-,A^
CcvX  ?
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CASES and TOSERVATIONS ;
B Y  T H E
MEDICAL    SOCIETY


   Of NEW-HAVEN Coumty, ir thi
                       i
     State or CONNECTICUT,


    Injlituted in the Tear 1784.

wsks

New-Haven : PnW ^ 7* ^#'> x788 
 
      PREFACE.

A   number of Phyjicians  in the city and county of
      New-Haven, Jlimulated by the importance cf
the objeEl, and the laudable example of the faculty in
the various nations of Europe,  and injome parts of
America, formed a Jociety in the year 1784, for  the
purpofe  of improving themjelves in Medical know-
ledge.

   The   cafes and  objervations, which have been
exhibited  to the  Jociety,  are given  to the public,
in the following fheets, who it is hoped will regard
with a favourable eye, thefirft ejfay of this infant in-
Jlitution.  All attempts to imfrove a Jcience which
is Jubjervient to the dearefl interefts of humanity, mufi
meet the approbation of every benevolent mind.   At-
tempts of this nature are particularly necefary,  and
muft be peculiarly ujeful  in an  infant empire, where
 the feeds of Jcience, though widely dijfeminated,  are
 butjufl- beginning to germinate.   Their future gro zvth
 and increaje depend  on the  care  and attention with
 which they are nurtured.   To excite others to this
 laudable andjalutary work, is one principal objccl of
 this publication.   It  has not we prejnme proceeded
from incapacity, or a criminal inattention to the inte-
 reds of humanity that the faculty in this country have
 hitherto contributed Jo little to  the general feck of
 Medical knowledge.   In a widely extended country,
 at a didance from each other, it has not been in their
 power to unite, their  efforts in this noble purjuit.  The
 late war brought many  ingenious and iearned Phy-
jicians together from all parts of the continent, und
 the army formed them into a temporary Jociety, wboje
 unrejerved communications have contributed  to  /fa
                                    improvement
c 
(iv. )
 improvement of medical knowledge, and the eftablijh-
 ment of a new and important <era  in the healing art.
 By this mean the faculty have become more Jenjible
 of the importance of uniting their  endeavours, and
Jeveral Medical  focieties have been formed in differ-
 ent parts of the United States.   Should Jimilar infti-
 tutions become general,  and permanent, there is rex-
Jon to hope that Medical literature willjoon be in as
Jlourifhing a ftate in  this  country as   in  any part
 of Europe.  AJpirit of emulation  will take place,
jloth  and  ignorance  decline,  and  the  art appear
 with dignity and luftre.  Should this effort of thejo-
 eiety contribute  in the Jmalleft degree  to effeft thoje
 dejrable ends, it will afford them ample Jatisfailion
for their labour.
   This Jociety was formed on the moft liberal and gen-
 erous principles,  and was dejigned firft to lay a foun-
 dation for that unanimity and friendfhip  which is ej-
Jential to the dignity  and ujefulnefs of the profeffion ;
 to accomplifh which,  they  rejolved Jecondly, to meet
 once  in three months : thirdly, that in all cajes where
 counjel is  requifite they will affifi each  other without
 rejerve : fourthly,  That all  reputable practitioners
 in the county,  who have been in the pratlice for  one
 year or more, may be admitted members: fifthly, that
 they  will  communicate their objervations on the air,
 Jeajons and climate, withjuch  dijcoveries as they may
 make inphyjtc, Jurgery, botany or chemiftry,  & deliver
 Jaithful hiftories of the various  difeafes  incident  to
 the inhabitants of this country,  with  the mode  of
 treatment and event injingular cafes :Jixthly, to open
 a correjpondence with the  Medical Societies  in  the
 neighbouring ft at es and in  Europe, for  which pur-
 poje  they  have a ftanding  committee of correjpond-
 ence : Jcventhly, to appoint a committee for the pur-
                                             pofe 
(v. )
pofe of examining candidates for the profeffion,  and
to give certificates to the dejerving.
   In purfuance. of theje resolutions, the Society have
punctually attended their meetings, examined and ap-
proved a number of candidates,  many  of  whom bid
fair to be ornaments to the profeffion : and of late
they have made fame advances towards the eflablifh-
ment of a fund, which promifes  permanency  to the
inftitution.

   Any communications which may  tend  to the ad-
vancement of the Jcience, from gentlemen  of the fa-
culty in  other parts of this  and in  the  neighbour-
ing ftates or  eljewhere,   will  be  thankfully re-
 ceived,   and Juch as may  be  deemed  worthy  of
publication  prejerved  for  a  future volume.-----
Such communications may be Jent to the  Secretary*,
 or any other member of the Society, by  whom they
 will  be exhibited  to  the Society, and   lodged on
 their files for future  ufe,

   New-Haven, June  \^th,   1788,
v Dr.  Samuel Darling. 
CONTENTS.
               Article I.
    CASE of a Singultus from an Adhefion of the
      Liver to the  Diaphragm,  proving fat-
al.  Communicated by  Dr.  Samuel Nefbitt.
F. M. S.
               Article  II.
Cafe  of a Puerperal Fever fuccefsfully treated.
  Communicated  by  Dr.  Elnathan  Beach,
  F.  M. S.
             Article   III.
Two cafes of difficult Deglutitionfromiextrane-
  ous  bodies lodged in the Gula. By Dr. Abra-
  ham Tomlinfon, F. M. S.
              Article  IV.
Cafe   of a  fractured  cranium  fuccefsfully
  treated. By John Spalding, Surgeon, F. M.S.
              Article  V.
Cafe   of  a  Gangrene of the  Scrotum.  By
  Dr. Leverett Hubbard,  F.  M.  S.
              Article  VI.
Cafe of the  Locked Jaw  fuccefsfully treated by
  Electricity. By Dr.  Eneas Munfon, F. M. S.
              Article  VII.
Cafe of an  H<zmatemefis,  fuccefsfully treated.
  By  Dr.  Samuel Nefbitt, F.  M.  S.

                               Article 
vTfii
              Article VIII.
Cafe of an Enteritis.   Communicated by  Dr.
  Ebenezer Beardjley. F. M. S.
               Article  IX.
Cafe of a d'formed Foetus, with a cut, communi-
   cated by Dr. Leverett Hubbard,  F.  M.  S.
               Article X.
Cafe of the fatal effects of the cor rofive fublimate
   of Mercury.  By Dr. Levi Ives,  F.  M.  S.
               Article  XI.
Cafe of the Jafm,  effects  of drinking  cold water
   when  heated.   By   Dr.   Samuel Nefbitt,
   V. M. S.
               Article XII.
Cafe of an Aflhma from an extraordinary caufe.
   By Dr.  Samuel  Nefbitt,  F. M. S.
              Article XIII.
Cafe of an Hydrocephalus Internus, By Dr. Eb*
   enezer  Beardjley,  F.  M. S.
              Article XIV.
Cafe of a Schirrous Tumour in the Pylorus.   By
Dr. Ebenezer Beardfley, F.  M. S.
               Article XV.
Cafe of afingular wound in the Eye.  By John
  Spalding, Surgeon, F. M.  S.
              Article XvI.
Cafe of a  Peripfieumony.  By  Dr. Ebenezer
  Beard/ley.    F.  M.  S.
              Article   XVII.
Cafe of an amputation  of the leg   in  confe-
  quence of a divided artery. By John  Spald-
  ing, Surgeon, F, M.  S.
                                Article 
             Article XVIH.
A letter from Dr. Benjamin Gale, C. M.  S.
   en the bite of a mad dog, Gommunicated  by
   Dn.  Leverett Hubbard.  F.  M. S.
              Article  XIX.
Cafe Jhewing the good effects of the antiphlogifl-
   ic regimen in the  eruptive  variolous fever.
   By Dr. Samuel Nefbitt,  F. M  S.
              Article  XX.
Hiftory  of a  dyjentery, occafioned  by ftagnant
   air.  By Dr. Ebenezer Beardfley. F. M. S.
              Article XXI.
Cafe of  a divifion of the  tendo Achillis.  By "Dr.
  Samuel Nefbitt, F. M. S.
              Article XXII.
Cafe of a wound in the Trachea  Arteria and  MJo-
  hpagus.  By John Spalding, Surgeon, F, M. S.
              Article XXIII.
Caje of an enlarged Gall bladder.  By Dr. Ebenezer
   Beardfley,   F.  M.  S.
              Article XXIV.
Caje of Dyfenteric Symptoms from worms.  By Dr.
  Samuel Nefbitt, F. M. S.
              Article  XXV.
Cafe of a Jchirrous in the pylorus of an infant.  By
  Dr. hezekiah Beardfley, F.  M.  S.
              Article XXVI.
Cafe of  Calculi in  the Lungs.   By  Dr,  Eneas
  Munjon, F. M S. 
/#^W,

CASES  and OBSERVATIONS.
A Singultus  (from an  adhejion  of the  Liver  to
   the Diaphragm) proving fatal.  By  Dr. Samuel
   Nefbitt.   Read   to  the  Society,  3d  May,
   1784.

     ON the 4th of October, 1783,  I was called in
      council with Dr. Eneas Munfon, to vifit
Polydorc, a Negro fervant of Capt. Trowbridge of
this city, aged  16; his fymptoms  were,  a fixed
pain under the Cartilago Enfiformis, a fenfe of ful-
nefs at the pit of the ftomach, with dyfpnasa, and
very frequent hiccup that was violent, and affect-
ed greatly his  pulfe, fo  as to produce  the true
faultering, or interrupted pulfe, he had no cardial-
gia, nordifpofition to vomit,  only  an eructation,
arifing from the fpafms of the diaphragm; he had
been  attacked twice with the fame difeafe, in the
courfe of the laft twelve months, previous to the
prefent.   In  the  former  attacks, Abforbents,
Correctors, and Antifpafmodics, had  been tried
to little purpofe, the difeafe fpent itfelf gradually,
and the Singultus wore off,  in proportion as the
patient  grew weak.  Perhaps the tenfion and in-
flammation, gave way to relaxation  and refolution;
but I make no doubt, left an adhefion of the Li-
ver to the diaphragm, from the firft attack j which
might gain ground as the difeafe  recurred, and
I think it may be warranted from this circum-
ftance of the patient's being uneafy in the inter-
vals of the recited affections, with that fenfe of
                                     fulnefs
                      B 
10
 fullnefs, at his ftomach, and  difturbed refpirati-
 ofl.
   From the hiftory of the difeafe,  previous to the
 4th of October, and  the Symptoms now fubfift-
 ing,  Dr. Munfon  and  myfelf were of opinion,
 that an inflammatory  affection of  the  diaphragm
 and liver was  deducible,  and that the ftomach.
 and other vifcera were not affected.  We adopted
 the  antiphlogiftic  treatment,  blood  drawn and
 Tpeated,  was fizey  and  cohefive,  the  ferum
 flrongly impregnated  with  bile,  correctors  and
 antifpafmodics  were given to temporize, epifpaft-
 ics over the part affected were applied, and after
 a  courfe of three weeks  attendance (the fymp-
 tcms gradually abating) the difeafe gave way, fo
 as to leave the  patient apparently well,  except
 that fenfe of fulnefs at his ftomach.
   On the 2.7th  of March laft, the patient called on
 me,  complained of a head-ache, and of being
 much preffed at his ftomach,  his pulfe  moderate,
 and no return of hiccups.   I prefcribed a cathar-
 tic, and heard  no more of him, until the 29th of
 that month. When  I vifited him,  he complained
 of head-ache, an uneafy breathing, with a final I
 frequent cough, the old fenfe  of fulnefs, but  no
 pain or hiccups.  I let  blood which was florid,
 but not fizey  nor uncommonly cohefive.   I pre-
 fcribed an emetic which operated gently, but exci-
 ted no fpafms nor additional uneafinefs. The 30th
 the head ache was encreafed  and fome degree of
 fever.   I prefcribed a bolus  of  five   gr.  mere.
 dulc. to be worked oft with falts and manna.
  On the 31ft he feemed relieved, head-ache and
fymptoms abated.    April ift.  found him  no
worfe, only  prefcribed  thedulcif. fp. of Nitre,  and
dikent*.   The 2d of April, he complained more
                                         of 
II
of his head,  and that the room was  dark,  his fe-
ver gone,  and pulfe rather fmall and interrupted;
but as the day was ftormy,  and the room  he was
then in was a dark room, I  did not apprehend a
failure of vifion. The 3d his complaints the fame,
and evident that  vifion  was affefted,  attended
with a degree of ftupor.  I applyed a large epi-
fpaftic to  the nape of his neck.  And on the 4th
repeated the purge  with the calomel,  which not
operating kindly  an enema was given.  On the 5th
I found him totally blind,  and fo infenfible as to
afford no fatisfaftory  anfwer to any  of my  quef-
tions,  his pulfe  feeble  and oppreffed, accompa-
nied with  a  fubfultus tendinum.  I gave him four
portions of the factit. cinnabar, a fcruple in each
dofe, once in fix hours.  On the 6th I fownd his
fight a little reftored,  and more fenfible,  tho' (till
incoherent in his anfwers and oblervations.  I was
favoured with Dr. Eneas Munfon in council this
evening; we agreed to prefcribe an infufion of the
valerian,  and to repeat the  next morning, the
mercurial purge ;  it did not operate.   On the 7th
we met in council,  ordered the repetition of ene-
mas,  the purge  not having operated  ;  On this
day the hiccups came on gradually at firft, and
with  a conftant eructation of a frothy  mucus
from the  lungs  and ftomach.  An  anodyne was
given this evening.   On  the  8th  I found him
much diftreffed with  an increafe of the  hiccups,
and a continuation  of all the other fymptoms ; In
the evening I  prefcribed two anodynes, one to be
given h.  f. alter  in  four  hour$  if the hiccups
were violent.  On the  9th his fymptoms  much
the fame,  with the addition of a ftrangury and re-
tention of urine, through the whole of the  night
and day ;  I prefcribed an emollient fotus to the
pubis, and a decoction of the  cooling feeds and
                                      roots, 
J2
roots, propofing to ufe the catheter in the morn-
ing  if he  was not relieved.   On  the ioth found
he had paffed urine freely  in the night, the ftran-
gury in fome meafure abated, the hiccups violent
and  almoft inceffant.  I prefcribed antifpafmodic
boluffes of camphor, opium, and gum affafastida,
to be walhed down with infus. valerian ; the hic-
cups were inceffant, and the eructation fo violent,
that he fpouted up every part of drink  or medi-
cine, as foon as he attempted  to fwallow,  altho'
he manifefted no averfion to any thing offered him.
On  the  nth,  he was evidently  growing worfe,
altho' the hiccups were not fo violent, yet were
they as inceffant,  with delirium, fubfultus tendi-
num, and a trembling pulfe.  On the 12th ha-
ving paffed  a very reftiefs  night,  the eructations.
and  hiccups continuing,  but lefs delirium; he
complained  of a  burning heat in  his belly, from
which a mortification of the vifcera was apprehend-
ed.  On the  13th in the morning he died, nor did
the hiccups  entirely leave  him, until he breathed
his laft.   On opening  the body,  in  prefence of
Drs. Hubbard, Munfon,  Darling &c.  it appear-
ed as follows; the omentum adhered ftrongly to
the peritoneum and inteftines, fo  as not to be fe-
parated without great difficulty,  the fat  of  the
omentum  was entirely wafted, fo as to be a mere
parchment,  except  fmall yeficles  of fat,  inter-
fperfed over it, and gangrenous.   The inteftines
only appeared to  view, occupying the place of
the ftomach and liver, and ftrongly drawn up to
the  diaphragm;  the  inteftines  were interfperfed
with mortified fjpots, and adhered to each other
by their external coats.  The vefica urinaria  was
high in the pelvis, anddiftended with urine. The
ftomach appeared found,  but drawn  out of its
place by the fpafms, lying under  the arch of th$
                                 diaphragm, 
*3
diaphragm,  and prcffed down  under the advan*
ced inteftines.   The liver adhered ftrongly to the
diaphragm, fo as not to be feparated without tear-
ing, and preffed out of view under the arch of the
retracted diaphragm.   The anterior and convex
part of  the  liver adhered  to the  diaphragm, fo
as  to  be almoft inverted,  and  alfo  adhered
ftrongly to the  peritoneum below.    The  ve-
fica fellis was fmall,  fhrunk, with a imall quanti-
ty of bile, and adhered ftrongly to that part of
the duodenum to which it lay contiguous,  and
not to be leparated without laceration.   On open-
ing the thorax,  the  heart and its pericardium,
 was found lying (or rather prcffed by the contrac-
 tion of the diaphragm) acrofs  the thorax,  with
 its apex to the left, and its top or auricles to the
 right; there was no fluid contained in the pericar-
 dium,  the heart  was about double the ufual  fize,
 and the  vena cava  and  aorta greatly diftended.
 The left lobe of the lungs was not to be feen un-
 till the heart was drawn afide, being preffed down
 to the left fide of the vertebras, adhering ftrongly
 to the pleura ; neither  lohe appeared otherwife
 difeafed.  May I not, gentlemen, from the hiftory
 of the cafe, and the appearances after death, be
 authorized to fay, that a primary inflammation of
 the liver and diaphragm, was the proximate caufe of
 the whole train of fymptoms, and preternatural ap-
 pearance of the abdominal & thoracic vifcera, that
 the Singultus  originated from the heat of an in-
 flamed liver,  and its adhefion  to  the diaphragm,
 that the dyfpnsea and cough,  were occafioned by
 the great fpafmodic contraction of the diaphragm,
 difturbing refpiration ; the heart's pofition and fize,
 alfo,   wcild naturally produce dyfpnsea, a tick-
 ling cough, &c.  May we not very readily deduce
 the head ache, and lofs of vifion, delirium &c.
                                        from 
T4
from the pofition and  preffure of  the  heart,  as
thereby the entrance of  the blood  by  the  vena
cava, was  greatly obftructed, and its  exit thro'
the  pulmonic arteries  and aorta, by the praeter-
natural  curve of thofe veffels greatly interrurpcd,
from whence might arife and fubfift, thofe affec-
tions of the brain fo manifeft in the laft  accefiion
of the difeafe.
  The great and preternatural enlargement of the
vena cava and aorta, prove the  increafed refin-
ance the blood  met with, both on its  return to
and  from the heart.  How neceffary then gentle-
men is it, rightly to diftinguifh or  develope, the
true fource of a fingultus,- as it may arife  from
various caufes;  I mean not that fingultus, which
is an attendant on death, and is irremediable from
the nature of the cafe.   An  acrimony in the ftom-
ach, irritating the nervous parts, will produce a
hiccup,  originating from the fame caufe as the
cardialgia,  and removable on  the fame  principle,
by abforbents, ore.   But a fingultus attended with
pain at  the pit of the  ftomach,  or accompanied
with pleuritic fymptoms,  denote an inflammation
of the diaphragm, and may be ftrictly accounted
a pathognomic fymptom of it.  Here it is appa-
rent, that abforbents and correctors will  remove
the one, while the lancet and  antiphlogiftic regi-
men only is capable of effecting the other.
Cafe of a Puerperal Fever, fuccefsfully treated with
  the  Bark.  By Dr.  Elnathan Beach.   Read
  October 13, 1785.

A  "Woman aged  twenty-one, of a fanguine
      habit,  on the 19th of March, 1784, be-
came  mother of a living' child -, her labour was ea- 
*s
fy,  natural,  and every circumftance favourable*
On the evening of the 23d, I was called—found
little or no fever attending ;  but great pain in the
abdomen, accompanied with a violent diarrhea,
which  had been  of fome days continuance; the
lochial difcharge irregular,  the fkin dry.   I  gave
an opiate, to abate the feverity of the  pain,  and
to  correct the  diarrhea accompanied it  with
Rhubarb.  This had the defired effect, and  (he ref-
ted well the fucceeding night. The next morning
I found her in  a  free,  gentle perfpiration,  and
without pain,  except what was occafioned  by the
operation of the purge.   Upon thefe fymptoms of
amendment,  I left her, and did not fee her until
tne 26th; when I found  lhe had bee-n  attack-
ed  with  rigors,    which  were  fucceeded  by
heat,  third,  and fever, together with  excruciat-
ing pains in the abdomen,-----extending to the
uterus,  with a reddifh ftreak  on  the  furface,
fpreading itielf to the  umbilical  region,  with
other  fymptoms of   an inflammation  of  that
vifcus.   I prefcribed the common antiphlogiftic
remedies, as  evacuants,  cooling febrifuges and
aperients, together  with epithems,  cataplafms,
and injections;  which courfe was  perfifted  in
until   the  30th,  when I  found  the  ftreak be-
fore mentioned was extended over the whole ab-
domen, and changed from a redifh to a cirteritious
hue,  the pulfe  fmall, the  countenance  pale
and wan ;—the  part affected  almoft infenfible to
the touch.    I directed to  the ufe of the  bark in
decoction, acidulated  with elixir  vitriol.  The
next morning, the 31 ft, found the diforder  greatly
increafed, every fymptom pregnant with danger—
the abdomen  almoft covered  with livid veficles,
the interfaces  of  a negro black, with a total in-
                                   fcnfibility 
i&
fenfibility of the part,  copious difcharges, fam-
ous and fetid, from the uterus.  The countenance
dejected  and ghaftly,  the voice indiftinct, pulfe*
weak and intermitting.   The cafe being thus al-
arming,  Dr. Andrews was confulted, we agreed
to make a thorough trial of the bark,  and direct-
ed it to be  taken in fubftance and  decoction,  ac-
companied with fome  alexipharmics.   She took
i~  ounces  a  day, befides the  application of  a
ftrong  tincture  externally, together with  injecti-
ons ; and in a few  days a defquamation of the
cuticle took place,  the lividity difappeared;  her
ftrength gradually returned, and by the beginning
of May, fhe acquired her former health.
Two Cafes of difficult deglutition, from extraneous
  bodies lodged in the Gula.  By  Dr.  Abraham'
  Tomlinjon.   Read  Otlober,   1784.

      MR.  Jofeph Smith,  of  Milford, aged  70
        years, eating pieces of hard faked flefh,
without fufHcient maftication, (his teeth, being
gone)  a piece lodged in the gullet.   Sundry me-
thods were tried, by  a  gentleman of the medical
profeflion, to remove it, but they proved ineffec-
tual.   Nine hours after the accident I was called,
and found him exercifed with pain, and a tumour
in his throat.  I firft prefcribed 2 or 3 fpoonfulls
of warm olive oil, to lubricate the parts ; then I
ordered him to drink fome warm water,  with a
view to excite a naufea and  vomiting; this  had
the defired effect, the flefh being .ejected by vom-
it in about 32 minutes.
                                      CASE 
            Case     ii.

  JOtfAfHAN NOftTHRUP, of  Milforci;
aged about 26 years, eating fome beef and cab-
bage,  fwallowed a fcale of beef bone in the cab-
bage,  of a triangular figure, of more thin one
inch in length,  from the  bale  to  the point : the
point of which as well as the fides, were thin and
lharp.  This bone lodged in  the  gula, between
the upper end of the fternum and pomum Adami,
The fituation might be difccrned  by feeling with
the fingers, on  each fide of the  trachea.   This
cafe was  attended with tumour and extreme pain.
  In this diftreffed ftate. Mr. Northrup made ap-
plication to fundry gentlemen of the faculty, who>
tried  various methods to relieve him, among the
reft a pair of long, (lender, curved,  crane bills;.
were introduced;  with a view to extract the bone;
but all to no purpofe.   Twenty-four hours after
this accident  Mr.  Northrup  applied to me.  I
made ufe of the method prefcribed in the  cafe of
Mr. Smith ; but it had no effect.
   I then made a folution of four  grains of tartar
emetic, in warm  water, which he drank,  and in
about fifteen minutes he brought up the bone by
Vomit, and was effectually relieved.
   As it is one of  the known laws of hydraulics;
that fluids when preffed,   prefs  undequaque, the
application  appeared  plain  to  me  in  the
recited cafes;  for I  confidered the  gula to be a
flexible,  cylindrical tube,  which by means of its
mufcular fibres,  may be contracted or dilated.  I
alfo confidered  the  great force of the mufcles
employed in the action of vomiting ; whereby the
fluid contents  of the ftomach are forced through
                     C                 the 
n
33             ..;.        g

the upper orifice,  into the cefophag-us, in  a full
ftream,;  there meeting with refiftance from  the
offending body, will expand the gula, and being
urged on by the impetus of the fluid,, will over-
come the refiftance and bear  away  the  offending
matter in the torrent of water by  the mouth.—
This, in facl, was the  iffue  of the two  cafes
above.
  .1 am  perfuaded" that the fame method may be
ufed with fuccefs,  in almoft every cafe where the
patient can  be prevailed  with,  to  drink a  fuffi-
cient quantity of water, or other liquid.
  I could add more fimilar cafes in confirmation
of the practice, but perhaps the foregoing will be
fufticient.
Cafe of a fractured cranium, fuccefsfully treated. .
  By Dr. John Spalding.  Read before the Society
  Qftober \^th, 1784;^

     ON  Saturday the 21ft of Auguft, 1784, I was
     called to vifit a fon of  Mr. Eraftus Brad-
ley,  of this Town ; aged  feven years ;  who fell '
from a  tree upon a ftone wall, and fractured the'
right os parietalia.   I arrived about half an hour
after the accident,  found a large wound through
the external integuments and a considerable hem-
orhage  from the wound;  upon introducing my
finger  found the  fractured  bone  depreffed and
compreffing the dura  mater ; the child being de-
lirious  and  much  convulfed.   Finding no prof-
j5Cet of relief but from the trepan, I  proceeded im-
mediately to  the operation : having  denuded the
cranium fufhciently to admit the trephine,  a he-
morrhage enfuedj rendering a delay neceffary until
                                        the 
  the arteries were fecured by ligature; then began a
  perforation on. the found part of the os bregmatis,
  near the os fronris,  a little to the right of thefpt-
  ura coronalis,  then introduced  the elevator, with
  which I  raited fome fmall pieces of the depreffed
  bones, and took them out: but  could not raife
  the largeft, fo as to difengage it from the under part
  of the found fkull; finding it neceffary to make a
   fecond perforation,  I applied the  trephine on  the
   os bregmatis,  back of. the'former, and introduced
   the elevator, with which I difengaged the fract-
   ured piece,  and took it out with my forceps, fay-
   ing the dura matter bare the extent of the-fracture.
   Then  proceeded to drefs the wound, after which
   I percieved the child had fainted, by reafon of the
   tedioufnefs of the operation and through the lots
   of blood ; I  ordered a little fpirits of lavender to be
   put into his mouth,  frefh air to be admitted,  and
   his extremeties rubbed,  we foon perceived life in
   him,  and he began to  breath and ftir his limbs.
      In the evening I  found his  pulfe a little quick-
   ened, ordered him  an en*ma,   he  appeared to
   be very reftlefs but a little more fenfible.  In the
   morning he came to his reafon Co as to fpeak and
*-•" take  fuch nouriftiment as was prefcribed.
      In the evening of the 22d found  his fever had  ■
    encreafed,  prefcribed a gentle  cathartic,  and in
    cafe  it did not operate by  morning,  to  aftiftit
    by an enema. He  being drowfy  all day, could
    h'atdiy be perfuadeid to take any thing.   _ .
      The  13d  found  his drowfmefs and fever 1?ad
    increafed; gave him fome febrifuges & ordered'h\&
    dreffmgs to be  kept wet with'fpirits, in order to
    facilitate the removal  of the dreffmgs next day.
      Vifited  him  the 24th in  company with  Dr.
    Munfon-----found his fever and ftupor abated;
    lc"                                  dreffed 
20
 dreffed the  wound :  every  thing  appearing a$
 favourable as could be expected.
    Vifit'ed him  the 25th in  company  with Dr.
 Beardfley ; dreffed his wound,  there being very
 little difcharge, we prefcribed  a gentle  cathart-
 ic ;  and after its'operation the Bark in decoction.
 '  Onthe 26th with Dr. Munfon; the wound had
 come to  fuppuratidn,  as the denuded part of the
 bones,* now  changed to a dark hue.  We ordered
 a more copious  ufe of the bark, arid  the  wound
 to be continually wet with fpirits;  he  was now
 perfectly  fehfible.
   On the 27th dreffed the wound, found a lauda-
 ble difcharge, and his  fever moderate; ordered a
 cathartic, and the bark to be fufpended during its
 operation.  ■• •• •  3■■;  ■
   On the 28th  with  Dr. Munfon,  dreffed his
 wound,   the dura mater  began to (lough,  with
 a proper difcharge from the wound ; iome fmall
 pieces of bone being loofe.           ~ *' '
   On  the 20th, found he  had paft a very good
 night; fat up to have his head dreffed; the wound!
 difcharged plentifully,   and every  fymptom was
 ill his favour. "'V
  On the  30th removed two fmall pieces of bone,
the wound difcharged freely.
  On the 31ft  dreffed his wound j no apparent
 alteration, only a little  more active and chearful.
  September ift  the wound beginning  to incarn,
 fince which  he has daily mended,  and is now
perfectly recovered.
JCASE 
2,1
Cafe of a Gangrene of the Scrotum,  Read January,
                     1785.

      MR.   S---- H----,  aged   forty  years,
       a  ternperate man, and of a  good  cori-
fticution,   by  profefiion a (hoe-maker and tan-
ner, was feized with an intenfe pain in the glands
of the left  groin, on September the 19th,  1784,
for which a plaifter was applied, formed of the
oily dirt which fwine leave on fences  after  rub-

   September aoth.   I was fent for, and  the mef-
fenger told me ;hat the pain was intolerable; but
I was engaged another  way, and concluding that
tfre diforder would fubfide  with an anodyne,4I fent
frim one.
   September  21ft.   I  vifited the patient,  and
found him in a high fever ; the fcrotum and penis
greatly tumified, and   of a livid colour;  I imme-
diately  opened a vein,  and took  away feventcen
ouqees  of blood, which was  as buffy as is ufual
jn a  violent pleurify,   with very  little ferum ; I
ordered  a fomentation  of bitter  herbs  boiled in
water,  to which was  added  rum.  After ufing
$he fomentation,  I  applied a cataplafm of white-
bread, milk, and white rofe Jeaves, and I order-
ed him to take a few dofes of camphorated nitre.
   September 23d.   I  found  him  {till under an
high  fever,  and took  twelve ounces more  of
blood, which was  lefs  buffy than  before;  the
parts affected now appeared to be in  a  ftate  of
mortiftcation, black, and infcnf;ble to the touch;
I fcarified the penis and the fcrptum  in feveral
places,  without giving  pain to the patient,  and
then applied ftrong fpirits and the cataplafms as
t>efore -, gave  him a tablc-fpoonful of  the cortex
                                      peruv. 
22
peruv. and ordered him to take a like dofe every
two hours, to be wafhed down with a . ftrong  de-
coction of the fame,  with the addition of red rofe
leaves.
  September 23d.  The tumour and inflamma-
tion were much abated ; he complained of a pain
in two of the fingers of his  right hand,  on which
I qbferved  tumours  much inflamed,   of a ripe
cherry colour.
  September 24th.   The   carpus of the fame
hand tumified  and inflamed,  and of a livid hue:
I continued the fame  prefcnptions, with the ad-
dition of an emollient clyfter.
  September 25th.  I found  his pulfe low, with
great faintnefs and dejection of mind, apprehend-
ing that death would Toon  clofe the feene.  I  or-
dered him fome wine,  which raifed his fpirits and
abated his gloomy apprehqnfions -,  and continued
the dreffmgs as ul'ual.  I opened a tumour on his
wrift, which difcharged purulent matter.
  September 26th.  I requefted the affiftance of
my  friend Dr.  Nefbitt.   We found the patient
under a high  fever,  and bled him the third time,
though we confidered  the cafe almoft defperate j
we continued  the bark, with the elixir vitriol,
which was given with the utmoft freedom,  with-
out any regard to the fever, as we judged it ef-
fential to  the patient's recovery.  In three days
carruon adigeftion and feparation of the mortified
parts,  which by  degrees were removed by the
knife; we dreffed the ulcer with dry lint, fome-
tirres making  ufe of the fpirits and the  common
digeftive, till the  whole of the fcrotum was tak-
en off, leaving the tefticles uncovered  with  the
proftate glans; after the fcrotum was Houghed off,
the ftate of the [uices was fo acrid as to deftroy
                                       ;two 
23
two  other  coats,  the  cremafter and  the  tunica
vaginalis, which digefted, and alfo floughed off,
leaving the tunica albugirtea in a found ftate :  he
had violent pain in the tefticles,  and there  was
reafon to fufpect fuppufation;  when preffed with
the finger the parts were very elaftic, which induced
us to think that there was matter contained within :
accordingly, we made a fmall puncture through
the tunica albuginea,  but the  difcharge was only
a bloody ferum;  we continued  the  fame  treat-
ment j the tefticles fuffered  the  fame  very pain-
ful fenfation for feveral days,  and  we concluded
that matter was formed in them, and  opened one
of  them to its  centre to  afcertain  it,  but  found
only a difcharge of bloody ferum ;  the wounded
tefticle was dreffed with a digeftive,   and  healed
in a few days, at which time the furface  of the tefti-
ticles  next the perineum began to granulate and
heal very faft,  artd caufed an adhefion,  or  union
of the tefticles,  from each extremity,  which now
refembled a twin peach or apple;  the fpermatic
chords fuffered  a great contraction, and  the tef-
cfes adhered clofely to the  perineum,  and cica-
trized favourably.
  The preputium  was entirely taken off the pe-
nis,  the mufcles were  difeafed,  and  partly def-
troyed, the urethra was left  without  a covering,
but the bulb or glans was not  affected ; a co-
vering however, gradually formed over the body
of th« penis, but  lefs fmooth than  before.   Soon
after the difcharge from the mortified parts abated,
he complained  of  a  pain in the left  fide  of the
abdomen, which extended up as  far as the fhorc
ribs,  it was here tumified and inflamed ; where-
upon we ordered that part to be fomented four or
five times a day with warm fpirits, and the inflam-
                                 mentioned 
*4
mation and fwelling foon  difappeared :   two or
three days afterwards a pain came on in the  right
fide,  extending as it had done  on the left; we
applied  the fpirits  as  before, but without ef-
fect ; we then ordered  the application of a"  ca-
taplafm, which foon brought on a fuppuration ;
we perforated the ulcer,  and it difcharged a la»"ge
quantity of pus,  which  continued more or  lefs
for ten days;  the patient  remaining feeble  and
greatly emaciated with fever; we ordered a decoc-
tion of barley with figs, fago, falop, and panada,
(gruel had been his ufual diet,  with a little wine)
and he continued recovering for the  fpace of ten
days, when he was fuddenly  feized with a pain in
his bowels, fucceeded by a fetid diarhoea: in
twenty-four hours he  was  greatly reduced,  fre-
quently difcharging two or three ounces of puru-
lent matter, attended with a  bloody  mucus; we
gave him lenient purges, fuch  as fenna,   manna,
and a folution of gum arabic,  in barley-water j
clyfters prepared with a decoction of the bark and
red rofe leaves were frequently adminiftercd ;  thefe
in a few days gave relief,  and the matter of the
internal ulcer being difcharged through the rectum,
the patient recruited every  day, and on  Decem-
ber the 5th, 1784, was able to attend his former
bufinefs.
   In forty-nine days he  took fifty-eight ounces
of  that  fovereign medicine,  the  bark, which
feemed to contribute in a  great meafure to  his
perfect recovery.
CASE 
as
Cafe of a locked jaw fuccefsfully treated by electricity.
  By  Dr. Eneas#  Munfon.  Read to the  Society,
  April 6th,  1785.

   JANE HARRISON,  a  fervant maid,  aje.!
    fourteen  years, of a ftrong and good bodily
habit, on the  17th of February  laft, voluntarily
threw herfelf out of a garret window, feet foremoft,
which gave her fuch a violent (hock as to deprive
her of-her' fenfes.   She was immediately taken
up, and many  attempts made to* bleed her, but it
was with great  difficulty that about twelve ounces
of blood was obtained.   She remained in a  ftate
of  infenfibility during the day and  the night  fol-
lowing -, but on Friday morning a little recovered,
fo as to fpeak and talk with an air of chearfulnefs
until evening ; when there  appeared a ri^dity of
her limbs,  together with a deprivation of fenfe
for fome time, and  then a return of fenfuion,
with  fome appearance of reafon.   On the evening
of  the 18th, I vifited her  for the  firft time, and
prefcribed for  her a nervine  antifpafm>dic decoc-
tion for the night.  On  Saturday morning found
her no better,  but fenfelefs, with her jaws locked,
which I was told had  been  the  cafe  u  iring the
night;  Co that  fhe  was unable to receive  any
food or  medicine ; and by reafon of the projection
of the upper jaw, the  upper  teeth, which  were
 very even and clofely  fet,  fhuc over the under
 teeth, quite down to the gums of the lo'.ver jaw,
 fo that nothing could be introduced into her mouth
 but what was ltrained through  a  double row of
 thick fet teeth.  The  mufcles  in her  neck,  es-
 pecially the  pofterior, wereyery ftraighr,  with a
 rigidity of the whole fpinej the  countenance was
                                         very
                        D 
 26

 very florid, the pulfe  quick, but rather  fmall j
 fhe  was ordered the liniment, faponac. with opium
 and ol. fuccin. to embrocate the  fpine and  parts
 contracted; a camphorated antifpafmodic fomen-
 tation was ordered to be applied to the ftomac h, and
 enemas with fe?id  gums injected,  and after the
 fwregoing prefcnptions, at  night (he was put into
 the warm bath, v hich  produced  a relaxation of
 *! herfpafms.  On Sunday morning (he appeared
 rational and chearful,  and fat up, but not without
 great complaint of pain aciofs her  reins,  extend-
 ing  under the fternum, with univerfal forenefs.
 She continued the  foregoing  prescriptions,  with
 the addition of valerian and fetida by  the mouth.
 As fhe was now able  to fwallow, (he remained
 calm during the day and better part of the night,
 but  towards morning was feized with the contrac-
 tion of  the  jaw  again,  together  with  violent
 ftruggles and convulfions:  in this fituation  fhe
 continued during  the day :  at night   with what
 laudanum was forced into the ftomach, and  in-
jected with an enema,  fhe  flept  fome time;  but
 on  Tuefday morning  no  relaxation  of  fpafm,
 but  ftupid and fenfclefs, with a great degree of
 opisthotonos, and  as I had, in feveral inftances
 heretofore, proved unfuccefsful in  the ufe  of the
 grand fpecific, viz. opium,  I  had  determined, in
 my own mind, if  ever I fhould  have  a  cafe of
 the kind  under my  direction, to depend  upon
 opium no longer than I found it  foporific;  and
 if a quantity fufficient to bring on  and produce a
 manifeft  foporofis  did  not remove the fpafm,  I
would feek a remedy from fome other  means.   I
therefore now endeavoured, at more lucid intervals,
 to get down fome  fmall dofes of calomel,  and
tried the warm bath  again,  which,  fo  far from
                                    yielding 
27
yielding the relief as before we experienced, that
it  produced immediate convulfions, fo violent as
to render the continuation impracticable, (he was
accordingly put to bed, and  was,  during Tuefday
night, attended  with all the fymptoms of opiftho-
tonos, lock'd jaw, and emprofthotonos alternately ;
but as the fpafms of opisthotonos & emprofthotonos
counteract each other, they were  productive of a
tetanus,  with  a considerable elevation  of the fter-
num,  attended with great pain and anxiety, with a
total inability of fwallowing.  She remained  in
this situation, with convulfions,  during Wednef-
day night, when an epifpaftic was applied to  the
nape of her neck,  and the calomel continued  in
fmall doles though the quantity  got into  the fto-
mach was altogether uncertain ;  (he continued
much in  the lame ftate on Thursday.  She growing
weaker  and more diflreffed,  and her cafe more
defperate, until Friday noon,  I determined to try
what effects electricity would  produce.   Accord-
 ingly a moderate fized receiver was filled, which
was difcharged on her leg, and paffed through the
 body to the head.  This immediately produced a
 tremulous motion in her lips, before (tiff and con-
 tracted,   and a grating of the teeth, a fymptom
 never before  obferved in  the courfe of her com-
 plaints,  on which I thought her  going into a con-
 vulfion fit; but to my furprize her jaws were ope-
 ned, and her tongue extended far out of her mouth,
 and (he  rubbing it with her  fingers.  I afked her if
 fhe could fpeak—(he gave me to underltand fhe
 could not.  I then difi-harg'd a fecund receiver in
 the fame direction with the firft, and her tongue
 was immediately  at liberty, fo that (he was able to
 fpeak plainly : Butobferving her thumbs  contrac-
 ted,  as they had been for twenty four hours,  into
                                          the 
28
 the palms of her hands,  there was  a third (bock
 paffed through her arms,  which loofed them inst-
 antly.  On Friday night  fhe rested  quietly,  and
 got up on Saturday morning; but on her  return
 to bed fne wasieized with fits, very fimilar to hy-
 fteric fits, but the locking of the  jaws did not re-
 turn ; the common nervine, antihyfteric medicines
 were  ufed,  but  to little purpofe,  till  Monday,
 when recourfe was again  had to electricity,  which
 was found effectual for thefe fits, and was apply'd
 repeatedly on their return,  until Wednefday fort-
 night from the time of her fall, when the  fits left
 her,  and (he is now in a comfortable ftate of health.
   Thus I have  given an  exact and plain narrative
 of fads onlv, in the  cale ;  and though, as doctor
 Sylvefter obferves, one instance is fcarce of confe-
 quence enough to deferve attention, yet as  it is a
 eliforder forare to this climate, but  fo  often fatal
 when it happens, it will not, I truft, be  thought
 ufeleis to communicate  a method, though  but
 once fuccefsful.    How far the early  ufe of mercu-
 ry may be depended on in this difeafe,. I  am not
 able,  from my own experience,  to fay,  though it
 has been'recommended as a fpecific in the disord-
 er.   Yet in the cafe above recited, there  appeared
 no amendment  until the ufe of electricity,  which
 molt inftantaneoufly relaxed the fpafms, to the aft-
onifhment of every byftander.  Indeed there was
no room to doubt of  its being the immediate  and
 fole caufe of relief to the  poor girl.   Should  this
 communication be an inducement to farther expe-
 riments of the kind in like diforders,  and prove it
fucceisful,  it will yield  the most ample recom-
pence and the higheft fatisfaction for  this commu-
 nication.
Caje 
29
Cafe of an  llamatemefis fuccefsfully treated.  By
  Dr.  Samuel Nefbitt.   Read April 6th, 178 5.

     ON  the  13th  of November,  1773.  about
       9'clock A. M. 1  was called, to VifitCapt.
Noble  Hinman, aged 40, of a very plethoric ha-
bit, who  was feized fuddenly  with  a violent and
copious difcharge of blood from the ftomach. The
fymptoms preceding, were, a fenfe of fulnefs in
the ftomach,  or  rather an encreafing  distention
thereof, which  was foon followed  with a naufea,
and a difcharge of blood from the ftomach by vo-
mit, to the quantity of.  above two quarts, as the
bystanders judged.   In this stage  of the com-
plaint, I received the call, and found the patient
languid,  and fenfibly affected  with the lofs of
blood; his vomiting had ceafed before  I arrived.
Notwithstanding, I immediately bled him to the
quantity  of fixteen ounc es, gave him an opiate pill,
prefcrib'd an astringent infufion, and the decoctum
corticis,  with elixir  vitriol.   I directed  all his
drinks to be ftrongly acidulated, to  be given cold,
and in  fmall quantities.
  I  remained with my  patient two hours, and in
eonfequence of a return of the ficknefs,  and vom-
iting of blood (to the quantity of about two pounds
by eftimation) I again let blood, to the amount of
twelve ounces.----1 vifited  my  patient at  one
P. M.  found  him more fenfibly affected by the lofs
of blood, and although no return of the  vomiting,
yet  there had been a difcharge of blood  by (tool,
procured by  an  enema previoufly administered.
His countenance  from being remarkably florid,
was now become very pale, yet the evident con-
tinuance  of the haemorrhage  and a tenfion of the
pulfe,  exceeding  the then apparent ftandard of
                                     fafety, 
3°

fafety, emboldened me to let blood again,  to the
amount  of  fourteen  ounces;  his  medicines
were continued,  and  the  anodyne  pill directed
to be  repeated  occafionally,  if the vomiting re-
turned :  I  then  informed  my  patient and his
friends, that I could  promife no relief in the pre-
fent cafe, unlefs I could reduce my patient to that
state of weaknefs, by the lancet,  which  might to
them  appear alarming, and  prelerve,  or  rather
fufpend him in  that ftate,  until  the  ruptured
bkx)d vellels collapled,  and the astringent medi-
cines might have time to effect the constriction of
the  heeding orifice.   My patient and his friends
acquiefced  ; of courfe no cordial of  the  vinous
or stimulating kind,  was, in this stage  of the
difeafe, administered ; except what cordial  was
received by the  decoduiTi  corticis.   At five,  P.
M.  vifited  my patient ;  he complained,  while  I
was prefenr, of a return of the fenfe of fulnefs,
which  was loon  fir ceeded  by a very copious vom-
iting of blood.  I held a large  wafh-hand bafon,
capable of containing  three  pints, to receive the
content^ of tht ftomach,  which veffel he fill'd, and,
continuing  to vomit, it ran over,  at leaft  a pint,
on the floor. I  then judged,  that  at  leaft  one
half the quantity difcharged was  blood.    It was
obfervable, in this and the two preceding turns of
vomiting, that the naufea, and confequent vomit-
ing was excited by the previous accumulation of
blood in his ftomach.   I  immediately gav*  an
anodyne  pill, continued in  fmall ' quantities the
decoct, corticis, and astringent infusion, with the
cold drinks Sparingly administered, and  let blood
again,  to the amount of  12 oz. for the fourth time
between nine in the morning and Ccven in the eve-
ning of the fame day.   Notwithstanding all thefe
                                 evacuations, 
                                            3'

evacuations, by hemorrhage  and  the  lancet, no
fyncope enfucd,  only a defirable languor.  I again
vifited my patient at late bed time, found  no  re-
turn of the vomiting, nor fymptoms that indicates!
a freih hemorrhage ; the fame regimen  was direct-
ed through the night,  with his drink  ftrongly aci-
dulated,  and with this  caution, to  be given in
fnrall quantities,  and frequently.
   On the 14th, early  in the  morning, I vifited
him ; found his pulfe a little fuller, and exceeding
the ftandard of fa fet y I had propoied.   I again let
blood, to the amount of  fourteen ounces, which
evacuation he endured without fyncope ;  the for-
mer regimen and medicine was perfilted  in, ex-
cept the pills.  At  10 A. M. I repeated my vifit,
my patient had a difcharge by ftool,  principally
coagulated blood ;  as he had no returns of vomit-
ing  as vet, and  had retained the decoct, corticis,
&c. I ftill found his  pulfe not fo languid as I
wiflied, I therefore let  blood to the  amount of
twelve ounces :  and complaining of fome  griping
uneafinefs in  his bowels,  I directed an emollient
enema, and an opiate  pill by rhe mouth, with a
continuation  of  rhe former  medicines,   &cc.  I
vifited him in the evening, no return  of  the vo-
miting, but  found  by the operation of the enema,
directed  in the  forenoon,  that a quantity  of co-
agulated hlood was  difcharged.  I again let blood
to the amount of twelve ounces,  and  gave an ano-
dyne pill,  he bore this  laft bleeding  as formerly,
without fainting, and  continued the other medi-
cines with the fame  precaution as before.
   On the 15th I vifited  him,  found no return of
the haemorrhage by any evident fymptom, there-
fore continued the decoct,  corticis, &c.  without
the anodyne.
                                        On 
32
  On the 16th, vifited him,  beginning to recruit
a little,  having had no return of the  hemorr-
hage, I thought it advifeable to fufpend the  af-
tringent medicines,  and interpofe a lenient purge
of manna only, which operated  gently, and pro-
duced a  difcharge  of fome coagulated  blood,
which, apparently from its colour, was  not pro-
duced by a recent  haemorrhage.
  On the 18th, finding no return of the haemorr-
hage, and judging  that the   ruptured  veffel, or
veffels,  were  fufficiently  coalefced, I indulged
my patient in a little  more  nutritious regimen,
and ordered  a continuance of the decod. cort. as
a restorative.   The treatment, by God's bleffmg,
had the defired effcd, and the patient, within three
weeks from the first attack, was able to return to
his ordinary bufinefs,  and enjoyed his ufual ftate
of health.
   I must acknowledge, gentlemen,  that  in  the
cafe now recited,  although the plan adopted  ap-
peared to me rational, yet it was not put in ex-
ecution without much concern, leaft my  patient
fhould mifcarry,  and  of courle my bold  pradice
be feverely cenfured ;  however,  this with many
other inftances I have met with,  to prove the
power of the lancet  in  similar cafes, has ftrongly
impreffed on me the importance of blood  letting.
The indifcriminate ufe of astringents in haemorr*
hages,  and  the good effeds of blood letting, af-
ford  fufficient matter, for animadverfion, but  at
prefent I will take up no  more of your time:
 another opportunity, perhaps, may-produce fome
 obfervarions on thefe fubjeds  from me, or fome
 abler pen.  At prefent  my defign is anfwered by
 a bare recital  of  a matter of fad.
It 
33
  It is wdrthy of remark, that the patient loft,
in about thirty-fix hours, ninety-two  ounces of
blood by the lancet;  and I am confident, by the
most moderate calculation,  double that  quantity
by haemorrhage.   The  blood drawn by lancet I
weighed accurately.



Cafe of an  Enteritis.  By Dr. Ebenezer Beardfley*
     Read before the Society, April 5, 1786.

     THAT article  in our constitution, which o-
      bliges every member of the fociety, to ex-
hibit a hiftory of all the  remarkable cafes  which
occur  in  his  pradice,  muft,  if  duly obferved,
conduce in the  highest degree  to promote the
defign and  end of our institution.   If we are faith-
ful, accurate and perfevering in our obfervations,
we (hall  foon  be furnifhed with a number of fad.*
and  histories,  which  at  fome future period may
be very interesting and  beneficial  to  the public,
and do honor  to the fociety.   It  is much to be
regretted that hitherto, the faculty,  in this coun-
try, have contributed  fo  little to the general  ftock
of medical knowledge.   Our  predeceffors  would
have rendered an important piece of fervice to us,
and to  future generations, if they  had made and
tranfrnitted down, faithful  histories  of  the dif-
eafes which prevailed  in their times.
   The dyfentery,  ulcerous fore throat,  and moft
of the other difeafes which have been epidemical
in this country, have been attended  with  pretty
long  intervals, during  which the difeafes have
not appeared  at all, or  in but a  few instances :
confequently, on a general return of any  of them,
moft of the praditioners  who  had  been  conver-
                  E                     fant 
34
 fantwith them being  dead,  and having  left no
 obfervations on record for the afliftance  and irr-
 ftrudion  of fucceeding praditioners, thofe dif-
 eafes have been  almoft as new and  strange,  and
 the proper mode of treating  them as uncertain as
 though they had never  occurred before.   It can-
 not be  doubted, under fuch circumftances,  that
 many valuable lives have been  ^ft, before the
 nature of the difeafe has been undcrflood, and a
 proper  mode of treatment  afcertained.   From
 whence it is probable the common and well known
 obfervation arofe, that a new difeafe is more fatal
 on its  firlt acceffion, than in  its advanced progrefs
 and later stages.   For  a number of years paft, we
 have  been  fo happy as not to be  vifited  with
 any  epidemic  difeafe :  but I  well remember,
 when the ulcerous fore throat made its appearance
 about fifteen years ago,  that there was not among
 rny acquaintance, but one or two phyficians, who
 had ever leen it before ; which was alfo the  cafe
 with refped to the dyfentery.  We ought  to ef-
 teem it  a peculiar  happinefs, that we have now
 an opportunity,  and have already made a  hopeful
 beginning in the eftablifhment of a  new  sera in
 the healing  art.  With  proper  attention,  fhould
 our country have the misfortune to be vifited again
 with any kind of epidemic difeafe, it will be in
 our power to mark  its origin, progrefs,  effeds,
 and termination, and to hand down  to  fucceed-
 ing generations,  a faithful hiftory of  the mode of
 treatment,  fuccefs,  and every other circumstance
 of importance.
   With a view to contribute by example,  as well
 as precept, to this  important defign, I now lay
 before you a cafe, which, from the violence of its
acceffion,  rapid progrefs, fudden and fatal termi-
nation,  appeared to deferve attention,
                                    JOHN 
35
  JOHN CHAPPF.L,  a healthy,  fprightly boy,
five years of  age, on his return from fchool,  at
noon, on Friday the 24th of  June,  1785, was
feized with  firknefs at  his ftomach, and vomit-
ing, which  was foon after fucceeded with  thirft,
heat, and reftlelfnefs.  Thefe fymptoms continued
through  the  afternoon and night,  during which
time he  ejeded  every thing he took into his fto-
mach,  and in rhe coiirfe of the night  and  next
morning,  brouyht up  ten large worms of the
round kind.   On Saturdav morning I first vifited
him,  at which time his pulfe was extremely quick,
fmall,  and  unequal ; his countenance  pale and
funk, his refpiration quick and laborious,  and  he
was fo reftlefs that it was with  difficulty that his
attendants kept  him on  the bed ;  his  thirft was
great,  but he almoft instantly threw up whatever
was given to him.   Nothing  had paffed his bow-
els since he was  firft taken ill,  but his abdomen
was not  at  all  tumefied  bur.   rather contra6ted.
He had  his fenfes  perfedly, but did not complain
of pain in his bowels, or elfewhere. I  preicribed
magnef.  alb. the neutral mixtures,  and other an-
tiemetics, with emollient fomentations, enemas,
and  fmall dofes  of calomel   through  the dav,
but without any  good  effed.  At evening the
fvmptoms were much increafed, at which time,
Dr.  Nefbitt, at  my defire,   was  called  in  to
confult  his  cafe.   We both judged it to  be  a
worm cafe, joined  with  inflammation  from their
irritation. The fomentations, enemas, calomel,
&c. were continued, and epifpaftics were applied
to  his extremities.   In   the night  his  vomiting
abated,  fo  that he  retained   the medicines and
drinks which were  administered to him untill his
ftomach feemed  to be overloaded, when they were
                                        ejeded 
36
ejeded to appearance from that caufe.  On Sunday
morning we vifited him again,  but though  the
vomiting was not fo frequent, hisdejeded coun-
tenance,  difficulty  of  refpiration,*  weak,  quick,
unequal  pulfe, and  cold extremities,  indicated
his approaching diffolution.   He died ai  eleven
o'clock this morning.   No  evacuation  was ob-
tained from the bowels, during the  courfe of the
difeafe,  by the  many injedions which were ufed,
aided by  the calomel,  &c.   On the afternoon of
the fame day,  I obtained permiffion from the pa-
rents, to open  the  body, in company with Dr.
Nefbitt and my  brother.  We  found  but one
worm in the whole intestinal canal.  The abdomi-
nal vifcera  were all found and, well conditioned,
except about two inches of the lower part  of the
duodenum, or upper part of the jejunum,  ^vhich
was  inflamed and fphacelated,  which appeared
clearly to be the caufe  of his  death.  From  the,
diffedion it appears, that the difeafe  was origin-
ally  a true  enteritis,  or  inflammation  of the
bowels,  and it  is  highly probable that the  worms
were not  at all concerned in  the produd'ion of it j
but being disturbed by  the increafed heat and dif-
agreeabienefs of  their  fituation, quitted  it  in
learch of a better.  It  alfo appears from this hif-
tory and diffedion, that we ought not implicitly
to trust thofe authors and others,  who are too apt
to consider  all  difeafes of the intestines in child-
ren,  as  arifing  from worms.  Such  a pre-con-
ceived opinion will be likely  to blind us, with re-
fped  to  the real caufe, if it fhould be of a differ-
ent nature,  and miflead us perhaps fatally  in our
prefcriptions.   Allen,  in his  Synopfis,   advifes
the praditioner in treating the difeafes of children,
if he meets with any fymptoms he cannot  readily
                                    account 
37
account for, to place it to the account of worms.
But this advice was certainly  unbecoming  a phi-
lofopher and phyfician.  It is much more fafe and
honourable to imitate the example  of the great
Boerhaave,  who affures us that he made it an in-
variable rule,  never  to quit the bed-fide  of his
patient, until  he had fully  afcertained  the ftate
and condition of all  the important  vifcera.  All
the common fymptoms of worms in the inteftines,
fuch as lofs of appetite,  acidity, pains  in the ab-
clomen,  alternate  bound  and loofe  body, (limy
and fetid ftools, grinding the teeth, erratic fever,
&c.  may  arife from an  increafed  quantity  of
mucus in the inteftines,  obftrudions  in the mef-
enteric  glands, and  dentition.   Symptoms of a
fimilar kind,  are alfo obferved in other difeafes
remote from this organ, particularly in the hydroce-
phalus internus.  How abfurd then,  and danger-
ous must it be, to  treat difeafes in the fame  me-
thod, that  are fo  diflimilar  in  their caufes and
feat, merely becaule there happens to be a simi-
larity in fome of the fymptoms!  Notwithstand-
ing the great similarity  in the fymptoms of fome
difeafes, there cannot be a doubt but what every
difeafe has  its own  pathognomonic or diftinguifh-
ing figns, by  which  it may b»  difcriminated,  by
the attentive and (killful phyfician.
  Amongst the other fymptoms which are com-
mon to worms, and the hydrocephalus,  the flow
pulfe,  and  dilated  pupil of the eyes, are ftriking
marks  by which the latter difeafe may be  readily
known.
   Dr.  Home of Edinburgh, in his clinical  ex-
periments affirms,  that he difcovered fixteen years
before he publifhed thofe experiment, a  certain
diagnostic fymptom of worms,  which in all that
                                        time 
33

time had never failed him ; which is,  an cedema-
tous fwelhng of the alse narium, upper lip, and
often of the contiguous parts of the cheeks; the
apertures of the noftrils are alfo diminifhed at leaft
the half of their  natural fize.   Since  1  read his
obfervations,  I have fee-n a few worm  patients,
which I apprehended were fwelled in  the manner
he defcnbes,  but I could not fatisfy myfelf fully ;
the fubjed deferves farther attention.   1 fhall con-
clude thefe  remarks, with this ^radical  caution,
that in  ail cafes that are  attended with heat, thirft
and  a fever,  though we may have  ocular  proof
that the patient is troubled with worms, we ought
to be circumfped in the administration of hot,
acrid,  stimulating fubftances, however much they
may be celebrated for their anthelmintic  virtues.
Caje of a deformed Fcetus.  By Dr. Leverett Hub-
  bard.  Read before the Society, April $th, 1786,

  IN the year 1786,  I was called to  a gentlewo-
   man in the fixth month of gestation.   I found
her attended  with a strong pain  in her breaft,
and left fide  of  the abdomen:  flooding  largely.
I examined the ftate of the os uteri,  found it not
dilated  in the leaft,  but tumefied and very hard ;
no  preffure from her pains.  I immediately let
blood,  which abated the flooding,   but  not the
pain.   I prefcribed her an anodyne, which  gave
no relief:  in two hours I gave  her another dofe,
which moderated the  pain a little.   I  tarried all
night,  and in  the morning I found the whole of
the abdomen fwelled to a prodigious fize,  with
                                        high 
39
highfever and inflammation. I ordered a fomenta-
tion of bitter  herbs,  which  abated the tumour
and inflammation  in  fomemeafure; after which
came on a naufea, and vomiting of a green  bilious
fluid, in quantity about three quarts.   I gave her
large dofes  of the fel. vip. which abated  the
vomiting; foon after came  on an univerfal lan-
guor and faintnefs;  fhe  remained in that ftate
the  greater  part of the day.  After the faintnefs
abated, fhe complained of a eoldnefs of the abdo-
men, which  on examination I found  to  be  ex-
treme :  this   alarmed  me, the  pulfe at the fame
time being  very  low.  I gave.her a  little wine
whey repeatedly,  which  accelerated the  motion
of  the  blood,  raifed the pulfe,  and  caufed  an
increafe of heat through the whole  body,  except
the  abdomen.  Her pain left her ;  I repeated the
fomentation with the  addition of a  little  fpirits,
and the wine whey to be given  now  and then,
and left her.   In about twelve hours I was called
again,  her pain returning;  I examined the  ftate
of the os uteri, I found it a little dilated.  Soon
after a violent flooding came on :  I judged thai
her prefent circumstances required  a  fpeedy  de-
livery.   By  repeated  trials  I gently dilated  the
os  uteri,  fo as  to introduce  two of my fingers,
with which I could feel  the foetus.  Its pofition
was preternatural  ; the abdomen first prefented; as
I judged, but was mistaken.   By further exami-
nation,  I  found it  could  not be  the  abdomen,
neither  could it be the head, for it  was  not hard
enough; my first  intention was to change its po-
fition,  fo as  to obtain the  head, but  could not
by reafon of a contradion attending every pain:
after a little  time  obtained one of  the feet, and
foon after the other, which gave me great encou-
ragement of a fpeedy delivery; I brought forward
                                        the 
the feet and legs, but to my great furprife the b6-
dy ftopt.   Then with my left hand extended the
thighs of the foetus as far afunder as I could, and
dipt the  two fore  fingers of my right hand,  in
order to obtain the extremity  of the inteftinum
redum.  But to my aftonifhment, I  found there
was no inteftinum  redum,  but  the fame  feeling
below the thighs as there was in the first touch,
as I  mentioned before, which proved to  be the
pendulous body which piefented  to  the birth,  as
delineated  in the  plate.
  Finding I could do nothing that  way, I thefi
returned the legs into their former position, and
by repeated trials,  turned the child fo  as to feel
one  of the  hands, after  that the  (boulder, and
then the  head which I caufed  to  prefent, and
foon after that obtained a delivery in the natu-
ral way.
  I fhould not have troubled you with  this cafe*
if the formation of the fcetus had  not been very
                                   fingular. 
4i
lingular.  Th- best dekription I can give 70U is
this;  as  I obferved  before, it was  in  the  fixth
month of gestation,  the fcetus  as large  as ufual.
The child, from the futura coronalis down to the
loweft or laft true ribs was natural, except  that
the cranium was uncovered; upon the left,  from
the futura coronalis,  down to the futura fquamo-
fa and futura tranfverfalis, except a pericranium.
I fhall next proceed  to the thighs ; the end of the
os femoris was rather flat than  round,  no os inno-
minatum but a ligament  formed, fattened to the
vertebrae immediately below the laft true ribs, the
ligament being about an inch long, gave liberty
for the  thighs  and legs to  move  exadly as a
fwingle is moved by the motion of  its  ftaff.  A
little below the joining of the thighs to  the verte-
bras, there was a neck formed a little larger than
that on the fhoulders, to.which was  formed ahead
as large as that of the natural,  consisting of  cere-
brum and cerebellum, not contained in a crani-
um but a cartilaginous cafe,  with  a dura mater,
which was feparate  from  the  cartilaginous cafe,
and covered with a (kin,  or fcalp,  as ufual, but
n© hair.  Upon the right fide of this falfe  head
(if I  may fo call it) appeared three  fmall perfo-
rations or inlets, placed in a triangular form, and'
 were about an  inch and  an half from each other;
two of which were about as large as a rye straw,
the other of an oval, about one fourth of an inch
long, which was lower than the other.   I  intro-
 duced a probe into the fmall perforations first,
 and found  they did not extend more than half an
 inch ; rhe other which  I  founded extended two
 or three inches in an afcending diredion, which
 with my knife, I laid open, and found it to be a
 fmall tube or canal, a little refembling the  cefo-
                    F                 phagus 
4*
phagus by  its wicker like ftrudure; it extended
no farther an entire tube, hut was divided into a
number of  fine tubes  or fibres, which were  loft
in that which I called the cerebellum, or medullary
fubftance.  The left leg was  flat, having two ti-
bias and two fibulas articulated about half way
from rhe patella to the ancle.
   I fhould have proceeded further in my diffedion
and enquiry,  but was fuddenly called off.
   What great reafon have we to praife the great
former of our bodies, that our  children  are  not
oftener deformed than they are.
On the fatal Effects of the  Corrojtve  Sublimate of
   Mercury.   Communicated by Doctor Levi Ives.
   Read February 7th, 1787-.
                       %
      ON  Friday, Dec. fepth, 1785, Mr.  I.  S.
       nineteen years of age, through an unhap-
py miftake of his own,  fwallowed four grains of
the corroiive  fublimate of mercury,  diffolved in
a fmall quantity of  water, which very  foon exci-
ted a violent  vomiting and purging,  with intenfe
pains and griping.   It was about thirty hours af-
ter he took the fatal dofe,  when I first vifited him.
I found him attended with a constant  naufea,  and
purging of a fanguineous mucus,  with a quick,
low pulfe,  great thirft, a moft intolerable cardial-
gis, and griping.  I  direded a  cooling  purge,
and to dilute plentifully with an infufion of viol-
e.s, together with an  infufion of gum arabic, which
was taken freely,  but without any mitigation of
his complaints.  Sunday  morning found him as
above defcrib^d, and no alteration for the be ter.
On Monday finding him  finking under his com-
                                    plaints, 
                                           43

plaints, directed to the ufe of ol. ric.  with barley
water and  nitre,  which gave fome relief to his
griping.   Tuefdav, January  i ft, his purging and
gripings much abated,  yet attended  with  a very
quick, low pulfe, cardialgia, and great thirft.  The
prefcriptions of Monday were continued,  and as
his pains became erratic and more univerial,  I di-
reded an anodyne for the night,  tho' with  little
advantage.  Wednefday  his diltrels  became ftill
more univerfal, the fane medicines were continu-
ed, with  an anodvne at evening, which procured
fome reft.  Thurfday the 3d, found him diftreff-
ed with the forementioned fymptoms, and nature
evidently finking.  Friday the  4th,  came  on a
fmall haemorrhage from the noie, with a fingultus
and a great acerbation of  all ihe  fymptoms.   Sa-
turday and Sunday following no material alterati-
on, except  a  manifest decay of strength.   On
Monday came on a profufe haemorrhage from the
nofe, which  continued until death  clofed  the
fcene, which was on the  eleventh  day froitfatft
ceiving the fatal dofe.
The fatal effects of drinking cold water,  when hea
  ted.   Communicated by Dotlor damuel Nejuitt.
  Read April tfh,   1787.

      ON   the 1 ith of August, 1774, I was called
       to visit Jofeph Kent, a labouring man, a-
ged 45, of a robust habit.  The account  he gave
of himfelf was, that a few davs before, when warm
with work, he had drank about a  quart of cold
water,  after a hearty  dinner  of fi(h, the imme-
diate  effeds  of which  were great dirtrefs at  the
pit of his ftomach, a trembling and difficulty of
                                  breathing
b&&£ 
44
 breathing, with faintnefs; the trembling and faint-
 nels went off foon, but the difficulty of breath-
 ing  and pain,   increafed,  extending  over the
 whole  hypocondriac region,  fo as to give him
 the idea of cholic, which idea he retained through
 the  whole difeafe,   notwithftanding every  perr
 fuafion  on my part, and the plaineft indications
 to the contrary,  as every enema and aperient  in
 the courfe of of the difeafe operated readily.   A
 phyfician was called immediately who had pre-
 scribed  a lenient  purge and  fedatives ;  but with-
 put relief.   I do not recoiled whether venaefedi-
 on was premifed; but I  think  it moft probably
 was before my visit, which was on the 4th or 5th
 clay of the attack.  I found him with every fympt-
 omof an extended and high inflammation, great
 diftrefs and difficulty of  refpiration,  accompanied
 with afevere fingultus, and extreme pain in there-
 gion of the liver.  I immediately let blood from the
 arm copioufly, which was repeated often and occa-
 sionally, without any permanent relief. For feveral
 days the moft rigid antiphlogistic courfe was pursu-
 ed, epifpaftics were applied & renewed to the cofta?,
 fternum, and parts adjacent, gentle cathartics & ene-
mas were administered, with the defiredeffed as eva-
 cuants.  Fotufes of emollient herbs were repeatedly
ufed,  with now and then a gentle anodyne as a pla-
 cebo. But the whole that was obtained from a bold
 antiphlogistic courfe, was a prevention of gangrene
in the inflamed vifcera, and of courfe a lefs fpeedy
termination of the difeafe. The iffue was a fuppura-
tion of the inflamed parts, probably about the 15th
day of the difeafe.  When fymptoms of the hectic
kind came on, and a formation of pus, the pains
grew more tolerable, and an apparent  diftenfion
began in the right hypochondrnam, which in the
                                    fequel, 
45
fequcl, about two days before his death, became
prominent  a little below and to the right of the
cartilago enfiformis, with  a fluduation about the
time of his death,  evident to the touch.  Death
was fo evidently near at hand, that I expeded no
relief to the patient nor credit to myfelf would ar-
ife from a pundure  of the abfcefs, and  therefore
deferred  it until diffedion.  On the ceffation of
the inflammatory fymptoms, and the commence-
ment of  the hectic, the antiphlogistic  courfe was
exchanged  for a regimen of the nutritious and
restorative kind, with a light preparation of the
bark.   The patient finding no profped of relief
from any remedies I had applied, and  (till retain-
ing the idea of cholic, as before  recited, difpatch-
ed a meffenger for a famous cholic dodor residing
in a neighbouring town,  without my knowledge.
I was informed,  however,  before the dodtor's ar-
rival, and defired the nurfe to let me know that I
might  attend  and ftate the cafe to him previous
to his attempting any thing for the patient.   The
dodor arrived about ten, in the night of the 4th of
September,  and immedjtely pronounced the difeafe
to be the cholic. I in vain endeavoured to remove
every  idea of the kind from  his mind ;  contrary
to my  remonstrances, he was puc under a courfe
of  ftrong   aloetic  purges,  combin'd with  ar-
omatics, commonly called Hull's bitter powder?.
The operation was violent, and he died  on the
6th, about thirty days from the  first attack.
   The appearance of the body, on  diffedion,
was as follows.  On punduring the abfcels ex-
tending from  the  liver,  a stream of pusiffued to
a distance from the body ; when the vifcera were
expofed to  view, the liver was found  to  have
been greatly distended  with  pus,  from  whence 
46
the  aforementioned  tumour was formed,  by a
diftenfion of the peritoneum and  intervening te-
guments ; it was  a mafs of corruption,  and its
fubftance  difcharged  by that and feveral fmaller
abfeeffes : the  lower  furface of the  diaphragm
was  overfpread with numbers of  fmall tumours,
of the fize of nutmegs and hazel nuts containing pusj
the mediastinum and the pericardium  in a similar
ftate, but the  tumours  fmaller.  In the place of
lymph,  in  the cavity of the  pericardium,  there
was  found  a purulent  matter to a confiderable
number of ounces: The heart's furface was  co-
vered or enrrulted like  the  diftirid fmall-pox in
a ftate of complete maturation, or a day or two
part  that period :  the external furface of each lobe
of the lungs was  affeded by previous  inflamma-
tion, and  matter was  contained in   the  right
cavity of the thorax,  which communicated by an
opening through the diaphragm  with  an abfeefs
in the liver.
An  extraordinary caufe of an  Afthma, in the caje
  of a Lady of this city,  proving fatal.  By Dr.
  Samuel Nefbitt.  Read before the Society, April
  \th, 1787.
  IN the morning of the 24th  of June, 1774,  I
   was called to  vifu  Mrs. R----,  aged  thirty-
eight years, in confultation with Dr. Bontecou.
We found the patient  fitting up, leaning her  el-
bows on a pillow, (upported  by a stand,  and  in
that pofture labouring for breath, with an  emaci-
ated countenance, feeble pulfe,  and every fymp-
tom of great debility, unable to  lay in a fupine
pofture,  having thus paffed her days and nights
for  fome time, except now and then on a bed bolf-
ered up : the patient was  then pregnant, and
                                      about 
47
about the fixth  or  feventh month of  gestation.
The difeafe  had been  gradually increafing  for
about two years, with this addition, that in  the
period of gestation  the fymptoms were  much  ag-
gravated by her increafe of bulk;  it appeared to
us impofiible (he could endure thro' the remaining
period of geftation, if the fymptoms increafed with
the bulk, even if her strength would have admit-
ted ; but as the cafe  then was, the fituation of our
patient was truly deplorable ;  however, we had
not much time  to deliberate  on the cafe, for on
the evening of the  fame day,  premature labour
came on  ; Dr. Hubbard was joined in  the coun-
cil,  and delivered  her in  a few  hours: we then
hoped for an abatement of the fymptoms, but none
weie obtained ;  every effort was made for her re-
lief  and recovery,  but fhe died on tht evening of
the 30th.
   We viewed the cafe as an  empyema, and  re-
quested liberty of the relatives to open the  body,
but with great reludance on their part,  obtained
leave to pundure  the  thorax.   I pundured  the
eight cavity  of  the  thorax,  but no fluid iffued,
I  did  not proceed  to  pundure the left,  left I
fhould  fail in finding a fluid contained,  which
was the apology  made to the relatives;  but loth
to ftop our enquiries, I  enlarged the pundure a
little with a fcalpel,  fo as to introduce my finger,
and found  it obftruded in its courle by a hard
body; we enlarged the opening  in the  courfe of
the rib and diftindly felt a hard  flefhy fubftance,
in form and (hape like a pine apple, crouding up
along the right cavity of the thorax, and preffing
ftrongly  the right lobe of the lungs upwards, and
against  the  mediastinum.  The tumour  was a
fchirrhous  enlargement of the liver, in form and
                                      about 
4«
about the fize of a moderate pine-apple,  with its
apex projeding into the cavity of the thorax, and
carrying by diftenfion  that  portion of  the dia-
phragm oppoied to its fuperior point,  and reach-
ing at leaft to  midway  of  the cavity :  we were
anxious to pufh our enquiries  further, and to have
examined more minutely into the ftate of the affed-
ed vifcus and other of the vifcera,  bin* the rela-
tives would  not  admit  of  any  further  defa-
cing of the corps, as they  called it.
  From  thefe  circumstances,  Gentlemen,  thus
difcovered  as it were  by accident, the investi-
gation  of the caufe of our deceafed  patient's com-
plaint  and its  gradual  acceffion,  was apparent;
the aggravated  fymptoms from  gestation by  the
increafe of the uterus, and its  confequent preffure
on the fuperior and afleded vifcus,  were like wife
cafy to be accounted for, and  that no fubftantial
relief was derived from delivery, we were at  no
lofs to determine,, all being deducible  from  the
grand and proximate caufe, the unnatural diften-
fion and elevation of the diaphragm; the interrup-
tion of the fame mufcular partition, fo neceffary
in both ads of refpiration ;  and the occupying by
the tumour the greater  part of that cavity  pre-
pared for the free adion of the right lobe  of the
lungs.
  From the hiftory of this Angular and  unfortu-
nate cafe, there appears no sera at which  we  could
promife any fuccefsful mode of treatment;   at the
time I faw the patient,  the cafe was irremediable,
and I am led to conclude that at no period of the
difeafe when the complaint of the afthma became
apparent, was their much,  if any chance for re-
lief, as undoubtedly  the fchirrhous  had  obtained
fome confiderable fize   before the difficulty of
                                  breathing 
                                            49

breathing was much noticed, and its caiife being
concealed, deftroys the firft principles of  pradicc
viz.
  Inveftigatio caufse, faepe morbum folvit.
                                    ClLSUS.
 Cafe of a J^drocephalus Internus. By Dr. Ebenezer
   17,  Beardfley.  Read before  the Society, Otttber^
   1787.

    FRIDAY,  January 13,  1787,  Polly Edwards;
     daughter of Pierpont Edwards, Efq. of this
 Cltvj  a£ed five years and three months,  was feiz-
 ed with thirft,  and reftleffnefs  ; the next day fhe
 was  fomething feverifh,  and dull,  but play'd
 abroad.   At  night her complaints returned, and
 fhe was  feverifh and  reftlefs  through the night.
 Sunday,  Monday and Tuelday, fhe complained
 of a forenefs in her  head,  which was fo great as
 to be much affeded  from a flight touch; {he1 was
 alfo  attended   with  a constant head-ach, and for
the moft part  was dull and  fleepy, but had turns
of anxiety and reftleffnefs :  her thirst contin-
ued, and  her countenance was very florid.  On
 Wednefday,  her diforder was fo increafed that
 fhe became confined  to her bed.  Thurfday night
fhe was very reftlefs, her deep  was much disturb-
ed and  fhe frequently cried out  that fome body
pulled her hair.  Her weakness increafed fo that
fhe became unable  to bear her own weight, her
eyes   appeared  bright,  fhining,   and inflamed;
fhe picked her nofe,  and often  put her hands up
to her  face and head.   She had no appetite for
food from the  beginning; fhe voided three worms
 in confequence of  a purge of mercurius dulcis.
                    G                Friday 
J0
Friday and Saturday, her anxiety and reftlcffneft
increafed,  and fhe  frequently threw her hands
round  the back  fide of her head.   Sunday her
pulfe,  which,  from  the beginning, had  been
quick, full and ftrong, becan^e remarkably weak
and fmall ; and (he totally loft her ipeech, which
returned no more.
  This evening I fawherfor the firft time, in com-
pany with the Dodors Prime and  INfcinfon, the
former of whom,  had attended her from the firft
acceffion  of the  diforder.   Her face was  Very
florid, and  a  little bloated,   her eyes inflamed,
weeping,  and  the pupils dilated, the  pulfe was
very fmall and weak, fo as hardly to be perceiv-
ed, but not remarkably quick, her extremities were
cold, but her  head, efpecially the hinder parts of
it, were very hor;  fhe had little or no third; fhe
had frequent  turns of the greatest anxiety and
diftrefs imaginable, during  write!1* fhe writhed
her body, threw  off the bed  clothes, grated her
teeth, started  up. on end in the bed, and clench-
ed her hands round the backside of her head.  In
 the  intervals  between thefe  paroxifms,  fhe lay
 quite  eafy and   compofed,   looked about,  and
 took notice of the people and things around her.
 Her reafon did  not appear to be at all impaired i
 fhe  appeared  to know every perfon of her ac-
 quaintance who came into the room, put out her
 tongue readily when defired,  for the infpedion  of
 her phyficians, &c. which continued till near the
 clofing  fcene.   In her intervals of eafe,  fhe lay
 upon her back,  with her feet drawn up.  In her
 paroxifms  of diftrefs,  her eyes were convulfed.
 Through the whole of this wtek her anguifh and
 diftrefs continued to increafe, her extremities be-
 came as  cold  as a corpfe,  her pulfe was quick,
                                       weak, 
5*
weak, and fo fmall as fcarcely  to be perceptible ;
yet her head remained hot, and her cheeks high-
ly coloured  to the  laft.   On Sunday  morning
fhe expired  without a struggle or a groan.  Pur-
ges  of mere. dulc.  with fenna,  rheubarb, and
the  Carolina pink  root, had  been the principal
medicines.   Thefe were fucceeded by fomenta-
tions,  feraicupium,  blisters, wine  and other cor-
 dials.    #
   Dr.  P. who attended  the patient from the firft
 acceffion of the  ditorder, had confidered it as a
worm cafe,  and notwithstanding the distent of the
 other  physicians who were  confulted,  he  main-
tained his opinion with confidence to the laft.  To
 remove all doubts  upon the fubjed,  and to in-
vestigate the nature of the difeafe, the body was
 infpeded in the afternoon of the fame day.  The
 inteftines,  which had been fuppoled  to be the
 feat of the  difeale,  were entirely found, without
 a fingle worm or any other  morbid appearance;
 which was  alfo the cafe  with  the other vifcera of
 the abdomen,  and  the thorax.    Finding  no
 morbid appearance  in the thorax or  abdoirun,
 we proceeded to infped the brain.  After the ex-
 ternal  integuments were removed,  the cranium
 was  fawed   off a little above the ears, and care-
 fully removed without injuring the dura mater,
 when with  a fcalpel, the upper part of the brain,
 with the furrounding integuments  down to the
 firft ventricle, were removed.   The firft and (ec-
 ond ventricles,  being laid open,  exhibited  no
 morbid appearance,  but  upon cutting into the
 third and fourth, five or fix  ounces of clear tranf-
 parent lymph flowed out,  and ran into aveffel
 which was   placed  to receive it.  The diffedion
 was performed in the prefence of a number of the
                                      faculty, 
52
faculty and others, who were fully fatisfied that
this was the feat of  the difeafe, and  that the pa-
tient's death  was occafioned by a compression of
the brain, efpec-ally the cerebelluum, from whence
the remarkable failure and weaknefs  of the vis
vitse,  lofs offpeech &c.  which took place many
days  before death,  though the animal fundions
remained  found to  the laft:  the reafoa of which
is obvious from anatomy and  physiology.
Caje of a Schirrous tufyour in the Pylorus,  Mefen^
" tery, and Inteftines, communicated by Dr. Ebene-
  zer Beardjley,  Oct. 17th, 1787.

      MRS. Sarah Tuttle, aged 64, had for feve-
       ral vears  been afflided  with indigestion,
naufea,  acidity,  and heart-burn,  with diarrhaea,
and  coftivenefs alternately.  Lime water, foap,
gum  pills,'  bitters,  and  abforbents,  which  her
phyficians had occasionally prefcribed for her, af-
forded her a temporary relief, but the  complaints
often recurred, and increafed, fo as to render the
laft fix or eight years of  her life very uncomforta-
ble.   About the beginning of laft July  fhe  was
taken down with a fever of the low depreffed kind,
attended with headach,  vertigo,  fleepleflhefs,
frequent flight rigors, and  the  ufual  complaints
in her firft paffages.  August the  10th, my advice
was afked.   She was much emaciated,  had a low
feeble pulfe,   constant  naufea,  cardialgia,   and
ficknefs at her  ftomach,  with frequent  ejedions of
an acid, flimy fluid, the thrufh,  and a  trouble-
fome and wasting diarrhaea.
  "She was wholly destitute of appetite, and had lit-
tle or no quiet deep.  I  prefcribed watery infusi-
                                        ons 
                                           si
pnsof rheubarb, flowers of camomile, fnake-roor,
and  other  stomachics, with the  bark,  and ano-
dynes, which gave  her  great relief for feveral
weeks.  But the naufea  and ficknefs at ftomach
returning,  and finding no relief from stomachics,
antacids, or any other medicines,  at  her request,
on the fecond of September,  I gave her about one
fcruple of  ipecacuanha,  which operated mildly
five or fix times.  "But the next day  the  ficknefs,
&c. returned, and  fhe  was,  in all refpeds, worfe
than  before.  After this  I   direded  her to the
ufe of porter, which abated the naufea  and fick-
nefs,  but produced an intolerable burning  and
uneafinefs in the ftomach,  upon which it was laid
afide.  She continued  flowly declining, without.
any remarkable alteration  in her fymptoms, till
Saturday the 12th instant,  when fhe died, at  ab-
out ten in the morning.  The  diffedion was per-
formed by  Dr.  Spalding,  in the  prefence of Dr.
Darling,  my brother, and  myfelf, the next morn-
ing.   The  thoracic vifcera,  liver, fpleen, omen-
tum,  and large inteftines were in  a  found ftate.
The ftomach was considerably distended, and fil-
led with  a  fluid which refembled chyle.  At  its
lower orifice, there was an oblong fchirrous tum-
our,  of the fize of a pullet's egg,  and  about two
inches and  an  half in length, extending down-
wards  into  the duodenum.  The  fchirrhus invest-
ed the pylorus on  all fides, and was nearly three
quarters of  an inch thick.  The  orifice was con^
traded to the fize of a goofe-quill, and upon cut-
:ir£ into the tumoufVthere was found a quantity of
S us-like matter, of an a(h colour, and of the confi-
 ence of thick cream. Thefubftanceofthetunour
confided of a number of round, hollow bodies, of a
hard  compad texture,  which bore a strong refem-
                                     b lance 
**
to  the round belly  worm,  but  they  adhered
clofely,  at each end, to? the furrounding  parts.
The mefentery, and a confiderable proportion of
the fmall inteftines were alfo in a fchirrhous ftate.
The uterus, vesica urinaria, &c. were not difeafcd,
nor was there-any fphacelation  in any part.   It
would be a curious and interesting enquiry, if we
were  able to  give a hiftory of the origin,  and
progrefs of this difeafe.  It is  highly  probable
that it had been of many years standing. The on-
ly pradical dedudion which I  fhall make from
this cafe is,  that, where  a patient has  been trou-
bled for  many years  with fimilar  complaints in
the primae viae, we ought to fufped the  existence
of a fchirrhous or cancerous tumour, and to be on
our guard againft exhibiting to fuch unhappy per-
fons strong emetics, or any other acrid, stimula-
ting  medicines, all of which muft increafe  the
malady,  and  precipitate the fufferer to the grave.
Cafe of a fingular Wound  in the Eye, from the
  burfting  of a  Gun.   By  Dr.  John  Spalding.
  Read before the Society, April id, 1788

      MR. Ezra Curtis, aged twenty years, on the
       18th  of  September,  1785,  received  a
wound by the burfting of a mufket, the breech-
pin of which, entering his  right eye,  drove the
eye, with the whole of its bon.yjprbit before it,, un-
til it was impeded in its progrefs  by the vertebrae.
of the neck, and os  maxilla inferior,  or  lower.
jaw.  The fpine  of the pin paffing through the
coracohyoidaeus and part  of the  maftoides  muf-
                                       cles, 
55
eles, to the adipofe membrane, without perfor-
ating the fkin.  The body of it was firmly wedged
between the proceffes of  the vertebrae of the neck
and the up]»er and  outer an2;le of the lower jaw.
The deftrudion of fuch a number of large blood
veffels producing a violent hasmor. hage  from the
wound, nostrils and mouth, which was fucceeded
ed bv  a  great degree of inflammation,  and tu-
mefadtion  of the face and neck,  no fufpicion was
entertained by the furgeons who attended him,  or"
any other perfon, that  the  pin had entered  the
eye, till  fix months after, when  a fu| pi ration
took place,  and the tumour  being  opened,  rhe
pin was difcovered,  to the great furprize and afto-
nifhment of the furgeons and fpedators.  After
the inflamation and tumour fubfided, the end  of
the pin projeded itfelf about three eighths of  an
inch beyond the fkin, where it remained  immove-
ably fixed, without admitting  any change in  it*
position  from the strongest efforts that could  be
made, until  May  31ft, when it was happily ex-
traded.
   Upon  his firft application  to me, which was
the firft of May,  I dilated the  wound  as much
 as  the nature of  the  parts  would  admit;  and
 then with a  pair of strong  forceps, attempted to
 turn the pin fo as to difengage it; but after my
 utmost exertions  I  was  obliged to relinquifh the
 attempt,  the cafe being of fo  Angular a  kind,
 and from the proximity of fuch a large number of
 blood veffels, attended with  the utmoft danger.
 On the  5th, I procured  a  confultation  of the  fa-
 culty  belonging  to  the city,  in which  it was
 agreed to denude  a part of the jaw bone, and
 with a fmall trephine cut out a piece opposite  to
 the pin, in the fhape of acrefcent; this opera-
                                        tion 
5«
tion I performed on  the 8th,  in preferice of  the
gentlemen of the faculty afore mentioned,  and
took out a fmall portion of the jaw, about half
the breadth of the (crew, by which it was loofened
a little,  fo as to admit of more  motion than  be-
fore,  but all our efforts  to extrad it  proving
ineffectual, and fearing that the jaw would be
rendered wholly ufelefs if the painful  operation
of cutting it any further fhould be  repeated;  I
determined,  as the dernier refort,  to attempt to
faw  off the  fpine  of the fcrew as  near to  the
body of it as  poflible,  hoping by that means to
give it  more liberty to turn within the narrow
circumference to which it was confined.   On  the
15th, having fixed  a fmall hand vife to  the  end
of the fpine which projeded out,  and fixed that
vice into a  larger one which  was fastened to  a
bench;  I  then began  the difficult,   painful  and
laborious  operation, which  I  continued till  his
ftrength  and patience were exhausted.   On  the
16th, I  reaffumed the operation,  and  repeated
from time to  time as  his ftrengh would admit,
until the  29th, when  the  feparation was  com-
pleated, and the fpine of the fcrew  was extraded
without difficulty,  the body of it  (till remaining
behind.  In attempting to  extrad  it I  unfortu-
nately broke my ..forceps;   but having  provided
myfelf with  a stronger pair, on the 31ft I  hap-
pily extraded  it, to* the incxprefijble joy of .the
patient;  who had exhibited an uncommon degree
of fortitude  and refolution  through the  whole  of
his  fevere fufferings and diftrefs.  The jaw, which
had been immoveably fixed from  the beginning,
fo that it  was with great difficulty he got down a
fufficient quantity of food  for his  fupport, gra-
dually recovered its former  motion, the wound
                                      healed 
healed well,  and except the lofs of the eye, he
is now perfedly recovered.
Caje of a fatal  Peripneumony.  Communicated by
  Do ft or Ebenezer Beardfley.  Read  January 2,
  1788.

    JULIA  MEIGS, daughter to Mr. Jofiah
     Meigs,  of this  city, a lovely and beautiful
child,  aged feven months,  was taken about eight
days ago, with a cold,  attended with a cough  and
feverifhnefs, efpecially at night,  feutthelympt-
oms were fo flight, that her parents were not alar-
med about her until Tuefda'y morning, the  23d
of Odober, 1787, when, by the advice of a phyfi-
cian, fhe took a dofc  of emetic tartar.   On the
evening of the fame day I  vifited her,  at which
time her pulfe was quick,  hard and strong ; her
refpiration  quick, laborious, and accompanied
with a  rattling noife :  her fkin -was  dry and (he
was very thirsty.  Her countenance was pale and
full, with a kind of fliining, leucophlegmatic ap-
pearance,  which extended over the whole body.
The emetic which fhe took in the morning oper-
ated fcveral  times,  both upward and downward,
but without  affording any relief.  I  prefcribed
fmall dofes of emetic  tartar,  as a febrifuge, with
pediluvium,  and diluting  drinks.   Wcdnefday
morning there was no abatement of the fympt-
oms, the pulfe continued quick  and hard,  the re-
fpiration laborious, attended with a noife not un-
like the boiling  of a  pot,  her  thirft was great,
and her fkin, notwithftanding the pediluvium, &c.
remained dry.
                       H                  It 
5«
   It now appeared that the difeafe was a true pe-
 ripneumony, and  from its  rapid  progrefs there
 was reafon to apprehend a fpeedy and fatal termi-
 nation,
   I attempted  to bleed her in feveral places in
 her arm* and feet, but the veins were fo impercep-
 tible, that all my attempts were unfuccefsful.  I
 then had rccourfe to deep fcanfication and cupping,
 which I repeated in  feveral places ;  but with all
 my endeavours  I could not extrad mor^ than two
 or three ounces  of  blood, which was very thick,
 without fcarce any appearance offerum.   Nitre,
 camphor, &c. with diluting  drinks, were freely
 exhibited, blifters were  applied to the sternum &
 fides, and emollient cataplafms  to the lower ex-
 tremities.   The fteam of  a  warm decodion of
 emollient herbs  wai received into the lungs,  and
emollient nitrated enemas were frequently injed-
ed.  But all thefe remedies proved ineffedual :—
fhe made an  eafy exit on Friday morning.
   As there had been fome difference in the fenti-
ments  of the phyficians who faw her during her
il'nefs, fome of them having fufpeded that the
diforder was  the croup, or that fuffocating difeafe
vulgarly called the rattles,  the body was opened
in the afternoon  of the fame day.
   The  diffedion was performed by Dr. Nefbitt,
in the prefence of ieveral gentlemen of  the facul-
ty.  Both lobes of the lungs were deeply and ex-
tensively inflamed,  and in feveral places entirely
fphacelated.   No other  morbid appearance was
found in any of  the vifcera, only the liver appea-
red to be of  an  unufual fize  and  hardnefs,   but
there were no figns of inflammation upon it.
   The hiftory and diffedion of this fubjed afford
 fome very importanc pradical hints, with refped
                                         to 
59
to the difeafes of infants  and children.   Difeaf-
es of the lungs are more frequent, violent and fa-
tal in infancy than  in  adult  age.  A large pro-
portion of children who die under two years of age
are carried off by difeafes in  this organ ;  and, to
the beft of my recolledion, many of thofe which
have fallen under my obfervation, have  been at-
tended with  the fame  fymptoms which occurred
in the prefent cafe.   But I  must candidly own,
that I have not been wont to  confider  and treat
fuch cafes as ftndly inflammatory,  and of courfe
have negleded venaefedion, or ufed it very fpar-
ingly, and the proper antiphlogistic regimen  and
medicines, for emetics, pedoral detergents,  &c.
Other praditioners, as  far as I am  acquainted,
have pursued the fame courfe.  But  for  the  fut-
ure, whenever I find an infant attended with a dry
cough, difficulty of refpiration, a hard, quick
pulfe, thirft,  &c. I am refolved to be more upon
my guard againft an inflammatory affedion of the
lungs ; and, where it is poflible,  to bleed fuch
fubjeds as readily as I would adult perfons atten-
ded with  the fame fymptoms.
   I beg leave to propofe  it as a question  to you,
my learned brethren, whether, in fuch  a cafe as
the foregoing, where no vein can be  found from
whence a proper quantity of  blood can  be obtai-
ned, it would not be warrantable to open an  arte-
ry ?  and whether a pundure in  the temporal  art-
cry, which is perhaps the  moft eligible, would
 not be admifiible ? 
 6p


 Caje of an amputation of the leg, in confequenee of a
   divided  artery.   By  John Spalding,   Surgeon.
   Read to the Society,  id January, 1778.

       MR. James Robinfon,  Jun. of  Durham,
        aged  tenty-two  years,   on the  27th of
 March, 1787, cut his leg with  a  straight edged
 axe, which  divided the poftica  arteria,  near the
jundion of the fibula  to the tibia tranfverfely,
 about  one  and three-fourths  of an inch from
 where it goes  off from the tibialis anticus, from
 which proceeded a violent  hcemorrhage, which
 was  reftrained for  the prefent by  a  common
 bandage; it remained  fccure to all  appearance,
until April 4th, when it began to digest and the
 hcemorrhage returned with as great force as before,
and was again fuppreffed by comprefs and band-
age.  On the 5th the hcemorhage returned  a fe-
coad time, when the Dodors Cole and  Gaylord,
were called in, who made a ligature  round  the
divided artery, by  which  the bleeding  was re-
ftrained until the 6 th ; in the morning the hcemorr-
hage returning, I was called to the affiftance of
thofe gentlemen; we agreed to make a ligature on
the upper part of the  divided artery, which re-
ftrained the bleeding until  the  nth;   but  the
ligature not  investing the wounded artery, but the
mufcles only, immediately below it, which we dis-
covered to be the cafe after amputation,  the up-.
per end  of the  artery having  receded from  the
wound fo far as to be out  of the reach of the
needle,  and the upper branch of the poftica dila-
ted,  fo as to form a fort of aneurism;   we then,
not knowing the impossibility of iecuring the ar-
tery,  agreed to fix  on Pettit's  tournequet,  and
                                       clear 
6i
clear the wound of the grumous blood, and cut
away the mufcles on each fide the wound, fo as to
admit the needle to pafs fo deep, if poflibie, as
to encircle  the artery;  which  operation proved
unfuccefsful as  the  former.  We  ordered the
tourniquet to remain,  that in cafe of its bleeding
it might be restrained, but to be fo loofe as not
to obftrud  the circulation in the leaft, unlefs upon
a return of the hcemorrhage.  He remained free
from  hcemorrhage until the 14th, when they were
again  alarmed  by  the blood flowing from the
wound  ; they fent a meffenger after  me  and the
gentlemen   before-mentioned;  we met  in the
evening, and from the lofs of blood,  which he
hadfuftained at different times, and the improba-
bility of faving  the limb by any further efforts,
made known our fentiments to him and his friends,
desiring them to call  in fuch  further counfel  as
they fhould think proper,  which they accordingly
d'«d.  We  met on the 15th, and  after maturely
examining  his cafe, gave it  as our opinion,  that
amputation was the only means of faviog hi? life;
oblerving,  at the fame time, that his recovery was
doubtful, from his extreme weaknefs: however,
as there appeared  no  alternative, we proceeded,
and amputated the limb in  the modern method,
by the double incifion, &c.   The wound digefted
well, had very little of the fymptomatic fever, ow-
ino-, perhaps, to the previous lofs of blood.  He
recovered fooner than ufual, has  a fine  coat  of
flefb, which covers rhe  (tump, and he now en-
joys a good ftate of heal h.

Cafe  of the  Bite cf a Mad Dag.   Communicated to
    the Society by Dr.  Benjamin Gale. C.f I.S.
     THE faliva of a mad dog, when mixed with
      the refluent  blood, is known to be a flow,
                                         but 
62
bvit  deleterious  poifon, and  unlefs relieved  by
art, brings on a train of grievous fymptoms, which
terminate in death.
  The inhabitants of thefe northern States,  have
not been expofed to the bite of mad dogs,  until
within thecompafs of a few years,  and for that
reafon I conclude physicians have not paid proper
attention to  fearch after a rational and  radical
cure.
  If you judge the following hiftory worthy to be
communicated to the public, you have my liberty
to do it, in that way, and by thole  methods, you
may think will render it moft ufeful to thofe who
may have the misfortune to be bit by a mad dog.
The truth of  the fads may be rdied upon, and
is well known in this vicinity.
  A  mad dog, on  the 4th of Odober,  1786,
came from the north part of this town,  about fix-
teen miles  from  the fea.   In his courfe down he
paffed through the east part of the town of  Guil-
ford,  and again entered and paffed through this
town on the poft-road, as far as the weft parifh of
Saybrook, where he was purfued,  overtaken, and
killed.  He attacked and bit a child in Eaft-Guil-
ford,  in the  vertebrae  of  the  neck, the  wound
much lacerated.  In this town  he bit a girl  about
eight or ten years  of age,  through  her cloaths In
her hip, one tooh perforated the fkin and  drew
blood. In his whole courfe, in the whole of cattle,
hogs, dogs,  including the children, he wounded
the fame day, to the number of fifteen or fixteen ;
all rhe dogs bitten, were killed foon after  being
bit,  except  one, which was permitted to run  at
large until it manifestly fhewed fymptoms of mad-
nefs,  and   then  was   killed:   all   the  other
animals bitten run mad and died, except one fow,
                                      which 
Sj
which  fuckled  a number of pigs,  fix or eight
weeks old; fhe  was bit in the tip  of one  ear,
which was perforated by one tooh only—The fow
nor her litter of pigs were in any perceptible man-
ner affeded  ; which, I conceive, was owing to the
poifon paffing into the blood, being immediately
drawn off by the ladeals, and diffeminated among
the whole litter of her pigs,  before it had  conta-
minated the mafs  of  blood,  it might not affed
either fow or pigs; as it is well known the moftde-
leterious poifon may be taken in fo fmall a dofe,
as not to injure the animal machine.
   I had certain  advice the  fame day  the child was
bit at Eaft-Guilford,  by one who both  favv the
dog and  the child, foon after  it was bit;  and
again faw the dog as he was paffing through this
town,  and informed me it was mad, which  was
the occafion of its  being purfu'ed  and killed.—
Never expeding to have fuch a cafe, I nad fpent
but little thoughts on the fubjed ; but had taken
fo much  notice of of pradical writers on the fub-
jed, in the courfe of my reading, as to think
their prefcriptions trifling and insignificant.  Be-
ing anxious for the  fafetyofthe  children bitten,
recoileding I had an abridgement of  all the me-
dical  cafes  that had been  read before the  royal
fociety, and finding one  among  others, wlmh  I
looked upon rational,  and  which had been  fuc-
ccfsful fo late as the  year  1731, which  was put
in pradice by Mr. Floyer,  in confequence of the
recommendation  of Dr. James, who  never had
made trial of the medicine himfelf,  which  was
turpeth. min. feveral times repeated.   The  trial
was  made firft  on dogs that were  mad;  giving
for the firft dofe twelve, the  fecond twenty-four,
the third forty-eight  giains,  and the method fuc-
                                    ceeded : 
64
ceeded :  it was afterwards tried on  three of the
human kind, and  was fuccefsful in all three.—
Concluding the child  bitten would fall under the
care of Dr.  Todd, a young gentleman who had
ftudied under my care, I immediately wrote him
my advice, as follows,  founded on that  intima-
tion given in the philofophical tranfadions,  No.
441, page  241.  (which fee)   I advifed  him to
drefs the wound vvith equal parts of  f. nit. and
f. marin, finely pulverized, to fcarrify the wound
as  much as the. part would admit,  if  neceffary,
and to fill the wound  with it, and likewife to in-
corporate with it  the digestive.
  Common fait I had  experienced of great effica-
cy in wounds from the bite of dogs not mad, and
the addition of f. nic. I  took as  a  hint from the
worthy prefident  of your fociety, and then imme-
diately to give an emet.  of turpeth miner, prop-
ortioned to the age of  the child, fo as  to  puke it
three or four times.  And to repeat  it for four or
five times,  at the distance of four, five or fix days,
taking in the intermediate days a portion of calo-
mel in theriac. audrom.  fufficient to purge it rwo
or three times the next day.   The calomel to be;
taken at night going  to  bed,  and  a  draught of
canker weed,  boiled  in  miik and  water,  every
night.   By canker weed, I mean an  herb  brought
into our astembly#by  a member fome years pad,
famous for its ufefulnefs  in the  malignant fpecies
of the apthas,  accompanied with a putrid ftver,
in order to fpread its utility thro' the government.
Mr. B. Batram,  the famous botanist,  of  Philad-
elphia, once fhewed me the fame plant, and told
me it was fovereign in the bite of the rattlefnake,
and termed it prenanthes, a name however I never
•could find in any botanic writer.  By this  method,*
                                    carefully 
H
carefully attended, the child  got well, and rem-
ains (o to the prefent time.
  The girl bitten the fame day in this town, I vi-
fited the next day from principles of philanthropy^
concluding they had fent for  a phyfician who at
prefent resides among u?.  I afked  the mother  of
the child whether her daughter  had  been bitten
by the mad dog the preceding day  ? who told me
with a fmiling countenance  fhe had,  and feemed
wholly unconcerned.  I then  afked her whether
fhe had  confulted a phyfician ? (he told me fhe had
not.   I then endeavoured to convince her of the
great danger her child was in : but  it made no
impreffion on her. I afked leave to  fee the wound,
which was on her hip.   I carefully examined the
wound,  and found one tooth had perforated the
fkin  and drew  blood. A little below where the
tooth had  perforated the  fkin  there  appeared a
ftreak,  which looked  like blood fettled under the
fkin  from being bruifed, but  rather of a darker
hue.  As the woman was fo  unconcern'd, I did
not think proper to urge a fcarification, but advi-
fed her  to make  a poultice  of wheat  bread and
milk, and incorporate as much of the f. marin.  as
could well  be mixed after it was" reduced to the
confiftence of a poultice, and  to  wear it steadily.
The contufed part appeared to be about one third
of an inch  in length, and the width of the narrow-
eft tape.  I told her  if (he would permit me to
give her child  medicines, I  would do it gratis,
which (he at laft confented  to.   I  put her  upon
the fame courfe of medicine I  had  advifed in the
cafe  of  the other child.  The  poultice feparated a
large flough from the wound,  but not deeper than
the  cutis,  about an  inch long and half an  inch
wide, and  afterwards foon healed.  I  fhould have
                   I                 thought 
66
thught the tooth  paffing thro all the cloaths the
child had on,  it might have wiped off all the  fali-
va, in which  I conceive the poifon is contained,
had it not caft off fo large a  (lough.   The child
continuing tne courfe of medicine prefcribed,  had
no fymptoms of  the rabies.
I    Cafe fhewing the good effects of the antiphlogiftic re-
\y [     gimen in the eruptive variolous fever.  By Dr.
j /     Samuel Nefbitt.  Read to the Society at their an-
       nual  meeting,  January i,  jy88.

        JOSIAH  TUTTLE,  of East  Haven,   aged
         twenty-one years, of a large frame and  rigid
     fibres, was feized on his paffage from New^York,
     on Sarurday, the 9th of June, with the eruptive
     variolous  fever;' the fymptoms ran very high, but
     at that time,  he  fuppofed he  had only caught cold
     by fleeping on the deck, and did not fufped he
     had received the infedion.   On  his  arrival that
     evening,  or the next  morning, Dr.  Hotchkifs
     was confulted, who bled him,  and prefcribed fe-
     brifuges.   On the  10th,  about  ten at night,  .1
     faw the patient for the firft time, found him very
     reftlefs, with great  delirium, a ftrong  throbbing
     pulfe, fkin hot  and dry,  his countenance  very
     florid, his eyes inflamed, and  a great determina-
     tion to the head, with a constant naufea and eruc-
     tation of bilious phlegm. I immediately let blood
     to the amount of twenty ounces,  then gave him a
     ftrong folution of emetic tartar.  During its ope-
     ration he ejeded great quantities  of  bile : after
     the operation of the emetic,  I gave him a cooling
     purge,  which had  its  defired effed, thoroughly
     cleanfing the intestinal canal,  the  vomit  having
                                           failed 
67
failed in that part of the operation.   I  remained
with the patient  until about four o'clock  in  the
morning,  and had an opportunity  of remarking
that he obtained  relief from all  and every part
of  the treatment ; the delirium almoft gone, the
reftleffnefs, &c.  fo  that  he could lie compofed,
which, before thefe evacuations, required the fa-
mily to detain him  in bed.   I  enquired  on  my
firft feeing him,  whether he had not been  expofed
to  the fmall-pox, as  at that time  no fatisfadory
informarion could be received from him ; I ftrong-
ly fufpeded the  fmall pox, and was  determined
in  this instance, to try the effeds of the antiphlo-
gistic regimen :  he  was allowed only alheet to co-
ver him when in bed, the doors and windows of
the room open constantly, and in the day  enjoined
to  be led out ;  his drinks were  beverage  impreg-
nated with nitre, &c.
   On the afternoon of the  nth, I  vifited  him,
the eruption  was  then  evident,  he was  much
better, but (till  too much fever for his fafety, and
had  now  and  then  intervals  of  wildnefs  and
delirium :  I let  blood again, to  the amount of
about fixteen ounces, gave him frequent dofes of
the nitre, his drinks and regimen  continued.
   On the 13th,  I  was called to vifit him, chiefly
to  determine whether the eruption  was the  fmall-
pox ; their doubts  arofe  from his  being  fo  well,
and fo free from any complaint, and the  eruption
fo diftind  and  favourable,  that the  family  and
others faid it was impoffible to  be the fmall-pox,
and therefore pronounced it was the chicken pox.
On infpedion I  was convinced  otherwife; I con-
tinued to affirm it was the fmall-pox, that he was
past all danger,  and felt  very happy  to  fee the
good effed of a bold antiphlogistic courfe.   Dr,
Hubbard agreed to inoculate the family  who had
                                       been 
6*3
been expofed, I therefore,  as a  matter of conve-
nience,  and a faving to the family, resigned  my
patient to the care of the Dodor, perfectly fatis-
fied with the iffueof my experiment: the Dodtor
carried  him through with eafe and fafety, he ma-
king no complaint,, except  from a few pustules
on the foles of his feet.
  This  cafe, Gentlemen,  and many  other obfer-
vations  I have had  opportunity  to  make  in  the
difeaie,   leads  me   to  draw  this  conclusion,
that the good or bad management of  the eruptive
fever, in moft habits, ft amps the extent and  fu-
ture progrefs of the difeafe,  perhaps I  may ven-
ture to fay,  the very  nature of the  pock;  and
that in this stage chiefly, if not principally, is  the
(kill of  a phyfician manifested and called for.
Hiftory of a Dyjentery, in the %id regiment of tb&
  late Continental Army,  occafioned by the  Bar-
  racks'  being over  crowded,  and not properly.
  ventilated.   Communicated by Doctor. Ebenezer
  Beardfley.   Read Jan. 2, 1788.

     ABOUT the firft of April,  1776, the Am-
       erican  army under  the  command of his
Excellency Gen. Waftiington, marched from Bo-
fton  to New-York,  at  which place they arrived
abou,t  the middle  of the month.  The fick and
invalids having  been left behind in the hofpitals,
the whole army was in perfed health.
  The troops  were quartered in barracks, and in
the houfes of  the  citizens, till  about the 10th of
May, when they went into  tents,  except the 22d
regirrent, under  the command of Col.  Samuel
Wyllys,  who for want of tents,  continued in their
quarters  in Smith Street.                The 
69
  The regiment were very healthy till about the
middle of the month,  when more than one hund-
red men were  taken down with the dyfentcry in
the fpace of one wedk.   Such a fudden invafion of
this  formidable difeafe alarmed me very much,
and I was greatly furprifed, upon enquiry to find,
that there was not a fingle dyfenteiic patient in the
whole army, except thofe  which belonged to our
regiment.  From this circumstance I concluded,
that the difeafe was occafioned  by fome caufe pe-
culiar to the city; but after a  particular enquiry,
I could not find that there was a fingle inhabitant
fick with this difeafe in the city :  thofe who lived
in the fame street with us, and many of  them in
ths fame houfes, were free from that  or any other
acute difeafe. For feveral days I was much perplexed
and entirely at a lofs to determine what had given
rife to the difeafe.  At length I obferved,  that not
only the inhabitants who  lived with  us  were free
from the distemper,  but feveral whole companies
of the fame regiment had nothing of it.   This led
me to consider more minutely the  circumstances
and fituation of the fick,  the whole of which were
quartered either  in  low,  underground rooms, or
in chambers or garrets, which were fo situated as
not to admit a free circulation of air.  The rooms
were alfo confiderably lefs than ufual in proportion
to the number of men.   Having made thefe dis-
coveries and  obfervations,  I  concluded   at once
that the difeafe originated from the confined and
putrid atmofphere,  which thefe unfortunate  men
lived in.  I immediately communicated my ob-
servations to the Colonel,  and  requelted  that the
men, both fick and  well,  might be  removed out
pf thofe  rooms into fuch as were more  airy and
capacious.  This meafure was attended  with the
                                       moft 
70
moft falutany confequences :  Thofe who  were
fick recovered in a  fhort time, except two, who
died ; and no more being feized with the distemp-
er, in a few weeks the regiment became quite heal-
thy.   This ftriking instance of the pernicious eff-
eds of putrid, Stagnant air,  was of great fervice
to me in the courfe  of  the  campaign.  In the
months of July, August and September,  the dyf-
entery, bilious and other fevers of the putrid kind,
became  very rife in the army.  I took great pairas
to procure for our men who were down with thofe
diforders,  large  rooms;  and to  have them well
ventilated, and cleanfed once or  twice  a week.
Yet under thefe circumstances I frequently found,
caeteris paribus, that  the fick who  lay in  and near
the  corners  of the "rooms,  were  handled much
more feverely than thofe who lay in and  near the
middle of them.   I do not remember to have met
with this obfervation before,  but I  think it is of
no fmall importance in the treatment of dyfenter-
ies, and other putrid fevers.
  From the foregoing hiftory the following prac-
tical dedudions may  be made.  Firft, that caeter-
is paribus, people who live in  airy,  capacious hou-
fes, are  lefs liable to be feized with dyfenteries
and other putrid fevers,  than thofe who live  in
fmaller  houfes and  breathe a more  confined air.
Secondlv, that patients labouring  under thefe dif-
eafes  instead of  being confined  in  fmall, tight
rooms,  (the common and fatal  pradice  of the
country in general)  ought either  not to be confi-
ned to the houfc  at all, or to be placed in the moft
fpacious and airy  rooms.  Thirdly,  that it  is
highly  probable  that fmothering  feather beds,
warm, clofe rooms,  and over careful nurfing,  are
among the principal caufes of the  fatality whteh
                                        too 
7i
too often attends this clafs of difeafes.  Fourthly,
that  perfons  in  the latter ftages of a pulmonary
confumption,  when they ufually fpit large quanti-
ties of purulent matter,  and their perfpiration and
other excreta are of a putrid difpofition, ou.:hc to
be treated in this  refped,  as tho' they  were fick
with a dyfentery  or other putrid  fever; which  will
not only conduce  to their ptefervation and com-
fort, but is the  only means of  fafety to their at-
tendants and friends.
Cafe of a divifton of the Tendo Ac hi His.  By Dr.
  Samuel Nefbitt.  Read to the  Society,  January
  id,  1788.
      WILLIAM HOTCHKISS, aged ten years,
       fon of Captain Stephen Hotchkifs, of this
city, on the 3d of Odober,  1783, was wounded
a little above the heel of his left leg, by the stroke
of a drawing knife.  I happened to be prefent at
the  time of the accident,  and on examining  the
wound, found a compleat divifion of  the tendon
of the gaftrocnemei mufcle, commonly called the
tendon of Achilles, about three quarters  of  an
inch above its infertion into the os calcis ;  having
no convenient drefling on the fpot, I  dreffed it
Superficially, fo as to  preferve it from the  adion
of the air ;  the  accident happening  abroad,  he
was carefully conveyed home, with his  leg and
foot placed in the moft favourable pofture to pre-
vent the receding of the tendon.
  In confequence of a call, I vifited the  patient,
and  in the prefence of Dr. Eneas Munfon, exam-
ined the wound.  A   compleat   divifion of the
tendon was clearly afcertained, and  that part  of
the tendon adjoining the mufcle  was found recc- 
7'2
ded about  an inch and  a half  from the  lower
part, and hid under the common  integuments ef
the parts.   We concluded  tt>  bring  the divided
ends of the tendon into contad, by  future;  and
in order  thereto,  found  it neceffary to make  a
longitudinal incision, about two inches, thro' the
integuments previous to a future  of  the tendon,
thereby exposing the receded point of the  tendon
about half an inch; I  then paffed  an armed nee-
dle through each  extremity of the tendon, about
half an inch  from the  divided extreme,  pre-
vioufly placing the limb in a ftate of flexion, with
the heel ftrongly bent  back, and,  by means  of
Straps,  &c.  continually through the cure, retain-
ed in  that pofition.  The wound was then dreffed
tip with Small pledgets of dry lint,  and a pledget
of the linim.  arccei.  over the whole.  Reft was
enjoined the patient, a ftrid antiphlogistic regim-
en prefcribed, and an  anodyne for the night.  On
the 4th we vifited our patient: found him much
eafier than we expeded : ordered an emollient cat-
aplafm over the dreffings : an  enema to be admi-
nistered, and an anodyne for  the night.
   On  the  5th we vifited our patient :  the tend-
on and inflammation moderate:  he had  rested
well:  therefore found  no occafion to alter the ab-
ove method ;  but direded  as  before.
   On  the  6th we  removed the  dreffings, the
wound beginning to digest, and  the divided part
remaining  in compleat  contad,  gave a favorable
afped to the cafe  : dreffed with warm pledgets of
liniment, arccei.  purfued the  antiphlogistic treat-
ment, reft, and anodyne, h.   f. with the ftrideft
attention to the flexure of the limb and foot.  On
 the 7th we  continued the fame treatment;  fever
 and other fymptoms moderate, the afped  of  the
                                      wound 
73
wound favourable ;  repeat an enema,  and the an-
odyne, h. f.
  On the 8th dreffed the wound as ufual, tension
and inflammation of the parts moderate, a lauda-
ble difcharge of  pus, and the future beginning to
loofen, fo as to  call our attention more particul-
arly to the affiftance of  bandages  and  the (trap,
left the parts, by inattention or a  fudden motion,
might be torn  afunder.  Continued the regimen
and the anodyne h. f.
   On the 9th the difcharge and appearance of the
wound continued favourable, the  thread was re-
moved, and the parts  remaining  yet in complete
contad,  a Small  flough beginning  to cast off from
that part of the tendon that was compreff'd by the
thread.  Treatment as ufual, only with the omif-
fion of the anodyne, and the addition of an oily
embrocation to the  knee,  ancle, &c
   On the 10th the  (loughs caft off,  a fine appea-
rance of  a granulation,  Or increafe of that part of
the tendon caft off, and the fymptoms  in every
refped mild and favourable.
   The 11 th granulations increafe,  and appear  to
extend thcmfelves along the whole furface of the
denuded tendon, the parts in complete  contad,
with a laudable difcharge  from the wound.
   The 12th,  granulations increafing a little too
fast,  praecip. mere. r.  was added to the former
dreffings,
   The 13th, and for fome days, the fungus rath-
er luxuriant rendered the  continuance of the pre-
 cipitate  neceffary ;  however,  the granulations,
 gradually fubdued  and  restrained, changed  their
 appearance and texture,  from a  foft.fungus, to
 that of a tendon ;  fo that  at the end of the month
 a complete cure took place, without  any accid-
                       K                e:u 
74
ent or bad fymptom, except a trifling one of a fall,
which the patient had in attempting to walk after
the wound was completely cicatrized,  by  which,
on examination, there appeared to be a iaceration,
or feparation of the integuments in contad with
the exterior furface of the tendon, and a fmall dif-
fusion of blood marking the extent of  the  tranf-
verfe and longitudinal  incision.   As foon as the
patient was fit to go abroad,  a fhoe wascontiived
with a high heel,  and the limb guarded by a ftrap,
to prevent a fudden extension of the limb or muf-
cle, and this regulation complied  with for fome
months,  gradually lowering the heel to the ftand-
ard of the other foot,  fo that by degrees, a free
and perfed ufe of the  limb was restored,  and at
the prefent no difficulty remains, but  is as adive
as any lad  of his age and constitution.
   The apparatus made ufe of to  restrain the limb
in a ftate of flexure, and its mufcles from any un-
favourable  adion,  were a ftrong piece of paste-
board, accommodated to the uppet part of the
foot or  instep and ancle,, and confined by band-
age,  which by its preffure againft the anterior and
inferior  part of the  leg, prevented the elevation
of the foot; the leg was preferved in a  ftate of
flexure,  and the gaftrocnemei mufcle in a ftate of
constant relaxation, by a ftrap affixed to the heel
Of a flipper,  that went over all the bandages  on
the foot, and led to a bandage above the  knee,
with  a buckle to lengthen or fhorten it at plea-
 fure.  The few instances  that occur,  or are  re-
 corded of Similar  cafes, induced me  to  lay this
 before you, Gentlemen, more efpecially, as there
 have been many objedions offered againft  futures
 in the cafe of fuch wounds,:  it is true, the patient
 referred to in this cafe, was  young and of afpare,
                                     delicate 
75
delicate habit, and of courfe lefs difpofed to inflam-
mation, and a numerous train of bad  fymptoms,
common to fuch wounds in the plethoric and adult
habit,  yet,  in  my  opinion,  it  does not argue
againft the fafety of the pradice,  provided the an-
tiphlogistic  method is carried to the extent  Such
plethoric habits require, as the degree of fymtom-
atic fever alone, in fuch, and  perhaps all wounds,
(not in themfelves  mortal) must determine the
proportion of danger or difficulty.
Cafe of a  Wound in the Trachea Arteria and CEJo-
  phagus.   By John Spalding, Surgeon. F. M. S,
  Read to tbe Society  April,  2,  1788.

     ON January the 22d,  1781, I was called to
       vifit Mrs.  Potter,  aged 58  years,  who
had been afrlided with a large fcrophulous tumour
on  the fore part of her neck,  and much fubjed
to melancholly, and under temptations to put a
period to  her life,  for  a   number of years.   On
the  22d  day  of January,  fhe, with a  pair  of
(hears  (which  fhe  had fecreted for that purpofe)
attempted her own  life,  by: thrusting one blade
of them into her throat; cutting the  trachea ab-
out two thirds off;  and wounding the cefophagus.
I arrived  about half an hour after, and found a
deep and frightful wound' in  her throat;  the fore
part of the trachea open, and extended about an
inch.  Dr.  Ives being in  the neighborhood,'
was called in to aflift me.   I made two ligatures
on  the trachea, one on the right and the other on
the left fide of it ;  direded her to fwallow no-
thing but liquids, until I  faw  her again ; and to 
76
   keep her head in a prone Situation.   On the 23d,
   found (lie  had flept  very  little,  her  pulfe calm,
   the wound difcharging a gleety matter copioufly :
   drelTcd it with lint dipped  in balf. traumaticum;
   direded her to take 20 drops of the balfam, in a
   tea of baum. On the  24th  found her pulfe a little
   accelerated, and her reft disturbed in  confequence
   pf a cough :  prefcribed a tea of flaxfeed and hon-
   ey, with a  dofe of the elixir afth. to  be taken at
   night, and chicken broth  fparingly, on  account
   of the difficulty of deglutition, which never fail-
   ed to excite the  cough.  The wound difcharged
   a  viicid gleet; ordered  a Saline draught,  and  a
   cooling enema ;  her cough abated, and fhe rested
   better.  On the 25th found a full pulfe, a dyfp-
   nea,  with  an  inflammation on the  fcrophulous
^  tumour  threatening a gangrene.  I  let blood, &
   gaye her a folution of Sal  nit. ordered her feet
   to be bathed in warm  water, and to take her broth
   fparingly,  part  of which  efcaped  through  the
   wound.
     On the 26th,  I found her pulfe very full, with
   great difficulty in refpiration, and the fcrophulous
   tumour much inflamed ;  ordered her feet  to  be
   bathed in warm  water, and took from her  about
   twelve ounces of Mood, which gave  her immedi-
   ate relief:  continued the  nitrous folution, and
   fhe retted much  better that  night than the preced-
   ing ;  the  wound continuing to difcharge a gleet
   with  a little purulent  matter.  On the 27th, per-
   ceived  an  abfcefs  had formed in  the body of
9  the tumour, which had emptied its  contents into
   the wound, part of which  was difcharged by the
   mouth; the inflamation abated, the gleet lefs, a
   d S:barge of pus, and the fever abating.   On the
   2.8th, I found,  by  a  fit  of coughing  the night
                                        before 
77
before, the ligatures had given way, her breath and
liquids  which (lie took came out ar  the wound;
I then paffed an armed needle through  the divi-
ded mufcles  and trachea, making three futures
pn the  gaping  wound,  drawing  the  edges into
clofe contad ; then dilated the  fcrophulous tu-
mour,  at its depending  finus, in order to  give
vent to the  matter, advising her  not to take any
thing into her-mouth for  feveral hours ; (he rested
better than fhe had done  at any time before.   On
the 29th, Sound the inflammation much abated,
owing to the Sree diScharge at the depending ori-
fice ; her reSpiration relieved, yet on her taking
 drink fome  of it efcapcd through  the wound ;
 the matter difcharged was of a  better  kind.   I
 direded her head  to be  kept Still and in a prone
 fituation.   On the 30th,  Sound fhe had  rested
 very well, her mind a little  more compofed, the
 tumour leffening daily,  (lie could fwallow much
 better, efpecially  when  fhe took but a little at a
 time;  her  fever fubfiding, and the appearance of
 the wound favourable. On the 31ft, fhe had a cra-
 ving appetite for food thatwas more nourifhing;
 gave  her an egg beat up  with  wine and  fugas;
 fhe fwallowed it without much difficulty; and ap-
 peared mending in every refped.  Feb. ift, found
 her craving folid food;  I informed her  it was not
 admiffible under her prefent circumstances, and
 must content  herfelf with her liquid  diet, until
 the wound  cicatrized.   On the 2d, found fhe had
 rested very well,  fwallowed with eafe, very little
 of it efcaping at the wound.   From this time fhe
 mended daily, and the  wound incarned and cica-
 trized, and fhe now enjoys her ufual health.
Caje 
7S
Cafe of an enlarged Gall Bladder.  By  Ebenezer
        Beardfley.   Read April id 1788.

      MRS. Scott, a healthy temperate  industrious
       woman  aged 44,  was Seized  with a  vio-
lent paroxySm  of the bilious  colic,  attended
with  the  ufual fymptoms of  naufea, vomiting,
Severe  pain in the abdomen and coftivenefs.  She
obtained relief from purges and  other  remedies
commonly  ufed in that diforder; and in about
a week was quite free from pain and difeafe,  ex-
cept a flight jaundice,  which  difappeared within
a few weeks, in the ufe of faponaceous and other
medicines.  She   continued  healthy  for  about
three months,  when fhe was again attacked with
a more feverefit of the cholic, which lasted lon-
ger and was more difficult  to cure than the former:
this paroxyfm,  like the firft, was Succeeded  by a
jaundice,  which was more obftinate than beSore ;
£>ut  at the end  of fix  or  eight  weeks it  difap-
peared, and  left her to appearance in a ftate  of
health. She continued apparently  healthy  for
about four months, when  fhe  was attacked with
a third paroxyfm of cholic, which was much more
Severe  than either of the former.   Aloetic purges,
fomentations, enemas,  &c. removed the  consti-
pation of the bowels and pain in about  a week.
But from this period fhe began to  complain of  an
inceffant  cardialgia,   which  preyed upon  her
without intermiffion:    an  obtufe,  deep  feated
pain in   the   pit   of her ftomach  and  right
hydochondrium,  a yellowneSs  in her eyes  and
fkin, obftinate  coftiveneSs,  with other Symptoms
oS an inveterate jaundice.   FortheSe  complaints
fhe took mercurials, Soap,  lime-water, gum pills,
abSorbents,  bitters,  &c.   Bar  notwithstanding 
79
 her complaints daily increafed, her appetite for-
fook  her,  the  heat  and  uneafinefs  about her
ftomach became intolerable,  and  in  about four
months fhe died,  quite  emaciated.   Soon  after
her dcajh I examined the body in prefence of my
brother and another phyfician.  Upon making a
tranfverfe incifion through the integuments, a lit-
tle below the diphragm, we were furprifed at the
fudden and  violent protrusion of a hard elaftic
body  through the aperture we  had made, which
upon  farther examination we found to be the gall
bladder, distended to the enormous length of ten
inches,  and proportionably large in  its diameter.
  The coats of the bladder, notwithstanding the
amazing diftenfion, were thick, hard,  and elaftic.
we feparated it from the liver,  and opened it  by a
longitudinal incifion from the neck  to the fundus,
and found  that the diftenfion and enlargement,
were occafioned by a preternatural flefhy fubftance,
which appeared to have fprouted out from all that
part of the  bladder which is conneded  with  the
liver, and had gradually increafed to fuch a mon-
strous  fize.   The  fungus,  or flefhy  fubftance,
confifted of coarfc parallel fibres, not  unlike  the
mufcular parts of lean beef, and from  the middle
of it we extraded  near an ounce of a foft, grey
coloured calculus.   The end of the fungous  fub-
ftance, next to  the fundus of the bladder,  was in
a ftate of Suppuration, and there was  a  fpoonful
of very thick cream coloured  pus  about  it.   It
did not adhere to the bladder any where but at its
infertion into the liver. There was no  appearance
of bile  in  the  gall-bladder, the communication
with the liver being wholly cut off by the fungous
body.
  What could have given rife to this  formidable
difeafe ?  Must there  not have been  a  previous
                                    wound, 
So
wound,  laceration,  or inflammation in the part
whence the fungus ifiued ?
  Permit me again to repeat the pradical caution^
which I gave at  the  clofe of the  hiftory of the
fchirrous. pylorus, at  our laft meeting, against the
ufe of ftrong  emetics in  long  continued biliary
obftrudions.   In a ca(e like the preceding,  their
effeds must be terrible to the  unhappy Sufferer.
Cafe of Dyfent eric  Symptoms from worms. By  Dr.
 . Samuel Nefbitt.   Read before the  Society April
  2, 1788.

  IN the winter of 1784, I was called to vifit a
   child of the Rev. Bela Hubbard,  Aged  two
years.   The child was  feized  on the night  pre-
ceeding with a violent fever, great reftleffnefs, a
conftant naufea,  and vomiting,  attended  with
alarming dyfenteric  fymptoms,  viz.  a frequent
difcharge of an acrid mucus, refembling in  col-
our beef brine, adiftrefling tenefmus, with atum-
efadion and tension  of the abdomen.   Under
thefe circumstances I  found my  little patient on
the morning fucceeding the attack.   The  dyfen-
enteric fymptoms  were fo  ftrongly marked,  that;
overlooking the circumstance of  worms,  I  bent
my whole attention  to  deterge the acrid offend-
ing matter; and  accordingly prefcribed  two gr.
of emetic tartar,  to  be diffolved  in four  table
fpoonfulls of warm water,  and one fpoonfull  to be
given every  half  hour,  until the child  had taken
1 he whole, or a fufficiency to clear well the ftom-
ach.  The firft Spoonfull fuppreffed every  appea-
rance of ficknefs  at the ftomach, the fecond was
                                      given, 
                                            8i

given, and the whole  according to the d'rcdtions
above, without any apparent d.froiiticn  to vom-
it.   Its operation  was  cathartic,  and procured,
within three hours from  the firft dofe of  the tart-
ar,  a difcharge of  thirty two large worms of tie
round kind.   Some of them meafured  8 and  9
inches in  length,  nene,  that I. remember,  (ill
fhort of four inchi'S. The first difcharge  ccn-rain-
ed  twenty, which were forced into the snus in
Such a body, that  the affiftanrs found it r■eceiTary
to relieve the child by the hand.  Two difchages
roore coni[ leated the number, they were ail alive
and fquirming on the receiver. From the expul-
sion of fuch a number  of difagreeable  tenants,
every dyfenteric fymptom vanifhed,  the tension
of the abdomen  and  fever  iubfided, and  from
that period a perfed recovery took place,  without
any further affiftance from  medicine.
  Thus, gentlemen, without affuming any credit
to myfelf, a happy and fpeedy iffue  was,  bv acci-
dent, obtained in the prefent alarming cafe,  and
by a medicine, which, in  its operation,  proved
the moft adive and powerful  anthelmintic I had,
or ever have met with in my practice; curing, as
Celfus fays,
       "  Tuto, ciio £f? jucundo."
  I moft Sincerely wifh  we could always be So for-
tunate in our prefcriptions, when we are right in
our conjedures of the proximate caufe of d.leafes.
But it is not to be expeded that a mistaken ti.to-
ry will always terminate fo favourably.

Cafe of a fchirrhus in the Pylorus  cf an infr.t.
  Canmuhkated by Doctor Hezekiah  Beardjley.
  Read dpril 2,  1788
A  CHILD  of Mr.  Joel Grannis,  a  re Spect-
      acle farmer in the town cf Southingron, in
the firfi week of its infancy,  was attacked with a
                L                  puking 
32
puking, or ejedion of the milk, and of every other
fubftance it received  into its  ftomach almost in-
Stantaneoufly, and very little changed.  The fceces
were in fmall  quantity and of an afh colour,
which continued with little variation till its death.
For thefe complaints a  phyfician was confulted,
who treated it  as a common cafe  arising from aci-
dity in  the prima via; the testaceous powders
and other abforbents  and corredors of acid acri-
mony, were ufed for along time without any ap-
parent  benefit.   The child, notwithftanding  it
continued to ejed whatever was received into the
ftomach, yet feemed otherwife pretty well, and
increafed in Stature nearly in the fame proportion
as is common to that ftate of infancy, but  more
lean, with a pale  countenance and  a loofe  and
wrinkled fkin like that of old people.  This,  as
nearly as I  can recoiled at this distance  of time,
was his  appearance and fituation  when I was  firft
called to attend him ;  he was now about two years
old.  I  was at firft inclined to attribute  the dif-
order to a deficiency of the bile and gastric juices,
{6 neceffary to digeftion and chylification,  joined
with a morbid  relaxation of  the ftomach, the ac-
tion of which feenred wholly owing to the weight
and preffure of its contents,  as aliment  taken  in
Small quantities would often remain on it, till by
the  addition oS frelh quantities, the whole, or
nearly  all was ejeded ;  but  his  thirft, or Some
ether caufe, molt commonly occafioned his fwal-
lowing fuch large draughts  as to  caufe an  imme-
diate ejedion,  and oftentimes before the cup was
taken from his.mouth.  It did not appear that he
was  attended with  naufea or ficknefs at  his fto-
mach, but he often complained that he was choak-
ed, and  of his own accoid  would  introduce
his  finger or the probang, fo as to exeite the  hea-
                                        ving 
«J
vingof the ftomach and an ejedion of its contents;
the ufe of this instrument wis generally neceffary
if the ftomach did not of itfelf, in a few morr.ents,
difcharge its contents, the choaking would in that
fhort fpace of tims  beco ne al n )  t  intolerable,
which by this difcharge  was  entirely removed.
In this fituation, with vrrv little variation of fymp-
toms  he  continued  r l! death  clofed the  painful
and melancholy  fcene,  when he was  about  five
years of age.  He was uncommonly chearful and
adive confidering his fituation.   A  number of
the moft refpedable med'eal charaders werecon-
fultedand a variety of medicines were ufed  to little
or no effed.   His death, though  long expeded,
\yas fudden,  which I did not learn till the fecond
day after it  to >k  place.  This late  period, the
almoft intolerable ftench,  and the  impatience of
the people who had  colleded for rhe funeral pre-
vented fo thorough an examination of the body,
as  might otherwife  have been made.  On open-
ing the thorax, the cefophagus was  found  greatly
diftended beyond its  ufual dimenfions  in  fuch
young fubjeds'; from one end to the other of this
tube,  between the circular  fibres which compofe
 the middle  coat, were  fmall  veficles,  fo ne of
 which contained  a table fpoonful of a thin fluid
 like water,  and feemed capable of  holding much
 more.  I next examined the ftomach, which was
 unulually large, the coats were about the thicknefs
 of a hog's bladder when frefh and diftended with
 air, it contained about a wine pint of a fluid exadly
 refembling  that found in the  veficles before-men-
 tioned, and which I fuppofe to have been  received
 juft before  his death.   The pylorus was invested
 with  a  hard compad fubftance, or fchirrofity,
 which fo completely  obftruded  the  paffage  in:o
                                         the 
84
the duodenum, as to admit w:th the greatest dif-
firulrv the finest  fluid ;  whether rhii. was rhe ori-
g nil  diforder, or onlv' a confcqucm e, may per-
Lai s be a qt.tfticn.   Injustice  to u.yfelfl  o j^ht
to iiennon, that  I had pronounced a  fchi.rofiry
in that part  for months befoe the child s  death.
On removing the  integuments of the aodoirt r, I
v as struck with rhe appearance of the vefita fell is,
wlvch \* as nearly  five  irches  in length and  more
than ore in diameter, it  lay trinlvtrlly  acrofi> the
abdomen, and was bedded into the  fmaJl mtef-
ti-es,  which were  fpiucela^ed  wherever  they came
in contad vvith it; its contents were rather folid
thai fluid, and refemblcd flefh  in a highly putrid
ftate; its colour was that of a  very daik gretn,
like the juice of the night-fhade berry, and a fluid
pf the fame colour exuded through its fphacelated
coats.   The necedry shere was of  interring the
body that evening, rut  a stop to any further ex-
amination.
   I fhould have been happy, Gentlemen,  if I had
heen able to have gnen you  a more  particular
and accurate defcription  of this very  fingnlar cafe,
but the above-mentioned circumstances forbad.
Cnje cf Calculi in the  Lungs.  Communicated by
  Dr.  E;itas Munjcn.' Read April i,  1788.

T\  /T  R. CALEB   HOTCHKISS,   aged 45
jj\ j^   vears, of a choleric  dilpofuion, died of
aconiiimption of the lungs,  in the month of De-
cember,  1784.   His difeafe by  his own account
cfhimfelf, commenced about 15 years  before his
death.   Sometime in the year 1769, he was  ex-
ercifcd with extreme pain in his cheit, at different
                                   periods, . 
»S
periods, which ended in a nephritis; and at length
in an haemoptofis, when, by coughing,  a calculus
was thrown  out  from his lungs, after which he
paffed about 12 years oS tolerable health ;  he liv-
ed a Sedentary life,  and was able to purfue amod-
erare courfe of ftudy, and  preached  occafionally,
until July 1784, when I was confulted iu his cafe.
He complained  of a general laffitude and weak-
nefs, attended with a flow fever and cough, with
a quick,  hedical pulfe ; tho' without any pain in
or about the cheft.   His cough was  neither hard
nor frequent:  he had been riding fhortjournies,
for thepurpofe of recruiting his health, and had
found  fo iiiu- h advantage thereby, that he was de-
termined to take a  more lengthy one of fomehun-
dred miles.  But his  weaknefs and  Hippbcratic
countenance,  together  with a  fmall  hemoptoe
whic h  artended his cough, made me diffident  in
recommending fo lengthy a journey as was  p.opo-
fed, and the more fo on account of a number of
fmill  calculi, which  at  different  times  he had
coughed up, rh:>  with lefs "irritation than might
have  been  rxpeded,  they  being  of very even,
fmo,)th turfuces, but of different figures, and ab-
out the fize of a large orange feed.   But  feeing
the great confidence'he had  of the adv antages  he
fhould derive from the propoied journev,  I con-
sented, rather than advifed to ir, with all the pre-
cautions I thought nec-ffary for one under his in-
firmity.   He returned in about fix weeks, and ap-
peared rather recruited,  and continued fo un:il
the month of September,  v.'hen his cough  increa-
f-d, and  on  the 9th  he r.i;f.vl  abcut a p'nt of blood
foir his lungs ; which came So fast  a.:d Suddenly
upon him,  as to threaten  an immediate fuffocati-
on.  I was  called  in the night, but before I arri-
                                         ved 
86
 ved his hsernoptoe  ceafed.  But just on my ent-
 rance into the room he cxpedorated a large mourh-
 tiAl, which appeared by candle light to refemble
 a mixture of blood and pus.  This  I direded to
 be thrown into a fmall veffel of water, and after
 maceration, found it to consist of a portion of the
 internal membrane of the lungs, about one inch
 and a quarter in length, and half the  breadth, and
 about a quarter of an inch  thick.  About this time
 he expedorated another calculus, after which he
 continued gradually to decay, until the latter end
 of December following,   when  welcome  death
 c!ofed the fcene.
  As this is but the fecond cafe of the kind that
 has fallen under my obfervation,  in the  courfe of
 thirty years pradice, I narrate it as fomething An-
 gular, with this remark only,  by way of quaere.
As,  in  the  prefent cafe,  many fevere pedoral
 complaints were terminated with a fit  of the gra-
vel,  whether very confiderable relief may not be
expeded in like cafes, from  thofe means which
have proved fo fpecific in refolving and brin^ino-
off  calculous matter  from the kidnies  and^tire"
ters ? Which is humbly fubmitted to thofe more
fkilful and experienced to determine.
 O

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