P«SiM j I'SliJ; ;c: !''',' i* Tuisil l:':i|!'!;S NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service 7 AN ESSAY ON THE EFFECTS OF LEAD: COMPRISING A FEW EXPERIMENTS ON THE SACCHARUM SATURNI, AND ITS APPLICATION IN THE CURE OF DISEASES. By THOMAS SEMMES, OF MARYLAND; Member of the Philadelphia Medical and Chemical Societies. u Poifons in fmall dofes are the beft medicines, and the beft medicines in too large dofes are poifonous." Withering's Botanical Arrangement. PHILADELPHIA: PRINTED BY CARR Ci? SMITH. 1801. ' MaT AN INAUGURAL ESSAT, FOR THE DEGREE OF DOCTOR OF MEDICINE. SUBMITTED TO THE EXAMINATION OF THE REV. JOHN EWING, S.S. T. P. PROVOST; THE TRUSTEES AND MEDICAL FACULTY OF THE UNIVERSITY OF PENNSYLVANIA, ON THE EIGHTH DAY OF JUNE, 1801. TO DOCTOR ELISHA CULLEN DICK. TO you, in whom ^ concentred, talents, profeffional eminence, and domeftic virtues; under whofe patronage and direction, my medical education was commenced and finiihed, with pleafure and improvement to myfelf; I beg leave to infcribe the following pages. Although the connection of preceptor and pupil will now ceafe between us, permit me, dear fir, to hope for the conti- nuance of thofe prudent counfils, and valuable inftruclions, with which, you have been pleafed to favor me. For the many polite and flattering attentions I have re- ceived from you, and your amiable family, accept the grate- ful acknowledgements of Your Sincere Friend, And Affectionate Pupil, THOMAS SEMMES. % TO BENJAMIN SMITH BARTON, M. D. Professor of Materia Medica, Natural History, and Botany, IN THE UNIVERSITY OF PENNSYLVANIA; Sir, IT is with great pleafure, I avail myfelf of the prefent op- portunity, to exprefs my gratitude for the many particular marks of politenefs and friendfhip, with which vou have honored me, during my refidence in Philadelphia. That your happinefs, and fuccefs in practice, may be com- menfurate with your talents and eminence in public life, is the wifh of Your Sincere Friend, And Obedient Servant, THE AUTHOR. INTRODUCTION. WHEN we contemplate the mifchiefs, which have arifen from the application of dif- ferent preparations of lead to the human bo- dy, the objections of thofe medical writers', who have viewed them in a light, fo unfavou- rable ; and have fo flrenuoufly oppofed their internal exhibition, would appear to be juft. That lead has produced many difagreeable confequences will be readily granted. But to fuppofe that the preparations of this metal are invariably followed by deleterious effects, when admitted into the body, (if exhibited with- in bounds) would, in my opinion, be equally abfurd, and erroneous. If we take a view of the materia medica, we fhall behold envelop- ed in poifon, many of our moil active and ufe- ful medicines. The datura ftrammonium, the conium maculatum, and innumerable me- B C 10 ] tallic fubflances, in the hands of the ignorant, or when exhibited in improper quantities, dif- organize the vital functions, and extinguiih life. But, if thefe fubflances be managed judicioufly, and adminiflered with difcretion, they relieve difeafe, prolong life, and prove highly advantageous to mankind. The effects of fubflances, ufually called poifons, are relative ; and the flightefl obfer- vation will convince us, they act either as me- dicines, or as poifons, according lo their quan- tity and quality. Animals have a greater or lefs aptitude to be acted on, by one fub- flance, than by another ; or pofTefs a peculiar idiofyncrafy of habit, whereby the mofl bane- ful effects will be produced by a certain fub- flance,upon one, while upon another, the fame fubflance would be attended with little or no ef- fect. Hemlock is innoxious to cows ; hogs fat- ten on henbane; and goats may confume large quantities of euphorbium, without injury; but each of thefe vegetables are poifonous to many Other animals. The flrammonium con- flitutes an article of food to fome animals, while the admifiion of a few grains into the flomach of a man, proves deleterious. Opium is a valuable medicine, yet it is known, that two perfons, taking equal quantities, may be C n ] differently affected. Perfons, who labour in quickfilver mines, feldom remain free from palfy, or fome other complaint, longer than two, three, or four years; the effects of this mineral, are not lefs flriking, than thofe which fometimes arife from the effluvia of lead: Gil- ders and others, who fuffer from mercury, are much afflicted with tremors and debility, particularly in their hands; and, when the difeafe is once confirmed, they have no com- mand over the mufcles, which naturally obey the will.* It alfo, under certain flates of the fyflem, difpofes wounds of the mildefl nature to ulceration, and not unfrequently occafions the true phagedena, a diflreffmg and often fatal ulcer ; a child, whofe fyflem was under the influence of this mineral, was blooded, the orifice, inile ad of healing, became inflamed ; the wound in three days had confi- derably enlarged, deflroying the integuments and leaving bare the blood-veffels; on the fourth day, death enfued.f The oxygenated muriate of mercury,in the proportion of an eighth or fixth of a grain, and arfenic in fmall dofes, are innocent and falutary remedies, in certain difeafes ; but, * Vid. Clutterbuck on the poifon of lead and copper. -f Notes from Profenbr Barton's M. S. Lectures. [ 12 ] when taken in too large quantities, are fol- lowed by the molt fatal confequences. The different fyftems of the fame body are not alike influenced by the fame poifon. The carbonic acid gas, when inhaled, immediately deflroys life, but, when taken into theflomach, is not unpleafant to the tafle, and, in fome cafes, is ufeful as a medicine. The venom of the viper, according to the experiments of Fontana, may, without danger be taken into the flomach, and is faid to poffefs tonic pow- ers, but, if it be introduced into the fanguife- rous fyflem, it proves rapidly deflructive. Examples, illuflrating the relative opera- tion of poifons, might be advanced without number; fuffice it to fay, that the preparations of copper, arfenic, zinc, and other metals, though the molt deleterious articles, belong- ing to the catalogue of medicines, are, when properly managed, important acquifitions to the materia medica. I have fhewn above, that the molt valuable medicines may,occafionally,prove deleterious, yet no one contends on this account, that thefe articles fhould be excluded from the materia medica; lead,like all other powerful medicines when given in too large quantities, becomes a poifon ; but, we have the authority of many [ 13 ] refpectable phyficians, for afferting that its cautious internal exhibition, may be practifed with perfect fafety, and frequently with the greatefl advantage to the patient. It was my intention, when I chofe lead, as a fubject of a differtatiori,.to have inflituted an extenfive feries of experiments, in order to af- certain, as nearly as poflible, its operation on the human body. But I regret that, from the difficulty of obtaining a fufficient number of fubjects,upon which to operate; together with the limited time, allowed to prepare a thefis; my defign has been in a great meafure frus- trated. [ 14 ] OF THE MORBID EFFECTS OF LEAD. Nicander, a phyfician and poet, who lived foon after the time of Hippocrates, feems to have been the firfl, who noticed the poifonous nature of lead ; he mentions ceruffe and li- tharge as the only metallic poifons, known at that time; fince that period, much has been written on the fubject. The effects of lead on the conllitution are too obvious to efcape our notice ; the pallid countenances and frequent indifpofition of perfons, daily occupied in lead mines, are fufficient indications of its unwholefome qualities. I ftiall, however, no- tice a few inflances, in which its deleterious effects were very plainly marked. The cholic, which was fo long epidemic in Devonfhire, was owing to the poifon of the leaden uten- fils, employed by the inhabitants of that part of the country in making cider, which confli- flitutes their principal drink.* The celebrated German traveller, Profeffor Thunberg, on his paffage to the Cape of Good Hope, fupped, together with many * Vid. Med. Tranf. Vol. I. C 15 ] others on board the veffel, on fome pancakes, in which, through miflake, there was a confi- derable quantity of white lead. The confe- quences of this accident were very diflreffmg, although no life was loft; its firfl effeas were ficknefs at flomach and puking; and mofl of thofe, in whom this took place immediately, remained entirely exempt from further incon- venience. The captain, however, who vo- mited in the commencement,was attacked two days after, with a molt violent cholic; he was of a confumptive habit, but while the morbid effeas of the poifon prevailed, he was free from cough and other fymptoms of the pul- monic affeaion. No one, who fuffered from this unfortunate miflake, fuftained greater injury than Dr. Thunberg ; he was affeaed with naufea, violent Teachings, cholic, a com plete falivation and ulceration of the mouth, accompanied with a difagreeable flench; in- flammation of the eyes and face, great pains in the ears, difficulty of breathing, violent throbbing of the temples, with pain in the head to fuch a degree, as to warrant the ap- prehenfion of apoplexy. The chaplain and cook's mate, were affeaed nearly in the fame manner, except that they had, at times, a per- fea iliac paflion. [ 16 ] The injurious effeas of this mineral are not exclufively confined to the human fpe- cies ; quadrupeds, birds, and even vegeta- bles fometimes fuffer by it noxious influence. Dr. Percival mentions a dog, who from laying frequently on a plate of lead, before a fire was feized with a paralytic affeaion of his limbs. Cats, he likewife obferves, are fome- times driven to madnefs by it; and we have inftances, on his authority, of birds being killed by eating pieces of red wafer, into the compofition of which, enters a fmall quantity of lead. The effluvia, that arifes from fmelt- ing mills, where lead is obtained from the ore, by fettling on the adjacent fields, effeaually deitroys the herbage. OF THE PREMONITORY SYMPTOMS FROM THE POISON OF LEAD, AND PROPHYLAXIS. As the prevention of difeafe ought to be a primary confideration with phyficians, a knowledge of the fymptoms, which indicate its approach, are certainly of the greatelt impor- tance ; from ignorance and inattention to thefe circumflances, many difeafes have proved fatal, which might eafily have been remedied, had they been attended to in their commencement. Some of the molt formida- C 17 ] ble, as pulmonary confumption, mania, epi- lepfy, apoplexy, &c. (part of them till lately fuppofed to be incurable,) are now known to be frequently cured, when attended to in their recent or forming flate ; but when ne- gleaed till they are perfeaiy formed, or have attained their greatefl degree of violence ; how often, is even the phyfician, of fkill and information, vanquifhed in his efforts to give relief? and how feeble is theory in aiding his attempts? In few difeafes is the danger from delays greater, than in thofe in- duced by the poifon of lead, and the preven- tion of none, can be accomplifhed, with greater eafe; its deleterious effeas, difcover themfelves by a flow and almofl imperceptable progref- fion; fmelters, miners, painters and potters are feldom affeaed before they are expofed to its effluvia for fome months ; and frequently not till two, three or even four years have elapfed. The firfl remarkable change which is produced in perfons, who are expofed to the pernicious influence of this metal, is an unu- fual yellownefs of the complexion, with a dark flreak below the eyes. The itomach next begins to be diforded, accompanied with preturnatural conflipation of the bowels, flight pains about the precordia, cramps in the c C 18 ] legs at night, and a fenfe of weight about the epigaflric region. An enlargement of the glands about the throat, and fwelling of the gums,with an increafed fecretion of the faliva, fometimes occur ; and thefe fymptoms when not attended to, frequently terminate in colic and paralyfis, confumption, rheumatifm and aflhma. As foon therefore, as we are appriz- ed of their approach, it becomes neceffary to counteraa them by every poflible means. With this intention, perfons, who are difcover- ed to be in the leafl affeaed, fhould immedi- ately difcontinue, all employments in any manner conneaed with the metal; obviating at the fame time coflivenefs, and other urgent fymptoms. Among the various articles, which have been propofed, as antidotes for this poi- fon, particular dependence has been placed upon oleagenous and mucilaginous fubflances; I am led however, from the refult of feveral experiments, to conclude, that they are in- effeaual, when large quantities of the metal have been received into the ltomach; experi- ence teaches us, neverthelefs, that a greafy unauous diet, in fome degree proteas per- fons who work in lead, from the noxious influ- ence of its effluvia. Mercury in fmall dofes has been lately recommended as a preven- [ 19 ] tive againft this poifon ; and there is no doubt it would be ferviceable; but the inconveni- ences arifing from its operation, are too confi- derable, ever to allow of its general adoption. Cleanlinefs, is an objea of great importance, and it is known, that perfons, employed in the different manufaaories of lead ore, who keep themfelves clean, are lefs liable to be affeaed by it, than thofe who are negligent of their perfons, and who never take the precaution of wafhing their hands, previous to eating. OF THE PRIMARY EFFECTS, OF THE SAC- CHARUM SATURNI,ON THE HUMAN BODY. There has been a great change of opi- nion, concerning the operation of medicines, within the lafl few years. The doarine of their fedative operation, was for a long time univerfally admitted. But latter obfervation and experience have fhewn its abfurdity. The juflly celebrated Dr. John Brown, was the firft to affert, the flimulating qualities of opium ; and from this period, fucceeding writers were induced to examine more atten- tively, the primary effeas of other fubflances. Thofe, who have written on the fubjeft of lead, have noticed only its remarkable power C 20 ] in leffening the frequency and force of the arterial fyflem, and there are many, who itill adhere to the opinion of its direa fedative aaion. In order to determine, whether its primary operation be that of a fedative or in- citant, I made the following experiments. EXPERIMENT I. At 9 o'clock in the morning, half an hour after eating a moderate breakfafl of light food, I took one grain of faccharum faturni, mixed with a little fyrup. My pulfe beating 69 flrokes in a minute. In 5 minutes, it flood at 69 ; in 10 minutes, it was increafed 2 flrokes ; in 15 minutes, it beat 73, but was not increafed in fullnefs. In 20 minutes, I believed it to be quicker, and it beat 75 ; in 30 minutes, my pulfe beat 72; at 40 minutes it beat 72; in 50 minutes, beat 68, and was fomewhat fmaller. In one hour, I felt a flight degree of uneafinefs at the flomach, which foon went off. In 70 minutes, my pulfe beat 66, and was reduced in volume; I attributed this finking of the pulfe, to the temperature of the room, which was lowered from fuffering the fire to go out. In 80 minutes, my pulfe was 68, and na- tural ; but continued to vary from 67 to 70, for an hour after. C 21 ] EXPERIMENT II. At 10 o'clock, A. M. about one hour after breakfalt, I took 2 grains of fugar of lead, mixed in a little fyrup. My pulfe beat 70 flrokes in a minute, its natural flandard; when the following changes were obferved. In P. B. 3 70 6 70 9 72 12 72 15 74 18 7t 20 74 23 73 26 70 29 ! 68 M. St. In P. B. 32 68 36 67 40 69 45 68 50 67 55 65 60 1 70 1 80 1 90 65 | 66 J 64 | 66 M. St. In P. B. 100 67 110 67 120 1 130 69 | 67 140 68 150 68 160 70 M. St. In 15 minutes, after taking the medicine; my pulfe was increafed in number, and rather quicker ; but no increafe of flrength was perceptible. In 50 minutes, my pulfe was flower, and a little diminifhed in volume, at the expiration of one hour, there was an evi- dent diminution of flrength in the pulfe—at 80 minutes, had a naufea, which lafled 15 minutes, with pulfe contraaed; in 150 mi- nutes my pulfe had refumed its natural aaion. I continued to examine it for feveral hours after, when it varied from 68 to 73. EXPERIMENT III. In one hour and 20 minutes, after mak- ing a light breakfalt; I took 3 grains of [ 22 ] faccharum faturni, diffolved in a little fyrup; my pulfe beating 72 flrokes in a minute.* In P. B. 2 72 5 68 8 75 I11 73 14 75 17 76 20 74 23 71 26 70 29 71 M. St. In P. B. 32 68 35 68 38 70 41 70 45 72 50 69 60 64 65 64 70 60 80 61 M. St. In P. B. 85 61 90 62 KM 68 ) 110 64 120 67 13C 60 \ 140 68 150 69 M. St. In P. B. 165 65 180 68 190 70 210 70 225 67 240 71 M. St. In 8 minutes, my pulfe was perceptibly flronger, with a flight heat, about the precor- dia ; at the end of 14 minutes, my pulfe had increafed in frequency and was quicker; when 20 minutes, had elapfed, my pulfe was confi- derably reduced in volume ; but remained preternaturally quick. In one hour, my pulfe was flill fmaller than natural, and in frequency, reduced from 70 to 64, with an uneafy fen- fation in the head. In 85 minutes, my pulfe was round and foft: at one hour, and 20 mi- nutes, it had nearly refumed its original full- nefs. At the expiration of two hours, and 40 mi- nutes, had a pain in the head, with naufea, which lafled about 15 or 20 minutes, during * Dr. Horfefield did me the favour to be prefent during this experiment. C 23 ] the remainder of the day, my pulfe was natural. EXPERIMENT IV. At 40 minutes, palt ten o'clock A. M. Mr. George Lee, took 4 grains of fugar of lead, formed into a pill, with a fmall quantity of conferve of rofes. His pulfe beating 60 flrokes in the minute, and perfeaiy natural. In 5 minutes, his pulfe beat 61—In ten mi- nutes it beat 62—At 15 minutes, his pulfe had increafed three flrokes in frequency, but was not fuller. In 20 minutes, his pulfe flood at 63, and was quicker; in 25 minutes, it beat 64, but no unufual fenfations were ex- perienced. In 40 minutes, it was at 60, and a little contraaed. From one to two hours his pulfe had leffened in force, and was gradua- ally finking ; I was now prevented from fur- ther examination ; but had every reafon to conclude that it would have been reduced feveral flrokes more. EXPERIMENT V. At ten o'clock in the morning, being a lit- tle indifpofed, with a flight head-ach, and fome increafe of tention and fullnefs in my pulfe ; I took 4 grains of fac. fat. combined C 24 ] with a fmall quantity of conferve of rofes. My pulfe beating 74 flrokes in the minute. In 3 6 9 12 15 18 21 24 28 3x .'vi. P-B. 74 73 75 76 78 8o 80 83 81 82 St. In 36 4o 50 60 70 90 100 110 120 M. P. B. 81 80 78 80 76 78 76 75 72 St. In P. B. 130 68 140 70 150 67 160 69 In 8 minutes, I experienced a fenfation of heat at my ftomach. Before 20 minutes had elapfed my pulfe was increafed in number and fulnefs, with an increafe of heat at ftomach ; when 40 minutes had expired,my ftomach was more affeaed, but had no difpofition to vo- mit; with a preternatural warmth of the cuta- nious fyflem. In 50 minutes,had an operation on the bowels ; in an hour my fkin became moift, which continued for 15 minutes; my pulfe at the end of two hours was quicker, though not more frequent than natural; about this time I had a fmall billious evacuation from the bowels. In three hours, my ftomach recovered its tone, and my head was relieved of pain. During the remafnder of the day, I felt in no other refpea difordered, than a flight dif- ficulty of breathing; my pulfe being rather more feeble than ufual. C 25 ] EXPERIMENT VI. On the tenth day after experiment the 5th was made, at feven o'clock A. M. I took on an empty ftomach, five grains of fugar of lead ; my pulfe beating 66 in a minute. In P. B. 3 66 6 68 9 71 12 71 15 1 18 73 j 76 20 75 23 75 26 74 30 76 M. St. In P. B. 35 75 40 73 45 70 50 1 55 73 j 72 60 70 70 67 80 1 90 68 | 67 M. St. In P. B. 100 65 no 63 120 1 130 60 | 58 140 60 150 58 160 57 M. St. In 6 minutes, I felt a warmth at the ftomach; in 12 minutes, my pulfe was fomewhat increaf- ed in force, with an increafe of heat at fto- mach ; in 20 minutes the fullnefs of the arte- rial fyflem was rather greater. At the end of 40 minutes, my cheeks feemed warmer than ufual; when one hour had elapfed, I felt fome uneafinefs at ftomach, my pulfe being weak and corded ; when two hours had elapfed, confiderablenaufea occurred; my pulfe feeble and not fo frequent; at 130 minutes, made feveral effeas to vomit, but difcharged no- thing from my ftomach; at 140 minutes the naufea returned. At 160 minutes feeling extremely unplea- fant, with my pulfe feeble and tremulous, and not having eat any thing during the morning, D C 26 ] I took fome toaft and coffee, which raifed my pulfe and much compofed my ftomach. I laid down and after a while a moifture came on, that lafted about half an hour ; at one o'clock I arofe, being much recovered, and took a little foup. I had throughout the af- ter part of the day, a fmall degree of tightnefs, acrofs the thorax; my pulfe being irregular and feeble ; my urine was highly coloured, but my head and bowels remained unaffeaed. The two following experiments were com- municated to me, by Dr. Robert Black, and Mr. Walhington, of Alexandria. Having made, fays Dr. Black, a very light and early breakfaft, at ten o'clock, my pulfe beating 88 in a minute, I took two grains of fugar of lead. In ten minutes my pulfe rofe to 96, fome what contraaed and a little tenfe ; my hands and wrifls were rather cool, accompa- nied with a confiderable degree of moifture. In 20 minutes my pulfe fell to 90 ; became ra- ther feeble, and the moifture on my fkin in- creafed ; in 25 minutes my pulfe flood at 88. I felt a flight fenfation of heat and uneafmefs about the region of the ftomach ; it was not accompanied with the flighteft naufea, but it appeared to be confined principally to the ex- ternal parts. In 50 minutes my pulfe rofe [ 27 ] to 94 and became irregular. This change I attributed to my approaching near the fire and placing my feet on the projeaing plate of a Franklin flove which was heated. In 75 minutes my pulfe beat 90, which is nearly its natural flandard, it was foft and regular, continuing in the fame ftate throughout the day. EXPERIMENT VIII. At ten o'clock, fays Mr. Walhington, after making a flight breakfaft of bread and coffee, I took one grain of fac. fat. mixed in fugar and water ; my pulfe beating 80 flrokes in the minute, was fomewhat fuller and more irregular, than natural. In 5 minutes it rofe to 84, but not fb full or varying. In 10 mi- nutes it was 98 but appeared fmall, tenfe and irregular. In 15 minutes it fell to 86 was foft and even ; in 20 minutes, there was fome degree of warmth about my ftomach, accom- panied with a flight naufea, and difpofition to vomit, though an emefis did not take place. In 25 minutes my pulfe was at 84, uneven and full, at this time my fkin became moift and clammy, imparting to the touch a fen- fation, not diflimilar to that which is ufually experienced, about the clofe of a paroxyfm of [ 28 ] fever. In 60 minutes it was regular and foft, and at 76 minutes I felt a difagreeable tafte in my mouth, very like that produced by copper, and refembling that which accom- panies an incipient ptyalifm; and in a fhort time after an increafed fecretion of faliva took place, which continued during the day. At the expiration of 100 minutes, my pulfe re- fumed its natural ftandard. EXPERIMENT IX. To a dog, whofe pulfation, as well as I could determine, was about 114 in a minute, I gave one drachm of fugar of lead; In 10 minutes he appeared a little uneafy; in 15 mi- nutes his pulfe became more frequent and ftronger, with a difpofition to vomit. At 20 minutes there was a great irregularity in his movements; with laborious refpiration, the diaphram feeming to be much convulfed. In a few minutes after this, he difcharged from his ftomach fome frothy matter, and I judged, nearly all the medicine. At 32 minutes he had an evacuation from the bowels, con- fining of fceces and mucus. When 50 mi- nutes had elapfed, his pulfe was nearly imperceptible, imparting to the touch a tre- C 29 ] mulous fenfation. In an hour he became dull, being much relieved, and fell afleep. In 4 hours from this time, I injeaed into his right jugular vein,, a faturnine folution. In about 30 minutes, he expired ; having been previoufly affeaed with convulfions, delirium, and other diftreffmg fymptoms. On exa- mining his body, the appearances, were as follow. The whole ftomach was con- traaed, particularly its fuperior orifice ; its blood-veffels diftended, with inflamma- tion in feveral parts, efpecially at the termi- nation of the cefophagus. The duodenum was turgid and inflamed, containing a fmall quantity of a dark fluid ; the other inteftines had a natural appearance : the bladder kidneys and liver were not affeaed. The gall-bladder was filled with a quan- tity of bile, of a darker colour than ufual. There were fome marks of congeftion in the lungs. On opening the cranium, the exter- nal part of the brain appeared natural, but within its fubfiance, was found a fmall quan- tity of extravafated blood. In two fimilar experiments, except, that, the folution was not injeaed into the blood- veffel ; the refult was nearly the fame : in the one, however, a preternatural fecretion C 30 ] of faliva occurred ; and in the other, it was remarkable, that the reaum was the only part of the inteftines, which fhewed marks of inflammation. Since the firft introduaion of lead into the ma- teria medica, it has been uniformly claffed with medicines, called fedatives, till Profeffor Barton fuggefted the probability of its pri- mary operation, being that of a ftimulant; this opinion, is corroborated by the preceding ex- periments ; and the analogy of its effeas, with thofe of other incitants, affords additional proof of the truth of the doarine: Let us then briefly point out this fimilarity of the effeas of lead, to thofe of other flimulants. Do many flimulants, as alkohol, opium, digitalis, ftrammonium, &c. increafe the fre- quency and force, of the arterial fyflem ? So does the fugar of lead. In experiments the 4th, 5th, 6th and 7th, the pulfe rofe from 8 to 12 flrokes in the minute, with confiderable encreafe of force, tenfion, and quicknefs. Have incitants the effea of ultimately re- ducing the force and frequency of the arterial fyflem ? fo has the fac .fat. to a great degree. Do opium, mercury, and fenaka root, oc- cafion an increafed fecretion of faliva ? fo likewife do the preparations of lead. This C 31 ] fymptom occurred in two of my experiments. Dr. R.Warren, fays, out of thirty-two cafes of colica piaonum, caufed by lead, which he had an opportunity of obferving, four were fali- vated, and others complained that their mouths and throats were fore.* The fame fymptoms occurred to a very extenfive de- gree, in Mr. Thunberg and others, as already mentioned. Are not heat at ftomach, naufea, and vo- miting, confequent upon taking flimulants ? fuch are the effeas of lead. Do not arfenic, opium, and other poifons, produce convulfion and paralyfis? The preparations of lead have done the fame. Various flimulating fubflances are known to conftipate the bowels; lead has the fame effea. Is the cutanious fyflem influenced by fti- muli ? fo likewife it is by the fugar of lead, caufing preternatural heat; this was the ef- fea of lead on myfelf and feveral of the fub- jeas of my other experiments. Do certain incitants induce diaphorefis ? In the experiments communicated by Mr. Walhington and Dr. Black, and in one that I made upon myfelf, the fame effea was pro- * Vid. Med. Tranf. Vol. I. C 32 ] duced. Are the different fecretions and excre- tions affeaed by flimuli ? fo likewife they are by the preparations of lead. Have diffeaions, difcovered inflamation, and other morbid phenomena, to be the effeas of flimuli ? Such alfo, are the confequences of the fugar of lead; in the examination of two dogs, that had taken a drachm of this fait, nearly the whole alimentary canal evinced marks of inflamation and exceffive aaion. The interefting and minute relations of its deleterious effeas by Mr. Thunberg, as men- tioned above, confirms the opinion beyond a doubt; fever, inflamation, and a numerous train of other malignant fymptoms, were in this inftance its confequencs; and no one will contend that thefe phenomena. could have been produced but by powerful flimulants. We may then, fairly conclude the primary operation of the preparations of lead, is that of a flimulant, but that thefe effeas are ex- tremely tranfitory, and are quickly followed by thofe of a contrary nature. Although we are able by experiment, to decide whether the firft effeas of a fubfiance be fedative or flimu- lating; ftill the fubjea of the modus ope- randi of medicines is cloathed in much mif- try. To afcertain precifely, upon what prin- C 33 ] ciple, or in what manner, the aaion of fub- ftances upon the human body, is brought about, will be a point as likely to elude the investigation of man, as any conneaed with the fcience of medicine.—A pill of opium may be taken and exert every aaive property it poffeffes, without a diminution of bulk.* From the rapid improvements, which the fci- ence of chemiftry has lately undergone fome, have been induced to fuppofe this beautiful and pleafing ftudy would lead to an explanation of thofe mifterious laws and operations of nature. The chemift by ana- lyfis, may difcover if afubftance be compofed of a gum, refm, etc. he may, more over, de- termine accurately the proportion of each elementary part that is neceffary to the for- mation of a fubftance; but can he, by thefe means, explain the principles and funaions of animator vegetable life; or is this fcience,fuffi- cient to teach us, why two gums, the external characters of which are the fame, fhould in their operation produce fuch different effeas; or will it inform us wherefore, fome fubftances create falivation, fome vomiting, and others fleep ? * Karr Boerhaave. E [ 34 ] Whether it depends upon a peculiar modi- fication of particles, or whether it depends upon a particular proportion of the incitant, aftringent, and fedative principles; or upon what circumftances, it does depend ; muft re- main a fecret, until phifiologifts fhall obtain a more perfect knowledge of the laws and (econo- my of organic matter. OF THE INTERNAL USE, OF SUGAR OF LEAD IN DISEASES. Before we enter, upon the confideration of the ufe of lead in difeafes, it will be necef- fary to enquire, to what extent, the prepara- tions of this metal have been taken, either in- tentionally or by accident, without injury. A girl took eighteen grains of fugar of lead every day, for three weeks, without any injurious confequences. A weak man, forty years old, took at four dofes, in the courfe of forty-eight hours, in a liniment, one drachm of faccharum faturni, without any other difa- greeable effea, than a giddinefs, and heat at ftomach. At Salford, in Warwickfhire, a per- fon, fwallowed near a bottle of Goulard's ex- traa ; and no inconvenience enfued.* * Johnfon's Medical Effays. C 35 ] A woman took by accident, a fcruple of acetate of lead; without inconvenience from it.* I knew a child, fix years old, to drink a portion of faturnine folution, which contained about four grains of facch. fat. and no ill effea followed. A man for the cure of the gout, was advifed by an empiric, to ufe an oxid of lead, which he did, in fuch quantities, as to take two pounds, in fifteen days; he remained free from difeafe, till twenty days after he began its ufe ; when he was attacked with dyfentery. His recovery was preceeded by a very obfli- nate jaundice.f I have been informed by a gentleman of Devonfhire, fays, Sir George Baker, that it had long been a cuftom with him, to reftrain the acetous fermentation of his cider, by throwing into it a quantity of fugar of lead; and, that he was convinced, no ill effeas ever followed the praaice.J Many Englifh Difpenfatories, and old fyf- tems of medicine, recommend, from feven to twelve grains of faccharum faturni at a dofe. And in their former naval and military Dif- * Johnfon's Medical Effays, P. 117. 123, 124. f Profeffor Barton's M. S. Notes. % Lon. Med. Tranf. C 36 ] penfatories, a fcruple is ordered for a fingle dofe. Anterior to the time of Paracelfus, we have nothing certain, refpcaing the internal ufe of the preparations of lead. From the early part of the fixteenth century,. till the middle of the feventeenth, Tachenius, Crol- lius, and others were accuftomed to employ them, as valuable medicines. In 1741, Hun- dertmark, publifhed a differtation at Lipfic, wherein he affures us, that he gave the fugar of lead, to the quantity of four grains, with wonderful fuccefs, in fome defperate cafes of phrenetic delirium, and in fome cafes of peripnumony,* and feveral diflertations alfo, appeared in Europe, on the fame fubjea, towards the end of the eighteenth century. However much, modern phyficians have wifhed to lay afide, the internal ufe of thefe preparations, it is not the lefs certain, that the ancients afcribed confiderable virtues to them, as powerful and ufeful remedies, in many difeafes. The Chinefe, very frequently adminifter internally various preparations of lead, to which, they afcribe extraordinary virtues. * Vid. Gmelin C 37 ] Such efficacy was this mineral fuppofed to poffefs in phthifis pulmonalis, that one of its preparations, acquired the appellation of tinctura antiphthisica. Etmuller who direa- ed his attention particularly to the ufe, of faturnine preparations in confumption, to prevent the cough and fweating that occur in heaics, recommends, aformula containing ten grains of the fugar of lead, to be taken every night at two dofes Mr. White in a letter to Dr. Duncan,* ob- ferves, that, he found the aaion of the heart, and the frequency of the pulfe, evidently di- minifhed, by the ufe of the tinaura faturni and that in phthifis pulmonalis, it conftantly abated the heaic fever, and fweats. Sir George Baker acknowledges, that, there are fcarcely any medicines, which produce, their effeas more immediately, or more certainly, than the preparations of lead, in collequative fweats, in fluxes, or in hemorrhagic s.f The digitalis has been particularly fer- viceable, in certain flages of confumption, and from the fimilarity of its operation, to that, of fugar of lead, I am lead to conclude, the latter, will prove a valuable remedy, in that * Med. Com. Vol. III. f Med. Tranf. Vol. I. C 38 ] ftage of the difeafe, in which, great morbid aaion of the arterial fyftem prevails. In Diabetes,* the acetate of lead, has been ufed with great advantage. Dr. Rufh has lately endeavoured to explain, the pheno- mena of this difeafe, by confidering it a ftate of fever, and the fuccefs which attended the praaice, to which this opinion leads, cor- roborates the idea of its being a febrile affec- tion. The remedies which he recommends, are, repeated blood-lettings; in fmall quanti- ties, falivation, low regimen, &c. Confider- ing, the power of faccharum faturni, in ref- training all morbid fecretions, and evacua- tions, and its known influence over the pulfe, it appears to me, that much good would be derived from its application in this difeafe. Much likewife, has been faid, concerning the ufe of this medicine in dyfentery and diarrhoea ; and indeed, from their inflamma- tory nature, and from their being feated in that fyflem, on which, lead exerts its moft immediate, and permanent operation, it ap- pears, to be particularly adapted to their cure, and accordingly, we find that it has been ufed with advantage by refpeaable writers. When there is inflammation of the inteftines, Re- * Vid. Etmuller's Practice. [ 39 ] virius obferves, it will be neceffary to let blood, and give glyfters of the fugar of lead, diffolved in rofe water ; and at the fame time, fays, ten grains of this fait, mixed with con- ferve of rofes, fhould to be taken by the mouth; every morning. By Etmuller the acetate of lead, is confidered a fpecific in dy- fentery; and when aftringents, and abfor- bents are indicated, Dr. Shaw, confidently informs us, it is a moft valuable and ufeful medicine. At the royal and univerfal difpenfary, there is a formula, containing half a grain of this fait, which is often employed by the phy- ficians of that inftitution, in cafes of hemorr- hagies, and obftinate diarrhoeas, with advan- tage ; and no inftance has occured, in which any injury arofe from its ufe.f The New-York Repofitory contains an in- terefting account of the efficacy of the acetate of lead, in relieving feveral cafes of chronic diarrhoea, communicated in a letter from Dr. John Archer, jun. of Maryland, to Dr. John Claiborne of Virginia. The firft cafe which Dr. Archer relates was of a Mr. S. R. aged 22 years, a man of ftrong conftitution, who, \ Vid. Clutterbuck's Paper, &c. C 40 ] in June, 1798, after fevere exercife, was at- tacked with dyfentery, which at the expiration of four weeks terminated in a painful diarr- hoea, which continued unreftrained until the latter end of November. His body was much emaciated, and during this time he had vio- lent pains in his bowels, with frequent dis- charges of blood. After the failure of the ufual remedies, faturnine injeaions were ad- miniftered, but thefe alfo proving ineffeaual, recourfe was had to the exhibition of this pre- paration of lead, by the mouth, to the quan- tity of three grains, three times a day, made into a pill, with fyrup ; with inftruaions to the patient, to difcontinue the medicine, as foon as the purging moderated. In two days the diarrhoea was much abated; he continued however, to take the medicine; the confe- quence was, coftivenefs, and extreme pain of the bowels ; which was fpeedily removed, by a dofe of glauber's falts. His difeafe again returned, but by the ufe of the faturnine pills, reduced to two grains of the fait, his diarrhoea was kept under, and in the courfe of two weeks, the difeafe was per- feaiy cured. The other cafes related by this gentleman are equally interefting: in none of them were there any permanent difagreeable [ 41 ] confequences from the ufe of the medicine : the flight inconvenience which occurred was obviated by a fingle dofe of falts. I regret that the pulfe was not more attended to in the relation of thefe cafes. IN EPILEPSY. There is no difeafe, the pathology of which is involved in more obfcurity than this, and till theory and experience fhall elucidate its nature, every medicine that can be prefcribed for its cure, mult be in a great meafure bor- dering on empiricifm. Dr. Rufh, to whom we are much indebted for the explanation of the phenomena of fome difeafes, is of opinion, that to epilepfy, no de- terminate feat can be afligned. He fuppofes it to be exclufively confined, neither to the ar- terial, nor nervous, nor any other fyftem, but to extend its morbid influence over the whole animal economy. He admits it to be a ner- vous or febrile difeafe, and not unfrequently partaking of the nature of both in the fame perfon, but if we judge of the truth of theory, from the fuccefs of its application, in praaice, we mult acknowledge that this, like every other, ferves only to inform us of our ignorance, and to convince us, that we have F [ 42 ] yet to acquire much important information, from the myfterious laws and operations of nature, before the fcience of medicine fhall become perfea, and man fhall ceafe to die, but from old age. That epilepfy is often a febrile difeafe, may be infered from its being induced by the fame caufes, which produce other fevers, and from its being accompanied with many of the ufual fymptoms of fever; the pulfe is often full and tenfe, pupils of the eyes dilated, face flufhed, &c. It moreover attacks, per- fons at that time of life, when the fyflem is plethoric, and pre-difpofed to febrile difeafes ; it fometimes alfo, occurs with confiderable violence, without any appearance of fever. Opium, camphor, mercury, and lately the ni- trate of filver, have all been ufeful, but the fugar of lead will probably prove to be equal, if not fuperior, to any of them, in this difeafe; it has frequently been known to fufpend the fits, and has fometimes cured the difeafe, but admitting, that it only protraas the intervals between the fits, this effea alone would be fufficient, to recommend it to the attention of phyficians. A perfon, not well verfed in the treatment of epilepfy, will find it difficult to point out the particular C 43 ] ftages and circumftances of this difeafe, un- der which the acetite of lead will be moft likely to fucceed, but from the known power of this medicine in lowering the pulfe, I fhould fuppofe it particularly adapted to the cure of thofe cafes of the difeafe which are accompanied wtth an inflammatory dia- thefis, and which have regular periods of oc- currence; but as this medicine, to be effeaual, requires to be taken for fome time before the fit, it might be objeaed to, in cafes where the fits occurred atdiftant and irregular intervals, or where the paroxyfm was not ufhered in, by fome charaaeriftic fymptom ; as injurious effeas fometimes refult from its long continu- ed ufe. Near two hundred years ago it was ufed with fuccefs in the epilepfy of children by Agricola ; and a boy was lately effeaually cured of this formidable difeafe by taking two grains of the acetate of lead three times a day ; and in two inftances like wife in the Pennfylvania Hofpitalit fufpendedthe fits for feveral weeks.* In fluor albus and gleets, the acetate of lead has been adminiftered internally, with fuc- *Dr. Rufh. M. S. Notes. [ 44 ] cefs. In the year 1799, I had an opportunity of witnefling its efficacy, in a cafe of leucor- rhoea, in a poor woman aged about 27 years ; fhe had been fubjea to the complaint for near twenty months ; her pulfe beat 85 or 86, and was preternaturally quick and tenfe ; fhe was blooded, fallvated, and had obferved an an- tiphlogiftic regimen, without any benefit. In this fituation, fhe was direaed to take half a grain of fugar of lead, combined with two grains of gum kino, three times a day; on the third day after the ufe of the medicine, the pulfe, was diminifhed in frequency three or four flrokes, but the difcharge, and other fymptoms remained as before. The quantity of the fait was now increafed, to one grain, to be taken at the fame intervals as before, on the fecond day after the ufe of the increaf- ed dofe, her pulfe continued to decreafe in frequency, and the difcharge was fome- what abated ; fhe was now coftive, and being apprehenfive that difagreeable fymptoms might ehfue, from the too long retention of the medicine in the fyftem, it was intermitted and a dofe of caftor oil exhibited. In a few days after, the medicine was again had re- courfe to, which effeaually relieved the pa- [ 45 ] tient, without caufing the moft trifling un- pleafant fymptom. IN HEMORRHAGES. In the cure of no difeafe will the fugar of lead be found more advantagious, than in hemorrhagy; and with Dr. HeberdenI believe there is fcarcely any medicine, that could with more propriety be called an internal fpecific, than faccharum faturni, in hemorrhages of the primoe vice . Dr. Reynolds of London, has experienced in a particular manner, the efficacy of the pre- parations of this mineral, in reftraining hsem- potoe,epiftaxis, and memorrhagia. To a young man labouring under hsemoptyfis was given the following formula. R. fac. Sat. gr. 1. Con. ros. rub. grs. ii. Laud. gtt. v. m. In a day or two, the dofe was increafed to a grain and a half. He had been bled feve- ral times, had taken faline medicines, and obferved the loweft diet without advan- tage. His pulfe beat 108 flrokes in the mi- nute, full and hard; on the 4th day after taking the medicine, the fpitting ceafed en- [ 46 ] tirely, his pulfe reduced to 90, foft and even; he had regularly two motions a day.* If the fpitting of blood is violent, Shaw, advifes, half a fcruple of faccharum faturni, to be taken every fifth hour, the patient at the fame time to drink freely of diluted tinc- ture of red rofes. In June 1800, a poor white man, aged 30, of flender make and healthy habit, was at- tacked with a hymoptoefis, which was occa- fioned by the too great exercife of the lungs, from blowing the fife, his pulfe, beating 89 in a minute, quick and tenfe, breathing labo- rious, and indicating confiderable congeftion. He was direaed to take the following for- mula, every fourth hour: R. Sac. fat. ii. grs. Theriac. And. hi. grs. m. In 15 hours after he commenced taking this medicine, the fpitting had entirely ceafed; his pulfe much reduced in force, and leffen- ed in frequency. The congeftion being not effeaually relieved, he took fifteen grains of calomel ; which operated mode- rately on the bowels, at the fame time flightly affeaing the mouth. Nothing elfe after this was neceffary. * Med. Com. Vol. III. [ 47 ] a A woman between 40 and 50 years old, labouring under uterine haemorrhages, was relieved by the fatunine tinaure." " Another woman had a flooding terminated, which had lafted two months, unchecked by all the moft powerful aftringents in common ufe, by taking four grains of fac. fat.* Equal quantity of white vitriol and fugar of lead, in the proportion of half a grain, has alfo been given with the happieft effeas, in menorrhagia. In epiftaxis, the fuccefs attending the in- ternal ufe of this fait, has been alike evi- dent ; but I fuppofe it might be employed ex- ternally in this variety of bleeding^ with # every advantage. A phyfician in this city, was in the habit of ufmg it as a fnuff, in bleed- ing from the nofe ; which had every defired effea. In tetanic affeaions, might not the faccha- rum faturni, be employed with great advan- tage ? The ufe of this remedy in tetanus, is fanaioned by the authority of Mr. John Hun- ter, and at all events deferves a trial. * Med. Tranf. Vol. II. C 48 ] The following interefting relation of faas and obfervations was communicated to me in a letter by Dr. Barton. " DEAR SIR, " I exceedingly regret, that my late fevere illnefs has prevented me from furnifhing you with the particulars of my praaice with the acetite, or fugar of lead, in the treatment of different difeafes. At prefent, I can give you but little on the fubjea, that is worthy of your attention. " In the courfe of the lafl five years, I have employed this preparation of lead in cafes of haemorrhages ; in hcemoptyfis, haemorrhages frbm the ftomach and inteftines, and in uter- i«e haemorrhages, both of pregnant and of non- pregnant women. Of late, I have alfo em- ployed it, very largely, in a cafe of obltinate gonorrhoea. But my praaice having been principally confined to the treatment of hae- morrhages, I fhall content myfelf with making a few obfervations on the ufe of the medicine in thefe difeafes. In a cafe of haemoptyfis, which threaten- ed the fpeedy death of the patient, I gave the fugar of lead, in dofes of fix grains every two hours, for feveral hours together. Iafcribe the complete recovery of my patient folely to this C 49 ] treatment. This was one of the firft cafes in which I exhibited the medecine, and I fhould not have ventured'upon fuch do- fes (for I had been taught to believe, that the preparations of lead ought always to be exhibited with the greateft circum- fpeaion), had I not thought the patient irrecoverable by any other means. I had no caufe, however, to regret the employment of the lead ; for it produced not the leaft incon- venience. But it is chiefly in uterine haemorrhages that I have adminiftered the fugar of lead. I have now exhibited it in many cafes ; I think not lefs than eighteen or twenty% I have ever given it with fome advantage ; generally to the complete cure of the patient, and, I have never known it to produce any ferious inconvenience. It has fometimes feemed to occafion a flight ficknefs at ftomach, but this, which could not always be afcribed to the lead, was nowife injurious to the patient. In one cafe, it feemed to occafion a flight degree of tenefmus. But this was foon removed by a dofe of caftor-oil. I am certain, that it fome- times operates, even in fmall dofes, as a laxa- tive. G [ 50 ] In the adminiftration of the fugar of lead, I have almoft always combined it with a por- tion of opium. I ftill continue this praaice, becaufe I have been induced to believe, that the lead may be given in much larger dofes with than without the opium. Perhaps I may be miftaken. With refpea to the dofe of the fugar of lead, this, I need not tell you, muft vary ac- cording to the age, the flrength, and the cafe of the patient. Hitherto, my praaice with this medicine, has been almoft folely confined to adults. In uterine haemorrhages, I have feldom given lefs than two grains at a dofe (in conujnation with a grain of opium), twice a day. But I have often given larger dofes. Even fmall dofes, however, fometimes pro- duce an early, I was going to fay an immedi- ate effea. This, Ihave particularly remarked, in the cafe of a lady, who had laboured under a menorrhagia for fourteen days, before I faw her. I found her with a quick and irritated pulfe, fluftiings, fevere pain in the region of the loins,and with much affeaion of the head: I had no hefitation in advifmg her to lofe fome blood from her arm ; to this fhe objea- ed. She was immediately put upon the ufe C 51 ] of the fugar of lead; in lefs than one hour, the haemorrhage was confiderably diminifhed; fhe took a fecond dofe, about four hours after the firft, and was fo completely recovered that there was no neceflity to continue the me- dicine. I fhall not trouble you with any fpecula- tions concerning the modus operandi of this medicine in curing haemorrhages. I have touched upon this fubjea in my leaures, which you have done me the honour to at- tend ; and, I doubt not, that you have, in the courfe of your experimental inquiry, been able, in fome meafure, to fatisfy yourfelf as to the manner in which the lead is of ufe in thefe cafes. I will only obferve,<-that I am perfuaded, that the medicine does not produce all its good effeas, merely by its quality of lowering the pulfe. It appears to be ufeful both in the aaive, and in the paflive haemorr- hages. I am not afhamed to mention thefe old names. I have had fome experience with the ufe of the digitalis in the treatment of uterine haemorrhages. This is, certainly, a valuable medicine. I can readily believe Dr. Ferriar, that it has often done much good. In my hand, however, it has appeared to be much [ 52 ] lefs efficacious than the fugar of lead. Of one thing I am perfuaded, that the digitalis does not, in general, produce fo immediate an effea upon the difeafe as the lead does. I am fure that you, who know with what caution I always fpeak of medicines in my leaures, will not fuppofe, that I recommend the fugar of lead as a specif c for the cure of uterine or other haemorrhages. I confidently recommend it, however, as a powerful and valuable medicine ; and I cannot but fuppofe that it may generally, if not always, be exhi- bited with perfect safety. Yet it may be ne- ceffary, in cafes in which we have not already given the medicine, to watch its effeas with a nice attention. I believe, that there are fome perfons who are liable to be injured by very fmall portions of lead. I believe it is a faa, that lead, whether it be taken into the ftomach, or applied in the fhape of vapour, externally to the body, does not, in general, produce its bad effeas until fome days after it has been applied. Thefe faas fhould lead us to obferve fome degree of circumfpeaion in the ufe of the me- dicine, in the treatment of difeafes. It is not impoflible that one or two grains of the fugar of lead, may now and then, occafion fome in- [ 53 ] convenience. But in the exhibition of this medicine, I have been more governed by the other circumftances which I have men- tioned : I have been fearful, left the patient might fuffer from an accumulation of the lead in the fyftem. When, therefore, in the treat- ment of hoemorrhages, I have not found evi- dent benefit from the medicine in two or three days, I have laid it afide for a fhort time (three or four days); and, when neceffary, have refumed the ufe of it again. I fear that this very imperfea, but faithful ftatement of my praaice, can be of little ufe to you. Such as it is, I beg you to receive it with my beft wiflies for your profperity and ufefulnefs in life. I am, My dear Sir, Your affeaionate friend, And humble fervant, BENJAMIN SMITH BARTON. Philadelphia, June 4th, 1801. To Mr. Semmes. FINIS. M«A. Hist. WZ. no I SOIa- wmWh Mm l:}!v:.!:'>;!'!.:^::l^ . -:-'. •;■ j "■ ■'^•■■■"i:'^-::;j; ■■ '"; ■•'■■■■ r:" '"':>';-;ii:'.:'sUN t-'iS <.;;.. :«-':■ •■■:v'-'!r.U:.i'^yi:J!lMlpt&J ..-■• ::■ .:!- -U^:,./^ 1»;1.M ,. *■■'-,!■.' ■;"' 1'.^" ^"oili ■>/■ ■:|!-.-::-''-:.::'::|;i;l!;l^:.:--.ii.!..:li:':;"fi:?,'i! ■,"'■■■..■."■■! :;"v-("'!:':'" M''li mm&Bmi III f'jjilir'' lifcv iii ». ••'■■"■*■ !Vi4ip." ;:i toht;!!.;.;!',. Il#!f mm-