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I 3>',:5 ">; 3> 3 >X> i '3 > > 3 3 'J' 12> S 5 y> m,,jj n , I > > • > >> ^ j >. 3 I- -~))5; 33 3) n < > )3 3J > 5 ;> ~> }j > j -> J >3 v> > > 3 3^ o 5 3 3 33 ^3 5J>3 . • v > "3 1 - 3 > O > > ^ ■ 3 j> >.j> -_>.j > > ^ ■ 3- •3 >■ O > 23>x> 3 > -JISED 53^.-*' y ■* j. L> 3 '.J- 3 -> '' JU> ^> :>. > > - Utyy • > 3) ">> J > > , ^»» •>> yt > >>>■> ^»s> ■ 3* » , 00 ■>; .-> . . j»j» ->33> 33 * 3 > > ) O ' 33>> 53 ■ " 35 ^' 3 ? > • ^ 3^ 1 >J> 5 3} - 3> y^ 33 k 3> ±y> px yy j) y ^y yy 3^ yy 3^>: 3 y ■>'3 »y-»3o»*j» 3> > 3 •" »> • > - n . . ^> -3 »3 3 », ,33), .^^ a 5 >>3-^ z>y 333' 33 ; ■3 ->j y>) a 3^, ^j) - 3 3>^ -^ 33 T>33 j-> .^_JJ3^ 5 j>, ;333C» 33 1 33> )» J, j 3) J 3 y 3 3)> 33 3 330 >3 5^3>>) 55 3 ''33 3 ) 33 33 3 .)>35i 1 >i> i-» > j; 3 * > ■ j> >. in > > J> 3>»33 353 i3 >33J>5> 53 . £ *** i 4rrJ2 / r\-\f TRANSACTIONS O F T H E COLLEGE of PHYSICIANS, - OF PHILADELPHIA. VOLUME I.—-r a k t I. HON SIBI SED TOT1. phi irA del p hi a : PRINTED BY T. DOBSON, N°. 41, SO. SECOND-STREET | MDCCXCUI- .% 4 I i ' i PREFACE. lVJiEDICAL Communications have been gc* nerally found to be amongjl the mofl certain and extenfve means of impt oving the praclice ofphyfic. JVe therefore offer the prefent work as a pledge to our medical brethren that we fhall publifh as often as materials are afforded. 'The accuracy and Fidelity ofthe fa els mufl reft entirely upon the credit of their refpeBive authors. No papers merely fpeculative can be admitted; and it is expeBed none will be offer- ed us, which have been communicated to any other fociety. The Tables which commence this Volume we give as the mofl faithful Regifler of Difeafes which I ( fr ) which could be procured—we believe them to he accurate, and intend that they fhall be regu- larly conti?iued. ErERfnce the Injlitution of the College one of their principal views has been the formation of an American Pharmacopoeia. To make this work more generally ufeful, circular letters were feveralyears fince aidreffed to all the known Medical Societies, and to many of the PraBi- tioners of Phyfc in the United States, requeu- ing their advice and ajjiflance. Thefmall num- ber of communications on this fubjecl, have hi- therto retarded the completion of their defgn. The utility of recording 'Epidemics is fo evident, that we regret having no more ac- counts of the Infuenza of 1789, to infert in the firft part of our Fir/l Volume. We hope, however, that this deficiency will be fupplied be- fore a fecond publication. It is not only ofthefe more uncommon diforders that accounts would be acceptable y but a knowledge of the peculiar appearance of many others in America, fuch as meafes, fcarlatina, ISc. would be highly fer- viceable, as well for the invefligation of dif- eafes, ( V ) . eafes, as for the affiflance of the praBitioner, who fees them for the frft time, and who feels embar raffed from the want offuch information % as reports of this kind could not fail to give. We conclude with an affurarce, that Uriel; impartiality fhall be obferved infeleBing papers for publication, and no unneceffary delay ad- mitted. Philadelphia July 5th, 1793. An ACT FOR THE INCORPORATION O F THE COLLEGE OF PHYSICIANS OF PHILADELPHIA. HE RE AS the Phyficians of Philadelphia, influenced by a conviction of the many ad- vantages which have arifen from literary inftituti- ons, have affociated themfelves under the name >> and title of The College of Phyficians of Phila- delphia. And whereas, the objects of this College are to advance the fcience of medicine, and thereby to leffen human mifery, by inveftigating the dif- eafes and remedies which are peculiar to this coun- try ; by obferving the effe&s of different feafons, climates and fuuations upon the human body; by recording the changes which are produced in dif- eafes, w ( viii ) eafes, by the progrefs of agriculture, arts, popu- lation and manners; by fearching for medicines in the American woods, waters, and in the bow- els of the earth ; by enlarging the avenues to knowledge from the difcoveries and publications of foreign countries; and by cultivating order and uniformity in the practice of phyfic. And whereas, the faid College of Phyficians have prayed us, the Reprefentatives of the Free- men of the Commonwealth of Pennfylvania, that they may he created a body politic and corporate, for ever, with fuch powers, privileges and immu- nities as may belt anfwer the laudable purpofes which the members thereof have in view ; where- fore to affift and encourage the faid College of Phyficians in the profecution and advancement of ufeful knowledge, for the benefit of their country and of mankind: Be it enacled, and it is hereby enacled, by the Re- prefentatives of the Freemen of the Commonwealth of Pennfylvania, in General Affembly met, and by the authority of the fame, That the members of the faid College of Phyficians, that is to fay, John Red- man, John Jones, William Shlpipen, junior, Adam Kuhn, John Morgan, Benjamin Rufh, Samuel Duffield, Gerardus Clarkfon, George Glentworth, Thomas Parke, James Hutchinfon, Robert Har- ris, ( i* ) ris, John Carfon, Benjamin Duffield, William W. Smith, John Foulke, Samuel Powel Grifhtts, Wil- liam Clarkfon, William Currie, Benjamin Say, Andrew Rofs, John Morris, Nathan Dorfey, James Cuningham, Cafpar Wiftar,yaw/or, Michael Leib, and John H. Gibbons, be, and the fame perfons are, and fhall be a body corporate and po- litic in deed and in name, by the name and ftile of " The College of Phyficians of Philadelphia," and by the fame name, they and their fucceffors, are here- by conflituted and and confirmed one body corpo- rate and politic in law, to have perpetual fucceffi- on, and to be able and capable to have, hold and enjoy, any goods and chattels, lands, tenements, rents, hereditaments, gifts, and bequefts, of what nature foever, in fee-fimple, or for term of years, life or lives, or otherwife ; and alfo to grant, fell, alien, affign, or let the fame lands, tenements, he- reditaments and premifes, according to the nature of the refpedtive grants and bequefts made to the faid corporation, and of the eflate of the faid cor- poration therein, provided that the amount of the clear yearly value offuch real eftate exceed not the fum of five hundred pounds lawful money of this commonwealth. And be it further enacled hy the authority afore- faid, That the faid corporation be, and fhall be forever hereafter, able and capable in law, to fue and ( 3= ) and be fued, plead and be impleaded, anfwcr and be anfwered unto, defend anti be defended in all or any courts of juflice and other places in all manner of fuits, actions, complaints, pleas, caufes and matters of what nature or kind foever ; and that it fhall and may be lawful to and for the faid corporation forever hereafter, to have and ufe a common feal, and the fame feal, at the will and pleafure of the faid corporation, to break, change, alter and renew. And be it further enacled by the authority afore- faid, That for the well ordering of the faid cor- poration and its affairs, there fhall be, at all times hereafter, the following Officers of the fame, that is to fay, one Prefident, one Vice-Prefident, four Cenfors, a Secretary and a Treafurer, who fhall be chofen annually from amongfl the fellows of the faid College of Phyficians, on the firft Tuefday in the month of July forever hereafter, or within one kalendar month after the fame day, in any year ; and that John Redman, be the prefent Prefident of the faid College; John Jones, the prefent Vice-Prefident; William Shippen, junior, Adam Kuhn, Benjamin Rufh and Samuel Duffield, the prefent Cenfors ; Samuel Powel Griffitts, the prefent Secretary, and that Gerardus Clarkfon be the prefent Treafurer of the faid College, and fhall be and remain the Prefident, Vice-Prefident, Cenfors, ( sri ) Cenfors, Secretary'and Treafurer, reflectively, of the faid College, until they be fuperfeded by a new election to be made by the fellows of the faid Col- lege as aforefaid, and all vacancies by death, re- fignation or otherwife, which fhall at any time hereafter happen in any of the faid offices, may be filled by a fpecial eleftion, to be holden fo often as occafion fhall require. And be it further enacled by the authority afore- faid, That the authorities and duties of the offi- cers of the faid Corporation, who are herein be- fore mentioned, and of any others which the faid Corporation fhall fee fit to appoint, the times of meeting of the faid Corporation, the admiffion of members, and the other concerns of the faid Corporation, fhall be regulated by the bye-laws and ordinances of the faid Corporation heretofore made or to be made, touching the premifes. Provided always, and be it 'enabled by the au- thority aforefaid, That no bye-laws nor ordinan- ces of the faid Corporation hereafter made, fhall be binding upon the officers or members thereof, unlefs the fame fhall be propofed at one regular meeting of the faid Corporation, and enacted and received at another, after the intervention of at leaft thirty days. And that no fale or alienation pr leafe for aboye three years, of any part of the real ( xii ) real eflate of the faid Corporation, fliall be valid, unlefs the terms and nature of fuch fale or leafe be propofed at a previous meeting of the faid Corporation. Signed by crd.ir of the Hofc, RICHARD PSfT.RS, Speaker. EnaBed into a Laiv at Philadelphia, on Thurfday, the tnventy-fxth day of March, in the year of our Lcrd one thou/and feven hundred and eighty-nine. Peter Zachary Lloyd, Clerk of the General Affembly. / a CONSTITUTION O F THE COLLEGE OF PHYSICIANS OF PHILADELPHIA. THE Phyficians of Philadelphia, influenced by a conviction of the many advantages that have arifen in every country from literary inftitu- tions, have affociated themfelves under the name and title of « The College of Phyficians of Phi- ladelphia." The objects of this College are, to advance the fcience of medicine, and thereby to leffen human mifery, by inveftigating the difeafes and remedies which are peculiar to our country ; by obferving the effects of different feafons, climates and fitua- tions upon the human body; by recording the changes that are produced in difeafes, by the pro- grefs of agriculture, arts, population, and man- ners ; by fearching for medicines in our woods, waters and the bowels of the earth ; by enlarging our avenues to knowledge, from the difcoveries and ( xiv ) and publications of foreign countries ; by appoint- - ing ftated times for literary intercourfe and com- munications ; and by cultivating order and unifor- formity in the practice of phyfic. For the purpofe of obtaining thefe objects, the following rules have been adopted. I. The, College fliall confift of fellows and af- fociates. II. The fellows fhall confid of practitioners of Phyfic, of character in their profeffion, who refide in the city, or diftrict of Southwark, or Liberties of Philadelphia, and are not under twenty-four years of age. III. The affociates fhall confifl of perfons of merit in the profeffion of medicine, who do not live within the limits above defcribed.* IV. Three- admission OF ASSOCIATES. * I. The number of affociates fhall not exceed forty, ex- cept when fellows remove beyond the limits prefcribed by the conftitution, in which cafe they fhall be confidered as affociates without an election. Ten of the affociates fhall be foreigners. II. The affociates fhall confift only of perfons above thir- ty years of age, who are of well known and eftablifhed character in medicine. III. The fame forms fhall be obferved in electing affociates %s in electing fellows of the College, except that they fhall he ( *v ) IV. Three-fourths of the whole number of fellows met, fhall concur in the admiffion of a fel- low or affociate. V. The Officers of the College fliall confift of a Prefident, Vice-Prefident, four Cenfors, a Trea- furer and Secretary, who fhall be chofen annually, from amongft the fellows, on the firft Tuefday in July. VI. The flated meetings of the College fliall be on the firft Tuefday in every month; befides thefe meetings, the Prefident, or, in cafe of his abfence or indifpofition, the Vice-Prefident, fliall have power to call extraordinary meetings, when- ever important or unexpected bufinefs fhall re- quire, of which he lhall be the judge. It fhall likewife be in the power of any fix fellows of the College, who concur in their defires for a meeting, to authorife the Prefident, or, in cafe of his ab- fence or indifpofition, the Vice-Prefident, to call it. VII. The bufinefs of the Cenfors fhall be to infpect the records, and examine the accounts and expenditures be propofed by a fellow inftead of making a written appli- cation. Every affociate fhall be furnifhed with a certificate from the College, figned in the fame manner as thofe which are given to the fellows. IV. The affociates, when in this city, fhall have the pri- vilege of attending the meetings of the College, but with- out taking any part in the private bufinefs thereof* ( *vi ) expenditures of the College, and report thereon. And all communications made to the College, af- ter being read at one of their flated meetings, fhall be referred to the Prefident, Vice-Prefident, Cenfors, and fuch other Members of the College as fliall be nominated for the purpofe; who fhall determine by a vote, taken by ballot, on the propriety of publiftiing them in the Transactions of the College.* VIII. The bufinefs of the Secretary fliall be to keep minutes of all the meetings and transactions of the Society, and to record them in a book pro- vided for that purpofe. Likewife to receive and preferve all books and papers belonging, and let- ters addreffed, to the College. IX. The bufinefs of the Treafurer fhall be to receive all the monies of the College, and to pay them to the order of the Prefident or Vice-Prefi- dent only : which order fliall be the voucher for his expenditures. X. Every member of the College fhall have a certificate of his election, with the feal of the Col- 3 lege * All papers communicated to the College for publica- tion, fhall be referred to a printing' committee, which is to confift of the Prefidents and Cenfprs, and a number of other members to be nominated when each memoir is referred to the committee ; after which, the confideration of the paper is to be conduced according to the feventh article of the Conftitution. ( xvii ) lege affixed thereto, figned by the Prefident and Vice-Prefident, and counterfigned by the Cenfors and Secretary. The flyle of certificates, and of all iiddreffes from the College, fhall be as follows : The Prefident, or, The Vice-Prefident, and College of Phyficians of Philadelphia. XI. No affociate, who comes to refide within the limits mentioned in the fecond rule, fhall be admitted to a fellowlhip in the College, without being elected in the manner prefcribed for the ad- miffion of fellows—no new member fhall be cho- fen who has not been propofed at a previous flat- ed meeting. XII. No law nor regulation fhall be adopted, that has not been propofed at a previous flated meeting ; nor fhall any part of the conftitution be altered, without being propofed for confideration, for three months. The Prefident, or Vice-Prefi- dent, when he takes the chair, fhall have no vote, exception queflions where there is an equal divifi- on of voices. Seven fellows fhall be a quorum for all ordinary bufinefs; but for the expenditure of money, the making of laws, election of mem- bers, or altering the conftitution, eleven fellows fliall be a quorum. XIII. Every fellow, upon his admiffion, fliall fubfcribe to the above rules, as a teflimony of his contenting to be bjund by them—-he fhall, at the Vol. L b fame ( xviii ) fame time, pay into the hands of the Treafurer, the fum of ten pounds, towards eftablifliing a fund for the ufe of the College ; he fliall likewife pay two dollars, annually, for the fame purpofe. The following Phyficians are the prefent mem- bers of the College. FELLOWS. John Redman, Prefident. William Shippen, junior, Vice-Prefident. Benjamin Rufli, | Adam Kulv.i, „ r „ , > Cenfors. Thomas Parke, j J ' James Hutchinfon, J Benjamin Say, Treafurer. Samuel Powel Griffins, Secretary. Samuel Duffield, James Cuningham, Robert Harris, Nathan Dorfey, Benjamin Duffield, Michael Leib, John Foulke, John H. Gibbons, Andrew Rofs, Nicholas B. Voters, William Currie, Benjamin S. Barton, John Carfon, Thomas Redman, Charles Moore, William M'Uvaine, Cafpar Wirtar, P. F. Glcntworth. associates. James Tilton, M. D. Dover, Delaware. Nicholas Way, M. D. Wilmington, Delaware. faac Senter, M. D. Newport, Rhode-Iftand. A DISCOURSE delivered before the COLLEGE of PHYSICIANS OF PHILADELPHIA, Feb. 6th, 1787. ON THE OBJECTS OF THEIR INSTITUTION. BY BENJAMIN RUSH, M.D. &c. &c Mr. President and Gentlemen, I FEEL peculiar pleafure in reflecting, that the late revolution, which has given fuch a fpring to the mind in objects of philofophical and moral en- quiry, has at laft extended itfelf to medicine, and in lefs than five years after the peace, before the human faculties had contracted to their former di- menfions, a college of phyficians, formed upon principles accommodated to the prefent ftate of fociety and government in America, has been ef- tablilhed in the capital of the United States. The defign of the prefent elfay is to point out, in a few words, the advantages which, may be de- b 2 rlve the jirft ox fecond year after they arrive in our country ? Is there any mode of preventing thefe difeafes ? And laftly, do thefe perfons exceed in health or life the na- tives of America? We have many facts which will enable us to determine each of thefe queftiorts. The effects of the mixture of the human fpecies of different nations and countri cs upon health and life, may here be determined by accurate obferva- tions. It is certain, that the inferior fpecies of animals are improved in flrength by the mixrure. But further; the mulatto poffdfes flronger ftamina than belonged to his father or mother. The fize, ftrength, health and longevity of Englillimen have been afcribed to the intimate mixture of the blood of half the nations of Europe, from which they are ( XXYli ) are defcended. To the effects of this mixture, like wife, may be afcribed that elevation and per- fection which the human underftanfting has ac- quired in Great Britain. I take pleafure in facri- ficing national prejudice to truth and philofophy by introducing this obfervation, efpecialiy as I an- ticipate the fame national character from the ope- ration of flmilar caufes upon the citizens of Ame- rica. There are feveral difeafes peculiar rto our country which have never beendefcribed, The vomiting and purging, which are fo fre- quent and fatal in the fummer months, in all the ci- ties of America, would furnifh an excellent fub- ject for medical enquiry. The caufe of the decay of the teeth, which is fo frequent in the middle and eaftern ftates of Ame- rica, will admit of much curious and.ufeful Specu- lation. The fudden and often fatal effects of a draught of cold water upon the human body in this city, and the remedies proper to remove them, will fur- nifli another fubject for a medical communication*. The * This fubject has fince been examined by lie author, in a Volume of Medical Inquiries ajid Obiervations, publilhed in 178S. ( xxviii ) ■The qualities of our pump water, and the in- fluence of building upon it, are proper fubjects for chemical inveftigation. The reafon why the fuburbs and fouth end of our city are more fubject to autumnal fevers than its centre and north end, and why thefe fevers are lefs frequent within thefe three years than formerly, deferve our attention. The high price of fire-wood, makes it ne- ceffary to examine the effects of foffil coal, and ftove rooms, upon health and life. The fymptoms and degrees in which our acute and chronic difeafes agree and difagree with the defcriptions of the fame difeafes publifhed in Eu- rope, will furnifh ample matter for obfervation. An enquiry into the caufes why the Dyfentery is equally the confequence of a dry and.wet fum- mer, and why it appears on the fummit of high grounds, while the vallies below them are vifited with remitting and bilious fevers, may lead us to determine, whether that diforder be idiopathic, or whether it be the febris iniroverfa of Dr. Sy- denham. For the fake of obtaining full information and accurate obfervations of the flate of the air and weather ( xxix ) weather (fo eflential to obtaining a hiftory of dif- eafes), I would recommend to the College, to ap- point one of their body for the following purpofes. i ft. To record and communicate to the College an exact account of the temperature of the wea- ther as meafured by Fahrenheit's Thermometer. 2ndly. To record, the variations in the weight and moiflure of the air, by the Barometer and Hydrometer. 3dly, To record the ftate of the winds. 4thly. To meafure exactly the the quantity of water that falls in our city. Thefe obfervations will be more ufeful, if we can obtain from the fex- tons of the different churches in the city, fuch a return of the deaths, as will enable us to afcertain the increafe or decreafe of mortal difeafes by the bills of mortality. To render thefe bills more ufeful, let the fexton be directed, in every cafe of death, to apply to the phyfician who has attended the patient for the name of the mortal diftemper. Let the obfervations on each of thefe fubjects, be delivered every month to the College. To obtain an accurate knowledge of the epidemics of the city, I would recommend the prefer- ( XXX ) prcfervation of the accounts of the difeafes that are kept in the Difpenfary. If thefe difeafes be recorded by the names that are ^iven to them by Dr. Cullen, in the laft edition of his Nofologia Me- thoaica, the account of ihcm cannot fail of being highly ufe ul and beneficial to the public* To de- rive the mm oft poffible advantage from this hiftory of our epidemics, let us endeavour to procure fi- milar obfervations from different parts of the ftate, and from every ftate in the union. To render our city as celebrated for medical ad- vantages, as it has long been for other things, it will be neceffary to erect in it warm and cold baths. The advantages of both thefe remedies in a coun- try where the,difeafes from heat and cold arefo predominant, need not be mentioned. A medical Library f, will help to diffufe know- ledge among us upon eafy t?rms, while a botani- eal garden will furnifli us with an opportunity cf cultivating that part of the Materia Medica, which is derived from the vegetable kingdom. Should * The Tables, with which this volume commences, will {hew that this propofal has been fully adopted. ■f It has been eflablifhed by the College;, and now con- Sfcs of a number of fcarce and valuable bocks. ( xxxi ) Should an application be made to the legifla- ture, there can be no doubt of our obtaining a fuitable piece of ground for that purpofe. Thus, Mr. Prefident and Gentlemen, have I pointed out in a few words, the great objects and advantages of our College of Phyficians. I shall conclude with the following remarks. It is a general opinion that the condition of man in our world is mending. The conveniences and pleafures of life, are daily multiplying by the in- ventions of philofophy. Many diforders, once deemed incurable, now yield to medicine. No wonder then that a general expectation prevails— that a revolution is foon to take place in favour of human happinefs. Natural means appear to be the inftruments defigned by heaven to fulfil its purpofes of mercy and benevolence to mankind. I am fully perfuaded there does not exift a difeafe in nature, that has not an antidote to it. And when I con- fider the influence of liberty and republican forms of government upon fcience, and the vigour which the American mind has acquired by the events of the late revolution, I am led to hope that a great portion of the honor and happinefs of dif- covering and applying thefe antidotes may be re- ferved for the phyficians of America. TABLE of contents. Page TABLES of Difeafes from December 1786, to December 1792$ 1 Cafe of a Curvature of the Spine, by Thomas Dolbeare, in a letter to Benjamin Rufh, M. D. Cenfor of the College, and Profejfor of the Infiitutes and of Clinical Medicine, in the Univerfity of Pennfylvania, 45 II. Cafe of Hydrocephalus Internus, fuccefsfully treated by Mercury, by Dr. Michael Leib, Fellow of the College. 49 III. Account of a Tetanus from the extraclion of two Teeth, fuccefsfully treated by the ufe of Wine and Mercury, by Benjamin Rufh, M. D. Ssfo 54 ( » ) IV. Account of the Tania difcovered in the Livers of a number of Rats, by Dr. Jofeph Capelle of Wilmington, 60 V. Cafe of Tetanus, by William Clarkfon, M. B. Fellow of the College. 66 ■ VI. Account of the fuccefsful application of cold Wa- ter to the lumbar region in Calculous cafes, by John Willday, j6 VII. Cafe of Hydrocephalus Internus, with the ap- pearance on diffeclion, by Dr. Michael Lcib, 78 VIII. State of the Barometer for 1789. 84 IX. Singular Cafe of Ifchuria, by Ifaac Senter, M. D. affociate of the College, 96 X. Two Cafes of Retroverfio Uteri, by Ifaac Sen- ter, M. D. EifV, 130 ( 'm ) XL Account of a fuppofed Cafe of Internal Dropfy of ■ the Brain, fuccefsfully treated by Mercury, by Benjamin Rufti, M. D. SsrV. 146 XII. Short account of the Influenza of 1789, by Dr, William Currie, Fellow of the College, • 150 XIII. State of the Barometer for 1790, 155 XIV. Cafe of Inverted Uterus, by Benjamin Duffield, M. D. Fellow of the College, 167 XV. Cafe of Rupture of the Ligament of the Os Hu- meri, by Dr. Benjamin Say, Treafurer of the College, 176 XVI. Account of an Head-each, cured by the dif- charge of a Worm from the Nofe, by Dr. Thomas H. Stocket, South River, Mary- land. 181 c 2 ( iv ) XVII. Account cf a new Bitter prepared from the Bark ^ of the Root of the Liriodendron, Tulipifera, Benjamin Rufli, M.D. &c. , ^183 XVIII. Singular Cafe of Small-pox, fuccefsfully treaU ..'.£ ed by the plentiful ufe of the Bark, ferment- ted Liquors, and Animal Food, by Benjamin Rufh, M.D.tstc. • 186 XIX. Account of the Effecls of Eleclricity, in the Re- moval of an obflruclion in the biliary Duel, by Dr. Jacob Hall, Principal of Cokefbury College, Maryland, ^192 XX. "" ^ Medical Pads and Obfervations, by the late Mofes Bartram, M. D. of South Caro- lina, I95 XXI. Account of the fudden effecls of the Affufion of cold Water upon the Body in a cafe of Teta- nus, by Dr. Benjamin H. Tallman of New J?rfey, 2Q5 XXII. Cafe of Anthrax, by the late John Jones M. D. Vice Prefident of the College, 2Qy ( v ) XXIII. State of the Thermometer for 1791. 213 XXIV. Cafe of a Chronic Dyfentery, cured by Alum, by Dr. Michael Leib, 225 XXV. Account of one of the Caufes of the Trifmus Na- fcentium, by the late Mofes Bartram, M. D. 227 XXVI. Practical Obfervations on Phthifis Pulmonalis, by Ifaac Senter, M. D. &c. 232 XXVII. Cafe of Hydrophobia, by Dr. George Benfell, jun, 238 XXVIII. Remarks on the effecls ofCorrofive Sublimate in Cancerous Affeclions,by\h2,c Senter, M. D. cifV. with additional Remarks, by Dr. Wil- liam Currie, 245 XXIX. Cafe of Hydrocephalus Internus, by Dr. Wil- liam Currie3 249 f MEDICAL TRANSACTIONS. To the President and College of Physicians of Philadelphia. "ln^TE, the Committee appointed to deliver * ™ in a return of the Difeafes of rthe Patients of the Philadelphia Difpenfary, have agreed on the following report, which in- cludes all the Cafes admitted from December 12, 1786, to December 1, 1787. We have, for the fake of concifenefs, en- deavoured to arrange the Difeafes under the generic Names of Doctor Cull en; but the difficulty, and, in many inftances, the im- poffibility of adhering to this plan have often obliged us to deviate from it. We hope that thefe, with fimilar Commu- nications from our Fellow-Members, will en- able the College to form a jufl and accurate Eftimate of the Difeafes of the City, and would wifh that fome plan might be adopted to carry this Defign into Execution. Samuel P. Griffitts, J. Morris, John R. B. Rodgers, Caspar Wistar, Jim. William Clarkson, Michael Leib. PiiiladeIpiiia Dispensary, ~) December 4,1787. j Vol. I. A / PATIENTS ADMITTED. DISEASES. 1786,1787 Dec. 1 Jan. Feb. Mar. 'April 1 h May June July Aug. Sept. Abortus Abfceflus Albugo Amenorrhoca Anafarca Anchylofis Apoplexia Aphtha Afcites Afphyxia Afthma Atrophia Cancer Caries Cataradus Catarrhus Cephalalgia Chlorous 3 2 1 1 2 1 2 3 I 6 2 I I 2 I 1 1 1 1 1 1 7 I I 7 2 2 1 I I I I 7 I 2 2 I I I I I 2 2 I 2 I 4 I I 3 1 1 1 Carried forward, 6 9 7 7 U H 11 12 i 10 1 8 0 B 1 n p. n 2-«; P* D.S »> JO 3 2 Pi § jo 8*3 0 5- o PATIENTS ADM 1 T T E D. 0 O X o1 gllto the JO n 1 a. 0° < n P* 3. ST -1 OQ .3" a Hof. fc H. .„ 2. (U 3 3« 1786 17871 DISEASES. Dec. Jan. Feb, VlaT. April May June J«iy Aug. Sept oa. Nov * 71 . C- of E. • c a 1 Brought forward, 6 9 7 7 13 H II 12 IO 8 7 16 13 l9 2 | - 16 Cholera - 1 3 I 2 6 3 - 1 - 17 - - - - - Cholera Infantum - - - - - 2 26 21 6 4 - 53 6 - - - - Colica - 4 3 2 2 2 2 4 3 2 3 3 29 1 - - - - Conftipatio - 1 3 2 - I 1 1 •• - 3 12 - - - - I Contuiio 2 4 5 3 3 2 7 3 1 2 3 34 - - I I - Convulfio I - 1 2 * . - 1 1 1 7 - - - - - Cynanchepnrotidea - - - - . - - - - - 1 - 1 - - - - - tonhllaris 2 . 2 . - - 2 - - 2 2 11 - - - - - trachea-lis - . . 1 ■ - . - - 1 1 - 4 - - - - - Diarrhoea - - - 2 7 5 II *9 10 9 2 2 61 2 4 - - - Dyfenterta - - 3 2 1 3 4 5 7 5 3 31 1 1 - - I Dyipepfia - - 3 6 8 4 4, 1 5 1 4 29 - 5 - - 3 Dyiuria - - - 1 . - 1 . - - - - 2 - - - ^ - Epilepiia - - 2 2 - 2 1 1 - 1 - - 2 - 2 2 2 1 Epiftaxis - - 1 1 . . - - - - 1 - 3 - - - - - Eryiipelas - - > - - - 1 - - - 1 - 1 - - I - - Eruptiones - - 1 3 1 1 1 3 - 2 5 3 18 - - - - 2 1 Carried forward, II '9l 20 351 40 39 1 42 89 j 57 43 37 40 386 23 3' 1 6 1 3 I H 1 PATIENTS ADMITTED. 0 e P* P* •* J« < n P* 0 sl a. 3 !» §.g • O O W **» 0 0 a c- 3 n 3 EJ 5" n W B a DISEASES. 1786 Dec, 1787 Jan. Feb. Mar. April May June July Aug, Sept. oa. Nov Brought forward, Febris remittens quotidiana tertiana quartana verminofa puerpera Fiftula in perinaso Fradura Gangrena Gaftritis Gonorrhceavirulen; benigna Kaematemefis Haemoptoe Haemorrhois Hemiplegia Hepatitis 11 I i I I 19 I I 3 I I 20 2 I I I I I 35 1 2 1 2 40 1 3 5 2 1 39 • 1 2 1 4 1 1 42 I 3 8 1 1 89 7 2 7 1 1 5 1 57 8 1 4 1 6 1 1 43 10 34 6 1 2 •3 2 3 2 37 3 14 3 5 1 1 1 1 40 3 2 3 1 6 1 1 1 385 33 57 37 4 2 3 1 8 1 25 2 3 5 4 8 23 2 I I 31 2 1 6 1 1 3 1 24 I 2 8 1 i 1 Carried forward, *S 26 27 4' 52 49 56 "3 79 106 66 58 57B 27 34 8 4 3?-; — *"«M P. (U £> ?^ PATIENTS ADM I T T E D. n c 0 0. b P* 1 9 £ •1 V a. %> , 0-3 0 3* a-3 >"i EJ. p 3 n a* 1786 1787 LMSEASES. Dec. Jan. Feb. Mar. April May June July Aug. Sept. ua. Nov. 578 a. Pjf a Brought forward, »5 26 27 41 52 49 56 IX3 79 106 66 58 27 34 8 4 37 Hernia inguinalis - I - - - - - - - - ~ 1 - - - Herpes - I 4 I 2 2 I 3 1 2 1 4 l9 " - - - 3 liydartlirus - - I - I - I - - - - - 1 1 - 1 Hydroccp. internus I 1 - 2 - - - - • - Hypochondriafii - - . - - I I - . - - - 2 - - - - - Hyfteria I 7 4 5 - 2 7 4 7 3 1 2 21 " 18 - - 4 Iercnis - - . - I - - - . - . - 1 1 - - - - 1 Infitio vaiiolarum . . 2 17 56 IO 2 - _ 1 10 3 100 - - - - 1 Ifcliias . _ . . . _ 1 . _ 1 2 - - - . - Leucorrhoea I . 1 1 - I 1 1 . . 1 - 3 - 4 - . - Lnx.itio . . . . . I 1 - . 1 . - 2 - 1 - . - 3Vl.ir.iu - 1 - . - - - .1 . - - - - - 1 - • - Menorrhagia - - - . I - 1 - . - 1 2 - 1 - - - Nephritis - . . . . . 1 - . . - - - - 1 - - - Odontaloia . . . _ . I 1 . *i . . 2. 4 - - - - - Ophthalmia - 2 - 3 3 9 1 6 2 7 4 7 38 - 2 1 ■ - 3 Palpitatio - - - 1 - - - - - - - - - " - - - 1 Carried forward, l7 38 39 70 116 76 74 127 90 121 84 79 774 27 64 10 4 5> PATIENTS ADMITTED. DISEASES. 1786 Dec. I787 Jan. Feb. Mar. April May June J«iy Aug. Brought forward, Paralyfis Paronychia Parturitio Peripneumon. noth Phimofis Phlogofis Phrenitis Phthifis-pulmon. Pneumonia Podagra Prolapfus uteri Pfora Rachitis Rheumatifmus Scarlatina anginofa Scrophula Spafmi .*#^ 17 I I 2 2 I 38 1 1 1 1 9 1 7 39 1 1 1 5 6 7 1 70 I I 5 6 1 2 9 2 Il6 I I I I I 20 IO I 76 5 3 2 7 1 74~ I I 2 9 1 1 16 4 1 3 127 1 3 1 5 2 90 1 3 1 1 2 25 2 Carried over, 24 59 61 97 152 94 "3 J53 125 n c ►1 n P* d n p P" JO n 0' < P* 2. $ rL°S * & •ri Is I 0 0 S-• 0 a t S. r> CI *» S" Sept. oa. Nov. 121 2 6 5 3 3 5 1 84 1 1 1 1 1 9 1 6 4 1 79 1 1 4 4 1 7 2 1 774 3 4 17 1 7 2 4 73 12 74 11 to 5 27 I I 12 5 I I I I 64 2 5 1 1 1 30 2 IO 4 51 1 4 1 7 z 146 no 100 998 50 106 10 4l 66 — ' 1 * JO 0 £ **3 JO a. ° P A T I ENTS A D M I T T E D. 0 0 0 a. < rt .v Co 0 £• 1 n 0 2. 5 3 DISEASES. 1786 Dec, 178: Jan. I Fc'i. Mar. April May June J«iy Aug. Sept. .___ 0 8 7 4 49 8 4 - - 2 Dyfenteria - - - 1 1 - - 2 3 1 3 1 12 - - - - - Dyfpepfia 5 2 4 5 4 11 16 9 10 6 5 2 73 - 3 - - 3 . Dyfpnea - - 1 - 3 - - - - - - 4 -.» - - - - Dyfuria - - - 1 1 - - - - - - 2 - ' - . - . Enurefis - - 1 1 - - - - - - 1 1 . 1 . . 1 Epilepfia - 3 - 1 1 1 1 1 - - 1 1 - 3 I - 4 Epiftaxis - 1 - - - - - - - - - 1 - - • Eryfipelas 1 2 - - - - - 1 1 2 4 8 - - - - 3 Eruptiones 2 1 - 2 3 2 1 - - - 3 11 - - - - 3 Febris-Remittens 1 1 - 1 - 4 4 3 3 1 1 J7 2 - - - " Carried forward 41 1 44 27 43 45 341 57 85 62 35 35 I55 452 u 25 3 1 x 25 PATIENTS A D M I T T E D. 0 c "1 0 JO a. if-2 3-S.5J 0. 3 0.? 33 0 £. % 3 p* p* < n a. *T a- "oS « 5' 1787 1 788 1 DISEASES. Dec. j an. Feb. Mar. April May June July Aug. Sept. oa. Nov. *I c Brought forward I 41 44 27 43 45 34 57 85 63 35 35 35 45 2 38 25 3 I 25 'Quotidiana 1 2 I - I I 1 2 4 - 3 9 25 - - - - - Tertiana 6 1 - 1 2 3 2 5 2 7 6 2 35 - * 1 - I Quartana 1 - - - - - - - - - - - 1 - - - - - 1 < Synocha 1 - - - - - - - 1 - - 2 - - - - - Synochus 1 - l 1 2 I - - - - Typhus 1 - - 1 I 1 1 - 1 5 2 4 10 5 - 2 - - Hectica . . - 1 - - - . . - - - 1 - - - - Puerpera - - - 2 • - - - 1 - - 1 4 - - - - - Fractura . . - - . 3 1 - . - - 2 4 - - - - 2 Gonorrhoea 1 1 4 3 3 1 6 1 5 5 2 1 32 - - - - I Hasmatcmelis . . 1 - - - - - 1 - - - - - Hamioptoe 1 - 1 1 - 1 - - - - - - 3 - - - - - Hoemorrhoi s 1 1 - . - . 1 . . - - 1 3 - - - - I Hemiplegia - - - 1 - - - 1 - - - - - 1 I - - - Hepatitis - 1 - - - 3 1 - - - - 1 6 - - - - - Herpes 3 3 - 2 3 - 3 3 2 - 1 1 18 - I - - 2 Hematuria 57 - - 1 - - - - - - - - I - - - Brought forward, S3 34 5^ 57 47 73 97 78 53 49 57 588 46 28 1 6 I 32 ag » f? e-? PATIENTS ADM I T T E D. 0 n> P* 0 re P P* JO f» S' < p" >srg. S.S Eg 0 Sr * 2 n v p -• 1 0 DISEASES. 1787 Dec. 1788 Jan, Feb. Mar. April May June July Aug. Sept, oa. Nov. 57 n e c Brought forward, 57 53 34 56 57 47 73 97 78 53 49 588 46 28 6 1 32 Hernia - - - - - I I - - 1 1 I - - - - 3 Hydarthrus 1 - - - - - - - - - - - - I - - Hydroceph. intern. - - - I - - - - - - 1 I - - - 1 Hydroceph. extern. - -' - - - I - - - - -- - - - - - 1 Hypocliondriafis 2 - - - - c I - - - - 2 - 3 - - - Hyiteria 1 3 6 2 8 5 7 12 6 3 3 - 44 - 10 - - 2 Icierus 2 - - - - 1 - - - 1 4 6 - - - - 2 Infitio variolar. 5 2 - I I 32 21 - - - - 5 75 - - - . 1 Ifcliias 1 - - - - - - - - - - 1 . - - . - Ifchuria - 3 1 - 1 - - . - - - 3 - 2 - - - Leucorrhaea 1 1 - - - 1 - Mania - - - - 1 - - - - 2 - - - - - 1 2 Melasna - - - - - - 1 - - - - 1 . - - - - Menorrhagia 1 - - - 1 - - - 1 1 - - 4 - - - - - Nephritis 1 - - - 2 - . - 1 1 1 - - 4 I 1 - - - Obftipatio 1 1 2 2 - I - 1 1 - - - 9 - - - - - Odontalgia 1 - - - 1 I - - - - - 1 2 - - 1 - 1 Carried forward, 73 62 43 72 1 103 80 1 83 111 87 58 56 70 74» 48 45 7 2 45 PATIENTS ADMITTED. 0 e f» a. G n JO < p.S| S v 2.*> ill PS 0 S- 3 3 1 5. ft g DISEASES. 1787 Dec. 1/88I Jan. Feb. Mar. April May June July Aug. Sept. oa. Nov. P* ? 2* -*f» s • Brought forward, 73 62 43 72 103 1 80 83 111 87 58 56 70 741 48 45 7 2 45 Ophthalmia 2 - 6 3 I 7 - 5 " 2 I 24 Otalgia - - - - - 2 - " " Palpitatio 1 - 1 Paralyfis - - 2 - I ■ - - ■ Paronychia Parturitio 1 I 2 * - ■ . 2 3 2 - 1 I 10 - - - - 1 Peripneum. Notha. - - - - - 1 - - - " " " " Phlogofis 1 - - - - 1 - • " Pertuffis . 2 2 - - - - - 4 - _ 4 9 I Phthifis Pulmon. 5 2 3 2 5 1 2 1 2 2 1 3 2 l5 3 1 I 7 Phvfconia - - 1 - - ■ - • ~ " Phymofis - - - 2 - - 1 ■ - j ■ ™ 3 Paraphymofis - - - - 1 - • ■ " " 3 Pneumonia 8 21 l3 12 10 7 7 1 1 2 1 3 77 5 Podajrra . - - - - 1 - - • — " %■ Polypus - - - 1 - - - - - - ■ " 2 Prolapfus Uteri - - - - - 1 1 * Carried forward, 90 88 7i 93 121 IOI 95 123 96 64 59 84 876 69 52 12 3 63 1 / a. b'. » jo 3 fo S-? PATIENTS ADMITTED. 0 c 0 JO 2 3" 01 OQ e. 3 . 0 3 3 S 2. DISEASES. 1787 Dec, 90 1788 Jan. "88~ Feb. 71 M3r. April. VI ay. June. ~95~ July. Aug. Sept. O&. Nov- p. a. 2. n 2,5- C a Brought forward, | 93 121 IOI 123 ~96~ ~6T 59 84 876 69 52 12 3 63 Pfora 2 4 I 1 3 9 6, - 1 6 - 2 35 - - - - Pyrofis - -■ - - - - I - - - - - 1 - - - - - Raphania - - I - - - - - - - - - 1 - - - - - Rheumatifmus 4 8 IO 13 II 10 II II 6 15 6 4 78 - 17 3 3 8 Sarcocele - 1 - . 1 - - 1 - 1 . . - 2 Scarlatina anginofa 2 - - - I - - I - - - - 4 - - - - ■ Scrophula - - - 1 - 1 - I 1 2 2 4 - I - - 3 Spafmi 1 - - - - - - - - - 1 - 2 - - - - - Sphacelus £.nT,llyTorn? - _ - - I - - - - - - - 1 - - - - - ourJitas - - - - I - - - - 1 - - - - I - - 1 Syncope - - - - - - - - - - - 1 - - - - - Syphilis 6 6 6 7 3 "20 II II 7 13 H 7 79 1 4 10 5 12 Tinea Capitis - 6 1 I - 1 - 2 - - - 10 - 1 - . - 1 Trifmus - . - . - . . . . - 1 - . . - - Tumores 1 1 2 - 1 - - 1 1 - - 6 - 2 . - - Variola 16 7 6 5 6 9 9 8 5 - - 2 62 11 - - - - Carried forward, 120 j 121 1 98 121 1 148 152 137 1 l55 120 102 1 80 IOI 1162 81 78 25 u i 90 PATIENTS ADMITTED. 0 e 1 ft O. n w p. s* P* 2 3* ft. ^ 2 CFQ JL ft E.B 8,3" ^ rt 3 3 « 2 "» 3. " ^ <—i c s rt <—1 >5" > e en ft 0 8> 2 0 < p Abfcellus Albugo Amenorrhoea Amaurofis Anafarca Anchylofis Anthrax Apoplexia Aphtlia Afcites Afthma Atvopliia Caiicc; Calculus Veficas Cataraftus Catarrhus Cephalalgia Cholera 1 2 1 2 I I 4 2 1 4 2 I I I 2 -I 1 I 1\ I I I 1 2 1 1 9 2 1 2 1 5 2 1 2 3 1 1 1 2 1 I 5 1 1 8 2 I I 9 1 2 1 1 1 4 1 1 I I I 24 I I 2 7 1 20 1 7 1 1 1 5 3 7 4 3 2 1 65 3 22 Curried forward, 4 8 13 7 7 M H 11 16 *3 12 27 4 *54 n e ►1 ft p* 0 P* J« . f> ft* < ft. a r> a cr Ft" 0 S 1-1 Oq ^ f> ^ ft ft P Jfl 3 2 a.3 IS 0 S-»tl ft w£ • 0 n 2. £ B • e 3 7 1 4 1 4 1 4 2 1 65 3 20 1 1 1 2 2 1 1 1 1 3 1 1 - I 1 I I I 2 1 130 7 9 I 1 6l o> / PATIENTS ADMITTED. H c n c i "2 DISEASES. Lg=o I*1 = 0-n -« r> „ &3 s u -1 > *-* 5 rt <-^ > c ■ 0 2 0 a P" Brought forward Cholera Infantum Golica Conftipalio Contuiio Convulfio Cynanche parotid. tonllllaris trachcalis Diarrhoea LyJei t.:-ria Dyfpepiia Dyfphagia Dyfuria Epilepfia Epitl.fxis Eryfipelas Eruptiones 4 3 i i 3 2 3 8 3 6 i 3 i 2 2 6 13 3 9 4 1 4 2 1 7 1 3 3 7 1 1 4 3 1 "2 7 2 1 2 1 4 3 4 1 14 2 6 2 1 1 2 3 7 1 3 ,*4 1 6 4 1 1 2 7 1 2 I I 5 4 2 3 1 1 1 9 1 H 5 1 16 33 2 11 13 12 1 1 2 *3 21 2 5 2 I I 7 *9 1 1 2 12 3 3 1 4 1 1 5 16 8 1 5 27 1 4 2 4 1 f 9 4 1 4 , 5 2 6 1 6 1 6 1 1 1 2 *54 6.7 41 16 53 5 5 4 5 66 64 88 2 3 J5 1 • 7 25 I3O 59 41 16 52 4 5 4 1 55 57 83 2 3 3 1 6 25 Carried forward,. l7 32 37 33 26 40 39 58 91 87 61 6c 36 621 547 M a. JO (-5 ft' 0 ft 3* n c V cr ft" ?ft ft s> JO a n ft.3 13 0 3-'■»> n w I • 0 JO r> ft.3 i £. f> 2. K 3 JSW • e 3 7 9 - I 1 6 8 - - - - - - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - - ■• - - - - - . 4 - - - - - 10 - - - - 1 5 - - I 1 - - 3 - I - 1 - - - - - - - - - - - - - 8 - - - 4 - - - - - - - - - - - - 1 - - * - - . 35 20 3 2 M. PATIENTS-ADMITTED; 0 p 0 c DlSFASES. '■ 3 *7 2 1 32 3 1 1 1 1 b ^ 37 1 5 2 3 1 1 2 33 3 2 1 2 2 a' _26 I 1 1 2 I I > •0 4c I 5 1 •< 1 5 5 2 1 1 2 2 1 <—1 c 3 rt ■^H 1% 01 0 P5 3 0 < p* Brouglit forward; Febris-Remittens quotidiana tertiana qui.rtana puerpera Fraiftura (ror.oriiuca virul. Hasmatcmefis Haemoptoe Hsemorrhois Hemiplegia Hepatitis Hernia Herpes liydartlirus Hydrocep. acutus j 58 2 3 3 2 2 ^ 3 91 4 2 5 1 7 1 1 1 87 4 3 1 1 1 2 102 61 7 2 2 1 i 3 1 79 60 4 5 1 1 2 1 74 36 1 2 1 1 5 46 621 20 28 38 1 5 12 21 1 2 5 5 6 21 1 1 547 17 25 38 1 3 12 19 1 2 5 1 4 *5 Carried forward,/ 3° 39 52J 43 331 471 59 761114 788 690 b. a p ft JO n' f» ft. 3" 0 c •-t p ST C 0 |i ft. SJ 2. o *T ft ' ft p 50 3 a e. 3 . O a 3" >■*■) n pi 33 JO q. " m 3 >-i p 0 1! Ej 3 5 35 1 2 1 2 1 20 2 2 - 3 1 1 2 I 14 3 1 1 4 1 1 42 * - 5 3 24 00 PATIENTS ADMITTED. H 0 c DISEASES. 13 3 3" 3 P ^1 > 1 si? P 1 3 ^ ft CO fl ►0 0 8> 55 0 < ft ft Brought forward, Hydrocep. chron. Hydrothorax Hydrocele H ypo clion dri afis Hyfteria Idterus Infitio Variolar. Ifchuria Leucorrhoea Luxatio Mania Mehrna Menorrhagia Nephritis Odontalgia Otalgia Ophthalmia 3° i 2 1 2 I 39 3 i i i 2 52 I I 5 2 1 3 1 '43 1 3 1 1 1 33 1 7 1 1 2 4 47 2 1 59 5 1 1 3 3 76 1 1 4 1 1 1 2 7 114 1 1 4 1 1 2 7 102 1 5 1 1 1 7 79 2 4 1 1 7 74 2 1 1 1 1 1 1 7 46 2 1 1 788 2 4 2 3 47 6 2 1 6 2 7 1 *3 8 2 1 48 690 I I 32 6 1 1 5 2 4 1 3 2 1 43 Carried forward, 37 47 66 5.1 49 jo! 73 94 !3» 118 94-I 89 5°, 943 8o6i 0 r» P ft JC g: < n ft 0 I p 1 r£ ft" 0*3-»i P ft W -1 ft - 2s 0 g — c H_ < O n I5 J* n c rt oq * C 3 42 I I I 24 I I IO I 2 2 5 1 1 1 2 1 3 1 1 24 I 4 1 1 4 I 45 39 2 11 5 35 ^O PATIENTS ADMITTED. H 0 0 ■c "1 ft ft b fo ft ja n < rt ft 3 a y cr ft£ a- £; 2 w 2- f» JO g.3 res **> ft 8-P 5 3 " E. ft a c DISEASES. 53- c n N 5 " i 3-1 -° :| :| • § 1 > s 1 n 5> <—< c 3 > n ►3 0 2 < Brought forward, Paralyfis Paronychia Parturitio Pertufils Phlogolis Phrenitis Phthifis PlrJiins incip. Pneumonia Podagra Prolapfus uteri ani Polypus Pfora Rubeola Rheumatifmus Scarlatina Cynan. 37 2 I 4 i i i i 2 4 47 2 2 1 3 3 17 8 3 66 i 5 2 2 2 9 5 5 i 51 2 1 1 l5 2 8 7 49 2 1 1 3 8 1 1 1 43 *5 50 1 8 2 5 4 11 4 54 8 73 1 2 1 1 1 2 11 4 36 10 94 1 3 3 . 4 1 3 2 18 4 I3I 3 8 2 4 1 1 1 1 11 Il8 2 2 1 4 1 1 3 7 2 94 1 2 1 1 2 2 3 3 7 2 89 1 2 5 1 2 18 8 2 5° 3 1 3 12 13 5 943 4 4 17 33 22 1 28 23 108 1 3 3 1 40 163 99 10 806 2 4 17 28 21 1 *3 98 3 3 37 l59 72 10 45 3 !5 9 1 4 39 1 3 9 21 2 11 5 1 1 1 1 _ 35 1 2 9 1 3 6 Carried forward 54 86 98 87 125 147 142 J33 165 141 118 128 8? 1503 1274 77 73 2 II 9 57 1 PATIENTS ADMITTED. H 0 0 c ft ft. b s ft 7* S V ^ <—c c 3 <—1 > c CO O 2; 0 •< Brought forward, Scrophula Schirrhus Spafmi Surditas Sphacelus Synocha Synochus Syphilis Tinea Capitis Tumores Tuilis Tympanites Typhus Variola Vermes Vertigo Ulcus 54 2 12 I 7 86 2 1 3 7 98 1 11 1 4 8 6 87 1 1 10 2 4 8 1 125 3 2 3 10 1 1 2 6 147 1 1 12 1 1 3 1 2 1 1 4 142 2 2 2 6 9 1 1 J33 1 1 1 1 '8 1 2 1 2 1 8 165 1 *3 I I ,5 6 141 J3 1 1 1 1 3 1 9 Ilo I I H 1 1 2 2 2 8 I 28 2 I I I 12 I I I I 2 3 1 2 87 12 1 4 2 7 3 1503 II 2 5 I I 7 8 140 7 10 27 2 19 1 41 68 1274 6 5 7 8 104 7 C 25 1 14 1 •38 3 44 77 1 2 1 4 1 73 5 1 1 2 1 11 2 I I I 5 3 9 3 2 57 24 2 1 1 2 8 Carried forward, 76 105 129 114 *53 '75 165 160 192 171 *5* l57 116 1756 *545 86 94 2 20 H 95 PATIENTS ADMITTED. 0 0 c "-I ft ft ft Jtf ft' < rt ft 0 c 1 V rT 3" 2*05; 2- ft •_. ft ft. 3 . O -ff 73 ft g ™ S. 3 3 ft w 5 DISEASES. S"3 •3 1 b -0 00 3 ^ ►a rt 0" 2 > »-f S Pi? -? j P e > 3 rt u 2 0 < Brought forward Uftio Vomica Vulnus 76 1 105 3 1 129 2 2 114 5 2 *53 2 2 J75 1 165 I I 2 l6o 1 3 192 2 I 4 171 1 5 177 J5* 1 2 J55 *57 3 160 116 3 119 1756 *9 2 3° 1545 18 28 86 1 2 94 2 20 H 95 -2 Total, 77 109 *33 121 157 176 169 164 199 1807 1591 89 94 2 20 H 97 1st PHILADELPHIA— —PATIENTS ADMITTED. 0 c DISEASES. ET ? pa 0-ft -* O 00 3 2 p *< «—■ 1 <—1 3 c 3 cr c Cf} n 0 1 z Cb 0 ' 1 ? Abortus Abfceffus Albugo j Vmeaorrhoea Anafr.ca Anchylofis Aphtha Afcites AiUima Atrophia C f culas Vefi:iE iLi'iccr C.r.ar.-lnvi Cephalalgia Cholera ° ( holera Infant Chorea Colic a 1 I 2 I I 4 1 3 2 1 5 4 1 1 6 1 20 5 2 1 8 1 8 25 1 2 1 8 5 17 1 1 4 1 80 1 5 93 I 2 4 21 1 2 2 2 7 42 1 1 1 3 2 1 8 17 3 44 2 I 3 1 1 2 1 17 2 3° 2 2 I I 4 i 6 3 3 4 27 I 2 1 4 2 1 6 17 2 8 i 1 0 2 5 22 8 5 2 6 2 149 8 J3 34 44 Carried forward,' i j 121 11 *5 300 js b r£ : *•?! b 5' < n ft S1- ft = .~ 0 w 2: ; 3 0 h' ■-t 5 ' O c 3 e - - - - . 2 I - - - - 6 - I - - - I - - - - 3 25 3 4 - 2 1 18 - 1 - - 1 2 - - - - - 5 - 2 - 2 2 8 - 11 I - - 18 1 * - - - 3 1 - - - - 1 1 - - - - 1 - 2 - - 3 154 - - - - >- 8 1 - - - - 14 6 - I - - 41 - - - - 2 2 ■ 21 - - 1 45 H 2 4 »3 354 PHILADELPHIA— —PATIENTS ADMITTED. r c >i ft ft b n a. ft S' < ft 0- b ft *< !§ £.3" Remaining im-der care H 0 DISEASES. ?: s: (t 1 •a » *< 3 a > to a" 13 ^ £ c' < Brought over, i 12 11 20 2? !? 9.' 42 44 3<* 27 17 It 300 H 21 2 4 13 354 ' Coiiliip.itio _ I _ I 1 2 : it 2 / " - - 16 - - - - - 10 Contuiio i s . 5 9 t ■ 3 11 IL 6 4 • 3 62 - - I 1 3 (17 Convulho _ i - - - ' - 1 - 1 - - - 3 - - - - - 3 Cynanche Parotid . I i - - - - - - - - - - 2 - - - - - 2 ToniU . 2 _ 1 1 I 1 1 2 2 - 10 1 - - - - 11 Triclv.al _ . . - - I : 1 1 1 2 - 6 2 - - - - 8 Cvfiltr. _ _ i . - - ■ - - - - - - - 1 - - - - - 1 Diarrhoea i 4 i 2 2 3 £ 3 15 IC 11 5 4 <>3 2 1 - - - 06 Dyfenteria . i . 1 2 1 I 4 1 3. 4 2 1 18 2 - " 1 - 21 Dyfpepiia 2 7 6 5 3 8 ( 4 12 ( 5 4 3 67 - 3 I - 3 74 Dyfphagia . - 1 - 1 - - - - - - - 1 - - I - - 2 Epilepfia 3 - - 1 2 1 I 2 - I - - - 2 - 9 - - - 11 Eruptiones - 2 - 2 3 ( 3 3 1 1 1 3 23 - 1 " - 1 25 Ervfip-Jas . i 2 1 - 1 - - 1 - - 2 - 7 - - - 1 - 8 Fcbris i'.cmittcns r 2 1 2 2 3 ] 4 4 fc 4 / ? 3» - - 3 - - 41 Ouctidian 2 I 1 3 1 1 ; 2 4 0 12 c 6 43 . - - - - 1 44 Y.rtiana - ;17 I 2 8 1 44 1 5i 2 51 < '37 6 79 2 100 5 1 82 2 75 1 53 3* 29 - - - - - 29 783 Carrie .1 forward IO 691 21 35 8 7 21 PHILADELPHIA-—PATIENTS ADMITTED. DISEASES. sr? jo -< 3 a Brought forward Febris Quartana Synocha Synochus Puerpera Typhus Fiftula in Ano in Perinaeo Fra3 3 t—1 3 3 ft «—1 c >5* > C/j 1 ■3 G "«4 25 0 43 Brought forward, H 46 39 4« 58 60 149 84 104 IO4 83 Hernia - 1 - - - - - 2 " 1 - Herpes Hydarthrus Hydroceph. acut. Hydrothorax Hypocliondriafis 5 2 1 2 2 1 1 6 1 1 1 - 2 3 1 1 1 I I I - 1 1 Hyfteria Hydrocele 5 IO 2 1 2 3 II I 2 3 8 I 1 4 Hydrops burfae mu, - - - - - - - I - - " - - Icterus - - 1 - - - - - - - - - Infitio variolar. - - - - 1 40 26 - - - " 3 1 Ifchuria - - - - 1 1 - - 1 - I - - Leucorrhoea - - - - - 3 3 2 2 1 - - 1 Mania - - - - 1 - - - - - - - - Melancholia i - - - - - - - - - - 2 - Nephritis CEdema La&eum i 2 1 1 1 1 - 1 - - - - 1 - Carried forward, 26 64 48 56 67 107 191 91 116 116 87 72 5i b n w ft. n S3 ft a &. 0 a. B J° ftS 4 a, s-**> rt * c jo p 5' ft K ""- 3 3 0 31 2 I 39 2 1 9 1 1 1 9 1 1 1 8 I 28 I 2 I 2 I I 896 4 24 3 2 3 4 53 1 1 1 71 4 l3 1 2 8 1 34 54 l.» 1 9 36 1092 PHILADELPHIA -PATIENTS ADMITTED. 0 c 1-t rt ft I b ft DISEASES. R.un. c- fin, la. yr. C " <—i 1 3 „, 8? 0* S > 2_ p . e 3 a «—1 c > 3 IK) CO ft O 2 0 Brought forward, 26 64 48 56 54 107 191 91 116 Il6 87 72 5' 947 34 Ophthalmia 3 2 3 2 1 3 1 6 4 5 6 3 1 38 - Paralyfis I - 2 - 2 1 1 1 1 - . 1 - 1 - Paronychia - - - - - - - - - 1 - - 2 - Parturitio - 2 3 1 - 4 2 4 1 2 1 - 21 - Pertuflls 3 - 1 1 4 2 2 - - 1 1 - 16 - Phlogofis 2 3 1 1 - 2 - 2 1 2 1 16 - Phrenitis - - - 1 - 1 - - - - _ - 1 1 Phthifis Pulmon. 9 2 4 2 2 3 1 2 - 2 1 2 1 3 9 Phyfconia - 1 - - - - 5 2 - 1 - - 5 - Pneumonia - 11 6 11 12 13 15 3 1 - .2 7 5 72 10 PoJagra Polypus - 1 I-olapfus Uteri - 1 1 1 - - - - - 1 * - 2 3 - Pfora - 1 - - - 1 1 5 3 1 - 3 - H - Rheumatifmus 8 11 9 *3 9 10 9 7 7 7 6 6 2 82 - Rubeola - - 2 1 3 7 1 - - - - - - 14 - Sea-' laiina - - 2 - 89152 226 124 2 140 4 140 108 98 2 8 2 Carried forward, 5° 97 85 65 1245 56 PHILADELPHIA---PATIENTS ADMITTED. n c >1 TO ft b ft JO 0 ft •< S S3 *E 0 0 ~ tn K ■ 0 0 3 EJ 5' ft 3rq c H O D'SKAST. S. 3 » =r > 1 !> •* 1 s^ »«5 «—1 c a rt <—1 > CO ft 13 c 2 0 < Brought forward, ScliinitiJ Scrophula Sph:u-e.'u* Syncope Syphilis Tetanus Tinea capitis Tumores Tympanites Tuflis "Varicella Variola Vermes Vertigo Vomica Vomitus Ulcus 5° i 23 1 2 3 12 97 5 1 2 7 5 8 85 9 2 2 4 8 5 91 9 1 7 5 89 I I 7 1 4 3 2 152 1 5 1 1 1 5 226 IO 2 I I IO 4 I24 2 *3 I 2 4 2 9 140 2 7 1 1 2 4 2 1 10 I4O l5 1 3 7 2 10 4 108 I I 7 2 2 7 1 1 3 98 6 1 1 3 5 2 10 65 11 2 2 5 1245 2 4 i 106 6 1 33 1 12 57 j 2 5i 56 I 2 I I 2 95 1 2 2 1 1 9 3 1 3 *5 3 1 1 3 55 2 *3 I 3 1 1 16 1478 3 7 2 1 127 1 6 18 1 38 1 13 62 1 1 2 82 1 Carried forward 92 126 IJ5 116 108 166 l55 157 170 182 *33 126 85 1536 63 111 21 23 92 1844 00 PATIENTS ADMITTED. c 1-1 n ft b n ft. rt* < ft ft ftb 2.£i a.'S 3 g ft s MB Cu rt % 3 * g: c 3 H c 1. DISEASES. .*• —■> c 1 n » ."• ? ? 1 * ° 1—I H S ^ • <• -3 2 > -3 *1 2 p •^ c 3 ft <—1 c > c Ore) CO n ■T3 0 3> c Brought forward Urticaria Uftio Vulnus 92 2 126 1 2 "5 3 1 116 3 2 108 2 5 115 166 I 5 172 *55 2 !57 J57 1 1 *59 170 1 4 S7J 182 I 2 I85 133 2 I I '37 126 2 128 85 2 1 88 J536 3 28 6_3 III 21 2 23 92 2 I844 3 *5 3° Total, 94 129 H9 121 1580 <^3 III 23 23 94 1892 SO PATIENTS ADMITTED. DISEASES. Trans-fers. jb" <—1 * 13 cr 5 n > <—1 3 a 0 til 3 > e Of, CO ft Abortus I - - 1 - - - - - ' - Albugo - - - - 3 - - - I - - Abfcelfus - - I - - I - - I - - Amenorrhoea 3 I I - - I - 3 - 3 I Anafarca i - - - 1 - 1 - 2 - 3 Anchylofis i - - - - I - - - - • Anthrax - - I - - - - - - - ■ /Ypoplexia - - - - 1 - - - - 1 - Afcites 2 - I I - - - 1 1 1 - Afthma - 2 - I 1 - - 1 I - - Atrophia - - - I - 1 - - - - - Calculus Veficse Cance - Caries - - - - - - - - - - 1 Catarrhus 3 IO 28 18 16 7 3 4 I 4 3 Cephalalgia Cholera " - " 4 2 I 6 1 6 2 Cholcra-infantum - 26 11 1 2 12 6 Carried fir ward ,ol 13 32 22 5 14 26 22 IO n c 3 I b 0 JO I ST. 1 O < 1 O IB 0 3-►a- 3 E. ft b * 09 3 3 H 0 u 0 0 < M l 3 1 1 1 1 1 2 2 6 1 1 1 3 11 4 1 1 3 1 102 8 17 17 6 2 4 1 2 4 3 1 1 1 2 4 1 I I I I I I I I I 4 3 14 13 2 1 2 7 9 3 1 1 103 8 17 ! „, 7 12 170 *9 13 4 1 4 U i 0 PATIENTS ADMITTED. 0 c 1-1 ft ft 170 23 21 40 8 1 6 1 27 63 30 1 3 1 b ft f» K' < b ST «i ft |X r» •T1 O "a 5 " 8*3 n 5* w 5" 0 DISEASES. Trans-fers. c -rt ■» f) .o <—< - ft S "1 > i-t_ 2. p <—1 3 3 ft *-< 3 > CO ft G 8> ^5 0 < 3 2 2 SO «—t 3 3 ft > 3 CO rt 0 r3 2 0 < Brought forward Eryfipelas Eruptiones Fcbris remittens quotidiana tertiana Quartana puerpera Fillula in ano Fracrura Gangraena Gaftritis Gonorr. virvrh Gaftrodynia HxmorriiaL,ia Hxmatcmelis Hamoptcc Haemorrhois '? I I 2 3 23 i 2 1 1 1 2 1 32 42 3 1 1 1 1 2 51 42 ] I I 2 3 ■i 48 2 3 4 1 2 2 62 38 7 5 1 1 2 1 55 16 1 4 1 2 1 1 1 26 I I I 63 I 3 1 4 1 1 74 58 3 5 1 2 1 1 74 34 5 7 5 2 1 1 1 2 58 26 1 5 8 3 3 1 47 29 3 6 2 2 1 43 395 6 34 12 4i 10 1 2 8 1 22 2 2 3 3 9 31 1 18 2 1 IO I 2 I I I I 9 464 6 35 12 42 10 1 2 2 9 1 24 2 2 4 4 IC Carried forward, 1. 26 | 27I 29I 55i 32 .. H 3 9 63© PATIENTS ADMITTED. < c ft b ft JO < p. ♦-1 ft n P J° 5- 5 jj£ 0 0 =r ►*> ft • c JC rt £-3 0 3 1 Tot; O fi DISEASES. 5"P jc r> " ? b " 0 <—1 - "4 ft rt) 1 to *< «—1 c 3 ft «—1 > a co | c -a £p 1 * 0 0 14 * h«, Brought forward Hydrothorax Hemiplegia Hepatitis Hernia [lerpes Hydaithrus Hydrorachitis »—» I. y droccph. Intern. Hxpochondriafis Hyfteria Plyirocele Icterus Infitio vai-iol. Ifchuria Leucorrhoea Luxatio Mania 26 2 1 2 1 2 32 1 1 3 37 51 1 1 1 4 1 1 1 1 62 52 1 2 1 1 1 2 1 62 62 1 4 5° 1 1 119 55 1 1 47 104 27 2 2 I 2 5 39 29 I 3 1 34 74 1 2 1 1 74 2 1 3 2 58 I 2 I I I 47 1 1 i 1 1 1 43 1 1 1 1 1 1 55* 3 4 1 8 3 18 4-106 1 3 2 3 32 1 1 1 4 1 21 2 1 3 1 i 4 5 1 *4 3 1 2 9 1 -1 1 63c 3 5 6 9 1 1 7 23 1 6 106 1 4 2 5 Carried forward 34 79 82 64 53 49 707 40 39 ! 14 6 »l 818I 00 I > PATIENTS ADMITTED. 0 c .-1 rt ft b p ft J2 rt ft' < rt b cH ►n ft rt •7 » rf ft.3 0 S* -n rt MS Remaining un-der care. DISEASES. .L. -, fc 1 ^ ? ? a -n "* ■—i P xj ►n rt SI > 3 1 5. p ^ c a rt <—1 e > 3 CO ft *3 O 2 0 < Brought forward, Menorrhagia Melancholia Nephritis Odontalgia Otalgia Ophthalmia Pcrtufiis Paralyfis Paronychia Parturitio Phlogofis Phrenitis Phthifs Pneumonia Prolapfus Uteri Ani Pemphigus 34 i i 7 4 i 37 i i i i i i 3 2 1 62 I I 2 8 74 62 I I I 2 5 5 1 78 119 2 1 3 1 1 1 1 10 1 140 104 1 1 4 1 2 1 .1 39 1 2 7 1 34 1 1 1 2 1 40 I 79 1 1 1 3 4 2 3 94 82 1 2 1 1 1 7 64 I 2 I I 2 I I 53 2 1 2 4 62 49 1 1 2 1 2 8 1 65 707 9 1 1 2 i5 5 5 1 9 11 1 4 65 2 1 1 840 40 *3 1 39 1 2 2 10 3 1 H 1 1 6 1 12 I I 818 9 1 2 1 2 18 5 7 1 9 11 1 28 68 5 2 1 Carried forward, 48 1 49 122I 50' 95I 73 54 58 16 7 H 989 ( 35 ) Total. on On OO N ON w On ISNO i-i 00 m 1-4 coco r-00 i-i no l>- in >o ON mm 00 M O0 m rt-**• H Remaining un-, dtr care. | M I !•» 1 CO ; 1 NO | 1 1 1 1 1 1 -0 « CO CO R<. m.totheHos' ^ and 11. of ^. 1 1 <-< 1 i "i 1 1 11 1 "" 1 1 1 ' i-i M Difordcrly. NO , 1 i-1 1 i i . OS ; , | «* i -1 i . I Relieved. OO , ^o -I l-~ | - . , r4 i -. m , , , , NO - 00 On Dead. rt- . 1 •"' 1 ■ i 1 1 1 l , W i NO i « -i «o Cured. O On rt- N 00 r-- t--1 NO M M i^ tfj !>0 r}- HI Z \ r-~ O N r^ »►-,-■- no -^ no m O CO N M PATIENTS ADMITTED. Nov. io rt- CO 1-1 , C>M M MMMONCO • 1 1 On On OA. o CO 1 ,_, 1 ** , \C >-i NO N 1 , I I ... ON Sept. CO 'N 00 1 1 . , CO ' CO M - vN M 0 CO ^ a. > i O rt |^v\ , O ■SI 3 U5 rt •' •S 3 *3 '0 wlj rt -a '£ "f •- rt' -?; ;:-? ~: ,r Jr rt T3 .* 5 „ c 3 :-i '-^ - -s-.y .2 " " o c Q- ■-■ Sj S ""^ « 'H £ u ^ A'.'.pi^r1^ i> l> f~< .-J rtj >-. 'J I PATIENTS ADMITTED. If 0. 3 rt ft b p 0. ja S" < n ft •1 n~ *<* "p J° 3 2 ft 5 33 «■ . 0 0 3- JO ft ft 3 ft g « 2 p 3 3w 0 p * H74 DlSFASES. jr.ft Jo ►i ? 3 ~9° b - 3 ^ 3* 2 p 2. 3 I'S* c > 3 QJJ CO ft rt) 0 Brought forward, 124 117 180 172 9o 68 127 126 98 95 99 1230 75 98 27 II 33 Vulnus i - " 1 - 1 1 3 I 3 - 1 IO - I - " 1 12 Vomica i 1 1 Vomitus " - I " - - - - - - - r - I - - - " - 1 Urticaria 91 79 125 117 181 1 Total, 173 91 69 130 127 IOI 95 100 1242 75 99 27 II 35 1489 PATIENTS ADMITTED. 3 a. b p 0. JO ft n' < rt ft b ft •T P Jo 3 3 ft.3 Pi 1 2. S H 0 H. DISEASES. 5T.° jc v^i E1 3 ^ • 7 o -rt "" P V 3 -c T5 (t p > M, P a rt "5" 3 cc n -0 r 0 , 2: 1 • Abfceflus Albugo Amenorrhoea Anafarca Amaurofis Anchylofis Apoplexia Afcites Afthma Atrophia Caries Cataradtus Catarrhus Cephalalgia Cholera Infantum Chorea Colica I 2 I I 2 7 I I 5 5 12 I 2 I 7 i 4 16 I I 4 i i i i 2 2 I 9 3 I I I 2 I I 7 i 3 18 I 3 2 3 IO i 5 26 I I I 4 2 2 5 I 2 6 12 5 I I 6 11 3 22 I 3 1 3 5 2 *5 1 1 5 1 12 "2 2 1 5 5 6 5 1 2 5 2 ■ 5° 1 l9 27 33 3 4 3 2 2 I 2 I I 6 1 2 1 1 1 2 1 2 3 2 2 1 6 1 5 2 12 1 1 1 5 13 5 3 56 2 19 31 2 35 207 Carried forward) 7. 20 l6r 26 10 156 13 H 7 1 17 PATIENTS ADMITTED. 0 DISEASES. Dec. R. un. c. fin la. yr. = 3 v a 2 p > rt) i-i 1 ^ <—1 n <—1 c *5f > 3 C/3 rtj 1 0 P3 I ^' •-1 rt a. Brought over, 7 12 It) 7 20 . Ic 2( It 26 22 1 ^ / 12 1 10 156 Conftipatio - - - 5 T C - - 2 - 1 2 - 10 Contufio i I I < 2 I 2 1 4 5 1 l r 23 Convulfio - - - - I - - - 1 1 - 1 -1 - 1 Cynanche Parotid - - - - - - - - 2 - - 1 " - 2 Tonfil - - - 1 I - - - - - - ' * - 3 _ - - - _ 1 Diarrhcea - - I - ' 4 2 8 3 3 H 1 .32 Dyfenteria - 2 I - 1 - - 2 10 7 3 - 24 Dyfpepfia - 3 3 3 (. i t 2 2 6 8 5 40 Dyfuria i - i - - ] - - - - 1 - 1 Epilepfia i i 2 - - I i 2 - - 1 1 - 1 Epiftaxis - - - - - - - - - - 1 • - 1 Eryfipelas - - - - i - - I - 1 - - 2 4 Eruptiones i i I I 3 2 3 1 2 2 - - 2 *7 Febris Remittens - 3 - 1 i - - I 2 8 11 11 2 3i .-----Quotidiana - I 2 i 2 - - 2 ? 9 4 2 27 -----Tertiana - - I 2j 3 37 1 40 36 31 4 54 58 2 60 58 1 25 11 Carried forward n 23 29 385 ; b 0 p 2. jc 2 •-i I J* Rem. _ g ^ 3 to the 3 p Kof. r. S. of E. ' g P. 12 I 2 7-2 I 5 H 3 2 8 7 1 1 4 I 17 I I 4 1 1 1 1 1 4 207 IO . 25-3 2 3 2 40 27 47 4 10 1 5 *9 40 28 12 i3o 27 H I 28 '485 ( 39 ) Total. "O i-i >h N oo rt-rt- r}- N CONO CO N CO N CO N to CI i-i to rt-N Remaining un-der care. QO , , m N 1 1 1 I-I 1 1 1 1 1 1 1 ■ I 1 O CO Rem. to the H. and H. of E. ^ l t l I-l 1 1 1 1 1 1 1 1 I 1 1 1 1 N Diforderly. rt" 1 l l 1 1 1 1 1 l l 1 l i l 1 1 1 Relieved, f- . I « N ! <-i t , | 1 I-I | N 1 M 1 w t^ rt^ Deadi O i ■ i CO i ■ ■ ■ ■ IH • i"i i 1 1 - I . CO CO Cured, ■•o rt- m , CO CO f)M tfjlf|Cf) H N W M N to w i rt- r- W ►—< H CO 1 1 ON CO May NO CO ' ' ' M CO 1 1 CO i I CO rt- April o ^f. 1 1 1 —« rt- i—i i-i i-i i— ■ ■ ■ ►-4 i-l CO 1 rt-to Mar. t-» -1 CO ■ « i-i i-i ii i i i i i 1 1 i-l CO 1* Feb. CO N ' ' ' N N i 1 1 1 l l l 1 1 N i 1 ON N 17 9' Jan. ON M 1-1 N ' i-l N 1 1 1 1 1 1 i M . 1 - 00 CO CO "H I-I N N N 1 I III 1 I-l 1 1 rt-co l 7 j i Dec. R- un. c.fin. la. yr. I"1 1 1 1 ►H 1 II 1 1 "l 1 1 i-1 1 1 1 1 W rt^ brought forward, Febris Quartana puerpera Fiftula in Ano 3 > jj V> tf _i 8 '? y J: 2 "w> v. 3 i- C c: O O . —< ^ .:. &%££&■$ B >L~: rt o ^ H H >-> j u ■J t/5 Hydroceph. Intern. Hypocliondriafis Ilylteria < en 3 rt .S3 P a U PATIENTS ADMITTED. C c b r» p 5' •< DISEASES. R.un. c. fin. la. yr. b-ro "■< 0 « 1—11-p vi 3 „ p I-l > •rt Aug. July June May O 0 < Brought forward, Hydrocele Icterus Infitio Variolar. Ifchuria Leucorrhoea Luxatio Mania Menorrhagia Melancholia Nephritis Odontalgia Ophthalmia Otalgia Para h'! is Paravhymofis Paronychia Parlurilio ".4 I I I 34 1 1 2 38 1 2 29 I I 2 I 44 1 2 4 1 1 54 24 1 1 1 2 83 43 1 1 H 2 1 1 1 ' 39 1 1 1 61 1 1 2 66 1 1 1 1 1 1 2 5 1 1 63 I 64 65 2 5 I I 74 27 2 I 457 I 3 42 1 5 1 7 ' 1 2 20 1 1 1 • 4 7 33 41 1 1 1 2 2 Carried forward, 1 17 1 38' 41! 35^ 53' 64J 42' 65I 81I 32 554 33 48 PAT IENTS ADMITTED. o a •-1 <» CL. 0 a p K? !» 0 " <—1 - ^ S > 2 <—1 «—i > en c !4 0 DISEASES. 1 3 3 ?: 41 ."35 p 53 •-1 •■< a r» •5" °? ►d u> < Brought forward, i7 38 83 64 42 65 Hi 64 74 32 554 00 Pertuffis - 1 I - 2 6 Phlogofis - I - 1 4 - - - - - - - " Phthilis Pulmon. 2 7 6 - 4 5 5 3 2 2 4 6 " 7 *7 Phyfconia - 56 Pneumonia I 5 5 11 10 4 2 4 2 b 4 2 1 I Podagra - 1 Prolapfus uteri - aru - - - - - - ■ 1 - - " 1 " 2 Pfora - 3 1 2 - - 2 1 4 2 * • - 15 " Rachitis - Rheumatifmus 2 7 10 7 4 4 6 4 8 - 7 10 4 55 I Scarlatina Angin. - - - - - - - - 1 - - 1 1 3 ' Scrophula 3 - 1 1 1 1 - - 1 1 - - ■ 1 Spafmi 1 1 - 1 - " • 3 Sphacelus - Splenitis - Synocha - 64| 57 35 •94 81 95 39 f Canicd forward ' 25 1 61I 76J 97] 82J57 705 54 0' a. O s. ro ►1 *** r» 0 rt S "t s. 8} S' n n ' c 3 H 0 ;____ 6S9 2 6 46 2 57 1 1 2 15 1 73 3 9 3 1 1 1 48 13 I I IO 6 16 3* 1 1 4 2 1 34 4 1 6 1 1 I79 21 7 47 513' PATIENTS ADMITTED. c c 1? p a. re ft' •S a. p. 5 da ^ 3 g-: . 0 pn 3 SJ P rt~ S' 5 tn e 3 1» DISEASES. p-p r< i si b ^ fc " s: ?» rt er N "1 rt) 2. 2 p <—1 c 3 ft 1—1 > c 0 rt) 0 ft1 5S 0 < Brought forward Synochus Syphilis Tetanus Tinea capitis Tumores Tuffis Typhus Variola Vermes Vertigo Vulnus Vomica ■Vomitus Ulcus Uftio 25 6 1 1 1 8 61 3 3 3 2 74 64 11 2 1 2 2 2 1 *5 57 7 2 2 3 3 74 76 3 1 2 1 1 1 2 89 97 7 2 2 3 1 1 7 1 124 82 2 2 2 7 2 5 2 118 57 2 3 4 2 2 1 9 80 «5 7 1 2 2 2 1 2 5 108 94 6 1 n D 4 3 4 1 9 125 81 IO 2 I 4 9y 95 8 1 2 6 2 3 117 39 11 1 2 2 3 1 3 2 *4 705 2 69 8 11 16 *3 3 29 1 H 2 41 6 54 2 1 '3 2 79 7 2 1 1 6 21 I I I I 5 7 2 1 2 47 *3 1 2 3 2 8 2 9*3 2 94 1 9 21 19 6 29 1 16 1 2 62 8 Total, 42 920J 62 96 3° 12 78 I1198 MEDICAL TRANSACTIONS. ( 45 ) MEDICAL TRANSACTIONS. I. Cafe of Curvature of the Spine, by Thomas Dolbeare, in a letter to Benjamin Rum, M. D. Cenfor of the College, and Projeffor of the Inflitutes, and of Clinical Medicine in the Univerfity of Pennfylvania. Read September 4, 1787. London $th Mayy 1787. S I R, SEEING the publication from your me- dical fociety, I fend you the enclofed for the benefit of my fellow creatures, via Bofton, where i have a brother, Mr. John Dolbeare, that ( 46 ) that mould you want any further information, through him you may receive it. With my beft wifhes to fo laudable, chriftian an in- ftitution. I am, Sir, , Your mofl obedient fervant, THOMAS DOLBEARE. Dr. Benjamin Rufh. IN September preceding it, (1792) I was taken deaf (which came on gradually for a week) I could not hear a word, and while electrifying for it the fucceeding April, I was taken when walking the ftreet with a fmall pain in the calves of my legs, by which my walk was much impeded, my hands and arms were confiderably affected at the fame time, though not fo much as my legs--in a few hours I found myfelf much weaker in walk- ing, but went out as ufual—in two or three days, in going up and down ftairs my knees gave way—Still I went out, and fhoitly after, I fell down in the ftreet, and was unable of myfelf, to get up ; but after being taken up, could v^alk 100 yards or more, but could not get into a carriage without aid—My refpira- tion ( 47 ) tion was very heavy—It was treated as para- lytic, but it is quite another matter. In abaiit ten days I had great pains in my back-bone, for which nothing was done nor was it even looked at, and I found great coldnefs in my lower limbs, my toes hung down, and my heels would not come to the ground, and my knees came together. After being in this ftate about three weeks I went to Bath, where, on the pain in my back-bone continuing (for which bladders of warm water, and fometimes a book was applied, laying that part of my back on the book, where the pain was, by which I was fomething relieved) the apothecary defired to look at it, when he at once difcover- ed the curvature of two or three joints in the middle, on which a confultation was held, and pumping in the warm bath recommended and adopted ; but in a few days I had two morti- fications in my pofteriors, and urinal ftop- page foon after, together with a prodigious coldnefs in my legs and feet, fo much fo that I doubt if I fhould have felt if they had been amputated—the cure of the mortifications took two months, after which purging was renew- ed, from which 1 had but little benefit—I had fpafms foon after I got to Bath that violently 4 fhook ( 48 ) fhook my body, and they continued for two years, but not violently, but are now off— I was unable to move, a toe, or turn in my bed of myfelf. After being in Bath fix months, I came to London and fent for Mr. Pott, who immediately recommended cauftics to bring on a difcharge, on each fide of the curvature—fo foon as they were applied and he ■ found the difcharge effect- ed, he at once faid I fhould walk and do bufinefs as well as I ever did, and ever fince I have been recovering, and I can now walk ten miles a day with a cane, and am ftill reco- vering, on every application—I have had eight cauftics (always two at a time) and five fetons—I always benefit very foon after a dif- charge—but moft from the cauftic—and I ferfibly feel the obftrudtions remove—I find the flefh on my thighs to recover the leaft of any part—my legs were little more than fkin and bone, and the abdomen was fwelled to a prodigious fize—the curvature was gone in about four months after the application—I have been obliged to take purgatives ever fince, almoft conftantly;—my appetite and fpirits have been generally very good—- 3 I find ( 49 ) • t find myfelf more active and juftnile than for a confiderable time before I was taken— I then was 36—Mr Pott (ays, he never knew one to have it that was above 4c—and it is moft common to children from eight to twelve—(vide his publications thereon) I do not find my recovery altogether progreffive, for I have intervals of a fortnight or three weeks that I am at a ftand—t he time of reco- very is quite uncertain, it is fometimes in a few months, and at other times feveral years, —as I recover of the curvature fo my hearing returns—I mean to keep up the operations at all events* II. Cafe of dn Hydrocephalus Internus, fuccefs- fully treated by Mercury. By Dr. Mi- chael Leib, Fellow of the College. Read January 1, 1788. WILLIAM COLES, aged three years, foil of William Coles, printer, in Black-Horfe alley, was admitted as a Difpen- VoL. I. D fary ( 5° ) fary patient on the I ith of September i 7S7* His fymptoms were as follow, viz. extreme dilatation of the pupils of the eyes, ftrabifmus, violent pain in the head, his hand in conftant motion towards it, frequently crying ou* " Mammy Oh ! my head tie it up, tie it tight," uneafy ajid fhort {lumbers, with fre- quent ftartings as if fuddenly affrighted, ftu- por, a defire. to be in the dark and extreme uneafinefs at the approach of the leaft light, pulfe fmall and frequent, fkin hot and dry. As worms in the prima: vise frequently pro- duce a train of fymptoms counterfeiting hydrocephalus internus, a brifk cathartic of ca- lomel and rhubarb was exhibited, which gave feveral dejections, and difcharged a few fmall worms ; but as the cathartic made no impref- fion on the difeafe, hewasordered, on the 12th,, Calomel gr. xij in four powders, one of which was to be given morning and evening. 13th. Symptoms increafing in violence, his countenance maniacal, his eyes infenfible to light, conftant moaning and complaints of the head, pulfe fmall, and lefs frequent. The calomel had no effect: upon hi 3 bowels. 14th, ( 51 ) 14th. 12. grains of calomel were order- ed as before—no variation in the difeafe. 15th. Bowels untouched by the calomel, pulfe more frequent, fkin hot and dry. 16th. 16 grains of calomel and 2 grains of tartar emetic were ordered in 8 powders, one of which was to be taken every third hour; a few loofe ftools were produced. 17th. 20 grains of calomel with 5 grains of opium were exhibited in 8 powders, one of which was ordered every third hour—a blifter was applied to the back of the neck. 18th. The blifter rofe well, but gave no relief—the opium difpofed too much to fleep. 19th. 16 grains of calomel with gum arabic divided into 8 parts were exhibited eve- ry third hour—fymptoms fomewhat mitiga- ted, pulfe lefs frequent, fkin more temperate, bowels more regular, urine in fmall quan- tity. 20th. A large worm of the lumbricus kind was difcharged—fymptoms as before, D2 2lft, ( 5* ) 21 ft. The di'feafe appeared ftationaty, lit- tle alteration being obfervable. 2 2d. 16 Gr a i n s of calomel with mucifoger of gum arabic and tincture of bark were exhi- bited in a mixture of four ounces, two tea, fpoons full of which were ordered every 2nd. hour. The calomel affected the mouth and throat with fwelling. Symptoms much mo- derated ; pupils fomewhat contracted, pain in the head much abated, pulfe regular, urine copious. He called for victuals, eat a little, and noticed objects. 23d. Symptoms on the decline—fwelling of the throat and tongue increased, but no fpit- ting. 24th. Pupils much contracted, pain in the head removed, pulfe natural, fkin temperate,; bowels regular, urine copious, he flept well,. had a good appetite, laughed, and feemed dif- pofed to play. 25th. Swelling of the throat and tongue' continued, which made him uneafy—no ptyalifm. 2-6thv ( 53 1 2 6. The calomel was difcontinued as the difeafe appeared to be fubdued. 27th. Pain in the head and fymptoms of uneafmefs returned—20 grains of calomel were ordered in a mixture as before. 28th, 39th, and 30th. He continued recovering—no fymptom but a fmall dilata- tion of the pupils remaining—He walked about, was cheerful, and eat heartily. The quantity of calomel exhibited in this cafe from the 12th of Sept. to the 28th. was j 12 grains. It is worthy of remark that no impref- fion was made on the difeafe till the mer- cury affected the mouth, at which time a co- pious difcharge of urine was produced and immediate relief obtained. On enquiring if any injury in the head had been fuftained by the child, the mother men- tioned that he had received a violent fall on the head a few days before his illnefs, which had rendered him infenfible for fome mo- ments. May not this (as Dr. Fcrhergill fup- pofes) ( 54 ) pofes) have caufed a rupture of a lymphatic in the brain, and have produced the difeafe ? III. An account of a Tetanus from the extrac- tion of two teeth, fuccefsjully treated by the ufe 0/~wine and mercury.—-In a letter from Benjamin Rufh, M. D. to John Redman, M .D. Prefident of the College of Phyficians of Philadelphia. Read May 6, 1788. Dear Sir, IT is not lefs from refpedt to the rank you hold in our college, than from motives of a perfonal nature, that I have taken the liberty of addreffmg, through you, my firft commu- nication of a medical cafe to the College of Phyficians. Adam Sirbit, a failor, aged about thirty years, came into the Pennfylvania hofpital to be cured of fore legs. Soon after his admif- fion he was afflicted with a pain in one of the molares of the upper jaw, for which I order- ed him to have his tooth drawn. In extract- ing ( 55 ) jng the affected tooth, a found tooth was un- fortunately broken, with a fmall portion of the jaw-bone, and the roots of the tooth left in the bone. A few days after this operation he acted as door-keeper t© the hofpital, in which ftation he was expofed to a cold damp ?:ir, the morbid effects of which were render- ed more certain, from his having been previ- pufly confined to a warm and comfortable ftove room. February 2nd. 1788, the day ?fter he ferved in this capacity, he was affect- ed with a trifmus, accompanied with a fwelling on each fide of his throat—a full pulfe—and a total inability to fpeak. He complained of neither pain nor rigidity in any part of his bo- dy except in the places abovementioned. Up- pn the moft minute examination of his cafe, I candidly acknowledged in the prefence of the young gentlemen who attended my practice in the hofpital, that I was at a Jofs to determine whether it was a tetanus or the fore throat, which then prevailed in the city and neighbourhood (and as ufual) with many anomalous fymptoms. The fu}- nefs of his pulfe indicated bleeding ; but leaft the difeafe fhould prove to be fpaf- modic, I called upon my colleague Dr. Hut- chinfon ( 56 ) chinfon, who was then in another apartment of the hofpital, and afked his advice with refpect to the propriety of that remedy. The Dr. did not hefitate a moment in adviling the opening a vein, and under the influence or the fame ideas of the diforder which dictated this advice,! gave mypatient two grains of tar- tar emetic, and ordered a blifter to be applied to his neck. Withi n a few minutes after he was bled, our doubts of the nature of his diforder were fuddenly removed, for he was feized with convulfions of the opifthotonos kind.— The trifmus continued without any change -—and he now began to complain of a pain (which feldom fails of attending the tetanus) at the bottom of the ftemum. As loon as thefe fymptoms difcovered themfelves, I or- dered him to take Port and Madeira wines for his common drink, with as much bark as he could fwallow, and to have the outfide of his v throat and jaws rubbed with mercurial oint- ment. , 1 4 Feb. 3. I had the pleafure of finding a confiderable abatement in the fymptoms of the tetanus. He opened his mouth near half fin inch, and complained of no pain. He took ( 57 ) took, in the courfe of the laft four and twenty hours, five quarts of wine, the greateft part of which was conveyed into his ftomach through the aperture made by the lofs of his two teeth. He took in this time only one ounce of bark, owing to the extreme difficulty of conveying it through the abovementioned opening into his ftomach. In the courfe of the time that has been mentioned, he fpit about a pint. Feb. 4th. He took about three quarts of wine fince yeftcxlay—continued to fpit plen-« tifully—and opened his mouth fo as to admit two of my fingers placed over each other. Feb. 5th. I found him fitting up by the ftove,—-and able to fpeak diftinctly. His jaw was perfectly free from rigidity, and he ap-j pcared to be in his ufual ftate of health. A few days after his recovery, a fmall piece of his jaw bone which had been detached in the extraction of his teeth, projected above his gum, and was taken away. It may not be improper to add here, that the rairtar emetic which I gave him the firil time I f;v/ ( 58 ) faw him, produced no operation upon bis fto-. mach,or bowels. His faeces during every ftage of his diforder were difcharged by means of glyf- ters. I mention this fact in order to reduce to greater certainty, the fymptom of coftivenefs Wonging to the tetanus. Dr. Cullen ex- preffes a doubt whether this fymptom be the effect of opiates or of the difeafe*. In the pre^ fent cafe it was certainly the effect of the dif» eafe, for he did not take in any ftage of ryi$ ^iforder, afingle grain of opium* I shall conclude with the following ob- fervations. I have heard of two inftances of tetanus following the extraction of teeth, both of which proved fatal. One was in St. Thomas's hofpital in London,—the other was in Bucks county in this ftate. I have feen feveral inftances of an obftinate rigidity in the lower jaw fucceed the extract tion of a tooth, which yielded, without any alarming * Firft Lines MCCLXV, ( 59 ) alarming fymptoms, to confinement and emol- lient applications. I have heard of one cafe of a conftriction of the lower jaw after the extraction of a tooth being cured by the jaw being preffed down by a ftrong mechanical force. I communicate thefe facts without attempt- ing to reafon upon them. Perhaps when more facts of a fimilar nature are collected, and more minutely defcribed, we may be able to diftinguifh with precifion when the rigidity of the lower jaw, which follows the extraction of a tooth, may be confidered as a local com- plaint, or as a fymptom of general difeafe, IV. An { 6o ) IV. An account of the Tania difcovered in the Liver of a number of Rats—In a letter from Dr. Jofeph Capelle, of Wilmington, to Benjamin Rufh, M. D. &c. Read May 5th, 1788. Wilmington% March %oth, 1788, Doctor Benjamin Rush, Sir, PERSUADED that you are always dif- pofed to encourage any thing which may lead to new difcoveries, particularly in that fciehce which you profefs, I therefore take the liberty of addreffing to you the en- clofed obfervations, reque fling that you would lay them before the medical fociety, if you think them worthy of their attention. I could wifh that the fubjects of my enqui- ries had been nobler ones than rats ; and yet if ( 6. ) if we may believe medical records, fome of the moft valuable difcoveries, which have contri- buted greatly to the perfection of medical knowledge, have been made by zoologifts— Whether this is new or not, I cannot fay ; but it is fo to me, and this is the motive that has- induced me to lay it before you. Wilmington, January 17th, 1788?. Upon opening the abdomen of a rat, I was ftruck with the appearance of three tubercles on the convex part of the liver. They were of a whitifh and tranfparent colour, and appeared to me* to be fat. This particularly led me to take out the liver, on the concave part of which I difcovered two more tubercles. I de- tached one of them to fee what kind of fab- ftance they were compofed of, whether glan- dular, or containing nothing elfe than a lym- phatic humour; when, to my great furprize, after deftroying the matrix or enveloppe, I fpund it contained a worm of the Taenia kind, alive, and about fixteen inches long—I open- ed another matrix, and found a fimilar worm of about the fame fize. I examined a third tubercle, which was fmaller than the former, and found the matrix much thicker, which I fuppofe ( 62 ) fuppofe was owing to the worms not having diftended it. In this matrix I found eight fmall worms, and an infinite quantity of fmall fubftances much refembling fly blows, which I judged were eggs. The largeft of the worms was about an inch long; the others very fmall, but eafily diftinguifhable fo as to leave no doubt of their being worms. Being of opinion that this was fomething new, I thought proper to preferve the other two tubercles in fpirit of wine. The rat from which this liver was taken was very fat, and the liver, I thought, un- commonly large, but it appeared no ways dif- eafed—I alfo obferved that the larger the worm was, the thinner was the matrix, which induced me to believe, that in a future day, it would have forced its way through it, and have fallen into the abdomen. It appears to me that thefe animals origi- nated in this vifcus—Each of them had a bed or cavity, proportioned to its fize and figure, and was conneded to it by atiffu, fimilar to that ( 63 ) that which unites the mufcular fibres.—Thefe matrices contained a white ferum ; and as I could not perceive blood-veffels of any kind in them, I concluded that the worms muft have derived their fubfiftence from the lymphatics. January 21. I opened another rat, but did not difcover any thing particular in it. This animal was of a middle fize, and had but a very fmall liver. January 23. I opened a third rat, in the liver of which I found a matrix containing a taenia of about eight inches in length, when ftretched ; but as it was alive it contraded it- felf to about five inches—I alfo difcovered a white fpeck, about the fize of a common pin's head, in which, by the aid of a microfcope, I difcovered a fmall worm—This animal was very fat, and the liver of a good proportion. January 27. Opened a fourth, and found but one matrix, containing a worm of the fame kind—This animal was large and its li- ver was of an uncommon fize. As thefe rats were all caught in the fame neigh- ( 64 ) neighbourhood, I was inclined to believe that their diet might be the caufe of thefe particula- rities—I therefore determined to get a few from another place, and procured fome from the Brandy wine Mills, the biggeft had in its liver, feven matrices, the largeft of wbich had partly fallen from the liver, the worm had pierced the matrix, and had nearly efcap- ed from it—This confirms my firft fuppofi- tion—But whether the rat feels any inconve- nience after their efcape from the liver, how they get rid of them, or whether this is a dif- eafe peculiar to thefe animals, in all feafons and climates, ccc. is a point which I leave to men of more abilities to determine. It does not appear that thefe worms breed in one part of the liver in preference to ano- ther, as I have found them in every part of it •^When confined in the matrix they are in a convoluted fituation. I THINK it needlefs to give you a further particular defcription of the rats I opened, as I found the fame appearances exifting in fixteen out of eighteen that were the fubjeds of my zoological refearches—I fhall conclude with 3 obferving, ( 65 ) obferving, that in one of the laft I found nine matrices, each of them containing worms of the taenia kind—-Three of them had difen- gaged themfelves from their matrices, two lay on the interlines, and the other on the liver—I fliall further obferve, that the two rats, in which I found no worms, were very lean, and their livers finaller in proportion than the others. April 8, 1788. Since writing the other part of this letter, I opened a rat, in whofe ftomach I found thirteen worms, diftind from each other, twelve tape worms, and a round one. The taeniae were abundantly broader and larger than thofe found in the livers of the other rats—As this was the firft in whom I difcovered this appearance, I did not take a particular defcription of it, but fhould my future diffedions difcover any thing particular, I will do myfelf the pleafure to communicate it to you. P. S. Should you wifh for any further in- formation, Dodor Duffield, Senr. will be kind enough to give it to you, as he was pre- fent at one of my diffedions. If any fur- Vol. I. E ther ( 66 ) ther enquiries on this fubjed are thought nc- ceffary, I will cheerfully undertake them, I mean I will cheerfully aflift in them. V. Cafe of Tetanus, by William Clarkfon, M. B. Fellow of the College. Read jfune 3d, 1788. AS this college was inftituted for the pur- pofe of promoting medical enquiry, I think it the duty of every member to com- municate from time to time fuch information as may tend to advance the Science of medi- cine. Impreffed with this fentiment, I have drawn up the following cafe, and flatter my- felf that, although it has proved unfuccefsful, it will not therefore be altogether unufeful. On Friday April 4, 1788, a young hearty man, 20 years of age, being at work in ( 67 ) in the fhip yard of Mr. John Hutton, trod upon a rufty nail, and immediately felt exqui- fite pain, which, however, foon abated, 'and entirely ceafed by the end of the fecond day. Friday April i ith. he went with feveral of his fellow workmen down the river to raft lumber, and wrought very hard, during this day, in the rain and in the water. He was expofed all the fucceeding night, in his wet clothes, to the open air, and to the cold wet earth for his bed* Saturday April 12. his fatigue was renew- ed, and he laboured fo hard in the rain, that pain in the ftomach and limbs, with extreme wearinefs, obliged him to requeft a comrade to take his oar and relieve hiim Sunday morning, 13th, very early he was brought home, when I was fuddenly called to his affiftance, and received the above account* I found him fuffering excruciating pain in thd epigaftric region, pains in all the limbs, with great wearinefs as from fevere fatigue. He found difficulty in opening the mouth from a fenfe of ftiffnefs of the jaw. He was free from E 2 fever, ( 6S ) fever, the pulfe being neither quick nor tenfe, the belly was bound—he was without appe- tite, as had been the cafe for feveral days—The wounded foot was apparently found and gave no pain when preffed. At firft 1 was alarm- ed, but undetermined as to the caufe of the complaint. From the affurfmce of the patient and others who knew him, that he was liable to ftiffnefs of the jaw from tooth-ach,and from taking cold, I was inclined to hope that his difeafe might have arifen from his late fevere expofure to the weather and fatigue.—I di- reded 70 drops of the Thebaic tindure imme- diately ; wet hot cloths were applied to the region of the ftomach ; and after fome time, when the pain had moderated, a ftrong infu- fion of fenna, &c. was given. The jaws were anointed with a volatile oily liniment. In the evening I found him greatly relieved from pain, and that the laxative had produced a copious and very foetid difcharge. For the night a diaphoretic anodyne draught was or- dered. Monday 14th. Early'this morning I was told that my patient had paffed a reftlefs night with great pain at ftomach, extending through the ( 69 ) the back, frequent jerkings of the neck back- wards, and profufe fweating, all which had diftreffed him, fince two o'clock in the morn- ing—Sufpeding a foul ftomach to aggravate his fymptoms, I ordered a gentle emetic. This brought off a great quantity of cauftic, porraceous bile with much relief. Notwith- ftanding this circumftance, I concluded I fhould have to combat with Tetanus. For, befides the abovementioned fymptoms, about noon the mufcles of the neck became rigid, the jaws were with difficulty opened ; the redi and other abdominal mufcles were tenfe and retracted ; fome pain in the ad of fwallow- ing ; a diftreffed contraded countenance; pulfe feeble though regular, and palpitation of the heart. I direded the ungt. mere. fort, to be often rubbed upon the neck and jaws, The- baic tindure to be given freely at fhort intervals, with a liberal ufe of wine and the bark. Scald- ed bran was applied very warm to the ftomach. Tuefday 15 th. This morning found my patient better, as he had refted in the night— The fole of the foot where the pundure had been received, being fomewhat painful when preffed, led me to lay it open, and to apply fpirits ( 7° ) ipirits of turpentine,v to induce a topical in- flammation. The twitchings of the neck frill continued, but the intervals of relaxation were lengthened. He complained of pain and ftiffnefs of the fhoulders, with fpafins of the arms and legs ; the jaws were within half an inch of being clofed ; pain in fwallowing was diminifhed ; the pulfe more flow, fmall and loft ; the tenfion of the abdominal muf- cles and the retradion at the fcrobiculus cordis unabated; the countenance lefs diftreffed, great thirft and defire of cold drinks—During the laft 24 hours he had taken two quarts of wine and 300 drops of liquid laudanum, with but little appearance of intoxication ; the bark alfo was continued----This evening, the fymptoms much as in the morning-—The irri- bility of the fyftem increafed, for the leaft noife in the room, or any one fpeaking to him fuddenly, occafioned violent jerks—The or- bkrdares palpebrarum were remarkably con- traded, and the fpafmus cynicus, frequently diftorted the whole vifage—He flept but little this day and began to naufeatc the bark. Wedriefday 16. A. M. Had fome reft laft night? but was difturbed hj company. Toek ( 7' ) bark, wine, and laudanum freely. The fric- tions of mercurial ointment were continued. His limbs are more relaxed; fpafms at the fcro- biculus cordis are frequent >,pulfe foft and beat- ing 90 ftrokes ; the countenance more placid ; fome pain at the wound, but little fuppuration. The above medicines were ordered to be per- fifted in. The wine which he drank laft night being moftly diluted, he now requefted fome unmixed, and expreffed his agreeable fenfa- tions when taking it in that ftate. A clyfter emptied the bowels of much flatus, and the ap- plication of the fcalded bran always afforded relief. Having feen the good effeds of the Haarlem oil, in a tetanic complaint produc- ed by cold, in a fubjed who followed the painter's bufinefs, I was led to alternate it with the laudanum, giving 25 drops of the former, every two hours, in a fpoonful of wine.-----Evening. The above medicines had been ufed pundually, and the oil gave very fenfible eafe whenever it was taken. Thurfday morning 17th. He refted tole- rably laft night, and upon his fide for the firft time. He expreffed much fatisfadion in the ufe of Haarlem oil, which warmed the fto- mach ( T- ) mach and eafed his pains confiderably, but complains now that the wine afteds his head with intoxication. He took but 45 drops of the thebaic tindufe in the night. The fpafms were far from being frequent or diftrefling. The abdominal mufcles were much relaxed. The pain of the ftomach was inconsiderable. The motion of his head more under the pati- ent's command. The pulfe foft and flow not exceeding 70 ftrokes in a minute. I now be- gan to be flattered with hopes of fuccefs, and by his defire, I remitted the ftrid ufe of the wine and bark.-----Evening. The fcene be- came changed, for the convulfions were now ftrong and frequent. He had, while I" was prefent, one fevere fpafm over the whole fyftem; and his head, body and extremities being rigid, he turned himfelf forcibly from his back to his fide—This paroxyfm was but momentary, and a general relaxation fuc- ceeded. Friday Morning 18th. The laft night he was reftlefs—The convulfions frequently dif- turbed him. This morning his head was much affeded ; and he had the appearance of one fomewhat intoxicated, talking inceffantly, and ( 73 ) and defiring to be fhifted from his fide upon his back, and vice verfa. The pulfe was fort and beat 70—The abdomen was quite relax- ed, as alfo the mufcles of the neck—Difcharg- ed wind freely per anum. Some fuppura- tion at the wound. The volatile alkali was fubftituted for wine, as this difagreed with him. A bolus of calomel was ordered to move the bowels—60 drops of thebaic tindure to be exhibited every two hours with diluted wine as drink—Evening. The convulfions were frequent and fevere during this day. The rigidity of the body prevented him from fitting up in his bed.—The jaw was ftiff, though not clofed—He made frequent com- plaints of danger from ftranglmg, when about to fwallow. He was diftreffed with heat, and earneftly defired fanning, and would fcarcely fuffer any intermiflion of this opera- tion. He had fwallowed an ounce of the the thebaic tindure fince the morning. The bark alfo had been liberally ufed. No ftool for two days, therefore repeated calomel bo- lus and a laxative clyfter. Saturday 19th. He was perfedly free from fpafms laft night, but was reftlefs; had a plentiful ( 74 ) plentiful foetid dejedion. He drank near a §uart of wine, diluted, and took 25 drops of the Haarlem oil every two hours during the might, 3i. of the volat. alkali alfo was taken— Panada and other light food were adminifter- ed freely.—The pulfe this morning languid, beating 65 ftrokes. The jaw more relaxed, and the palpitation abated. His head but lit- tle dlfturbed, and he fat up without any un- ^afinefs about the neck—Noon, the bad fymptoms returning, recourfe was had to the former remedies—Evening. The fwallowing is become difficult—conftantly craves cold drink which was moderately allowed—Gene- ral convulfions came on, which continued for a fhort time, and at length, in the night he died rigid. In conclufion of this cafe, I have to re- mark, that I was flattered with hopes of fuc- eefs, from the adoption of the above plan, inas- much asbleeding and other relaxing means have fo often proved ineffedual—and efpecially as fo many appearances of debility feemed to juf- tify the ufe of tonics and ftimulants, which of |ate have proved fo fuccefsful in cafe of teta- nus—>. ( 75 ) nus—How far an extenfion of the tonic me- thod, even to immerfion in cold water, might have contributed to a cure, I fhall net under- take to determine. Tins patient was afliduoufly attended— and in the courfe of the-difeafe he took twelve quarts of good wine, near three ounces of the thebaic tindure about four ounces of the bark—half an ounce of Flaarlem oil, and two drachms of the volatile alkali—near two ounces of the ftrong mercurial ointment were rubbed into the neck and jaws. Although the mercurial fridions falivat* ed the nurfe for near a week, there was but little appearance of ptyalifm in the patient. VI. ( 7* ) VI. Account of the fuccefsful application of cold water to the lumbar region in calculous cafes. In a letter to Benjamin Rufh, M. D, &c. Read Sept. 2nd. 1788. Atherfone, March 15, 1788. Sir, HEN I was in America, and feveral years before I left England, fay from about the twenty fifth year of my age, I was terribly afflided with the gravel ; and three or four times in a year, paffed large rough pieces, which occafioned violent fits of the ftone cholic, fo that my life appeared fre- quently in great danger; but now, by the bleffing of God, / have difcovered a method of preventing thofe terrible fits of the ftone, fo that I have not had one of them for near two years, and my remedy has been tried by another perfon with equal fuccefs, And w ( 77 ). And as I wifh to do all in my power, to relieve thofe that are afflided with that com- plaint, I fhall inform you of my method cf prevention. Having been a great fufferer for twenty five years, I was led to read eve- ry author I could meet with who wrote on the ftone and gravel ; by which means I learn- ed that moft of thofe that are afflided in that way, are of a relaxed habit of body ; on which I thought if I ufed a partial cold bath, on the fmall of my back, it might be of fer- vice to me. Accordingly after I had palled fome ftones, I had reafon to hope there were no more large ones left in my kidneys—I be- gan the application. I placed a bafon of cold water on a night chair, and on getting out of bed every morning ftripped myfelf naked, and placing myfelf over it, I applied a large wet fpunge to the fmall of my back two or three times, and I fometimes applied it to my fundament and the genitals ; the confe- querice of which has been, that the veffels of my kidneys have been contradedand ftrength- ened, fo that they have expelled the fand and gravel as faft as it formed or generated, fb that though I pafs as much fand and gravel as before, I have never had a bad fit fince I began ( 7§ ) began with the above method which is now nearly two years. 1 fhould remark, that I al- ways ufe a dry towel immediately after the application, and ufe all the exercife I can. If giving you this information, fhould be the the means of relieving any one perfon in America it would give me great pleafure. JOHN WILLDAY. VII. Cafe of Hydrocephalus Internus, with the ap- pearance on di/feclion. By Dr. Michael Leib. Read Feb. 3, 1788. AN accurate knowledge of difeafes being effentially neceffary towards the cure of them, I have thought the following cafe worthy your attention, as it may aflift in cha- raderifing, with more precifion, a diforder j which fo often proves fatal, and which, till of late years, has been unknown to phyficians— And | { 79 ) And though mercury wras infufricient to the cure of the prefent cafe, yet the unfortunate termination of it has convinced me, that the cafe I communicated to the college fome time ago, which was cured by mercury, and whole leading fymptoms correfponded exadly m&fa. the one I am going to relate, was really a cafe of Hydrocephalus internus. In this child's complaint mercury could not be faidffea have had a fair trial, from an unhappy opi- nion of the mother, that if he furvived, he would be helplefs, which occafioned a neglect in the due adminiftration of that medicine— Indeed, when the difficulty of fwallowing pre- vented the exhibition of calomel, mercurial fridion Was fufpended for near two days. The difeafe, as in the former cafe, arofe after a fevere fall down flairs, which ferves to ftrengthen the conjedure of Dr. FothergHl, that it may be occafioned by the rupture of a lymphatic in the brain. 2 JAMES ( 8° ) JAMES BOLAND, aged two years arid an half, of a delicate habit, was admitted to the care of the Difpenfary, November 28th, 1788. About twelve days before his admif- fion he had a violent fall down ftairs, which was attended with a fmall contufion of the forehead—A week after the fall he complain- ed of indifpofition, and the fourth day of his illnefs was admitted as a difpenfary patient, and had the following fymptoms, viz. Great dilatation of the pupils, ftrabifmus, the cor- nea being fcarcely perceptible, violent pain in the head, ftupor, moaning, and when afked what ailed him he would anfwer, / amfick, and at the fame time point to his head—grind- ing of his teeth, vomiting, a flow and une- qual pulfe, not beating more than fixty in a minute, were likewife among his fymptoms —From the account which was given by his mother of his fall down ftairs, I fufpeded a de- prefiion of the fcull, but after the moft atten- tive examination no injury was perceptible. 29th. I direded fix grains of calomel to be given, as he had been coftive for three or four days, and ordered a blifter to the neck.—■ The calomel gave but a fingle dejedion. 3 30lr* ( 8i ) 36th. Symptoms the fame, excepting a eeffation of vomiting—a grain of calomel was exhibited every two hours, and mercurial fridion was ufed to his thighs. December ift. Symptoms more unfa- vourable ; irregularity of his pulfe more evi- dent than before; a kind of fpafmodico-con- vulfive affedion of one fide, and a paralyfis of the other ; ftupor fomewhat incrcafed—the calomel Was continued as before™he ,had three loofe black ftools. 2d. Symptoms much worfe, flight con- vulfions, pulfe 80, and irregular; mercurius calcinatus was fubftituted for the calomel, and mercurial fridion continued-—he dofed all night. 3d. He was infenfiUt to every objed ; pulfe 100—the calomel was again ufed. 4th. Stupor the fame—he had a difcharge of matter, of a pus Hke appearance, from the eyes, which had become immoveable, and had the veffels of the tunica albuginea much diftended with blood ; his cheeks were fwell- Vol. I. F ed, ( 82 ) ed, and he had a difficulty of deglutition— Pulfe regular with confiderable adion in it— he had a dark-coloured ftool. 5 th. An apparent alleviation of the dif- eafe, ftrabifmus lefs, pupils fomewhat con- traded, ftupor abated, pulfe full and at an hundred, fkin moift, bowels regular—he no- ticed objeds, replied when fpoken to, and fwallowed fome drink and calomel. 6th. Symptoms moderated, pulfe natural, - bowels loofe, eyes much inflamed ; he an- fwered when I fpoke to him. 7th. Every fymptom more unfavourable, pulfe intermitting and tremulous ; convulfi- ons, with profufe fweat, which continued till death. Having obtained permiffion from the pa- rents for my friend Dr. Wiftar, and myfelf, to examine the body, we opened the head, and found the following appearances: DIS- ( S3 ) DISSECTION. Upon removing the cranium the blood- veffels of the meninges appeared more dif- tended than they ufually are ; and there were feveral fmall adhefions of the dura and pia mater to each other. The furface oflthe cere- brum was extremely moift—the colour of it's cortical fubft'ance was more pallid than ufual, and, upon cutting into it, there were very few of the red punda which are fome- times obfervable. All the ventricles were diftended, with a clear watry fluid; each of the lateral ventricles contained at leaft one ounce and a half of it, and the other two about an ounce. F 2 •( «4 ) VIII. Account of the State of the Baro- meter. M B. JANUARY, 1789. W. i 3°-5 Clear day, ' - N. W. 2 3°-5 Do. - N. W. 3i3M Do. - ^30.5 Do. 5J3°-3 Do. - • - NT. 6|3°-3 Do. - W. 7i3°-3 Do. - N. W. 8;3°'3 Do. 9|3°-3 Do. very cold day. 10J3°-3 Slight fnow. N. W. 11 30.0 Clear day, little wind. N. W. 12J30.0 Do. and fevere froft. W. I3 29-5 A fall of fnow. N. t. 14129.4 Cloudy, little wind. W. I5J27-7 ' Clear, fine day. w. i6'3o.o Do. 17I29.5 Cloudy morning. P. M. clear. w. 18 30.0 Clear fine day w. 19 29.5 Cloudy, and little wind w. 20 29.3! Foggy day and thaw s. 21 29-7 i Cloudy - . - w. 22 27.7 i Snow, hail and fleet N. E. 23 30.4 Clear day - N. W. 24 30.0 ' Warm cFar day S. 25 29.5 j Fo^gy, overcafl. fky E. 26 29.5 : Fair morning. P. M. fnow E. 27 2:>5 ■ Rain ■;, cloudy day E. 28 30.0 Overcafl: and moderate N. E. 29 29.5 Do. little wind S. 3° 29.7 Do. - N. 31 29.7 A fall of fnov/ W. M B. 3°-4 i 2 3°-5 3 30.0 4 30.0 5 3°-5 6 30.0 7 3°-4 8 29.7 9 29.5 IO 30.0 ii 30.0 12 30.0 T3 30.0 M 30.0 l5 30.0 16 29-5 17 30.0 18 30.0 x9 30.0 20 30.0 21 30.0 22 29.7 23 29.7 24 30.0 25 3°-3 26 3°-4 27 30.0 28 30.0 ( s5 ) FEBRUARY, 1789. Severe frofty day Do. Fine pleafant day Hazy, overcafl: Clear cold day Overcafl: and cold Fine clear day Hazy and fnow Variable weather Fine pleafant day Do. Do. * Do. but colder Sharp frofl: - Do. Snow - - Clear cold day Hazy, overcafl: Snow from Deep fnow and clear Clear pleafant day Hazy foggy day Do. Clear cold day Extreme cold Do. Pleafant day Do. 1 VT. N. W. W. s. w. • N. ■ N. W. • N. • N. W. ■ S. E. ■ W. s. w. N. W. !N. W; I ■IS- SN. W. •!N. E. ■!N. E. ■|N. W. W. w. ■ N. W. ■ N. W. ■ N. W. ■s. w. ■ E. ( 26 ) M » B. 30.0 MARCH, 1789. w. i Fair pleafant day - _ - - s. 2 30.4 Do. and calm - 3 30.0 Heavy rain from - s. A 30.0 Cold clear day, win d N. W. 5 30.4 Do. • N. W\ 6 30.0 Overcafl, heavy rain at night - S. 7 29-5 Cloudy morn. P. M. clear N. W. 8 30.0 Fine clear day - N. W. 9 30.0 Do. - s. JO 3°-5 Do. - n 3°-5 Do. _ 12 30.0 Overcafl, and rain at pight i3 30.0 Fair pleafant day r w. M 3°-° Do. . w. 15 3°-5 Do. w. 16 30.0 Cloudy - s. 17 30.0 Fine clear day E. 18 30.0 Do. - E. 19,29.7 Do. heavy rain at night w. 20 30.0 Clear pleafant day - W 21 3°-° Variable weather E. 22 30.0 Clear day - N. W. 23 30.0 Do. very cold - N. W. 24 30.0 Do. - N. W ^5 3°-4 Sharp cold wind » N. E. 26 3°-4 Do. 27 3°-4 Warm fine day - 28 30.0 Rain and wind - S. E. 29.30.0 Clear day - N. W. 3°j29-5 Rainy day - 31! 29-5 Fair day - N W, ( 87 ) Ml B. i 30.0 2 30.0 3 3°-° 430.0 5'3°-0 6,30.0 7129-5 8,29.5 9,3°-° 10I29.0 11*29.5 12:29.7 30.0 APRIL, 1789. W. Very variable W. Fair day - N. W. Do. - W. Do. - Do. - Rainy day s. Fair and high wind w. Do. - . - - Overcafl, little wind S. E. Violent gufls of rain S. E. High wind at - W. Cold Cloudy day w. Clear, cold at - w. Fair day, wind - s. Do. s. w. Do. little wind at E. Do. high wind N. W. Fair pleafant day - - - W. Do. - - w. Do. - Rain till 3 P. M. E. Fair day, wind - N. W. Hazy warm day s. W. Heavy rain from s. W. Clear day, high wind w. Do. cold wind - N. Variable weather Cold day - - - N. W. Do. N. W. Do. N. W. M B. ( 88 MAY, ) 1789. 29.7 29-5 29.7 29.7 529.7 6 30.0 0 10 11 12 J3 J4 15 J6 *7 l! 30.0 29.7 30.0 30.0 30.0 30.0 3°-3 29.7 29.7 29.7 2£>-7 29.7 1929.7 20 30.0 2129.7 22 30.0 23 30.0 2430.0 25 30.0 26ho.o 27 30.0 28 30.0 29 30.O 3C30.O 3IJ30.0 Clear pleafant day Rainy day Fine warm day Overcafl Variable weather Cold windy day Rainy morning Hazy cloudy weather Fine clear day Rainy day - i Hazy morning. P. M. fair Fair day, wind Do. little wind T Rainy day Cold windy day Rainy morning. P. M. fair Clear warm day Do. Do. Hazy, overcafl, and cold Rainy morning Clear cool day Fine pleafant day Do. Rainy day, wind Clear pleafant day Cloudy day, and cold wind Rainy morning Fair day • Do. fharp lightning and thunder Cloudy morning * - W. -N. -E. o. N. W. S. s. N. W. S. E. -W. - s. w. -E. -E. -N. E. -W. -W. -s. w. -s. -s. w. -s. w. -N. Av~. -W. :S. W. -N. -N. E. ■ N. E. N. E. S. W. ( *9 ) M B. JUNE, 1789. "\ i 30.0 Fair pleafant day N. 2 30.0 Do. N. 3 30.0 Do. - ;_ N. 4 300 Do. - N. 5 30.0 Rainy morning S. 6 30.0 Fine pleafant day 3.1 7 30.0 Rain, thunder, and lightning 3. 8 30.0 Warm pleafant day S. 9 30.0 Do. i. IO 30.0 Sultry over caft weather 3. 11 29.7 Do. s. 12 29.7 Fine pleafant day N. *3 29.7 Do. - W. »4 30.0 Do. - _ w. 15 30.0 Do. w. 16 30.0 Do. - N. 17 30.0 Do. - _ w. 18 30.2 Do. very cool NL J9 30.2 Pleafant warm day S. 20 29.7 Very warm. Gufl: P. M. w. 21 30.0 Do. and fair s. 22 29.7 Do. and gufl: P. M. s. 23 29.7 Fine pleafant day w. 24 30.C Cool fine day - _ !N. 25 30.0 Do. - - |W. 26 30.0 Do. - - 27 30.0 Do. - - 28 30.0 Do. warm c 29 30.0 Do. with fhowers, A. M. s. 3°J 30.0 Fine pleafant day - iW. M 9 10 ii 12 13 14 16 17 18 J9 20 21 22 23 24 25 26 27 28 29 39 31 B. 30.0 30.0 30.0 30.0 30.0 30.0 30.0 30.0 30.0 30.0 30.0 30.0 0.0 30.0 30.0 30.0 30.0 30-0 30-0 3o-6 30-0 30-0 30-0 36-0 30-0 30-0 30-0 30-0 30-0 30-0 3o-o ( 90 ) JULY, 1789. Warm clear day Do. guft P. M. Do. and gufl: Do. - Do. Cool clear day Do. Clear, pleafant Do. very warm Do. cool wind at Do. Rainy morning. P. M. clear Clear morning. P. M. guft Clear cool day Do. Do. - ■ Do. Do. Do. rain at night Fine pleafant day Do. Do. Do. very warm Do. - Do. P. M. heavy' guft Fine clear day Do. Do. rain at night Do. Rainy day Overcafl lowring day -S. -S. -S. -S. W. -S. W. -W. -N. W. -W. -W. -N. W. -S. w. -N. W. -W. -W. -S. w. -w. -S. w. -S. -S. w. -S. w. -S. w. -S. w. -N. E. -N. -S. w. ■ N. E. • E. £ W Jxj WW & £ w£ w £ ^—_ CO co co CO CO CO 00 ■ i t t i t i CO CO CO II II 14 JZ 55 55 cd i < i i i ■ t £ w w-w i i « < i cd £^£ r § .f ... ,§ v ON On 1 i i t 00 i . l^ 1 1 i 1 > i i i i , t i H ^ - * >> i c o CO weathei at night ers ery fulti >^ . >> 0 i i 1 fultr 2rP. P. M ar da rain day t rt t rt b rt £0 £ a goo SQP CO X u £ ■£ > n £ qqqqqqqqqqqt^-r-r^r^r-r^qqppmmoooot^t^r-qo dcdddddddddd\6\cKcVd\C>dddcidddddc\a\d\oa fnwfommmwfiwnifn^ cm cm cm cm cm ro ro co co oo co co co oocm t ro ro r-~ oo oTb «-^ cm cm cm co co I- cm ro ^ u-i^o r—oo OvO « w ro ^}- uino r-^ao On C ** «m»-i«-.wphc1CM co **■ u-iV3 CM CM CM CM ( 9* ) M B. 29-5 SEPTEMBER, 1789. W. i Cloudy - - W. 2 29-5 Pleafant warm day s. w. 3 29-5 Do. s. w. 4 30.0 Clear cold day N. W. 5 30.0 Do. - N. W. 6 30.0 Do. . - . N. 7 30.2 Clear pleafant day N. E. 8 30-3 Do. E. 9 30-3 Do. E. IO 3°-3 Do. - . ii 2.0.0 Do. 12 30.0 Rainy, hazy E. J3 30.0 Hazy - S. E. 14 30.0 Fair E. *5 29.7 Rainy - E. 16 29.7 Fair 17 29.7 Hard Rain - - E. 18 30.0 Fair N. W. *9 3°-3 Do. - W. 20 3°-3 Do. - - W. 21 3°-3 Do. very warm W. 22 30.0 Do. W. 23i3°-o Do. - - 2430.O Do..... s. w. 2513O.O Do. - 26 30.O Do. - 27,30.0 Do. and flight rain N. 28!30 O Do. 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An account of a fingular cafe of Ifchuria, in a young Woman, which continued for more than three years : during which time, if her urine was not drawn off with the catheter\ fhe frequently voided it by vomiting ; and for the lafi 20 months, pajfed much gravel by the catheter, as well as by vomiting, when the ufe of that inflrument ivas omitted, or unfuc- cefsfully applied. To which are annexed fome Remarks and Phyfiological Obfervations. By Ifaac Senter, M. D. affociate member of the. College of Phyficians of Philadelphia, and Senior Surgeon in the late American Army. Read January 5, 1790. LUCY FOSTER, aged fifteen years, a flefhy, healthy looking, well proporti- - oned young woman, was taken June ill, 1785, with a pain in the left Hypochondrium, accompanied with cough, fever, oppreffion at her breaft, and difficulty of breathing. 3 Being ( 97 ) Being in very poor circumftances, her friends neglected afking advice till about a fortnight from her firft feizure, when I was called to her affiftance; , I was informed by her mother that me be- came a woman at thirteen, and continued pretty regular in her menf'es, till within five weeks ' of her prefent illnefs ; and that from her fee- ing nothing during that period, fhe fuppofed her to have taken a Bad cold, as fhe was very inattentive to her health, and had been oblig- ed to do the duty of a fervant maid in a family at the other end of the town. Her pulfe was upwards of ioo in a mi- nute, her tongue coated with that fort of fur which often accompanies a bad kind of chro- nic inflammation of the thoracic vifcera. I tock ten ounces of blood from her aririj gave her an emetic, and directed an epifpaftic of flies to the affeded fide. The blood when cool, heft up its eoagulable lymph as is com- mon in pneumonic inflammation ; but the buff was tender, and the craflamentum and Vol. I. G ferumi ( 9» ) ferum did not feparate, as is ufual in cafes of acute inflammation of the breaft. Expectorant febrifuge mixtures were given her with emollient ptyfans of barley wa- ter, &c. and another blifter applied to her fide witlain a few days. Thefe medicines produced an abatement of the fymptoms, and in the courfe of three weeks, I ceafed to vi- fit her. I however looked upon her difeafe to have a ftrong tendency to a confumption : and about the fourth week from my firft vi- fiting her, fhe vomited up a quantity of bloody pus, of a very difagreeable kind, which with the preceding fymptoms, induced me to think a vomica had burft in her ftomach ; for during the whole of this illnefs from my firft feeing her, her ftomach was fo irritable, that it was with much difficulty, that either food or medicine could be made to fit upon it; and fhe often vomited up the moft fimple barley drink. She had a fuppreffion of urine for twenty- four hours, but did not get any aid from me- dicine, as nature relieved herfelf. She, how- ever, ( 99 ) ever, became regular in her menfes, and re- covered fo far in about two months, as to return to her ufual labour, and continued ca- pable of doing her duty to the fatisfa&ion of her employers, till the June following, 1786. On the third of this month, I was defired to vifit her again, when I found all her old complaints (except the fuppreffion of her menfes), returned with greater feverity than they appeared the laft yean She was now let blood, and treated in other refpecls as before : her diftrefs continuing fo great, that I found it necefTary to repeat the operation, (drawing fmall quantities) feveral times, as nothing elfe appeared to afford her any confiderable relief. Her tongue was covered with a yellowifh coat in the middle, arid a muffin colour at the edges 3 her pulfe beat 120 ftrokes in a minute. The irritability of her ftomach was fo great, that it had become extremely difficult to give any article either of medicine or nou- rifhment, but what fhe vomited up immedi- ately. The effervefcent draughts, infufions G 2 of ( I0° ) ' of <}oiumbo, with fpirits of fweet nitre and fweet vitriol, liq. anod. min. &c. were tried without any lafting effect. Opium gave the moft permanent relief, and afforded her that refefhment from fleep, which fhe could obtain by no other means. As I now looked upon her cafe to be of long continuance, and refiding in a diftant part of the town, I called but feldom, after the feverity of her fymptoms had fubfided ; which they did in about three weeks. On the 2nd of July, fhe was feized with a total fuppreffion of urine, without any per- ceptible caufe, which continued five days, not being able to void a fingle drop; and not- withftanding her pain and diftrefs were very great, fhe did not let her circumftances be fully known to her friends, for fear of hav- ing it drawn off with an inftrument. The beginning of the fixth day, fhe was taken with a vomiting, which lafted till fhe brought up nothing but water, which, fhe faid, tailed in every refpect like urine. As ( »°' ) As her vomiting continued, fhe found re- lief in the bottom of her belly, from the fwell- ing and great forenefs fhe had felt for feveral days. She now thought herfelf much* better, but her vomiting recurred the next day, as I was informed, and continued more or lefs every day till I faw her, which was on the 14th of the month. As fhe had difcharged from her ftomach every thing fhe ate or drank, from the time of her firft vomiting till this, fhe did not fuffer fo much from the Ifchury, which ftill continued, as fhe did before the firft evacuation. I pre- vailed upon her to let me pafs the catheter in- to the bladder, whence I drew about three pints of urine, clear, but high-coloured ; her ftrength was very much exhaufted, and fhe felt great heat and forenefs throughout the abdominal vifcera. A variety of medicines were prefcrib- ed, and every method purfued that could be thought of to allay the extreme irritability of her ( 102 ) her ftomach, and reftore the natural action of the bladder. For ten weeks fucceffively, fhe was inca-r pable of retaining in her ftomach either food or medicines, except opium ; this was her only fplace by day as well as night. From this time to December, fhe conti- tinued with very little abatement of her dif- trefs, or alteration of her circumftances. And as fhe could lie in no other pofition, fhe was conftantly fupported in an armed chair, in a reclined pofture, with pillows under her hips, Whenever I omitted to draw off her wa-, ter once in 30 or 36 hours at fartheft, fhe ne- ver failed to vomit it up. To afcertain fo extraordinary a fact beyond the poffibility of a miftake on my part, or a deception on hers, I often vifited her about the time I knew fhe muft vomit if the catheter was not introduced; and I examined her bladder, found it full, hard, and tender; and fat by her till the vomiting recurred, faved the wa- ter that fhe brought up this way, and com- pared ( io3 ) pared it with what I drew off, and found it the fame in every refpect. During the time her urine came off by vomiting, fhe fuffered extreme anxiety, and always complained of great heat, fmarting, extreme thirft, and a fenfation of inverfion or turning up of fomething (running, as fhe ex- preffed it) that appeared to tear her bowels. As the affair had become fo lengthy, and my bufinefs was fuch that it was not in my power to attend upon her as often as her cafe required, I inftru&ed the young gentlemen who lived with me, in the ufe of the cathe- ter, and they waited on her in my abfence as often as they could conveniently. In the month of January 178 7, from fome caufe unknown fhe could not be relieved with the inftrument, nor could fhe vomit up her urine for feveral days ; when it paffed off by the navel, for three days fucceffively; af- ter which, the catheter was ufed with the fame effect as before. From ( i©4 ) From this time, to the Auguft following, there was fo great a fameneis in her com- plaints, that nothing occurred worth noticing. About the beginning of this month, a brick- coloured gravel began to pafs off through the catheter, and foon became fo large and plentiful, that neither urine or gravel could be completely evacuated by the inftrument in its ufual form. I had one made of a differ- ent conftruction, open at two of the fides for about half an inch, which anfwered my wifhes. She continued to difcjiarge gravel this way, whenever her urine was drawn off, till the t>eginning of November, at which time fhe felt more diftrefs than ufual, whenever her urine came off by vomiting, and fhe foon obferved a gritty fubfance in her mouth. When I was informed of this new phenomenon,. I re- quefted her to fave the urine for my infpec- tion, the next time fhe vomited. I compar- ed this with what I drew off, and found it contained the fame kind of gravel as that which paffed the catheter. I procured and fayed feveral drachms of this gravel, that came from her both by the inftrumcrit and by ( ioj ) by vomiting, and could obferve no difference either in the colour or confiftence of them. From this period to thefummer 1788, her complaints continued much the fame. When her water was not drawn off, fhe always brought it up by vomiting, commonly at- tended with great pain in the head. During this fummer, fhe twice paffed a fmall quantity of urine, through the urethra, in confe- quence of being frightened, once by thunder, and the fecond time by the falling of a win- dow in her room. This ferved only to raife her fpirits for a few days, with the expec- tation of her urine returning through its na- tural channel. Her cafe, however, continu- ed the fame in that refpect, and grew every day more complicated in others. The hypo- ga/lrium became more tumid and tender, and her bladder appeared very much thickened, and extremely fore, even after it was evacua- ted. Add to this, the apparent inequality of the furface of the bladder, was fo great, and the tumour fluffing fometimes towards the right, and at others to the left inguen accord- ing as her body was moved, that I began ftrongly to fufpect a ftone. Through - ( io6 ) Through the month of September, her urine could very rarely be drawn off; for upon the introduction of the catheter, a fpafm feized the urethra and neck of the bladder, and though the inftrument appeared to pafs high up into the fundus of the bladder, not more than a gill could be drawn, before it flopped entirely, with a fenfation of fome- thing falling down againft its cervix, which fhe was very confident was -3.fione. In the courfe of this month fhe vomited more fand than fhe had at any time beforehand failed in ftrength and fpirits fo fall, that I was apprehenfive fhe would not live the month out. Her urethra, bladder, and external geni- tal parts, were fo extremely fore, that, for fome time, it prevented my fearching her for the « ftone in the manner I intended. About the beginning of October, I was able to introduce the found, when I readily met with a ftone, which appeared of a fmall fize, and rather fofter than urinary calculi commonly are. I repeated the examination a number of times, till I was perfectly fatisfied that this was the cafe. She ( i°7 ) She would readily have undergone the. operation of Lithotomy ; but I told her no lafting advantage could be expected from it, while her vifcera continued in fuch a dif- eafed condition. During this month, her urine could be drawn off but prat of the time; and fhe vomited it up for more than a week, without the poffibility of any relief from the inftrument, notwithftanding it was kept in the bladder fometimes during the whole night. She had, at different feafons of the year, fe- veral ill-conditioned fmall abfceffes in her arm pits, and on other parts of her body; but they did not appear to benefit her general complaints. She alfo voided at different times, by vomiting, (after fhe had thrown up all ' her urine), a bloody pus, of a very difagree- able appearance and coppery tafte. As her cafe was fo very uncommon, I, at different periods of it, requefted the advice of moft of the faculty of this town. She was vifited by the late Dr. Fletcher, Drs. Oly- phant and Mafon, the laft of thefe gentlemen frequently attended her, both with me and in my abfence, repeatedly relieved her by the catheter, ( 108 ) catheter, and faw her vomit up both urine and gravel. She was alfo vifited tranfiently by Dr. Waterhoufe of Cambridge, and feveral other phyficians of eminence, who belonged out of the ftate. During the remainder of the fall, and principal part of the winter enfuing, the fame troublefome fenfation of the falling down of a ftone in the bladder, upon the ufe of the ca- theter, continued, and induced the moft ex- cruciating pain and mifery imaginable. She was put into different pofitions, when the catheter was introduced, and I gave the inftrument various directions in the bladder, fometimes with fuccefs, at others without. Her bowels, for the moft part, were much' iefs conftipated than could have been ex- pected, confidering the frequency of vomit- ing, her fupine fituation, and the little nou- rifhment fhe was able to retain upon her fto- mach : And during the whole of her difeafe, till within three months of her death, the ca- tamenia were irregular. Sometimes they ap- peared every fortnight, and at others, fhe paffed ( I09 ) mailed the regular period for that evacuation two or three months, without having any ; but it did not appear to me that her difeafe was much influenced by either. Sh e had, by times, a dry cough, with the return of the old pain in the fide; but fhe never expectorated, by coughing, any kind of purulent matter, that could induce me to fup- pofe her lungs were confiderably difeafed. The bloody matter that fhe brought up, al- ways came by vomiting, preceded by a more morbid than ordinarily irritability of the ftomach, forenefs, and extreme anxiety. Early in the fpring 1789, her urine be- gan to pafs per anum, loaded with the fame kind of gravel that had come away by the catheter. This gave her fome refpite with refpect to her vomiting, though fhe continu- ed to throw up more or lefs urine as well as gravel that way every week. This new courfe of her water gave her a very troublefome tenefmus ; but the ftone in the bladder, as well as the pain and difagree- ablenefs arifing from the fenfation of its de- cent. ( no ) fcent, became daily lefs fatiguing. Her ftrength and fpirits decayed faft, and the fever that fhe had before continually laboured un- der, grew more completely hectical. AfTeR the 13th of May, her bladder riej ver became fo much diftended with urine as it had been before; and both this, and the gravel, now generally paffed her once in twenty-four hours, either by vomiting or purging. She, however, introduced the cathe- ter herfelfj and fometimes drew off her urine- to the quantity of a gill. The fecretion of urine, as well as the for- mation of calculi, evidently diminifhed, in proportion to her lofs of ftrength, and the in- creafe of the diarrhcea. The menfes entire- ly ceafed. During the latter part of fpring and fummer, fhe became.quite paralytic at times j the frequency of vomiting increafed, and fhe had feveral convulfion fits after vomiting. She grew more and more emaciated ; her con- vulfions returned more frequently ; her fever was ( "I ) was more putrid ; fhe at laft became lethar-« gic ; and on the 11 th of Auguft, death, which fhe had long and ardently wifhed for, put a period to a feries of the moft compli- cated and fmgular mifery that I have ever feen fince my acquaintance with difeafe. The next day after her death, I obtained leave to examine her body ; when there were prefent, Drs. Waterhoufe and Mafon. The weather being very warm, there was fuch a fcetor proceeding from the corpfe, that the family thought fit to inter it fo foon, that we had not time to make our examination fo minute as we wifhed. We found much lefs ravage in the vifcera than was expected. Thorax. In this cavity there was nothing appeared unnatural, except a confiderable ad- hefion of the right lobe of the lungs to the pleura. Abdomen. The omentum was principal- ly wafted, but not more than is commonly the cafe with thofe who die tabid. It was, however, ( It* ) however, of a dark gangrenous colour pretty generally. • Stomach. This appeared very much chang- ed from its natural colour, and in a gangre- nous ftate, containing a femi-purulent mat-« ter of a fcetid fcent. Liver and Gall bladder. There were no preternatural adhefions of the former, nof gall ftones in the latter ; and their colour* &c. not unufual. Intefiines. In thefe there were no rup- tures either of their mufcular coats, blood- veffels, or lymphatics, that we could difcover. The villous coat was much deftroyed, and the colour of the inteftines darker than is common, except the duodenum, which was very much difcoloured with the bile. Kidneys and Ureters, I n thefe there was no confiderable deviation from a ftate of foundnefs ; they were lax or flabby, but no rupture of any of their veffels, or any calculi difcoverable. 2 Urinary ( "3 ) Urinary Bladder. This was in its natural fituation not the leaft thickened, had no fand or gravel in it, nor did it adhere preteruatu- rafly to any of the circumjacent parts ; and the mufcular fphincter of its neck yielded rea- dily to the introduction of the finger from the bladder into the urethra. Uterus. In its cavity was contained about. a drachm of thick, darkifh, fcetid pus; but no other appearance of difeafe in its body. Tubes Fallopian^. Were larger than common in virgins, and ftrung with feveral hydatids, or veficula, the fize of a walnut, filled with a watery glutinous humour. Corpora Fimbriata. Had a gangrenpus ap- pearance. Ovaria* Were enlarged to the fize of a fmall hen's egg, and contained a confiderable quantity of a clear limpid fluid immediate- ly under the firft coat. In the hiftory of a complaint fo lengthy as this, where there is nothing new occurs Vol. I. U for ( »4 ) for many days or weeks, to enter into the minute detail of a diary, would not only exhaiift the patience of the reader, but far exceed the bounds commonly prefcribed to papers of this kind. I have endeavoured to exhibit all the principal phenomena attend- ing this uncommon cafe, from the original minutes which I kept, in as fimple a manner as the nature of it would admit. In order to elucidate the cafe more fatis- factorily to thofe readers, whofe circumftan- ces, perhaps, have not afforded them an oppor- tunity of becoming acquainted with the late difcoveries and improvements in the know- ledge of the lymphaticfyft em,ox in thofe difeafes, either ariting from, or accompanied with, a retrograde motion of the fluids in the human body ; I hope it may not be thought impro- per to clofe this paper with fome obfervations upon thefe fubjefe, as well as fome others connected with the cafe in queftion. But before I proceed to this, it ought not to be forgotten, that this young woman, when a child, was fo unfortunate as to have a quantity of boiling water fall on her body, by ( "5 ) by which the greater part of the left hypo* chondrium was fo deeply fcalded, that her life was defpaired of for feveral days. How far this might operate towards laying a foun- dation for the pain and diftrefs which fhe fuf- fered in this fide for fuch a length of time, I cannot determine. As the acme of life approached, the fubja- cent veffels of that fide might not evolve in the fame ratio with the reft, or their condi- tion might perhaps be otherwife altered, fo as to embarrafs the powers of circulation and refpiration ; but the figure of her cheft was not perceptibly injured, though the cicatrix occafioned by the fcald was large and deep. An Ifchuria arifirig from almoft -any caufe, is a difeafe, in general, not only extremely painful,* in its advanced ftages, but juftly looked upon as one of a very alarming na- ture. H 2 The * Tiberius, tks Roman Emperor, v/as Hot ignorant of the torture ariiing from a iupprefiion of urine; fince \vs are told that he ufed to tie up the urethra,, in thofe whom he hated maft; after firft obliging them to drink highly" of wa;a. ( "6 ) The caufes of a preternatural retention of urine are various. It has been confidered as arifing ift. From atony in the mufcular fi- bres of the body of the bladder, depriving it of the natural power of contraction. 2nd. From a paralytic ftate of that organ; in which cafe the natural ftimulus of the urine is incapable of producing its ufual effect, while fuch infenfibility remains. 3d. From inflamma- tion or fpafm of the mufcular fafciculi which furround the opening of the bladder into the urethra. 4th. From the urinary canal lead- fc ing from the bladder, being rendered incapa- ble of dilatation, by inflammation, fpafm, ftricture or preffure. 5th. From an extra- neous body, as a ftone lying upon the orifice of the bladder, or lodged in the urethra. 6th. From laceration or burftingof the coats of the bladder. Sauvages, with his ufual minutenefs, has divided this complaint into no lefs than 44 fpecies. 1 he one that fell to the lot of this poor unhappy girl was undoubtedly what he calls the Ifchuria veficalis paralytica. And whatever might have been the caufe of this unhappy ftate of the bladder, it could not be fo ( "7 ) fo clearly afcertained in the hiftory of her cafe as I could have wifhed. It does not, however, admit of a doubt, that the contrac- tile power of her bladder was not fufficient to overcome the refiftance of the fphincter of its neck. Had the catheter been ufed before the paralytic affection of this vifcus took place, the energy of the extrufores urince would, in all probability, have been reftored, and the retrograde courfe of her urine been prevented. That of the hiftory of this cafe which may appear the moft furprifing, is the ex- traordinary outlets that nature found for the evacuation of the urine. And it may very naturally be afked, how is it poffible that this perfon fhould difcharge fuch large quantities of urine by vomiting and by ftool for the fpace of three years, and even gravel for a confider- able part of that that time ; yet upon the exa- mination of the vifcera, no breach of the bladder or any part of the alimentary canal could be difcovered ? But however extra- ordinary this may appear to thofe who have been led to conclude, that there is no other way for fluids to pafs from the ftomach into the bladder, and vice verfa, but by the arterial circulation ; ftill facts are of too ftubborn a nature ( "8 ) nature to bend to the fyftems of the moft in- genious theorifts. To the truth of this re- mark, phyficians and furgeons of extenfive practice, who have united reading, reafoning, and obfervation, can teftify. At every period of the healing art there have been thofe who were firmly perfuaded, that there was fuch a connection between the ftomach and the bladder, as that in cer- tain conditions of the human body, fluids would pafs from the former to the latter, without entering the common courfe of fan- guiferous circulation. But the circumftances neceffary to afcertain the fact, were referved for thofe of the prefent century to difcover. Mr. Hewfon and fome other ingenious modem phyfiologifts, have demonftrated, that the urinary lymphatics are joined with the inteftinal abforbents, by numerous ftcmatc- mofes. This being known as an anatomical truth, the conjectures of the ancients in this refped appear well founded. And although fluids paffing from the ftomach into the blad- der, by the urinary branches of the lympha- tics* muft in all probability, invert the com- mon ( "9 ) mon order of their valvular mechanifm, yet it is well known, that this is not the only mftance of fuch an inverfion taking place in the other parts of our fyftem, under particular circurnftances and conditions of our bodies, by a retrograde motion of their contents. Were it not for fear of fwelling thefe obfer- vations to an unwarrantable length, I could not refrain from quoting the judicious, fcien- tific and conclusive experiments of Mr. Dar- wine upon this fubject, as well as thofe of M. Macquire in his Diclionary of Chemiftry, un- der the article urine, to prove not only the exiftence of fuch a direct communication be- tween the alimentary canal and the urinary bladder, but alfo to fhew that many fubftan- ces pafs from the ftomach to the vejica urina- ria, without undergoing any confiderable al- teration in the nature of their peculiar pro- perties. Th e exiftence of fuch a vafcular connec- tion between the alimentary canal and urinary bladder being admitted, and the certainty of fluids paffing in particular circurnftances from the former to the latter ii: rcelijimo curfu, be- ing t ( H6 ) ing no longer problematical; it may frill be thought doubtful by fome, whether the urine in the bladder can poffibly afcend into the ftomach, though water in this vifcus may defcend into the other. It has not efcaped the obfervation of phy- ficians in every period of the healing art, that patients labouring under an Ifchury, have been known to pafs their urine off through the pores of their fkin *. And there are fome inftance* * A Fifherman belonging to this town, 55 years.old, after being mvch fatigued with labour, until he became quite fweaty, in the month of November, and expofed in the water imme lately after, was taken with a fup- preffion of urine, for which he was directed to take fome purging faits and mercurial pills. I was defired to attend him, but could not till the 4th day of his difeafe. I found his comi/^.int fb very preffing, that after he was bled, and had an anodyne oleaginous clyfter without relief. I introduced the catheter and took from hjm a large quan- tity cf high coloured urine, by which he was immediately made eafy. The caufe not being 'removed, his urine be- gan to accumulate lo faft, that, by the next day it became troublefome. I ordered him a faline diuretic mixture, and attempted to pafs a bougie into his biadder, but was foiled ; I tried different fize^ ineffectually. Gentle ca- thartic- medicines, with a repetition of the anodyne injec- tions were ufed, but his complaint continued obftinat e On ( "I ) inftances upon medical record, of a ptyalifm coming on in confequence ©f retained urine in the body. Dr. On tne 4th day from the commencement of this laft ac- cumulation, his fever was very high, had much thirfl, and complained of great pain in his head. I took more blood from him,' which was very huffy, and continued the feveral medicines before in ufe. I tried again the bougies and catheter without effect j he was put into warm water, arid after it cold water was thrown on his extremities; but not a drop of urine could be produced. Upon the 5 th he was more fwelled ; he was put into the bath again, and a variety of other means were ufed. His brain was now evidently affected. He dozed much ; a. urinous fweat came out upon him plentifully. Upon the 6th he was feized with a vomiting which continued till night with very lit- tle intermiflion. His cafe now feerhed defperate, as death appeared to be fait approaching. I let him more blood, and directed him again into jhe bath, with a determina- tion, if he jfhould not be relieved by this, to puncture the bladder without delay. "While in the bath, he wag feized with a liepothytnia, and in this condition carried to bed. His urine now began to flow, though infenfibly to himfelf. He fweat much, continued to have fainting fits, and vomited, by fpells, through the night. By the morning the fpafm was fo far overcome in the neck of the bladder, that he was out of pain, though tfot freed froti* all his urine. It however continued to flow, and his bladder flowly recovered its expulfive power, till he was entirely well. :.(' l2* ) Dr. .Daniel, in the Medical Communica- tions, Vol. I. relates a cafe of a woman, who had a ptyqlifm, apparently occafioned by a diminifhed fecretion of urine, cured by di- luted draughts of alkaline faits. And Mr. Warner, in his judicious collection of cafes in Surgery, has recorded the extraordinary cafe of a young woman, who, in attempting to raife a weight above her ftrength, was taken with a pain in the fmall of her back, accom- panied with a total fuppreflion of urine, which continued five days, notwithftanding the moft judicious means were ufed to remove it. Upon the 5th, fhe was relieved by the introduction of the catheter. During this fuppreflion fhe was feized with an acute fever, and for eighteen or twenty hours before her urine was drawn off, fhe difcharged by the mouth, a great quantity of faltifh water, tinged with blood, which, upon lying down, flowed in fo great quantities as to threaten fuffocation. Upon this cafe, Mr. Warner, contrary to his general method, makes no remarks; he does not even conjecture how this faltifh water could come from the blad- der to the mouth. This girl temained for '* near ( *23 } near three years, without paffing any water but by the afliftance of the catheter. She was finally cured by dividing the, urethra, and taking, by ligature, out of the neck of the bladder an excrefcence the fize of a turkey's egg- While writing this, I have the care of a black girl more than 2o years of age, who has for near two years been troubled with a variety of diftrefling fenfations, which appear to arife from polypus concretions in the heart and large blood veffels. She firft complained of pain deep in the thorax, extending down the right fide into the liver. Her pulfe was flow, unequal, and intermitting; and upon motion fhe frequently complained of faintnefs, fhortnefs of breath, and palpitation of the heart. He tongue was generally foul, had but little appetite, and was fubject to coftive- nefs. But, till within about three months, by fmall bleedings, epifpaftics, and eccopro- tics, joined to a cooling laxative diet, fhe was enabled to keep about houfe the moft of the time. For the three months laft paft, all thefe %mptoms increafed, and induc- ed a multiplicity of others. She at fun- dry ( lH ) dry times had a paucity of urine followed by a ptyalifm. Thefe, however, appeared to give way to the remedies that were ufed, till within about fix weeks paft ; when fhe was feized with a total fuppreflion, which lafted eight days, followed with a vomiting and pytalifm. During all this time, her bladder was not fo much diftended as to make the hy- pogaflrium tenfe, or tender to the touch. I however drew off above two pints of water, with the catheter, which was neither high co- loured nor fcetid. She now feldom panes her urine oftener than once in three or four days, and then not in confiderable quantities. She fpits nearly three pints of a faltifh water mix- ed with phlegm, every 24 hours, vomits more or lefs every day, a brackifh pituit, and has nothing pafs her bowels, without afliftanee. In her fevereft paroxyfms of dif- trefs fhe is extremely agitated with tremors, fubfultus tendinum, vomiting and- convulfi- ons, accompanied with fuch a furious deli- rium, that the family are obliged to confine her with cords. She froths and foams at the mouth, like the ancient Dsemoniacs; and what is peculiarly fmgular and worthy of re- marking, is, in her moft violent agonies, her pulfe < m ) pulfe lofe entirely the intermijjion and inequa* lity that they always have at the intervals of her greateft eafe and tranquillity. They are, however, generally quick and fmajl. She has very frequently zfcotomia, pain in her head and eyes, and indeed in every part of her body, but more efpecially in her back and lumbar regions ; and in proportion to the di- minifhed difcharge of urine, her vomiting, ptyalifm, and univerfal diftrefs are increafed. She has frequent returns of a diftention, fore- nefs, and pulfation in the external iliac artery of the right fide, which extends down the thigh. Whether this ptyalifm was occafioned by a diminifhed fecretion of urine in the kid- neys, or from the retention of it in the blad- der, is very uncertain. The pain in her back and loins has been very conftant for ma- ny weeks, and fhe did not appear to fuffer as much from retained urine in the bladder as might be expected, confidering that fhe fo feldom voids it in the natural way. It, how- ever, does admit of a doubt that the difcharge of her ftomach and fauces are urinous. When nature is hardly puf&ed, fhe has many refources that a mere knowledge of the anato- ( 126 ) anatomical ftructure of our bodies, as far as it has been inveftigated, has not been able to difcover to us. ' And though fhe often makes ufe of fuch violent means to free herfelf of difeafe, as to deftroy the exiftence of the vi- tal principle itfelf , yet we are often aftonifhed with recoveries that the moft cautious prog* nofticators had deemed impoflible. Whether, in thefe cafes, the urine paffes back into thefyftem by percolation, or inverts the courfe of circulation in the urinary lym- phatics, may be matter of doubt with many, though I am decidedly of the latter opinion, from what I have obferved in more cafes than one of this kind. In the above related cafe of L. F. I never could difcover the leaft fmell of urine in either her fweat or perfo- ration. EvhRy circumftance confidered in this cafe, it appears to me beyond even a doubt, that the retrograde courfe of the urine was through the lymphatics into the inteftines and ftomach; that when it went into the former, it foon excited a paflage downwards; and when it could find none in either of thefe ( 1*7 ) thefe ways (as was the cafe for three days) it forced one through the urachus out at the navel ; nor does our not being able, (from the hafty manner in which we were obliged to conduct our examination) to difcover thefe paffages in a ftate of enlargement, a- mount to any proof to the contrary ; fince it is well known, that in dead bodies fuch an alteration foon takes place in the veffels by collapfe and otherwife, as often to defeat a much more advantageous opportunity for the difcovery of difeafe. Few phyficians of experience and obfer- vation but muft have noticed inftances of partial, fudden, and extraordinary actions of the veffels in cafes which have fallen under their care ; fuch as the tranflation of the mat- ter, of chyle, of milk, &c. and mention is frequently made of them in books of medi- cine. But I do not remember an inftance on record, of a cafe exactly fimilar to that which is the fubject of this article. That which comes the neareft to it of any within my prefent recollection, is one ta- ken notice of by Dr. Percival in his 2d Vol. o of ( "8 ) oi a woman with an encyfte4 dropfy of the left ovarium, who, after a fpontaneous vo- miting of federal days, during which fhe brought up three gallons of water, was en- tirely cured, by this difcharge, of a dropfy that was before looJke4 upon as incurable. Another cafe of the extraordinary ener- gy of the abforbiag lymphatics, is recorded by Dr. Simpfon, of a young man who was feized with a fever, to which a diarrhoea fuc- ceeded, with an extreme ftupor. He would drink nothing to allay his thirft, though burn- ing up with the violent heat. He ordered his feet to be immeried in warm water, which being done, he (the Doctor) fuddenly per- ceived a furprifmg decreafe of the water in the veffels, aJWbrhe4 by his feet, and poured out again per anum like a cataract. Another cafe mentioned by Dr. Chair mers of South-Carolina, of a negro man who was hung alive in gibbets, and in that fitua- tion deprived of any kind of drink, yet had regularly a difcharge of nearly the fame quantity of urine every morning. This, as he obferves, undoubtedly took place, in con- * fequence ( I29 ) fequence of the abforption of the dews which fell during the night; One more circumftance in the cafe of this girl appears worthy of a particular remark, as it tends ftrongly to evince the extraordina- ry power of the abforbing veffels. of her mouth, cefophagus, and ftomach ; fince it ap- pears that fhe was fupported for ten weeks at a time in ho other way than that of abforp- tion ; as fhe never kept any nourifhment on her ftomach for more than ten or fifteen mi- nutes after eating, during the above-mention- ed period, before a vomiting enfued and con- tinued till her ftomach was, to appearance, en- tirely evacuated. From the effect of the fudden fhocks fhe experienced by the fright from thunder, as well as the falling of the window, as menti- oned in the hiftory of her cafe, I fhould have been induced to employ the power of electricity for her ; but not being able to pro- cure an apparatus of that kind, till towards the clofe of her diforder, it was unavoidably omitted. Vox, I. I By ( *30 ) By what fecret inftruments in her extra- ordinary fyftem the ftone in the bladder was decompofed, is no lefs furprifing than many other appearances in her cafe. Though fuch a ftate of the fluids in the body may be as ea- fily conceived of, as that which changes the hardeft bones of adults into a fubftance as foft as mummy. This, though a rare occur- rence, is neverthelefs true. X. Two Cafes fome degree of inflamma- tion foon takes place ; and were it not that the os tinea is generally preffed fo hard againft the bones of the pubis and diftended bladder, which prevents any dilatation of its orifice, nature would moft probably very often relieve herfelf by an expulfion of the foetus. And I have known more inftances than one of abor- tions, ( '43 ) tions, which appeared to me to take place iri confequence of a defcent of the uterus, but in fuch a direct line, as to leave the os tinea room to dilate whenever the contents of the uterus preffed fuffieiently hard upon it. In differently conftructed pelvifes, as well as the different caufes producing this difeafe, fome confiderable variation with refpect to the direction of the uterus, may, and no doubt has, taken place in a ret rover ted ftate. The os tinea and collum uteri may be thrown into the hollow of the coccyx and the fundus uteri lddged upon the pubis ; or it may de- fcend in a direct line with the axis of the uterus. But I believe thefe petitions very rarely happen, efpecially where there is any confiderable accumulation of urine and faces accompanying the firft ftages of the difeafe. I have know feveral inftances of women m labour, at their full reckoning, when the orificium uteri was thrown high up into the hollow of the facrum, and remained fo many hours, after the head of the child had preffed the anterior part of the collum uteri, low down under the upper edge of the fymphyfis pubis. But \ ( J44 ) But they were in general, tedious travels, ow- ing principally to the rigidity of the os tinea.) and the mal-direction of the uterus. Itf whatever manner the uterus is difplac- ed, the earlier it is attended to the more ea- fily the difficulty is removed : and in the more early ftages of it, by an advantageous pofture of the woman, joined to a freedom of the dis- charges of the bladder and alvine tube, it is not improbable that the uterus might, in fome in- ftances, reftore itfelf to its natural fituation. But if once this difeafe gets fo far advanced, as totally to obftruct the exit of the urine and faees, the hand of a dexterous Accoucheur ap- pears to me indifpenfibly neceffary to effect the repofition. But previous to this, the bladder and the reftum ought, if poffible, to be emptied by the gentleft means that can effect it. And the pa- tient in this, as in all other cafes oifirangula- ted hernia ought to lofe blood immediately, unlefs contraindicated by a very relaxed and enfeebled conftitution. 2 Other ( '45 ) Other means have been directed, as well by ancient, as modern phyficians, for reftoring the uterus when difplaced. However, in ad- vanced flages of this malady, no time fhould be loft in employing any other remedy than the manual operation* If a repofition cannot be effected by the hand, as has fometimes been the cafe, the ce- lebrated Dr. William Hunter of London, to whom the world is fo much indebted for his judicious directions in this, as well as fome other difeafes, advife to puncture the uterus with a trochar, in order to difcharge the liquor amnii, and thereby facilitate the reduction of the vaginal tumour. Vol. I. K An ( 146 ) XL An account %f a fuppofed cafe of Internal Drop* fy of the Brain, fuccefsfully treated by Mer- cury ; by Benjamin Rufh, M. D. &c. Read May 4th, 9790. MISS S. F. aged 26, the daughter of a reputable citizen of Philadelphia, was feized about fix months ago, in confe- quence of having taken cold by wetting her feet, with a puking after taking aliment, and a pain in her head, both of which complaints were fo flight as not to confine her, for five months, to the houfe. During this time fhe was frequently troubled with a coldnefs in her hands, and pains in her neck, fhoulders and limbs, which fhe fuppofed to be of the rheu- matic kind. Her eye-fight was likewife im- paired fo that fhe could not read by candle- light ; but under all thefe circurnftances her appetite was better than ufual, I er bowels were regular, and the catamenia diminifhed only a little in quantity. About ( '47 ) About eight weeks ago the pain in hef head encreafed, and was ufhered in every afternoon by a chilly fit. The puking be- came more conftant—She feldom paffed a night without being attacked by it about i 2 o'clock. Much bile was difcharged from her ftomach. Her bowels became obflinately bound, fo as to be opened only by means of glyfters given every day. In this Situation, I was fent for to vifit her, in confultation with Dr. Say, who had admi- niftered to her all the ufual remedies for a weaknefs of the ftomach. Her pulfe was flow, her fkin dry, and her countenance in- dicated greatlangUor and diftrefs. Upon my firft vifit I fufpected, with Dr. Say, the dif- eafe to be a high degree of Dyspepsy, and fuggefted the exhibition of milk by fpoonfuls in the manner recommended by the late Dr. William Hunter. For a while her ftomach retained this mild aliment, but two days after- wards, ,fhe was feized with a return of her vo- miting, accompanied by a violent convulfion, together with a perpetual winking, and a turning up of the whites of her eyes when fhe K 2 dofed. ( '48 ) dofed. She complained now more than ever of a pain in the back part of her head, and was frequently delirious. Her coftivenefs con- tinued, and fhe paffed more than four and twenty hours without difcharging any urine. From this new complexion of her fymptoms, we changed our opinion of the caufe of her diforder, and fufpected an effufion of water in the brain. Under the irnpreffion of this idea we directed a large quantity of mercurial oint- ment to be rubbed on her fide.. The next day fhe had another fit, which was followed by an* encreafe of her delirium and a low weak pulfe. On the third day from the ap- plication of the ointment, the mercury affect- ed her mouth. For feveral days fhe difcharge ed about a quart of faliva in the courfe of four and twenty hours. It was extremely agreea- ble to obferve, in one week from the time the mercury began to act upon the glands of her throat, that the delirium left her—her fto- mach retained aliment—her pulfe became full, though fomewhat quicker than natural,—and her fleep, with the help of an anodyne, was eafy and refrefhing. In two weeks from the application of the mercury fhe walked about her ( H9 ) her room, and appeared to be perfectly re- covered. Her complexion, ftrength and chearfulnefs, a month afterwards, afforded •marks of her reftoration to perfect health. A dilatation of the pupil and ftrabif- mus were abfent in this fuppofed cafe of inter- nal dropfy of the brain. Difeafes with a train regular fymptoms are to be found chiefly in books. The flownefs of the pulfe in one, and its quicknefs in another ftage—the vo- miting mentioned by Dr. Huck in the cafe of Hargrave *, the pains in the limits—the obftinate pain in the head—the diminution of fight—the flow difcharges by urine and ftools, and laftly, the convulfions, all of which oc- purred in the above cafe, appear to be the moft common and characterise fymptoms of an effufion of water in the ventricles of the brain. Th ere was one more fymptom, which I dis- covered after the recovery of our patient, which I have * In the account of Hydrocephalus internus, .publifcVd in Dr. Fothergill's worJcs. ( 15° ) have I never known to be abfent from this dif- order, viz. troublefome and difireffing dreams. She informed me, that from the firft attack of her difeafe, they had rendered her nights mi- ferable; and that (he had not known any relief from them, fcarcely for a fingle night, till af- ter her recovery. XII. Afhort Account of the Influenza which pre- vailed in Ameiica in theyear"1789. By William Currie. Read May 4, 1790. A DISEASE known in Europe by the name of the Influenza, by which is meant a contagious catarrh, made its appear- ance in North-America in 1789. Whether it originated in this country, or was import- ed, or which of the northern ftates it firft ap- peared in, I have not learned; but there is fufficient proof that it appeared in New-York fome time before it was obferved in Phila- delphia, It ( '5' ) It appeared in the place laft mentioned the latter end of September, during the an- nual meeting of the Friends, by fome of whom, perhaps, it was brought from New- York. From Philadelphia it fpread to all the fou- thern ftates in the courfe of a few weeks; but whether it proceeded to the Spanifh fettle- ments on the Miffifippi, or affected any of the Indian tribes, I have not been able to learn. Its continuance in Philadelphia was a- bout feven weeks, during which time the ma- jor part of the inhabitants were affected by it. The rapidity of its progrefs, and the univerfality of its fway, gave rife to an opi- nion with fome that its caufe was blended with, or fufpended in the air, and conveyed by the winds. But the known manner in which every other contagious difeafe is pro- pagated renders this conjecture groundlefs. The origin of this difeafe, as well as that of the fraall-pox and meafles, appears to be involved in impenetrable obfcurity. This ( .'J* ) This difeafe commenced with fymptoms of laffitude, debility, and chillinefs, fucceeded by feverifh heat, oppreffion about the praecor- dia, fenfe of fulnefs and pain in the fore-part of the head and in the thorax, and alfo in the back, together with a teafing cough, and a difcharge of thin acrid fluid from the bron- chise and noftrils. Some were alfo troubled with fneezing and fore-eyes-^-and during the chill, feveral were affected with an inclination v to puke, or with a diarrhoea, I met with a few who had the fymptoms of pneumonia, but thefe cafes were not very common. In general, the pulfe was accelerated, and the fkin confiderably hotter than natural for the firft two or three days, but the pulfe was feldom full or very hard—In many it was low, weak, and frequent—the appetite was always impaired. The feverifh fymptoms, pain and cough, generally increafed for the firft three or four days, but after that time gradually decreafed, and for the moil part ceafed altogether by the eighth. When the fymptoms began to abate, a diaphorefis was generally ( '53 ) generally obferved, as well as a freer ex- pectoration. This difeafe proved fatal to none, except a few very infirm or phthifical patients, in Phi- ladelphia—but in the fouthern ftates it was more mortal. In the cure of this difeafe, in general, mild laxatives, joined with antimonials, and the an- tiphlogiftic regimen, with bleeding, occafion- ally, when the pulfe was full and hard, were all that I found neceffary for the removal of the inflammatory fymptoms : After which I found moderate dofes of opium the moft cer- tain remedy for the cough. The cafes, however, in which I found bleeding of fervice, were very few' in Compa- rifon of thofe in which it was the reverfe. Mild emetics had good effects after the inflammatory fymptoms began to fubfide; whether they would have been ufeful at an earlier period I do not know, as I did not make trial of them. Thosi ( '54 ) Those who were left weak and languid had their ftrength and health rellored by tak- ing a decoction of bark, with elixir of vitri- ol—or an infufion of columbo root, and by the moderate ufe of claret, or other found wine, a nutritive diet of eafy digeftion, exer- cife, and fuitable cloathing. Ac ( *55 ) XIII. Account of the State of the Baro- meter. M B. JANUARY, 1790. W. i 3°-4 Fine pleafant day 3. W. 2 3°-4 Do. calm - - - 3 3°-4 Do. - ... 4 3°-4 Df. - 5 30.4 Cloudy overcaft N. 6 3°-5 Clear, frofty day - - N. 7 30.0 Cloudy, with fhowers S. W. 8 29.7 Overcaft - s. w. 9 29.5 Clear day, - - w. IO 30.0 Do. and windy N. W, ii 30.0 Hazy, with fnow - - S. E, 12 30.0 Cloudy S. 13 30.0 Do. and rain P. M. S. E, 14 3°-3 Foggy calm day - - 15 3°-3 Snow and rain P. M. N. E. 16 30.0 Rainy day - - s. w. 17 30.0 Fine clear day - - w. ?8 30.0 Hazy, foggy, calm day 19 29.5 Thick, foggy and calm 20 30.0 Fair windy day - N. "W, 2.1 30.0 Clear cold wind N. W, 22 30.0 Do. warmer s. w. 23 30.0 Fine pleafant day s. w. 24 29.7 Rain and light fnow N, E, 25 30.0 Hazy overcaft fky N, 26 30.0 Do. and rain at night S. 27 29.7 Snowy day - - w. 28 30,0 Foggy morning. P. M. clear w. 29 30.0 Fine clear day w. 3C 30.0 Do. 31 30.4 Do. - Ml B. ( IS* ) FEBRUARY, 179a W. 1 2 3' 4 5 6 7 8 9 10 11 12 *3 30.0 30.0 30.0 29.5 30.0 3 co po p< w m en m w m r^ooqqoooooot—r^t-oo ddddddd\ddd6ddddQdo\o\d\db co co cr co co co ct '•ooncococococooofoooct cf ^ N (^, ^f v>\0 i—oo On O -I c« ro ^f- ioNO i^oo 0\0 « m mi- "^ r^oo On O — >,ianwMi»tiHW»iMNWrtc GO E 3 2 ^ >>B 13 O O O O O , O o 'S »- ~ ,i-gQQpp§gpqp EwG oo a T3 C I ^ "o u >, * rt >-.-"a rt rt rt ST* O 0 O O On On On On O co co d d d d co co d d co co d or~-t— d'o^olor^-i>-oqqqqqqooqqoqqq 6 6\6\6 6 6\ 6\ 6\ 6\ 6 6 6 6 6 6 6 6 6 6 6 o 6 a 6 ' d d COCOCOCOCOCOCOCOCO.COCOCOCO co co co **- voO r—00 ftO * « m^t u-iV5 i— oo On O <-> d corf loO r—oo 0\0 h .Mw«>-iwt-l«wHwc'fc«c Do. Do. Snow .. - Fine clear day Do. Do. Overcaft hazy Clear cold Overcaft M. W M. E. W". N. W. NT. W. NL W. - tf. W. -N. W. -N -E. -E. -W. -3. w. - N. W. -w. -E. -N. W. -N. W- -S. w. -s. w. -N. E. . -N. W. -S. w. -S. w. -N. E. -W. -w. -w. -S. -N. -N. W. ( *67 ) XIV. Cafe of Inverted Uterus; by Benjamin Duffield, M. D. Fellow of the College. Read Feb. ifi, 1791. Decern.^VN the fifth day of this month, 1790, V^/ about hajf after two o'clock in the afternoon, I was defired to vifit the wife of--------------, in the diftri£t of South- ward The hufband, who called me, in- formed me that his wife had juft been deliver- ed of a fine child ; but that the midwife wifh- ed immediate affiftance, as fome uncommon accident had happened, which had much alarmed her. I immediately accompanied him—and found the patient lying on the foot of the bed, upon her fide, in a cold and clammy fweat—her eyes glalTy—no pulfe per- ceptible at the wrift, and all appearances feem- ing to indicate immediate diffolution. Urg- ed by the clamours which furrounded me, and which the fears and terror of the mid- wife excited in the friends attending her, I ( i68 ) was hurried to an inftant exemination with- out enquiring accurately, or indeed at all, what was the matter. As I attempted to pafs my hand between the thighs, in order to touch, I immediately found the uterus inverted in a very great de- gree. It appeared, as nearly as I could efti- mate, by inclofing it in my hands, to be pro- truded about feven inches in its fhorteft, and nine inches in its longeft diameter. The room being dark, I thought proper to take the ad- vantage of the confufion ufual on fuch occa- f-ns, to requeft a candle. It was brought and I was fuffered to have a flight view of the parrs. The appearance of the uterus exhi- bited that of a parenchyma, ftriated with. veffels of different kinds and colours, as they were full or emptied; and I imagined, that I could accurately define the fpot to which the placenta had been affixed. This I was led tobe- lieve, from what I may not improperly term the parenchymatous fubftance of that part, being rugous- -bloody, and its furface being covered with membranous and gelatinous fubftances. As I chofe not to expofe the deranged part to the action of the air any longer, I immedi- ately ( i69 ) ately called for a foft greafed cloth, and pre- pared to attempt the reduction. My reafon for ufing the cloth greafed was this—I conceived that if applied dry, its adhefion to the irrrita- ble furface of the uterus would be intimate, and its feparation from it in confequence be very painful. I then*placed one hand on each fide of the uterus, and bv erradual compreffion, affifted with a gentle motion up- wards, affimilated as nearly to the axis of the pubis as poffible, after fome minutes perfeve- rance, I completed the reduction'. It is to be obferved, that previous to the attempt, 1 had, as well as my frightened affirmants could afford me their aid, placed her on her back, with her buttocks elevated by pillow?, and her knees feparated by perfons on each fide. I now began to examine the (ituation of my patient, with refpect to hsemorrhnge pre- vious to my arrival. By the appearances of the floor and the bed, I perceived that a confi- derable quantity of blood had been loft : and indeed from the ftate in which I found her, I could not have fufpected otherwife. Du- ring the time of reduction the ha:mo:Thr.ge was ( J7° ) was not profine, and when that was effected, it was confiderably diminifhed. It may now be proper to obferve, that fhe was a woman of thirty years and fix months old, rather above the middle fize, well made, of a chearful difpofition, and accuftomed to an actively induftrious life. She had already been delivered of feven living children. Some months previous to the prefent labour, fhe had been afflicted with pains in her back of a tranfient duration. The child of which fhe had been jult delivered was large and well formed in every refpect. I then endeavoured to collect the hiftory of the cafe from the midwife. She informed me, that the prefentation was natural; the labour gradual and fhort. That as foon as the child was bom, fhe tied the cord, and proceed- ed to the extraction of the placenta; in which fhe obftinately infilled, fhe had ufed no uncom- mon force; but from my knowledge of her, I was much inclined to difbelieve her affertion. To ufe her own language, fhe had made a lit- tle effort to pull it away, when out all came to- ther. ( i7< ) gether. That fhe found a great round body coming behind the cake which was faft to it, juft like two muffins or rolls baked together: and that fhe put her fingers between the. cake and that body and tore away the fkins which faftened them—then the cake came away, and the reft inftantly fell down farther. From this account, from the appearance of the woman, from the recollection of fi- milar cafes, of which the event is almoft con- ftantly recorded as fatal, I had but flender hopes of rendering further fervice to my patient. I, however, turned her a little on one fide, and as the haemorrhage now appeared to, in- creafe, I ordered cloths dipped in vinegar with a fmall proportion of brandy, to be applied to the os externum, and to the whole abdo- men with a greater proportion of the ardent fpirit. Cold wine was prefcribed to be given in the dofe of a tea-fpoonful or two every fifteen minutes, and that fhe fhould not be ftirred from her pofture until I again vifited her. This was about five o'clock in the even- ing—when 1 found they had put her to bed in the ufual manner. She 'poke low, and faintly—no pulfe was to be felt at the wrilt— the ( »7* ) the forehead and extremities, covered with cold clammy fweats, and the countenance by no means favourable. I ftaid a confiderable time with her; defired the continuance of the applications and the wine alone, or diluted, as fhe chofe it, at very fhort intervals. The midwife was ordered in cafe of pain and refiS leffnefs, to give thirty five drops of lauda- num, and if thofe were not fufficient, to add fifteen every hour till it took effect. I in- fifted particularly on abfolute filence, and as much folitude as poffible. Dec. 6. I was called this morning at feven, and informed fhe had been fo deli- rious about eleven o'clock the night before as to require being held. That fhe had com- plained of fhiverings and ficknefs at ftomach. But that after the opium fhe had refted near two hours. Large glyfters of oil, rendered mifcible with water by means of vegetable mucilage, were directed every hour. I. P. M. No evacuation by flool or urine. Pulfe not yet perceivable. Sweat clammy, yet ( '73 ) yet not cold. Eyes and countenance rather more natural. 6. P. M. A fmall creeping pulfe to be per- ceived-----countenance and fpirits better. Hands cold, but the arms warmer; her feet' dry, and more agreeable to the feel. She dif- covers fome inclination to urine, for which, as well as obvious reafons, I omit the ufe of the catheter. Repeat the draught, and con- tinue the regimen. Dec. 7. 8. A. M. Find her pulfe rather quick and active, tho' fmall. The natural heat in fome degree returned. She has twice made water with great eafe. As her milk fever feems to approach, and pulfe is active, a julep of fpiritus nitri dulcis ordered to be taken every two hours. She complains of ficknefs at ftomach and a little pain in the abdomen ; which has not yet dif- covered any tenfion, or much pain on pref- fuae. Let the wine l?e difcontinued for toaft and water. 5. P.M. > ( x74 ) 5. P. M. She has difcharged three pints and one half of urine at twice. Pulfe fuller and more active. Thirft increafing—no ftool— ordered fome caftor oil to be added to the ufual glyfter. I muft here obferve, that as fhe had no ftools in time of labour, I was lefs anxious to procure one for reafons evident to every practitioner. Continue her diluent drinks, and repeat the draught as ufual. Dec. 6. 10. A. M. Found her almoft eafy and free from pain, except the feat of the lower dorfal and firft of the lumbar ver- tebrae now and then being attacked with fling- ing fenfations. Her belly not more painful to the touch, and has no great increafe of ac- tion in her pulfe. She has paffed urine free- ly, and has had one very large evacuation by ftool—Continues her diluents—The child has fucked eagerly, and the night paffed comfort- ably without the laudanum. 7. P. M. Not fo well—fever and thirft in- creafed, and a light tenfion of the abdomen perceivable. Another ftool and difcharge of urine—feeis an appetite for the firft time— ordered ( '75 ) ordered fago, and a ftrict obfervance of her horizontal pofture. Repeat the draught. 9. During the Sth and this day better; and has had comfortable fleep. Voice and countenance better; takes nourifhment freely, and is almoft free of fever—abdomen nearly natural with refpect to the touch, and its evacuations—Draught difcontinued. I o. In the fame fituation as yefterday, ex- cept a kind of tedioufnefs in making water. 11. Better. 12, 13, 14. As on the nth. 16 to 21. Has not yet fat up, but in very impatient, and recruits ftrength. 22. Sat up an hour. 25. Find her convalefcent. 1791, Jan. 3d. Free from every complaint and confiders herfelf as perfectly welU 3 An ( i7<* ) XV. An Extraordinary Cafe of a rupture of the ligament of the Os Humeri, with the cure thereof. By Dr. Benjamin Say, Treafurer of the College. Read February j, 1791. ON the eighth day of May 1789, I was fent for to vifit James Bartram, fenior ; a gentleman near fixty years of age, in King- feffmg, four miles from town, who, the mef- fenger informed me, had a fall from his horfe, and diflbcated his right fhoulder. I rode out with all convenient fpeed. Up- on examining the moulder, I found a pro- minence of that part of the clavicle next the humerus, and as 1 thought of the acro- mion fcapulae, together with an apparent cavity, the common criterion by which lux- ation is generally known, and found the head of the humerus as low as the axilla ; from this view of the parts, I did not hefitate to pronounce that there was a complete difloca- tion of the limb, in confequence of which 2 the ( in ) the neceffary bandages were prepared, toge- ther with proper afliftants to reinftate the joint, when we made a confiderable extenfion upon • it; but what was my furprife, when, in this intended reduction, the feparation of the bones from each other was evidently increafed, and the fcapula appeared to be, (as it really was) attached to the head of the humerus, thofe two bones retaining invariably their contiguity with each other. Finding myfelf now in a perplexed fituation, I requefted the gentlemen to relax the parts by declining the extenfion; I then clafped the fhoulder with both my hands, and with confiderable eafe to myfelf, / and not much pain to my patient, brought all the parts into their proper places ; but up- on removing my hands, the humerus and fca- pula together immediately fell down again to that part from which I had juft before brought them. I was now convinced that there was fomething very extraordinary in this cafe, and that the ligament uniting the clavicle with the acromion fcapulae was completely feparated; for, upon minute and clofe inflection, there was neither fracture nor luxation to be found. As it was at a diftarice from the city I could not immediately confult any of my brethren Vol* L M mpoa C '78 ) upon this new and important cafe, and there- fore concluded, for the prefent, to attempt the retention of the bones by the Common luxation bandage, fupporting the arm with the handkerchief fling. He complained of much pain in his right fide, which part, upon examination, did not exhibit the leaft de- gree of external injury, yet from the ac- cutenefs of the pain, I feared that inflamma- tion might take place from internal contufion; to prevent which, I bled him plentifully, and gave him fmall dofes of the fal glauberi to be repeated pro re nata, with diluent drinks. I left him after the firft vifit with very little fatisfaction to myfelf, being fearful that the dreffmgs, which I had now applied to the difordered part, would be attended with no great advantage, and upcn vifiting him the next day, the cth, found my apprehenfions verified, fertile bones were not retained in their natural fituation as 1 in fome meafure had left them ; the bandage was now tighten- ed, but with little hopes of being more fortu- nate. 1 communicLited the cafe to two or three of the faculty, members of the College, who declared the cafe to be new, and confe- quently, ( *79 ) ^uently, from previous experience, nothing could be gained in what way this rare accident might beft be treated. He ftill complained of the pain in his fide, and alfo in the fhoulder, attended with fome fever, but the latter foon gave way to the antiphlogiftic treatment—-X continued to vifit him occafionally till the 14th, and was mortified to find, that the bones could not be kept together by this mode, the bandage having been tightened fo as to give him extreme pain ; 1 was, however, greatly relieved from much anxiety of min,d, upon applying the leathern fling communicated by Mr Parke of Liverpool to Dr Monroe, a draw- ing and defcription whereof appear in the 6th volume of Bell's Surgery, which fling I had made for the purpofe, and applied it on the 16th of May, juft eight days after the ac- cident, the bones being ftill eafily brought in- to contiguity with each other. I was much pleafed upon vifiting him on the 18th, the fecond day after this new mode of treatment, to find that the head of the humerus was ftill as I had left it on the 16th, nearly in its natu- ral pofition, and confidently congratulated my patient with a fuccefsful cure. I continued my attention to him, tightening the ftrap which M 2 extended ( '8o ) extended to the collar, as occafion required, till the i ith day of June, being near four weeks from the time the fling was applied, when I ventured with care to remove it. Up- on examining the joint, 1 was pleafed to find the bones in proximity, with even a fmall degree of motion in them ; I concluded, how- ever, that it would be proper to reapply the fling, the parts being yet in a ftate of debility^ he experiences now but little pain, except- ing at night after having lain a few hours in bed • but to remedy this, I defired him to loofen the ftrap when he went to bed, but to be careful to tighten it upon rifmg, which he continued in the practice of for fome time, and found an advantage in it. June 22d. This day I removed the fling for about half an hour, moved the limj) in different directi- ons, the bones being nearly in their natural fituation. He now fleeps better, is clear of fever, bowels regular, with a good appetite. I recommended to him to leave off the fling every night from this time, but be careful to re-apply it every morning upon rifing.—I continued my vifits occafionally till the I oth df July, on which day I found him bufily employed ( '8. ) employed fhocking grain after the reapers in his harveft field, with his left hand, ftill conti- nuing to wear his fling, which he faid he could not leave off without pain ; I recommended that he fhould wear it one month longer,which he complied with ; and I can now with great fatisfaction mention, that the cure is com- pleated, that he has the perfect ufe of his arm, and is in a good ftate of health- XVI. An account of an Head-ach, cured by the Dif- charge of a Worm from the Nofe. By Thomas H. Stockett.—Pratlitioner of phy- fic at South River, Maryland. Read April 5 th, 1791. AN old lady in Lower Malbro', had for fix or eight months paft, an excrucia- ting head-ach ; about three weeks ago, there commenced a difcharge of bloody matter from one noftril, the pain by degrees falling to ( '8a ) to the corner of the eye on the fide from which the difcharge proceeded. Within a few days, fhe clofed the noftril not affected and blew hard, when out flew a worm, about two inches long, apparently with a head at each end, which was white, and the body brown. Its action was like what is called an inch worm, and on its back fcales were percep- tible. This old lady fays, that one day laft fum- mer, fhe was walking in her garden, pulled a rofe and fmelled it, and immediately a painful fenfation took place in her head, juft above the noftril that has been affecled ; and fhe remembers to have obferved fome fmall white worms on the rofe, which are common to that flower, from which moment fhe has not been without pain until fhe difcharged it. i An t **3 ) XVI [. >f« Account of a new Bitter prepared from the bark of the root of the LiriodendronTu- lipifera. By Benjamin Rufh, M. D. &c* Read May 3, 1791. HAVING frequently heard from different country people that the bark of the Li- riodendron Tulipifera of Linnseus, common- ly called by them the red poplar tree, afford- ed a ftrong bitter, I employed a man in the month of February laft to procure about thir- ty pounds of it for me. It had a ftrong bit- ter, accompanied with a flight aromatic tafte, in its frefh ftate. To afcertain its fenfible1 qualities and virtues more accurately, ^ fub- jected it to the following pharmaceutical ex- periments, the refult of which I beg leave to communicate to the College. ift. I boiled about two pounds of the frefh root in half a gallon of water, from wVich I obtained a ftrong bitter extract, equal, in my opinion, to the extract of gentian. 2(1 ( i«4 ) 2d. I infufed four ounces of the frefh bark, cut into fmall pieces, in a quart of proof fpi-? rit, from which I obtained a tincture which poffeffed a tzfoefimply bitter, and of a peculi- arly mild.nature. 3d. 1 boiled an ounce of the dried bark in a quart of water, to a pint—-the liquor was bit- ter, but lefs fo than the tincture made with fpirit. m 4th. I infufed an ounce of the dried bark in a pint of water for twenty-four hours. The infufion was bitter. 5th. In attempting to reduce the dried bark to powder, I found it broke in fmall fi- bres, fo that little powder was obtained from it. Upon toafting it a little over a flow fire, jt was pulverifed without difficulty. The powder was ftrpngly impregnated with a bit- ter tafte. I have prefcribed this new bitter feveral times, and have found it equal to moft of the common bitters of our fhops. I ( »85 ) I have no doubt of its efficacy in all thofe (difeafes in which mild bitters are ufed. Con- fidering how great a proportion that clafs of medicines compofes of the quantity and ex- pence of all our prefcriptions, efpecially in chronic difeafes, I flatter myfelf that the intro- duction of a new article belonging to that clafs, and which may be procured in great quantities in every part of pur country, at a trifling expence, will be an acceptable addi- tion to the interefts of medicine in the Uni- ted States. I have accompanied this communication with fpecimens of each of the preparations of ihe root, which I fubmit to the examination of the College. May 2d, 1791. P. S. Since the above communication, I have prefcribed a large quantity of the root of this bitter in powder; and, I am happy in being able to add, with as much fatisfadion as any of the common bitters of our fhops. May 30, 1793. XVIIL ( 1*6 ) XVIIL An Account of afingular Cafe of the Small- Pox, fuccefs fully treated by the plentiful ufe •of Bark, fermented liquors, and animal food. By Benjamin Rufh, M. D. &c. Read July 5, 1791. SAMUEL EWING, aged twenty-five,* citizen of the State of Kentucke, was feized, foon after his arrival in our city from a fea voyage, with a fever, which, from the circurnftances and fymptoms attending it, I judged to be the eruptive fever of the fmall- pox. I was called to him on the 24th of May, when his pulfe was adive, but not fo tenfe or full as to require bleeding. I ordered him a dofe of tartar emetic and calomel, which operated plentifully both upwards and down- wards, and gave him confiderable relief. Two days afterwards an eruption appear- ed on his fkin, attended with delirium. His pock ( '87 ) pocks were diftind, but very fmall, and fo numerous, that every part of his body was covered with them, except a fmall fpace on his neck and breaft. His appearance gave me but a flender hope of his recovery; but I was refolved to attempt it—For this pur- pofe I began by applying a blifter to the neck, which removed his delirium in four and twenty hours; and by giving him calomel in fmall dofes, with a view of fupporting and Attenuating the difcharge from the faiiv?.ry glands, during the fecondary fever, a mode of treating that fymptom which I had purfu- ed with fuccefs in many cafes, before the pradice of inoculating became general in our city, and which I learned from my firft Pre- ceptor in Medicine the worthy Prefident of our College. I gave him, at the fame time, the bark, increafing it gradually from two drachms to two ounces a day. On the 5th day after his eruption, all the pocks below his knees were of a purple colour, and a large mortification was difcovered on both his buttocks. Not the leaft fwelling appeared in his face, or matter in his pock; nor was there any tendency to a defluxion jon ( i88 ) on the glands of his throat. The danger of thefe fymptoms was much increafed by the heat of the weather, for the mercury during their worft ftage flood at 90 ° in Fahrenheit's thermometer. Such was the fmell which came from his body, at this time, that it was perceived^in every room of the houfe in which he lodged. In this fituation of my patient I ordered him to drink wine, porter and cyder in large quantities, and recommended his eating plen- tifully of animal food. Soon after the ufe of thefe cordial remedies, the pocks afTumed a better appearance, and a vigour was given to his pulfe which encou- raged me to entertain ftronger hopes of his re- covery. I ordered his nurfe to cut off the heads of the pocks with a pair of fciffars, and to wipe the matter from them with a foft piece of cloth, and afterwards to bathe them with equal parts of rum and vinegar—alfo with oil of turpentine and fweet oil. His room was fumigated with vinegar, and with burnt gun-powder and tobacco, every day— and ( 189 ) and his feet and legs bathed twice a-day in warm water. The greateft attention was paid to fre- quent changes of his linen. Opium was gi- ven, occafionally, both day and night. Its dofe was regulated by the ftate of his bowels, and by the prefence or abfence of fleep. On the 8 th of June the fcabs began to fall off, and on the 12th of the fame month I confidered him as out of danger. A flight cough con- tinued for a few days after, which yielded to a diet of mufh and milk.* Th e following circurnftances in the above cafe appear to merit attention. i ft. There was no fwelling in the face or falivation in any ftage of the diforder. Dr. Sydenham fays he never faw but one cafe of a recovery from a malignant or dangerous fmall-pox, without a falivation. I never faw one before, and never an inftance- of fuch a number * This cough was fo much increafed after every dofe of bark he took, in the beginning of his, convalefcericey that I was obliged to leave off giving it to him foone* than I intended. ( *9° ) number of pocks, accompanied with fo little fwelling, which did not terminate in death. 2d. The quantities of fermented liquors which were taken by this patient. Thefe li- quors were gradually increafed and gradual- ly diminifhed as his difeafe advanced and de- clined. He drank five bottles of porter on the 7th day of June, three bottles en the 8th, and two and an half of cyder; three bottles of porter on the 9th, two on the 10th, and one a-day for three days afterwards. Thefe liquors have an immenfe advantage over ar- dent fpirits, in conveying nouriihment into the body, and thereby extending a more du- rable ftimulus to every part of the fyftem. 3d. A third circumftance attending this cafe was, his plentiful ufe of animal food, confift- ing chiefly of falted ham and tongue, and cf beef-fteaks. Tins was likewife increafed and diminifh- ed with the increafe and decline of his difor- der. He took about eight ounces of this fo- lid and ftimulating diet on the 7th of June ; fix on the 8th, and i\\e on the 9th—with each ( '9i ) each of thefe meals he ate a large quantity of bread and green peas. He drank likewife oc- cafionally of ftrong coffee, with which he eat plentifully of bread and butter. 4. Befides thefe unufual quantities of cord- ial ' drinks and diet, he took, in the courfe of his illnefs, a pound and an half of the pow- der of bark. I should be ungrateful in clofing this account of Mr Ewing's cafe, without ac- knowledging my obligations to the nurfe who attended him. All my diredions were executed by her with a degree of fidelity, judgment, and humanity which contributed greatly to his recovery. I hope our College will permit me to mention her name in this commemoration—It is Mary Waters. Whole pages of hiftory have often been fill- ed with the exploits of perfons lefs worthy •f being known to the public. June 16, 1791. P. S. I have had an opportunity laft month of feeing the good effeds of cordial and ftimulating aliment in a cafe of typhus 4 fmall- ( *92 ) fmall pox in a black woman, an hired fervant of Peter Miller's of this city. The pocks were Very numerous—and for a while flat and wa- tery. There was fcarcely any fwelling in her face. She ate every day two or three boil- ed eggs, Ukewife frefh and falted meat, and drank plentifully of fermented liquors^ She is now in good health. June 4th, 1793. XIX. An Account 0} the Effecls of Electricity, in the removal of an ObftrucTion in the bi- liary duel, in a letter from Dr. Jacob Hall, Principal of Coke/bury College in Maryland, to Benjamin Ruih, M. D. &c* Read Auguft 2, 1791. " A M O N G S T the many well-attefted jljL inftances of the good effects of Elec- tricity in the cure of difeafes, I beg leave with gratitude to mention, for the benefit of others, a recent cure effeded in myfelf; by the re- moval of an obftrudion in the biliary dud— i a cafe ( *93 ) a cafe which! do not remember to have feeri upon record— \bout the latter end of Febru- ary laft, while engaged in the duties of my ftation, 1 was fuddenly feized with a fharp, pungent pain of the ftomach, accompanied with an unufual diftenfion, and fixed pain in the region of the liver—;—I repaired home as fpeedily as poffible, through a heavy rain, where as foon as I arrived, a fpontaneous vo- miting came on, which continued till evening, when, by the power of an anodyne, the vo- miting ceafed, and I enjoyed a tolerable night In the morning j attempting to rife, I was ar- refted by a fhort fyncope or fainting fit—af- ter which the vomiting returned} together with the pain in the right hypocondrium as before. As foon as the vomiting (but not the pain) had yielded to medicine, I began to examine into the caufe of my complaint, which, from the ideric fymptoms, I knew to be the jaun- dice, and the proximate caufe, an obftrudion in the biliary dud—I had recourfe to the medicines commonly prefcribed in this dif- eafe, without being able to remove the pain— which continued for feveral days, with vari- ous decrees of intenfity and remiffion, while I enjoyed eafy nights from the palliative power Vol. L N of ( IQ4 ) of opium. Tired, at length, of this amufing medicine, I thought of taking reft without it—the confequence was a painful, reftlefs night ; but during my refledions on the re- medies recommended by medical writers for expelling Gall-fiones, it was fuggefted to me, that Eleclric fire would effed the cure. Ac- cordingly, in the morning, with pain and diffi- culty, I came to the college, and the ma- chine being put in order, I received three firong fhocks, which paffed through my left arm and breaft, and out of my right fide, through the part affeded; after which, the pain fuddenly and entirely ceafed ! and, in the evening, a diarrhoea came on, which, by its appearance, demonftrated that the obftruc- tion was removed. N 2 XX. ( l9S ) XX. Medical FaBs and Obfervations, extraBed from a letter from Mofes Bartram, M. D. of St. Paul's Parifhy South Carolina, to Ben- jamin Rufh, M. D. &c. Read September 6th, 1791. THE hiftories of difeafes and daily ex- perience confirm the great variety of types difeafes affume from the operation of climate, the arts and refinements of a po- lifhed life, peculiar fituation and intercourfe of men, and the various modes of treatment; but notwithftanding the dark veil thofe com- bined caufes throw over the genuine face of nature, a prominent feature will always pro- trude here and there, to lead to a difcovery of the truth—Natura femper eundem habet modum et fimpliciter. A long continued feries of particular motions or adions, gene- rates ( ^ ) rates a peculiar and more or lefs durable difpofition of parts, effluvia, or humors, which, agreeably to the well known axiom of like caufes producing like effeds, will propagate and reproduce fimilar ones. The former be- ing entailed on the pofterity, pre dace heredita- ry difeafes; and the others, by coming in con- tad with bodies predifpofed to morbid changes. Many difeafes, originally or naturally quite void of infedion or contagion, may become fo from a particular concurrence of circurn- ftances, and may lofe that quality entirely, or in part, from other caufes. Thus dyfentery, fcurvy, confumption, influenza, and fome of the impetigines, have been alternately afferted and denied to be infedious or contagious. I have been led to adopt the above notions from obfervation of feveral cafes of Lepra in this country, and of a moft terrible univerfal eruption of the pfora genus, infefting the in- habitants on the Eaft coaft of Africa; of which I faw and attentively examined feveral cafes in fome fhipwrecked Frenchmen, whom we took aboard from the Ifland Johanna in my voyage to the Indies. The latter, though in a refidence of feveral months on the ifland, and. ( T97 ) and a ftay of near two aboard our fhip," did not communicate the leaft of the infedion to any body in the freeft intercourfe and famili- arity with the moft of the company. I have feen feveral cafes of Lepra here, which Dr. Cullen and moft writers declare to be infec- tious ; but the patients, from the united tefti- mony of many people lived in families in the moft unreftrained fociability for years with- out the leaft bad confequence to any body. I have known feveral people thus affected, who folemnly declared, that their complaints arofe from fudden expofure to cold, when excef- fively heated ; and from the exadnefs with which they traced them, it was indifputably the truth. A lady informed me lately that, fome years ago, fhe laboured under a moft fevere tym- panitis inteftinalis above a year, which was miftaken fome months for pregnancy, and at length reduced her fo low, that her life was de- fpaired of, and her phyficians, men of great emi- nence, gave her over. One day fhe conceived a ftrong fancy,for tobacco, which fhe indulg- ed ( '98 ) ed herfelf in, fmoking moft liberally; and in a very fhort time, was both furprized and de- lighted with a fudden relief from her extreme mifery, by the total fubfiding of her tumid abdomen, and a copious expulfion of the fla- tus. She fpeedily recovered her health, but for fome time was liable to a return of her complaint, which baffled all the tonics and ftimulants that could be devifed, and readily yielded to tobacco fmoked. The hint I have often heard you give of the probability of a fpecific adion of certain fubftances, as of fome being confined to the nerves, and others to the vafcular fyftem, feemed to receive fupport from a very interef- ting cafe I fome time fince had under my care. A child three years old, was feized with infi- nity or rather idiotifm, fuddenly, without the fmalleft degree of fever, or any other com- plaint to account for fo ftrange an affedion.— The parents were greatly alarmed and fent for me;—I arrived when the child had been a few hours in this condition, examined it very clofely, found its pulfe moderate and na- tural, no preternatural heat or flufhing, no thirft, ( 199 ) thirft, tongue clean, no internal fundion whatever difturbed, but thofe of the brain ; the child was to all appearance happy, talk- ing all the incoherent nonfenfe that can be imagined, laughing, and in conftant motion ; but laboured under fo great a debility, that it could not ftand or walk without tottering; and feveral times in attempting it fell down ; it was a perfed delirium mite. I had fortu- nately feen feveral fuch cafes from eating the feeds of the datura ftramonium, or thorn ap- ple, in Philadelphia, which made a confider- able impreflion upon me. Perfuaded that the cafe before me was an©ther of the fame kind, I queftioned the patients ftridly, if the child had not been eating fomething impro- per ; they anfwered confidently in the nega- tive ; I ftill expreffed my doubts, and at laft told them pofitively it had been taking fome of the above apple; they were furprifed at my obftinacy, and declared none grew near the houfe.—I immediately gave it a large dofe of tartar emetic, recolleding that, in the for- mer cafes, there had been a great infenfibility of the ftomach ; this not proving fufficient, and the child taking the medicine with re- ludance, ( 20Q ) ludance, I introduced a funnel into the mouth, and forced down a great quantity of warm wa- ter,which had the defired effed.The matter was now determined ; I was highly gratified and the byftanders ail aftonifhed at the fight of a table fpoonful of the feeds and the thorny co- vering. The child after this improved rapid- ly, and in a few days was perfedly recovered- I lately attended a cafe pf pleurify in a vio- lent degree in a negro man, middle aged, whom I bled on the third day of the difeafe, being the firft vifit, and notwithftanding this, bliftering and all theufualremedies,it went on ragingwith a burning fever, till the 9th day, with a con- ftant fweat all the time, when his fpirits and ftrength were exceffively reduced, and his pulfe intermitted and fluttered in a remark- able degree, from three to nine or ten pulfa- tions, ftrong and rapid, followed by an inter- miffion equal to the time of five or fix. This remarkable irregularity continued between two and three days. This, with other fymp- toms equally threatening, made me almoft de- fpair; but I did not relinquifh him, as I make it a point never to give up a patient. What was to be done ? There was no apparent dif- ficulty ( -aoi ) Acuity of expedoration,—cough mild and moderate. I had tried every thing that could be thought of, without effed—a brifk vomit prefented itfelf to my mind as as the laft re- fource ; I gave it; was amazed at the fuccefs, and faved my patient. He difcharged a great quantity of vifcid olive-coloured phlegm, and felt immediate relief. I mean to repeat this experiment, and hope to find it of great confe- quence. It is a general remark here that one bleeding in the pleurify is fiifficient; and a certain eminent phyfician, fome time deceaf- ed, famed for his fuccefs in this difeafe, ufed to truft entirely to one bleeding as early as poffible, and profufe Sweating. I have ob- ferved in feveral fuccefsful cafes, a very great diaphorefis kept up with great eafe, five or fix days, with a rapid tolerably ftrong pulfe the whole time. Does not this invalidate Dr. Cullen's dodrine of fever ? A strong defire to have my doubts re- moved upon a matter of fome confequence, induces me to trefpafs a little farther upon your patience. I lately had a moft obftinate cafe of colic, moft probably from cold, though it differed confiderably from all the fpecies de- fcribed ( 202 ) fcribed in nofologies and commonly met with. It is an eftablifhed opinion among the Blacks, and indeed many Whites, that the negroes are very apt to poifon one another, and that the effeds produced are exadly, ad punBum, like the cafe to which I allude. It was a moft obftinate conftipation, with tumefadion, ten- fion, and pain of the abdomen, frequent, almoft conftant vomiting, and quick full pulfe for feven or eight days. At the end of this time, the pulfe funk amazingly, and for three days before the happy relief from the remedy to be prefently mentioned, it was like a mere thread with the pulfation too quick to be num- bered, extremities cold and debility extreme. Having tried lenient and ftrong purges, vari- ous enemata, opium, heat, in a dry and hu- mid form, ftimulant fomentations, and a blifter to the abdomen, without the leaft advantage, and placing no dependance on argentum vi- vum,from the ill fuccefs of it in a variety of cafes mentioned both by Dr. Stevenfon and others, I was dtermined to have recourfe to the ce- lebrated remdy of the former, mentioned in the Edinburgh Medical effays, viz. cold water dafhed upon the extremities. I ordered the cold- eft water to be procured, and threw it myfelf up- on ( 2o3 ) On the legs, thighs, and pubes. He felt eafy di- redly, but had no difcharge. Ithen fwathedthe belly in a cloth^ dripping wet with cold water, and fome time after repeated it to the lower extremities.—In half an hour after this, he had a fine difcharge, which was followed by half a dozen others very copious. From this time he .mended very rapidly. My doubts are with refped to the rationale of the appli- cation. Here was a diredly debilitating power ufed in a great degree of afthenia with advantage. This too militates againft two remedies univerfally admitted in the above complaint, viz. Laudanum, and warm bath. Does it operate by reducing the excitement, already far below the healthy ftandard, and increafing the excitability, thus taken in a ge- neral fenfe, whereby the adion of the bowels is effeded by the natural ftimulus of fasces ? Or does it ad as an afthenic power on the furface, and thus leave a relatively greater ftimulus upon the inteftines ? This is quite oppofite to one of Dr. Brown's fundamental principles, that the excitement is indivifible, univerfal, and of only one kind. L have ( 204 ) I have colleded a few more medical fads, which I will take great pleafure in detail- ing from time to time, if you fhould, dear fir, wade through this with any fort of relifh. If you will pleafe to gratify me with an anfwer, and in it point out the exceptionable parts of this epiftle with their amendments, one effential purpofe I had in writing will be fully anfwer- ed. An ( 205 ) XXI. An Account of the fudden effeBs of the affufion of cold water upon the body, in a cafe of Tetanus, by Dr. Benjamin H. Tallman, vf Haddonfield, New-J erfey. Read OBober ^th, 1791* 1WAS called July the nth, 1791, to a young woman about twenty years of age, of a plethoric habit of body, who was affed- ed with a Tetanic complaint, accompanied with Hyfteria. The fymptoms* wxere a rigi- dity of the mufcles of the neck, a pain at the lower end of the fternum, a flight ftiffnefs of the mufcles of the lower jaw, a httle difficulty of deglutition, and an hard full pulfe. -----On enquiry, I found that fhe had com- plained of a pain in the fcrobiculus cordis, three days previoufly to my being called. The only probable caufe of her complaints was a fmall excoriation of one toe, from wear- ing a tight leather fhoe, which happen- ed a week before the firft appearance of the diforder. Her pulfe being full, I took twelve ounces C 206 ) ounces of blood from her, and then gave her mufk, camphor, and one grain of opium every hour, till the fpafms fhould abate. The ' opium was continued till twenty grains were taken, which produced a fmall remiffion of the fymptoms for three hours only. I vi- fited her the 12th, and found every fymptom much increafed with the lofs of her eye-fight, hearing and fpeech. She was coftive; an enema was exhibited. The medicines were continued with the addition of Pilulse Fcetidae and Unguentum Cceruleum. On the 1 3th, I found her no better. I vifited her on the 14th, and found her diforder much increafed; her de- glutition was obftruded, fo that not the leaft medicine 01 aliment could be taken. I re- quefted that a phyfician fhould be called from Philadelphia. Dodor Rufh was fent for, who recommended an affufion of cold water over her whole body. Her pulfe was now full and foft:—A large bucket of water from the river was thrown over her, which produced inftantly a fyncope that lafted upwards of half an hour. When fhe recovered from this .ftate fhe fpoke, and in half an hour more fhe was able to fwallow. Immedi- ately after the fyncope went off, her ca- temenia ( 207 ) temenia returned, a few days before their re- gular time of approaching. On the 15th, I gave her a few drops of aether and the oil of amber, and. on the 16th, fhe took bark and wine in Hberal quantities; from the ufe of all which remedies, fhe was, in a few days, reftored to perfed health. XXII. Cafe of Anthrax, by John Jones, M. D. late Vice-Prefident of the College. Read De- cember 6, 1791. AS the following cafe may throw fome light Upon the treatment of a difeafe, violent and painful in its nature and frequently dangerous in its confequences, the College may not think it undeferving a place in their colledion. IN the month of January, 1789, I was de- fined to vifit a lady approaching her 60th year, but of a good conflitution, adive and 4 healthy ( 208 ) healthy : fhe was then confined to her bed, but as the fymptoms, which previoufly at- tended her, appear very charaderiftic of the difeafe, I fhall relate them in her own words as communicated to me in a letter. " Early in the month of January, I found my felt ex- tremely indifpofed, attended with an unufual depreffion offpirits, and a want of appetite, which I could by no means account for—I felt a feverifh heat and conftant thirft—had frequent chills, and foon perceived a difagree- able fenfation upon the back of my neck, which I compared to the crawling of cater- pillars, and very often it appeared to me as my handkerchief was riling from my neck. A few days after this fenfation began, a fmall pimple made its appearance juft below the neck bone, attended with excruciating pain— my fleep was difturbed by frightful dreams. One night particularly, I fancied I was thrown upon a grate of red hot coals, and that my neck burft into burning flakes—I awaked in the utmoft terror, and related this dream to the family—I complained more and more of the inflammation which gave me ftill greater torture, and had then affumed the appearance of a fmall angry blind bile—the night before 2 I ( 2°9 ) my chamber, which was near a fortnight from my firft indifpofition, as I went up ftairs I felt a fhock through my whole frame, as fudden and general as a fevere fhock of eledricity—A poultice of bread and milk was then applied, and continued for three or four days till you was called in-----At this period, when I firft faw her, the inflammation had extended itfelf from the firft vertebra of the neck to the inferior fpines of the fcapula, and from fhoulder to fhoulder—the tumour was extremely hard, of a deep red colour in the circumference, but approaching to livid in the central part with very little elevation of the fkin—her pulfe was quick but not full— her thirft great, with a conftant fenfation of heat, like burning coals upon the part affeded, which was now evidently tending to a mor- tification.—Under thefe circurnftances, the principal curative indications appeared to be a proper fupport of the patient's ftrength—a re- o-ulation of the natural iecretions and excretions, t> and'at the fame time as much alleviation of the extreme burning pain as could be prudently procured by anodynes. With thefe views, a poultice of the farina lini was applied over Vol. I. O the ( 31© ) the inflamed parts, and renewed every fix or eight hours—a diet, confifting of gruel, pana- da, and wine whey, was ordered in fuch quan- tities as her ftomach would bear—the body was kept gently open by emollient glyfters—■ fhe took a tea-fpoonful of bark in powder every four or five hours, and, at night, fuch a quantity of laudanum, as ferved to compofe her for a few hours. Under this manage- ment fhe continued till the 19th day from the firft application of the poultice, when the whole extent of the inflammation appeared of a deep black, and completely mortified. Preffure with the fingers upon the mortified parts, though very hard and tenfe, evidently indica- ted, from a crafhing undulating noife and feel, the exiftence of fome fluid beneath, and in- duced me to make a longitudinal incifion through the true fkin the whole length of the tumour, by which means a large quantity of tolerably well digefted matter was not only difcharged from the cavity, but large por- tions of it poured from the cells of the true fkin become perfedly fpongy and enlarged to the thicknefs of an inch and a half—This ope- ration gave not the leaft pain; but, on mak- ing ( 211 ) ing another crofs incifion, feemed to afford a fenfible relief, by taking off a moft uneafy ftridure which fhe had before complained of —The wound was dreffed with foft lint, cover- ed with fimple cerate, and a thick comprefs, dipped in brandy, laid over the whole. As the difcharge was very great and offenfive, it was dreffed twice a-day, and the comprefs fre- quently moiftened with brandy. The ufe of the bark was continued, her diet rendered more cordial by a liberal ufe of wine, and dif- ferent portions of the mortified membrana adipofa daily removed, till a complete fepa- ration between the found and mortified parts took place ; but as this feparation, which was the work of nature, left the edges of the fore with large flabby irregular lips, under which the matter lodged, and prevented a re-union, I was under the difagreeable neceffity of re- moving them from the whole circumference of the fore. This was a very painful ope- ration, but it was abfolutely neceffary, and fhe bore it with great fortitude. From this pe- riod, the cure went on very happily, though (lowly, and in the beginning of June, the O 2 fore ( 212 ) fore was rompleatly healed, leaving a cicatrix, of a radiated form, eight inches long and five broad. Her' health has been fince very good, and fine finds no other inconvenience, than a degree of tightnefs and reftraint in the motions of her arms about the fhoulders. ( 213 ) XXIII. THERMOMETER. JANUARY, 1791. 1 2 3 4 5 6 7 8 9 10 11 12 *3 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 3° 31 at 8 A. M. 15 at 2 P-M. 21 9 3° 14 34 32 40 35 40 36 45 40 48 35 32 27 27 34 39 27 28 22 32 31 49 36 49 38 4i 37 44 32 38 31 36 23 25 26 34 32 46 29 22 17 32 23 34 37 48 38 5° 33 44 29 31 l9 33 34 40 20 28 ( 214 ) FEBRUARY, 1791. at 8. A. M. 20 at 2 P. M. 2 30 3 20 4 32 5 34 6 35 7 39 8 49 9 25 10 24 11 23 12 30 13 3° M 35 15 23 16 39 17 6 18 '4 19 27 ao 27 21 20 22 *5 23 28 24 25 25 26 26 40 27 31 28 5* , 26 32 32 39 35 44 50 60 25 32 3^ 4i 39 54 35 3* 30 32 32 25 39 42 33 37 41 54 52 ( 215 ) MARCH, 1791. I 1 at 8. A. M. 28 at2. P.M. 33 2 28 42 3 3* 52 4 36 49 5 34 48 6 42 i6 7 52 62 8 36 45 9 31 45 IO 48 60 ii 46 44 12 43 49 *3 45 44 *4 37 48 *5 47 52 x6 44 57 17 45 77 18 42 79 x9 47 38 20 33 38 21 3d 5i 22 44 SO 23 39 52 24 48 64 25 54 62 26 43 5» 27 40 52 28 37 45 29 43 54 30 31 45 40 55 60 ( 216 ) APRIL, 1791- I at 8. A. M " 45 at 2. P. M. 63 2 43 61 3 32 60 4 37 52 5 40 55 6 35 54 7 3.8 56 8 40 5° 9 38 56 10 43 57 11 45 68 12 50 76 *3 60 75 14 42 54 *5 5° 60 16 5° 60 37 5° 66 18 5^ 7° 19 49 *5 20 47 66 21 47 °7 22 57 ^9 23 60 73 24 52 65 .25 54 80 26 55 70 27 45 65 28 53 62 29 54 71 3° 55 68 ( 2*7-) MAY, 1791. 'i at 8. A. M. 55 nt 2. P. M. 79 2 52 7* 3 1 54 66 4 55 70 5 59 68 6 5Q 60 7 47 60 8 5° 66 9 55 71 IO 49 77 ii 61 84 *2 65 82 T3 65 81 14 5° 61 *5 66 71 16 57 73 J7 5? 75 18 60 77 '*9 60 76 2b 60 7* 21 55 7° 22 60 74 23 55 81 24 62 82 25 70 7? 26 *5 82 27 69 84 28 70 87 29 70 8P 3° ' 7,i 9* ( 218 ) I 2 3 4 5 7 S S> 10 IX 12 *3 14 H 36 J? *$ So 31 32 *3 34 35 ±6 37 28 39 30 at 8. A. M fE, 1791. *5 at 2. P. M. 79 66 80 7i 80 66 75 62 80 66 78 63 76 64 87 74 93 75 80 *5 «5 do 86 70 9l U 93 84 do 85 72 92 74 85 75 88 57 74 5» 74 60 80 70 88 76 89 76 89 74 92 70 80 62 84 62 81 65 « \ ( 2T9 ) JULY, 1791. I at 8. A. M. 6^ at 2. P. M. do 2 57 75 3 62 77 61 76 4 5 A 60 77 62 86 7 8 70 88 72 92 P IO 72 9i 73 95 ii T 9 7i 73 94 86 IZ »3 14 t r* 72 «? 75 95 73 94 *5 16 75 68 80 52 *7 x8 63 76 62 80 *9 20 21 22 *3 7i 7<5 72 8i 83 9i 86 23 73 9o 24 68 84 25 2<5 d4 88 ^5 87 27 28 65 68 9o 89 29 30 72 83 3*J 74 «5 ( 220 ) AUGUST, 1791. I ,' at 8, A. M. 70 at 2. A. M- 9? 2 63 82 3 •63 86 4 66 84 5 65 87 6 67 »S 7 7* 88 8 70 87 9 72 88 10 75 88 11 74 82 12 7i 83 *3 67 81 14 68 87 x5 63 81 ?6*" 7Q 89 17 67 86 18 69 . 84 19 64 71 30 62 74 21 63 77' 22 61 77 23 66 86 24 67 88 35 7* 89 26 73 93 27' 68 92 28' 7i 91 29 86 95 3a 70 93 V 67 86 ■ I 2 3 4 5 6 7 8 9 lo ii 12 *3 M J5 16 *7 18 J9 20 21 22 23 24 25 26 27 28 29 30 ( 221 ) SEPTEMBER, 1 [791. at 8. A. M. 69 at 2. P.M. 81 62 79 61 61 60 68 62 * 7* 62 74 65 78 64 81 65 79 66 76 71 73 64 7i 59 85 63 69 57 58 52 66 5° 70 60 75 59 77 65 82 60 74 57 75 7* 82 70 82 65 72 58 60 62 74 55 69 51 69 60 81 ( 222 ) OCTOBER, 1791. at 8. A. M. 61 at 2. P. M. 82 70 82 61 64 40 58 53 64 42 66 41 70 48 69 45 67 40 49 40 *S 47 67 36 5* 33 63 5i 75 44 5° 39 54 32 3* 36 5«> 37 40 36 5^ 30 43 30 5° 33 54 40 49 42 59 35 52 39 55 41 60 44 67 57 68 ( 1*3 ) NOVEMBER, 1791." z at 8. A. M. 44 at 2. P. M. 55 2 32 53 3 40 3* 4 " 27 32 5 29 52 6 37 55 7 33 61 8 34 62 9 40 5<> 10 46 51 11 37 50 12 3° 49 J3 36 52 14 5° 67 15 51 54 16 49 54 17 3° 44 18 28 40 19 32 49 20 28 4* 21 37 59 22 42 59 23 3i Is 24 40 60 25 45 49 26 30 37 27 29 50 28 30 49 29 3° 3«> 5« 2 ( ' a*4 ) DECEMBER, 179'- I at 8. A. Mi 49 1 at 2. P.M. 63 2 43 40 3 27' 37 4 26 38 5 3° 34 6 31 32 7 21 25 8 l9 28 9 22 32 io 25 39 ii 2^ 43 12 35 35 l3 29 "33 M 28 34 *5 27 38 16 28 47 17 34 47 18 37 42 *9 40 40 20 27 31 21 23 • 22 27 27 23 31 32 24 20 28 25 23 39 26 28 48 27 3° 46 28 33 5^ 29 33 41 3° 26 41 31 36 48 3 ( 225 ) XXIV. Cafe of Dyfenteria Chronica cured by Allum, by Dr. Michael Leib. Read March 6, 1792. A B. aged thirty-two years, was^admitted ■*• •*■" as a patient of the Difpenfary on the fixth of Odober, 1789. About eight months previous to his admiffion he was attacked with Dyfentery. At his admiffion his dejedions were frequent and bloody, the tormina and tenefmus confiderable, with little or no py- rexia—he was much emaciated, and rendered unable to work—Cathartic, ftimulant, and a- ftringent medicines were exhibited for a long time, but without effed—His body at length exhibited a cachedic appearance, his legs became cedematous, and general anafarca feemed to be forming. Finding the ineffica- cy of emetics, cathartics, opium, the bark, cinnamon, port wine, &c. on the fixth of May, 1791, I exhibited the following mix- ture. Vol. I. P r. Al- ( 226 ) r. Aluminis 3}. Tindt. thebaic, giij. ----Cort. Peruv. Inms. Amar. aa Jiv. m. cap. coch. mag. an. quater in die. Opiate pills wTere conftantly given at night. He felt fome relief from the mixture, and had it repeated on the fifteenth, in the follow- ing manner. r. Aluminis 3ifs. Tinft. Opii 311J- ----Cort. Peruv. Jvj. m. cap. ut antea. Th 1 s mixture made an evident impreffi- on on his difeafe. On the 2 2d he had it re- peated in the following proportion. r. Aluminis 31J. Tinft. Opii siij. Inms. Amar. Tinft. C. P. aa Jiv. m. cap. ut antea. His health now became much improved, his countenance was animated, and the oede- ma fubfided. On the 31ft. the laft prefcribed mixture was repeated, and compleated his cure. Lest , ( **7 ) Lest it might be fuppofed that the cure was owing t© the other medicines which were exhibited with the alum, it may be pro- per to remark, that they were adminiftered for a long time without the alum, and with- out effed;, XXV. An Account of one of the Caufes of the Trif- mus Nafcentium. By the late Mofes Bar- tram, M. D. of South-Carolina, extraBed ftom a Letter to Benjamin Rufh, M. D. &c.—Read May i, 1792. NO T a little chagrined fince entering in- to practice in this country at the uni- form fatality of the Trifmus Nafcentium, fa prevalent among the infant negroes, to which I have often been a painful witnefs, I have applied myfelf to difcover its caufes, not only for my own fatisfadion, but to endeavour, if poffible, to cut off one of the many ave- nues to death. If future experience and obfervations fhould prove my opinion of one of its caufes to be P 2 well { 228 ) well founded, 1 fhall enjoy the confolation- of having elucidated an obfcure fubjed—for I can trulv aver, that I have never feeh or heard a fmgle hint refpeding the caufe of which I am about to attempt the explanation.' The mifmanagement of the navel very lic-n after birth, peculiar to the negroes, is the fource of this direful malady. After making the ligature, and cutting the umbili- cal chord, they very often negled to fwathe or bandage the abdoYnen, whence the drop- ping of the piece is retarded, the umbilicus is diilended and puffed out even with the natu- ral moderate efforts, but much more when vi- olent ftruggles are excited in crying, and colic, occafioned fometimes by the mother's milk, rendered pernicious by unavoidable errors in diet, their hard fate often compelling them to food of a deftrudive quality. When it drops there is commonly left a bad ulceration both from the caufe jufl mentioned, and the fridi- on of loofe coarfe cloths. The violent irrita- tion from this fore, even with lenient, emolli- ent dreffings, in fuch delicate fyftems, feems competent to produce the difeafe; but how much more fo> when, inftead of endeavour- ing ( 229 ) mg to abate it by fuch means, they augment the evil by the worft of dreffings, viz. burnt rag or burnt lint. This they invariably ufe. It not only fuddenly conftrids the ulceration, but at the fame time violently irritates—the gradual depletion of the veffels is checked, they become diftended, and inflammation is the confequence. When it is healed, this procefs is fo rapid in the integuments, that the parts beneath, from a want of fuffici- cient digeftion, do not accommodate them- felves, but fuffer violent ftretching in every ef- fort of the abdominal mufcles, which, from a negled of the neceffary precaution of tight bandaging, eafily yield to any increafed adi- on of the interlines preffmg againft the um- bilicus : Hence the very frequenj: tumefied na- vels, fo many partial hernia umbilicales among negroes. This reafoning will be rendered more pro- bable by a fhort lketch of the hiftory of the difeafe. For the moft part it makes its attack with the dropping of the cord. It never oc- curs before the ligature falls, though it fome- times, but very rarely, dees feveral days, nay 3 ( *3° ) a week after it is entirely healed, to appear- ance. Howrever this will not in the leaft in- validate our pofition or furprife us, when it is compared with feveral inftances upon re- cord of tetanus in adults taking place long af- ter the wound is perfedly cicatrifed. In this cafe the difeafe can always be traced to the healing of the cord, though at firft the fymp- toms were obfcure, the child only fhewing a reftleffnefs until the evil is manifefted in fpafms. It moftly comes on about the ninth day after the birth, and then feldom lafts a- bove three days. But when it comes on two or three weeks after birth, it is mucli flower in its progrefs to death, which is the infalli- ble termination of it after the jaw-fall is con- firmed. .All the cafes I have feen, or heard of from others, after diligent enquiry, are melancholy proofs of this truth, notwith- ftanding the affiduous exhibitions of unguen- tum mercuriale, opium, warm bath, purga- tives, enemata, eataplafms to the navel, and univerfal fridion with oil. Though this fpe- cies of trifmus is affuredly fatal after it is fix- ed, a reform in the treatment of the navel, both before and after the decay of the rem- nant .( 23* ) nant of the cord, holds out a certain and ea- fy preventative. What gave birth to the foregoing theory was a cafe to which I was called fome time ago, but an hour or two before the patient's death. The child was three weeks old. It being only the fecond cafe I had feen, having had no information concerning this difeafe, I did not attend to the navel, or fufped any complaint there, till the attendants mention- ed it, and defired me to examine it. I found it much fwelled, inflamed, and ulcerated, with burnt rag covering it, which immediately ftruck me as the fole caufe of all the mif- chief. The firft fymptoms of the difeafe, though obfcure, came on a few hours after the firing dropped, which happened eleven or twelve days before, when the inflain- mation and ulceration began, and conti- nued increafmg till death. The convulfive twitches in the back were in the beginning trifling, and repeated after very long inter- vals. They gradually became more frequent and violent—the mufcles of the jaws rigid and contraded, but deglutition very little, if at all, impeded. At length the fpafmodic ri- gidity became general from head to foot, not a ( 232 ) a fmgle mufcle of voluntary motion but the eye-lids relaxed, with frequent paroxyfms in which it lay quite infenfible, with the refpi- ration fuppreffed almoft to ftrangulation, hands clinched, and feet contraded. Very fcanty difcharge of fxces in hard, roundifh fcybala, like rabbits'. This was the condi- tion in which I found it, and in which if died. XXVI. Practical Obfervations on Phthifis pulmonalis ; ExtraBed from a letter from Ifaac Senter, M. D. to Dr. William Currie. Read Auguft 7, 1792. WITH refped to the kaumis, which vou hint as beino; ferviceable in con- fumption, I can fay nothing pradically. I have feen mention made of it in the tranfac- tions you fpeak of; but notwithftanding this, and every other aid that the very imperfed art of medicine can devife, I have long fince defpaired of ever curing the phthifis pulmona- lis ( ^33 ) lis in certain conftitutions, and in certain ftages of the complaint. Many chronic dif- eafes, may, probably, owe their caufes to debility ; ftill there are many more that fall under that defcriprion, which I am by no means fatisfied with as the origin of the com- plaint. A faulty organization appears to me to induce a very confiderable proportion of the difeafes both of body and mind. There are many perfons afflided with chronic difeafes, which terminate fatally, who, till within a fhort time of their death, difcover no confider- able atony or debility in the digeftive or chyli- ferous organs, and many of thofe who do difcover fuch complaints, bear the tonic or corroborating plan of medicine, but very imperfedly and perhaps not all. In the cure of the complaints of the breaft, one very effential point appears to me of the greateft confequence for the patient to have effeded, that is, to adjuft by the thermome- ter, the temperature of the atmofphere to the morbid ftate of the body. This may be done in our northern climates, where the circum- ( 234 ) circurnftances of the fick will afford it with- out the inconvenince of changing their place pf refidence.-— The extreme antiphlogiftic re- gimen, and other treatment of the fick, fo flrenuonfty infilled on by many European writers in this difeafe, as well as in all the complaints of the lungs, I am fearful has done much injury in the pradice of medicine. I have tried it with all the zeal that Fothergill or Fordyce ever recommended it, and have been foiled in many cafes. For after eight or ten bleedings, with a ftrong huffy blood every time, the difeafe advanced without my being fenfible of any other change, than a more or lefs diminution of the ftrength after every fuch evacuation. Writers in general on the phthifis that I have perufed give me but little fatisfadion. I know of no author, who has fo clearly and fully defcribed" the glandular -confumption as I could wifh, and at the fame time pointed out the true charac- teriftic marks, by which they might be known from thofe arifing from other caufes. In this fpecies of phthifis, I am very fure, little depend ance is to be put upon the ufe of the ( *3S ) the lancet: ftill it is but too common to fee it recommended.—Dr. Ruffel, fome time fince, favoured the world with a valuable treatife on the difeafes of the glands ; but as the lym- phatic fyftem was but very imperfedly un^ derftood then to what it is now, there is un- doubtedly great room for improvement on his effays. One of the moft valuable medicines that I have ever ufed in the tuberculous or glandu- lar phthifis, is the vitriolum c$ruleum; for the ufe of which I am principally indebted to the remarks of the bold, dogmatic, and eccentric Maryatt. He advifes it united witli the tar- tar emetic as a vomit; butl have found, from experience, that it not only almoft entirely deftroyed the emetic power of the tartar by this union, but that it would oftener purge than vomit. To prevent fuch an injurious operation of this medicine, 1 now unite the ipecacuanha with the vitriol in lieu of the tartar, which is peculiarly ferviceable when we wifh to vomit a phthifical patient, who lias at the fame time a diarrhoea. For this purpofe, I commonly give five pills, con- taining ( 23« ) taming from feven to ten grains of each of thefe ingredients, in the morning falling, and direct that nothing be drank to urge the emetic effed:. If five or fix plentiful evacuations are produc- ed by this dofe, I generally continue the fame quantity in the fubfequent vomitings,but if not, I increafe the dofe to fix or more pills of the fame kind. Thefe emetics I frequently repeat every fecond or third day, according to the irritability of the ftomach and other circurn- ftances of the fick, and in the mean time, give as much as the ftomach will bear of the antifeptic mixture of Dr. Griffith's, compof- ed of myrrh, fal martis, and fal tartar; and by thefe medicines, I can affure you, that I have reftored to health more perfons labouring un- der a hedic fever from glandular fuppurations, than by all the other medicines and methods that I have ever read of, or tried from my own invention. I look on the blue vitriol as one of the moft fafe and efficacious emetics, joined with ipecacuanha, that the Materia Medica fur- nifhes us with—Even in bilious complaints, where there are evident marks of too great an effufion ( m ) effufion of that fluid into the alimentary tube',? I totally reject the antimony and employ the vitriol. For children I have ufed the white vitriol according to the recipe of Dr. Mofely, with very good effed, and efpecially in the hooping cough, and the fummer and au- tumnal fluxes. In the afthma, from pituita, weak lungs, and obftruded vifcera ; and in the dyfpeptic ftate of the ftomach, I much prefer the vitriol to the tartar emetic, which is fo often employed to the great injury of thoufands. What makes the vitriol vomit fo preferable to the oxymel is, its not being produdive of the extreme debilitating effed; of the latter. It is faid by our old people here, that con- fumptions are more prevalent than formerly, but I am not certain as to the juftnefs of the obfervation. I cured a man two years ago in this place of a tuberculous confumption, whofe cough was very fevere, and who dai- ly difcharged large quantities of bloody puru- lent matter accompanied with fee tor. He was * ( 238 ) was much emaciated, had night fweats, and eyery evidence of a completely formed hectic. In the courfe of about three weeks, he took « twenty-four dry emetics, and perhaps half a dozen Jviij mixtures of Griffith's antihectic, and confined himfelf to a milk diet. I could enumerate a very confiderable number of fi- milar cafes, of what is called a fcrophulous phthifis, that I have cured without giving any other medicine of confequence befides the two above mentioned. XXVII. Cafe of Hydrophobia ; by Dr. George Benfell, of Germantown. Read Aug. 7, 1792. April T WAS called to the daughter of Ja- 16th. -*- cob Niece, a girl between feven and eight years old, who had been bit by a mad dog nineteen days before. The dog had never difcovered any fymptoms of difeafe until the day before he bit the child, and thofe fo flight ( n9 ) flight as not to indicate the neceflity of fe- curing him. He bit the child on Friday the 30th of March in the face, the arm, and an- kle, the marks of his teeth were fcarcely per- ceptible in the two firft places, and the blood was barely drawn from the laft. The dog- Was immediately tied; and after exhibiting evident marks of madnefs, died on the Sun- day following. The fymptoms of hydrophobia had made their appearance fixteen hours before I faw the patient, accompanied with Uncommon ap- prehenfion and uneafmefs at the fudden ap- proach of any objed, otherwife there was nothing uncommon in her actions—her fkin was moift, and the heat of her body mode- rate-—her pulfe fomewhat quickened, but by no means remarkable—her tongue was par- tially covered with a flight whitenefs, but not dry—and her underftanding was perfedly found. Notwnthftanding there was a pecu- liar dread, and wildnefs in her countenance, which was ftrongly expreffed in every fea- ture, but particularly in the pupil of the eyes, which were uncommonly dilated, although 1 the ( 24o j the pofition in which fhe lay to receive the light was favourable to producing a contrary effed ; this was obfervable in comparing them with the eyes .of feveral fpedators in the darkeft part of the room. She never complained of thirft, or expreffed any great defire to drink, but, at my requeft, confented to take fome. Her father offered to bring a tea-cupful of water. This threw her into great agitation, though he was at the extremity of the room. She begged it might be given to her in a tea-fpoon; which, though not half full, fo difconcerted her, that, until the greater part, was thrown out, fhe refufed to touch it; then with a tolerable degree of firmnefs, brought it near her lips, haftily threw it into her mouth, and fwallowed it with the utmoft dif- ficulty and trepidation—uttering deep fighs, wdiich as they were expired, bore no incon- fiderable refemblance to the whining of a dog when under confinement—~I tried to get fome bread foaked in wine into her mouth, but the effect it produced was nearly the fame. I desired mercurial fridion to be freely ufed, upon her neck, arms, thighs and legs, 3 beinS ( HI ) being prevented from exhibiting mercury in any other form as well as any other medi- cine. In the evening of the fame day, no confi- derable alteration had taken place ; the pupils ftill continued unnaturally dilated ; the white* nefs of the tongue was not more extended, but appeared in fpots—its moifture not dimi- nifhed—the pulfe perfedly regular—no un- common thirft—and the furface of the body pervaded with that due degree pf heat which might be expected in a perfed ftate of health. In the morning of the feventeenth, little or no change had taken place, except the dif- ficulty of fwallowing had fomewhat abated ; which afforded a ray of hope to the difcon- folate parents, and led to a repetition of the mercurial friction. At three in the afternoon, her apprehen- fions at the approach of any thing were con- fiderably increafed—the mufcles that perform the offices of deglutition, were ftrangely con- vulfed the moment any kind of liquor touch- ed the fauces, and fhe appeared to be in dan- Vol. I. Q^. ger ( 242 ) ger of immediate fuffocation. The pulfe was ftill uniform and moderate, and no mate- rial alteration in the colour of her tongue, and the heat and moifture of her fkin. This evening fhe was greatly alarmed at the appearance of a dog that had followed one of the neighbours into the room, and exprefP- ed the greateft anxiety for it to be turned out. In the morning of the eighteenth, I found her out of bed and dreffed ; fhe had begged for her cloaths repeatedly ; and her parents could not refift the urgency of intreaty from a beloved child. Hitherto her countenance was florid, but now it was overfpread with a general palenefs—yet 1 difcovered no altera- tion in the pupils of her eyes, which were, if any thing, rather more dilated than on the pre- ceding days. She always expreffed the great- eft joy in feeing me, and, though confcious of being ill, uniformly declared fhe felt no pain. I repeatedly afked her, why, if fhe felt no pain, fhe did not fwallow the drink given to her ? She replied that fhe would ; but eve- ry attempt demonftrated the impoffibility— her pulfe at this time was perceptibly lower, and ( 243 ) knd the fpafms were more frequent and more generally extended. At four o'clock in the afternoon, I was greatly fhocked at her fituation—every fymp- tom had evidently increafed—the fpafmodic conftriction was general, and the pupils of her eyes were fo enlarged as to leave but a line by which their colour might be known __her pulfe was fcarcely to be diftinguifhed, and the whitenefs of her tongue had chang- ed to a brownifh colour, yet even at this pe- period her underftanding was not the leaft de- ranged. She had hitherto thrown up none, or very little phlegm: but from a very fmgular ac- tion of the tongue, which was occafionally thrown out of the mouth, and performed with inconceivable quicknefs, a kind of vi- bratory motion enfued, by which fomething like froth was produced and with difficulty fpit out, At this time her dread of every thing was greatly augmented, and a quantity of vifcid phlegm was at intervals brought up, generally tinged with blood. * QjS FN ( 244 ) In proportion as this was multiplied her efforts to throw it up became ftronger, and all the mufcles in the body were more or lefs agitated in bringing this about. A kind of undulatory motion might ftill be felt at the wrift. At fix o'clock, when the phlegm, which was now conftantly propelled to the mouth, had been cleared but for a moment, fhe would ftill fpeak to her parents rationally* At ten o'clock at night, the efforts of nature feemed to be exhaufted, and this fcene of hu- man mifery. was foon to be clofed—at eleven fhe expired. I shall forbear to make obfervations on this cafe, any further than to mention, that the patient had taken the celebrated medicine of Goodman s in Philadelphia, agreeably to his diredions—-that eight drachms of ftrong mer- curial ointment had been ufed at different peri- ods of the difeafe—that fhe hadfrequently made ufe of the warm bath, and that an epifpaftic had been applied to the fear which remained from the only wound by which this wonderful poifon could have been conveyed into the fyftem—that no inflammation was produced either upon the fear or on the furrounding parts ( 245 ) parts that the plaifter occupied—that fhe ne- ver complained of any pain in the part before or after the bliftering plaifter was applied— that the wound had not the leaft morbid ap- pearance—and that the fpafms and mufcular exertions were more frequent, and of longer duration as the difeafe advanced, from its firft invafion to the final period. XXVII. Remarks on the EffeBs ofCorrofive Sublimate, in Cancerous AffeBions. ExtraBed from a Letter from Ifaac Senter, M. D. to Dr. William Currie ; with additional Remarks by Dr. Currie. Read September 4, 1792. 1 I/VM apprehenfive that the account which Dr. Mofely has given of the efficacy of the fublimate of mercury, in the cure of can- cers, is not derived from that mature degree of experience and obfervation which is re- quifite ( 246 ) quifite, when fuch a corrofive and dangerous fubftance is recommended to the world. Some years before his treatife on tropical difeafes was publifhed, I had been a witnefs to the tragical effeds of this rugged efcharo- tic in feveral inftances in the town. It was employed by a very daring and unprincipled Quack who refided here at that time—He deftroyed the lives of no lefs than three grown perfons with it, to my knowledge, in the courfe of a few days. The firft had an anthrax on the back, the fecond a ganglion of the flexor tendon of the inftep, and the other had a real cancer of the breaft. In the firft, a mortifi- cation w7as produced which fpread to the intef- tines. The fecond died convulfed foon after the application. And the third, of a moft rapid hectic. Several other perfons in the vicinity of this place wTere alfo killed by the application of his fublimate plafters; and a negro man with a fungous excrefcence on his penis, would have loft his life by the fame application, if I had not faved him by amputa- ting it above the fphacelus occafioned by it. The, ( 247 ) The pain occafioned by thefe plafters was excruciating, and was communicated to all parts of the fyftem. I am at the fame time, certain from my own experience of this medicine, as a topi- cal application in cancerous affedions, that it is capable of doing much good in fome habits, if applied with a very cautious hand, and guarded by the ufe of opium. But my experience convinces me (notwithftanding what Dr. Mofely has afferted to the contrary) that it deftroys the living found, and organic fibre, inftead of detaching the morbid and in- organic parts by exciting inflammatory ac- tion. I have ufed the fublimate in a great variety of fchirrous, fcrophulous and fun- gous tumours, and feveral cancers, and have paid no fmall attention to its effeds in the parts difeafed as well as in the fyftem at large, but I can affure you that I have never feen a real cancer cured by it, or by any other cor- * rofive application, either in my own hands, or when ufed by others. The ufe of corrofive fublimate as a topical application in cancers is no new pradice, Fallo- ( «4§ ) Fallopius, Penot, Theodoric, and Valefius ufed it mixed with arfenic ; and Boerhaave in his Chemiilry, and Van Swieten in his Commen- taries, 'both mention it, (if my memory ferves me) as a powerful, though dangerous, efcha- rotic in difeafes of this kind." In addition to the obfervations of Dr. Senter, the tranfcriber begs leave to "add, that he has applied the corrofive fublimate to fe- veral ulcerated cancers ; but inftead of effect- ing a cure by it, has generally accelerated the exit of the patients. In two cafes where the cancer was fituated on one of the lower limbs, it not only in- creafed the ulceration, and produced an ex- tenfive and painful inflammation, but occa- fioned the difeafe to be conveyed to the in- guinal gland of the affected fide ; in confe- quence of which, both patients after fuffer- ing fome months an increafe of mifery, ex- pired. From the pernicious effeds of fubli- mate, he has been deterred from making trial of arfenic ; the operation of which appears to depend on a fimilar quality, If ( 249 ) If the action of the common cauftic could be fufficiently limited, perhaps (from the immediate fphacelus it produces in the affect- ed part) it might be employed with more certainty and fafety than any thing elfe, ex- cept the knife. XXVIII. Cafe of Hydrocephalus Internus, attended with equivocal fymptoms, with the appearances on diffeBion. By Dr. William Currie.—Read April 2, 1793. I VISITED a mulatto boy, between feven and eight years of age, on the thirteenth of March laft, at which time his pulfe was low and irregular, and his fkin hot and dry. His countenance had a vacancy of expreffion re- fembling that of an ideot—his tongue whitifh and parched in the middle, but red and moift at the fides. While I was examining his pulfe and eyes he moaned very much, and upon being afked what ailed him, he replied his head-ached, and that he was very hun- ( 25° ) His miftrefs informed me that he had firft begun to complain on the tenth of March, at which time he faid his head-ached very bad ; that he had a giddinefs in it, and a trembling in his limbs ; foon after which he went to bed, and had not been able to leave it fince*. He anfwered pertinently to every quef- tion, and could diftinguifh objeds at this time perfedly. From the flupidity and infenfibility indi- cated by his eyes, I fufpeded that he was af- feded by the hydrocephalus internus, but there was no double vifion or ftrabifmus ; and being informed that he had lived, previous to the laft month, with his mother, a worth- lefs debauched woman, through whofe inca- pacity and negligence he had frequently been nearly famifhed, I was at a lofs to determine whether his fymptoms were occafioned by water in the ventricles of the brain, or by the irritation of worms in the inteftines. Though * I have been fince informed that this boy had, for a long time, appeared very dull and ftuped; and that he was conftantly either fleeping or eating from the time he had changed his abode, which was about five weeks, previqus to his confinement. ( 2S1 ) Though feveral of the fymptomc, as well as fome of the circurnftances which favour the generation of typhus fiver, were prefent, yet his appetite, which was conftant and in- fatiable, left no room to fuppofe the com- plaint to be of that nature. After I had compared and confidered every circumftance with the moft fcrupulous attention, I concluded to employ fuch medi- cines as experience had proved to be moft effedual for the expulfion of worms; and which, with very little variation, have alfo fucceeded beft in cafes of hydrocephalus. My firft prefcription, therefore, was calo- melgr, iij. faccfi. alb. gr. x. ol. menth. piper. gutt. i. This I directed to be taken at one dofe, and to be repeated every fourth hour till it fhould operate three or four times. After the exhibition of the third dofe, a copl? ous diarrhoea came on, and feveral large worms were difcharged. 14th. His ftrength was fo much exhauft- ed by the operation of the calomel, that I dis- continued it, and direded a ftrong infufion of Caryophillus Indicus (fpigelia of Linnaeus) to be adminiftered three times a-day. An almoft ( 252 ) almoft incredible number of lumbriei were voided in the courfe of the night. 15th. Appeared much debilitated to- day, and was confiderably comatofe, but had neither ftrabifmus nor fpafmodic affedions of the eye-lids, though the pupils were very much dilated—fkin cool—pulfe flow and ir- regular. Directed a blifter to his back, and a repetition of the fame medicines as yefter- day, with an addition to his wine, which he had been allowed to take liberally from the beginning, mixed with water, or made into wThey ; and to continue his diet of panada and chocolate; the latter he appeared to be very fond of. He was alfo indulged with bread dipt in molaffes, which he had con- flantly craved, and had eaten voracioufly previous to the acceffion of coma. 16th. Informed that he had feveral involuntary ftools, and had made a great deal of urine in the night, but that no more worms had appeared. The pink root was now difcontinued, and a ftrong decodion of cort. peruv. and ferpen- tar. virgin, fubftituted, Sinapisms ( *S3 ) Sinapisms to his feet, boluffes of vola- tile alkali, &cwere tried to be adminiftered, but he could not be prevailed on to fwallow them—A julep of the fame was fubftituted, &c. 17th. Symptoms of coma—infenfibili- ty and general debility increafed—deglutition impeded—evacuations by ftool and urine continue. A blifter was now applied to his head, and finapifms to his wrifts and ancle6: Muftard whey was alfo direded, but he re- fufed to fwallow every thing that was of- fered. 18th. He laid all this day in a ftate of the moft profound infenfibility, with his eyes and mouth wide open ; and continued in this manner till the night following, when he expired. Appearances on DiffeBion. On removing the cranium I obferved that the dura mater was not attached to it any where but at the futures, which is contrary to the affertions of both Haller and Pott. I The ( 254 ) The dura mater as well as the external £art of the brain, was free from any morbid appearance—but, when an incifion was made into the ventricles, between fix and feven ounces, at leaft, of a limpid fluid was dis- charged, and received into a veffel. Remarks. In this cafe all the fymptoms mentioned by authors, as pathognomonic, (except a conftant moaning) viz. ftrabifmus, double vi- rion, fick qualms, fudden and frequent fhrieking, and holding the head with the hands, ftridor, dentium, were abfent; nor was there that infenfibility of the bowels com- mon to compreffed brain. This is a frefh inftance of the difficulty which often occurs of diftirtguifhing the feat and nature of difeafes ; of the importance of acquiring a perfect knowledge of the cha- rader of every difeafe to which the human body is liable ; and of the propriety of fre- quent diffedions for the purpofe of acquiring this knowledge. end of the first part. " c « C C C C C K1 t c c c Co C ccf ccc c f C 1!*.' ■ . , ., *- r ir r' r c c .f,r c/ ( i <1 c.«ec 'CC c C:^ci\ ViV - . Cfc-'.V*' ^c c 1 - ' - - cv: c. cc t. " C« c > cC ' cCC « ^^-V cic < ^cc « 1 cc «r.r- - • <« c ' _ ^r" C'^c c . <1 .« i «... ■-■ ^ t „ ^^ <^ c C C C <«c<-f c << < r e -CC"<5C C< ( CCSKiCC «CC«. h 7* ^ cf cC c^ c^Tc'c-! V^ - * ' Z-r tr<<~ c c^ ccwrrc . c«atr^ r«c^. ; V> >*- <^rr c ccc c c c - «c C ■ §C t cc C i«CI « « C ' Vr' . C ' c*«cc><_ ■'■% Cc" '< cc . c -CC -f CC Cc «:c( cjksc cc f CCC c c: • «- ,V7c< ^! 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