were, on the whole, more tardy of healing—especially if they 
were frequently exposed to the air—than in warm ones. He had too 
often occasion to verify the trxith of this remark in the dreadful campaigns 852 
WOUNDS 
of Russia, Saxony, and France; especially when contrasted with the mem- 
orable one of Egypt. It was during these wars that the admirable effects 
of his “ appareil inamovible” were most conspicuous. We were retreat- 
ing, he says, all the while, and yet unwilling to leave our wounded behind. 
Accordingly, most of our patients, after they had their wounds dressed 
according to my plan, were immediately dispatched forward, and some 
of them even reached their homes in France before the original dressings 
of their wounds were removed. We give but one instance. A soldier, 
after having his arm amputated, at the shoulder joint, after the terrible 
battle of Moskowa, was advised to proceed direct on to his native place 
in Provence, and do nothing to the wound except keep it clean by spong- 
ing away any discharge from the outward dressings, and cover the limb 
with a good sheep’s skin, to guard it from the cold and damp air. When 
he reached home, and the dressings were removed, the wound was found 
to be nearly cicatrized. This is one of many scores of similar cases, where 
the primary dressings were not removed for two, three, or even four weeks 
after they had been put on. 
The following are the instructions given by Larrey how to arrange and 
apply his “ appareil.” If the fracture of the limb be complicated with a 
wound, we should first simplify it, as much as possible, by freely incising 
(idebrider) its edges, extracting all foreign substances or pieces of broken 
bone, and arresting the hemorrhage. . When all has been done, we should 
approximate the edges and keep them in apposition by means of a piece 
of linen (linge fenetre) on which some balsamic substance, such as the 
Styrax ointment, balsam of Mecca, etc., has been spread. Pledgets of 
lint, carded cotton or tow, are then to be placed over the dressing, and 
the anfractuosities that correspond to the wound; also, some square com- 
presses dipped in a glutinous, strengthening fluid, that is prepared by 
beating up the white of two or three eggs with camphorated wine or vine- 
gar, or, in lieu of these, with salt water. These compresses should be care- 
fully applied over the whole of the injured jjart, while an assistant is en- 
gaged in maintaining the fractured bone or bones in exact apposition by 
appropriate extension and counter-extension. These compresses perform 
the service of immediate splints, without their inconvenience. They are 
kept hi their place and are moreover strengthened by an eighteen-tailed 
bandage, which, when properly applied, maintains everything firmly to- 
gether. The foot and ankle joint should previously be enveloped in long 
compresses, that have been wetted in the same fluid. A pad of tow, of a 
pyramidal shape, is to be placed under the tendo Achillis, to make all level 
and even, so that the pressure of the apparatus may be uniform through- 
out. The surgeon is then to take two cylindrical rolls of new rye straw, 
and, wrapping them up in the opposite edges of a tow'el or small sheet, 
which is to be stretched out under the leg, he applies them on each side, 
having previously interposed two or three flat cushions filled wflth oat 
chaff, to prevent the pressure of the straw rolls on the skin. These are 
secured in their place by a good many broad tapes or ribbons, which 
should be tied over the outer roll of straw, and in such a manner that they 
do not press directly upon the crest of the tibia. The advantage of the 
straw rolls is that they are so elastic, that, although they give way at first, 
to the swelling of the limb, they continue to remain in close contact with it 
as the swelling subsides, and no void ever exists between it and the ap- 
paratus—an objection to the paste-board splints, and other substitutes WOUNDS, 
853 
which have been suggested of late years. As a substitute for the foot- 
board, I use a piece of folded sheet placed like a stirrup under the sole, 
some tow being previously interposed to fill up the concavity; the two 
ends are brought up, crossed over the instep, and then secured to the 
straw rolls with strong pins. 
The loose end of the sheet, stretched under the leg, which extends be- 
low the inferior ends of the straw-rolls, is to be folded under the foot and 
over the ends of the rolls, and then firmly secured by a few stitches 
or pins. 
With such a simple, yet so efficient an apparatus, the reader will read- 
ily understand how a patient is able to walk about with the aid of crutches, 
the foot being merely suspended by a ribbon passed over the neck. The 
same apparatus is equally well suited for fractures of the body, or of the 
neck of the femur. We have only to lengthen the external straw-roll 
as far up as the pelvis, and secure it firmly by a belt passed round the 
body. The limb, in such cases, should be kept in the horizontal position, 
until the callus has become consolidated. 
The camphorated albumino-vinous wash, which we have recommended, 
has the great advantage of increasing the tonic action of injured parts, 
and of preserving their natural heat, without obstructing the meshes of 
the linen or cotton cloth that is used in making the apparatus. The thin- 
ner portion of the discharge oozes out, and may be removed with a sponge, 
whenever it is necessary. Part xi., p. 120. 
Punctured Wound and Ligature of the Posterior Tibial Artery.—Take 
the wound as a centre, and cut down upon the vessel, and tie it both above 
and below the seat of injury. (Arnott). If it be a case of secondary hem- 
orrhage, and there is a good deal of coagulum in the parts surrounding 
the vessel, it will be advisable to tie the femoral artery. When there is 
a wound in the calf of the leg, with sufficient bleeding to warrant a belief 
that the posterior tibial artery is wounded, separate the soleus from its' 
attachment to the tibia, cutting through the deep fascia, and secure the 
vessel. (Mr. B. B. Cooper.) Part xiii., jp. 216. 
Wounds of the Eyelids.—Diefenbach insists strongly on the advantages 
of his fine insect needles in producing union by the first intention. A suffi- 
cient number must be applied to effect exact apposition. If the edges do 
not correspond, they must be made to do so by the use of fine scissors. 
If a large piece of skin be lost and the edges cannot be united, subsequent 
ectropium is avoided by making an incision a quarter of an inch from 
the edge of the wound, which allows the edges then to be united. Open- 
ing of the lids during the healing process to be prevented by a strap of 
plaster, carried over them both. About the third or fourth day the 
needles are to be carefully removed, and the adherent wound supported 
by strips of plaster, to prevent reopening. If the needles are properly 
applied, no scar, remains. Part 313. 
Ergotine as a Styptic in Wounds of Arteries.—M. Bonjean has strongly 
advised the use of ergotine (ergot of rye) to arrest hemorrhage from 
wounded arteries. It is stated that in a recent experiment, he divided the 
right carotid artery of a horse by a transverse incision, which comprised 
one-third of the circumference of the vessel. The hemorrhage was speedily 
arrested by the application of ergotine. Part xiv., p. 192. 854 
WOUNDS. 
Severe Wounds of the Throat inflicted for the purpose of Self-Destruc- 
tion.—Dr. A. M. McWhinnie arranges them thus: 
1st. Those in which the skin, superficial muscles, and vessels, are divid- 
ed, and which are the most frequent in occurrence ; 2nd, Those in which 
an opening is made either into the fauces, pharynx, larynx, trachea, or 
oesophagus, and which are next in point of frequency; and, 3d, Those in 
which blood-vessels of large calibre, or other parts, have been injured, so 
as to cause a sudden or speedy cessation of life, and which are compara- 
tively rare in occurrence. 
Treatment.—If the superficial parts are simply divided, and there is no 
mischief done to the air-passages, etc., a suture or two, aided by the 
approximation of the chin to the sternum, will generally suffice. Where 
the wound has opened the pharynx, larynx, or trachea, our first object 
must 'be to inquire as to the extent of the hemorrhage which may have 
taken place, and to spare no pains, even at the risk of enlarging the wound, 
to secure by ligature every divided vessel. Mr. John Bell says, that 
“ they are often retracted among the cellular tissue, and that wTe are saved 
all trouble and care, except that of making our outward suture for uniting 
the external wound.” These observations, coming from so eminent a 
surgeon, must carry with them considerable authority; but I cannot sub- 
scribe to so dangerous a proceeding. With regard to sutures, they should 
be employed only in superficial wounds; or, if allowable in deep ones, 
they must be confined to those cases in which the aii’-passages have 
escaped. In extensive wmunds, where the cartilages of the larynx have 
been injured or separated from each other, sutures are irritating and hurt- 
ful. They cannot promote what never takes place in these parts, viz., 
union by the first intention; and by closing the outward wound, they will 
act in the most deleterious manner by confining the discharge, which 
should have as free an outlet as possible. 
The wound is to be left freely open, and narrowly watched, in the event 
of any recurrence of the bleeding, when reaction has been established. 
The patient should be in a well-ventilated room, the head gently raised 
with pillows, and everything is to be avoided which may produce any 
bodily irritation or mental excitement. An elastic tube is to be introduced 
through the nostril, and, if the patient does not greatly object, should be 
allowed to remain in the oesophagus. Although it may at fii*st produce 
some inconvenience, the patient will generally become accustomed to its 
presence. When the tube is passed, it should be quickly carried along the 
fioor of the right nostril, and the finger of the left hand introduced, either 
through the mouth or wound, to guide its extremity into the pharynx. 
This is very important; for I have frequently seen the surgeon well-nigh 
foiled in his repeated attempts to introduce the insti’ument, in consequence 
of its hitching against, or passing into the aperture of, the glottis, which 
it will be liable to do, if not properly directed by the finger of the operator. 
The distress has been so great that every resistance has been offered to its 
employment. Much of the comfoi't to be derived from our treatment 
depends upon its use. All attempts at deglutition, and even speaking, are 
to be. avoided, that these extremely movable parts may be kept as tran- 
quil as possible. Evei-y loose portion of cartilage or other tissue should 
be carefully removed, on account of the irritation and inconvenience pro- 
duced. I have seen it necessary to take away the epiglottis, when nearly 
separated from its connections. WOUNDS 
855 
The lightest and simplest dressings will be found best adapted to these 
cases ; water-dressing, with fine linen or muslin—occasionally a light poul- 
tice placed over the latter. The wound should be constantly cleansed; 
and if very extensive, and in the neighborhood of the glottis, the introduc- 
tion and frequent renewal of soft portions of sponge will be found very 
useful in absorbing the purulent discharge which might otherwise flow into 
the larynx. The only nourishment allowed for some time should be fluids. 
The individual xvho has thus attempted suicide should be carefully watched; 
for the melancholy and deplorable condition in which he is placed urges 
him to resort to every possible means to accomplish his end; and the 
strictest restraint, during the treatment, is sometimes absolutely necessary, 
to prevent the infliction of further injury. Great advantage is derived 
from the administration of opium and other narcotics, introduced by the 
oesophagus tube, or by means of enemata. 
With regard to other internal remedies, these will be few and simple, in 
the absence of cerebral and general febrile excitement, which, if present, 
must be combated by suitable treatment; and the great depression, both 
mental and physical, often supervening upon the cessation of the inflam- 
matory symptoms, will demand the judicious employment of. stimuli. 
Local and general bleeding, antimony, and mercurials, must be had recourse 
to, in the event of inflammation affecting the lining membrane of the air- 
passages and lungs. 
[The plan suggested by Mr. Liston is now generally adopted, of intro- 
ducing a tube through the glottis, when there is an (edematous state of 
the mucous membrane ; and in those cases when dyspnoea has supervened 
after some time, in consequence of excrescences or granulations encroach- 
ing upon the air-tubes, Sir Charles Bell’s plan of performing tracheotomy 
must be practised.] 
In general, we may augur favorably of superficial wounds of the throat. 
When deep, their danger diminishes in proportion as they are remote from 
the aperture of the glottis. Thus, wounds entering the mouth above the 
os hyoides, or dividing the larynx below the glottis—i. e., through the 
lower part of the thyroid cartilage, or between it and the cricoid, will (as 
also wounds of the trachea, generally) do well; but, for reasons above 
mentioned, we should pronounce very unfavorably of a case where the 
incision has extended through the thyro-hyoid membrane, through the 
centre or upper part of the thyroid cartilage, or in any other direction 
toward the rima-glottidis, by which that part is exposed or injured. 
Still, however, a great deal of comfort may be derived from proper 
treatment, and the chances of a favorable termination may thereby be 
much augmented. These wounds, from the great surface exposed, are 
extremely tedious in healing—a process which must take place almost 
wholly by granulations ; and it has been shown that the patient must not 
be considered safe for a considerable time after the healing of the external 
wound. Part xiv., p. 194. 
Wound of Branches of the Palmar Arch of Arteries.—Gallic acid lias 
proved a most useful addition to our use of astringents. Both as an ex- 
ternal and internal remedy in hemorrhages its character stands high, and 
justly so ; it is now generallly alleged to be the active principle in Rus- 
pini’s celebrated styptic, which Dr. Thompson is of opinion consists of 
gallic acid, sulphate of zinc, opium, alcohol, and rose-water j the gallic 856 
WOUNDS. 
acid evidently being the active ingredient. Some time since, says Dr. 
Hughes, I saw the power of Ruspini’s styptic put to the test in a case of 
a gentleman who had some of the branches of the palmar arch of arteries 
opened by the bursting of a bottle of soda water; profuse hemorrhage 
having ensued, and attempts to secure the bleeding vessels having been 
tried in vain, graduated pressure was applied, but to such an extent, and 
for such a length of time, that sloughing of the palm of the hand ensued, 
with inflammation extending up the forearm, and considerable fever, 
together with repeated periodical hemorrhages, by which the patient was 
considerably reduced; at this stage I saw the case in consultation, when 
if was agreed to give a trial to this powerful styptic, and a single applica- 
tion of it was followed by an immediate arrest of the hemorrhage, and 
recovery. Part xv., p. 143. 
Prevention of Infection from Dissecting Wounds.—Dr. Hargrave 
directs to wash the wound (on the fingers or thumb) for a few minutes in 
cold water; then suck it, and immediately tie a ligature on the cardiac 
side of the wound, so tightly as to induce numbness, and keep it on for at 
least twelve hours. The physiology of such treatment is explained by the 
ligature causing a permanent stasis in the fluids of the parts injured on its 
distal side, and producing a well-marked plethora in them; the greater 
the amount of it the greater will be the impediment to absorption, admit- 
ted by all. The constriction caused by the ligature will also oppose a 
barrier to the return of the venous and lymphatic fluids into the system, 
consequently to their being circulated through it, so that the poison is 
prevented entering into the constitution and destroying it, which will then 
be eliminated locally from the parts where it was first applied. 
Part xvi., p. 299. 
Treatment of Dissection Wounds.—Mr. B. Cooper advises not to apply 
caustic, unless infection has been received from a diseased subject. For an 
ordinary dissection wound, wash the part well, wrap up in a poultice, and 
keep the arm in a sling; take an aperient of calomel, James’s powder, and 
rhubarb, followed by a saline, and go into the country for a week. 
As precautionary measures, Dr. T. Cattell would apply sticking plaster 
to old abrasions, and anoint the whole surface of the hands, or wear india- 
rubber gloves. If wounded, immediately apply oil of turpentine, nitrate 
of silver, strong solution of alum, nitric acid with camphor, chloride of 
antimony, chloride of zinc, creasote, or concentrated solution of chloride 
of soda or lime. Part xvi., p. 300. 
Wounds of the Chest.—[Mr. Guthrie recommends the treatment of 
wounds of the chest in the following manner :] 
1. All incised or penetrating wounds of the chest should be closed as 
quickly as possible, by a continuous suture through the skin only, and a 
compress supported by adhesive plasters, the patient being afterward 
placed on the wounded side. 
2. If blood flows freely from a small opening, the wound should be 
enlarged, so as to show whether it does or does not flow from within the 
cavity. If it evidently proceed from a vessel external to the cavity, that 
vessel must be secured by torsion or by ligature. 
3. If blood flow from within the chest, in a manner likely to endanger 
life, the wound should be instantly closed ; but as the loss of a reasonable 
quantity of blood in such cases, say from two to three pounds, will be WOUNDS 
857 
beneficial rather than otherwise, this closure may be delayed until syncope 
takes place, or until a further loss of blood appears unadvisable. 
4. If the wound in the chest have ceased to bleed, although a quantity 
of blood is manifestly effused into the cavity of the pleura, the wound may 
be left open, although covered, for a few hours, if the effused or extrava- 
sated blood should seem likely to be evacuated from it, when aided by 
position ; but as soon as this evacuation appears to have been effected, or 
cannot be accomplished, the wound should be closed. It must be borne 
in mind that the extravasation which does take place is usually less than is 
generally supposed—a point which auscultation and percussion will here- 
after in all probability disclose. • 
5. If auscultation and percussion should indicate that the cavity of the 
pleura is full of blood, and the oppression of breathing and the distress are 
so great as to place the life of the patient in immediate danger, the wound, 
although recent, should be reopened. 
6. As soon as the presence of even a serous fluid in the chest is ascer- 
tained to be in sufficient quantity to compress the lung against the spine, 
and time has been allowed for the closure of the vessel from which blood 
originally flowed, a counter-opening should be made in the place of election 
for its evacuation by the trocar and canula,: which may be afterward en- 
larged, unless the reopening of the wound should be thought preferable, 
which will not be the case unless be low in the chest. 
Part xvii., p. 149. 
Solutions for Protecting the Skin against Contagion.—Mr. Acton has 
made various experiments with solutions of gun cotton, gutta percha, and 
caoutchouc, with a view of testing their property of protecting the surface 
from the influence, by contact, of contagious poisons, and the following 
are the conclusions at which he arrived: 1. That a solution of gun cotton, 
when dry, corrugates the skin too much to be available for the purposes 
required. 2. That gutta percha alone is devoid of elasticity and sufficient 
adhesive quality—that the solution of caoutchouc wants body and is too 
sticky, but that—3. The compound solution of caoutchouc and gutta 
percha possesses the requisite qualities to fulfill the purpose required. It is 
prepared by adding a drachm of gutta percha to an ounce of benzole, 
(the volatile principle of coal naphtha,) and ten grains of india-rubber to 
the same quantity of benzole, each being dissolved at a gentle heat, and 
then mixed in equal proportions. The author has employed this compound 
in painting the surface surrounding a chancre, with the solution, and 
found that the acrid secretion had no effect upon it when dried, and warm 
or cold water may be applied with impunity. He considers that it may 
be employed advantageously in many andKsarious ways, as in protecting 
the hands during post-mortem examinations, in preserving the cheek from 
excoriation in gonorrhoeal ophthalmia, and in covering the parts contiguous 
to a sore where water-dressing is the application, etc. Part xix., p. 208. 
Gunshot—Practice of “ Debridement.”—The question, as it now 
stands in Paris, says Dr. C. Shrimpton, may be rendered thus: Should 
large incisions be made to divide the aponeurotic membranes as a preven- 
tive means immedately on the receipt of a gunshot wound, or not ? 
Larrey, the illustrious representative of French military surgery, and 
his son, the Baron, have, it is true, greatly recommended debridement, but 
this practice is not continued at the present day. 858 
WOUNDS, 
Hie potent antiphlogistic remedies, constant cold application, by means 
of ice or irrigations of cold water, so generally employed, have now com- 
pletely superseded it. 
In most cases, submitted to a proper treatment, the strangulation does 
not take place, and these large incisions may be avoided; but when the 
tumefaction does take place beneath the resisting membrane, it is time 
enough to open the aponeurosis and liberate the compressed tissues. 
Part xix., p. 307. 
Treatment of the Sting of a Pee.—The immediate application of honey 
i» good; the use of indigo is better ; and tobacco juice is thus recom- 
mended : “ Apply the juice of tobacco as you find it in the mouth end of 
a smoked cigar, or in the reservoir of a German pipe. It not only imme- 
diately relieves the pain, but prevents swelling.” The substance recom- 
mended is not, it must be remarked, the juice, but the empyreumatic oil 
which, according to Dr. Morris, is a much more energetic poison than the 
juice. Part xx., p. 283. 
Wounds— Union of.—M. Vidal has contrived a number of minute for- 
ceps of different shapes, whereby the lips of the wounds, especially after 
the operation for phimosis, being gently kept in apposition by their self- 
applying pressure, the use of sutures is rendered unnecessary, the- pressure 
exerted not being so great as to perforate the skin. The period for their 
application does not exceed twenty-four hours. Part xxii., p. 259. 
Poisoned Wounds.—Dr. Maclagan, having removed the poison as much 
as possible by suction, encouraging the part to bleed, or excision of the 
whole tract of the wound, applies caustic to the surface freely. Venereal 
chancre may be regarded as a poisonous wound, and according to Ricord 
and others, if it is cauterized during the first three or four days, constitu- 
tional symptoms never follow, as the surface secreting the poison is 
destroyed, and the virus is thus prevented getting into the system. 
Part xxii., p. 345. 
Protection of Granulating Surfaces.—[Professor Miller protects raw 
granulating surfaces “ from the influence of the atmosphere, by imitating 
the incrustation of nature.” This he does by using “ a thick semifluid 
aqueous solution of gum tragacanth.” This is] 
Laid gently and uniformly on the raw surface, so as completely to 
protect it; and if at any portion the envelope threaten to become imperfect, 
the attendant is directed to effect an immediate repair. The application 
is productive of no irritation; and, being translucent, permits a complete 
surveillance of the part. Atmospheric influence is completely excluded; 
and the raw sm-face would seem to be placed in circumstances somewhat 
analogous to its normal state, as if still invested by the integument. Should 
inflammation ensue, no harm has been done ; on the contrary, action is 
likely to prove less intense than it otherwise would have been ; the gum 
is loosened and wmslied away by the purulent secretion; and water- 
dressing may then be used, as in ordinary circumstances. 
Part xxiii., p. 288. 
New Forceps for Extraction of Bullets, etc.—These consist in the blades 
being separate, so that one blade at a time can be introduced into a sinus 
or cavity, and when the object is secured the handles can be locked like 
the midwifery forceps. Part xxxi., p. 312. WOUNDS. 
859 
Glycerine as a Dressing for Wounds.—M. Demarquay considers glyce- 
rine a capital application to wounds of almost any description, and espe- 
cially if sloughy. It is very clean, soft and comfortable to the patient, 
and it promotes cicatrization. The manner of applying it is by simply 
dipping a piece of lint into it, and placing it over the whole of the wound. 
Dart xxxiii., p. 238. 
As formulae frequently occur in this work, in which mention is made of 
French weights and measures, a table is here given of the value of those 
denominations which most frequently occur in pharmacy. 
FRENCH MEASURES. 
Millilitre = 16.3 min. Brit. Apoth. Meas. 
Centilitre = 2.705 fl. drs. Do. 
Decilitre = 3.381 fL oz. Do. 
Litre = 1.7608 Imp. Pint. 
Milligramme = .0154 grs. English Troy. 
Centigramme = .1543 grs. Do. 
Decigramme = 1.5434 grs. Do. 
Gramme = 15.4340 grs. Do. 
FRENCH WEIGHTS. 860 
A TABLE OF THE MUSCLES. 
Dr. W. S. Wells : 
Dear Sir : I send you the following compilation, written several years ago for my own use. As it may be serviceable to students, it 
is at your option to publish. Yours, respectfully, Samuel R. Percy, M.D., New York City. 
Showing the Origin, Insertion, and Action of the Muscles of one Longitudinal Median Section of the Human Body, not including the three Muscles 
of Hearing, the five of the Larynx, the Diaphragm, or Septum Medium, the six Inter-Spinal, eleven Inter-Transversal of the Neck, the five of 
the Loins, and the Cremaster. 
Name. 
Origin. 
Insertion. 
Use. 
1. Occipito-frontalis. 
From the outer 2-8 of the superior curved line 
of the occipital bone, and from the mastoid 
portion of the temporal. 
Into the orbicularis palpe- 
brarum muscle and nasal tu- 
berosity of the frontal bone. 
To raise the eyebrows, thereby throwing the integuments of the 
forehead into transverse wrinkles. 
2. Corrugator Supercilii. 
From the inner extremity of the superciliary 
ridge. 
Into the inner and inferior 
fleshy part of the occipito- 
frontalis, where it joins with 
the orbicularis palpebrarum. 
To draw the eyebrow of that side toward the other, and make it 
project over the inner canthus of the eye. When both act they 
pull down the skin of the forehead and make it wrinkle, particu- 
larly between the eyebrows. 
3. Pyramidalis Nasi. 
Is a pyramidal slip of muscular fibres sent 
downward upon the nose by the occipito- 
frontalis. 
Into the tendinous expan- 
sion of the compressores nasi. 
Assists the occipito-frontalis in its action, draws down the inner 
angle of the eyebrow, and by its insertion fixes the aponeurosis 
of the compressores nasi. 
AURICULAR REGION, 3. 
4. Retrahens Aurem (Auricu- 
laris posticus.) 
By 2, 3, or 4 muscular slips from the mastoid 
process immediately above the insertion of the 
stemo-cleido mastoid muscle. 
Into the back part of the 
ear,which is opposite to the sep- 
tum that divides the scapha 
and concha. 
To draw the ear back and stretch the concha. 
5. Attollens Aurem. 
From the tendon of the occipito-frontalis 
where it covers the aponeurosis of the temporal 
muscle. 
Into the upper part of the 
concha. 
To draw the ear upward, and make the parts into which it is 
inserted, tense. 
6. Attrahens Aurem (Auricu- 
laris anticus.) 
Thin and membranous near the posterior 
part of the zygoma at the edge of the aponeu- 
rosis of the occipito-frontalis. 
Into a small eminence on 
the back of the helix, covering 
in the anterior and posterior 
temporal arteries. 
To draw this eminence a little forward and upward. 
A TABLE OF THE MUSCLES, 
Muscles of Facial Expression. 
EPICRANIO-FRONTAL REGION, 3. A TABLE OF THE MUSCLES. 
861 
PALPEBRAL REGION, 2. 
7. 
( 
Orbicularis Palpebrarum 
From the internal angular process of the 
Into the lower border of the 
To shut the eye by drawing both lids close together, the fibres 
Palpebrarls Anticus.) 
frontal bone, from the nasal process of the 
tendo oculi and nasal pro- 
contracting from the outer angle toward the inner, press the eye- 
superior maxillary, and from a short tendon 
cess of the superior maxillary 
ball, squeeze the lachrymal gland, and convey the.tears toward 
(tendo oculi), which extends from the nasal 
process of the superior maxillary bone to the 
bone. 
the puncta lachrymalla. 
inner extremities of the tarsal cartilages of 
the eyelids. 
8. Levator Palpebrae Supe- 
From the under surface of the lesser wing 
Into the upper border of 
To open the eye by drawing the eyelids upward, which it does 
rloris. 
of the sphenoid, immediately above the optic 
the superior tarsal cartilage. 
completely by being fixed to the tarsus, pulling it below the eye- 
foramen, and from the fibrous sheath of the 
optic nerve. 
brow, and within the orbit. 
CUBITO-OCULAR REGION, 6. 
9. 
Rectus superior 
Oculi 
From the margin of the optic foramen, and 
Into the upper surface of \ 
(Attollens.) 
from the fibrous sheath of the optic nerve. 
the globe of the eye. 
10. Rectus inferior Oculi (de- 
From the inferior margin of the optic fora- 
Into the inferior surface of 
J 
pressor.) 
men, by a tendon, which is common to it, 
and the internal and external rectus (liga- 
ment of Zinn), and from the fibrous sheath of 
the optic nerve. 
the globe of the eye. J 
( 
The four recti, acting singly, pull the eyeball in the four direc- 
tions of upward, downward, inward, and outward. Acting by 
v. pairs, they carry the eyeball in the diagonal of these directions— 
11. 
Rectus internus 
(Adductor.) 
Oculi 
From the common tendon, and from the 
fibrous sheath of the optic nerve. 
Into the inner surface of the 
globe of the eye. j 
■''Viz., upward and inward, upward and outward, downward and 
inward, downward and outward. Acting altogether they directly 
retract the globe within the orbit. 
12. 
Rectu9 externus 
Oculi 
By two distinct heads, one from, the com- 
Into the outer surface of l 
(Abductor.) 
mon tendon, and the other with the origin of 
the superior rectus from the margin of the 
optic foramen; the nasal, third, and sixth, 
nerves passing between its heads. 
18. 
Obliquus superior 
Oculi 
From the margin of the optic foramen, and 
Into the tunica sclerotica, \ 
(trochlearis.) 
from the fibrous sheath of the optic nerve; it 
about half-way between the ' 
passes forward to the pulley beneath the ’in- 
ternal angular process of the frontal bone; 
insertion of the attollens oculi / 
and the optic nerve. i 
The superior oblique, acting alone, rolls the globe inward and 
its tendon is then reflected beneath the superior 
forward, and carries the pupil outward and downward to the 
rectus, to the outer and posterior part of the 
lower And outer angle of the orbit. The inferior oblique,_ acting 
globe of the eye. The tendon is surrounded 
alone, rolls the globe outward and backward, and carries the 
by a synovial membrane while passing through 
pupil outward and upward to the outer and upper angle of the 
the cartilaginous pulley. 
eye. Both muscles acting together, draw the eyeball forward, 
and give the pupil that slight degree of eversion which enables it 
14. Obliquus inferior Oculi. 
From the inner margin of the superior max- 
Into the outer and posterior 1 
to admit the largest field of vision. 
illary bone, immediately external to the 
part of the sclerotica at about 1 
lachrymal groove, and passes beneath the 
two lines from the optic) 
rectus inferior. 
nerve. ' 862 
A TABLE OF THE MUSCLES. 
SUPRA MAXILLO NASAL REGION 
3. 
Home. 
Origin. 
Insertion. 
Use. 
15. Compressor Nasi. 
By its apex from the canine fossa of the 
superior maxillary bone, and spreads out upon 
the side of the nose. 
Slightly into the interior ex- 
tremity of the os nasi, and 
nasal process of the superior 
maxillary bone, which it meets 
with some of the fibres de- 
scending from the occipito- 
frontalis. 
To compress the ala toward the septum nasi, particularly when 
we want to smell acutely, but if the fibres of the frontal muscle, 
which adhere to it, act, the upper part of this thin muscle assists 
to pull the ala outward. It also corrugates the skin of the nose, 
and assists in expressing certain passions. 
16. Levator labii superioris 
alaque nasi. 
By two distinct origins: the first from the 
external part of the orbitar process of the su- 
perior maxillary bone, which forms the lower 
part of the orbit, immediately above the 
foramen infra orbitarium; the second por- 
tion arises from the nasal process of the supe- 
rior maxillary bone, when it joins the os 
frontis at the inner canthus, descending along 
the edge of the groove for the lachrymal 
sac. 
The first and shortest por- 
tion into the upper lip and or- 
bicularis labiorum; the second 
and longest into the upper lip 
and outer part of ala nasi. 
To raise the upper lip toward the orbit, and a little outward; 
the second portion serves to draw the skin of the nose upward and 
outward, by which the nostril is dilated. 
SUPRA 
MAXILLO LABIAL, 4. 
17. Depressor labii inferioris 
alseque nasi (Myrtiformis) 
Is seen by drawing upward the upper lip, 
and raising the mucous membrane; it is a 
small oval slip of muscle, situated on each 
side of the fraenum, arising from the incisive 
fossa, and passing upward. 
Into the upper lip and ala of 
the nose. 
To draw the upper lip and ala nasi downward and backward. 
18. Levator labii superiorus 
proprius. 
From the lower border of the external part 
of the orbitar process of the superior maxil- 
lary bone. 
Into the side of the upper 
lip. It covers in the infra or- 
bital nerve and artery. 
To raise the upper lip. 
19. Levator anguli oris. 
From the canine fossa of the superior max- 
illary bone, and passes outward. 
Into the angle of the mouth, 
intermingling its fibres with 
those of the orbicularis, zygo- 
matic!, and depressa anguli 
oris. 
To draw the corner of the mouth upward. 
20. Zygomaticus major. 
From the os malse near the zygomatic 
suture. 
Into the angle of the mouth, 
continuous with the other mus- 
cles attached to this part. 
To draw the corner of the mouth and under lip toward the 
origin of the muscle, and make the cheek prominent, as in 
laughing. 
21. Zygomaticus minor. 
From the upper prominent part of the os 
malse above the origin of the former muscle. 
Into the upper lip, near the 
corner of the mouth, along 
with the levator anguli oris. 
To draw the corner of the mouth obliquely outward and up- 
ward toward the external canthus of the eye. A TABLE OF TI1E MUSCLES. 
863 
INTER 
MAXILLO LABIAL, 2. 
22. Buccinator (the Trum- 
peter’s Muscle.) 
From the lower jaw, as far back as the last 
dens molaris and fore-part of the root of the 
coronoid process, from the upper jaw, between 
the last dens molaris and pterygoid process of 
the sphenoid bone continued between both 
jaws, to the constrictor pharyngis superior, 
with which it joins. 
Into the angle of the mouth 
within the orbicularis oris. It 
is pierced opposite the second 
molar tooth of the upper jaw 
for the passage of Stenoni’s 
duct. 
To draw the angle of the mouth backward and outward, and to 
co#i act its cavity by pressing the cheek inward, by which the 
food is thrust between the teeth. 
23. Orbicularis oris. 
Is formed by the muscles that move the lip 
scending, those of the inferior ascending, and 
the corner of the mouth, run along the lips to 
It is a sphincter muscle. 'Che unper segment i 
muscular fasciculus (naso-labiaife; to the colurr 
s, the fibres of the superior de- 
decussating each other about 
bin those of the opposite side, 
attached by means of a small 
ina of the nose. 
To shut the mouth by contracting and drawing both lips to- 
gether, and to counteract all the muscles that assist in forming it. 
INFRA 
MAXILLO LABIAL, 3. 
24. Depressor anguli oris (tri- 
angularis oris.) 
By a broad base from the external oblique 
ridge of the lower jaw. 
Into the angle of the mouth, 
joining with the zygomaticus 
major and levator anguli oris. 
To pull down the corner of the mouth. 
25. Depressor labii inferioris 
(Quadratus menti vel 
genae. 
From the depression by the side of the 
symphysis of the lower jaw. 
Into the orbicularis oris and 
integument of the lower lip. 
To pull the under lip and the skin of the side of the chin down- 
ward and a little outward. 
23. Levator labii inferioris. 
From the incisive fossa of the lower jaw, a 
number of separate, slender, fleshy fibres. 
Into the integuments of the 
chin. 
To pull the parts into which it is inserted upward. 
THORACO LABIAL. 
27. Platysma Myoides vel 
(Musculus Cutaneus.) 
• 
From the cellular substance that covers the 
upper parts of the deltoid and pectoral mus- 
cles ; in their ascent they all unite to form a 
thin muscle which runs obliquely upward 
along the side of the neck, adhering to the 
skin. 
Into the side of the chin, ob- 
lique line of the lower jaw, 
the angle of the mouth, and 
into the cellular tissues of the 
face. 
To assist the depressor anguli oris in drawing the skin of the 
cheek downward. 
The entire muscle is analogous to the cutaneous muscles of 
brutes, the panniculus carnosus. 
- 
The Masticatory Muscles. 
28. Masseter. 
Is composed of two planes of fibres, superfi- 
cial and deep. The superficial layer arises by 
a strong aponeurosis from the tuberosity of 
the superior maxillary bone, and the lower 
border of the malar bone and zygoma, and 
passes backward. 
The deep layer arises from the posterior part 
of the zygoma, and passes forward. 
Into the ramus and angle of 
the inferior maxillary. 
Into the upper half of the 
ramus. 
To pull the lower to the upper jaw, and by means of its oblique 
decussation a little forward and backward. This muscle is crossed 
by a duct of the parotid gland, by the transverse facial artery, 
and by several branches of the facial nerve. 864 
A TABLE OF THE MUSCLES. 
TEMPORA 
INFRA MAXILLARY, 
2. 
Name. 
Origin- 
Insertion. 
Use. 
29. Temporalis. 
By tendinous fibres from the whole length of 
Into the apex of the coronoid 
To pull the lower jaw upward and press it against the upper, at 
the temporal ridge, and by muscular fibres 
process, and for some way 
the same time drawing it a little backward. 
from the temporal fascia, and from the entire 
surface of the temporal fossa. Its fibres con- 
verge to a strong and narrow tendon. 
down upon its inner surface. 
This muscle is covered in by a very dense fascia (temporal 
fascia.) 
PTERYGO 
INFRA MAXILLARY, 
2. 
30. Pterygoideus externus 
From the pterygoid ridge on the greater ala 
Into the neck of the lower 
To pull the lower jaw forward and to the opposite side and to 
(tninor.) 
of the spheroid, and from the external ptery- 
jaw, and inter-articular fibro- 
pull the ligament from the joint, that it mav not be pinebefl Hnr. 
gold plate, and tuberosity of the palate bone. 
cartilage. 
ing these motions. When both external ptervgnid mnseles net. 
81. Pterygoideus intemus 
From the inner and upper part of the inter- 
Into the ramus and angle of 
the fore teeth of the under jaw are pushed forward beyond those 
of the upper jaw. 
(major.) 
nal plate of the pterygoid process, filling all 
the lower jaw internally. 
To draw the jaw upward aud obliquely toward the opposite 
32. Levator palati (mollis.) 
the space between the two plates, and from 
the pterygoid process of the os palati between 
these plates. 
Musclt 
FIERI 
From the extremity of the pars petrosa of 
3S of Deglutition. 
rGO STAPHYLIN, 6. 
Into the whole length of the 
side. 
To draw the velum upward and backward, so as to shut the pas- 
the temporal bone, where it is perforated by 
velum pendulum palati, as far 
sage from the fauces Into the mouth and nose. 
83. Circumflexus, or tensor 
the eustachian tube, and also from the mem- 
branous part of the same tube. 
From the spinous process of the sphenoid 
as the root of the uvula. 
Into the velum pendulum 
To stretch the velum, to draw it downward, and to a side toward 
palati. 
bone behind the foramen ovale ; from the eus- 
palati, and the semi lunar edge 
the hook. 
84. Azygos uvulae (levator 
tachian tube not far from its osseous part, 
and then runs down the pterygoideus inter- 
nus, passes over the hook of the internal 
plate of the pterygoid process, by a round 
tendon, which soon spreads into a broad mem- 
brane. 
Is a pair of small muscles placed side by 
of the os palati, and extends 
as far as the suture, which 
joins the two bones. 
Into the apex of the uvula. 
Raises the uvula upward and forward, and shortens it. 
uvulae.) 
85, Palato pharyngeus. 
side in the middle line of the soft palate. 
They arise from the spine of the palate bone. 
From the middle of the velum pendulum 
Into the muscular structure 
• 
Draws the uvula and velum downward and backward, and at A TABLE OF THE MUSCLES. 
865 
palati, at the root of the uvula posteriorly, 
and from the tendinous expansion of the cir- 
cumflexus palati. 
of the pharynx and posterior 
border of the thyroid carti- 
lage. 
the same time pulls the thyroid cartilage and pharynx upward, 
and shortens it; with the constrictor superior and tongue it assists 
in shutting the passage into the nostrils ; and, in swallowing, it 
thrusts the food from the fauces into the pharynx. 
36. Constrictor isthmi fau- 
cium (palato-glossus.) 
From the side of the tongue near its root; 
runs upward within the anterior arch before 
the amygdalia. 
Into the middle of the velum 
pendulum palati at the root of 
the uvula anteriorly. 
Draws the velum toward the root of the tongue, which it raises 
at the same time, and with its fellow contracts the passage be- 
tween the two arches, by which it shuts the opening into the fauces. 
TIIARYNGEAL, 4. 
37. Constrictor pharyngis in- 
ferior. 
From the side of the thyroid cartilage, near 
the attachment of the thyroideus and thyreo- 
hyoideus muscles; and from the cricoid car- 
tilage near the crico-thyroides. 
Into the white line in the 
middle of the pharynx. 
To compress that part of the pharynx which it covers, and to 
raise it with the larynx a little upward. 
38. Constrictor pharyngis 
medius. 
From the appendix of the os hyoides; from 
the cornua of that bone, and from the liga- 
ment which connects it to the thyroid car- 
tilage. 
Into the middle of the cunei- 
form process of the os occipi- 
tis, and joined to its fellow at 
a white line in the middle back 
part of the pharynx. 
To compress that part of the pharynx which it covers, and to 
draw it and the os hyoides upward. 
39. Constrictor pharyngis su- 
perior. 
Above from the cuneiform process of the os 
occipitis, near the holes where the ninth pair 
of nerves pass out, lower down from the 
pterygoid process of the sphenoidal bone; 
from the upper and under jaw near the roots 
of the last dentes molares; and between the 
jaws it is continued with the buccenator muscle 
and with some fibres from the root of the 
tongue and from the palate. 
Into the middle of the pha- 
rynx, where it is overlapped 
inferiorly by the constrictor 
medius. 
To compress the upper part of the pharynx, and draw it for- 
ward and upward. 
40. Stylo-pharyngeus. 
From the root of the styloid process. 
Into the side of the pharynx 
and back part of the thyroid 
cartilage. 
To dilate and raise the pharynx and thyroid cartilage upward. 
GLOSSAL, 4. 
41. Lingualis. 
From the root of the tongue laterally runs 
forward between the hyo-glossus and genio- 
glossus. 
Into the .tip of the tongue 
along with part of the stylo- 
glossus. 
To contract the substance of the tongue and bring it backward, 
and to elevate the point of the tongue. 
42. Genio-hyo-glossus. 
From a rough protuberance in the inside of 
the middle of the lower jaw. Its fibres run 
like a fan, forward, upward, and backward. 
Into the whole length of the 
tongue, from its base to the 
apex, and into the base of the 
os hyoides, near its cornua. 
Acccording to the direction of its fibres to draw the tip of the 
tongue backward into the mouth, the middle downward, and to 
render its dorsum concave, to draw its root and os hyoides for- 
ward, and to thrust the tongue out of the mouth. 
43. Hys-glossus. 
From the base, cornua, and appendix of the 
os hyoides. 
Into the side of the tongue 
between the stylo-glossus and 
lingualis. 
To pull the tongue inward and downward. 
VOL. If.—5\ 866 
A TABLE OF THE MUSCLES. 
Name. 
Origin. 
Insertion. 
Use. 
44 Stylo-glossus. 
From the styloid process and stylo-maxillary 
ligament. 
Into the root of the tongue, 
runs along its side, and is in- 
sensibly lost near its apex. 
To draw the tongue laterally and backward. 
SUPRA HYOIDAL, 4. 
45. Stylo-hyoideus. 
By a round tendon, from the middle and 
inferior part of the styloid process it is 
pierced by the tendon of the digastricus 
muscle. 
Into the os hyoides at the 
junction of the base and 
cornua. 
To pull the os hyoides to one side and a little upward. 
46. Digastricus. 
From the digastric fossa immediately be- 
hind the mastoid process of the temporal 
bone ; it is fleshy at each extremity, and ten- 
dinous in the middle. 
Into a depression on the 
inner side of the lower jaw, 
close to the symphysis. The 
middle tendon is held in con- 
nection with the body of the 
os hyoides, by an aponeurotic 
loop through which it plays as 
through a pulley; the loop 
being lubricated by a synovial 
membrane 
To open the mouth by pulling the lower jaw downward and 
backward, and when the jaws are shut to raise the os hyoides, 
and consequently the pharynx upward, as in deglutition. 
47. Mylo-byoideus. 
From the molar ridge on the lower jaw, and 
proceeds obliquely inward; it is a broad tri- 
angular plane of muscular fibres, forming 
with its fellow of the opposite side the inferior 
wall or floor of the mouth. 
Into the raphd of the two 
muscles, and into the base of 
the os hyoides. 
To pull the os hyoides upward, forward, and to a side. 
48. Genio-hyoideus. 
From a small tubercle upon the inner side 
of the symphysis of the lower jaw. 
Into the body of the os 
hyoides. 
To pull the os hyoides toward the chin. 
* 
Muscles of the Neck. 
HYOIDO-THYROIDAL, OR 
ANTERIOR SUPERFICIAL CERVICAL, 4. 
49. Tbyro-hyoideus. 
From the oblique line on the thyroid carti- 
lage. It is a continuation upward of the sterno- 
thyroid. 
Into the lower border of the 
body, and great cornua of the 
os hyoides. 
To pull the os hyoides downward, or the thyroid cartilage 
upward. 
50. Sterno-thyroldeus. 
From the posterior surface of the upper 
bone of the sternum, and from the cartilage of 
the first rib. 
Into the oblique line on the 
great ala of the thyroid car- 
tilage. 
To draw the larynx downward. 
01. Sterno-hyoldeus. 
From the cartilaginous extremity of the 
first rib, the upper and inner part of the ster- 
num, and from the clavicle where it joins with 
the sternum. 
Into the base of the os hy- 
oides. 
To pull the os hyoides downward. A TABLE OF THE MUSCLES. 
867 
52. Omo-hyoideus. 
From the upper border of the scapula, and 
from the transverse ligament of the supra 
scapular notch. 
Into the base of the os hy- 
oides between its cornua and 
the insertion of the sterno- 
hyoideus. 
To pull the os hyoides obliquely downward. 
ANTE-TRACIIELIAN, Oil DEEP ANTERIOR 
CERVICAL, 3. 
53. Rectus antieus major. | 
From the anterior tubercles of the trans- 
verse processes of the third, fourth, fifth, and 
sixth cervical vertebrae. 
Into the basilar process of 
the occipital bone. 
To bend the head forward. 
54. Rectus antieus minor. 
From the anterior border of the lateral mass 
of the atlas. 
Into the basilar process. 
To bend the head forward. 
55. Longus colli. 
The upper portion arises from the anterior 
tubercle of the atlas. 
The lower portion from the bodies of the 
second and third, and transverse processes of 
the fourth and fifth vertebrae. 
Into the transverse processes 
of the third, fourth, and fifth 
cervical vertebrae, into the bo- 
dies of the three lower cervi- 
cal and three upper dorsal 
vertebrae. 
To bend the neck gradually forward and to one side. 
LA.TERO-TRACIIELIAN, OR LATERAL CERVICAL, 4. 
56. Rectus capitis lateralis. 
From the transverse process of the atlas. 
Into the os occipitis opposite 
the foramen stylo-mastoid 
curve of the temporal bone. 
To bend the head a little to one side. 
5T. Scalenus antieus. 
5S. Scalenus posticus. 
From the anterior tubercles of the trans- 
verse processes of the third, fourth, fifth, and 
sixth cervical vertebrae. 
From the posterior tubercles of all the cer- 
vical vertebrae, excepting the first. 
Into the tubercles upon the ' 
inner border of the first rib. 
The phrenic nerve and sub- 
clavian vein lie on this muscle, 
and the subclavian artery be- 
hind it. 
By two fleshy strips into the 
first and second ribs. Hence 
the scalenius medius and pos- 
ticus of some anatomists. 
The scaleni muscles taking their fixed point from below are 
flexors of the vertebral column, and from above elevators of the 
ribs, and therefore inspiratory muscles. 
59. Sterno-cleido-mastoideus. 
Arises by two distinct origins : the anterior 
from the top of the sternum, near its junction 
with the clavicle; the posterior from the upper 
and anterior part of the clavicle; both unite a 
little above the anterior articulation of the 
clavicle, to form one muscle which runs ob- 
liquely upward and outward. 
By a thick strong tendon 
into the mastoid process, which 
it surrounds; and gradually 
turning thinner is inserted as 
far back as the lambdoid 
suture. 
To draw the head to one side, and bend it forward. This is the 
great anterior muscle of connection between the thorax and the 
head. The anterior border of this muscle is the guide for the in- 
cisions in ligature of the carotid artery. It is pierced at its upper 
third by the spinal accessory nerve. 868 
A TABLE OF THE MUSCLES. 
P08T-TRACHELIAN, OR DEEP POSTERIOR CERYICAL, 4. 
Name. 
Origin. 
Insertion. 
Use. 
60. Rectus posticus major 
(capitis.) 
From the spinous process of the axis. 
Into the inferior curved line 
of the os occipitis near the 
rectus capitis lateralis, and the 
insertion of the obliquus capi- 
tis super. 
To pull the head backward, and assist a little in its rotation. 
61. Rectus posticus minor 
(capitis.) 
From the spinous tubercle of the atlas. 
Into a rough surface of the 
occipital bone, beneath the in- 
ferior curved line. 
To assist the rectus major. 
62. Obliquus superior (capitis) 
From the extremity of the transverse pro- 
cess of the atlas. 
Into the os occipitis near the 
rectus posticus major. 
To draw the head backward. 
63. Obliquus inferior. 
From the spinous process of the axis. 
Into the extremity of the 
transverse process of the atlas. 
To give a rotary motion to the head. 
POST-TRACHELIAN, OR 
MEDIAN POSTERIOR 
CERVICAL, 3. 
64. Splenitis. 
Is single at its origin, but divides soon after 
The splenius capitis into the 
To bring the head and upper vertebrae of the neck backward 
into two portions, which have different inser- 
rough surface of the occipital 
laterally, and when both act to pull the head directly backward. 
tions. 
From the spinous processes of ten vertebras, 
the four lower cervical and six upper dorsal, 
and divides, as it ascends the neck into the 
S. capitis and S. colli. 
between the two curved lines, 
and into the mastoid portion 
of the temporal. 
The S. colli into the posterior 
tubercles of the transverse 
processes of the four upper 
cervical vertebrae. 
65. Trachelo Mastoldeus. 
From the transverse processes of the four 
upper dorsal and four lower cervical vertebra:. 
Into the mastoid process. 
To assist the complexus, but it pulls the head more to one side. 
66. Complexus. 
From the transverse processes of the four 
Into the rough surface on 
To draw the head backward and to one side. 
upper dorsal and four lower cervical vertebrae. 
the occipital bone between the 
A portion of the complexus is named biventer cervicis, from 
It is a large muscle, and with the splenius 
forms the great bulk of the back of the neck. 
two curved lines, and near to 
the occipital spine. 
consisting of a central tendon, with two fleshy bellies. 
Muscles of the Thorax. 
ANTE-COSTAL OR ANTERIOR THORACIC, 3. 
CT. Pectoralis major. 
From the sternal 2-8 of the clavicle; from 
By a broad tendon into the 
To move the arm forward and obliquely upward, toward the 
i the breadth of sternum its w'hole length; 
anterior bicipital ridge of the 
sternum. That portion of the muscle which arises from the 
and from the cartilages cf all the true ribs, 
except the first. 
humerus. 
clavicle, is separated from that connected with the sternum, by a 
distinct cellular interspace; hence we speak of the clavicular 
portion and sternal portion of the pectoralis major. A TABLE OF THE MUSCLES. 
869 
68. Pectoralis minor. 
From the upper edge of the third, fourth, 
and fifth ribs, near where they join with their 
cartilages. 
Into the inner and upper 
surface of the coracoid pro- 
cess of the scapula. 
To bring the scapula forward and downward, and to raise the 
ribs upward. 
69. Subclavius. 
By a round tendon from the cartilage of the 
first rib. 
Into the under surface of the 
clavicle. 
Draw's the clavicle downward and forward, and thereby assists 
in steadying the shoulder. This muscle is concealed by the costo 
coracoid membrane, an extension of the deep cervical fascia, by 
which it is inserted. These three muscles are agents in forced 
respiration, but are unable to act until the shoulders are fixed. 
LATERI COSTAL, 1. 
70. Serratus magnus. 
By fleshy serrations from the nine upper 
ribs, excepting the first, and extends back- 
ward upon the side of the chest. 
Into the whole length of the 
base of the scapula. 
Is the great external inspiratory muscle, raising the ribs when 
the shoulders are fixed, and thereby increasing the cavity of the 
chest. Acting upon the scapula it draws the shoulder forward, as 
we see to be the case in diseased lungs, where the chest has be- 
come almost fixed, from apprehensions of the expanding action 
of the respiratory muscles. 
POST COSTAL, 
OR POSTERIOR THORACIC, 2. 
71. Serratus posticus superior. 
From the spinous processes of the two last 
cervical and two upper dorsal vertebr®. 
By four serrations into the 
second, third, fourth, and fifth 
ribs. 
To elevate the ribs and dilate the thorax. 
72. Serratus posticus inferior. 
From the spinous processes of the two last 
dorsal and two upper lumbar vertebr®. 
By four serrations into the 
four lower ribs. 
To depress the ribs into which it is inserted. 
DEEP COSTAL, 
OR INTERNAL THORACIC, 23. 
73. Inter-costales externi, 11 
in number on each side. 
From the inferior acute edge of each supe- 
rior rib, and run obliquely forward, the whole 
length from the spine to near the joining of 
the ribs with their cartilages; from which to 
the sternum there is only a thin membrane 
covering the internal inter-costals. 
Into the upper obtuse edge ' 
of each inferior rib, as far 
back as the spine, into which 
the posterior portion is fixed. 
To raise the ribs when they act from above, and depress them 
when they take their fixed point from below. They are, there- 
fore, both inspiratory and respiratory muscles. 
74. Inter-costales interni, 11 
on each side. 
In the same manner as the external; but 
they begin at the sternum and run obliquely 
backward as far as the angle of the rib; from 
that to the spine they are wanting. 
In the same manner as the 
external. 
75. Triangularis sterni. 
By a thin aponeurosis from the side of the 
sternum, cuneiform cartilage, and sternal ex- 
tremities of the costal cartilages. 
Into the cartilages of the 
third, fourth, fifth, and sixth 
ribs, and often into the second. 
To depress these cartilages and the extremities of the ribs, and 
consequently to assist in contracting the cavity of the thorax. 870 
A TABLE OF THE MUSCLES. 
Name. 
Origin. 
Insertion. 
Use. 
76. Trapezius, or (Cucularis.) 
From the superior curved line of the occipi- 
tal bone; from the ligamentum nuchae, 
supra spinous ligament, and spinous processes 
of the last cervical and all the dorsal verte- 
brae. The fibres converge from these various 
points. 
Into the scapular third of the 
clavicle, the acromion process, 
and the whole length of the 
upper border of the spine of 
the scapula. 
Moves the scapula according to the three different directions of 
its fibres. 
77. Rhomboideus, or inferior 
major. 
From the spinous processes of the four, five, 
or six upper dorsal vertebrae, and from the 
supra spinous ligament. 
Into the posterior border of 
the scapula, as far as its infe- 
rior angle below the spine. 
To draw the scapula obliquely upward, and directly inward, or 
rotator of the scapula. 
Or superior minor. 
From the spinous processes of the two last 
cervical vertebrae and ligamentum nuchae. 
Into the edge of the trian- 
gular surface, on the posterior 
border of the scapula above 
the spine. 
78. Levator anguli scapulae. 
By distinct slips from the posterior tubercles 
of the transverse processes of the four upper 
cervical vertebrae, which soon unite. 
Into the upper angle and 
the posterior border of the 
scapula as far as the triangu- 
lar smooth surface at the root 
of its spine. 
To pull the scapula upward and a little forward, and rotate. 
SUPERFICIAL SCAPULAR, 4. 
79. Supra spinatus. 
From all that part of the base of the scapula 
that is above the spine; also from the spine 
and superior costa; passes under the acro- 
mion, and adheres to the capsular ligament of 
the os humeri. 
Into that part of the large 
protuberance on the head of 
the os humeri, that is next the 
groove for lodging the tendon 
of the long head of the biceps. 
To raise the arm upward, and at the same time to pull the cap- 
sular ligament from between the bones, that St may not be 
pinched. 
80. Infra spinatus. 
From all that part of the base of the scapula 
that is between its spine and inferior angle. 
Into the middle depression 
upon the great tuberosity of 
the humerus. 
To roll the humerus outward; to assist in raising and supporting 
it when raised, and to pull the ligament from between the bones. 
81. Teres minor. 
From all the round edge of the inferior 
border of the scapula. 
Into the back part of the 
large protuberance on the head 
of the os humeri, a little be- 
hind and below the termina- 
tion of the infra spinatus. 
To roll the humerus outward, and draw it backward, and pre- 
vent the ligament being pinched. 
82. Teres major. 
From the lower third of the inferior border 
of the scapula, encroaching a little upon its 
dorsal aspect. 
In common with the tendon 
of the latissimus dorsi into the 
posterior bicipital ridge. 
To roll the humerus inward, and draw it backward and down- 
ward. 
SUPRA AND INFRA SCAPULAR, 3. 
Scapular Muscles. A TABLE OF THE MUSCLES, 
871 
DEEP SCAPULAR, 1. 
83. Sub-scapularis. 
From the whole of the under surface of the 
scapula, excepting the superior angle. 
The tendon of this muscle forms a part of 
the capsule of the joint, and communicates 
with the synovial membrane of the articu- 
lation. 
Into the lesser tuberosity of 
the humerus. 
To roll the humerus inward, and to draw it to the side of tile 
body, and to prevent the capsular ligament being pinched. 
Muscles of the Arm. 
SUPRA HUMERAL, 1. 
84. Deltoid. 
Fleshy, from all the posterior part of the 
clavicle that the pectoralis major does not 
possess; tendinous and fleshy from the acro- 
mion, and lower margin of almost the whole 
spine of the scapula opposite to the insertion 
of the trapezius. The fibres from this broad 
origin converge to the middle of the outer 
side of the humerus. 
Into a rough protuberance in 
the outer side of the os humeri, 
near its middle, where the 
fibres of this muscle intermix 
with some parts of the bra- 
chialis externus. 
The Deltoid is the elevator of the arm in a direct line, and by 
means of its extensive origin can carry the arm forward or back- 
ward, so as to range with the hand a considerable segment of a 
large circle. 
POST HUMERAL, 
OR POSTERIOR BRACHIAL, 1. 
85. Triceps extensor cubltL 
' 
The external head arises from the humerus 
immediately below the insertion of the teres 
minor. The external head (short) from the 
humerus immediately below the insertion of 
the teres major. The scapular head (long) 
lies between the two others, and arises from 
the upper third of the inferior border of the 
scapula. The three heads unite and form a 
broad muscle. 
By an aponeurotic tendon 
into the olecranon process of 
the ulna; a small bursa is situ- 
ated between its tendon and 
the upper part of the ole- 
cranon. 
Extensor of the forearm. 
ANTE-HUMERAL, 
OR ANTERIOR BRACHIAL, 3. 
8C. Biceps fiexor cubiti. 
By two tendons; the short head from the 
coracoid process of the scapula, in common 
with the coraco brachialis; the long head 
from the upper edge of the glenoid cavity of 
the scapula. 
The long head, a long slender tendon passes 
of the shoulder joint, inclosed in a sheath of 
leaving the cavity of the joint, it is lodged in t 
the two tuberosities of the humerus, the bici 
bursa is interposed between the tendon of ir 
radius. At the bend of the elbow, the tendon 
inner side a broad tendinous band, which prot 
continuous with the fascia of the forearm. 
By a strong roundish tendon 
into the tubercle on the upper 
end of the radius internally. 
through the capsular ligament 
the synovial membrane; after 
he deep groove that separates 
fital groove. A small synovial 
sertion and the tubercle of the 
of the biceps gives off from its 
ects the brachial artery, and is 
Flexor and supinator of the forearm. 
i 872 
A TABLE OF Tllfi MUSCLES. 
Name. 
Origin. 
Insertion. 
Use. 
87. Coraco-brachlalis. 
From the forepart of the coracoid process 
of the scapula, adhering in its descent to the 
short head of the biceps. 
About the middle of the in- 
ternal part of the os humeri, 
near the origin of third head 
of the triceps, whence it sends 
down a thin tendinous expan- 
sion to the internal condyle of 
the os humeri. 
Draws the humerus inward and assists in flexing it upon the 
scapula. 
88. Brachialis anticus (in- 
ternus). 
Fleshy, from the middle of the os humeri, 
at each side of the insertion of the deltoid, 
covering all the inferior and forepart of this 
bone, runs over the joint, and adheres firmly 
to the ligament. 
By a strong tendon into the 
coronoid process of the ulna. 
Flexor of the forearm. It is a powerful protection to the elbow 
joint. 
Muscles 
of the Fore-Arm. 
SUPERFICIAL ANTE-BRACHIAL, 10. * 
89. Supinator Longus. 
From the external condyloid ridge of the 
humerus, nearly as high as the insertion of the 
deltoid. 
Into the base of the styloid 
process of the radius. 
To roll the radius outward, and consequently the palm of the 
hand upward. 
90. Extensor carpi radialis 
longior. 
From the external condyloid ridge below the 
preceding. Its tendon passes through a 
groove in the radius immediately behind the 
styloid process. 
Into the base of the meta- 
carpal bone of the index 
finger. 
To extend and bring the hand backward. 
91. Extensor digitorum com- 
munis. 
From the external condyle. 
Before it passes under the ligamentum carpi 
into four tendons. Opposite the first phalanx 
to form a broad aponeurosis, which covers the 
the finger. At the first joint the aponeurosis d 
middle slip is inserted into the base of the seco 
portions are continued outward on each side 
the last. Little oblique tendinous slips connect 
they cross the back of the hand. 
Into the second and third 
phalanges of all the fingers, 
annulare externum it divides 
?ach tendon spreads out so as 
whole of the posterior'aspect of 
vides into the three slips. The 
ad phalanx, and the two lateral 
f the joint to be inserted into 
the tendons of this muscle as 
Restores the fingers into the straight position, after being flexed 
by the two flexors—sublimis and profundis. 
92. Extensor minimi digit! 
(auricularis). 
Is an offset from the extensor communis. 
It assists in forming the tendinous expansion 
on the back of the little finger. 
Into the two last phalanges. 
It is to this muscle that the little finger owes its power of sepa- 
rate extension; and from being called into action when the point 
of the finger is introduced into the meatus of the ear for the pur- 
pose of removing unpleasant sensations; the muscle was called 
by old writers “Auricularis.” 
93. Extensor carpi ulnaris. 
From the external condyle of the os hu- 
merus, and from the upper 2-3 of the border 
of the ulna. Its tendon passes through the 
posterior groove in the lower extremity of the 
ulna. 
Into the base of the meta- 
carpai bone of the little finger. 
Assists in extending the hand. 
• A TABLE OF THE MUSCLES. 
873 
94. Anconeus. 
From the posterior part of the external 
condyle of the os humeri. 
Into the olecranon and tri- 
angular surface on the upper 
extremity of the ulna. 
Assists in extending the forearm. 
95. Flexor carpi ulnarls. 
By two heads—one from the inner condyle, 
and the other from the olecranon and upper 
2-3 of the inner border of the ulna. The 
ulnar nerve passes between its two heads. 
Into the plsciformebone and 
base of the metacarpal bone 
of the little finger. 
Flexor of the wrist. 
96. Palmaris brevis. 
From the palmar fascia, and passes trans- 
versely inward. 
Into the integuments on the 
inner border of the hand. 
To assist in contracting the palm of the hand. 
97. Palmaris iongus. 
From the internal condyle of the os humeri, 
and from the sheath of fascia which sur- 
rounds it. 
Into the palmar fascia. 
Tensor of the palmar fascia. 
98. Pronator radii teres. 
By two heads—one from the inner condyle 
of the humerus and fascia of the forearm, the 
other from the coronoid process of the ulna. 
The median nerve passes between them. 
Tendinous into the middle 
third of the oblique ridge of 
the radius. 
Rotates the radius upon the ulna and the hand inward. 
MIDDLE 
ANTE-BRACHIAL, 2. 
99. Extensor carpi radialis 
brevior. 
From the external condyle of the humerus. 
Its tendon is lodged in the same groove of the 
radius, with the extensor carpi radialis longior. 
Into the base of the meta- 
carpal bone of the middle 
finger. 
To assist in extending the hand. 
100. Flexor sublimis digitorum 
(perforatus). 
From the inner condyle, coronoid process of 
the ulna, and oblique line of the radius. The 
median nerve and ulnar artery pass between 
its origins. 
Divides into four tendons, 
which are inserted into the 
base of the second phalanges 
of the finger, splitting at their 
termination to give passage to 
the tendons of the deep flexors 
(thence perforatus.) 
Flexors of the second phalanges. 
RADIO-CUBITAL, 
OR DEEr ANTE-BRACIIIAL, 8. 
101. Flexor iongus pollicis. 
From the upper 2-3 of the radius, and part 
of the interosseous membrane. Its tendon 
passes beneith the annular ligament. 
Into the base of the last 
phalanx of the thumb. 
Flexor of the last phalanx of the thumb. 
102. Extensor ossk metacarpi 
pollicis. 
From the middle and posterior part of the 
ulna, immediately below the insertion of the 
anconeus, from the posterior part of the 
middle of the radius, and from the interos- 
seous membrane. 
Into the base of the meta- 
carpal bone of the thumb. 
Its tendon passes through the 
groove immediately in front of 
the styloid process of the radius 
Extends the meta-carpal bones of the thumb. 
103. Extensor pnmi iuternodii 
pollicis. 
From the interosseous membrane and radius, 
and passes through the same groove, as the 
former. 
Into the base of the first 
phalanx of the thumb. 
Extensor of tire first phalanx of the thumb. 874 
A TABLE OF THE MUSCLES. 
Name. 
Origin. 
Insertion. 
Use. 
104. Extensor secundi inter- 
nodii pollicis. 
From the ulma and interosseous membrane. 
Its tendon passes through a distinct canal in 
the annular ligament. 
Into the base of the last 
phalanx of the thumb. 
Extensor of the second phalanx of the thumb. 
105. Extensor indicia. 
From the ulna as high as the ex. ossis 
metac. pollicis, and from the interosseous mem- 
brane. Its tendon passes through a distinct 
groove in the radius. 
Into the aponeuroses formed 
by the common extensor ten- 
don of the index finger. 
Extensor of the second phalanx of index finger. 
106. Flexor profundus digi- 
torum (perforans.) 
From the upper 2-8 of the ulna, and part of 
the interosseous membrane, and terminates 
in four tendons, which pass beneath the annu- 
lar ligament, and between the two slips of the 
tendons of the flexor sublimis (hence per- 
forans.) 
Into the base of the last 
phalanges. 
Common flexor of the third phalanges of the fingers. 
* 
107. Supinator brevis. 
.From the external condyle and external 
lateral ligament, and winds round the upper 
part of the radius. 
Into the head, neck, and 
tubercle of the radius. 
Rotator of the fore-arm outward. 
108. Pronator quadratus. 
From the lower and inner part of the ulna. 
Into the lower one-fourth of 
the oblique line of the radius. 
Rotator of the fore-arm Inward. 
Muscles cf the Hand. 
METACARPO CARPAL, OR SUPERFICIAL PALMAR, 7. 
100. Abductor pollicis. 
From the scaphoid bone and annular liga- 
ment. 
Into the base of the first 
phalanx. 
Bends the thumb toward the radius. 
110. Flexor ossis metacarpi 
(opponens pollicis.) 
From the trapezium and annular ligament. 
Into the whole length of the 
metacarpal bone. 
Rotates the thumb toward the palm. 
111. Flexor brevis pollicis. 
Consists of two portions, between which lies 
the tendon of the flexor longus pollicis. The 
external portion arises from the trapezium 
and annular ligament; the internal portion 
from the trapezoides and os magnum. 
They are both inserted into 
the base of the first phalanx 
of the thumb, having a ses- 
moid bone in each of their 
tendons, to protect the joint. 
Flexor of the first phalanx of the thumb. 
112. Adductor pollicis. 
Fleshy from almost the whole length of the me- 
tacarpal bone, that sustains the middle finger. 
Into the inner part of the root 
of the 1st phalanx of the thumb. 
To pull the thumb toward the fingers. 
118. Abductor minimi digiti. 
From the pisciform bone, and from that part 
of the ligamentum carpe annulare next to it. 
Into the base of the first 
phalanx of the little finger. 
Bends the little finger toward the ulna. 
114. Flexor brevis minimi 
digiti 
From the unciform bone and annular liga- 
ment. 
• 
Into the inner and anterior 
part of first phalanx of the 
little finger. 
Flexor of the first phalanx of little finger. A TABLE OF THE MUSCLES. 
875 
115. Flexor ossls metacarpi 
(adductor opponens.) 
From the unciform bone and annular liga- 
ment. 
Into the whole length of the 
metacarpal bone of little 
finger. 
Rotates the little finger toward the palm. 
METACABPO PHALANGE AN, OR DEEP PALMAR, 12. 
116. Lumbricales (four in 
number.) 
From the radial side of tendons of the deep 
flexor (four in number.) 
Into the aponeurotic exten- 
sion of the extensor tendons on 
the radial side of the fingers. 
Cooperative with the flexors of the fingers. 
117. Ipterossei palmares. 
Adducts the thumb, or inclines it toward the ulna. 
Interossei pollicis. 
118. Interossei indicis. 
119. Interossei annularis. 
From the base of the metacarpal bone of 
one finger. 
Into the base of tWe first 
phalanx and aponeurotic ex- 
pansion of the extensor ten- 
don of the same finger, the 
middle finger being excluded. 
Adducts the fore finger and bends it toward the ulna. 
Adducts or bends the ring finger toward the radius. 
120. Interossei auricularis. 
121. Interossei dorsales. 
122. 
128. 
124. 
■ 
Are bipenniform muscles, and arise by two 
heads from the adjoining sides of the base of 
the metacarpal bones. 
The radial artery passes into the palm of the 
hand between the two heads of the first dor- 
sal interosseous muscle and the perforating 
branches of the deep palmar arch between 
the heads of the other dorsal interossei. 
Into the base of the first 
phalanges and aponeurosis of 
the extensor tendons. The 
first is inserted into the index 
- finger; the second and third 
into the middle finger, com- 
pensating its exclusion from 
the palmar group; the fourth 
into the ring finger. 
Adducts or bends the little finger toward the radius. 
Adducts or bends the index finger toward the radius. 
Adducts or bends the middle finger toward the radius. 
Adducts or bends the middle finger toward the ulna. 
Abducts or bends the ring finger toward the ulna. 
Muscles 
of the Abdomen. 
TORSO PELVIC, 
OR ANTERIOR ABDOMINAL, 5. 
125. Obliquus externus ab- 
dominis, descendens. 
By fleshy digitations from the external sur- 
face of the eight inferior ribs. The five upper 
digitations being received between corres- 
ponding processes of the pectoralis major and 
serratus magnus, and the three lower of the 
latissimus dorsi, it spreads out into a broad 
aponeurosis. The lower border of the aponeu- 
rosis, which is stretched between the anterior 
superior spinous process of the ilium and 
spine of the pubis is folded inward, forming 
Poupart’s ligament; the insertion into the 
pectineal line is Gimbernat’s ligament. 
Into the outer lip of the 
crest of the ilium for one-half 
its length, the anterior supe- 
rior spinous process of the 
illium, spine of tire pubis, pec- 
tineal line, front of the pubis 
and linea alba. 
The external oblique muscle acting singly, would draw the 
thorax toward the pelvis, and twist the body to the opposite side. 
Both muscles acting together would flex the thorax directly on the 
pelvis. It is a muscle of expiration. Its name is derived from 
the obliquity of its direction, and the descending course of its 
fibres. 
126. Obliquus internus ab- 
dominis, ascendens. 
From the outer half of Poupart’s ligament; 
from the middle of the crest of the ilium for 
two-thirds of its length, and by-a thin aponeu- 
rosis from the spinous process jof the lumbar 
Into the pectineal line, crest 
of tlie pubis, linea alba and 
lower borders of the five infe- 
rior ribs. 
Assists the former, but bends the trunk in the reverse direction. 
This is the middle flat muscle of the abdomen. It is a muscle of 
expiration. 876 
A TABLE OF THE MUSCLES. 
Name,. 
Origin. 
Insertion. 
Use. 
126. Obliquus intemus abdo- 
minis, ascendens (Con- 
tinuedl.) 
vertebrae. Its fibres diverge from their origin, 
so that those from Poupart’s ligament curve 
downward; those from the anterior part of the 
crest of the ilium pass transversely, and the 
rest ascend obliquely. 
The spermatic cord passes beneath the arche 
muscle, between it and Poupart’s ligament. 1 
are given off from the lower border of the mus 
downward, to the testicles, and form loops a 
muscle. In the descent of oblique inguinal 
course with the spermatic cord, the Crema 
coverings. 
d border of the internal oblique 
during its passage some fibres 
cle which accompany the cord 
round it; this is the Cremaster 
hernia, which travel the same 
ster muscle forms one of its 
127. Transversalis. 
From the outer third of Poupart’s ligament 
from the internal lip of the crest of the ilium, 
its anterior two-thirds; from the spinous and 
transverse processes of the lumbar vertebra;, 
and from the inner surfaces of the five infe- 
rior ribs, indigitating with the diaphragm. Its 
lower fibres curve downward. 
With the lower fibres of the 
internal oblique, into the pec- 
tineal line, and form the con- 
joined tendon. Through the 
rest of its extent it is inserted 
into the crest of the pubis and 
linea alba. The lower fourth 
of its aponeurosis passes in 
front of the rectus to the linea 
alba; the upper three-fourths 
with the posterior lamella of 
the internal oblique, behind it. 
To support and compress the abdominal viscera, and it is so 
particularly well adapted for that purpose that it might be called 
proper constrictor of the abdomen. This is the internal flat 
muscle of the abdomen. It is a muscle of expiration. 
128. Rectus abdominis. 
By two heads from the ligament of the car- 
tilage, which joins the two ossa pubis to each 
other; runs upward the whole length of, and 
parallel to, the linea alba, growing broader 
and thinner as it ascends. 
It is transversed by several tendinous zig-z 
One of these is usually situated at the umbilit 
sometimes one below. 
Into the cartilages of the 
fifth, sixth, and seventh ribs 
and often intermixes with 
some fibres of the pectoral 
muscle. 
ag lines called linse transversal, 
us, two above that point, and 
i 
Depresses the thorax and compresses the viscera muscle of ex- 
piration. 
129. Pyramidalis abdominis. 
From the crest of the pubis in front of the 
rectus. 
Into the linea alba %bout 
midway between the umbilicus 
and the pubis. 
Compresses, lowers, and extends the linea alba muscle of expi- 
ration. 
SUPERFICIAL LUMBAR, 3. 
130. Latissimus dorsi. 
_ From the spinous processes of the six infe- 
rior dorsal vertebrae, all the sacral and lum- 
bar, from the posterior third of the crest of the 
ilium, and from the three lower ribs by mus- 
cular slips which indigitate with the external 
oblique muscle of the abdomen. The inferior 
With the teres major into 
the posterior bicipital ridge of 
the humerus. 
Post-motor, adductor, and depressor of the arm, which it rotates 
inward. A TABLE OF THE MUSCLES. 
877 
fibres ascend obliquely, and the superior run 
transversely over the inferior angle of the 
scapula toward the axilla, where they are col- 
lected, twisted, and folded. 
181. Sacro-lumbalis. 
By a common origin from the posterior third 
of the crest of the ilium, from the posterior 
surface of the sacrum, and from the lumbar 
vertebra. Opposite the last rib a line of sepa- 
ration begins to be marked between the two 
muscles. 
By separate tendons into the 
angles of the six lower ribs. 
Straightens the trunk and bends the thorax backward toward 
the pelvis. 
182. Longlssimus dorsl. 
On turning the sacro-lumbalis a little out- 
ward a number of tendinous slips will be seen 
taking their origin from the ribs, and termi- 
nating in a muscular fasciculus, by which the 
sacro-lumbalis is prolonged to the upper part 
of the thorax. 
Into all the ribs between 
their tubercles and angles. 
Extends or straightens the trunk, or bends it backward and to 
one side. 
Musculus accessorius (ad 
sacro lurabalem.) 
This is the musculus accessorius ad sacro- 
lumbalem; it arises from the angles of the six 
lower ribs. 
By separate tendons into 
the angles of the six upper 
ribs. 
Cervicalis ascendens. 
Appears to be a continuation of the sacro- 
lumbalis upward into the neck. 
From the angles of the four upper ribs. 
Into the transverse pro- 
cesses of the four lower cervi- 
cal vertebras. 
DEEP LUMBAR, 3. 
188. Psoas magnus. 
From the intervertebral substances, part of 
the bodies and bases of the transverse pro- 
cesses, and from a series of tendinous arches, 
thrown across the constricted portion of the 
last dorsal and four upper lumbar vertebrae. 
These arches are intended to protect the lum- 
bar arteries and sympathetic filaments of 
nerves from pressure in their passages beneath 
the muscle. The tendon of the psoas magnus 
unites with that of the iliacus and the con- 
joined tendon. 
Into the posterior part of the 
trochanter minor. 
Flexes the thigh on the pelvis, and rotates it inward. 
184. Psoas parvus. 
From the tendinous arches and interverte- 
bral substance of the last dorsal and first lum- 
bar vertebrae, and terminates in a long, slen- 
der tendon. 
Into the pectineal line of 
the pubis. The tendon is con- 
tinuous by its outer border 
with the iliac fascia. 
Bends down the loins forward on the pelvis. 
135. Quadratus lumboruir. 
From the last rib, and from the transverse 
processes of the four upper lumbar verte- 
brae. 
Into the crest of the ilium. 
Depresses the last false rib, and bends the thorax to one side. 878 
A TABLE OF THE MUSCLES. 
Name. 
Origin. 
Insertion. 
Use. 
136. Sphincter ani. 
Is a thin elliptical plane of muscles closely 
adherent to the integument, and surrounding 
the opening of the anus. It arises posteriorly 
in the superficial fascia around the coccyx, 
and by a fibrous raphe from the apex of the 
bone. Internally it is a muscular ring em- 
bracing the extremity of the intestine, and 
formed by an aggregation of the circular mus- 
cular fibres of the rectum. 
Anteriorly into the tendi- 
nous centre of the perineum, 
and into the rapli6 of the in- 
tegument nearly as far for- 
ward as the commencement 
of the scrotum. 
Constrictor of the anus. 
• 
13T. Levator anl. 
From the inner surface of the pubis; from 
the spine of the ischium, and between those 
points from the angle of division between the 
obturator and the pelvic fascia. Its fibres 
descend. 
Into the extremity of the 
coccyx, into a fibrous raphd in 
front of that bone, into the 
lower part of the rectum and 
base of the bladder and pros- 
tate gland. In the female 
this muscle is inserted into the 
coccyx and fibrous raphe ex- 
tremity of the rectum and 
vagina. 
Raises the anus. It is the antagonist of the diaphragm and the 
rest of the expulsory muscles, and serves to support the rectum 
and vagina during their expulsive efforts. It acts in unison with 
the diaphragm, and raises and falls like that muscle in forcible 
respiration. Yielding to the propulsive action of the abdominal 
muscles, it enables the outlet of the pelvis to bear a greater force 
than a resisting structure, and on the remission of such actions it 
restores the perineum to its original form. 
138. Coccygeus. 
From the spine of the ischium. It is in 
immediate contact with the lesser sacro-ischi- 
atic ligament. 
Into the side of the coccyx 
and lower part of the sacrum. 
The coccygic muscles restore the coccyx to its natural position 
after it has been pressed backward during defecation or during 
parturition. 
genital oe THE MALE, 3. 
139. Erector penis. 
From the ramus and tuberosity of the 
ischium, and curves round the root of the 
penis. 
The upper surface of the 
corpus cavernosum where it is 
continuous with a strong fascia 
which covers the dorsum of 
the organ, the fascia penis. 
To compress the crura penis, by which the blood is pushed from 
it into the forepart of the corpora cavernosa. And the penis is 
by that means more completely distended. 
140. Accelerator urtnse. 
From a tendinous point in the centre of the 
perineum, and from the raphd. From these 
origins the fibres diverge like the plumes of a 
pen. 
The posterior fibres are in- 
serted into the ramus of the 
pubis and ischium; the middle 
to encircle the corpus spon- 
giosum, and meet upon its 
upper side, and be inserted 
partly into its fibrous structure, 
and partly into the fascia of 
the penis. 
Accelerator of the urine and semen. 
141. Transversus perine. 
From the tough, fatty membrane that covers 
the tuberosity of the os ischium. 
Into the central tendinous 
part of the perineum. 
Constrictor of the urethra. 
COCCYGEAL, OR ANAL, 3. A TABLE OF THE MUSCLES. 
879 
GENITAL 
OF THE FEMALE, 2. 
142. Erector clitoridis. 
From the crus of the os ischium internally, 
and in its ascent covers the crus of the cli- 
toris as tar up as the os pubis. 
Into the upper part of the 
crus and body of the clitoris. 
Erector of the clitoris. 
143. Constrictor vaginae. 
' From the sphincter ani, and from the pos- 
terior side of the vagina, near the perineum; 
from thence it runs up the side of the vagina, 
near its external orifice, opposite to the 
nymphsei, and covers the corpus cavernosum 
vagina. 
Into the crus and body, or 
union of the crura clitoridis. 
Constrictor of the vagina. 
Muscles of the Pelvis. 
POSTERIOR 
ILIAC, OR GLUTEAL, 
3. 
144. Gluteus maximus. 
From the posterior fifth of the external 
crest of the ilium; from the border of the 
sacrum and coccyx; and from the great sacro- 
ischiatic ligament. It passes obliquely out- 
ward and downward. This muscle forms the 
convexity of the nates. 
Into the rough line leading 
from the trochanter major to 
the linea asperia, and is con- 
tinuous by means of its ten- 
don with the fascia lata cover- 
ing the outer side of the thigh. 
A large bursa is situated be- 
tween the broad tendon of the 
muscle and the femur. 
Extensor or post-motor of the thigh, which it rotates outward. 
146. Gluteus medius. 
From the outer lip of the crest of the 
ilium, for four-fifths of its length from the 
surface of the bone between the border, and 
the superior curved line on the dorsum ilii, 
and from a deep and dense fascia. 
Its fibres converge to the 
upper part of the trochanter 
major, into which its tendon 
is inserted. 
Abductor, and slightly a rotator of the thigh outward. 
146. Gluteus minimus. 
Is a radiated muscle, arising from the sur- 
face of the dorsum ilii between the superior 
and inferior curved lines, and over the 
acetabulum. 
Its fibres converge to the 
anterior border of the tro- 
chanter major, into which it is 
inserted, by means of a round- 
ed tendon. 
Assists the former. 
ANTERIOR ILIAC, 1. 
147. Iliacus lntemus. 
Is a flat, radiated muscle ; it arises from 
the inner concave surface of the ilium, and 
after joining with the tendon of the psoas 
magnus. 
Into the posterior part of 
the trochanter minor. 
Flexes the thigh on the pelvis. 880 
A TABLE OF THE MUSCLES. 
Name. 
Origin. 
Insertion. 
Use. 
148. Obturator internus. 
From the inner surface of the anterior wall 
of the pelvis, being attached to the margin of 
bone round the obturator foramen, and to the 
obturator membrane. It passes out of the 
pelvis through the lesser sacro-ischiatic fora- 
men. The lesser sacro-ischiatic notch over 
which this muscle plays as through a pulley, 
is faced with cartilage, and provided with a 
synovial bursa to facilitate its movements. 
The tendon of the obturator is supported on 
each side by the two gamelli muscles (hence 
their names), which are inserted into the sides 
of the tendon, and appear to be auxiliaries 
or superadded portions of the obturator 
internus. 
By a flattened tendon into 
the trochanteric fossa of the 
femur. 
Rotator of the thigh outward. 
149. Obturator externus. 
From the obturate membrane, and from the 
lower surface of bone immediately surround- 
ing it—viz., from the body and ramus of the 
os pubis and ischium; its tendon passes 
behind the neck of the femur. 
With the external rotator 
muscles into the trochanteric 
fossa of the femur. 
Idem. 
150. Pyriformis. 
From the anterior surface of the second, 
third, and fourth bones of the sacrum, by 
little slips that are interposed between the 
anterior sacral foramina. It passes out of 
the pelvis through the great sacro-ischiatic 
foramen. 
By a rounded tendon into 
the trochanteric fossa. 
Idem and abducting. 
151. Gemellus superior. 
From the spine of the ischium. 
Into the upper border of the 
tendon of the obturator inter- 
nus, and into the anterior tro- 
chanteric fossa. 
Idem. 
152. Quadratus femoris. 
From the external border of the tuberosity 
of the ischium, anterior to the biceps semi- 
tendinosus and semi-membranosus. 
Into a rough line on the 
posterior border of the tro- 
chanter major, which is thence 
named linea quadrati. 
Idem. 
• 
Muscles of the Thigh. 
158. Rectus femoris. 
FEMORO-ROTULAR, OR ANTERIOR FEMORAL, 2. 
By two round tendons, one from the anterior 1 By a broad and strong ten- 1 Extensor of the leg and flexor of the thigh, 
inferior spinous process of the ilium, the other I don, into the upper border of ' 
PELT I-TROCH ANTERIAL, 5. 881 
A TABLE OF THE MUSCLES. 
from the upper lip of the acetabulum. It is 
fusiform in its shape, and bipenniform in the 
disposition of its fibres. 
the patella. It is more cor- 
rect to consider the patella as 
a sesamoid bone, developed 
within the tendon of the rec- 
tus ; the ligamentum patella? 
is the continuation of the ten- 
don to its insertion into the 
spine of the tibia. 
164. Triceps extensor femoris 
—viz.: 
Vastus externus. 
From the outer border of the patella, nar- 
row below and broad above. 
Into the femur and outer ' 
side of the linea asperia, as 
high as the base of the tro- 
chanter major. 
Vastus internus. 
From the inner border of the patella, nar- 
row above and broad below. 
Into the femur and inner 
side of the linea asperia, as 
high as the anterior inter-tro- 
chanteric line. 
Extensor of the leg. 
Crureus. 
From the upper border of the patella. 
Into the front aspect of the 
femur, as high as the anterior 
inter-trochanteric line. 
FEMORO-ISCHIATIC, OR POSTERIOR FEMORAL, 2. 
155. Semi-tendinosus. 
In common with the long head of the biceps; 
from the tuberosity of the ischium, and send- 
ing down a long roundish tendon. 
Into the inner tuberosity ' 
of the tibia. 
156. Semi-membranosus. 
Tendinous in common with the biceps and 
semi-tendinosus from the tuberosity of the os 
ischium, sends down a broad flat tendon, 
which ends in a fleshy belly, and in its de- 
scent runs at first on the forepart of the 
biceps, and, lower, between it and the semi- 
tendinosus. 
Into the posterior part of 
the inner tuberosity of the 
tibia; at its insertion the ten- 
don splits into three portions, 
one of which is inserted into 
a groove on the inner side of 
the head of the tibia, beneath 
the internal lateral ligament. 
The second is continuous with 
the aponeurotic expansion, 
that binds down the popliteus 
muscle—the popliteal fascia; 
and *the third turns upward 
and outward to the external 
condyle of the femur, form- 
ing the posterior ligament of 
the knee-joint (ligamentum 
posticum AVinslowii). 
Post-motors and rotators of the thigh inward, and flexors of the 
thigh. 
YOL. II.—56 882 
A TABLE OF THE MUSCLES. 
Name. 
Origin. 
Insertion. 
Use. 
157. Biceps flexor cruris. 
By two distinct heads—one by a common 
tendon with the semi-tendinosus; the other, 
muscular and much shorter, from the lower 
two-thirds of the external border of the linea 
asperia. This muscle forms the outer ham- 
string. 
By a strong tendon into the 
head of the fibula, fascia and 
outer tuberosity of the tibia. 
Post-motor of the thigh, flexor and rotator of the leg outward. 
FEMERO-PUBAL, 
OR INTERNAL FEMORAL, 6. 
158. Sartorius (tailor’s muscle) 
Is a long ribbon-like muscle, arising from 
the notch, immediately beneath the anterior 
superior spinous process of the ilium; it 
crosses obliquely the upper third of the thigh, 
descends behind the inner condyle of the 
femur. 
By an aponeurotic expansion 
into the inner tuberosity of the 
tibia. The inner border of the 
sartorius is the guide to the 
operation for tying the femo- 
ral artery in the middle of its 
course. 
Flexor of the leg and thigh on the pelvis, rotates the thigh, and 
powerfully adducts the leg. 
159. Pectineus. 
From the pectineal line (pecten a crest) of 
the os pubis. 
Into the line leading from 
the anterior inter-trochanteric 
line to the linea asperia. 
Adductor flexor and rotator inward of the thigh. 
• 
160. Gracilis. 
By a broad but very thin tendon, from the 
edge of the ramus of the pubis and ischium. 
It is situated along the inner border of the 
thigh. 
By a rounded tendon into 
the inner tuberosity of the 
tibia beneath the expansion of 
the sartorius. 
Flexes and adducts the leg. 
161. Adductor longus. 
By a round tendon from the angle of the os 
pubis, assuming a flattened shape. It is the 
most superficial of the three adductors. 
Into the middle third of the 
linea asperia. 
Adductor of the thigh. 
162. Adductor brevis. 
Placed between the pectineus and adductor 
longus, is fleshy and thicker than add. longus. 
Arises from the body and ramus of the os 
pubis. 
Into the upper third of the 
linea asperia. It is pierced by 
the middle perforating artery, 
and supports the anterior 
branch of the obturator nerve 
and artery. 
Idem. 
168. Adductor magnus. 
Is a broad and extensive muscle, forming a 
septum of division between the muscles situ- 
ated on the anterior, and those on the poste- 
rior aspect of the thigh. It arises by fleshy 
fibres from the ramus and side of the tube- 
rosity of the ischium, and radiating in its pas- 
sage outward. 
Into the whole length of the 
linea asperia and inner con- 
dyle of the femur. It is 
pierced by five openings; the 
three superior for the three 
perforating arteries; the fourth 
for the termination of the pro- 
funda ; the fifth is the large 
oval opening in the tendinous 
portion of the muscle, that 
gives passage to the femoral 
vessels. 
Idem. 883 
A TABLE OF THE MUSCLES. 
EXTERNAL FEMORAL, 1. 
164. Tensor vaginae femoris. 
Is a short, flat muscle, situated on the outer 
side of the hip. It arises from the crest of 
the ilium, near to its anterior superior spinous 
process. 
Between two layers of the 
fascia lata, at about one-fourth 
down the thigh. 
Abductor and tensor of the aponeurosis called fascia lata. 
Muscles of the Leg. 
SUPERFICIAL TIBIO-PERONEAL OR TIBIAL, 4. 
166. Tibialis anticus (flexor 
tarsi tibialis.) 
From the upper two-thirds of the tibia, 
from the interosseous membrane, and from 
the deep fascia: its tendon passes through a 
distinct sheath in the annular ligament. 
Into the inner side of the in- 
ternal cuneiform bone and 
base of the metatarsal bone of 
the great toe. 
Flexes and bends the foot inward. 
166. Extensor longus com- 
munis digitorum. 
From the head of the tibia; from the upper 
three-fourths of the fibula; from the inter- 
osseus membrane; and from the deep fascia. 
Below it divides into four tendons, which pass 
beneath the annular ligament. 
The mode of insertion of the extensor tendoi 
foot, is remarkable; each tendon spreads int 
first phalanx; this aponeurosis divides into th 
serted into the base of the second phalanx, an 
tinued onward, to be inserted into the base of 
Into the second and third 
phalanges of the four lesser 
toes. 
is both in the hand and in the 
a broad aponeurosis over the 
ree slips, the middle one is in- 
d the two lateral slips are con- 
he third. 
Common extensor of the toes and flexor of the foot. 
• 
16T. Peroneus longus (exten- 
sor tarsi fibularis longior). 
From the upper third of the outer side of 
the fibula, and terminates in a long tendon, 
which passes behind the external malleolus, 
and obliquely across the sole of the foot, 
through the groove in the cuboid bone. 
Into the base of the meta- 
tarsal bone of the great toe. 
The upper part of its origin 
is pierced by the peroneal 
nerve; its tendon is thickened 
where it glides behind the ex- 
ternal malleolus, and a sesa- 
moid bone is frequently de- 
veloped in that part which 
plays upon the cuboid bone. 
Extends the foot and elevates its outer edge. 
168. Gastrocnemius. 
By two heads from the two condyles of the 
femur, the inner head being the longest. 
By means the tendo 
Achillis into the lower part of 
the tuberosity of the os calcis, 
a synovial bursa being placed 
between that tendon and the 
upper part of the tuberosity. 
Extensor of the foot and flexor of the leg. 
MIDDLE TIBIO-PERONEAL, OR TIBIAL, 3. 
169. Popliteus. 
By a rounded tendon from a deep groove on 
the outer side of the external condyle of 
femur, beneath the external lateral ligament, 
spreads obliquely over the head of the tibia. 
Into a ridge at the upper 
and internal edge of the tibia 
a little below its head. 
Flexes the leg and rotates it inward. 884 
A TABLE OF THE MUSCLES. 
Name. 
Origin. 
Insertion. 
Use. 
170. Soleus. 
From the head and upper third of the 
fibula; from the oblique line and middle third 
of the tibia. 
It is a broad muscle, upon which the planta 
and tibial regions of this muscle is a tendinous 
liteal vessels and nerve pass into the leg. 
Its fibres converge to the 
tendo A chillis, by which it is 
inserted into the tuberosity of 
the os calcis. 
ris rests. Between the fibular 
arch, beneath which the pop- 
Extensor of the foot. 
171. Plantaris. 
Is a very small muscle, situate at its upper 
third, between the gastrocnemius and soleus ; 
arises from the outer condyle of the femur, 
above the gastrocnemius. 
By its long and delicately 
slender tendon into the inner 
side of the tuberosity of the 
os calcis, by the side of the 
tendo Achilils. 
Extensor of the foot and flexor of the leg. 
DEEP TIBIO-PERONEAL, OR TIBIAL, 6. 
172. Extensor proprius pollicis 
pedis. 
Lies between the tibialis anticus and exten- 
sor longus digitorum. Arises from the lower 
two-thirds fibula and interosseus membrane. 
Its tendon passes through a 
distinct sheath in the annular 
ligament, and is inserted into 
the base of the last phalanx 
of the great toe. 
Extends the great toe and flexes the foot. 
173. Peroneus brevis. 
Lies beneath the peroneus longus; arises 
from the upper 2-3 of the fibula. 
Terminates in a tendon, 
passes behind the external 
malleolus, and passes through 
a groove in the os calcis, and 
is inserted into the base of the 
metatarsal bone of the little 
toe. 
Extends the foot and raises its outer *dge. 
174. Peroneus tertius (flexor 
tarsi fibularis). 
From the lower fourth of the fibula. 
Although apparently but a mere division of 
the extensor longus digitorum, this muscle 
may be looked upon as analogous to the 
flexor carpi ulnaris of the forearm. Some- 
times it is altogether wanting. 
Into the base of the meta- 
tarsal bone of the little toe. 
Flexor of the foot, which it inclines outward. 
175. Tibialis posticus (exten- 
sor tarsi tibialis). 
Lies upon the interosseus membrane be- 
tween the two bones of the leg. It arises by 
two heads from the adjacent sides of the tibia 
and fibula, their whole length, and from the 
interosseus membrane. Its tendon passes in- 
ward, beneath the tendon of the flexor longus 
digitorum, and runs in the same sheath, lying 
internally to it into the sole of the foot. 
Into the tuberosity of the 
scaphoid bone and internal 
cuneiform bone. 
Extensor of the tarsus upon the leg, and an antagonist to the 
tibialis anticus. It combines with the tibialis anticus in adduction 
of the foot. 
176. Flexor longus pollicis 
(pedis). 
From the posterior half of the fibula. 
Some way below its head, passes under the 
Into the base of the last 
phalanx of the great toe. 
Flexor of the great toe. A TABLE OP THE MUSCLES. 
885 
annular ligament; through a distinct tendinous 
canal into the sole of the foot. 
177. Flexor longus digitorum 
(pedis perforans). 
From the surface of the tibia immediately 
below the popliteal line. Its tendon passes 
through a sheath common to it, and the tibi- 
alis posticus behind the inner malleolus into 
the sole of the foot, where it divides into four 
tendons. 
Into the base of the last 
phalanx of the four lesser 
toes, perforating the tendons 
of the flexor brevis digitorum. 
Common flexor of the toes and extensor of the foot. 
Muscles of the Foot. 
• 
DORSAL, 1. 
178. Extensor brevis digi- 
torum. 
From the outer side of the os calcis, crosses 
the foot obliquely, and terminates in four 
tendons. 
. 
* 
The innermost of which is 
inserted into the base of the 
first phalanx of the great toe, 
and the other three into the 
sides of the long extensor 
tendons of the second, thud, 
and fourth toes. 
Common extensor of the toes. 
SUPERFICIAL PLANTAR, 5. 
, 
179. Adductor pollicis. 
From the cuboid bone; from the sheath of 
the tendon of the peroneus longus, and from 
the base of the third and fourth metatarsal 
bones. 
Into the base of the first 
phalanx of the great toe. 
Adductor and flexor of the great toe. 
180. Flexor brevis pollicis. 
By a pointed tendinous process from the os 
calcis, the side of the cuboid, and from the 
external and middle cuneiform bones. 
By two heads into the base 
of the first phalanx of the 
great toe. Two sesamoid 
bones are developed in the 
tendons of insertion of these 
two heads, and the tendon of 
the flexor longus pollicis lies in 
the groove between them. 
Flexor of the great toe. 
181. Flexor brevis digitorum 
perforatus. 
From the under surface of the os calcis, 
and plantar fascia. 
By four tendons into the 
base of the second phalanx of 
the four lesser toes. Each 
tendon divides previously to 
its insertion, to give passage 
to the tendon of the long flexor 
(hence perforatus). 
Common flexor of the toes. 
182. Flexor brevis minimi 
digiti pedis. 
From the base of the metatarsal bone of 
the little toe, and from the sheath of the ten- 
don of the peroneus longus. 
Into the base of the first 
phalanx of the little toe. 
Flexor of the little toe. 886 
A TABLE OF THE MUSCLES. 
Name. 
Origin. 
Insertion. 
Use. 
183. Abductor minimi digiti 
pedis. 
From the outer side of the os calcis, and 
from the base of the metatarsal bone of the 
little toe. It lies along the outer border of 
the sole of the foot. 
Into the base of the first 
phalanx of the little toe. 
Abductor of the little toe. 
DEEP PLANTAR, 14. 
184. Musculus accessorius (se- 
cond portion of flexor 
long. com. digitorum— 
Massa carnea Jacobii 
Svlvii.) 
By two slips from either side of the under 
surface of the os calcis, the inner slip being 
fleshy, the outer tendinous. 
Into the outer side of the 
tendon of the flexor longus 
digitorum. 
Rectifies the oblique action of the long flexor communis of the 
toes. 
1S5. Four Lumbricales. 
Are four small muscles arising from the 
tibial side of the tendons of the flexor longus 
digitorum. 
Into the expansion of the 
extensor tendons, and into the 
base of the first phalanx of 
the four lesser toes. 
Bend the phalanges upon the metatarsus. 
186. Transversus pedis. 
18T. Interossei plantares. 
By fleshy slips from the heads of the meta- 
tarsal bone of the four lesser toes. 
Tendinous into the base of 
the first phalanx of the great 
toe. 
Abducts the great toe. 
Abducts the great toe. 
188. Idem. 
189. Idem. 
From the base of the metatarsal bones of 
the toes. 
Into the inner side of the 
extensor tendon and base of 
the first phalanx of the same 
toes. 
Adducts the third toe. 
Adducts the fourth toe. 
190. Idem. 
191. Interossei dorsales. 
192. Idem. 
193. Idem. 
194. Idem. 
< 
By two heads from the adjacent sides of the 
metatarsal bones. 
Into the base of the ‘first 
phalanx, and into the digital 
expansion of the tendons of 
the long extensor. The first 
is inserted into the inner side 
of the second toe, and is 
therefore an adductor. The 
other three are inserted into 
the outer side of the second, 
third, and fourth toes, and 
are therefore abductors. 
Adducts the fifth toe. 
Adductor of the second toe. 
Adducts the second toe. 
Adducts the third toe. 
Adducts the fourth toe. A TABLE OF INCOMPATEBLES. 
A TABLE OF INCOMPATIBLES. 
SAMUEL R. PERCY, M.D., NEW YORK. 
Most of the articles here presented must he understood to be in solution. The formulae 
given of them are as they are obtained in the dry state, and uncombined with water of crystal- 
lization. Many of the vegetable preparations present incompatibles with their infusions 
which are not incompatible with the alkaloids contained in their infusions, and it may be 
doubted if such re-agents injure their medicinal activity. The writer would respectfully sug- 
gest that there is as much, perhaps more, necessity for studying therapeutic incompatibles 
as chemical ones. 
1. Absinthium, with acetate of lead, tartar emetic, nitrate of silver, sulphates of iron 
and zinc. 
2. Aoacia—C12 Hlu 010—with alcohol, sulphuric ether and its compound spirits, strong 
acids, ammonia, subacetate of lead, tinct. mur. iron, nitrate of mercury. 
3. Acidum Aceticum—C4 IF O3—with alkalies, alkaline and earthy carbonates, metallic 
oxides, etc. 
4. Acidum Arseniosum—As O3—with lime water, astringent vegetable infusions and 
decoctions, hydrated peroxide of iron, magnesia. 
5. Acidum Benzoicum—C14 H5 O3 + Aq—with the mineral acids. 
6. Acidum Citricum—C4 H2 04—with mineral acids, nitrate and acetate of mercury, 
acetate of lead, alkalies, alkaline carbonates and sulphurets, metallic oxides. 
7. Acidum Gallicum—C7 H3 O5—with the sulphate of copper, lime water, carbonates 
of iron and potash, acetate of lead, nitrate of silver, solutions of opium, Goulard’s 
extract, iodide of iron, tartar emetic, and albumen. 
8. Acidum Hydriodicum—HI—with atmospheric air, nitrate of silver, sulphate of cop- 
per and iron, nitric acid, chlorine, sulphuric acid. 
9. Acidum Hydrocyanicum—HCy—with nitrate of silver, chlorine, mineral acids, 
metallic oxides. 
10. Acidum Hydrochloricum—HC1—with alkalies, alkaline earths and their carbonates, 
with most metallic oxides and salts, especially those of silver, sulphuret of potas- 
sium, salifiable bases. 
11. Acidum Hydrosulphuricum—HS—with nitrate of silver, acetate of lead, arsenious 
acid, sulphate of copper, metallic solutions, alkalies, etc. 
12. Acidum Lacticum—HO, C6 H5 O5—with mineral acids, alkalies. 
13. Acidum Nitricum—NO6—with alkalies, alkaline earths and their carbonates, essen- 
tial oils, metallic oxides, salifiable bases. 
14. Acidum Oxalicum—C2 O3, HO+Aq—with alkalies, alkaline earths and their carbon- 
ates, metallic oxides, lime-water, nitrate of silver, chloride of barium, sulphuric 
acid. 888 
A TABLE OF INCOMPATIBLES. 
15. Acidum Phosphoricum—PO6—with alkalies, alkaline earths and their carbonates, 
chloride of barium, sulphate of lime and magnesia, nitrate of silver, acetate of lead. 
16. Acidum Succinicum—C4 IP 0s—with sesquichloride of iron, oils, acetate of lead, 
chloride of barium, nitrates of silver and mercury, mucilage. 
17. Acidum Sulphuricum—SO3—with alkalies, alkaline earths and their carbonates, sul- 
phurets, oxalic acid, phosphates, borates, hydrochlorates, nitrates, acetates, iodine, 
metallic iodides, baryta strontia, lead. 
18. Acidum Sulphurousum—SO2—with atmospheric air by which it is converted into 
sulphuric acid, hydrosulphuric acid. All the sulphites evolve sulphurous acid when 
treated with sulphuric or hydrochloric acid. Chlorine converts most sulphites to 
sulphates, chloride of barium precipitates neutral sulphites, but not free sulphurous 
acid. 
19. Acidum Tannicum—C18 H8 012—with albumen, gelatine, the persalts of iron, alka- 
lies, alkaline earths and their carbonates, acetate of lead, tartar emetic, solutions of 
the vegetable alkaloids. (See Galla.) 
20. Acidum Tartaricum—C4 II2 06 + HO—with alkalies, alkaline earths and their car- 
bonates, salts of potassa, chloride of calcium. 
21. Aconitia—NC60 H47 014—Precipitated from its solutions by potassa, soda and ammonia, 
but is redissolved by an excess of ammonia; by the carbonates of these alkalies, 
which do not redissolve the precipitate ; by the vegetable astringents, magnesia and 
its carbonate, salts of iron, copper, zinc, silver lead. 
The same will apply to the tinctures and extracts of aconite. 
Tents of Purity.—It is fusible at a gentle heat; and is entirely dissipated, leaving 
no residue, at a high temperature. It is sparingly soluble in water, requiring 
for its solution 150 parts of cold and 50 parts of boiling water. Is perfectly 
soluble in the dilute mineral acids, from which solution it should be precipitated 
without loss of weight by ammonia, cautiously added. Is soluble in ether and 
alcohol. 
22. JEther Sulphuricus—C4 H6 0.—Ether, as it evaporates, should leave but little foreign 
odor. When shaken with an equal volume of water, it should lose twenty-two per 
cent, of its volume. “ In a test tube half filled and grasped in the hand for a short 
time, it should commence to boil very slowly on the addition of small fragments 
of broken glass.” It should not redden litmus paper. 
23. iEtheris Spiritus Nitrici.—Sulphate of protoxide of iron produces a deep olive color; 
tincture of guaiacum, a blue changing to a green. It should boil if held in water at 
a temperatuae of 160°F., upon the addition of small fragments of broken glass. 
24. Albumen—C400 H310 N60 O120 S2 P—Nitric and hydrochloric acids, alcohol, corrosive 
sublimate, chloroform, creasote, heat, persulphate of iron, tannin, alum, nitrate 
silver. 
25. Alcohol—C4 H8 02—with mucilages, nitrate of lime, chloride of barium. 
26. Aloe, with galls, oak bark, and astringent vegetable infusions, chlorine, alum proto- 
cliloride of tin, nitrates of silver and mercury, tartar emetic, acetate lead. 
27. Alumen—Al2 0s, 3S03 + KO, SO3—with alkalies and their carbonates, lime and lime- 
water, magnesia and its carbonate, tartarate of potassa, acetate of lead, astringent 
vegetable infusions, salts of mercury, ammonia. 
28. Ammonia—NH3—with acids, mineral salts, alum, the alkaloids, etc. 
29. Ammoniae Acetas—Nil3, C4 H3 03—(Ammonia Acetatis Liquor) with strong acids, 
alkalies, alkaline earths, nitrate of silver, corrosive sublimate, lime water, alum, 
sulphates of iron, copper, zinc and magnesia. 
30. Ammoniae Bicarbonas—NH3, 2C02—with acids, fixed alkalies, lime-water, etc. 
31. Ammoniae Carbonas—NH8, CO2—with acids, fixed alkalies and their carbonates, 
lime-water, magnesia, chloride of calcium, alum, bitartrate and bisulphate of 
potassa, solutions of iron (except the tartrate of iron and potassa), corrosive sub- 
limate, acetate of lead, sulphate of zinc. 889 
A TABLE OF IXCOMPATIBLES. 
Test of Purity.—When heated on a piece of glass, it should evaporate without 
residue. 
32. Ammoniee Hydrochloras—NH3, IIC1—with nitric and sulphuric acids, acetate of 
lead, nitrate of silver, soda, potassa, lime and their carbonates. 
33. Ammoniee Hydrosulphuretum—ISTH3 2HS—with acids, metallic salts. 
34. Amygdalin— —with the alkalies, alkaline earths and their carbonates, when 
mixed with emulsin or emulsion of sweet almonds, it forms hydrocyanic acid and 
volatile oil of bitter almonds; this is caused by a fermentation that takes place 
between them, that may be prevented by adding alcohol or acetic acid. 
Tests of Purity.—It should form a perfectly transparent solution with water; inso- 
luble in ether; should leave no residue on incineration. 
35. Amylum—C12 H10 010—Iodine, acids, lime water, baryta water, subacetate of lead, 
tannin, bromine. 
36. Angustura, with sulphates of iron and copper, tartar emetic, acetate of lead, corro- 
sive sublimate, citrate of silver, potassa, ammonia, tannin. 
37. Anthemis, with gelatine, gallic acid, salts of iron, nitrate silver, corrosive sublimate. 
38. Antimonii Oxidum—SbO3—Sulphureted hydrogen, tartaric acid, zinc, etc. 
39. Antimonii et Potassae Tartras—SbO3, K02C4 IP O5—with acids, alkalies, and 
their carbonates, most of the earths and metals, chloride of calcium, acetate of lead, 
astringent vegetable infusions and decoctions, soap, sulphureted hydrogen, impure 
water. 
Tests of Purity.—One hundred grains dissolved in water should yield forty-nine 
grains of ter-sulphuret of antimony to a solution of hydrosulphuric acid. A 
dilute solution should not be precipitated by chloride of barium, nitrate of silver, 
nor rendered blue by ferrocyanuret of potassium. 
40. Antimonii Sulphuretum—SbS3—with nitric and nitro-hydrochloric acids, tartaric 
acids. 
41. Argenti Cyanuretum—AgCy—with hydrochloric acid, hydrosulphuric acid, etc. 
42. Argenti Nitras—AgO, NO5—with organic matter, impure water, the soluble chlo- 
rides ; sulphuric, hydrosulphuric, hydrochloric, tartaric acids and their salts; the 
alkalies and their carbonates ; lime water; astringent vegetable infusions. 
Tests of Purity.—If copper is present, its solution becomes blue on being super- 
saturated with ammonia. A solution of chloride of sodium, added in excess 
to one of nitrate of silver, throws down a white, curdy precipitate, and • 
nothing besides; this precipitate should be entirely soluble in ammonia. To 
detect nitre, a very common adulteration, a solution of the suspected salt should 
be precipitated by hydrochloric acid, and sulphureted hydrogen; the filtered 
solution, if the salt be pure, will entirely evaporate by heat; if it contains nitre 
it will be left. “ When a small piece of caustic is crushed to powder and 
spread evenly over a piece of paper, and the paper and powder then rolled up 
together, twisted, and burned as a match, it should leave a tasteless residue.” 
43. Argenti Oxidum—AgO—with hydrosulphuric and nitric acids, heat, etc. 
44. Arnica, with sulphates of iron and zinc, acetate of lead, nitrate of silver. 
45. Assafcetida, with the mineral acids, lime, hydrosulphuric acid, nitrate silver. 
46. Atropa Belladonna, with alkalies, alkaline earths and their carbonates; vegetable 
astringents; lime water. 
4* 
47. Atropia—NC34 H23 Oa=At—with alkalies, alkaline earths and their carbonates, lime 
water, tannin, the salts of iron, zinc, lead and copper. 
Tests of Purity.—It is entirely soluble in absolute alcohol and ether; 100 parts 
of chloroform dissolves 51 parts of atropia. It is perfectly soluble in the dilute 
mineral acids, and is precipitated from- its solution without loss of weight by 
ammonia, which should not be added in excess, as it redissolves the pre- 
oinitatfi. 890 
A TABLE OF INCOMPATIBLES. 
48. Barii Chloridum—BaCl—with the sulphates, oxalates, tartrates, borates, carbonates 
and alkaline phosphates, nitrate of silver, acetate of mercury, acetate of lead. 
49. Barytae Carbonas—BaO, CO2—with sulphuric acid and sulphates, sesqui-oxide of iron, 
alumina. 
50. Belladonna—(See Atropa Belladonna.) 
61. Benzole—C12 H6—Is mentioned here more for its great solvent powers; its incom- 
patibles have not been sufficiently tested. It dissolves sulphur, phosphorus, iodine, 
mastic, camphor, wax, fatty and essential oils, caoutchouc, gutta percha. It dissolves 
quinia, but not cinchonia. Its boiling point is 176°F. 
52. Bismuthi Subnitras—BiO31 NO5—with hydrosulphuric acid, carbonate and chromate 
of potassa, vegetable astringents. 
53. Brominium—Br—with chlorine, water, atmospheric air, nitrate of silver, starch. 
+ 
54. Brucia—C46 H26 N2 08=Br—with potassa and carbonate of soda. 
Tests of Purity.—Ammonia produces a white precipitate pn solution of salts of 
brucia, which appears at first like a number of minute drops of oil, but changes 
subsequently—with absorption of water—to small needles. The precipitate 
redissolves, immediately after separation, very readily in an excess of the pre- 
cipitant, but after a very short time—or, in dilute solutions after a longer time 
—the brucia combined with crystallization water, crystallizes from the ammo- 
niacal fluid in small, concentrically grouped needles which addition of ammonia 
fails to redissolve. 
Bicarbonate of soda produces in neutral solutions of salts of brucia a precipitate 
of brucia, which separates into concentrically aggregated needles of silky lustre 
and are insoluble in an excess of the precipitant, but dissolve in free carbonic 
acid. Concentrated nitric acid dissolves brucia and its salts to intensely red 
fluids, which subsequently acquire a yellowish-red tint and become completely 
yellow upon application of heat. Upon addition of protochloride of tin or 
sulphide of ammonium to this yellow fluid, it changes to a most intense violet. 
Chlorine water imparts to solutions of its salts a fine bright red tint, to which 
if ammonia is added, it changes to yellow brown. 
55. Cadmii Sulphas—CdO, SO3—with potassa ammonia and their carbonates, hydro- 
sulphuric acid, lime water, the carbonates and sulphurets. 
56. Calcis Carbonas—CaO, CO2—with acids, acidulous salts, alum, vegetable astrin- 
gents, soaps. 
57. Calcii Chloridum—CaCl—with the soluble sulphates, the carbonates of potassa, 
soda, magnesia. 
58. Calcis Liquor, with atmospheric air, mineral and vegetable acids, alkaline carbonates, 
and sulphates, soap, vegetable astringents, alum, acidulous and metallic salts, 
spirituous preparations. 
59. Calcis Phosphas—8CaO, 3P05—with oxalate of lime, acetate of lead, nitrate of 
silver, carbonate of soda, potassa, ammonia. 
60. Calx Chlorinata—CaO, Cl—with the acids, sulphate of iron, nitrate of silver, 
iodides. 
61. Camphora—C10 H8 0—with strong sulphuric and nitric acids, assafoetida, galbanum 
sagapenum, anime, tolu. 
62. Cantharis, with strong acids, caustic alkalies. 
63. Capsicum, with sulphate of iron, acetate of lead, nitrate of silver, corrosive sub- 
limate, sulphates and sulphurets of the metals. 
64. Castoreum, with strong acids, caustic alkalies, tannin. 
65. Catechu, with gelatine, albumen, gluten, starch, the salts of the sesqui-oxides of iron 
the salts of lead, copper, silver, mercury, tin. 
66. Cinchona, with alkalies, sulphates of iron and zinc, sulphurets, lime, magnesia, nitrate 
of silver, tartar emetic. 891 
A TABLE OF INCOMPATIBLES. 
67. Cinchonia—C40 H24 N2 02=Ci—with the alkalies, alkaline earths and their car- 
bonates. 
Tests of Purity.—Cinchonia and its salts are insoluble in ether and benzole. 
Potassa, ammonia and their neutral carbonates produce in solution of cinchonia 
a white, loose precipitate, which does not redissolve in an excess of the pre- 
cipitants. If chlorine water is added to a solution of the salts of cinchonia, 
it does not change the color, but if ammonia is added, a yellowish white pre- 
cipitate is formed. 100 parts of chloroform dissolve but 4.31 of cinchonia. 
Cinchotina, with which it is sometimes admixed, is soluble in ether. (See 
Quinia.) 
68. Chloroformum—C2 HC13—with albumen. It would be improper to mix chloroform 
with any of the vegetable preparations whose alkaloid is soluble in chloroform, in 
any quantity more than sufficient for one dose, as the chloroform would dissolve the 
whole of the alkaloid. 
Tests of purity.—If equal parts of colorless, concentrated sulphuric acid and 
chloroform are shaken together in a glass-stoppered vial, there should be no 
color imparted to either liquid, nor any sensible heat developed at the time of 
mixing. If chloroform is dropped into water, it should not assume a milky 
appearance, but should be in transparent globules under the water. It 
should evaporate from the hand or bibulous paper without foreign odor. 
69. Cimicifuga, with the sesqui salts of iron, with alkalies. 
70. Cocculus, with alkalies and alkaline earths. 
71. Coccus, with the salts of zinc, bismuth and nickel, which produce a lilac precipitate; 
with the salts of iron a dark purple; with the salts of tin a brilliant scarlet; with 
alumina the lakes. 
72. Colchicum, with acetate of lead, nitrates of silver and mercury, tannin. Acids 
are said to render its preparations more drastic, and alkalies to render them milder 
in their operation, but as acids dissolve and alkalies precipitate its alkaloid, it will be 
seen that alkalies cannot be added but in extemporaneous mixtures. 
73. Colocynthis, with sulphate of iron, acetate of lead, nitrate silver, tannin, alkalies. 
+ 
74. Conia—NC16 H15=Co—with tannin, albumen, salts of aluminum, copper, lead, zinc, 
manganese, iron, nitrate silver, alkalies. 
75. Creasotum—C13 Hs O2—with nitric and sulphuric acids, nitrate and acetate of silver, 
albumen. 
76. Cupri Subacetas—2CuO, C4 H3 O3—with sulphuric acid, water which changes it to a 
neutral acetate and trisacetate, nitrate of silver, lime water. 
77. Cupri Sulphas—CuO, SO3—with potassa, soda and the alkaline carbonates; by 
ammonia, which, if added in excess, redissolves the precipitate; borax, acetates of 
lead and iron, nitrate silver, corrosive sublimate, tartrate of potassa, chloride of 
calcium, tannin, arsenites, hydrosulphuric acid, metallic iron. 
78. Cuprum Ammoniatum—Nil3, S03 + NH3, CuO + HO—with potassa, soda, lime water, 
arsenious acid, acids; water and air on long exposure; tannin. 
79. Curcuma—alkalies change its color to reddish-brown, as do also the concentrated 
mineral acids, pure boracic acid and numerous metallic salts, so that it cannot alone be 
relied upon as a test for alkalies. Its alcoholic solution produces colored precipitates 
with nitrate of silver, acetate of lead and other salts. 
80. Datura Stramonium, with the salts of iron, lead, mercury, and silver, alkalies, alka- 
line earths and their carbonates, tannin. 
81. Daturia—NC34 H23 O6—with alkalies, tannin. 
82. Delphinia, with alkalies, alkaline earths and their carbonates, tannin. 
83. Digitalis, with sulphate of iron, acetate of lead, nitrate of silver, vegetable infusions or 
tinctures containing kinic, tannic or gallic acids. 892 
A TABLE OF INCOMPATIBLES. 
84. Digitalin, with tannic and gallic acids, alkalies and their carbonates. 
85. Elaterium, with alkalies and their carbonates, tannic and gallic acids. 
86. Elaterin, with strong mineral acids, alkalies and their carbonates, tannin. 
87. Emetia, with gallic and tannic acids, acetate of lead, corrosive sublimate, alkalies. 
88. Ergota, with acetate of lead, nitrate of silver, astringent vegetable infusions and 
tinctures, 
89. Ferri Ammonio Citras, with potassa, lime water, mineral acid, tannin. 
90. Ferri Chloridi Tinctura, with alkalies, alkaline earths and their carbonates, astringent 
vegetable infusions and tinctures, mucilage of gum arabic, Fowler’s solution. 
91. Ferri Citras—Fe2 O3, C12 H5 On—with mineral acids, alkalies, lime water, tannin. 
92. Ferri ferro-cyanuretum—Fe7 Cy9—with nitric and hydrochloric acids, oxide of mer- 
cury with chromate of lead, it forms a beautiful green. 
93. Ferri Iodidi—Fel—alkalies and their carbonates, and all other substances by which 
the sulphate of iron is decomposed. 
94. Ferri Liquor Perchloridi, with atmospheric air, alkalies and their carbonates, 
metallic salts, vegetable astringents, nitrate silver, etc. 
95. Ferri Liquor Persulphatis (Mousel’s solution), albumen, fibrin, gluten, etc. 
96. Ferri Oxidum Hydratum—Fe2 03 + 2II0—used principally as an antidote to arsenic. 
is incompatible with the same substances as the other sesqui-oxides. 
97. Ferri Phosphas—FeO, P05 + Fe2 O5, PO6—same as sulphate of iron. 
98. Ferri Pulvis—Fe—(iron reduced by hydrogen) atmospheric air, water, acids and 
acidulous salts, solutions of vegetable astringents, vegetable extracts. 
99. Ferri Fyrophosphas.—This is a double salt, composed of about 49 per cent, of anhy- 
drous pyrophosphate of iron, 35 per cent, of citrate of ammonia, and 16 per cent, 
of water. Eobiquet states that it is not incompatible with the vegetable tonics and 
astringents, but this is not the case; but the changes do not take place quickly, 
therefore there is no objection to their mixture for extemporaneous administration. 
100. Ferri Subcarbonas (Ferri Sesqui-oxidum)—Fe2 O3—with acids and acidulous salts. 
101. Ferri Sulphas—FeO, SO3—with alkalies, alkaline earths and their carbonates, lime- 
water, nitric acid, borax, iodide of potassium, acetate of lead, vegetable astringents, 
soap, muriate of barytes, nitrate of potassa, tartrate of soda and potassa, nitrate of 
silver, phosphate of soda. 
102. Ferri Sulphuretum—5FeS + Fe2 S3—with acids which unite with the iron, with 
acidulous salts and vegetable astringents, etc. (See Potassii Sulphuretum.) 
103. Ferri Syrupus Superphosphatis, is a double salt in solution like the last, the phos- 
phoric acid being in excess. It is decomposed by the same substances that decom- 
pose most of the salts of iron. 
104. Ferri Valerianas, with boiling water, mineral acids, alkalies and their carbonates, 
vegetable astringents, salts of copper and zinc, etc. 
105. Ferrum Ammoniatum, with atmospheric air, alkalies and their carbonates, lime- 
water, acids and acidulous salts, astringent vegetable infusions and tinctures. 
106. Galla—Sulphuric and hydrochloric acids, acetate of lead, sulphates of iron and cop- 
per, nitrates of silver and mercury, lime water, carbonates of ammonia and potassa, 
tartar emetic, corrosive sublimate, infusions of Colombo, opium, peruvian bark and 
most other vegetables containing alkaloid principles, gelatin, albumen, gluten, alka- 
lies and their carbonates. (See Acid. Tannicum.) 
107. Guaiaci Tinctura, with mineral acids, spirits nitric ether, water. 
108. Hematoxylon, with sulphuric, nitric, hydrochloric, and acetic acids, alum, sulphates 
of iron and copper, acetate lead, tartar emetic, gelatine, etc. 
109. Helleborus Niger, with alkalies, alkaline earths and their carbonates, tannin. 893 
A TABLE OF INCOMPATIBLES. 
110. Hydrargyrum—Hg—with the mineral acids, iodine, bromine. 
111. Hydrargyrum Ammoniatum—HgCl, NIP—with mineral acids, alkalies, protochlo- 
ride of tin, boiling wa ter. 
112. Hydrargyrum cum Creta, with acids, iodine, bromine, acidulous salts, alum, etc. 
113. Hydrargyri Chloridum Corrosivum—HgCl3—with many of the metals, alkalies 
and their carbonates, nitrate of silver, soap, lime water, tartar emetic, acetate of 
lead, sulphurets of potassium and sodium, sulphur, hydrosulphates, iodide of potas- 
sium, protochloride of tin, volatile oils, several vegetable infusions and decoctions, 
and animal and vegetable substances containing albumen, gelatine, or gluten, 
piperin. 
In some books this is called a chloride, in others a bichloride. It is better and 
safer, therefore, always to designate it by the epithet Corrosivum. 
Tests of Purity.—It should sublime, when heated, without residue. It should be 
readily and entirely soluble in ether, and in water. 
114. Hydrargyri Chloridum Mite—HgCl—with alkalies, alkaline earths and their 
carbonates, hydrosulphates, hydrocyanic acid, bitter almonds, lime water, iodide 
of potassium, iodine, soap, r.itric acid, salts of iron, lead and copper, nitrate of 
silver. 
Tests of Purity.—It is completely sublimed by heat. Solutions of the fixed alka- 
lies strike wish it a black color free from a reddish tinge. Calomel washed with 
boiling distilled water, and the water tested with ammonia, will give no precipi- 
tate, if free from corrosive sublimate. If any is present there will be a white 
precipitate. Distilled water, with which calomel has been washed, should 
yield no precipitate to nitrate of silver, sulphureted hydrogen or iodide of 
potassium. 
115. Hydrargyri Cyanuretum—IlgCy*—with the mineral acids, nitrate of silver, hydro- 
sulphates, iodide of potassium, etc. 
116. Hydrargyri Xodidum—Hgl—with mineral acids, chloride of sodium, etc. It should 
completely sublime by heat. If it contains biniodide it may be separated by washing 
with alcohol. 
117. Hydrargyri Iodidum Rubrum (Biniodidum)—Hgl2—with mineral acids, nitrate 
of silver, alkalies, acetate of lead, tartar emetic, sulphurets, etc. 
Tests of Purity.—It should completely sublime by heat. It is perfectly soluble 
in alcohol, and in solutions of iodide of potassium and chloride of sodium. 
118. Hydrargyri Oxidum Nigrum—HgO—with mineral acids, acetic acid, iodine, etc. 
119. Hydrargyri Oxidum Rubrum—HgO2—with the mineral acids, ferrocyanurets. 
120. Hydrargyri Sulphas—HgO2 2S03—with the alkalies and their carbonates, chloride 
of sodium, lime water, etc. 
121. _Hydrargyri Sulphas Flavus—3Hg02, 2S03—with the alkalies, iodine, etc. 
122. Hyoscyamus, with alkalies and their carbonates, nitrate of silver, sulphate of iron,. 
tannin. • 
123. Hyoscyamia, with alkalies and their carbonates, tannin. 
124. IchthyocoUa Gelatine—C98 H82 NT’5 O36—Alcohol, tannin, and creasote, corrosive 
sublimate. 
125. Iodinum—I—with starch and vegetable preparations containing it, magnesia. 
126. Ipecacuanha, with acetate of lead, vegetable astringents, nitric acid, corrosive sub- 
limate, alkalies. 
127. Jalapa, with mineral acids, tannin, lime water. 
128. Jalapin, with mineral acids. 
129. Kino, with lime water, sesquichloride of iron, gelatine. 
130. Lactucarium, with acetate lead, tannin, nitrate silver, corrosive sublimate, alkalies, 
lime water, oxalates. 894 
A TABLE OF INCOMPATIBLES. 
131. Lobelia, with alkalies, alkaline earths, and their carbonates, tannin, nitrate of silver, 
corrosive sublimate. 
132. Lobelina, with tannin, alkalies, and their carbonates; it is decomposed by boilin'* 
water. 
133. Lupulin, with the mineral acids, water. 
134. Magnesia—MgO—with acids and acidulous salts, metallic salts. 
135. Magnesia Carbonas—3(MgOC02-f-IIO)4-NgO, jjq—wj aci<}g an<j acidulous salts, 
hydrochlorate of ammonia, nitrate of silver, corrosive sublimate, cream of tartar, 
acetate of lead, phosphate of soda. 
136. Magnesia Sulphas—MgO, SO3—with potassa, baryta, soda, and their carbonates, 
lime, strontia, baryta, and their soluble salts, ammonia partially forming with the 
remaining salt a double sulphate; carbonate of ammonia and bicarbonates of 
potassa and soda, do not decompose it when cold, but do upon boiling ; phosphate 
of soda. 
137. Mangesii Binoxidum—MnO2—with acids. 
138. Maranta. (See Amylum.) 
139. Mel, with nitric acid. 
140. Mistura Ammoniaci, with acids, ether, spirits of nitric ether, corrosive sublimate, 
nitrate silver, acetates potassa and lead*. 
141. Mistura Amygdalae, with alcohol, tinctures, oxymel and sirup of squills, spirits of 
nitric ether, hard water, cream of tartar, corrosive sublimate. 
142. Mistura Creta, with cream of tartar acids and acidulous salts, etc. 
4* 
143. Morphia—C34 H19 N06=Mo—precipitated from its solutions by potassa, soda, and 
ammonia, and redissolved by an excess of these alkalies ; the carbonates of these 
alkalies precipitate but do not redissolve the morphia by vegetable astringents con- 
taining tannin, which precipitate is soluble in acetic acid; magnesia, the salts of 
iron, copper, zinc, silver, and lead, alum. (See also narcotina.) 
Tests of Purity.—It is almost insoluble in ether and chloroform, one hundred 
parts of chloroform dissolving but .57 of morphia, whereas one hundred parts 
of chloroform dissolve 31.17 of narcotina. It should be perfectly soluble in 
dilute nitric, hydrochloric, sulphuric, and acetic acids, and precipitated by 
potassa and ammonia, which precipitate should dissolve in an excess of these 
alkalies. Should leave no residue on incineration. A given weight of morphia, 
dissolved in dilute sulphuric acid, should be precipitated from its solution by 
potassa cautiously added, without loss of weight. It is but sparingly soluble in 
benzole. 
144. Moschus, with corrosive sublimate, nitrate of silver, sulphates of iron and copper, 
mineral acid, infusion of cinchona, tannin. 
145. Mucilago. (See Acacia, Tragacantha.) 
146. Narcein—NC28 H20 O12—with alkalies and their carbonates, tannin. 
Like morphia, it is insoluble in ether; it does not, like morphia, become blue by 
the action of the salts of iron, nor red by that of nitric acid. Mineral acids 
slightly diluted render it blue. 
4* 
147. Narcotina—C46 H25 N014=Na—with alkalies, alkaline carbonates, and bicarbonates and 
the precipitate is insoluble in an excess of the precipitants; tannin. It is soluble in 
cold acetic acid, but is separated if the solution is heated. 
It may be distinguished from morphia by its solubility in chloroform and ether; 
by its insolubility in alkaline solutions when added in excess; by not forming a 
blue color with the salts of iron, and by not affecting vegetable colors. 
If the solution of a salt of narcotina is mixed with chlorine water, it acquires a 
yellowish green color, to which, if ammonia is added, it becomes yellowish 
red. A TABLE OF INCOMPATIBLES. 
895 
148. Nickel—(protoxide) NiO—with sulphide of ammonium, hydrosulphuric acid, potassa, 
soda, cyanide of potassium. 
149. Nicotia—N2 C20 H14—with alkalies and their carbonates, tannin. It is soluble in 
alcohol, ether, water, oil of turpentine. 
150. Olea Destillata, with alkalies, mineral acid, sulphur, heat and light, corrosive sub- 
limate, nitrate of silver. 
151. Olea Expressa, with alkalies and alkaline earths, chlorine, mineral acids, acidulous 
salts, corrosive sublimate, lime water. 
152. Opium, with alkalies, alkaline earths and carbonates; nitrate of silver, salts of 
copper, iron, zinc, and lead, tannic and gallic acids. (See Chloroform.) 
153. Phosphorus—P—atmospheric aid, heat, nitric and nitro-hydrochloric acids, alkaline 
solutions. 
154. Piper, alkalies and their carbonates, corrosive sublimate. 
155. Piperin—N2 C70 H37 O10—with corrosive sublimate, the alkalies and their carbonates. 
It is soluble in alcohol and ether, and is precipitated from these solutions by water, 
or the infusion of any substance in water. It is not precipitated by tannin in 
solutions of alcohol, or ether, or chloroform. It is very soluble in chloroform. 
With hydrochloric acid diluted with two parts of water, its solutions strike a 
brilliant yellow-green color, but do not precipitate the piperin. With nitric and 
sulphuric acids treated in the same manner, the color produced is a bright yellow. 
It is incompatible with soap, and therefore with the liniments containing it. 
156. Flumbi Acetas—PbO, C4 H3 03—with sulphuric hydrochloric, citric and tartaric, 
lime-water, cream of tartar, alum, borax, metallic sulphates and sulphurets, soap, 
milk, infusion of opium, hard water, vegetable astringents, with iodide of potassium, 
it forms a yellow precipitate, with sulphureted hydrogen, a black precipitate; with 
carbonated alkalies, a white one; with chromate of potassa, a beautiful lemon- 
yellow ; albumen. 
157. Plumbi Carbonas—2(PbO, CO2) + PbO, IIO—with sulphureted hydrogen, the 
acids. » 
158. Plumbi lodidum—Pbl—with solution of potassa, sulphuric acid. 
159. Plumbi Liquor Subacetatis—2PbO, C4 H3 O3—with hard water, alkalies, alkaline 
earths, and their carbonates, sulphuric and hydrochloric acids, sulphates, sulphurets, 
hydrochlorates, the soluble iodides and chlorides, lime water, infusion of opium, 
vegetable astringents, soaps and liniments containing it, tartrates, chromate of 
potassa, solutions of acacia, albumen, gelatine. 
160. Podophillin, as at present prepared, is a compound of two resinous principles, one 
soluble in ether and alcohol, the other in alcohol only. It is precipitated from its 
solution by hydrochloric acid; sulphuric acid darkens it; nitric acid produces a 
color much resembling tincture of iodine. Like jalapin, it is rendered milder 
in its operation by trituration, and by combination with an alkaline carbonate. 
161. Potassa—KO—with acids and most acidulous salts, carbonic acid, ammonia and its 
salts. 
162. Potassse Acetas—KO, C4 H3 O3—with mineral acids, sulphates of magnesia and 
soda, tartaric acid, nitrate of silver, corrosive sublimate, ammonia and its salts, lime 
water. 
163. Potassse Arsenitis Liquor, with acids, lime water, nitrate of silver, chloride of 
calcium, sulphate magnesia, alum, the salts of copper, tincture of chloride of iron, 
sulphureted hydrogen, vegetable astringents, piperin, infusions of vegetables con- 
taining alkaloids. 
164. Potasses Bicarbonas—KO, 2C02—with acids, and acidulous salts, lime water, 
tincture of chloride of iron, nitrate of silver. 
165. Potassse Bichromas—KO, 2Cr03—with nitric, sulphuric, hydrosulphuric, tartaric 
and oxalic acids, nitrate of silver, acetate of lead, chloride of barium, sulphites. 896 
A TABLE OF INCOMPATIBLES. 
166. Potassae Bisulphas—KO 2S03—with many of the metals and most oxides, with 
alkalies, alkaline earths, and their carbonates, lime water, etc. 
167. Potassae Bitartras—KO, 2C4 II2 05—with salifiable bases which form soluble tar- 
trates, as soda, antimony, iron, etc., it gives rise to double salts. It is rendered 
very soluble by addition of boracic acid or borax. It is decomposed by strong 
acids, lime water, sulphate of magnesia, ammonia, carbonates of soda, potassa and 
magnesia, acetate of lead, nitrate of silver. 
168. Potassae Carbonas—KO, CO2—with acids and acidulous salts, sulphates of mag- 
nesia, copper, iron and zinc, lime and lime water, acetate and hydrochlorate, and 
carbonate of ammonia, chloride of calcium, iodine, tartar emetic, nitrate of 
silver, calomel, corrosive sublimate, tincture of chloride of iron, acetate of lead, 
alkaloids. 
169. Potass Citras—3K0, C12 H5 011—with sulphuric and other acids, the salts of lead, 
lime and silver. 
170. Potassae Chloras—KO, CIO5—with sulphuric and muriatic acids, sulphur, phos- 
phorus, nitrate of silver. 
171. Potassae Liquor, with carbonic acid, acids and acidulous salts, and all metallic and 
earthy preparations held in solution by an acid, calomel, corrosive sublimate, 
ammoniacal salts, iodides of iron, zinc, mercury, silver; with all vegetable 
infusions containing an alkaloid principle. The neutral and acid solutions of 
potassa are precipitated of a yellow color by bichloride of platinum and of a white 
color by tartaric acid. 
172. Fotassse Nitras—KO, KO5—with sulphuric acid, sulphate of magnesia, and metallic 
sulphates, alum, tartaric acid. 
173. Potassse Sulphas—KO, SO3—rvith nitric hydrochloric and tartaric acids, nitrate of 
silver, acetate of lead, corrosive sublimate, chloride of calcium and barium, 
sulphate of magnesia, chlorinated lime, chloride of platinum, nitrate of strontia. 
174. Potassse Tartras—KOC4 H2 O6—with strong acids and many acidulous salts, chloride 
of barium and calcium, acetate of lead, lime water, nitrate of silver. 
175. Potassii Bromidum—KBr—with acids, chlorine, nitrate of silver, starch. 
176. Potassii Cyanuretum—KCy—with most of the salts with metallic oxides. 
177. Potassii Ferrocyanuretum—2KCy, FeCy=2K, Cfv—with soluble salts of 
metallic oxides, chlorides, the salts of sesqui-oxide of iron, with which it strikes 
a deep blue color, a brown color with the salts of copper, and a white one with 
those of zinc. 
178. Potassii Iodidum—KI—with nitrate of silver, acetate of lead, tartaric acid, 
metallic salts, corrosive sublimate, acids and acidulous salts except cream of tartar, 
chlorine. 
179. Potassii Sulphuretum—K, S3—-with acids, which unite with the potassium and set free 
the sulphur, precipitate part of it, and expel the other part in the form of sulphu- 
reted hydrogen gas; with metallic solutions, which unite with the sulphur and form 
sulphurets; with water, whose oxygen unites with the potassium of the bisulphuret 
forming potassa, and whose hydrogen unites with the sulphur, forming sulphuret- 
ed hydrogen; when exposed to the air, oxygen combines with the sulphur, forming 
sulphuric acid, and with the potassium of the bisulphuret, forming potassa, and 
these two new combinations unite and form sulphate of potassa. 
180. Populin, with alkalies and their carbonates. 
181. Quassia, with nitrate of silver, tannin; but as it contains no tannin, it is not incom- 
patible with the salts of iron, copper, zinc, lead, corrosive sublimate, iodine, chlo- 
rine, gelatine. 
182. Quercus Tinctoiia. (See Acidurn Tannicum.) 
+ 
183. Quinia—C40 II24 N2 O4 = Q—with tartaric acid, tartrate of potassa, lime water, tan- 
nin ; with alkalies, their carbonates, alkaline earths, the precipitate redissolves to a 
very slight extent in potassa, but more freely in ammonia, the alkaline carbonates A TABLE OF INCOMPATIBLES. 
897 
do not redissolve it. Soluble salts of baryta and lead precipitate it from its solu- 
tions, and the precipitate from baryta is insoluble in the acids ; concentrated nitric 
acid dissolves quinia to a colorless fluid, becoming yellowish upon the application 
of heat. The addition of chlorine water to a solution of a salt of quinia imparts no 
color, but if ammonia is added, the fluid acquires an emerald green color. If to the 
chlorine solution, ferrocyanide of potassium in solution is added, a dark red color is 
produced, which ultimately passes into green. This does not take place with cincho- 
nia. If a solution of quinia is precipitated with ammonia, ether added, and the mix- 
ture shaken, the quinia redissolves in the ether, and the clear fluid presents two 
distinct layers. Such may also be done with benzole. This is not the case with 
cinchonia. Chloroform dissolves, to each 100 parts, 57.47 of quinia, whereas, of 
cinchonia, 100 parts dissolve but 4.81. (See Cinchonia.) 
184. Quinoidine, or amorphous quinia, bears the same relation to quinia that uncrystalliz- 
able sugar does to crystallizable. It would probably be more used if it were not so 
much adulterated. It should be entirely soluble in alcohol and in dilute sulphuric 
acid, and its precipitate from these solutions, by ammonia, should weigh as much as 
the original substance. 
185. Rheum, with the sesquioxide of iron and its salts, nitric acid, lime water, infusion of 
cinchonia, solution of quinia, acetate of lead, nitrates of silver and mercury, Gou- 
lard’s extract, corrosive sublimate, tartar emetic. 
186. Sabadilla. (See Yeratria). 
187. Salicine—C26 H18 O14—is soluble in alcohol and water, and insoluble in ether. No 
reagent precipitates salicine as such. If salicine is treated with concentrated sul- 
phuric acid, it agglutinates into a resinous lump, and acquires an intensely blood- 
red color without dissolving in the acid; the color of the acid is at first unaltered. 
If an aqueous solution of salicine is mixed with hydrochloric acid or dilute sulphuric 
acid, and the mixture boiled for a short time, the fluid suddenly becomes turbid, 
and deposits a finely granular crystalline precipitate (saliretine). It is not precipi- 
tated from its solutions by the alkalies. As silicine is frequently added to quinia as 
an adulteration, it may be readily distinguished by these tests. 
188. Salvia, with the sesquisalts of iron, and vegetable infusions containing alkaloids. 
189. Sanguinaria, with alkalies. 
190. Sapo—and liniments containing it—with acids, earths, earthy and metallic salts. 
191. Scillse, with alkaline carbonates, nitrate of silver, acetate of lead, lime water. 
192. Senna, with strong acids, tannin, solution of subacetate of lead. 
193. Soda—NaO—with acids and most acidulous salts, carbonic acid, etc., etc. 
194. Sodee Acetas—NaO, C4 H3 O3—with mineral acids, carbonate of lime, phosphate of 
sesqui-oxide of iron. 
195. Sodse Bicarbonas—NaO, 2C02—with the same as the carbonate, excepting sulphate 
of magnesia in the cold. 
196. Sodee Boras—NaO, 2B03—with acids, salts of ammonia, and many metallic oxides, 
carbonate of soda and potassa. 
197. Sodee Carbonas—NaO, CO2—with acids, acidulous salts, lime water, earthy and 
metallic salts, hydrochlorate of ammonia, borax, vegetable acids, tartar emetic, 
sulphates, sulphureted hydrogen, calomel, corrosive sublimate, salts of iron, alka- 
loids, sulphate of magnesia. 
198. Sodee Liquor, with carbonic acid, acids and acidulous salts, and all metallic and 
earthy preparations held in solution by an acid; calomel, corrosive sublimate, 
ammoniacal salts, iodides of iron, zinc, mercury, silver; with all vegetable infusions 
containing an alkaloid principle. 
199. Sodee Liquor Chlorinatae, with acids, lime water, carbonic acid, alum, nitrate of 
silver, iodides, calomel, sulphate of iron. 
200. Sodse Phosphas—2NaO, PO6—with all the soluble salts of lime, and magnesia; 
mineral acids, nitrate of silver, alum, neutral metallic salts. 
vol. ii.—57 898 
A TABLE OF INCOMPATIBLES. 
201. Sodae el Potassae Tartras—KO, C4 H3 05-}-Na0, C4 H3 O6—with acids and acidu- 
lous salts except cream of tartar, soluble salts of lime and baryta, acetate and 
subacetate of lead, nitrate of silver. 
202. Sodae Sulphas—NaO, SO3—with carbonates and acetates of potassa, chloride of cal- 
cium, nitrate of silver, acetate and subacetate of lead, lime water, ammonia, but 
not its subcarbonate, salts of barytes, chlorinated lime and soda. 
203. Sodii Chloridum—NaCl—with nitrate of silver, nitric and sulphuric acids, carbonate 
of potassa, protoxide of mercury, sulphates of soda and potassa, salts of iron. 
204. •Stramonium. (See Datura.) 
205. Stanni Protochloridum—SnCl—chloride of mercury, hydrosulphuric acid, nitrate 
of silver, potassa, ammonia, and their carbonates, terchloride of gold, coccus 
cacti. 
+ 
206. Strychnia—C44 II34 N3 04=Sr—Potassa and carbonate of soda produce in solution 
of the salts of strychnia, precipitates of strychnia, which are insoluble in an excess 
of the precipitants. Ammonia produces the same precipitate which redissolves in 
an excess of ammonia, and after a time crystallizes in needles. Strong chlorine 
water produces a white precipitate which dissolves in ammonia to a colorless fluid. 
Concentrated nitric acid dissolves strychnia to a colorless fluid, which becomes 
yellow by heat. 
On putting a drop of concentrated sulphuric acid on a watch-glass, and adding to 
it a little strychnia or salt of strychnia, solution ensues without any particular reac- 
tion ; but if a drop of solution of chromate of potassa is now added, it instantly 
acquires a deep blue color, which speedily changes to red. If the strychnia is 
rubbed together with binoxide of lead and concentrated sulphuric acid containing 
one per cent, of nitric acid, the mass acquires first a blue, then a violet color, which 
changes to red, and finally to yellowish green. 
It is incompatible with tannic, but not with gallic acid, nor with sesqui-oxide of 
iron. One hundred parts of chloroform dissolve 20.16 of strychnia. It is but 
sparingly soluble in benzole. 
207. Sulphur—S—with nitric and nitrohydrochloric acids, boiling solution of soda. 
208. Sulphuris Iodidum—IS3—with heat, boiling water, the acids, chlorine. 
209. Tobacum, with oxides of mercury and antimony, nitrate of silver, sulphurets, chlo- 
rine, mineral acids. 
210. Toxicodendron, with the sesquisalts of iron, alkalies, and alkaline carbonates, 
acetate of lead, sulphate, and valerianate of zinc. 
211. Tragacantha, with sulphate of copper, iron, acetate of lead, alcohol, iodine. 
212. Uva Ursa, with subacetate of lead, carbonate of potassa, gelatine. 
213. Valeriana, with salts of iron and zinc, nitrate of silver. 
214. Veratrum Album, with alkalies their carbonate, tannin. 
215. Veratrum Viride, with alkalies their carbonates, tannin. 
+ 
216. Veratria—C34 II33 N06=Ve—with alkalies, their carbonates, tannin, corrosive sub- 
limate, chloride of gold, tincture of iodine. Veratria is insoluble in water, sparingly 
so in ether, freely in alcohol; 100 parts of chloroform dissolve 58.47 of veratria. It 
is soluble in the dilute acids. The alkalies and their carbonates and bicarbonates 
precipitate veratria from its solutions and the precipitate is not dissolved by an 
excess of the precipitants except ammonia in the cold, heat again causing a preci- 
pitate. Sulphuric acid produces with veratria a ruby or crimson-red color, nitric 
acid a yellow color, tincture of iodine a brownish red, soluble on boiling into clear 
red liquid, to which if ammonia was added while warm, it gave a yellow precipitate 
gradually changing to white. Solution of chloride of gold caused a yellow precipi- 
tate, insoluble in an excess of the precipitant until boiled, when it formed a green- 
ish liquid, in which caustic potassa gave a purplish black precipitate. 
Mr. Richardson has given a very elaborate treatise on veratria in the “ American 
Journal of Pharmacy,” 3d series, voL v., No. 3, p. 209, in which he has proved the A TABLE OF INCOMPATIBLE8. 
899 
similarity of the veratria obtained from veratrum viride and Y. alba, so far as they 
are amenable to chemical tests. The writer has repeated these tests upon veratria 
from V. viride, made by himself, and veratria from Y. album made by Merck, with 
the same results arrived at by Mr. Richardson, but although apparently identical in 
their chemical characteristics, they are not, according to the writer’s observations, 
identical in their medicinal or therapeutic characteristics. 
217. Zinci Acetas—ZnO, C4 H3 0s—with the mineral acids and acidulous salts, car- 
bonates of ammonia, potassa, and soda, lime water, vegetable astringents, ferrocy- 
anuret of potassium, hydrosulphurie acid. 
218. Zinci Chloridum—ZnCl—with nitrate of silver, carbonates of soda, potassa, and 
ammonia, ferrocyanuret of potassium; ammonia and potassa throw down a white 
precipitate which is dissolved in an excess of the precipitants. 
219. Zinci Oxidum—ZnO—with ammonia, potassa, soda, acids, acidulous salts. 
220. Zinci Sulphas—ZnO, SO3—with alkalies and their carbonates, ferrocyanuret of 
potassium, hydrosulphate of ammonia, nitrate of silver, acetate of lead, lime water, 
chloride of barium, hydrosulphates, mucilages, milk, vegetable astringents. 
221. Zinci Valerianas, with acids and acidulous salts, alkalies and their carbonates, 
metallic salts, vegetable astringents. LATIN VOCABULARY. 
OR LATIN TERMS USED BY MEDICAL MEN. 
Abdomen, is—The belly (abdominales). 
Abduco, xi—To draw from (abductor). 
Abluo, lui—To wash away (abluents). 
Abnormis, e—Abnormal, out of the usual rule or order. 
Abomasum, i—The fourth stomach of the Ruminantia. 
Abortio, nis—Premature expulsion of the fetus. 
Abrado, si—To rub off, abrasion. 
Absedo—To separate (abscess). 
Absente febre (abs. febr.)—While the fever is absent. 
Absorbeo—to suck up (absorbents). 
Absorptio, onis—The function of the absorbents. 
Abslineo, ui—To refrain from food, abstinence. 
Ac (ac si, as if) (simul ac, as soon as)—And. 
Acceleratio, onis—Increased rapidity of the pulse, respi- 
ration, etc. 
Accelerator, oris—A muscle which contracts to accele- 
rate the passage of the urine. 
Accessio, onis—The approach of the pyrexial period in 
fevers. 
Acelimatio, onis—Naturalization to a foreign climate. 
Accurate—Accurately. 
Accurate misceantur—Mix them thoroughly. 
Accurate pensi—Weigh them accurately. 
Aciditas, or acidum (acer, sour)—Sourness, acescence. 
Acini (pi. acinus, a grape stone)—The minute parts of 
the lobules of the liver, connected together by vessels. 
Acme—The height of a disease. 
Acrimonia, ae—Sharpness of flavor. 
Acutus, a, um—Disease or pain of a sharp character. 
Acupungo, pupungi—To insert needles into the skin or 
flesh. 
Ad—To, at, until. 
Ad libitum (ad lib.)—At pleasure. 
Adde—Add. 
Addantur—Let them be added. 
Addendus—Being added. 
Addendo—By being added. 
Adduco, xi—To draw to (adductor). 
Adeps, ipis—Fat, auimal oil. 
Adhaereo, hsesi—To adhere, adhesion. 
Adiposis—Hypertrophy of the adipose substance. 
Adjuvo, juvi—To assist or promote the operation of 
another (adjuvants). 
Adjuvanta—Medicines which assist to relieve diseases. 
Admoveatur (admov.)—Let it be applied. 
Admoveantur—Let them be applied. 
Adnascor—To grow to (adnata). 
Adolescentia, se—Youth, from the age of puberty to 25. 
Adstante febre (ads. febr.)—While the fever is present. 
Adultus, a, um—Adult age from 25 to 50. 
Adultero, avi—To adulterate, to corrupt. 
-Eger—A male patient. 
ASgra—A female patient. 
-Etas, atis—Age, term of life. 
Afferens, tis—Afferent vessels that convey lymph to the 
lymphatic glands. 
Affmitas, tis—Relationship, attraction, affinity. 
Agglutino, avi—To form an adhesive union, agglutinate. 
Aggressus—An attack. 
Aggressus febris—An attack of fever. 
Agito—To shake. 
Ala, se—A wing (alse nasi, etc.) 
Albumen, inis—Albumen. 
Albus—White (albino). 
Alga, se—Seaweed. 
Alienatio, onis—Estrangement, mental derangement. 
Aliformis, is—Wing-like. 
Alimentum, i—Substances which nourish the body. 
Aliquot—Some. 
Aliquoties—Sometimes. 
Alter, a, um—The other (alteratives). 
Alterne—By turns, alternately. 
Alternis hoi-is—Every other hour. 
Alternis diebus—Every other day. 
Altrix, icis—A nurse. 
Alumnus, i—He that is brought up a pupil. 
Aluta—Soft leather. 
Alvearium, i (a beehive)—The meatus auditorius ex- 
tern us. 
Alveolus, 1 (channels)—The alveolar processes or sock- 
ets of the teeth. 
Alvus, i—The bowels, the belly (hence looseness, flux). 
Alvo adstricta—The bowels being costive. 
Alvo relax—The bowels being loose or relaxed. 
Amentia, se—Senseless, imbecility of intellect. 
Amplus, a, um—Large. 
Ampullula, se (a little bottle)—The extremity of each 
villus of the mucous coat of the intestines. 
Amputatio, onis—The removal of a limb or other part 
of the body by means of the knife. 
Amuletum, i—A supposed charm against infection or 
disease. 
Amylurn, 1—Starch. 
Anatomia, se—A surgical dissection of the body. 
Ancon, onis—The elbow. 
Angina, se—An inflammation of the throat. 
Angina pectoris—Spasm of the chest. 
Angor, oris—A strangling, a choking. 
Anhelitus, us—Difficulty of breathing, dyspnoea. 
Anima, ae—The vital principle, the soul. 
Animal, is—A living creature. 
Animalculus—Animalcule. 
Annulus—A ring, a circle, a rounded margin. 
Ante—Before. 
Anteversio uteri—A morbid inclination of the fundus 
uteri forward. 
Antidotum, i—A counter poison, antidote". 
Anus, i—The fundament. 
Antrum Maxillare—A cavity above the molar teeth of the 
upper jaw. 
Aperiens, entis—Opening, mildly purgative. 
Apex, icis—The extremity of a part. 
Apotheca, se—A place in which anything is laid up. 
Apparatus, us—That with which preparation is made. 
Apendix, icis—An appendage. 
Appetitus, us—A longing or desire after anything. 
Applicans, antis—Applying. 
Applicantur—Let there be applied. 
Aqua—Water. 
Aqua communis—Common well water. 
Aqua bullientis (aq. bul.)—Boiling water. 
Aqua ferventis—Hot water. 
Aqua fluvialis—River water. 
Aqua fontis—Spring water. 
Aqua marina—Sea water. 
Aquula, se—A fatty tumor under the skin of the eyelid. 
Arbor, oris—A tree (arborescent). 
Arctatio, onis (narrow)—Constipation of the Intestines, 
also preternatural straitness of the vagina. 
Arcus senilis (bow of old age)—An opacity round the 
margin of the cornea occurring in advanced age. 
Ardor, oris—A heat, sense of heat, burning. 
Ardor urinse—A sense of scalding on passing the 
urine. 
Area, se—An open space. 
Area differens, area serpens, area pellucida, areji vas- 
culosa. 
Areola, se—The pink or brown circle which surrounds 
the nipple. 
Aridus, a, um—Dry, arid, without moisture. 
Ars, artis—A knowledge acquired by learning. 
Arteria, se—An artery. 
Arthriticus, a. um—Afflicted with the gout. 
Articularis, e—Relating to the joints. 
As, assis—A pound weight. 
Assimilatio, onis—Conversion of food into nutriment. 
Astringo, inxi—To bend or draw together (astringent). 
Athleticus, a, um—Athletic, strong. 
Atomus, i—Any small invisible body, an atom. 
Atque—And, also. 
Atqui—But, however. 
Ater, tra, trum—Black, fatal, mortal. 
Ater panis—Black bread. 
Atra febris—A malignant fever. 
900 LATIN VOCABULARY. 
901 
Atrum venenum—Rank poison. 
Attente—Carefully. 
Attenuo, avi—To make thin, attenuate. 
Attollens, entis—A muscle which draws any part up- 
ward. 
Attondeo—To shave. 
Attonsum caput—The head being shaved. 
Attraho, xi—To draw toward oneself (attraction). 
Attrahens auris—The muscle which draws the ear for- 
ward and upward. 
Attritus—Rubbing, chafing. 
Audio, ivi—To hear. 
Auris, i (pi. es, ibus)—The ear. 
Auriscalpium, i—An ear pick. 
Aurium tinnitus—A ringing noise in the ears. 
Auscultatio, onis—Listening by the application of the 
ear in the examination of disease. 
Aut—Or. 
Autem—But, notwithstanding. 
Aviditas, atis—Eagerly, greedily. 
Bacca—A berry. 
Balneum arerne—A sand bath. 
Balneum maris—A sea bath. 
Balneum vaporis— A vapor bath. 
Balneum califeri jube—Order the bath to be made hot. 
Balsamum—A balsam. 
Barba, se—The beard. 
Basis, is—That on which anything rests. 
Bene—Well. 
Bene mane—Very early. 
Bene multi—A great many, plenty. 
Bibe—Drink. 
Bibat (bibo)—Let him drink. 
Bess, or bessis—Two thirds of a pound weight. 
Biceps, ipitis— That has two heads. 
Biduum—Two days. 
(Omni biduo vel triduo)—Every two or three days. 
Biduo continente—During two days. 
Bifldus, a, um—Bifid, divided into two parts. 
Bifer, a, um—That bears twice a year. • 
Biformis—Double formed. 
Bifurcus—Bifurcated having two points. 
Bilinguis—Double-tongued, treacherous. 
Biliosus—Full of bile. 
Bimembris—Having double members. 
Binominis—Having two names. 
Binoctium—The space of two nights. 
Bipartio—In two parts. 
Bipatens—Open on both sides. 
Bipennis, e—Having two wings. 
Bipes, edis—Two footed, biped. 
Bis—Twice. 
Bi in dies—Twice daily. 
Bis terve—Twice or thrice. 
Bis quinque—Ten. 
Bis tanto—As much more. 
Bolus—A bolus, a large pill. 
Bonus, a, um—Good. 
Brevi—-Soon after, shortly. 
(Ad brevi)—A little while. 
Bulliat—Let it boil. 
Blandimentum—Means of charming or soothing. 
Blandus, a, um—Caressing, coaxing. 
Blatero, avi—To talk foolishly. 
Bombyx, ycis—A silkworm. 
Braca—A covering for the legs and thighs. 
Brachialis—Of, or belonging to the arm. 
Brachium—The arm from the wrist to the elbow. 
Bubo—A swelling of the glands of the groin. 
Bucca—A cheek. 
Buccea—A mouthful. 
Bucco—Chub-cheeked (hence a fool). 
Bufo—A toad. 
Bulla, se—Blebs, vesicles raised by a watery fluid. 
Butyrum—Butter. 
Caehinno, are—To laugh immoderately. 
Caco, avi—To go to stool. 
Cadaver, eris—A corpse, a dead body. 
Caduca—The deciduous membrane. 
Cseco, avi—To blind (caecum). 
Cselebs—Single, unmarried. 
Cseruleus—Blue. 
Calcarius, a, um (calx)—Of, or belonging to lime. 
Calculus, i—Stone in the bladder or kidney. 
Calefacio—To make warm. 
Calide—Hotly, warmly. 
Calidus—Hot, scalding. 
Calix, icis—A drinking vessel, a cup. 
Calix vitreus—A glass drinking vessel. 
Callide—Skillfully, cleverly. 
Callosus—Callous, having a hard thick skin. 
Callus, i—Hard skin, want of feeling. 
Calor, oris—Warmth, heat vehemence. 
Calva, se ; calvaria, se—The skull. 
Calveo, ere—To be bald. 
Calvities, ei—Baldness. 
Calyx, ycis—The bud or calyx of a flower. 
Campa, se, e, es—Canker worm, caterpillar. 
Canalis, is—Canal, a conduit. 
Cancello, avi—To make lattice-wise, cross-barred. 
Cancer, cri—A crab. 
Candefacio—To make red hot. 
Caedela, se—A taper, a candle. 
Candesco, ere—To become of a glowing heat. 
Canesco, ere—To become grey or white. 
Canis, is—A dog. 
Canities, ei—Grey hair. 
Cannabis, is—Hemp. 
Canula—A small tube. 
Canus—Hoary, old. 
Capillamentum, i—False hair, a peruke. 
Capillus, i—The hair of the head (capillary). 
Capito, onis—That hath a large head. 
Capripes—Goat footed, 
Capsula—A cover, a small chest. 
Capto, avi—To snatch at, to catch. 
Capularis, e (capulus)—Of, or belonging to a coflin. 
Caput, itis—A head. 
Capiat—Let him take. 
Cap. coch. magna—Take a tablespoonful. 
Capiendus—To be taken. 
Capiendus omni mane ac vespere—To be taken every 
morning and evening. 
Carbo, onis—A coal. 
Carbunculus—A carbuncle, anthrax. 
Career—A prison, a gaol. 
Carcinoma—A cancer. 
Carcinosus, i—Cancerous. 
Cardiacus—Belonging to the stomach. 
Cartes—Decay, rottenness. 
Cariosus—Corrupt, rotten. 
Carnifex, icis—A tormenter, a gaoler. 
Carnivorus, a, um—Feeding on flesh. 
Carnosus—Fleshy, muscular. 
Carno, carnis—Flesh. 
Carpus—The wrist. 
Cartilago—Cartilage. 
Caruncula—A small piece of flesh. 
Caseus, i—Cheese. 
Castitas, atis—Chastity, honesty. 
Castro, avi—To castrate, geld. 
Casus, us—A falling, an accident. 
Catharticus, a—Cleansing, purgative. 
Catharticum medicamentum—A purging medicine. 
Cauda, se—A tail. 
Causarius, a, um—Sick, indisposed. 
Causticus—Burning, caustic, biting. 
Caute, ius, issime—Cautiously, carefully. 
Cavea, se—A cavity. 
Caverna, se—A hollow place. 
Celeriter—Swiftly, quickly. 
Centimanus—Having a hundred hands. 
Centum—A hundred. 
Ceratum, i—Acerate made with wax. 
Cerebellum—The little brain. 
Cerebrum—The chief portion of the brain. 
Ceroma—An ointment composed of wax. 
Certe—Certainly, surely. 
Cervical—Of the neck. 
Cervix—The neck. 
Cerevisia, se—Ale, beer. 
Cestus—A band, a tie, a girdle. 
Ceterus (et cetera)—The other 
Ceu—As, like as, as if. 
Chalceus—Brazen, of brass. 
Chaos—Infinite empty space. 
Charta—Paper. 
Charta cerulea—Blue paper. 
Chartula—A small paper, or letter. 
Chart, in No. x. divide—Divide into ten papers, or pow- 
Chiragra—The gout in the hand. 
Chirurgia, se—Surgery, chirurgery. 
Chirurgicus, a, um—Of surgery. 
Chirurgus, i—A surgeon. . 
Cholera, se—Bile, a bilious complamt. 
Cholericus, a, um—Afflicted with a bilious complaint. 
Chorda, se—A tendon, a gut, intestine, catgut. 
Cibarius, a, um—Belonging to food. 
Cibo—To feed. 
Cibus, i—Anything which is eaten, food. 
Cicada—A tree cricket. 
Cieatricosus, a, um—Full of scars. 
Cicatrix, icis—The scar of a wound. 
Cilium, i—The eyelash. 
Cimex, icis—A bug. 
Cincinnus—Curled hair, a lock, a curl. 
Cinctus—A girdle, a belt. 
Cinefactus—Reduced to ashes. 
Cingo—To bind, to dress. 
Cinis—Ashes, lye. 902 
LATIN VOCABULARY. 
Circa (circiter)—Around, about, near. 
Circulatio, onis—The iiow of blood through the heart, etc. 
Oirculatrix—A female mountebank, quackish. 
Oircumcido, idi—To circumcise. 
Circumcisio, onis—Circumcision. 
Circumligo, avi—To bind around, to encompass. 
Circumplico, exi—To fold around. 
Circumtondeo—To shave all round. 
Cirratus (cirrus)—Having curled or crisped hair. . 
Cis—On this side, within. 
Citatim (cito)—Hastily, quickly. ’ 
Citissime—As quickly as possible. 
Clan, or clanculum—Secretly, privately. 
Clandico—To be lame, halt, limp. 
Clando—To limp. 
Clausus, a, um—Covered. 
Clauso vase—In a covered vessel. 
Clavicula, te—The clavicle or collar bone. 
Clementer—Mildly, gently. 
Clinicus—A physician who visits patients who are con- 
fined to their beds. 
Cloaca—A common sewer. 
Clyster, eris—A clyster. 
Coagulum, i—Curdled. 
Coalesco, lul—To grow together. 
Coccyx—A cuckoo, the lower end of the spine. 
Coctus—Boiled. 
Cochlearum—A spoon. 
Coecum—The cul de sac, coeeum. 
Coeliacus, a, um—Belonging to the stomach. 
Coena, se— Dinner, the principal meal. 
Ccenaturio, ire—To have an appetite for eating. 
Coenito—To take a meal frequently. 
Coeno—To eat at table, to take a meal, 
Coenula—A lunch, a lesser meal. 
Cognatio, onis—Alliance by birth, relation by blood. 
Cola—Strain, filter. 
Colatus—Strained. 
Cola trans chartam—Strain through paper. 
Colato liquori—To the strained liquor. 
Colentur—Let them be strained. 
Collacrimo, avi—To weep together, to bewail. 
Collaris—Belonging to the neck. 
Colliquefacio, feci—To make fluid, to melt. 
Colloco, avi—To place, or put. 
Collum—The neck. 
Colluo, ui—To wash, to wet. 
Collyrium—A wash for the eyes. 
Colo, avi—To sift, to strain. 
Colon—The colon, the large intestine. 
Color, oris—Color, complexion. 
Colostrum—The first milk in the breasts after the birth 
of young. 
Colum—A strainer, colander. 
Coma—The hair of the head. 
Comans, tis—Having hair. 
Combibor—To be drank together. 
Comburor—To be burned. 
Comedo—To eat, eat away, eat up. 
Commaculo, avi—Tt pollute. 
Commendo, avi—To intrust to one’s charge. 
Commissura, at—A commissure, a joint. 
Commorior—To die at the same time. 
Compar, aris—Equal. 
Compositus—Compound, put together. 
Cornprimens—Binding, pressing together. 
Concaco—To bedaub, to pollute with ordure. 
Conceptio, onis—Conceiving, becoming pregnant. 
Concerpo—To tear to pieces, to rend. 
Concha—A shell, a sea shell. 
Conditorium, i—A coffin. 
Condylus, i—A knuckle. 
Congelo, avi—To freeze, to congeal. 
Conguis—A gallon. 
Conjunctiva—The mucus membrane of the eye. 
Conjugium, i—A union, marriage. 
Connubialis, e—Relating to marriage. 
Consanguineus, a, um—Related to blood. 
Conscreor, arl—To spit, to hawk. 
Consorbinus, a, um—Born of two sisters, cousins. 
Conspergo, si—To sprinkle, bestrew. 
Constipatio, onis—Costiveness of the bowels. 
Consultum—Deliberation. 
Consumptio, onis—Wasting away, phthisis. 
Contactus—A touching contagion. 
Contagio (contingo)—Contagion. 
Contamino—To pollute, contaminate. 
Contemero—To violate, dishonor. 
Contero, trivi—To grind, crush, pound. 
Continuantur remedia—Let the medicines be continued. 
Contra—Over, against, opposite. 
Contra—Otherwise, on the other haud. 
Contundo, tudi—To beat, to bruise. 
Contusus—Bruised. 
Contusio—A bruise, a contusion, 
i onvalescentia—A regaining of health. 
Couvomo—To cover with vomiting. 
Convoluto—To roll round. 
Conv uls us—Convulsed. 
Copulatio, onis—Joining together. 
Coquo—To cook. 
Coque—Boil, cook. 
Cor, dis—The heart 
Coram—Before, in the presence of. 
Cordolium—Sorrow at heart 
Corium—Leather, the hide. 
Comeus—Horny (cornea). 
Cornipes—Horny feet, hoofed. 
Cornu—A horn. 
Cornu cervl ustum—Burnt hartshorn. 
Corona, se—A garland (coronal). 
Corporeus, a, urn—Corporeal, having a body 
Corpulentus—Corpulent, fleshy. 
Corpus—Body, anything not spiritual. 
Corpusculum—A little body. 
Corrodo—To corrode. 
Cortex, icis—The end, bark, peel. 
Corvus—A raven, a surgical instrument. 
Cosmeta, se—A female slave, an adomer. 
Costa, se—A rib. 
Coxa, se, coxendrix—The hip bone. 
Coxendrix luxa—Dislocation of the hip. 
Cras—To-morrow. 
Cras mane—To-morrow morning. 
Cras mane sumendus—To be taken to-morrow morning. 
Cras nocte—To-morrow night 
Crastinus—Of to-morrow. 
(In usum crastinum—For to-morrow’s use.) 
(In crastinum differre—To put off till to-morrow.) 
Crassamentum, i—The dregs, thickening. 
Crepitus, us—A creaking. 
Creta—Chalk. 
Cribro, avi—To sift. 
Cribrum—A sieve (cribriformis). 
Crinalis—Of, or belong to the hair. 
Crinis—Hair which is combed, a tress. 
Crisis—Judgment, a state. 
Croceus—Like saffron. 
Crudesco—To grow raw, of wounds when they open. 
Cruditas—Indigestion. 
Cruor—Blood which runs out of a wound. 
Cruralis—Of, or belonging to the shin or leg. 
Crus—The leg from the knee to the ankle. 
Crusta, se—A hard rind, a scab. 
Crypta, se—A passage, a vault 
Crystallum, 1—A crystal. 
Cubicularis, i—Of a bedchamber. 
Cubitalis—Belonging to the elbow. 
Cubito, are (cubo)—To lie down. 
Cuius—Of which. 
Cuius, 1—The fundament 
Cum—With, when, although. 
Cum minime—With the least. 
Cum plurimum—Most frequently. 
Cuneus—A wedge. 
Cupreus—Of copper. 
Curate—Carefully. 
Curator—One who takes the management of a thing. 
Curo—To take care of, heal, cure. 
Cuticula, as (cutis, is)—The skin. 
Cyathus—A cup, a drinking vessel. 
Cyathus vinarius—A wineglass. 
Da, detur, dentur—Give, let it be given. 
De—In respect of, about. 
Deambulo—To walk abroad. 
Deartuo—To rend limb from limb. 
Deauro—To gild. 
Debilitas, atis—Lameness, weakness. 
Debilito—To lame, to maim. 
Decern—Ten. 
Deaurentur pilulae—Let the pills be gilt. 
De die in diem—From day to day. 
Debitus—Due, proper. 
(Ad debitam spissitudinem—To the proper consist- 
ence.) 
Decies—Ten times. 
Deciduus—Deciduous, that falls off. 
Decimo—To take out a tenth part, decimate. 
Decoctus, us—A decoction. 
Decoctor—One who decocts anythtng. 
Decoquo, xi—To boil down. 
Decumbo—To lie down to sleep. 
(Hora decubitus—At bed time.) 
Defseco—To clean from dregs. 
Deformis, e—Misshappen, deformed. 
Deformo, avi—To disfigure, to deform. 
Deglutio—lo swallow. 
Deglutietur—Let it be swallowed. 
Dejectio onis—A casting down, dejection. 
tions ““ dejecUones «M—After two alvine evacua- 
(°moved twiceb.)S dejeclat-IJntil towels have been LATIN VOCABULARY. 
903 
Delinquo, liqui—To omit. 
Deliquesco, cui—To melt down (deliquescent). 
Deliquo, are—To strain, to render fluid. 
Delirium, i—Madness, low of reason. 
Delumbo, avi—To lame in the hip, or loins, to enervate. 
Deluo—To wash, to cleanse. 
Dementia—Madness, folly. 
Demo, nisi—To diminish, withdraw. 
Demum—At last, at length. 
Denaso—To deprive of a nose. 
Denique—Finally, lastly. 
Dens, tjs—A tooth. 
Dentio, ire—To cut teeth. 
Dentiscalpium—A toothpick. 
Dentitio—The teething of children, dentition. 
Dentifricium, ii—A dentifrice. 
Denuo—Again, anew. 
Depilo, avi—To pull off hair. 
Depilatus—Made bald. 
Depono, sui—To lay aside. 
Depuratus—Purified. 
Desideratum—That which Is desired.’ 
Desperatus, a, um—Given over, past hope. 
Despuo—To spit out. 
Desquamo—To scale off, to desquamate. 
Desterto—To cease snoring. 
Destillo—To distill. 
Desudo—To sweat, so exude. 
Detego—To lay open, to uncover. 
Dexter—The right. 
(Manus dextra—The right hand.) 
(Auri dextro—The right ear.) 
Diseta—Diet, food. 
Diseteticus—Pertaining to food, or regimen. 
Dico, avi—To say, to tell. 
Dictus, a, um—Spoken of, said. 
Dies—A day. 
Die—In a day. 
(Bis dies—Twice a day.) 
(Tertius diebus—Every third day.) 
(De die—In the day time.) 
Digestus, a, um—That has a good digestion. 
Digitus—A finger. 
Digitalis—Of or belonging to a finger. 
Digitulus—A little finger. 
Dilutus—Thin, diluted. 
Dilutium—An infusion or dilution. 
Dimidius—The half. 
Diploma—A public document. 
Directio, onis—Direction, order. 
Directione propria—With the proper direction. 
Discipulus—A scholar, a pupil. 
Dispenso—To weigh out, to dispense. 
Dissectus (disseco)—Cut asunder, dissected. 
Dissolutio—Separation, dissolution. 
Dissolvo—To dissolve, to loosen. 
Distincte—Distinctly. 
Diu, diurnus—By day. 
(Tere diu—Rub for a long time). 
Diutinus—Lasting, durable. 
Dinturna trituratione—By long continued trituration. 
Divido, lsi—To part, divide, separate. 
Do, dedi, datum, dare—To give. 
Doctor, oris—A teacher, instructor. 
Doctrina, se—Teaching, instruction. 
Doctus, a, um—Learned, skillful. 
Documentum Anything by which one can learn, etc. 
Dogma—An opinion or tenet of a philosopher. 
Dolor, oris (dolens)—Pain.* 
Domus—Home, a dwelling place. 
(Domus et placens uxorcula.) 
Donee (donicum)—Until. 
Dormio, ivi—To sleep. 
Dormitor, oris—A sleeper. 
Dorsum, i—The back. 
Drachma—A drachm. 
Dropax, acis—An ointment that takes off the hair 
Ductus, us—A duct. 
Dulcis, e—Sweet. 
Dum—Whilst, during. 
Duo, se, o—Two. 
Duodecem—Twelve. 
Duodenum—A portion of the intestine, 
Duplex—Double, twofold (duplieature). 
Duplicatio, onis—A doubling. 
Durante dolor—While the pain continues. 
Duris, a, um—Hard. 
Dura mater—The outer membrane of the brain. 
E, or ex—Out of, or from. 
Ebullio—To bubble up (ebullition). 
Edax, acis—Gluttonous, voracious. 
Edento, avi—To deprive of teeth. 
Edo, edi—To eat, to consume 
Edulis—Eatable. 
\vasMng,r bottle, for separating by 
Effeminatus—Womanish, delicate. • 
Effervesco, vi—To ferment, to effervesce. 
Effetus—That has brought forth young. 
Effligo, xi—To strike dead, to kill. 
Effloresco—To blossom, to effloresce. 
Effundo, udi—To pour out. 
Effluvium—Exhalation, vapor. 
Egilidus—Coolish, lukewarm. 
Ejaeulator—To cast out (ejaculatores muscles). 
Ejusmodi—Of that kind, like. 
Elanguesco—To faint, to grow languid. 
Elavo—To wash out, to bathe away. 
Electe—With choice. 
Elementum—Element, first principle. 
Elephantus—An elephant (elephantiasis). 
Elinguis—Speechless, dumb. 
Elinguo, are—To deprive of the tongue. 
Eliquo, are—To make liquid. 
Emitto to send out, to send forth. 
Emetica, se—An emetic. 
Emollio, avi—To soften. 
Emorior—To die, to pass away. 
Empirice, es—An art of healing founded on mere prac- 
tice. 
Empiricus, i—A physician instructed only by practice, 
a quack, an empiric. 
Emplastrum—A plaster for a wound. 
Emulsio—An emulsion. 
Eneco, cui—To kill, to torture. 
Enema—A clyster. 
Enervis, e—Weak enervated, feeble. 
Enim—For, therefore. 
Enimvero—Surely, of a truth. 
Enixus, us—The act of bringing forth young. 
Enterocele, es—A kind of rupture or hernia. 
Enterocelicus, a, um—Afflicted with rupture. 
Enucleo, avi—To take out the kernel, enucleate. 
Enudo, avi—To make bare. 
Eo, avi—To go. 
Eo, (adv.)—Thither, for that reason. 
Eodem—To the samp purpose. 
Epiphora, se—A stoppage of humors in the body. 
Epitaphium, i—An epitaph. 
Epuhe, arum—Upright. 
Ergo—Therefore, because. 
Erodo—To eat away. 
Eratim—An error. 
Erubesco, bui—To redden, to blush. 
Eructo, are—To belch or vomit forth (eructation). 
Erudite, adv.—Learnedly (tactus eruditus). 
Eruptio, onis—A breaking out, an eruption. 
Esculentus, a, um—Eatable. 
Esse (est, sunt)—To be. 
Esito, avi—To eat. 
Estur—A gormandizer. 
Estrix—A female eater, a gormandizer. 
Esurio, iro—To hunger, to be hungry. 
Esuritor, oris—A hungry person. 
Et—And. 
Ethicus, a, um—Belonging to moral or manners. 
Etiam—Also, although. 
Etiam atque etiam—Again and again. 
Etsi—Although, yet, but. 
Eu 1 (euge, evax)—Well done, well, bravo. 
Eunuchus, i—Eunuch. 
Evaporatio, onis—Evaporation. 
Evanesco—To vanish, to disappear. 
Evigilo—To wake, be wakeful. 
Eviro, avi—To castrate. 
Evomo, ui—To vomit forth. 
Exania—A falling down of the anus. 
Exanimus, e—Without breath. 
Exanthemata—An eruptive disease. 
Excandenscentia, se—Heat of passion, violent anger. 
Excelsus, a, um—High, lofty, elevated. 
Excido, idi—To hue or cut out of, excise. 
Excito—To stimulate (excitants). 
Excrementum, i—That which passes from the body, 
secretion. 
Excorio—To take off the skin (excoriation). 
Exedo—To eat out of, destroy. 
Exhalatio, onis—An exhalation, an evaporation. 
Exhalo, avi—To breath out, exhale, evaporate. 
Exhibeo, ui—To exhibit, to give, to impart. 
Exhumo—To disinter. 
Exique—Briefly, shortly. 
Exoculo, avi—To deprive of eyes. 
Exosis, ossis—Without bone. 
Exosso, avi—To deprive of bone.' 
Exostosis, osis—A morbid enlargement of bone. 
Exacerbo—To exasperate, (exacerbation). 
Excresco—To grow from (excrescence). 
Exfoetatio—Extra uterine fetation. 
Exfoliatio—Separation of dead bone from the living 
Expecto—To wait for (expectant). 
Expectoratio—Expectoration. 
Expedite—Easily, promptly, quickly. 
Experientia, se—Proof, trial, experience 
Experimentum—Experiment, trial. 904 
LATIN VOCABULARY, 
Experto, ivi—To attain anything, to aim at. 
Expiratio—Expiration, to breathe out. 
Exploratio, onis—An examination, investigation. 
Exsectio, onis—A cutting off or out. 
Exsicco—To dry up, make dry. 
Exspisso—To make thick, to exspissate. 
Extendo—To stretch out, to extend. 
Extensor—A muscle which extends. 
Externus—External, outward. 
Extirpo—To pluck up by the roots, extirpate. 
Extractum—An extract. 
Extravasatio—The passage of fluids out of their proper 
vessels. 
Exudatio—Transpiration. 
Exuviae—The slough, the cast off covering of certain ani- 
mals. 
Fac—Make. 
Facio, feci—To make, to do. 
Facies—The face. 
Facies hippocratica—A peculiar appearance of the face 
before death. 
Facies rubra—The old name for gutta rosacea, or acne. 
Factitious, a, um—Artificial. 
Facultas—From facere, to make (faculty). 
Faecula, a—The dregs, the lees. 
Fsex, cis (faeces pi.)—Sediment, dregs, excrement. 
Falciforma—Like a sythe. 
Falx—A scythe, a sickle. 
Falx cerebri, falx cerebelli—Processes of the dura 
mater. 
Fama, »—Fame, public opinion. 
Fames, is—Hunger. 
Far—Corn. 
Farina—Meal, flour. 
Farcimen—Farcy. 
Fascia, ae—A long, narrow band. 
Fascia lata—The aponeurosis of the thigh. 
I'ascia superficlalis—A membrane extending over the 
abdomen. 
Fascialis—The tensor vaginae femoris. 
Fasciculus, i—A small bundle. 
Fastidium. i—Nausea, or distaste for food. 
Fatuus—Insipid, tasteless. 
Faux, cis (fauces pi.)—The throat, the gullet. 
Favus, i—Honeycomb, a non-acuminated pustule. 
Febris, is—A fever, pyrexia. 
Febriculoscus, a, um—Sick of a fever. 
Febricula—A slight degree of fever. 
Febrifugum—A febrifuge. 
Febrifugum magnum—A name given to cold water as a 
drink in ardent fever. 
Febris accessus—The accession of a fever. 
Febris decessus—The decline of a fever. 
Febre durante—While the fever continues. 
Fecunde—Fruitfully. 
Fecundo—To make"fruitful, fertilize. 
Fecundatio—Impregnation. 
Fel, fellis—Gall, bile. 
Fel, bovis—Ox gall. 
Felis, is—A cat (feline). 
Felliflua passio—Ancient name for cholera (gall flux). 
Femella—A little woman, a girl. 
Femina, ;n—A female. 
Feminalis—Belonging to a woman. 
Femineus—Womanlike. 
Femur, femoris—The thigh. 
Fenestra—A window (fenestra ovalis, etc.) 
Feralis, e—Of, or belonging to the dead, fatal. 
Fere—Almost, nearly. 
Fermento, avi—To cause, to ferment. 
Fermentum, i—That which causes anything to ferment, 
leaven. 
Fermentatus panis—Leavened bread. 
Ferrum, i—Iron. 
Ferrugineus, a, um—Of, or pertaining to iron, the color 
of iron. 
Fertilizatio—The function of the pollen of plants, etc. 
Ferula, ;e—An umbelliferous herb with a soft pith in 
which fire was easily harbored. 
Fervefacio, eci—To cause to boil. 
Fervefactus—Made hot. 
Fervens, entis—Hot, glowing. 
Ferveo—To be hot, or heated, to burn. 
Fervesco—To begin to boil, to grow hot. 
Fessulus, a, um—Somewhat fatigued. 
Fessus—Weary, tired. 
Fetura, ae—A treading, a bearing. 
Fetus (foetus)—Offspring, young. 
Fibra—A fibre, a filament (fibrin, fibril). 
Fibrae—The entrails (old). 
Fibula, ae—A clasp or buckle, the lesser bone of the 
leg from its being opposite to where the knee buckle 
was attached. 
Ficatio, or ficus—A fig-like tubercle about the anus. 
Ficus—A fig. 
Filia, ae—A daughter. 
Filius, i—A son. 
Filum, 1—A thread. 
Filamentus—A small thread, a filament. 
Filaria—A thread-like parasitic worm. 
Filix, icis—A fern. 
Filiformum—Thread-like. 
Filtrum—A strainer. 
Fimbra—A fringe, the fringe-like extremity of the Fal- 
lopian tube. 
Fimbriatus—Having the margin bordered with filiform 
processes. 
Fimus—Excrement of animals. 
Finis—An end, limit. 
Flo fieri—To make, to become. 
Fissura—A fissure, a groove. 
Fistula—An ulcer, a fistula, a pipe. 
Fistula, in ano—Fistula in the rectum. 
Fistula lacrymalis—Fistula of the lacrymal sac. 
Flabelliformis—Fan shaped, like the rays of a fan. 
Flaccidus—Languid, without force. 
Flagelliformis—Whip-like, long, taper. 
Flamma, ae—A flame. 
Flammatus—Inflamed. 
Flatus—A blast, wind in the intestines. 
Flavus—Yellow. 
Flebilis—Tearful, mournful. 
Flecto, xi—To bend. 
Flexio, onis—Bending (flexor). 
Floccitatio—Picking of the bedclothes, forerunner of 
death. 
Flocculus—Vel lobus nervi pneumogastrici. 
Floreo (flores)—To flower, to blossom. 
Fluctus—A flowing (flux). 
Fluctuatio—Fluctuation, perceptible, motion on pres- 
sure. 
Fluidus—Fluid, not solid. 
Foeteo—To stink, to smell badly. 
Folium—A leaf, a herb. 
Folicula—A minute secreting cavity. 
Fomentum—A fomentation, an application. 
Fomes, fomites pi.—Substances imbued with contagion. 
Fons, tis—A fountain. 
Fontanella—Spaces left in the head of an infant. 
Fonticulus—A little fountain, an issue. 
Foramen (foro)—An opening, aperture. 
Forceps, icis—A pair of tongs, pincers. 
Formica—An ant, a creeping itching. 
Formico—To raise in pimples, to creep. 
Formidibalis—Terrible, formidable. 
Formula—A prescription, a given form. 
Fornix—An arch, a triangular lamina in the brain. 
Fortis, e—Strong. 
Fossa—A depression, a sinus 
Fractus (frango)—Brittle, broken, (fracture). 
Fragmentum—A piece broken off. 
Frater, tris—A brother. 
Frenum—A bridle (frenum lingue). 
Frenum labiorum—The fourchette. 
Fremitus—Vibration (In auscultation, etc.) 
Frigidus—Cold. 
Frigeo, xi—To freeze. 
Frons, frontis—The forehead. 
Fructus—Fruit. 
Frumentum—Corn or grain for making bread. 
Fuligo—Soot or smoke (antimony guv.) 
Fuligo ligni—Soot of wood (fuliginous). 
Fulmer—Lightning that strikes. 
Fumigatio (fumo)—To smoke, to perfume. 
Functio (fungor, to do)—To discharge an office, function 
Fundus—The bottom of any viscera. 
Fundamen—A foundation. 
Funebris—Of, or belonging to a funeral. 
Funginus (fungus)—A mushroom, a fungus. 
Fungiformis—Like a fungus. 
Funiculus—The spermatic cord. 
Funis (umbelicus)—The umbilical cord. 
Funus, eris—A dead body, a corpse. 
Furfur—Bran, a desquamation or the cuticle. 
Furor—Madness, vehement desire. 
Furor uterinus—Old name for nymphomania. 
Fusus—Melted, poured out, (fusibility). 
Fusiformis—Spindleshaped, 
Futurus—That shall or will be. 
In futurum—Hereafter. 
Galla—Galls. 
Gelu (gelatus—Frost (gelatine). 
Gemellus—Double, twins, the name of two muscles. 
Gemma—Precious stones, the leaf bud. 
Gena—The cheek. 
Genero, avi—To produce (generation). 
Genesis—Generation, creation, birth, 
Genu—The knee. 
Genus—A race. 
Germen—A bud (germinate). 
Gestatio—A carrying, the state of pregnancy. 
Glacies—Hardness, icy. 
Gians, dis—An acorn, a gland. 
Glandula—A snA.Il gland. LATIN VOCABULARY. 
905 
Glaucoma, atis—An optical illusion. 
Globo, avi—To make round. 
Globus, i—A globe, a ball, a pellet. 
Globulus, i—A globule. 
Globus hystericus—A sensation of hysteria. 
Gluten, inis, glutinum, i—Glue, gluten. 
Gradatim—Step by step, by degrees. 
Gratus, a, um—Pleasing, agreeable. 
Granum—A grain, a small portion. 
Granula—A little grain. 
Gravido, avi—To load, to impregnate. 
Gra vitas—Heaviness. 
Gula—The gullet, the esophagus. 
Gulosus—Gluttonous. 
Gurgulio—The windpipe (hence gargle). 
Gustatus—A tasting (gustatory). 
Gutta—A drop. 
Guttifera—Drop bearing. 
Guttatim—By drops. 
Guttatus, a, um—Spotted, speckled. 
Guttur—The throat. 
Gymnas, adis—Exercise. 
Gyrus, i—A circle, the spiral cavity of the Internal ear, 
the convolutions of the brain. 
Ilabendus—To be had or held. 
Habeo, in—To have, to hold. 
Hac—Here, thither. 
Haesitatio—Stammering, hesitation. 
Halitus—An aqueous vapor, exhalation. 
Hallucinatio—Erroneous imagination. 
Halo—A circle surrounding a light, areola. 
Hamulus—A little hook. 
Hamulus cochleae—A portion of the inner ear. 
Haustus (haurio, to draw)—A draught 
Hemitritaeus—A semitertian ague. 
Hepar—The liver. 
Hepatarius—Relating to the liver 
Hepaticus—Diseased in the liver. 
Herba, ae—Herbage, an herb. 
Hereditas—Inheritance. 
Heri—Yesterday. 
Hesperus—The evening. 
Hiatus—An opening, an aperture. 
Hibrida, ae—Of ambiguous origin. 
Hie, haec, hoc—This, such. 
Hiems, emis—Winter. 
Hieto—To gape, to yawn. 
Hilum—The base of a seed at its attachment. 
Hilus lienis—A fissure in the spleen. 
Hinc—Hence, from this place. 
Hinc et hinc—On this part or that. 
Hira, se—A gut. 
Hircus—A he-goat, a goatish smell, the rank smell of 
the armpits. 
Hirudo—A leech. 
Hirsutus—Shaggy, superfluous growth of hair. 
Hodie—To-day. 
Homicidium—Manslaughter, homicide. 
Homo, inis—A human being, a man. 
Hora—An hour. 
Hora somni—At the hour of sleep. 
Hora decubitus—At bed-time, or time of lying down. 
Horis intermediis—At intermediate hours. 
(In horas—Every hour.) 
Hordeum—Barley. 
Hornus—Of this year. 
Horridus, a, um—Dreadful, terrible. 
Humanitas, atis—Humanity, human nature. 
Humanus, a. um—Human. 
Humerus, i—The upper bone of the arm. 
Humidus, a, um—Moist, wet, damp. 
Humo—To bury, to inter. 
Humoris, oris—A moisture, a humor. 
Humus, i—The earth, the ground. 
Hyalus—Glass. 
Hydraulicus, a, um—Relating to the scientific motion of 
the water. 
Hydrocele, es—A watery rupture, a hydrocele. 
Hydropsis, is—The dropsy. 
Hydrargyrum, i—Mercury, quicksilver. 
Hymen, inis—A 
Hystericus, a, um—Hysterical. 
Ibi—There, in that place. 
Ibidem—In the same place. 
Ictericus, a, um—Jaundiced, 
Icterus—Jaundice, a small yellow bird, the sight of 
which was said to cure the jaundice. 
Ictus soils (ictus, a blow)—Sun stroke, coup de soleil. 
Idea, se—An image, from (hence idea, notion). 
Idiota—A senseless person. 
Idolum, i—An image that is present to our eyes or mind, 
a spectre, a ghost. 
Igneus—Fiery, burning. 
Ignis fatuus—A luminous appearance. 
Ignis sacer—(Old) St. Anthony’s fire, erysipelas, 
lie, is—A small gut, the ilium. 
Iliacum, os—Os coxarum, old name for osinnomination. 
Ille, a, ud—He, she, that, 
Illusio, onis—Deception as to the sight, imagination, etc. 
Illutatio, onis—Mud bathing. 
Imago—Image, shadow, image of the mind. 
Imbibo—To drink, imbibe. 
Imbecilis, e—Weak, infirm of mind. 
Imberbis.e—Without a beard, beardless. 
Imbibo—To drink, to suck in. 
Imbrex—A roof tile, (imbricated). 
Immanis, e—Wild, savage, cruel, inhuman. 
Immaturus—Untimely, unripe. 
Immergo—To dip, to plunge, immerse. 
Immortalis, e—Immortal, divine. 
Impar—Unequal, uneven. 
Impatientia, se—Impatience, unability to suffer or en- 
dure. 
Impenetrabilis, e—Impenetrable. 
Imperfectus—Incomplete, unfinished. 
Impetigo (impeto to infest)—A pustular disease. 
Implantatio, onis—Ingrafting. 
Impluvium, i—A shower bath. 
Impono—To place, set, or apply upon. 
Impotens—Powerless, weak, impotent. 
Impransus—That has not taken any food, fasting. 
Imponderabilis—Without weight. 
Impregnatio—Impregnation, conception. 
Imprimo—Principally, in the first place. 
Impubes, eris—Beardless. 
Impudicus—Shameless, unchaste. 
Impure, (adv.)—Filthily, impurely. 
In—In. 
In die—In a day. 
Indies—Every day, daily. 
Inanimis—Without breath, lifeless. 
Inanis—Void, empty, (inanition). 
Inauris, is—An ear ring. 
Incandesco—To grow white, (incandescence). 
Incanto—To enahant, to bewitch. 
Incarcero—To imprison, to incarcerate. 
Incarnatio (in carnis, flesh)—Granulation. 
Ineeptio—To begin. 
Inceste—Unchastely, impurely. 
Incisio, onis—An incision. 
Incisorus, es fl.—The front or cutting teeth. 
Incontiens—Not holding together, incontinent. 
Incoquo—To boil together. 
Incubatio—Incubation. 
Incuratus—U nhealed. 
Incubus—Nightmare, oppressive sensation. 
Incus, udis—An anvil, a small bone of the internal ear. 
Inde—Hence, from that place. 
Index (indico, to front out)—The forefinger. 
Indicatio—A pointing out, indication. 
Indigena—A native of the country, indigenous. 
Indigestio (indigero, to distribute)—Dyspepsia, indiges- 
tion. 
Indolens—Indolent, slow in action. 
Inductus—Persuaded, induction. 
Induratio (induro)—Induration, hardening. 
Inebrio, avi—To make drunk. 
Iuedia, se—Abstinence from food, 
Inertia—Inactivity. 
Ineruditus—Unlearned, awkward, unskilled. 
Infans—An infant, that cannot speak. 
Infantiscido (infans csedo, to kill)—Infanticide. 
Inficio, eci—To stain, to poison (infection). 
Infirmitas—Weakness, infirmity (infirmary). 
Infiltratio—Diffusion of fluid into the cellular tissue. 
Inflammatio (to burn)—Inflammation. 
Inflatio—A blowing up, inflation. 
Infloresco—To flourish, inflorescence. 
Infra—Beneath, below, under. 
Infundibulum—A little funnel-shaped process. 
Infusus—Pouring into, infusion. 
Ingestus—A pouring in, ingesta. 
Inguen, inis—The groin. 
Inhalo—To breath on (inhalation). 
Inhumanus—Inhuman, not human. 
Inhumo—To inter. 
Inibi—Therein. 
Injectus—A throwing in, an injection. 
Injuria, se—Hurt, injury, harm, damage. 
Innominatus—Nameless. 
Innuptis, a, um—Unmarried. 
(Nuptiae innuptise—An unfortunate marriage.) 
Inoculatio—An insertion of virus. 
Inopia—Poverty, need, destitution. 
Inquietus, a, um—Restlessness, unquiet. 
Inosculatio (osculum, a little mouth)—Union of vessels, 
anastomosis. 
Insaluber, bris—Unwholesome, not conducive to health. 
Insanabilis, e—That cannot be cured or healed. 
Insania, se—Madness, phrenzy. 
Insecta—An insect. 
Inserto, avi—To put in, to insert. 
Insiccatus—U ndried. 
Insidiosus, a, um—Dangerous. 906 
LATIN VOCABULARY, 
Insolo, avt—To dry in the sun. 
Insolubilis, e—That cannot be dissolved. 
Insomnia, as—Want of sleep, sleeplessness, 
lusomnium, i—A dream. 
Inspiro—To breathe upon, inhale (inspiration). • 
Inspergo—To sprinkle upon. 
Inspico, exi—To inspect, examine. 
Inspisso—To render thick, inspissate. 
Instrumentum, i—Instrument, tool. 
Insufflatio—To blow into, insufflation. 
Insulatio—Insulation. 
Integumentum, i—A covering, integument, cuticle. 
Intelligens—Intelligent, sensible. 
Intemperans, tis—That cannot moderate himself. 
Interne—With earnestness. 
Inter—Between or among. 
Interdie—By day, in the daytime. 
Interim—In the meantime. 
Intestinus, a, um—Internal, intestine. 
Intime—Most intimately. 
Intra—Within, on the inside. 
Intolero—That cannot be borne. 
Iutumesco—To swell, intumesence. 
lntus susceptio (intus, within, suseipio, to receive)—The 
descent of a higher portion of intestine into a lower 
one. 
Invaginatio (in vagina, a sheath)—Synonymous with in- 
lus-susception. 
Inverminatio—An affection in which worms or larvae in- 
habit the stomach or intestines. 
Inverto—To turn, turn up or about. 
Involucrum—The designation of membranes that cover 
any part. 
Ipse—Self. 
Ira—Anger, wrath, rage, 
lrritabilis, e—Easily excited, irritable. 
Irrito—To incite, to irritate, excite. 
Irrigo—To irrigate, to apply cold water or lotion to an 
affected part 
Ita—Thus, even so. 
Item—Also, likewise. 
Iterum—Again, the second time. 
Jactatio, vel jactitatio (jacto)—Restlessness, change of 
position. 
Jam—Now, at this time, at present. 
Janitor, oris—A porter, a doorkeeper. 
Jecur, oris—The liver. 
Jecusculum, i—A small liver. 
Jejunum, i—The upper two-fifths of the small intes- 
tines, so called from this part being usually found 
empty. 
Jejunus, a, um—Fasting, hungry, empty. 
Jentaculum—A breakfast. 
Jento, avi—To break one’s fast. 
Juba, ®—The mane, the flowing hair of an animal. 
Jugulum, i—The throat. 
Junctim—Unitedly, jointly. 
Jus, juris—Broth, soup. 
Jusculum—Diminutive of jus. 
Jureus—Consisting of broth, full of broth. 
Jus ovilli—Mutton broth. 
Jusculum, coactum—Jelly. 
Juxta—Near to, by. 
Labium, l—A lip. 
Labellum—Lip-like, used in botany. 
Labor, oris—Work, toil, child-birth. 
Lac, Us—Milk. 
Lac vaccinum—Cow’s milk. 
Lac recens—New milk. 
Lacti depulsus—Weaned. 
Lacero—To tear, (laceration). 
Lacertus, i—The arm, (hence lacertus, a blow). 
Lacryma, ee—A tear. 
Lacrymo—To shed tears. 
Lactitio, are—To give milk, to suckle. 
Lactuca, te—A lettuce. 
Lacuna, ae—A lake, follicles in the mucous membrane 
of the urethra. 
Lallo, are—To sing to sleep, to sing lulla, or lullaby. 
Lamina, ae—A thin plate or leaf. 
Lana—Flannel, wool. 
Lana philosophies—White oxide of zinc. 
Languor, oris—Faintness, feebleness, weariness. 
Lancetta (lanca a shear)—A lancet. 
Lapis, idis—A stone. 
Larva, ae—A visor, a mask. 
Lascivus—Wanton, lustful. 
Lassitudo, inis—Faintness, weakness, fatigue. 
Latus, eris—A side, a flank (lateral). 
Lavo, avi—To wash, to bathe. 
Laxo, avi—To loosen (laxatives). 
Lectus, I—A bed. 
Lectulus, i—A sofa, a lounge. 
Lecto teneri—To be sick in bed. 
Legumen, inis—Pulse. 
Lenio ivi—To alleviate, to soften, to mitigate, (lenitives). 
Lens, Us—A bean, a lenUl (lenticular). 
Lentigo—Freckles, yellow spots on the skin. 
Lentus—Glutinous, clammy, (lentor of the blood). 
Lesio—Hurt, Injury, morbid change. 
Lethe, es—Forgetfulness. 
Leto—To kill. 
Letum, vel lethum—Death. 
Letum ibi, consciscere—To kill oneself. 
Levator—A lifter up. 
Levigo—To polish, to smooth (levigaUon). 
Liber, a, um—Free. 
Liber, bri—A book. 
Libet, lenit—It pleases, is agreeable. 
Libet adlibitum—As you please). 
Libitina—Any kind of furniture for funerals. 
Libra, se—A pound. 
Libramen—A balance, counterpoise. 
Lien, enis—The milt or spleen. 
Ligamentum—A band, a ligament. 
Ligo, avi—To bind, to tie, (ligature). 
Lignum—Wood. 
Lima* (limus, slime)—A snail (cochlea terrestris). 
Linamentum (linum, linen)—Lint, a tent for a wound. 
Lineamentum, i—Features, lineaments, a line. 
Linimentum (lino, to besmear)—A liniment, embroca- 
tion. 
Linum, i—Flax, lint. 
Lippio—To have blear eyes. 
Lippitudo, inis—An affection of the eyes. 
Ligneo, qui—To be liquid or fluid. 
Liquefacio—To melt, to liquefy. 
Liquor, oris—A liquid, fluid. 
Lividus—Of a bluish color. 
Livor, oris—Black and blue, a mark produced by a 
blow. 
Lix, licis—Lye, (lixivium). 
Lobus (lobulus)—A lobe, a lobule. 
Locales—Local diseases. 
Locomotio—Moving from one place to another. 
Lomentum, i—That which is used for washing, an emo- 
lent used for softening the skin. 
Longus—Long. 
Lotio—A lotion, a wash. 
Lubrico, aid—To make smooth, to lubricate. 
Lues, is—A contagious disease, a pestilence. 
Lues Venerea—The plague of Venus, syphilis. 
Lumbus, i—A loin. 
Lumbricalis—Muscles of the hand and foot. 
Lumbricus—The earth worm. 
Luna—The moon (lunatic). 
Lunula (a little morn)—The white semilunar mark at 
the base of the nails. 
Lupia—A wen, a tumor. 
I.up us (a wolf)—A tubercular affection, noli me tangere. 
Luscus—Blind in one eye. 
Lusciosus—Purblind, dimsighted (luscitas). 
Luxus, us—A dislocation, luxation. 
Lympha—Water (lymphatics). 
Macero, avi—To make soft, to steep, to macerate. 
Macies, ei—Leanness, thinness. 
Macula, se—A spot. 
Magis—More. 
Magnus, a, um—Large, great. 
Magnesia—An earth, oxide of magnesium. 
Mala, as—A cheek bone, jaw. 
Male—Badly, ill. 
Malignus—Of a bad kind, malignant. 
Malleolus, i—A small hammer, the ankle bone. 
Malleus—One of the small bones of the ear. 
Mai us, a, um—Bad, evil. 
Maliformis—Badly formed, malformed. 
Malus, i, vel malum, i—An apple. 
Mamma, se—The breast. 
Mammalia—Vertebrata with mammary glands. 
Mamilla—Synonymous with papilla. 
Mancus—Maimed, defective m limbs. 
Mane—In the morning. 
Mane primo—The first thing in the morning. 
Maneo—To remain. 
Manes, ium—The spirits of the dead. 
Mania, se—Madness, insanity, rage. 
Manipulus, i—A handful. 
Manebrium, i—A handle, the upper bone of the ster- 
num. 
Manus, us—A hand. 
Mare, is—The sea. 
Margo, inis—An edge, border. 
Maritus, a, um—Of, or belonging to marriage. 
Masculus, a, um—Male, masculine. 
Massa—A lump, a mass. 
Mastico—To chew, to masticate. 
Matella, se—A chamber pot, a night stool. 
Masturbatio—Masturbation. 
Mater—A mother. 
Materia medica—That branch of medical science which 
relates to medicines. 
Matrimonium, i—Marriage, matrimony. 907 
LATIN VOCABULARY. 
Maturo—To ripen (maturation). 
Maxilla—The cheek bone. 
Maximus, a, um—The greatest, largest. 
Meatus, us—A passage. 
Medicabilis, e—That can be healed or cured. 
Medicamen, inis—Any remedy applied to diseases or 
wounds. 
Medicamentum, i—That heals diseases. 
Medicinus, a, um—Of, or belonging to physic. 
Medico—To heal, to cure. 
Medicus—A physician. 
Medulla, ae—The marrow of bones, the pith of plants. 
Mel, mellis—Honey. 
Melancholia, se—Black bile, melancholy. 
Membrana, se—The skin or membrane that covers the 
separate members of the body. 
Membratim—By members, limb by limb. 
Membrum—A limb, a member of the body. 
Mens—The mind. 
Mensis, is—A month. 
Menstruus, a, um—That happens every month (men- 
struation). 
Mensura, se—A measure. 
Mentum—The chin. 
Mephitis, is—A noxious and pestilential vapor. 
Meridtes—Mid day, noon. 
Metallicus—Of, or belonging to metals. 
Metamorphosis, is—Transformation, change. 
Miliaria—Miliary fever, vesiculse. 
Milium—A millet seed, a small white tumor. 
Mille—A thousand. 
Minimum—The least. 
Misceo—To mix, to mingle. 
Missus (mitto)—Sent. 
Mistura, te—A mixture. 
Mitella, se—A bandage around the head. 
Mitigatio, onis—A mitigation, alleviation. 
Mitto, misi—To send. 
Miira—A mitre, a covering of the head (mitral). 
Moderate—With moderation, temperately. 
Modus, i—Way or manner, measure. 
Modo prsescripto—In the manner directed. 
Molaris (mola, a millstone)—A double or grinding tooth. 
Molestus—Tro ublesome. 
Mollis, is—Soft. 
Molluscum—A wen, a movable tumor (ord. tubercula). 
Mons—A mountain. 
Mons veneris—The eminence over the os pubis in wo- 
men. 
Monstrum, i—A monster, contrary to the usual course 
of nature. 
Mora, se—A delay, tarrying. 
Morbus, i—A disease. 
Mordeo—To bite with the teeth. 
Mordex—A tooth. 
Moribundus—Dying, ready to die. 
Morior—To die. 
Mors, tis—Death. 
Mortalis, e—Mortal, subject to death. 
Morticinus—That has died through disease. 
Morpheus—The God of sleep (morphia). 
Mortificatio (mors fio)—Mortification. 
Motio, onis—A moving, a motion. 
Moveo, movi—To move, to set in motion, to stir. 
Mucosus, a, um—Slimy, mucous. 
Mucus, i—Mucus, the discharge from the nose. 
Muliebris, e (mulier)—Womanly. 
Mulier, eris—A woman. 
Multiformis, e—Having many forms or shapes. 
Multiplex, icis—That has many folds. 
Multus, a, um—Many, numerous. 
Musca, se—A fly. 
Muscae volitantes—An appearance of motes or small 
bodies floating before the eyes. 
Musculus, i—A muscle of the body 
Muto, avi—To move, to change. 
Mutus, a, um—Dumb, silent, mute. 
Naevus, i—A mark or mole on the body. 
Nam—For. 
Nanus—A dwarf. 
Nares, ium, vel nasus, i—The nose. 
Naris, is—A nostril. 
Narthecium, i—A chest for unguents and medicines, a 
gallipot. 
Nata, te—A daughter. 
Natalis, e—Of, or belonging to one’s birth. 
Nads, is—A buttock. 
Natura, ae—Nature, birth, the universe. 
Natus—A son. 
Nausea, ae—Desire to vomit, nausea. 
Nauseo, avi—To feel sick, to be ready to vomit, to loathe, 
to be disgusted with. 
Naviculare, os—A boat-shaped bone of the carpus and 
tarsus. 
Nebula, se—A mist, vapor, cloud, haziness. 
Nec—Neither, nor. 
Nervus, 1—A nerve. 
Nex, necis—Death by violence. 
Nieto, avi—To wink with the eyes (nictitation). 
Niger, gra—Black. 
Nisi—If not, unless. 
Nix, nivis—Snow. 
Noceo, ni—To injure, to harm, to hurt. 
Nocturnus, a, um—By night, nocturnal. 
Noctambulatio, onis—Night-walking. 
Nodo, avi—To knot. 
Nodus, i—A swelling of the bone, a node. 
Nodula—A small bone. 
Nodus cerebri—The pons varolii or tuber annulure ol 
the brain. 
Nolo—To be unwilling. 
Noli me tangere—Touch me not. Lupus (tubercula). 
Nomen, inis—A name, appellation. 
Norma, ae—Rule, prescript (normal, abnormal). 
Nostrum—Our own, a quack medicine. 
Nothus, a, um—Spurious, counterfeit, not genuine. 
Novo, avi—To make anything new, to renew. 
Nox, noctis—Night. 
Nocte (or de nocte)—By night. 
(De multa nocte—Late at night.) 
Noxius, a, um—Noxious, hurtful, harmful. 
Nubes, is—A cloud. 
Nebula, as—A small cloud. 
Nubilis, e—Marriageable. 
Nubo, psi (to veil, to cover)—To marry, as the bride puts 
on a veil. 
Nupta, as—A bride, a wife. 
Nucleus, i—The kernel, the solid centre. 
Nudus, a, um—Bare, naked. 
Nullus, a um—None, nothing. 
Numero, avi—To number, to reckon, to count. 
Nunc—Now. 
Nunquam—Never. 
Nuptae, arum—Marriage, wedding. 
Nurus, us—A daughter-in-law. 
Nuto, avi—To nod. 
Nutrimentum, i—Nourishment, support. 
Nutrio, avi—To give nourishment. 
Nympha, as—A veiled bride, the chrysalis of an insect. 
Nymphas—Labia minora. 
Nymphomania—Lascivious madness in females. 
Obesus, a, um—Fat, corpulent (obesity). 
Obliquus—Oblique, crooked, slanting. 
Oblitero, avi—To efface, to deface, to close. 
Oblivio—Forgetfulness, failure of memory. 
Obsoletus—Old, no longer new. 
Obstetrix, icis—A midwife. 
Obsto, iti—To stand before or against. 
Obstructio—A stopping up, obstruction. 
Obturo, avi—To stop up, (obturator). 
Occiput, ids (ob. caput)—The back part of the head, 
occiput. 
Occlusus, a, um—Shut, closed. 
Occulto—To hide, to conceal. 
Oceanus, i—The ocean. 
Ocellus, i—A little eye. 
Octes—Eight times. 
Octo—Eight. 
Oculatus, a, um—Furnished with, or having eyes. 
Oculus, 1—An eye (oculist). 
Odor, oris—Scent, smell. 
Cdorifer, a, um—That brings an odor or scent. 
Oestrus, i—The gad fly. 
Oflicina, ae—A workshop (officinal). 
Olea, ae—An olive. 
Oleum, i—The expressed oil of olives, an oil. 
Olfactorius, a, um (olfacio;—That serves or belongs to 
smelling. 
011a, se—A pot, a jar. 
Ollaris, e—Preserved in jars. 
Omasum, i—The third stomach of Ruminantia. 
Omentum, i—The membrane which incloses the bowels. 
Omitto, isi—To lay aside, to leave off, omit. 
Omnis, e—All. 
Onyx, ychis—A finger nail. 
Onychia—An abscess near the finger nail. 
Opacus—Shaded, opaque. 
Operosus, a, um—Full of pains or endeavor. 
Ophthalmicus, a, um—Of, or relating to the eyes. 
Opposio, sui—To set or place against, oppose. 
Optio, onis—Free will, choice. 
Orbiculus, i—A small circle. 
Orbis, is—Anything of a circular shape. 
Orbita, aa—The cavity in which the eye is fixed. 
Organum, i—A part which has a determinate office in 
the animal economy. 
Origo, inis—An origin, beginning. 
Orificium, i—An orifice, a mouth or entrance. 
Os, oris—The moulh. 
Os, ossis—A bone. 
Osseus, a, um—Of, or pertaining to bone. 
Osslficatio, onis—Becoming bone, formation of bone. 
Ostium—The door of a chamber (osteum abdominale). 
Ovis, is—A sheep. 908 
LATIN VOCABULARY. 
Ovarium (ovum)—An organ containing the ova. 
Ovulum, i—A little egg (ovula). 
Ovum, i—An egg. 
Pabulum, i—Food, nourishment, support. 
Psedor—Nastiness, by want of proper attention. 
Palam—Openly, publicly. 
Palatum, i—The palate. 
Pallidus, a, um—Pale, wan, pallid. 
Palma, as—The palm of the hand. 
Palpebra, se—An eyelid. 
Palpatio, onis (palpo)—Manual examination, palpation. 
Palpitatio, onis (palpito)—An action of the heart. 
Panacea, as—A herb said to cure all diseases. 
Panis—Bread. 
Pannus—(A rag, a cloth) a disease of the eye. 
Papilla, as—The nipple of the breast, a small eminence. 
Papula, as—A pimple, a papule. 
Par, paris—Equal, even. 
Parasitus, i—A parasite, a sponger. 
Parate—Preparedly, carefully. 
Parco, pepersi—To spare. 
Parce—Sparingly, moderately. 
Parens, tis—A parent. 
Paries, parietis—Partition wall, parietal. 
Paro, avi—To prepare, to make. 
Pars—Part, piece. 
Parturio, ivi—To bring forth, to be in travail. 
Parturifaciens, tis—A medicine which causes uterine 
pains. 
Parvus—Small, little. 
Pastillus, i—A perfumed or sweet ball. 
Patella, Be—The knee pan. 
Patens, tis—Open, passable. 
Pater, tris—A father. 
Patiens, tis—Patient, enduring. 
Patulus, a, um—Open, standing open. 
Pecco, avi—To do a thing wrongly, to be in fault 
(peccant). 
Pecten, tinis—A comb (pectineus, pectenate). 
Pectus, oris—The breast (pecloralia). 
Pediculus—A louse. 
Pediculosus, a, um—Full of. lice, lousy. 
Peduculatio, onis—An affection of the skin, phtheiriasis. 
Pediluvium, i (pes lavo)—A foot bath. 
Pedunculus—Splay footed, peduncle. 
Pellicula, os (pellis)—A thin skin, pellicle. 
Pellis, is—A hide, or skin. 
Pellucidus, a, um—Transparent, pellucid. 
Pendeo, pependi—To hang down, to suspend. 
Pendo, pependi—To hang down (pendent). 
Pendulus, a, um—Hanging, hanging down. 
Peniculum, i—(A painter’s pencil) a tent, a pledget. 
Penis, is—The male organ of generation, membrum 
virile. 
Penite—Inwardly, internally. 
Penna, as—A feather, a wing. 
Pennatus, a, um—Winged, feathered. 
Pennipes, edis—Feather-footed. 
Penso, avi—To weigh, to weigh out. 
Penus, us—Provision, store of food. 
Per—Through, by. 
Percolo, avi—To filter or strain through, to percolate. 
Percutio, ussi—To strike through, percussion. 
Perditus, a, um—Lost, hopeless. 
Perennis, e—That lasts for a year or more, perennial. 
Perfectus, a, um—Perfect, complete. 
Perforo, avi—To bore through, to pierce through, to 
perforate. 
Perfrico, cui—To rub over. 
Periodus, i—A period. 
Peritia, se—Skill, practical knowledge. 
Peritus, a um—Well versed or skilled, able, expert. 
Permeo, avi—To pass through (permeate). 
Perna, se—The hip together with the leg. 
Pernio, onis—A cnilblain. 
Permitto, issi—To permit, to allow. 
Perscribo, psi—To write down, to write out at length. 
Perscriptio, onis—Any written composition. 
Persona, se—A mask, a person, an individual. 
Perspiro—To breath through (perspiration). 
Pertineo, nui—To extend, to reach. 
Perturbo, avi—To disturb (perturbation). 
Pertussus—A cough, hooping cough. 
Pervado, si—To pass through. 
Pervigil, is—Very watchful, always wakeful. 
Pervius, a, um—That may be passed through, 
Pes, pedis—A foot. 
Pestiferus, a, um—Causing or bringing pestilence. 
Pestilens, tis—Pestilential, unwholesome. 
Pestis, is—A plague, pestilence, infestion. 
Petra, se—A rock, a stone. 
Phalanga, se—A phalanx, bones of the fingers and toes. 
Phantasia, se—A thought, an idea, phantasm, hallucina- 
tion. 
Phantasma, atis—An apparition, spectre. 
Pharmaceutia, se—(An enchantress) the compounding 
of drugs. 
Pharmacopola, se—A seller or dealer in medicines. 
Phiala, se—A drinking vessel, a small glass. 
Philosophus, a, um—Philosophical, erudite. 
Philtrum, i—A charm, a love potion. 
Phlegmon, onis—A tense, painful swelling. 
Phosphorus, i—A bringer of light. 
Phrenesis, is—Phrenzy, madness. 
Phthisis—A consumption. 
Physica, se—The science or study of nature. 
Physice—Physically. 
Physicus, a, um—An inquirer into nature. 
Physiognomon, onis—One who judges of the character 
of men by their features. 
Physiologia, ae—The science of natural philosophy. 
Pica, m—Depraved appetite, craving for improper sub- 
stances. 
Pico, avi—To bedaub with pitch. 
Pigmentum, i (pingo)—A paint, a color, a pigment. 
Pila, ae—A mortar. 
Pilum, i—A pestle or pounder for a mortar. 
Pilula, se—A pill. 
Pilus, i—A hair, a short hair. 
Pingo, nxi—To paint. 
Pinguis, e—Fat. 
Pinna, se—A feather. 
Pinus, us—The fir tree. 
Piper, eris—Pepper. 
Pirum, i—A pear tree. 
Pieis, is—A fish. 
Pisinnus, i—A little boy. 
Pisinna, ae—A little girl. 
Pisum, i—A pea. 
Pisiformis—Pea like. 
Pituita, ae—Phlegm, viscid mucus, 
Pix, picis—Pitch. 
Placenta, ae (a cake)—The afterbirth. 
Placenta prsevia—Presentation of the placenta 
Placidus, a, um—Soft, gentle, mild. 
Planta, a:—A vegetable, a plant. 
Planta pedis—The sole of the foot. 
Plantaris, e—Of, or belonging to the sole of the foot. 
Planus, a, um—Smooth, plain, even. 
Plenus, a, um—Full, loaded. 
Plecto, xi—To plait, to braid, to weave. 
Plexus—A net-work of blood vessels. 
Plico, avi—To fold, to knit together. 
Plica, ae—A fold, a duplicature, a plait. 
Plica polonica—A disease of the hair. 
(Saepe sub pica latet seu foetus seu plica.) 
Ploro, avi—To cry, to weep, to bewail. 
Pluma, ae—Down, soft feathers. 
Plumbago, inis—Lead ore. 
Plumbum, i—Lead 
Pluo, pluvi—To rain. 
Pluries—Often, frequently, several times. 
Pluviometer—A rain gauge, pluvio. 
Pneumaticus, a, um—Of, or belonging to the air. 
Poculum, i—A little cup, a poisonous draught. 
Podagra, ae—Gout in the feet. 
Podex, ids—The fundament. 
Polenta, ae—A prepared barley. 
Pollen, inis—Very fine meal or flour, powdery matter. 
Pollex, icis—The thumb. 
Polluo, ni—To pollute, contaminate. 
Polypus—A polypus, a swelling or excrescence. 
Pomum, i—Fruit, an apple. 
Pondus, eris—A weight. 
Pono, posui—To set, lay, place. 
Pons—A bridge. 
Poples, itis—The leg behind the knee. 
Populus, i—The people. 
Populus, i—A poplar tree. 
Porous, i—A hog, swine. 
Porrigo, inis (porrum, garlic)—A pustular disease of 
the skin. 
Porta, ae—A gate, an entrance (portal). 
Portio, onis—A part, a portion. 
Porto, avi—To carry, to bear. 
Possum, potui—To be able, to have the power. 
Post—After, or since. 
Post mortem—After death. 
Postea—Afterward. 
Posteritas, atis—Future times, future generations. 
Potatio, onis—A drinking. 
Potens, tis—Able, having power 
Poto, potavi—To drink. 
Potus, us—A draught, a potion. 
Prae—Before. 
Praecipito, avi—To throw or cast down, precipitate. 
Praecisc—Concisely, briefly. 
Praecordia, orum—The diaphragm. 
Praedico, xi—To say beforehand, predicate. 
Praegnans, tis—With child, pregnant. 
Praematurus, a, um—Very early, untimely, premature. 
Praeparo, avi—To make ready beforehand, to prepare. 
Praeputium, i (puto, to cut oft)—The prepuce, foreskin. 
Praescribo, psi—To proscribe, order, appoint before- 
hand. LATE* VOCABULAKY. 
909 
Praescriptio, onis—Order, rule, prescription. 
Frandeo, di—(To eat before breakfast) to eat, to dine. 
Pravus, a, um—Depraved, deformed. 
Prehenso, avi—To take hold of, to seize. 
Pressura, ®—Pressure, expressed. 
Priina—The first. 
Prim® vise—The first passages, the stomach and intes- 
tines, as distinguished from the lacteals or second® viaj. 
Primipara, ae—One who is delivered of her first child. 
Priapus—Permanent rigidity of the penis, priapism. 
Pro re nata—According to the nature of the case. 
Probo, avi—To try, examine, inspect. 
Proboscis, idis—The snout of an animal, proboscis. 
Procedo, essi—To spring forth, proceed (processus). 
Procreator, oris—One who brings forth, procreator. 
Procresco, ere—To grow forth, to spring up. 
Procurator, oris—One who superintends anything. 
Produco, xi—To bring forth, to produce. 
Professor, oris—A public teacher. 
Proflatus, us—A snoring. 
Progenero, are—To generate, beget, bring forth. 
Progenitor, oris—The founder or progenitor of a family. 
Prognosticum,' i—A sign or token of anything future 
(prognosis). 
Progressus, ns—A going before, advancement 
Prohibeo, ui—To restrain, hinder, prohibit. 
Prolapsus, a, um—A falling, a slipping down of a 
part. 
Procidentia (cado, to fall)—Synonymous with prolapsus. 
Proluvies, ei—Filth cast forth. 
Promineus, tis—That which projects, a prominence. 
Promiscuus, a, um—Mixed, in common. 
Prompte—Without delay, quickly. 
Pronitas, atis—Pronation, a bending down. 
"Venus, a, um—Bent, inclined. 
'ropagatio, onis—A propagating, enlarging. 
Propinquitas, atis—Relationship, nearness. 
Proscribo, psi—To make a thing publicly known by 
writing. 
Proseda. ®—A common prostitute. 
Prostibilis, e (pro, sto)—That publicly exposes itself for 
hire. 
Rrotrudo—To thrust or put forward. 
Prosector, oris—One who prepares subjects for anato- 
mical lectures. 
Proximo, are—To approximate. 
Prurigo, inis—An itching, severe itching (pruritus). 
Psellismus—Misenunciation, stammering. 
Psilothrum, i—An ointment by means of which the hair 
falls off'. 
Ptisanarium, i—A decoction of barley or rice, ptisan. 
Pubeo, iui—To be pubescent, 
l’ubertas, ati—The age of puberty. 
Pubes, is—Puberty, the pubis. 
Pubis, os—The pubic bone. 
Pudendum—The external parts of generation in the 
female. 
Pudeo, ui—To be ashamed. 
Puelia, ®—A young woman, a girl. 
Puellus, i—A little boy. 
Puer, eri—A child, a boy. 
Puerpera, ®—A woman recently delivered. 
Puerperium, i—Child-birth, child-bed. 
Pugnus, i—A fist. 
P ulcher, chra—Beautiful. 
Pulmo, onis—The lungs. 
Pulmoneus, a, um—Of, or belonging to the lungs. 
Pulpa, ®—The flesh with fat or bone. 
Puls, tis—A gruel or pottage made of pulse. 
Pulsatio, onis—A beating, throbbing, pulsation. 
Pulsus cordis—The impulse of the heart. 
Pultatio, onis (puls.)—Substances having the consis- 
tence of porridge. 
Pulvis, eris—Dust, powder. 
Punctum, i—A small mole, a puncture. 
Pungo, pupungi—To prick, to penetrate, to enter. 
Pupula, ®—The pupil of the eye. 
Purgatus, us—Cleansed, a purging. 
Purgo, avi—To purge (purgatives). 
Puriformis, is—Resembling pus. 
Purpura, as—An eruption of the skin. 
Purus, a, um—Pure, clean. 
Purifico, avi—To cleanse, to purify. 
Pus, purls—Matter. 
Pustula—A pimple containing matter, a pustule. 
Puteo, ui—To stink, to rot. 
Putresco—To rot, to putrefy. 
Putre.factio, onis—Decomposition, putrefaction. 
Putridus, a, um—Fetid, stinking. 
Pyga, ®—The buttocks. 
Pyramis, idis—A pyramid. 
Pytessa, are—To spit out. 
Pyriformis—Pear shaped. 
Qua—How, in what manner. 
Quadrans, tis—The fourth part, quarter (quadrant). 
Quadratus, a, um—Square, four-cornered, the name of 
several musles. 
Quadrigeminus, (four double)—A term applied to four 
tubercules in the brain, nates, testes. 
Quadrupes, edis—Four-footed, quadruped. 
Quam—How, as, as much as. 
Quam, vis—As much as you like. 
Quantitas, atis—Extent, quantity, number. 
Quantus, a, um—How great, how much, as much as. 
Quantum sufficiat, Q. S.—As much as is sufficient. 
Quies, etis—Rest, quiet, calm. 
Quiesco, evi—To be a rest, quiet. 
Quarante—Forty (quarantine 40 days). 
Quotidianus, a, um—Daily, every day, quotidian. 
Rabies, el—Maddess, phrenzy. 
Rabide—Ravingly, madly. 
Racemus, i—A bunch of grapes (raceme). 
Radicula—A small root, radicle. 
Radius, i.—A rod, the small bone of the arm. 
Radex, icis—A root. 
Radiatio, onis—Radiation. 
Ramentum, i—Filings, shavings, scrapings, 
Ramtx, icis—The vessels of the lungs. 
Ramus, i—A branch. 
Rana, ®—A frog. 
Ranula, ae—(A little frog, frog-tongue, a tumor under 
the tongue. 
Rancidus—Rancid, stinking. 
Rapidus, a, um—Rapid, quick, swift. 
Rare—Thinly. 
Raptus, (rapio to seize)—Raptus nervosum, or cramp, 
raptus supinus, or opisthotonos. 
Rarefacio—The act of making a substance less dense. 
Ratio, onis—A reason, a principle, a maxim. 
Raucus, a, um—Hoarse, husky of voice, raucitas. 
Ravio, ire—To speak oneself hoarse. 
Reago—To act again or upon (re-action, re agent). 
Recalvus, a, um—Bald-headed. 
Recedo, essi—To go back, recede. 
Recens, tis—Fresh, recent, new. 
Receptaculum, i—A receptacle. 
Receptaculum chyli—The receptacle of the chyle. 
Recipio, epi—To take, to secure, take back. 
Recipe—Take. 
Reclino, avi—To lean or support onself upon, recline. 
Recte—Rightly, directly. 
Rectificatio, onis—Redistillation, rectification. 
Rectum, i—The straight gut, the last portion of in- 
testine. 
Rectus, a, um—Straight, the name of several muscles. 
Recumbo, ui—To lie back, recline. 
Recuperatio, onis—A recovering, obtaining again. 
Recuro, avi—To heal or cure. 
Recurro cucurri—To run back, recurrent. 
Reduco, xi—To take or draw back (reduction). 
Reduvia—A whitlow, agnail. 
Reflecto, xi—To bend back (reflection). 
Refrigero—To make cool, refrigerate (refrigerants). 
Regimen, inis—A rule of diet, etc., prescribed for a 
patient. 
Regio, onis—Region, artificial divisions of the body. 
Regurgitatio, onis—Regurgitation. 
Relapsus—Relapse, recurrence. 
Relaxo, avi—To loosen, to relax. 
Remedium, i—Remedy, means of healing or cure. 
Remissio, onis—A cessation of febrile symptoms. 
Remitto—To remit (remittent, a class of fevers). 
Remora, as—A stoppage or obstacle. 
Remotus, a, um—Remote, distant. 
Ren, renis—A kidney, usually plural renes, kidneys. 
Reniformis, is—Kidney shaped. 
Repello, puli—To drive back (repellent). 
Reproduco—Generation, continuation of the species. 
Reptilia, »—A reptile. 
Requiesco, evi—To rest, repose, recreate. 
Res—A matter or thing. 
Resanesco, nui—To grow sound, or heal again. 
Reseco, cui—To cut out, to cut off (resection). 
Resolvo, solvi—To loosen again, to dissipate (resolv- 
ents). 
Resono, avi—To reecho, resound (resonance). 
Respiratio, onis—The act of fetching breath in and ex- 
piration. 
Resuscitato, onis—The act of recovering life, or reviv- 
ing. 
Restiformis—Cord-like, two cord-like process of the 
brain. 
Rete, is—A net, a vascular net-work, or plexus of ves- 
Retentio, onis—A keeping back, retention. 
Reticulum, i—A little network, the second stomach of 
the rumlnantia. 
Retiformis—Net-llke. 
Retina—A net-hke expansion of the optic nerve, the 
retina. 
Retraho, xi—To draw back (retractor, retrahens). 
Retro—Behind, backwards. 
Retrocedo, ere—To go back, to retrocede. 910 
LATIN VOCABULARY. 
Retroversto, onis—A turning backwards. 
Retroversio uteri—A morbid inclination of the uterus 
backward. 
Reverbero, avi—To beat back again. 
Revulsus—A pulling away, revulsion. 
Rkonchus, i—A snorting, a snoring, rale. 
Rictus, i—The mouth wide open. 
Rideo, si—To laugh. 
Rigidus, a, um—Stiff, inflexible, rigid. 
Rigor, oris—Stiffness, rigor. 
Rigor mortis—The stiffness of death. 
Rima, se—A fissure, a cleft (rima, glottidls). 
Risus—Laughter. 
Risus sardonicus—A species of convulsive laughter. 
Roboro, avi—To strengthen (roborants). 
Robustus, a, um—Hardy, strong. 
Rodo, si—To gnaw (rodentia). 
Rosa, se—A rose. 
Rosalia, ae—Old term for scarlatina. 
Roseola (roseus, rosy)—Rose colored efflorescence. 
Rostrum i—The bill or beak of birds. 
Rota, se—A wheel, a circuit. 
Roto, avi—To turn around (rotator, rotation, rotifera). 
Rubefacio, eci—To make red, rubefacient. 
Rubeola, se (ruber, red)—Measles. 
Rubigo—Rust. 
Ructus, us—A belch, an act of belching. 
Ruga, se—A fold, a wrinkle. 
Rugosus, a, um—Full of wrinkles (rugose, rugosity). 
Ruminatio, onis—A chewing again, ruminating (rumi- 
nantia, 
Ruptus, a, um—Broken, a rupture. 
Saccharum. i—Sugar. 
Saccus, i—A sack or bag, a natural or morbid cavity. 
Sacculus, i.—A little bag, minute vesicular bags. 
Sacrum, i—The base of the vertebral column. 
Ssepe—Often, frequently. 
Sagitta, as—An arrow (sagittalis, sagittate). 
Sal, sails—Salt. 
Salinus, a, um—Of, or belonging to salt, saline. 
Saliva, se—Spittle. 
Salivatio, onis—Salivation, augmentation of the secre- 
tion of the saliva. 
Saltus, us—A spring, a bound, a leap. 
Solubritas, atis—Heathfulness, salubrity. 
Salveo, ere—To be well, or in good health. 
Salvatella, se—A vein of the foot, the opening of which 
was said to preserve health, and cure melancholy. 
Sanatio, onis—A curing, healing. 
Sanate—Inviolably. 
Sanguen, inis—Blood. 
Sanguis, inis—Blood. 
Sanguificatio, onis—The process by which chyle is con- 
verted into blood. 
Sanies, ei—A thin, serous, foetid matter. 
Sanitas, atis—Soundness of body, 
Sano, avi—To heal, to cure. 
Sanus, a, um—Sound in body, in good health. 
Sapo, onis—Soap. 
Sartor, oris—A tailor, a muscle of the leg 
Sat, satis—Sufficient enough. 
Satietas, atis—Fullness, satiety, disgust. 
Saturo, avi—To satisfy (saturation). 
Saucio, avi—To wound, to hurt mortally. 
Scabies, ei—Scab, itch. 
Soabo, bi—To scratch, to rub (scab). 
Scala, se—A ladder, a flight of stairs (scalae of the coch- 
lea). 
Scalpellum, i—A scalpel. 
Scalpo, psi—To rub, to scrape. 
Scambus, a, um—Crooked-legged, bow-legged. 
Scapula, se—The shoulder-blade. 
Scarabeus, i—A beetle. 
Scarificio, avi—To lance, to scarify. 
Sciens, tis—Knowing, skillful. 
Scientia, ae—Knowledge, science. 
Scintilla, ae—A small spark. 
Scoria, ae—The dross or refuse of metals, excrement. 
Scrobis, is, vel scrobs, is—A depression. 
Scrobiculus cordis—The pit of the stomach. 
Scrofa, ae—A sore (scrofula). 
Scrotum, i—A leather bag, the envelope of the testes. 
Scrupulus, i—A scruple, 20 grains. 
Scutiformis—Shield-shaped. 
Sebum, vel sevum, i—Suet, tallow. 
Secerno, crevi—To separate, remove (secernents). 
Secretio, onis—A separating, parting, secretion. 
Secta, ae—a party, set, faction. 
Sectio, onis—A cutting off, section. 
Seculum, i—A race, a generation. 
Secundarius, a, um—The second in order (secundines). 
Sedamen, inis (sedo allay)—The means of allaying or 
composing, sedative. 
Sedimen, inis (sedo, to settle)—That which setttes at tho 
bottom of a liquid. 
Seduco, xi—To lead aside, mislead, seduce. 
Secundum—According to. 
Segmentum, i—A cut, incision, segment. 
Selectio, onis—A selecting, choosing. 
Sella, se—A seat. 
Sella Turcica—Part of the sphenoid bone. 
Semen, inis (seminum, i)—Seed, fecundating fluid. 
Semi—Half. 
Senesco, nui—To grow old. 
Senex, senis—Old, aged (senilis). 
Sentio, sensi—To perceive by the senses (sensation, 
sensibility, sensorium). 
Separatus, a, um—Separated, divided. 
Sepes, is—A hedge (septum). 
Sepulcrum, i—A grave, a sepulchre. 
Sequor, quutus—To follow or move after. 
Sequela, se—A morbid affection which follows another. 
Sequestrum, i—The portion of bone which is detached 
in necrosis. 
Sericeus, a, um—Silky, covered with fine, long hairs, 
giving a silky appearance. 
Serpens, tis—A serpent. 
Serpigo, iglnis (serpo)—Ringworm, tetter. 
Serratus, a, um—Serrated like a saw (serratus magnus 
posticus). 
Serum, i—The watery part, serum. 
Serum lactis, serum sanguinis, serum chyli. 
Sesqui—Half as much more. 
Sesqui-hora—One hour and a half. 
Seta, se—A bristle (seton). 
Siccus, a, um—Dry, without moisture. 
Sideratio, onis—An old name given to erysipelas of the 
face or scalp, from an idea of its being produced by the 
influence of the planets. 
Silentium, i—Silence, quietness. 
Silex, icis—A flint. 
Silus, a, um—Snub-nosed, nose turned up. 
Silva, se—A forest. 
Similes, e—Like, similar. 
Simplex, icis—Simple, not mixed. 
Sin—But if, if however. 
Sine—Without. 
Sinciput, itis—The fore part of the head. 
Singulus, a, um—Single, one alone. 
Singultus, us—A sobbing, hiccough. 
Sinister, tra—Left, to the left hand, or side. 
Sinus, us—A hollow, a gulf, a cavity within the sub 
stance of bone, etc. 
Sipho, onis—A siphon. 
Siti8, is—Thirst. 
Sol, soils—The sun. 
Solamen, inis—Comfort, solace, consolation. 
Solea, se—The sole of the foot. 
Solidus, a, um—Solid, dense. 
Solus, 1—Alone, only. 
Solutio, onis—A loosening, dissolving, solution. 
Solvo, vi—To loosen, dissolvo, solvent. 
Somnus, i—Sleep. 
Somniferus, a, um—That causes sleep. 
Somnambulo—To walk in the sleep. 
Sono, ui—To sound, to make a noise. 
Sophisticatio, onis—Adulteration. 
Sopor, oris—Profound sleep (soporific). 
Sorbeo, ui—To suck in, absorb. 
Sordes, is—Dirt, filth, viscid matter. 
Spado, onis—A eunuch, a gilding. 
Spargo, si—To strew, to sprinkle, to moisten. 
Spatha, se—A spatula. 
Specto, avi—To look at anything. 
Spectrum, 1—A form or image, whether real or imagin 
nary. 
Specularis, e—Like a mirror (speculum). 
Sphsera, se—Any round body. 
Spica, se—A point, an ear of corn, the name of a band 
age. 
Spina, se—A thorn, the back bone. 
Spira, se—A spire, fold (spiral vessels. 
Spiritus, us—Spirit. 
Spisso, avi—To make thick, to thicken. 
Splen, enis—The spleen. 
Spongia, ae—A sponge. 
Spumo, se—Foam, froth. 
Spumo, avi—To foam. 
Spuo, ui—To spit up or out. 
Sputo, are—To spit. 
Sputum, i—Spittle, expectoration. 
Squamo, se—The scale of a fish, scale-like substance. 
Stagno, avi—To stagnate. 
Stamen, inis—The male organ of flowering plants. 
Statura, se—Stature, size of body. 
Stella, seA star (stellated). 
Stercoreus, a, um—Of the nature of excrement, dung 
Sterilis, e—Unfruitful, barren. 
Sternum, i—The breast bone. 
Sterto, ui—To snore. 
Sternutatio, onis—Sneezing (sternutatories). 
Stigma, tis—A mark, a small red speck. 
Stigma—In plants, the upper extremity of the pistil. 
Stillicidium, i—A liquid which falls by drops, strangury, 
a discharge of the urine guttatim. LATIN VOCABULARY. 
911 
Stimulo, avi—To goad, to increase the vital activity of 
an organ (stimulant). 
3to, steti—To stand. 
Stoicus, a, um—Belonging to the Stoics or their philoso- 
phy. 
Stomachius, a, um—Having a weak stomach. 
Stomachus, i—The stomach (stomachic). 
Strabo, onis—Squint-eyed, one that has a cast in the eye 
(strabismus). 
Stramen, inis—Straw, litter. 
Stramentum, i—That which is spread, or strewed under. 
Strangulo, avi—To strangle, to stifle. 
Strang ulatio, onis—The close constriction of a part. 
Stranguria, te—Strangury. 
Stratum, i—A thing thrown upon another. 
Strictura, ®—A contracted state of some part of a tube 
or duct. 
Stridor, oris—A grating, creaking. 
Stridor dentium—A grinding or gnashing of the teeth, 
brygmus. 
Stridulus, a, um—A hissing, goating, creaking. 
(trigilis, is—A scraper, or flesh brush used by the Ro- 
mans in bathing. . 
truma, te—Scrofula, king’s evil. 
'tudeo, ui—To apply the mind to a thing, to study. 
itupefacio, onis—To produce stupor or insensibility. 
tupor dentium—An affection called teeth on edge. 
tuprum, Disgrace, rape. 
uadeo, si—To persuade, to give advice. 
uavis, e—Pleasant, agreeable to the senses. 
Jub—Under, 
ubduo, didi—To put or lay under, subdue. 
■Jubsultus—Twitching, sudden and irregular twitching 
of the tendons. 
Succedaneus, a, um—A medicine substituted in place 
of another. 
Succussus, us—A shaking, a mode of exploring the chest 
by shaking the patient’s body and observing the sounds 
produced. 
Succus, i—Juice. 
Sudo, avi—To sweat, perspire (sudorifics). 
Sufiio, ivi—To fumigate. 
Suffitus—Fumes of burning substances used for inhala- 
tion. 
Suffoco, avi—To suffocate, arrest of the respiratory func- 
tion. 
Suffundo, fudi—To pour under, suffusion, (suffusio 
nigra). 
Sugellatio, onis—Discoloration of the skin by a blow, 
ecchymosis. 
Sulcus, i—A groove, furrow, depression. 
Sulfur, sulphur, uris—Sulphur. 
Sumo, ere—To take (by the mouth). 
Super—Above, over, beyond. 
Supercilium—The eyebrow. 
Superficies, ei—A surface. 
Supino, avi—To bend backward, to lie on the back (su- 
pination, supinator). 
Suppositus, a, um—Put in the place of, substitute, (sup- 
pository). 
Supprimo, essi—To check, to stop, cessation of secre- 
tion. 
Suppuro, avi—To suppurate, gather matter or pus. 
Sura, a—The calf of the leg. 
Surditas, atis—Deafness, hardness of hearing. 
Suspento, di—To hang up (suspension, suspensory). 
Suspiro, avi—To exhale, to draw a deep breath. 
Susurrus, i—An acute, continuous hissing sound, a 
whisper. 
Sutura (suo, to sew)—A seam, a suture. 
Synthesis, is—The formation of any body from its ele- 
ments. 
Sirupus—A sirup. 
Tabella, as—A tablet. 
Tabeo, ui—To waste away. 
Tabes, is—A gradual wasting away by disease. 
Tabes mesenterica, tabes dorsales, tabes saturnia. 
Tabula vitrea—A term applied to the dense internal 
plate of the skull. 
Taenia, ae—A tape-worm. 
Taenia, ae—A ligature, a long narrow riband, (tenia hip- 
pocampi, etc.) 
Talipes, dis—Clubfoot, walking on the ankles. 
Talus, i—The ankle bone. 
Talpa, ae—A mole, a tumor under the skin. 
Tango tetegi, tactum—To touch (tactus eruditus). 
Tarsus—The instep ; also the thin cartilage situated at 
the edge of the eyelids. 
Tegumentum, i (tego, to cover)—A covering of the body, 
as the cuticle. 
Tela, ae—A web, a term applied to web-like tissues. 
Tellus, uris—The earth. 
Temperatura, a:—Temperature, state of the atmos- 
phere or a body, as to heat. 
Tempus, oris—Time. 
Tempora, ae—The temples (temporalis). 
Temulentus, a, um—Drunk ’-mxicaied. 
Tendo, tetendi—To stretch, extend (tensor). 
Tenaculum, i—A hook to take hold of bleeding vessels. 
Tenesmus, i—Painful and constant urgency to alvine 
discharges. 
Tenuo, avi—To make thin or weak, lessen. 
Tepidus, a, um—Lukewarm, tepid. 
Teres, etis—Long and round (teres major and minor), 
lerminatio, onis—A fixing of limits, an ending. * 
Tero, trivi—To rub, to make smooth. 
Terra, ae—Earth. 
Testa, ae—A shell. 
Testis, is—A testicle, testis virilitatis. 
Tetre—Foully, shockingly. 
Thalamus, i—A bedroom ; that part of the brain from 
which the optic nerve arises. 
Theca, ae—A sheath, a case, an envelope. 
Thorax, acis—The breast, the chest. 
Tibia, se—The shin bone. 
Tibialis, e—The name of two muscles, anticusand pos- 
ticus. 
Tinea, se—A gnawing worm,a disease of the scalp. 
Tinnitus, us—A ringing. 
Tinnitus aurium—Ringing in the ears. 
Titubatio, onis—General restlessness with a perpetual 
desire of changing the position, fidgets. 
Toleratio, onis—A bearing, suffering, enduring. 
Tonsiila, se—A tonsil. 
Tormen, inis—A griping pain in the intestines, tormina. 
Torpor, oris—-Numbness, torpor. 
Torreo, torrui—To burn, to consume, inflame. 
Tortus, a, um—Crooked, twisted. 
Torticollis—Wry neck. 
Toxicum, i—Poison in which arrows were dipped,poison. 
Trabecula, se trabs, a beam—The small medullary 
fibres of the brain, which constitute the commissures. 
Tractus, us—A line, a region, a space tractus opticus,etc. 
Tranquillitas, atis—Calmness, tranquillity, rest. 
Trans—Beyond, on the further side of. 
Transformatio, onis—Change from one shape to another. 
Transversus, a, um—Lying across, transverse (trans- 
versalis. 
Tremor, oris—A trembling, tremulous motion (tremor 
tendinum). 
Triceps, ipitis—Three headed, (several muscles). 
Tricuspis, idis—Three points, three triangular folds be- 
tween the right auricle and ventricle of the heart. 
Tritura, se—A rubbing or pounding, trituration. 
Trochus, i—A lozenge, a round tablet, 
l'runcus, i—The trunk of the body. 
Tuba, se—A tube, trumpet (tuba eustachiana). 
Tuber, eris—A protuberance, excrescence. 
Tuberculum, i—A tubercle, a peculiar morbid product. 
Tub ulus, i—A little tube or pipe, (tubuli lactiferi). 
Tumefacio, eci—To cause to swell, tumefaction. * 
Tumeo, ui—To swell, tumor. 
Turbo, inis—That turns round in a circle, turbinated. 
Turgidus, a, um—Swollen, inflated, turgid. 
Tus, vel thus, uris—Frankincense. 
Tussis, is—A cough. 
Tuto—With safety. 
Tympanum, i—The drum of the ear. 
Uber, eris—A teat, a nipple. 
Ubi—Where. 
Ulcus, eris—An ulcer, sore. 
Ulna, se—The elbow, the large bone of the fore-arm. 
Umbilicus, i—The navel. 
Uncia, se—An ounce. 
Unetus, a, um—Anointed, greasy. 
Uncus, i—A hook. 
Unciformis—Formed iike a hook, a bone of the carpus. 
Unguentum, is—An ointment. 
Unguis, i—A nail of the finger or toe. 
Unio, onis—Joining together, the growing together of op- 
posite surfaces. 
Urina, se—Urine. 
Urtica, se—A nettle, an itch. 
Urticaria—Nettle rash. 
Ustus, a, um—Burnt, scorched. 
Uterus, i—The womb. 
Uva, se—A berry, a grape. 
Uvula, te—The pendulous body that hangs down from 
the middle of the soft palate. 
Vaccinatio, onis—The act of inserting vaccine matter. 
Vacuus, a, um—Empty, vacuum. 
Vagina, se—A sheath, the membranous canal that ex- 
tends from the os externum to the cervix uteri. 
Valens, tis—In good health, strong. 
Valetudinaries, a, um—Sickly, ill, infirm of health. 
Valgus, a, um—Bent outward, bowed. 
Valva, se—The folding door, a valve. 
Valvula, se—A little valve. 
Vapor, oris—Steam, vapor, exhalation. 
Varix, icis—A swollen or dilated vein in the leg. 
Varus—A spot, a pimple eruption. 
Vas, vasis—A vessel (vas deferens, vasa brevia etc.) 
Vectis, is—An iron bar. 912 
LATIN VOCABULARY, 
Vehiculum, i—Any vehicle. 
Velum, i—A veil, a curtain. 
Vena, ®—A vein. 
Venesectio, onis—Blood-letting. 
Ventriculus, i, (ventus)—The stomach (ventricles of the 
heart). 
Vermis, is—A worm. 
Vermiculus, i—A little worm. 
Vermiformis—Worm-like. 
Vermifugo—To expel worms, vermifuge. 
Verminatio, onis—Breeding of worms, infestment by 
parasitic animalcules. 
Verrucosus, a, um—Full of warts. 
Veripellis, e—That changes its hide or skin. 
Vertebra, se—A bone of the spine. 
Vertebrata, se—Animals that have a vertebral column. 
Vertigo, inis—giddiness, dizziness. 
Veru, u—A spit. 
Veru montanum—A little eminence of the urethra, 
caput gallinaginis. 
Vesania, ®—Madness without coma or pyrexia. 
Vesica, se—A bladder, the urinary bladder (vesicate). 
Vesicula, se—A little bladder. 
Vespera, se—Evening. 
Vestibulum, i—A threshold. 
Veternus, a, um—Old, lethargic, sluggish. 
Via, ®—A way, a passage. 
Vi® lacrymales—The tear passages. 
Vibro, avi—To move quickly, to vibrate. 
Vibrissa, ®—The hair of the nostrils. 
Vicarius, a, um—A substitute, vicarious. 
Victus, us—(vivo)—Nourishment, provision. 
Video, vidi—To see (vidian), 
Vigilans, tis—Watchful, careful. 
Vigor, oris (vigeo, to live)—Life, vigor, activity. 
Villosus, a, um—Covered with long, soft, shaggy hair. 
Villus, i—The shaggy hair of beasts, villi or villosities 
of the mucous membranes, resembling downy tissue. 
Vinum, i—Wine. 
Vir, i—A man, male person. 
Virgo, inis—A virgin. 
Viridis, e—Green. 
Virilis—Of, or belonging to man. 
Virus, i—Venom, poison, virus. 
Vis, is—Force, power. 
Vis a tergo, Vis medicatrix naturae, Vis vitae, etc. 
Viscus, eris, viscera—Any organ which has an appro- 
priate use. 
Visio, onis—A seeing, sight, vision. 
Vita, ae—Life. 
Vitalis, e—Of, or pertaining to life, vital. 
Vitellus ovi—The yolk of an egg. 
Vitio, avi—To corrupt, spoil, vitiate. 
Vitrum, i—Glass. 
Vivo, vixi—To live, be alive. 
Vivipario—Animals which bring forth their young alive 
and perfect, as distinguished from oviparous animals. 
Vivisectio, onis—Dissection of living animals for the 
purpose of study. 
Voealis, e—That is heard vocal. 
Vola, ae—The hollow of the hand or foot. 
Volo, avi—To fly. 
Volo, volui—To will, be willing. 
Volsella, ae—Small pincers, tweezers. 
Volvo, \d—To roll, to turn. 
V olvulus—Intussusceptio. 
Vomer, eris—The middle bone of the nose. 
Vomica, ae—An abcess of the lungs. 
Vomicus, a, um—Purulent, nasty, noxious. 
Vomito, are—To vomit, to spit up. 
Voracitas, atis—Voracity, ravenousness. 
Vorax, acis—That swallows greedily, consuming. 
Vox, vocis—The voice. 
Vulnero, avi—To wound (vulnerary). 
Vulpis morbus—Alopecia, baldness, decay and fall of the 
hair. 
Vulsus, a, um—Smooth, bald, without hair. 
Vultus, us—The looks, the countenance. 
Vulva, ae—The elliptic opening inclosed by the labiae 
majorae of the pudendum. 
Vulva cerebri—A small aperture of the brain. 
Zona pellucida—A thick membrane constituting the ex- 
ternal investment of the ovum. 
Zonula ciliaris—A thin vascular layer connecting the 
anterior margin of the retina with tiie circumference of 
the lens. 
Zotheca, ae—A small private chamber for study. 
PHARMACEUTICAL ABBREVIATIONS, 
AND EXPLANATION OF TERMS USED IN PRESCRIPTIONS. 
A, aa, ana, of each—Hither by weight or measure. 
Abdom., Abdomen—The belly. 
Abs. feb., Absente febre—Fever being absent 
Ad du. vie., Ad duas vices—For two times. 
Ad sec. vie., Ad secundum vices—To the second time. 
Ad gr. acid., Ad gratam aciditatem—To an agreeable 
acidity. 
Ad def. anlmi, Ad defectionem animi—To fainting. 
Ad del. an., Ad deliquium animi—To fainting. 
Ad lib.. Ad libitum—At pleasure. 
Add., Adde vel addentur—Add, or let them be added. 
Adden., Addeudus—To be added. 
Adjac., Adjacens—Near, adjacent. 
Admov., Admove, admoveatur, admoveantur—Apply, 
let it be applied, let them be applied. 
Ads. feb., Adstante febre—While the fever is present. 
Alter, hor., Alternis horis—Every other hour. 
Alvo adstr., Alvo adstricta—When the bowels are con- 
fined. 
Aq. astr., Aqua astricta—Frozen water. 
Aq. bull., Aqua bulliens—Boiling water. 
Aq. com., Aqua communis—Common water. 
Aq. dest., Aq. destillata—Distilled water. 
Aq. fluv., Aqua fluviatilis—River water. 
Aq. mar., Aqua marina—Seawater. 
Aq. niv., Aqua nivalis—Snow water. 
Aq. pluv., Aqua pluvialis—Rain water. 
Aq. ferv., Aquafervens—Hot water. 
Aq. font., Aqua fontana—Spring water. 
Bisind., Bis indies—Twice a day. 
Bib., bioe—Drink. 
Bbds., Barbadensis—Barbadoes (as aloe bbds.) 
Bain, mar., Balneum mar® (or maris)—A salt water 
bath. 
Bain, ar., Balneum arenm—A sand bath. 
Bain, tep., Balneum tepidum—A tepid bath. 
Bain, vap., Balneum vaporis—A vapor bath. 
Bol., Bolus—A bolus. 
Bui., Bulliat—Let It boil. 
But., Butyrum—Butter. 
Cap., Capiat—Let him take. 
Cserul., Caeruleus—Blue. 
Calom., Calomelas—Calomel. 
Cath., Catharticus—Cathartic. 
Cue. cru., Cucurbitula cruenta—Cupping glass. 
Cochleat., Cochleatim—By spoonful. 
Coch. ampl., Cochleare amplum—A tablespoonful, half 
fluid ounce. 
Coch. mag., Cochleare magnum—A tablespoonful. 
Coch. med., Cochleare medium ) A medium sized or des- 
Coch. mod., Cochleare modicum $ sert spoonful, 2 tid. dr. 
Coch. parv., Cochleare parvum—A teaspoonful, 1 fluid 
drachm. 
Col., Cola, colatus—Strain, strained. 
Colet., Coletur or colatur—Let it be strained. 
Colatur®—To the strained liquor. 
Colent., Colentur—Let them be strained. 
Color., Coloretur—Let it be colored. 
Comp., Compositus—Compounded. 
Cong., Congius—A gallon. 
Cons., Conserva—A conserve (also conservo, keep). 
Cont. rem. vel med., Continuentur remedia vel medica- 
ments—Let the remedies or medicines be continued. 
Cop., Copiosus—Plenteous. 
Coq., Coque, boil, coquantur—Let them be boiled. 
Coq. ad med. consumpt., Coquatur ad medietatis con- 
sumptionero—Let it be boiled to the consumption of 
one half. 
Coq. s. a., Coque secundum artem—Boil according to art. 
Coq. in s. a., Coque in sufllclente quantitate aquae—Boil 
in sufficient quantity of water. 
Cort., Cortex—Bark. Pages 913-914 missing INDEX TO VOL. II. 
PAGE 
Hysteria 3 
Indian Hemp 10 
Infants 11 
Inflammation 13 
Influenza 15 
Insanity 16 
Intestinal Affections. 33 
Intestinal Obstruction 36 
Intestines 39 
Intoxication 45 
Iodic Preparations 4V 
Ipecacuanha 51 
Iron 53 
Irrigation 54 
Issues 55 
Jaundice 56 
Joints 58 
Ankle Joint 6V 
Elbow Joint VO 
Hip Joint V3 
> Knee Joint 82 
j Shoulder Joint 96 
Wrist Joint 99 
Kidney Affections 100 
Labium 118 
Labor 119 
Placental Complications 145 
Premature Labor 149 
Lactation 152 
Laryngeal Affections 155 
Larynx 160 
Lead 161 
Leeches 161 
Leech Bites 162 
Leucorrhcea 163 
Ligatures 164 
Ligaments 165 
Liniments 165 
Lint 166 
Lip 166 
Lithectasy 169 
Litholiby 171 
JAthotomy 172 
PACK 
Lithotrity 184 
Lobelia Infiata 190 
Lock-Jaw 190 
Loins 192 
Lumbago 193 
Malaria 194 
Manganese 194 
Mania . 199 
Marasmus 202 
Matico 203 
Measles 204 
Medicines 204 
Melancholia 221 
Melanosis 221 
Melcena... 223 
Meningitis 223 
Menorrhagia 224 
Menstruation 22V 
Mercury 230 
Milk 233 
Moles 234 
Morbus Coxarius 234 
Mortification 235 
Mouth 23V 
Moxa 243 
Muscles 244 
Ncevi 245 
Necrcemia 251 
Necrosis 252 
Needles 253 
Nervous Disorders 254 
Neuralgia 25 V 
Nipples 261 
Nitric Acid 263 
Nose 264 
Nymphomania 269 
(Edema 269 
(Esophagus 2V0 
Oil 2V1 
Omentum 2V2 
Onychia 2V3 
Oophoritis, or Ovaritis 2V6 
Operations 278 
Opium 282 
917 918 
INDEX. 
PAGE 
Orchitis 286 
Ovarian Affections 289 
Ox-Gall.'. 297 
Palate 298 
Pancreas 302 
Paracentesis 302 
Paraphimosis ... 304 
Paralysis 304 
Paraplegia 313 
Parasites 314 
Paronychia 315 
Pediculi 316 
Penis 316 
Pericarditis 318 
Perineum 319 
Periosteal Affections 322 
Peritonitis 
Perspiration 330 
Pessaries 
Phlebitis 332 
Phlegmasia Dolens 333 
Phthisis Pulmonalis 333 
Phimosis. 347 
Pills 349 
Placenta 350 
' Plasters 351 
Pleurisy 355 
Pneumonia 357 
Poisoning.—Aconite 865 
Aconitina 366 
Arsenic 367 
Belladonna 872 
Colchicum 372 
Copper 873 
Corrosive Sublimate 373 
Cubebs 378 
Prussic Acid 378 
Lead 3S4 
Opium 385 
(Enanthe Crocata 388 
Strychnine 389 
Upas Antlar 394 
Yew-Berries 394 
Zinc 395 
Polypi.—Ear 395 
Yose.. 397 
Becfnm 402 
UroritS 403 
Pregnancy 410 
Prolapsus Ani 414 
Prolapsus Uteri 416 
Prolapsus Vesicce 418 
Prostatic Affections 419 
Puerperal A ffections 423 
Puerperal Fever. 429 
Puerperal Mania 433 
Pulse 434 
Purgatives 436 
Pyrosis 438 
Quinine 440 
PAGE 
Rectum 441 
Respiration 447 
Rheumatism 448 
Rickets 462 
t 
Salivation 464 
Sarsaparilla 466 
Scalp 467 
Scarlatina 468 
Sciatica 476 
Scorbutic Affections 480 
Scrofula 482 
Sea-Sickness 485 
Sensation 486 
Silver 486 
Sinuses 489 
Skin 489 
Skin Disease.—Acne 490 
Eczema 493 
Herpes 501 
Impetigo 502 
Ichthyosis 502 
Itch 502 
Lepra 504 
Pemphigus 507 
Pityriasis 507 
Prurigo 508 
Psoriasis 510 
Sycosis Henti 515 
Syphilitic Eruptions 517 
Tinea Capitis 519 
Urticaria 527 
Miscellaneous 528 
Sleeplessness 
Small-pox 538 
Snake Rites 541 
Soaps . 543 
Sores 543 
Spasmodic Affections 544 
Spermatocele 545 
Spermatorrhoea 546 
Spina Bifida 553 
Spine 554 
Spleen 561 
Sponge Tents 562 
Sprains 562 
Squill 563 
Stammering 563 
Sterility 564 
Stomach 566 
Strangury 579 
Stricture of Rectum 579 
Stricture of (Esophagus, etc 581 
Stricture of Urethra 581 
Styptic 599 
Suppositories 599 
Sutures 600 
Synovitis 600 
Syphilis 601 
Tabes Mesentcrica 636 
Tannin 638 
Teeth 649 INDEX TO YOL. I. 
PAGE 
Abaomen 17 
Abdominal Affections 18 
Abortion 20 
Abscess 27 
Acids and Alkalies 37 
Aconite 37 
Air 41 
Albumen 42 
Albuminuria 44 
Aloes 49 
Alum 49 
Amenorrhcea 50 
Ammonia 54 
Amputation 56 
Anannia 95 
Ancesthesia 102 
Anaesthetics 103 
Anchylosis 106 
Aneurism 109 
Antimony 131 
Antiseptic 134 
Anus 134 
Aperients 142 
Aphonia 143 
Aphtha 146 
Apoplexy 146 
Arsenic 153 
Arteries 154 
Asphyxia 165 
Asthma 177 
Baldness : 185 
Baths 185 
Bebeerine 187 
Bed-Sores 187 
Benzoic Acid 190 
Bites 191 
Bladder 191 
Blenorrhagia 204 
Bloodletting 205 
Boils 208 
Bones 211 
Brain 225 
Bread 239 
Breast 240 
Bromine 244 
Bronchitis 245 
Bunion 254 
Burns—Scalds 256 
Bursal Affections 266 
Cachexia 272 
Caesarian Section 273 
Calculi . 275 
Camphor 281 
Cancerous Affections 285 
Carbuncle 323 
Caries 358 
Cartilage 330 
Castration. ... 331 
Catalepsy 331 
Catarrh 333 
Cathc/crism. 337 
Caustic* 339 
Chaps and Fissures 343 
Charcoal 344 
Chilblains 345 
Chloroform 346 
Chlorosis 352 
, Cholera 359 
Cholera Infantum 372 
Choking 372 
Chordee 373 
Chorea 373 
Cicatrices 381 
Club-Foot 381 
Clysters 385 
Colchicum 386 
Cold 387 
Colic 389 
Collapse 392 
Collodion 392 
Coma 397 
Condyloma 398 
Congestion 402 
Conium 402 
Constipation 403 
Convulsive Affections 409 
Copaiba... 414 
Corns 416 
Coup de Soleil 417 
Coryza 417 
Counter-Irritants 418 
Cough 422 
915 916 
INDEX. 
PAGE 
Cramp 424 
Creasote 426 
Croup 427 
Cupping 433 
Cynanche 434 
Cysts 435 
Deafness !.. 436 
Deformities 441 
Delirium 441 
Delirium Tremens 444 
Dentition 450 
Diabetes 451 
Diaphragm 461 
Diarrhoea 461 
Digitalis 477 
Diphtheritis 478 
Disinfectants ... 483 
Dislocations .. 484 
Diuresis 494 
Diuretics 495 
Dropsy 496 
Drowning 510 
Dysentery 516 
Dysmenorrhcea 524 
Dyspepsia 533 
Ear 551 
Ecraseur 561 
Electricity 562 
Emmenagogues 568 
Emphysema 568 
Empyema 570 
Enuresis 576 
Enteritis 580 
Epilepsy 581 
Epistaxis 589 
Ergot 591 
Erysipelas 592 
Ether 602 
Eye.—Amaurosis 604 
Cataract 605 
Cornea 612 
Entropion 622 
Iris... 623 
Artificial Pupil 629 
Lachrymal Affections 630 
Ophthalmia 633 
Venereal Disease of the Eye 642 
Ptosis 645 
Strabismus 646 
Miscellaneous 649 
Eyelids 653 
Feet 656 
Fever 657 
Enteric, or Common Continued 
Fever 663 
Infantile Gastric Fever 666 
Nervous Fever 667 
Intermittent Eever 668 
Typhoid Fever 674 
Typhus 677 
PAGE 
Remittent Fever 691 
Yellow Fever 694 
Finger " 697 
Fire 698 
Firing 700 
Fistulce 701 
Fistulse in Perineo 707 
Recto-Urethral Fistula 709 
Recto-Vaginal Fistula 709 
Urethral Fistula 710 
Urethro-Vaginal Fistula 711 
Urethro-Vesical Fistula 712 
Vesico-Vaginal Fistula 713 
Fistulous Openings 717 
Flatulence 718 
Food 719 
Fractures 720 
Frozen Persons 740 
Galactagogue 740 
Gallic Acid 742 
Ganglion 742 
Gangrene 743 
Gastralgia 754 
Gastrodynia 754 
Glanders 756 
Glandular Affections 757 
Gleet 760 
Glycerine 761 
Gonorrhoea 764 
Gout 773 
Gravel 780 
Guar ana 782 
Gums 783 
Gum Resins 785 
Gutta Percha 787 
Hcetnatemesis 788 
Hcematuria 790 
Hemorrhagic Diathesis 795 
Hemoptysis 798 
Hemorrhage 8°2 
Hemorrhoids 805 
Hair 822 
Hand 824 
Hanging 827 
Harelip 829 
Hay Asthma 832 
Headache 833 
Hematocele 836 
Hemicrania 838 
Heart 839 
Hemiplegia 861 
Hepatic Affections 863 
Hernia 869 
Hiccough 887 
Hoarseness 888 
Hooping-Cough 889 
Hydatids 896 
Hydrocele 898 
Hydrocephalus 904 
Hydrophobia 910 
Hypochondriasis 912